The Need for Level 1 Clinical Evidence in Daily Practice

2019 ◽  
pp. 119-131
Author(s):  
Athina Koutouleas ◽  
Mansoor Raza Mirza
Keyword(s):  
Clinical Evidence ◽  
Daily Practice ◽  
Level 1

scholarly journals Communication techniques for improved acceptance and adherence with therapeutic footwear

2016 ◽  
Vol 41 (2) ◽  
pp. 201-204 ◽  
Author(s):  
Jaap J van Netten ◽  
Anthony Francis ◽  
Ashley Morphet ◽  
Lauren V Fortington ◽  
Klaas Postema ◽  
...  
Keyword(s):  
Communication Skills ◽  
Clinical Evidence ◽  
Daily Practice ◽  
Assistive Technologies ◽  
Shared Decision ◽  
Clinical Note ◽  
Communication Techniques ◽  
Therapeutic Footwear ◽  
Conscious Decision ◽  
To Receive

Background and aim: Clients’ acceptance and adherence with orthoses can be influenced by a clinician’s communication skills. In this clinical note, we describe two communication techniques, in the context of therapeutic footwear. Technique: Person-centred communication involves engaging with and listening to the attitudes of the client towards their condition, as well as discussing acceptance and expectations, in a structured consultation. Building a relationship is crucial and requires clients to feel heard and understood. An important influence on the acceptance and adherence is that a client makes a conscious decision to receive their device. This active receipt can be facilitated through shared decision making, wherein clinicians give clear, relevant and meaningful examples, based on clinical evidence, and ensure this is understood. Discussion: Two communication techniques for clinicians providing therapeutic footwear are described. These can be adapted for use with provision of other assistive technologies to improve client acceptance and adherence. Clinical relevance Small changes in how clinicians communicate to their clients in daily practice can have a big influence on the subsequent acceptance and adherence with therapeutic footwear and indeed other prescribed assistive technologies.

scholarly journals Extension Trial of Qigong for Fibromyalgia: A Quantitative and Qualitative Study

2013 ◽  
Vol 2013 ◽  
pp. 1-12 ◽  
Author(s):  
Jana Sawynok ◽  
Mary Lynch ◽  
Dana Marcon
Keyword(s):  
Controlled Trial ◽  
Daily Practice ◽  
Trial Duration ◽  
Open Label ◽  
Health Gains ◽  
Level 1 ◽  
Practice Time ◽  
Level 2 ◽  
Extension Trial ◽  
Significant Health

This extension trial is an open-label observational trial of 20 subjects with fibromyalgia who undertook level 2 Chaoyi Fanhuan Qigong (CFQ) training following an earlier controlled trial of level 1 CFQ. Subjects practiced 60 min/day for 8 weeks and continued some daily practice for 6 months. Quantitative measures, assessed at baseline, 8 weeks, 4 and 6 months, were of pain, impact, sleep, physical and mental functions, and practice time. Qualitative comments also were recorded. Compared to baselines, CFQ practice led to significant improvements in pain, impact, sleep, and physical function in the 13 subjects (65%) who completed the trial; changes were present at 8 weeks and were maintained for the 6-month trial duration. A highly motivated subgroup ofN=5, who practiced the most, had the best outcomes in terms of end symptomology, and qualitative comments indicated health benefits in other domains as well. Qualitative comments by the remainingN=8trial completers andN=7withdrawals indicate different experiences with the practice. This extension trial indicates that diligent CFQ practice over time produces significant health gains in fibromyalgia in a subset of individuals. Future studies will need to address factors that might predispose to favourable outcomes.

scholarly journals Clinical Experience of Dabigatran and Rivaroxaban in Electrical Cardioversion of Atrial Fibrillation

2015 ◽  
Vol 4 ◽  
pp. 71 ◽  
Author(s):  
Charlène Coquard ◽  
Ghassan Moubarak ◽  
Mathilde Baudet ◽  
Damien Logeart ◽  
Jean-Guillaume Dillinger ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Trials ◽  
Gastrointestinal Bleeding ◽  
Clinical Experience ◽  
Clinical Evidence ◽  
Oral Anticoagulants ◽  
Transoesophageal Echocardiography ◽  
Daily Practice ◽  
Electrical Cardioversion ◽  
Efficacy And Safety

