Doctors Question Research Articles

Automatic Interpretation of Laboratory Tests and Its Influence on Follow-up.

Failing to follow up on the abnormal test results can cause serious health problems to patients. We conducted a retrospective medical record review of 3200 randomly selected patients aged 18 to 76 in 14 state clinics and two private laboratory services querying the common regional patient registry. One patient could be included (1 clinical case) in the study only once. We invited patients to take part in the interviews to gain a deeper understanding of the motives to follow up or not after receiving a recommendation and explanation of the role of the automatically generated interpretation in this decision. A qualitative study of the patients' motivation was performed with a group of 689 patients. All the patients who received their interpretations showed a much higher follow-up rate (68% average) than the patients who did not receive interpretations (49 % average). The results of our research demonstrated that there is a significant impact on the patients' decision to follow up on the tests. Patients consider time factor as an important advantage of the computer interpretations and are willing to get automatic interpretations if they can receive it faster than the ones from their doctor (question 4: median =3 out of 7). Discussing the reasons behind the decision to follow up, the patients do trust the computerized clinical decision support systems (question 5: median = 5 out of 7), however, they prefer to receive interpretations and recommendations from doctors (question 3: median = 7).

Psoriasis of oral cavity- A review

Psoriasis is a chronic, genetically seen, scales, and inflammatory disease of the skin. Oral manifestations of psoriasis are rare and are often difficult to diagnose. Elbows, knees, sacral portion, and scalp are usually infected. Nail association is commonly more occurring. oral inclusion is uncommon. A few doctors question whether psoriasis influences the oral mucosa, especially because early reports of oral psoriatic lesions needed histologic affirmation. In this review article, we will show what are various parts of the oral cavity affected by psoriasis.

Management recommendations for patients with chronic kidney disease during the novel coronavirus disease 2019 (COVID-19) epidemic

COVID-19 has become a pandemic and it has already spread to at least 171 countries/regions. Chronic kidney disease (CKD) is a global public health problem with a total of approximately 850 million patients with CKD worldwide and 119.5 million in China. Severe COVID-19 infection may damage the kidney and cause acute tubular necrosis, leading to proteinuria, hematuria and elevated serum creatinine. Since the SARS-CoV-2 enters the cells by binding to the angiotensin-converting enzyme 2 receptor, some doctors question its ability to increase the risk and severity of developing COVID-19. Neither clinical data nor basic scientific evidence supports this assumption. Therefore, patients who take angiotensin-converting enzyme inhibitor or angiotensin receptor blocker are not advised to change their therapy. Patients with CKD are generally the elderly population suffering from multiple comorbidities. Moreover, some patients with CKD might need to take glucocorticoids and immunosuppressants. Dialysis patients are recurrently exposed to a possible contaminated environment because their routine treatment usually requires three dialysis sessions per week. Considering all the above reasons, patients with CKD are more vulnerable to COVID-19 than the general population. The development of COVID-19 may worsen the impaired kidney function and further lead to rapid deterioration of kidney function and even death. Strict comprehensive protocols should be followed to prevent the spread of COVID-19 among patients with CKD. In this review, we provide some practical management recommendations for health care providers, patients with CKD, dialysis patients and dialysis facilities.

Invasive preoperative diagnosis of idiopathic normal pressure hydrocephalus

Introduction. Until now, the most informative methods for selecting patients with idiopathic normal pressure (iNPH) for neurosurgical treatment were invasive diagnostic methods: tap test, lumbar infusion test, external lumbar drainage. Nevertheless, choosing the sequence of using these diagnostic tools and the assessment of their results cause number of questions for doctors in everyday practice.The study objective is to assess the informational content of invasive tests for differential diagnosis of iNPH and to create an algorithm of applying mentioned methods for clinical purposes.Materials and methods. At least one of the invasive diagnostic methods was used for 374 patients, who were treated in the period from 2006 to 2018 in the neurosurgical clinic of S. M. Kirov Military Medical Academy. The patients with final diagnosis of iNPH (n = 231), aged 58–87 years old, were selected for shunt surgery. The informativeness measures were calculated for each method on the basis of revealed data.Results. Sensitivity and specificity of tap test were 57.5 and 86.4 %, respectively, positive predictive value – 92.5 %, negative predictive value – 41.3 %, accuracy – 64.9 %. For lumbar infusion test sensitivity was 39.1 %, specificity – 63.6 %, but we calculated low negative predictive value (20.0 %) and accuracy (43.9 %) of the method despite of relatively high positive predictive value (81.8 %). External lumbar drainage revealed the highest significance of positive predictive value (92.9 %).Conclusion. Excluding of lumbar infusion test from the pre-operative diagnostic algorithm of iNPH and recommendation for sequential using of tap-test and external lumbar drainage after questionable result of the last one are an advisable option for practitioners.

