This document discusses different approaches to reading medical literature. It begins by noting the challenge of finding reliable information amid large quantities of unreliable data. It then outlines three main approaches: surveillance reading, an exhaustive review of a topic, and searching for a solution to a specific clinical problem. For each approach, it provides details on the purpose, focus, and type of reading involved. It also discusses important sources of bibliographic information and tips for determining what to read and how to read efficiently and effectively. The goal is to help physicians optimize their learning from scientific publications.
O documento discute como médicos e pacientes devem desenvolver critérios para avaliar a grande quantidade de evidências publicadas na área da saúde. É explicado que ler 19 artigos por dia seria necessário para acompanhar tudo o que é publicado, portanto é importante saber como selecionar artigos de qualidade. O documento fornece diretrizes sobre como realizar uma leitura crítica de artigos científicos, incluindo entender os principais delineamentos de pesquisa, avaliar a validade metodológica e estatística e analis
The document provides an overview of conducting a literature review. It defines a literature review as analyzing significant research on a particular topic and placing one's own research question in the context of previous and current studies. The purpose is to evaluate research, recognize relevant sources, synthesize studies, and help answer the research question. It also discusses developing search strategies, evaluating sources, and writing the review. Key steps include formulating a question, identifying search terms, searching databases, appraising sources, and recording search methods.
Here are the answers to fill in the blanks:
- PubMed is a biomedical information resource
- OR
- the library catalogue
- MeSH terms
- Single Citation Matcher
- limits
- save
This document discusses evidence-based medicine and searching PubMed for evidence to answer clinical questions. It provides an example of a focused clinical question about treating strep throat in children with amoxicillin versus penicillin. The best study design to answer a therapy question would be a randomized controlled trial. The document also outlines strategies for searching PubMed, including using Boolean operators, MeSH terms, and Clinical Queries filters.
1. The document discusses the differences between background and foreground questions and provides examples. Background questions are broad while foreground questions are more focused on a specific problem.
2. It also discusses formulating a good study question using the PICO format which includes the Patient/Problem, Intervention, Comparison, and Outcome.
3. Key steps in formulating a study question are ensuring it is related to the problem and will facilitate precise searching for an answer.
This document summarizes four major biomedical databases: PubMed, Embase, Web of Knowledge, and Scopus. It provides information on the number of records in each database, years of coverage, subject areas, search features, and tips for effective searching. The document also provides an example of developing search terms for the topic "Is CBT effective for teenagers with eating disorders?". Key details are extracted to formulate searches using Boolean logic and synonyms. Searching techniques and getting help from librarians are also advised.
O documento discute como médicos e pacientes devem desenvolver critérios para avaliar a grande quantidade de evidências publicadas na área da saúde. É explicado que ler 19 artigos por dia seria necessário para acompanhar tudo o que é publicado, portanto é importante saber como selecionar artigos de qualidade. O documento fornece diretrizes sobre como realizar uma leitura crítica de artigos científicos, incluindo entender os principais delineamentos de pesquisa, avaliar a validade metodológica e estatística e analis
The document provides an overview of conducting a literature review. It defines a literature review as analyzing significant research on a particular topic and placing one's own research question in the context of previous and current studies. The purpose is to evaluate research, recognize relevant sources, synthesize studies, and help answer the research question. It also discusses developing search strategies, evaluating sources, and writing the review. Key steps include formulating a question, identifying search terms, searching databases, appraising sources, and recording search methods.
Here are the answers to fill in the blanks:
- PubMed is a biomedical information resource
- OR
- the library catalogue
- MeSH terms
- Single Citation Matcher
- limits
- save
This document discusses evidence-based medicine and searching PubMed for evidence to answer clinical questions. It provides an example of a focused clinical question about treating strep throat in children with amoxicillin versus penicillin. The best study design to answer a therapy question would be a randomized controlled trial. The document also outlines strategies for searching PubMed, including using Boolean operators, MeSH terms, and Clinical Queries filters.
1. The document discusses the differences between background and foreground questions and provides examples. Background questions are broad while foreground questions are more focused on a specific problem.
2. It also discusses formulating a good study question using the PICO format which includes the Patient/Problem, Intervention, Comparison, and Outcome.
3. Key steps in formulating a study question are ensuring it is related to the problem and will facilitate precise searching for an answer.
This document summarizes four major biomedical databases: PubMed, Embase, Web of Knowledge, and Scopus. It provides information on the number of records in each database, years of coverage, subject areas, search features, and tips for effective searching. The document also provides an example of developing search terms for the topic "Is CBT effective for teenagers with eating disorders?". Key details are extracted to formulate searches using Boolean logic and synonyms. Searching techniques and getting help from librarians are also advised.
This document provides tips for studying and answering multiple choice questions (MCQs) to improve exam outcomes. It outlines 10 tips for studying MCQs, such as writing a study plan, studying in groups, and focusing on important topics. It also gives 10 tips for answering MCQs, like paying attention to key words, using logical thinking, and not changing answers unless certain. Examples are provided of MCQ questions on common pediatric respiratory conditions like bronchiolitis, epiglottitis, and croup. Strategies are suggested for quick revision summaries, updates with evidence-based medicine, and writing abstracts. The overall aim is to help maximize learning from each MCQ encountered.
The Process of Health Research and literature reviewsDr. Khaled OUANES
Identifying a study topic is often the most challengingpart of a research project.Each of the possible study topics has its own set of virtues and shortcomings.
This document discusses formulating clinical questions using the PICO framework and conducting evidence-based medicine research. It provides an example of a clinical question that could be asked about a 5-year-old female patient presenting with acute otitis media. The question focuses on whether antibiotics are necessary for this condition, as the patient's mother is concerned about antibiotic overuse and resistance. Well-formulated clinical questions are the starting point for evidence-based practice and help focus the literature search on the specific needs of the patient case.
