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Evidence based medicine: what it is and what it isn't

Evidence based medicine, whose philosophical origins extend back to mid-19th century Paris and earlier, remains a hot topic for clinicians, public health practitioners, purchasers, planners, and the public. There are now frequent workshops in how to practice and teach it (one sponsored by the BMJ will be held in London on 24 April); undergraduate1 and postgraduate2 training programmes are incorporating it3 (or pondering how to do so); British centres for evidence based practice have been established or planned in adult medicine, child health, surgery, pathology, pharmacotherapy, nursing, general practice, and dentistry; the Cochrane Collaboration and Britain's Centre for Review and Dissemination in York are providing systematic reviews of the effects of health care; new evidence based practice journals are being launched; and it has become a common topic in the lay media. But enthusiasm has been mixed with some negative reaction.4 5 6 Criticism has ranged from evidence based medicine being old hat to it being a dangerous innovation, perpetrated by the arrogant to serve cost cutters and suppress clinical freedom. As evidence based medicine continues to evolve and adapt, now is a useful time to refine the discussion of what it is and what it is not.  
bmj.com
almost 4 years ago
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Transiently Pink-Tinged Serum in a Patient on Lenalidomide

What was the cause of discolored serum in this multiple myeloma patient undergoing chemotherapy with lenalidomide?  
medscape.com
almost 4 years ago
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Microbiome Diversity Affects Chemotherapy-Related Infection

Analyzing the microbiome of patients with acute myelogenous leukemia during chemotherapy could help risk-stratify patients for infection, a new study suggests.  
medscape.com
almost 4 years ago
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FDA OKs New Oral Drug for Refractory Colorectal Cancer

A new oral drug has been approved for use in patients with advanced colorectal cancer who are no longer responding to chemotherapy and biological agents.  
medscape.com
almost 4 years ago
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Guiding Fluid Therapy in High-Risk Thoracic Surgery

In 2009 the institutional guidelines changed for perioperative fluid therapy in patients undergoing extrapleural pneumonectomy. This study assesses the consequences of those changes.  
medscape.com
almost 4 years ago
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Platelet transfusions to treat bleeding compared with platelet transfusions to prevent bleeding in people with blood cancers receiving intensive treatment | Cochrane

We evaluated the evidence regarding whether giving platelet transfusions to patients with low platelets who are bleeding (therapeutically) is as effective and safe as giving platelet transfusions regularly to prevent bleeding (prophylactically). Our target population was people with blood cancers who were receiving intensive myelosuppressive (causing decreased blood cell production) chemotherapy treatments or stem cell transplantation.  
cochrane.org
almost 4 years ago
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Pharmacotherapy for Bipolar Depression

While this meta-analysis is the most current and comprehensive summary regarding drug treatments for bipolar depression--both approved and off-label--some of the conclusions may be controversial.  
medscape.com
almost 4 years ago
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Prototype Device Allows for Real-Time White Cell Counts Through the Skin, Personalized Chemotherapy |

Team Leuko, an international group collaborating between the Massachusetts Institute of Technology (MIT) and a handful of centers, hospitals, and foundatio  
medgadget.com
almost 4 years ago
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Rethink urged on prostate drug use - BBC News

Senior doctors are calling for a rethink over the use of a chemotherapy drug to treat prostate cancer.  
bbc.co.uk
almost 4 years ago
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Brentuximab -- First-Line Option in Elderly Hodgkin's Lymphoma

A phase 2 trial has shown that brentuximab vedotin monotherapy is safe and effective as first-line therapy in elderly lymphoma patients who cannot tolerate standard chemotherapy.  
medscape.com
almost 4 years ago
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High-dose chemotherapy and stem cell transplant compared to conventional therapy for children with high-risk neuroblastoma | Cochrane

Despite the development of new treatment options, the prognosis of high-risk neuroblastoma patients still remains poor; in more than half of patients the disease returns. Stem cell rescue replaces blood-forming stem cells that were destroyed by high-dose chemotherapy in order to recover the bone marrow. It is also known as myeloablative therapy and might improve the survival of these patients. A well-informed decision on the use of myeloablative therapy in the treatment of children with high-risk neuroblastoma should be based on high quality evidence of effectiveness for treating tumours and side effects.  
cochrane.org
almost 4 years ago
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Combining Immunotherapy and Anticancer Agents

Learn more about the immune-mediated effects of chemotherapy and their clinical relevance, the biological and clinical features of immune checkpoint blockers and more.  
medscape.com
almost 4 years ago
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With better adjuvant therapy, does breast cancer stage still matter?

