scholarly journals Principles of drug therapy for acute bacterial rhinosinusitis: from evidence-based medicine to practice

2018 ◽  
Vol 26 (1) ◽  
pp. 106-116
Author(s):  
D. S. Pshennikov ◽  
I. B. Angotoeva
Keyword(s):  
Evidence Based Medicine ◽  
Therapeutic Approach ◽  
Bacterial Resistance ◽  
Diagnostic Errors ◽  
High Rate ◽  
Differential Diagnostics ◽  
Evidence Based ◽  
Wide Range ◽  
Acute Bacterial Rhinosinusitis ◽  
Based Medicine

The problem of treatment of acute rhinosinusitis (ARS) is extremely important due to high prevalence of the disease. According to statistical data the ARS affects from 6% to 15% of population and does not show any tendency to reduction. These figures are associated with a high rate of acute respiratory viral infection (ARVI) which directly leads to rhinosinusitis. But, however, despite the fact that practically every individual experiences from 2 to 5 episodes of ARVI every year, only 0.5-2% of them are complicated with acute bacterial rhinosinusitis (ABRS). Despite this low percentage of bacterial infection, in 80% of cases systemic antibacterial treatment is prescribed which further worsens the problem of bacterial resistance in the world. The main difficulty in determination of therapeutic approach to ABRS is associated with absence of reliable methods of differential diagnostics of viral and bacterial etiology of the disease. Because of low sensitivity and specificity, none of additional visualization methods of ABRS diagnosing such as radiography, ultrasonography, computed tomography, can be used as a routine laboratory method. Thus, the main method of differential diagnostics of viral and bacterial ARS remains analysis of clinical data which leads to a high rate of diagnostic errors and to polypragmacy. Nowadays there exists a wide range of medications for treatment of ABRS in the pharmacological market. The choice of therapeutic approach by our international colleagues is mostly based on the requirements of evidence-based medicine. Russian scientists, besides evidence-based medicine principles take into account the pathogenesis of the disease. In this article different groups of medications for treatment of ABRS are presented. Some of them do not meet the requirements of evidence-based medicine so far, but they are included to the Russian standards and are used for management of ABRS.

scholarly journals Principles of drug therapy for acute bacterial rhinosinusitis: from evidence-based medicine to practice

2018 ◽  
Vol 26 (1) ◽  
pp. 106-116
Author(s):  
D. S. Pshennikov ◽  
I. B. Angotoeva
Keyword(s):  
Evidence Based Medicine ◽  
Therapeutic Approach ◽  
Bacterial Resistance ◽  
Diagnostic Errors ◽  
High Rate ◽  
Differential Diagnostics ◽  
Evidence Based ◽  
Wide Range ◽  
Acute Bacterial Rhinosinusitis ◽  
Based Medicine

The problem of treatment of acute rhinosinusitis (ARS) is extremely important due to high prevalence of the disease. According to statistical data the ARS affects from 6% to 15% of population and does not show any tendency to reduction. These figures are associated with a high rate of acute respiratory viral infection (ARVI) which directly leads to rhinosinusitis. But, however, despite the fact that practically every individual experiences from 2 to 5 episodes of ARVI every year, only 0.5-2% of them are complicated with acute bacterial rhinosinusitis (ABRS). Despite this low percentage of bacterial infection, in 80% of cases systemic antibacterial treatment is prescribed which further worsens the problem of bacterial resistance in the world. The main difficulty in determination of therapeutic approach to ABRS is associated with absence of reliable methods of differential diagnostics of viral and bacterial etiology of the disease. Because of low sensitivity and specificity, none of additional visualization methods of ABRS diagnosing such as radiography, ultrasonography, computed tomography, can be used as a routine laboratory method. Thus, the main method of differential diagnostics of viral and bacterial ARS remains analysis of clinical data which leads to a high rate of diagnostic errors and to polypragmacy. Nowadays there exists a wide range of medications for treatment of ABRS in the pharmacological market. The choice of therapeutic approach by our international colleagues is mostly based on the requirements of evidence-based medicine. Russian scientists, besides evidence-based medicine principles take into account the pathogenesis of the disease. In this article different groups of medications for treatment of ABRS are presented. Some of them do not meet the requirements of evidence-based medicine so far, but they are included to the Russian standards and are used for management of ABRS.

