Scientific Evidence and Medical Practice: The “Drunkard’s Walk”
Arch Int Med Volume 169(7), 13 April 2009, p 649–650
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The Drunkard’s Walk: How Randomness Rules our Lives, Leonard Mlodinow.
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In his recent book “The Drunkard’s Walk: How Randomness Rules our Lives, Leonard Mlodinow describes how humans are notoriously bad at, and often even averse to, the straightforward use of data and probability in making daily judgments. This characteristic is not restricted to certain educational levels, sexes, or professions.
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Como exemplo, na medicina, em 1991, foi estimado que apenas 15% das intervenções médicas eram embasadas em sólidas evidências científicas. Uma revisão mais recente mostrou uma variação de 11% a 70% das condutas com respaldo sólido.
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É um exercíco interessante esse:
Pegue um papel e escreva os últimos 10 conselhos ou condutas médicas que você tomou recentemente e veja quantas são fortemente embasadas em pesquisas.
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Surpreso?!?
Dia: 24 de abril de 2009
Quanto pior a diástole, pior o refluxo mitral.
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Diastolic dysfunction and left atrial enlargement as contributing factors to functional mitral regurgitation in dilated cardiomyopathy: Data from the Acorn trial.
Am Heart J Volume 157(4), April 2009, p 762e3–762e10
Park, Seong-Mi MDa; Park, Seung Woo MDb; Casaclang-Verzosa, Grace MDc; Ommen, Steve R. MDc; Pellikka, Patricia A. MDc; Miller, Fletcher A. Jr. MDc; Sarano, Maurice E. MDc; Kubo, Spencer H. MDd; Oh, Jae K. MDc,*
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“These findings suggest that LA enlargement caused by advanced diastolic dysfunction may contribute to causing significant MR by augmenting mitral annular dilatation in DCM“
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The severity of functional MR in this patient cohort was correlated most significantly with the mitral valvular tenting area, which was in turn more closely related to mitral annular size and diastolic dysfunction severity than to LV volume. Diastolic dysfunction, therefore, appears to be an important contributing factor for development of MR in patients with DCM, probably by causing enlarging of the LA volume and the mitral annulus and subsequent augmenting of the tenting area.
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