scholarly journals ANALYSIS OF EFFICACY OF USING PLATELET-RICH PLASMA AND BETAMETHAZONE IN THE TREEATMENT OF ALOPECIA AREATA

2020 ◽  
Vol 20 (4) ◽  
pp. 4-10
Author(s):  
M. A. Aljabali ◽  
L. V. Kuts
Keyword(s):  
Alopecia Areata ◽  
Platelet Rich Plasma ◽  
Treatment Options ◽  
Venous Blood ◽  
Smoking Habit ◽  
Diagnostic Errors ◽  
Statistical Processing ◽  
Evidence Based ◽  
Based Medicine ◽  
Instrumental Methods

In the era of evidence-based medicine, confirming a disease by using various instrumental methods is one of the important tasks. This enables to reduce the number of diagnostic errors and to prescribe the appropriate treatment in accordance with the current views on the problem of alopecia areata in each case. Moreover, monitoring the course of the disease, data recording and their statistical processing opens up the prospect for obtaining evidence-based treatment methods. Studying the effectiveness of various treatment options and approaches including the registration of results obtained and their statistical processing is of great clinical significance. The aim of this study is to compare the efficiency of monotherapy with betamethasone injections, with platelet-rich plasma, and their combination. The venous blood of 104 patients aged (35.7 ± 8.9 years with alopecia areata was used in the study. All patients were randomly divided to three groups. The group І received intradermal injections of betamethasone (4 sessions per month). The group ІІ received intradermal injections of platelet-rich plasma once every 2 weeks for 16 weeks. The group ІІІ received 4 sessions of betamethasone which were alternated with 4 sessions of platelet-rich plasma treatment at interval of 2 weeks. The patients were examined before the treatment and in 3, 6 and 17 months. The following factors as the age, sex, smoking habit, the presence of alopecia in relatives, the duration, shape and stage of the disease, the index of the severity of alopecia and hair growth, the presence of "yellow and black dots", "conical" and terminal hair were considered in the study. Statistical analysis was performed using SPSS (version 22.0.). The results have shown the combination therapy allows us to obtain the best result, especially in long follow-up period.

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.

Comparatively Ineffective? PCORI and the Uphill Battle to Make Evidence Count in US Medicine

2020 ◽  
Vol 45 (5) ◽  
pp. 787-800
Author(s):  
Eric M. Patashnik
Keyword(s):  
Health Care ◽  
Affordable Care Act ◽  
Treatment Options ◽  
Cultural Barriers ◽  
Health Care Spending ◽  
Evidence Based ◽  
Medical Evidence ◽  
Patient Centered ◽  
The Us ◽  
Based Medicine

Abstract The Patient-Centered Outcomes Research Institute (PCORI) was established as part of the Affordable Care Act to promote research on the comparative effectiveness of treatment options. Advocates hoped this information would help reduce wasteful spending by identifying low-value treatments, but many conservatives and industry groups feared PCORI would ration care and threaten physicians' autonomy. PCORI faced three challenges during its first decade of operation: overcoming the controversy of its birth and escaping early termination, shaping medical practice, and building a public reputation for relevance. While PCORI has won reauthorization, it has not yet had a major impact on the decisions of clinicians or payers. PCORI's modest footprint reflects not only the challenges of getting a new organization off the ground but also the larger political, financial, and cultural barriers to the uptake of medical evidence in the US health care system. The growing attention among policymakers and researchers to provider prices (rather than utilization) as the driver of health care spending could be helpful to the political prospects of the evidence-based medicine project by making it appear to be less as rationing driven by costs and more as an effort to improve quality and uphold medical professionalism.

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 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.

Postmastectomy Neuropathic Pain

2018 ◽  
Author(s):  
Heena Pranav ◽  
Dalia H. Elmofty
Keyword(s):  
Neuropathic Pain ◽  
Multidisciplinary Approach ◽  
Treatment Options ◽  
Pain Syndrome ◽  
Interventional Treatment ◽  
Evidence Based ◽  
Detailed History ◽  
Multiple Domains ◽  
Based Medicine ◽  
Pharmacologic Agents

Neuropathic pain can burden patients in multiple domains. It is a complex pain syndrome that remains difficult to treat. Detailed history and physical examination would reveal patients with neuropathic conditions complaining of burning, shocklike pain. There are a variety of neuropathic pain conditions that can be considered in a differential diagnosis. Because patients with neuropathic pain fail to obtain satisfactory relief from pharmacologic agents alone, a multidisciplinary approach that includes preventative and interventional options is recommended. Interventional treatment options may offer relief to patients with refractory neuropathic pain. Success in the treatment of neuropathic pain depends on evidence-based medicine and individualized patient care.

