scholarly journals The issue of preservatives in light of evidence based medicine

2021 ◽  
Vol 8 (3) ◽  
pp. 180-184
Author(s):  
Marta Misiuk-Hojło ◽  
Karolina Pawłowska
Keyword(s):  
Antimicrobial Activity ◽  
Drug Therapy ◽  
Benzalkonium Chloride ◽  
Bibliographic Databases ◽  
Evidence Based ◽  
Eye Drops ◽  
Primary Role ◽  
Meta Analyses ◽  
Based Medicine ◽  
Topical Medications

Glaucoma is the leading cause of irreversible blindness worldwide. Most patients will require drug therapy for the rest of their lives. Preservatives play a key role in the development of topical medications whose primary role is to provide antimicrobial activity to maintain sterility. The most common preservative is benzalkonium chloride, which has antibacterial, antifungal, and antiviral properties. This article was written based on the latest research in MEDLINE and other major bibliographic databases for studies published in English by August 1st, 2021. Our meta-analyses confirm that eye drops side effects are not caused solely by the presence of preservatives, and the effectiveness of anti-glaucoma drugs containing benzalkonium chloride and those without preservatives is comparable. During the COVID-19 pandemic, studies showed the protective effect of preservatives against SARS-CoV-2.

scholarly journals Revisiting Statistics and Evidence-Based Medicine: On the Fallacy of the Effect Size Based on Correlation and Misconception of Contingency Tables

2021 ◽  
Author(s):  
Sergey Roussakow
Keyword(s):  
Effect Size ◽  
Evidence Based Medicine ◽  
Binary Data ◽  
Contingency Tables ◽  
Evidence Based ◽  
Mean Square ◽  
Bias Analysis ◽  
Contingency Coefficient ◽  
Meta Analyses ◽  
Based Medicine

Abstract BACKGROUND: Evidence-based medicine (EBM) is in crisis, in part due to bad methods, which are understood as misuse of statistics that is considered correct in itself. The correctness of the basic statistics related to the effect size (ES) based on correlation (CBES) was questioned. METHODS: Monte Carlo simulation of two paired binary samples, mathematical analysis, conceptual analysis, bias analysis. RESULTS: Actual effect size and CBES are not related. CBES is a fallacy based on misunderstanding of correlation and ES and confusion with 2 × 2 tables that makes no distinction between gross crosstabs (GCTs) and contingency tables (CTs). This leads to misapplication of Pearson’s Phi, designed for CTs, to GCTs and confusion of the resulting gross Pearson Phi, or mean-square effect half-size, with the implied Pearson mean square contingency coefficient. Generalizing this binary fallacy to continuous data and the correlation in general (Pearson’s r) resulted in flawed equations directly expressing ES in terms of the correlation coefficient, which is impossible without including covariance, so these equations and the whole CBES concept are fundamentally wrong. misconception of contingency tables (MCT) is a series of related misconceptions due to confusion with 2 × 2 tables and misapplication of related statistics. Problems arising from these fallacies are discussed and the necessary changes to the corpus of statistics are proposed resolving the problem of correlation and ES in paired binary data. CONCLUSIONS: Two related common misconceptions in statistics have been exposed, CBES and MCT. The misconceptions are threatening because most of the findings from contingency tables, including meta-analyses, can be misleading. Since exposing these fallacies casts doubt on the reliability of the statistical foundations of EBM in general, we urgently need to revise them.

scholarly journals THERAPEUTIC METHODS IN CEREBRAL PALSY FROM THE STANDPOINT OF EVIDENCE-BASED MEDICINE

2019 ◽  
Vol 21 (3) ◽  
pp. 168-174
Author(s):  
Leila A. Pak ◽  
K. V. Zherdev ◽  
L. M. Kuzenkova ◽  
A. L. Kurenkov ◽  
B. I. Bursagova
Keyword(s):  
Cerebral Palsy ◽  
Stem Cell ◽  
Evidence Based Medicine ◽  
Vagal Stimulation ◽  
Clinical Manifestations ◽  
Evidence Based ◽  
Complementary Treatment ◽  
Epidural Stimulation ◽  
Meta Analyses ◽  
Based Medicine

In the article the authors consider such methods of the alternative/complementary treatment of the cerebral palsy (CP), presented in the modern domestic and foreign literature, as metabolic (amino acid composites), metamer (I.A. Skvortsov), intravenous administration of baclofen, antiepileptic (vagal stimulation, levetiracetam), acupuncture, transcranial cerebral micropolarization, epidural stimulation, modified motion-induced restriction therapy (MMIRT), stem cell therapy, as well as some other complementary/palliative approaches to the correction of clinical manifestations of various forms of CP. The final part of the article presents the attitude of modern evidence-based medicine to the main methods of the alternative/complementary treatment of cerebral palsy. These data are based almost exclusively on international systematic reviews and relevant meta-analyses.

