La ricerca empirica in psicoanalisi e psicoterapia analitica. Paradossi e provocazioni

2019 ◽  
pp. 38-55
Author(s):  
Fabrizio Alfani
Keyword(s):  
Evidence Based Medicine ◽  
Evidence Based ◽  
Based Medicine

L'autore, dopo una breve sintesi storica degli approcci teorici alla ricerca in psicoterapia, sottolinea alcuni aspetti problematici della Evidence Based Medicine applicata alla psicoterapia analitica. Vengono inoltre descritti i risultati di alcune ricerche sugli esiti delle terapie analitiche che ne dimostrano l'efficacia, confermata negli studi di follow-up. Vengono infine presentate alcune riflessioni su quale possa essere il ruolo della ricerca empirica nello sviluppo della conoscenza in psicoanalisi e psicologia analitica.

A Train-the-Trainer Model for Integrating Evidence-Based Medicine Training into Podiatric Medical Education

2005 ◽  
Vol 95 (5) ◽  
pp. 497-504 ◽  
Author(s):  
Michael L. Green
Keyword(s):  
Faculty Development ◽  
Curriculum Reform ◽  
Evidence Based Medicine ◽  
Development Program ◽  
Evidence Based ◽  
Faculty Development Program ◽  
Train The Trainer ◽  
Implementation Planning ◽  
Based Medicine

This article presents the development, implementation, and evaluation of a national evidence-based medicine faculty-development program for podiatric medical educators. Ten faculty members representing six accredited colleges of podiatric medicine, one podiatric medical residency program, and a Veterans Affairs podiatry service participated in a 2-day workshop, which included facilitated discussions, minilectures, hands-on exercises, implementation planning, and support after the workshop. Participants’ evidence-based medicine skills were measured by retrospective self-reported ratings before and after the workshop. Participants also reported their implementation of “commitments to change” on follow-up surveys at 3 and 12 months. Participants’ evidence-based medicine practice and teaching skills improved after the intervention. They listed a total of 84 commitments to change, most of which related to the program objectives. By 12 months after the workshop, participants as a group had fully implemented 24 commitments (32%), partially implemented 36 (48%), and failed to implement 15 (20%) of a total of 75 commitments with follow-up data. The most common barriers to change at 12 months were insufficient resources, systems problems, and short patient visit times. A train-the-trainer faculty-development program can improve self-reported evidence-based medicine skills and behaviors and affect curriculum reform at podiatric medical educational institutions. (J Am Podiatr Med Assoc 95(5): 497–504, 2005)

Abstract 16755: Association Between Achievement of Risk Factor Standard of Care Goals and Major Adverse Cardiovascular Events in Patients With Stable Coronary Artery Disease in the STABILITY Trial

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Harvey D White ◽  
Ralph A Stewart ◽  
Anthony J Dalby ◽  
Amanda Stebbins ◽  
Christopher P Cannon ◽  
...  
Keyword(s):  
Evidence Based Medicine ◽  
Cardiovascular Events ◽  
Standard Of Care ◽  
Cox Proportional Hazards Model ◽  
Major Adverse Cardiovascular Events ◽  
Diabetic Patients ◽  
Evidence Based ◽  
Stable Coronary Heart Disease ◽  
Based Medicine

Introduction: Clinical practice guidelines have recommended evidence based medicine (EBM) and treatment targets for optimal management of BP, LDL Cholesterol (LDLc) and of HbA1c in diabetic patients with stable coronary heart disease [CHD]. However the importance of achieving these goals is uncertain. Hypothesis: In patients with stable CHD achievement of goals for blood pressure, LDLc, and HbA1c in diabetics, and use of EBM are associated with a lower risk of major adverse cardiovascular events [MACE]. Methods: In 13,624 patients with stable CHD, who participated in the STabilisation of Atherosclerotic plaque By Initiation of darapLadIb TherapY (STABILITY) trial, BP, LDLc and HbA1c in diabetes were assessed at baseline, and at 3, 6 and 12 month follow-up visits; BP and medication use were additionally assessed at 1 month. EBM; aspirin, beta blockers, ACE / ARB, and statins, were recommended for patients without contraindications. Standard of care (SOC) targets were BP<140/90 mmHg, LDLc <70mg/dl and <100mg/dl, and HbA1c<7% in 4711 diabetics. Achievement of each of these targets was defined as meeting the target on ≥4 of 5 visits for BP and EBM, and ≥3 of 4 biochemical measurements. A landmark analysis assessed the association between achievement of EBM and of each SOC target during the first year of the study and MACE, defined as cardiovascular death, MI, or stroke, during a further 2.7 years follow-up, after adjusting for baseline predictors of MACE in a Cox proportional hazards model. Results: See Table. Conclusions: High rates of evidence based medicine use were achieved. MACE was related to LDLc. After one year the risk of subsequent MACE was reduced for patients who met target LDLc levels and for diabetic patients who achieved target HbA1c.

