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At least 667 records · Page 37Linked to original sources
PubMed2004

The use of oxygen in the palliation of breathlessness. A report of the expert working group of the Scientific Committee of the Association of Palliative Medicine.

Dyspnoea is a common, distressing symptom and difficult to control with medical treatment. The role of oxygen in reducing the severity of the symptoms and improving quality of life is still unclear. A working party of the Association of Palliative Medicine Science Committee set out to examine the evidence concerning the use of oxygen for the palliation of breathlessness in COPD, advanced cancer and chronic heart failure and to make recommendations for clinicians working in palliative care. There were very few randomised controlled trials available for any of these conditions. There was no evidence available for heart failure, very little for advanced cancer and although there were a number of trials on the use of oxygen in COPD very few, until recently, used reduction of breathlessness as an outcome measure. Recommendations are made on the basis of the evidence available and expert opinion such as the Royal College of Physicians report on the use of domiciliary oxygen. Oxygen use has to be tailored to the individual and a formal assessment made of its efficacy for reducing breathlessness and improving quality of life for that person [corrected].

Dyspnea↗
PubMed2006

Cancer screening in older adults in an era of genomics and longevity.

OBJECTIVES: To provide an overview of cancer genomics and cancer screening in older adults with a focus on breast, prostate, and colon cancers. DATA SOURCES: Journal articles, research articles, and web sites. CONCLUSION: Cancer screening in older populations is often in the context of one or more co-morbid conditions, cancer survivorship, genomic information, and competing health priorities. The field of cancer screening has outgrown the tools available to enable health care providers and older adults to make informed cancer screening decisions. Research is needed to develop clinical screening tools that integrate age, cancer risk, life expectancy, and comorbidity. IMPLICATIONS FOR NURSING PRACTICE: Health care providers are faced with opportunities and challenges in the prevention and early detection of cancer in older Americans.

Aged↗
PubMed2004

Evidence-based practice of transfusion medicine: is it possible and what do the words mean?

Evidence-based medicine (EBM) optimizes clinical decision making by dictating that clinical decisions be based on the best available research evidence and by integrating best research evidence with clinical expertise and patient values. Several rankings of the strength of the evidence generated from different types of clinical research designs have been presented, and, in addressing a particular problem, clinicians can base their decision making on the types of clinical reports that have been published, along with an assessment of the strengths and weaknesses of each study. At a policy level, the concept of EBM would dictate that policy decisions also be made based on the best available research evidence. In transfusion medicine, however, decisions are based on a broader range of inputs, and the criteria for evaluating the efficacy and/or cost-effectiveness of proposed interventions differ from those used in other areas. Reasons why policy decisions are often based on considerations other than the best research evidence include public expectations about transfusion safety and proposals for applying the precautionary principle to transfusion medicine. Using the debate over the appropriateness of introducing universal white-cell reduction as an example, this review describes 2 perspectives for assessing evidence and/or making clinical or policy decisions: the evidence-based approach and the precautionary-principle approach; and also considers whether decisions in transfusion medicine can be truly evidence based.

Blood Transfusion↗
PubMed1997

Effects of intensive diet and exercise intervention in patients taking cholesterol-lowering drugs.

Patients taking cholesterol-lowering drugs were placed on a very low fat, high-complex-carbohydrate diet with daily aerobic exercise and achieved 19%, 20% and 29% reductions in total cholesterol, LDL-cholesterol and triglycerides, respectively. Fifty-one percent of the primary care physicians had not used diet therapy before initiating drugs and 29% did not use diet therapy along with the drugs as recommended by the National Cholesterol Education Program.

Adult↗
PubMed2002

Ethical issues in biomedical publications.

Peer-reviewed biomedical journals are expected to publish accurate and important information. In the process, numerous ethical issues may arise from within both the editorial and research communities. This paper will focus on four general ethical issues-authorship, peer review, duplicate or repetitive publication, and conflict of interest. Issues of authorship include multiple authorship, misconduct among coauthors, guest and honorary authorship, order of authorship, and credit for those not qualifying for authorship. Peer review attempts to ensure that what is published is valid. Peer review ethical issues include confidentiality of the manuscript, potential editor and reviewer bias, and conflict of interest on the part of the reviewer. Duplicate or repetitive publication, in which the same information is reported two or more times, can damage a journal's reputation for publishing new and important information and can waste its resources. Conflicts of interest, in which financial and personal considerations may affect the investigator's personal judgment, can seriously damage the integrity of the author and of the journal. Increased awareness of these ethical issues should stimulate everyone to take an active role in promulgating and enforcing the highest ethical standards in biomedical publications.

Authorship↗
PubMed2003

Interventions to overcome clinician- and patient-related barriers to pain management.

