Prescriptions of homeopathic remedies at the expense of the German statutory health insurance from 1985 to 2021: scientific, legal and pharmacoeconomic analysis.

The prescription of homeopathic remedies at the expense of the statutory health insurance (SHI) system in Germany has been criticized for years due to a lack of evidence. Now, on the planned abolition of the reimbursement of homeopathic medicines in Germany, the debate on this topic has been reignited. The aim of this paper is to show the costs and their development over time incurred by homeopathic remedies in the healthcare system from 1985 to 2021. For this purpose, 15 selected homeopathic medicines were chosen from the drug prescription report (Arzneiverordnungsreport) and analyzed with regard to their development of DDD (Defined Daily Dose) using data from the Wissenschaftliches Institut der Ortskrankenkassen (WidO, Scientific Institute of the General Local Health Insurance Funds) and compared with their respective rational pharmacological alternatives. The price comparison was based on the DDD costs and the pharmacy retail price of the smallest packaging in each case. The clinical study situation for the preparations was also analyzed. For this purpose, the clinical studies provided by the manufacturer and those on PubMed were divided into evidence levels and analyzed. In addition, the presentation of homeopathic remedies on company websites, in online pharmacies, in specialist information and package leaflets was analyzed with regard to side effects, interactions, indication, and information on the alleged effect/proof of efficacy. In many media, information on homeopathic medicines remained incomplete, and non-compliance with the Therapeutic Product Advertising Act (Heilmittelwerbegesetz) was noted. Naming of the products if often very suggestive, too. Manufacturers' claims of efficacy go far beyond what can be considered proven in terms of evidence-based medicine and the quality of most clinical studies is poor. Homeopathic remedies are on average significantly more expensive than their rational pharmacological alternatives. Furthermore, DDD costs have continued to rise over the years analyzed. In aggregate, from a pharmacoeconomic, legal, and scientific perspective, abolition of reimbursement of homeopathic medicines in Germany at the expense of the SHI system is well justified.

[Conservative treatment of trauma-associated fractures of the cervical spine with orthoses-A review]. / Konservative Behandlung traumatisch bedingter Frakturen der Halswirbelsäule mit Orthesen ­ ein Review.

BACKGROUND: Traumatic injuries of the cervical spine are common and can significantly differ in the prognosis and treatment depending on the structure affected. We present the current evidence for conservative treatment of these fractures with orthoses in this review. METHODOLOGY: The literature search followed the PRISMA protocol. The risk of bias was assessed using ROBINS­I and evidence levels were determined according to AHCPR. RESULTS: A total of 22 studies were identified. The level of evidence according to AHCPR is limited (IIb, III and IV) and every study had a serious risk of bias in at least one subdivision. Of the authors 11 presented conservative treatment concepts for C2 dens fractures, 7 studies focussed on vertebral arch fractures and 9 on vertebral body fractures. Radiological parameters (kyphosis angle, bone consolidation) and the neurological status were frequently reported as endpoints. CONCLUSION: Stable C2 dens fractures without relevant clinical restrictions allow conservative treatment in a rigid cervical orthosis under radiological monitoring every 1-4 weeks. Type II fractures require special attention due to the risk of instability. Hangman's fractures can be safely treated in rigid cervical orthoses. The current state of knowledge does not allow any recommendation for conservative treatment of Hangman's fractures with orthoses. Stable vertebral body fractures without involvement of the spinal canal can also be treated conservatively with orthotic devices. Randomized controlled studies are required to develop a secure state of evidence and are currently not available.

Pharmacogenes that demonstrate high association evidence according to CPIC, DPWG, and PharmGKB.

