scholarly journals SCSS-01. ANTICONVULSANT PROPHYLAXIS IN PATIENTS WITH NEWLY DIAGNOSED BRAIN TUMORS: DOES IT PREVENT FIRST SEIZURES, DOES IT IMPROVE SURVIVAL, AND DO WE BELIEVE THE DATA?

2021 ◽  
Vol 3 (Supplement_4) ◽  
pp. iv7-iv8
Author(s):  
Timothy Brown ◽  
Christina Zoccoli ◽  
Alireza Mansouri ◽  
Michael Glantz
Keyword(s):  
Brain Tumors ◽  
Practice Change ◽  
Evidence Based ◽  
Metastatic Brain Tumors ◽  
Literature Searches ◽  
Level Data ◽  
History Of ◽  
One Year ◽  
Based Medicine ◽  
American Academy Of Neurology

Abstract BACKGROUND Despite an American Academy of Neurology Practice Guideline and ASCO/SNO endorsement against the routine use of anticonvulsant prophylaxis in patients with primary and metastatic brain tumors, there remains widespread variation in practice and several unanswered questions. METHODS Exhaustive evidence-based literature searches were conducted, and patient-level data from randomized controlled trials (RCTs) were analyzed to answer three questions: does anticonvulsant prophylaxis reduce the risk of first seizures in patients with primary and metastatic brain tumors; does prophylaxis improve one-year overall survival in patients with primary and metastatic brain tumors; and what effect have practice guidelines had on practice patterns. RESULTS Five RCTs (n=441 patients) addressed anticonvulsant prophylaxis in patients with brain tumors. Overall, anticonvulsant prophylaxis did not reduce the risk of a first seizure in patients with any brain tumor (RR= 0.95 [0.58-1.55], p= 0.85, anticonvulsant prophylaxis vs. placebo), brain metastasis (RR = 0.96 [0.73-1.25], p=0.77, 5 RCTs) or primary brain tumors (RR= 1.03 [0.19-5.72], p=0.97, 4 RCTs). Eleven RCTs of anticonvulsant prophylaxis (n=3767 patients with CNS tumors) provided data for survival analysis and demonstrated a lower RR of death at one year compared to those who did not receive prophylaxis (0.88 [0.81-0.94] p = 0.0006). Physician-reported practice of prescribing anticonvulsant prophylaxis diminished only negligibly after initial guideline publication (54.9% [1 study] vs. 51.6%, [3 studies] p<0.014). CONCLUSION Prophylactic anticonvulsants in patients without a history of seizures does not reduce the risk of first seizures in patients with primary or metastatic brain tumors. Despite this, anticonvulsant prophylaxis provides a small survival benefit at one year, although, this finding may be driven by confounded studies. Rates of anticonvulsant prophylaxis prescription have decreased only minimally and remain very high despite strong evidence against this practice and guideline publication. Evidence-based medicine requires additional mechanisms for encouraging practice change.

scholarly journals Miasmas, mental models and preventive public health: some philosophical reflections on science in the COVID-19 pandemic

2021 ◽  
Vol 11 (6) ◽  
Author(s):  
Trisha Greenhalgh
Keyword(s):  
Mental Models ◽  
Relative Weight ◽  
Evidence Based ◽  
Science And Policy ◽  
Hierarchy Of Evidence ◽  
John Snow ◽  
History Of ◽  
Support Policy ◽  
Preventive Public Health ◽  
Based Medicine

When the history of the COVID-19 pandemic is written, it is likely to show that the mental models held by scientists sometimes facilitated their thinking, thereby leading to lives saved, and at other times constrained their thinking, thereby leading to lives lost. This paper explores some competing mental models of how infectious diseases spread and shows how these models influenced the scientific process and the kinds of facts that were generated, legitimized and used to support policy. A central theme in the paper is the relative weight given by dominant scientific voices to probabilistic arguments based on experimental measurements versus mechanistic arguments based on theory. Two examples are explored: the cholera epidemic in nineteenth century London—in which the story of John Snow and the Broad Street pump is retold—and the unfolding of the COVID-19 pandemic in 2020 and early 2021—in which the evidence-based medicine movement and its hierarchy of evidence features prominently. In each case, it is shown that prevailing mental models—which were assumed by some to transcend theory but were actually heavily theory-laden—powerfully shaped both science and policy, with fatal consequences for some.

Evidence-Based Medicine

2016 ◽  
Author(s):  
Emily R. Winslow
Keyword(s):  
Evidence Based Medicine ◽  
Critical Appraisal ◽  
Reporting Guidelines ◽  
Evidence Based ◽  
Treatment Benefits ◽  
Therapeutic Decisions ◽  
History Of ◽  
Evidence Based Surgery ◽  
Key Resources ◽  
Based Medicine

Descriptions of “evidence-based” approaches to medical care are now ubiquitous in both the popular press and medical journals. The term evidence-based medicine (EBM) was first coined in 1992, and over the last two decades, the field has experienced rapid growth, and its principles now permeate both graduate medical education and clinical practice. The field of EBM has been in constant evolution since its introduction and continues to undergo refinements as its principles are tested and applied in a wide variety of clinical circumstances. This review presents a brief history of EBM, EBM: fundamental tenets, a critical appraisal of a single study, reporting guidelines for single studies, a critical appraisal of a body of evidence, evidence-based surgery, and limitations in EBM. Tables list strength of evidence for treatment decisions (EBM working group), Oxford Centre for Evidence-Based Medicine revised levels of evidence for treatment benefits , “4S” approach to finding resources for EBM, critical appraisal of individual studies examining therapeutic decisions, reporting guidelines by study design, and key resources for evidence-based surgery. This review contains 6 tables and 85 references

Internal Mammary Artery Ligation versus Sham Sternotomy for Angina Pectoris

2017 ◽  
Author(s):  
Michael P. Catanzaro
Keyword(s):  
Angina Pectoris ◽  
Internal Mammary Artery ◽  
Historical Study ◽  
Evidence Based ◽  
Artery Ligation ◽  
Sham Surgery ◽  
Internal Mammary ◽  
History Of ◽  
Clinical Questions ◽  
Based Medicine

This chapter provides a summary of a landmark historical study in cardiac surgery related to internal mammary artery ligation versus sham sternotomy for angina pectoris. It describes the history of the procedure and a summary of the study including study design and results, and relates the study to a modern-day principle of evidence-based medicine: blinding and sham surgery. Whether or not sham surgery is ethical remains under debate. Proponents for sham surgery agree that it should be used only when a question cannot be answered adequately by other methods. Cobb and his colleagues were among the first to demonstrate the value of sham studies in addressing important clinical questions.

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