Lucynara Gomes Lima Tambon, Cleber Luz Santos, Erika Pedreira da Fonseca, Dislene Nascimento dos Santos, I. Gomes, A. Fontes Baptista, Katia Nunes Sá
{"title":"Effect of neuromodulation on pain and functional mobility in people with HTLV-1: randomized clinical trial protocol","authors":"Lucynara Gomes Lima Tambon, Cleber Luz Santos, Erika Pedreira da Fonseca, Dislene Nascimento dos Santos, I. Gomes, A. Fontes Baptista, Katia Nunes Sá","doi":"10.17267/2675-021xevidence.2022.e4193","DOIUrl":"https://doi.org/10.17267/2675-021xevidence.2022.e4193","url":null,"abstract":"BACKGROUND: The main symptoms of myelopathy associated with human T-cell lymphotropic virus type 1 or tropical spastic paraparesis (HAM / TSP) are the presence of high intensity pain in the lower back, spasticity and weakness in the lower limbs, loss of balance and difficulties in locomotion. Pulsed Transcranial Magnetic Stimulation (rTMS) has been able to influence cortical plasticity, decreasing spasticity, increasing motor performance and promoting analgesia in several similar conditions. OBJECTIVE: To analyze the effect of neuromodulation by pulsed transcranial magnetic stimulation (rTMS) on pain and functional mobility in individuals with HAM / TSP. METHODOLOGY: A randomized clinical trial will be conducted in a sample made up of 40 participants randomly allocated into two groups: Sham Group (SG) with 20 and Test Group (TG) with 20 patients. Individuals aged> 20 years, community walkers with or without orthosis, with chronic pain (? 6 months) in the lumbar region and / or lower limbs will be included. Individuals with epilepsy, cancer, pregnant women, patients with cardiac pacemakers, metallic implants in the brain or skull, users of illicit drugs and / or use of controlled medications in the last six months will be excluded. The protocol will be applied for 10 consecutive days with eight months of follow-up. Our hypothesis is that when using rTMs according to the proposed procedure, it will be possible to relieve pain and improve the functional mobility of these individuals with a long-lasting effect. CONCLUSION: We hope that rTMS is a promising treatment to reduce pain intensity and to improve functional mobility in individuals undergoing active modality. We declare this protocol a promising resource for the treatment of htlv-1 individuals in reducing pain and improving functional mobility. Yes, this protocol has already been applied to 6 patients. However, with the pandemic the study had to be discontinued. However, despite the small sample size and not being fully applied as suggested by the protocol, it was possible to notice a satisfactory result of the intervention. Thus, the application of this protocol can contribute to identify the result of this therapeutic modality in a safer way, as well as assist in the treatment of symptoms of this population, favoring a better quality of life.","PeriodicalId":55996,"journal":{"name":"International Journal of Evidence-Based Healthcare","volume":"10 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89694449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Cristine Miron Stefani, Liliana Vicente Melo de Lucas Rezende, Lia Rosana Honnef, L. Butini Oliveira, Nathan Da Cruz Lopes, C. Massignan, G. De Luca Canto, Júlia Meller Dias de Oliveira
{"title":"Methodologic quality and risk-of-bias in systematic reviews of healthcare interventions: a review of methods","authors":"Cristine Miron Stefani, Liliana Vicente Melo de Lucas Rezende, Lia Rosana Honnef, L. Butini Oliveira, Nathan Da Cruz Lopes, C. Massignan, G. De Luca Canto, Júlia Meller Dias de Oliveira","doi":"10.17267/2675-021xevidence.2022.e4067","DOIUrl":"https://doi.org/10.17267/2675-021xevidence.2022.e4067","url":null,"abstract":"OBJECTIVE: To compare the characteristics of systematic reviews of healthcare interventions that assessed or did not methodologic quality/risk-of-bias of included studies. Additionally, to analyze methodologic features of those assessing the methodologic quality/risk-of-bias. METHODS: PubMed database was searched. From 25,571 systematic reviews retrieved, a random sample of 1,025 was screened. Frequencies were used to describe outcomes. Unadjusted and adjusted logistic regressions were performed to test the associations with methodologic quality/risk-of-bias results assessment. In a second analysis, systematic reviews that assessed methodologic quality/risk of bias were dichotomized according to the design of included studies (randomized clinical trials-only versus non-randomized studies of intervention or a combination of both). RESULTS: 303 systematic reviews were fully analyzed. Methodologic quality/risk of bias was assessed