RSS 2012 Developing Research Idea and QuestionWesam Abuznadah
This document discusses the research process and how to formulate answerable research questions. It explains that the research process begins with identifying a knowledge gap and transforming it into a clear research question. It also discusses where research questions come from and how to define a good question based on importance, interest, and answerability. The document provides guidance on formulating an answerable PICO (population, intervention, comparator, outcome) question and determining the best feasible study type to answer the question. Common study types discussed include observational studies like cross-sectional, cohort and case-control studies, as well as experimental intervention studies.
The document provides guidance on how to write the methods section of a scientific paper, including key elements that should be included such as study design, participants, interventions, outcomes, statistical analysis, and ethical approval. It emphasizes that the methods section should provide enough detail for other researchers to reproduce the study. It also offers tips for writing clearly and concisely such as using active voice and short sentences.
Introduction to Evidence Based MedicinePaul Albert
The document provides an introduction to evidence-based medicine (EBM). It defines EBM as using the best current evidence from clinical research in medical decision making. EBM requires considering both research evidence and a patient's values and preferences. Reliable evidence comes from systematic reviews and meta-analyses of multiple studies rather than individual studies or expert opinions. Practicing EBM involves forming a clear clinical question, finding the best evidence, critically evaluating it, and applying the results to patient care. While evidence-based studies aim to be rigorous, their results could still mislead due to biases or other limitations if not properly appraised.
- Formulating the right research question is crucial to a successful research project. A good research question should be feasible, interesting, novel, ethical, and relevant.
- The FINER criteria evaluates research questions based on these characteristics. A well-formulated research question helps ensure the research enjoys studying the topic and has a high chance of a good outcome.
- Developing a research question involves identifying an area of interest, narrowing it into subareas, selecting the most interesting subarea, and then raising potential research questions to evaluate using criteria like FINER. The goal is to have a question specific enough to answer but also general enough to study.
Evidence and Science Based Medicine A Primer.pptxKaushik Banerjee
This document discusses evidence-based medicine and different types of medical evidence and study designs. It begins by defining evidence-based medicine as applying the best available evidence from clinical research to medical decision making. It then discusses different types of medical studies and evidence, including randomized controlled trials, observational studies, systematic reviews, and qualitative research. It emphasizes that not all medical evidence is equal and that higher quality evidence comes from studies with rigorous designs like randomized controlled trials that minimize bias. The document stresses the importance of critically appraising medical evidence to assess its validity, clinical importance, and applicability to a specific patient.
The document provides an overview of a continuing education course on finding evidence-based clinical information in the Cochrane Library and PubMed. It discusses developing well-built clinical questions using PICO, searching efficiently in PubMed and the Cochrane Library, critically appraising evidence, and hands-on exercises for practicing search skills. Examples of clinical questions and their PICO components are provided to illustrate how to develop search strategies.
رای جستجوي اطلاعات مناسب، یافتن بهترین شواهد موجود در کمترین زمان ممکن بسیار مهم و حیاتی می باشد. از این رو آشنایی با روشهای صحیح جستجو، نحوه طرح سوال قابل پاسخ (PICO ) و پایگاههای اطلاعاتی مناسب ضروری به نظر می رسد
استراتژی عمومی جستجو در بالین
مرحله اول: طراحی PICO
در مرحله اول جستجوی اطلاعات، چند دقیقه وقت بگذارید و به خوبی در مورد سوال خود و آنچه که می خواهید در مورد آن جستجو کنید فکر کنید. جستجوگر بایستی مشکل و سوال خود را بخوبی بررسی و تجزیه و تحلیل کند. يكي از بهترين توصيه ها در این زمینه براي كادر بالینی، طرح سوال قابل پاسخ و یا به اصطلاح PICO است
مرحله دوم: تعیین کلیدواژه ها و مترادفات
پس از طراحی PICO ، کلیدواژه های جستجو بر اساس P ، I ، C و O در سوال موردنظر تعیین می شوند. واژه های مترادف و مرتبط این کلیدواژه ها از قبیل اختصارات، واژه های با دامنه وسیع تر و یا دامنه محدودتر، رسم الخط های متفاوت و ... نیز در صورت نیاز تعیین می شوند و جستجو آغاز می شود
مرحله سوم: انتخاب پایگاه اطلاعاتی مناسب
انتخاب پایگاه اطلاعاتی مناسب و مرتبط با موضوع جستجو یکی از کلیدی ترین مراحل جستجو است. با توجه به اینکه بسیاری از پایگاههای اطلاعاتی بویژه در حوزه پزشکی براساس نوع اطلاعات و مطالعات در حال تخصصی شدن هستند، آشنایی با دامنه موضوعی و کاربردهای آنها موجب بازیابی اطلاعات مناسب تر و صرفه جویی در زمان خواهد شد.
مرحله چهارم: طراحی روش جستجو
جستجو در اینترنت و پایگاه اطلاعاتی با بکارگیری روشهای ساده و در عین حال صحیح جستجو بسیار آسان و لذت بخش خواهد بود. برعکس، عدم آشنایی با این روشهای آسان ممکن است موجب شود که یا اطلاعات غیرمرتبط بازیابی کنید و یا بسیاری از اطلاعات مفید را از دست بدهید.
Formulating a Research question/ hypothesisshubhaasharma
This document discusses how to formulate a research question and hypothesis. It defines the different types of research (basic, applied, qualitative, quantitative) and fields of research. A research question seeks to answer something about a topic, while a hypothesis predicts the outcome of an experiment. A well-built research question includes the PICO elements - population/patient, intervention, comparator, and outcome. Characteristics of a good research question are that it is feasible, interesting, novel, ethical, relevant, and clear. The document provides examples of strong and weak research questions and emphasizes thoroughly selecting a topic and framing the question or hypothesis.
1) The document discusses a presentation given by clinical librarians to medical staff about finding medical evidence in the neonatal intensive care unit.
2) It provides an overview of library services available from both hospital and university libraries and how to access full text articles off-site using the proxy server.
3) The presentation demonstrates how to effectively search PubMed, including using clinical queries and filters, to find relevant research studies to answer clinical questions.
