Medical care for individual patients: concepts beyond evidence-based medicine

2004 ◽  
Vol 42 (12) ◽  
pp. 680-689
Author(s):  
J. Bonelli ◽  
K. Felsenstein ◽  
E.H. Prat ◽  
M. Schwarz
Keyword(s):  
Medical Care ◽  
Evidence Based Medicine ◽  
Evidence Based ◽  
Based Medicine

scholarly journals Managed healthcare in South Africa : impact on patient care and ethical pharmaceutical sales in Kwa-Zulu-Natal

2003 ◽  
Author(s):  
◽  
Krishnavelli Marla Naidoo
Keyword(s):  
South Africa ◽  
Managed Care ◽  
Medical Care ◽  
Patient Care ◽  
General Practitioners ◽  
Evidence Based Medicine ◽  
Evidence Based ◽  
Pharmaceutical Sales ◽  
Based Medicine

Managed care is defined by Chetty (1999: 1) as "the practice of evidence based medicine with an approach to managing both the quality and cost of medical care". Managed care was introduced into South Africa in the last decade due to increasing cost of healthcare. All forms of managed care represent attempts to control costs by modifying the behaviour of general practitioners.

Evidence-Based Medicine in Otolaryngology Part XII: Assessing Patient Preferences

2020 ◽  
pp. 019459982095072
Author(s):  
Matthew R. Naunheim ◽  
Gregory W. Randolph ◽  
Jennifer J. Shin
Keyword(s):  
Clinical Practice ◽  
Medical Care ◽  
Patient Preferences ◽  
Evidence Based Medicine ◽  
Data Sources ◽  
Evidence Based ◽  
Patient Centered ◽  
Rigorous Evaluation ◽  
Current State ◽  
Based Medicine

Objective To provide a contemporary resource to update clinicians and researchers on the current state of assessment of patient preferences. Data Sources Published studies and literature regarding patient preferences, evidence-based practice, and patient-centered management in otolaryngology. Review Methods Patients make choices based on both physician input and their own preferences. These preferences are informed by personal values and attitudes, and they ideally result from a deliberative evaluation of the risks, benefits, and other outcomes pertaining to medical care. To date, rigorous evaluation of patient preferences for otolaryngologic conditions has not been integrated into clinical practice or research. This installment of the “Evidence-Based Medicine in Otolaryngology” series focuses on formal assessment of patient preferences and the optimal methods to determine them. Conclusions Methods have been developed to optimize our understanding of patient preferences. Implications for Practice Understanding these patient preferences may help promote an evidence-based approach to the care of individual patients.

scholarly journals Narrative Medicine – the methodology of doctor-patient communication analysis

2017 ◽  
Vol 15 (1-2) ◽  
pp. 105-128
Author(s):  
Ioana Silistraru
Keyword(s):  
Medical Care ◽  
Narrative Analysis ◽  
Evidence Based Medicine ◽  
Medical Knowledge ◽  
Narrative Medicine ◽  
Health Practitioner ◽  
Evidence Based ◽  
Communication Analysis ◽  
Patient Narratives ◽  
Based Medicine

AbstractThe present paper aims at presenting a non-exhaustive list of methodology instruments for narrative analysis in medical communication. Patient narratives became of more and more importance while evidence-based medicine has created a gap between patients, their illness and their doctors. While being investigated through high-technology instruments used in medicine, the patient vanishes behind the computer screen where his body is analysed based on the biomedical factors. Narrative medicine is defined by one of its founders as the interaction between a health practitioner who doesn’t simply look at diseases, but treats the person who’s suffering from an illness by listening closely to his story (Charon 2001). Therefore, as mentioned by Rita Charon in her works, the doctor-patient interactions are measured considering the effectiveness of medical care. The patient is empowered with medical knowledge related to his illness, transposed into an accessible language. On the other side of the communication spectrum, the doctor reconnects with his patient, manifesting interest on how the patient’s life is affected by illness, not only on how it can be effectively treated. ‘Now, in recent years medical narrative is changing—from the stories about patients and their illnesses, patient narratives and the unfolding and interwoven story between healthcare professionals and patients are both gaining momentum, leading to the creation or defining of narrative-based medicine (NBM).’ (Kalitzkus and Matthiessen 2009). Narrative based medicine is presented to counteract the pitfalls of evidence-based medicine (EBM). NBM can foster a better care while taking into account the patient’s story on the way illness is affecting the quality of his everyday life. The final objective of effective medical care is to alleviate, if not to dismiss completely the illness and the suffering of the patients.

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.

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