Clinical failure is more common in young children with acute otitis media who receive a short course of antibiotics compared with standard duration
Commentary on: Hoberman AParadise JLRockette HE. Shortened antimicrobial treatment for acute otitis media in young children. N Engl J Med 2016;375:2446–56. Context Acute otitis media (AOM) is a leading cause of doctor consultations and antibiotic prescriptions in young children.1 Strategies to reduce antibiotic prescribing for AOM and thereby the emerging spread of antimicrobial resistance have focused on watchful waiting and delayed prescription, in particular in children over 2 years.2 An alternative strategy to combat antimicrobial resistance is to reduce the duration of antibiotic treatment. So far, the evid...
Source: Evidence-Based Medicine - June 9, 2017 Category: Internal Medicine Authors: Venekamp, R. P., Schilder, A. G. M. Tags: Therapeutics/Prevention Source Type: research
Close contact casting may result in similar outcomes compared with plate fixation for unstable ankle fractures in patients over 60 years old
This study compared outcomes among older adults with ankle fractures who received ORIF versus close contact casting. Methods This study was prospective, powered and randomised to determine the outcomes at 6 months of adults aged 60 years or older using the Olerund-Molander Ankle Score (OMAS). Patients were randomised to casting or surgery (ORIF) in a 1:1 ratio. The surgeons were trained in the casting technique before the study. If casting failed and the patient underwent ORIF, the patient... (Source: Evidence-Based Medicine)
Source: Evidence-Based Medicine - June 9, 2017 Category: Internal Medicine Authors: Younger, A. Tags: Therapeutics/Prevention Source Type: research
A clinical risk score to predict the incidence of postpartum venous thromboembolism
Commentary on: Sultan AA, West J, Grainge MJ, et al.. Development and validation of risk prediction model for venous thromboembolism in postpartum women: multinational cohort study. BMJ 2016;355:i6253. Context Around 1 in 1000 postpartum women suffers from venous thromboembolism (VTE).1 The occurrence of deep vein thromboses (DVT), often found in proximal veins, may affect long-term quality of life,2 and pulmonary embolisms (PE) are a leading cause of direct maternal death in this very healthy population. Given the overall low absolute risk of VTE, as well as the cost of thromboprophylaxis and its possible side-effects, th...
Source: Evidence-Based Medicine - June 9, 2017 Category: Internal Medicine Authors: Blondon, M., Hugon-Rodin, J. Tags: Therapeutics/prevention Source Type: research
Early invasive strategy in patients with non-ST segment elevation acute coronary syndrome delays death or MI by 18 months
Commentary on: Wallentin L, Lindhagen L, Ärnström E, et al. Early invasive versus non-invasive treatment in patients with non-ST-elevation acute coronary syndrome (FRISC-II): 15 year follow-up of a prospective, randomised, multicentre study. Lancet 2016;388:1903–11. Context The role of coronary arteriography in patients with non-ST segment elevation acute coronary syndrome is controversial. Many cardiologists advocate a ‘routine invasive strategy’, which comprises coronary arteriography within a few days of presentation and myocardial revascularisation determined by the angiographic f...