Working conditions and health of doctors of a large medical organization

The assessment of working conditions and morbidity with temporary disability of doctors of a large multidisciplinary hospital, questioning of doctors to assess the relationship between the level of health of doctors and their attitude to the preservation of their own health. Programs of health protection of doctors and the organization of their medical care and health saving are developed.

Reflections on Doctor Question – Patient Answer Sequences and on Lay Perceptions of Close Translation

ABSTRACT The lay perception of those who work with interpreters in their professional conversations (and sometimes of interpreters themselves) is that translation of what they and their patients/clients say should be as close as possible. The very idea of close translation may seem simple, but the practice of rendering spontaneous talk-in-interaction as close as possible is quite complex, and requires much more from the mediator than textually close renditions. In this paper, we discuss what is involved in the accomplishment of close rendering in talk. We focus on question-answer sequences with clinicians and patients, when details about the patients’ history and their symptoms are collected. We show that meaning is achieved and rendered through processes that may go rather beyond the single words and utterances and that involve the contribution of all the interlocutors. We show three types of sequences taken from a collection of authentic data audio-recorded in health care services in Italy and transcribed to allow for analysis. The sequences show three different forms of talk, found in the data, where participants pursue close, precise rendition of medical details. The analysis highlights that the Italian intercultural mediators (just like those trained and assigned as public service interpreters in other countries), even in these cases which are peculiarly focused on precise details, do need to take responsibility not only for translating the textual items but also for coordinating turns at talk. It is responsible turn-coordination which leads to rendering meaning closely.

Effect of an Interactive Website to Engage Patients in Advance Care Planning in Outpatient Settings.

Online programs may help to engage patients in advance care planning in outpatient settings. We sought to implement an online advance care planning program, PREPARE (Prepare for Your Care; http://www.prepareforyourcare.org), at home and evaluate the changes in advance care planning engagement among patients attending outpatient clinics. We undertook a prospective before-and-after study in 15 primary care clinics and 2 outpatient cancer centers in Canada. Patients were aged 50 years or older (primary care) or 18 years or older (cancer care) and free of cognitive impairment. They used the PREPARE website over 6 weeks, with reminders sent at 2 or 4 weeks. We used the 55-item Advance Care Planning Engagement Survey, which measures behavior change processes (knowledge, contemplation, self-efficacy, readiness) on 5-point scales and actions relating to substitute decision makers, quality of life, flexibility for the decision maker, and asking doctors questions on an overall scale from 0 to 21; higher scores indicate greater engagement. In total, 315 patients were screened and 172 enrolled, of whom 75% completed the study (mean age = 65.6 years, 51% female, 35% had cancer). The mean behavior change process score was 2.9 (SD 0.8) at baseline and 3.5 (SD 0.8) at follow-up (mean change = 0.6; 95% CI, 0.49-0.73); the mean action measure score was 4.0 (SD 4.9) at baseline and 5.2 (SD 5.4) at follow-up (mean change = 1.2; 95% CI, 0.54-1.77). The effect size was moderate (0.75) for the former and small (0.23) for the latter. Findings were similar in both primary care and cancer care populations. Implementation of the online PREPARE program in primary care and cancer care clinics increased advance care planning engagement among patients.

