scholarly journals FRI0427 EULAR RECOMMENDATIONS FOR INTRA-ARTICULAR TREATMENTS FOR ARTHROPATHIES

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 812.2-812
Author(s):  
J. Uson Jaeger ◽  
E. Naredo ◽  
S. C. Rodriguez-García ◽  
R. Castellanos-Moreira ◽  
T. O’neill ◽  
...  
Keyword(s):  
Systematic Reviews ◽  
Health Professionals ◽  
Adult Patients ◽  
Background Information ◽  
Evidence Based ◽  
Efficacy And Safety ◽  
Research Support ◽  
Level Of Evidence ◽  
Face To Face ◽  
Delphi Round

Background:Intra-articular therapies (IAT) are widely used in clinical practice to treat patients with rheumatic and musculoskeletal diseases (RMDs). Many factors influence their efficacy and safety. There is a wide variation in the way IATs are delivered by health professionals. In an attempt to standardise these procedures, evidence-based recommendations are the right way forward.Objectives:To establish evidence-based recommendations to guide health professionals using IAT in adult patients with peripheral arthropathies.Methods:At a first face-to-face meeting, the results of an overview of systematic reviews were presented to the multidisciplinary task force of members from 8 countries. The aim, scope and outline of the taskforce were also established at this meeting. Thirty-two clinical questions ranked for priority (relevance for practice plus feasibility) drove the systematic reviews performed by two fellows. In addition, two surveys addressed to physicians, health professionals and patients throughout Europe were agreed to acquire more background information. At the second face-to-face meeting, the evidence for each research question was discussed, and each recommendation shaped and voted in a first Delphi round. Level of agreement was numerically scored 0 to 10 (0 completely disagree, 10 completely agree). All panellists voted anonymously using a sli.do app. Agreement needed to be greater than 80% to be included in a second Delphi round, which also allowed reformulation of statements. Finally, a third Delphi round was sent to the taskforce. The level of evidence was assigned to each recommendation according to the EULAR SOP for establishing recommendations.Results:Recommendations focus on practical aspects for daily practice to guide health professionals before, during and after IAT in adult patients with peripheral arthropathies. Five overarching principles were established, together with 11 recommendations that address the following issues: (1) patient information; (2) procedure and setting; (3) accuracy issues; (3) routine and special antiseptic care; (4) safety issues and precautions to be addressed in special populations; (5) efficacy and safety of repeated joint injections; (6) the usage of local anaesthetics; and (7) aftercare. The document includes the supporting evidence and results from the surveys, level of evidence and agreement.Conclusion:We have developed the first evidence and expert opinion based recommendations to guide health professionals using IAT.Acknowledgments:Eular Taskforce grant CL109Disclosure of Interests:Jacqueline Uson Jaeger: None declared, Esperanza Naredo: None declared, Sebastian C Rodriguez-García Speakers bureau: Novartis Farmaceutica, S.A., Merck Sharp & Dohme España, S.A., Sanofi Aventis, UCB Pharma, Raul Castellanos-Moreira: None declared, Terence O’Neill: None declared, Hemant Pandit Grant/research support from: Glaxo Smith Kline (GSK) for work on Diclofenac Gel, Speakers bureau: Bristol Myers Squibb for teaching their employees about hip and knee replacement, Michael Doherty Grant/research support from: AstraZeneca funded the Nottingham Sons of Gout study, Consultant of: Advisory borads on gout for Grunenthal and Mallinckrodt, Mikael Boesen Consultant of: AbbVie, AstraZeneca, Eli Lilly, Esaote, Glenmark, Novartis, Pfizer, UCB, Paid instructor for: IAG, Image Analysis Group, AbbVie, Eli Lilly, AstraZeneca, esaote, Glenmark, Novartis, Pfizer, UCB (scientific advisor)., Speakers bureau: Eli Lilly, Esaote, Novartis, Pfizer, UCB, Ingrid Möller: None declared, Valentina Vardanyan: None declared, Jenny de la Torre-Aboki: None declared, Lene Terslev: None declared, Francis Berenbaum Grant/research support from: TRB Chemedica (through institution), MSD (through institution), Pfizer (through institution), Consultant of: Novartis, MSD, Pfizer, Lilly, UCB, Abbvie, Roche, Servier, Sanofi-Aventis, Flexion Therapeutics, Expanscience, GSK, Biogen, Nordic, Sandoz, Regeneron, Gilead, Bone Therapeutics, Regulaxis, Peptinov, 4P Pharma, Paid instructor for: Sandoz, Speakers bureau: Novartis, MSD, Pfizer, Lilly, UCB, Abbvie, Roche, Servier, Sanofi-Aventis, Flexion Therapeutics, Expanscience, GSK, Biogen, Nordic, Sandoz, Regeneron, Gilead, Sandoz, Maria Antonietta D’Agostino Consultant of: AbbVie, BMS, Novartis, and Roche, Speakers bureau: AbbVie, BMS, Novartis, and Roche, Willm Uwe Kampen: None declared, Elena Nikiphorou: None declared, IRENE Pitsillidou: None declared, Loreto Carmona Grant/research support from: Novartis Farmaceutica, SA, Pfizer, S.L.U., Merck Sharp & Dohme España, S.A., Roche Farma, S.A, Sanofi Aventis, AbbVie Spain, S.L.U., and Laboratorios Gebro Pharma, SA (All trhough institution)

