scholarly journals Clasificación Oxford para la validación de un  protocolo de antibioticoterapia subcutánea  paliativa

2017 ◽  
Vol 14 (1) ◽  
pp. 95
Author(s):  
Miguel  Antonio  Sánchez-Cárdenas ◽  
Laura  Camila  Pulido-Garzón ◽  
Leydy  Viviana Santamaría-Orozco ◽  
Lina  Katerine  Rodríguez-Laverde ◽  
Mónica  Andrea  Preciado-Vargas ◽  
...  
Keyword(s):  
Palliative Care ◽  
Evidence Based Medicine ◽  
Review Process ◽  
Scientific Evidence ◽  
Evidence Based ◽  
Promising Alternative ◽  
Revisión Sistemática ◽  
Nursing Skills ◽  
Based Medicine ◽  
Systematic Review Process

Introducción: los casos de pacientes con procesos infecciosos al final de la vida muestran la necesidad de contar con alternativas que garanticen el cuidado y el manejo terapéutico instaurado. Las vías clásicas intravenosa, intramuscular y oral se ven limitadas, mientras que la vía subcutánea demuestra ser una alternativa prometedora; sin embargo, la escasa evidencia científica reflejada en el bajo número de investigaciones, devela la necesidad de explorar y generar productos científicos que respalden esta práctica. Metodología: estudio documental, con base en un proceso de revisión sistemática, en el cual se realiza la búsqueda de 10 acciones descritas en un protocolo. Fueron seleccionados 34 artículos en idioma inglés y español, excluyendo 17.Los artículosfueron clasificados a partir de la escala del Centre for Evidence-Based Medicine, Oxford, consultando las bases: Nursing Skills, Clinicalkey, Pubmed, Springerlink, Science Direct, ProQuest y Cochrane. Se utilizaron como descriptores: antibacterianos, cuidados paliativos, protocolos, catéter, subcutáneo, signos, tiempo, antibiótico, enfermería, registros, consentimiento informado, valoración. Resultados: el 60% de las acciones propuestas en el protocolo no tuvo artículos que respaldaran su práctica, solamente el 40% fue clasificado. Conclusión: el protocolo no se recomienda, puesto que más del 50% de las actividades no cuentan con evidencia científica que las respalde.PALABRAS CLAVE: antibacterianos, cuidados paliativos,  protocolos, tejido subcutáneo.Oxford classification for the validation of a protocol of palliative subcutaneous  antibiotic therapy                                                              ABSTRACTIntroduction: the cases of patients with infectious processes at the end of life show the necessity  to count with alternatives that guarantee the care and the established therapeutic management.  The classic intravenous, intramuscular and oral routes are limited, while the subcutaneous route  demonstrates to be a promising alternative; however, the scarce scientific evidence reflected in  the low number of research, unveils the necessity to explore and generate scientific products to  endorse this practice. Methodology: a documental study, based on a systematic review process,  in which the search of 10 actions described in a protocol is performed. 34 articles in English and  Spanish were selected, excluding 17. The articles were classified based on the scale from Centre for  Evidence-Based Medicine, Oxford, consulting the databases: Nursing Skills, Clinicalkey, Pubmed,  Springerlink, ScienceDirect, ProQuest and Cochrane. The used descriptors: antibacterials, palliative  care, protocols, subcutaneous catheter, signs, time, antibiotic, nursing, records, informed consent,  and valuation. Results: 60% of the actions proposed in the protocol did not have articles to endorse  their practice, only 40% was classified. Conclusion: the protocol is not recommended, since more  than 50% of the activities do not have scientific evidence to endorse them.KEYWORDS: anti-bacterial agents, palliative care, protocols, subcutaneous tissue.Classificação Oxford para a validação de um  protocolo de aplicação paliativa de antibióticos                                           por via subcutânea                                                                      RESUMOIntrodução: os casos de pacientes com processos infecciosos ao final da vida mostram a necessidade  de contar com alternativas que garantam o cuidado e o manejo terapêutico estabelecido. As vias  clássicas intravenosa, intramuscular e oral estão limitadas, enquanto que a via subcutânea demostra  ser uma alternativa prometedora; porém, a escassa evidencia científica refletida no baixo número de  pesquisas, revela a necessidade de explorar e gerar produtos científicos que respaldem esta prática.  Metodologia: estudo documental, baseado num processo de revisão sistemática, no qual se realizou  a busca de 10 ações descritas num protocolo. Foram selecionados 34 artigos em idioma inglês e  espanhol, excluindo 17. Os artigos foram classificados a partir da escala do Centre for Evidence-Based  Medicine, Oxford, consultando as bases: Nursing Skills, Clinicalkey, Pubmed, Springerlink, Science  Direct, ProQuest e Cochrane. Utilizaram-se como descritores: antibacterianos, cuidados paliativos,  protocolos, cateter, subcutâneo, signos, tempo, antibiótico, enfermagem, registros, consentimento  informado, valoração. Resultados: o 60% das ações propostas no protocolo não teve artigos que  respaldaram sua prática, somente o 40% foi classificado. Conclusão: o protocolo não se recomenda,  já que mais do 50% das atividades não têm evidencia científica para apoiá-lo.PALAVRAS-CHAVE: antibacterianos, cuidados paliativos, protocolos, tela subcutânea.

