scholarly journals Metabolic therapy in cardiology from the perspective of evidence-based medicine

2021 ◽  
Vol 6 (1) ◽  
pp. 60-68
Author(s):  
V. I. Kostin ◽  
O. A. Shangina ◽  
V. G. Shelikhov
Keyword(s):  
Large Scale ◽  
Krebs Cycle ◽  
Creatine Phosphate ◽  
Evidence Base ◽  
Convincing Evidence ◽  
Major Adverse Cardiovascular Events ◽  
Beneficial Effects ◽  
Tissue Resistance ◽  
Based Medicine ◽  
Dependent Processes

Over the past few decades, various applications of the metabolic drugs have been extensively tested. Most of them affect oxygen-dependent processes, improving cellular metabolism and increasing tissue resistance to hypoxia and ischemia. The most promising candidates include components of the respiratory chain, purine nucleosides, and creatine phosphate which affect glucose oxidation and fatty acid metabolism in the Krebs cycle. This review critically evaluates the most popular drugs of this group (adenosine triphosphate, adenosine-5-monophosphate, creatine phosphate, coenzyme Q10, cytochrome C, adenosine, glucose-insulin-potassium solution, L-carnitine, mildronate, and trimetazidine), which are widely represented on the pharmaceutical market. Of all metabolic drugs, only trimetazidine was included in the European and Russian recommendations for the second-line treatment of stable angina. In most clinical studies, the therapeutic efficacy of metabolic drugs has been evaluated using the surrogate endpoints. Despite being actively advertised and widely used in the clinical practice, metabolic drugs currently do not have a convincing evidence base for affecting prognosis (mortality and/or major adverse cardiovascular events). Further studies in large-scale randomised trials are needed to confirm the beneficial effects of the metabolic drugs in cardiovascular medicine.

THE ROLE OF PHAGE THERAPY IN THE FORMATION OF THE INTESTINAL MICROECOSYSTEM

2020 ◽  
pp. 183-191
Author(s):  
Gladkov S.F. ◽  
Perevoshchikova N.K. ◽  
Chernykh N.S. ◽  
Pichugina Yu.S. ◽  
Surkova M.A.
Keyword(s):  
Intestinal Microbiota ◽  
Allergic Diseases ◽  
Evidence Base ◽  
Immunological Tolerance ◽  
Convincing Evidence ◽  
Selective Decontamination ◽  
Genetic Characteristics ◽  
Treatment And Prevention ◽  
Intestinal Infections ◽  
The Individual

The current adverse situation associated with the presence of a pandemic of allergic diseases is due to the lack of a scientifically based concept of treatment and prevention. The increased interest of researchers from different countries in the formation of immunological tolerance by modeling the intestinal microbiota is of high importance. Methods of influence on the microbial communities of the child's intestine should be as delicate as possible, taking into account the individual genetic characteristics of the microecosystem and the possibility of anaphylaxis. Until now, probiotic drugs have been widely used to correct dysbiosis, but data is gradually accumulating that there is no convincing evidence base for their use for the treatment and prevention of atopy. The use of bacteriophages is very relevant and one of the promising, actively studied areas of correction of intestinal biocenosis today, which are an alternative to antibiotic and probiotic medications. Selective decontamination of representatives of opportunistic flora, as the main factor in the implementation of the atopic phenotype, makes it possible to preserve and accelerate the formation of a unique and individual composition of the intestinal microbiota of the child, which can form an immunoregulatory balance. More than a century of experience in the use of bacteriophages indicates the safety of their use. Today, bacteriophages are actively used in various fields of practical medicine − obstetrics-gynecology, perinatology, urology, pediatric otorhinolaryngology, in the treatment of purulent-septic and intestinal infections. In some cases, bacteriophages are very effective against antibiotic-resistant pathogens. The active personalized use of bacteriophages in real clinical practice will make it possible to solve a number of serious, long-standing health problems in the Russian Federation and to win a world priority in this direction.

scholarly journals Co-occurrences of tropical trees in eastern South America: disentangling abiotic and biotic forces

Plant Ecology ◽  
2021 ◽  
Author(s):  
Emma-Liina Marjakangas ◽  
Otso Ovaskainen ◽  
Nerea Abrego ◽  
Vidar Grøtan ◽  
Alexandre A. de Oliveira ◽  
...  
Keyword(s):  
South America ◽  
Tree Species ◽  
Large Scale ◽  
Environmental Filtering ◽  
Limiting Similarity ◽  
Phylogenetic Relatedness ◽  
Biogeographical Regions ◽  
Dependent Processes ◽  
Occurrence Of Species

