To What Degree Could Clinical Trials in Evidence Based Medicine Reflect The Real World in The Treatment of Pneumonia?

BackgroundEvidenced based medicine (EBM) is necessary to standardize treatments for infections because EBM has been established based on the results of clinical trials. Since entry criteria for clinical trials are very strict, it ​may cause skepticism or question whether the results of clinical trials reflect the real world ​of medical practice.MethodsTo examine how many patients could join any randomized clinical trials for the treatment of community-onset pneumonia, we reviewed all the pneumonia patients in our institute during 2014-2017. The patients were divided into two groups: patients who were eligible for clinical trials (participation possible group), and those who were not (participation impossible group). Exclusion criteria for clinical trials were set based on previous clinical trials.ResultsA total of 406 patients were enrolled in the present study. Fifty-seven (14%) patients were categorized into the participation possible group, while 86% ​of patients belonged to the participation impossible group. Patients in the participation possible group had less comorbidities and ​more favorable outcomes than those with the participation impossible group. As for the outcomes, there were significant differences in the 30-day and in-hospital mortality rates between the two groups. In addition, the participation possible group showed a longer overall survival time than the participation impossible group (p<0.001 by Log-Rank test).ConclusionThere is a difference in patients’ profile and outcomes between clinical trials and the real world. Though EBM is essential to advance ​medicine, we should acknowledge the fact​s and the limit​s of the clinical trial.

Pemberian Steroid untuk Meningkatkan Bilirubin Clearance pada Pasien dengan Atresia Bilier Pasca Prosedur Kasai

Latar belakang. Insidensi atresia bilier di dunia berkisar antara 5-37 kasus/100.000 kelahiran hidup. Setelah prosedur Kasai, bilirubin clearance hanya tercapai 50%. Pemberian steroid diharapkan dapat mengurangi inflamasi, tetapi keuntungan penggunaan steroid belum dapat dibuktikan. Oleh karena itu, dilakukan laporan kasus berbasis bukti untuk menilai bilirubin clearance setelah pemberian steroid pada pasien dengan atresia bilier pasca prosedur Kasai.Tujuan. Mengetahui efektivitas pemberian steroid untuk meningkatkan bilirubin clearance pada pasien atresia bilier pasca prosesur Kasai.Metode. Pencarian studi dilakukan melalui penelusuran tiga pangkalan data ilmiah, yaitu PubMed, Scopus, dan Cochrane. Setelah dilakukan penapisan judul dan abstrak, didapatkan 3 studi yang akan ditelaah secara kritis meliputi validitas, kepentingan, dan kemamputerapan menggunakan Oxford Center of Evidenced-Based Medicine 2011.Hasil. Telaah kritis dilakukan pada 3 studi dan didapatkan hasil yang valid, penting, dan mampu diterapkan. Ketiga studi tersebut menjukkan pemberian steroid dosis sedang-tinggi efektif dalam meningkatkan bilirubin clearance pada pasien atresia bilier pasca prosedur Kasai dibandingkan dengan plasebo atau terapi nonsteroid, terutama pada anak yang berusia kurang dari 70 hari saat prosedur Kasai dilakukan. Pemberian steroid dapat meningkatkan bilirubin clearance setelah follow up jangka pendek (≤1 tahun).Kesimpulan. Pemberian steroid dosis sedang-tinggi efektif dalam meningkatkan bilirubin clearance pada pasien atresia bilier pasca prosedur Kasai yang berusia kurang dari 70 hari saat prosedur dilakukan.

Repetitorium Kardiologie 5. Auflage

Kompakte Darstellung der aktuellen Kardiologie Das E-Book ist als Repetitorium für den klinischen Alltag konzipiert und eignet sich hervorragend zur Vorbereitung für die Facharztprüfung. Auf der Grundlage der klinisch relevanten Ergebnisse maßgeblicher Studien und Übersichtsarbeiten wurde die 5. Auflage komplett überarbeitet. Sie gibt den aktuellen Stand der Kardiologie klar strukturiert und übersichtlich wieder. Der Inhalt orientiert sich streng an der "evidenced based medicine" und den etablierten Leitlinien der Fachgesellschaften. Gut gerüstet für den klinischen Alltag und die Facharztprüfung!

Advances in Dorsal Column Stimulation

Spinal cord stimulation (SCS) has been a long established therapy for various pain conditions including low back pain, failed back surgery syndrome, complex regional pain syndrome, and other neuropathic and nociceptive pain states. Since the first report of SCS in 1967 by Shealy, advances have occurred in the technology used to achieve clinical analgesia. Developments in both the hardware and software involved have led to significant improvements in functional specificity, as seen in dorsal root ganglion stimulation, along with increasing breadth and depth of the field of neuromodulation. The patient experience during the implantation of the systems, as well as post-procedurally has been enhanced with improvements in programming. These technological improvements have been validated in quality evidenced-based medicine: what was a static area now is a dynamic field, with neuromodulation poised to allow physicians and patients more viable options for better pain control for chronic painful conditions.

Reflections from the Jury Box: Improving Evidence Based Practice through a Comparison with Our Legal System

Background: An experience serving jury duty prompted reflection on the parallels between evidenced based medicine and our legal system. Findings: The steps of the legal system can be tied to each step of the practice of evidenced based medicine. Implications: Patients should be included in evidence based decisions. Pharmacists can act as resources for other providers practicing evidenced based medicine. Educators can use this analogy to teach evidence based medicine. Conflict of Interest We declare no conflicts of interest or financial interests that the authors or members of their immediate families have in any product or service discussed in the manuscript, including grants (pending or received), employment, gifts, stock holdings or options, honoraria, consultancies, expert testimony, patents and royalties. Type: Commentary