scholarly journals Evidence-Based Medicine in judicial decisions concerning right to healthcare

2016 ◽  
Vol 14 (1) ◽  
pp. 1-5 ◽  
Author(s):  
Eduardo Rocha Dias ◽  
Geraldo Bezerra da Silva Junior
Keyword(s):  
Health Insurance ◽  
Evidence Based Medicine ◽  
Private Health Insurance ◽  
Scientific Evidence ◽  
Federal Court ◽  
Public Healthcare ◽  
Evidence Based ◽  
Unified Health System ◽  
The Individual ◽  
Based Medicine

ABSTRACT Objective To analyze, from the examination of decisions issued by Brazilian courts, how Evidence-Based Medicine was applied and if it led to well-founded decisions, searching the best scientific knowledge. Methods The decisions made by the Federal Courts were searched, with no time limits, at the website of the Federal Court Council, using the expression “Evidence-Based Medicine”. With regard to decisions issued by the court of the State of São Paulo, the search was done at the webpage and applying the same terms and criterion as to time. Next, a qualitative analysis of the decisions was conducted for each action, to verify if the patient/plaintiff’s situation, as well as the efficacy or inefficacy of treatments or drugs addressed in existing protocols were considered before the court granted the provision claimed by the plaintiff. Results In less than one-third of the decisions there was an appropriate discussion about efficacy of the procedure sought in court, in comparison to other procedures available in clinical guidelines adopted by the Brazilian Unified Health System (Sistema Único de Saúde) or by private health insurance plans, considering the individual situation. The majority of the decisions involved private health insurance plans (n=13, 68%). Conclusion The number of decisions that did consider scientific evidence and the peculiarities of each patient was a concern. Further discussion on Evidence-Based Medicine in judgments involving public healthcare are required.

The principles of evidence-based medicine

2021 ◽  
pp. 1268-1278
Author(s):  
Miriam J. Johnson ◽  
David C. Currow
Keyword(s):  
Palliative Care ◽  
Evidence Based Medicine ◽  
Evidence Based ◽  
Care Providers ◽  
Personalized Care ◽  
Practice Of Medicine ◽  
Increasing Demand ◽  
Medical Disciplines ◽  
Based Medicine ◽  
Dominant Paradigm

Evidence-based medicine (EBM) has transformed clinicians’ approach to the practice of medicine. In most disciplines, EBM is the fundamental component of decision-making driving expectations of the care received by patients and families. To improve outcomes, EBM blends science and compassion to provide personalized, effective treatments, and consistent application of interventions. The ever-increasing demand for palliative care will continue unabated due to longer lifespans and a shift in the approach to disease from primarily acute illnesses to predominantly chronic conditions. The adoption of EBM by palliative care providers will advance the knowledge and practice base, elevating its position among other medical disciplines that have adopted EBM as the dominant paradigm. The framework of EBM informs a systematic and manageable approach to the overwhelming amount of available evidence. Patients will benefit from EBM practices when palliative care practitioners provide the most effective and personalized care tailored each patient’s needs, characteristics, and preferences.

scholarly journals The difficult crossroads of decisions at COVID-19: how can the deontology implicit in Evidence-Based Medicine help us to understand the different attitudes of doctors at this time?

