View Of Evidence-based Medicine Research Articles

Фармакологічний профіль фітокомпозиції Нормоцикл у терапії гормональних дисбалансів у жінок

У статті наведені фармакодинамічні характеристики компонентів фітокомпозиції Нормоцикл® (фармацевтична компанія «Organosyn»), основними діючими компонентами якої є екстракти Symplocos racemosa, Asparagus racemosus, Glycyrrhiza glabra, Curcuma longa. Проаналізовані з точки зору доказової медицини компоненти фітокомпозиції Нормоцикл®, обґрунтована клінічна ефективність та безпеч-ність Нормоциклу в терапії гормональних дисбалансів у жінок.

The Application of Physiotherapy in Cerebral Stroke from the Evidence-Based Medicine Standtpoint

The review summarizes the results of the search for high-quality clinical studies related to the use of physical therapy methods in stroke rehabilitation meeting modern requirements from the point of view of evidence-based medicine. To solve this problem, the following databases are used: Physiotherapy Evidence Database – PEDro, Cochrane Library, PubMed, Stroke, Articles presenting the results of randomized controlled trials (RCTS) are selected. To search for information, the queries “physiotherapy”, “electrotherapy”, “evidence-based physiotherapy”, “electrostimulation”, “transcranial magnetostimulation”, “Transcutaneous Electrical Nerve Stimulation”, “magnetotherapy”, “cryotherapy”were used. Despite the obvious lack of research on a large number of applied physiotherapy factors and individual methods of influence, the modern evidence base of physiotherapy in stroke has recently been supplemented by a considerable number of studies. It is mainly related to the section of electrotherapy, which allow us to talk about individual methods of exposure as based on a high-quality evidence base that allows to form recommendations of a high level of evidence. Additional research is needed to make recommendations on other physiotherapy methods and factors.

Is the Prescription of Antidepressants for Bipolar Depression Justified from the Point of View of Evidence-Based Medicine?

Background: prescribing antidepressants in the treatment of bipolar depression remains highly controversial due to the inconsistence between routine clinical practice and the results of controlled trials. Purpose: to assess the validity of antidepressants use in bipolar depression from the point of view of evidence-based medicine. Material: database search (Scopus and MEDLINE) followed by analysis of studies concerning the efficacy and safety of antidepressants in bipolar depression treatment. Сonclusion: the search found 23 studies. There was a high degree of inconsistency in the results, apparently related to the methodology. Only two studies compared the effectiveness of antidepressants in monotherapy with placebo, with no differences found in the study with 740 participants and in the study with 70 participants with type 2 bipolar disorder antidepressants were found to be more effective than placebo. Nevertheless, both studies had significant methodological issues. In 6 studies comparing the effectiveness of the combination of antidepressants with mood stabilizers against the combination of mood stabilizers with placebo, only the effectiveness of fluoxetine in combination with olanzapine was revealed, other antidepressants were ineffective. At the same time, studies where antidepressants were compared with each other in combination with mood stabilizers revealed a significant clinical response to therapy. Analysis of routine clinical practice studies has shown that antidepressants are prescribed very often, for about 50% of patients with bipolar depression. International guidelines for therapy differ quite widely on the use of antidepressants in bipolar depression, but in principle allow their use. Thus, despite the contradictory literature data, the use of antidepressants in bipolar depression is justified from the point of view of evidence-based medicine for certain groups of patients with taking into account risk factors.

Management of menopausal women with a history of endometriosis

Aim. To formulate a position statement on the management of the menopause in women with a past history of endometriosis from the point of view of evidence-based medicine.
 Materials and methods. Review of domestic and foreign literature, position of IMS and EMAS.
 Results. The article describes the main modes snd ways of introducing MHT and their advantages. The expert position on the management of patients with a history of endometriosis during surgical and natural menopause is highlighted. Information on the prevalence and methods of treatment of postmenopausal endometriosis is given.