<p>Patients scheduled for atrial fibrillation (AF) cardioversion were excluded from clinical trials of novel oral anticoagulants (NOACs).</p><p>We evaluated efficacy and safety of NOACs in patients undergoing electrical cardioversion for AF.</p><p>We performed a monocentric study of all patients on NOACs who underwent elective electrical cardioversion for non-valvular AF between January 2012 and December 2014. We analyzed incidence of stroke and bleeding  at 30 days.</p><p>Fifty patients were included, 28 receiving dabigatran, 22 rivaroxaban. Mean age was 65 ± 12 years. Mean CHADS2-VA2SC and HASBLED scores were 3 ± 1.8 and 2.2 ± 1.1 respectively. Transoesophageal echocardiography was performed in 41 (79%) patients, revealing a thrombus in 2 (5%). No clinical evidence of stroke occurred in the 30 days, 1 major gastrointestinal bleeding (2%) in patient on rivaroxaban (led to premature discontinuation) and 3 minor bleedings.</p><p>NOACs seem to be safe in daily practice of electrical cardioversion in our population.</p>

Comprehensive analysis of advanced-stage solid tumors from TCGA reveal widespread variation of genomics evidence levels across cancer types.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e13547-e13547
Author(s):  
Dilhan Weeraratne ◽  
Elisa Napolitano Ferreira ◽  
Miguel Mitne Neto ◽  
Hu Huang ◽  
David Brotman ◽  
...  
Keyword(s):  
Clinical Evidence ◽  
The Cancer Genome Atlas ◽  
Braf V600e ◽  
Precision Oncology ◽  
Cancer Type ◽  
Tumor Type ◽  
Advanced Stage ◽  
Level Of Evidence ◽  
Cancer Types ◽  
Level 1

e13547 Background: Improved scalability and affordability of next generation sequencing (NGS) has pivoted cancer care toward genomics-driven treatment decisions. Particularly in advanced-stage or refractory cancer, clinical insights gleaned from NGS have become an integral option as these patients have typically exhausted all lines of available therapy. As precision oncology evolves, NGS is expected to have a differential impact based on the cancer type. In this study, a comprehensive NGS panel was used to determine the strength of clinical evidence in various advanced stage tumor samples from The Cancer Genome Atlas (TCGA). Methods: A hybrid capture panel, Oncofoco, was developed to evaluate SNVs, INDELs, CNVs and TMB in 366 genes. The panel’s utility was validated by interrogating a broader cohort of 2847 TCGA samples (advanced tumors with T3 or T4; or N > = 1; or M > = 1). Watsonä for Genomics, an artificial intelligence offering, was used for variant interpretation and annotation of the 366 genes. A clinical evidence classification system that evaluated the strength of biomarker/drug response associations was used for annotation with level 1/R1 strongest and level 4 weakest from clinical literature, FDA drug labels and guidelines (PMID:28890946). Results: The highest level of evidence for the top nine frequently occurring advanced stage cancers in TCGA is shown in Table. Conclusions: Thyroid cancer and cutaneous melanoma have emerged as the cancer types with the most level 1 evidence (FDA approved drugs) owing to BRAF V600E mutations. Kidney and prostate cancers show no cases with level 1 evidence and also had the largest fraction of unactionable tumors. Over half of colorectal cancer cases had level R1 resistance evidence attributed to KRAS and NRAS mutations. The clinical utility of NGS in late-stage refractory cancer varies widely by tumor type. The presence of level 3 and level 4 evidence in all cancer types bodes well for the development of new targeted drugs. [Table: see text]

Optimal Treatment of Retinal Vein Occlusion: Canadian Expert Consensus

2015 ◽  
Vol 234 (1) ◽  
pp. 6-25 ◽  
Author(s):  
Alan R. Berger ◽  
Alan F. Cruess ◽  
Filiberto Altomare ◽  
Varun Chaudhary ◽  
Kevin Colleaux ◽  
...  
Keyword(s):  
Retinal Vein Occlusion ◽  
Clinical Evidence ◽  
Randomized Clinical Trials ◽  
Vitreous Hemorrhage ◽  
Daily Practice ◽  
Optimal Treatment ◽  
Expert Consensus ◽  
Inadequate Response ◽  
Vein Occlusion ◽  
Anti Vegf

Background: The availability of new therapeutic approaches, particularly intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapies, has prompted significant changes to the established treatment paradigms for retinal vein occlusion (RVO). Better visual outcomes and significantly lower rates of adverse events have been noted in multiple large randomized clinical trials and have led to a new standard of care for this sight-threatening condition. Objective: To develop an expert consensus for the management of RVO and associated complications in the context of recent clinical evidence. Methods: The development of a Canadian expert consensus for optimal treatment began with a review of clinical evidence, daily practice, and existing treatment guidelines and algorithms. The expert clinicians (11 Canadian retina specialists) met on February 1, 2014, in Toronto to discuss their findings and to propose strategies for consensus. Results: The result of this expert panel is a consensus proposal for Canadian ophthalmologists and retina specialists treating patients presenting with RVO. Treatment algorithms specific to branch and central RVO (BRVO and CRVO) were also developed. Conclusions: The consensus provides guidelines to aid clinicians in managing RVO and associated complications in their daily practice. In summary, laser remains the therapy of choice when neovascularization secondary to RVO is detected. Adjunctive anti-VEGF could be considered in managing neovascularization secondary to RVO in cases of vitreous hemorrhage. Intravitreal anti-VEGF should be considered for symptomatic visual loss associated with center-involving macular edema on optical coherence tomography. Patients with BRVO and a suboptimal response to anti-VEGF could be treated with grid laser, and those with CRVO and an inadequate response to anti-VEGF may be candidates for intravitreal steroids.

