Evidence Based Medicine

The mild traumatic brain injury (MTBI) is one of the most frequent diseases treated in emergency departments. Extensive studies addressing evidence-based treatment criteria have been published, the indication for CT scans depending on clinical symptoms appeared to be one of the critical issues. In this study, the question was raised whether or not the developed evidence-based criteria may be transferred to the patients of a German level 1 trauma centre. Within 2 years (2004/05) 1841 patients with a traumatic brain injury were treated, 1042 patients with a mild traumatic brain injury and with an age over 14 years were included in the study. The indication for a head CT scan was checked by criteria of a phase 3 study (New Orleans Criteria - NOC). Furthermore, the length of hospitalisation, number and character of secondary aggravation, and kind of inpatient care were analysed. 69.5 % of our patients were diagnosed with the help of a CT scan, according to the evidence criteria 98.8 % o...

People migrate to improve their well-being, whether through an expansion of economic and social opportunities or a reduction in persecution. Yet a large literature suggests that migration can be a very stressful process, with potentially negative impacts on mental health reducing the net benefits of migration. However, to truly understand the effect of migration on mental health one must compare the mental health of migrants to what their mental health would have been had they stayed in their home country. The existing literature is not able to do this and typically settles for comparing the mental health of migrants to that of natives in the destination country,which takes no account of any pre-existing differences between these groups. This paper overcomes the selection problems affecting previous studies of the effect of migration on mental health by examining a migrant lottery program. New Zealand allows a quota of Tongans to immigrate each year with a lottery used to choose amo...

Ankle Foot Orthoses (AFOs) to promote walking ability are a common treatment in patients with neurological or muscular diseases. However, guidelines on the prescription of AFOs are currently based on a low level of evidence regarding their efficacy. Recent studies aiming to demonstrate the efficacy of wearing an AFO in respect to walking ability are not always conclusive. In this paper it is argued to recognize two levels of evidence related to the ICF levels. Activity level evidence expresses the gain in walking ability for the patient, while mechanical evidence expresses the correct functioning of the AFO. Used in combination for the purpose of evaluating the efficacy of orthotic treatment, a conjunct improvement at both levels reinforces the treatment algorithm that is used. Conversely, conflicting outcomes will challenge current treatment algorithms and the supposed working mechanism of the AFO. A treatment algorithm must use relevant information as an input, derived from measur...

Multicultural professional psychologists routinely assert that psychotherapeutic interventions require culturally competent delivery for ethnoracial minority clients to protect the distinctive cultural orientations of these clients. Dominant disciplinary conceptualizations of cultural competence are "kind of person" models that emphasize specialized awareness, knowledge, and skills on the part of the practitioner. Even within psychology, this approach to cultural competence is controversial owing to professional misgivings concerning its culturally essentialist assumptions. Unfortunately, alternative "process-oriented" models of cultural competence emphasize such generic aspects of therapeutic interaction that they remain in danger of losing sight of culture altogether. Thus, for cultural competence to persist as a meaningful construct, an alternative approach that avoids both essentialism and generalism must be recovered. One means to capture this alternative is...

Evidence on the value of some cur rent physiotherapeutic practices and the in - effectiveness of others is accumulating . This paper addresses the best evidence available on the efficacy and effective - ness of physiotherapeutic modalities in ankylosing spondylitis. General issues in the assessment of physiother apy in this disease are briefly discussed. Core sets for assessments are nowa

Renal anemia is the result of chronic kidney disease (CKD) and deteriorates with disease progression. Anemia may be the first sign of kidney disease. In all patients with anemia and CKD, diagnostic evaluation is required. Prior to diagnosing renal anemia, it is necessary to eliminate the other possible causes. Direct correlation between the concentration of hemoglobin and the stage of renal failure is well known. Early development of anemia is common in diabetic patients. Correction of anemia may slow the progression of CKD. Anemia is an independent risk factor for developing cardiovascular disease in patients with CKD. Treatment of anemia in patients with CKD is based on current guidelines. Recently, the Kidney Disease: Improving Global Outcomes (KDIGO) group has produced comprehensive clinical practice guidelines for the management of anemia in CKD patients and ERBP (European Renal Best Practice) group its position statement and comments on the KDIGO guidelines. The Croatian Socie...

In the Western world, calcified aortic valve stenosis is the most common form of valvular heart disease, affecting up to 3% of adults over the age of 75 years. It is a gradually progressive disease, characterized by a long asymptomatic phase that may last for several decades, followed by a short symptomatic phase associated with severe restriction of the valve orifice. Investigations on treatments for aortic valve stenosis are still in progress. Thus, it is believed that calcification of aortic valve stenosis is similar to the process of atherosclerosis that occurs in coronary artery disease. Recent studies have suggested that cholesterol lowering through the use of statins may have a salutary effect on the progression of aortic valve stenosis

A large proportion of non-communicable disease can be attributed to modifiable risk factors such as poor nutrition and physical inactivity. We present data on planning and transport practitioners' perceptions and responses to government public health guidance aimed at ...

Research has shown that numerous dietary bioactive components that are not considered essential may still be beneficial to health. The dietary reference intake (DRI) process has been applied to nonessential nutrients, such as fiber, yet the majority of bioactive components await a recommended intake. Despite a plethora of new research over the past several years on the health effects of bioactives, it is possible that the field may never reach a point where the current DRI framework is suitable for these food components. If bioactives are to move toward dietary guidance, they will likely require an alternative path to get there.

Een intensieve vijfdaagse training Evidence-Based Medicine (EBM) leidt tot betere kennis en vaardigheden in de EBM-methode bij verzekeringsartsen. De training zorgt ook voor een betere onderbouwing van arbeidsongeschiktheidsbeoordelingen. In EBM getrainde verzekeringsartsen blijken gemotiveerd en empowered te zijn om EBM te blijven gebruiken. Zij zien de invoering van evidence-based werken als een verbetering van de kwaliteit van hun werk en als een factor die hun werk aantrekkelijker maakt. Voor het op grotere schaal invoeren van evidence-based werken, zien we bevordering van (EBM-)casuïstiekgroepen als de meest veelbelovende aanpak. Vooral wanneer deze casuïstiekbesprekingen ertoe leiden dat ook andere verzekeringsartsen profiteren van de opgedane kennis, bijvoorbeeld door middel van verzekeringsgeneeskundige mediprudentie, richtlijnen of protocollen.
- Een intensieve vijfdaagse EBM-training leidt tot een betere onderbouwing van arbeidsongeschiktheidsbeoordelingen.
- Verzekeringsartsen geven aan empowered te worden door het leren van deze methodiek, waardoor ook de communicatie met medisch specialisten en collega’s verbetert.
- Een zoekstrategie voor het identificeren van artikelen over de prognose van arbeidsongeschiktheid helpt verzekeringsartsen om sneller en beter deze onderzoeksinformatie te vinden.
- Het toepassen van EBM vereist het continu up-to-date houden van opgedane kennis en vaardigheden door middel van EBM-casuïstiekgroepen, EBM-onderwijs, en beschikbaarheid van EBM-tools en bibliotheekfaciliteiten.