scholarly journals EULAR recommendations for intra-articular therapies

2021 ◽  
pp. annrheumdis-2021-220266
Author(s):  
Jacqueline Uson ◽  
Sebastián Cruz Rodriguez-García ◽  
Raul Castellanos-Moreira ◽  
Terence W O'Neill ◽  
Michael Doherty ◽  
...  
Keyword(s):  
Health Professionals ◽  
Task Force ◽  
Healthcare Providers ◽  
Local Anaesthetics ◽  
Adult Patients ◽  
Background Information ◽  
Level Of Evidence ◽  
Safety Issues ◽  
Eular Recommendations ◽  
Final Agreement

ObjectivesTo establish evidence-based recommendations to guide health professionals using intra-articular therapies (IAT) in adult patients with peripheral arthropathies.MethodsA multidisciplinary international task force established the objectives, users and scope and the need for background information, including systematic literature reviews) and two surveys addressed to healthcare providers and patients throughout Europe. The evidence was discussed in a face-to-face meeting, recommendations were formulated and subsequently voted for anonymously in a three-round Delphi process to obtain the final agreement. The level of evidence was assigned to each recommendation with the Oxford levels of evidence.ResultsRecommendations focus on practical aspects to guide health professionals before, during and after IAT in adult patients with peripheral arthropathies. Five overarching principles and 11 recommendations were established, addressing issues related to patient information, procedure and setting, accuracy, routine and special aseptic care, safety issues and precautions to be addressed in special populations, efficacy and safety of repeated joint injections, use of local anaesthetics and aftercare.ConclusionWe have developed the first evidence and expert opinion-based recommendations to guide health professionals using IAT. We hope that these recommendations will be included in different educational programmes, used by patient associations and put into practice via scientific societies to help improve uniformity and quality of care when performing IAT in peripheral adult joints.

scholarly journals Promoting evidence-based practice: training health professionals for the evidence synthesis

2021 ◽  
Vol 55 ◽  
Author(s):  
Daniela Filipa Batista Cardoso ◽  
Diana Gabriela Simões Marques Santos ◽  
Joana Filipa Cunha Rodrigues ◽  
Nichole Bento ◽  
Rogério Manuel Clemente Rodrigues ◽  
...  
Keyword(s):  
Systematic Review ◽  
Training Program ◽  
Systematic Reviews ◽  
Health Professionals ◽  
Evidence Based Practice ◽  
Evidence Synthesis ◽  
Evidence Based ◽  
Centre Of Excellence ◽  
Satisfaction Evaluation ◽  
Students Satisfaction

ABSTRACT Objective: To report the experience of the Portugal Centre For Evidence Based Practice (PCEBP): a JBI Centre of Excellence in the training of health professionals, researchers, and professors in the Comprehensive Systematic Review Training Program, a course on Evidence Synthesis, specifically on Systematic Literature Reviews. Method: This article aims to report the experience of the Portugal Centre For Evidence Based Practice: a JBI Centre of Excellence in the implementation of the Comprehensive Systematic Review Training Program that trains health professionals, researchers, and teachers to develop Systematic Reviews, according to the JBI approach. Results: By the end of 2020, 11 editions of the course had been developed with 136 participants from different educational and health institutions, from different countries. As a result of the training of these participants, 13 systematic reviews were published in JBI Evidence Synthesis and 10 reviews were published in other journals. Conclusion: The reported results and the students’ satisfaction evaluation allow us to emphasize the relevance of the course for health professionals training on evidence synthesis.

scholarly journals Scientific Research in Homeopathic Medicine: Validation, Methodology and Perspectives

