Best practice pharmacologic treatment of schizophrenia: Applying principles of evidence-based medicine

2005 ◽  
Vol 3 (2) ◽  
pp. 53-60 ◽  
Author(s):  
Rajiv Tandon ◽  
Naakesh A. Dewan ◽  
Robert J. Constantine ◽  
Jerry Wells
Keyword(s):  
Evidence Based Medicine ◽  
Best Practice ◽  
Evidence Based ◽  
Pharmacologic Treatment ◽  
Based Medicine

scholarly journals Awareness and the use of evidence-based medicine resources among physicians

2019 ◽  
Vol 6 (10) ◽  
pp. 4612-4614
Author(s):  
Amjad Alhelo ◽  
Bashar Samara
Keyword(s):  
Evidence Based Medicine ◽  
Best Practice ◽  
Response Rate ◽  
Cross Sectional Study ◽  
Cochrane Library ◽  
Evidence Based ◽  
Cross Sectional ◽  
Evidenced Based ◽  
The Cochrane Library ◽  
Based Medicine

Aim: to evaluate awareness and the use of evidence-based medicine resources among physicians in Jordan.  Method: A cross-sectional study by internet was performed among 517 doctors who were responsive from a total of 717 doctors, a total of 72.1% response rate. Doctors from all specialties were contacted from a Facebook group called doctors café in Jordan. A questionnaire was given to each one of them to measure their awareness and use of Evidence based database.   Result: From 517 physicians 377 they are using evidenced based resources frequently, and 91 using resources but not frequently and 49 not using evidence-based resources. The resource that was mostly used by the doctors was PubMed, followed by other resources such as Up to date, National Guideline Clearinghouse, Medscape, BMJ best practice, e-books and other online journals for published papers. The Cochrane Library was surprisingly not so familiar amongst physicians. Conclusion: There is good awareness about EBM among physicians in Jordan, and that benefits health care in Jordan.

The Limits of Evidence-Based Medicine and Its Application to Mental Health Evidence-Based Practice: Part One

2013 ◽  
Vol 15 (1) ◽  
pp. 18-34 ◽  
Author(s):  
Tomi Gomory
Keyword(s):  
Mental Health ◽  
Clinical Judgment ◽  
Evidence Based Medicine ◽  
Process Model ◽  
Best Practice ◽  
Political Process ◽  
Community Treatment ◽  
Evidence Based ◽  
Systematic Analysis ◽  
Based Medicine

The present article outlines the major limitations of evidence-based medicine (EBM) and through a close review demonstrates that the three component EBM process model is a pseudoscientific tool. Its “objective” component is the collection, systematic analysis, and listing of “effective” treatments applying a research hierarchy from most rigorous (systematic reviews of randomized controlled trials [RCTs]) to least rigorous (expert opinion). Its two subjective components are the clinical judgment of helping professionals about which “evidence-based” treatment to select and the specific and unique relevant personal preferences of the potential recipients regarding treatment. This procedural mishmash provides no more rigor in choosing “best practice” than has been provided by good clinical practitioners in the past because both turn out to be subjective and authority based. The article also discusses EBM’s further methodological dilution in the National Institute of Mental Health (NIMH) endorsed Evidence-Based Mental Health Practice (EBP) movement. In EBP, the allegedly rigorous EBM protocol is altered. Instead of systematic expert protocol-driven EBM reviews of RCTs, NIMH sanctioned expert consensus panels decide “evidence-based practices.” This further problematizes the development of best practices in mental health by converting it to a political process. The article concludes with some observations on these issues. In a second article (part two) forthcoming, assertive community treatment (ACT) is examined as an example of an EBP that fails as a scientifically effective treatment despite its EBP certification and general popularity among practitioners.

Evidence-based Medicine - A Critical Review

2017 ◽  
Vol 41 (S1) ◽  
pp. S16-S16
Author(s):  
W. Gaebe
Keyword(s):  
Mental Disorders ◽  
Evidence Based Medicine ◽  
Best Practice ◽  
Mental Healthcare ◽  
Evidence Based ◽  
Deutschland Gmbh ◽  
Therapeutic Procedures ◽  
Personal Accounts ◽  
Based Medicine ◽  
Social Support Systems

Evidence-based medicine is a method to establish best practice recommendations based on graded recommendations for diagnostic and therapeutic issues in health care. In mental healthcare, evidence-based medicine has shown that the therapeutic procedures are efficient and can help to not only ameliorate the symptoms of mental disorders, but also to improve the quality of life of those affected by mental disorders. Evidence-based medicine is not, however, cookbook medicine. While evidence is mostly generated in larger group trials and should be applicable to the majority of cases, aspects of the personal situation, social support systems and legal boundaries all affect mental healthcare and may modulate the interpretation of the findings of evidence-based medicine. A human-based psychiatry will therefore need to use the methods of evidence-based medicine as a basis for diagnostic and therapeutic recommendations, but will also need to extend into the acknowledgements of personal accounts, traditions and the cultural framework, in which mental healthcare is provided. This presentation will highlight some of the issues associated with the questions of the roles of evidence-based medicine in mental healthcare, and in a human-based approach towards mental healthcare.Disclosure of interestUnterstützung bei Symposien/Symposia Support.Janssen-Cilag GmbH, Neuss.Aristo Pharma GmbH, Berlin.Lilly Deutschland GmbH, Bad Homburg.Servier Deutschland GmbH, München.Fakultätsmitglied/Faculty Member.Lundbeck International Neuroscience Foundation (LINF), Dänemark.

scholarly journals Use of Evidence in Acute Stroke Decision-Making: Implications for Evidence-Based Medicine

