scholarly journals Lack of cause-effect evidence for the association between exercise and mortality: a true scientific debate for a false clinical issue

2018 ◽  
Vol 23 ◽  
pp. 1-4
Author(s):  
Philipe de Souto Barreto ◽  
Kelly Samara Silva
Keyword(s):  
Clinical Decision ◽  
Target Population ◽  
Preventive Strategy ◽  
Clinical Issue ◽  
Scientific Debate ◽  
Randomized Controlled ◽  
Recent Debate ◽  
Therapeutic Element ◽  
Clinical Meaningfulness ◽  
Opinion Article

A recent debate raises the issue that there is no cause-effect data from well-powered randomized controlled trials showing that exercise decreases mortality. In this opinion article, we further discuss this issue focusing on the definitions of physical activity (PA) and exercise and the clinical meaningfulness of mortality in the context of PA and exercise. In sum, although mortality is a major clinical outcome, the extent to which its risk should guide PA global recommendations and even exercise prescription is probably negligible, in particular for the large majority of healthy individuals. The debate about prescribing exercise on the basis of cause-effect association regarding mortality is a scientific debate rather than a clinical decision discussion. Health professionals should continuing to stimulate sedentary people to increase their PA and to prescribe exercise adapted to the target population as both a preventive strategy and a therapeutic element, focusing in clinical outcomes individuals consider important.

scholarly journals A Narrative Review of Clinical Decision Support for Inpatient Clinical Pharmacists

2021 ◽  
Vol 12 (02) ◽  
pp. 199-207
Author(s):  
Liang Yan ◽  
Thomas Reese ◽  
Scott D. Nelson
Keyword(s):  
Patient Safety ◽  
Quality Of Care ◽  
Decision Support ◽  
Clinical Decision Support ◽  
Clinical Decision ◽  
Controlled Trials ◽  
Clinical Pharmacists ◽  
Randomized Controlled ◽  
The Impact

Abstract Objective Increasingly, pharmacists provide team-based care that impacts patient care; however, the extent of recent clinical decision support (CDS), targeted to support the evolving roles of pharmacists, is unknown. Our objective was to evaluate the literature to understand the impact of clinical pharmacists using CDS. Methods We searched MEDLINE, EMBASE, and Cochrane Central for randomized controlled trials, nonrandomized trials, and quasi-experimental studies which evaluated CDS tools that were developed for inpatient pharmacists as a target user. The primary outcome of our analysis was the impact of CDS on patient safety, quality use of medication, and quality of care. Outcomes were scored as positive, negative, or neutral. The secondary outcome was the proportion of CDS developed for tasks other than medication order verification. Study quality was assessed using the Newcastle–Ottawa Scale. Results Of 4,365 potentially relevant articles, 15 were included. Five studies were randomized controlled trials. All included studies were rated as good quality. Of the studies evaluating inpatient pharmacists using a CDS tool, four showed significantly improved quality use of medications, four showed significantly improved patient safety, and three showed significantly improved quality of care. Six studies (40%) supported expanded roles of clinical pharmacists. Conclusion These results suggest that CDS can support clinical inpatient pharmacists in preventing medication errors and optimizing pharmacotherapy. Moreover, an increasing number of CDS tools have been developed for pharmacists' roles outside of order verification, whereby further supporting and establishing pharmacists as leaders in safe and effective pharmacotherapy.

scholarly journals Arguments about face masks and Covid-19 reflect broader methodologic debates within medical science

2021 ◽  
Author(s):  
Neil Pearce ◽  
Jan Paul Vandenbroucke
Keyword(s):  
Controlled Trial ◽  
Scientific Evidence ◽  
Medical Science ◽  
Epidemiological Evidence ◽  
Advisory Committees ◽  
Scientific Debate ◽  
Randomized Controlled ◽  
Political Challenge ◽  
Order Of Magnitude ◽  
Scientific Challenge

AbstractThere has perhaps been no issue as contentious in Covid-19 as face masks. The most contentious scientific debate has been between those who argue that “there is no scientific evidence”, by which they mean that there are no randomized controlled trials (RCTs), versus those who argue that when the evidence is considered together, “the science supports that face coverings save lives”. It used to be a ‘given’ that to decide whether a particular factor, either exogenous or endogenous, can cause a particular disease, and in what order of magnitude, one should consider all reasonably cogent evidence. This approach is being increasingly challenged, both scientifically and politically. The scientific challenge has come from methodologic views that focus on the randomized controlled trial (RCT) as the scientific gold standard, with priority being given, either to evidence from RCTs or to observational studies which closely mimic RCTs. The political challenge has come from various interests calling for the exclusion of epidemiological evidence from consideration by regulatory and advisory committees.

