The document discusses evidence-based periodontology. It defines evidence-based practice and outlines the stages in evidence-based practice, including framing clinical questions and searching for evidence through systematic reviews. Critical appraisal of evidence is important to determine internal and external validity. The best available evidence was searched for various periodontal therapies and procedures, finding that mechanical debridement remains the foundation treatment, while some adjunctive therapies provide modest benefits. A review found reduced pocket depth reduction in smokers compared to non-smokers following nonsurgical periodontal therapy.
Surgical v/s Non surgical periodontal therapy Achi Joshi
Both surgical and nonsurgical therapy produced improvement in the periodontal health.
Treatment approach was based on the comfort level of the practitioner.
In the late 60’s and continuing into the 70’s and 80’s, many series of longitudinal studies were conducted, aimed to document the immediate and most importantly long term clinical results following several types of periodontal therapy.
A brief description of all topics to recent advances,SDD, host modulation and diabetes, host modulation in smokers, chemically modified tetracyclines, bisphosphonates
Bruxism and its effect on periodontiumRamya Ganesh
Bruxism/teeth grinding is a common habit seen among pediatric patients and in older patients with relation to improper occlusion. This habit can cause extreme damage to facial muscles and TMJ. Various treatment options are available including botox injections. Hence as a dentist it is our duty to restore patient's oral health in harmony with other oro facial structures.
Periodontitis is a chronic infectious inflammatory disease caused by microbes; however the presence of microbes is not enough for the cause of its complex nature of disease. Inflammation is the prime cause of periodontal disease. It commences with the aggregation of pathogenic microbes that induce the host to stimulate a cascade of inflammatory response reactions which in-turn leads to the destruction of the host tissues itself. There is a complex interplay of innate and adaptive immune responses which fights against the pathogens by direct interaction or by release of certain molecules including cytokines.
Cytokines are cell signalling molecules that aid cell to cell communication in immune responses and stimulate the movement of cells towards sites of inflammation, infection and trauma. Cytokine biology reveals that there are some subsets of cytokines which are pro-inflammatory cytokines which stimulate the inflammatory responses and cause tissue destruction.
A periodontist is expected to have a sound basis of the cytokine profile to understand the pathogenesis of periodontitis and also to discover the new treatment modality of anti-cytokine therapy.
REFERENCES TAKEN FROM CARRANZA'S TEXTBOOK OF CLINICAL PERIODONTOLOGY AND LINDHE'S TEXTBOOK OF CLINICAL PERIODONTOLOGY AND IMPLANT DENTISTRY. CONTAINS ENOUGH AND MORE DETAILS OF THIS TOPIC FOR BDS STUDENTS.HOPE THIS PRESENTATION WILL HELP U GAIN SOME KNOWLEDGE ABOUT PERIODONTAL PLASTIC AND ESTHETIC DENTISTRY.
Influence of systemic disorders on periodontal diseases is well established. However, of growing interest is the effect of periodontal diseases on numerous systemic diseases or conditions like cardiovascular disease, cerebrovascular disease, diabetes, pre-term low birth weight babies, preeclampsia, respiratory infections and others including osteoporosis, cancer, rheumatoid arthritis, erectile dysfunction, Alzheimer's disease, gastrointestinal disease, prostatitis, renal diseases, which has also been scientifically validated. This side of the oral-systemic link has been termed Periodontal Medicine and is potentially of great public health significance, as periodontal disease is largely preventable and in many instances readily treatable, hence, providing many new opportunities for preventing and improving prognosis of several systemic pathologic conditions. in this power point Dr Harshavardhan Patwal , highlights the importance of prevention and treatment of periodontal diseases as an essential part of preventive medicine to circumvent its deleterious effects on general health.
Evidence based dentistry, public health , Prosthodontics and EBD,
history of ebd steps, evidence based medicine,evidence based practise. steps in ebd. advantages ,disadvantages, limitations.
prosthodontic considerations.
Surgical v/s Non surgical periodontal therapy Achi Joshi
Both surgical and nonsurgical therapy produced improvement in the periodontal health.
Treatment approach was based on the comfort level of the practitioner.
