Pub Date : 2017-08-01Epub Date: 2017-07-17DOI: 10.1136/ebmed-2017-110743
Alex Stagnaro-Green
Overt thyroid disease, be it overt hypothyroidism or overt hyperthyroidism, is associated with a multitude of adverse outcomes during pregnancy including miscarriage, gestational hypertension, gestational diabetes, preterm delivery and decreased IQ in the offspring.1 In its most severe form, overt hypothyroidism results in cretinism. The impact of subclinical hypothyroidism (SCH) on pregnancy outcomes is complex. Observational and retrospective studies have shown a correlation with adverse maternal and fetal events.2 In 1999, Pop et al 3 and Haddow et al 4 reported a correlation between hypothyroidism and isolated hypothyroxinaemia (IH) with decreased neurocognitive function in the offspring. However, only two prospective randomised studies have evaluated the impact of levothyroxine therapy for SCH or IH on pregnancy outcomes. In an Italian study, levothyroxine therapy for SCH in thyroid antibody-positive women in the first trimester of pregnancy …
{"title":"Second trimester levothyroxine treatment for subclinical hypothyroidism or hypothyroxinaemia of pregnancy does not improve cognitive outcomes of children.","authors":"Alex Stagnaro-Green","doi":"10.1136/ebmed-2017-110743","DOIUrl":"https://doi.org/10.1136/ebmed-2017-110743","url":null,"abstract":"Overt thyroid disease, be it overt hypothyroidism or overt hyperthyroidism, is associated with a multitude of adverse outcomes during pregnancy including miscarriage, gestational hypertension, gestational diabetes, preterm delivery and decreased IQ in the offspring.1 In its most severe form, overt hypothyroidism results in cretinism. The impact of subclinical hypothyroidism (SCH) on pregnancy outcomes is complex. Observational and retrospective studies have shown a correlation with adverse maternal and fetal events.2 In 1999, Pop et al 3 and Haddow et al 4 reported a correlation between hypothyroidism and isolated hypothyroxinaemia (IH) with decreased neurocognitive function in the offspring. However, only two prospective randomised studies have evaluated the impact of levothyroxine therapy for SCH or IH on pregnancy outcomes. In an Italian study, levothyroxine therapy for SCH in thyroid antibody-positive women in the first trimester of pregnancy …","PeriodicalId":12182,"journal":{"name":"Evidence-Based Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/ebmed-2017-110743","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35176156","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 : 2017-06-01Epub Date: 2017-05-25DOI: 10.1136/ebmed-2017-110737
William Clark, Paul Bird, Terry Diamond, Peter Gonski, Elizabeth Barnes, Val Gebski
We are concerned by commentary1 about the VAPOUR trial2 written by authors of two previous masked vertebroplasty trials.3 4 Having participated in the larger of these trials, INVEST,3 we adopted similar trial methodology in VAPOUR but restricted patient inclusion criteria to fractures <6 weeks duration causing severe pain (table 1). View this table: Table 1 Comparison of inclusion criteria, baseline fracture duration and NRS pain measures, baseline hospitalisation status prior to enrolment, placebo and masking analysis, crossover and primary endpoints in the three masked vertebroplasty trials that have been published The commentary speculates that …
{"title":"Criticisms of the VAPOUR trial in a recent commentary are unsubstantiated and incorrect.","authors":"William Clark, Paul Bird, Terry Diamond, Peter Gonski, Elizabeth Barnes, Val Gebski","doi":"10.1136/ebmed-2017-110737","DOIUrl":"https://doi.org/10.1136/ebmed-2017-110737","url":null,"abstract":"We are concerned by commentary1 about the VAPOUR trial2 written by authors of two previous masked vertebroplasty trials.3 4 Having participated in the larger of these trials, INVEST,3 we adopted similar trial methodology in VAPOUR but restricted patient inclusion criteria to fractures <6 weeks duration causing severe pain (table 1).\u0000\u0000View this table:\u0000\u0000Table 1 \u0000Comparison of inclusion criteria, baseline fracture duration and NRS pain measures, baseline hospitalisation status prior to enrolment, placebo and masking analysis, crossover and primary endpoints in the three masked vertebroplasty trials that have been published\u0000\u0000\u0000\u0000The commentary speculates that …","PeriodicalId":12182,"journal":{"name":"Evidence-Based Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/ebmed-2017-110737","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35028798","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 : 2017-06-01Epub Date: 2017-05-29DOI: 10.1136/ebmed-2017-110704
