Requirements Of Evidence-based Medicine Research Articles

Les pratiques de soin énergétique en France : phénoménologie et processus psychiques dans les thérapies alternatives

AimsIn this paper, we look at energy healing, a relatively under-studied therapeutic approach in France, despite its strong influence on a wide variety of complementary and alternative therapies. This article attempts to clarify the reasons for the success of these approaches by analyzing the psychic processes inherent in them. MethodTwenty-five therapists (energy therapists, magnetic healers, alternative therapists) were recruited to take part in several semi-directive interviews focusing on the phenomenology of energy healing. The corpus of data was analyzed using a psychoanalytical approach in order to highlight the specific features of these practices. ResultsEnergy healing is a set of therapeutic practices with heterogeneous methods based on the representation of a vital energy. These practices are frequently used in contexts of “ordinary misfortune” that combine persistent somatic symptoms, psychological suffering, and critical stages in life. The practice and effectiveness of energy healing seem to be based on unconscious psychic processes. These processes encourage the emergence of non-ordinary states of consciousness that potentiate processes of psychic transformation. In some aspects, this setting could be compared to a form of mediation in which the therapist uses body and object manipulations to induce psychic effects. DiscussionThe apparently “magical” nature of these therapies polarizes the scientific and media debate around the way in which they do or do not comply with the requirements of evidence-based medicine. The model proposed in this article allows us to move away from these issues and take into account the anthropological aspects of alternative therapeutic systems. ConclusionThe approach developed in this article extends and opens up clinical research on exceptional experiences, by showing that the study of alternative therapies, when it is not solely centered on the question of specific proof of efficacy, offers a fruitful perspective for making more explicit the processes of the caregiving relationship.

QUALITY OF TREATMENT OF ARTERIAL HYPERTENSION IN COMBATANTS TAKING INTO ACCOUNT THE PRESENT COMORBID PATHOLOGY

Objective: Assessment of compliance of treatment of arterial hypertension (AH) in participants of modern armed conflicts with the requirements of evidence-based medicine, taking into account their comorbid pathology. Design and method: The design of the study was passive retrospective one-time (cross-sectional). The medical charts of inpatient patients of 213 male combatants, aged 27-59 years, average age 45.0 ± 6.8 years, who underwent treatment during 2018-2021, were analyzed by the method of random sampling. Results: It was established that all combatants with hypertension were prescribed antihypertensive drugs: angiotensin-converting enzyme inhibitors (54% of patients), calcium channel blockers (26%), angiotensin receptor blockers (25%) (that is, not all patients used angiotensin-converting enzyme inhibitors or angiotensin receptor blockers), beta blockers (24%) and diuretics (16%). In combatants suffering from hypertension with comorbid coronary heart disease (CHD), beta blockers were prescribed in 26%, calcium channel blockers in 28%, statins in only 45% of patients, without monitoring the achievement of target levels of low-density lipoprotein cholesterol density; antiplatelet therapy was prescribed for 70% of patients, which does not meet the requirements of modern medical and technological documents and needs correction. An insufficient prescription of antihypertensive drugs from the groups of beta blockers (26% of patients) and calcium channel blockers (28%) was established in military personnel with hypertension - participants in modern armed conflicts with comorbid coronary artery disease. Inadequate prescribing of statins (only in 45% of patients) and antiplatelet therapy (70%) to patients with hypertension with comorbid coronary heart disease and lack of strict control of low-density lipoprotein cholesterol levels were revealed. Conclusions: It is necessary to increase the awareness of military doctors about the need for cardiovascular risk stratification in all patients with hypertension and patients with hypertension with comorbid coronary heart disease of combatants, regarding modern requirements for the treatment of patients with hypertension with concomitant pathology, on issues of safety and feasibility of prescribing statins and antiplatelet therapy to combatants with hypertension and concomitant coronary heart disease to reduce the risk of developing cardiovascular complications and improve the prognosis with this comorbidity.

