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How do we see medicine, health and disease? A basic set of rules and fundamental paradigms (including evidence!)
Published in Milos Jenicek, Foundations of Evidence-Based Medicine, 2019
In the GRADE group's first article in a 20-part series53–54 spanning from 2011 to 2015, the group states its contributions ‘provide guidance for rating quality of evidence and grading strength of evidence of recommendations in health care. It has important implications for those summarizing evidence, for systematic reviews, health technology assessment and clinical practice guidelines’. This group's contributions are richest in the evaluation of the essence and nature, as well as the structure and process, of medical activities and care. However, evaluation of the impact of these initiatives and recommendations will only be possible after more extensive usage in research and practice. Ideally, any process for categorizing and assessing knowledge and activities should reflect further resulting impacts on the health of individuals, communities and on the health system and activities which adopt them.
Evidence-based healthcare
Published in Antony Stewart, Basic Statistics and Epidemiology, 2018
It is important to remember, however, that a well-designed cohort study may actually provide better evidence than a badly conducted RCT, for example. Indeed, the appropriateness of study used, plus quality of study design and execution also needs to be taken into account when assessing the strength of evidence. Another important consideration is that even if well planned and conducted, the strength of evidence from a single study is limited by its sample size and generalisability to the population as a whole.
Evidence-Based Treatment of Addictive Disorders
Published in James MacKillop, George A. Kenna, Lorenzo Leggio, Lara A. Ray, Integrating Psychological and Pharmacological Treatments for Addictive Disorders, 2017
John F. Kelly, Brandon G. Bergman, Cristi L. O’Connor
In order to provide some context for the chapters on specific addictive disorders that follow, in this chapter we describe and review: (a) the nature and strength of evidence and its relationship to clinical research designs and the research process; (b) the origins and definitions of evidence-based approaches; (c) a description and comparison of medical and contextual models of evidence-based treatment; (d) challenges in the implementation and regulation of evidence-based treatments; (e) why a practitioner might deviate from the specific guidelines of an evidence-based treatment; (f) the Veterans Administration Quality Enhancement Research Initiative (QUERI) as an example of implementing and evaluating evidence-based treatment in practice; and (g) a proposal to enhance evidence-based treatment paradigms by highlighting practice-based evidence and measurement-based practice. We conclude with considerations for future directions of the evidence-based treatment paradigm, as related to substance use disorder (SUD) treatment.
Nutrition counseling and monitoring via tele-nutrition for healthy diet for people with spinal cord injury: A case series analyses
Published in The Journal of Spinal Cord Medicine, 2022
Shelley Wood, Cria-May Khong, Benjamin Dirlikov, Kazuko Shem
The interactive tele-nutrition counseling was conducted by a dietitian following the Nutrition Guidelines for Individuals with SCI set forth by the Academy of Nutrition and Dietetics’ Evidence-Based Analysis Toolkit.17 This SCI-specific toolkit aims to assist dietitians with providing evidence-based MNT for those with SCI and provides a summary of outcomes, assessment factors, expected outcomes, and ideal values for MNT. Scientific evidence is provided with a recommended strength of evidence: Strong, Fair, Weak, Consensus, and Insufficient Evidence. HBM served as the framework behind each counseling sessions to address “buy-in” when making changes to nutritional habits. Participants’ belief that incorporating healthier eating habits as well as the desire to prevent and/or reverse negative health consequences (e.g. perceived seriousness, susceptibility, threat, benefits, barriers, cues to action) resulting from a poor diet following SCI (e.g. weight gain) were a main portion of each tele-nutrition session.
One size fits all? How to optimize the prescribing of appropriate polypharmacy in chronic diseases, using a behavioral approach – a United Kingdom perspective
Published in Expert Review of Clinical Pharmacology, 2022
Synthesis of trial findings has not found strong evidence as to what supports the prescribing of appropriate polypharmacy. A Cochrane review published in 2018 (and currently being updated) found little evidence on how to achieve appropriate polypharmacy and included studies reported little detail on the approach to intervention development and content [1]. A review of systematic reviews examining interventions addressing polypharmacy reported that interventions focusing on appropriate prescribing in the context of polypharmacy produced some benefits, but there was no consistent evidence on other outcomes, such as health-care utilization, morbidity, or mortality [11]. It is important to consider the impact of an intervention on outcomes that are important to patients, health-care providers and policymakers to ensure that assessed interventions can have the widest possible impact and which will allow for synthesis of similar studies to reinforce the strength of evidence [12].
Comparisons of effects of SOX and mFOLFOX6 chemotherapy regimens on patients with locally advanced gastric cancer
Published in Journal of Chemotherapy, 2022
Gui-dong Chen, Bin-xiao Cao, Ying Shi, Jie-min Lv, Dong-hai Wang, Lun-bo Shi
In this study, some limitations should be pointed out. Firstly, this study belonged to retrospective analysis of cases, and failed to use randomized controlled design to analyze the effect of the two regimens on locally advanced gastric cancer. Thus, the evidence strength of evidence-based medicine is not enough, the results of this study need to be further confirmed by mean of randomized controlled trials with large sample. Secondly, the duration of follow-up was a little short, mid- and long-term follow-up will help to verify the differences of survival conditions between SOX regimen and mFOLFOX6 regimen. Lastly, there were many kinds of neoadjuvant chemotherapy regimens for locally advanced gastric cancer, such as SOX regimen, mFOLFOX6 regimen, FLOT regimen, but there still was a lack of ‘golden standard’ in the selection of chemotherapy regimen In this study, only SOX regimen and mFOLFOX6 regimen were comparatively analyzed, the differences of clinical outcomes of any other regimen should be further investigated in the future.