Perspective Of Evidence-based Medicine Research Articles

Protocol for the systematic review of the Pneumocystis jirovecii-associated pneumonia in non-HIV immunocompromised patients.

Pneumocystis jirovecii pneumonia (PJP) is a well-known and frequent opportunistic infection in HIV patients. However, there has been an increase in the number of reports of PJP in other immunosuppressed patients with autoimmune inflammatory disorders or because of chemotherapy and high doses of steroids, especially when used in combination as part of immunosuppressive therapy. Despite the increasing importance of PJP in non-HIV patients, there is a lack of comprehensive and updated information on the epidemiology, pathogenesis, diagnosis, microbiology, treatments, and prophylaxis of this infection in this population. Therefore, the objective of this systematic review is to synthesize information on these aspects, from a perspective of evidence-based medicine. The protocol is prepared following the preferred reporting items for systematic reviews and meta-analyses (PRISMA-P) guidelines. We will perform a systematic review of literature published between January 2010 and July 2023, using the databases PubMed, Google Scholar, ScienceDirect, and Web of Science. In addition, manual searches will be carried out through related articles, and references to included articles. The main findings and clinical outcomes were extracted from all the eligible studies with a standardized instrument. Two authors will independently screen titles and abstracts, review full texts, and collect data. Disagreements will be resolved by discussion, and a third reviewer will decide if there is no consensus. We will synthesize the results using a narrative or a meta-analytic approach, depending on the heterogeneity of the studies. It is expected that this systematic review will provide a comprehensive and up-to-date overview of the state-of-the-art of PJP in non-HIV patients. Furthermore, the study will highlight possible gaps in knowledge that should be addressed through new research. Here, we present the protocol for a systematic review which will consider all existing evidence from peer-reviewed publication sources relevant to the primary and secondary outcomes related to diagnosing and managing PJP in non-HIV patients.

The Crucial Role of Prognostic Factor Research Models in Guiding Homeopathic Prescriptions: An Evidence Based Medicine perspective.

The Crucial Role of Prognostic Factor Research Models in Guiding Homeopathic Prescriptions: An Evidence Based Medicine perspective.

Аллергия к белкам коровьего молока у младенцев: новые тенденции в профилактике и лечении

This article presents a literature review on the dynamics of dietary approaches to the prevention and treatment of cow’s milk allergy (CMA): from elimination of food allergens to the need to develop food tolerance; controversial views on the efficacy of using partially hydrolyzed formulas for the prevention of CMA from the perspective of evidence-based medicine. Of particular interest are current data on the lower prevalence of CMA and the need for accurate prescription of extensively hydrolyzed formulas with specific organoleptic qualities, composition features and high price, which may affect nitrogen metabolism, increase the financial burden on families and health care systems, and be a risk factor for the development of eating disorders in children in later years. Opinions are presented on approaches to dietary therapy for CMA from two major expert groups, the Middle East and the European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN). Key words: cow’s milk allergy, prevention, diet therapy, children

Ulcerative colitis in the practice of a family doctor

Ulcerative colitis is a chronic disease that is caused by a genetic predisposition and occurs under the influence of unfavorable environmental factors on the intestinal microflora. Having an inflammatory nature, it manifests itself in the form of erosive hemorrhagic and ulcerative destructive changes in the mucous membrane of the rectum and colon. The prevalence of ulcerative colitis is widespread, but it is especially common in economically developed countries. Issues of timely diagnosis cause difficulties among practicing physicians. This is explained by the fact that ulcerative colitis manifests itself not only with classic intestinal symptoms, but also often debuts with various extraintestinal manifestations. Modern medicine provides doctors with many methods for high-quality diagnosis of this pathology. This article presents current aspects of the pathogenesis, clinical picture, diagnosis, and treatment of ulcerative colitis from the perspective of evidence-based medicine.

Statin Use and the Risk of All-cause Mortality

Statins are the cornerstone in primary and secondary prevention of atherosclerotic cardiovascular disease. Most benefits of statin treatment mainly come from lowering low-density lipoprotein cholesterol levels. However, statins have pleiotropic effects on vascular dysfunction, inflammation, and immunomodulation beyond cholesterol-lowering, suggesting a positive impact on various health outcomes. All-cause mortality is a commonly chosen outcome in randomized controlled trials (RCTs) of statins. Nevertheless, the effect of statin treatment on the risk of all-cause mortality remains uncertain since it has usually been evaluated as a secondary outcome or a component of the primary composite outcome. A recent meta-analysis of RCTs also failed to draw a clear conclusion on this issue. Further studies investigating all-cause mortality as a primary endpoint are needed to determine the effect of statins on all-cause mortality from the perspective of evidence-based medicine.

