A Review of Scientific Evidence for Public Perspectives on Online Rating Websites of Healthcare Providers

The history of pacing for bradycardia started more than 50 years ago and in these five decades the technologically driven evolution of devices and tools has been complemented by the acquisition of important scientific evidence of benefit in specific patient settings. The current prevalence of bradyarrhythmias requiring permanent cardiac pacing therapy is not precisely known, but the progressive ageing of the population makes it necessary to improve knowledge of the impact of bradycardia on patients’ health, as well as to improve the implementation in daily practice of the most appropriate and evidence-based device treatments, with an adequate reorganization of care. Moreover, the impressive technological evolution that occurred in this field, as a result of extensive cooperation between physicians, scientists, engineers, manufacturers, regulatory agencies, and healthcare providers, led to the appearance of new requirements such as improved clinical skills, the need for continuous education on rapidly evolving technology, the assessment of treatment costs, the need for consensus guidelines, and the need for reorganization of care delivery including telemedicine for device follow-up.

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Maternal, fetal, and neonatal pharmacokinetics

10.1093/med/9780198713333.003.0005 ◽

2016 ◽

Author(s):

Karel Allegaert ◽

Kristel Van Calsteren

Keyword(s):

Medical Treatment ◽

Pregnant Women ◽

Postpartum Period ◽

Drug Transport ◽

Scientific Evidence ◽

Healthcare Providers ◽

Off Label ◽

Dosing Regimens ◽

Peripartum Period ◽

Instructions For Use

Most drugs are not thoroughly evaluated for use during pregnancy, delivery, or postpartum (e.g. breastfeeding). The same holds true for early infancy, and results in extensive off-label, unlicensed pharmacotherapy in these specific subpopulations. At present, most drug labels do not contain any instructions for use during pregnancy, in infancy, or during breastfeeding, yet these are the main concerns of healthcare providers considering medical treatment. Anaesthetists commonly treat pregnant women with similar dosing regimens recommended for use in adults and subsequently titrate to effect. The (dis)continuation of breastfeeding in the postpartum period following anaesthesia is commonly based on opinions instead of scientific evidence. This chapter describes the alterations in pharmacokinetics (absorption, distribution, metabolism, elimination) in pregnant women with specific emphasis on placental drug transport, and in neonates, with additional emphasis on breastfeeding. Drugs commonly administered by anaesthetists to women in the peripartum period are discussed with particular reference to the changed pharmacodynamics in both mother and infant.

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Irritable Bowel Syndrome Subtypes: New Names for Old Medical Conditions

Digestive Diseases ◽

10.1159/000505287 ◽

2019 ◽

Vol 38 (Suppl. 2) ◽

pp. 122-127 ◽

Cited By ~ 3

Author(s):

Simona Grad ◽

Dan L. Dumitrascu

Keyword(s):

Irritable Bowel Syndrome ◽

Scientific Evidence ◽

Healthcare Providers ◽

Gastrointestinal Disorder ◽

Rome Criteria ◽

Conceptual Changes ◽

Diagnosis And Classification ◽

Criteria For Diagnosis ◽

Irritable Bowel

The irritable bowel syndrome (IBS) is the most common functional gastrointestinal disorder (FGID), also called disorders of the gut-brain interaction (DGBI). Over the years, the definition and classification of IBS suffered several conceptual changes. The work of the Rome Committees has largely contributed to the progress in knowledge and awareness of IBS. This paper is an overview of the evolution of diagnosis and classification criteria of IBS. Background: The majority of the complaints causing presentation to the general gastroenterological centers are represented by FGID. IBS is the most frequent among them. IBS is not a uniform condition but includes an array of particular forms called subtypes. Criteria for the identification of the IBS subtypes have suffered several changes in parallel with the accumulation of scientific evidence about this disorder. Classification of IBS subtypes relies on symptoms. Summary: This is a review of the evolution of the criteria for diagnosis and classification of IBS subtypes. Starting with older names given to IBS, some changes in definition and diagnosis have been operated by each edition of the Rome criteria. These changes have led to the better identification of patients with IBS. The management of IBS depends on subtypes and should be individualized. Key Messages: IBS is the main FGID, called also DGBI. It is not a homogenous disorder but a generic name for an array of subtypes with common features but with clinical differences. The diagnosis and classification of IBS subtypes have evolved in time, in accordance with the progress of the knowledge on pathogenesis. It is important for healthcare providers to recognize the subtypes and to use a common nomenclature (that offered by the Rome Committees work).

