Evidence-based Medicine Databases Research Articles

Clinical efficacy and safety of treatments for exocrine pancreatic insufficiency: A systematic literature review

Introduction: Exocrine pancreatic insufficiency (EPI) is caused by multiple clinical conditions such as cystic fibrosis (CF) and chronic pancreatitis (CP). Standard management of EPI includes Pancreatic Enzyme Replacement Therapy (PERT) along with consultation with a dietitian. While PERTs have been on the market for several decades, newer publications on their clinical efficacy and safety raised the need for a comprehensive review of the literature. We aimed to identify the available evidence on the clinical efficacy and safety of treatments for EPI to understand the current treatment landscape and unmet need in patients with EPI. Methods: A systematic literature review was conducted in Embase, Medline, and Evidence-Based Medicine databases from 2010–2022; conference proceedings from 2020–2022 were also searched. Articles were screened independently by two reviewers at abstract and full-text stage against pre-defined eligibility criteria. Results: We identified 26 journal publications and two conference abstracts, reporting on 22 randomized control trials, four observational studies and two single-arm interventional studies. The most reported treatment was pancrelipase, specifically Creon® (n=12). Fourteen studies reported coefficient of fat absorption (CFA) results. Across studies, patients experienced a considerable increase in CFA post-initiation of treatment regardless of intervention or timepoint. Mean change in CFA ranged from 7.5% in patients with CP who received placebo to 36% in patients with CP treated with Creon®. Ten studies reported coefficient of nitrogen absorption (CNA). Where reported, pancrelipase (including Creon®) increased CNA levels in EPI patients compared to placebo. Only one study compared PERT brands head-to-head: no significant differences were reported in the CNA-72 h values (Creon® 82.0% [SE 1.2] versus Zenpep® 80.9% [SE 1.2]). Loss of body weight and low body mass index (BMI) are important features of EPI. Overall, treatment with PERT increased BMI and body weight, or limited their decline, with increases ranging from 0.1 to 6.1 kg. Based on the 18 studies that reported safety outcomes, PERT was considered safe and well tolerated. Conclusions: This systematic literature review confirmed that PERT is an effective and tolerable treatment option for patients with EPI. However, nutritional parameters and health-related quality of life data were sparsely reported, and future clinical trials should look to incorporate these data given their importance in clinical practice and patient outcomes.

Management of unilateral craniofacial microsomia with orthopaedic functional appliances: A systematic literature review.

The study aimed to summarize current knowledge regarding the use of orthopaedic functional appliances (OFA) in managing unilateral craniofacial microsomia (UCM). The eligibility criteria for the review were (1) assessing use of OFA as a stand-alone treatment and (2) using OFA in combination during or after MDO. The PICO (population, intervention, comparison and outcome) format formulated clinical questions with defined inclusion and exclusion criteria. No limitations concerning language and publication year were applied. Information sources: A literature search of Medline, Scopus, Embase, Cochrane Central Register of Controlled Trials, Web of Science databases without restrictions up to 30 September 2022. The risk of bias was assessed. According to Cochrane and PRISMA guidelines, two independent authors conducted data extraction. The level of evidence for included articles was evaluated based on the Oxford evidence-based medicine database. Due to the heterogeneity of studies and insufficient data for statistical pooling, meta-analysis was not feasible. Therefore, the results were synthesized narratively. A total of 437 articles were retrieved. Of these, nine met inclusion criteria: five assessing OFA and four assessing OFA during or after MDO. There is limited evidence to suggest that stand-alone and combination treatment with OFA is beneficial for treating mild-to-moderate UCM-related dentofacial deformities in short term. No studies assessed the burden of care. In the management of UCM, there is insufficient evidence supporting the efficacy of OFA as a stand-alone treatment or when combined with MDO. Additionally, there is a lack of evidence regarding treatment protocols and the effect on the condyles and the TMJ. The study was registered at Prospero database number CRD42020204969.

How are countries responding differently to COVID-19: a systematic review of guidelines on isolation measures.

