La Biblioteca Médica Nacional de Cuba tiene la primicia : Curso Cochrane Library, aprendizaje con estrategias para obtener las mejores evidencias en salud

La Biblioteca Médica Nacional de Cuba ha puesto en marcha un programa de alfabetización informacional para adiestrar a sus usuarios y fomentar en ellos las habilidades necesarias para el uso de bases de datos, así como para fomentar el uso de estrategias de búsquedas bien diseñadas y validadas por los bibliotecarios especialistas en información. En el presente trabajo se describen contenidos y habilidades que se fomentan en el curso "Cochrane Library: La Medicina Basada en Evidencias", cuyo objetivo es que el usuario domine esta base de datos y el concepto de medicina basada en evidencias para la toma de mejores decisiones en la atención médica. Durante el curso se introduce además el Modelo Big 6, como guía del pensamiento para resolver problemas de información que facilite la búsqueda y la organización de la información médica basada en evidencias. Igualmente, se capacita al estudiante para que diseñe productos informativos, como boletines electrónicos, que le permitan tanto presentar los resultados de búsquedas de información como promover información para el cuidado de la salud en el futuro

La Biblioteca Médica Nacional de Cuba tiene la primicia : Curso Cochrane Library, aprendizaje con estrategias para obtener las mejores evidencias en salud

La Biblioteca Médica Nacional de Cuba ha puesto en marcha un programa de alfabetización informacional para adiestrar a sus usuarios y fomentar en ellos las habilidades necesarias para el uso de bases de datos, así como para fomentar el uso de estrategias de búsquedas bien diseñadas y validadas por los bibliotecarios especialistas en información. En el presente trabajo se describen contenidos y habilidades que se fomentan en el curso "Cochrane Library: La Medicina Basada en Evidencias", cuyo objetivo es que el usuario domine esta base de datos y el concepto de medicina basada en evidencias para la toma de mejores decisiones en la atención médica. Durante el curso se introduce además el Modelo Big 6, como guía del pensamiento para resolver problemas de información que facilite la búsqueda y la organización de la información médica basada en evidencias. Igualmente, se capacita al estudiante para que diseñe productos informativos, como boletines electrónicos, que le permitan tanto presentar los resultados de búsquedas de información como promover información para el cuidado de la salud en el futuro

La Biblioteca Médica Nacional de Cuba tiene la primicia : Curso Cochrane Library, aprendizaje con estrategias para obtener las mejores evidencias en salud

La Biblioteca Médica Nacional de Cuba ha puesto en marcha un programa de alfabetización informacional para adiestrar a sus usuarios y fomentar en ellos las habilidades necesarias para el uso de bases de datos, así como para fomentar el uso de estrategias de búsquedas bien diseñadas y validadas por los bibliotecarios especialistas en información. En el presente trabajo se describen contenidos y habilidades que se fomentan en el curso "Cochrane Library: La Medicina Basada en Evidencias", cuyo objetivo es que el usuario domine esta base de datos y el concepto de medicina basada en evidencias para la toma de mejores decisiones en la atención médica. Durante el curso se introduce además el Modelo Big 6, como guía del pensamiento para resolver problemas de información que facilite la búsqueda y la organización de la información médica basada en evidencias. Igualmente, se capacita al estudiante para que diseñe productos informativos, como boletines electrónicos, que le permitan tanto presentar los resultados de búsquedas de información como promover información para el cuidado de la salud en el futuro

Representing clinical documents to support automatic retrieval of evidence from the Cochrane Library

The overall aim of our research is to develop a clinical information retrieval system that retrieves systematic reviews and underlying clinical studies from the Cochrane Library to support physician decision making. We believe that in order to accomplish this goal we need to develop a mechanism for effectively representing documents that will be retrieved by the application. Therefore, as a first step in developing the retrieval application we have developed a methodology that semi-automatically generates high quality indices and applies them as descriptors to documents from The Cochrane Library. In this paper we present a description and implementation of the automatic indexing methodology and an evaluation that demonstrates that enhanced document representation results in the retrieval of relevant documents for clinical queries. We argue that the evaluation of information retrieval applications should also include an evaluation of the quality of the representation of documents that may be retrieved. ©2010 IEEE.