How missing evidence-based medicine indicators can inform COVID-19 vaccine distribution policies: a scoping review and calculation of indicators from data in randomised controlled trials

ObjectiveReports of efficacy, effectiveness and harms of COVID-19 vaccines have not used key indicators from evidence-based medicine (EBM) that can inform policies about vaccine distribution. This study aims to clarify...

Body mass index and the risk of abdominal hernia: a Mendelian randomization study.

Abdominal hernia (AH) is one of the most common clinical diseases. A large number of observational studies have found that obesity is an important risk factor for AH. However, the causal relationship between obesity and AH cannot be determined because of the clinical studies on AH induced by obesity are relatively few and only have some small- or medium-scale observational studies. Observational studies have so many confounding factors and reverse causality due to their shortcomings. From an evidence-based medicine perspective, they are not sufficiently convincing. Therefore, there is still a lack of high-quality, evidence-based medical evidence supporting a causal relationship between obesity and AH. A causal relationship between obesity and AH is also almost impossible to confirm by randomized controlled trials (RCTs). Our study based on Mendelian randomization (MR) may provide a higher level of evidence-based medical support for the relationship between obesity and AH. Body mass index (BMI) is the most common measure used for defining obesity. Finally, we employed two-sample Mendelian randomization (TSMR) to explore the causal relationship between BMI and AH. AH-related single nucleotide polymorphisms (SNPs) data were obtained from the FinnGen Biobank (FB), and BMI-related single nucleotide polymorphisms (SNPs) data were obtained from the UK Biobank (UKB). Genetic loci are used as instrumental variables (IVs), methods such as inverse variance weighted (IVW) were used for two-sample Mendelian randomization analysis, and the odds ratio (OR) value was used to evaluate the causal relationship between BMI and AH. The results of the horizontal pleiotropy test were calculated by Egger-intercept method: p = 0.34 > 0.05. The Cochran Q test of MR-Egger method and IVW method showed heterogeneity P = 0.03 < 0.05, so the IVW random effect model was used as the gold standard. We found a genetically determined 1-standard deviation (SD) increment of BMI causally increased a 66.0% risk of AH (N = 371 SNPs, OR = 1.66, 95% CI 1.46-1.89, p = 1.55E-14) based on the IVW random effect model which was almost consistent with the results of other seven methods. Our MR found genetic evidence for BMI and AH. The risk of developing AH increases with the number of BMI. This finding provides further evidence that maintaining a healthy BMI can prevent the development of AH. In addition, clinicians may need to focus on the potential risk of AH on some high-BMI patients.

Gastric stasis following pancreatoduodenal resection: terminology and prevention issues

Gastric stasis constitutes a common complication of pancreaticoduodenal resection, which is insufficiently covered in Russian literature. The paper considers issues pertaining to terminology and the current classification of gastric stasis. The possibilities of preventing this complication are discussed from the perspective of evidence-based medicine.

English Version of Clinical Practice Guidelines for the Management of Atopic Dermatitis 2021.

This is the English version of the Clinical Practice Guidelines for the Management of Atopic Dermatitis 2021. Atopic dermatitis (AD) is a disease characterized by relapsing eczema with pruritus as a primary lesion. In Japan, from the perspective of evidence-based medicine, the current strategies for the treatment of AD consist of three primary measures: (i) use of topical corticosteroids, tacrolimus ointment, and delgocitinib ointment as the main treatment of the inflammation; (ii) topical application of emollients to treat the cutaneous barrier dysfunction; and (iii) avoidance of apparent exacerbating factors, psychological counseling, and advice about daily life. In the present revised guidelines, descriptions of three new drugs, namely, dupilumab, delgocitinib, and baricitinib, have been added. The guidelines present recommendations to review clinical research articles, evaluate the balance between the advantages and disadvantages of medical activities, and optimize medical activity-related patient outcomes with respect to several important points requiring decision-making in clinical practice.

