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1.
Urologiia ; (5): 94-98, 2021 Nov.
Artículo en Ruso | MEDLINE | ID: mdl-34743440

RESUMEN

Lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) are common disorder in older men. The mainstay of conservative treatment for BPH is 1-adrenoblockers. A review of the literature on silodosin, a selective -adrenergic blocker, is discussed in the article. In clinical studies, there was a significant improvement in IPSS scores and maximum urinary flow rate in patients who received silodosin at a daily dose of 8 mg compared to those receiving placebo. It should be noted that silodosin has demonstrated long-term safety and early onset of efficacy. Compelling literature data to support the clinical benefit of silodosin for the treatment of LUTS associated with BPH is presented.


Asunto(s)
Síntomas del Sistema Urinario Inferior , Hiperplasia Prostática , Antagonistas de Receptores Adrenérgicos alfa 1/uso terapéutico , Anciano , Medicina Basada en la Evidencia , Humanos , Indoles , Síntomas del Sistema Urinario Inferior/tratamiento farmacológico , Síntomas del Sistema Urinario Inferior/etiología , Masculino , Hiperplasia Prostática/complicaciones , Hiperplasia Prostática/tratamiento farmacológico , Resultado del Tratamiento
2.
Surg Clin North Am ; 101(6): 951-966, 2021 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-34774274

RESUMEN

Surgical site infection (SSI) remains an important complication of surgery. SSI is estimated to affect 2% to 5% of all surgical patients. Local and national efforts have resulted in significant improvements in the incidence of SSI. Familiarity with evidence surrounding high-quality SSI-reduction strategies is desirable. There exists strong evidence for mechanical and oral antibiotic bowel preparation in colorectal surgery, smoking cessation before elective surgery, prophylactic antibiotics, chlorhexidine-based skin antisepsis, and maintenance of normothermia throughout the perioperative period to reduce SSI. Use of other practices should be determined by the operating surgeon and/or local hospital policy.


Asunto(s)
Infección de la Herida Quirúrgica/prevención & control , Medicina Basada en la Evidencia , Humanos , Infección de la Herida Quirúrgica/etiología
3.
BMC Health Serv Res ; 21(1): 1198, 2021 Nov 05.
Artículo en Inglés | MEDLINE | ID: mdl-34740338

RESUMEN

BACKGROUND: Implementation and uptake of novel and cost-effective medicines can improve patient health outcomes and healthcare efficiency. However, the uptake of new medicines into practice faces a wide range of obstacles. Earlier reviews provided insights into determinants for new medicine uptake (such as medicine, prescriber, patient, organization, and external environment factors). However, the methodological approaches used had limitations (e.g., single author, narrative review, narrow search, no quality assessment of reviewed evidence). This systematic review aims to identify barriers and facilitators affecting the uptake of new medicines into clinical practice and identify areas for future research. METHOD: A systematic search of literature was undertaken within seven databases: Medline, EMBASE, Web of Science, CINAHL, Cochrane Library, SCOPUS, and PsychINFO. Included in the review were qualitative, quantitative, and mixed-methods studies focused on adult participants (18 years and older) requiring or taking new medicine(s) for any condition, in the context of healthcare organizations and which identified factors affecting the uptake of new medicines. The methodological quality was assessed using QATSDD tool. A narrative synthesis of reported factors was conducted using framework analysis and a conceptual framework was utilised to group them. RESULTS: A total of 66 studies were included. Most studies (n = 62) were quantitative and used secondary data (n = 46) from various databases, e.g., insurance databases. The identified factors had a varied impact on the uptake of the different studied new medicines. Differently from earlier reviews, patient factors (patient education, engagement with treatment, therapy preferences), cost of new medicine, reimbursement and formulary conditions, and guidelines were suggested to influence the uptake. Also, the review highlighted that health economics, wider organizational factors, and underlying behaviours of adopters were not or under explored. CONCLUSION: This systematic review has identified a broad range of factors affecting the uptake of new medicines within healthcare organizations, which were grouped into patient, prescriber, medicine, organizational, and external environment factors. This systematic review also identifies additional factors affecting new medicine use not reported in earlier reviews, which included patient influence and education level, cost of new medicines, formulary and reimbursement restrictions, and guidelines. REGISTRATION: PROSPERO database (CRD42018108536).