A survey of Hip Society surgeons concerning the direct anterior approach total hip arthroplasty

2020 ◽  
Vol 102-B (7_Supple_B) ◽  
pp. 57-61
Author(s):  
Steven T. Woolson
Keyword(s):  
Clinical Practice ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Evidence Based Medicine ◽  
Anterior Approach ◽  
Direct Anterior Approach ◽  
Evidence Based ◽  
The Past ◽  
Based Medicine

Aims To establish whether there was a consensus among the members of the Hip Society (HS) on the role of direct anterior approach (DAA) contemporary primary total hip arthroplasty (THA). Methods An online survey was sent to all 112 active and senior members of the HS, to which 71 members responded. The survey was constructed to determine whether they believed that evidence-based medicine proves, in modern clinical practice, that the DAA has significant benefits compared to risks when contrasted with other approaches. In addition, they were asked if they currently used the DAA. Results While only 16.9% (12/71) of respondents had been trained in a generic anterior approach during residency, 49.3% (35/71) had used the DAA in their clinical practice in the past or were using it at the present time. Unexpectedly, 42.9% (15/35) of respondents who had used the DAA in the past had abandoned it by the time of this survey. Only 22.5% (16/71) of all respondents believed that evidence-based medicine proves that the DAA has significant benefits compared to risks in contrast to other approaches. Conclusion A comprehensive literature review found only three prospective randomized clinical trials (RCT) comparing the DAA with another approach with greater than one-year follow-up. Two showed minor benefits within the early postoperative period only, and one of those showed poorer mid-term results. Most of the published comparison studies with short follow-up show longer surgical times and greater blood loss for the DAA, and many three-month comparison studies show higher complication rates for the DAA using a proprietary traction table. The complications included problems with wound healing, lateral femoral cutaneous nerve injury, femoral component loosening, and femoral fractures. Because of the lack of evidence from RCTs showing superiority of the DAA over other approaches and reports of higher complications, the opinion of a large majority (77.5%; 55/71) of HS surgeons was that the DAA lacks sufficient evidence to warrant its use. Cite this article: Bone Joint J 2020;102-B(7 Supple B):57–61.

Cholangiokarzinome

Praxis ◽  
2002 ◽  
Vol 91 (34) ◽  
pp. 1352-1356
Author(s):  
Harder ◽  
Blum
Keyword(s):  
Supportive Care ◽  
Evidence Based Medicine ◽  
Best Supportive Care ◽  
Evidence Based ◽  
Systemische Chemotherapie ◽  
Chirurgische Resektion ◽  
Multimodale Therapiekonzepte ◽  
Based Medicine

Cholangiokarzinome oder cholangiozelluläre Karzinome (CCC) sind seltene Tumoren des biliären Systems mit einer Inzidenz von 2–4/100000 pro Jahr. Zu ihnen zählen die perihilären Gallengangskarzinome (Klatskin-Tumore), mit ca. 60% das häufigste CCC, die peripheren (intrahepatischen) Cholangiokarzinome, das Gallenblasenkarzinom, die Karzinome der extrahepatischen Gallengänge und das periampulläre Karzinom. Zum Zeitpunkt der Diagnose ist nur bei etwa 20% eine chirurgische Resektion als einzige kurative Therapieoption möglich. Die Lebertransplantation ist wegen der hohen Rezidivrate derzeit nicht indiziert. Die Prognose von nicht resektablen Cholangiokarzinomen ist mit einer mittleren Überlebenszeit von sechs bis acht Monaten schlecht. Eine wirksame Therapie zur Verlängerung der Überlebenszeit existiert aktuell nicht. Die wichtigste Massnahme im Rahmen der «best supportive care» ist die Beseitigung der Cholestase (endoskopisch, perkutan oder chirurgisch), um einer Cholangitis oder Cholangiosepsis vorzubeugen. Durch eine systemische Chemotherapie lassen sich Ansprechraten von ca. 20% erreichen. 5-FU und Gemcitabine sind die derzeit am häufigsten eingesetzten Substanzen, die mit einer perkutanen oder endoluminalen Bestrahlung kombiniert werden können. Multimodale Therapiekonzepte können im Einzellfall erfolgreich sein, müssen jedoch erst in Evidence-Based-Medicine-gerechten Studien evaluiert werden, bevor Therapieempfehlungen für die Praxis formuliert werden können.

The Commitment of the Documentation Service of the Swiss Academy of Medical Sciences for the Impartment of Evidence Based Medicine

Swiss Surgery ◽  
1999 ◽  
Vol 5 (4) ◽  
pp. 183-185
Author(s):  
Bleuer
Keyword(s):  
Evidence Based Medicine ◽  
Cochrane Library ◽  
Evidence Based ◽  
Medical Sciences ◽  
Based Medicine

Die mit dem Aufkommen der elektronischen Medien einhergehende Informationsflut hat die Erwartungen an den Dokumentationsdienst (DOKDI) der Schweizerischen Akademie der Medizinischen Wissenschaften verändert: Insbesondere Evidence Based Medicine (EBM) verlangt nicht nur die Beschaffung von Information, sondern auch eine Selektion hinsichtlich Qualität und Relevanz: Die sich aus der klinischen Situation ergebende Frage fordert eine Antwort, die inhaltlich richtig ist und in der konkreten Situation auch weiterhilft. Dem Ideal, sich durch kritische Lektüre der Originalarbeiten ein Bild über die vorhandene Evidenz für die Richtigkeit eines bestimmten Prozederes zu verschaffen, stehen in der Praxis meist Zeitmangel und methodische Schwierigkeiten im Weg; man wird sich deshalb oft auf die durch andere erarbeitete Evidenz abstützen müssen und z.B. die Cochrane Library konsultieren. Der DOKDI engagiert sich sowohl bei der Erarbeitung von systematischen Übersichtsarbeiten als auch bei der Dissemination der gefundenen Evidenz, indem er seine Erfahrung in der Dokumentation mit elektronischen Medien und die entsprechende Infrastruktur zur Verfügung stellt. Als Ergänzung zu diesen Aktivitäten hat die Akademie einen Grant zur Ausbildung von EBM-Tutoren gesprochen. In einem einwöchigen Kurs in Oxford werden Kliniker zu EBM-Tutoren ausgebildet: Dies wird zukünftig ermöglichen, vermehrt EBM-Workshops in der Schweiz durchzuführen.

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