Lactulose: a kaleidoscope of pleiotropic effects (literature review and own data)

The article presents in-depth analysis of literature data on the multifaceted effects of lactulose and the opportunities for its practical use. History of the study of lactulose therapeutic effects is described. Currently, lactulose as a medicine is registered in more than 100 states. Indications are constipation and hepatic encephalopathy, in some countries — treatment of salmonella carriage. However, the prospects and possibilities for the clinical use of lactulose are very broad.
 In 2005, lactulose was officially recognized as the first choice for chronic constipation from the point of view of evidence-based medicine. Mechanism of lactulose action in case of constipation is analyzed; literature data on its safety in pregnant women, children and the elderly are presented.
 Lactulose is superior to other treatment options for hepatic encephalopathy. It has been successfully used for any stage of severity of this condition, including latent encephalopathy and hepatic coma. The effectiveness and safety of lactulose in hepatic encephalopathy is confirmed by a large number of high-evidential studies.
 Possible indications are: as a prebiotic for the treatment of bacterial overgrowth syndrome, primary and secondary prevention of gallstone disease, for the elimination of endotoxemia in hepatorenal syndrome, exocrine pancreatic insufficiency, hypercholesterolemia. Despite its sweet taste, lactulose is not contraindicated, but, on the contrary, is useful in diabetes.
 Contraindications to treatment with lactulose are limited.
 The article also presents authors’ own data demonstrating the effectiveness of Medulak in a prebiotic dose in the treatment of chronic pancreatitis with exocrine pancreatic insufficiency combined with bacterial overgrowth syndrome.

Rehabilitation in acute stroke from the point of view of evidence-based medicine: possibilities of drug treatment

The review highlights the fundamental principles of early rehabilitation in ischemic stroke, the benefits and risks of early and very early patient mobilization. It presents data on the efficiency of CIMT-kinesiotherapy and mirror therapy in restoring upper extremity function, as well as procedures for nonpharmacological correction of spatial neglect syndrome. The effect on the rehabilitation of concomitant Alzheimer's disease is analyzed. The areas of pharmacological potentiation of poststroke rehabilitation, the efficiency of cerebrolysin in particular, are considered.

Placenta praevia і Placenta accreta: сучасні методи діагностики і розродження

The article presents data from recent randomized trials and published in 2018 two guidelines from the Royal College of Obstetricians and Gynecologists of Great Britain on epidemiology, risk factors, modern diagnostic methods, modern algorithms and innovative surgical methods in cases of placenta (pl. praevia/accreta). From the point of view of evidence-based medicine, the relevance of the problem in the aspect of antenatal diagnosis of placental pathology for prediction and prevention of life-threatening hemorrhagic complications is highlighted. Data are presented indicating the need for a multidisciplinary approach to pregnancy in the case of diagnosis of placenta percreta with cesarean section and hysterectomy without attempting to separate the placenta. The given data will be useful for practitioners of obstetrician-gynecologists for the purpose of optimal management and delivery of pregnant women with this difficult obstetric pathology. Key words: placenta previa, abnormal invasive placenta, placenta accreta, placenta accreta spectrum disorders, increta/percreta.

Issues of conservative treatment of patients with flatfoot

Flatfoot is the most common foot disease, the prevalence of which is 30-70% according to many authors. Planovalgus foot deformity asymptomatically existing for a long time can further lead to pain syndrome and limping, sensitivity disorders, trophic disorders, limitation of foot joints mobility, development of arthritic changes with corresponding progression of the function impairment. Timely initiation of treatment, complex pathogenetic and symptomatic therapy as well as strict adherence to the doctor's recommendations help to achieve maximum effect. The aims of treatment of patients with flatfoot are posture stabilization and support of overloaded zones of the plantar surface, improvement of supply of the foot and musculoskeletal apparatus, as well as foot joints, and reduction of pain syndrome. Despite the prevalence of pathology, as well as a wide range of methods of treatment and rehabilitation, conservative treatment does not always lead to a positive result and the problem remains unresolved. This literature review describes the main directions of conservative therapy of patients with flatfoot from the view of evidence-based medicine. The data on the use of special ortheses and orthopedic shoes for correcting the foot deformities are discussed with a description of possible complications. The main forms of exercise therapy used to stabilize the foot muscles tonus, are analyzed. The application of physiotherapeutic factors aimed at improving trophic and blood supply of tissues, as well as strengthening of the musculoskeletal apparatus of the lower legs and feet, is described. Data on the use of complex conservative treatment of patients with flatfoot are presented. The article also focuses on the use of drug therapy as part of the complex treatment.