Mark H Ebell, Randi Sokol, Aaron Lee, Christopher Simons, Jessica Early
Our goal was to determine the extent to which recommendations for primary care practice are informed by high-quality research-based evidence, and the extent to which they are based on evidence of improved health outcomes (patient-oriented evidence). As a substrate for study, we used Essential Evidence, an online, evidence-based, medical reference for generalists. Each of the 721 chapters makes overall recommendations for practice that are graded A, B or C using the Strength of Recommendations Taxonomy (SORT). SORT A represents consistent and good quality patient-oriented evidence; SORT B is inconsistent or limited quality patient-oriented evidence and SORT C is expert opinion, usual practice or recommendations relying on surrogate or intermediate outcomes. Pairs of researchers abstracted the evidence ratings for each chapter in tandem, with discrepancies resolved by the lead author. Of 3251 overall recommendations, 18% were graded 'A', 34% were 'B' and 49% were 'C'. Clinical categories with the most 'A' recommendations were pregnancy and childbirth, cardiovascular, and psychiatric; those with the least were haematological, musculoskeletal and rheumatological, and poisoning and toxicity. 'A' level recommendations were most common for therapy and least common for diagnosis. Only 51% of recommendations are based on studies reporting patient-oriented outcomes, such as morbidity, mortality, quality of life or symptom reduction. 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.
{"title":"How good is the evidence to support primary care practice?","authors":"Mark H Ebell, Randi Sokol, Aaron Lee, Christopher Simons, Jessica Early","doi":"10.1136/ebmed-2017-110704","DOIUrl":"https://doi.org/10.1136/ebmed-2017-110704","url":null,"abstract":"<p><p>Our goal was to determine the extent to which recommendations for primary care practice are informed by high-quality research-based evidence, and the extent to which they are based on evidence of improved health outcomes (patient-oriented evidence). As a substrate for study, we used Essential Evidence, an online, evidence-based, medical reference for generalists. Each of the 721 chapters makes overall recommendations for practice that are graded A, B or C using the Strength of Recommendations Taxonomy (SORT). SORT A represents consistent and good quality patient-oriented evidence; SORT B is inconsistent or limited quality patient-oriented evidence and SORT C is expert opinion, usual practice or recommendations relying on surrogate or intermediate outcomes. Pairs of researchers abstracted the evidence ratings for each chapter in tandem, with discrepancies resolved by the lead author. Of 3251 overall recommendations, 18% were graded 'A', 34% were 'B' and 49% were 'C'. Clinical categories with the most 'A' recommendations were pregnancy and childbirth, cardiovascular, and psychiatric; those with the least were haematological, musculoskeletal and rheumatological, and poisoning and toxicity. 'A' level recommendations were most common for therapy and least common for diagnosis. Only 51% of recommendations are based on studies reporting patient-oriented outcomes, such as morbidity, mortality, quality of life or symptom reduction. 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.</p>","PeriodicalId":12182,"journal":{"name":"Evidence-Based Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/ebmed-2017-110704","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35038566","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 : 2017-06-01Epub Date: 2017-04-03DOI: 10.1136/ebmed-2017-110683
Alastair Younger
