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The literature on nudges and their evaluation is extensive, and it highlights the diversity of behavioural biases and possible interventions. Nudges seek to modify the architecture of individual decisions. They change people’s behavior in a specific direction and at a low cost. Its impact must take into account the cost-effectiveness of the money invested, compared to other traditional public interventions that pursue the same objective. The use of experiments in its evaluation has made nudges an important tool of evidence-based policy, thus improving the design and effectiveness of public action. In this article we seek to review the current knowledge regarding the design and evaluation of nudges, and its importance for the development of evidence-based policies. [ABSTRACT FROM AUTHOR]

Experimental studies are used to assess the effi cacy and eff ectiveness of therapeutic (pharmacological or surgical), preventive (such as vaccination or lifestyle changes) or educational interventions (e.g., workshops to improve quality and healthcare). There are diff erent experimental studies but, currently, randomized controlled trial (RCT) is recognized as the type of study that provides the highest level of evidence. When this type of research cannot be carried out, there are quasi-experimental studies, where there may be no randomization or a control group; however, this type of studies has a lower degree of validity. This article describes the way diff erent types of RCT and quasi-experimental studies are performed; their advantages and disadvantages are also explained. [ABSTRACT FROM AUTHOR]

Introduction: Intravenous rescue analgesia in the postoperative anesthesia care unit (PACU) is the most effective method for reducing postoperative pain (POP) when perioperative multimodal analgesia fails to control it. Appropriate analgesia during these first postoperative hours may prevent morbidity associated with pain. Objective: To compare the effectiveness of intravenous morphine versus fentanyl in the PACU for reducing severe POP. Methods: Randomized, prospective, double blind trial that included patients with severe POP using VAS in the PACU. Rescue was performed on one group with 0,1 mg/Kg morphine and with another with 1 μg/Kg of fentanyl every 5 minutes intravenously until pain was reduced from severe to mild (VAS < 4). Thirty patients were included in both groups. Results: There were no significant differences in the percentage of patients with reduction of severe POP to mild 5 minutes after the injection of morphine or fentanyl, or in the subsequent rescue analgesia intervals (P > .05). Similarly, there were no significant differences in mean VAS (95% CI) in morphine or fentanyl groups beginning 5 minutes after the first analgesic dose (P > .05) between the groups. There were no significant differences in side effects such as respiratory depression, nausea, vomiting or pruritus (P = 1,0). There was a high satisfaction in both groups (P > ,05). Conclusions: Morphine and fentanyl were equally effective in treating severe POP after 5 minutes and following intervals after rescue analgesia was initiated, during 25 minutes at PACU, with no differences in efficacy or adverse effects between groups (Register # NCT02145975 clinicaltrials.gov, prospective). [ABSTRACT FROM AUTHOR]

Physicians should always remember that a negative result in a superiority trial never would prove that the therapies under research are equivalent; more often, there may be a risk of type 2 (false negative) error. Equivalence and not inferiority studies demand high standards to provide reliable results. Physicians should take into account above all that the equivalence margins tend to be too large to be clinically significant and that the claim of equivalence can be misleading if a study has not been conducted at a sufficiently high level. In addition, physicians must be a bit skeptical of judgments that do not include the basic requirements of information, including the definition and justification of the equivalence margin, the calculation of the size of the sample bearing in mind this margin, the presentation of both analysis (intention-to-treat and by protocol), and provide confidence intervals for the results. Equivalence and inferiority studies are not indicated in certain areas. If one follows the required strict adherence to the specific methodology, such studies can provide new and important knowledge. [ABSTRACT FROM AUTHOR]

