Pub Date : 2017-10-01Epub Date: 2017-07-22DOI: 10.1136/ebmed-2017-110754
Neri A Alvarez-Villalobos, Rene Rodriguez-Gutierrez, Victor M Montori
{"title":"Value of screening for and treating pre-diabetes is reduced by low test accuracy and indirect evidence of impact on patient important outcomes.","authors":"Neri A Alvarez-Villalobos, Rene Rodriguez-Gutierrez, Victor M Montori","doi":"10.1136/ebmed-2017-110754","DOIUrl":"10.1136/ebmed-2017-110754","url":null,"abstract":"","PeriodicalId":12182,"journal":{"name":"Evidence-Based Medicine","volume":"22 5","pages":"180-181"},"PeriodicalIF":0.0,"publicationDate":"2017-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35191232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-10-01Epub Date: 2017-08-11DOI: 10.1136/ebmed-2017-110726
Mario Cazzola, Paola Rogliani
{"title":"In stable COPD, long-acting muscarinic antagonist plus long-acting beta-agonists resulted in less exacerbations, pneumonia and larger improvement in FEV <sub><sub>1</sub></sub> than long-acting beta-agonists plus inhaled corticosteroids.","authors":"Mario Cazzola, Paola Rogliani","doi":"10.1136/ebmed-2017-110726","DOIUrl":"10.1136/ebmed-2017-110726","url":null,"abstract":"","PeriodicalId":12182,"journal":{"name":"Evidence-Based Medicine","volume":"22 5","pages":"183-184"},"PeriodicalIF":0.0,"publicationDate":"2017-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35260722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-10-01Epub Date: 2017-08-26DOI: 10.1136/ebmed-2017-110791
Robert S Rosenson
{"title":"CETP inhibition improves the lipid profile but has no effect on clinical cardiovascular outcomes in high-risk patients.","authors":"Robert S Rosenson","doi":"10.1136/ebmed-2017-110791","DOIUrl":"10.1136/ebmed-2017-110791","url":null,"abstract":"","PeriodicalId":12182,"journal":{"name":"Evidence-Based Medicine","volume":"22 5","pages":"184-185"},"PeriodicalIF":0.0,"publicationDate":"2017-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35449387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-10-01Epub Date: 2017-08-17DOI: 10.1136/ebmed-2016-110585
Sarah D de Ferranti, Radley C Sheldrick
Paediatric lipid screening has been recommended for decades to identify youth at increased risk for early atherosclerotic disease but is controversial and not universally adopted. A 2016 review by the US Preventive Services Task Force (USPSTF) found inadequate evidence to recommend for or against lipid screening in childhood. In this Perspective article, we examine this controversial and important topic more broadly. We consider whether the USPSTF framework is asking the right questions, and whether the answers to these questions should be valued equally, whether the USPSTF questions are answerable and by what types of evidence and whether the burden of proof is appropriate. We argue that using a broader framework that includes the magnitude of potential benefits and harms, considering more types of evidence beyond randomised controlled trials, and more fully incorporating patient and parent perspectives could lead to more practical and more widely applicable guidance for practitioners, guide future research priorities and be more inclusive of patient priorities.
{"title":"USPSTF is unable to recommend for or against lipid screening to identify multifactorial dyslipidaemia in childhood: no recommendation is not without consequences.","authors":"Sarah D de Ferranti, Radley C Sheldrick","doi":"10.1136/ebmed-2016-110585","DOIUrl":"https://doi.org/10.1136/ebmed-2016-110585","url":null,"abstract":"<p><p>Paediatric lipid screening has been recommended for decades to identify youth at increased risk for early atherosclerotic disease but is controversial and not universally adopted. A 2016 review by the US Preventive Services Task Force (USPSTF) found inadequate evidence to recommend for or against lipid screening in childhood. In this Perspective article, we examine this controversial and important topic more broadly. We consider whether the USPSTF framework is asking the right questions, and whether the answers to these questions should be valued equally, whether the USPSTF questions are answerable and by what types of evidence and whether the burden of proof is appropriate. We argue that using a broader framework that includes the magnitude of potential benefits and harms, considering more types of evidence beyond randomised controlled trials, and more fully incorporating patient and parent perspectives could lead to more practical and more widely applicable guidance for practitioners, guide future research priorities and be more inclusive of patient priorities.</p>","PeriodicalId":12182,"journal":{"name":"Evidence-Based Medicine","volume":"22 5","pages":"162-163"},"PeriodicalIF":0.0,"publicationDate":"2017-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/ebmed-2016-110585","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35279454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-10-01Epub Date: 2017-08-17DOI: 10.1136/ebmed-2017-110775