Evaluation of the tolerability of zoledronic acid preparations for parenteral administration

Introduction. From the perspective of evidence-based medicine, bisphosphonates (BP) represented by several drugs with various routes of administration and dosing regimens have been recognized as the gold standard for the treatment of osteoporosis (OP). Generic BPs are widely used for the treatment of OP due to the availability and optimal balance of cost and effectiveness.The aim is to compare the tolerability of the generic zoledronic acid 5 mg (Osteostatics) and the original zoledronic acid 5 mg (Aclasta).Materials and methods. A total of 54 women aged 56–65 years with postmenopausal OP were enrolled in the study and divided into two groups: 28 patients (Group 1) received intravenous infusions of Osteostatics 5 mg, 26 (Group 2) received Aclasta. Patients in both groups received concomitant therapy with calcium carbonate (1000 mg once a day) and vitamin D (2000 IU once a day). Adverse event data were collected within a week.Results. Among side effects, it was fever that occurred most often: 57.1% in patients receiving Osteostatics (Group 1), and 61.5% in patients receiving Aclasta (Group 2). Headache occurred in 53.5% and 50% of cases, respectively. Side effects such as arthralgia and flu-like syndrome were less common and accounted for 17.8% and 15.4% of cases. Nausea only occurred in 14.2% and 11.5%, myalgia in 42.8% and 38.4%, respectively. In most cases the side effects did not last for more than 48 hours. The frequency and severity of side effects were comparable in patients with comorbidities in both groups.Conclusion. The tolerability of the generic zoledronic acid Osteostatix at a dose of 5 mg is comparable to the original drug Aklasta.

Acupuncture from the perspective of evidence-based medicine - options of clinical use based on National Comprehensive Cancer Network (NCCN) guidelines.

Acupuncture is one of the oldest therapeutic methods. The traditional view of acupuncture is represented by influencing energy pathways through stimulation of specific points. The original meridian theory, which works with the assumption of normalization of the flowing energy Qi in the organism is, with increasing evidence, supplemented with information about the bio-logical impact of the use of acupuncture from the perspective of Western medicine. Specific stimulation of particular points on the body leads to the activation of hypothalamus and pituitary gland through neurotransmitters, resulting in a wide range of systemic effects. Stimulation of nerves in the muscle, which then trans-mits a signal to the spinal cord, midbrain, and hypothalamic-pituitary system, releases neurotransmitters, endogenous opioid peptides, or hormones. Stimulation of acupuncture points changes the levels of proinflammatory cytokines, including IL-1-beta, IL-6, IL-17, and TNF-alpha. Currently, according to the National Comprehensive Cancer Network (NCCN) guidelines, the following symptoms are indicated for acupuncture treatment: pain including neuropathic pain, arthralgia, and myalgia, especially in the aromatase inhibitors therapy, nausea, and vomiting, fatigue, vasomotor symptoms in women and vasomotor symptoms in men caused by androgen deprivation therapy. Acupuncture seems to be an effective and safe treatment method for many of the cancer symptoms or the side effects of cancer treatment, but, like any other treatment method, it has its indications and contraindications. This work aims to provide a comprehensive overview of the use of acupuncture in defined indications, according to current international guidelines. Thus, the therapeutic possibilities of symptomatic treatment of cancer and therapy of adverse events of oncological treatment can be extended.

Effect of Clinical Nursing Pathway Intervention Based on Evidence-Based Medicine on Venous Thrombosis in Long-Term Bedridden Patients.

Background Venous thrombosis is a type of medical condition that establishes as deep vein thrombosis of the limb or pulmonary embolism. This disease arises as a result of interrelating hereditary, ecological, and interactive risk aspects. Clinical nursing pathways also known as critical pathways are pathways that guide nurses when developing a patient's care plan. However, the effect of nursing intervention on venous thrombosis in long-term bedridden patients from the perspective of evidence-based medicine had not been reported. Methods A total of 170 patients hospitalized in the hospital from January 2021 to October 2021 were selected, and the bed time was more than 2 weeks. The patients were randomly divided into the control group and observation group. 85 cases in the control group received routine nursing in cardiology, and 85 cases in the observation group received clinical nursing pathway. Venous thrombosis, lower limb pain, swelling, D-dimer level, hemodynamic parameters, and nursing satisfaction were compared in two groups. Results The incidence of deep venous thrombosis in the observation group was 8.2%, lower than 24.7% in the control group (P < 0.05). The incidence of lower limb pain and elevated D-dimer in the observation group was lower than that in the control group (P < 0.05). The improvement of hemodynamic parameters such as SBP, DBP, CBV, PR, CI, and CO in the study group was better than that in the control group (P < 0.05). The satisfaction of the observation group was 90.58%, which was higher than that of the control group (82.35%) (P < 0.05). Conclusion Clinical nursing pathway can improve patients' nursing efficiency, improve the treatment effect, shorten hospital stay, and improve nursing satisfaction.