AbstractSpecies co-occurrences in local communities can arise independent or dependent on species’ niches. However, the role of niche-dependent processes has not been thoroughly deciphered when generalized to biogeographical scales, probably due to combined shortcomings of data and methodology. Here, we explored the influence of environmental filtering and limiting similarity, as well as biogeographical processes that relate to the assembly of species’ communities and co-occurrences. We modelled jointly the occurrences and co-occurrences of 1016 tropical tree species with abundance data from inventories of 574 localities in eastern South America. We estimated species co-occurrences as raw and residual associations with models that excluded and included the environmental effects on the species’ co-occurrences, respectively. Raw associations indicate co-occurrence of species, whereas residual associations indicate co-occurrence of species after accounting for shared responses to environment. Generally, the influence of environmental filtering exceeded that of limiting similarity in shaping species’ co-occurrences. The number of raw associations was generally higher than that of the residual associations due to the shared responses of tree species to the environmental covariates. Contrary to what was expected from assuming limiting similarity, phylogenetic relatedness or functional similarity did not limit tree co-occurrences. The proportions of positive and negative residual associations varied greatly across the study area, and we found a significant tendency of some biogeographical regions having higher proportions of negative associations between them, suggesting that large-scale biogeographical processes limit the establishment of trees and consequently their co-occurrences.

scholarly journals Type 1 Diabetic Neuropathy and C-peptide

2004 ◽  
Vol 5 (1) ◽  
pp. 65-77 ◽  
Author(s):  
Anders A. F. Sima ◽  
Weixian Zhang ◽  
George Grunberger
Keyword(s):  
Clinical Trials ◽  
Animal Studies ◽  
Large Scale ◽  
Structural Changes ◽  
Diabetic Complication ◽  
Diabetic Patients ◽  
C Peptide ◽  
Beneficial Effects ◽  
Regulatory Effects

The most common microvascular diabetic complication, diabetic peripheral polyneuropathy (DPN), affects type 1 diabetic patients more often and more severely. In recent decades, it has become increasingly clear that perpetuating pathogenetic mechanisms, molecular, functional, and structural changes and ultimately the clinical expression of DPN differ between the two major types of diabetes. Impaired insulin/C-peptide action has emerged as a crucial factor to account for the disproportionate burden affecting type 1 patients. C-peptide was long believed to be biologically inactive. However, it has now been shown to have a number of insulin-like glucoseindependent effects. Preclinical studies have demonstrated dose-dependent effects onNa+,K+-ATPase activity, endothelial nitric oxide synthase (eNOS), and endoneurial blood flow. Furthermore, it has regulatory effects on neurotrophic factors and molecules pivotal to the integrity of the nodal and paranodal apparatus and modulatory effects on apoptotic phenomena affecting the diabetic nervous system. In animal studies, C-peptide improves nerve conduction abnormalities, prevents nodal degenerative changes, characteristic of type 1 DPN, promotes nerve fiber regeneration, and prevents apoptosis of central and peripheral nerve cell constituents. Limited clinical trials have confirmed the beneficial effects of C-peptide on autonomic and somatic nerve function in patients with type 1 DPN. Therefore, evidence accumulates that replacement of C-peptide in type 1 diabetes prevents and even improves DPN. Large-scale food and drug administration (FDA)-approved clinical trials are necessary to make this natural substance available to the globally increasing type 1 diabetic population.

What Can Feminist Epistemology Do for Surgery?

Hypatia ◽  
2014 ◽  
Vol 29 (2) ◽  
pp. 404-421 ◽  
Author(s):  
Mary Jean Walker ◽  
Wendy Rogers
Keyword(s):  
Health Care ◽  
Evidence Base ◽  
Feminist Epistemology ◽  
Cultural Barriers ◽  
Evidence Based ◽  
Surgical Practice ◽  
Lack Of Fit ◽  
What Works ◽  
Based Medicine ◽  
Contemporary Health Care

Surgery is an important part of contemporary health care, but currently much of surgery lacks a strong evidence base. Uptake of evidence‐based medicine (EBM) methods within surgical research and among practitioners has been slow compared with other areas of medicine. Although this is often viewed as arising from practical and cultural barriers, it also reflects a lack of epistemic fit between EBM research methods and surgical practice. In this paper we discuss some epistemic challenges in surgery relating to this lack of fit, and investigate how resources from feminist epistemology can help to characterize them. We point to ways in which these epistemic challenges may be addressed by gathering and disseminating evidence about what works in surgery using methods that are contextual, pluralistic, and sensitive to hierarchies.

scholarly journals A review of guidance on fish consumption in pregnancy: is it fit for purpose?