Modern possibilities and prospects of conservative treatment of patients with peripheral arterial diseases

The most common clinical manifestation of peripheral arterial disease is intermittent claudication due to insufficient blood supply to the affected limb. The article summarizes and systematizes the latest achievements in the field of conservative treatment of patients with intermittent claudication. In accordance with the requirements of evidence-based medicine, an overview of modern promising trends in conservative therapy presented in the latest Russian and foreign consensus documents, is given. The basis of the complex treatment of patients with peripheral arterial diseases is: non-drug and drug treatment to relieve the symptoms of chronic ischemia, pharmacotherapy for the secondary prevention of cardiovascular complications, open or endovascular revascularization to increase the distance of painfree walking. With the development of atherosclerosis, disturbances in the peptide composition of the endothelium occur, which reduce the ability of the vascular wall to resist inflammation and the associated triggering of pathological processes. It has been experimentally proven that the use of a complex of peptides obtained from the vessels of healthy and young animals in this situation restores the endothelial function of the arteries, affecting the main links of pathogenesis. Decrease in oxidative stress, decrease in atherogenic and lipidemic action, normalization of vascular tone and blood coagulation parameters, increase in the microvascular bed – these are the mechanisms that justify the indication of peptides to patients with atherosclerosis obliterans. Angioprotector based on a complex of polypeptides isolated from blood vessels can become an important part of the treatment of patients with obliterating diseases of the arteries of the lower extremities, providing a complex pathogenetic effect. It is necessary to further study in multicenter clinical trials the duration of the therapeutic effect of a drug in a longer period after a course of treatment, its effect on long-term outcomes of the disease, the possibility of using repeated courses, in chronic obliterating diseases of the arteries of the lower extremities III-IV stages according to the Fontaine classification, as well as the use drug for the treatment of systemic atherosclerosis of various arterial basins.

Virtual Reality Therapy in France: A Therapeutic Innovation Between Technology and Care.

The latest form of cognitive behavioral therapy, virtual reality therapy has been developing in France since 2012, in both university hospitals and private practices. Patients receiving this therapy are immersed in a digitally created environment, using a virtual reality headset, in order to be exposed to their phobias. How does the introduction of technical objects such as the virtual reality headset affect and transform the care relationship between the patient and the therapist? Based on an ethnographic study conducted between 2012 and 2018 in the psychiatric unit of a French university hospital, this article outlines the emergence of virtual reality therapy, describes how it operates, and analyzes how it shapes the patient-therapist relationship. I argue that this device-namely virtual reality therapy-promotes a new therapeutic style in psychiatry, whose format and therapeutic indications align with the requirements of evidence-based medicine.

Problem questions regarding rationale expert results in cases of occurrence deaths from strongulation asphixia

Purpose – to analyze the state of the level of research and macroscopic diagnosis by forensic experts of corpses in cases of strangulation asphyxia by sectional methods, detection of specific and general asphyxial signs.Material and methods. As objects of research, the maintenance of «Conclusions of the expert» was studied, first of all, for their compliance with the «Rules of carrying out forensic medical examination (research) of corpses in the bureau of forensic medical examination» on the following indicators: 1) quality and completeness of description of external damages, dimensional parameters; 2) completeness of internal research; 3) description and reflection of species and general asphyxiation features; 4) referral to laboratory research methods; 5) use of additional sectional techniques; 6) completeness and correctness of summarizing.Results and conclusions. In accordance with the modern requirements of evidence-based medicine, when conducting forensic expert examinations of corpses with strangulation asphyxia, it is not enough to rely only on macroscopic signs when conducting forensic medical expert examinations of corpses with strangulation asphyxia. Our analysis of archival data from the "Expert Conclusions" suggests that most experts treat their responsibilities irresponsibly, do not attach importance and difference between such concepts as species characteristics of strangulation and general asphyxiation. In compiling the results, experts rely only on the presence of a strangulation furrow and general asphyxiation signs. In the “Conclusions of experts” we analyzed, some species traits were unjustifiably classified as general asphyxiation manifestations, and some were not paid attention to or were not studied at all.

