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[Is there evidence in evidence-based medicine? A comparison of common gradation systems and critical evaluation].

AIM: Evidence-based medicine is still discussed controversially. The current literature offers a huge amount of tables, recommendations and modifications for the levels of evidence and degrees of recommendations. The scientist who is critical of new techniques and who wants to continue his education might be confused by the different recommendations. Unfortunately, the gradation of the recommendations is not always cited which has led to the controversially held discussion about evidence-based medicine. It was, therefore, the aim of the current article to present the most often used gradations and to discuss them critically. METHOD: In the current study we performed an analysis of the currently used recommendations and gradations in evidence-based medicine and discussed them critically. RESULTS: The great number of the available divisions to evidence-based medicine are often technical and partially differ considerably. An unambiguous assignment of the evidence classes and of recommendation degrees can only succeed if the source is indicated clearly. CONCLUSION: As far as the authors are concerned, the confusing status of evidence-based medicine makes one gradation necessary, which should be accepted and used worldwide.

Evidence-Based Medicine↗
PubMed1997

[Effectiveness of pulmonary artery catheterization in the critically ill patient--attempt at evaluating current status].

Pulmonary artery catheterization is currently used for more than 25 years for the hemodynamic monitoring of critically ill patients. As for every monitoring technique, its indication is based on the goal, that knowledge of the obtained additional hemodynamic parameters may lead to an optimization of therapy and thereby to an improvement in patients'outcome. Despite of the presence of clinical studies which documented changes in therapy following such extended monitoring, there is no clear proof for a positive effect on patients' mortality. While some of the available studies showed a benefit by pulmonary artery catheterization, others did not or even demonstrated a negative effect. However, no study fulfilled the scientific requirements which enables to make a statement to the effectiveness of pulmonary artery catheterization by objective criteria. The purpose of this review article is to summarize the currently available literature with regard to the effectiveness of pulmonary artery catheterization in the critically ill patient.

Catheterization, Swan-Ganz↗
PubMed2006

The construct and predictive validity of different approaches to combining urine and self-reported drug use measures among older adolescents after substance abuse treatment.

Reconciling urine results and self-reports is a classic challenge in substance abuse treatment research in general. For adolescents, the problems are compounded by the facts that they are more likely to use marijuana (which takes longer to metabolize) and to be coerced into treatment (which may increase lying). This article examines the construct and predictive validity of several different approaches for combining urine and self reported drug use including using common individual measures (urine tests and self-reported recency, frequency, and peak use), taking either as positive, using a summary scale, and using a latent model. Data are from 819 older adolescents 24 to 42 months after intake in seven sites. Days of use, the GAIN's substance frequency scale, and a latent model were the three best methods in terms of construct and predictive validity. Implications for treatment and longitudinal evaluation will be discussed.

Adolescent↗
PubMed2001

Conversion from laparoscopic to open appendicectomy: a possible drawback of the laparoscopic technique?

OBJECTIVE: To analyse the reasons for, and outcome of, conversion from laparoscopic to open appendicectomy and to identify factors that may predict the need for conversion. DESIGN: Subgroup analysis from a randomised multicentre study. SETTING: One university hospital and four county hospitals, Sweden. SUBJECTS: A total of 500 patients were randomised to laparoscopic (n = 244) or open (n = 256) appendicectomy. Thirty operations (12%) were converted to open appendicectomy. MAIN OUTCOME MEASURES: Reasons for conversion, outcome, and preoperative predictive variables. RESULTS: Difficult anatomy or the presence of an abscess were the main reasons for conversion (25/30). The incidence of perforated appendicitis was higher among patients who required conversion compared with both the open and laparoscopic group. Operating time, anaesthetic time, and duration of hospital stay were longer after conversion. Time to full recovery and length of sick leave were also longer, except for patients with perforated appendicitis. There was no difference in the complication rate. No predictive factors were identified. CONCLUSION: The main reasons for conversion were difficult anatomy and the presence of an abscess. After conversion patients recovered more slowly than those operated on laparoscopically or by primary open operation.

Adolescent↗