scholarly journals Perimenopause and Postmenopause – Diagnosis and Interventions. Guideline of the DGGG and OEGGG (S3-Level, AWMF Registry Number 015-062, September 2020)

2021 ◽  
Author(s):  
Elisabeth C. Inwald ◽  
Christian Albring ◽  
Erika Baum ◽  
Maria Beckermann ◽  
Kai J. Bühling ◽  
...  
Keyword(s):  
Treatment Options ◽  
Therapeutic Interventions ◽  
Short Version ◽  
Evidence Based ◽  
Physiological Changes ◽  
Ovarian Insufficiency ◽  
Nice Guideline ◽  
S3 Guideline ◽  
Routine Medical Care ◽  
Based Medicine

Abstract Aim The aim of the interdisciplinary S3-guideline Perimenopause and Postmenopause – Diagnosis and Interventions is to provide help to physicians as they inform women about the physiological changes which occur at this stage of life and the treatment options. The guideline should serve as a basis for decisions taken during routine medical care. This short version lists the statements and recommendations given in the long version of the guideline together with the evidence levels, the level of recommendation, and the strength of consensus. Methods The statements and recommendations are largely based on methodologically high-quality publications. The literature was evaluated by experts and mandate holders using evidence-based medicine (EbM) criteria. The search for evidence was carried out by the Essen Research Institute for Medical Management (EsFoMed). To some extent, this guideline also draws on an evaluation of the evidence used in the NICE guideline on Menopause and the S3-guidelines of the AWMF and has adapted parts of these guidelines. Recommendations Recommendations are given for the following subjects: diagnosis and therapeutic interventions for perimenopausal and postmenopausal women, urogynecology, cardiovascular disease, osteoporosis, dementia, depression, mood swings, hormone therapy and cancer risk, as well as primary ovarian insufficiency.

scholarly journals ANALYSIS OF EFFICACY OF USING PLATELET-RICH PLASMA AND BETAMETHAZONE IN THE TREEATMENT OF ALOPECIA AREATA

2020 ◽  
Vol 20 (4) ◽  
pp. 4-10
Author(s):  
M. A. Aljabali ◽  
L. V. Kuts
Keyword(s):  
Alopecia Areata ◽  
Platelet Rich Plasma ◽  
Treatment Options ◽  
Venous Blood ◽  
Smoking Habit ◽  
Diagnostic Errors ◽  
Statistical Processing ◽  
Evidence Based ◽  
Based Medicine ◽  
Instrumental Methods

In the era of evidence-based medicine, confirming a disease by using various instrumental methods is one of the important tasks. This enables to reduce the number of diagnostic errors and to prescribe the appropriate treatment in accordance with the current views on the problem of alopecia areata in each case. Moreover, monitoring the course of the disease, data recording and their statistical processing opens up the prospect for obtaining evidence-based treatment methods. Studying the effectiveness of various treatment options and approaches including the registration of results obtained and their statistical processing is of great clinical significance. The aim of this study is to compare the efficiency of monotherapy with betamethasone injections, with platelet-rich plasma, and their combination. The venous blood of 104 patients aged (35.7 ± 8.9 years with alopecia areata was used in the study. All patients were randomly divided to three groups. The group І received intradermal injections of betamethasone (4 sessions per month). The group ІІ received intradermal injections of platelet-rich plasma once every 2 weeks for 16 weeks. The group ІІІ received 4 sessions of betamethasone which were alternated with 4 sessions of platelet-rich plasma treatment at interval of 2 weeks. The patients were examined before the treatment and in 3, 6 and 17 months. The following factors as the age, sex, smoking habit, the presence of alopecia in relatives, the duration, shape and stage of the disease, the index of the severity of alopecia and hair growth, the presence of "yellow and black dots", "conical" and terminal hair were considered in the study. Statistical analysis was performed using SPSS (version 22.0.). The results have shown the combination therapy allows us to obtain the best result, especially in long follow-up period.