Battery of tests for studying the adaptogenic effects of biologically active substances in preclinical trials

Based on the materials of the article, the authors offer researchers of the problems of adaptation and the study of specific adaptogenic activity standardized approaches to biomedical (preclinical) research of new biologically active substances, ensuring their comparability. The analysis of modern views on adaptation processes, as an increase in nonspecific resistance to adaptive effects, and the properties of known adaptogens is carried out. It has been shown that adaptogenic action can be realized through the involvement of several regulatory pathways, such as changes in the activity of neurons and endocrine response in response to adverse effects, interaction with cell receptors and modulation of their sensitivity to endogenous regulators, changes in the composition of cell membranes, structure of the cytoskeleton, activities of enzyme complexes, epigenomic regulation, antioxidant and antiradical activity. A grouping of methods for the experimental study of adaptogens is proposed on the basis of their compliance with the definition of this pharmacological class and the requirements of evidence-based medicine. The groups of methods aimed at increasing the rate and stability of the formation of a state of increased resistance to adverse influences, reparative-restorative processes, nonspecific resistance, psychoactivating and neuroplastic effects, antimutagenic and anticarcinogenic effects were identified. Specific schemes of adaptive influences and criteria for assessing adaptogenic activity are proposed on the basis of comparing the results obtained with the effects of reference adaptogens. The technology of the integrated assessment of the results of the methods, which are different in their informational significance, has been substantiated.

Diagnostics of mechanical asphyxia – experience of foreign countries (literature review)

The aim of this study is to establish modern, global trends in the diagnosis of mechanical asphyxia.
 Materials and methods: search and bibliographic method (theoretical analysis, systematization and classification of library catalogues, printed and electronic sources on mechanical asphyxia) from open anchor databases Scopus preview, Web of Science and using information retrieval systems Google Scholar, Open Ukrainian Citation Index (OUCI), ScienceDirect on the Internet.
 Results: mechanical asphyxia, as one of the most common types of violent death, ranks first among deaths from mechanical injuries. Its study is of great interest among medical scientists in various fields, especially for resuscitators and forensic experts. Establishing the causes of asphyxia, clinical and morphological manifestations, and the consequences that unfortunately most often lead to death. With the rapid development of society, science is also developing rapidly, and the latest sensitive methods of diagnosing diseases are emerging. However, unfortunately, in the post-Soviet space, the diagnosis of most pathological conditions, including asphyxia, is determined by experience and sensory organs, which are determined using instrumental research methods in compliance with the requirements of evidence-based medicine.
 Given the peculiarities of the pathophysiological processes of the asphyxiation state and their manifestations in the body, doctors should rely primarily on general knowledge about hypoxic and asphyxiation disorders, which are determined using instrumental research methods in compliance with the requirements of evidence-based medicine.
 Conclusions: at present, the diagnosis of asphyxia consists of many morphological features. Failure to take into account the state of the body, the presence of chronic diseases, and drug or alcohol intoxication at the time of asphyxiation complicate the diagnosis. Detection of individual clinical manifestations or morphological features does not allow asserting its lifelong origin. Therefore, it is necessary to use modern research methods that should expand the possibilities of forensic diagnosis of the viability of injuries in terms of evidence-based medicine and provide forensic experts with a scientific basis for their results. One such method is immunohistochemical, which is gaining popularity and consolidating its position in the EU, China, Japan and America. In addition, this method is well-established and widespread in morphological studies of differential diagnosis of tumours. Some scientific works prove the expediency of using the immunohistochemical method to solve the problems of forensic expert practice, which is an actual scientific and practical task

Formation and development of osteopathy as a scientific discipline

The formation and development of osteopathy as a scientific discipline is considered. Despite its one and a half century history, osteopathy is a relatively young medical specialty. At the same time, throughout the history of the existence of osteopathy, its supporters carried out an active search for scientific evidence of its effectiveness. Currently, osteopathy is going through the stage of scientification, its formation as a scientific discipline. However, even now even the term osteopathy itself is often interpreted quite loosely and, in some cases, tendentiously. In this regard, the purpose of this work is to trace the development of osteopathy — from the earliest works of its founders to the latest stage of development, when osteopathy has become more and more consistent with the basic requirements of evidence-based medicine. To achieve this goal, much attention is paid to all stages of the formation and development of osteopathy, both abroad and in Russia. There are considered such problems as the formation of the basic terminology, the development and change of the basic concepts of osteopathy, including the concept of osteopathic lesion and the concept of somatic dysfunctions, the development of modern methods of evidence-based medicine, the dynamics of publication activity of osteopathic researchers. It concludes that new ways of obtaining the data about the health effects of osteopathy will continue to emerge, and the level of evidence and the number of quality clinical trials are likely to change.