Asunto(s)
Prescripciones de Medicamentos , Adulto , Medicina Basada en la Evidencia , Humanos
4.
Orv Hetil ; 162(45): 1818-1825, 2021 11 07.
Artículo en Húngaro | MEDLINE | ID: mdl-34747362

RESUMEN

Összefoglaló. Bevezetés: A ritka betegséggel élok ellátásában fontos elorelépések történtek az elmúlt években. Egy következo lépés lehetne hazánkban a Ritka Betegségek Nemzeti Eroforrás (Uni-Versum) Központjának (a továbbiakban: Központ) létrehozása, amely az egészségügyi, szociális és köznevelési szolgáltatásokat összehangolva és kiegészítve személyközpontú ellátást nyújtana a betegek és támogatóik részére. Célkituzés: Célunk az volt, hogy egy nemzetközi tudományos módszertan alapján javaslatokat tegyünk arra, hogy milyen eszközökkel lehet feloldani a Központ megvalósításának lehetséges korlátozó tényezoit. Módszer: A Központ megvalósíthatóságának értékelésére interdiszciplináris szakmai egyeztetést szerveztünk különbözo érintett érdekcsoportok részvételével, a SELFIE H2020 kutatási projekt által kidolgozott módszertan alapján. Az elozetesen rangsorolt legfontosabb korlátozó tényezokre lehetséges megoldási javaslatokat tettünk. Eredmények: A lehetséges korlátozó tényezoket a résztvevok relevánsnak tartották a Központ létrehozásával kapcsolatban, és ezekre összesen 17 olyan konkrét javaslat született, amelyben a résztvevok között egyetértés alakult ki. A javaslatok kiterjedtek az ellátás tartalmára, az alkalmazott technológiák támogató szerepére, a humáneroforrás-korlátok megoldására, a hatékony vezetés és szervezés kialakítására, az összetett finanszírozási struktúra kialakítására és a kutatási lehetoségek megteremtésére is. Megbeszélés: A Központ megvalósítása esetén a ritka betegséggel élok ellátása az egészségügyi, szociális és köznevelési tevékenységeket integráló megközelítés felé mozdulna el. A kutatás során megfogalmazott javaslatok hozzájárulhatnak a Központ létrehozásához, amennyiben megvan az ehhez szükséges szakpolitikai támogatás is. Ezen túlmutatóan, a leírt munkamódszer más integrált ellátási modellek bevezethetoségének elemzéséhez is mintaként szolgálhat. Következtetés: Összefoglalva megállapíthatjuk, hogy a Központ létrehozásához számos, elozetesen is látható korlátozó tényezot kell feloldani. Az érdekcsoportok közös javaslatai alapján kialakítható egy olyan muködési forma, amely az ellátórendszerek kiegészítésével és összehangolásával jelentos társadalmi értéktöbbletet eredményezhet. Orv Hetil. 2021; 162(45): 1818-1825. INTRODUCTION: In Hungary, significant achievements have been made in the care of patients with rare diseases in recent years. A next step could be the establishment of the National Resource Centre for Rare Diseases (hereinafter: Centre) to facilitate patient-centered complex care by the integration and supplementation of existing health, social and educational services. OBJECTIVE: This research aimed to develop recommendations based on international scientific methodology to overcome potential implementation barriers of the aforementioned Centre. METHOD: To evaluate the feasibility of the implementation, we organized an interdisciplinary workshop with representatives of different stakeholder groups, adopting the methodology developed in the SELFIE H2020 research project. During the workshop, we discussed the previously ranked, most significant implementation barriers and made recommendations for potential solutions. RESULTS: The potential implementation barriers were considered relevant by the participants and, reflecting on these barriers, altogether 17 recommendations were developed by consensus. These recommendations were related to the content of service delivery, use of supportive technologies, overcoming workforce issues, establishing effective leadership, implementing a complex financing structure and creating research opportunities. DISCUSSION: Implementation of the Centre would shift the care of rare diseases towards personalized and integrated health, social and educational services. Our recommendations will contribute to the establishment of the Centre, subject to positive policy decision. Furthermore, our methodological approach could support the feasibility assessment of future integrated care solutions and programs. CONCLUSION: Several predictable barriers must be overcome to establish the Centre. Recommendations developed by representatives of relevant stakeholders could support successful implementation and societal value generation. Orv Hetil. 2021; 162(45): 1818-1825.