by 278 (92%). Methodologic quality/risk-of-bias assessment was associated with a higher number of databases searched (>4, P= 0.008), the presence of meta-analysis (P= 0.005), and the design of included studies (randomized clinical trials-only, P= 0.042). The chance of using a suitable tool and a tool designed for risk-of-bias assessment rather than methodologic quality was higher for randomized clinical trials-only systematic reviews (P< 0.05). The most used tool was Cochrane’s RoB Tool without a clear studies’ overall risk classification system. CONCLUSION: methodologic quality/risk-of-bias assessment was associated with included studies’ design (randomized clinical trials-only), a meta-analysis of data, and the number of databases searched (>4). The most used tool was Cochrane’s RoB Tool, with no clearly defined rating system. Methodologic quality/risk-of-bias assessment methods description, results, and impacts on meta-analysis, the certainty of evidence, and systematic reviews’ results are still to be consistently addressed.\u0000 ","PeriodicalId":55996,"journal":{"name":"International Journal of Evidence-Based Healthcare","volume":"25 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78800746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Fernanda Christina De Carvalho, Isabella Stagliorio Dumet Faria, A. Medrado
{"title":"Study protocol for thermographic analysis of the nasolabial fold region in women submitted to hyaluronic acid filling","authors":"Fernanda Christina De Carvalho, Isabella Stagliorio Dumet Faria, A. Medrado","doi":"10.17267/2675-021xevidence.2022.e3754","DOIUrl":"https://doi.org/10.17267/2675-021xevidence.2022.e3754","url":null,"abstract":"INTRODUCTION: Due to the increasing number of cases with immediate and late complications caused by the action of facial fillers such as hyaluronic acid (HA), there is an urgent need to better evaluate the effect of these aesthetic and functional procedures. In this sense, it is relevant to use Infrared Thermography (IRT) as an auxiliary tool for the diagnosis of local dysfunctions. This diagnostic method allows the professional who applies the injections to be certain about the condition of the microcirculation of the anatomical site being treated, enabling the possibility of early intervention in case of adverse effects, such as the development of microbubbles, vascular compression, among other conditions. OBJECTIVE: The aim is to describe the thermal coefficient of the nasolabial sulcus (NLF) region of patients undergoing HA filling, using TRI. METHODS AND MATERIALS: This is a prospective study involving 25 female patients from a private clinic. Thermal imaging will be performed before, immediately after, 1 hour, 3 hours, and 1 month after filling the NLF region with AH. Study approved by CAAE: 34546620.7.0000.5544. RESULTS: The result of this study will allow preventive follow-up and early intervention in cases of vascular alterations related to facial fillings with AH.","PeriodicalId":55996,"journal":{"name":"International Journal of Evidence-Based Healthcare","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90306334","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Vânia Mozetic, Valéria Barros, L. Denadai, Nilva Simeren Bueno de Moraes
{"title":"Risk of bias analysis in diabetic retinopathy randomized clinical trials evaluated by RoB-1 tool from Cochrane systematic reviews","authors":"Vânia Mozetic, Valéria Barros, L. Denadai, Nilva Simeren Bueno de Moraes","doi":"10.17267/2675-021xevidence.2022.e3791","DOIUrl":"https://doi.org/10.17267/2675-021xevidence.2022.e3791","url":null,"abstract":"The objective of clinical trials is to answer about intervention in the real-world, for which they must be properly designed and executed by presenting the results reliably with the findings and in a clear way. OBJECTIVES: To identify the risk of bias in clinical trials about interventions for diabetic retinopathy and/or diabetic macular edema from Cochrane systematic reviews. METHODS: A sensitive search strategy was designed to search Cochrane systematic reviews of interventions in diabetic retinopathy and diabetic macular edema. The assessment of the risk of bias was captured as presented by the author. FINDINGS: We found eight SR and one meta-analysis network totaling 116 randomized clinical trials. Our sample revealed that among the domains randomization, allocation secret, masking of participants and personnel, incomplete outcomes, selective outcomes and others, the risk of bias assessed as low ranged from 30.4 to 49.1%; unclear risk between 22 to 56% and high risk from 1 to 21.7%. CONCLUSIONS: The risk of bias in diabetic retinopathy randomized clinical trials exists in high frequency and the reader must be aware of it.","PeriodicalId":55996,"journal":{"name":"International Journal of Evidence-Based Healthcare","volume":"27 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83714671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