ПОВЫШЕНИЕ ЭФФЕКТИВНОСТИ КОМПЛЕКСНОГО ЛЕЧЕНИЯ ВОСПАЛИТЕЛЬНЫХ ЗАБОЛЕВАНИЙ ПАРОДОНТА

Subject. The results of a sociological survey and questioning of doctors about prescribed antiseptic drugs and comparative data on their effectiveness are considered.
 The goal is to justify the feasibility of using various antiseptics in the complex treatment of patients with periodontal diseases.
 Methodology. Dentists were questioned to identify the most commonly prescribed drugs. 36 patients were divided into 3 experimental groups depending on the composition or concentration of the antiseptic drug used.
 Results. The values of the GI, SBI and API indices statistically significantly and more pronounced decreased at almost all stages of observation after the use of the traditional antiseptic at a concentration of 0.2 % and rinse aid Curasept. After 2 weeks of the study after completion of treatment, the pH level in the 1st group was 7.33 ± 0.035, in the 2nd and 3rd — 7.02 ± 0.049 and 6.69 ± 0.131, respectively. When analyzing the detection rate of P. gingivalis in the 1st group, it was found that out of 8 patients (72.7 %) after the completion of therapeutic measures, only 2 (18.2 %) had a high level of dissemination (χ2 = 6.60 p = 0.010), when studying the level of inoculation of A. Actinomycetemcomitans, similar results were obtained.
 Conclusions. Antiseptic 0.2 % chlorhexidine bigluconate solution and mouthwash Curasept ADS 212 (0.12 % chlorhexidine solution) in the treatment of chronic periodontitis lead to a more pronounced destruction of periodontal pathogenic microflora, normalization of acid-base balance and GI, SBI and API indices both at the initial stage of research, and in its most remote dates. After the use of the drug chlorhexidine bigluconate 0.05 %, the microbial contamination rates decrease, but bacteria do not completely eradicate and at all stages of observation, the average index values in the 3rd group are significantly higher compared to other groups.

The use of decorative braces in Jeddah, Saudi Arabia.

OBJECTIVE:To assess the practice of using orthodontic brackets as tooth decorations among dental offices and patients in Jeddah, Saudi Arabia.MATERIALS AND METHODS:The study was a cross-sectional survey using 2 questionnaires. The first included 14 doctor questions where 300 dental offices in Jeddah, Saudi Arabia were contacted by phone. The second questionnaire included 22 patient questions where 50 patients who currently have or have had decorative braces answered the questions online.RESULTS:Out of 250 dental offices that responded, 91 offices (36.4%) answered “yes” to offering decorative braces. Most dentists use metal brackets (96.3%) on both the upper and lower arches (98.8%) and ligate a wire (83.8%) using colored elastomeric ligatures. Out of 50 patients who answered the patient questions, 28 patients (56%) were females and the mean age was 19.84 years (±2.32). 37 (74%) patients reported that their decorative braces were not placed by dentists and mostly by over the counter glue. Finally, 62% reported they were not satisfied, and 84% said they would not recommend getting decorative braces to their family and friends.CONCLUSION:Our results indicate that the use of decorative braces is prevalent, and most are not being placed by dentist. As healthcare providers, we are obliged to educate the public of potential harm that can result when decorative braces are used, to hopefully limit the spread of this unfortunate practice.

Fifty years since the discovery of Bromocriptine

An ergot alkaloid, 2-Br-alfa-ergocriptin, and its effect on lactation in rats was first mentioned by E. Fluckiger and H. Wagner in the twenty-fourth issue, published in 1968, of the journal "Experientia". Initially, this work did not attract much attention; however, after the isolation of pure prolactin, and the establishment of its physiological role, the high efficacy of bromocriptine in the treatment of hyperprolactinemia quickly became clear. Bromocriptine has been actively studied not only by American and European scientists but also in the USSR since 1975. Bromocriptine was used in the treatment of persistent lactorrhea and amenorrhea, acromegaly, and also the drug was experimentally prescribed for Itsenko Cushings disease. Unique data about the children of mothers with hyperprolactinemia who received bromocriptine therapy was collected in the USSR. Bromocriptine also made a huge contribution to the treatment of Parkinsons disease, for which it has been used since the 1960s. Much later, in 2009, bromocriptine in small doses was approved for the treatment of type 2 diabetes. Currently, different studies of the effect of bromocriptine on various metabolic pathways are continuing. Thus, even 50 years after the discovery of bromocriptine, not all of its effects are well studied, and this world-famous drug continues to raise more and more new questions for scientists and doctors.