In the late 60’s and continuing into the 70’s and 80’s, many series of longitudinal studies were conducted, aimed to document the immediate and most importantly long term clinical results following several types of periodontal therapy.
A brief description of all topics to recent advances,SDD, host modulation and diabetes, host modulation in smokers, chemically modified tetracyclines, bisphosphonates
Bruxism and its effect on periodontiumRamya Ganesh
Bruxism/teeth grinding is a common habit seen among pediatric patients and in older patients with relation to improper occlusion. This habit can cause extreme damage to facial muscles and TMJ. Various treatment options are available including botox injections. Hence as a dentist it is our duty to restore patient's oral health in harmony with other oro facial structures.
Periodontitis is a chronic infectious inflammatory disease caused by microbes; however the presence of microbes is not enough for the cause of its complex nature of disease. Inflammation is the prime cause of periodontal disease. It commences with the aggregation of pathogenic microbes that induce the host to stimulate a cascade of inflammatory response reactions which in-turn leads to the destruction of the host tissues itself. There is a complex interplay of innate and adaptive immune responses which fights against the pathogens by direct interaction or by release of certain molecules including cytokines.
Cytokines are cell signalling molecules that aid cell to cell communication in immune responses and stimulate the movement of cells towards sites of inflammation, infection and trauma. Cytokine biology reveals that there are some subsets of cytokines which are pro-inflammatory cytokines which stimulate the inflammatory responses and cause tissue destruction.
A periodontist is expected to have a sound basis of the cytokine profile to understand the pathogenesis of periodontitis and also to discover the new treatment modality of anti-cytokine therapy.
REFERENCES TAKEN FROM CARRANZA'S TEXTBOOK OF CLINICAL PERIODONTOLOGY AND LINDHE'S TEXTBOOK OF CLINICAL PERIODONTOLOGY AND IMPLANT DENTISTRY. CONTAINS ENOUGH AND MORE DETAILS OF THIS TOPIC FOR BDS STUDENTS.HOPE THIS PRESENTATION WILL HELP U GAIN SOME KNOWLEDGE ABOUT PERIODONTAL PLASTIC AND ESTHETIC DENTISTRY.
Influence of systemic disorders on periodontal diseases is well established. However, of growing interest is the effect of periodontal diseases on numerous systemic diseases or conditions like cardiovascular disease, cerebrovascular disease, diabetes, pre-term low birth weight babies, preeclampsia, respiratory infections and others including osteoporosis, cancer, rheumatoid arthritis, erectile dysfunction, Alzheimer's disease, gastrointestinal disease, prostatitis, renal diseases, which has also been scientifically validated. This side of the oral-systemic link has been termed Periodontal Medicine and is potentially of great public health significance, as periodontal disease is largely preventable and in many instances readily treatable, hence, providing many new opportunities for preventing and improving prognosis of several systemic pathologic conditions. in this power point Dr Harshavardhan Patwal , highlights the importance of prevention and treatment of periodontal diseases as an essential part of preventive medicine to circumvent its deleterious effects on general health.
Evidence based dentistry, public health , Prosthodontics and EBD,
history of ebd steps, evidence based medicine,evidence based practise. steps in ebd. advantages ,disadvantages, limitations.
prosthodontic considerations.
This ppt will help dentists in taking Evidence Based decision in daily practice and will also help researchers to categorized result of research on the basis of hierarchy of Evidence Based Dentistry
evidence based practice is best for the people working with patients
ebp should be used by the heath care provider.
ebp based upon clinical experties
best research evidence
patient preference and values
EVIDENCE –BASED PRACTICES 1
Evidence-Based Practices
Stephanie Petit-homme
Miami Regional University
Professor: Garcia Mercedes
07/05/2021
Evidence-Based Practices to Guide Clinical Practices
In other terms recognized as evidence-based medication, evidence-based scientific practice is elucidated as the careful, obvious, and judicious use of the best indication in creating results for the outstanding care of separate patients. It helps those who brand the choices to device best healthcare practices while drawing the roadmaps for the health system. In clinical trials, the integration of the EBCP entails clinical respiratory medicine considers two fundamental principles. For example, the principle is the hierarchy of the evidence and the art of clinical decision-making.
