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PubMed1999

Assessing "best evidence": issues in grading the quality of studies for systematic reviews.

BACKGROUND: Evidence-based medicine, clinical practice guidelines, quality and value of health services, and science-based decision making are becoming mainstays of the health care sector. As part of the evidence-based movement, systematic reviews of the literature on clinical questions are becoming increasingly common. Part of the structured approach to evaluating the literature involves assessing the quality of individual studies included in systematic reviews. REVIEW QUESTIONS: To clarify issues in this area, in 1998 the Agency for Health Care Policy and Research commissioned a small project to determine how its 12 Evidence-based Practice Centers were carrying out this part of their systematic reviews (called evidence reports). The number of potential checklists, scales, and similar tools for grading the methodology or the clinical relevance of individual reports is large; the reliability, the validity, the feasibility, and the utility of these tools are either unmeasured or quite variable. CONCLUSIONS: Numerous methodologic questions await definitive research and answers, but in the meantime teams developing authoritative systematic reviews can take certain steps to ensure that their approaches to grading the quality of articles meet applicable scientific standards. Clinicians, program administrators, and health policymakers can then be confident in the overall strength of the evidence and study conclusions.

Bias↗
PubMed2003

Lung protective mechanical ventilation in acute respiratory distress syndrome.

The evidence supports the idea that mechanical ventilation can potentially cause further lung injury. The only ventilator manipulation that so far has been shown definitively to reduce injury and improve mortality is the reduction of VT to 6 mL/kg PBW or lower and targeting Pplat to 30 cm H2O or lower. Much research is needed to provide further guidance in applying ventilatory support techniques.

Animals↗
PubMed2004

The yellow zone in asthma treatment: is it a gray zone?

OBJECTIVE: To review the available literature on methods of preventing and minimizing exacerbations and to target problems for improvement. DATA SOURCES: PubMed and Cochrane Review searches of the English-language literature using the following key yellow zone terms: asthma exacerbation, self-management plans, inhaled corticosteroids, and acute management of asthma exacerbations. STUDY SELECTION: Articles relevant to our yellow zone intervention inquiry. RESULTS: The National Institutes of Health (NIH) guidelines advocate that physicians give patients written action plans with instructions on managing home (yellow zone) exacerbations. However, the criteria used to identify the yellow zone are ambiguous and often confusing to patients and physicians. In addition, apart from a passing mention that doubling doses of inhaled corticosteroids may be an option in asthma step-up care, the guidelines contain no recommendations for yellow zone treatment strategies. This deficiency is directly related to the paucity of organized evidence on the efficacy of the various pharmacological interventions that can be used during an exacerbation. CONCLUSIONS: Translating the NIH guidelines into realistic clinical practice requires a clearer and more patient-friendly definition of the yellow zone, and this improved definition will facilitate the prescription of effective interventions in the management of yellow zone exacerbations.

Administration, Inhalation↗
PubMedDate not supplied

Protocols and guides, tools.

The author describes in the first part of the review the definitions and relations of the occurring concepts. In the second part a short history of the topic is overviewed. The third part is dealing with the electronic patient record based development of guidelines in addition what are the relations among guidelines, protocols, tools, knowledge-based systems, diagnosis supporting systems, expert systems, outcome analysis and artificial intelligence. A short review of what was presented in the MIE '97 in this area is finally described and the Session Chairman's conclusion.

Computer Communication Networks↗
PubMed2006

Should adjuvant chemotherapy become standard treatment for patients with stage II colon cancer? For the proposal.

Adjuvant chemotherapy is regarded as standard treatment for patients with stage III colon cancer; however, use of chemotherapy after surgery in patients with stage II disease remains controversial because of a lack of level I evidence. In 2005, the Minimum Clinical Recommendations, issued by the European Society for Medical Oncology (ESMO), did not advocate use of chemotherapy in stage II disease, but did state that chemotherapy "may be considered in selected node-negative patients". Similarly, in 2004, treatment recommendations from the American Society of Clinical Oncology (ASCO) for stage II colon cancer proposed that there might be some "patients with stage II disease that could be considered for adjuvant therapy, including patients with inadequately sampled nodes, T4 lesions, perforation, or poorly differentiated histology". Consequently, use of adjuvant chemotherapy in patients with stage II colon cancer is not universal. In this Debate, Alberto Sobrero from Genoa, Italy, and Claus-Henning Köhne from Oldenburg, Germany, present the arguments for and against the use of this type of treatment.

Antimetabolites, Antineoplastic↗
PubMed2000

Commentary on the multimodal treatment study of children with ADHD.

The multimodal treatment study of attention deficit hyperactivity disorder (MTA Study) constitutes a landmark in the history of treatment research in child psychopathology, being the largest single study of its kind ever undertaken. Important findings have emerged from this project, as the papers in the present volume will attest. This commentary focuses on several concerns about the assumptions that appear to have guided the design of the MTA study, particularly its psychosocial treatment component, as well as the manner in which treatment results have been presented to date. In particular, no explicit theory of ADHD appears to have guided the construction of the treatment components, relying instead on implicit theories associated with those treatments, such as the notion that the symptoms of ADHD arise through faulty learning and defective contingencies of reinforcement. Future articles from this study will need to address these and other concerns if the results of the study are to be properly interpreted and the scientific and clinical yield is to be maximized.

Attention Deficit Disorder with Hyperactivity↗
PubMed2003

Towards understanding molecular mechanisms of action of homeopathic drugs: an overview.

The homeopathic mode of treatment often encourages use of drugs at such ultra-low doses and high dilutions that even the physical existence of a single molecule of the original drug substance becomes theoretically impossible. But homeopathy has sustained for over two hundred years despite periodical challenges thrown by scientists and non-believers regarding its scientificity. There has been a spurt of research activities on homeopathy in recent years, at clinical, physical, chemical, biological and medical levels with acceptable scientific norms and approach. While clinical effects of some homeopathic drugs could be convincingly shown, one of the greatest objections to this science lies in its inability to explain the mechanism of action of the microdoses based on scientific experimentations and proofs. Though many aspects of the mechanism of action still remain unclear, serious efforts have now been made to understand the molecular mechanism(s) of biological responses to the potentized form of homeopathic drugs. In this communication, an overview of some interesting scientific works on homeopathy has been presented with due emphasis on the state of information presently available on several aspects of the molecular mechanism of action of the potentized homeopathic drugs.

Homeopathy↗
PubMed2004

Editorial.

Explore the source record for details and available documents.

Adrenergic beta-Antagonists↗