Isolation strategies have been implemented in numerous countries worldwide during the ongoing community transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). However, various countries and organizations have implemented their isolation measures at varying intensities, even during the same period. Therefore, we systematically reviewed the key information contained in currently available guidelines regarding the isolation of the general population, aiming to better identify the heterogeneity of the current isolation strategies. We conducted searches in four evidence-based medicine (EBM) databases and five guideline websites to identify guidelines, guidance, protocols, and policy documents published by authoritative advisory bodies or healthcare organizations, which provided information on the implementation of isolation for general populations with COVID-19. One author extracted data using a standardized data extraction checklist, and a second author double-checked all extractions for completeness and correctness. Discrepancies were resolved through discussion. The information extracted from the included articles was summarized both narratively and using tables. We included 15 articles that provided information on isolation measures recommended by nine different countries and organizations. The included articles consistently recommended isolating individuals with a positive COVID-19 test, regardless of the presence of symptoms. However, there were variations in the duration of isolation, and substantial differences also existed in the criteria for ending the isolation of COVID-19 patients. Different countries and organizations have substantial differences in their isolation policies. This reminds us that scientifically sound guidelines on isolation that balance the risk of prematurely ending isolation with the burden of prolonged isolation are a crucial topic of discussion when faced with a pandemic.

Photography in dermatology - a scoping review: Practices, skin of color, patient preferences, and medical-legal considerations.

Clinical photography is essential in dermatology. However, a comprehensive literature review of photography in dermatology is lacking. This scoping review aims to summarize the literature regarding photography practices in dermatology, photography of skin of color, patient preferences, and medical-legal considerations. A search was conducted utilizing Embase, MEDLINE, PubMed, and Evidence Based Medicine databases in accordance with the PRISMA extension for Scoping Reviews. In total, 33studies were summarized. Clinical photography is commonly used in biopsy site marking, assessment, diagnosis, disease monitoring, evaluation of treatment response, medical education, research, seeking advice from colleagues, and teledermatology. Although dermatologic photography remains devoid of skin of color representation, photographic considerations for darker skin are available. Most patients support medical photography, with a preference for clinical photographs to be taken by their own physicians, and for use of clinic/hospital-owned cameras over personal devices. Pertinent medical-legal issues include concerns around privacy, personal device use, and documentation of consent. Photography in dermatology is continuously evolving with broader applications. Improved practices and innovations will benefit individuals of various skin tones. Management of consent and privacy must be upheld to sustain the increasing ease of image capture and sharing.

Experiences and perceptions of self-management in people with prediabetes: A qualitative meta-synthesis.

Diabetes has become a global public health problem. Strengthening the self-management ability of people with prediabetes plays an important role in preventing the occurrence and development of type 2 diabetes. The aim of this study is to synthesise the self-management experiences and perceptions of people with prediabetes, which can contribute to the development of self-management programs. This review adheres to the ENTREQ Guide. Evidence-based medicine database (JBI and Cochrane) and original literature database (PubMed, Medline, EMbase, Web of Science, Wanfang, CNKI and VIP) were searched up to 31 May 2022. Both Chinese and English literature of qualitative research on self-management experiences and perceptions of prediabetic patients were included. The quality of the included studies was evaluated, and the data were synthesised and analysed by thematic synthesis method. A total of 23 primary studies containing 504 participants were included. After repeated reading and coding of the literature, three analytical themes were finally identified: coping with role management, success and failure in medical management, seeking and perceiving support. Role management for people with prediabetes needs more attention. Healthcare providers should identify problems from patients' self-management experiences and improve professional skills to assist program modifications. Integrating the self-management program into community activities under the guidance of medical staff and inviting family members and peers to participate can increase involvement and improve the self-management ability. These findings describe the different stages and issues in the self-management process of prediabetic patients. The practice of prediabetes self-management should incorporate the psychosocial, physical, and financial issues of the patients. As the main provider of health services, nurses should make patients aware of the susceptibility and severity of prediabetes and help them improve their self-management skills. This is a meta-synthesis without direct participation of patients.

A cross-sectional study evaluating the knowledge, attitude, and practice of evidence-based medicine among resident doctors of a health-care Institution of National Importance in India.