Comparative pharmacoepidemiological assessment of antianginal, antiplatelet and lipid-lowering drugs in patients with stable angina in outpatient practice in Kursk and Chisinau

Aim. To study structure of medical purposes of anti-anginal, antiplatelet and hypolipidemic means at coronary heart disease patients in ambulatory practice of Kursk (Russian Federation) and Chisinau (Republic of Moldova). Materials and methods. During the period from October, 2017 to January, 2018 as a one-stage descriptive research, questioning of doctors of the medical organizations of Kursk and Chisinau was carried out. Questionnaires included questions on pharmacoepidemiological aspects of purpose of antianginal, antiplatelet and hypolipidemic means. Total number of respondents was 132, of them 66 (2 cardiologists and 64 therapists) - in Kursk and 66 (10 cardiologists and 56 therapists) - in Chisinau. Results. Doctors of Kursk and Chisinau have no statistically significant differences in structure of appointments of the main groups of anti-anginal means, antiplatelet and hypolipidemic drugs. The tendency to more frequent use of blockers of calcium channels and nitrovazodilatator among doctors of Chisinau while in structure of appointments of doctors of Kursk some prevalence of a trimetazidin, antiagregants and statines was noted was noted (p>0.05). Leaders in group of beta blockers were bisoprolol and metoprolol in the conditions of the pharmaceutical market of Kursk and Chisinau. Priority of the choice of blockers of calcium channels authentically differed in the considered regions only on a felodipin - in Kursk appointed it to a thicket (p

Safety of using the preparation “Licopid®” in opinion of experts in various specialities

Aim. To study the safety of the preparation “Licopid®” using the data, obtained with the method of questioning of doctors of various specialities. The reactant of “Licopid®” tablets is glucoseminylmuramildipeptide – a synthetic analogue of the structural fragment of bacterial cells membrane (peptidoglycan), which is an activator of congenital and acquired immunity;it strengthens the defense of the body from viral, bacterial and fungal infections; it has an adjuvant effect in development of immunological reactions.
 Materials and methods. The object of this study were the answers of 2315 specialists to the questions of surveys regarding the safety of using immunomodulator“Licopid®” in their practical activity. The regions, involved into the survey were the following cities: Moscow, Kazan, Krasnodar, Ekaterinburg, St. Petersburg, Chelyabinsk, Novosibirsk, Perm, Samara and Voronezh as well as Krasnodar Krai. Processing of the results was fulfilled with the methods of descriptive statistics; the obtained data were compared with the method based on calculation of chi-square criterion.
 Results. The analyzed results showed that 962 respondents (41.5 %) indicated the fact of revealing undesirable reactions (UR) of the preparation “Licopid®” in their own practice. It was noted by them that all undesirable reactions were not severe and predicted, i.e. they were indicated in the instruction for medical use of “Licopid®” 1 mg and 10 mg.
 Conclusions. While conducting questioning, the authors revealed statistically significant differences in the structure of respondents’ answers depending on the region of residence and medical speciality. At the same time, for all UR, indicated in instruction, subjectively estimated occurrence rate of reactions coincided with that, declared upon registration, except myalgias and arthralgias, which were noted by doctors much rarely.

To the question of knowledge of doctors of responsibility for corruption crimes

Introduction. Precedents of reception of compensation for the rendered services connected with forgery and abusing by office position, continue to take a leading place in structure of actions of the medical personnel characterised as «crime».Purpose of the study was carrying out of the analysis of knowledge and legal literacy of doctors concerning criminal responsibility for the acts falling under determination «corruption».Materials and methods. Research is conducted according to questioning of doctors of the medical organisations concerning corruption crimes in a health care in 2018. Data processing. In research it is included correctly filled 115 questionnaires. For an objective estimation of degree of the coordination of answers of doctors counted an Cohen's kappa (κ). Results and discussion.Results of research have revealed unsatisfactory knowledge of medical personnel concerning a legal estimation of the professional activity regarding possibility of reception of material compensation from patients for the actions entering into functions.Conclusion. One of ways of decrease in frequency of attraction of medical personnel to criminal responsibility under «corruption» clauses in obligatory inclusion of legal questions in cycles of qualification improvement of doctors irrespective of their speciality within the limits of continuous continuous medical education.