Source: Evidence-Based Medicine - June 9, 2017 Category: Internal Medicine Authors: Henderson, R. Tags: Therapeutics/Prevention Source Type: research
Team-based primary care with integrated mental health is associated with higher quality of care, lower usage and lower payments received by the delivery system
This study compares measures of healthcare quality and usage as well as actual payments received and programme investment costs for patients receiving care in TBC/mental health integration practices versus those in usual care. Methods This was a retrospective, longitudinal, cohort study of adult patients (n=113 452) who received primary care at Intermountain Healthcare primary care practices. Patients ≥18 years old... (Source: Evidence-Based Medicine)
Source: Evidence-Based Medicine - June 9, 2017 Category: Internal Medicine Authors: English, A. F. Tags: Therapeutics/Prevention Source Type: research
Similar prostate cancer and all-cause mortality in men with localised prostate cancer undergoing surgery or radiation therapy versus active monitoring at 10 years of follow-up
Commentary on: Hamdy FC, Donovan JL, Lane JA, et al.. 10-Year outcomes after monitoring, surgery, or radiotherapy for localized prostate cancer. N Engl J Med 2016;375:1415–24. Donovan JL, Hamdy FC, Lane JA, et al. Patient-reported outcomes after monitoring, surgery, or radiotherapy for prostate cancer. N Engl J Med 2016;375:1425–37. Context Prostate cancer (PCA) remains a common and potentially fatal condition. Effective and safe treatment options are needed. However, few randomised trials have assessed the benefits and harms of radical prostatectomy (RPX), radiation therapy (XRT) and watchful waiting/observati...
Source: Evidence-Based Medicine - June 9, 2017 Category: Internal Medicine Authors: Dahm, P., Ilic, D., Wilt, T. Tags: Therapeutics/Prevention Source Type: research
How good is the evidence to support primary care practice?
In conclusion, approximately half of the recommendations for primary care practice are based on patient-oriented evidence, but only 18% are based on patient-oriented evidence from consistent, high-quality studies. (Source: Evidence-Based Medicine)
Source: Evidence-Based Medicine - June 9, 2017 Category: Internal Medicine Authors: Ebell, M. H., Sokol, R., Lee, A., Simons, C., Early, J. Tags: Editor's choice Original EBM Research Source Type: research
Rating the certainty in evidence in the absence of a single estimate of effect
When studies measure or report outcomes differently, it may not be feasible to pool data across studies to generate a single effect estimate (ie, perform meta-analysis). Instead, only a narrative summary of the effect across different studies might be available. Regardless of whether a single pooled effect estimate is generated or whether data are summarised narratively, decision makers need to know the certainty in the evidence in order to make informed decisions. In this guide, we illustrate how to apply the constructs of the GRADE (Grading of Recommendation, Assessment, Development and Evaluation) approach to assess the...
Source: Evidence-Based Medicine - June 9, 2017 Category: Internal Medicine Authors: Murad, M. H., Mustafa, R. A., Schünemann, H. J., Sultan, S., Santesso, N. Tags: Open access EBM Primer Source Type: research
Grading evidence from test accuracy studies: what makes it challenging compared with the grading of effectiveness studies?
This article presents solutions adopted to addresses above challenges for judicious estimation of the strength of test accuracy evidence used to inform evidence syntheses for guideline development. (Source: Evidence-Based Medicine)
Source: Evidence-Based Medicine - June 9, 2017 Category: Internal Medicine Authors: Rogozinska, E., Khan, K. Tags: Editor's choice Perspective Source Type: research
Evidence-Based Medicine these 7 years: time for the editor to go on permanent sabbatical
Seven years seems the right term for an editorship. It is a time for the land that has been sown and reaped to remain uncultivated for a while (see Exodus or Leviticus, The Bible)—time for a sabbatical. When I came on in 2010, Evidence-Based Medicine (EBM) was already well established (for 15 years, its adolescence)1 as was the field of EBM (>3 years earlier, its birth).2 At the beginning, the journal aimed to serve this ‘emerging clinical discipline by providing easier access to high-quality evidence that is ready for prime-time clinical application’. The journal scanned a list of 29 other j...
Source: Evidence-Based Medicine - June 9, 2017 Category: Internal Medicine Authors: Saitz, R. Tags: Editor's choice Editorials Source Type: research
Passive leg raising may serve as the primary method to quickly assess fluid responsiveness in haemodynamically unstable patients
Commentary on: Bentzer P, Griesdale DE, Boyd J, et al.. Will this hemodynamically unstable patient respond to a bolus of intravenous fluids? JAMA 2016;316:1298–309. Context Administration of intravenous fluids still serves as the cornerstone of haemodynamic resuscitation, yet both insufficient as well as overzealous fluid loading can increase morbidity and mortality. Correctly predicting fluid responsiveness is thus of the utmost importance, especially since only half of critically ill patients positively respond to a fluid bolus. Bentzer et al investigated the diagnostic performance of different methods in predictin...