Ewelina Rogozińska, Nadine Marlin, Shakila Thangaratinam, Khalid S Khan, Javier Zamora
Meta-analysis based on individual participant data (IPD), often described as the 'gold standard' for effectiveness evidence synthesis, is increasingly being deployed despite being more resource intensive than collating study-level results. Its professed virtues include the ability to incorporate unreported data and to standardise variables and their definitions across trials. In reality, the unreported data, although present in shared datasets, might still not be usable in the analysis. The characteristics of trial participants and their outcomes may be too diversely captured for harmonisation and too time and resource consuming to standardise. Embarking on an IPD meta-analysis can lead to unanticipated challenges which ought to be handled with pragmatism. The aim of this article is to discuss the opportunities created by access to IPD and the practical limitations placed on such meta-analyses, using an international IPD meta-analysis of trials on the effect of lifestyle interventions in pregnancy as an example. Despite the increasing uptake of IPD meta-analysis, they encounter old problems shared by other research methods. When embarking on IPD meta-analysis, it is essential to evaluate the trade-offs between the ambitions, and what is achievable due to constraints imposed by the condition of collected IPD. Furthermore, incorporation of aggregate data from trials where IPD was not available should be a mandatory sensitivity analysis that makes the evidence synthesis up-to-date.
{"title":"Meta-analysis using individual participant data from randomised trials: opportunities and limitations created by access to raw data.","authors":"Ewelina Rogozińska, Nadine Marlin, Shakila Thangaratinam, Khalid S Khan, Javier Zamora","doi":"10.1136/ebmed-2017-110775","DOIUrl":"https://doi.org/10.1136/ebmed-2017-110775","url":null,"abstract":"<p><p>Meta-analysis based on individual participant data (IPD), often described as the 'gold standard' for effectiveness evidence synthesis, is increasingly being deployed despite being more resource intensive than collating study-level results. Its professed virtues include the ability to incorporate unreported data and to standardise variables and their definitions across trials. In reality, the unreported data, although present in shared datasets, might still not be usable in the analysis. The characteristics of trial participants and their outcomes may be too diversely captured for harmonisation and too time and resource consuming to standardise. Embarking on an IPD meta-analysis can lead to unanticipated challenges which ought to be handled with pragmatism. The aim of this article is to discuss the opportunities created by access to IPD and the practical limitations placed on such meta-analyses, using an international IPD meta-analysis of trials on the effect of lifestyle interventions in pregnancy as an example. Despite the increasing uptake of IPD meta-analysis, they encounter old problems shared by other research methods. When embarking on IPD meta-analysis, it is essential to evaluate the trade-offs between the ambitions, and what is achievable due to constraints imposed by the condition of collected IPD. Furthermore, incorporation of aggregate data from trials where IPD was not available should be a mandatory sensitivity analysis that makes the evidence synthesis up-to-date.</p>","PeriodicalId":12182,"journal":{"name":"Evidence-Based Medicine","volume":"22 5","pages":"157-162"},"PeriodicalIF":0.0,"publicationDate":"2017-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/ebmed-2017-110775","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35279451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-10-01Epub Date: 2017-08-30DOI: 10.1136/ebmed-2017-110761
Donald Dudley
Commentary on: Esplin MS, Elovitz MA, Iams JD, et al . Predictive accuracy of serial transvaginal cervical lengths and quantitative vaginal fetal fibronectin levels for spontaneous preterm birth among nulliparous women. JAMA 2017;317:1047–1056. Approximately 10% of pregnancies in the USA are delivered preterm, with two-thirds being spontaneous.1 While the single greatest risk factor for preterm birth (PTB) is a history of PTB, about 40% of pregnancies occur in nulliparous women. Identifying nulliparas who are most at risk for spontaneous PTB would allow for new approaches to lower the PTB rate. Two strategies have been promoted to identify women at high risk for PTB, including serial cervical length (CL) measurements and quantitative fetal fibronectin (FFN) concentrations. A short cervix has been shown to place women with a prior PTB at high risk for subsequent PTB …
