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-Parere degli “esperti”
-Pubblicazioni
-Esperienza clinica
-Adeguamento della
terapia al singolo
paziente
Prima di far praticare un esame,
bisogna chiedersi quale sarà
l'atteggiamento:
a) se il risultato è positivo
b) se il risultato è negativo.
Se nei due casi l'atteggiamento
previsto è identico, l'esame
non va richiesto
Archibald Cochrane: L'inflazione medica.
Efficacia ed efficienza in medicina
prima edizione 1972
- acetaminophen, chlorpheniramine,
dextromethorphan, pseudoephedrine
- Pseudoephedrine, phenylpropanolamine,
dextromethorphan,
- phenylpropanolamine, brompheniramine
Antibiotics for acute maxillary sinusitis
(Cochrane Review)
Williams Jr. JW, Aguilar C, Makela M, Cornell J, Hollman DR, Chiquette E, Simel DL
Reviewers' conclusions: For acute maxillary sinusitis confirmed
radigraphically or by aspiration, current evidence is limited but
supports penicillin or amoxicillin for 7 to 14 days. Clinicians
should weigh the moderate benefits of antibiotic treatment
against the potential for adverse effects.
Decongestants and antihistamines for acute
otitis media in children (Cochrane Review)
Flynn CA, Griffin G, Tudiver F
Reviewers' conclusions: Given lack of benefit and increased
risk of side effects, these data do not support the use of
decongestant, antihistamine, or combined DC/AH treatment
in children with AOM. The small statistical benefit found in the
combination medication group is of small clinical significance
and study design may be biasing the results.
Nasal decongestants for the common cold
(Cochrane Review)
Taverner D, Bickford L, Draper M
Reviewers' conclusions: A single dose of nasal decongestant in
the common cold is moderately effective for the short term relief
of congestion in adults, while there is no evidence available to
show benefit after repeated use over several days.
These medications are not recommended for use in young
children with the common cold.
Oral or topical nasal steroids for hearing loss
associated with otitis media with effusion in
children (Cochrane Review)
Butler CC, van der Voort JH
Reviewers' conclusions: There is evidence that steroids
combined with an antibiotic lead to a quicker resolution of OME
in the short term. However, there is not evidence for long term
benefit from treating hearing loss associated with OME with
either oral or topical nasal steroids. These treatments are
therefore not recommended at the present time. Future studies
should document hearing loss associated with OME before the
start of study treatment. Follow up should be longer and ideally
include symptom, audiometry and developmental outcomes.
Vaccines for preventing influenza in people
with asthma (Cochrane Review)
Cates CJ, Jefferson TO, Bara AI, Rowe BH
Reviewers' conclusions: There is not enough evidence to assess
the benefits and risks of influenza vaccination for people with
asthma.
Pneumococcal vaccine for asthma (Cochrane
Review)
Sheikh A, Alves B, Dhami S.
Reviewers' conclusions: This review found very limited evidence
to support the routine use of pneumococcal vaccine in people
with asthma. A randomised trial of vaccine efficacy in children
and adults with asthma is needed.
Echinacea for preventing and treating the
common cold (Cochrane Review)
Melchart D, Linde K, Fischer P, Kaesmayr J
Reviewers' conclusions: The majority of the available studies
report positive results. However there is not enough evidence to
recommend a specific Echinacea product, or Echinacea
preparations for the treatment or prevention of common colds.
Homoeopathic Oscillococcinum for preventing
and treating influenza and influenza-like
syndromes (Cochrane Review)
Vickers AJ, Smith C.
Reviewers' conclusions: Oscillococcinum probably reduces the
duration of illness in patients presenting with influenza
symptoms. Though promising, the data are not strong enough to
make a general recommendation to use Oscillococcinum for firstline treatment of influenza and influenza-like syndrome. Further
research is warranted but required sample sizes are large. Current
evidence does not support a preventative effect of homeopathy in
influenza and influenza-like syndromes.
Antibiotics for acute bronchitis (Cochrane
Review)
Smucny J, Fahey T, Becker L, Glazier R
Reviewers' conclusions: Overall, antibiotics appear to have a
modest beneficial effect in patients who are diagnosed with acute
bronchitis. The magnitude of this benefit, however, is similar to
that of the detriment from potential adverse effects. Furthermore,
patients with other symptoms of the common cold who have
been ill for less than one week are not likely to have any benefit
from antibiotics.
Chest radiograph in acute respiratory
infections in children (Cochrane Review)
Swingler GH, Zwarenstein M
Reviewers' conclusions: There is no evidence that chest
radiography improves outcome in ambulatory children with acute
lower respiratory infection. The findings do not exclude a
potential effect of radiography, but the potential benefit needs to
be balanced against the hazards and expense of chest
radiography. The findings apply to ambulatory children only.
Beclomethasone for asthma in children: effects
on linear growth (Cochrane Review)
Sharek PJ, Bergman DA, Ducharme
Reviewers' conclusions: In children with mild-moderate asthma,
beclomethasone 200 mcg twice daily caused a decrease in
linear growth of -1.54 cm per year. These studies lasted a
maximum of 54 weeks, so it remains unclear whether the
decrease in growth is sustained or whether it reverses with 'catch
up' after therapy is discontinued. We are unable to comment on
growth effects of other inhaled steroids that have potentially less
systemic effects. If inhaled steroids are required to control a
child's asthma, we recommend using the minimum dose that
effectively controls the child's asthma and closely following
growth
Inhaled beclomethasone versus placebo for
chronic asthma (Cochrane Review)
Adams NP, Bestall JB, Jones PW
Reviewers' conclusions: This review has quantified the
efficacy of BDP in the treatment of chronic asthma and
strongly supports its use. Current asthma guidelines recommend
titration of dose to individual patient response, but the published
data provide little support for dose titration above 400 mcg/d in
patients with mild to moderate asthma. There are insufficient data
to draw any conclusions concerning dose-response in patients
with severe disease.
Heated, humidified air for the common cold
(Cochrane Review)
Singh M.
Reviewers' conclusions: Three trials demonstrated beneficial
effects on the symptoms of the common cold. One study from
Israel showed a decrease in nasal resistance measured by peak
nasal expiratory and inspiratory flow rate. Studies done in
North America failed to show any objective improvement in
outcome measures with the study intervention. A multi-centre
double blind randomised controlled trial testing this therapy with
uniform outcome measures is recommended
House dust mite control measures for asthma
(Cochrane Review)
Gøtzsche PC, Johansen HK, Burr ML, Hammarquist C
Reviewers' conclusions: Currently available evidence from
controlled trials of chemical and physical approaches to reducing
exposure to house dust mite antigens in the homes of mitesensitive asthmatics does not provide a secure basis for advice
and policy. Further trials – one of them very large - are currently
in progress. The additional evidence from these studies will help
to clarify whether or not the substantial efforts required to
implement strategies intended to reduce mites can be expected to
yield beneficial effects of a magnitude that people with mite
sensitive asthma consider worthwhile.
Perizia
Scienza
Prudenza
Coscienza
Diligenza
Economia sanitaria
Farmacoeconomia
DRG (ROD)
Budget
EBM
ECM
Deontologia
Etica
Bioetica
Leggi:
-Finanziaria
-675/96
-626
-502
-ecc. ecc.