Source: Evidence-Based Medicine - March 23, 2017 Category: Internal Medicine Authors: Cherpanath, T. G. Tags: EBM Diagnosis Source Type: research
Both a stage shift and changes in stage-specific survival have contributed to reductions in breast cancer mortality
Commentary on: Welch HG, Prorok PC, O'Malley AJ, et al.. Breast-cancer tumor size, overdiagnosis, and mammography screening effectiveness. N Engl J Med 2016;375:1438–47. Context Since randomised trials demonstrated a reduction in breast cancer mortality with mammographic screening, such screening has become widespread in developed countries, and mortality from breast cancer has declined in recent decades.1 There is interest in quantifying the proportion of this mortality reduction attributable to screening and that attributable to improvements in treatment. Methods This paper reported on analysis of breast cancer inc...
Source: Evidence-Based Medicine - March 23, 2017 Category: Internal Medicine Authors: Duffy, S. W., Etzioni, R., Sasieni, P. Tags: EBM Diagnosis Source Type: research
Adverse events associated with mood stabiliser treatment should be continuously monitored in patients diagnosed with bipolar affective disorder
Commentary on: Hayes JF, Marston L, Walters K, et al.. Adverse Renal, Endocrine, Hepatic, and Metabolic Events during Maintenance Mood Stabilizer Treatment for Bipolar Disorder: A Population-Based Cohort Study. PLoS Med 2016;13(8):e1002058. Context Bipolar disorder is most often severe and recurrent, requiring pharmacological maintenance treatment in combination with psychoeducation and/or other interventions.1 Evidence for the efficacy and tolerability of pharmacological treatment is primarily based on randomised controlled trials (RCTs). However, RCTs are usually characterised by a relatively short duration of follow-up ...
Source: Evidence-Based Medicine - March 23, 2017 Category: Internal Medicine Authors: Nielsen, R. E., Licht, R. W. Tags: Aetiology/Harm Source Type: research
Patients with coronary heart disease and very low blood pressure are at increased risk of cardiovascular events
Commentary on: Vidal-Petiot E, Ford I, Greenlaw N, et al.. Cardiovascular event rates and mortality according to achieved systolic and diastolic blood pressure in patients with stable coronary artery disease: an international cohort study. Lancet 2016;388:2142–52. Context Very large observational studies have provided evidence against a ‘J-shaped association’ between systolic blood pressure (SBP) or diastolic blood pressure (DBP) and risk of cardiovascular disease (CVD).1 The log-linear relationship observed in these studies indicates that, within the normal physiological BP range, there is no threshold b...
Source: Evidence-Based Medicine - March 23, 2017 Category: Internal Medicine Authors: Rahimi, K., Mohseni, H. Tags: Aetiology/Harm Source Type: research
High-dose sulphonylurea treatment in patients with renal impairment should be considered with caution
Commentary on: van Dalem J, Brouwers MC, Stehouwer CD, et al.. Risk of hypoglycaemia in users of sulphonylureas compared with metformin in relation to renal function and sulphonylurea metabolite group: population based cohort study. BMJ 2016;354:i3625. Context Type 2 diabetes mellitus (T2DM) is one of the most serious health problems worldwide.1 Strict glycaemic control has been emphasised, and the number of patients with the risk of hypoglycaemia has increased.2 Hypoglycaemia is a serious side effect of treatment with sulphonylureas, which stimulate insulin secretion regardless of blood glucose level. It is more common in...
Source: Evidence-Based Medicine - March 23, 2017 Category: Internal Medicine Authors: Kim, G., Kang, E. S. Tags: Aetiology/Harm Source Type: research