2021 ◽  
Author(s):  
Timothe Langlois-Therien ◽  
Brian Dewar ◽  
Ross Upshur ◽  
Michel Shamy
Keyword(s):  
Decision Making ◽  
Evidence Based Medicine ◽  
Best Practice ◽  
Medical Decision Making ◽  
Medical Decision ◽  
Evidence Based ◽  
Physician Decision Making ◽  
Prescriptive Model ◽  
Based Medicine

Evidence-Based Medicine proposes a prescriptive model of physician decision-making in which “best evidence” is used to guide best practice. And yet, proponents of EBM acknowledge that EBM fails to offer a systematic theory of physician decision-making. In this paper, we explore how physicians from the neurology and emergency medicine communities have responded to an evolving body of evidence surrounding the acute treatment of patients with ischemic stroke. Through analysis of this case study, we argue that EBM’s vision of evidence-based medical decision-making fails to appreciate a process that we have termed epistemic evaluation. Namely, physicians are required to interpret and apply any knowledge — even what EBM would term “best evidence” — in light of their own knowledge, background and experience. This is consequential for EBM as understanding what physicians do and why they do it would appear to be essential to achieving optimal practice in accordance with best evidence.

The Limits of Evidence-Based Medicine and Its Application to Mental Health Evidence-Based Practice (Part Two): Assertive Community Treatment Assertively Reviewed

2013 ◽  
Vol 15 (2) ◽  
pp. 73-86 ◽  
Author(s):  
Tomi Gomory
Keyword(s):  
Mental Health ◽  
Assertive Community Treatment ◽  
Evidence Based Medicine ◽  
Best Practice ◽  
Evidence Based Practice ◽  
Community Treatment ◽  
Evidence Based ◽  
Health Delivery ◽  
Based Medicine ◽  
Over 40 Years

This article is the second of two published in Ethical Psychology and Psychiatry; the first appeared in Volume 15, Number 1. The first article argued the very serious limitations of evidence-based medicine (EBM) and its very popular mental health offshoot evidence-based practice (EBP; Gomory, 2013). This article is meant to be a consolidation and update of a 1999 analysis of Assertive Community Treatment (ACT), the best “validated” mental health EBP according the National Institute of Mental Health (NIMH) and academic researchers. This analysis reconfirms the failure of ACT as a treatment modality and a platform for successfully reducing hospitalization; its touted consistent effect except when ACT can apply administrative coercion to keep its clients out of the hospital or quickly discharge them. When ACT fails to have such administrative coercive control, it does no better than other community mental health delivery systems. The use of ACT coercion begun over 40 years ago, the article further argues, set the table for conventionalizing psychiatric coercion as evidence-based best practice.

EBM: Rationalist Fever Dreams

2018 ◽  
Vol 12 (3) ◽  
pp. 227-230 ◽  
Author(s):  
Devorah Klein ◽  
David Woods ◽  
Gary Klein ◽  
Shawna Perry
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Evidence Based Medicine ◽  
Best Practice ◽  
Decision Makers ◽  
Evidence Based ◽  
Naturalistic Decision Making ◽  
The Face ◽  
Based Medicine

In 2016, we examined the connection between naturalistic decision making and the trend toward best practice compliance; we used evidence-based medicine (EBM) in health care as an exemplar. Paul Falzer’s lead paper in this issue describes the historical underpinnings of how and why EBM came into vogue in health care. Falzer also highlights the epistemological rationale for EBM. Falzer’s article, like our own, questions the rationale of EBM and reflects on ways that naturalistic decision making can support expertise in the face of attempts to standardize practice and emphasize compliance. Our objectives in this commentary are first to explain the inherent limits of procedural approaches and second to examine ways to help decision makers become more adaptive.

Cholangiokarzinome

Praxis ◽  
2002 ◽  
Vol 91 (34) ◽  
pp. 1352-1356
Author(s):  
Harder ◽  
Blum
Keyword(s):  
Supportive Care ◽  
Evidence Based Medicine ◽  
Best Supportive Care ◽  
Evidence Based ◽  
Systemische Chemotherapie ◽  
Chirurgische Resektion ◽  
Multimodale Therapiekonzepte ◽  
Based Medicine

Cholangiokarzinome oder cholangiozelluläre Karzinome (CCC) sind seltene Tumoren des biliären Systems mit einer Inzidenz von 2–4/100000 pro Jahr. Zu ihnen zählen die perihilären Gallengangskarzinome (Klatskin-Tumore), mit ca. 60% das häufigste CCC, die peripheren (intrahepatischen) Cholangiokarzinome, das Gallenblasenkarzinom, die Karzinome der extrahepatischen Gallengänge und das periampulläre Karzinom. Zum Zeitpunkt der Diagnose ist nur bei etwa 20% eine chirurgische Resektion als einzige kurative Therapieoption möglich. Die Lebertransplantation ist wegen der hohen Rezidivrate derzeit nicht indiziert. Die Prognose von nicht resektablen Cholangiokarzinomen ist mit einer mittleren Überlebenszeit von sechs bis acht Monaten schlecht. Eine wirksame Therapie zur Verlängerung der Überlebenszeit existiert aktuell nicht. Die wichtigste Massnahme im Rahmen der «best supportive care» ist die Beseitigung der Cholestase (endoskopisch, perkutan oder chirurgisch), um einer Cholangitis oder Cholangiosepsis vorzubeugen. Durch eine systemische Chemotherapie lassen sich Ansprechraten von ca. 20% erreichen. 5-FU und Gemcitabine sind die derzeit am häufigsten eingesetzten Substanzen, die mit einer perkutanen oder endoluminalen Bestrahlung kombiniert werden können. Multimodale Therapiekonzepte können im Einzellfall erfolgreich sein, müssen jedoch erst in Evidence-Based-Medicine-gerechten Studien evaluiert werden, bevor Therapieempfehlungen für die Praxis formuliert werden können.

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