Hierarchy of Technoscience Estimation

2019 ◽  
Vol 56 (3) ◽  
pp. 186-201
Author(s):  
Sergei Yu. Shevchenko ◽  

Semantic framework of the discussion about the equivalence and interchangeability of the original drugs and generics is considered in the article. Generics are identical to the original drugs in terms of chemical structure, nevertheless some patients and doctors consider that generics are less effective and have more severe side effects than original drugs. These discussions are considered as an example of a public deliberation concerning the achievements of technoscience. The conflicting parties determined the identity either from the chemical structure of the drug (according to D. Chalmers – secondary intensional) or from the phenomenal characteristics of the situation of its application (primary intensional). In this regard, the method of resolving the conflict is the alignment of the hierarchy of methods for determining equivalence in biomedicine. The methodology of evidence-based medicine already has such a hierarchy, which makes it possible to determine the validity of outcomes of clinical trial. According to this hierarchy, the phenomenal characteristics of the outcome of treatment (quality and life expectancy of patients) are more important than instrumentally established indicators. Thus, new clinical data on the efficacy and safety of a generic should give the opportunity to cancel the recognition of drug equivalence. More generally, this means that technoscience achievement which directly affects a person can only be assessed by him/her. The recognition of such priority is the basis of the ‘division of linguistic labor’ during public deliberation concerning the achievements of technoscience.

Author(s):  
Perry Nisen ◽  
Patrick Vallance

Clinical trials are the bedrock of evidence-based medicine. Introduced in the mid 20th century, they heralded a move away from opinion and anecdote to a more scientific evaluation of new treatments. Indeed, it could be argued that it is the clinical trial and the application of scientific method to determine which treatments work that distinguishes ‘medicine’ from ‘alternative medicine’. The aim of this short section is to outline the way in which clinical trials are likely to evolve over the next few years....


2007 ◽  
Vol 14 (2) ◽  
pp. 160-166 ◽  
Author(s):  
Madhusmita Behera ◽  
Ambuj Kumar ◽  
Heloisa P. Soares ◽  
Lubomir Sokol ◽  
Benjamin Djulbegovic

2009 ◽  
Vol 2009 (jul14 1) ◽  
pp. bcr0220091558-bcr0220091558
Author(s):  
A. Fremault ◽  
D. Rodenstein

2021 ◽  
Vol 16 (1) ◽  
pp. 58
Author(s):  
Muhammad Sobri Maulana ◽  
Nurfadhilah Al Adabiyah

Latar Belakang: Tuberculosis merupakan penyakit infeksi oleh Mycobacterium tuberculosis. Tuberculosis merupakan  salah satu  diantara sepuluh  penyebab  utama kematian di  dunia. Penelitian terdahulu membuktikan bahwa suplementasi vitamin D dapat meningkatkan aktivitas anti-mikrobial, mempercepat konversi sputum dan kultur, mengurangi inflamasi, meningkatkan clinical outcome, serta meningkatkan mediator untuk aktivitas anti-mikrobial. Meskipun demikian, masih terdapat perbedaan pendapat akan manfaat suplementasi vitamin D pada pasien tuberculosis paru.Tujuan: Mengevaluasi bukti yang ada sampai saat ini terkait manfaat suplementasi vitamin D terutama dalam mempercepat konversi sputum. Metode: Pencarian literatur dilakukan pada tiga databases terkemuka yakni PubMed, SCOPUS, dan Cochrane dengan kata kunci berupa “Tuberculosis”, “Vitamin D”, “Suplementation”, dan “Sputum Conversion” dengan seluruh kata yang berhubungan. Dari seleksi artikel berdasarkan kriteria inklusi dan eksklusif didapatkan 1 systematic review oleh Jollifee D et al (2019) dan 1 clinical trial oleh Afzal A et al (2018), yang kemudian ditelaah berdasarkan aspek validity, importance, dan applicability menggunakan form telaah dari Oxford Center for Evidence Based Medicine. Hasil: Kedua artikel memenuhi kriteria validity, importance, dan applicability masing-masing. Dari segi efikasi, penelitian Jollifee D et al membuktikan bahwa pemberian suplementasi vitamin D tidak mempercepat konversi kultur sputum pada populasi umum (aHR 1.06, 95% CI 0.91-1.23; P=0.44; P for heterogeneity=0.84), namun mempercepat konversi kultur sputum pada populasi MDR-TB(aHR 13.44, 95% CI 2.96-60.90). Kedua studi membuktikan bahwa pemberian suplementasi vitamin D mampu mempercepat konversi apusan sputum namun konversi apusan sputum memiliki validitas yang lebih rendah sebagai marker prognosis untuk outcome suatu tatalaksana dibandingkan konversi kultur sputum. Kesimpulan: Pemberian suplementasi vitamin D tidak mempercepat konversi kultur sputum namun mempercepat konversi apusan sputum. Diperlukan penelitian lebih lanjut terkait manfaat suplementasi vitamin D pada percepatan konversi kultur sputum populasi MDR-TB.