Evidence-based medicine (EBM) promotes the integration of updated- best evidence with patient preferences and medical expertise for clinical decision-making. Despite the availability of high-quality evidence such as systematic review and meta-analysis, some clinicians manage their patients based on past experiences and expert opinion. Thus, this study was proposed to assess the knowledge, attitude, and practice of EBM among resident doctors at a tertiary care hospital in India. This cross-sectional questionnaire-based study was conducted among senior residents and final-year postgraduates (PGs) who were independently involved in clinical decision-making. By convenience sampling method, the participants were recruited, and the validated EBM Questionnaire (EBMQ) was distributed online for assessing the knowledge, attitude, and practice of EBM. Descriptive statistics were represented as frequency and proportions. A total of 102 resident doctors participated with male preponderance (74.5%). Nearly, 96 (94.1%) participants were already practicing EBM and 21.6% had undergone EBM training. Textbooks (50%) were the most often referred sources for EBM information. Specific EBM databases such as MEDLINE and Cochrane were also utilized by 37.3% of participants. More than 70% of participants understood the terms such as a randomized controlled trial, case-control study, and P value. A higher proportion (80.4%) of participants showed a positive attitude about patient care improved by EBM. The majority of the resident doctors exhibited good knowledge and a positive attitude toward applying EBM in clinical decision-making. Periodic training through workshops or courses and integration of EBM with the PG curriculum would potentially enhance the EBM practice.

РАЗРАБОТКА ОБРАЗОВАТЕЛЬНОЙ ПРОГРАММЫ ПО СПЕЦИАЛЬНОСТИ «ПАРАМЕДИЦИНА»

The issue of introducing paramedic services is currently relevant for the healthcare systems of Russia and Kazakhstan. The article describes the experience of developing a training program for paramedics based on the analysis and synthesis of scientific publications in evidence-based medicine databases (PubMed, UpToDate, TripDatabase, ResearchGate, GoogleScholar, CyberLeninka). The criteria for inclusion of publications in the analysis were the presence of keywords (paramedical service, emergency medicine, emergency medical services, emergency health care system, paramedic) and the publication period from 2000 to 2019.

Evaluating Doac Efficacy and Safety Against Vka/LMWH in Patients with Atrial Fibrillation and Malignancies: A Systemic Review and Meta-Analysis

Background Atrial fibrillation (AF) affects more than 30 million people and is the most common form of arrhythmia worldwide. Patients with cancer frequently develop AF during active treatment, and several studies have shown that AF is also prevalent at the time of cancer diagnosis. Patients with cancer and AF commonly require anticoagulant therapy (direct oral anticoagulants (DOAC) or vitamin K antagonist (VKA)) for stroke and systemic embolism (SE) prevention. Data on the efficacy and safety of oral anticoagulants are unclear in this patient population. Objectives We sought to assess the rates of of stroke/SE and major bleeding in patients with cancer and AF on oral anticoagulant therapy (DOAC or VKA). Methods A systematic search of MEDLINE, EMBASE, COCHRANE and all Evidence Based Medicine database (from inception to January 2022) were conducted. The primary efficacy outcome was stroke/SE, and the primary safety outcome was major bleeding as defined by the individual studies. The quality of the studies was assessed by the ROBINS-1 tool. Incidence rates of stroke/SE and major bleeding by anticoagulant therapies were pooled using random effects model and expressed as event per 100 patient-years with its associated 95% confidence intervals (CI) using R software (version 4.0.3). Results Of the total 2,151 article records that were screened, 24 observational studies (N=352,672 patients) from 12 different countries were included in the meta-analysis. The mean age of included patients was 73.4 years old, 70.8% of them were male, and the most represented race were caucasian and asian. The most common tumor sites were urinary tract tumors (N=16,865), followed by prostate (N=14,800), breast (N=14,451), gastrointestinal tract (N=13,897), hematological (N=11,697) and lung (N=9,278). All studies were judged to have moderate to serious risk of bias. Overall, the incidence rates of stroke/SE and major bleeding for patients with cancer and AF on oral anticogulant therapy were 2.33 (95% CI: 1.69 to 3.21) and 3.17 (95%CI: 2.23 to 4.51) per 100 person-years, respectively. The incidence of stroke/SE was 1.81 (95% CI: 0.89 to 3.68) per 100 patient-years for patients receiving a DOAC and 3.41 (95% CI: 1.38 to 8.41) for patients receiving VKA (Figure 1). Similarly, the incidence of major bleeding was 2.59 (95%CI: 1.54 to 4.38) per 100 patient-years for patients receiving a DOAC and 3.60 (95% CI: 1.68 to 7.71) for patients receiving VKA. Conclusion Patients with cancer and AF receiving oral anticoagulant therapy are at high risk of both stroke/SE and major bleeding complications. DOACs seem to provide a good risk benefit profile for this patient population. Randomized controlled trials are needed to confirm these findings. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Blood Disorders in Patients with Obstructive Jaundice: A Literature Review