Asunto(s)
Medicina Basada en la Evidencia , Política de Salud , Humanos , Hungría
5.
Artículo en Inglés | MEDLINE | ID: mdl-34769813

RESUMEN

This study aimed to determine the prevalence of high levels of knowledge, positive attitude, and good practice on evidence-based medicine (EBM) and identify the associated factors for practice score on EBM among emergency medicine doctors in Kelantan, Malaysia. This cross-sectional study was conducted in government hospitals in Kelantan. The data were collected from 200 emergency physicians and medical officers in the emergency department using the Noor Evidence-Based Medicine Questionnaire. Simple and general linear regressions analyses using SPSS were performed. A total of 183 responded, making a response rate of 91.5%. Of them, 49.7% had a high level of knowledge, 39.9% had a positive attitude and 2.1% had good practice. Sex, race, the average number of patients seen per day, internet access in workplace, having online quick reference application, and attitude towards EBM were significantly associated with EBM practice scores. It is recommended that appropriate authorities provide emergency doctors with broader access to evidence resources. EBM skill training should be enhanced in the current medical school curriculums.


Asunto(s)
Conocimientos, Actitudes y Práctica en Salud , Médicos , Actitud del Personal de Salud , Estudios Transversales , Servicio de Urgencia en Hospital , Medicina Basada en la Evidencia , Humanos , Malasia
6.
Pol Merkur Lekarski ; 49(293): 321-324, 2021 Oct 22.
Artículo en Polaco | MEDLINE | ID: mdl-34800015

RESUMEN

Evidence Based Medicine (EBM) is a core competence for clinicians and should be taught in all medical faculties. AIM: The aim of the study was to survey how EBM is taught in medical faculties in Poland. MATERIALS AND METHODS: We conducted a questionnaire study, asking the deans of medical faculties to fill it. RESULTS: We got a response from all medical faculties. Teaching of EBM is carried out in all medical faculties in Poland, apart from Kopernicus University in Torun. EBM is a separate subject in 7 faculties (from 5 to 36 hours). The most often EBM is taught on the IIIrd to the Vth course of the study with exception of Kielce, where it is held on the IInd course. In the most faculties teaching EBM is obligatory. In Lodz and Krakow, apart of being obligatory, EBM may be continued facultatively. Teachers are competent in EBM and continuosly trained. EBM study ends with a credit in 3 faculties. Some faculties intend to introduce EBM as a separate subject or extend number of hours. CONCLUSIONS: Our study showed that EBM is generally taught in medical faculties in Poland although in various length (5-36 hours). It should be extended to 30 hours and unified within a separate subject which ends with a credit.


Asunto(s)
Medicina Basada en la Evidencia , Docentes Médicos , Humanos , Polonia , Encuestas y Cuestionarios
7.
Zhongguo Zhong Yao Za Zhi ; 46(19): 5117-5122, 2021 Oct.
Artículo en Chino | MEDLINE | ID: mdl-34738409

RESUMEN

In order to standardize the clinical diagnosis and treatment decision-making with traditional Chinese medicine for pa-tients of coronavirus disease 2019(COVID-19) and put the latest clinical study evidence into clinical practice, the international trust-worthy traditional Chinese medicine recommendations( TCM Recs) working group started the compilation of Living Evidence-based Guideline for Combination of Traditional Chinese and Western Medicine for Treatment of COVID-19 on the basis of the standards and re-quirements of WHO handbook, GRADE and RIGHT. This proposal mainly introduces the formulation methods and processes of the living guidelines in details, such as the composition of the working group, the collection and identification of clinical issues and out-comes, the production of the living systematic review and the consensus of recommendations. The guidelines will continue to monitor the clinical study evidences of TCM in the prevention and treatment of COVID-19, and conduct regular evidence updating, retrieval and screening. When there is new study evidence, the steering committee will evaluate the possibility of the evidence to change clinical practice or previous recommendations, so as to decide whether the recommendations for the guidelines shall be implemented or upda-ted. The main criteria considered in the guideline updating are as follows:(1) There are new high-quality randomized controlled trial(RCT) evidences for TCM uninvolved in the previous edition of the guidelines;(2) as for the TCM involved in the guidelines, living sys-tematic review shows that new evidence may change the direction or strength of the existing recommendations. The specific implementation of the living evidence-based guidelines will take this proposal as the study basis and framework, in order to ensure the standardization of the formulation process and methods. This will be the first exploration of the methodology for living guidelines in the field of TCM.


