Evidence-based medicine as a tool

Clinicians need current best evidence to help them treat their patients optimally. It is impossible for them to read all the relevant clinical literature and their reading time decreases after completion of medical school. The practice of evidence-based medicine helps clinicians meet these challenges.     

Evidence-based medicine

The need to improve the quality of health care and to contain its costs has become mandatory. Simultaneously we are confronted by a growing body of clinical information, most of it irrelevant. This paper describes the origin and methods of Evidence-Based Medicine, a new alternative to the usual ways of medical information. The recent development of computerized data bases is permitting the rapid location of relevant clinical information concerning specific questions on diagnosis, therapy or prognosis. Critical analysis is then used to determine the validity of the evidence obtained, which can be employed in clinical decision making. The future role of Evidence-Based Medicine in education and clinical practice seems highly promissory.     

Evidence-based medicine

This paper presents the origins and the concepts in which the paradigm of a new line of clinical reasoning "Evidence Based Medicine", is based. We describe its basic components such as: problem-oriented clinical policy formulation; information retrieval distillation and synthesis of the medical literature; critical appraisal of the evidence and clinical application. Additionally, we describe them already well established, for promoting and Evidence Based Clinical Practice. We particularly focus on the so called "Cochrane Collaboration", an international initiative whose mission is to prepare, maintain and disseminate systematic and updated reviews of the effects of health care.     

As good as it seems? A review of EMDR experimental research.

The article reviews 7 experimental studies that examined eye movement desensitization and reprocessing (EMDR) treatment. The 7 studies varied greatly in their complexity, their designs, how treatment effects were measured, and their results. Each study is detailed and critically examined. A summary of results is provided as well as suggestions for clinical application and future research. In addition, questions are raised regarding F. Shapiro's (1995) approach to disseminating information about EMDR. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evidence-based emergency medicine

Evidence Based (Emergency) Medicine (EB(E)M is a term referring to the application into daily clinical practice of only those methods, procedures, medications etc. which are based on scientific evidence. Where diagnostic and therapeutic principles have not been validated on a prospective, controlled randomised basis, this should be tried out at a later time, if at all possible. This concept may allow to bridge the gap between research and clinical practice, and represents the major goal of EB(E)M. Protagonists of EBEM are at times confronted with criticism that EBEM does not constitute the only but one out of several possible approaches to quality controlled medical care. The fact that more than 50% of all emergency procedures are not evidence based give rise to the question as to whether the performance of randomised controlled studies is ethically justifiable, if control groups are included whose treatment leaves out generally recommended and recognised (though not evidence based) therapeutic and/or diagnostic principles. The following examples may enumerate some of the procedures, methods or medications, respectively, without proven scientific evidence: Medication for resuscitation of cardiac arrest victims. Medication for acute asthmatic attacks Initial treatment of uncontrolled haemorrhagic shock. Endotracheal intubation in VF/VT. The principle need for initial ventilation and the volumes of ventilation in cardiac arrest patients. Effectiveness of ACD- and VEST-CPR. A few typical examples are presented to illustrate the requirements of current study designs which have to be met before results of an evaluation are accepted by the EBEM scientists to obtain approval for application of a procedure, method or medication in clinical practice (large patient numbers, power calculations, ethical issues) as well as their benefits and drawbacks.     

Epistemological beliefs and mathematical text comprehension: Believing it is simple does not make it so.

Examines epistemological belief assessment and the relationship between belief in simple knowledge and mathematical text comprehension. Exp 1, an epistemological questionnaire developed earlier (M. Schommer, 1990) was administered and factor analyzed. The factor structure was replicated, measuring beliefs in externally controlled learning, simple knowledge, quick learning, and certain knowledge. In Exp 2, Ss were instructed to read either to determine the comprehensibility of passage information or to teach passage information. Ss read a statistical passage, assessed their understanding, and completed a mastery test and study strategy inventory. Regression analyses indicated that the less Ss believed in simple knowledge, the better they performed on the mastery test and the more accurately they assessed their comprehension. A path model indicates that study strategies may mediate epistemological effects. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evidence-based medicine: what is the evidence?

The cytology of nasal secretions in 20 patients with allergic rhinitis and 15 patients with chronic maxillary sinusitis was investigated with transmission electron microscope to study the ultrastructure of the cluster epithelial cells in nasal secretions of allergic rhinitis. The results showed that the cluster epithelial cells were predominant cellular element in allergic nasal secretions. The number of cluster cells correlated positively with the number of eosinophils and the levels of eosinophilic cationic protein. It is suggested that the exfoliation of cluster nasal epithelial cellular elements may be caused by eosinophic cationic protein with resultant hyperreactivity of nasal mucosa.     

Evidence-based medicine and cost-effectiveness analysis

Health care has become increasingly expensive and clinicians have come under increased scrutiny to critically appraise the economic impact of medical programs and interventions. To ensure an equitable allocation of scarce resources and the attainment of maximal clinical benefit, it is vital to adhere to certain basic tenets of economic analysis and to understand the basic approach to cost-effectiveness analysis. These principles are applied to critical care medicine and analogies are made to the methodological rigor of evidence-based medicine.     

DNA topology: topoisomerases keep it simple

The ability of type II DNA topoisomerases to perturb the equilibrium distributions of DNA topoisomers is a consequence of their ability to hydrolyse ATP. A sliding mechanism of topoisomerase action has been proposed to account for this phenomenon.