SEARCH · PubMed Health
Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
Hyperlipidemia is a serious disease that affects the health and well-being of many, and further complicates other chronic illnesses. When treating a patient who has a lipid disorder, it is wise to take a global approach to the problem by assessing the patient's history and risk factors, collaborating on developing a healthy lifestyle plan to which the patient can commit, and initiating appropriate therapy when indicated.
Incorporation EBM into one's practice will not only make one a better clinician, it also allows one to provide the best possible quality of medical care to his or her patients. Becoming a medical information master is a task that all can learn [8,9]. In a primary care specialty that, by definition, is broad in scope, and with the seemingly overwhelming amount of medical literature that is produced on a daily basis, this task is essential. One constantly should be o the look out for validated evidence that is relevant to everyday practice, focusing on those POEMs that address issues that are common to primary care practice. Using the tools and steps that are outlined in this article, along with taking the Web-based courses that are mentioned in Box 1, will allow the primary care physician to develop the essential skills that are required in today's practice of medicine.
Explore the source record for details and available documents.
PURPOSE: This paper describes the hierarchy of analytical studies, from the observational studies to the experimental ones. STATE OF THE ART AND MAIN POINTS: Case-control studies, the most frequently performed among analytical studies, may generate or confirm hypotheses. They are of particular use for rare diseases. Cohort studies aim mainly at confirming hypotheses already tested, and at precisely quantifying the magnitude of effect. Randomisation aims at the elimination of confounding factors, and meta-analysis, at decreasing potential selection biases and increasing power. Those goals may not always be achieved. PERSPECTIVES AND PROJETS: The study power, or the beta error, are major factors to be determined when designing a study, before any attempt of realization.
Explore the source record for details and available documents.
Asthma is a chronic disorder, characterized by airway hyperresponsiveness (AHR), airway inflammation and airway remodelling. Evidence has been provided for a relationship between pathophysiology, airway inflammation and remodelling. Moreover, these asthma features have been shown to respond to anti-inflammatory therapy. According to current guidelines, monitoring of asthma is predominantly based on symptoms and lung function data. However, these parameters appeared as poor indices for asthma control. Alternatively, asthma control relates well to exacerbations and (anamnestic) surrogate biomarkers of airway inflammation. Hence, appropriate treatment of asthma should primarily target the airway inflammation. According to current guidelines for asthma management, anti-inflammatory therapy with inhaled corticosteroids (ICS) is the cornerstone in the treatment of persistent asthma. To further optimize asthma control, add-on therapy with long-acting beta2-agonists (LABA) or leukotriene receptor antagonists (LTRA) should be combined with low to high doses of ICS. While the first combination focuses on optimal control of symptoms and lung function, the second provides a more complete suppression of the airway inflammation. In this paper we discuss treatment of asthma according to current guidelines versus new insights, addressing practical issues.
The problem of lack of transfer of knowledge in surgery is well illustrated by the variations in surgical practice across areas and countries. Surgery is not unique in this respect, and such variations have been documented in virtually all specialties and in primary care. The first issue is recognition that there is an inescapable and growing information problem. Unless we focus some of our research and practice effort on better organizing, filtering, and using the research that we have, the gap between what we know and what we do will continue to grow.
Evidence-based medicine came into focus in 1992 when scholars recognized the need for valid information required for optimal patient care. Because of the increasing volume and uncertain quality of new knowledge, traditional sources of information such as books and journals failed to meet the needs of busy practitioners.Evidence-based medicine promoted strategies for identifying and appraising relevant information and making it readily available. Surgeons face unique challenges in the recognition and application of best evidence. Evidence-based surgery requires careful appraisal of the existing evidence, expanding the pool of level 1 evidence,and improving the availability of best evidence. Ultimately, the organization of systems will incorporate best evidence into the processes of care and will document the outcomes of care.
Explore the source record for details and available documents.
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.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Corticosteroid (steroid) use is common but controversial in rheumatoid arthritis (RA). Some observational studies suggest that mortality might be increased with steroid use, and several large retrospective reviews indicate that long-term low-dose steroid use is a significant independent predictor of numerous, potentially serious adverse events. Both cumulative and average steroid dose are independent important adverse-event predictors. There is a lack of long-term data on the efficacy of steroid therapy, since few studies exceed 1 year in follow-up. Most of the short- and medium-term steroid studies reveal similar or improved disease activity when compared with control therapy. A meta-analysis of the few randomized studies available showed that steroids were equivalent or slightly better than placebo and active controls in improving RA disease activity. Studies of disease-modifying effects have not produced definitive results.
The depressed phase of bipolar affective disorder is a significant cause of suffering, disability, and mortality and represents a major challenge to treating clinicians. This article first briefly reviews the phenomenology and clinical correlates of bipolar depression and then focuses on the major pharmacological treatment options. We strongly recommend use of mood stabilizers as the first-line treatment for the type I form of bipolar depression, largely because longer-term preventative therapy with these agents almost certainly will be indicated. Depressive episodes that do not respond to lithium, divalproex, or another mood stabilizer, or episodes that "breakthrough" despite preventive treatment, often warrant treatment with an antidepressant or electroconvulsive therapy. The necessity of mood stabilizers in the type II form of bipolar depression is less certain, aside from the rapid cycling presentation. Both experts and practicing clinicians recommend bupropion and the selective serotonin reuptake inhibitors as coequal initial choices, with venlafaxine and monoamine oxidase inhibitors, such as tranylcypromine, preferred for more resistant cases. The risk of antidepressant-induced hypomania or mania with concomitant mood stabilizer therapy is low, on the order of 5% to 10% during acute phase therapy. Additional therapeutic options and optimal durations of therapy also are discussed.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.