Asunto(s)
COVID-19/terapia , China , Medicina Basada en la Evidencia , Humanos , Medicina China Tradicional , Guías de Práctica Clínica como Asunto , SARS-CoV-2
8.
Rev Esp Salud Publica ; 952021 Oct 01.
Artículo en Español | MEDLINE | ID: mdl-34593751

RESUMEN

The objective of this work was to describe the implantation project presented by the Virgen de las Nieves University Hospital (Granada, Spain) to be selected as a candidate for "Best Practice Spotlight Organization"® (in Spain CCEC®) program in the cohort (2015-2017) to implement three guidelines for Nurses Association of Canada Ontario (RNAO) clinical practice of care. The methodology used was the model called "knowledge for action" and the actions developed for each of the phases of the action cycle for applying knowledge to practice were described: 1) identification of the problem, 2) adaptation to the local context, 3) evaluation of facilitators and barriers, 4) adaptation and implementation of interventions, 5) monitoring and evaluation of results and 6) sustainability. This work adds to the set of studies that address the improvement and maintenance of evidence-based practice programs in nursing, and in health services in general. It shows the application of a framework for the implementation of clinical practice guidelines for care in a specific health environment for its replication in other different health settings. It has been shown that it is essential to dedicate efforts to planning the implementation of this type of programs, taking into account the context in which they are developed, the specific characteristics of the population being served, identifying the different barriers and facilitators that may affect during the course of the program. process and defining actions to make the changes in practice sustainable.


Asunto(s)
Medicina Basada en la Evidencia , Hospitales Universitarios , Desarrollo de Programa , Medicina Basada en la Evidencia/organización & administración , Hospitales Universitarios/organización & administración , Humanos , España
9.
Zhonghua Yi Xue Za Zhi ; 101(5): 311-316, 2021 Feb 02.
Artículo en Chino | MEDLINE | ID: mdl-34645249

RESUMEN

Evidence-based interventional radiology is the result of the evolution and integration of evidence-based medicine and interventional radiology. It adopts the concepts and methods of evidence-based medicine to guide the best clinical practice in interventional radiology. We aim to systematically elaborate on the status quo of Clinical Research, Systematic Review/Meta-Analysis and Clinical Practice Guidelines in interventional radiology, analyze the existing problems, and put forward thoughts and suggestions on promoting the development of evidence-based interventional radiology in the future.


Asunto(s)
Medicina Basada en la Evidencia , Radiología Intervencionista , Predicción
10.
Front Endocrinol (Lausanne) ; 12: 707726, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34659109

RESUMEN

Subacute thyroiditis (SAT) is a thyroid disease of viral or post-viral origin. Whether SAT represents a complication of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is still unclear. Our aim was to systematically review the literature to 1) explore the size of the literature about SAT in COVID-19 and 2) evaluate the clinical characteristics of SAT. PubMed/MEDLINE, Embase, and Scopus were searched until April 20, 2021. Original papers, case reports, and case series reporting SAT in COVID-19 patients were included. Authors and their country, journal, year of publication, COVID-19 and SAT clinical presentation, thyroid function, therapy, and follow-up data were extracted. Nineteen papers (17 case reports and 2 case series) were included, describing 27 patients, 74.1% females, aged 18 to 69 years. COVID-19 was diagnosed by nasopharyngeal swab in 66.7% cases and required hospitalization in 11.1%. In 83.3% cases, SAT occurred after COVID-19. Neck pain was present in 92.6% cases and fever in 74.1%. Median TSH, fT3, and fT4 were 0.01 mU/l, 10.79 pmol/l, and 27.2 pmol/l, respectively. C-reactive-protein and erythrocyte sedimentation rate were elevated in 96% of cases. Typical ultrasonographic characteristics of SAT were observed in 83.3% of cases. Steroids were the most frequent SAT therapy. Complete remission of SAT was recorded in most cases. In conclusion, the size and quality of published data of SAT in COVID-19 patients are poor, with only case reports and case series being available. SAT clinical presentation in COVID-19 patients seems to be similar to what is generally expected.