The study of the osteopathic diagnostics results′ coincidence frequency

Introduction. The quality of diagnostics in various branches of medicine including the use of complex and expensive equipment leaves much to be desired. In any case, the doctor evaluates the patient′s examination results and makes a diagnosis, which may be wrong. In manual medicine the main tool is the hands of the doctor and it makes the diagnostic process even more subjective. There are few studies confi rming the reliability of manual diagnostic methods; the reproducibility estimates in the most cases do not satisfy the evidencebased medicinerequirements, and in some cases are simply absent. One of the indicators characterizing the diagnostics quality is the indicator of the diagnoses matches or discrepancies frequency.The goal of research— to determine the coincidence frequency of the osteopathic diagnostics results (osteopathic conclusions) formulated by the osteopathic doctors working as teachers of one osteopathic school.Materials and methods.The cross-blind study involved 6 osteopaths-teachers of the Institute Osteopathy of Saint-Petersburg. Their experience as an osteopathic doctor was from 3 to 14 years (median 7.5 years). The osteopaths were randomly divided into two «triples». Each triple worked on the same day on the same contingent of subjects (students of the Osteopathy Institute). A total of 75 people aged 22 to 58 years (median 35 years) were examined, including 36 women and 39 men. Each person was examined by three osteopaths with completinga standard osteopathic conclusion. Osteopaths carried out only osteopathic diagnosis without taking a history and analysis of the additional examinations results. All subjects fi lled out an anamnestic questionnaire in which they noted the regions where there were operations or injuries, or the problem was identifi ed by objective examination methods (there was a diagnosis). Statistical processing of the results was performed using nonparametric statistics by a specialist who did not know who specifi cally performed the osteopathic diagnosis.Results. The following patterns were revealed after comparing the osteopathic conclusions made by three osteopathic doctors examining one group of patients. For 12 regions of the body (including variants of somatic (soma) and visceral (viscera) components), 8 regions showed agreement on the presence or absence of biomechanical somatic dysfunctions (SD) by the results of groups comparing according to the Friedman criterion p>0,05. In the head and chest (soma) regions in both triplets there was the greatest coincidence of diagnoses, and in the lower back (viscera) region — the least, perhaps the latter region is the most diffi cult for osteopathic examination. Regional neurodynamic SD was detected rarely, from 1 to 3 per group, and so there was almost complete negative consent among osteopathic doctors, perhaps these SD are very rare. Global SD either were not detectedby the osteopaths, or the detected global SD did not match in most cases, perhaps the global SD identifi cationis the most diffi cult part of the osteopathic examination. For the most cases (84 % in the fi rst triple and 60 % in the second triples), 2 osteopaths out of 3 revealed the same dominant SD, and the original diagnoses were from 28,9 % to 53,3 %. In 73 % of the subjects the localization of the dominant SD coincided with the localization of the problems indicated in the questionnaire (a history of trauma or surgery; a diagnosis confi rmed by objective examination methods). These results are very important for confi rming the osteopathic diagnosisobjectivity, since SD is likely to form at the site of an injury or operation (i. e. acute infl ammation).Conclusion. The obtained results of osteopathic diagnostics can be regarded as quite good and acceptable, especially in comparison with the so-called objective methods (ultrasound, MRI, etc.).

Contemporary Approaches to the Treatment of Gastroesophageal Reflux Disease

Aim:to describe existing approaches to the treatment of gastroesophageal reflux disease (GERD) in accordance with the requirements of evidence-based medicine, as well as to discuss controversial issues in the management of GERD patients.Key findings.Nonmedical GERD treatment should be based on the reduction of body weight by decreasing the calorie intake and its proper distribution throughout the day, as well as by increasing the level of physical activity. Proton-pump inhibitors (PPIs) are used as the main class of drugs for reflux esophagitis and non-erosive reflux disease (NERD), as well as in cases when the disease is characterized by certain specific features (e.g., the presence of night symptoms) and extraesophageal manifestations. The efficacy of PPI treatment may depend on the genetic polymorphism of the CYP2C19 cytochrome. Rabeprazole is characterized by a predominantly non-enzymatic pathway, providing a more stable pharmacokinetics profile, which is less dependent on the CYP2C19 polymorphism. The duration of the initial and maintenance PPI course is determined by the GERD form. Long-term PPI maintenance therapy is indicated for erosive esophagitis. In the presence of Barrett’s esophagus, this measure is considered from the standpoint of cancer prevention.Conclusion.The use of PPIs is considered to be the key approach in the drug treatment of GERD. The choice of a PPI is based on factors that determine the efficacy and safety of such drugs, namely the rate of the onset of acid suppressive effects, the intensity of acid suppressive effects, the time of the onset of GERD clinical remission, the dependence on the CYP2C19 genetic polymorphism, the absence of significant interaction with other drugs, as well as the presence of pleiotropic effects.