2018 ◽  
Vol 21 (11) ◽  
pp. 2149-2159 ◽  
Author(s):  
Caroline M Taylor ◽  
Pauline M Emmett ◽  
Alan M Emond ◽  
Jean Golding
Keyword(s):  
Pregnant Women ◽  
Fish Consumption ◽  
Evidence Base ◽  
Positive Contribution ◽  
National Guidelines ◽  
International Guidelines ◽  
Beneficial Effects ◽  
Use Of Technology ◽  
The Impact ◽  
In Pregnancy

AbstractObjectivePublic health messages to reduce Hg exposure for pregnant women have focused exclusively on advice on fish consumption to limit Hg exposure, with little account being taken of the positive contribution of fish to nutritional quality. The aim of the present review was to compare and contrast the content and presentation of national guidelines on fish consumption in pregnancy, and comment on their evidence base and impact on consumption.DesignWe searched for national and international guidelines on fish consumption in pregnancy using Internet search strategies. The detailed content and style of presentation of the guidelines were compared. The evidence base for the guidelines, and evidence for the impact of the guidelines on fish consumption levels, were assessed.ResultsWe identified nineteen national guidelines and three international guidelines. There was great variation in the content, complexity and presentation style. The guidelines were based largely on the Hg content of fish with far less consideration being given to the positive beneficial effects of nutrients provided by fish. The complexity of the guidelines may lead to pregnant women reducing their fish intake, or not eating fish at all.ConclusionsGuidelines on fish consumption in pregnancy should take the beneficial effects of fish into account. Guidelines need to be clear and memorable, and appropriately disseminated, to achieve impact. Guidelines could include visual rather than narrative content. Use of technology, for example apps, could enable women to record their fish consumption in real time and log compliance with guidance over a week or other time period.

Unhealthy Politics

2020 ◽  
Author(s):  
Eric M. Patashnik ◽  
Alan S. Gerber ◽  
Conor M. Dowling
Keyword(s):  
United States ◽  
Health Care ◽  
Scientific Evidence ◽  
The United States ◽  
Evidence Base ◽  
Medical Industry ◽  
Evidence Based ◽  
Evidence Based Practices ◽  
Delivery Of Medical Care ◽  
Based Medicine

The U.S. medical system is touted as the most advanced in the world, yet many common treatments are not based on sound science. This book sheds new light on why the government's response to this troubling situation has been so inadequate, and why efforts to improve the evidence base of U.S. medicine continue to cause so much political controversy. The book paints a portrait of a medical industry with vast influence over which procedures and treatments get adopted, and a public burdened by the rising costs of health care yet fearful of going against “doctor's orders.” It offers vital insights into the limits of science, expertise, and professionalism in American politics. The book explains why evidence-based medicine is important. First, the delivery of unproven care can expose patients to serious risks. Second, the slow integration of evidence can lead to suboptimal outcomes for patients who receive treatments that work less well for their conditions than alternatives. Third, the failure to implement evidence-based practices encourages wasteful spending, causing the health care system to underperform relative to its level of investment. This book assesses whether the delivery of medical care in the United States is evidence based. It argues that by systematically ignoring scientific evidence (or the lack thereof), the United States is substantially out of balance.