EVIDENCE-BASED PRACTICE IN SPLINTING THE INJURED HAND

Hand Surgery ◽  
2002 ◽  
Vol 07 (02) ◽  
pp. 215-218 ◽  
Author(s):  
Cecilia W. P. Li-Tsang ◽  
Mary M. L. Chu
Keyword(s):  
Exponential Growth ◽  
Evidence Based Medicine ◽  
Clinical Evidence ◽  
Evidence Based Practice ◽  
Treatment Effectiveness ◽  
Daily Practice ◽  
Evidence Based ◽  
Asian Countries ◽  
Based Medicine ◽  
New Evidence

Evidence-based medicine has been practised in the early 1990s in the Western countries and its model has aroused interests in the Asian countries including Hong Kong in the late 1990s. The need for evidence-based practice was called upon by Sackett and his colleagues14–16 mainly because of the exponential growth of new evidence of treatment effectiveness. There is a great demand for clinicians to search for the best evidence and to incorporate into the daily practice so as to ensure the best quality and standard of treatment. This paper is to review the development and process of evidence-based practice in the area of hand splinting for our local clinicians. Some major problems were identified in the delivery of clinical evidence-based practice, and suggestions have been made to overcome these problems with a view in supporting its model in the local clinical field.

Ultrastructural Study of Human Testicular Biopsies in Infertility

1976 ◽  
Vol 34 ◽  
pp. 156-157
Author(s):  
Shirley Siew ◽  
Philip Troen ◽  
Howard R. Nankin
Keyword(s):  
Electron Microscopy ◽  
Transmission Electron Microscopy ◽  
Basement Membrane ◽  
Leydig Cells ◽  
Clinical Evidence ◽  
Young Male ◽  
Germinal Epithelium ◽  
Transmission Electron ◽  
Age Range ◽  
Male Subjects

Testicular biopsies were obtained from six young male subjects (age range 24-33) who complained of infertility and who had clinical evidence of oligospermia. This was confirmed on histological examination which showed a broad spectrum from profound hypospermatogenesis to relatively normal appearing germinal epithelium. Thickening of the tubular walls was noted in half of the cases and slight peritubular fibrosis in one. The Leydig cells were reported as normal or unremarkable.Transmission electron microscopy showed that the thickening of the supporting tissue of the germinal epithelium was caused more by an increase in the thickness of the layers of the lamina propria than of the tubular wall itself. The changes in the basement membrane of the tubular wall consisted mostly of a greater degree of infolding into the tubule and some reduplication which gave rise to a multilayered appearance.

Ultrastructural study on the development of rat amygdaloid body

1990 ◽  
Vol 48 (3) ◽  
pp. 432-433
Author(s):  
A. Manolova ◽  
S. Manolov
Keyword(s):  
Nerve Cells ◽  
Amygdaloid Complex ◽  
Amygdaloid Body ◽  
Thin Ring ◽  
Morphological Criteria ◽  
Neural Processes ◽  
Abundant Cytoplasm ◽  
Level 1 ◽  
Few Data ◽  
Oval Shape

Relatively few data on the development of the amygdaloid complex are available only at the light microscopic level (1-3). The existence of just general morphological criteria requires the performance of other investigations in particular ultrastructural in order to obtain new and more detailed information about the changes in the amygdaloid complex during development.The prenatal and postnatal development of rat amygdaloid complex beginning from the 12th embrionic day (ED) till the 33rd postnatal day (PD) has been studied. During the early stages of neurogenesis (12ED), the nerve cells were observed to be closely packed, small-sized, with oval shape. A thin ring of cytoplasm surrounded their large nuclei, their nucleoli being very active with various size and form (Fig.1). Some cells possessed more abundant cytoplasm. The perikarya were extremely rich in free ribosomes. Single sacs of the rough endoplasmic reticulum and mitochondria were observed among them. The mitochondria were with light matrix and possessed few cristae. Neural processes were viewed to sprout from some nerve cells (Fig.2). Later the nuclei were still comparatively large and with various shape.

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