Asunto(s)
COVID-19/complicaciones , Tiroiditis Subaguda/etiología , Adolescente , Adulto , Anciano , Medicina Basada en la Evidencia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven
11.
BMC Med Educ ; 21(1): 547, 2021 Oct 29.
Artículo en Inglés | MEDLINE | ID: mdl-34711206

RESUMEN

BACKGROUND: Teaching evidence-based medicine (EBM) is not an easy task. The role of the electronic book (e-book) is a useful supplement to traditional methods for improving skills. Our aim is to use an interactive e-book or PowerPoint to evaluate instructors' teaching effects on EBM. METHODS: Our study group was introduced to learning EBM using an interactive e-book available on the Internet, while the control group used a PowerPoint presentation. We adopted the Modified Fresno test to assess EBM skills both before and after their learning. EBM teaching sessions via e-book or PowerPoint were 20-30 min long, followed by students' feedback. We adopted Student's t-test to compare teachers' evaluation of their EBM skills prior to the class and the students' assessment of the teachers' instruction. We also adopted repeated measures ANCOVA to compare teachers' evaluation of their EBM skills using the Fresno test both before and after the class. RESULTS: We observed no difference regarding EBM skills between the two groups prior to their experimental learning, which was assessed by the Modified Fresno test. After learning, physicians in the study group ranked higher in choosing a case to explain which kind of research design was used for the study type of the question and explaining their choice (P = 0.024) as assessed by the post-test to pre-test Fresno test. Teaching effect was better in the e-book group than in the control group for the items, "I am satisfied with this lesson," "The teaching was of high quality," "This was a good teaching method," and "It aroused my interest in EBM." However, no differences were observed between the two groups in physicians who had more than 10 years' experience. CONCLUSIONS: The use of interactive e-books in clinical teaching can enhance a teacher's EBM skills, though not in more senior physicians. This may suggest that teaching methodology and activities differ for teachers' varying years of experience.


Asunto(s)
Medicina Basada en la Evidencia , Multimedia , Libros , Electrónica , Medicina Basada en la Evidencia/educación , Humanos , Aprendizaje , Enseñanza
12.
J Med Libr Assoc ; 109(3): 382-387, 2021 Jul 01.
Artículo en Inglés | MEDLINE | ID: mdl-34629966

RESUMEN

Objective: To compare the accuracy, time to answer, user confidence, and user satisfaction between UpToDate and DynaMed (formerly DynaMed Plus), which are two popular point-of-care information tools. Methods: A crossover study was conducted with medical residents in obstetrics and gynecology and family medicine at the University of Toronto in order to compare the speed and accuracy with which they retrieved answers to clinical questions using UpToDate and DynaMed. Experiments took place between February 2017 and December 2019. Following a short tutorial on how to use each tool and completion of a background survey, participants attempted to find answers to two clinical questions in each tool. Time to answer each question, the chosen answer, confidence score, and satisfaction score were recorded for each clinical question. Results: A total of 57 residents took part in the experiment, including 32 from family medicine and 25 from obstetrics and gynecology. Accuracy in clinical answers was equal between UpToDate (average 1.35 out of 2) and DynaMed (average 1.36 out of 2). However, time to answer was 2.5 minutes faster in UpToDate compared to DynaMed. Participants were also more confident and satisfied with their answers in UpToDate compared to DynaMed. Conclusions: Despite a preference for UpToDate and a higher confidence in responses, the accuracy of clinical answers in UpToDate was equal to those in DynaMed. Previous exposure to UpToDate likely played a major role in participants' preferences. More research in this area is recommended.


Asunto(s)
Medicina Basada en la Evidencia , Ginecología/educación , Obstetricia/educación , Sistemas de Atención de Punto , Estudios Cruzados , Estudios Transversales , Ginecología/economía , Humanos , Distribución Aleatoria , Encuestas y Cuestionarios
13.
Transl Psychiatry ; 11(1): 531, 2021 10 16.
Artículo en Inglés | MEDLINE | ID: mdl-34657142