Commentary on: Willett K , Keene DJ , Mistry D , et al . Close contact casting vs surgery for initial treatment of unstable ankle fractures in older adults: a randomized clinical trial. JAMA 2016;316:1455–63.[OpenUrl][1] Surgery has been considered the mainstay of treatment for unstable ankle fractures. Early mobilisation and weight bearing is possible with stable anatomic fracture fixation (open reduction internal fixation (ORIF)). Surgery also increases the risk of wound problems. This study compared outcomes among older adults with ankle fractures who received ORIF versus close contact casting. 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, … [1]: {openurl}?query=rft.jtitle%253DJAMA%26rft.volume%253D316%26rft.spage%253D1455%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx
{"title":"Close contact casting may result in similar outcomes compared with plate fixation for unstable ankle fractures in patients over 60 years old.","authors":"Alastair Younger","doi":"10.1136/ebmed-2017-110683","DOIUrl":"https://doi.org/10.1136/ebmed-2017-110683","url":null,"abstract":"Commentary on: Willett K , Keene DJ , Mistry D , et al . Close contact casting vs surgery for initial treatment of unstable ankle fractures in older adults: a randomized clinical trial. JAMA 2016;316:1455–63.[OpenUrl][1] \u0000\u0000Surgery has been considered the mainstay of treatment for unstable ankle fractures. Early mobilisation and weight bearing is possible with stable anatomic fracture fixation (open reduction internal fixation (ORIF)). Surgery also increases the risk of wound problems. This study compared outcomes among older adults with ankle fractures who received ORIF versus close contact casting.\u0000\u0000This 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, …\u0000\u0000 [1]: {openurl}?query=rft.jtitle%253DJAMA%26rft.volume%253D316%26rft.spage%253D1455%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx","PeriodicalId":12182,"journal":{"name":"Evidence-Based Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/ebmed-2017-110683","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34881782","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 : 2017-06-01Epub Date: 2017-05-12DOI: 10.1136/ebmed-2017-110707
Igho Onakpoya
Commentary on: Shah SS, Srivastava R, Wu S, et al . Intravenous versus oral antibiotics for postdischarge treatment of complicated pneumonia. Pediatrics 2016;138:e20161692. In children, complicated pneumonia implies pneumonia infection that is associated with pleural effusion or empyema.1 Initial management involves use of parenteral broad spectrum antibiotics to cover the most common organisms1; thoracotomy or chest tube insertion may be indicated if there is no response to antibiotic therapy, or if there is significant respiratory difficulty. Most national guidelines do not specify the preferred route of antibiotic therapy for postdischarge treatment. For instance, British guidelines recommend a switch to oral antibiotics if there is clear evidence of improvement,2 while American guidelines are non-specific.3 This retrospective study compared the benefits and harms of intravenous versus oral antibiotic therapy for treatment of complicated pneumonia in children postdischarge. This was …
{"title":"Oral antibiotics are as effective as intravenous antibiotics for postdischarge treatment of complicated pneumonia in children.","authors":"Igho Onakpoya","doi":"10.1136/ebmed-2017-110707","DOIUrl":"https://doi.org/10.1136/ebmed-2017-110707","url":null,"abstract":"Commentary on: Shah SS, Srivastava R, Wu S, et al . Intravenous versus oral antibiotics for postdischarge treatment of complicated pneumonia. Pediatrics 2016;138:e20161692.\u0000\u0000In children, complicated pneumonia implies pneumonia infection that is associated with pleural effusion or empyema.1 Initial management involves use of parenteral broad spectrum antibiotics to cover the most common organisms1; thoracotomy or chest tube insertion may be indicated if there is no response to antibiotic therapy, or if there is significant respiratory difficulty. Most national guidelines do not specify the preferred route of antibiotic therapy for postdischarge treatment. For instance, British guidelines recommend a switch to oral antibiotics if there is clear evidence of improvement,2 while American guidelines are non-specific.3 This retrospective study compared the benefits and harms of intravenous versus oral antibiotic therapy for treatment of complicated pneumonia in children postdischarge.\u0000\u0000This was …","PeriodicalId":12182,"journal":{"name":"Evidence-Based Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/ebmed-2017-110707","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34991356","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 : 2017-06-01Epub Date: 2017-03-23DOI: 10.1136/ebmed-2017-110672