scholarly journals Subacute cough in preschool children: differential diagnostics and differentiated therapy under ambulatory practice

2021 ◽  
pp. 46-55
Author(s):  
S.A. Mokiya–Serbina ◽  
◽  
T.V. Litvinova ◽  
N.I. Zabolotnyaya ◽  
◽  
...  
Keyword(s):  
Preschool Children ◽  
Respiratory Tract ◽  
Evidence Based Medicine ◽  
Respiratory Infections ◽  
Differential Diagnostics ◽  
Evidence Based ◽  
Acute Respiratory Infections ◽  
Upper Respiratory Tract ◽  
Outpatient Practice ◽  
Based Medicine

The multifactorial nature of subacute cough, combined with the anatomical and physiological characteristics of preschool children, the impossibility of their full examination in outpatient practice, complicates its diagnosis. An algorithm for the differential diagnosis of acute respiratory infections accompanied by subacute cough in preschool children has been developed, it can contribute to the early identification of its causes and targeted treatment of the disease that caused the cough. A sequence of diagnostic measures is proposed, it includes anamnesis of life and diseases with a list of key questions that should be asked when collecting anamnesis in children with prolonged cough; objective examination of the child; determination of the tactics of further management (inpatient or outpatient); the choice of therapy that is comparable to the intended diagnosis; and evaluation of ongoing therapy. The emphasis is made on the importance of a full-fledged collection of anamnesis, taking into account the data of the time and conditions of the disease, and clinical data for making a presumptive diagnosis in an outpatient practice. It is recommended to carry out trial therapy if the diagnosis is difficult. The article presents modern approaches to the diagnosis of bronchial asthma in children with recurrent virus-induced vising. The modern approaches to the diagnosis and treatment of acute respiratory infections of the upper and lower respiratory tract are outlined in accordance with the principles of evidence-based medicine. It is noted that the most effective methods of treating cough are etiological and pathogenetic approaches, which consist in eliminating or weakening the action of factors that cause cough. It is emphasized that if treatment is impossible or insufficient, symptomatic cough therapy should be carried out. The main directions of symptomatic treatment of cough have been substantiated, which include measures to improve the drainage function of the lungs and restore adequate mucociliary clearance. The expediency of using ambroxol and acetylcysteine preparations was confirmed. Attention is also paid to the use of centrally acting antitussives. Discussion of the problem «to treat or not to treat subacute cough in acute respiratory infection of the upper respiratory tract» from the standpoint of evidence-based medicine is shown. No conflict of interest was declared by the authors. Key words: children, subacute cough, acute respiratory infections.

Achieving quality: Comparing recommendations for cancer care between NCCN and ESMO.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 6579-6579
Author(s):  
Jennifer Gao ◽  
Geoffrey Calkins ◽  
Michael J. Birrer ◽  
Don S. Dizon
Keyword(s):  
Breast Cancer ◽  
Colon Cancer ◽  
Evidence Based Medicine ◽  
B Cell Lymphoma ◽  
The United States ◽  
Treatment Recommendations ◽  
High Rate ◽  
Partial Breast Irradiation ◽  
Evidence Based ◽  
Based Medicine