Massage for Low Back Pain An Updated Systematic Review Within the Framework of the Cochrane Back Review Group

Study Design. Systematic Review. Objectives. To assess the effects of massage therapy for nonspecific low back pain. Summary of Background Data. Low back pain is one of the most common and costly musculoskeletal problems in modern society. Proponents of massage therapy claim it can minimize pain and disability, and speed return to normal function. Methods. We searched MEDLINE, EMBASE, CINAHL from their beginning to May 2008. We also searched the Cochrane Central Register of Controlled Trials (The Cochrane Library 2006, issue 3), HealthSTAR and Dissertation abstracts up to 2006. There were no language restrictions. References in the included studies and in reviews of the literature were screened. The studies had to be randomized or quasi-randomized trials investigating the use of any type of massage (using the hands or a mechanical device) as a treatment for nonspecific low back pain. Two review authors selected the studies, assessed the risk of bias using the criteria recommended by the Cochrane Back Review Group, and extracted the data using standardized forms. Both qualitative and meta-analyses were performed. Results. Thirteen randomized trials were included. Eight had a high risk and 5 had a low risk of bias. One study was published in German and the rest in English. Massage was compared to an inert therapy (sham treatment) in 2 studies that showed that massage was superior for pain and function on both short- and long-term follow-ups. In 8 studies, massage was compared to other active treatments. They showed that massage was similar to exercises, and massage was superior to joint mobilization, relaxation therapy, physical therapy, acupuncture, and self-care education. One study showed that reflexology on the feet had no effect on pain and functioning. The beneficial effects of massage in patients with chronic low back pain lasted at least 1 year after the end of the treatment. Two studies compared 2 different techniques of massage. One concluded that acupuncture massage produces better results than classic (Swedish) massage and another concluded that Thai massage produces similar results to classic (Swedish) massage. Conclusion. Massage might be beneficial for patients with subacute and chronic nonspecific low back pain, especially when combined with exercises and education. The evidence suggests that acupuncture massage is more effective than classic massage, but this need confirmation. More studies are needed to confirm these conclusions, to assess the impact of massage on return-to-work, and to determine cost-effectiveness of massage as an intervention for low back pain.

IRC préterminale : il n'est jamais trop tôt pour référer au spécialiste : Revue cochrane pour le praticien

Cette rubrique présente les résultats d'une revue systématique récente telle que publiée dans la Cochrane Library (www.thecochranelibrary.com). Volontairement limité à un champ de recherche circonscrit, cet article reflète l'état actuel des connaissances de ce domaine. Il ne s'agit donc pas de recommandations pour guider la prise en charge d'une problématique clinique considérée dans sa globalité (guidelines). Les auteurs de ce résumé se basent sur la revue systématique et ne remettent pas en question le choix des articles inclus dans la revue. Scénario: Vous suivez un patient de 71 ans connu pour un diabète et une hypertension bien contrôlés, ainsi qu'une insuffisance rénale chronique de longue date, progressive, actuellement sévère (créatinine à 267 mmol/l, taux de filtration glomérulaire estimé (TFGe) à 21 ml/min/1,73 m2). Son état général est bon, son poids est stable et il ne présente pas de symptômes urémiques. Question: Faut-il adresser ce patient à un néphrologue ?

Mapeamento das evidências do grupo de odontologia da Colaboração Cochrane pra condutas em saúde

Pós-graduação em Bases Gerais da Cirurgia - FMB

Current State of Reporting Pain Outcomes in Cochrane Reviews of Chronic Musculoskeletal Pain Conditions and Considerations for an OMERACT Research Agenda.

OBJECTIVE To assess the current state of reporting of pain outcomes in Cochrane reviews on chronic musculoskeletal painful conditions and to elicit opinions of patients, healthcare practitioners, and methodologists on presenting pain outcomes to patients, clinicians, and policymakers. METHODS We identified all reviews in the Cochrane Library of chronic musculoskeletal pain conditions from Cochrane review groups (Back, Musculoskeletal, and Pain, Palliative, and Supportive Care) that contained a summary of findings (SoF) table. We extracted data on reported pain domains and instruments and conducted a survey and interviews on considerations for SoF tables (e.g., pain domains, presentation of results). RESULTS Fifty-seven SoF tables in 133 Cochrane reviews were eligible. SoF tables reported pain in 56/57, with all presenting results for pain intensity (20 different outcome instruments), pain interference in 8 SoF tables (5 different outcome instruments), and pain frequency in 1 multiple domain instrument. Other domains like pain quality or pain affect were not reported. From the survey and interviews [response rate 80% (36/45)], we derived 4 themes for a future research agenda: pain domains, considerations for assessing truth, discrimination, and feasibility; clinically important thresholds for responder analyses and presenting results; and establishing hierarchies of outcome instruments. CONCLUSION There is a lack of standardization in the domains of pain selected and the manner that pain outcomes are reported in SoF tables, hampering efforts to synthesize evidence. Future research should focus on the themes identified, building partnerships to achieve consensus and develop guidance on best practices for reporting pain outcomes.

