Applying the results of trials and systematic reviews to Individual patients
Paul Glasziou,Gordon H. Guyatt,Antonio L. Dans,Leonila F. Dans,Sharon E. Straus,David L. Sackett +5 more
TLDR
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).read more
Citations
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Efficacy of spinal manipulation and mobilization for low back pain and neck pain: a systematic review and best evidence synthesis.
TL;DR: In this article, the authors evaluated the efficacy of spinal manipulation for low back pain and neck pain using randomized clinical trials (RCTs) and applied more stringent criteria for study admissibility into evidence and for isolating the effect of SMT and/or MOB.
Efficacy of spinal manipulation and mobilisation for low back and neck pain : A systematic review and best evidence synthesis
TL;DR: Recommendations can be made with some confidence regarding the use of SMT and/or MOB as a viable option for the treatment of both low back pain and NP, with special attention to applying more stringent criteria for study admissibility into evidence.
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Users' Guides to the Medical Literature: XX. Integrating Research Evidence With the Care of the Individual Patient
TL;DR: Clinicians must consider a patient's risk of adverse events from any intervention and incorporate the patient's values in clinical decision making by using information about the risks and benefits of therapeutic alternatives.
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Can we individualize the ‘number needed to treat’? An empirical study of summary effect measures in meta-analyses
TL;DR: The fixed effects OR, random effects OR and random effects RR appear to be reasonably constant across different baseline risks, and clinicians may wish to rely on the random effects model RR and use the PEER to individualize NNT when they apply the results of a meta-analysis in their practice.
References
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Measurement of health state utilities for economic appraisal.
TL;DR: A framework for economic appraisal is presented displaying the various components that must be measured, and showing how the three forms of analysis relate to the framework and to each other.
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The number needed to treat: a clinically useful measure of treatment effect.
Richard J. Cook,David L. Sackett +1 more
TL;DR: The relative benefit of an active treatment over a control is usually expressed as the relative risk, the Relative risk reduction, or the odds ratio, but for clinical decision making, it is more meaningful to use the measure "number needed to treat."
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An assessment of clinically useful measures of the consequences of treatment.
TL;DR: The goal is to provide a clear picture of the individual components of the immune system and provide a strategy for individualized treatment of these components according to their Kesslerian importance.
Journal ArticleDOI
Users' guides to the medical literature. II. How to use an article about therapy or prevention. A. Are the results of the study valid? Evidence-Based Medicine Working Group.
Journal ArticleDOI
Decision aids for patients facing health treatment or screening decisions: systematic review
Annette M. O'Connor,Alaa Rostom,Valerie Fiset,Jacqueline Tetroe,Vikki Entwistle,Hilary A. Llewellyn-Thomas,Margaret Holmes-Rovner,Michael J. Barry,Jean Jones +8 more
TL;DR: In this paper, a systematic review of randomised trials of patient decision aids in improving decision making and outcomes was conducted, which included randomized trials of interventions providing structured, detailed, and specific information on treatment or screening options and outcomes to aid decision making.