2007 ◽  
Vol 4 (2) ◽  
pp. 271-273 ◽  
Author(s):  
Giuseppina Pitari
Keyword(s):  
Systematic Reviews ◽  
Evidence Based Medicine ◽  
Scientific Research ◽  
Medical Community ◽  
Evidence Based ◽  
Efficacy And Safety ◽  
Homeopathic Medicine ◽  
Full Immersion ◽  
Based Medicine

Verona's School of Homeopathic Medicine (www.omeopatia.org) organized a day of full immersion in the field of homeopathy, focusing on the validity of this much-debated discipline. There is widespread consensus in the medical community that evidence-based medicine is the best standard for assessing efficacy and safety of healthcare practices, and systematic reviews with strict protocols are essential to establish proof for various therapies. Students, homeopathic practitioners, academic and business representatives, who are interested in or curious about homeopathic practices attended the conference.

scholarly journals Evaluation of efficacy and safety of Qiangzhu-qinggan formula as an adjunctive therapy in adult patients with severe influenza: study protocol for a randomized parallel placebo-controlled double-blind multicenter trial

2021 ◽  
Author(s):  
Lei Qiu ◽  
Xianwei WU ◽  
Shaoyan Zhang ◽  
Ming Yang ◽  
Shunxian Zhang ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Adjuvant Therapy ◽  
Herbal Medicines ◽  
Multicenter Trial ◽  
Adult Patients ◽  
Evidence Based ◽  
Efficacy And Safety ◽  
Double Blind ◽  
Chinese Herbal ◽  
Severe Influenza

Abstract Background: Influenza can fall into three categories according to severity: mild influenza, severe influenza, and critical influenza. Severe influenza can result in critical illness and sometimes death particularly in patients with comorbidities, advanced age, or pregnancy. Neuraminidase inhibitors (NAIs) are the only antiviral drugs in widespread use for influenza. However, the effectiveness of NAIs against severe influenza is uncertain. New effective drugs or regimens are therefore urgently needed. Qiangzhu-qinggan (QZQG) formula has been found to be effective against influenza virus infection during long-term application in China, which lacks support of evidence-based clinical trial till now. This study is designed to assess the efficacy and safety of QZQG formula as an adjuvant therapy in adult patients with severe influenza. Methods: This protocol is drawn up in accordance with the SPIRIT guidelines and CONSORT Extension for Chinese herbal medicine formulas. This is a randomized, placebo-controlled, double-blind, multicenter trial. 228 adults with severe influenza are randomly assigned in a 1:1 ratio to QZQG or placebo for 7 days and receive 1 day of screening, 7 days of intervention and 21 days of observation. The primary outcome is the proportion of clinical improvement, defined as the proportion of patients who met the criteria of 3 points or less in the seven-category ordinal scale or 2 points or less in National Early Warning Score 2 within 7 days after randomization. Discussion: This is the first randomized, controlled, parallel, double-blind clinical trial to evaluate the efficacy and safety of traditional Chinese herbal formula granules as an adjuvant therapy in adult patients with severe influenza. This study aims to redefine the value of traditional Chinese herbal medicines in the treatment of virus-related respiratory infectious diseases and serves as an example of evidence-based clinical trials of other Chinese herbal medicines.

Antipyretic drugs in patients with fever and infection: literature review

2019 ◽  
Vol 28 (10) ◽  
pp. 610-618 ◽  
Author(s):  
Jennifer Ludwig ◽  
Hazel McWhinnie
Keyword(s):  
Literature Review ◽  
Patient Outcomes ◽  
Mortality Risk ◽  
Health Professionals ◽  
Secondary Care ◽  
Adult Patients ◽  
Evidence Based ◽  
Defence Mechanisms ◽  
Underlying Illness ◽  
Controversial Topic

Background: antipyretic drugs are routinely administered to febrile patients with infection in secondary care. However, the use of antipyretics to suppress fever during infection remains a controversial topic within the literature. It is argued that fever suppression may interfere with the body's natural defence mechanisms, and may worsen patient outcomes. Method: a literature review was undertaken to determine whether the administration of antipyretic drugs to adult patients with infection and fever, in secondary care, improves or worsens patient outcomes. Results: contrasting results were reported; two studies demonstrated improved patient outcomes following antipyretic administration, while several studies demonstrated increased mortality risk associated with antipyretics and/or demonstrated fever's benefits during infection. Results also demonstrated that health professionals continue to view fever as deleterious. Conclusion: the evidence does not currently support routine antipyretic administration. Considering patients' comorbidities and symptoms of their underlying illness will promote safe, evidence-based and appropriate administration of antipyretics.