Breast cancer mortality is declining throughout the Western world.1 2 3 If, as J F Kennedy said, “victory has a thousand fathers,” then progress in breast cancer surely has a lot of parents. In the late 1970s, guidelines recommended screening mammography for women over the age of 40, resulting in implementation of national and regional screening programmes in most developed countries. Soon after, adjuvant endocrine therapy and chemotherapy were found to reduce the risk of breast cancer recurrence and death.4 5 Meanwhile, the combination of early detection and effective radiation therapy enabled breast conserving surgery as an option for most women.6 The implementation of these truly multidisciplinary treatment programmes, combining local and systemic treatments with public health screening initiatives and health awareness campaigns, revolutionised and improved breast cancer care.  
feeds.bmj.com
almost 4 years ago
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With better adjuvant therapy, does breast cancer stage still matter?

Breast cancer mortality is declining throughout the Western world.1 2 3 If, as J F Kennedy said, “victory has a thousand fathers,” then progress in breast cancer surely has a lot of parents. In the late 1970s, guidelines recommended screening mammography for women over the age of 40, resulting in implementation of national and regional screening programmes in most developed countries. Soon after, adjuvant endocrine therapy and chemotherapy were found to reduce the risk of breast cancer recurrence and death.4 5 Meanwhile, the combination of early detection and effective radiation therapy enabled breast conserving surgery as an option for most women.6 The implementation of these truly multidisciplinary treatment programmes, combining local and systemic treatments with public health screening initiatives and health awareness campaigns, revolutionised and improved breast cancer care.  
feeds.bmj.com
almost 4 years ago
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Nivolumab: Immunotherapy in Malignant Melanoma

Melanoma rates have been steadily increasing since the 1970s, but cytotoxic chemotherapy generally prolongs survival.  
medscape.com
almost 4 years ago
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The Underutilization of Intraperitoneal Chemotherapy

Dr Maurie Markman expresses concern over a recent report illustrating the underuse of intraperitoneal chemotherapy for ovarian cancer, despite evidence that this therapy improves survival rates.  
medscape.com
almost 4 years ago
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Does more support increase success amongst people using medications to quit smoking? | Cochrane

Medications (including all types of nicotine replacement therapy, bupropion and varenicline) have been shown to help people quit smoking, and people seeking help to quit smoking will frequently be offered medication (pharmacotherapy). Behavioural support also helps people to quit. Behavioural support may include brief advice or more intensive counselling, and may be provided face-to-face individually or in groups, or by telephone, including 'quitlines'. It has been unclear how much additional benefit is gained from adding support, or providing more intensive support for people who are using medication for a quit attempt.  
cochrane.org
almost 4 years ago
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Team Approach Needed to Curb Inappropriate Prescribing

Infectious disease physicians and pharmacists should be involved in setting up antibiotic stewardship programs to minimize divisions, experts advise.  
medscape.com
almost 4 years ago
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Live Hangout with Dr. Gidi Stein, CEO of MedAware Medication Error Prevention Platform |

Though medication errors continue to be a common occurrence, software designed to prevent them often creates its own problems while not really solving the  
medgadget.com
almost 4 years ago
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The SPLIT Trial: Saline vs Plasma-Lyte Fluid Therapy - R.E.B.E.L. EM - Emergency Medicine Blog

What is the best fluid to give to our patients who need fluid resuscitation? The answer to this question is not known, but another step in finding the answer was taken with the release of the SPLIT trial  
rebelem.com
almost 4 years ago