An evident view of evidence-based practice in perinatal medicine: absence of evidence is not evidence of absence.

OBJECTIVE: To provide valuable elements and some humor in this so-called era of "evidence-based practice" with the aim of helping clinicians make better choices in the care they deliver based on evidence, not simply or exclusively based on a randomized clinical trial (RCT) or meta-analysis (which may not be evidence). SOURCES: Books and peer-reviewed articles are quoted and listed in the bibliography. Evidence of life, learning from our own mistakes and many other evident facts that support this review are not quoted. SUMMARY OF THE FINDINGS: 1) "Absence of evidence is not evidence of absence" and "lack of evidence of effect does not mean evidence of no effect." 2) RCTs with "negative" results and those with "positive" results, but without outcomes that matter, often cannot conclude what they conclude. 3) Non-randomized clinical trials and practical trials may be important. 4) Research to prove is different than research to improve. 5) Clinical choice must assess effects on outcomes that matter to patients and their parents. 6) Quantifying adverse outcomes, number needed to damage and to treat is not that simple. CONCLUSIONS: Significant challenges inherent to health service research must be correlated to possible clinical applications using tools to have a more "evident view of evidence-based practice" in perinatal medicine, recalling that absence of evidence is not evidence of absence.

Cardiotrophin-1 protects cortical neuronal cells against free radical-induced injuries in vitro.

Cardiotrophin-1 (CT-1) was initially defined as a mediator of cardiomyocyte hypertrophy. Additional studies have showed that CT-1 enhanced survival of differentiated cardiac muscle cells and inhibited cardiac myocyte apoptosis after serum deprivation or cytokine stimulation. Moreover, CT-1 has recently been shown to act as a neuroregulatory cytokine in the peripheral nervous system. However, its effects in the central nervous system have not been determined. In the present study, we evaluated whether CT-1 protects cultured cortical neurons against oxidative injuries caused by the hydroxyl radical-producing agent FeSO4 and by the peroxynitrite-producing agent 3-morpholinosydnonimine (SIN-1). CT-1 reduced neuronal cell death caused by FeSO4 and also attenuated the neurotoxic effect of SIN-1 in a dose-dependent manner. These results indicate that CT-1 is neuroprotective in an in vitro model of cerebral ischemia. This study indicates that further evaluation of CT-1 in acute brain injury should be investigated in vivo.

Oxygen as a neonatal health hazard: call for détente in clinical practice.

UNLABELLED: Education in oxygenation and in how oxygen is given to newborns needs to increase. Treatment with oxygen should no longer be considered proverbial and customary, regardless of our 'past experience' or consensus recommendations in clinical guidelines, since oxygen may lead to acute or chronic health effects. CONCLUSION: Inappropriate oxygen use is a neonatal health hazard associated with aging, DNA damage and cancer, retinopathy of prematurity, injury to the developing brain, infection and others. Neonatal exposure to pure O2, even if brief, or to pulse oximetry >95% when breathing supplemental O2 must be avoided as much as possible.

Uma visão evidente da prática baseada em evidências na medicina perinatal: ausência de evidência não é evidência de ausência / An evident view of evidence-based pratice in perinatal medicine: absence of evidence is not evidence of absence

OBJETIVO: Proporcionar elementos valiosos e um pouco de humor nesta chamada era da "prática baseada em evidências" com o objetivo de ajudar os clínicos a fazer escolhas melhores no cuidado que eles provêem com base em evidências, e não simples ou exclusivamente com base em um ensaio clínico randomizado (ECR) ou meta-análise (o que pode não ser evidência). FONTE DOS DADOS: Livros e artigos com revisão por pares são citados e listados na bibliografia. Evidências de vida, aprendizado através de nossos próprios erros e muitos outros fatos evidentes que sustentam esta revisão não são citados. SÍNTESE DOS DADOS: 1) "Ausência de evidência não é evidência de ausência" e "falta de evidência de efeito não significa evidência de nenhum efeito". 2) Os ECR com resultado "negativo" e aqueles com resultado "positivo", mas sem os resultados importantes, muitas vezes não podem concluir o que concluem. 3) Os ensaios clínicos não-randomizados e os estudos práticos podem ser importantes. 4) A pesquisa em busca de provas é diferente da pesquisa em busca de aperfeiçoamento. 5) A escolha clínica deve avaliar os efeitos nos desfechos importantes para os pacientes e seus pais. 6) A quantificação de desfechos adversos, do número necessário para causar dano e do número necessário para tratamento não é assim tão simples. CONCLUSÕES: Desafios importantes inerentes à pesquisa em serviços de saúde devem ser correlacionados a possíveis aplicações clínicas usando ferramentas que permitam uma "visão mais clara da prática baseada em evidências" na medicina perinatal, lembrando que a ausência de evidência não é evidência de ausência.

OBJECTIVE: To provide valuable elements and some humor in this so-called era of "evidence-based practice" with the aim of helping clinicians make better choices in the care they deliver based on evidence, not simply or exclusively based on a randomized clinical trial (RCT) or meta-analysis (which may not be evidence). SOURCES: Books and peer-reviewed articles are quoted and listed in the bibliography. Evidence of life, learning from our own mistakes and many other evident facts that support this review are not quoted. SUMMARY OF THE FINDINGS: 1) "Absence of evidence is not evidence of absence" and "lack of evidence of effect does not mean evidence of no effect". 2) RCTs with "negative" results and those with "positive" results, but without outcomes that matter, often cannot conclude what they conclude. 3) Non-randomized clinical trials and practical trials may be important. 4) Research to prove is different than research to improve. 5) Clinical choice must assess effects on outcomes that matter to patients and their parents. 6) Quantifying adverse outcomes, number needed to damage and to treat is not that simple. CONCLUSIONS: Significant challenges inherent to health service research must be correlated to possible clinical applications using tools to have a more "evident view of evidence-based practice" in perinatal medicine, recalling that absence of evidence is not evidence of absence.