Principles of drug therapy for acute bacterial rhinosinusitis: from evidence-based medicine to practice

The problem of treatment of acute rhinosinusitis (ARS) is extremely important due to high prevalence of the disease. According to statistical data the ARS affects from 6% to 15% of population and does not show any tendency to reduction. These figures are associated with a high rate of acute respiratory viral infection (ARVI) which directly leads to rhinosinusitis. But, however, despite the fact that practically every individual experiences from 2 to 5 episodes of ARVI every year, only 0.5-2% of them are complicated with acute bacterial rhinosinusitis (ABRS). Despite this low percentage of bacterial infection, in 80% of cases systemic antibacterial treatment is prescribed which further worsens the problem of bacterial resistance in the world. The main difficulty in determination of therapeutic approach to ABRS is associated with absence of reliable methods of differential diagnostics of viral and bacterial etiology of the disease. Because of low sensitivity and specificity, none of additional visualization methods of ABRS diagnosing such as radiography, ultrasonography, computed tomography, can be used as a routine laboratory method. Thus, the main method of differential diagnostics of viral and bacterial ARS remains analysis of clinical data which leads to a high rate of diagnostic errors and to polypragmacy.
 Nowadays there exists a wide range of medications for treatment of ABRS in the pharmacological market. The choice of therapeutic approach by our international colleagues is mostly based on the requirements of evidence-based medicine. Russian scientists, besides evidence-based medicine principles take into account the pathogenesis of the disease.
 In this article different groups of medications for treatment of ABRS are presented. Some of them do not meet the requirements of evidence-based medicine so far, but they are included to the Russian standards and are used for management of ABRS.

Principles of drug therapy for acute bacterial rhinosinusitis: from evidence-based medicine to practice

The problem of treatment of acute rhinosinusitis (ARS) is extremely important due to high prevalence of the disease. According to statistical data the ARS affects from 6% to 15% of population and does not show any tendency to reduction. These figures are associated with a high rate of acute respiratory viral infection (ARVI) which directly leads to rhinosinusitis. But, however, despite the fact that practically every individual experiences from 2 to 5 episodes of ARVI every year, only 0.5-2% of them are complicated with acute bacterial rhinosinusitis (ABRS). Despite this low percentage of bacterial infection, in 80% of cases systemic antibacterial treatment is prescribed which further worsens the problem of bacterial resistance in the world. The main difficulty in determination of therapeutic approach to ABRS is associated with absence of reliable methods of differential diagnostics of viral and bacterial etiology of the disease. Because of low sensitivity and specificity, none of additional visualization methods of ABRS diagnosing such as radiography, ultrasonography, computed tomography, can be used as a routine laboratory method. Thus, the main method of differential diagnostics of viral and bacterial ARS remains analysis of clinical data which leads to a high rate of diagnostic errors and to polypragmacy.
 Nowadays there exists a wide range of medications for treatment of ABRS in the pharmacological market. The choice of therapeutic approach by our international colleagues is mostly based on the requirements of evidence-based medicine. Russian scientists, besides evidence-based medicine principles take into account the pathogenesis of the disease.
 In this article different groups of medications for treatment of ABRS are presented. Some of them do not meet the requirements of evidence-based medicine so far, but they are included to the Russian standards and are used for management of ABRS.

