ABSTRACT
BACKGROUND: The clinical view is essential in the application of a new paradigm on "evidence based medicine". Also, we hardly haven't studies that had been made with patients in real time and place. We analyzed the rate of evidence that found our clinical praxis. METHODS: A randomized observational epidemiological study was made over 689 clinical decisions in relation with 167 pathological processes, considered in 36 patients. Age (65.9, SD 2.1), sex (23 F, 13 M), comorbidity (4.6, SD 2.1), poly-pharmacy (8.8, SD 3.3). Case-mix of GRDs (infections--even HIV-, chronic respiratory affections, neurologic, cardiovascular diseases, diabetes and its complications ..., in decreased order. We used the D.L. Sackett's criterium (evidence level one "experimental", level two "no experimental but convincing-rational", level three "without any scientific base". A progressive internal control was used in order to adjust the "arbitrariness in the assignation". RESULTS: 60% of the decisions provided elevated care evidence level; 24.5% in level number two, and 15.5% without any foundation. The proceedings reasonably founded were 84.5%. The pharmacological treatment had more evidence. The diagnosticum was more empiric. The primary illness and its treatment concentrated more evidence that the enclosed conditions (65% level one and 50% respectively). The prediction is still unknown (null evidence). CONCLUSIONS: More than a half of the patients were benefited of a clinical praxis, tested in effectiveness and safety. 15.5% of the decisions had an uncertain effect (favourable, newer or damaging). Nowadays, the complex clinical praxis, despite of exceeding the paradigm of "evidence based medicine", should tend toward scientific foundation as much as possible.
Subject(s)
Clinical Medicine , Evidence-Based Medicine , Aged , Aged, 80 and over , Diagnosis , Diagnosis-Related Groups , Drug Therapy , Evaluation Studies as Topic , Female , Humans , Male , Meta-Analysis as Topic , Middle Aged , Random Allocation , ResearchABSTRACT
Fundamentos. La perspectiva clínica es esencial en la aplicación del nuevo paradigma de "medicina basada en evidencia". Sin embargo, apenas disponemos de estudios realizados con pacientes en escenario real y en tiempo real. Analizamos qué grado de evidencia fundamenta nuestra práctica clínica. Pacientes y métodos. Estudio epidemiológico observacional aleatorio sobre 689 decisiones clínicas relacionadas con 167 procesos patológicos, tomadas en 36 pacientes. Edad (65,9, DS 2,1), sexo (23 M, 13 H); comorbididad (4,6, DS 2,1); polifarmacia (8,8, DS 3,3). Case-Mix según GRDs (infecciones-incluido HIV-, afecciones respiratorias crónicas; neurología; afecciones cardiovasculares; diabetes y sus complicaciones..., por orden decreciente). Empleamos el criterio de D.L. Sackett (nivel evidencia 1 o "experimental"; nivel 2 "no experimental pero convincente-racional"; nivel 3 o "insustancial". Se empleó un control interno progresivo para el ajuste de "arbitrariedad en la asignación". Resultados. El 60% de las decisiones aportaron cuidados de alto nivel de evidencia. El 24,5 porciento de nivel 2. El 15,5 porciento sin fundamento. Las intervenciones razonablemente fundadas lo fueron en el 84,5 porciento. El tratamiento farmacológico fue "más evidente". El diagnóstico "más empírico". La enfermedad primaria y su tratamiento concentraron más evidencias que las condicciones concurrentes (65% nivel 1 respecto a 50% respectivamente). El pronóstico continúa siendo una incógnita (evidencia nula o marginal). Conclusión. Más de la mitad de los enfermos se beneficiaron de una práctica clínica probada en eficacia y seguridad. Un 15,5% de las decisiones tuvieron un efecto incierto (favorable, neutro o perjudicial). La complejidad clínica diaria, si bien excede actualmente a la simplificación del paradigma "basado en evidencia", debe tender hacia la fundamentación científica tanto como sea posible (AU)
Subject(s)
Aged , Female , Male , Middle Aged , Aged, 80 and over , Humans , Diagnosis , Diagnosis-Related Groups , Drug Therapy , Research , Random Allocation , Clinical Medicine , Evidence-Based MedicineABSTRACT
We report five cases of psychosis in patients with antibody to human immunodeficiency virus. All patients was man and intravenous drug abuser. The age range was 22 from 31 years with a mean of 25 years. In all cases acute schizophrenia was the first clinical picture of the HIV. Four patients had opportunistic infections and AIDS-Dementia Complex months later. If there is a genuine biological association between HIV carriage and schizophrenia illness, then HIV infection should be considered in the differential diagnosis of such an illness.
