scholarly journals Treating psychiatric symptoms and disorders with non-psychotropic medications

2019 ◽  
Vol 21 (2) ◽  
pp. 193-201
Keyword(s):  
Internal Medicine ◽  
Psychotropic Drugs ◽  
Psychiatric Symptoms ◽  
Neuropsychiatric Disorders ◽  
Psychotropic Medications ◽  
Point Of View ◽  
Evidence Based ◽  
Sufficient Data ◽  
Level Of Evidence ◽  
Based Medicine

A few drugs prescribed in internal medicine, ie, non-psychotropic drugs, can be used to treat certain neuropsychiatric disorders. For most of these situations, the level of evidence remains low. But when sufficient data becomes available, these molecules are then included in official guidelines for the treatment of neuropsychiatric disorders. In this article we review interesting drugs which may be relevant from an evidence-based medicine point of view, and could become part of psychiatric practice in the future.

scholarly journals The Application of Physiotherapy in Cerebral Stroke from the Evidence-Based Medicine Standtpoint

2021 ◽  
Vol 20 (1) ◽  
pp. 27-34
Author(s):  
Natalya V. Karachintseva ◽  
Elena Yu. Mozheyko
Keyword(s):  
Evidence Based Medicine ◽  
Evidence Base ◽  
Point Of View ◽  
Cochrane Library ◽  
Cerebral Stroke ◽  
Evidence Based ◽  
High Quality ◽  
Level Of Evidence ◽  
Search For Information ◽  
Based Medicine

The review summarizes the results of the search for high-quality clinical studies related to the use of physical therapy methods in stroke rehabilitation meeting modern requirements from the point of view of evidence-based medicine. To solve this problem, the following databases are used: Physiotherapy Evidence Database – PEDro, Cochrane Library, PubMed, Stroke, Articles presenting the results of randomized controlled trials (RCTS) are selected. To search for information, the queries “physiotherapy”, “electrotherapy”, “evidence-based physiotherapy”, “electrostimulation”, “transcranial magnetostimulation”, “Transcutaneous Electrical Nerve Stimulation”, “magnetotherapy”, “cryotherapy”were used. Despite the obvious lack of research on a large number of applied physiotherapy factors and individual methods of influence, the modern evidence base of physiotherapy in stroke has recently been supplemented by a considerable number of studies. It is mainly related to the section of electrotherapy, which allow us to talk about individual methods of exposure as based on a high-quality evidence base that allows to form recommendations of a high level of evidence. Additional research is needed to make recommendations on other physiotherapy methods and factors.

scholarly journals Risk communication: ethics, psychology, law

2021 ◽  
Vol 26 (9) ◽  
pp. 4678
Author(s):  
E. O. Taratukhin
Keyword(s):  
Risk Communication ◽  
Cultural Practice ◽  
Point Of View ◽  
Evidence Based ◽  
Psychological Perspective ◽  
State Health ◽  
Holistic View ◽  
Cultural Phenomenon ◽  
Based Medicine ◽  
Clinical Interactions

When communicating with a patient, a doctor is within a certain cultural practice (science-based medicine and state health care system), falling outside the limits of which is not legal. However, a broader understanding of medicine as a cultural phenomenon with a focus on health also requires a more varied perspective on patient care. The patient’s problem can be more complex than looking at it from science- and evidence-based point of view. Therefore, in risk communication as an element of work with adherence or as part of signing informed consent, different ways are needed to consider a patient’s situation. An ethical and psychological perspective on clinical interactions allows for a more holistic view of the disease.

scholarly journals Internal medicine, complexity, evidence based medicine, almost ‘‘without evidences’’

2013 ◽  
pp. 191-200
Author(s):  
Roberto Nardi ◽  
Tatiana Fabbri ◽  
Gelorma Belmonte ◽  
Paolo Leandri ◽  
Magda Mazzetti ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Evidence Based Medicine ◽  
Models Of Care ◽  
Evidence Based ◽  
Suitable Alternative ◽  
The Real ◽  
Economic Problems ◽  
Clinic Management ◽  
Individualised Care ◽  
Based Medicine