The document outlines an introduction to evidence-based medicine (EBM) presented by Judy Tarselli. It begins with an overview of EBM, defining it as the conscientious use of current best evidence in patient care decisions. The presentation then covers the basic steps of EBM, which include forming a clear clinical question, finding the best evidence to answer it, critically appraising the evidence, applying useful evidence in practice, and evaluating the process. It emphasizes that a good clinical question is patient-focused, problem-oriented, and answerable through current literature. The document provides examples to illustrate the key points about EBM.
Introduction to Evidence Based Medicine (EBM)Elsayed Salih
This document provides an overview of evidence-based medicine (EBM), including its definition, importance, and process. It defines EBM as the conscientious use of the best available evidence in making decisions about patient care. The key steps in EBM are asking a clear clinical question using the PICO framework, acquiring evidence through a literature search, appraising the evidence for validity and applicability, and applying the evidence to the individual patient. Examples of question types and appropriate study designs are also discussed.
Introduction to research and developing research ideaKaimrc_Rss_Jd
The document discusses research planning and methods. It describes identifying a knowledge gap and formulating a research question. Key aspects of a good research question are that it is important, innovative, answerable, and worth answering. The document contrasts background and foreground clinical questions. It emphasizes formulating questions focused on a specific problem, intervention, comparator, and outcome. Different study types - observational (descriptive, analytical) and interventional - are outlined, including their advantages and disadvantages. Cross-sectional, cohort, and case-control observational study designs are described in detail.
This document provides information and instructions for several assignments in an HCS 465 health care research course. It includes assignments on researching the research process and methods, sampling methodologies, components of a research study, research ethics and validity, and an ethical scenario involving a company using patient DNA without consent. Students are instructed to complete worksheets, annotated bibliographies, and presentations on these topics, citing peer-reviewed sources and following APA style guidelines. The course aims to help students understand and apply key concepts in health care research.
HEALTHCARE RESEARCH METHODS: More on reviewing the literatureDr. Khaled OUANES
Once you have a good idea about the existing literature in general (Gather as many articles, reports and books as possible), You can start digging into individual articles.
The document provides an overview of evidence-based medicine, including what it is, why it is important, where evidence comes from, levels of evidence, and the steps to practice evidence-based medicine. It discusses formulating a clear clinical question, searching for relevant information and studies, critically appraising the evidence, and applying the evidence to a specific patient case. Key aspects covered include evaluating the validity, importance, and applicability of various types of studies to determine the strength and relevance of the evidence. The goal is to systematically review and apply the best available research findings to clinical decision making.
How to search for literature - Lecture at Forskning ved fjæra, Holmsbu May 2015Hilde Strømme
This document outlines four steps for searching literature: 1) Formulate a question using PICO, 2) Choose sources to search, 3) Prepare a search strategy, and 4) Review results and revise the strategy if needed. It provides guidance on using PICO to organize terms and choosing relevant articles. Key tips include using synonyms when searching, combining terms with Boolean operators, and refining searches with filters or limits to reduce overly broad results. The goal is to conduct a systematic and thorough literature search.
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This document provides tips for studying and answering multiple choice questions (MCQs) to improve exam outcomes. It outlines 10 tips for studying MCQs, such as writing a study plan, studying in groups, and focusing on important topics. It also gives 10 tips for answering MCQs, like paying attention to key words, using logical thinking, and not changing answers unless certain. Examples are provided of MCQ questions on common pediatric respiratory conditions like bronchiolitis, epiglottitis, and croup. Strategies are suggested for quick revision summaries, updates with evidence-based medicine, and writing abstracts. The overall aim is to help maximize learning from each MCQ encountered.
The Process of Health Research and literature reviewsDr. Khaled OUANES
Identifying a study topic is often the most challengingpart of a research project.Each of the possible study topics has its own set of virtues and shortcomings.
This document discusses formulating clinical questions using the PICO framework and conducting evidence-based medicine research. It provides an example of a clinical question that could be asked about a 5-year-old female patient presenting with acute otitis media. The question focuses on whether antibiotics are necessary for this condition, as the patient's mother is concerned about antibiotic overuse and resistance. Well-formulated clinical questions are the starting point for evidence-based practice and help focus the literature search on the specific needs of the patient case.
RSS 2012 Developing Research Idea and QuestionWesam Abuznadah
This document discusses the research process and how to formulate answerable research questions. It explains that the research process begins with identifying a knowledge gap and transforming it into a clear research question. It also discusses where research questions come from and how to define a good question based on importance, interest, and answerability. The document provides guidance on formulating an answerable PICO (population, intervention, comparator, outcome) question and determining the best feasible study type to answer the question. Common study types discussed include observational studies like cross-sectional, cohort and case-control studies, as well as experimental intervention studies.
The document provides guidance on how to write the methods section of a scientific paper, including key elements that should be included such as study design, participants, interventions, outcomes, statistical analysis, and ethical approval. It emphasizes that the methods section should provide enough detail for other researchers to reproduce the study. It also offers tips for writing clearly and concisely such as using active voice and short sentences.
Introduction to Evidence Based MedicinePaul Albert
The document provides an introduction to evidence-based medicine (EBM). It defines EBM as using the best current evidence from clinical research in medical decision making. EBM requires considering both research evidence and a patient's values and preferences. Reliable evidence comes from systematic reviews and meta-analyses of multiple studies rather than individual studies or expert opinions. Practicing EBM involves forming a clear clinical question, finding the best evidence, critically evaluating it, and applying the results to patient care. While evidence-based studies aim to be rigorous, their results could still mislead due to biases or other limitations if not properly appraised.
- Formulating the right research question is crucial to a successful research project. A good research question should be feasible, interesting, novel, ethical, and relevant.
- The FINER criteria evaluates research questions based on these characteristics. A well-formulated research question helps ensure the research enjoys studying the topic and has a high chance of a good outcome.
- Developing a research question involves identifying an area of interest, narrowing it into subareas, selecting the most interesting subarea, and then raising potential research questions to evaluate using criteria like FINER. The goal is to have a question specific enough to answer but also general enough to study.
