scholarly journals Intellectual Virtue and the Epistemological Nature of Medical Evidence

2021 ◽  
Vol V (4) ◽  
pp. 138-156
Author(s):  
Anastasia Ugleva

This article examines the problem of defining the epistemological nature of evidence in modern medicine through its two interrelated aspects — bias in the collection of data in randomized controlled trials and personal bias of the physician — which form part of the general bias problem in various professional fields. This problem is widely discussed today in the medical community, in which there is no unanimity in understanding what grounds for making the correct clinical decision are considered decisive — randomized controlled trials or the doctor's own clinical experience. In this article, it is interpreted from the point of view of the modern epistemology of virtues, which makes it possible to raise the question of the doctor's responsibility not from the position of professional deontological morality, but from the point of view of intellectual virtue. The virtuous nature of the medical profession lies in the ability of the subject to make responsible clinical decisions in the course of the cognitive process and to find the optimal balance between standardized protocols for diagnosis, prevention and treatment and their own clinical experience, which makes an individualized approach to each individual medical history possible. A standardized approach requires the “grafting” of the hermeneutic experience expressed in a general theory of understanding and interpretation. Against the background of a decrease in the level of social trust in the medical community, the substantiation of individualizing standardization as a methodologically productive way of integrating various cognitive practices is intended to help overcome the limiting abstraction of the epistemological subject in the classical epistemology of medicine and to recognize the productive-heuristic role of the doctor as a subject of cognition.

2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
Alla Osadchy ◽  
Myla E. Moretti ◽  
Gideon Koren

Background. There is a controversy within the medical community regarding the role of domperidone as a galactagogue and the drug has been removed from the US market owing to safety concerns.Objective. To perform a systematic review and meta-analysis of the available data assessing the effect of domperidone on breast milk production in women experiencing insufficient lactation.Study Selection. Randomized controlled trials (RCTs) examining the effect of domperidone on breast milk production of puerperal women were eligible for inclusion.Data Analysis. Absolute and relative changes from baseline were calculated for individual studies and pooled using a random effects model.Results. Three RCTs including 78 participants met the inclusion criteria. All showed a statistically significant increase in breast milk production following treatment with domperidone. The analysis of pooled data demonstrated a statistically significant relative increase of 74.72% (95%  CI=54.57; 94.86,P<0.00001) in daily milk production with domperidone treatment compared to placebo. No maternal or neonatal adverse events were observed in any of the trials.Conclusions. Evidence from a few small RCTs of moderate to high quality suggests that domperidone produces a greater increase in breast milk supply than placebo.


2021 ◽  
Vol 64 (2) ◽  
pp. 139-151
Author(s):  
Sung Soo Kim ◽  
Hyun Kuk Kim

Clinical practice guidelines published by the European Society of Cardiology and the American College of Cardiology/ American Heart Association provide recommendations based on evidence, including randomized controlled trials and registry data, for clinicians to enable efficient clinical decision-making and improve prognosis for patients with acute myocardial infarction (AMI). However, there are several differences in practice, health systems, and races between Korea and Western countries; further, many studies on pharmacotherapy were conducted in the prepercutaneous coronary intervention era. An expert consensus document on pharmacotherapy for AMI was recently published following demands for the establishment of Korean guideline reflecting data in the modern percutaneous coronary intervention era. In this review, we summarized AMI guidelines from Europe, America, Japan, and Korea, and analyzed studies on pharmacotherapy for AMI including well-organized randomized controlled trials by Korean researchers and large-sized registry datasets, such as the Korea Acute Myocardial Infarction Registry and the Korean National Health Insurance Service.


2019 ◽  
Author(s):  
Devin Mann ◽  
Adam Szerencsy ◽  
Leora Horwitz ◽  
Simon Jones ◽  
Masha Kuznetsova ◽  
...  

BACKGROUND Clinical decision support (CDS) is a valuable feature of electronic health records (EHRs) designed to improve quality and safety. However, due to the complexities of system design and inconsistent results, CDS tools may inadvertently increase alert fatigue and contribute to physician burnout. A/B testing, or rapid-cycle randomized tests, is a useful method that can be applied to the EHR in order to understand and iteratively improve design choices embedded within CDS tools. OBJECTIVE This paper describes how rapid randomized controlled trials (RCTs) embedded within EHRs can be used to quickly ascertain the superiority of potential CDS tools to improve their usability, reduce alert fatigue and promote quality of care. METHODS A multi-step process combining tools from user-centered design, A/B testing and implementation science is used to understand, ideate, prototype, test, analyze and improve each candidate CDS. CDS engagement metrics (alert views, ignores, orders) are used to evaluate which CDS version is superior. RESULTS Two experiments are highlighted to demonstrate the impact of the process. First, after multiple rounds of usability testing, a revised CDS influenza alert was tested against usual care in a rapid RCT. The new alert text resulted in minimal impact but the failure triggered another round of testing that identified key issues and led to a 70% reduction in alert volume in the next round. In the second experiment, the process was used to test three versions (financial, quality, regulatory) of text supporting tobacco cessation alerts as well as three supporting images. Three rounds of RCTs showed that the financial framing was 5-10% more effective than the other two but that adding images did not have a positive impact. CONCLUSIONS These data support the potential for this new process to rapidly develop, deploy and improve CDS within an EHR. This approach may be an important tool for improving the impact and experience of CDS. CLINICALTRIAL Our flu alert trial was registered in January 2018 with ClinicalTrials.gov, registration number NCT03415425. Our tobacco alert trial was registered in October 2018 with ClinicalTrials.gov, registration number NCT03714191.


