Critical Evaluation Of Evidence Research Articles

Anticoagulation for Patients with Venous Thromboembolism: When is Extended Treatment Required?

The need for extended venous thromboembolism (VTE) treatment beyond 3 to 6 months is usually determined by balancing the risk of recurrence if treatment is stopped against the risk of bleeding from continuing treatment. The risk of recurrence, and in turn the decision to extend, can be determined through the nature of the index event. Patients with VTE provoked by surgery or trauma (major transient risk factors) are recommended to receive 3 months of anticoagulation therapy because their risk of recurrence is low, whereas patients with VTE provoked by a major persistent risk factor, such as cancer, or those considered to have “unprovoked” VTE, are recommended to receive an extended duration of therapy based on an established high risk of recurrence. Nonetheless, recent evidence and new guidance identify that this approach fails to consider patients with risk factors classed as minor transient (e.g., impaired mobility and pregnancy) or minor persistent (e.g., inflammatory bowel disease and congestive heart disease). Indeed, the risk of recurrence with respect to VTE provoked by minor persistent risk factors has been demonstrated to be not dissimilar to that of VTE without identifiable risk factors. This review provides an overview of the available data on the risk of recurrence according to the underlying cause of VTE, a critical evaluation of evidence from clinical studies on the available anticoagulants for extended VTE treatment, models of risk prediction for recurrent VTE and bleeding, and guidance on how to apply the evidence in practice.

Does Truth Have a Future?

Does Truth Have a Future?

Components of Writing a Review Article

The term research is well-known to the logical world which plays an important role in finding the new problems and solutions, ideas, techniques, procedures, drugs, etc. Good use of research knowledge especially in writing is imperative to make it beneficial for larger community. In writing of knowledge, proper review of literature is very essential to gather research-problem-related information. Writer should follow the steps throughout collection of data during writing of review article. Review of literature increases clarity, reliability, uniformity and critical evaluation of evidence. This paper attempts to explain the guidelines and steps of review manuscript writing.

Prática baseada em evidências: competências entre enfermeiros novatos e preceptores em hospital de ensino

Objetivo: verificar competências para a Prática Baseada em Evidências entre enfermeiros novatos e seus preceptores. Métodos: estudo observacional, transversal, constituído por amostragem não probabilística a fim de se alcançar o número máximo de participantes. Foram realizadas entrevistas estruturadas utilizando-se Evidence-Based Practice Questionnaire para verificação das competências. Resultados: participaram 83,1% da população (n=104 enfermeiros), maioria de mulheres, jovens adultas. Em média, foram moderadas as competências para Prática Baseada em Evidências (novatos = 4,8; preceptores = 5,0). Ambos acreditam ser fundamental a utilização de evidências na prática. Entretanto, a avaliação crítica das evidências no cotidiano de atuação tem sido pouco recorrente entre eles. Definir tempo no trabalho para buscar evidências apresentou-se como dificuldade, sendo maior entre novatos (p=0,05). Preceptores apresentaram melhor habilidade em informática para busca de evidências (p=0,043). Conclusão: em geral, as competências para Prática Baseada em Evidências foram similares entre enfermeiros novatos e preceptores.

Lateralization of Brain Functions: A Randomized Single-Blinded Observational Study

Background: Cerebral dominance, also known as lateralization of brain functions, is the neurologic phenomenon in which one hemisphere dominates over the other. In humans, the majority of people are of left cerebral dominance. This study aims to derive a statistical inference between determined parameters of cerebral dominance (handedness, gender, and language skills) and the 3-dimensional visual analytic skills. Objectives: To investigate the presence of a correlation between the lateralization of brain functions and visual analytic skills. This study is purely observationally and cross-sectional in design using survey tool. Despite purely observational, proper randomization and blinding were done for the participants, to prevent coverage and selection biases among participants. Methods: This cross-sectional survey targeted an audience of undergraduate medical students, 103 of them replied and fully completed an electronic survey. All participants were blinded to the outcome and aims of the study. The survey was created via Google Forms, and made available online for three days, on the university intranet system. Compiled data resulted in 523 pages. Statistics were done using SPSS v.20, Microsoft Excel 2016, and Shodor-Interactivate software. Referencing for this paper were retrieved via a detailed systematic review of literature databases while carrying out critical evaluation of evidence. The databases included: PubMed, the Cochrane Library, Scopus, OpenGrey, and Google Scholar. Results: Males and females participated in the survey, 34 and 69 participants respectively. Approximately 88.4% of participants were right-handed. Mapped participants’ demographics included: age, gender, handedness, siblings’ and parents’ handedness, the number of siblings and birth order, and the number of spoken languages. Statistics have proven that there was no significant correlation between the 3D-visual skills and any of the tested parameters. Significance was considered at an alpha value of 0.05 Conclusions: The tested hypothesis regarding the presence of potential correlation between handedness (and other parameters of cerebral dominance) with the three-dimensional visual analytic skills, were proven to be non-existent.