Features of the Course of the Pathological Process in Multiple Sclerosis as Confirmed by Changes in Biochemical Markers for Oxidative Stress

Objective. To analyze the features of the course of the pathological process in multiple sclerosis (MS) in terms of measures of oxidative stress and antioxidant defense (AOD). Materials and methods. A total of 220 patients with different clinical forms and stages of MS were studied; patients were divided into four clinical groups. Markers of the intensity of free radical oxidation of lipids and proteins were evaluated in terms of the levels of ketodienes, diene conjugates, malondialdehyde, and Schiff bases. The functioning of the endogenous AOD was assessed in terms of measures of the activity of the following markers: vitamin E and SH groups – total and nonprotein thiols – to assess the nonenzymatic compartment of the AOD. Markers of the enzymatic compartment were: superoxide dismutase, glutathione peroxidase, and glutathione reductase. Results and conclusions. Differences were found in measures of the intensity of oxidative stress in groups of patients with different clinical forms and stages of MS, not only verifying oxidative stress in MS from the point of view of evidence-based medicine, but also supporting the continuity of the pathological process in this disease.

A Postmodern View of Evidence-based Medicine (EBM): Barthes. Heidegger, Deleuze and Guattari, and Derrida.

The language of an EBM paper screams objectivity. The personal interests of the authors are skilfully expunged. These are men and women of science! Taken out altogether are the drivers of the project—desire, interest, professional advancement (surely not money). The EBM paper presents an image. My paper interrogates the objectivity of the subject-object distinction, arguing that it is based on the subject, from Descartes, “I think, therefore I am”. The subject-object distinction, fundamental to science / EBM, is not used by Martin Heidegger. He depicts people immersed in the environment, coping, they hope. Their world is a world that matters, a world of joy and sorrow. Absent is the contrived distinction between subject and object, yielding a detached, “objective” universe, set up for scientists to study and gain knowledge of. Deleuze and Guattari do not read an EBM paper to ascertain its meaning. Rather they analyse how meaning is set up. They would note how the conceptual structure and language created an experimental subject depicted in biomedical terms. They would note the use of fixed terms, fossilised, such as experimental subject, rather than as a continually evolving process. Derrida tells us that, although God and metaphysics have been pushed off the conceptual cliff in out scientific age, we still read with misty, metaphysical eyes. We read in the myth of truth, based on origins and centres, about the realuniverse. We read in the coherence of the paper, and the reliability of reason. We think that words have fixed meanings, and that all readers understand the same as all authors intend.

A view of Evidence-based Medicine from Karl Popper.

Background: Popper has argued that knowledge is insecure, and moved the emphasis to conjecture and refutation. Science, Popper avers, does not build up universal laws from singular statements (representing events), since the principle of induction is non-existent. He would see many instances of confirmation of EBM methods, but EBM theory is too vague for refutation. Methods: I consider whether EBM has a theory, or whether it is heuristic, a method. I examine EBM's use of inductivism and falsificationism. I look at Popper's approach to knowledge (conjecture and refutation) and I relate this to EBM. Results: Popper writes about how to evaluate whether theories are scientific. But this scarcely applies to EBM. This is because EBM has left theory to the academics while it proceeds to develop and promulgate a method of practising medicine. Contra Popper, EBM does not put forward a theory for scholarly debate or empirical testing. By contrast, it promulgates a strict, detailed method whose merits are self-evident. (Who will argue against the evidence?) Conclusions: While EBM makes extensive use of falsification in evaluating tests and treatments, as a whole it fails to reach scientific status, as judged by Popper. It scarcely puts forward a risky theory to be challenged, and such theory as can be spider-webbed together is too diffuse to be precisely defined then falsified. Even so, I have provided a guide towards evaluating such EBM theory as there is.

Oral Acetyl-L-Carnitine treatment in hepatic encephalopathy: view of evidence-based medicine

Objective. To systematically review the effect of Acetyl-L-Carnitine in patients with hepatic encephalopathy.Material and methods. Design: systematic review and meta-analysis. Data sources: The Cochrane Library, MEDLINE, EMBASE.com, Science Citation Index, Google search and the China Biological Medicine Database to June 2012.Review methods: randomized placebo controlled trials of Acetyl-L-Carnitine in patients with hepatic encephalopathy assessing whether Acetyl-L-Carnitine an effective therapy or not. No language restrictions were applied. Two reviewers independently extracted data and assessed quality.Results. 7 methodologically sound randomized controlled trials were identified involving 660 participants with hepatic encephalopathy, totaling 249 with subclinical hepatic encephalopathy, 189 with West Haven grade 1, 162 with West Haven grade 2 and 60 with West Haven grade 3. Acetyl-L-Carnitine was effective to improve serum ammonia level (weighted mean difference 25.90, 95% confidence intervals 20.89 to 30.91, P < 0.05) and the number connection test completion time (weighted mean difference 16.62, 95% confidence intervals 9.88 to 23.36, P < 0.05). The outcome was consistent in subgroup analyses. No publication bias was detected. Adverse events were reported infrequently and were minor.Conclusions. Acetyl-L-Carnitine is promising as an effective and tolerable treatment for hepatic encephalopathy that associated with improved serum ammonia levels and the number connection test.