Issues and perspectives of building a regional system of donor services (on the example of Nizhny Novgorod region)

Aim: to determine the perspectives of development a regional system of donor services (on the example of Nizhny Novgorod region) based on analysis of current results of its activity.Materials and methods. Protocols of the donor’s initial examination, acts of organ removal for transplantation, questionnaires of 266 doctors of donor bases in the region. Research methods: sociological, statistical.Results. The efficacy of the system of collaboration between the participants of organ donation existing in Nizhny Novgorod region is mainly determined by the activity of doctors on donor bases. According to the results of the questioning of doctors, the most significant factor determining their inclination to collaborate with the Center of organ donation is the direction by the administration of the medical organization (59,3 ± 3,0%). Only 11,1 ± 1,3% of the interviewed doctors stressed their understanding of the importance of the development of organ transplantation programs. As a result, the number of hospitals actually reporting the presence of donors was a half of the number established by the local administration of medical services in 2009. This indicator decreased more than 50% by 2017. During the period of 2009–2017, 488 calls of donor services were registered, while 354 calls ended up being ineffective mainly due to low level of qualification among the specialists of donor bases. During the examined period, there were registered 83 posthumous removals of donor organs with the death of the subjects being mainly (87,6 ± 3,4%) caused by an infarction of cerebral blood circulation. The losses of the donor resource resulted from inability to receive organs from persons who died as a result of injuries due to the rejection of their relatives (49 cases).Conclusion. Optimization of the use of the donor resource of the region is possible only if the development of the organ donation program is promoted at the level of the territorial public health authority. In the case of solving this issue, it is hypothetically possible for the region to achieve an indicator of donor activity of 25 per 1 mln. person.

Problems of promoting drugs in the Kyrgyz Republic

The article describes the results of the assessment methods of medicines promotion in health care organizations The purpose of our study was to study the factors affecting the prescribing, consumption and dispensing of medicines to develop measures to contain unethical drug marketing. For study this issue was used the method of interviewing and questioning of doctors, pharmacists and patients. Our results have shown that there are numerous factors in the health system, which contribute to a violation of the practice for rational prescribing and dispensing of medicines, as well as the absence of regulatory mechanisms in the medicines promotion on the market in the Kyrgyz Republic. The results of the study among this category of respondents confirm the limited access of doctors and pharmacists to quality sources of medicines information, which explains the shortcomings in informing patients on their part, which also serves unethical drug marketing. A direct correlation was established between information sources of about medicines and work experience, i.e. than more work experience, the more information is used from medical representatives and activities conducted by pharmaceutical companies (p < 0.05). The identified factors are associated with unethical medicines promotion, inadequate implementation of the generic strategy, non-prescription dispensing of all medicines, inadequate provision of quality reliable information, low awareness, lack of skills in critical assessment of the information provided. In connection with this, there is a high sensitivity of specialists to various incentives from pharmaceutical companies. All of the above in aggregate contribute to the irrational use of medicines, with all the ensuing consequences.

COMPARATIVE PHARMACOEPIDEMIOLOGICAL ASSESSMENT OF ANTIHYPERTENSIVE DRUGS PRESCRIPTION IN OUTPATIENT PRACTICE IN KURSK AND CHISINAU