Inequalities of health insurance guidelines for the treatment of symptomatic varicose veins

2013 ◽  
Vol 29 (4) ◽  
pp. 236-246 ◽  
Author(s):  
M W Schul ◽  
T King ◽  
L S Kabnick
Keyword(s):  
Evidence Based Medicine ◽  
Varicose Veins ◽  
Treatment Options ◽  
Healthcare Delivery ◽  
Healthcare Providers ◽  
Standards Of Care ◽  
Evidence Based ◽  
Treatment Providers ◽  
Based Medicine ◽  
Vein Disease

Objectives The emerging model of US healthcare delivery is aimed at reducing costs, standardizing care, and improving outcomes. Although it is necessary for healthcare providers and insurance carriers to work together to achieve those goals, insurers have the added duty of assuring physicians and patients that they comprehend the medical evidence and, based on that understanding, construct policies. Are US insurers meeting that responsibility or are they simply creating policies to serve their own needs? Methods The medical policies of several US health insurers were analysed. The goal was to see whether it could readily be determined if these carriers used evidence-based medicine consistently to create uniform policies for the treatment of patients with symptomatic varicose veins. The literature was also reviewed to determine whether increased insurance documentation requirements have affected cost reduction, standardization of care and/or improvement of outcomes related to chronic vein disease management. Results There is a dramatic lack of uniformity among the insurance policies reviewed. Insurers appear to not choose important papers to create policy but use carefully chosen articles to reinforce what they want their policies to say. In so doing, conflicting policy criteria are being created. Complicating this inconsistency, rules for medical necessity are modified frequently, raising frustration levels among vein providers and their patients. What is clear is that costs are not being lowered, care is not being standardized and little is being done to prevent potential complications resulting from chronic vein disease. Conclusions Patients and physicians are increasingly ill-served by, and frustrated with, the clear lack of consistency in the medical policy criteria being created by US insurance carriers in covering the treatment of patients with symptomatic varicose veins. The contradictory coverage requirements, seemingly based on no understanding of evidence-based medicine guidelines, and total variability in reimbursement for various types of treatment options is particularly worrisome. Collaboration between venous treatment providers and insurance carriers, to create evidence-based standards of care, would be timely and beneficial in creating guidelines for optimal patient care.

The process of producing a “NICE” guideline

2010 ◽  
Vol 19 (3) ◽  
pp. 211-213 ◽  
Author(s):  
David Goldberg
Keyword(s):  
United Kingdom ◽  
Evidence Based Medicine ◽  
Clinical Guideline ◽  
Clinical Excellence ◽  
The Other ◽  
Evidence Based ◽  
Nice Guideline ◽  
The United Kingdom ◽  
The One ◽  
Based Medicine

SUMMARYThis paper describes the process of preparing a Clinical Guideline for “NICE”, the National Institute for Health and Clinical Excellence in the United Kingdom. The procedure involves the group appointed to prepare the guideline relating to the various “stakeholders” who have an interest on the one hand, and satisfying the fairly demanding standards set by NICE on the other. The strengths and limitations of the approach based on evidence based medicine are discussed.

Evidence-based medicine and machine learning: a partnership with a common purpose

2020 ◽  
pp. bmjebm-2020-111379
Author(s):  
Ian Scott ◽  
David Cook ◽  
Enrico Coiera
Keyword(s):  
Machine Learning ◽  
Evidence Based Medicine ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Therapeutic Interventions ◽  
Evidence Based ◽  
Rigorous Approach ◽  
Common Purpose ◽  
Future Outcomes ◽  
Based Medicine

From its origins in epidemiology, evidence-based medicine has promulgated a rigorous approach to assessing the validity, impact and applicability of hypothesis-driven empirical research used to evaluate the utility of diagnostic tests, prognostic tools and therapeutic interventions. Machine learning, a subset of artificial intelligence, uses computer programs to discover patterns and associations within huge datasets which are then incorporated into algorithms used to assist diagnoses and predict future outcomes, including response to therapies. How do these two fields relate to one another? What are their similarities and differences, their strengths and weaknesses? Can each learn from, and complement, the other in rendering clinical decision-making more informed and effective?

Comparatively Ineffective? PCORI and the Uphill Battle to Make Evidence Count in US Medicine

2020 ◽  
Vol 45 (5) ◽  
pp. 787-800
Author(s):  
Eric M. Patashnik
Keyword(s):  
Health Care ◽  
Affordable Care Act ◽  
Treatment Options ◽  
Cultural Barriers ◽  
Health Care Spending ◽  
Evidence Based ◽  
Medical Evidence ◽  
Patient Centered ◽  
The Us ◽  
Based Medicine

Abstract The Patient-Centered Outcomes Research Institute (PCORI) was established as part of the Affordable Care Act to promote research on the comparative effectiveness of treatment options. Advocates hoped this information would help reduce wasteful spending by identifying low-value treatments, but many conservatives and industry groups feared PCORI would ration care and threaten physicians' autonomy. PCORI faced three challenges during its first decade of operation: overcoming the controversy of its birth and escaping early termination, shaping medical practice, and building a public reputation for relevance. While PCORI has won reauthorization, it has not yet had a major impact on the decisions of clinicians or payers. PCORI's modest footprint reflects not only the challenges of getting a new organization off the ground but also the larger political, financial, and cultural barriers to the uptake of medical evidence in the US health care system. The growing attention among policymakers and researchers to provider prices (rather than utilization) as the driver of health care spending could be helpful to the political prospects of the evidence-based medicine project by making it appear to be less as rationing driven by costs and more as an effort to improve quality and uphold medical professionalism.