Evidence and Science Based Medicine A Primer.pptxKaushik Banerjee
This document discusses evidence-based medicine and different types of medical evidence and study designs. It begins by defining evidence-based medicine as applying the best available evidence from clinical research to medical decision making. It then discusses different types of medical studies and evidence, including randomized controlled trials, observational studies, systematic reviews, and qualitative research. It emphasizes that not all medical evidence is equal and that higher quality evidence comes from studies with rigorous designs like randomized controlled trials that minimize bias. The document stresses the importance of critically appraising medical evidence to assess its validity, clinical importance, and applicability to a specific patient.
The document provides an overview of a continuing education course on finding evidence-based clinical information in the Cochrane Library and PubMed. It discusses developing well-built clinical questions using PICO, searching efficiently in PubMed and the Cochrane Library, critically appraising evidence, and hands-on exercises for practicing search skills. Examples of clinical questions and their PICO components are provided to illustrate how to develop search strategies.
رای جستجوي اطلاعات مناسب، یافتن بهترین شواهد موجود در کمترین زمان ممکن بسیار مهم و حیاتی می باشد. از این رو آشنایی با روشهای صحیح جستجو، نحوه طرح سوال قابل پاسخ (PICO ) و پایگاههای اطلاعاتی مناسب ضروری به نظر می رسد
استراتژی عمومی جستجو در بالین
مرحله اول: طراحی PICO
در مرحله اول جستجوی اطلاعات، چند دقیقه وقت بگذارید و به خوبی در مورد سوال خود و آنچه که می خواهید در مورد آن جستجو کنید فکر کنید. جستجوگر بایستی مشکل و سوال خود را بخوبی بررسی و تجزیه و تحلیل کند. يكي از بهترين توصيه ها در این زمینه براي كادر بالینی، طرح سوال قابل پاسخ و یا به اصطلاح PICO است
مرحله دوم: تعیین کلیدواژه ها و مترادفات
پس از طراحی PICO ، کلیدواژه های جستجو بر اساس P ، I ، C و O در سوال موردنظر تعیین می شوند. واژه های مترادف و مرتبط این کلیدواژه ها از قبیل اختصارات، واژه های با دامنه وسیع تر و یا دامنه محدودتر، رسم الخط های متفاوت و ... نیز در صورت نیاز تعیین می شوند و جستجو آغاز می شود
مرحله سوم: انتخاب پایگاه اطلاعاتی مناسب
انتخاب پایگاه اطلاعاتی مناسب و مرتبط با موضوع جستجو یکی از کلیدی ترین مراحل جستجو است. با توجه به اینکه بسیاری از پایگاههای اطلاعاتی بویژه در حوزه پزشکی براساس نوع اطلاعات و مطالعات در حال تخصصی شدن هستند، آشنایی با دامنه موضوعی و کاربردهای آنها موجب بازیابی اطلاعات مناسب تر و صرفه جویی در زمان خواهد شد.
مرحله چهارم: طراحی روش جستجو
جستجو در اینترنت و پایگاه اطلاعاتی با بکارگیری روشهای ساده و در عین حال صحیح جستجو بسیار آسان و لذت بخش خواهد بود. برعکس، عدم آشنایی با این روشهای آسان ممکن است موجب شود که یا اطلاعات غیرمرتبط بازیابی کنید و یا بسیاری از اطلاعات مفید را از دست بدهید.
Formulating a Research question/ hypothesisshubhaasharma
This document discusses how to formulate a research question and hypothesis. It defines the different types of research (basic, applied, qualitative, quantitative) and fields of research. A research question seeks to answer something about a topic, while a hypothesis predicts the outcome of an experiment. A well-built research question includes the PICO elements - population/patient, intervention, comparator, and outcome. Characteristics of a good research question are that it is feasible, interesting, novel, ethical, relevant, and clear. The document provides examples of strong and weak research questions and emphasizes thoroughly selecting a topic and framing the question or hypothesis.
1) The document discusses a presentation given by clinical librarians to medical staff about finding medical evidence in the neonatal intensive care unit.
2) It provides an overview of library services available from both hospital and university libraries and how to access full text articles off-site using the proxy server.
3) The presentation demonstrates how to effectively search PubMed, including using clinical queries and filters, to find relevant research studies to answer clinical questions.
The document outlines an introduction to evidence-based medicine (EBM) presented by Judy Tarselli. It begins with an overview of EBM, defining it as the conscientious use of current best evidence in patient care decisions. The presentation then covers the basic steps of EBM, which include forming a clear clinical question, finding the best evidence to answer it, critically appraising the evidence, applying useful evidence in practice, and evaluating the process. It emphasizes that a good clinical question is patient-focused, problem-oriented, and answerable through current literature. The document provides examples to illustrate the key points about EBM.
Introduction to Evidence Based Medicine (EBM)Elsayed Salih
This document provides an overview of evidence-based medicine (EBM), including its definition, importance, and process. It defines EBM as the conscientious use of the best available evidence in making decisions about patient care. The key steps in EBM are asking a clear clinical question using the PICO framework, acquiring evidence through a literature search, appraising the evidence for validity and applicability, and applying the evidence to the individual patient. Examples of question types and appropriate study designs are also discussed.
Introduction to research and developing research ideaKaimrc_Rss_Jd
The document discusses research planning and methods. It describes identifying a knowledge gap and formulating a research question. Key aspects of a good research question are that it is important, innovative, answerable, and worth answering. The document contrasts background and foreground clinical questions. It emphasizes formulating questions focused on a specific problem, intervention, comparator, and outcome. Different study types - observational (descriptive, analytical) and interventional - are outlined, including their advantages and disadvantages. Cross-sectional, cohort, and case-control observational study designs are described in detail.
This document provides information and instructions for several assignments in an HCS 465 health care research course. It includes assignments on researching the research process and methods, sampling methodologies, components of a research study, research ethics and validity, and an ethical scenario involving a company using patient DNA without consent. Students are instructed to complete worksheets, annotated bibliographies, and presentations on these topics, citing peer-reviewed sources and following APA style guidelines. The course aims to help students understand and apply key concepts in health care research.