BACKGROUND: Mechanical jaundice is a pathological syndrome consisting in a violation of the outflow of hepatic bile through the bile ducts into the duodenum due to mechanical obstacles. The most common causes of mechanical jaundice are gallstone disease, malignant tumors, as well as cicatricial stricture of the bile duct or the large duodenal papilla of the duodenum. All this leads to the development of renal-hepatic insufficiency. Thrombohemorrhagic changes develop in the vascular bed, leading to the development of disseminated intravascular coagulation syndrome. Prevention and treatment of cholemic bleeding in case of mechanical jaundice remains one of the complex problems of hepatobiliary surgery. This article is an overview of the causes and pathophysiological changes affecting hemostasis in mechanical jaundice, as well as the main points of treatment of hemostasis disorders in patients with mechanical jaundice. AIM: This study aims to study the literature on homeostasis in patients with mechanical jaundice. SEARCH STRATEGY: To conduct a systematic search for scientific information and to achieve this goal, an analysis of scientific publications in evidence-based medicine databases (PubMed), using specialized search engines (Google Scholar) and in electronic scientific libraries (CyberLeninka, e-library) was carried out from 2005 to 2020. INCLUSION CRITERIA: Research of high methodological quality: Meta-analysis, systematic review and cohort studies, as well as publications with clearly formulated and statistically proven conclusions in English, Russian, and Kazakh. EXCLUSION CRITERIA: Summaries of reports, reports in the form of abstracts, and advertising articles. RESULTS: The mechanisms that affect hemostasis in obstructive jaundice can be considered from four perspectives: The first relates to Vitamin K deficiency in obstructive jaundice, the second describes the effect of ongoing fibrosis and cirrhosis of the liver on hemostasis, the third analyzes the relationship between infectious-septic mechanisms and the hemostasis system, their clinical significance in patients with obstructive jaundice, and the latter involves the analysis of specific factors that manifest obstructive jaundice and may themselves affect the blood coagulation system. CONCLUSION: Understanding the pathophysiology of hemostatic changes in patients with cholestasis and, more generally, liver disease is a clear way to accurate diagnosis and treatment. The combination of good knowledge with careful examination of each patient can lead to the most promising result.

Coronary Heart Disease and Coronavirus Disease 2019: Pathogenesis, Epidemiology, Association with Myocardial Revascularization

BACKGROUND: Coronavirus disease 2019 (COVID-19) causes a hypercoagulable state with a high incidence of thrombotic complications. Patients with a history of myocardial revascularization have more severe complications due to COVID-19. Coronary stent thrombosis has become significantly more common during the COVID-19 pandemic. AIM: The aim of our study is to analyze scientific information on the risks of stent thrombosis in patients who underwent COVID-19. METHODS: A search was made for scientific publications in evidence-based medicine databases and web resources: PubMed, MEDLINE, UpToDate, TripDatabase, ResearchGate, and Google Scholar. Inclusion criteria were: (1) Observational studies or case series involving patients with a confirmed diagnosis of COVID-19 and myocardial infarction requiring myocardial revascularization; (2) the division of the population into survivors and non-survivors; and (3) data on the presence of the previous myocardial revascularization. Exclusion criteria: Case description and editorials/bulletins. In all articles selected for further analysis, 49 sources were considered that met the inclusion criteria and excluded duplication or repetition of information. RESULTS: Coronavirus infection has contributed to the change in the course of myocardial infarction in patients undergoing myocardial revascularization. The incidence of stent thrombosis has a positive correlation with the severity of the coronavirus infection. The previous myocardial revascularization procedures significantly increase the risk of mortality in patients with coronavirus infection. This is especially actual for elderly patients. CONCLUSION: One of the most vulnerable groups is elderly patients who have undergone myocardial revascularization after myocardial infarction in the past and have concomitant diseases. An analysis of scientific publications has shown that further larger-scale clinical studies are needed to confirm the hypothesis about the negative impact of coronavirus infection on stent thrombosis in patients who have undergone COVID-19.

Comparative Analysis Of Triage Systems At Emergency Departments Of Different Countries: Implementation In Kazakhstan

Medical sorting is aimed at assessment of disease severity and has to be carried out within a short time to determine the priorities for patient care and transportation to the most appropriate place for future treatment. The goal of this study was to provide an integrative review by analyzing the publications on the most common triage systems worldwide in order to select and implement the most reliable system at emergency departments. We searched for publications relevant to our comparative analysis in evidence-based medicine databases. A total of 1,740 literary sources were identified, of which 42 were selected for analysis. Comparative analysis of different triage systems may help implementing the most efficient system in Kazakhstan. The Emergency Severity Index is considered the most reliable and accurate tool used in international practice, and it could provide a basis for introduction of triage system at emergency departments in Kazakhstan.