Consensus on Treatment of Acne Scars in China (2021) #

Acne scars are caused by inflammatory reactions, infections, and improper handling of acne lesions. Such scars have a high incidence and are difficult to treat. There are many methods currently used to treat acne scars, including medications, photoelectric technology, surgery, filling, chemical peeling, traditional Chinese medicine, biotherapy, and microneedle therapy, and many new methods are constantly emerging. However, there are still many issues, such as the lack of high-quality clinical studies, non-uniform treatment methods, and unsatisfactory therapeutic effects. The selection of appropriate methods for the comprehensive treatment of different types of acne scars at different stages in clinical practice remains challenging and is a research topic of great interest. From the perspective of evidence-based medicine, this consensus aims to provide a reference for the treatment of acne scars in clinical practice.

New understanding and research opportunities of metabolically healthy obesity

The paradox of obesity and metabolically healthy obesity are being challenged. More and more studies have disputed the potential mechanism and prognostic value of metabolically healthy obesity. The study of metabolically healthy obesity is helpful to clarify the potential causes of obesity paradox and the potential mechanism of different degrees of obesity harm to the population. From the perspective of evidence-based medicine, combined with the relevant literature at home and abroad, this study reviewed the new understanding of metabolically healthy obesity, lifestyle factors, the impact of fat factors on metabolically healthy obesity, and the new opportunities of metabolically healthy obesity research, in order to explore whether metabolically healthy obesity can maintain and gradually reduce weight for a long time, so as to improve cardiovascular disease In order to achieve the purpose of primary prevention of related diseases.

Perspective of Evidence-Based Medicine among Egyptian Family Physicians in Egypt

Objective: To assess family practitioners’ attitudes toward and awareness of evidence-based medicine in Egypt. Introduction: Evidence based medicine (EBM) is a systematic approach to medicine in which health care professionals use the best available scientific evidence to help make decisions about the care of individual patients. The use of evidence-based medicine may help plan the best treatment and improve quality of care and patient outcomes. Methodology: This is a cross-sectional study conducted on 135 family physicians from Rural and urban family medicine centres throughout Egypt that are affiliated with Ministry of Health and the private sector by using self- administered Evidence-Based Medicine Questionnaire distributed between October and November 2020. Results: With a 100% response rate most of the participants were females 91 (68.9%), aged between 30-39 (73.3 %), and worked in mixed urban and rural settings (53.3%). Most physicians welcomed or strongly welcomed the use of EBM (54.1% and 38.2% respectively). Moreover, 97% of the respondents agreed that EBM is useful or extremely useful.The majority (98.5% ) agreed that EBM improves patient care. . About 71% of the participants thought that the adoption of EBM will add more load on the family medicine practitioners Conclusion: Egyptian family physicians generally have a good attitude towards EBM, however their general knowledge about it is still insufficient. Keywords: Guidelines, Standards, Care pathways, Africa, Quality of health care

Анти-VEGF-терапия диабетического макулярного отека: актуальные подходы к ведению пациентов с высокими и низкими исходными функциональными параметрами