HEALTHCARE RESEARCH METHODS: More on reviewing the literatureDr. Khaled OUANES
Once you have a good idea about the existing literature in general (Gather as many articles, reports and books as possible), You can start digging into individual articles.
The document provides an overview of evidence-based medicine, including what it is, why it is important, where evidence comes from, levels of evidence, and the steps to practice evidence-based medicine. It discusses formulating a clear clinical question, searching for relevant information and studies, critically appraising the evidence, and applying the evidence to a specific patient case. Key aspects covered include evaluating the validity, importance, and applicability of various types of studies to determine the strength and relevance of the evidence. The goal is to systematically review and apply the best available research findings to clinical decision making.
How to search for literature - Lecture at Forskning ved fjæra, Holmsbu May 2015Hilde Strømme
This document outlines four steps for searching literature: 1) Formulate a question using PICO, 2) Choose sources to search, 3) Prepare a search strategy, and 4) Review results and revise the strategy if needed. It provides guidance on using PICO to organize terms and choosing relevant articles. Key tips include using synonyms when searching, combining terms with Boolean operators, and refining searches with filters or limits to reduce overly broad results. The goal is to conduct a systematic and thorough literature search.
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Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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3. Epidemiologia Clínica
Introdução
• Encontrar a melhor resposta para uma questão
clínica é quase como encontrar uma agulha no
palheiro.
• As informações essenciais estão misturadas com
uma grande quantidade de informações não
confiáveis.
• Desafio: separar o joio do trigo!
• GESTÃO DO CONHECIMENTO
7. Epidemiologia Clínica
• Embora o objetivo de leitura de publicações
científicas possa ser resumido à necessidade
de uma constante atualização, entender
como a literatura pode ser abordada é
fundamental.
8. Epidemiologia Clínica
• Três tipos de abordagens são possíveis:
1) Leitura de vigilância
2) Revisão exaustiva de um tema
3) Busca de solução para um problema específico
9. Epidemiologia Clínica
Leitura de Vigilância
• Serve para:
– Satisfazer a curiosidade científica
do médico acerca das novidades
– Adquirir uma cultura biomédica
geral mais ampla e atualizada
• Trata-se de uma leitura “corrida” dos
artigos e revistas.
― Triagem de artigos que serão lidos depois com mais
atenção.
― Triagem de artigos que serão lidos depois com mais
atenção
• É uma leitura menos comprometida.
10. Epidemiologia Clínica
Revisão exaustiva do tema
• A revisão exaustiva é muito mais dirigida.
• Geralmente, foca apenas um assunto e deve
abranger, esgotar toda a literatura científica relativa
a ele que possa ser encontrada.
• Ela é finita e concentrada no tempo.
• Em geral, direciona-se mais para objetivos de
caráter acadêmico.
– Monografias, dissertações, teses
– Livros
11. Epidemiologia Clínica
Busca de solução para um problema específico
• É abordagem que mais interessa à maioria dos
profissionais, pois resulta diretamente do
exercício profissional.
• Decorre dos questionamentos, dúvidas,
problemas e doenças trazidos pelos pacientes.
• A leitura deve ser atenta e cuidadosa, pois
destina-se a fundamentar cientificamente a
solução de um problema clínico.
• É a forma mais comum de
aprendizado contínuo - MBE
12. Epidemiologia Clínica
Fontes de informação bibliográfica
• Existem diversas formas de publicações:
• Artigos científicos originais
• Revisões da literatura
• Meta-análises
• Capítulos de livros
• Livros
Artigos Originais têm
maior probabilidade
de trazer novidades
13. Epidemiologia Clínica
• Os artigos originais são atraentes, mas
requerem mais atenção e cuidado.
• A maioria das novidades não trazem implicações
imediatas para a prática profissional.
• As revisões, as metanálises e os livros, em
geral, são bastante seguros, mas padecem
do fato de chegarem à publicação vários
anos após os artigos que lhe deram origem.
• Entretanto, devemos nos lembrar que este
envelhecimento pode representar amadurecimento com
conclusões mais sólidas.
15. Epidemiologia Clínica
O que ler?
• De um modo geral deve-se ler as novidades
com o objetivo de completar ou atualizar o
que o médico deve saber sobre os quatros
aspectos básicos da sua atuação profissional:
16. Epidemiologia Clínica
• O que há de novo quanto a etiologia (ou
fatores causais e de risco) de uma doença?
• Qual a validade do que há de novo nos
procedimentos diagnósticos (clínicos ou
laboratoriais) de uma doença?
• Quais as vantagens , os benefícios e os riscos de
um determinado tratamento, novo ou não?
• Quais os atuais perspectivas de evolução e de
prognóstico de um determinado paciente?
17. Epidemiologia Clínica
Como ler?
• A estratégia adequada implica em cinco
etapas bem definidas:
1) O que é preciso ler?
2) Qual a melhor evidência?
3) O que vale a pena ler?
4) Análise da qualidade do material selecionado
para a leitura.
5) Identificação das conclusões que têm
repercussão na prática médica.
18. Epidemiologia Clínica
1. O que é preciso ler?
• Saber previamente que informação se busca.
• Jamais fazer uma busca a esmo.
• Antes de iniciar a seleção das leituras é
necessário uma definição do tema a ser
abordado e quais as perguntas para as quais se
busca resposta.
• As questões devem ser colocadas por escrito, de
forma clara, delimitada, bem definida.
19. Epidemiologia Clínica
Exemplo
Origem da busca Tema e Pergunta de busca
• Lactentes sibilantes
cujos pais têm asma
– Tema de interesse
• Asma Brônquica
– Pergunta a ser
respondida
• Qual risco de asma em
lactentes sibilantes cujos
pais são asmáticos?
