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Cognitive Behavioral Therapy for Insomnia

28 May, 15 | by BMJ Clinical Evidence

by Cathy A. Alessi and Michael V. VitielloCathy Alessi imageMVV cropped

Cognitive-behavioral therapy for insomnia (CBT-I) has been consistently demonstrated to be efficacious in a wide variety of settings and patient populations including older adults. This efficacy has been demonstrated in both patients with uncomplicated insomnia and in those whose insomnia is comorbid with a variety of medical and psychiatric conditions, more…

A gap in the evidence – What is the role of surgery in the patient with severe (secondary) Raynaud’s phenomenon?

21 May, 15 | by BMJ Clinical Evidence

by Ariane Herrick and Lindsay Muir

Herrick

Lindsay_Muir_crop

 

People with Raynaud’s phenomenon secondary to an underlying disease or condition (the best researched one being systemic sclerosis) can progress to irreversible tissue injury with ulceration and/or critical ischaemia and gangrene. Although there has been increasing interest in recent years in identifying new drug therapies for severe Raynaud’s phenomenon with randomised controlled trials (RCTs) of, for example, phosphodiesterase inhibitors and endothelin receptor antagonists, the recent BMJ Clinical Evidence overview identified no RCTs of any of the surgical procedures that  have been advocated for advanced peripheral vascular disease. more…

Addressing gaps in evidence

9 Apr, 15 | by BMJ Clinical Evidence

?????????????????????????????????????????????????????????????????????????Evidence-based medicine (EBM) is an approach that—in addition to clinical experience and patient preferences—takes into account existing research evidence to draw conclusions on the best approach for the care of individual patients. It is a key tool for clinical decision making as the need to balance research, new tests and treatments, and available resources with clinical experience and patient requirements continues to be an important focus in healthcare. more…

Clinical Evidence for the Brave New World on Multimorbidity

12 Mar, 15 | by BMJ Clinical Evidence

by Victor Montori

The most common chronic condition worldwide is, or will soon be, multimorbidity. Previously a concern reserved to the very old, multimorbidity increasingly affects younger people. A prevalence study in Scotland found that the average middle age person is no longer a healthy one, but a patient with at least one chronic condition; 1 in 4 had two chronic conditions. As the population ages, the proportion with multimorbidity approaches universality. As the evidence, often obtained in people with a paucity of comorbidities, gets incorporated into practice guidelines, guideline panels face a key task. more…

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