2020 ◽  
Vol 47 ◽  
Author(s):  
MIGUEL PRESTES NACUL ◽  
MARCO ANTÔNIO AZEVEDO
Keyword(s):  
Evidence Based Medicine ◽  
Scientific Evidence ◽  
Healthcare Providers ◽  
Well Being ◽  
Medical Decision ◽  
Evidence Based ◽  
Conservation Of Resources ◽  
Health Measures ◽  
The Many ◽  
Based Medicine

ABSTRACT One of the struggles faced by physicians in clinical decisions during the COVID-19 pandemic is how to deal with already available or lacking scientific evidence. The COVID-19 pandemic has a large impact in the routine of the many health services, including surgery, which demanded changes in assist protocols. Questions began to arise about well-established surgery conducts due to situations related to SARS-COV-2 infection, and, according to public health measures that are necessary to fight the pandemic. In situations of scarce available evidence, it is natural for us to have to deal with systematically more fragile, provisory and bias-susceptible information. Considering the principles that guide Evidence Based Medicine and Bioethical, the authors analyze the complexity of the medical decision-making during this time. Medical conducts must be adapted to the context of fighting the pandemic and consider patients and healthcare providers exposure and well-being and, lastly, the conservation of resources. The authors conclude that acceptance and tolerance to divergence is commendable, being a path to achieving unity in the diversity of medicine in times of little safe knowledge.

scholarly journals Cochrane method for evaluating the efficacy of drugs, national contribution to international Cochrane collaboration

2019 ◽  
Vol 10 (4) ◽  
pp. 31-39
Author(s):  
D. L. Varganova ◽  
C. S. Pavlov ◽  
A. A. Svistunov
Keyword(s):  
Clinical Trials ◽  
Evidence Based Medicine ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Scientific Evidence ◽  
State Level ◽  
Cochrane Collaboration ◽  
Historical Background ◽  
Evidence Based ◽  
Based Medicine

Modern approaches in medicine are based on the principles of evidence-based and balanced decisions in the age of personalized evidence-based medicine. Cochrane collaboration plays an important role in the development of evidence-based medicine; it’s methodology of meta-analysis, summarizing the scientific evidence from randomized clinical trials (RCTs) to answer the clinical questions about safety and effectiveness of various medical interventions. The article provides a brief historical background on the main milestones in the development of the methodology of evidence-based medicine, on the formation of Cochrane collaboration. The authors explain the concept of meta-analysis and systematic review, their types, methodological features and current requirements. The article defines the sequence of writing a metaanalysis: determing a task, inclusion and exclusion criteria, systematic search for randomized clinical trials, methodological assessment of studies, error risk assessment, meta-analysis models: fixed and random effects; determination of heterogeneity, presentation of meta-analysis results, assessment of confidence level using the GRADE system. The domestic experience of establishing evidence-based medicine in Russia and the contribution to the Cochrane international collaboration are represented separately: the opening of the first branch of the North European Cochrane Cooperation Center in Russia in 1998, the development of educational activities, the work of the Russian clone of the Cochrane Hepatobiliary Group and the appearance of the first qualitative meta-analysis, written by Russian authors, the introduction of an adapted system and the development of a national system for supporting medical decisions. The policy of introducing evidence-based medicine at the state level, legal acts, and the prospects for the development of evidence-based medicine in Russia are reflected.

Achieving Evidence-Based Practices in Colorectal Surgery

2014 ◽  
Author(s):  
Imran Hassan
Keyword(s):  
Colorectal Surgery ◽  
Evidence Based Medicine ◽  
Scientific Evidence ◽  
Evidence Based ◽  
Evidence Based Practices ◽  
The Past ◽  
Hierarchy Of Evidence ◽  
Evidence Based Surgery ◽  
Key Resources ◽  
Based Medicine

The concept of evidence-based medicine (EBM) and evidence-based surgery (EBS) involves combining the best scientific evidence available with the clinician’s judgment while also considering the patient’s needs and preferences. In the past, the practice of colorectal surgery was based on tradition and anecdotal experience from experts rather than scientific rationale. However, the rise of EBM has led to changes in how colorectal surgery is performed. This review discusses the hierarchy of evidence, fundamental principles of EBS, and practicing evidence-based colorectal surgery. Tables review the Oxford Centre for Evidence-Based Medicine revised levels of evidence, four steps of evidence-based surgery, key resources for evidence-based surgery, the “PICO” technique, and the Dindo-Clavien classification system. This review contains 5 tables and 69 references.

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