Ревматическая полимиалгия в клинических рекомендациях 2018–2020 годов. Часть I. Группы риска, адъювантная терапия

В начале Декады здорового старения стал доступен ряд клинических рекомендаций по ведению ревматических болезней у пожилых. Цель публикации — характеристика и обсуждение руководства по ревматической полимиалгии Итальянского общества ревматологов (2020) и рекомендаций по применению позитронно-эмиссионной томографии/компьютерной томографии при васкулитах крупных сосудов и ревматической полимиалгии Европейской ассоциации ядерной медицины, Общества ядерной медицины и молекулярной визуализации и Американского общества ядерной кардиологии (2018). Материалы и методы. Содержание, первоисточники и методология разработки руководств изучены с помощью методов информационного анализа и сопоставлены с рекомендациями 2018–2020 гг. по ревматической полимиалгии и гигантоклеточному артерииту Европейской антиревматической лиги, Американской коллегии ревматологов, Немецкого, Австрийского, Швейцарского, Британского обществ ревматологов, Европейской федерации головной боли и их первоисточниками. Установлен приоритет консенсусного подхода в разработке современных руководств по ревматической полимиалгии. Особенность методологии создания итальянских рекомендаций состоит в сужении поиска прототипов до двух баз данных доказательной медицины и «серой» литературы и в отборе для адаптации трех руководств, включая разработку обществ ядерной медицины. Актуализированы вопросы ведения пациентов в первичном звене (предложен алгоритм), совместного принятия клинических решений, настороженности в отношении гигантоклеточного артериита. Доказательствами поддержаны лишь начальные дозы глюкокортикоидов как терапии первой линии; допускается альтернирующий режим их снижения. Обоснована неэффективность гидроксихлорохина, не обсуждается прием азатиоприна и средств альтернативной медицины. Следует установить факторы риска развития васкулита, рецидивов, длительного приема глюкокортикоидов и их побочных эффектов. Впервые для выявления васкулита рекомендовано применение позитронно-эмиссионной томографии/компьютерной томографии. Самой доказанной, сильной, согласованной является рекомендация по адъювантной терапии метотрексатом и отказу от биологических препаратов, наименее согласованной — позиция по направлению к ревматологу. Выводы. Решение такой актуальной проблемы здравоохранения, как повышение качества медицинской помощи при ревматической полимиалгии, предполагает усовершенствование медицинских стандартов по большинству клинически важных вопросов, выявление пациентов высокого риска, направление их к ревматологам и офтальмологам и рассмотрение преимуществ лечения метотрексатом.

Bleeding Risk Using INR/aPTT Pre-Surgery: Systemtic Review (BRUISR) (BRUISR)