A method of hand motor control assessment in patients with post-stroke spasticity

Abstract Introduction: In order to assess hand spasticity in post-stroke patients, it is necessary to apply an objective and sensitive method which allows for characterising motor control. It is significant due to the necessity to monitor the effects of the therapeutic process according to the requirements of Evidence-Based Medicine (EBM). The aim of the study was to assess the usefulness of the measurement of pressure generated during a maximal palmar grasp and after its release for evaluating the level of hand motor control in poststroke patients compared to subjective scales. Material and methods: In order to characterise motor control, a numerical indicator calculated on the basis of the measurements of pressure generated during a maximal palmar grasp and after its release was suggested. To perform the measurements, 12 poststroke patients with hemiparesis were included in the study. In the research, the level of hand paresis was assessed with Brunnström Approach, the intensity of spasticity was graded with Modified Ashworth Scale, while hand motor function was classified with Fugl-Meyer Assessment (FMA). Pressure generated during a palmar grasp and after its release as well as palm area were measured with the use of a photometric method. The assessment was made twice, i.e. on the day of admission to the in-patient rehabilitation ward and after a three-week hospital treatment. Results: In the second measurement, a slight decrease in paresis intensity according to Brunnström Approach and lower intensity of spasticity according to Ashworth Scale were noted. A higher number of points in the FMA scale was observed. The values of the suggested indicator changed; however, in no case were these changes statistically significant. Conclusions: 1. Compared to other subjective scales, the usefulness of the measurement of pressure generated during a maximal palmar grasp and after its release for assessing the level of hand motor control in post-stroke patients was not confirmed. 2. The usefulness of the recommended method of spastic hand motor control assessment needs to be verified in further research carried out according to EBM requirements.

VEN and frequency analysis of the quality of pharmacotherapy of patients with chronic hepatitis

VEN and frequency analysis were used to analyze the quality of pharmacotherapy of 79 patients with chronic hepatitis (CH) who were treated in a healthcare institution (HCI) in the city of Dnipropetrovskin 2015. It has been found that pharmacotherapy at the HCI corresponded to main areas of the treatment specified in the clinical protocol of medical care (CPMC) to patients with CH.It has confirmed the rationality of drug prescriptions. However, a significant number of prescriptions per a patient (on average 8.9 drugs) indicates the polypharmacy in this department of the HCI. Moreover, according to the results of the formal VEN analysis a significant number of drugs with the index N (non-essential drugs) has been determined; it indicates the need for correction of drug prescription by doctors at this HCI in accordance with the current science-based medical regulations – the National Drug Formulary of Ukraine (the 7th edition) and the CPMC to patients with CH – by reducing prescriptions of non-essential drugs that are not included in these regulations. Today, being developed 11 years ago, the CPMC to patients with CH needs to be updated since it does not meet modern requirements to the current science-based medical practice guidelines that allow making the best clinical decisions in favour of the patient in accordance with the requirements of evidence-based medicine.

Conflict of interests as a problem of evidence-based medicine

The role of ideology (principles) of evidence-based medicine in prophylaxis and correction of con?flict of interests in various spheres of medicine and socio-medical assistance is considered. Professional ethics formed in the course of education and undergoing modification under conditions of real practical work is a main sphere of medical and related edological practices associated with conflicts of interests. Of special importance are principles of bioethics based on the requiremnents of evidence- based medicine. The role of evidence-based medicine in prophylaxis and resolution of conflicts of interests is related to the training and re-training of specialists, prevention and correction of their professional degradation and deformation in the course ofpractical clinical work. Analysis of prima, y and secondary motives underlying occupational out. activities and their role in the formation of the conflict of interests was carried.

Hyperthermic Intraperitoneal Chemotherapy in Ovarian Cancer: Where Do We Go From Here?

The ongoing debate regarding a potential role for hyperthermic intraperitoneal chemotherapy in the management of ovarian cancer represents an excellent example of the rarely publicly discussed fundamental clash between the requirements of evidence-based medicine and the roles of clinical innovation and optimization of care for the individual patient.

S2e guideline: positioning and early mobilisation in prophylaxis or therapy of pulmonary disorders : Revision 2015: S2e guideline of the German Society of Anaesthesiology and Intensive Care Medicine (DGAI).