Vestnik ◽  
2021 ◽  
pp. 62-67
Author(s):  
Н.Е. Айдаргалиева ◽  
А.О. Доскулова ◽  
Ж.C. Шерияздан ◽  
М.Е. Рамазанов

Применение антикоагулянтов у пациентов с фибрилляцией предсердий (ФП) - краеугольный камень профилактики инсульта. Обзор включает современные данные доказательной медицины по эффективности и безопасности применения Эдоксабана - ингибитора Xa фактора - для предупреждения инсульта при ФП, включая больных с чрескожными коронарными вмешательствами. The use of anticoagulants in patients with atrial fibrillation (AF) is the cornerstone of stroke prevention. The review includes modern evidence-based medicine data on the efficacy and safety of the use of Edoxaban, a factor Xa inhibitor, for the prevention of stroke in AF, including in patients with percutaneous coronary interventions.


2020 ◽  
pp. 62-69
Author(s):  
I.L. Vysochyna ◽  
◽  
V.V. Kramarchuk ◽  

Numerous publications, meta-analyzes and systematic reviews suggest different approaches to the treatment and prevention of ARI, therefore, in the practice of a doctor both in Ukraine and in other countries, there is a variety of schemes, protocols, regulations and professional recommendations for the management of these patients. Therefore, for competent, effective and safe treatment and prevention of ARI among national and world standards, a doctor needs to find the most optimal and effective algorithm for the management and treatment of viral infections of the respiratory tract, which ideally has a high level of evidence-based medicine and can be used in specific practice with the point of view of patient management and routing. Purpose — to analyze the knowledge of the existing in Ukraine and the world of the regulatory framework and national protocols for the management of patients with ARI by general practitioners — family medicine, as well as to study the opinion of family doctors about the efficacy and safety of using flavonoids in the treatment and prevention of ARI. Materials and methods. Anonymous survey of 149 family doctors in the city of Dnipro and the region was conducted in the current 2020. Among the respondents there were 55 doctors with a primary specialization in Pediatrics (37%), 37 doctors with a primary specialization in Internal Medicine (25%) and 57 with a primary specialization in Family Medicine (38%). The distribution normality was checked using the Kolmogorov+Smirnov test. Considering that 90% of the data were normally distributed, we used parametric statistics methods. To assess relationships between binary features, the ϕ-coefficient of mutual conjugation was used. The critical level of statistical significance was accepted as <5% (p<0.05). Results. Family physicians are aware of current trends in the strategy of therapy and prevention of ARI. According to family doctors, drugs with the active substance Proteflazid, when prescribed for the treatment and prevention of acute respiratory viral infections, are safe (no toxic effect) and effective (according to our own observations) by reducing the duration and severity of the disease, the severity of fever and manifestations of intoxication syndrome, reducing the frequency of acute respiratory diseases (frequency rate per year), and that the above effects obtained in their own practice are associated with direct antiviral action, suppression of viral reproduction and multiple mechanisms of action of Proteflazid bioflavonoids. In addition to the professional opinion of family doctors, the opinion of parents about the effectiveness of drugs with the active substance Proteflazid for the treatment and prevention of ARI (feedback from a doctor) in the form of their positive feedback and a note that they are often used for self+treatment, and their choice is associated with the fact that Proteflazid preparations shorten the period of illness and, according to parents, children are less ill with ARI. Conclusions. The presence of the proven antiviral action of flavonoids, as a class of polyphenolic compounds, and the fact that the flavonoids that make up Flavovir have a proven mechanism of antiviral activity, which is confirmed in clinical outpatient practice by the positive experience of primary care physicians (pronounced clinical efficacy) allows you to recommend Flavovir syrup for the treatment and prevention of influenza and seasonal ARI to children from birth. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of these Institutes. The informed consent of the doctors was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: ARI, flavonoids, treatment, outpatient practice, evidence-based medicine.


