1,721,099 research outputs found
Anxiety above the clouds
Full text linkThe first in this series of Dr Cochrane clinical vignettes is based upon an overview of Cochrane Reviews that was published in the previous issue of Evidence-Based Child Health: Manassis K, Russell K, Newton AS: The Cochrane Library and the treatment on childhood and adolescent anxiety disorders: an overview of reviews. Evid-Based Child Health 2010, 5: 541–554.
Dr Cochrane is a unique self-learning experience—the integration of Cochrane evidence with a quirky fictional story and multiple-choice questions provides readers with the opportunity to explore and understand the applicability of a Cochrane Review or Overview in a new way.
In this series of fictional clinical vignettes, Dr Cochrane travels across time from the past century to the present day, to solve clinical problems using evidence from Cochrane Reviews. Read the associated article and/or listen to the Evidence-Based Child Health podcast available online at www.cochrane.org/podcasts/ and then test your knowledge with six multiple choice questions. You can find the answers to the questions on page 1547.
In the next issue of Evidence-based Child Health, Dr Cochrane explores the evidence for chronic cough, based upon the Cochrane Overview available in this issue (Russell K, Chang AB, Foisy M, Thomson D, Williams K: The Cochrane Library and the Treatment of Chronic Cough in Children: An Overview of Reviews. Evid-Based Child Health 2010, 5: 1196–1205). Copyright © 2010 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. The Cochrane Collaboratio
WHO position statement on the use of delamanid for multidrug-resistant tuberculosis : Expedited review of the phase III clinical trial data of delamanid added to an optimised background MDR-TB regimen
No full textIn the presence of conceptual heterogeneity, results of network meta-analysis comparing therapies in Crohn's disease need to be interpreted with caution
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Il medico igienista e “ECCE” : le migliori prove di efficacia in un programma di formazione a distanza nazionale
No full textGestione del cambiamento attraverso le revisioni sistematiche come strumenti per orientare la pratica clinica: risultati preliminari di una collaborazione tra l'IRCCS Istituto Ortopedico Galeazzi e il Centro Cochrane Italiano (CCI)
No full textIntroduzione
L’Istituto Ortopedico Gaeazzi è un IRCCS polispecialistico di 350 posti letto, prevalentemente ortopedici. La leadership culturale dell’ente nell’ortopedia era tradizionalmente legata al prestigio accumulato nel tempo, alla presenza di scuole di specialità e a chirurghi di fama. La produzione scientifica era caratterizzata dalla pubblicazione di studi quasi-sperimentali (serie di casi), e in misura ridotta, da studi controllati. Oggi questo modello
è messo in discussione, perché sempre di più le scelte clinico terapeutiche necessitano di essere supportate da solide prove scientifiche ottenute attraverso sperimentazioni rigorose.
Obiettivo
Realizzare un programma che preveda la promozione e la produzione di linee-guida scientifiche attraverso la metodologia GRADE (Grading of Recommendations Assessment, Development and Evaluation) e di revisioni sistematiche.
Metodi e risultati
Per facilitare l’uptake di nuove conoscenze metodologiche è stata avviata una collaborazione tra Galeazzi e CCI, affiancando quindi ai clinici figure di supporto metodologico. E’ stato avviato un programma di formazione sviluppato su rilevanti problematiche ortopediche.Infine stato sono esplorati alcuni quesiti clinici, per selezionarne due da trasformare in una revisione sistematica e una linea guida.Il percorso formativo in aula è stato caratterizzato da un’iniziale non ottimale partecipazione. Gli incontri hanno affrontato le metodologie evidence-based e la valutazione critica della letteratura scientifica per prendere decisioni al letto del paziente. L’approccio didattico favoriva la discussione tra pari e
esercitazioni pratiche in piccoli gruppi. L’afflusso di partecipanti è aumentato durante le sessioni e si è concluso con la costituzione di un gruppo attivo e interessato.
Il gruppo ha poi cominciato la stesura di una revisione sistematica della letteratura dal titolo “Definizione dei fattori di rishio di per chirurgia riparativa delle fratture di femore: qual è il tempo d’attesa preoperatorio ottimale?” e avviato la produzione di una linee guida con il sistema GRADE per un uso ottimale delle sacche di sangue dopo interventi di chirurgia
ortopedica maggiore.