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Health Food Stores' Recommendations for Nausea and Migraines During Pregnancy

Annals of Pharmacotherapy ◽

10.1345/aph.1e433 ◽

2005 ◽

Vol 39 (2) ◽

pp. 274-279 ◽

Cited By ~ 14

Author(s):

Kaitlin D Buckner ◽

Mary L Chavez ◽

Erin C Raney ◽

James D Stoehr

Keyword(s):

Dietary Supplements ◽

Scientific Evidence ◽

Healthcare Providers ◽

Health Food ◽

Food Stores ◽

Health Food Store ◽

Phone Calls ◽

Correct Usage ◽

Phoenix Metropolitan Area ◽

In Pregnancy

BACKGROUND: Many pregnant women use dietary supplements during pregnancy; however, relatively scant information is available on the safety of these products. Consumers of dietary supplements often rely on employees of health food stores to provide recommendations. OBJECTIVE: To evaluate recommendations made by health food store employees in the Phoenix metropolitan area regarding treatment of nausea/vomiting and migraines during pregnancy. METHODS: Phone calls were made by a disguised shopper to 155 health food stores in the greater Phoenix area. The caller posed as a woman 8 weeks' pregnant asking for recommendations for treatment of nausea/vomiting and migraines. Responses and recommendations were recorded and then compared with current scientific evidence obtained during a search of the literature using MEDLINE (1966–September 2004) as to whether or not the supplements and the methods of their use during pregnancy were contraindicated. RESULTS: Eighty-nine percent of stores offered recommendations for nausea/vomiting, and 82% provided recommendations for migraines. The use of ginger was the most recommended therapy for nausea/vomiting. Only 3.6% of respondents recommended correct usage, but failed to supply the correct dosage and duration. A total of 15 of 278 (5%) recommendations, for both nausea/vomiting and migraines, were for products contraindicated in pregnancy. CONCLUSIONS: In light of the increased use of dietary supplements by women during pregnancy, the willingness of personnel in health food stores to make any recommendations should foster concerns by patients and healthcare providers alike. Use of dietary supplements contraindicated in pregnancy could cause significant harm to the mother and/or fetus. Studies are needed to address the need for more stringent guidelines regarding health food stores and their recommendations.

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The difficult crossroads of decisions at COVID-19: how can the deontology implicit in Evidence-Based Medicine help us to understand the different attitudes of doctors at this time?

Revista do Colégio Brasileiro de Cirurgiões ◽

10.1590/0100-6991e-20202705 ◽

2020 ◽

Vol 47 ◽

Author(s):

MIGUEL PRESTES NACUL ◽

MARCO ANTÔNIO AZEVEDO

Keyword(s):

Evidence Based Medicine ◽

Scientific Evidence ◽

Healthcare Providers ◽

Well Being ◽

Medical Decision ◽

Evidence Based ◽

Conservation Of Resources ◽

Health Measures ◽

The Many ◽

Based Medicine

ABSTRACT One of the struggles faced by physicians in clinical decisions during the COVID-19 pandemic is how to deal with already available or lacking scientific evidence. The COVID-19 pandemic has a large impact in the routine of the many health services, including surgery, which demanded changes in assist protocols. Questions began to arise about well-established surgery conducts due to situations related to SARS-COV-2 infection, and, according to public health measures that are necessary to fight the pandemic. In situations of scarce available evidence, it is natural for us to have to deal with systematically more fragile, provisory and bias-susceptible information. Considering the principles that guide Evidence Based Medicine and Bioethical, the authors analyze the complexity of the medical decision-making during this time. Medical conducts must be adapted to the context of fighting the pandemic and consider patients and healthcare providers exposure and well-being and, lastly, the conservation of resources. The authors conclude that acceptance and tolerance to divergence is commendable, being a path to achieving unity in the diversity of medicine in times of little safe knowledge.