{"title":"Serial transvaginal cervical length measurements and quantitative vaginal fetal fibronectin concentrations did not predict spontaneous preterm birth in low-risk nulliparous women.","authors":"Donald Dudley","doi":"10.1136/ebmed-2017-110761","DOIUrl":"https://doi.org/10.1136/ebmed-2017-110761","url":null,"abstract":"Commentary on: Esplin MS, Elovitz MA, Iams JD, et al . Predictive accuracy of serial transvaginal cervical lengths and quantitative vaginal fetal fibronectin levels for spontaneous preterm birth among nulliparous women. JAMA 2017;317:1047–1056.\u0000\u0000Approximately 10% of pregnancies in the USA are delivered preterm, with two-thirds being spontaneous.1 While the single greatest risk factor for preterm birth (PTB) is a history of PTB, about 40% of pregnancies occur in nulliparous women. Identifying nulliparas who are most at risk for spontaneous PTB would allow for new approaches to lower the PTB rate. Two strategies have been promoted to identify women at high risk for PTB, including serial cervical length (CL) measurements and quantitative fetal fibronectin (FFN) concentrations. A short cervix has been shown to place women with a prior PTB at high risk for subsequent PTB …","PeriodicalId":12182,"journal":{"name":"Evidence-Based Medicine","volume":"22 5","pages":"188"},"PeriodicalIF":0.0,"publicationDate":"2017-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/ebmed-2017-110761","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35457613","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-10-01Epub Date: 2017-07-17DOI: 10.1136/ebmed-2017-110742
Colm P Travers, Waldemar A Carlo
{"title":"Antenatal corticosteroid administration between 24 hours and 7 days before extremely preterm delivery is associated with the lowest rate of mortality.","authors":"Colm P Travers, Waldemar A Carlo","doi":"10.1136/ebmed-2017-110742","DOIUrl":"10.1136/ebmed-2017-110742","url":null,"abstract":"","PeriodicalId":12182,"journal":{"name":"Evidence-Based Medicine","volume":"22 5","pages":"189"},"PeriodicalIF":0.0,"publicationDate":"2017-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9709903/pdf/nihms-1847900.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35176155","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-10-01Epub Date: 2017-07-29DOI: 10.1136/ebmed-2017-110753
Christopher de Gara, Vanessa Falk
Commentary on : Lazzati A, De Antonio M, Paolino L, et al . Natural history of adjustable gastric banding: lifespan and revisional rate. A nationwide study on administrative data on 53,000 patients. Ann Surg 2017;265:439–445. Worldwide obesity and its consequences are increasing at alarming rates.1 The only long-term proven treatment for obesity and its comorbidities is bariatric surgery.2 In 2008, the adjustable gastric band (AGB) was the most commonly performed bariatric procedure.3 Its early low complication rate and technically easy learning curve made it very popular; however, long-term complications have dogged this operation. Additionally, weight recidivism has led to band removal in 50% of patients4. This large French national retrospective study of prospectively collected data examines AGB survival and revision rates after …
{"title":"Over half of the patients who undergo adjustable gastric banding may require revision bariatric surgery.","authors":"Christopher de Gara, Vanessa Falk","doi":"10.1136/ebmed-2017-110753","DOIUrl":"https://doi.org/10.1136/ebmed-2017-110753","url":null,"abstract":"Commentary on : Lazzati A, De Antonio M, Paolino L, et al . Natural history of adjustable gastric banding: lifespan and revisional rate. A nationwide study on administrative data on 53,000 patients. Ann Surg 2017;265:439–445.\u0000\u0000Worldwide obesity and its consequences are increasing at alarming rates.1 The only long-term proven treatment for obesity and its comorbidities is bariatric surgery.2 In 2008, the adjustable gastric band (AGB) was the most commonly performed bariatric procedure.3 Its early low complication rate and technically easy learning curve made it very popular; however, long-term complications have dogged this operation. Additionally, weight recidivism has led to band removal in 50% of patients4. This large French national retrospective study of prospectively collected data examines AGB survival and revision rates after …","PeriodicalId":12182,"journal":{"name":"Evidence-Based Medicine","volume":"22 5","pages":"191"},"PeriodicalIF":0.0,"publicationDate":"2017-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/ebmed-2017-110753","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35365912","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-10-01Epub Date: 2017-07-12DOI: 10.1136/ebmed-2017-110756
Jessica L Roberts, Ravi M Patel