RESUMEN

Several care models have been developed to improve treatment for depression, all of which provide "enhanced" evidence-based care (EEC). The essential component of these approaches is Measurement-Based Care (MBC). Specifically, Collaborative Care (CC), and Algorithm-guided Treatment (AGT), and Integrated Care (IC) all use varying forms of rigorous MBC assessment, care management, and/or treatment algorithms as key instruments to optimize treatment delivery and outcomes for depression. This meta-analysis systematically examined the effectiveness of EEC versus usual care for depressive disorders based on cluster-randomized studies or randomized controlled trials (RCTs). PubMed, the Cochrane Library, and PsycInfo, EMBASE, up to January 6th, 2020 were searched for this meta-analysis. The electronic search was supplemented by a manual search. Standardized mean difference (SMD), risk ratio (RR), and their 95% confidence intervals (CIs) were calculated and analyzed. A total of 29 studies with 15,255 participants were analyzed. EEC showed better effectiveness with the pooled RR for response of 1.30 (95%CI: 1.13-1.50, I2 = 81.9%, P < 0.001, 18 studies), remission of 1.35 (95%CI: 1.11-1.64, I2 = 85.5%, P < 0.001, 18 studies) and symptom reduction with a pooled SMD of -0.42 (95%CI: -0.61-(-0.23), I2 = 94.3%, P < 0.001, 19 studies). All-cause discontinuations were similar between EEC and usual care with the pooled RR of 1.08 (95%CI: 0.94-1.23, I2 = 68.0%, P = 0.303, 27 studies). This meta-analysis supported EEC as an evidence-based framework to improve the treatment outcome of depressive disorders.Review registration: PROSPERO: CRD42020163668.


Asunto(s)
Trastorno Depresivo , Trastorno Depresivo/terapia , Medicina Basada en la Evidencia , Humanos , Ensayos Clínicos Controlados Aleatorios como Asunto , Resultado del Tratamiento
14.
Adv Physiol Educ ; 45(4): 849-855, 2021 Dec 01.
Artículo en Inglés | MEDLINE | ID: mdl-34705577

RESUMEN

To evaluate the efficacy of an educational module on evidence-based medicine (EBM) assisted with electronic medical databases (EMDs) for preclinical education, medical students (n = 111) were matriculated in a program consisted of 16 2-h sessions on EBM plus hands-on experience on EMDs in a problem-based learning-type format. Students were required to make an oral presentation on designated clinical scenarios before and after the sessions, without prior notice, as an indicator of performance. In addition, questionnaires focusing on behavioral changes, awareness, and confidence of mastering EBM were administered before and after the sessions to assess the attitudinal and behavioral impact of the intervention on the participants. We found evidence of better postprogram performance in utilizing EBM-relevant concepts and resources when the enrolled medical students were giving oral presentations. Moreover, the participants reported increased awareness of EBM and, behaviorally, increased utilization of EBM-relevant resources provided by libraries. Also, they reported improvement on appropriately using EBM-relevant resources, and 99% of the participants reported strong confidence in practicing EBM. In conclusion, modules on EBM implemented with EMDs benefitted medical students in scenario-oriented PBL tutorials. Improvements in awareness, behavior, confidence, and performance in mastering EBM were noted.


Asunto(s)
Educación de Pregrado en Medicina , Estudiantes de Medicina , Electrónica , Medicina Basada en la Evidencia/educación , Humanos , Aprendizaje Basado en Problemas
15.
FEMS Microbiol Lett ; 368(18)2021 10 09.
Artículo en Inglés | MEDLINE | ID: mdl-34617570

RESUMEN

The Covid-19 pandemic has demanded modifications to undergraduates' learning experiences and promised a more challenging scientific world in which they will live. Bespoke evidence synthesis and critical appraisal skills modules are an opportunity to utilize our information-saturated world to our advantage. This program of study made use of a virtual journal club, structured literature searches, scoping review methods and a variety of online research tools to navigate and critique the literature. The program design is here outlined with sample learning objectives and reference to the resources used.


Asunto(s)
Educación Médica/métodos , Enseñanza , COVID-19/epidemiología , Medicina Basada en la Evidencia , Humanos , Periodismo Médico , SARS-CoV-2 , Pensamiento
18.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 35(10): 1336-1340, 2021 Oct 15.
Artículo en Chino | MEDLINE | ID: mdl-34651490

RESUMEN

Low back pain is a common disease. In 2020, the North American Spine Society (NASS) formulated an evidence-based clinical guideline for the diagnosis and treatment of non-specific low back pain. The guidelines mainly addressed five aspects of non-specific low back pain: diagnosis, imaging examination, conservative treatment, interventional treatment, and surgical treatment. Based on an in-depth understanding of the guidelines, this article gives a brief explanation of the diagnosis and treatment of non-specific low back pain, so as to provide references for clinicians.


