Showing papers in "ACP journal club in 1998"
TL;DR: Your patient is a 60-year-old hypertensive, alcobolic woman whose symptomless atrial fibrillation was first documented 3 months aqo, and an echocardiogram shows an enlarged left atrium, rendering successful cardio-version unlikely.
Abstract: Your patient is a 60-year-old hypertensive, alcobolic woman whose symptomless atrial fibrillation was first documented 3 months aqo. An echocardiogram shows an enlarged left atrium, rendering successful cardio-version unlikely. She tells you that both of her parents bad severe strokes that made the lest years of their lives horrible, and she is terified of having a stroke. Yon know that a meta-analysis of 5 randomized trials of warfarin in nonvalvular atrial fibrillation demonstrated a 68% relative risk reduction (RRR) in stroke (I). You consider prescribing watfarin for this patient but know that she would not have qualified for the study because alcoholism increases her risk for major hemorrhage (2).
82 citations
TL;DR: This EBM Note reviews the derivation and meaning of numbers in the Evidence-Based Medicine abstracts that describe diagnostic tests, and introduces the latest additions of terms to the Glossary.
Abstract: In the Evidence-Based Medicine abstracts that describe diagnostic tests, we provide our readers with numbers that summarise the tests9 accuracy. Several years ago, an editorial in ACT Journal Club (1) summarised some guides to help readers critically appraise articles about diagnostic tests. This EBM Note reviews the derivation and meaning of those numbers and introduces the latest additions of terms to our Glossary.
45 citations
Journal Article•
16 citations
TL;DR: CM constitutes an important area for the implementation of evidence-based medicine for better patient care because use of this type of medicine is increasing in health care and evidence from randomised trials supports some interventions commonly described as CM.
Abstract: Applying evidence-based medicine to complementary medicine (CM), which includes such therapies as acupuncture, chiropractic, hypnosis, and herbal medicine, seems at first contradictory. CM is often defined as techniques for which no evidence of benefit exists (or as a speaker at a recent Cochrane Colloquium put it, “medicine is either scientific or complementary”) But many of the interventions used by conventional clinicians have little scientific support. Conversely, evidence from randomised trials supports some interventions commonly described as CM. Use of this type of medicine is increasing in health care: About 10% of the U.K. population visits a CM practitioner each year (1), and about 40% of U.K. general practices offer their patients access to CM services through the National Health Service (NHS) (2). Thus, CM constitutes an important area for the implementation of evidence-based medicine for better patient care.
12 citations
TL;DR: Further thoughts from the perspective of a clinician who has found that the decision-making process is for more complex than is currently acknowledged are offered.
Abstract: Glasziou and colleagues (1) offer 4 extremely useful criteria for applying evidence to the decision-making interface between clinicians and patients. The process of applying average group-derived data (e.g., from a randomized controlled trial) to an individual patient remains a difficult, time-consuming, and incompletely studied skill. Glasziou and colleagues highlight parts of the skill, including 1) stratifying findings according to individual patient characteristics, 2) assessing whether the intervention can be approximated in a nonstudy setting, 3) quantifying the benefits and harms, and 4) incorporating individual preferences. Lest we become complacent that these are the only challenges in applying evidence to individual patients, I offer further thoughts from the perspective of a clinician who has found that the decision-making process is for more complex than is currently acknowledged.
8 citations
TL;DR: The 1998 edition of Best Evidence has just been released and it will tell you about its benefits so you can decide for yourself whether it might help you in providing evidence-based medical care.
Abstract: The 1998 edition of Best Evidence has just been released. We are proud of it, but given our involvement in assembling it, reluctant to boast. We will tell you about its benefits so you can decide for yourself whether it might help you in providing evidence-based medical care.
7 citations
TL;DR: Once you get into the right frame of mind, it is hard not work in an evidence-based way, and is lots of fun.
Abstract: Often hear people say, “Real doctors don9t have time for evidence-based medicine.” In fact, practising evidence-based medicine while you work Desn9t take much time at all—just motivation. I did it as a house officer intern), and you don9t get much busier than that. Once you get into the right frame of mind, it is hard not work in an evidence-based way, and is lots of fun.
5 citations
TL;DR: Predicting on the basis of history, physical examinations, and laboratory results when diagnose, prognosticate, discuss causes, and choose treatment options is central to most of the authors' actions as clinicians.
Abstract: Prediction is central to most of our actions as clinicians. We are faced with the task of predicting on the basis of history, physical examinations, and laboratory results when we diagnose, prognosticate, discuss causes, and choose treatment options. Is the patient with pain radiating down her left arm having a myocardial infarction, and to what extent should my prediction change if the pain radiates only to her right shoulder? What is the risk for an embolic stroke in a hypertensive woman with nonvalvular atrial fibrillation? What degree of benefit can a man with symptomatic 90% carotid stenosis derive from carotid endarterectomy if he also has diabetes and a 60 pack-year history of smoking?
5 citations
4 citations
TL;DR: Source Citation Mayo-Smith MF, for the American Society of Addiction Medicine Working Group on Pharmacological Management of Alcohol Withdrawal, Pharmacological management of alcohol withdrawal.
Abstract: Source Citation Mayo-Smith MF, for the American Society of Addiction Medicine Working Group on Pharmacological Management of Alcohol Withdrawal. Pharmacological management of alcohol withdrawal. A ...
3 citations
TL;DR: Source Citation Fried LP, Kronmal RA, Newman AB, et al.