Evidence-based approaches to psychiatry

2017 ◽  
pp. 119-134
Author(s):  
Paul Harrison ◽  
Philip Cowen ◽  
Tom Burns ◽  
Mina Fazel
Keyword(s):  
Patient Experience ◽  
Meta Analysis ◽  
Psychiatric Research ◽  
Evidence Based ◽  
High Quality ◽  
Qualitative Methodologies ◽  
Meta Analyses ◽  
Based Medicine ◽  
Quality Evidence

‘Evidence-based approaches to psychiatry’ describes the application of evidence-based medicine (EBM) to psychiatric practice. The chapter covers the key processes in EBM, including the formulation of a clinically relevant question, the systematic search for high-quality evidence and the meta-analytic synthesis of data. It demonstrates how evidence-based approaches to psychiatry have led to important developments showing quantitative effects of different treatments through advanced meta-analysis of data from randomized trials. This has underpinned the development of clinical guidelines that have the aim of improving the reliability and quality of treatments that patients receive. The chapter also describes how meta-analyses should be critically reviewed, as well as their problems and limitations. Not all relevant questions in psychiatric research are susceptible to the quantitative approach offered by EBM, and the chapter also outlines how qualitative methodologies can play a key role in answering important questions related, for example, to the patient experience.

scholarly journals Pearls for Interpreting Neurosurgical Systematic Reviews and Meta-Analyses: Lessons From a Collaborative Effort

Neurosurgery ◽  
2020 ◽  
Vol 87 (3) ◽  
pp. 435-441 ◽  
Author(s):  
Victor M Lu ◽  
Christopher S Graffeo ◽  
Avital Perry ◽  
Michael J Link ◽  
Fredric B Meyer ◽  
...  
Keyword(s):  
Systematic Reviews ◽  
Evidence Based Medicine ◽  
Lessons Learned ◽  
Evidence Based ◽  
Cranial Neuralgia ◽  
The Individual ◽  
Meta Analyses ◽  
Based Medicine ◽  
Over Time

Abstract Systematic reviews and meta-analyses in the neurosurgical literature have surged in popularity over the last decade. It is our concern that, without a renewed effort to critically interpret and appraise these studies as high or low quality, we run the risk of the quality and value of evidence-based medicine in neurosurgery being misinterpreted. Correspondingly, we have outlined 4 major domains to target in interpreting neurosurgical systematic reviews and meta-analyses based on the lessons learned by a collaboration of clinicians and academics summarized as 4 pearls. The domains of (1) heterogeneity, (2) modeling, (3) certainty, and (4) bias in neurosurgical systematic reviews and meta-analyses were identified as aspects in which the authors’ approaches have changed over time to improve robustness and transparency. Examples of how and why these pearls were adapted were provided in areas of cranial neuralgia, spine, pediatric, and neuro-oncology to demonstrate how neurosurgical readers and writers may improve their interpretation of these domains. The incorporation of these pearls into practice will empower neurosurgical academics to effectively interpret systematic reviews and meta-analyses, enhancing the quality of our evidence-based medicine literature while maintaining a critical focus on the needs of the individual patients in neurosurgery.

scholarly journals Current Status of Cell-Based Therapy in Patients with Critical Limb Ischemia

2020 ◽  
Vol 21 (23) ◽  
pp. 8999
Author(s):  
Frantisek Jaluvka ◽  
Peter Ihnat ◽  
Juraj Madaric ◽  
Adela Vrtkova ◽  
Jaroslav Janosek ◽  
...  
Keyword(s):  
Cell Therapy ◽  
Critical Limb Ischemia ◽  
Evidence Based Medicine ◽  
Odds Ratio ◽  
Limb Ischemia ◽  
Current Evidence ◽  
Evidence Based ◽  
Cell Based Therapy ◽  
Meta Analyses ◽  
Based Medicine

(1) Background: The treatment of peripheral arterial disease (PAD) is focused on improving perfusion and oxygenation in the affected limb. Standard revascularization methods include bypass surgery, endovascular interventional procedures, or hybrid revascularization. Cell-based therapy can be an alternative strategy for patients with no-option critical limb ischemia who are not eligible for endovascular or surgical procedures. (2) Aims: The aim of this narrative review was to provide an up-to-date critical overview of the knowledge and evidence-based medicine data on the position of cell therapy in the treatment of PAD. The current evidence on the cell-based therapy is summarized and future perspectives outlined, emphasizing the potential of exosomal cell-free approaches in patients with critical limb ischemia. (3) Methods: Cochrane and PubMed databases were searched for keywords “critical limb ischemia and cell therapy”. In total, 589 papers were identified, 11 of which were reviews and 11 were meta-analyses. These were used as the primary source of information, using cross-referencing for identification of additional papers. (4) Results: Meta-analyses focusing on cell therapy in PAD treatment confirm significantly greater odds of limb salvage in the first year after the cell therapy administration. Reported odds ratio estimates of preventing amputation being mostly in the region 1.6–3, although with a prolonged observation period, it seems that the odds ratio can grow even further. The odds of wound healing were at least two times higher when compared with the standard conservative therapy. Secondary endpoints of the available meta-analyses are also included in this review. Improvement of perfusion and oxygenation parameters in the affected limb, pain regression, and claudication interval prolongation are discussed. (5) Conclusions: The available evidence-based medicine data show that this technique is safe, associated with minimum complications or adverse events, and effective.

scholarly journals What is a multiple treatments meta-analysis?