6579 Background: Guidelines for the treatment of cancer are in place in both the United States and Europe. However, specific recommendations that can be utilized as measures of quality care have not been evaluated in either guideline set, nor have they have been compared against one another. Our aim was to delineate the number of concrete treatment recommendations made using the PICO model for evidence-based medicine. Methods: Three authors (JG, GC, DD) independently reviewed treatment guidelines of the National Comprehensive Cancer Network (NCCN) and the European Society for Medical Oncology (ESMO) for three common cancers: 1) breast cancer; 2) colon cancer; 3) non-Hodgkin lymphoma (specifically diffuse large B-cell lymphoma and follicular lymphoma). The primary objective was to differentiate the concordant versus discordant recommendations. Recommendations were identified by first identifying all category 1 and 2 guidelines in ESMO, then finding the equivalent NCCN recommendations, and finally assessing their fulfillment of the PICO model (Patient/Problem – Intervention – Comparison – Outcome). Each recommendation was separately analyzed by the three aforementioned authors of this abstract. The results reflect the unanimous agreement of all three reporters. Results: Using PICO criteria, we identified a total of 46 recommendations (10 colon cancer, 22 breast cancer, and 14 in NHL). Concordance between NCCN and ESMO was 80, 86, and 100 percent, respectively. Discordance between NCCN and ESMO were noted in first line chemotherapy regimens in localized colon cancer and fluoropyridine as maintenance therapy in unresectable colon cancer; patients who should receive partial breast irradiation and chemotherapy regimens in the elderly with breast cancer. Conclusions: The number of actual recommendations that meet the PICO evidence-based medicine criteria is relatively small. However, comparing NCCN and ESMO, there is a high rate of agreement between guidelines reviewed regarding treatment recommendations. Our data suggest that it may be possible to identify specific measures of quality treatment as defined by evidence based medicine criteria.

scholarly journals Viral and recurrent croup in children

2019 ◽  
pp. 100-105
Author(s):  
D. Y. Ovsyannikov ◽  
L. G. Kuzmenko ◽  
O. V. Alekseeva ◽  
V. Nguyen ◽  
O. G. Topilin ◽  
...  
Keyword(s):  
Diagnostic Criteria ◽  
Clinical Picture ◽  
Evidence Based Medicine ◽  
Differential Diagnostics ◽  
Evidence Based ◽  
Diagnostic Features ◽  
International Consensus ◽  
Clinical Recommendations ◽  
Modern Information ◽  
Based Medicine

The article presents modern information about epidemiology, etiology, pathogenesis, clinical picture, classification by severity, diagnostics and differential diagnostics, treatment and prognosis of viral and relapsing croup in children. Etiological factors, differential diagnostic features and prognosis of croup recidivism in children are considered. The basic diagnostic criteria of alternative diseases with a stridor are given. Croup therapy is characterized on the basis of the Federal Clinical Recommendations and international consensus documents using the principles of evidence-based medicine.

Cholangiokarzinome

Praxis ◽  
2002 ◽  
Vol 91 (34) ◽  
pp. 1352-1356
Author(s):  
Harder ◽  
Blum
Keyword(s):  
Supportive Care ◽  
Evidence Based Medicine ◽  
Best Supportive Care ◽  
Evidence Based ◽  
Systemische Chemotherapie ◽  
Chirurgische Resektion ◽  
Multimodale Therapiekonzepte ◽  
Based Medicine

Cholangiokarzinome oder cholangiozelluläre Karzinome (CCC) sind seltene Tumoren des biliären Systems mit einer Inzidenz von 2–4/100000 pro Jahr. Zu ihnen zählen die perihilären Gallengangskarzinome (Klatskin-Tumore), mit ca. 60% das häufigste CCC, die peripheren (intrahepatischen) Cholangiokarzinome, das Gallenblasenkarzinom, die Karzinome der extrahepatischen Gallengänge und das periampulläre Karzinom. Zum Zeitpunkt der Diagnose ist nur bei etwa 20% eine chirurgische Resektion als einzige kurative Therapieoption möglich. Die Lebertransplantation ist wegen der hohen Rezidivrate derzeit nicht indiziert. Die Prognose von nicht resektablen Cholangiokarzinomen ist mit einer mittleren Überlebenszeit von sechs bis acht Monaten schlecht. Eine wirksame Therapie zur Verlängerung der Überlebenszeit existiert aktuell nicht. Die wichtigste Massnahme im Rahmen der «best supportive care» ist die Beseitigung der Cholestase (endoskopisch, perkutan oder chirurgisch), um einer Cholangitis oder Cholangiosepsis vorzubeugen. Durch eine systemische Chemotherapie lassen sich Ansprechraten von ca. 20% erreichen. 5-FU und Gemcitabine sind die derzeit am häufigsten eingesetzten Substanzen, die mit einer perkutanen oder endoluminalen Bestrahlung kombiniert werden können. Multimodale Therapiekonzepte können im Einzellfall erfolgreich sein, müssen jedoch erst in Evidence-Based-Medicine-gerechten Studien evaluiert werden, bevor Therapieempfehlungen für die Praxis formuliert werden können.