A prática de exercícios físicos em pacientes com transtornos alimentares

CONTEXTO: Diferentes estudos discutem a relação da prática excessiva de exercícios físicos com transtornos alimentares como estratégia para perda de peso. OBJETIVO: Revisar a literatura sobre a prática de exercícios físicos em pacientes com transtornos alimentares, discutindo definições, critérios diagnósticos e propostas terapêuticas. MÉTODOS: Levantamento bibliográfico foi realizado por meio de MedLine, LiLacs e Cochrane Library, com os termos "transtornos alimentares", "anorexia", "bulimia", "exercício físico excessivo", "atividade física", "exercício obrigatório", "exercício compulsivo" e "exercício excessivo". RESULTADOS: Dos 80 artigos encontrados, foram selecionados 12 que incluíam a investigação de um padrão de atividade física considerado excessivo em indivíduos acima dos 18 anos e uso de algum instrumento de avaliação para essa finalidade. A prática de exercícios físicos em pacientes com transtornos do comportamento alimentar é revisada. CONCLUSÃO: Não há consenso sobre critérios diagnósticos e instrumentos para considerar o exercício físico como inadequado ou excessivo e seu uso como recurso para perder peso. Por outro lado, a prática de exercícios físicos durante o tratamento de pacientes com transtornos alimentares pode ser benéfica desde que orientada e supervisionada.

Sensory phenomena in obsessive-compulsive disorder and tic disorders: A review of the literature

Introduction: A variety of subjective experiences have been reported to be associated with the symptom expression of obsessive-compulsive disorder (OCD) and Tourette syndrome (TS). First described in TS patients, these subjective experiences have been defined in different ways. There is no consensus in the literature on how to best define subjective experiences. This lack of consensus may hinder the understanding of study results and prevents the possibility of including them in the search for etiological factors associated with OCD and TS. Methods: The objective of this article was to review the descriptions of subjective experiences in the English-language literature from 1980-2007. This meta-analytic review was carried out using the English-language literature from 1980-2007 available on MEDLINE, PsycINFO, and the Cochrane Library databases using the following search terms: premonitory urges, sensory tics, ""just-right"" perceptions, sensory phenomena, sensory experiences, incompleteness, ""not just-right"" phenomena, obsessive-compulsive disorder and TS, including OCD and/or TS, in all combination searches. We also searched for the references cited in each article previously found that referred to the aforementioned terms. Thirty-one articles were included in the study. Results: Subjective experiences, in particular, the sensory phenomena, were important phenotypic variables in the characterization of the tic-related OCD subtype and were more frequent in the early-onset OCD subtype. There is a paucity of studies using structured interviews to assess sensory phenomena, their epidemiology and the etiological mechanisms associated with sensory phenomena. Conclusion: The current review provides some evidence that sensory phenomena can be useful to identify more homogenous subgroups of OCD and TS patients and should be included as important phenotypic variables in future clinical, genetic, neuroimaging, and treatment-response studies.

Does primary medical practitioner involvement with a specialist team improve patient outcomes? A systematic review.

Patients with chronic or complex medical or psychiatric conditions are treated by many practitioners, including general practitioners (GPs). Formal liaison between primary and specialist is often assumed to offer benefits to patients The aim of this study was to assess the efficacy of formal liaison of GPs with specialist service providers on patient health outcomes, by conducting a systematic review of the published literature in MEDLINE, EMBASE, PsychINFO, CINAHL and Cochrane Library databases using the following search terms family physicians': synonyms of 'patient care planning', 'patient discharge' and 'patient care team'; and synonyms of 'randomised controlled trials'. Seven studies were identified, involving 963 subjects and 899 controls. most health outcomes were unchanged, although some physical and functional health outcomes were improved by formal liaison between GPs and specialist services, particularly among chronic mental illness patients. Some health outcomes worsened during the intervention. Patient retention rates within treatment programmes improved with GP involvement, as did patient satisfaction. Doctor (GP and specialist) behaviour changed, with reports of more rational use of resources and diagnostic tests, improved clinical skills, more frequent use of appropriate treatment strategies, and more frequent clinical behaviours designed to detect disease complications Cost effectiveness could not be determined. In conclusion, formal liaison between GPs and specialist services leaves most physical health outcomes unchanged, but improves functional outcomes in chronically mentally ill patients. It may confer modest long-term health benefits through improvements in patient concordance with treatment programmes and more effective clinical practice.