The ‘Number Needed to Treat’ and the ‘Adjusted NNT’ in Health Care Decision-Making

1998 ◽  
Vol 3 (1) ◽  
pp. 44-49 ◽  
Author(s):  
Jack Dowie
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Evidence Based Medicine ◽  
Clinical Decision Making ◽  
Treatment Options ◽  
Clinical Decision ◽  
Population Based ◽  
Number Needed To Treat ◽  
Evidence Based ◽  
Based Medicine

Within ‘evidence-based medicine and health care’ the ‘number needed to treat’ (NNT) has been promoted as the most clinically useful measure of the effectiveness of interventions as established by research. Is the NNT, in either its simple or adjusted form, ‘easily understood’, ‘intuitively meaningful’, ‘clinically useful’ and likely to bring about the substantial improvements in patient care and public health envisaged by those who recommend its use? The key evidence against the NNT is the consistent format effect revealed in studies that present respondents with mathematically-equivalent statements regarding trial results. Problems of understanding aside, trying to overcome the limitations of the simple (major adverse event) NNT by adding an equivalent measure for harm (‘number needed to harm’ NNH) means the NNT loses its key claim to be a single yardstick. Integration of the NNT and NNH, and attempts to take into account the wider consequences of treatment options, can be attempted by either a ‘clinical judgement’ or an analytical route. The former means abandoning the explicit and rigorous transparency urged in evidence-based medicine. The attempt to produce an ‘adjusted’ NNT by an analytical approach has succeeded, but the procedure involves carrying out a prior decision analysis. The calculation of an adjusted NNT from that analysis is a redundant extra step, the only action necessary being comparison of the results for each option and determination of the optimal one. The adjusted NNT has no role in clinical decision-making, defined as requiring patient utilities, because the latter are measurable only on an interval scale and cannot be transformed into a ratio measure (which the adjusted NNT is implied to be). In any case, the NNT always represents the intrusion of population-based reasoning into clinical decision-making.

Postmastectomy Neuropathic Pain

2018 ◽  
Author(s):  
Heena Pranav ◽  
Dalia H. Elmofty
Keyword(s):  
Neuropathic Pain ◽  
Multidisciplinary Approach ◽  
Treatment Options ◽  
Pain Syndrome ◽  
Interventional Treatment ◽  
Evidence Based ◽  
Detailed History ◽  
Multiple Domains ◽  
Based Medicine ◽  
Pharmacologic Agents

Neuropathic pain can burden patients in multiple domains. It is a complex pain syndrome that remains difficult to treat. Detailed history and physical examination would reveal patients with neuropathic conditions complaining of burning, shocklike pain. There are a variety of neuropathic pain conditions that can be considered in a differential diagnosis. Because patients with neuropathic pain fail to obtain satisfactory relief from pharmacologic agents alone, a multidisciplinary approach that includes preventative and interventional options is recommended. Interventional treatment options may offer relief to patients with refractory neuropathic pain. Success in the treatment of neuropathic pain depends on evidence-based medicine and individualized patient care.

The history of evidence-based medicine

2016 ◽  
Keyword(s):  
Randomized Controlled Trial ◽  
Evidence Based Medicine ◽  
Controlled Trial ◽  
Scientific Data ◽  
Therapeutic Interventions ◽  
Evidence Based ◽  
Randomized Controlled ◽  
History Of ◽  
Historical Accounts ◽  
Based Medicine

The pursuit of tests for therapeutic interventions has been a characteristic of Western medicine since ancient times. Historical accounts of the clinical trial are usually expressed through the lens of presentism: how the various components of the first modern randomized controlled trial-the comparison, blinding, and randomization-culminated in Austin Bradford Hill’s 1946 trial of streptomycin for tuberculosis. The factual context of the development of the randomized controlled trial is important if only to emphasize the historicity of contemporary research methodology. However, the adoption of the various components of the trial at any one time has as much to do with changing the socio-political and ethical contexts as the ‘objective’ scientific standards of evidence. Evidence is not just scientific data floating in some ethereal medium, but is also linked to facts and beliefs of the various members of diverse medical communities who interpret evidence and deploy it to legitimize various strategies. This introductory chapter aims to present the background and context through which evidence-based medicine has emerged.

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