Barriers to optimal cancer pain management exist among clinicians and patients, and within the healthcare system. This article focuses on clinician- and patient-related barriers and the interventions that have been tested to overcome them. Although individual studies have shown promise in improving patient outcomes, overall the studies do not provide clear answers to guide practice. Further research is required to determine what components of educational interventions are necessary to facilitate optimal cancer pain management.

Algorithms↗
PubMedDate not supplied

Defining specific goals of therapy in treating dyslipidemia in the patient with low high-density lipoprotein cholesterol.

Because patients with low high-density lipoprotein (HDL) cholesterol (HDL-C) are at high risk for clinical coronary artery disease (CAD) events, these patients require aggressive treatment with lifestyle modifications-increased exercise, smoking cessation, and weight loss in overweight patients-and available pharmacological agents. Drugs that raise HDL-C include nicotinic acid, fibric acid derivatives, estrogens, 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins), alpha-blockers, and alcohol. However, all agents that increase HDL-C may not have the same clinical benefit, just as, as shown in genetic studies in humans and mice, genetic causes of high HDL-C do not always protect against CAD, nor do genetic causes of low HDL-C always increase risk for CAD. Better understanding of the complexities of HDL metabolism and the mechanisms by which HDL protects against CAD is needed to enable the development of new therapeutic strategies--novel drugs or gene delivery systems--to increase HDL-C and reduce CAD events. The statins are the agents with the greatest evidence for slowing progression of CAD and reducing clinical events in patients with low HDL-C, but additional research is needed to determine the potential benefits of additional interventions that increase HDL-C, including combination therapy, which may provide greater improvements in the entire lipid profile.

Animals↗
PubMed1994

Trials of women.

Explore the source record for details and available documents.

Clinical Trials as Topic↗
PubMed2000

Evidence-based analysis of prophylactic treatment of asymptomatic retinal breaks and lattice degeneration.

PURPOSE: To assess the quality of information in the literature regarding the benefits of prophylactic treatment of asymptomatic retinal tears and lattice degeneration. CLINICAL RELEVANCE: Asymptomatic retinal breaks occur in approximately 7% of patients over age 40, and lattice degeneration is present in approximately 8% of the general population. Because retinal breaks cause retinal detachment and lattice degeneration is associated with approximately 30% of retinal detachments, prophylactic treatment of these lesions has sometimes been recommended. LITERATURE REVIEWED: A panel of vitreoretinal experts performed a literature review of all publications regarding prevention of retinal detachment that have been published in English. These articles were then used to prepare recommendations for patient care in an American Academy of Ophthalmology Preferred Practice Pattern (PPP). Each recommendation was rated according to: (1) its importance in the care process and (2) the strength of evidence supporting the given recommendation. RESULTS: Most recommendations were rated as A (most important to patient care). Only a single publication was graded as I (providing strong evidence in support of a recommendation), and this was not a prospective trial. Of the few publications rated as II (substantial evidence), most were studies documenting a lack of treatment benefit. Because of an absence of level I and level II studies in the literature, level III (consensus of expert opinion) was the basis for most recommendations in the PPP. CONCLUSIONS: The current literature regarding prevention of retinal detachment does not provide sufficient information to support strongly prophylactic treatment of lesions other than symptomatic flap tears. Prospective randomized trials of prophylactic therapy are indicated. Eyes highly predisposed to retinal detachment should be considered for such studies.

Adult↗
PubMed1998

[Consensus guidelines for respiratory endoscopy issued by the Argentine Society of Bronchoesophagology].

The international consensus is that guidelines for respiratory endoscopy are inadequate, regarding such issues as institutional requirements, benefits, risks and limitations of the procedure, training programs and accreditation, with the result that the way or performing endoscopy varies according to how an operator was trained. The absence of precise recommendations means that practice is highly diverse and inappropriate use of the procedure has increased. The Argentine Consensus Group for Normalization of Respiratory Endoscopy was created in 1995 to unify criteria for several aspects of endoscopic practice. The official recommendations of the Group and of the Argentine Society of Bronchoesophagology define the indications (diagnostic, therapeutic and investigative) and contraindications (absolute, relative and high risk) for bronchoscopy. Required pre-bronchoscopic studies for routine and special cases are defined, as are indications for premedication, intubation and general anesthesia. Requirements for the setting, support personal and instruments are specified. Guidelines for topical anesthesia and techniques for insertion of the endoscope are suggested. The technique, indications and limitations of bronchoalveolar lavage, bronchial brushing and biopsy and transbronchial needle biopsy are defined. The utility and limitations of the various therapeutic techniques of bronchoscopy (laser, radiotherapy and stents) are defined. Norms to safeguard the patient, instruments and operator are emphasized.

Anesthesia, General↗