Background: Different levels of evidence related to the variable responses of individuals to drug treatment have been reported in various pharmacogenomic (PGx) databases. Identification of gene-drug pairs with strong association evidence can be helpful in prioritizing the implementation of PGx guidelines and focusing on a gene panel. This study aimed to determine the pharmacogenes with the highest evidence-based association and to indicate their involvement in drug-gene interactions. Methodology: The publicly available datasets CPIC, DPWG, and PharmGKB were selected to determine the pharmacogenes with the highest drug outcome associations. The upper two levels of evidence rated by the three scoring methods were specified (levels A-B in CPIC, 3-4 in DPWG, or 1-2 levels in PharmGKB). The identified pharmacogenes were further ranked in this study based on the number of medications they interacted with. Results: Fifty pharmacogenes, with high to moderately high evidence of associations with drug response alterations, with potential influence on the therapeutic and/or toxicity outcomes of 152 drugs were identified. CYP2D6, CYP2C9, CYP2C19, G6PD, HLA-B, SLCO1B1, CACNA1S, RYR1, MT-RNR1, and IFNL4 are the top 10 pharmacogenes, where each is predicted to impact patients' responses to ≥5 drugs. Conclusion: This study identified the most important pharmacogenes based on the highest-ranked association evidence and their frequency of involvement in affecting multiple drugs. The obtained data is useful for customizing a gene panel for PGx testing. Identifying the strength of scientific evidence supporting drug-gene interactions aids drug prescribers in making the best clinical decision.

Pathology in the era of "Personalized Medicine": The need to learn how to integrate multivariate immunohistochemical and "omics" data with clinicopathologic information in a clinically relevant way".

"Personalized medicine" has been proposed as a new paradigm for patient care that, based on the integration of genomics and other "omics" data with clinical and other multidisciplinary information, promises early disease detection, improved outcomes and reduced side effects to therapies. Pathologists have become important participants in this new approach as the guardians of tissues and experts in the performance of molecular and other laboratory tests. Large amounts of new laboratory data in multiple neoplasms and other entities are being reported but there has been limited discussion about how best to evaluate the clinical significance of this information and how to integrate it into currently available diagnostic and therapeutic modalities. This article introduces a variety of epistemological problems presented by the "personalized medicine" paradigm and briefly discusses various topics that will be evaluated in further detail in future articles of this new series on Evidence-Based Pathology.

Recomendaciones analgésicas en el perioperatorio del adulto mayor / Analgesic recommendations in the perioperative of the elderly adult

Resumen: El envejecimiento acelerado de la población representa un reto importante para el sector salud. En México, la pirámide poblacional tiene la proyección de modificarse hacia el año 2050 y el cambio ya ha comenzado. Las estimaciones del Consejo Nacional de Población indican que, para el año 2040, una de cada cuatro personas que vivan en nuestro país será mayor de 60 años. Además de la longevidad, los servicios quirúrgicos también se van incrementando y, en consecuencia, es necesario implementar esquemas de analgesia ajustados a este grupo etario que envejece. El siguiente escrito pretende resumir los cambios que ocurren con la edad y presenta los diversos grupos analgésicos y su indicación acordes a los niveles de evidencia de la National Health and Medical Research Council designation (NHMRC, 1999).

Abstract: The accelerated ageing of the population represents an important challenge for the health sector. In Mexico, the population pyramid has the projection to be modified by the year 2050 and the change has already begun. Estimates from the National Population Council indicate that by the year 2040, one in four people living in our country will be over 60 years. In addition to longevity, surgical services are also increasing therefore, it is necessary to implement analgesia schemes according to this age aging group. The following writing aims to summarize changes occurring with age and presents the analgesic groups with their indication according to the levels of evidence of the National Health and Medical Research Council designation (NHMRC, 1999).

Chromosome 17 Missing Proteins: Recent Progress and Future Directions as Part of the neXt-MP50 Challenge.

