Resumo: Partindo da leitura lacaniana de que a ascensão do discurso científico produziu uma mudança na posição do médico, interrogam-se os efeitos do estabelecimento do evidence-based como paradigma ...para a prática médica. Se a inferência estatística exemplifica a convergência entre matematização e objetividade, lança-se mão de uma vinheta relativa à prática em um ambulatório de Distúrbios da Diferenciação Sexual para interpelar os impasses relativos à designação do sexo nesses casos. Pretende-se evidenciar a diferença entre a práxis da psicanálise e a abordagem médica que se orienta na direção da universalização, situando assim seus limites frente ao real do sexo.
Abstract: From the Lacanian interpretation that the rise of scientific discourse produced a change in the physician’s position, the effects of the establishment of evidence-based as a paradigm for medical practice are examined. If the statistical inference exemplifies the convergence between mathematization and objectivity, an example related to the practice in a Sexual Differentiation Disorders clinic is used to question the impasses related to the designation of sex in these cases. It is intended to highlight the difference between the praxis of psychoanalysis and the medical approach that is oriented towards universalization, thus placing its limits related to the real of sex.
Hypertension Canada provides annually updated, evidence-based guidelines for the diagnosis, assessment, prevention, and treatment of hypertension in adults and children. This year, the adult and ...pediatric guidelines are combined in one document. The new 2018 pregnancy-specific hypertension guidelines are published separately. For 2018, 5 new guidelines are introduced, and 1 existing guideline on the blood pressure thresholds and targets in the setting of thrombolysis for acute ischemic stroke is revised. The use of validated wrist devices for the estimation of blood pressure in individuals with large arm circumference is now included. Guidance is provided for the follow-up measurements of blood pressure, with the use of standardized methods and electronic (oscillometric) upper arm devices in individuals with hypertension, and either ambulatory blood pressure monitoring or home blood pressure monitoring in individuals with white coat effect. We specify that all individuals with hypertension should have an assessment of global cardiovascular risk to promote health behaviours that lower blood pressure. Finally, an angiotensin receptor-neprilysin inhibitor combination should be used in place of either an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker in individuals with heart failure (with ejection fraction < 40%) who are symptomatic despite appropriate doses of guideline-directed heart failure therapies. The specific evidence and rationale underlying each of these guidelines are discussed.
Chaque année Hypertension Canada publie une mise à jour de ses lignes directrices fondées sur des données probantes relatives au diagnostic, à l'évaluation, à la prévention et au traitement de l'hypertension chez l'adulte et l'enfant. Cette année, les lignes directrices applicables aux adultes et aux enfants sont combinées en un seul document. Les nouvelles lignes directrices 2018 portant précisément sur l'hypertension pendant la grossesse sont publiées séparément. Pour 2018, cinq nouvelles lignes directrices sont présentées, et une ligne directrice existante portant sur les seuils et les cibles de pression artérielle dans le contexte de la thrombolyse dans un cas d'accident vasculaire cérébral ischémique aigu est révisée. L'utilisation de tensiomètres-bracelets validés pour l'estimation de la pression artérielle chez les personnes dont le bras a une circonférence élevée est à présent incluse. Des indications sont données pour les mesures de la pression artérielle dans le cadre d'un suivi à l'aide de méthodes normalisées et de dispositifs électroniques (oscillométriques) positionnés au niveau du bras chez les personnes hypertendues, ainsi que de la surveillance de la pression artérielle ambulatoire ou à domicile chez les personnes sujettes au « syndrome de la blouse blanche ». Nous recommandons notamment de procéder à une évaluation du risque cardiovasculaire global de toutes les personnes atteintes d'hypertension afin de les inciter à adopter de saines habitudes de vie permettant d’abaisser leur pression artérielle. Enfin, chez les personnes atteintes d'insuffisance cardiaque (présentant une fraction d'éjection < 40 %) qui sont symptomatiques malgré un traitement de cette affection à des doses appropriées et conforme aux lignes directrices, il est recommandé d'utiliser une association de médicaments inhibiteurs des récepteurs de l'angiotensine et de la néprilysine au lieu d’un inhibiteur de l’enzyme de conversion de l'angiotensine ou d'un antagoniste des récepteurs de l'angiotensine en monothérapie. Les données probantes et la justification qui sous-tendent chacune de ces lignes directrices sont analysées.