The German Society of Anesthesiology and Intensive Care Medicine (DGAI) commissioneda revision of the S2 guidelines on “positioning therapy for prophylaxis or therapy of pulmonary function disorders” from 2008. Because of the increasing clinical and scientificrelevance the guidelines were extended to include the issue of “early mobilization”and the following main topics are therefore included: use of positioning therapy and earlymobilization for prophylaxis and therapy of pulmonary function disorders, undesired effects and complications of positioning therapy and early mobilization as well as practical aspects of the use of positioning therapy and early mobilization. These guidelines are the result of a systematic literature search and the subsequent critical evaluation of the evidence with scientific methods. The methodological approach for the process of development of the guidelines followed the requirements of evidence-based medicine, as defined as the standard by the Association of the Scientific Medical Societies in Germany. Recently published articles after 2005 were examined with respect to positioning therapy and the recently accepted aspect of early mobilization incorporates all literature published up to June 2014.

Issues and promise in clinical studies of botanicals with anticonvulsant potential.

Botanicals are increasingly used by people with epilepsy worldwide. However, despite abundant preclinical data on the anticonvulsant properties of many herbal remedies, there are very few human studies assessing safety and efficacy of these products in epilepsy. Additionally, the methodology of most of these studies only marginally meets the requirements of evidence-based medicine. Although the currently available evidence for the use of cannabinoids in epilepsy is similarly lacking, several carefully designed and well controlled industry-sponsored clinical trials of cannabis derivatives are planned to be completed in the next couple of years, providing the needed reliable data for the use of these products. The choice of the best botanical candidates with anticonvulsant properties and their assessment in well-designed clinical trials may significantly improve our ability to effectively and safely treat patients with epilepsy. This article is part of a Special Issue entitled "Botanicals for Epilepsy".

Kurzversion S2e-Leitlinie – „Lagerungstherapie und Frühmobilisation zur Prophylaxe oder Therapie von pulmonalen Funktionsstörungen“

The German Society of Anesthesiology and Intensive Care Medicine (DGAI) commissioned a revision of the S2 guidelines on "positioning therapy for prophylaxis or therapy of pulmonary function disorders" from 2008. Because of the increasing clinical and scientific relevance the guidelines were extended to include the issue of "early mobilization" and the following main topics are therefore included: use of positioning therapy and early mobilization for prophylaxis and therapy of pulmonary function disorders, undesired effects and complications of positioning therapy and early mobilization as well as practical aspects of the use of positioning therapy and early mobilization. These guidelines are the result of a systematic literature search and the subsequent critical evaluation of the evidence with scientific methods. The methodological approach for the process of development of the guidelines followed the requirements of evidence-based medicine, as defined as the standard by the Association of the Scientific Medical Societies in Germany. Recently published articles after 2005 were examined with respect to positioning therapy and the recently accepted aspect of early mobilization incorporates all literature published up to June 2014.

Peculiarities of adaptive and compensatory abilities of the modern pupils

In conditions of an intense functioning of child organism an influence of unfavorable factors can result into breakdown of adaptive and compensatory mechanisms and to become a presupposition for forming pathology. Aim : to define peculiarities of adaptive and compensatory abilities of school-aged children during the school year. Methods . 970 children 9-17 years old were examined at the beginning and at the end of school year. Children were divided in 2 groups: I – 673 children with chronic somatic diseases, II – 297 conventionally healthy children. The study of adaptive and compensatory mechanisms was carried out with a glance to vegetative regulation of body functions. Robinson index (IR) was used for an express-assessment of somatic health. Statistic data-processing was done according to the requirements of evidence-based medicine. Result . An analysis of an examination results at the beginning of the school year showed that the pupils of the I group have a complex disturbances of vegetative regulation, low level of aerobic abilities of organism. Among the children of the II group no more than 25% have a satisfactory state of adaptive and compensatory mechanisms that ensure an adequate response of child organism on the stress factors of educational process. At the end of the school year the part of children who have a balanced level of neuroreflex systems of organism decreases by 50%, the number of children with an overstrain of regulatory systems of organism increases by 28%, with unsatisfactory state of adaptive and compensatory mechanisms – by 22% that becomes presupposition for formation and chronization of somatic pathology. An examination of pupils health level at the end of the school year showed that the number of conventionally healthy children decreases by 19,2%. The syntropy of pathological states formed in 54,2% of pupils with chronic somatic pathology, in 34,5% of children the functional disturbance transformed into somatic pathology. Conclusion . The definition of indicators of the state of adaptive and compensatory mechanisms and energy potential of organism when medical examination of the school-aged children allows to distinguish the risk group on the subject of formation and chronization pathology opportunely and to carry out prophylactic