R. Tesch, Esther Takamori, Thayanne B B Calcia, F. Lobo, Eduardo Leitão, L. E. Fontes
{"title":"Platelet-Rich Fibrin for treating temporomandibular disorders in adults: a Scoping Review protocol","authors":"R. Tesch, Esther Takamori, Thayanne B B Calcia, F. Lobo, Eduardo Leitão, L. E. Fontes","doi":"10.17267/2675-021xevidence.2022.e4165","DOIUrl":"https://doi.org/10.17267/2675-021xevidence.2022.e4165","url":null,"abstract":"INTRODUCTION: Different biologically active products have been applied for management of pain and mandibular functional disability in intra-articular TMD but without the ability to effectively control degenerative joint disease. Platelet concentrates aim to enhance tissue healing and facilitate its regeneration. Intra-articular injections of liquid Platelet-Rich Fibrin (PRF) in patients with TMD have demonstrated effectiveness in the management of pain and dysfunction, also having a stimulatory effect on cartilage and bone tissues. OBJECTIVE: The objective of this review is to examine how research has been conducted regarding use of PRF as a treatment tool for temporomandibular joint disorders (TMD). INCLUSION CRITERIA: This review will focus on studies that address adults with TMD without restrictions on gender or ethnicity. TMD will be classified according to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) physical axis (Axis I). Also, we will include publications in any language or date of publication. METHODS: This protocol will follow the JBI guidance for Scoping Reviews. We shall conduct a literature search to identify published research, with no limits on year of publication/conception, format, or language. Two independent reviews will screen and select publications, based on inclusion criteria. Review decision process will be provided in a flowchart based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations for Scoping Reviews. Finally, we shall present extracted data from each study in piloted forms in conceptual categories such as intervention type, population and sample size, duration of intervention, aims, methodology adopted, key findings and gaps in the research.","PeriodicalId":55996,"journal":{"name":"International Journal of Evidence-Based Healthcare","volume":"599 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78951486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Eve Tomlinson, D. de Silva, Jana Stojanova, Roses S Parker, Muriah Umoquit, Stephanie Lagosky, B. Schmidt, K. Head
{"title":"Covid-19 research evidence: An international survey exploring views on useful sources, preferred formats, and accessibility","authors":"Eve Tomlinson, D. de Silva, Jana Stojanova, Roses S Parker, Muriah Umoquit, Stephanie Lagosky, B. Schmidt, K. Head","doi":"10.17267/2675-021xevidence.2022.e4010","DOIUrl":"https://doi.org/10.17267/2675-021xevidence.2022.e4010","url":null,"abstract":"INTRODUCTION: In a pandemic, stakeholders such as policy makers, clinicians, patients, and the public need access to high-quality, timely, relevant research evidence in a format that is understandable and applicable. OBJECTIVES: An online survey was used to determine where a global audience finds research evidence about COVID-19 and how they prefer to keep up to date. METHODS AND MATERIALS: We conducted an online survey of people interested in research in English and Spanish. We used a convenience sample of people visiting websites and social media accounts of Cochrane, an international organisation that collates systematic reviews of research. RESULTS: 831 people with various roles and locations responded over a short period with little active promotion. Healthcare professionals, members of the public, and policy influencers wanted research evidence to inform decisions about COVID-19. More than half found research evidence from government websites (52%), international organisations (57%), journals (56%), and evidence collation organisations (60%) useful. People wanted research evidence about COVID-19 formats such as lay summaries (60%), online systematic reviews (60%), short summaries with commentaries (51%), and visual summaries (48%). People preferred to be kept up to date about COVID-19 research via email updates and newsletters, tailored to people’s interests (34%), traditional media (13%) and social media (12%). CONCLUSIONS: It was feasible to collect feedback rapidly using a simple online survey. Websites