Diabetic macular edema (DME) is a serious complication of diabetes mellitus (DM) and a vision-threatening condition which can lead to irreversible blindness. Its prevalence correlates with the number of cases of DM and diabetic retinopathy and demonstrates a stable upward trend. Though modern medicine has made tremendous strides and developed several options for DME treatment which comply with the efficacy and safety criteria from a perspective of evidence-based medicine, DME remains a challenge in the clinical practice. There is no doubt that the key role is played by anti-angiogenic (anti-VEGF) therapy which has become the gold standard treatment for DME and is supported by a strong evidence base. However, some aspects of this method application are understudied. Thus, most of the randomized clinical studies (RCSs) of anti-VEGF therapy included patients with the "averaged" baseline values of visual acuity (within the range of 23–79 letters using ETDRS chart / 0.06–0.7 in decimal system). But in real clinical practice ophthalmologists often observe atypical DME cases where the baseline visual acuity values fall outside the range described in RCSs. The present literature review is aimed at considering tactics of the rational management of patients with atypically low and high baseline visual functions and provides analysis of the recent publications in which the outcomes of anti-VEGF therapy are discussed in the context of this problem. Keywords: macular edema, anti-VEGF therapy, diabetic retinopathy, diabetes, diabetic macular edema, high visual acuity, low visual acuity. For citation: Bobykin E.V. Anti-VEGF therapy for diabetic macular edema: up-to-date approaches to the management of patients with high and low baseline functional parameters. Russian Journal of Clinical Ophthalmology. 2022;22(3):181–186 (in Russ.). DOI: 10.32364/2311-7729- 2022-22-3-181-186.

Meta-Analysis of Elderly Lower Body Strength: Different Effects of Tai Chi Exercise on the Knee Joint-Related Muscle Groups.

Objective To determine whether lower body strength such as keen extension and flexion strength may be improved by Tai Chi exercise in older adults from the perspective of evidence-based medicine. Methods Databases of PubMed, Embase, and Cochrane Library were searched up to July 1, 2021. Randomized clinical trials are adopted to compare Tai Chi exercise with sedentary behavior or other low intensity exercise in terms of influence on lower body strength rehabilitation, especially keen extension and flexion strength in people aged over 60. A meta-analysis was performed to discuss outcomes of lower body strength, knee muscle strength, and knee extension/flexion strength. Results A total of 25 randomized trials involving 1995 participants fulfilled the inclusion criteria. (1) Tai Chi exercise significantly improved elderly lower body strength (−0.54, [−0.81, −0.28], p < 0.00001, I2 = 74%), but there was no differential improvement in the strength of the knee joints (0.10, [−0.02, 0.23], p=0.11, I2 = 34%). (2) Elderly individual lower body strength declined with age, while this trend was suppressed by Tai Chi exercise (−0.35, [0.14, 0.56], p=0.001, I2 = 70%). (3) Although Tai Chi exercise did no significantly improve the large muscle group of knee joint extensor like quadriceps femoris (3.15, [−0.69, 6.99], p=0.24, I2 = 26%), it showed marked enhancement to the strength of deep small muscle group of knee joint flexor (10.25, [6.90, 13.61], p < 0.00001, I2 = 0%). The heterogeneity might be caused by distinguished measurements of muscle strength. Therefore, Tai Chi exercise specifically enhanced some certain muscle strength of knee joints and improved muscle fitness rehabilitation as well as function activity for elderly. Conclusions In this RCT meta-analysis, Tai Chi exercise has positive effects on lower body strength of elderly. Although no obvious improvement on the knee extensor is observed, it may be used as a rehabilitation treatment for training stable deep muscle groups to improve the knee flexion strength significantly.