Asunto(s)
Dolor de la Región Lumbar , Dolor de Espalda , Medicina Basada en la Evidencia , Humanos , Dolor de la Región Lumbar/diagnóstico , Dolor de la Región Lumbar/terapia , América del Norte , Columna Vertebral
19.
BMC Med Educ ; 21(1): 537, 2021 Oct 23.
Artículo en Inglés | MEDLINE | ID: mdl-34688288

RESUMEN

BACKGROUND: Evidence based medicine (EBM) helps clinicians to integrate latest research evidence into their daily clinical practice. There is a need for all healthcare professions to adopt it in order to provide safe and most cost-effective care. Postgraduate doctors are at the frontline of healthcare delivery and all medical institutions should strive to produce practitioners of EBM. Studies have shown that physicians are still struggling to adapt to this paradigm shift in the practice of medicine but very few studies have been done in Sub Saharan Africa. This study explored the self-reported knowledge, attitudes, practices and barriers of evidence-based practice among resident physicians in a tertiary teaching hospital. METHODS: A mixed methods cross-sectional study that used convergent parallel design was conducted. The quantitative arm was conducted among all residents enrolled in the Master of Medicine programme at Aga Khan University Hospital Nairobi (AKUHN). It included an online survey exploring self-reported knowledge, attitudes, practices and barriers of EBM among all residents. Simultaneously, semi-structured In-Depth Interviews were carried out among 18 purposefully selected residents in order to explore the same themes in more depth. RESULTS: One hundred and one residents (99%) responded to the survey. The mean scores for self-reported knowledge, attitude and practice of EBM among residents were 73.88, 66.96 and 63.19% respectively, which were generally higher than in comparable studies. There was a significant association between year of residency and practice of EBM. The most common barriers faced by residents were lack of time, lack of EBM skills and patients' unawareness about EBM. From the qualitative study, residents demonstrated good knowledge and support of EBM but practice remained relatively poor. Barriers to EBM were characterized by lack of motivation, time, skills and resources, patient overload and fear of challenging consultants. CONCLUSION: There was good understanding and support of EBM among residents at AKUHN, though challenges were experienced in regards to practice of EBM because of lack of time and skills. Therefore resources should be allocated towards integrating EBM into undergraduate medical curricula to cultivate critical thinking skills at an early stage before transition into residency.


Asunto(s)
Conocimientos, Actitudes y Práctica en Salud , Médicos , Actitud del Personal de Salud , Estudios Transversales , Medicina Basada en la Evidencia , Humanos , Kenia , Autoinforme , Encuestas y Cuestionarios
20.
Artículo en Español | PAHO-IRIS | ID: phr-55077

RESUMEN

[RESUMEN]. Introducción. La Organización Mundial de la Salud declaró en el 2020 la pandemia de la enfermedad por el coronavirus 2019 (COVID-19, por su sigla en inglés), causada por el coronavirus de tipo del síndrome respiratorio agudo grave (SARS-CoV-2, por su sigla en inglés) y que se ha extendido alrededor del mundo. Aproximadamente 5% de los pacientes infectados son críticos y requieren admisión a la unidad de cuidado intensivo (UCI). En estos pacientes, la COVID-19 puede estar complicada con un síndrome de dificultad respiratoria aguda, choque séptico y falla multiorgánica, que incluye la falla renal y cardíaca. Objetivo. Sintetizar las recomendaciones incluidas en la Guía para el cuidado de pacientes adultos críticos con COVID-19 en las Américas, versión 3 publicada por la Organización Panamericana de la Salud en 2021, con el fin de orientar el manejo de pacientes adultos críticos con COVID-19 atendidos en la UCI y abordar aspectos clave de su implementación. Métodos. Se llevó a cabo una síntesis de la guía y sus recomendaciones. Además, se realizó una búsqueda sistemática en Pubmed, Lilacs, Health Systems Evidence, Epistemonikos y literatura gris de estudios desarrollados en la Región de las Américas con el fin de identificar barreras, facilitadores y estrategias de implementación. Resultados. Se presentan 43 recomendaciones que abordan la identificación de marcadores y factores de riesgo de mortalidad, prevención y control de infecciones, recolección de muestras, cuidado de soporte (ventilatorio y hemodinámico), tratamiento farmacológico, rehabilitación temprana, uso de estudios por imágenes, prevención de complicaciones y criterios de egreso de los pacientes críticos con COVID-19. Conclusiones. Las recomendaciones buscan proveer el conocimiento sobre el manejo de pacientes críticos con COVID-19 y ofrecer consideraciones para su implementación en la Región.


