evidence-based medicine literature review
DESCRIPTION
Evidence-based Medicine Literature Review. Jauch Symposium, May 2014. EBM – Key Concepts. POEMS - Patient Oriented Evidence that Matters - changes our practice Strategies to keep up - 50,000 RCTs by 2019 Evaluating articles in context. Evidenced-based Sources. Dynamed - PowerPoint PPT PresentationTRANSCRIPT
![Page 1: Evidence-based Medicine Literature Review](https://reader035.vdocument.in/reader035/viewer/2022062302/56816585550346895dd83263/html5/thumbnails/1.jpg)
Evidence-based Medicine Literature ReviewJauch Symposium, May 2014
![Page 2: Evidence-based Medicine Literature Review](https://reader035.vdocument.in/reader035/viewer/2022062302/56816585550346895dd83263/html5/thumbnails/2.jpg)
EBM – Key ConceptsPOEMS - Patient Oriented
Evidence that Matters - changes our practice
Strategies to keep up - 50,000 RCTs by 2019
Evaluating articles in context
![Page 3: Evidence-based Medicine Literature Review](https://reader035.vdocument.in/reader035/viewer/2022062302/56816585550346895dd83263/html5/thumbnails/3.jpg)
Evidenced-based SourcesDynamedEssential Evidence PlusCochrane DatabaseACP Journal ClubUS Preventive task forceTrip databaseSome specialty guidelines
![Page 4: Evidence-based Medicine Literature Review](https://reader035.vdocument.in/reader035/viewer/2022062302/56816585550346895dd83263/html5/thumbnails/4.jpg)
Oxford Centre Evidence Levels1A- Systematic reviews1B - Randomized controlled trials2 - Cohort studies3 - Case-control4 - Case series5 - Expert Opinion
A,B,C, and D
![Page 5: Evidence-based Medicine Literature Review](https://reader035.vdocument.in/reader035/viewer/2022062302/56816585550346895dd83263/html5/thumbnails/5.jpg)
EBM – Key ConceptsKeep track of systematic reviews
and randomized controlled trials with patient-oriented results
Consider using synthesized database to keep up with literature
Evaluate new information in context and for practice change
![Page 6: Evidence-based Medicine Literature Review](https://reader035.vdocument.in/reader035/viewer/2022062302/56816585550346895dd83263/html5/thumbnails/6.jpg)
Diets/Supplements
![Page 7: Evidence-based Medicine Literature Review](https://reader035.vdocument.in/reader035/viewer/2022062302/56816585550346895dd83263/html5/thumbnails/7.jpg)
Mediterranean diet What we know – Observational studies and a secondary
prevention trial showed decrease cv risk Low fat diets standard treatment Takes extreme decrease in cholesterol
intake to create plaque reversal Study for primary prevention vs low fat
diet
![Page 8: Evidence-based Medicine Literature Review](https://reader035.vdocument.in/reader035/viewer/2022062302/56816585550346895dd83263/html5/thumbnails/8.jpg)
Mediterranean diet 7447 people in Spain 55-80 yrs old with type 2 DM or 3 risk
factors followed for 4.8 yrs Mediterranean diet + olive oil or + nuts
(mix of hazelnuts, almonds, and walnuts) Low fat diet Scores for diet adherence similar Combined endpoint of MI, stroke and death
– both arms did better than low fat
![Page 9: Evidence-based Medicine Literature Review](https://reader035.vdocument.in/reader035/viewer/2022062302/56816585550346895dd83263/html5/thumbnails/9.jpg)
Mediterranean diet But… all the benefit was in the prevention
of ischemic strokes, and no sign women Reduction from 2.4% to 1.6% event rate Subgroups better if BMI > 30, nonsmokers,
better adherence, htn, dyslipids, neg FH And the nuts or the olive oil was donated
by food companies More intensive diet counseling control
after 3 years
![Page 10: Evidence-based Medicine Literature Review](https://reader035.vdocument.in/reader035/viewer/2022062302/56816585550346895dd83263/html5/thumbnails/10.jpg)
Omega-3 FA Supplements Omega-3 FA and fish oil What we know – recent studies
indicating no benefit – cholesterol, dementia,
The new Vit E – touted for everything but nothing panning out
But wait…
![Page 11: Evidence-based Medicine Literature Review](https://reader035.vdocument.in/reader035/viewer/2022062302/56816585550346895dd83263/html5/thumbnails/11.jpg)
Omega-3 FA Supplements Patients with RA < 12 mo, DMARD – naïve
started on triple DMARD therapy 86 on high dose Fish oil supplement and 53
low dose fish oil supplement Previous meta analysis subj & obj benefits High dose fish oil group 22% less failure of
triple therapy, remission 2x more in a year 88% f/u, only 122 pts finished, trend SAEs
![Page 12: Evidence-based Medicine Literature Review](https://reader035.vdocument.in/reader035/viewer/2022062302/56816585550346895dd83263/html5/thumbnails/12.jpg)
Diagnostic studies
![Page 13: Evidence-based Medicine Literature Review](https://reader035.vdocument.in/reader035/viewer/2022062302/56816585550346895dd83263/html5/thumbnails/13.jpg)
D-DimerVery good at excluding DVT and PE if
negative (<500)Not good in elderlyADJUST-PE study – JAMA March 19, 2014Multicenter, consecutive ER patientsAge-adjusted D-Dimer level (age x 10