from official organisations were key sources of COVID-19 research evidence. More research is needed on how best to provide evidence that is easy to access and understand.","PeriodicalId":55996,"journal":{"name":"International Journal of Evidence-Based Healthcare","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83108341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"A literature review on COVID-19 [coronavirus] research specific to Australia including manuscripts on policy and media releases.","authors":"D. Hilton","doi":"10.17267/2675-021xevidence.2022.e3846","DOIUrl":"https://doi.org/10.17267/2675-021xevidence.2022.e3846","url":null,"abstract":"INTRODUCTION / OBJECTIVES: Comprehending the avalanche of statistical research on COVID-19 [coronavirus] is laborious. Predictions, forecasts, and diagnostic algorithms are important for planning, allocation, and meeting the needs of the increasing population disease burden. Statisticians must be aware of spreadsheets, databases, and calculation methodology to produce valid estimates. Policymakers, government officials, and planners interpret results and read reports without knowing calculation intricacies. Health care workers must be aware of scientific websites whilst they are under increasing stress due to aging populations and improved technology. It is important that context-specific information is sought, read, and understood. METHODS: A literature review was undertaken to find context-specific statistical research information on COVID-19. The author performed a Pubmed search, a search utilising the coronavirus MeSH terms (Medical Subject Headings), adding the additional MeSH terms of Australia AND policy, and then another search with media as a text word. \u0000RESULTS: The Pubmed search, utilising the MeSH (Medical Subject Headings) on coronavirus, adding the MeSH terms [Australia AND Policy] resulted in 52 records being retrieved. The Australian Government Department of Health website dedicated link listing coronavirus (COVID-19) news reports, statements, and media releases included 347 departmental media retrievals. CONCLUSION: The COVID-19 pandemic has posed itself as the most critical health issue of the 21st century. It is important to understand the quality evidence-based information within the context, specific to the reason for seeking information so that well-informed decisions are made that relate to preventative actions, early detection, and treatment options. ","PeriodicalId":55996,"journal":{"name":"International Journal of Evidence-Based Healthcare","volume":"64 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86184357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
J. Lopes, João Souza Filho, Carlos Danilo Crusoé Gomes, Luis Cláudio Lemos Correia
{"title":"Overuse: medical novelty or age-old phenomenon?","authors":"J. Lopes, João Souza Filho, Carlos Danilo Crusoé Gomes, Luis Cláudio Lemos Correia","doi":"10.17267/2675-021xevidence.2022.e3792","DOIUrl":"https://doi.org/10.17267/2675-021xevidence.2022.e3792","url":null,"abstract":"INTRODUCTION: Mentions of overuse tend to imply it is a recent phenomenon as if irrationality was brought about by technological advances and the development of new procedures. However, it is possible that physicians have been prone to the same cognitive biases since antiquity, also performing inappropriate and excessive procedures. This raises the question of whether the contemporary issue of overuse is a modern phenomenon or inherited from a multi-millennial medical tradition. OBJECTIVE: To infer an answer to this question by summarizing the medical literature about overuse throughout the history of medicine. METHODS: Medical overuse is defined as futile, low-value procedures characterized by excessive use of methods with a high probability of causing more harm than good to patients. It examines the history of medical literature, with a critical look at procedures that might be characterized as harmful, futile, or with excessive use of diagnostic and therapeutic methods. RESULTS: This analysis revealed evidence that such procedures have been taking place throughout many periods of history. Studies have shown that the current prevalence of inappropriate medical procedures can be as high as 29% in the United States and 80% of cases for some individual services around the world. Lack of reliable data thwarts accurate analysis of the prevalence of overuse before the last decade. CONCLUSIONS: Instead of a recent phenomenon, overuse has permeated medical practice from its beginnings until today, regardless of technological advances, and is possibly inherent to the human species.","PeriodicalId":55996,"journal":{"name":"International Journal of Evidence-Based Healthcare","volume":"149 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77476547","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Daniell Lima Muniz, Priscilla Araújo Dos Santos, Julian Junior dos Santos Barbosa, Josias Melo Leite, Jefferson Petto