2012 ◽  
Vol 21 (2) ◽  
pp. 151-153 ◽  
Author(s):  
A. Cipriani ◽  
C. Barbui ◽  
C. Rizzo ◽  
G. Salanti
Keyword(s):  
Evidence Based Medicine ◽  
Treatment Effects ◽  
Meta Analysis ◽  
Evidence Based ◽  
Relative Efficacy ◽  
Analytical Technique ◽  
Multiple Treatments ◽  
Meta Analyses ◽  
Based Medicine ◽  
Indirect Comparisons

Standard meta-analyses are an effective tool in evidence-based medicine, but one of their main drawbacks is that they can compare only two alternative treatments at a time. Moreover, if no trials exist which directly compare two interventions, it is not possible to estimate their relative efficacy. Multiple treatments meta-analyses use a meta-analytical technique that allows the incorporation of evidence from both direct and indirect comparisons from a network of trials of different interventions to estimate summary treatment effects as comprehensively and precisely as possible.

‘Evidence-based’, ‘Cost-Effective’ and ‘Preference-Driven’ Medicine: Decision Analysis Based Medical Decision Making is the Pre-Requisite

1996 ◽  
Vol 1 (2) ◽  
pp. 104-113 ◽  
Author(s):  
Jack Dowie
Keyword(s):  
Decision Making ◽  
Decision Analysis ◽  
Evidence Based Medicine ◽  
Medical Decision Making ◽  
Clinical Effectiveness ◽  
Cost Effective ◽  
Medical Decision ◽  
Evidence Based ◽  
Meta Analyses ◽  
Based Medicine

Three broad movements are seeking to change the world of medicine. The proponents of ‘evidence-based medicine’ are mainly concerned with ensuring that strategies of proven clinical effectiveness are adopted. Health economists are mainly concerned to establish that ‘cost-effectiveness’ and not ‘clinical effectiveness’ is the criterion used in determining option selection. A variety of patient support and public interest groups, including many health economists, are mainly concerned with ensuring that patient and public preferences drive clinical and policy decisions. This paper argues that decision analysis based medical decision making (DABMDM) constitutes the pre-requisite for the widespread introduction of the main principles embodied in evidence-based medicine, cost-effective medicine and preference-driven medicine; that, in the light of current modes of practice, seeking to promote these principles without a prior or simultaneous move to DABMDM is equivalent to asking the cart to move without the horse; and that in fact DABMDM subsumes and enjoins the valuable aspects of all three. Particular attention is paid to differentiating between DABMDM and EBM, by way of analysis of various expositions of EBM and examination of two recent empirical studies. EBM, as so far expounded, reflects a problem-solving attitude that results in a heavy concentration on RCTs and meta-analyses, rather than a broad decision making focus that concentrates on meeting all the requirements of a good clinical decision. The latter include: Ensuring that inferences from RCTs and meta-analyses to individual patients (or patient groups) are made explicitly; paying equally serious attention to evidence on values and costs as to clinical evidence; and accepting the inadequacy of ‘taking into account and bearing in mind’ as a way of integrating the multiple and distinct elements of a decision.

scholarly journals The role of chondroprotectors in the pharmacological treatment of osteoarthritis

2019 ◽  
pp. 100-109
Author(s):  
L. K. Peshekhonova ◽  
P. A. Krasyukov
Keyword(s):  
Drug Therapy ◽  
Musculoskeletal System ◽  
Evidence Based Medicine ◽  
Cartilage Tissue ◽  
Evidence Based ◽  
Third Generation ◽  
Based Medicine ◽  
Vitro Effect

The article is devoted to third-generation slow-modifying chondroprotective drug therapy including Alflutop. The evidence-based  medicine showed and substantiated in vitro effect of the drug on the pathogenetic processes in the cartilage tissue, its promotion  of the inflammation regression in the musculoskeletal system. The authors present a series of clinical studies of top osteoarthritis doctors, which showed that Alflutop had an anti-inflammatory, chondroprotective, analgesic effect, and that the administration of  the drug allowed patients to reduce the doses of NSAIDs, and it could be used in patients with comorbid diseases. 

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