2000 ◽  
Vol 90 (6) ◽  
pp. 300-302 ◽  
Author(s):  
MA Turlik ◽  
D Kushner

The authors reviewed 322 articles in podiatric medical journals to determine their level of evidence. Only 1% of the articles reviewed were randomized controlled trials. The authors concluded that if the podiatric medical profession wishes to become a participant in evidence-based medicine, greater emphasis must be placed on studies that assess hypotheses.


10.2196/16651 ◽  
2021 ◽  
Vol 23 (4) ◽  
pp. e16651
Author(s):  
Jonathan Austrian ◽  
Felicia Mendoza ◽  
Adam Szerencsy ◽  
Lucille Fenelon ◽  
Leora I Horwitz ◽  
...  

Background Clinical decision support (CDS) is a valuable feature of electronic health records (EHRs) designed to improve quality and safety. However, due to the complexities of system design and inconsistent results, CDS tools may inadvertently increase alert fatigue and contribute to physician burnout. A/B testing, or rapid-cycle randomized tests, is a useful method that can be applied to the EHR in order to rapidly understand and iteratively improve design choices embedded within CDS tools. Objective This paper describes how rapid randomized controlled trials (RCTs) embedded within EHRs can be used to quickly ascertain the superiority of potential CDS design changes to improve their usability, reduce alert fatigue, and promote quality of care. Methods A multistep process combining tools from user-centered design, A/B testing, and implementation science was used to understand, ideate, prototype, test, analyze, and improve each candidate CDS. CDS engagement metrics (alert views, acceptance rates) were used to evaluate which CDS version is superior. Results To demonstrate the impact of the process, 2 experiments are highlighted. First, after multiple rounds of usability testing, a revised CDS influenza alert was tested against usual care CDS in a rapid (~6 weeks) RCT. The new alert text resulted in minimal impact on reducing firings per patients per day, but this failure triggered another round of review that identified key technical improvements (ie, removal of dismissal button and firings in procedural areas) that led to a dramatic decrease in firings per patient per day (23.1 to 7.3). In the second experiment, the process was used to test 3 versions (financial, quality, regulatory) of text supporting tobacco cessation alerts as well as 3 supporting images. Based on 3 rounds of RCTs, there was no significant difference in acceptance rates based on the framing of the messages or addition of images. Conclusions These experiments support the potential for this new process to rapidly develop, deploy, and rigorously evaluate CDS within an EHR. We also identified important considerations in applying these methods. This approach may be an important tool for improving the impact of and experience with CDS. Trial Registration Flu alert trial: ClinicalTrials.gov NCT03415425; https://clinicaltrials.gov/ct2/show/NCT03415425. Tobacco alert trial: ClinicalTrials.gov NCT03714191; https://clinicaltrials.gov/ct2/show/NCT03714191


Author(s):  
Joana R. Lascasas ◽  
Joana S. Peixoto ◽  
Sofia C. Vedor

<p>Frontal fibrosing alopecia (FFA) is a primary lymphocytic cicatricial alopecia, characterized by recession of frontotemporal hairline with frequent involvement of eyebrows and affecting occasionally other body areas. Entitled an emerging epidemic, due to its rising incidence, FFA etiology remains unclear without proven effective therapies. This study reviews relevant publications on FFA, regarding pathogenesis, clinical findings, histology along with treatment and prognosis. A bibliographic search was conducted in the main international databases, using the term ‘FFA’. Guidelines, observational studies, randomized controlled trials, reviews, systematic reviews and meta-analysis regardless of publication date, presented in English, Portuguese or Spanish, were included in this review. 50 publications were fully analysed. The majority of FFA cases were observed in postmenopausal women, although both men and women from younger ages can be victims. From an etiological point of view, immune-mediated hypothesis is widely spread, as stem cells localized in the bulge region of the follicle are destroyed by an inflammatory infiltrate. However, environmental factors raised interest, since sunscreen use was related to a bigger incidence of FFA. Three clinical patterns have been described. Yet the failure to use standardized assessment methods in addition to the absence of prospective studies evaluating available therapies, do not concede comparable data. Spontaneous stabilization of disease can occur, but regrowth was only seen in scarce cases. Outcomes from randomized controlled trials and prospective studies are missing to draw further understanding of FFA.</p>


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