The purpose of the article is to analyze the question regarding the admissibility of illicit means of evidence in civil proceedings based on the 2015 Code paradigm, seeking to identify to what extent ...the normative diploma changed the dynamics of such institute. The descriptiveexploratory method was adopted through bibliographic review on the fundamental character of the right to the proof; the classic and contemporary trends on the concept and admissibility of illicit evidence and the proper reasoning for decisions on the matter, further investigating the contribution of the weighting technique brought by art.489, section 2 of CPC / 2015 to its implementation. Keywords: Civil Procedure. Illegal means of evidence. Admissibility. Rationale. Consideration technique. O artigo tem por finalidade a analise da questao referente a admissibilidade dos meios de prova ilicitos no processo civil a partir do paradigma do Codigo de 2015, buscando identificar em que medida o diploma normativo alterou a dinamica de tal instituto. Adotou-se o metodo descritivo-exploratorio por meio de revisao bibliografica sobre o carater fundamental do direito a prova; as correntes classicas e contemporaneas sobre o conceito e admissibilidade da prova ilicita e a fundamentacao idonea das decisoes sobre a materia, investigando-se ademais a contribuicao da tecnica de ponderacao trazida pelo art.489, section 2 do CPC/2015 para sua concretizacao. Palavras-chave: Processo Civil; Prova ilicita; Admissibilidade; Fundamentacao; Ponderacao.
Abstract This article deals with inconsistency of relative (rather than absolute) treatment effects in binary/dichotomous outcomes. A body of evidence is not rated up in quality if studies yield ...consistent results, but may be rated down in quality if inconsistent. Criteria for evaluating consistency include similarity of point estimates, extent of overlap of confidence intervals, and statistical criteria including tests of heterogeneity and I2 . To explore heterogeneity, systematic review authors should generate and test a small number of a priori hypotheses related to patients, interventions, outcomes, and methodology. When inconsistency is large and unexplained, rating down quality for inconsistency is appropriate, particularly if some studies suggest substantial benefit, and others no effect or harm (rather than only large vs. small effects). Apparent subgroup effects may be spurious. Credibility is increased if subgroup effects are based on a small number of a priori hypotheses with a specified direction; subgroup comparisons come from within rather than between studies; tests of interaction generate low P -values; and have a biological rationale.
En el presente artículo se pretende utilizar el fútbol, y en especial la incorporación de asistencia de video en la toma de decisiones en juego, como herramienta para explicar las ideas básicas de la ...teoría de la prueba en el derecho. Dentro de lo que se trata, se incluyen los momentos de la actividad probatoria, el objeto de prueba y los estándares y cargas probatorias, así como la legitimación y la iniciativa para la verificación de supuesto fáctico. Se presenta como una forma de relacionar contenidos teóricos del derecho probatorio y la epistemología jurídica en el contexto de deportes masivos, en que su utilización parece más cercana a quienes inician su estudio de la evidencia desde una perspectiva teórica.
O Brasil registra, nos últimos anos, aumento significativo da taxa de incidência de indivíduos diagnosticados com Transtorno do Espectro Autista (TEA). Esse fenômeno vem acompanhado do crescente ...número de políticas inclusivas e de cartilhas para educadores e agentes de saúde, com vistas a orientar sobre práticas interventivas que garantam a educação/tratamento desses indivíduos em contextos escolares e não escolares. Seguindo-se a metodologia de pesquisa de revisão sistemática da literatura, associada à pesquisa documental, o objetivo desse estudo foi analisar documentos consultivos, disseminadas pelo Ministério da Saúde e da Educação, que abordam práticas interventivas para indivíduos com TEA, publicados nos últimos 20 anos. Os resultados da análise dos 6 documentos identificados sustentam que a conceituação do transtorno, as práticas sugeridas e a definição do perfil profissional dos que atendem essa população nem sempre se alinham aos protocolos empiricamente validados. Alternativas para a produção, disseminação e aprimoramento de Práticas Baseadas em Evidências (PBE) para educandos com TEA são discutidas.
Los vastos paisajes cordilleranos, con sus altas montañas, lejos de ser considerados como obstáculos o lugares inaccesibles, fueron la morada de deidades, conformando una territorialidad simbólica e ...ideológica con una fuerte presencia material y cultural en los paisajes. During the process of territorial expansion of the Incas, the road systems played an essential structural role by shaping a type of spatial continuity through built infrastructure, which started in the capital of Tawantinsuyu and spread to distant peripheries. ...a little more than two hundred mountains with archaeological evidence have been studied in the Andes and other neighboring mountain ranges. Here, we present an extensive list of mountains with roads in an attempt to establish some archaeological and spatial indicators of these particular paths, built in some of the most extreme environments in the world.
Although first applied in the medical sciences in the 1970s, systematic reviews have been recently, and increasingly, used in the field of international development to examine the impacts of a range ...of development and humanitarian interventions. However, to date, there has been only limited critical reflection on their application within this field. Drawing on the authors' first-hand experiences of conducting eight systematic reviews, this article reflects upon the use of systematic reviews in international development research. It is concluded that although using systematic review principles can help researchers improve the rigour and breadth of literature reviews, conducting a full systematic review is a resource-intensive process which involves a number of practical challenges. Further, it raises a series of fundamental concerns for those working in international development, as well as the social sciences more broadly. Ultimately, systematic reviews should be viewed as a means to finding a robust and sensible answer to a focused research question, but not as an end in themselves.
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