mcg/dl)3346 patients suspected PE (53-74)
![Page 14: Evidence-based Medicine Literature Review](https://reader035.vdocument.in/reader035/viewer/2022062302/56816585550346895dd83263/html5/thumbnails/14.jpg)
D-Dimer age adjusted19% PE rateHigh clinical likelihood – CTA2898 – D-dimer, 337 in age-adjust1 of 331 patients had confirmed VTE
in 3 months Similar to rates with negative workupNo CTA in negative group
![Page 15: Evidence-based Medicine Literature Review](https://reader035.vdocument.in/reader035/viewer/2022062302/56816585550346895dd83263/html5/thumbnails/15.jpg)
Treatment Studies
![Page 16: Evidence-based Medicine Literature Review](https://reader035.vdocument.in/reader035/viewer/2022062302/56816585550346895dd83263/html5/thumbnails/16.jpg)
Migraine Treatment Abortive therapy options – NSAIDS,
Ergotamines, Triptans, Combo agents, Narcotics, Barbituates
Significant risk of rebound headaches Patients often develop tolerance to
meds Have to take meds right away to get
benefit OTCs often used, most Rxs expensive
![Page 17: Evidence-based Medicine Literature Review](https://reader035.vdocument.in/reader035/viewer/2022062302/56816585550346895dd83263/html5/thumbnails/17.jpg)
Migraine Treatment Cochrane Database Meta-analysis of 13
RCTs, noted in a PURL in The Journal of Family Practice, Feb 2014
3 aspirin tabs with/without 10 mg metoclopramide
5 placebo studies, 4 against common treatments, 4 both
> 3200 patients, 2 hour pain-free, 2 hour headache relief, 24 hour headache relief
![Page 18: Evidence-based Medicine Literature Review](https://reader035.vdocument.in/reader035/viewer/2022062302/56816585550346895dd83263/html5/thumbnails/18.jpg)
Migraine Treatment NNT vs placebo – 9 for pain free status Equivalent to sumatriptan 50 mg 2 hour
measures 2/4 studies Metoclopramide reduced nausea and
vomiting No GI bleeds, NNH 34 vs placebo for GI
upset No comments about rebound headaches
![Page 19: Evidence-based Medicine Literature Review](https://reader035.vdocument.in/reader035/viewer/2022062302/56816585550346895dd83263/html5/thumbnails/19.jpg)
Sore throat Cochrane systematic review 2012 Eight studies, 743 pts 369 kids, 374
adults Antibiotic with/without steroids Studies used one dose oral, three days
oral, one dose IM and three days IM One day course oral probably enough –
all were similar in effectiveness
![Page 20: Evidence-based Medicine Literature Review](https://reader035.vdocument.in/reader035/viewer/2022062302/56816585550346895dd83263/html5/thumbnails/20.jpg)
Sore throat The Results: Reduced pain faster 8 vs 14 hours Mean time to resolution of pain 14 hours
faster More pain resolved at 24 hours (27%) and 48 hours (30%) Not clear if would work without
antibiotics No difference in risks, adverse events
![Page 21: Evidence-based Medicine Literature Review](https://reader035.vdocument.in/reader035/viewer/2022062302/56816585550346895dd83263/html5/thumbnails/21.jpg)
Forearm fractures in kids UK study – 317 kids, mostly falls, mostly
radius fractures, all minimally displaced Bone Joint Journal Dec 2013 Half fiberglass cast for 3 weeks (std
care) Half soft cast tape for 3 weeks 2 patients had increased pain converted No complications at 6 mo f/u (91%)
![Page 22: Evidence-based Medicine Literature Review](https://reader035.vdocument.in/reader035/viewer/2022062302/56816585550346895dd83263/html5/thumbnails/22.jpg)
Forearm fractures
![Page 23: Evidence-based Medicine Literature Review](https://reader035.vdocument.in/reader035/viewer/2022062302/56816585550346895dd83263/html5/thumbnails/23.jpg)
Prevention news
![Page 24: Evidence-based Medicine Literature Review](https://reader035.vdocument.in/reader035/viewer/2022062302/56816585550346895dd83263/html5/thumbnails/24.jpg)
TIAs/Minor Strokes What we know: Patients with TIAs and minor strokes at
higher risk or another stroke (10-20% in 3 months)
Clopidogrel + asa not better than either alone and increase risk of bleeding
Asa benefits post TIA/stroke
![Page 25: Evidence-based Medicine Literature Review](https://reader035.vdocument.in/reader035/viewer/2022062302/56816585550346895dd83263/html5/thumbnails/25.jpg)
TIAs/Minor Strokes Randomized, double-blind, in China 5170 patients with TIA/minor stroke All patients asa first day 75 – 300 mg Had to begin in study in first 24 hours Asa group 75 mg daily and placebo Clopidogrel group – 300 mg load, 75 mg
daily + asa day 2-21, then placebo Only 90 day f/u
![Page 26: Evidence-based Medicine Literature Review](https://reader035.vdocument.in/reader035/viewer/2022062302/56816585550346895dd83263/html5/thumbnails/26.jpg)
TIAs/Minor Strokes 8% strokes in 90 days in combined
group, 11.7% in aspirin group, no sign difference in bleeding risks
NNT 29, stroke rate in China 5x US Only included high risk TIAs – score
based on age, blood pressure, clinical features, duration and diabetes
Minor stroke < 4 stroke scale