Abstract: Source Citation Fried LP, Kronmal RA, Newman AB, et al. Risk factors for 5-year mortality in older adults. The Cardiovascular Health Study. JAMA. 1998 Feb 25;279:585-92.9486752
TL;DR: Effect of prophylactic amiodarone on mortality after acute myocardial infarction and in congestive heart failure and the meta-analysis of these trials found it to be beneficial.
Abstract: Source Citation Amiodarone Trials Meta-Analysis Investigators. Effect of prophylactic amiodarone on mortality after acute myocardial infarction and in congestive heart failure: meta-analysis of ind...
TL;DR: The cost-effectiveness of misoprostol in preventing serious gastrointestinal events associated with the use of nonsteroidal antiinflammatory drug...
Abstract: Source Citation Maetzel A, Ferraz MB, Bombardier C. The cost-effectiveness of misoprostol in preventing serious gastrointestinal events associated with the use of nonsteroidal antiinflammatory drug...
TL;DR: Source Citation Sim I, McDonald KM, Lavori PW, Norbutas CM, Hlatky MA: Quantitative overview of randomized trials of amiodarone to prevent sudden cardiac death.
Abstract: Source Citation Sim I, McDonald KM, Lavori PW, Norbutas CM, Hlatky MA. Quantitative overview of randomized trials of amiodarone to prevent sudden cardiac death. Circulation. 1997 Nov 4;96:2823-9.93...
TL;DR: Source Citation Le Bars PL, Katz MM, Berman N, et al., for the North American EGb Study Group, A placebo-controlled, double-blind, randomized trial of an extract of ginkgo biloba for dementia.
Abstract: Source Citation Le Bars PL, Katz MM, Berman N, et al., for the North American EGb Study Group. A placebo-controlled, double-blind, randomized trial of an extract of ginkgo biloba for dementia. JAMA...
TL;DR: The plasma concentration of C-reactive protein and risk of developing peripheral vascular disease is associated with an increased risk of adverse events and death in women.
Abstract: Source Citation Ridker PM, Cushman M, Stampfer MJ, Tracy RP, Hennekens CH. Plasma concentration of C-reactive protein and risk of developing peripheral vascular disease. Circulation. 1998 Feb 10; 9...
TL;DR: A systematic review of clinical trials of tacrine in the treatment of Alzheimer's disease and its role in the development and use in clinical practice concluded that tacrine should be considered as a potential treatment for Alzheimer’s disease.
Abstract: Source Citation Arrieta JL, Rodriguez Artalejo F. Methodology, results and quality of clinical trials of tacrine in the treatment of Alzheimer's disease: a systematic review of the literature. Age ...
TL;DR: Keenan et al. as discussed by the authors performed a meta-analysis on the effect of noninvasive positive pressure ventilation on mortality in patients admitted with acute respiratory failure, and found that positive pressure ventilations improved the survival rate.
Abstract: Source Citation Keenan SP, Kernerman PD, Cook DJ, et al. Effect of noninvasive positive pressure ventilation on mortality in patients admitted with acute respiratory failure: a meta-analysis. Crit ...
TL;DR: The medical consultant's role in caring for patients with hip fracture should be considered when selecting a consultant, according to the severity of the fracture and the need for follow-up care.
Abstract: Source Citation Morrison RS, Chassin MR, Siu AL. The medical consultant's role in caring for patients with hip fracture. Ann Intern Med. 1998 Jun 15;128:1010-20. Erratum. Ann Intern Med. In press.
TL;DR: The use of selective serotonin-reuptake inhibitors or tricyclic antidepressants and risk of hip fractures in elderly people are studied to determine whether these drugs should be considered as a single treatment or a combination.
Abstract: Source Citation Liu B, Anderson G, Mittmann N, et al. Use of selective serotonin-reuptake inhibitors or tricyclic antidepressants and risk of hip fractures in elderly people. Lancet. 1998 May 2;351...
TL;DR: Hemminki et al. as discussed by the authors studied the impact of postmenopausal hormone therapy on cardiovascular events and cancer using pooled data from clinical trials, and found that the effect of hormone therapy was positively associated with cardiovascular events.
Abstract: Source Citation Hemminki E, McPherson K. Impact of postmenopausal hormone therapy on cardiovascular events and cancer: pooled data from clinical trials. BMJ. 1997 Jul 19;315:149-53.
TL;DR: Source Citation Gough A, Clapperton M, Rolando N, et al.
Abstract: Source Citation Gough A, Clapperton M, Rolando N, et al. Randomised placebo-controlled trial of granulocyte-colony stimulating factor in diabetic foot infection. Lancet. 1997 Sep 20;350:855-9.9310604
TL;DR: Source Citation Bucher HC, Griffith LE, Guyatt GH: Effect of HMGcoA reductase inhibitors on stroke, a meta-analysis of randomized, controlled trials.
Abstract: Source Citation Bucher HC, Griffith LE, Guyatt GH. Effect of HMGcoA reductase inhibitors on stroke. A meta-analysis of randomized, controlled trials. Ann Intern Med. 1998 Jan 15;128:89-95.
TL;DR: Source Citation McDermott MM, Schmitt B, Wallner E. Impact of medication nonadherence on coronary heart disease outcomes: a critical review.
Abstract: Source Citation McDermott MM, Schmitt B, Wallner E. Impact of medication nonadherence on coronary heart disease outcomes: a critical review. Arch Intern Med. 1997 Sep 22;157:1921-9.