-
Revista Da Associacao Medica Brasileira... Mar 2019
Topics: Brazil; Health Knowledge, Attitudes, Practice; Humans; Phytotherapy; Plants, Medicinal; Public Health
PubMed: 30994823
DOI: 10.1590/1806-9282.65.3.292 -
Minnesota Medicine May 2015
Topics: Arousal; Emergency Medicine; Humans; Minnesota; Work Schedule Tolerance; Workload
PubMed: 26065170
DOI: No ID Found -
Journal of Evaluation in Clinical... Dec 2014This article explores the philosophical implications of evidence-based medicine's (EBM's) epistemology in terms of the problem of underdetermination of theory by... (Review)
Review
This article explores the philosophical implications of evidence-based medicine's (EBM's) epistemology in terms of the problem of underdetermination of theory by evidence as expounded by the Duhem-Quine thesis. EBM hierarchies of evidence privilege clinical research over basic science, exacerbating the problem of underdetermination. Because of severe underdetermination, EBM is unable to meaningfully test core medical beliefs that form the basis of our understanding of disease and therapeutics. As a result, EBM adopts an epistemic attitude that is sceptical of explanations from the basic biological sciences, and is relegated to a view of disease at a population level. EBM's epistemic attitude provides a limited research heuristic by preventing the development of a theoretical framework required for understanding disease mechanism and integrating knowledge to develop new therapies. Medical epistemology should remain pluralistic and include complementary approaches of basic science and clinical research, thus avoiding the limited epistemic attitude entailed by EBM hierarchies.
Topics: Biomedical Research; Evidence-Based Medicine; Female; Humans; Knowledge; Male; Philosophy, Medical; Quality Assurance, Health Care; Randomized Controlled Trials as Topic; Research Design
PubMed: 25406418
DOI: 10.1111/jep.12258 -
Nature Medicine Jul 2018
Topics: Child; Clinical Trials as Topic; Humans; Molecular Targeted Therapy; Precision Medicine
PubMed: 29988140
DOI: 10.1038/s41591-018-0113-8 -
Lakartidningen Apr 2023Overdiagnosis and overtreatment receive increasing attention. More than 20 percent of health expenditure is without patient benefit, so-called low-value care. Several...
Overdiagnosis and overtreatment receive increasing attention. More than 20 percent of health expenditure is without patient benefit, so-called low-value care. Several national and international initiatives have been launched to minimize low-value care. Arguably, the most widely spread initiative is Choosing Wisely. First launched by the American Board of Internal Medicine in 2012, this campaign has spread to more than 20 countries. The Swedish Society of Medicine has identified low-value care as a significant problem in Swedish health care and has established a working group to investigate if and how a campaign based on Choosing Wisely would be feasible in Sweden. Here, the working group reports on the history of Choosing Wisely, identifies potential challenges for deimplementation generally and in the Swedish context specifically.
Topics: Humans; United States; Sweden; Internal Medicine; Delivery of Health Care
PubMed: 37057979
DOI: No ID Found -
Critical Care Nursing QuarterlySupportive, or palliative, care has moved into medicine's mainstream with well-known and studied benefits but continues to be inadequately utilized in many health care... (Review)
Review
Supportive, or palliative, care has moved into medicine's mainstream with well-known and studied benefits but continues to be inadequately utilized in many health care environments particularly intensive care units (ICUs). With diverse patient populations in the various ICU settings, the supportive care team must adapt and mold their goals-of-care discussions and relationship building based on the ICU culture and individuals involved. Despite the differences in disease processes, early supportive care involvement in the ICU provides much needed emotional support and symptom management to patients and families in addition to identifying the patient's goals of care early in the hospital stay. The purpose of this article is to provide a general overview of the history of supportive care and clarify current misperceptions, particularly related to hospice, surrounding the specialty. The types of supportive care consults will be explained and their uses in the various ICU settings, and illustrate the advantage of early involvement to not only patients and families but the medical team as well.
Topics: Critical Care; Humans; Intensive Care Units; Length of Stay; Palliative Care; Palliative Medicine
PubMed: 35980795
DOI: 10.1097/CNQ.0000000000000425 -
Journal of the American Board of Family... 2022Female physicians earn less than their male counterparts, and many explanatory factors have been offered to account for these differences. An analysis of the 2019...
Female physicians earn less than their male counterparts, and many explanatory factors have been offered to account for these differences. An analysis of the 2019 American Board of Family Medicine New Graduate Survey Data demonstrates that women make 16% less than men, regardless of experience or hours worked.
Topics: Family Practice; Female; Humans; Income; Male; Salaries and Fringe Benefits; Sex Factors; Surveys and Questionnaires; United States
PubMed: 35039406
DOI: 10.3122/jabfm.2022.01.210086 -
Studies in Health Technology and... Feb 2022Precision medicine offers the potential to improve health through deeper understandings of the lifestyle, biological, and environmental influences on health. Under Dr....