scholarly journals Surgical Approaches to Upper Limb Spasticity in Adult Patients: A Literature Review

2021 ◽  
Vol 2 ◽  
Author(s):  
Mahdis Hashemi ◽  
Nadine Sturbois-Nachef ◽  
Marry Ann Keenan ◽  
Paul Winston
Keyword(s):  
Systematic Reviews ◽  
Upper Limb ◽  
Surgical Techniques ◽  
Adult Patients ◽  
Surgical Approaches ◽  
Cochrane Central Register ◽  
Level Of Evidence ◽  
Cochrane Database ◽  
Limb Deformities ◽  
Almost All

Introduction: Spasticity is the main complication of many upper motor neuron disorders. Many studies describe neuro-orthopedic surgeries for the correction of joint and limb deformities due to spasticity, though less in the upper extremity. The bulk of care provided to patients with spasticity is provided by rehabilitation clinicians, however, few of the surgical outcomes have been summarized or appraised in the rehabilitation literature.Objective: To review the literature for neuro-orthopedic surgical techniques in the upper limb and evaluate the level of evidence for their efficacy in adult patients with spasticity.Method: Electronic databases of MEDLINE, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews were searched for English, French as well as Farsi languages human studies from 1980 to July 2, 2020. After removing duplicated articles, 2,855 studies were screened and 80 were found to be included based on the criteria. The studies were then divided into two groups, with 40 in each trial and non-trial. The results of the 40 trial articles were summarized in three groups: shoulder, elbow and forearm, and wrist and finger, and each group was subdivided based on the types of intervention.Results: The level of evidence was evaluated by Sackett's approach. There were no randomized control trial studies found. About, 4 studies for shoulder, 8 studies for elbow and forearm, 26 studies for wrist and finger (including 4 for the thumb in palm deformity), and 2 systematic reviews were found. Around, two out of 40 trial articles were published in the rehabilitation journals, one systematic review in Cochrane, and the remaining 38 were published in the surgical journals.Conclusion: Most surgical procedures are complex, consisting of several techniques based on the problems and goals of the patient. This complexity interferes with the evaluation of every single procedure. Heterogenicity of the participants and the absence of clinical trial studies are other factors of not having a single conclusion. This review reveals that almost all the studies suggested good results after the surgery in carefully selected cases with goals of reducing spasticity and improvement in function, pain, hygiene, and appearance. A more unified approach and criteria are needed to facilitate a collaborative, evidence-based, patient referral, and surgical selection pathway.

Locating the Best Available Research

2016 ◽  
pp. 29-48
Author(s):  
John C. Norcross ◽  
Thomas P. Hogan ◽  
Gerald P. Koocher ◽  
Lauren A. Maggio
Keyword(s):  
Systematic Reviews ◽  
Information Sources ◽  
Clinical Evidence ◽  
Information Resources ◽  
Background Information ◽  
Evidence Based ◽  
Cochrane Database ◽  
Wild Cards ◽  
Clinical Questions

This chapter discusses the steps EBP clinicians should take in finding evidence that addresses their clinical questions: searching background information resources, which provide overviews of topics, and then moving to filtered information resources, which provide access to timesaving, synthesized information. To help clinicians navigate these resources, the chapter summarizes basic search concepts that are applicable across the resources, such as Boolean operators, truncation, wild cards, and limits. The chapter describes key background information sources, such as eMedicine, textbooks, and Wikipedia. It then discusses key filtered information sources, including the Cochrane Database of Systematic Reviews, BMJ Clinical Evidence, and several evidence-based journals. The chapter provides tailored tips for optimal searching within each resource introduced.

scholarly journals LO73: The state of the evidence for emergency medical services care of adult patients with sepsis: an analysis of appraised research from the Prehospital Evidence-Based Practice (PEP) program

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S34
Author(s):  
J. Greene ◽  
A. Carter ◽  
J. Goldstein ◽  
J. Jensen ◽  
J. Swain ◽  
...  
Keyword(s):  
Emergency Medical Services ◽  
Evidence Based Practice ◽  
Adult Patients ◽  
Medical Services ◽  
Evidence Based ◽  
High Quality ◽  
Level Of Evidence ◽  
Moderate Quality ◽  
Emergency Medical ◽  
High Flow Oxygen