The interrelationship between the theory, research, and EBP
The relationship between the theory, research, and the EBP supports the three recognition programs. They still relate in terms of the magnet model component of modern knowledge, innovation, and advancement. They describe in a way in which they lead to the promotion of quality in a setting that makes supports professional practices. Second, there is the identification of excellence in giving nursing services to sick people or the people who stay around. For instance, the model, which is other terms the magnet theory, has got five components ( Reddy, 2018).
The first constituent includes transformational management; the additional is structural authorization. The third one is archetypal specialized practices, new information, invention, and upgrading. Lastly, in the model, there are the empirical quality outcomes. For the achievement of the aims of the goals that have been set, there is a need to make sure that the theory, current knowledge innovation, and the improvements and the components that are found in view all the nurses who are located in the levels of the healthcare company need to get involved.
The research has its primary purpose for the help of coming up with knowledge or the validation done for the knowledge that has always been there from before based on the theory. There is systematic, scientific questioning in the research to give the answers to some of the specific questions. It can use the test hypotheses and the rigorous method, the primary purpose of the study being for investigation knowing of the new things and the exploration. There is a need to understand the philosophy of science.
Second, on the EBP, there is no development of the new knowledge or even the learning being validated. The primary purpose of the EBP is to translate the evidence and then apply it to medical executive. It uses the indication available to brand patient-care choices. The EBP goes yonder the exploration as fine as the persevering penchants and ideals. The EBP retains into deliberation that the best indication is for the opinion leaders and the experts. Even though there is the existence of definitiv ...
Evidence based nursing practice is one of most important for perfect and accurate in terms of saving a life.this presentation covers almost all aspect of EBD
University of sydney BDent1 - Finding the best evidence. Presentations goes over How to formulate a clinical question using PICO, How to find a systematic review in Cochrane & Medline, and how to find primary studies using the Ovid clinical queries limit in Medline. Contains links to the Sutherland Evidence-based Dentistry articles from the Journal of the Canadian Dental Association.
Module 2 of the Oral Health Tutorial, a production of UT HSC Libraries.
This module focuses on evidence-based dental health. View this tutorial to learn how to define evidence-based dental public health, learn effective retrieval strategy, be able to critique the literature and apply it to public health dental practice.
This tutorial is copyright Lara Sapp and Julie Gaines.
EBM is the practice of integrating individual clinical expertise with the best available clinical evidence from systematic research to maximize the quality and quantity of life for individual patients.
Running head CRITIQUE QUANTITATIVE, QUALITATIVE, OR MIXED METHODS.docxtodd271
Running head: CRITIQUE QUANTITATIVE, QUALITATIVE, OR MIXED METHODS DESIGN
5
CRITIQUE OF QUANTITATIVE, QUALITATIVE, OR MIXED METHODS DESIGN
Critiquing Quantitative, Qualitative, or Mixed Methods Studies
Adenike George
Walden University
NURS 6052: Essentials of Evidence-Based Practice
April 11, 2019
Critique of Quantitative, Qualitative, or Mixed Method Design
Both quantitative and qualitative methods play a pivotal role in nursing research. Qualitative research helps nurses and other healthcare workers to understand the experiences of the patients on health and illness. Quantitative data allows researchers to use an accurate approach in data collection and analysis. When using quantitative techniques, data can be analyzed using either descriptive statistics or inferential statistics which allows the researchers to derive important facts like demographics, preference trends, and differences between the groups. The paper comprehensively critiques quantitative and quantitative techniques of research. Furthermore, the author will also give reasons as to why qualitative methods should be regarded as scientific.
The overall value of quantitative and Qualitative Research
Quantitative studies allow the researchers to present data in terms of numbers. Since data is in numeric form, researchers can apply statistical techniques in analyzing it. These include descriptive statistics like mean, mode, median, standard deviation and inferential statistics such as ANOVA, t-tests, correlation and regression analysis. Statistical analysis allows us to derive important facts from data such as preference trends, demographics, and differences between groups. For instance, by conducting a mixed methods study to determine the feeding experiences of infants among teen mothers in North Carolina, Tucker and colleagues were able to compare breastfeeding trends among various population groups. The multiple groups compared were likely to initiate breastfeeding as follows: Hispanic teens 89%, Black American teens 41%, and White teens 52% (Tucker et al., 2011).