Precision medicine offers the potential to improve health through deeper understandings of the lifestyle, biological, and environmental influences on health. Under Dr. Donald A.B. Lindberg's leadership, the U.S. National Library of Medicine (NLM) has developed the central reference resources for biomedical research and molecular laboratory medicine that enable precision medicine. The hosting and curation of biomedical knowledge repositories and data by NLM enable quality information reachable for providers and researchers throughout the world. NLM has been supporting the innovation of electronic health record systems to implement computability and secondary use for biomedical research, producing the scale of linked health and molecular datasets necessary for precision medicine discovery.
Topics: Genomic Medicine; National Library of Medicine (U.S.); Precision Medicine; United States
PubMed: 35102830
DOI: 10.3233/SHTI210983 -
ESMO study on the availability and accessibility of biomolecular technologies in oncology in Europe.Annals of Oncology : Official Journal... Oct 2023Access to biomolecular technologies has become an essential requirement to ensure optimal and timely treatment of patients with cancer. This study sought to provide a...
BACKGROUND
Access to biomolecular technologies has become an essential requirement to ensure optimal and timely treatment of patients with cancer. This study sought to provide a comprehensive overview of the availability and accessibility of biomolecular technologies to patients, the status of their use and prescription, barriers to access, and potential economic issues related to cost and reimbursement.
MATERIALS AND METHODS
A total of 201 field reporters from 48 European countries submitted data through an electronic survey tool between July and December 2021. The survey methodology mirrored that from previous ESMO studies addressing the availability and accessibility of antineoplastic medicines, in Europe and worldwide. The preliminary data were posted on the ESMO website for open peer-review, and amendments were incorporated into the final report.
RESULTS
Overall, basic single-gene techniques are widely available, whereas access to advanced biomolecular technologies, including large next-generation sequencing panels and complete genomic profiles, is highly heterogeneous. In most countries, advanced biomolecular technologies remain largely inaccessible in clinical practice, are limited to clinical trials or basic research, and associated with progressively increasing cost as the technique becomes more advanced. Differences also exist regarding national sequencing initiatives or molecular tumour boards. The most important barriers to multiple versus single-gene sequencing techniques are the reimbursement of the test (59% versus 24%), and the availability of a suitable medicine, either through reimbursement of treatment (48% versus 30%), off-label treatment (52% versus 35%), or clinical trial enrolment (53% versus 39%).
CONCLUSIONS
Cost and availability of both treatment and test are the two main factors limiting patients' access to advanced biomolecular technologies and as a consequence to innovative anticancer strategies. In the era of precision medicine, tackling the accessibility to biomolecular technologies is a key step to reduce inequalities to transformative cancer care.
Topics: Humans; Antineoplastic Agents; Europe; Medical Oncology; Neoplasms; Precision Medicine
PubMed: 37406812
DOI: 10.1016/j.annonc.2023.06.011 -
Scanning 2022Though artificial intelligence (AI) has been used in nuclear medicine for more than 50 years, more progress has been made in deep learning (DL) and machine learning... (Review)
Review
Though artificial intelligence (AI) has been used in nuclear medicine for more than 50 years, more progress has been made in deep learning (DL) and machine learning (ML), which have driven the development of new AI abilities in the field. ANNs are used in both deep learning and machine learning in nuclear medicine. Alternatively, if 3D convolutional neural network (CNN) is used, the inputs may be the actual images that are being analyzed, rather than a set of inputs. In nuclear medicine, artificial intelligence reimagines and reengineers the field's therapeutic and scientific capabilities. Understanding the concepts of 3D CNN and U-Net in the context of nuclear medicine provides for a deeper engagement with clinical and research applications, as well as the ability to troubleshoot problems when they emerge. Business analytics, risk assessment, quality assurance, and basic classifications are all examples of simple ML applications. General nuclear medicine, SPECT, PET, MRI, and CT may benefit from more advanced DL applications for classification, detection, localization, segmentation, quantification, and radiomic feature extraction utilizing 3D CNNs. An ANN may be used to analyze a small dataset at the same time as traditional statistical methods, as well as bigger datasets. Nuclear medicine's clinical and research practices have been largely unaffected by the introduction of artificial intelligence (AI). Clinical and research landscapes have been fundamentally altered by the advent of 3D CNN and U-Net applications. Nuclear medicine professionals must now have at least an elementary understanding of AI principles such as neural networks (ANNs) and convolutional neural networks (CNNs).
Topics: Artificial Intelligence; Deep Learning; Magnetic Resonance Imaging; Neural Networks, Computer; Nuclear Medicine
PubMed: 35924105
DOI: 10.1155/2022/9640177