21. Epidemiologia Clínica
2. Qual a melhor evidência?
• Pesquisa, por exemplo,
no PubMed
• Ferramenta de pesquisa
gratuíta mantida pela
National Library of
Medicine, National
Institutes of Health
• Pode ser acessada no
endereço:
http://www.ncbi.nlm.nih.gov/PubMed/
22. Epidemiologia Clínica
Medline
• Selecionar termos do índice • Combinar os termos,
eletrônico, ou thesaurus. usando operadores
Thesaurus é constituído de lógicos:
MeSH (Medical Subject • OR, AND, WITH , NEAR
Headings). • NOT– elimina as palavras
• Pensar nos sinônimos digitas depois do NOT.
possíveis e nos termos • ( ) – parênteses são
relacionados que possam empregados para agrupar
ser utilizados. Podem ser partes da sintaxe, com o
usados os termos do MeSH objetivo de realizar
ou palavras textuais; pesquisas mais complexas
23. Epidemiologia Clínica
• Na busca, usa-se a língua • No exemplo anterior:
inglesa, evitando as • Buscar com a seguinte
palavras: about, the, of, a, frase : “Risco de asma em
in, as, if, why, never, lactentes sibilantes” ou,
before, is e it, pois os em inglês, “Risk of
mecanismos de busca as asthma in young children
ignoram. with recurrent wheezing”.
Desta frase, retiram-se as
palavras-chave: asthma
risk, recurrent wheezing e
young children. Busca-se
individualmente e depois
se combinam as buscas.
25. Epidemiologia Clínica
3. O que vale a pena ler?
• A partir das questões definidas na primeira etapa
temos que selecionar o que vale a pena ler;
• Artigos cuja qualidade vale a pena avaliar,
investindo mais tempo na busca das
respostas.
• Analisar com cuidado na busca da resposta mais
válida que satisfaça a necessidade do paciente
que gerou a pergunta de partida.
26. Epidemiologia Clínica
No exemplo:
• Na busca, digitando a palavra asthma risk na janela de
busca do PubMed, limitado aos últimos 10 anos,
encontrou-se, em 01/04/2012, 10275 títulos.
27. Epidemiologia Clínica
No exemplo:
• Acrescentando outro limite relacionado às crianças menores
de dois anos de idade e utilizando a outra palavra-chave
recurrent wheezing encontrou-se em torno de 111 títulos.
28. Epidemiologia Clínica
Pediatr Pulmonol. 2010 Feb;45(2):149-56.
Prevalence and risk factors of wheeze in Dutch infants in their first year of life.
Visser CA, Garcia-Marcos L, Eggink J, Brand PL.
Source
Princess Amalia Children's Clinic, Isala Klinieken, Zwolle, the Netherlands.
Abstract
Factors operating in the first year of life are critical in determining the onset and persistence of wheezing in
preschool children. This study was designed to examine the prevalence and risk factors of wheeze in the first
year of life in Dutch infants. This was a population-based survey of 13-month-old infants visiting well baby
clinics for a scheduled immunization. Parents/caregivers completed a standardized validated questionnaire on
respiratory symptoms in the first year of life and putative risk factors. The independent influence of these
factors for wheeze was assessed by multiple logistic regression analysis. A total of 1,115 questionnaires were
completed. Wheeze ever (with a prevalence in the first year of life of 28.5%) was independently associated with
male gender, eczema, sibs with asthma, any allergic disease in the family, day care, damp housing, and
asphyxia. Recurrent wheeze (prevalence 14.5%) showed independent associations with eczema, sibs with
asthma, and day care. In addition to these factors, severe wheeze (prevalence 15.4%) was also associated with
premature rupture of membranes during birth, and with damp housing. Wheeze is common during the first
year of life, and places a major burden on families and the health care system. Factors associated with wheeze
are mainly related to markers of atopic susceptibility, and to exposure to infections. The strongest modifiable
risk factor for wheeze in the first year of life is home dampness. Interventions to reduce home dampness to
reduce wheeze in infancy should be examined.
(c) 2010 Wiley-Liss, Inc.
29. Epidemiologia Clínica
Allergol Immunopathol (Madr). 2007 Nov-Dec;35(6):228-31.
Risk factors of developing asthma in children with recurrent wheezing in the first
three years of life.
Cortés Alvarez N, Martín Mateos MA, Plaza Martín AM, Giner Muñoz MT, Piquer M, Sierra Martínez JI.
Source
Paediatric Allergy and Clinical Inmunology Section. Sant Joan de Déu Hospital-Clínic Hospital. University of
Barcelona. Spain. 33891nca@comb.es
Abstract
INTRODUCTION: Recurrent wheezing is a common problem during the first years of life, but it is still difficult to
identify which of these children may develop asthma in the future.
OBJECTIVES: To study risk factors of developing asthma in a group of patients with frequent wheezing during
the first three years of life.
MATERIAL AND METHODS: A prospective study was performed of a group of 60 patients, aged below three,
referred to our Hospital for recurrent wheezing. Age, sex, parental and personal history of atopy, clinical
features, laboratory tests, evolution and response to treatment were analyzed.
RESULTS: 60 patients were enrolled in study. Most of children were boys and have had the first episode of
wheezing after the 6 months of life. 63 % had personal history of atopy and 55 % parental history of allergy. The
group of atopic children had more wheezing exacerbations and worse evolution than the group of non atopic.
They also had more treatment necessities.
CONCLUSIONS: The identification of young children at high risk of developing asthma could permit an early
intervention before irreversible changes in the airway appeared.
30. Epidemiologia Clínica
J Pediatr. 2007 Oct;151(4):347-51, 351.e1-2. Epub 2007 Jul 12.
Breast-feeding duration and infant atopic manifestations, by maternal allergic
status, in the first 2 years of life (KOALA study).
Snijders BE, Thijs C, Dagnelie PC, Stelma FF, Mommers M, Kummeling I, Penders J, van Ree R, van den Brandt PA
.
Source Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.
BEP.Snijders@EPID.unimaas.nl
Abstract
OBJECTIVE: To investigate the potential effect of modification by maternal allergic status on the relationship
between breast-feeding duration and infant atopic manifestations in the first 2 years of life.