Research methods and evidence-based medicine

2018 ◽  
pp. 19-24
Author(s):  
Tim Colbourn
Keyword(s):  
Research Methods ◽  
Meta Analysis ◽  
Research Question ◽  
Secondary Data ◽  
Evidence Base ◽  
Primary Data ◽  
Key Points ◽  
Study Type ◽  
Based Medicine ◽  
And Child Health

This chapter provides an overview of research methods used to build the evidence base for global maternal and child health. It covers primary data collection, secondary data analysis, systematic reviews, and meta-analysis, and provides tips on how to interpret the scientific literature. This chapter should be read in conjunction with Chapters 1–3, Chapter 5 on economic evaluation, and Chapter 4 on converting research into policy to put the use of research evidence into context. The three key points from this chapter are: (1) you need to clearly define a research question before deciding what study type is best suited to answer it; (2) designing a research study involves detailed attention to practical details, including how groups are going to be defined; and (3) scientific studies are sometimes published with incorrect conclusions. Critically appraise each study, and define appropriate conclusions that are based on the data and methodology.

scholarly journals What role should randomized control trials play in providing the evidence base for conservation?

Oryx ◽  
2019 ◽  
pp. 1-10 ◽  
Author(s):  
Edwin L. Pynegar ◽  
James M. Gibbons ◽  
Nigel M. Asquith ◽  
Julia P. G. Jones
Keyword(s):  
Large Scale ◽  
Relevant Literature ◽  
Evidence Base ◽  
Randomized Control Trials ◽  
High Quality ◽  
Bolivian Andes ◽  
Behavioural Effects ◽  
Randomized Control ◽  
The Impact ◽  
Conservation Interventions

AbstractThe effectiveness of many widely used conservation interventions is poorly understood because of a lack of high-quality impact evaluations. Randomized control trials (RCTs), in which experimental units are randomly allocated to treatment or control groups, offer an intuitive way to calculate the impact of an intervention by establishing a reliable counterfactual scenario. As many conservation interventions depend on changing people's behaviour, conservation impact evaluation can learn a great deal from RCTs in fields such as development economics, where RCTs have become widely used but are controversial. We build on relevant literature from other fields to discuss how RCTs, despite their potential, are just one of a number of ways to evaluate impact, are not feasible in all circumstances, and how factors such as spillover between units and behavioural effects must be considered in their design. We offer guidance and a set of criteria for deciding when RCTs may be an appropriate approach for evaluating conservation interventions, and factors to consider to ensure an RCT is of high quality. We illustrate this with examples from one of the few concluded RCTs of a large-scale conservation intervention: an incentive-based conservation programme in the Bolivian Andes. We argue that conservation should aim to avoid a rerun of the polarized debate surrounding the use of RCTs in other fields. Randomized control trials will not be feasible or appropriate in many circumstances, but if used carefully they can be useful and could become a more widely used tool for the evaluation of conservation impact.

scholarly journals Large Scale Clustering in the Universe

1978 ◽  
Vol 79 ◽  
pp. 217-226 ◽  
Author(s):  
P. J. E. Peebles
Keyword(s):  
Large Scale ◽  
Variable Stars ◽  
Convincing Evidence ◽  
The Universe

In 1924 Hubble presented the first generally convincing evidence, from the identification of variable stars, that some of the brightest “spiral nebulae” are galaxies of stars well outside the bounds of our own Galaxy. This led him to reconsider the idea that the faint “spiral nebulae,” which were known to be much more abundant than bright ones, might be similar objects at greater distances.

Embracing the Cascade: evidence-based medicine

UK-Vet Equine ◽  
2019 ◽  
Vol 3 (5) ◽  
pp. 162-167 ◽  
Author(s):  
Adam Redpath ◽  
Mark Bowen
Keyword(s):  
Evidence Base ◽  
Veterinary Medicines ◽  
Veterinary Surgeons ◽  
Prescribing Cascade ◽  
The Uk ◽  
Based Medicine ◽  
Potential Food ◽  
Case Basis ◽  
Selection Of ◽  
The Eu

The prescribing cascade is a risk-based algorithm that is applied on a case-by-case basis when selecting medicines that are not authorised in a given clinical scenario. It allows for the use of other veterinary medicines, whether authorised in the horse or other species, the use of human medicines from the UK and veterinary medicines from the EU or the use of specials (compounded or medicines produced extemporaneously). Its application brings with it several professional obligations and responsibilities, including the need to obtain written consent. Given the potential food-producing status of the horse, equine veterinary surgeons have additional considerations compared to those working with other species (whether farm animal or companion). Medicine selection under the Cascade must be based on valid justifications for not using authorised medicines (where available) and for the selection of subsequent steps in the Cascade. These justifications should be based on clinical need and a robust evidence base. Given that the Cascade exists to improve animal welfare, cost should not normally be considered as a reason for selecting medicines in the horse.

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