2018 ◽  
Vol 16 (2) ◽  
pp. 57-61
Author(s):  
Aida A Zurdinova

The article discusses the problems of irrational medicines use at the hospital level of the health care system from the perspective of evidence-based medicine and assessment of the adherence of doctors to follow the recommendations from the developed clinical guidelines and protocols of the Kyrgyz Republic. The study purpose was to analyze the use of medicines and assess the problems of irrational use in hospital-based health facilities in the Kyrgyz Republic. The material of the study was the sheets of prescriptions from the case histories and the questionnaire on the study of the determinants for using and prescription of medicines by methods of excavation, questionnaires and the analysis of the prescriptions to clinical guidelines and protocols. The results of our study showed that doctors admit inefficient use of medicines - polypharmacy, prescription of drugs with unproven efficacy and safety, do not follow recommendations from clinical guidelines and protocols under different pretexts. Data from the questionnaires of doctors revealed an inverse correlation between the prescriptions of medicines in accordance with approved national clinical guidelines and protocols and work experience, i.e. the longer the work of the doctor, the less they are guided by the clinical guidelines and protocols (p < 0.05). The results indicate a low level of adherence of doctors to the use of clinical guidelines and protocols, gaps in the awareness of the population on the use of drugs, the lack of a single information system in the sphere of drug circulation. (For citation: Zurdinova AA. Problems of rational medicines use: the situation in Kyrgyzstan. Reviews on Clinical Pharmacology and Drug Therapy. 2018;16(2):57-61. doi: 10.17816/RCF16257-61).


2018 ◽  
Vol 25 (6) ◽  
pp. 127-134
Author(s):  
I. N. Ochakovskaya ◽  
V. M. Durleshter ◽  
O. G. Ni ◽  
N. E. Shabanova

Aim. The study was conducted to assess the level of awareness of surgeons about the principles of safe perioperative pharmacotherapy.Materials and methods. The survey of surgeons was conducted in 2018 on the basis of a questionnaire made by the authors, consisting of 60 questions and tasks, divided into 6 thematic blocks. The respondents had to demonstrate their knowledge both in the field of general principles of safe pharmacotherapy and private issues of using analgesics, anticoagulants, antibiotics in the perioperative period. The results of the survey were assessed as a percentage (proportion of correct answers) individually for each respondent and in total.Results. The results of the survey showed a lack of a deep understanding of the principles of safe pharmacotherapy in most clinical cases. Despite the fact that a number of answers completely correlated with the positions of evidence-based medicine, in general, there was a lack of systemic knowledge. The survey made it possible to identify those important points that should be first highlighted in the preparation of the training program. Conclusion. Every doctor should strive to minimize the preventable medical errors associated with pharmacotherapy. This is feasible only in the process of continuous daily learning. Practitioners' interest in the efficacy and safety of pharmacotherapy and mastering the basic decision-making algorithms for prescribing, controlling safety and cancelling drugs will improve the quality of medical care.


2021 ◽  
Vol 23 (3) ◽  
pp. 418-424
Author(s):  
Alexey A. Bogdanov ◽  
Andrey A. Bogdanov

Decision making in clinical practice requires consideration of the relative efficacy and safety of medical interventions. A systematic review and meta-analysis, the results of which have the highest level of confidence in evidence-based medicine, only compare the effectiveness of two interventions, provided that there is a direct comparison between them in a set of randomized controlled trials. The development of statistical methods has led to the development of the network meta-analysis method, the application of which allows comparison for more than two interventions and even if the interventions were not directly compared in randomized controlled trials, but have a common comparison intervention. As a result, network meta-analysis is increasingly being used as an evidence base for the effectiveness of medical interventions. However, there are important assumptions and conditions underlying the performance of network meta-analysis. In this work, we tried to outline the main aspects of network meta-analysis that are important for clinicians in terms of its implementation and interpretation of its results.


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