scholarly journals Tendency towards operative treatment is increasing in children’s fractures: results obtained from patient databases, causes, impact of evidence-based medicine

2020 ◽  
Vol 5 (6) ◽  
pp. 347-353
Author(s):  
Hakan Ömeroğlu ◽  
Manuel Cassiano Neves
Keyword(s):  
Operative Treatment ◽  
Evidence Based Medicine ◽  
Scientific Evidence ◽  
Treatment Options ◽  
Treatment Preferences ◽  
Evidence Based ◽  
Fractures In Children ◽  
Paediatric Orthopaedic ◽  
High Level ◽  
Based Medicine

Results of numerous studies assessing the national or the local patient databases in several countries have indicated that the overall rate of operative treatment in fractures, as well as the rate in certain upper and lower limb fractures, has significantly increased in children. The most prominent increase in the rate of operative treatment was observed in forearm shaft fractures. Results of several survey studies have revealed that there was not a high level of agreement among paediatric orthopaedic surgeons concerning treatment preferences for several children’s fractures. The reasons for the increasing tendency towards operative treatment are multifactorial and patient-, parent- and surgeon-dependent factors as well as technological, economic, social, environmental and legal factors seem to have an impact on this trend. It is obvious that evidence-based medicine is not the only factor that leads to this tendency. A high level of scientific evidence is currently lacking to support the statement that operative treatment really leads to better long-term outcomes in children’s fractures. Properly designed multicentre clinical trials are needed to determine the best treatment options in many fractures in children. Cite this article: EFORT Open Rev 2020;5:347-353. DOI: 10.1302/2058-5241.5.200012

scholarly journals Evidence-Based Medicine in judicial decisions concerning right to healthcare

2016 ◽  
Vol 14 (1) ◽  
pp. 1-5 ◽  
Author(s):  
Eduardo Rocha Dias ◽  
Geraldo Bezerra da Silva Junior
Keyword(s):  
Health Insurance ◽  
Evidence Based Medicine ◽  
Private Health Insurance ◽  
Scientific Evidence ◽  
Federal Court ◽  
Public Healthcare ◽  
Evidence Based ◽  
Unified Health System ◽  
The Individual ◽  
Based Medicine

ABSTRACT Objective To analyze, from the examination of decisions issued by Brazilian courts, how Evidence-Based Medicine was applied and if it led to well-founded decisions, searching the best scientific knowledge. Methods The decisions made by the Federal Courts were searched, with no time limits, at the website of the Federal Court Council, using the expression “Evidence-Based Medicine”. With regard to decisions issued by the court of the State of São Paulo, the search was done at the webpage and applying the same terms and criterion as to time. Next, a qualitative analysis of the decisions was conducted for each action, to verify if the patient/plaintiff’s situation, as well as the efficacy or inefficacy of treatments or drugs addressed in existing protocols were considered before the court granted the provision claimed by the plaintiff. Results In less than one-third of the decisions there was an appropriate discussion about efficacy of the procedure sought in court, in comparison to other procedures available in clinical guidelines adopted by the Brazilian Unified Health System (Sistema Único de Saúde) or by private health insurance plans, considering the individual situation. The majority of the decisions involved private health insurance plans (n=13, 68%). Conclusion The number of decisions that did consider scientific evidence and the peculiarities of each patient was a concern. Further discussion on Evidence-Based Medicine in judgments involving public healthcare are required.

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 ‘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.

scholarly journals The difficult crossroads of decisions at COVID-19: how can the deontology implicit in Evidence-Based Medicine help us to understand the different attitudes of doctors at this time?

2020 ◽  
Vol 47 ◽  
Author(s):  
MIGUEL PRESTES NACUL ◽  
MARCO ANTÔNIO AZEVEDO
Keyword(s):  
Evidence Based Medicine ◽  
Scientific Evidence ◽  
Healthcare Providers ◽  
Well Being ◽  
Medical Decision ◽  
Evidence Based ◽  
Conservation Of Resources ◽  
Health Measures ◽  
The Many ◽  
Based Medicine

ABSTRACT One of the struggles faced by physicians in clinical decisions during the COVID-19 pandemic is how to deal with already available or lacking scientific evidence. The COVID-19 pandemic has a large impact in the routine of the many health services, including surgery, which demanded changes in assist protocols. Questions began to arise about well-established surgery conducts due to situations related to SARS-COV-2 infection, and, according to public health measures that are necessary to fight the pandemic. In situations of scarce available evidence, it is natural for us to have to deal with systematically more fragile, provisory and bias-susceptible information. Considering the principles that guide Evidence Based Medicine and Bioethical, the authors analyze the complexity of the medical decision-making during this time. Medical conducts must be adapted to the context of fighting the pandemic and consider patients and healthcare providers exposure and well-being and, lastly, the conservation of resources. The authors conclude that acceptance and tolerance to divergence is commendable, being a path to achieving unity in the diversity of medicine in times of little safe knowledge.

Achieving Evidence-Based Practices in Colorectal Surgery

2014 ◽  
Author(s):  
Imran Hassan
Keyword(s):  
Colorectal Surgery ◽  
Evidence Based Medicine ◽  
Scientific Evidence ◽  
Evidence Based ◽  
Evidence Based Practices ◽  
The Past ◽  
Hierarchy Of Evidence ◽  
Evidence Based Surgery ◽  
Key Resources ◽  
Based Medicine

The concept of evidence-based medicine (EBM) and evidence-based surgery (EBS) involves combining the best scientific evidence available with the clinician’s judgment while also considering the patient’s needs and preferences. In the past, the practice of colorectal surgery was based on tradition and anecdotal experience from experts rather than scientific rationale. However, the rise of EBM has led to changes in how colorectal surgery is performed. This review discusses the hierarchy of evidence, fundamental principles of EBS, and practicing evidence-based colorectal surgery. Tables review the Oxford Centre for Evidence-Based Medicine revised levels of evidence, four steps of evidence-based surgery, key resources for evidence-based surgery, the “PICO” technique, and the Dindo-Clavien classification system. This review contains 5 tables and 69 references.

scholarly journals Keeping up with Best Evidence: What Resources are Available?

2012 ◽  
Vol 46 (1) ◽  
pp. 4-7 ◽  
Author(s):  
Nasir Hussain ◽  
Mohit Bhandari ◽  
Sarah Turvey
Keyword(s):  
Evidence Based Medicine ◽  
Healthcare Professionals ◽  
Point Of Care ◽  
Scientific Evidence ◽  
Evidence Based ◽  
Medical Journals ◽  
Orthopedic Surgeons ◽  
Allied Healthcare ◽  
Based Medicine ◽  
Quality Evidence

ABSTRACT Evidence-based medicine (EBM) teaches physicians to base their decisions and actions on the best available scientific evidence in conjunction with their own expertise and the patient's values and preferences; however, this can be very time consuming as a one has to stay current and up-to-date with the most recent evidence. Several point-of-care databases, such as Up To Date and Dynamed, have been developed that distill the contents of medical journals into summaries with guidelines for practice in order to aid in EBM approach, but these also come with various limitations. Due to this, tools specific to surgical specialties are now beginning to be developed that systematically collect, appraise and summarize top quality evidence. One such tool is Ortho Evidence, which is an openaccess tool for orthopedic surgeons, researchers and allied healthcare professionals. How to cite this article Hussain N, Turvey S, Bhandari M. Keeping up with Best Evidence: What Resources are Available? J Postgrad Med Edu Res 2012;46(1):4-7.

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