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

Free to Choose: A Moral Defense of the Right-to-Try Movement

2020 ◽  
Vol 45 (1) ◽  
pp. 61-85 ◽  
Author(s):  
Michael Brodrick
Keyword(s):  
Clinical Trials ◽  
Drug Safety ◽  
Evidence Based Medicine ◽  
Treatment Options ◽  
Political Support ◽  
Individual Autonomy ◽  
Evidence Based ◽  
The Right ◽  
Based Medicine ◽  
Right To Try Laws

Abstract The claim that individuals legitimately differ with respect to their values seems to be uncontroversial among bioethicists, yet many bioethicists nevertheless oppose right-to-try laws. This seems to be due in part to a failure to recognize that such laws are intended primarily to be political, not legal, instruments. The right-to-try movement seeks to build political support for increasing access to newly developed drugs outside of clinical trials. Opponents of right-to-try laws claim that increasing access outside of clinical trials would undermine evidence-based medicine. They seek to maximize overall gains to patients by protecting them from adverse drug reactions and ensuring that drugs are more effective on average. In contrast, right-to-try activists have a point that regulatory judgments of drug safety and effectiveness impose one set of trade-offs on all individuals, regardless of their different values. That might be acceptable if determinations of safety and effectiveness were black and white, but that does not seem to be the case. This article argues that judgments of safety and effectiveness are in an important respect normative and reflect the perceived value of those ends relative to others. Such judgments, when universally imposed, harm patients who would readily make do with less knowledge of drug safety and effectiveness in exchange for more time and self-determination. The relevant moral principle is that of respect for individual autonomy. Just as that principle should lead one to substitute collective decisions for individual ones to regulate a natural monopoly, the same principle should lead one to substitute individual decisions for collective ones to avoid a government monopoly on access to newly developed drugs. It is argued that reforms should increase the number of treatment options available to patients outside of clinical trials. The final section of the article discusses ways in which current regulations might be reformed so as to provide more treatment options outside of clinical trials, without undermining evidence-based medicine.

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.

Drug-drug Interactions between COVID-19 Treatments and Antidepressants, Mood Stabilizers/Anticonvulsants, and Benzodiazepines: Integrated Evidence from 3 Databases

2021 ◽  
Author(s):  
Beatriz Oda Plasencia-García ◽  
María Isabel Rico-Rangel ◽  
Gonzalo Rodríguez-Menéndez ◽  
Ana Rubio-García ◽  
Jaime Torelló-Iserte ◽  
...  
Keyword(s):  
Drug Interaction ◽  
Drug Interactions ◽  
Treatment Options ◽  
Mood Stabilizers ◽  
Evidence Based ◽  
Ecg Monitoring ◽  
Ensure Patient Safety ◽  
Coronavirus Infection ◽  
Based Medicine ◽  
Potential Interactions

Abstract Introduction The SARS-CoV-2 pandemic with psychiatric comorbidities leads to a scenario in which the use of psychotropic drugs may be required. This requires the support of evidence-based medicine to take into account possible interactions between antidepressants, mood stabilizers, benzodiazepines, and coronavirus infection treatments. Methods Three databases were consulted: (a) Lexicomp Drug Interactions, (b) Micromedex Solutions Drugs Interactions, (c)Liverpool Drug Interaction Group for COVID-19 therapies. The CredibleMeds QTDrugs List was also queried. Hydroxychloroquine, chloroquine, azithromycin, lopinavir-ritonavir, remdesivir, favipiravir, tocilizumab, baricitinib, anakinra, and dexamethasone – drugs used for SARS-CoV-2 – were analyzed, and consensus recommendations are made. Results The potential interactions of agomelatine, desvenlafaxine, duloxetine, milnacipran, and vortioxetine with COVID-19 treatments shall be considered less risky. Antidepressant interactions with hydroxychloroquine, chloroquine, and azithromycin enhance the risk of QT prolongation, and ECG monitoring is advised for most antidepressants. Antidepressants with lopinavir/ritonavir involve multiple CYP enzyme interactions (except with milnacipran). Gabapentin, oxcarbazepine, pregabalin, topiramate, and zonisamide are safe treatment options that have no significant interactions with COVID-19 treatments. Lithium is contraindicated with hydroxychloroquine, chloroquine, and azithromycin. Precaution should be taken in using valproic acid with lopinavir-ritonavir. The use of benzodiazepines does not present a risk of drug interaction with COVID-19 treatments, except lopinavir/ritonavir. Conclusions Clinicians prescribing antidepressants, mood stabilizers/anticonvulsants, and benzodiazepines, should be aware of the probable risk of drug-drug interaction with COVID-19 medications and may benefit from heeding these recommendations for use to ensure patient safety.

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