Equipoise in epidemiology

Whether Cameron’s case will prove to be a cautionary tale for other “Lyme literate” doctors remains to be seen. Even as one branch of state government successfully prosecutes a “Lyme literate” doctor, another branch, the legislature, is considering forcing insurers to cover treatment of “chronic Lyme,” the subject of no less than three bills now pending. ( Assembly Bill 114 , Senate Bill 4713 , Senate Bill 670 ). Three other bills are sympathetic to the cause in that they will give “chronic Lyme” advocates yet another venue to argue for insurance coverage. ( Assembly Bill 4863 , Senate Bill 2168 , Assembly Bill 6927 ). Pseudoscience, it seems, is endemic in the state of New York.

Although patients who are involved in decision-making about their health have better outcomes, [34] healthcare professionals rarely involve them in these decisions. [35] A recently updated Cochrane review [36] has synthesized the body of evidence about different interventions that can be used to help healthcare professionals adopt practices to better involve their patients in the process of making decisions about their health. In this review of studies testing interventions to help healthcare professionals adopt practices to better involve their patients in the process of making decisions, five studies were identified. This review found that educational meetings, giving healthcare professionals feedback, giving healthcare professionals learning materials, and using patient decision aids are some techniques that have been tried and might be helpful. However, the review could not determine from the available studies which of these were best. The review makes some suggestions for how research studies could better evaluate healthcare professionals involving patients in the process of making decisions about their health so that we can understand this better in the future. [36] There is also a need for greater conceptual clarity. Involving patients in decisions is by definition a process that could occur over time and in many encounters. Much of the literature seems to assume that achieving shared decision-making is a matter of giving healthcare professionals enough information.

Chronic pain, especially of the neck and back, is also now recognized for its large contribution to the burden of disability. Neurological disorders such as epilepsy, migraine, Parkinson's disease, and multiple sclerosis make smaller but significant contributions. Stroke and perinatal asphyxia, with neurological complications, are also a significant problem in LMICs particularly since some of the causative factors of stroke such as hypertension are poorly treated in LMICs as compared to high-income countries.

Equipoise in epidemiology

equipoise in epidemiology

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equipoise in epidemiology

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