The relation between cerebral dominance and visual analytic skills in Iraqi medical students, a cross sectional analysis

Background: Cerebral dominance, also known as lateralization of brain functions, is the neurologic phenomenon in which one hemisphere is dominant over the other, and will thereby exercise greater influence over certain functions. The cerebral lateralization of many vertebrates, indicates an evolutionary advantage associated with the cerebral specialization. In humans, the majority of people are of left cerebral dominance. True bilateral cerebral dominance, manifested in ambidexterity, is exceedingly rare.Aims and Objective: To derive a statistical inference between determined parameters of cerebral dominance and the 3-dimensional visual analytic skills. The parameters are: handedness, , gender, and language skills.Materials and Methods: This survey targeted an audience of undergraduate medical students, 103 of them replied and fully completed an electronic-distributed survey. All participants were blinded to the outcome and aims of the study (single-blinded experimental design). The survey was created via Google Forms, and made available online for three days, on the University intranet system. Compiled data resulted in 523 pages. Statistical analyses were conducted using the Statistical Package for Social Sciences, Shodor-Interactivate software, and Microsoft Excel 2016. References of this paper, were retrieved via a detailed systematic review of literature databases, while carrying out critical evaluation of evidence. The databases included: PubMed, The Cochrane Library, Scopus, OpenGrey, and Google Scholar.Results: Males and females participated in the survey (34 and 69 participants respectively), 91 of participants (88.4%) were right-handed. Mapped participants’ demographics included: age, gender, handedness, siblings’ and parents’ handedness, number of siblings and birth order, and number of spoken languages. The 3D-visual analytic skills, were evaluated via a cross sectional survey and objectively-evaluated via a professional visual IQ testing. Statistics proven that there was no significant correlation between the 3D-visual skills and any of the tested parameters. Significance was considered at a p-value of 0.05 or less.Conclusion: In this sample of 103 tested subjects, all of which were not professional Anatomists. Our tested hypothesis of the presence of potential correlation between handedness (and other parameters of cerebral dominance) with the three-dimensional visual analytic skills, were proven statistically to be non-existent. Asian Journal of Medical Sciences Vol.7(5) 2016 47-52

Early programing of uterine tissue by bisphenol A: Critical evaluation of evidence from animal exposure studies.

Exposure to Bisphenol A (BPA) during the critical window of uterine development has been proposed to program the uterus for increased disease susceptibility based on well-documented effects of the potent xenoestrogen diethylstilbestrol. To investigate this proposal, we reviewed 37 studies of prenatal and/or perinatal BPA exposure in animal models and evaluated evidence for: molecular signatures of early BPA exposure; the development of adverse uterine health effects; and epigenetic changes linked to long-term dysregulation of uterine gene expression and health effects. We found substantial evidence for adult uterine effects of early BPA exposure. In contrast, experimental support for epigenetic actions of early BPA exposure is very limited, and largely consists of effects on Hoxa gene DNA methylation. Critical knowledge gaps were identified, including the need to fully characterize short-term and long-term uterine gene responses, interactions with estrogens and other endogenous hormones, and any long-lasting epigenetic signatures that impact adult disease.

Finding independent information on new drugs

I would like to suggest the Therapeutics Initiative (www.ti.ubc.ca) as an additional resource for independent, critical evaluation of evidence for drugs. All information is currently free of charge.

Homeopathy for insomnia and sleep-related disorders: a systematic review of randomised controlled trials

The aim of this review was the critical evaluation of evidence for the effectiveness of homeopathy for insomnia and sleep-related disorders. A search of MEDLINE, AMED, CINAHL, EMBASE and Cochrane Central Register was conducted to find RCTs using any form of homeopathy for the treatment of insomnia or sleep-related disorders. Data were extracted according to predefined criteria; risk of bias was assessed using Cochrane criteria. Six randomised, placebo-controlled trials met the inclusion criteria. Two studies used individualised homeopathy, and four used standardised homeopathic treatment. All studies had significant flaws; small sample size was the most prevalent limitation. The results of one study suggested that homeopathic remedies were superior to placebo; however, five trials found no significant differences between homeopathy and placebo for any of the main outcomes. Evidence from RCTs does not show homeopathy to be an effective treatment for insomnia and sleep-related disorders.

Critical evaluation of evidence: a lesson to learn from a recent meta‐analysis

Critical evaluation of evidence: a lesson to learn from a recent meta‐analysis

Learning in small groups

There is a recent trend towards small-group work in undergraduate medical courses. Current understanding of educational strategies supports the use of small groups as an effective method of learning. Small-group work recognizes a movement towards learner-centred, problem-based and self-directed learning. The exploration of knowledge, learning through curiosity, the critical evaluation of evidence and a capacity for self-education are all fostered in small-group interactions. This article explores the rational arguments that support the movement towards small-group learning, the many benefits from small-group activities and the many types of small-group methods. Small groups interact in a variety of ways and the teacher has an important role. Barriers, more often perceived than real, may impede the adoption of small-group teaching. Practical guidance is offered on why to adopt small-group work and how to do it effectively. The teacher is provided with a framework for running small-group sessions and is given three simple checklists to consider before, during and after the small-group activity.