RESUMO
In the era in which we face an increasing volume of scientific literature, it is important to analyze the one that answers our clinical questions efficiently and with the best level of evidence. Systematic reviews are especially useful for this purpose. The aim of this article is to give an introduction to the critical assessment of systematic reviews, through the solving of a therapeutic dilemma, which will be addressed through the analysis of a study of this type.
Assuntos
Relatório de Pesquisa , Revisões Sistemáticas como Assunto , Projetos de Pesquisa , Reprodutibilidade dos TestesRESUMO
Proton pump inhibitors (PPIs) are one of the most widely used types of drugs in clinical practice, designed to treat highly prevalent pathologies in the clinical activity of gastroenterology. Despite having precise and approved indications, reports have described a use beyond the established indications, such as management of various symptoms of the digestive tract or associated with polypharmacy, considering that their indication could be questionable in a significant percentage of individuals on prolonged treatment with PPI. In recent years, several basic, clinical and epidemiological studies have warned of possible adverse events associated with the use of PPIs that have generated concern in physicians and patients, and an impact on the public opinion due to the wide use of these drugs among the population. The purpose of this review is to critically analyze the available evidence regarding adverse events associated with the use of PPIs, in addition to providing some recommendations for clinical practice
Los inhibidores de bomba de protones (IBP) son fármacos ampliamente usados en la práctica clínica, destinados a tratar patologías altamente prevalentes en la actividad clínica de gastroenterología. Pese a contar con indicaciones precisas y aprobadas, reportes han descrito un uso más allá de las indicaciones establecidas, como manejo de diversos síntomas del tracto digestivo o asociado a polifarmacia, considerándose que su indicación podría ser cuestionable en un porcentaje importante de individuos en tratamiento prolongado con IBP. En los últimos años, diversos estudios básicos, clínicos y epidemiológicos han alertado sobre posibles eventos adversos asociados al uso de IBP que han generado preocupación en tratantes y pacientes, además de impactar en la opinión pública por la amplia distribución del uso de estos fármacos en la población. El objetivo de esta revisión es analizar críticamente la evidencia disponible respecto a los eventos adversos asociados al uso de IBP, además de entregar algunas recomendaciones para la práctica clínica.
Assuntos
Humanos , Inibidores da Bomba de Prótons/efeitos adversos , Gastroenteropatias/tratamento farmacológicoRESUMO
Dr. Ivan Oransky is a self-proclaimed science watchdog who, together with Adam Marcus, have taken on the world of science in a blaze of public shaming – disguised as science journalism – that has already caused irreparable damage to science, despite the informative nature of those reports. Their portal for launching attacks on the publishing establishment and on scientists is Retraction Watch, a blog that sees monthly traffic in the hundreds of thousands of hits. One of the loudly claimed key tenants of Retraction Watch is to hold science and scientists accountable, and to thus be open and transparent. What is not very known, because Oransky fails to provide a full listing of his own publications, i.e., he does not show equivalent transparency that he expects or demands from others, is that he held a very important role at Elsevier's The Lancet, a premier medical journal that he now aggressively critiques, almost without impunity. That role at The Lancet was primarily to record the death of medical scientists. In the real world, taking care of the dead and the deceased lies in the hands of an undertaker. It is thus very apt that the role of digital undertaker for The Lancet established the necessary credentials that Oransky required to overlook the cadaver he and Marcus wish to create of science, and of scientists’ and publishers’ reputations.
RESUMO
El incremento sustancial de estudios terapéuticos que utilizan el diseño aleatorio controlado, demanda que el cardiólogo se familiarice con los aspectos esenciales en el diseño y conducción de los mismos, con énfasis particular en la interpretación adecuada y la aplicabilidad de sus resultados. En esta revisión basada en casos clínicos, se discuten algunos aspectos importantes en la valoración de terapia novedosa contemporánea como el uso y análisis de objetivos de eficacia compuestos; implicaciones de la terminación temprana de estudios y la extrapolación de resultados a la población.
The substantial increase of randomized controlled trials demand familiarity with the essential aspects of their design and performance by the cardiologist, particularly the adequate interpretation and applicability of the results. In this clinically-based review, we discuss some important aspects in the assessment of novel contemporary therapy such as the use and analysis of composite endpoints; implications from early termination of trials and extrapolation of results to the population.
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Cardiopatias/tratamento farmacológico , Cardiologia , Epidemiologia , Medicina Baseada em Evidências , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
En el presente trabajo se efectúa un análisis crítico del empleo indiscriminado de la categoría género, realizando una puntuación de los distintos problemas derivados de la misma. Dichos problemas se presentan en distintos planos, acentuándose en algunos su carácter ontológico-epistemológico y en otros su aspecto praxiológico o político. Finalmente se esbozarán ciertos interrogantes para seguir pensando su utilización disciplinar y el valor heurístico de dicha implementación.
In the present work a critical analysis of the indiscriminate use of the category "gender" is carried out, pointing out the different problems derived from it. The mentioned problems appear at different levels, their ontological-epistemological character being accentuated in some and their practical or political aspects in others. Finally, certain questions will be outlined as to continue thinking their scientific use and the heuristic value of their implementation.
Assuntos
Humanos , Masculino , Feminino , Identidade de Gênero , Saúde Mental , Terminologia como Assunto , Mulheres , Sexualidade/classificaçãoRESUMO
Penetrating Injuries on the chest may be homicidal, suicidal or accidental in nature. There are certain features that are quite reliable pointers to the nature of these injuries. However differentiation is difficult particularly when the characteristics of stabbing are perplexed and information related to circumstances of the incident is misguiding. The present case projects the importance of careful examination of the stab wounds on the chest particularly when the information provided to the autopsy surgeon is ambiguous.
RESUMO
Accidents are now one of the major causes of death. In this study pathological features of these cases as type of injury, pattern and distribution of injuries, body parts involved, fatal injuries and cause of deaths were noted at the actual autopsy examination of victim. All the data thus collected was analyzed statistically.