8-hydroxyquinoline-5-(N-4-chlorophenyl) sulfonamide and fluconazole combination as a preventive strategy for Candida biofilm in haemodialysis devices

2021 ◽  
Vol 70 (7) ◽  
Author(s):  
Letícia Fernandes da Rocha ◽  
Bruna Pippi ◽  
Angélica Rocha Joaquim ◽  
Saulo Fernandes de Andrade ◽  
Alexandre Meneghello Fuentefria
Keyword(s):  
Biofilm Formation ◽  
Synergistic Effects ◽  
Local Treatment ◽  
The Other ◽  
Antibiofilm Activity ◽  
Preventive Strategy ◽  
Clinical Issue ◽  
Microdilution Method ◽  
Broth Microdilution Method ◽  
Time Kill

Introduction. The presence of Candida biofilms in medical devices is a concerning and important clinical issue for haemodialysis patients who require constant use of prosthetic fistulae and catheters. Hypothesis/Gap Statement. This prolonged use increases the risk of candidaemia due to biofilm formation. PH151 and clioquinol are 8-hydroxyquinoline derivatives that have been studied by our group and showed interesting anti-Candida activity. Aim. This study evaluated the biofilm formation capacity of Candida species on polytetrafluoroethylene (PTFE) and polyurethane (PUR) and investigated the synergistic effects between the compounds PH151 and clioquinol and fluconazole, amphotericin B and caspofungin against biofilm cells removed from those materials. Further, the synergistic combination was evaluated in terms of preventing biofilm formation on PTFE and PUR discs. Methodology. Susceptibility testing was performed for planktonic and biofilm cells using the broth microdilution method. The checkerboard method and the time–kill assay were used to evaluate the interactions between antifungal agents. Antibiofilm activity on PTFE and PUR materials was assessed to quantify the prevention of biofilm formation. Results. Candida albicans, Candida glabrata and Candida tropicalis showed ability to form biofilms on both materials. By contrast, Candida parapsilosis did not demonstrate this ability. Synergistic interaction was observed when PH151 was combined with fluconazole in 77.8 % of isolates and this treatment was shown to be concentration- and time-dependent. On the other hand, indifferent interactions were predominantly observed with the other combinations. A reduction in biofilm formation on PUR material of more than 50 % was observed when using PH151 combined with fluconazole. Conclusion. PH151 demonstrated potential as a local treatment for use in a combination therapy approach against Candida biofilm formation on haemodialysis devices.

Improving Recruitment, Retention, and Cultural Saliency of Health Promotion Efforts Targeting African American Men: A Scoping Review

2021 ◽  
Author(s):  
Guillermo M Wippold ◽  
Sarah Grace Frary ◽  
Demetrius A Abshire ◽  
Dawn K Wilson
Keyword(s):  
Health Promotion ◽  
Randomized Controlled Trial ◽  
African American ◽  
Scoping Review ◽  
African American Men ◽  
Controlled Trial ◽  
Target Population ◽  
Retention Rates ◽  
Randomized Controlled ◽  
Post Test

Abstract Background When health promotion efforts intend to include African American men, they experience challenges with recruitment and retention, in addition to limited cultural saliency—interventions that do not align the cultural preferences and experiences of the target population produce less effective results. Purpose This scoping review provides an understanding of (a) how health promotion efforts among African American men are developed and implemented, in addition to the (b) main outcomes, (c) retention rates, and (d) methodological rigor of those efforts. Methods The following databases were used: PubMed, EMBASE (Ovid), PsycINFO (EBSCO), CINAHL (EBSCO), Web of Science (Clarivate), and ProQuest. Included studies were restricted to those: (a) conducted among African American men and (b) reported the effects of a health promotion intervention. Interventions using single-group pre–post study, post-test-only study, non-randomized controlled trial, and randomized controlled trial (RCT) study designs were included. Results The results indicate that varying degrees of customization in the design and implementation of health promotion efforts targeting African American can improve recruitment, retention, and health-related outcomes. Results draw attention to the need for community input when designing and implementing efforts targeting these men. Conclusions These results indicate that opportunities exist to innovate health promotion efforts among African American men, such as the intentional incorporation of the community’s values, perspectives, and preferences in the effort (i.e., cultural saliency) and explicitly indicating how the efforts were culturally tailored to improve saliency. Opportunities also exist to innovate health promotion efforts among African American men based on literature-derived best practices.

Randomized controlled trial of the application of topical b-FGF-impregnated gelatin microspheres to improve tissue survival in subzone II fingertip amputations

2011 ◽  
Vol 36 (6) ◽  
pp. 455-460 ◽  
Author(s):  
Hirohisa Kusuhara ◽  
Yoshihito Itani ◽  
Noritaka Isogai ◽  
Yasuhiko Tabata
Keyword(s):  
Randomized Controlled Trial ◽  
Standard Treatment ◽  
Controlled Trial ◽  
Statistical Significance ◽  
Clinical Decision ◽  
Composite Graft ◽  
Gelatin Microspheres ◽  
Modest Improvement ◽  
Randomized Controlled ◽  
Tissue Surfaces

We undertook a randomized controlled trial of subzone II fingertip amputations, comparing standard treatment with topical application of gelatin microspheres prepared with basic fibroblast growth factor (b-FGF) to provide a slow, sustained release of b-FGF with microsphere degradation. Forty-eight digits from 42 patients were randomized into the two study arms. The microspheres were applied as a paste on exposed tissue surfaces, whereas standard treatment was without any topical treatment. Patients were treated either with microsurgical revascularization or by simple composite graft, based on the surgeon’s clinical decision. Tissue survival of the replanted fingertips was measured by a blinded evaluator 3 weeks postoperatively. A modest improvement in survival was seen with b-FGF-microsphere application for both revascularized and composite grafted fingertips, though this did not achieve statistical significance. Whether the slow release of b-FGF through a bioresorbable carrier gives any improvement in outcome in patients with subzone II fingertip amputations is unproven.

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