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Barriers to the Management of Patients with Surgically Remediable Intractable Epilepsy

CNS Spectrums ◽

10.1017/s1092852900008506 ◽

2004 ◽

Vol 9 (2) ◽

pp. 146-152 ◽

Cited By ~ 12

Author(s):

Kari Swarztrauber

Keyword(s):

Surgical Treatment ◽

Vulnerable Populations ◽

Small Proportion ◽

Scientific Evidence ◽

Healthcare Providers ◽

Intractable Epilepsy ◽

Minority Populations ◽

Recommended Care ◽

Patients With Epilepsy ◽

Specific Barriers

AbstractIt is estimated that only a small proportion of patients with surgically remediable intractable epilepsy receive surgical treatment. There are multiple reasons why this is the case. Patients with intractable epilepsy are sometimes severely disabled and disability can create barriers to getting recommended care. Patients with epilepsy are not well informed about their condition and the available treatments. The incidence of epilepsy is similar in minority populations, and surgically remediable epilepsy frequently presents in adolescence. Nevertheless, these vulnerable populations have specific barriers to receiving epilepsy care, which are often not addressed. In addition, despite scientific evidence for the benefits of the surgical treatment of epilepsy, many healthcare providers do not recommend or adequately discuss surgery with patients. Solutions to these barriers will require interventions that result in informed and capable patients who actively participate in their care and healthcare providers who practice culturally sensitive, recommended care.

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Ensuring Consistent European-Wide Urological Care by the Use of Evidence-Based Clinical Practice Guidelines: Can We Do Better

Biomedicine Hub ◽

10.1159/000479725 ◽

2017 ◽

Vol 2 (Suppl. 1) ◽

pp. 1-7

Author(s):

Emma Jane Smith ◽

Steven MacLennan ◽

Anders Bjartell ◽

Alberto Briganti ◽

Thomas Knoll ◽

...

Keyword(s):

Clinical Practice ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Best Practice ◽

Scientific Evidence ◽

Healthcare Providers ◽

Evidence Base ◽

Evidence Based ◽

Robust Methods ◽

Practice Recommendations

The European Association of Urology (EAU) annually updates 21 clinical practice guidelines in which summaries of the evidence base and best practice recommendations are made. The methodology applied to achieve this and integrate stakeholder opinion is continuously improving. However, there is evidence to suggest wide variation in clinical practice indicating that many patients receive suboptimal and heterogeneous care. Studies from certain countries suggest that 2 out of 5 patients do not receive care according to the current scientific evidence, and in 1 out of 4 cases the care provided is potentially harmful. Clearly, the harmonisation of care in alignment with evidence-based best practice recommendations is something to strive for. Development of robust methods to disseminate and implement guideline recommendations and measure their impact is an objective the EAU is committed to improving. An important strategy for achieving harmonisation in urological care across Europe is to ensure the availability of high-quality clinical practice guidelines and to actively promote their implementation by clinicians and healthcare providers.

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The Physiological and Biochemical Outcomes Associated with a Reflexology Treatment: A Systematic Review

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2014/502123 ◽

2014 ◽

Vol 2014 ◽

pp. 1-16 ◽

Cited By ~ 14

Author(s):

J. E. M. McCullough ◽

S. D. Liddle ◽

M. Sinclair ◽

C. Close ◽

C. M. Hughes

Keyword(s):

Scientific Evidence ◽

Healthcare Providers ◽

Current Evidence ◽

Controlled Trials ◽

Cochrane Central Register ◽

Diverse Range ◽

Assessment Development ◽

Review Team ◽

Randomised Controlled ◽

The Uk

Background. Reflexology is one of the top forms of complementary and alternative medicine in the UK and is used for healthcare by a diverse range of people. However, it is offered by few healthcare providers as little scientific evidence is available explaining how it works or any health benefits it may confer. The aim of this review was to assess the current evidence available from reflexology randomised controlled trials (RCTs) that have investigated changes in physiological or biochemical outcomes.Methods. Guidelines from the Cochrane Handbook of Systematic Reviews of Interventions were followed: the following databases were searched from inception to December 2013: AMED, CAM Quest, CINAHL Plus, Cochrane Central Register of Controlled Trials, Embase, Medline Ovid, Proquest, and Pubmed. Risk of bias was assessed independently by two members of the review team and overall strength of the evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation guidelines.Results. Seventeen eligible RCTs met all inclusion criteria. A total of 34 objective outcome measures were analysed. Although twelve studies showed significant changes within the reflexology group, only three studies investigating blood pressure, cardiac index, and salivary amylase resulted in significant between group changes in favour of reflexology. The overall quality of the studies was low.