Approaches to prevention of antibiotic-associated diarrhea in children

The incidence of antibiotic-associated diarrhea, according to various authors, ranges from 5 to 39% and depends on the patient’s age and other contributing factors. Antibiotic-associated diarrhea can be caused by any antibiotic, regardless of dosage form or route of administration. In the pediatric population, the prevalence of antibiotic-associated diarrhea ranges from 6 to 70%. An urgent problem is the development of this disease against the background of a course of H. pylori eradication therapy, which significantly complicates tolerance and adherence to therapy. This article presents current data on the pathogenesis and risk factors of antibiotic-associated diarrhea in children. The clinical picture ranges from idiopathic enteritis to antibiotic-associated diarrhea caused by Cl. difficile - pseudomembranous colitis.The main principle of antibiotic-associated diarrhea treatment is cancellation of the antibacterial medicine that caused the diarrhea, or reducing its dose (if the course of the disease allows it). In complex treatment sorbents are used, correction of water-electrolyte balance is carried out. The use of probiotics seems quite logical for the treatment and prevention of antibiotic-associated diarrhea in terms of the pathogenesis of this condition. To correct dysbiosis, drugs are used to maintain and restore the quantitative and qualitative composition of the intestinal microbiota.Taking into account modern recommendations the main groups of drugs (probiotics, prebiotics, synbiotics) used for correction of intestinal microbiocenosis are presented. The mechanism of action of probiotics and mechanisms of their effect on intestinal microflora are considered. The basic requirements for bacterial strains that are part of the probiotic drugs are presented.The results of various randomized clinical trials and meta-analyses confirming the necessity of including probiotic complexes in antibiotic-associated diarrhea treatment regimens are presented from an evidence-based medicine perspective. The clinical effects of strains of Lactobacillusspp., Bifidobacterium spp.,Streptococcusspp. and Lactococcusspp. on the digestive tract microbiota are considered. The role of a synbiotic containing 9 probiotic strains of 4.5 * 109 CFU in one capsule and the prebiotic component fructooligosac-charides in the prevention of antibiotic-associated diarrhea in children is discussed separately. The results of microbiological studies confirmed the presence of microorganisms of genera Bifidobacterium, Lactobacillus, Streptococcus in the product, and the content of bacteria in one dose of the product was not less than 2 x 1010 CFU.

Acupuncture combined with traditional Chinese medicine preparation for the treatment of marrow suppression after chemotherapy: A protocol for systematic review and meta-analysis.

Background:From the perspective of evidence-based medicine, the efficacy and safety of combined therapy for marrow suppression after chemotherapy is still unclear. Given that there is no high-quality meta-analysis to incorporate existing evidence, the purpose of this protocol is to design a systematically review and meta-analysis of the level I evidence to ascertain the efficacy and safety of acupuncture combined with traditional Chinese medicine preparation for marrow suppression after chemotherapy.Methods:The following databases will be searched electronically by keyword combination mode: 4 British literature databases including PubMed, EMBASE, Scopus, and Cochrane Library, and 4 Chinese literature databases, including Chinese national knowledge infrastructure, VIP, and Wan fang database. The randomized controlled trials on acupuncture plus traditional Chinese medicine preparation for marrow suppression after chemotherapy will be included. The primary outcome is the elevation of hemoglobin, platelets, leukocytes, and neutrophils. The other outcomes include clinical symptoms, quality of life, and absolute value of reticulocyte. Risk bias analysis of the studies will be performed independently by 2 reviewers using the Cochrane Risk of Bias Assessment Tool.Results:The review will add to the existing literature by showing compelling evidence and improved guidance in clinic settings.Conclusion:This protocol will provide a reliable theoretical basis for the following research.

The practices of antibiotics application in neurosurgical patients in Ukraine: a cohort study

Introduction. The outcomes of potential complications of surgical interventions in neurosurgical patients can cause a death. Efficient antibiotic prophylaxis decreases the risks of infection and improves the quality of health care.&#x0D; Purpose. To estimate the appropriateness of prescribing antibiotics in a neurosurgical ward from the perspective of evidence-based medicine.&#x0D; Material and method. A retrospective cohort study has been carried out in a neurosurgical ward of multidisciplinary healthcare setting of Ukraine. Data from 131 in-patient medical cards (MC) of neurosurgical patients has been analyzed. Descriptive statistics methods have been used for data analysis. The relative risk (RR) with the 95% confidence interval (95% CI) has been calculated.&#x0D; Results. We found that among the patients, females prevailed (n = 81 / 61.8%). The patients’ mean age was 49.83 ± 13.90 years. The frequency of antibiotics prescriptions was higher significant in patients, who received surgical procedures in comparison with patients, who did not receive surgical procedures (RR = 1.827; 95% CI: 1,137 – 2.935). Antibiotics were prescribed mostly during the postoperative period. The use of interchangeable antibiotics of the same group has been occurred. The use of antibiotics for prevention in the most cases was of unreasonably long duration.&#x0D; Conclusion. The practice of the use of antibiotics in neurosurgical ward does not correspond to scientifically founded recommendations. It is needed to clearly define the indications for prescribing antibiotics. Duration of antibiotic use should depend on specialization of wards in multidisciplinary healthcare setting. It is expedient to conduct an audit on the use of antibiotics at healthcare settings on a regular basis with involving a specialist in infection control, a clinical pharmacist, and a clinical microbiologist.