The high strength of quantitative analysis lies in providing data that is descriptive. The descriptive statistics helps us to capture a snapshot of the population. When analyzed appropriate, the descriptive data enables us to make general conclusions concerning the population. For instance, through detailed data analysis, Tucker and co-researchers were able to observe that there were a large number of adolescents who ceased breastfeeding within the first month drawing the need for nurses to conduct individualized follow-ups the early days after hospital discharge. These follow-ups would significantly assist in addressing the conventional technical problems and offer support in managing back to school transition (Tucker et al., 2011).
Qualitative research allows researchers to determine the client’s perspective on healthcare. It enables researchers to observe certain behaviors and experiences amo.
Most clinicians neither have enough time nor are trained to pick the best information from the enormous literature available. By practicing Evidence Based Medicine, they can give better patient care. EBM is the integration of the best research evidence with clinical expertise and patient values to make clinical decisions
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
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New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
2. Evidence based medicine
Evidence based dentistry
Evidence based practice
Evidence based decision making
Evidence based Periodontology
Development of EBP
Stages in evidence based practice
Evidence based approach in periodontal therapy.
Conclusion
3. Evidenced based medicine is conscientious, explicit, and
judicious use of current best evidence in decisions about the
care of individual patients.
Sackett et al 1996, Philips 2010
4. •.
Definitions of EBD
Evidence-based dentistry is an approach to oral
health that requires the judicious integration
of Systematic assessments of clinically
relevant Scientific evidence, relating to the
patient’s oral and medical condition and history,
with the dentist’s clinical expertise and the
patient’s treatment needs and preferences.
ADA policy on evidence-based dentistry (KAO 2006)
5. “
EBD is a Systematic
practice of dentistry in
which the dentist
Finds, Assesses, and
Implements
methods of Diagnosis And
Treatment on the basis of
the best available Current
Research, their Clinical
Expertise, and the needs
and preferences of the
patient”.
Mosby’s Medical Dictionary .
Evidence-based dentistry
is the practice of dentistry
that integrates the best
available evidence with
clinical experience and
patient preference in
making clinical decisions.
Sutherland S., J Can Dent
Assoc 2001; 67:204-6
6. The EBD process is not a rigid methodological
evaluation
Scientific basis
Best possible decisions
Appropriate health care
•Unbiased reviews
•Scientific evidence-MEDLINE
web based software
• Clinical and patient factors
7. Formalized process and structure for learning skills like:
a) Efficient and effective online searching skill
b) Critical appraisal skills
So, that best scientific evidence is considered when making patient care decisions.
evaluation Sorting out validity and Non validity
8. Evidence alone never
sufficient clinical
decision.
Hierarchies of quality
and applicability of
evidence exist to guide
clinical decision
making.
10. To improve the quality of health care.
Because there is
a. Variations in practice pattern.
b. Difficulties in Assimilating scientific evidence
into practices.
Demonstrate best use of limited sources.
EBD is sometimes described as doing the right
thing, for the right patient, at the right time.
11. Variations
What is known and what is
practiced
Integrating new evidence
Lack/Weak scientific
evidence
Assimilating
evidence
Up to date thorough
reading
Attending courses
Internet and electronic
databases-
MEDLINE
PUBMED
COCHRANE LIBRARY
12. Evidence is based on the existence of at least one
well-conducted randomized control trial (RCT).
Triveni et al IOSR-JDMS) (July. 2015),
It is considered as the synthesis of all valid
research that answers a specific question, which
distinguish it from single research study.
13. Dave Sackett and colleagues
who generated "levels of
evidence" for ranking the
validity of evidence.
Sackett DL, Rosenberg WM,
Gray JA, Haynes RB,
Richardson WS. Evidence
based medicine: what it is
and what it isn't. British
Medical Journal.
1996;312:71–72.
14. Primary source
•original research publications
that have not been filtered or
synthesized.
•Available online :electronic
journals
Secondary source
•synthesized publications of the
primary literature.
•Includes:
Systematic reviews
Meta analyses
Evidence-based article reviews
clinical practice guidelines
protocols.