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Exercise Training for Multiple Sclerosis: A Narrative Review of History, Benefits, Safety, Guidelines, and Promotion

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph182413245 ◽

2021 ◽

Vol 18 (24) ◽

pp. 13245

Author(s):

Yvonne Charlotte Learmonth ◽

Robert Wayne Motl

Keyword(s):

Multiple Sclerosis ◽

Exercise Training ◽

Disease Progression ◽

Clinical Education ◽

Scientific Evidence ◽

Historical Context ◽

Healthcare Providers ◽

Multidisciplinary Care ◽

Symptomatic Treatment ◽

Barriers To Exercise

Background: There have been significant advances in the medical treatment and management of multiple sclerosis pathogenesis, relapse and disease progression over the past 30 years. There have been advancements in the symptomatic treatment of multiple sclerosis, including management of secondary multiple sclerosis expressions such as walking, cognitive dysfunction, fatigue and depression. Scientific evidence and expert opinion suggest that exercise may be the single most effective non-pharmacological symptomatic treatment for multiple sclerosis. This article presents the historical context of exercise training within the multidisciplinary management of multiple sclerosis. We guide neurologists and healthcare providers on the recommended prescription of exercise and practical, theoretical methods to overcome barriers to exercise. Method: We undertook a critical search of the historical and current literature regarding exercise and multiple sclerosis from the viewpoint of exercise promotion by neurologists and the multidisciplinary care team. Results: We highlight the ever-strengthening body of research indicating that exercise is safe and effective for improving symptoms of multiple sclerosis. Further, exercise training may be necessary for reducing disease progression. Conclusion: We seek to encourage neurologists and specialists in multidisciplinary healthcare teams to prescribe and promote exercise at diagnosis and across all stages of the disease trajectory using prescriptive guidelines as part of comprehensive MS care. Available tools include clinical education to dispel any historical myths related to exercise in multiple sclerosis, clinical exercise guidelines and behaviour change theory to overcome patients barriers to exercise.

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ARTHROSCOPIC SURGERY FOR KNEE OSTEOARTHRITIS: IMPACT OF HEALTH TECHNOLOGY ASSESSMENT IN GERMANY

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462317000861 ◽

2017 ◽

Vol 33 (4) ◽

pp. 420-423 ◽

Cited By ~ 1

Author(s):

Naomi Fujita-Rohwerder ◽

Alric Rüther ◽

Stefan Sauerland

Keyword(s):

Knee Osteoarthritis ◽

Health Technology Assessment ◽

Technology Assessment ◽

Scientific Evidence ◽

Meniscal Tear ◽

Arthroscopic Surgery ◽

Healthcare Providers ◽

Health Technology ◽

Orthopedic Surgeons ◽

Community Information

Objectives: This study aims to describe how a negative reimbursement decision—based on the health technology assessment (HTA) report of a nondrug intervention—affects healthcare providers in Germany.Methods: Knee arthroscopy was chosen as an example, because as of April 2016 this procedure is no longer reimbursed for osteoarthritis, but is still covered for other indications, including meniscal lesions. The exclusion followed an HTA report prepared by the Institute for Quality and Efficiency in Health Care (IQWiG). Here, we examine how the decision to revoke reimbursement for arthroscopy was perceived by the surgical community. Information was collected from official hospital statistics, the internet, and informal interviews with orthopedic surgeons.Results: In 2015, a total of 37,920 arthroscopic procedures were performed for knee osteoarthritis in Germany. Several surgical societies were unhappy with the negative decision, which was issued as a directive in November 2015, and they challenged the decision-making process as well as the underlying scientific evidence. In March 2016, fifteen societies issued joint recommendations on how to differentiate osteoarthritis from other knee diseases and how to document other diseases in a way that inspections by representatives of health insurance funds would not detect any deficiencies. In informal interviews, orthopedic surgeons indicated that miscoding of the principal diagnosis (meniscal tear rather than knee osteoarthritis) is to be expected, especially in the hospital sector.Conclusions: HTA can have a significant impact on the provision of health services, but various loopholes allow physicians to undermine policy decisions. Therefore, it is important to involve all stakeholders in HTA and to convince them of the benefits of evidence-based medicine.

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