The Chromosome-centric Human Proteome Project (C-HPP), announced in September 2016, is an initiative to accelerate progress on the detection and characterization of neXtProt PE2,3,4 "missing proteins" (MPs) with a mandate to each chromosome team to find about 50 MPs over 2 years. Here we report major progress toward the neXt-MP50 challenge with 43 newly validated Chr 17 PE1 proteins, of which 25 were based on mass spectrometry, 12 on protein-protein interactions, 3 on a combination of MS and PPI, and 3 with other types of data. Notable among these new PE1 proteins were five keratin-associated proteins, a single olfactory receptor, and five additional membrane-embedded proteins. We evaluate the prospects of finding the remaining 105 MPs coded for on Chr 17, focusing on mass spectrometry and protein-protein interaction approaches. We present a list of 35 prioritized MPs with specific approaches that may be used in further MS and PPI experimental studies. Additionally, we demonstrate how in silico studies can be used to capture individual peptides from major data repositories, documenting one MP that appears to be a strong candidate for PE1. We are close to our goal of finding 50 MPs for Chr 17.

Nivel de evidencia de los artículos publicados en la Revista Chilena de Cirugía: evaluación del período 2007-2012 / Level of evidence of articles published in Revista Chilena de Cirugía: assessment of the period 2007-2011

Aim: to determine the level of evidence (LE) of articles published in Revista Chilena Cirugía (RCC) in the period 2007-2012 and their association with year of publication, subject area and university affiliation (UA). Material and Methods: bibliometric study. An analysis of articles published between 2007 and 2012 in the RCC, applying the classification of the Oxford Centre for Evidence-Based Medicine (OCEBM) was performed. The sample is composed of all articles published in the period under study, which was feasible to apply the CEBM classification. The variables analyzed were LE, research design, year of publication, subject area and UA dichotomized (Yes/No). The LE of the items was determined by three independent investigators and discrepancies were resolved by consensus. We performed an exploratory analysis of the data and the results are presented using descriptive statistics. Results: of the 688 articles published in the period, 452 meet the selection criteria. The most frequent LE was 4 and 2b (91.4 percent and 5.8 percent respectively). The most frequent research designs were case report and retrospective case series (45.6 percent and 32.3 percent respectively). The subject areas that most articles provided were liver, biliary tract and pancreas; and esophagus, stomach, duodenum and small intestine (18.6 percent and 18.1 percent respectively). The 76.5 percent of the articles presented UA. These had a higher proportion of articles with LE greater than 4 respect of those without UA (9.5 percent vs 5.6 percent respectively). Conclusion: a significant proportion of articles published in RCC during the study period are of low LE.

Objetivo: determinar el nivel de evidencia (NE) de los artículos publicados en la Revista Chilena de Cirugía (RCC) en el período 2007-2012 y su asociación con año de publicación, área temática y filiación universitaria (FU). Material y Método: estudio bibliométrico. Se realizó un análisis de los artículos publicados entre 2007 y 2012 en la RCC, aplicando la clasificación del Centro de Medicina Basada en Evidencia de Oxford (OCEBM). La muestra está compuesta por la totalidad de artículos publicados en el período en estudio, a los que fue factible aplicar la clasificación OCEBM. Las variables analizadas fueron NE, diseño de investigación, año de publicación, área temática y FU dicotomizada (Sí/No). El NE de los artículos fue determinado por 4 investigadores independientes, las discrepancias se resolvieron por consenso. Se realizó un análisis exploratorio de los datos y los resultados se presentan mediante estadística descriptiva. Resultados: de los 688 artículos publicados en el período, 452 cumplían los criterios de selección. Los NE más frecuentes fueron 4 y 2b (91,4 por ciento y 5,8 por ciento respectivamente). Los diseños de investigación más prevalentes fueron reporte de casos y serie de casos retrospectiva (45,6 por ciento y 32,3 por ciento respectivamente). Las áreas temáticas que más artículos aportaron fueron hígado, vías biliares y páncreas; esófago, estómago, duodeno e intestino delgado (18,6 por ciento y 18,1 por ciento respectivamente). El 76,5 por ciento de los artículos presentó FU, los que tenían mayor proporción de artículos de NE sobre 4 respecto de centros sin FU (9,5 por ciento vs 5,6 por ciento respectivamente). Conclusión: una considerable proporción de los artículos publicados en la RCC en el período estudiado son de bajo NE.