STUDY DESIGN: Data from 2705 infants of the KOALA Birth Cohort Study (The Netherlands) were analyzed. The
data were collected by repeated questionnaires at 34 weeks of gestation and 3, 7, 12, and 24 months
postpartum. Total and specific immunoglobulin E measurements were performed on venous blood samples
collected during home visits at age 2 years. Relationships were analyzed using logistic regression analyses.
RESULTS: Longer duration of breast-feeding was associated with a lower risk for eczema in infants of mothers
without allergy or asthma (P(trend) = .01) and slightly lower risk in those of mothers with allergy but no asthma
(P(trend) = .14). There was no such association for asthmatic mothers (P(trend) = .87). Longer breast-feeding
duration decreased the risk of recurrent wheeze independent of maternal allergy (P(trend) = .02) or asthma
status (P(trend) = .06).
CONCLUSIONS:
Our findings show that the relationship between breast-feeding and infant eczema in the first 2 years of life is
modified by maternal allergic status. The protective effect of breast-feeding on recurrent wheeze may be
associated with protection against respiratory infections.
31. Epidemiologia Clínica
Pediatrics. 2006 Jun;117(6):e1132-8.
Recurrent wheeze in early childhood and asthma among children at risk for atopy.
Ly NP, Gold DR, Weiss ST, Celedón JC.
Source Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Abstract
OBJECTIVES: Little is known about the natural history of wheezing disorders among children at risk for atopy. We
examined the relation between early wheeze and asthma at 7 years of age among children with parental history of
asthma or allergies followed from birth.
METHODS: Information on wheeze was collected bimonthly from birth to age 24 months and every 6 months thereafter.
Recurrent early wheeze was defined as > or =2 reports of wheezing in the first 3 years of life. Frequent early wheeze was
defined as > or =2 reports of wheezing per year in the first 3 years of life. At 7 years of age, asthma was defined as
physician-diagnosed asthma and wheezing in the previous year.
RESULTS: Of the 440 participating children, 223 (50.7%) had > or =1 report of wheeze before 3 years old, 111 (26.0%)
had recurrent early wheeze, and 12 (2.7%) had frequent early wheeze. Whereas only 31 (13.9%) of 223 children with >
or =1 report of wheeze developed asthma at 7 years of age, 24 (21.6%) of 111 children with recurrent early wheeze
developed asthma at 7 years of age. Among the 12 children with frequent early wheeze, 6 (50%) had asthma at 7 years
of age. After adjustment for other covariates, recurrent early wheeze in children at risk for atopy was associated with a
fourfold increase in the odds of asthma at 7 years of age, and frequent early wheeze was associated with an
approximately 12-fold increase in the odds of asthma at 7 years of age. Most (94%) of the children without frequent
early wheeze did not develop asthma at 7 years of age.
CONCLUSIONS: The absence of recurrent early wheeze indicates a very low risk of asthma at school age among children
with parental history of asthma or allergies. Early identification of children who will develop asthma at school age is
difficult, even in children at risk for atopy. However, children with parental history of asthma or allergies who have
frequent early wheeze, in particular, are at greatly increased risk of asthma and merit close clinical follow-up..
32. Epidemiologia Clínica
Chest. 2005 Feb;127(2):502-8.
Early life risk factors for current wheeze, asthma, and bronchial hyperresponsiveness
at 10 years of age.
Arshad SH, Kurukulaaratchy RJ, Fenn M, Matthews S.
Source Department of Respiratory Medicine, University Hospital of North Staffordshire
STUDY OBJECTIVES: We sought to identify early life factors (ie, first 4 years) associated with wheeze, asthma,
and bronchial hyperresponsiveness (BHR) at age 10 years, comparing their relative influence for these
conditions.
RESULTS: Independent significance for current wheeze occurred with maternal asthma (odds ratio [OR], 2.08;
95% confidence interval [CI], 1.27 to 3.41) and paternal asthma (OR, 2.12; 95% CI 1.29 to 3.51), recurrent chest
infections at 2 years (OR, 3.98; 95% CI, 2.36 to 6.70), atopy at 4 years of age (OR, 3.69; 95% CI, 2.36 to 5.76),
eczema at 4 years of age (OR, 2.15; 95% CI, 1.24 to 3.73), and parental smoking at 4 years of age (OR, 2.18; 95%
CI, 1.25 to 3.81). For CDA, significant factors were maternal asthma (OR, 2.26; 95% CI, 1.24 to 3.73), paternal
asthma (OR, 2.30; 95% CI, 1.17 to 4.52), and sibling asthma (OR, 2.00; 95% CI, 1.16 to 3.43), recurrent chest
infections at 1 year of age (OR, 2.67; 95% CI, 1.12 to 6.40) and 2 years of age (OR, 4.11; 95% CI, 2.06 to 8.18),
atopy at 4 years of age (OR, 7.22; 95% CI, 4.13 to 12.62), parental smoking at 1 year of age (OR, 1.99; 95% CI,
1.15 to 3.45), and male gender (OR, 1.72; 95% CI, 1.01 to 2.95). For BHR, atopy at 4 years of age (OR, 5.38; 95%
CI, 3.06 to 9.47) and high social class at birth (OR, 2.03; 95% CI, 1.16 to 3.53) proved to be significant.
CONCLUSIONS: Asthmatic heredity, predisposition to early life atopy, plus early passive smoke exposure and
recurrent chest infections are important influences for the occurrence of wheeze and asthma at 10 years of age.
BHR at 10 years of age has a narrower risk profile, suggesting that factors influencing wheezing symptom
expression may differ from those predisposing the patient to BHR.
33. Epidemiologia Clínica
Pediatrics. 2004 Feb;113(2):345-50.
Does environment mediate earlier onset of the persistent childhood asthma
phenotype?
Kurukulaaratchy RJ, Matthews S, Arshad SH.
Source The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Newport, Isle of Wight, UK.
OBJECTIVE: We investigated the role of environmental and hereditary factors in determining whether persistent
childhood wheezing phenotypes had an early or late onset.