Aim. To study the structure of medical prescriptions of antihypertensive agents for patients with arterial hypertension (HT) in the outpatient practice of Kursk (Russia) and Chisinau (Republic of Moldova).Material and methods. The questioning of doctors of medical organizations in Kursk and Chisinau was carried out as a one-stage descriptive study from October 2015 to February 2016. The questionnaires included questions on the pharmacoepidemiological aspects of prescribing antihypertensive drugs. Total number of respondents was 218, of them – 106 (26 cardiologists and 80 therapists) in Kursk and 112 (28 cardiologists and 84 therapists) in Chisinau.Results. In the real practice for HT treatment doctors in Kursk used more often beta-adrenoblockers (BAB), somewhat less often – angiotensinconverting enzyme (ACE) inhibitors, then diuretics. The shares of calcium channels blockers (CCB) and angiotensin II receptors blockers (ARB) were small – 8.8 and 5.2%, respectively. In Chisinau doctors gave preference to ACE inhibitors, then diuretics and BAB. Frequency of CCB prescriptions was almost identical to that of ARA – 13.7 and 13.6%, respectively. The additional antihypertensives, including central action drugs and alpha-adrenoblockers, were used rarely in both Chisinau and Kursk (1.3 and 1.6%, respectively). Doctors of Chisinau, when carrying out combined pharmacotherapy, gave priority to free combinations of antihypertensive drugs (64.4%), fixed combinations were used in 26.7% of cases. In Kursk, the ratio of these specified tactics of combined therapy was 53.5 and 34.1%, respectively. Among the pharmaceutical companies whose medicines were preferred by doctors in Kursk and in Chisinau, the leading positions were taken by KRKA (38.0 and 25.4%, respectively), Gideon Richter (13.5 and 28.7%, respectively) and Berlin-Chemie (26.7 and 15.6%, respectively).Conclusion. ACE inhibitors, diuretics, BAB were priority classes in the prescribing antihypertensive drugs according to survey of doctors in Kursk and Chisinau. In the conditions of the existing pharmaceutical market of Chisinau doctors used ARB and CCB more often than doctors from Kursk. The main share of doctor’s prescriptions in Kursk and Chisinau, considered both for group of antihypertensive drugs, and for certain representatives of each group of drugs, corresponds to the current recommendations on the pharmacotherapy of patients with HT.

Implementation and assessment of an undergraduate tissue engineering laboratory course

This study focused on examining how students’ perception and understanding of the tissue engineering field changed as a result of their participation in a hands-on experiential learning module. The module involved the cellular and biochemical characterization of three-dimensional cultures of mesenchymal stem cells in chondrogenic media. Students were instructed to complete concept maps depicting their perception of the tissue engineering field both prior to and after completion of the module. Similarly, they had to respond to provided design prompts and identify experimental tests and questions for doctors that would allow determination of their adaptive expertise. The results from this study demonstrate that students significantly broaden their perception of the tissue engineering field through statistically significant changes in their comprehensiveness and correctness scores on the concept map rubric. Similarly, the results of the adaptive expertise analysis demonstrate that students significantly increased adaptive expertise upon completion of the module in comparison to their responses at the start of the module. These results imply that a hands-on experiential module can be a beneficial tool for teaching students the complexity associated with a multidisciplinary field such as tissue engineering.

DIAGNOSTICS OF INFORMATIVE AND ANALYTICAL COMPETENCE FORMATION OF FUTURE DOCTORS

The ability to make responsible decisions, provide the necessary quality medical care to the patient using modern methods of diagnostics and treatment presupposes that the future doctor has formed information and analytical competence. Theoretical analysis of the scientific literature made it possible to define information and analytical competence as a component of professional competence that determines the willingness and ability of future doctors to apply the knowledge, skills acquired when they work with information of different types and forms of presentation, as well as the ability to effectively perform its analytical and synthetic processing with the aim of gaining new knowledge to ensure the process of taking responsible decisions and accomplishing tasks at the time of the examination of the patient, the specification of modern, efficient therapeutic and pharmaceutical activities. The article reviews the progress of the experimental check of the formation of the information-analytical competence of future doctors. Determination of the level of formation was carried out according to established indicators and criteria. As criteria and indicators for assessing the formation of information and analytical competence of future doctors, we have identified: motivational (the direction to acquire knowledge, the intensity of cognitive needs, the focus and strength of internal motives); cognitive (completeness of mastering theoretical knowledge on the search strategy, analytical-synthetic processing and presentation of information); activity (the completeness of the information and analytical activities carried out, the awareness of the actions of information and analytical activities, the transfer of actions to an unconventional situation); reflexive (level of development of reflexivity, ability to self-development, self-education). The following methods were included in the diagnostic tools: analysis of scientific literature, generalization and systematization of pedagogical literature; monitoring of students' activities, testing, interviews, questioning of students, teachers and doctors; methods of mathematical statistics. Generalized results of the assessment of the formation of information and analytical competence of future doctors are presented. The conclusion is that without the purposeful formation of information and analytical competence, future doctors do not acquire the high levels of competencies that are included in its composition (searching-informative, informatively-technological, analytical, communicative, social).