Background: Internal medicine has been defined as the specialty of the adult medical complex patients. Complexity science suggests that illness (and health) results from complex, dynamic, and unique interactions between different components of the overall system. In a patient, complexity involves the intricate entanglement of two or more systems (e.g.; body-diseases, family, socioeconomic status, therapies). Aim of the study: To evaluate the real applicability of Evidence Based Medicne (EBM) in clinical Departments of Internal Medicine and its critical perspectives. Discussion: Habitually the internist takes decisions in these situations: a) certainty (the ideal decision is adopted and the corresponding strategy follows), b) risk (the more suitable alternative selected can be the determination of the probable value or mathematical hope) and c) uncertainty, in which decisions linked to triple agents: beliefs and personal values of the doctors (I) for their patients (II) in the society (III). In the medical decisions there are often different factors that go beyond the field of technical and scientific knowledge (family, social, economic problems, etc.) and demanding an ethical analysis of the decision. Conclusions: The ‘‘evidence-based medicine’’, as other models of care, has — in itself — some limitations. ‘‘No evidence in medicine’’ matters that the postulates of the EBM are not always applicable to the real patients of Internal Medicine wards, mostly elderly, frail, complex, with comorbidities and polipharmacy, often with cognitive dysfunction and limitation of autonomy, with psycho-emotional, social and economic problems. The interacting effects of overall involved diseases/factors and their management require more complex and individualised care than simply the sum of separate guideline components. Further innovation is required to resolve the need to enhance integration of evidence with our patients’ values at the ‘‘bedside and/or clinic’’ management.

scholarly journals Guiding Nipple-Areola Complex Reconstruction: Literature Review and Proposal of a New Decision-Making Algorithm

2020 ◽  
Author(s):  
Guido Paolini ◽  
Guido Firmani ◽  
Francesca Briganti ◽  
Michail Sorotos ◽  
Fabio Santanelli di Pompeo
Keyword(s):  
Decision Making ◽  
Patient Satisfaction ◽  
Patient Selection ◽  
Evidence Based Medicine ◽  
Evidence Based ◽  
Patient Factors ◽  
Level Of Evidence ◽  
Areola Complex ◽  
Complex Reconstruction ◽  
Based Medicine

Abstract Background Nipple-areola complex reconstruction (NAR) most commonly represents the finishing touch to breast reconstruction (BR). Nipple presence is particularly relevant to the patient’s psyche, beyond any shadow of doubt. Many reconstructive options have been described in time. Surgery is easy, but final result is often disappointing on the long run. Methods The goal of this manuscript is to analyze and classify knowledge concerning NAR techniques and the factors that influence success, and then to elaborate a practical evidence-based algorithm. Out of the 3136 available articles as of August 8th, 2020, we selected 172 manuscripts that met inclusion criteria, which we subdivided into 5 main topics of discussion, being the various NAR techniques; patient factors (including patient selection, timing and ideal position); dressings; potential complications and finally, outcomes/patient satisfaction. Results We found 92 articles describing NAR techniques, 41 addressing patient factors (out of which 17 discussed patient selection, 14 described ideal NAC location, 10 described appropriate timing), 10 comparing dressings, 7 studying NAR complications, and 22 addressing outcomes and patient satisfaction. We elaborated a comprehensive decision-making algorithm to help narrow down the choice among NAR techniques, and choose the correct strategy according to the various scenarios, and particularly the BR technique and skin envelope. Conclusions No single NAR technique provides definitive results, which is why we believe there is no “end-all be-all solution”. NAR must be approached as a case-by-case situation. Furthermore, despite NAR being such a widely discussed topic in scientific literature, we still found a lack of clinical trials to allow for more thorough recommendations to be elaborated. Level of Evidence III This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266

scholarly journals Systematic Review and Expert Consensus on the Use of Orthoses (Splints and Casts) with Adults and Children after Burn Injury to Determine Practice Guidelines