METHODS: In a whole population birth cohort (n = 1456), children were seen at birth and at 1, 2, 4, and 10 years. At each
visit, information was collected prospectively regarding wheeze prevalence and used to classify subjects into wheezing
phenotypes. Information on genetic and environmental risk factors in early life was also obtained prospectively, and
skin-prick testing to common allergens was performed at 4 years.
RESULTS: Early-onset persistent wheezers (n = 125) had wheeze onset in the first 4 years, still present at age 10, whereas
late-onset persistent wheezers (n = 81) had wheeze onset after age 4 years that was still present at 10 years.
Multivariate logistic regression analysis identified independent significance only for inherited factors (parental asthma,
family history of rhinitis, eczema at 4 years, and atopic status at 4 years) in the development of late-onset persistent
wheeze. However, low social class at birth, recurrent chest infections at 2 years, and parental smoking at 2 years plus
inherited factors (eczema at 2 years; food allergy at 4 years; maternal asthma, sibling asthma, maternal urticaria, and
atopic status at 4 years) demonstrated independent significance for early-onset persistent wheeze.
CONCLUSION: Inheritance seems to be of prime significance in the cause of persistent childhood wheeze. Environmental
exposure in early life may combine with this tendency to produce an early onset of persistent wheeze. Absence of these
environmental factors might delay but not prevent the onset of wheeze in children with atopic heredity.
34. Epidemiologia Clínica
Eur Respir J. 2003 Nov;22(5):767-71.
Predicting persistent disease among children who wheeze during early life.
Kurukulaaratchy RJ, Matthews S, Holgate ST, Arshad SH.
Source
The David Hide Asthma & Allergy Research Centre, St Mary's Hospital, Newport, Isle of Wight, UK.
Abstract
This study sought to determine factors influencing the persistence of early life wheezing up to the age of 10 yrs
and to create a score identifying those with the highest risk of persistent disease. Children were seen at birth, 1,
2, 4 and 10 yrs in a whole population birth cohort study (n=1,456). Information was collected prospectively on
wheeze prevalence and subjects were classified into wheezing phenotypes. Early life genetic and environmental
risk factors were recorded and skin-prick testing (SPT) was performed at 4 yrs. Independently significant factors
for persisting wheeze were identified at logistic regression and used to create a score for persistence. Wheezing
persistence from the first 4 yrs to the age of 10 yrs occurred in 37% of early life wheezers. Independent
significance for persistence was associated with asthmatic family history, atopic SPT at 4 yrs and recurrent chest
infections at 2 yrs, whilst recurrent nasal symptoms at 1 yr conferred reduced risk. A cumulative risk score using
these factors identified wheezing persistence in 83% scoring 4 and transience in 80% scoring 0. Thus, a
combination of genetic predisposition, early life atopy and recurrent chest infections favours the persistence of
early life wheezing. Risk scores using such knowledge could provide prognostic guidance on the outcome of
early wheeze.
35. Epidemiologia Clínica
Artigo importante anterior à busca
Am J Respir Crit Care Med. 2000 Oct;162(4 Pt 1):1403-6.
A clinical index to define risk of asthma in young children with recurrent wheezing.
Castro-Rodríguez JA, Holberg CJ, Wright AL, Martinez FD.
Source
Respiratory Sciences Center, University of Arizona, College of Medicine, Tucson, Arizona, USA.
Abstract
Because most cases of asthma begin during the first years of life, identification of young children at high risk of
developing the disease is an important public health priority. We used data from the Tucson Children's
Respiratory Study to develop two indices for the prediction of asthma. A stringent index included frequent
wheezing during the first 3 yr of life and either one major risk factor (parental history of asthma or eczema) or
two of three minor risk factors (eosinophilia, wheezing without colds, and allergic rhinitis). A loose index
required any wheezing during the first 3 yr of life plus the same combination of risk factors described
previously. Children with a positive loose index were 2.6 to 5.5 times more likely to have active asthma
between ages 6 and 13 than children with a negative loose index. Risk of having subsequent asthma increased
to 4.3 to 9.8 times when a stringent index was used. We found that 59% of children with a positive loose index
and 76% of those with a positive stringent index had active asthma in at least one survey during the school
years. Over 95% of children with a negative stringent index never had active asthma between ages 6 and 13. We
conclude that the subsequent development of asthma can be predicted with reasonable accuracy using simple,
clinically based parameters.
36. Epidemiologia Clínica
4.Análise da qualidade do material selecionado
• Para analisar a literatura científica é
necessário:
– Ter objetivos bem claros
– Ter temas e perguntas bem definidos e
– Saber a que se destinam as publicações
selecionadas
– Saber analisar a metodologia e conhecer os
níveis de evidência científica
37. Epidemiologia Clínica
• Todos os artigos têm algum grau de evidência
científica, mas nem sempre ela é totalmente
confiável.
• A força e a qualidade das evidências estão
relacionadas ao tipo de delineamento de estudo.
38. Epidemiologia Clínica
• Analisando a pesquisa encontraram-se apenas artigos
relevantes, provenientes, na sua maioria de estudos de
coorte.
• Atualmente, as várias organizações de saúde (OMS,
American College of Physicians, UptToDate, Cochrane
Collaboation), utilizam o Sistema GRADE (Grading of
Recommendations, Assessment, Development and
Evaluation) para emitir recomendações (BMJ
2008;336:924 ).
• Sistema GRADE: Uma proposta que combina a força da
recomendação e qualidade da evidência para orientar
quais condutas devem ser adotadas ou evitadas na
prática clínica.
40. Epidemiologia Clínica
5. Identificação das conclusões que têm
repercussão na prática médica
• Aplicação dos resultados à duvida gerada pelo
atendimento do paciente.
• Baseado nas informações encontradas poder-se-ia
dizer, respondendo a angustia da mãe que existe,
nas condições da pergunta, risco maior do seu filho
vir a apresentar asma no futuro, com razoável nível
de evidência científica.