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Betamethasone for scars but then it would be a whole different situation.
[20, 21] If we consider the different effects of two forms treatment for scarring, we might have some reason for accepting a higher level of evidence concerning the efficacy these agents.
[21, 22] In any event, if we consider the potential of using one agent for scars over the other, we may have another rationale for accepting evidence of efficacy one therapy but not for the other.
[23]. If we are to find that a single treatment is preferable to more than one treatment, a single treatment must be superior to the other forms of treatment on a clinically significant level of evidence. To assess the superiority of a single treatment in this context, we may use a modified version of the scale used by National Institute for Health and Clinical Excellence ( NICE ) to assess the difference between treatments.
[24] A single agent is not preferable to an effective combination of two or more. If one combination is superior to another, then the two or more are only ones that should be used. The scale for assessing superiority of different treatments is as follows: [i -ii]
[25] The scale is given in Table 3:
TABLE 3 Comparison of treatment with a single agent for particular lesion [24] Comparison of treatment with an agent plus a combination of one or more other agents [25]
As the scale only considers evidence of superiority in a specific case, no absolute evidence is available to support a preferred choice of alternative treatment over a single agent treatment. However, one must be aware that the evidence of clinical superiority for an agent may be affected by other factors, for example, the amount of clinical experience person or team treating the patient. If patient does not have a particularly high degree of clinical expertise, other factors, Phentermine 37.5 mg online pharmacy such as the type of treatment plan used, and which option they follow, could influence their decision to use the single agent or combination of two more other treatments.
[26] There is a need for more evidence regarding the safety, dosage management, dosing frequency and tolerability, cost-effectiveness, adverse effects of these agents. As the choice of agents for topical steroids and/or oral steroid therapies involves decisions regarding whether to use high levels of the agent or not, a rigorous evidence-based method needs to be developed assess these alternatives. This evidence requires both the development of a rigorous clinical trial and follow-up study design a standardized methodology for gathering and analyzing the relevant data to evaluate their quality. Ideally, the findings of these studies would also be reported in the same manner as findings of other controlled trials topical and/or oral therapies and would have been rigorously published.
[27] The use of other agents would increase the overall efficacy of current therapies and the effectiveness would be enhanced by additional data on safety or side-effects as well other important issues that need to be considered; e.g., cost, availability, effectiveness in different age strata, and side-effects. Given the uncertainties concerning efficacy, side-effects and cost-effectiveness with current agents their combination, some alternative should be explored. There would benefits from further investigating and possibly developing alternatives of other agents to current therapies.
[28] A clear indication for the decision concerning whether a therapeutic approach or and/or combination of therapies, such as topical steroids or oral steroid therapies combined with a non-steroidal antiandrogen, should be based on the following evidence:
[i] an absolute minimum amount of evidence for therapeutic efficacy [ ii] a minimum of at least one study that provides evidence of safety and tolerability that satisfies the criterion of acceptable study design and conduct [ iii] evidence of clinical superiority with at least one study showing improvement and demonstrating deterioration [ iv] data to determine cost-effectiveness [ v] sufficient number of individuals to provide good quality data, i.e., not less than two patients, for every treatment arm
[29] There is an urgent need for more effective methods of assessment and efficacy to make them available and promptly. Further improvement in the standard methods used to assess study design, conduct and report clinical trials is necessary in order to increase the rigour of their findings.
[30, 31] A key question with respect to assessing effectiveness requires the evaluation of treatment as a whole from both sides. This question is not easily answered in a single, blinded, placebo-controlled setting, since the subjects treated are aware they receiving either the treatment or placebo. Consequently, in some cases, we need to evaluate both the treatment and plus one or more other treatments in order to determine how effective a therapy is. As matter of fact, the only appropriate method to determine superiority is the double-blind study that combines both sides so as not to compromise the treatment of either patients and to prevent bias favouritism.
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Impresión offset
Cuando los volúmenes son medianos a grandes, la mejor alternativa tanto en costo como en calidad es la impresión offset (no fluye, cambiar las palabras) en Laserge usamos la impresión offset para la reproducción de de revistas, folletos libros, flyers, etc y todo servicio en el que el volumen y los tiempos justifiquen el costo inicial que implica el poner a punto una impresión offset, esto es fotolitos, placas, etc
Cuando usar impresión digital o impresión offset?
Con cada necesidad de impresión, se puede emplear el mejor método, con el cual se satisfagan los requerimientos de calidad, velocidad y tiraje, estos requerimientos se evalúan tomando en cuenta las siguientes caracteristicas:
- Calidad: El estándar de calidad en la industria grafica es la impresión offset, con los equipos de impresión digital que poseemos, podemos acércanos a esta calidad reproduciendo su misma gama de colores además de nitidez
- Velocidad: Debido a su propia naturaleza, la impresión offset requiere de pasos intermedios para su implementación, entre ellos se encuentra la confección de fotolitos, placas, etc. Debido a esto, la inmediatez no es una posibilidad, cosa contraria con la impresión digital, que elimina a cero estos pasos intermedios, permitiendo al instante conseguir la copia impresa
- Tirajes: La impresión digital se caracteriza por impresiones cortas llegando hasta el punto en que el volumen justifica los pasos intermedios del offset, es a partir de este punto donde la impresin offset no tiene rival, dandole la mayor calidad y la mas alta versatilidad en papeles y gramajes de impresion
- Personalización: Con la impresión digital es posible dotar a la impresión de caracteristicas únicas impresión tras impresión, factor muy util en las actuales tendencias del marketing
- Costo: En la impresión digital los costos van en relacion directa con la cantidad a imprimir, no siendo asi en la impresión offset en donde después de un costo alto al inicio, el precio final se estabiliza, variando muy poco de impresión a impresión, esto es ideal para medios masivos de difusión impresa.
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