2019 ◽  
Vol 41 (3) ◽  
pp. 503-534
Author(s):  
Ingrid S Parry ◽  
Jeffrey C Schneider ◽  
Miranda Yelvington ◽  
Patricia Sharp ◽  
Michael Serghiou ◽  
...  
Keyword(s):  
Systematic Review ◽  
Practice Guidelines ◽  
Practice Guideline ◽  
Burn Injury ◽  
Expert Consensus ◽  
Evidence Based ◽  
Level Of Evidence ◽  
Rehabilitation Professionals ◽  
Adults And Children ◽  
Based Medicine

Abstract The objective of this review was to systematically evaluate the available literature addressing the use of orthoses (splints and casts) with adult and pediatric burn survivors and determine whether practice guidelines could be proposed. This review provides evidence-based recommendations specifically for rehabilitation professionals who are responsible for burn survivor rehabilitation. A summary recommendation was made after the literature was retrieved using a systematic review and critical appraisal by multiple authors. The level of evidence of the literature was determined in accordance with the Oxford Centre for Evidence-based Medicine criteria. Due to the low level of evidence in the available literature, only one practice guideline could be recommended: orthotic use should be considered as a treatment choice for improving range of motion or reducing contracture in adults who have sustained a burn injury. To address the rehabilitation-specific gaps found in the literature regarding orthotic use in burn rehabilitation and provide guidance to clinicians, a formal expert consensus exercise was conducted as a final step to the project. The resultant manuscript provides a summary of the literature regarding orthotic use with burn patients, one practice guideline, proposed orthotic terminology and additional practice recommendations based on expert opinion. The limitations in the current literature are also discussed, and suggestions are made for future studies in the area of orthotic use after burn injury.

scholarly journals Rehabilitation in acute stroke from the point of view of evidence-based medicine: possibilities of drug treatment

2019 ◽  
Vol 11 (3) ◽  
pp. 99-103
Author(s):  
A. A. Kulesh
Keyword(s):  
Ischemic Stroke ◽  
Drug Treatment ◽  
Acute Stroke ◽  
Evidence Based Medicine ◽  
Point Of View ◽  
Spatial Neglect ◽  
Evidence Based ◽  
Mirror Therapy ◽  
Upper Extremity Function ◽  
Based Medicine

The review highlights the fundamental principles of early rehabilitation in ischemic stroke, the benefits and risks of early and very early patient mobilization. It presents data on the efficiency of CIMT-kinesiotherapy and mirror therapy in restoring upper extremity function, as well as procedures for nonpharmacological correction of spatial neglect syndrome. The effect on the rehabilitation of concomitant Alzheimer's disease is analyzed. The areas of pharmacological potentiation of poststroke rehabilitation, the efficiency of cerebrolysin in particular, are considered.

scholarly journals Over-diagnosis and other crises facing evidence-based medicine

2014 ◽  
Vol 13 (3) ◽  
pp. 129-130
Author(s):  
Huw Llewelyn ◽  
Keyword(s):  
Evidence Based Medicine ◽  
Point Of View ◽  
Evidence Based ◽  
Raw Data ◽  
Acute Medicine ◽  
Coagulation Monitoring ◽  
Negative Results ◽  
Reduced Frequency ◽  
Low Threshold ◽  
Based Medicine

There is a crisis in ‘evidence-based medicine’ (EBM). Reviewers and meta-analysts have become aware that much of their work may be futile because some investigators only publish selected results that favour their own point of view. Such reviews can only be reliable if there is access to all the raw data or if everyone is compelled to publish ‘negative’ results too. This is proving difficult and controversial. The latest example is dabigatran, which was hailed as a safe advance that needs no coagulation monitoring. It seems that the reduced frequency of bleeding if there is coagulation monitoring was not reported. There is also widespread uncertainty about the thresholds for treatment. This has been highlighted in the ‘over-diagnosis campaign’ to address a concern that many patients are subjected to harm without much benefit. Many see the problem as one of vested interest e.g. where those who gain from supplying a treatment will tend to advocate a low threshold for treating whereas those who wish to reduce costs or effort prefer to set high thresholds. The evidence needs to support what is best for the patient and gathered by those who care for them e.g. acute medicine physicians.

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