Conclusioni
La partecipazione dei clinici ortopedici allo sviluppo di prove di efficacia dovrebbe affiancarsi stabilmente all’attività clinica, con un continuo scambio. Questo dovrebbe
facilitare la diffusione di una cultura evidence-based, con ricadute positive sino ai pazienti. Questi cambiamenti sono lenti e in parte indipendenti dalle attività Galeazzi-Cochrane,
appartengono cioè alla categoria delle modificazioni medico-sociali. Questa collaborazione ha l’ambizione di accelerare questi cambiamenti e aumentare il pay-back in termini di
pubblicazioni, grant e leadership culturale
Mechanical low back pain : Secular trend and intervention topics of randomized controlled trials
No full textPurpose: To evaluate the number of published randomized controlled trials (RCTs) focusing on mechanical low back pain (MLBP) rehabilitation, the secular (i.e., long-term) trend, and the distribution of interventions studied. Methods: All included RCTs were extracted from all Cochrane systematic reviews focusing on rehabilitation therapies for MLBP, and two independent reviewers screened and analyzed the information on interventions. Results: After removal of duplicates, the data set consisted of 196 RCTs published between 1961 and 2010. The number of RCTs published increased consistently over time: 2 trials (1% of the total) were published in 1961–1970, 10 (5%) in 1971–1980, 41 (21%) in 1981–1990, 68 (35%) in 1991–2000, and 75 (38%) in 2001–2010. The intervention of interest in the majority of RCTs was exercise therapy (115/399; 29%), followed by spinal manipulation therapies (60/399; 15%). Conclusion: The number of RCTs focusing on MLBP has risen over time; of all interventions studied, exercise therapy has attracted the most research interest
Transbronchial needle aspiration : a systematic review on predictors of a successful aspirate
Full text linkBackground: Transbronchial needle aspiration (TBNA) is a safe and useful sampling technique for the diagnosis of mediastinal adenopathies/masses, but its accuracy seems to be influenced by selected clinical and procedural aspects. Objectives: We performed a systematic review to identify the main predictors of a successful transbronchial aspirate according to different clinical settings. Methods: We searched Medline and Embase for all studies evaluating predictors of TBNA diagnostic yield, published up to February 2012. Two authors reviewed all titles/abstracts and retrieved the full text of articles that are potentially relevant to identify studies according to predefined selection criteria. The methodological quality of studies was assessed through the revised Quality Assessment of Diagnostic Accuracy Studies tool. Evidence synthesis was graded according to overall number of studies, patients involved and methodological features. Results: Fifty-three studies, involving more than 8,000 patients and evaluating 23 potential predictive factors, were included. Major predictors in an unselected population, as well as in patients with suspected/known lung cancer, included lymph node size (short axis length ≥2 cm), presence of abnormal endoscopic findings, subcarinal and right paratracheal location, and the use of histological needle by an experienced bronchoscopist. Stage I and sampling of more than one lymph node stations were the only predictors of a successful TBNA result in patients with suspected sarcoidosis. Conclusions: The diagnostic yield of TBNA depends on selected clinical and procedural features. Knowledge of factors that predict a positive TBNA result may help optimize the diagnostic success of the procedure in different clinical settings
Most appropriate animal models to study the efficacy of statins: a systematic review
No full textBackground: In animal models and clinical trials, statins are reported as effective in reducing cholesterol levels and lowering the risk of cardiovascular diseases. We have aggregated the findings in animal models - mice, rats and rabbits - using the technique of systematic review and meta-analysis to highlight differences in the efficacy of statins. Materials and methods: We searched Medline and Embase. After examining all eligible articles, we extracted results about total cholesterol and other blood parameters, blood pressure, myocardial infarction and survival. Weighted and standard mean difference random effects meta-analysis was used to measure overall efficacy in prespecified species, strains and subgroups. Results: We included in systematic review 161 animal studies and we analysed 120 studies, accounting for 2432 animals. Statins lowered the total cholesterol across all species, although with large differences in the effect size: -30% in rabbits, -20% in mice and -10% in rats. The reduction was larger in animals fed on a high-cholesterol diet. Statins reduced infarct volume but did not consistently reduce the blood pressure or effect the overall survival. Few studies considered strains at high risk of cardiovascular diseases or hard outcomes. Conclusions: Although statins showed substantial efficacy in animal models, few preclinical data considered conditions mimicking human pathologies for which the drugs are clinically indicated and utilized. The empirical finding that statins are more effective in lowering cholesterol derived from an external source (i.e. diet) conflicts with statin's supposed primary mechanism of action
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