Objective: The hypothesis was that the calcium and vitamin D supplementation prevents falls at the population level. Study design: The OSTPRE-FPS was a randomized populationbased open-trial with 3-year follow-up. The supplementation group (n = 1566) received daily cholecalciferol 800 IU + calcium carbonate 1000 mg, while the control group (n = 1573) received no supplementation or placebo. A randomly selected subsample of 593 subjects underwent a detailed measurement program including 25(OH)D measurements. Main outcome measure: The occurrence of falls was the primary outcome of the study. The participants in the subsample were telephoned at 4 months intervals and the rest of the trial population was interviewed by phone once a year. Results: In the entire trial population (ETP), there were 812 women with 1832 falls in the group and 833 women with 1,944 falls in the control group (risk ratio was 0.98, 95% CI 0.92-1.05, p = 0.160). The supplementation was not associated with single or multiple falls in the ETP. However, in the subsample, multiple fall incidence decreased by 30% (odds ratio [OR] 0.70, 95% CI 0.50-0.97, p = 0.034) in the supplementation group. Further, the supplementation decreased the incidence of multiple falls requiring medical attention (OR 0.72, 95% CI 0.53-0.97, p = 0.031) in the ETP. The mean compliance in the entire trial population was 78% and in the subsample 79%. Discussion: Overall, the primary analysis showed no association between calcium and vitamin D supplementation and risk of falls. However, the results of a post hoc analysis suggested that there was a decreased risk of multiple falls requiring medical attention: this finding requires confirmation. [ABSTRACT FROM AUTHOR]

Introduction: Randomized clinical trials (RCT) are one of the most reliable methods of scientific investigation in health sciences. It is a corner stone of evidence based medicine and the backbone of high standard knowledge. Several types of errors can compromise the results and affect its validity. Objectives: To assess the risk of bias of the clinical trials published in the Revista Colombiana de Anestesiología (RCA) medical journal by applying the «risk of bias detection» tool of the Cochrane Collaboration. Methods: All the clinical trials in the RCA journal were found by carrying out a systematic research. These trials were randomly distributed among 6 evaluators trained in the use of the «risk of bias detection» tool of the Cochrane Collaboration. Results were presented descriptively, graphically and chronologically to each of the 6 parameters that conform the «risk of bias detection» tool. Results: The RCA journal has published 40 volumes as of 1973. The searching process identified a total 75 RCT up until 2009. The frequency of RCT publication has risen with time. The cities with most publications were Bogotá DC and Medellín, and most trials were related to the management of acute and chronic pain. The greatest risk of bias (29% of all RCT) was found in the concealing of randomization sequences (parameter 2). 30% of the studies showed four or more parameter values of low risk of bias. A trend of decreasing proportion of high risk values was observed as time passed. Conclusions: There is a sustained trend of improvement and risk reduction in RCTs' in the RCA journal. [ABSTRACT FROM AUTHOR]

Borderline personality disorder (BPD) is a serious psychiatric disorder in which people suffer from emotional instability, severe emotional distress and behavioral difficulties regarding both the relationship they have with themselves and with others. Attempted suicides are common. There is a lot of research about the effectiveness of therapies for this mental disorder. The aim of this review is to show the main empirical studies about psychological interventions for the treatment of BPD. Systematic reviews and clinical trials point to the dialectical-behavior therapy as being the best psychotherapeutic practice for the treatment of people with borderline personality disorder, due to the fact that it can reduce risk of suicide as well as substance abuse. It is thought that cognitive-behavioral therapy might also be an useful approach, although there is less evidence for this; cognitive treatments have not yet shown their effectiveness. Finally, there is evidence that some drugs could significantly improve the therapeutic effects of the psychological treatments used on patients suffering from this disorder. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to analyze change of lifestyle in obese patients with cognitive behavior therapy and acupressure. Methods: An experimental study was performed with placebo control group. Forty patients were randomly assigned to intervention group (cognitive behaviour therapy + acupressure) and control group (information session). Outcome measure was a questionnaire for the assessment and quantification of obesity related lifestyles. Measures were performed at baseline and, after 3-months intervention. Results: After 3 months of treatment, the intervention group showed significant differences (p < 0.05) in weight loss, diet and physical activity. Conclusion: In the obese patient, cognitive behavior therapy and acupressure, it has lost at least three kilograms over three months and has changed lifestyles related to obesity. [ABSTRACT FROM AUTHOR]

The substantial increase of randomized controlled trials demand familiarity with the essential aspects of their design and performance by the cardiologist, particularly the adequate interpretation and applicability of the results. In this clinically-based review, we discuss some important aspects in the assessment of novel contemporary therapy such as the use and analysis of composite endpoints; implications from early termination of trials and extrapolation of results to the population. [ABSTRACT FROM AUTHOR]