17. 1.Convert information, needs and problems into
clinical questions so that they can be answered.
2. Conduct a computerized search with maximum
efficiency for finding the best external evidence with
which to answer the question
3. Critically appraise the evidence for its validity and
usefulness (clinical applicability).
4. Apply the results of the appraisal, or evidence, in
clinical practice.
5. Evaluate the process and your performance.
19. Evidence-based Periodontology is the application
of evidence-based health care to periodontology.
Muir Gray proposed a definition : “An approach
to decision making in which the clinician uses
the best evidence available, in consultation with
the patient, to decide upon the option which
suits that patient best.”
Muir Gray JA. Evidence-based, locally owned, patient-
centred guideline development. Br J Surg; 1997;84(12):1636-7
20. Evidence :
1. Highest quality
2. Lower levels of evidence.
(more prone to bias less reliable data)
In addition, the data presentation supplies more
clinically relevant information, including the
probability of achieving a certain effect such as a
benefit, and considering possible adverse effects.
21. Is not simply systematic reviews of randomized
controlled trials
Is an approach to patient-care and nothing more.
So,the expectations that are sometimes laid on it
can be inappropriate.
It cannot provide answers if research data do not
exist
It cannot substitute for highly developed clinical
skills.
Therefore, it can never be cookbook healthcare
or use statistics in isolation to drive clinical care.
What evidence-based periodontology is not
22.
23. EBP is built upon developments in clinical
research design throughout the18th, 19th and
20th centuries.
Evidence-based medicine has only been known
for just over a decade and the term was coined by
the Clinical epidemiology group at McMaster
University in Canada.
One of the earliest to take up the challenge in
periodontology (in fact in oral health research
overall) was Alexia Antczak Bouckoms in Boston,
USA.
24. 1994 : Alexia Antczak Bouckoms set up an Oral Health Group as part of the Cochrane
Collaboration.
1997 :The editorial base of the Oral Health group subsequently moved to Manchester University
with Bill Shaw and Helen Worthington as co-ordinating editors.
1996: World Workshop in Periodontology held by the American Academy of Periodontology which
included elements of evidence-based healthcare, supported by Michael Newman at UCLA.
2001 :The first Cochrane systematic review in periodontology was published and
researched the effect of guided tissue regeneration for infrabony defects
2002: European workshop on periodontology. The workshop was organized by the
European Academy of Periodontology for the European Federation of Periodontology
25. 2003 : Contemporary Science Workshop by the
American Academy of Periodontology
Many other groups are now using similar methods in
healthcare and research. Most recently
2003 : International Center for Evidence-Based
Oral Health was launched
(http://www.eastman.ucl.ac.uk/ iceboh)
to produce high quality evidence-based research
with an emphasis on, but not limited
to,periodontology and implants and to provide
generic training in systematic reviews and research
methods.
26. One of the barrier in application of research
findings in clinical practice
the way that results are often presented.
A mean value will be published, based on a
statistical analysis comparing experimental
groups.
Such an outcome could include achieving a health
benefit or preventing further disease.
Clinical Relevance
27. The NNT(number needed to treat) is the average
number of patients who need to be treated to
prevent one additional bad outcome.
NNT
achieve avoid
NNTb NNTh
•It is defined as the inverse of the Absolute risk
reduction.(ARR)
•It was described in 1988.
28. For detailed guidance regarding the use and calculation of
the NNT the reader is recommended to the electronic
journal Bandolier: http://www.jr2.ox.ac.uk/
bandolier/booth/painpag/NNTstuff/numeric.htm.
29.
30.
31.
32.
33. Framing the question:
Forces clinician to focus on what he and patient believes
Identify key terms for computerized
search.
Easy identification of:
a) Problems, results ,outcome.
b) Types of evidence and information
required.
Determine effectiveness of
intervention and application
Increase chances of finding the answer.
34. In patients with periodontal disease, will
short-term systemic antibiotics, when
compared to surgery, reduce pocket depth?
Outcome
Population Intervention Comparison
Population
intervention
comparison
outcome
35. Özkan Y, Orbak R (2016) The Evidence-Based Periodontology. JSM Dent 4(5):
1075.