NIAAA Creates Online Tool to Help Patients Obtain Treatment for AUD

Back to table of contents Previous article Next article Professional NewsFull AccessNIAAA Creates Online Tool to Help Patients Obtain Treatment for AUDRebecca GreenbergRebecca GreenbergSearch for more papers by this authorPublished Online:13 Mar 2018https://doi.org/10.1176/appi.pn.2018.3b1AbstractA new tool from the NIAAA provides comprehensive information about treatment options for alcohol use disorder.More than 15 million adults in the United States struggle with alcohol use disorder (AUD), but only 1 in 12 receives treatment, according to the National Institute on Alcohol Abuse and Alcoholism (NIAAA). Part of this problem has to do with limited information about treatment options and how to go about getting treatment, said Lori Ducharme, Ph.D., a sociologist and program director at NIAAA’s Division of Treatment and Recovery Research. Not knowing where to turn, some individuals call the NIAAA directly, often seeking help for a family member or friend. Inspired by these callers, Ducharme and a team at NIAAA developed the NIAAA Alcohol Treatment Navigator, an online tool that helps users gauge their drinking behaviors, provides information about treatment, and guides users through a step-by-step process to identify where they can receive high-quality, individualized treatment. “We see this as a tool to empower consumers so that they get better information about addiction treatment and are more likely to find a particular option that will work for them,” Ducharme said. “Many people think treatment is limited to Alcoholics Anonymous or a long-term residential rehab program. They have no idea about the variety of outpatient options or the variety of specialists who can deliver outpatient treatment; all of that is explained in the ‘what to know about treatment’ section.”The website links to directories of addiction specialists, including a list of board-certified addiction psychiatrists that is maintained by the American Board of Psychiatry and Neurology. It also outlines key components to look for when selecting a treatment program. “There are plenty of directories out there where you plug in your ZIP code and get a list of providers, and you can also search Google, but there is really nothing that gives people a comprehensive strategy on what to do, how to assess the information they get, and make a choice based on what is good for them. This is especially true for people with co-occurring mental health needs, which is why we wanted to give people a variety of specialists who can assist them with AUD in their area.” Ducharme said the navigator can also be used by clinicians. “They can use this tool to build a rolodex of local resources or to keep on hand in case they need to make a referral. They can also show patients the navigator to help guide them toward an evidence-based choice.”Many people find it difficult to discuss their drinking behaviors when seeking care for the first time, Ducharme noted. Sample scripts are posted to help people ask questions when speaking with health care providers. “Just like you would ask your primary care doctor or your surgeon questions about treatments in a routine health care environment, we want people to feel comfortable picking up the phone and asking questions about alcohol treatment.” ■The website of the NIAAA Alcohol Treatment Navigator can be accessed here. ISSUES NewArchived

Why evidence-based medicine failed in patient care and medicine-based evidence will succeed

Evidence-based medicine (EBM) has succeeded in strengthening the evidence base for population medicine. Where EBM has failed is in answering the practicing doctor's question of what a likely outcome would be when a given treatment is administered to a particular patient with her own distinctive biological and biographical (life experience) profile. We propose Medicine-based evidence (MBE), based on the profiles of individual patients, as the evidence base for individualized or personalized medicine. MBE will build an archive of patient profiles using data from all study types and data sources, and will include both clinical and socio-behavioral information. The clinician seeking guidance for the management of an individual patient will start with the patient's longitudinal profile and find approximate matches in the archive that describes how similar patients responded to a contemplated treatment and alternative treatments.