ABSTRACT
Introducción: La gran mayoría de las revistas biomédicas relacionadas con la cirugía artroscópica en el mundo, han adoptado el uso de la Medicina Basada en la Evidencia (MBE) como formato para sus publicaciones. Se intenta buscar de esta manera, claridad para identificar la calidad de los trabajos publicados, convertir la información brindada en preguntas que tengan respuestas válidas y la mejor evidencia posible para el lector. Propósito: Analizar en qué medida hemos adoptado el uso de la MBE para las publicaciones en revistas biomédicas de Latinoamérica y Brasil, y si la aplicáramos, que tipo de trabajos y Niveles de Evidencia obtendríamos. Material y Métodos: Se incluyeron todos los trabajos publicados en revistas especializadas de traumatología, cirugía y artroscopia de Latinoamérica y Brasil, entre enero del 2005 y diciembre de 2013, sobre artroscopia en humanos. Se utilizó la extensión CONSORT para evaluar los resúmenes, buscando la presencia del nivel de evidencia, el tipo de trabajo, el país de origen de la publicación, la región anatómica y si la investigación había tenido algún tipo de financiación o beca de tipo económica para costearla. Finalmente, a todos los resúmenes se les asigno un Nivel de Evidencia. Resultado: De 366 resúmenes que constituyeron el grupo final de investigación, solo en 29 estaba informado el Nivel de Evidencia y en 263 de los resúmenes figuraba el Tipo de Trabajo. Menos del 1% de los resúmenes eran de Nivel de Evidencia I, el 90% eran de Nivel de Evidencia IV y V y el 54% eran serie de casos retrospectivos. Conclusión: Latinoamérica y Brasil están lejos de haber adoptado la MBE como formato para sus publicaciones. La Evidencia científica que aportan estos trabajos no es, definitivamente, la mejor posible. Nivel de Evidencia: IV
Introduction: The great majority of biomedical publications related with arthroscopic surgery has adopted the evidence based medicine (EBM) format for its publications. With the intent to identify the quality of the published papers and convert the information given in questions that have valid answers with the best possible evidence to the reader. Purpose: Analyze the adoption of EBMA in the biomedical journals of latin America and Brazil and evaluat the level of evidence and type of study. Material and Methods: All published articles in specialized journals of orthopedics, surgery or arthroscopy in Latin America and Brazil, between January 2005 and December 2013 that were about arthroscopy in humans were included. The Abstract extension of the CONSORT was used to evaluate the abstracts, looking for the level of evidence, type of study, country of origin, anatomical region, and funding. Finally all the abstracts where assign a level of evidence. Results: Of 366 abstracts evaluated, only 29 had the level of evidence informed and in 263 had the type of study reported. Less than 1% were of level of evidence I, 90% were of levels IV and V and 54% were retrospective case series. Conclusions: Latin America and Brazil have not adopted the EBM format for its publications. The scientific evidence that bring these articles is not the best possile evidence. Level of Evidence: IV
Subject(s)
Arthroscopy , Publishing , Evidence-Based Medicine , Periodicals as Topic , Latin America , BrazilABSTRACT
The clinical decision analysis (CDA) has used to overcome complexity and uncertainty in medical problems. The CDA is a tool allowing decision-makers to apply evidence-based medicine to make objective clinical decisions when faced with complex situations. The usefulness and limitation including six steps in conducting CDA were reviewed. The application of CDA results should be done under shared decision with patients' value.
Subject(s)
Decision Support Techniques , Decision Trees , Evidence-Based Medicine , UncertaintyABSTRACT
El problema de la medicina actual radica en considerar que se cuenta con más evidencias de las que realmente existen, y lo cierto es que en buena medida se carece de ellas. Según estudios realizados, anualmente se publican 25 000 revistas biomédicas y 2 millones de artículos; únicamente en los EEUU existen 20 revistas de medicina interna, donde cada año se publican 6 000 artículos. Por consiguiente, se requeriría leer 17 artículos diarios durante los 365 días del año, para llegar a la conclusión de que el 95 por ciento de ellos no pueden ser considerados evidencia científica relevante. Otra investigación realizada demuestra que solo el 16,9 por ciento de los trabajos publicados en el New England cumplen con los criterios de la medicina basada en la evidencia. Este porcentaje baja al 12,2 por ciento en el caso de JAMA, al 13,4 por ciento en los Annals of Internal Medicine, al 8,5 por ciento en la British Medical Journal, y al 7,3 por ciento en Lancet(AU)
The problem of current medicine is to consider that there are more evidences than those existing but to a greater measure they are lacking. According to studies conducted, yearly 25 000 biomedical journals and two millions of articles are published; only in the United States there are 20 journals of internal medicine in which 6 000 articles are published. Therefore, it will be necessary to read 17 daily articles during the 365 days of the year to reach the conclusion that the 95 percent of them can't be considered as relevant scientific evidence. Another research performed demonstrated that only the 16,9 percent of papers published in the New England Journal of Medicine fulfill the evidence based medical criteria. This percentage goes to 12,2 percent in the case of JAMA, to 13,4 percent in Annals of Internal Medicine, to 8,5 percent in British Medical Journal, and to 7,3 percent in The Lancet(AU)
Subject(s)
Humans , Evidence-Based Medicine/history , Evidence-Based Medicine/trends , Periodicals as TopicABSTRACT
Severe sepsis and septic shock are conditions with a mortality rate about 50% despite of advances of antimicrobial treatment and supportive cares. Recently, investigators are trying to establish a scientific basis for identification of high-risk patients, or a standard practice for hemodynamic optimization and adjunctive pharmacologic therapies for these patients. Several randomized, controlled trials and meta-analyses about certain therapies showed significant reduction of mortality and morbidity. This article is a clinical review of contemporary management strategies recommended with evidences for severe sepsis and septic shock.
Subject(s)
Humans , Hemodynamics , Research Personnel , Sepsis , Shock, SepticABSTRACT
Severe sepsis and septic shock are conditions with a mortality rate about 50% despite of advances of antimicrobial treatment and supportive cares. Recently, investigators are trying to establish a scientific basis for identification of high-risk patients, or a standard practice for hemodynamic optimization and adjunctive pharmacologic therapies for these patients. Several randomized, controlled trials and meta-analyses about certain therapies showed significant reduction of mortality and morbidity. This article is a clinical review of contemporary management strategies recommended with evidences for severe sepsis and septic shock.