The Commitment of the Documentation Service of the Swiss Academy of Medical Sciences for the Impartment of Evidence Based Medicine

Swiss Surgery ◽  
1999 ◽  
Vol 5 (4) ◽  
pp. 183-185
Author(s):  
Bleuer
Keyword(s):  
Evidence Based Medicine ◽  
Cochrane Library ◽  
Evidence Based ◽  
Medical Sciences ◽  
Based Medicine

Die mit dem Aufkommen der elektronischen Medien einhergehende Informationsflut hat die Erwartungen an den Dokumentationsdienst (DOKDI) der Schweizerischen Akademie der Medizinischen Wissenschaften verändert: Insbesondere Evidence Based Medicine (EBM) verlangt nicht nur die Beschaffung von Information, sondern auch eine Selektion hinsichtlich Qualität und Relevanz: Die sich aus der klinischen Situation ergebende Frage fordert eine Antwort, die inhaltlich richtig ist und in der konkreten Situation auch weiterhilft. Dem Ideal, sich durch kritische Lektüre der Originalarbeiten ein Bild über die vorhandene Evidenz für die Richtigkeit eines bestimmten Prozederes zu verschaffen, stehen in der Praxis meist Zeitmangel und methodische Schwierigkeiten im Weg; man wird sich deshalb oft auf die durch andere erarbeitete Evidenz abstützen müssen und z.B. die Cochrane Library konsultieren. Der DOKDI engagiert sich sowohl bei der Erarbeitung von systematischen Übersichtsarbeiten als auch bei der Dissemination der gefundenen Evidenz, indem er seine Erfahrung in der Dokumentation mit elektronischen Medien und die entsprechende Infrastruktur zur Verfügung stellt. Als Ergänzung zu diesen Aktivitäten hat die Akademie einen Grant zur Ausbildung von EBM-Tutoren gesprochen. In einem einwöchigen Kurs in Oxford werden Kliniker zu EBM-Tutoren ausgebildet: Dies wird zukünftig ermöglichen, vermehrt EBM-Workshops in der Schweiz durchzuführen.

Stellenwert der Kinderneurologie im interdisziplinären Ansatz der Frühförderung

2003 ◽  
Vol 12 (1) ◽  
pp. 3-11 ◽  
Author(s):  
Ingrid Müller
Keyword(s):  
Evidence Based Medicine ◽  
Evidence Based ◽  
Based Medicine ◽  
Kosten Im Gesundheitswesen

Zusammenfassung. Die kinderneurologische Begleitung erfüllt zwei wesentliche Aufgaben innerhalb des interdisziplinären Konzepts der Frühförderung. Sie ist zum einen Teil des Diagnostik- und Therapieprozesses; dieser orientiert sich an der neurophysiologischen Erkenntnis, dass das Gehirn ein sich selbst organisierendes System ist und seine Funktionalität in der Interaktion mit dem Umfeld entwickelt. Heutige kinderneurologische Diagnostik basiert daher auf einem systemisch-ökologischen Ansatz. Zum anderen tragen entwicklungsneurologische Befunde, die sich zur prognostischen Beurteilung therapeutischer Maßnahmen eignen, wesentlich zur Qualitätssicherung und -kontrolle in der Frühförderung bei. In den letzten Jahren ist eine Inflation bei der Verordnung entwicklungsfördernder Maßnahmen zu beobachten. Um eine Explosion der Kosten im Gesundheitswesen zu verhindern, werden sich in Zukunft Kriterien der evidence-based medicine auch in der Frühförderung durchsetzen müssen.

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