Background:Multiple published studies have shown that abnormal coagulation tests, the prothrombin time (PT) and activated partial thromboplastin time (aPTT), are not helpful in predicting peri-operative bleeding. Despite numerous guidelines suggesting against their use, these tests continue to be ordered routinely in many pre-operative or pre-interventional settings.Objective:Our objective was to systematically assess the utility of unselected pre-operative PT and aPTT testing to predict bleeding outcomes.Data sources:We conducted a systematic literature review of MEDLINE, EMBASE and Evidence-based Medicine databases for articles published between 1970 and 2016 that addressed pre-operative and/or pre-interventional coagulation testing that was conducted in unselected fashion (i.e. not directed by the patient's personal/family history). Two independent reviewers (LL and AL) screened 3373 articles and 207 studies were included for full-text review.Study eligibility criteria:The minimum criteria for the 54 articles included in our qualitative analysis were: adult and/or pediatric patients undergoing elective surgery and/or an interventional procedure with pre-operative coagulation test results (PT and/or international normalized ratio (INR) and/or aPTT).Outcomes:The primary outcome was to examine the relationship between pre-operative coagulation results and peri-operative bleeding. As a secondary outcome, we also included studies that reported on the frequency of abnormal tests in routinely screened pre-operative patients as well as studies that described the cost of testing.Results:Of the 54 articles we included in our systematic review, studies were grouped according to procedure type: cardiac surgery (N=13), liver transplant (N=7) and tonsillectomy (N=13), major surgery (as defined in Choosing Wisely Canada, 2016) (N=12), and minor surgery (N=9). Within the combined studies of tonsillectomy and minor surgery categories, a total of 21 studies (after exclusion of 4 for insufficient data), there was only 1 study that showed an association between abnormal pre-operative coagulation testing and bleeding outcomes. Of the other 20 studies, 11 studies found no association between pre-operative coagulation studies and bleeding events, 4 studies had no bleeding events identified, 4 showed poor sensitivity of testing and 1 had no statistical information provided. In the major surgery category, there were a total of 26 studies (which included studies on liver transplant and cardiac surgery patients); only 4 studies identified an association between pre-operative coagulation testing and bleeding events, 17 found no association, and 4 described poor sensitivity of testing. In the studies that showed an association between pre-operative coagulation testing and bleeding, many used subjective definitions of bleeding, clinically insignificant thresholds to define abnormal aPTT and/or INR or provided insufficient data to support their conclusion. In summary, of the 45 studies with data on bleeding outcomes, the majority (71%) showed no association between bleeding events and pre-operative coagulation testing (Figure 1). As for assessment of quality, there were no randomized controlled trials (RCT) identified and the majority of observational studies were deemed at high risk of biasConclusion:To our knowledge, this is the largest systematic review that assesses the utility of pre-operative coagulation screening as a predictor of perioperative bleeding. Of the 54 studies that met our eligibility criteria, only 5 showed an association between coagulation test results and perioperative bleeding. Our findings support current guidelines which caution against unselected pre-operative coagulation testing and also emphasize the need for a well-designed and powered prospective cohort study or RCT to definitively answer this important question. [Display omitted] DisclosuresHicks:Gilead Sciences: Research Funding. Sholzberg:Octapharma: Honoraria, Research Funding; Shire: Honoraria, Research Funding; CSL Behring: Honoraria, Research Funding; NovoNordisk: Honoraria.

Фармако-экономический анализ применения лекарственных препаратов парентерального питания в условиях казахстанской системы здравоохранения

Objective: To study the clinical effectiveness, safety, and cost-effectiveness of parenteral nutrition medications. Methods. A modelling and a cost-effectiveness assessment were applied concerning the use of the NuTRIflex Lipid group medications. A comparative analysis of the parenteral nutrition medications’ effectiveness was performed, using cost-minimization, missed opportunities and budget impact analyses. The analysis was carried out by modelling in MS Excel Software. Results. The cost-minimization analysis demonstrated that NuTRIflex medications (NuTRIflex Lipid plus, NuTRIflex Lipid Special) were the least expensive options of parenteral nutrition for a minimum level of a daily dose’s cost as well as for a minimum level of costs for side-effects elimination. Based on the results of the missed opportunities analysis, the use of NuTRIflex Lipid peri medication will provide 55.8% (without side effects consideration) and 85.4% (with side effects consideration) more patients with parenteral nutrition, than that of Oliclinomel N4-550 E. From a payer’s perspective in the healthcare system, the budget impact analysis showed that the use of NuTRIflex Lipid peri will save costs equaling to 2.1 billion tenge versus Oliclinomel N4-550 E (on the assumption that side effects take place). Conclusion. It is impossible to make a definite conclusion on the superiority of NuTRIflex Lipid’s clinical effectiveness and safety over Oliclinomel and vice versa, since there are no direct comparative studies, assessing clinical effectiveness and safety in evidence-based medicine databases. More patients will receive parenteral nutrition if the NuTRIflex Lipid medication is used compared with the use of Oliclinomel, and it would be cost-saving from a payer’s perspective in Kazakhstan’s health system.