37. A review of a clearly
formulated question
that attempts to
minimize bias using
systematic and explicit
methods to identify,
select, critically
appraise and
summarize relevant
research.
38. 1.Find and summarize all available studies.
2. Provide an objective assessment of the quality or research and in
particular the degree of protection from bias within the original
studies.
3. Estimate research effects across multiple studies with meta-analysis.
a. Meta-analysis is valid only if studies are similar in their research
question and design.
b. Meta-analysis can estimate uncertainty and precision of the effect.
c. Meta-analysis may generate hypotheses for differential effects
across subgroups of the population tested.
4. If the effect is consistent across multiple studies (with small
differences in design), then it may more readily possible to
generalise the results to clinical practice than the results from a
single study.
5.Overcome limitations of underpowered studies in detecting a true
difference if such a true difference really exists.
What A High Quality Systematic Review Can
Do?
39. It cannot be used in isolation to dictate clinical
practice.
It is a synthesis of available research and must be used
in context with clinical judgement and patient
preference.
Produce strong conclusions if the research base is
weak in quality.
Overcome limitations of narrowly designed clinical
research.
Exclude relevant studies.
Be a miracle research design
What A High Quality Systematic Review
Can’t Do?
41. These components help in the design of the
search strategy that aims to be comprehensive.
Multiple electronic databases:
•MEDLINE
•EMBASE
•CENTRAL :
(Cochrane
Collaboration
Register of Trials
and Records).
Other Supplementary
approaches:
•bibliographies of retrieved
studies and review articles,
•hand-searching of journals for
missed reports
• contacting researchers,
industry and journals for
unpublished data.
42. Search strategy aims for high sensitivity.
Downside of this approach is low precision
The systematic review
screens the search findings against prestated criteria.
to exclude studies irrelevant to answering the question.
Increase the quality of relevant studies(critically
appraised)using objective criteria that
influence the study outcome.
Aim
43. Experimental studies:
Randomized-controlled trial: parallel group design
– a group of participants (or other unit of analysis,
e.g. teeth) is randomized into different treatment
groups. These groups are followed up for the
outcomes of interest.
Randomized-controlled trial: split-mouth design
– each patient is his/her own control. A pair of similar
teeth, or groups of teeth (quadrants), may be selected
and randomly allocated to different treatment groups.
Non-randomized controlled trial – allocation of
participants under the control of the investigator, but the
method falls short of genuine randomization.
Different study designs
44. Cohort: a longitudinal study, identifying groups of
participants according to their exposure/intervention
status. Groups are followed forward in time to measure
the development of different outcomes.
Case-Control: a study that identifies groups of
participants according to their disease/outcome status.
Groups are investigated/ questioned to determine their
exposure status.
Cross-sectional: a study (survey) undertaken on a defined
population at a single point in time (snap-shot). Subjects
are observed on just one occasion and are not followed
up.
46. Not all evidence is created equal (Richards 2003)
Quality of evidence vary according to study design
hierarchy of evidence.
The publication of research in a high-ranking journal
may not be an absolute guarantee of quality.
As quality is not merely a hypothetical concept but also
affects study outcomes.
concept
47.
48.
49. Guidelines are there to help:
Publication of clinical research
Authors
Editors
Reviewers
50. Guidelines are available to help the publication of clinical
research:
. 1. CONSORT (Consolidated Standards of Reporting Trials) for reporting
randomized controlled trials
2. STARD (Standards for Reporting of Diagnostic Accuracy) for reporting studies
on diagnostic tests (http://consortstatement.org/).
Guidelines for reporting systematic reviews are available:
1.QUOROM (Quality of Reporting of Meta-analyses) (http:// consort-
statement.org/)
2.MOOSE (Meta-analysis Of Observational Studies in Epidemiology)
3.QUADAS (Quality Assessment of studies of Diagnostic Accuracy included in
Systematic reviews).
51. some evidence is better than other evidence,
greater emphasis on good than on poor quality evidence
when making clinical decisions.
How exactly we decide what constitutes
good quality evidence. This process is
critical appraisal.