Introduction: The Prehospital Evidence-Based Practice (PEP) program is an online, freely accessible, continuously updated Emergency Medical Services (EMS) evidence repository. This summary describes the research evidence for the identification and management of adult patients suffering from sepsis syndrome or septic shock. Methods: PubMed was searched in a systematic manner. One author reviewed titles and abstracts for relevance and two authors appraised each study selected for inclusion. Primary outcomes were extracted. Studies were scored by trained appraisers on a three-point Level of Evidence (LOE) scale (based on study design and quality) and a three-point Direction of Evidence (DOE) scale (supportive, neutral, or opposing findings based on the studies’ primary outcome for each intervention). LOE and DOE of each intervention were plotted on an evidence matrix (DOE x LOE). Results: Eighty-eight studies were included for 15 interventions listed in PEP. The interventions with the most evidence were related to identification tools (ID) (n = 26, 30%) and early goal directed therapy (EGDT) (n = 21, 24%). ID tools included Systematic Inflammatory Response Syndrome (SIRS), quick Sequential Organ Failure Assessment (qSOFA) and other unique measures. The most common primary outcomes were related to diagnosis (n = 30, 34%), mortality (n = 40, 45%) and treatment goals (e.g. time to antibiotic) (n = 14, 16%). The evidence rank for the supported interventions were: supportive-high quality (n = 1, 7%) for crystalloid infusion, supportive-moderate quality (n = 7, 47%) for identification tools, prenotification, point of care lactate, titrated oxygen, temperature monitoring, and supportive-low quality (n = 1, 7%) for vasopressors. The benefit of prehospital antibiotics and EGDT remain inconclusive with a neutral DOE. There is moderate level evidence opposing use of high flow oxygen. Conclusion: EMS sepsis interventions are informed primarily by moderate quality supportive evidence. Several standard treatments are well supported by moderate to high quality evidence, as are identification tools. However, some standard in-hospital therapies are not supported by evidence in the prehospital setting, such as antibiotics, and EGDT. Based on primary outcomes, no identification tool appears superior. This evidence analysis can guide selection of appropriate prehospital therapies.

scholarly journals Evaluation of efficacy and safety of Qiangzhu-qinggan formula as an adjunctive therapy in adult patients with severe influenza: study protocol for a randomized parallel placebo-controlled double-blind multicenter trial

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Lei Qiu ◽  
Xian-wei Wu ◽  
Shao-yan Zhang ◽  
Ming Yang ◽  
Shun-xian Zhang ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Adjuvant Therapy ◽  
Herbal Medicines ◽  
Multicenter Trial ◽  
Adult Patients ◽  
Evidence Based ◽  
Efficacy And Safety ◽  
Double Blind ◽  
Chinese Herbal ◽  
Severe Influenza

Abstracts Background Influenza can fall into three categories according to severity: mild influenza, severe influenza, and critical influenza. Severe influenza can result in critical illness and sometimes death particularly in patients with comorbidities, advanced age, or pregnancy. Neuraminidase inhibitors (NAIs) are the only antiviral drugs in widespread use for influenza. However, the effectiveness of NAIs against severe influenza is uncertain. New effective drugs or regimens are therefore urgently needed. Qiangzhu-qinggan (QZQG) formula has been found to be effective against influenza virus infection during long-term application in China, which lacks support of evidence-based clinical trial till now. This study is designed to assess the efficacy and safety of QZQG formula as an adjuvant therapy in adult patients with severe influenza. Methods This protocol is drawn up in accordance with the SPIRIT guidelines and CONSORT Extension for Chinese herbal medicine formulas. This is a randomized, placebo-controlled, double-blind, multicenter trial. Two hundred twenty-eight adults with severe influenza are randomly assigned in a 1:1 ratio to QZQG or placebo for 7 days. All participants need to receive 1 day of screening before randomization, 7 days of intervention, and 21 days of observation after randomization. The primary outcome is the proportion of clinical improvement, defined as the proportion of patients who met the criteria of 3 points or less in the seven-category ordinal scale or 2 points or less in National Early Warning Score 2 within 7 days after randomization. Discussion This is the first randomized, controlled, parallel, double-blind clinical trial to evaluate the efficacy and safety of traditional Chinese herbal formula granules as an adjuvant therapy in adult patients with severe influenza. This study aims to redefine the value of traditional Chinese herbal medicines in the treatment of virus-related respiratory infectious diseases and serves as an example of evidence-based clinical trials of other Chinese herbal medicines.

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