Evidence-Based Medicine Approaches of Students in a Medical School

Aim: To define knowledge and attitudes of Cumhuriyet University Medical School (CUMS) students about Evidence-Based Medicine (EBM) and to determine opinions about the 1-week EBM education given to fourth-year students. Material and Methods: This was a descriptive study on third, fourth, and fifth-year students of CUMS. The 1-week EBM education given in 4th-year is an internship, they can take theoretically and practice lectures. The data collection tool used in research has questioned descriptive features of students, knowledge and attitudes about EBM, and their views on the internship. Results: 165 students volunteered to participate. The most common answers for investigation research question; for 3rd-year students' was general web sites, for 4th-year students' and 5th-year students' was electronic EBM database. While 3rd-year students valued to easy access for searching data, reliability was important for 4th and 5th-year students. The frequency of students' use of electronic databases (p<0.001), the rate of know the keyword as “good” (p=0.021), Medline usage frequency (p=0.003) and mean scores obtained from the pyramid of evidence (p<0.001) have differed significantly between students' years. There was a significant difference between students' English levels and electronic EBM database selection (p=0.034). Students', have upper-intermediate and upper English levels, 72.7%(8) chose the Electronic EBM database source to investigate. The most difficult parts for students when reading an article are their English insufficiency, statistics, and academic language. Students’ opinions about the EBM course; 77.2%(88) found that the course was beneficial, 7.0%(8) said course were not helpful, and 15.8%(18) were undecided. Conclusion: Improving students' English levels could increase their frequency of EBM database usage. It was observed knowledge and attitude of EBM were quite low in 3rd-year students, and general knowledge and attitude of 4th-year students, have received just new internship, were better than the other years. These findings show us that internship is beneficial.

O Ácido Acetilsalicílico na Prevenção do Carcinoma Colorretal: Uma Revisão Baseada na Evidência

INTRODUÇÃO: O carcinoma colorretal é uma das principais causas de morbimortalidade por cancro no nosso país. Tem surgido evidência de que o ácido acetilsalicílico tem uma ação quimiopreventiva do carcinoma colorretal. Assim, este estudo tem como objetivo rever a evidência sobre o efeito do ácido acetilsalicílico na incidência e mortalidade do carcinoma colorretal.MÉTODOS: Pesquisa de reviso?es sistema?ticas, meta-ana?lises, ensaios clínicos aleatorizados, estudos de coorte e normas de orientação clínica publicados entre 01/06/2010 a 01/06/2020, em base de dados de medicina baseada na evidência, com os termos MeSH “Aspirin” “Primary prevention” e “Colorectal neoplasms”. Para estratificar o ni?vel de evidência dos estudos e a atribuição da força de recomendação, foi utilizada a escala Strength of Recommendation Taxonomy (SORT) da American Family Physician.RESULTADOS: Selecionaram-se cinco de 57 artigos: uma meta-análise, duas revisões sistemáticas, um estudode coorte e uma norma de orientação clínica. De uma forma geral, os estudos mostraram que o uso diário de no mínimo 75 mg de ácido acetilsalicílico durante cinco ou mais anos reduzia a incidência e a mortalidade de carcinoma colorretal. Contudo, deve ser usado com cautela pois associa-se a um aumento do risco hemorrágico.CONCLUSÃO: O uso de ácido acetilsalicílico poderá ser efetivo na redução da incidência e mortalidade de carcinoma colorretal em adultos com risco médio para carcinoma colorretal, atribuindo-se uma força de recomendação B (SORT B). Futuros estudos são necessários para determinar a dose e duração mínima do uso de ácido acetilsalicílico que confira um benefício oncológico acompanhada de um risco hemorrágico mínimo.

The analysis of the evidence base of the clinical efficiency and safety of acyclovir for topical application

Herpes viruses are a family of DNA viruses, among them herpes simplex virus is the most common (HSV). An important task of modern medicine is effective and safe pharmacotherapy of viral diseases caused by HSV.Aim. To analyze the range of drugs for the topical application in the pharmacotherapy of HSV at the pharmaceutical market of Ukraine, as well as search the evidence base of acyclovir, the leader of the pharmaceutical market.Materials and methods. The analysis of the range of antiherpetic drugs for the topical application was performed according to the analytical system of the study of the pharmaceutical market of Ukraine “Pharmstandard” by the company “Morion”. To analyze the clinical efficiency and safety of the antiherpetic drug “Acyclovir”, the following well-known evidence-based databases were used: Cochrane Library, Trip Database, PubMed, Nice.Results. Antiherpetic drugs for the topical application at the pharmaceutical market of Ukraine for 2016-2018 were quantitatively represented from 17 to 20 TN based on 7 INNs, mainly by foreign manufacturers. Drugs of acyclovir were the most accessible and widely presented at the market. The search for the evidence base of acyclovir for the topical application made it possible to find 7 systematic reviews devoted to the treatment of herpes diseases in the evidence-based medicine databases. Numerous studies have shown that the topical treatment with the acyclovir HSV cream on the lips and in genital herpes is less effective than its systemic application. And the use of acyclovir ointments in the treatment of herpetic keratitis is not inferior in effectiveness to the reference drugs. Conclusions. The analysis of systematic reviews and meta-analyses has shown that the topical treatment with the acyclovir HSV cream is less effective than its systemic application. The effectiveness of the use of acyclovir ointments in the treatment of herpetic keratitis has also been proven.