53. The validity of published evidence is potentially
affected by the quality of every stage of the
experimental process from:
aims and objectives,
design,
execution,
analysis,
interpretation,
and finally publication
55. For systematic reviews , independent reviewers
usually undertake quality appraisal in
These checklists are based on a combination of
factors that have been shown empirically to affect
quality (such as allocation concealment) and also
topic specific factors deemed important by the
reviewers.
Two such checklists are there:
duplicate checklists
56.
57.
58.
59. EBA and mechanical nonsurgical pocket therapy
Effect of smoking on NST
EBA in periodontal regeneration
EBP and open flap debridement
EBA and mucogingival surgery
EBA and dental implants
60. A total of 9 reviews were searched for the best evidence.
Nonsurgical pocket therapy (NST) was found to have a
positive effect with the exception of pockets <3 mm.
Patient, environmental, and operator factors affect
therapy delivery.
No difference was found between the effect of hand and
machine-driven instruments.
Machine-driven instruments were faster than hand-driven
instruments.
61. The various antiplaque and/or antigingivitis agents don’t
offer substantial benefit for treatment of periodontitis.
They may however contribute to the control of gingival
inflammation that exists with periodontitis.
Supragingival irrigation may be used as an adjunct to
tooth brushing and aid in the reduction of gingival
inflammation.
Even when subgingival irrigation is used, the evidence
shows that there are no clear substantial long-term
benefits for the treatment of periodontitis.
62. Antibiotic therapy and periodontics:
The risk-benefit ratio indicates that systemic antibiotics
should not be used for the treatment of gingivitis and
common forms of adult periodontitis.
But evidence suggests that systemic antibiotics may be
useful in aggressive forms of periodontitis.
Local delivery of antimicrobial agents:
There was modest gain in clinical attachment level and
decrease in probing depth and gingival bleeding.
A few side effects were demonstrated namely, transient
discomfort, erythema, recession, allergy, and rarely,
candida infection.
Conclusion: adjunctive therapies continued to be
explored, mechanical debridement is still the single best
option available. It remains the foundation treatment for
many adjunctive antimicrobial treatment investigations.
63. Systematic review :conducted by Labriola et al(2000).
Search strategy included Medline, Embase and Central.
Study design : controlled clinical trial.
The outcomes were:
There was reduced pocket depth reduction in smokers, compared with
nonsmokers.
no significant difference in the change of Clinical Attachment Level (CAL)
between smokers and nonsmokers.
The reason could be that the increased vasoconstriction in peripheral blood
vessels of smokers leads to decrease in bleeding and edema. Also, smokers
would have less potential for resolution of inflammation and edema within
the marginal tissues and therefore less potential for gingival recession.
64. Guided tissue regeneration:
Study population included chronic periodontitis patients in
subjects 21 yrs or older.
The meta-analysis done by Needleman et al (2001) and
Murphy et al (2003).
The outcomes assessed were:
o Short-term clinical outcomes: It included soft tissue
changes such as increased CAL and decreased PPD.
o Long-term clinical outcomes: It included disease
recurrence and tooth loss.
65. Patient-centered outcomes:
a) When compared with OFD, GTR showed increase in
CAL, decrease in PPD, and defect fill.
b) When GTR with bone substitutes was compared
with GTR alone, the results were similar.
c) No evidence was found for difference in use of
ePTFE versus bioabsorbable membranes.
d) Long-term clinical outcomes/patient-centered
outcomes could not be determined due to lack of
available data. Heterogeneity was large and bias
could not be eliminated
66. Meta-analysis was done by Reynolds et al (2003) and Trombelli et al
(2002).
Short-term changes(12 months after intervention)
Autogenous bone: Trombelli et al : greater CAL gain but not
statistically significant.
Reynolds et al :statistically signifcant gain in CAL
Bone allograft: gain in CAL, and increased defect fill,PPD reduction
Dentin allograft: a gain in CAL
Coralline calcium carbonate: a gain in CAL and bone fill but no
improvement in pocket depth reduction.
Bioactive glass: improvement of bony lesion when compared with
open flap debridement [OFD]
Porous/nonporous hydroxyapatite:(PMMA)and (PHEMA)
Polylactic acid granules:gain in CAL and decrease in probing pocket
depth.
67. Long-term outcomes:
Two-thirds of the patients showed gain in CAL in the grafted group
and one third of open flap debridement showed a decrease in CAL.