Students' View of Evidence-Based Medicine: A Survey in Switzerland

Objective: Training in Evidence-based medicine (EBM) has been implemented in Swiss medical schools for the last 8 to 10 years. Still, there is little known about the undergraduates’ perception of EBM and Medical Statistics. Methods: Between February and July 2007, fifth- to sixth-year medical students during surgical clerkship at 15 adult surgical departments in German-speaking Switzerland were asked to participate in an anonymous survey. At the end of the surgical clerkship each student received a self-administered questionnaire on EBM. It included questions concerning the perception of the practical use of EBM, eight multiple-choice questions regarding the statistical literacy and 26 questions about the view of Science and Scientific Methods. Results: A total of 185/344 (53.8%) medical students participated in the study. On a seven-point Likert scale, the importance of teaching and knowledge in EBM was rated as high (5.7±1.1 and 5.9±1.0). The subjective knowledge on EBM was considered moderate on a five-point Likert scale (3.4±1.0), corresponding with the median percentage knowledge score of 33 (range 0-47). The frequency of literature research and number of publications as co-author proved to be the only significant predictors for a higher knowledge in EBM and Medical Statistics of medical students (p=0.01). The attitude toward Science was good with a total score for the value of Science and research of 80.0 ± 8.3 out of a maximum of 130. The main impediments for using EBM were lack of time (57/165, 35%), ignorance (36/165, 22%), and difficulties in integration into everyday life (32/165, 19%). Conclusions: Medical students in Switzerland were aware of their moderate knowledge in EBM and Medical Statistics and aimed for an improvement. More courses in EBM and journal clubs must be introduced and access to information resources must be ensured with an early introduction in search engines (i.e. MEDLINE, Cochrane Library, etc.). A general strengthening of the knowledge on EBM and Medical Statistics among medical students may be a good way of educating the critical number of academic physicians and establishing a foundation for their future academic environment.

Pharmacotherapy for Hepatic encephalopathy: view of Evidence-Based Medicine

Hepatic encephalopathy (HE) refers to a complex and reversible neuro-psychiatric syndrome that results from complications of acute or chronic hepatic failure, particularly alcoholic cirrhosis. It will lead to frequent life disruptions, poor quality of life and extensive use of health care resources. We conducted the review of several agents based on randomized controlled trials (RCTs) of high-quality Jadad scores (≥3) to provide effective information for clinical practice. Rifaximin appears at least to be as effective as conventional treatments, but not superior to them. L-Ornithine-L-aspartate appears to be a safe and effective treatment of chronic HE when compared with a placebo regime. Other treatments include non-absorbable disaccharides (NAD) and benzodiazepine receptor antagonists. In spite of the variability in the improvement of HE, NAD and non-absorbed antibiotics such as rifaximin offer a favorable benefit–risk ratio in the improvement of HE. Further RCTs with power calculation and a multi-centre approach with adequate population number are needed to resolve the heterogeneous results

Proximale Humerusfrakturen - was sollen wir tun?

Fracture of the proximal humerus, representing 5 % of all extremity fractures, is a common fracture in everyday clinical life. Apart from the distal fracture of the radius and fractures adjacent to the hip joint, the proximal humerus fracture is the most common fracture in elderly people. From the point of view of evidence-based medicine it is still not possible to define the "gold standard" for stabilisation of fractures of the humeral head. Operative stabilisation of fractures of the humeral head is still a surgical challenge and remains the subject of many clinical and experimental investigations. New findings about the biomechanics and pathophysiology of bones and soft tissue have, in recent years, influenced and pointed the way in the design and function of new forms of osteosynthesis. In particular, the development of locking implants has strongly influenced modern surgical techniques. The aim of this manuscript was to describe the special features of the proximal humerus fracture and its treatment.