[ABSTRACT]. Introduction. In 2020, the World Health Organization declared the coronavirus disease 2019 (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which has spread around the world. Approximately 5% of infected patients are critical cases that require admission to the intensive care unit (ICU). In these patients, COVID-19 can be complicated by acute respiratory distress syndrome, septic shock, and multi-organ failure, including kidney and heart failure. Objective. Summarize the recommendations included in the Guidelines for Care of Critically Ill Adult Patients with COVID-19 in the Americas, version 3, published by the Pan American Health Organization in 2021 to guide the management of critically ill adult patients with COVID-19 treated in the ICU, and address key aspects of implementation of the recommendations. Methodology. The guidelines and their recommendations were summarized. In addition, a systematic search was carried out in Pubmed, Lilacs, Health Systems Evidence, Epistemonikos, and gray literature on stu-dies carried out in the Region of the Americas, in order to identify barriers, facilitators, and implementation strategies. Results. Forty-three recommendations are presented that address the identification of markers and risk factors for mortality, infection prevention and control, specimen collection, supportive care (ventilatory and hemodynamic), pharmacological treatment, early rehabilitation, use of imaging studies, prevention of complications, and discharge criteria for critical patients with COVID-19. Conclusions. The recommendations seek to provide knowledge on the management of critical patients with COVID-19 and offer considerations for implementation of the recommendations in the Region.


[RESUMO]. Introdução. A Organização Mundial da Saúde declarou em 2020 a pandemia de COVID-19 (sigla em inglês), causada pelo coronavírus do tipo da Síndrome Respiratória Aguda Grave (SARS-COV-2, o vírus na sigla em inglês) e que tem se espalhado por todo o mundo. Aproximadamente 5% dos pacientes infectados ficam em estado crítico e precisam de cuidados em unidade de terapia intensiva (UTI). Nesses pacientes, a COVID-19 pode piorar em decorrência da síndrome do desconforto respiratório agudo, choque séptico e insuficiência de múltiplos órgãos, que inclui a falência renal e a insuficiência cardíaca. Objetivo. Sintetizar as recomendações do Guia para o cuidado de pacientes adultos em estado crítico com COVID-19 nas Américas, versão 3, publicado pela Organização Pan-Americana da Saúde em 2021, a fim de orientar o manejo de pacientes adultos em estado crítico com COVID-19 atendidos em UTI e abordar aspectos importantes na sua implementação. Métodos. Foi realizada uma síntese do guia e de suas recomendações. Além disso, foi feita uma busca sistemática nas bases Pubmed, Lilacs, Health Systems Evidence e Epistemonikos e na literatura cinzenta de estudos conduzidos na Região das Américas para identificar barreiras, facilitadores e estratégias de implementação.Resultados. São apresentadas 43 recomendações que abordam a identificação de marcadores e fatores de risco de mortalidade, prevenção e controle de infecções, coleta de amostras, cuidados de suporte (ventilatório e hemodinâmico), tratamento farmacológico, reabilitação prematura, uso de estudos por imagens, prevenção de complicações e critérios para a alta de pacientes em estado crítico com COVID-19. Conclusões. As recomendações buscam disponibilizar conhecimento sobre o manejo de pacientes em estado crítico com COVID-19 e oferecer considerações para sua implementação na Região.


Asunto(s)
COVID-19 , Coronavirus , Medicina Basada en la Evidencia , Infecciones del Sistema Respiratorio , Unidades de Cuidados Intensivos , Terapéutica , Américas , Medicina Basada en la Evidencia , Infecciones del Sistema Respiratorio , Unidades de Cuidados Intensivos , Terapéutica , Américas , Medicina Basada en la Evidencia , Infecciones del Sistema Respiratorio , Unidades de Cuidados Intensivos , Terapéutica , Américas
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