Fleming et al(1998), Galgut et al(1992), Yukna et al(1989).
Patient-centered outcome: No systemic or local adverse
effects.
◦ 1. Pebbled surface texture of grafted site
◦ 2. Transient slight gingival inflammation
◦ 3. Delayed soft tissue healing
◦ 4. Exfoliation/shedding of graft material
68. SRs :Heitz Mayfield et al(2002) and Antczak et al
(1993).
Pocket depth
reduction
•Surgical treatment
Clinical
attachment
level gain
•Moderate pockets
•Nonsurgical therapy
Furcation
involvement
•Unclear Predictability
69. Carlo Clauser in his meta-analysis found that:
a) All the surgical procedures allow complete root
coverage.
b) Connective tissue grafting achieves complete root
coverage more frequently than does GTR.
c) The probability of complete root coverage is high if the
initial recession is shallow, irrespective of the surgical
procedure employed.
d) The probability of achieving complete root coverage
decreases dramatically as the initial recession depth
increases.
70. Critical review by Pagliaro on surgical root
coverage led to the following conclusions:
a) The overall clinical outcome of different techniques
appears to be satisfactory, but the great variability
among different studies creates difficulties in deciding
which procedure is best suited for each clinical
situation.
b) The data are quite heterogeneous.
c) The data are seldom eligible for further comparative
analysis even after some missing data are computed.
d) The editors of periodontal journals could promote
decisive measures for establishing clear mandatory
standards for presenting data in research articles.
71. Taylor et al 2005
Most evidence is available for titanium implants, but some
evidence exist to support the use of hydroxyapatite and
titanium-plasma sprayed implant surfaces
There is also evidence to support the use of Two-stage
systems which require a second surgery to expose the
implant and also one-stage implant systems.
Clinicians should exercise caution when treating patients.
◦ Who smoke
◦ With untreated periodontal diseases
◦ Poor oral hygiene
◦ Uncontrolled systemic disease and
◦ History of radiation therapy in the region or active skeletal
growth.
72. The principles of evidence-based healthcare provide
structure and guidance to facilitate the highest levels
of patient care.
There are numerous components to evidence-based
periodontology including the production of best
available evidence, the critical appraisal and
interpretation of the evidence, the communication and
discussion of the evidence to individuals seeking care
and the integration of the evidence with clinical skills
and patient values.
Evidence-based healthcare is not an easier approach to
patient management, but should provide both
clinicians and patients with greater confidence and
trust in their mutual relationship
73. Carranza’s Clinical Peroidontology 10th ed,11th edition.
NeedlemanI, Moles DR ,Worthington H. Evidence-based
periodontology, systematic reviews and research quality.
Periodontology 2000 2005; 37:12-28.
Richards D. Not all evidence is created equal – so what is good
evidence? Evid Based Dent 2003: 4: 17–18.
Evidence-based approach. Dent Clin North Am 2002;46:54-62.
Muir Gray JA. Evidence-based, locally owned, patient centred
guideline development Br J Surg. 1997 Dec;84(12):1636-7.
Vishal Anand et al .Evidence - Based Periodontology - A
Review.Indian Journal of Dental Sciences.March 2013 Issue:1, Vol.:5
Özkan Y, Orbak R (2016) The Evidence-Based Periodontology. JSM
Dent 4(5): 1075.
Editor's Notes
Initially..
Classic example:william focal infection theory….
Consensus based conference….
Sr uses explicit crteria…
So,it’s the integration of evidence + clinical practice to make proper decision
Example in miiler’s class 1 an 2 recession both gtr + connective tissue graft both can be used and data sugeested ctg is better than gtr in reducing recession.so does this mean that only ctg can be used
Patient view is required.
In which they used systematic review to inform consensus under the chairmanship of klaus lang.
Mean value + c.i
Example: meta analysis :compare gtr and flap surgery.not always necessary gtr will give addition gain in CAL.
Which gingivitis Indices is valid or not
Cohort-incidence ,cause and prognosis;
Case control –risk factors
Cross sectional-prevalance in defined population at a specific time.
Reporting clinical research is crucial and quality issues ll be there.
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