{"title":"Protocolo de estudo para comparar a influência do uso de contraceptivo injetável nos níveis de proteína C reativa e lipoproteína de baixa densidade oxidada","authors":"Daniell Lima Muniz, Priscilla Araújo Dos Santos, Julian Junior dos Santos Barbosa, Josias Melo Leite, Jefferson Petto","doi":"10.17267/2675-021xevidence.2022.e3744","DOIUrl":"https://doi.org/10.17267/2675-021xevidence.2022.e3744","url":null,"abstract":"INTRODUÇÃO: Contraceptivos hormonais são amplamente utilizados em todo o mundo por mulheres para evitar gestação indesejada. Entretanto, pesquisadores sugerem que seu uso contínuo possa provocar efeitos colaterais, como em alteração no perfil lipídico e níveis de Proteína C-reativa (PCR), o que leva à inflamação subclínica e, consequentemente, maior risco cardiovascular. OBJETIVO: Testar a hipótese de que o uso contínuo de contraceptivo injetável (CI) altera os níveis de Proteína C reativa e Lipoproteína de Baixa Densidade – Oxidada de mulheres aparentemente saudáveis. MÉTODOS: Estudo observacional comparativo de corte transversal, que incluirá mulheres que usam e não usam contraceptivo injetável por pelo menos 6 meses. Serão recrutadas a partir de convites por redes sociais, convites em consultórios médicos e convites em unidades de atendimento em saúde. Serão coletados dados antropométricos e sanguíneos para análise dos critérios de exclusão e a coleta de sangue para mensurar a Proteína C-reativa (PCR) e a Lipoproteína de Baixa Densidade oxidada (LDL-ox). Para as voluntárias, serão apresentadas o Termo de consentimento livre e esclarecido. Foi realizado estudo piloto em que foi obtido 14 participantes e foi feito o cálculo de suficiência amostral para o desfecho primário PCR em que foi considerado um alfa de 0,05 e beta 0,80 para relação entre amostras 1:1 e assim foi estimado 82 participantes. Projeto foi submetido ao Comitê de Ética em Pesquisa com CAAE: 37695620.5.0000.0042. RESULTADOS ESTIMADOS: Este estudo poderá sugerir um redirecionamento de tomadas de decisão de trabalhadores da saúde no tocante uso de contraceptivos a mulheres com risco cardiovascular.","PeriodicalId":55996,"journal":{"name":"International Journal of Evidence-Based Healthcare","volume":"20 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89676308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Slow Medicine and Choosing Wisely: a synergistic alliance","authors":"M. Bobbio, S. Vernero, D. Colimberti, A. Gardini","doi":"10.17267/2675-021xevidence.2022.e4222","DOIUrl":"https://doi.org/10.17267/2675-021xevidence.2022.e4222","url":null,"abstract":"Choosing Wisely® is an initiative of the American Board of Internal Medicine Foundation to help physicians and patients engage in conversations about the overuse of tests and procedures and support physician efforts to help patients make smart and effective care choices. Choosing Wisely campaigns are now active and present in 25 countries around the world, on five continents. Italy is the only country where a Choosing Wisely campaign was launched, and it is currently steered by a Nationwide association (Slow Medicine), creating a synergistic alliance. The Slow Medicine Association was founded in 2011 when a group of health professionals and citizens shared a new paradigm of values, methodology, and interventions and decided to establish an association with the mission of working for a health system driven by ethics and quality principles. Three keywords summarize the philosophy of Slow Medicine: measured because it acts with moderation, gradualness, and without waste; respectful because it is attentive to the dignity of individuals recognizing their values; and equitable because it is committed to ensuring appropriate care based on the best available evidence. Slow Medicine allowed the spread of Choosing Wisely in Italy involving several professional societies and participating at the National meetings of the Societies as well as numerous other meetings, in which the mission of the Association is combined with the principle of the ‘do not’ recommendations. Numerous other initiatives were carried out, and new projects were planned in synergy with Choosing Wisely.","PeriodicalId":55996,"journal":{"name":"International Journal of Evidence-Based Healthcare","volume":"97 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85923698","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}