Commentary on: Ting JY, Synnes A, Roberts A, et al . Association Between Antibiotic Use and Neonatal Mortality and Morbidities in Very Low-Birth-Weight Infants Without Culture-Proven Sepsis or Necrotizing Enterocolitis. JAMA Pediatr . 2016;170:1181–1187. Concerns about antibiotic overuse have been raised since the 1940s, largely driven by worries about antibiotic resistance and the limited development pipeline for new antimicrobials.1 More recently, prolonged antibiotic exposure has been associated with adverse outcomes in preterm infants, including sepsis, necrotising enterocolitis and mortality.2 3 Paralleling these findings has been the rapid increase in our knowledge of the importance of the gut microbiome in health and disease,4 one that is substantially altered in infancy by antimicrobial exposure.5 Understanding the relationship between antimicrobial …
{"title":"Antibiotic utilisation in very low birth weight infants without sepsis or necrotising enterocolitis is associated with multiple adverse outcomes.","authors":"Jessica L Roberts, Ravi M Patel","doi":"10.1136/ebmed-2017-110756","DOIUrl":"https://doi.org/10.1136/ebmed-2017-110756","url":null,"abstract":"Commentary on: Ting JY, Synnes A, Roberts A, et al . Association Between Antibiotic Use and Neonatal Mortality and Morbidities in Very Low-Birth-Weight Infants Without Culture-Proven Sepsis or Necrotizing Enterocolitis. JAMA Pediatr . 2016;170:1181–1187.\u0000\u0000Concerns about antibiotic overuse have been raised since the 1940s, largely driven by worries about antibiotic resistance and the limited development pipeline for new antimicrobials.1 More recently, prolonged antibiotic exposure has been associated with adverse outcomes in preterm infants, including sepsis, necrotising enterocolitis and mortality.2 3 Paralleling these findings has been the rapid increase in our knowledge of the importance of the gut microbiome in health and disease,4 one that is substantially altered in infancy by antimicrobial exposure.5 Understanding the relationship between antimicrobial …","PeriodicalId":12182,"journal":{"name":"Evidence-Based Medicine","volume":"22 5","pages":"187"},"PeriodicalIF":0.0,"publicationDate":"2017-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/ebmed-2017-110756","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35162933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-10-01Epub Date: 2017-08-05DOI: 10.1136/ebmed-2017-110751
Redi Llubani, Michael Böhm
Commentary on: Schmidt M, Mansfield KE, Bhaskaran K, et al . Serum creatinine elevation after renin–angiotensin system blockade and long term cardiorenal risks: cohort study. BMJ 2017;356: j791. An increase in serum creatinine level may occur in the first 2 weeks that follow ACE inhibitor (ACEI)/angiotensin receptor blocker (ARB) therapy as a consequence of lowering intraglomerular pressure. Such renal impairment at baseline should stabilise within 2–4 weeks assuming normal volume and sodium intake. Renal function might deteriorate further when increasing the dose of diuretics, initiation of non-steroidal anti-inflammatory drugs (NSAIDs) or development of volume depletion from non-diuretic-induced causes such as gastroenteritis.1 Most guidelines recommend monitoring and stopping the treatment, if there is a creatinine increase of 30% or more. Recent studies have shown that ACEI and ARBs may be particularly effective in lowering the incidence of cardiovascular events.2 This study examined the incidence of cardiorenal events in ACEI/ARB …
{"title":"Early renin-angiotensin system inhibition induced renal deterioration may be a predictor for long-term cardiorenal outcomes.","authors":"Redi Llubani, Michael Böhm","doi":"10.1136/ebmed-2017-110751","DOIUrl":"https://doi.org/10.1136/ebmed-2017-110751","url":null,"abstract":"Commentary on: Schmidt M, Mansfield KE, Bhaskaran K, et al . Serum creatinine elevation after renin–angiotensin system blockade and long term cardiorenal risks: cohort study. BMJ 2017;356: j791.\u0000\u0000An increase in serum creatinine level may occur in the first 2 weeks that follow ACE inhibitor (ACEI)/angiotensin receptor blocker (ARB) therapy as a consequence of lowering intraglomerular pressure. Such renal impairment at baseline should stabilise within 2–4 weeks assuming normal volume and sodium intake. Renal function might deteriorate further when increasing the dose of diuretics, initiation of non-steroidal anti-inflammatory drugs (NSAIDs) or development of volume depletion from non-diuretic-induced causes such as gastroenteritis.1 Most guidelines recommend monitoring and stopping the treatment, if there is a creatinine increase of 30% or more. Recent studies have shown that ACEI and ARBs may be particularly effective in lowering the incidence of cardiovascular events.2 \u0000\u0000This study examined the incidence of cardiorenal events in ACEI/ARB …","PeriodicalId":12182,"journal":{"name":"Evidence-Based Medicine","volume":"22 5","pages":"185-186"},"PeriodicalIF":0.0,"publicationDate":"2017-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/ebmed-2017-110751","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35386827","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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