Sense and non-sense of polypharmacy: increasing efficacy, decreasing compliance?

2003 ◽  
Vol 18 (S2) ◽  
pp. 54s-61s ◽  
Author(s):  
Patrice Boyer
Keyword(s):  
Side Effects ◽  
Adverse Events ◽  
Evidence Based Medicine ◽  
Symptom Control ◽  
Single Agent ◽  
Effective Control ◽  
Evidence Based ◽  
Drug Classes ◽  
Psychotropic Agents ◽  
Based Medicine

The objective in managing patients with schizophrenia is to provide effective control of symptoms and enable the patient to reintegrate into society. Pharmacotherapy should, therefore, aim to provide optimum symptom control with minimal side effects using a simple dosage regimen. Ideally, this would be achieved through the use of a single agent. Some patients are successfully managed with a single antipsychotic drug, but it is often necessary or thought to be necessary to use a combination of agents to provide effective treatment. One European survey reported that most patients receive two to three psychotropic agents on average, but at least 5-22% receive five or more agents [53]. Unfortunately, the addition of more agents increases the risk of drug interactions, adverse events and non-compliance. This is amplified by the paucity of evidence-based medicine currently available to guide physicians in the use of combinations of agents, and the tendency of polypharmaceutical practice to be mostly driven by personal preference, clinical experience and marketing. This article therefore briefly looks at the feasibility of using various drug classes as adjunctive therapy in patients with schizophrenia.

scholarly journals Construction of Clinical Pathway Information Management System under the Guidance of Evidence-Based Medicine

2021 ◽  
Vol 2021 ◽  
pp. 1-12
Author(s):  
Xinyu Wang ◽  
Jie Chen ◽  
Fang Peng ◽  
Jingtai Lu
Keyword(s):  
Adverse Events ◽  
Information Management ◽  
Clinical Pathway ◽  
Evidence Based Medicine ◽  
Medical Staff ◽  
Management System ◽  
Information Management System ◽  
Evidence Based ◽  
Work Efficiency ◽  
Based Medicine

This study focuses on clinical pathways guided by evidence-based medicine (EBM). With the clinical pathway as the center, the subjective and objective medical knowledge of medical staff are collected, and a clinical pathway management system guided by EBM is established through a unified process; user demand analysis; main considerations; implementation, evaluation, and monitoring of the clinical path; and dictionary maintenance, to help hospitals fully regulate medical behaviors. Next, the study displays the path access prompt box, area 1 management page, table management page, exit prompt box, mutation record page, doctor order interface, revocation of execution, and monitoring interface, and the system designed is compared with the Beijing Shankang Technology (ASK) clinical data management system in terms of user experience. The results showed that the reporting rate of medical adverse events in the system in this study was 0.21%, and the work efficiency was increased by 14%. In terms of users’ satisfaction, the hospital managers’ satisfaction was 84 ± 5.36%, and it was 95 ± 4.72% for medical staff and 88 ± 4.91% for system administrators, superior to the ASK system; the differences were statistically significant ( P < 0.05 ). In conclusion, the clinical pathway information management system is in line with the working environment of medical staff, and the synchronous monitoring and management of medical quality are achieved through digital means, which can reduce the occurrence of medical adverse events and improve the work efficiency of medical staff.

scholarly journals Side effects of evidence-based medicine

2009 ◽  
Vol 2009 (jul14 1) ◽  
pp. bcr0220091558-bcr0220091558
Author(s):  
A. Fremault ◽  
D. Rodenstein
Keyword(s):  
Side Effects ◽  
Evidence Based Medicine ◽  
Evidence Based ◽  
Based Medicine

scholarly journals Observational studies and registers. Their quality and role in modern evidence-based medicine

2021 ◽  
Vol 20 (2) ◽  
Author(s):  
S. Yu. Martsevich ◽  
N. P. Kutishenko ◽  
Yu. V. Lukina ◽  
M. M. Lukyanov ◽  
O. M. Drapkina
Keyword(s):  
Side Effects ◽  
Randomized Controlled Trials ◽  
Therapeutic Effect ◽  
Evidence Based Medicine ◽  
Observational Studies ◽  
Controlled Trials ◽  
Evidence Based ◽  
Randomized Controlled ◽  
Based Medicine

The article describes the basic rules for conducting observational studies, in particular, registers. The principles of the assessment of its quality and impact on the results are discussed. The potential for evaluating therapeutic effect and side effects in randomized controlled trials (RCTs) and observational studies is compared. Effects of one drug identified in RCTs and observational studies are compared.

Old versus new: weighing the evidence between the first- and second-generation antipsychotics

2005 ◽  
Vol 20 (1) ◽  
pp. 7-14 ◽  
Author(s):  
John M. Davis ◽  
Nancy Chen
Keyword(s):  
Side Effects ◽  
Evidence Based Medicine ◽  
Second Generation ◽  
Psychotic Patient ◽  
Evidence Based ◽  
Random Assignment ◽  
Double Blind ◽  
Second Generation Antipsychotics ◽  
First And Second Generation ◽  
Based Medicine

AbstractIn our opinion the best guide to prescribing antipsychotics is the clinician’s experience with his patients and in particular the patient being treated. If treatment works, stick with it. We feel it is also important for the clinician to consider the evidence from well-controlled double-blind random-assignment studies because in “evidence-based medicine,” biases both known and unknown are controlled by blinding and randomization. The purpose of this paper is to summarize and discuss the evidence on efficacy. Choice of antipsychotic, in our opinion, is probably the most important decision that the clinician makes for the psychotic patient. This involves the choice of drug, its dose, balancing efficacy, side-effects and cost.

scholarly journals It's never too late to publish an abandoned trial

F1000Research ◽  
2015 ◽  
Vol 4 ◽  
pp. 120
Author(s):  
Celia Shiles ◽  
Julia Sinclair
Keyword(s):  
Side Effects ◽  
Effective Treatment ◽  
Evidence Based Medicine ◽  
Evidence Based ◽  
Research Areas ◽  
Based Medicine ◽  
Cover Up ◽  
File Drawer ◽  
Trial Participants ◽  
File Drawer Problem

It is estimated that half of all trials have never been published which can lead to patients being denied the most effective treatment and being exposed to unnecessary side effects.  Furthermore the trial participants have been misinformed since the trial results have not contributed to the care of future patients.However the non-publication of trials is often not due to a deliberate decision to cover up results.  Commonly in academia it is due to more understandable reasons such as researchers having busy clinical posts, moving onto other more demanding projects, changing research areas or starting a family.  This is called the “file drawer” problem.The examples in this editorial demonstrate that it is possible to go back, even decades later, and make the results available to inform future evidence based medicine.  We call on others to look into their “file drawer” for unpublished trials.

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.

Sign in / Sign up

Export Citation Format

Share Document