Analysis of the range of antifungal drugs for systemic use and evidence-based clinical efficacy and safety of fluconazole

Today, according to the WHO, every fifth inhabitant of the Earth is infected with fungi, and every tenth has pronounced clinical manifestations of fungal diseases. The incidence of mycotic foot infections among the population both in Ukraine and in various European countries varies from 20 to 70 %.Aim. To analyze the assortment of antifungal drugs for systemic use at the pharmaceutical market of Ukraine within 2016-2018 and the evidence base for efficacy and safety of the antifungal drug – fluconazole.Materials and methods. The analysis of the assortment of antifungal drugs was performed within 2016-2018 according to the “Pharmstandard” information and search system “Morion” of company. The analysis of clinical efficacy and safety of fluconazole was carried out according to the evidence-based medicine databases, such as Cochrane Library, Trip Database, PubMed, Nice.Results. Antifungal drugs for systemic use were presented at the pharmaceutical market within 2016-2018 in a sufficient assortment (103-111 TN drugs) based on 7 INN. However, most INN drugs were presented by 1-4 TN and had a narrow price range per package. Only fluconazole preparations had a significant amount of TH at the market (79-89 TN drugs) with a wide range of prices per package (from 8.63 to 1407.29 UAH). In 10 systematic reviews analyzed the results of clinical efficacy and safety of fluconazole for the prevention and treatment of fungal infections in children and adults were presented. Fluconazole has the proven pronounced clinical efficacy and is recommended by the American and European Communities of Infectious Diseases as a first-line therapy for candida infections.Conclusions. The analysis of systematic reviews and meta-analyses prove the safety and efficacy of fluconazole when used in children and adults for the prevention and treatment of fungal infections.

Current Research Trends in Randomized Controlled Trials Investigating the Combined Effect of Korean Medicine and Western Medicine Treatment

This review examined recently published (July 2014 to June 2017), randomized controlled trials (RCTs) which investigated the safety and effectiveness of combined Korean medicine/complementary alternative medicine (CAM) and Western medicine, to indicate the direction for integrative medical practice. The Korean Medicine Convergence Research Information Center evidence-based medicine database (KMCRIC EBM DB) was used to retrieve relevant RCTs indexed in the last 3 years. Study design, country, sample size, disease/condition with the Korean Standard Classification of Diseases code, interventions, direction of outcomes, and adverse events were extracted and summarized. A total of 93 RCTs were included in this review. Acupuncture/moxibustion was the most commonly used intervention (<i>n</i> = 47; 51%), and 19% (<i>n</i> = 18) of the studies treated musculoskeletal disorders, followed by circulatory disorders (<i>n</i> = 16; 17%), and mental and behavioral disorders (<i>n</i> = 9; 10%). Integrative treatment was reported as more effective than monotherapy in approximately 83% of these studies. Adverse events were poorly reported in most studies. This review suggests that integrative treatments are feasible, effective, and safe for various diseases/conditions, based on the evidence from recently published RCTs. Future studies on integrative healthcare are warranted.

Evidence-based medicine databases: An overview

Evidence-based medicine (EBM) helps to bridge the gap between current healthcare practice and recent research findings in health care. Today’s era of scientific information explosion makes hard for healthcare providers to remain up to date on the best clinical practices. In reality, a physician has to read 17 scientific literature works per day to remain up to date. This is a difficult challenge, but EBM databases provide quick access to research findings. This review aims to provide an overview of EBM databases. These databases provide information about guidelines, disease, treatment,diagnosis, clinical relevance, systematic reviews, clinical trials, observational studies, preappraised information,summary, abstract, full text, similar studies, short reports, clinical queries, images, e-textbooks, patient counseling information, and continuous medical education in a minimum period of time. The identification and utilization of recent research findings is a critical step to enhance patient care and clinical practice. This review provides an insight into various EBM databases, type of evidence, access details, and link to each database. Establishing educational requirements and awareness in the practice of EBM among healthcare professionals is a great step for promoting the practice of EBM