Stefan Kuhle, Christy G Woolcott
Commentary on : Yuan C, Gaskins AJ, Blaine AI, et al . Association between cesarean birth and risk of obesity in offspring in childhood, adolescence, and early adulthood. JAMA Pediatr 2016;170:e162385. Since 2008, several observational studies have reported an association between caesarean section (CS) and offspring obesity. The underlying biological mechanism hypothesised to explain this association is that children born via CS lack exposure to the maternal vaginal flora, resulting in colonisation of the gut with flora that increase energy harvesting from food, thereby contributing to the development of obesity. Maternal pre-pregnancy weight confounds this association, as obesity in the mother is associated with CS and offspring obesity. Not all previous studies were able to adjust for maternal pre-pregnancy weight, but a recent systematic review showed that in studies that were able to adjust for this confounder, there remained a statistically significant …
{"title":"Caesarean section is associated with offspring obesity in childhood and young adulthood.","authors":"Stefan Kuhle, Christy G Woolcott","doi":"10.1136/ebmed-2017-110672","DOIUrl":"https://doi.org/10.1136/ebmed-2017-110672","url":null,"abstract":"Commentary on : Yuan C, Gaskins AJ, Blaine AI, et al . Association between cesarean birth and risk of obesity in offspring in childhood, adolescence, and early adulthood. JAMA Pediatr 2016;170:e162385.\u0000\u0000Since 2008, several observational studies have reported an association between caesarean section (CS) and offspring obesity. The underlying biological mechanism hypothesised to explain this association is that children born via CS lack exposure to the maternal vaginal flora, resulting in colonisation of the gut with flora that increase energy harvesting from food, thereby contributing to the development of obesity. Maternal pre-pregnancy weight confounds this association, as obesity in the mother is associated with CS and offspring obesity. Not all previous studies were able to adjust for maternal pre-pregnancy weight, but a recent systematic review showed that in studies that were able to adjust for this confounder, there remained a statistically significant …","PeriodicalId":12182,"journal":{"name":"Evidence-Based Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/ebmed-2017-110672","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34854152","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 : 2017-06-01Epub Date: 2017-04-04DOI: 10.1136/ebmed-2017-110680
Marc Blondon, Justine Hugon-Rodin
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.[OpenUrl][1][Abstract/FREE Full Text][2] 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, the use of prophylactic heparin is unreasonable if given universally, but should be tailored to individual risks. The aim of this study was to generate a validated risk-assessment model or prediction tool to estimate the absolute risk of postpartum VTE in individual women. Using two population-based … [1]: {openurl}?query=rft.jtitle%253DBMJ%26rft_id%253Dinfo%253Adoi%252F10.1136%252Fbmj.i6253%26rft_id%253Dinfo%253Apmid%252F27919934%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/ijlink?linkType=ABST&journalCode=bmj&resid=355/dec05_12/i6253&atom=%2Febmed%2F22%2F3%2F98.atom
{"title":"A clinical risk score to predict the incidence of postpartum venous thromboembolism.","authors":"Marc Blondon, Justine Hugon-Rodin","doi":"10.1136/ebmed-2017-110680","DOIUrl":"https://doi.org/10.1136/ebmed-2017-110680","url":null,"abstract":"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.[OpenUrl][1][Abstract/FREE Full Text][2]\u0000\u0000Around 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, the use of prophylactic heparin is unreasonable if given universally, but should be tailored to individual risks. The aim of this study was to generate a validated risk-assessment model or prediction tool to estimate the absolute risk of postpartum VTE in individual women.\u0000\u0000Using two population-based …\u0000\u0000 [1]: {openurl}?query=rft.jtitle%253DBMJ%26rft_id%253Dinfo%253Adoi%252F10.1136%252Fbmj.i6253%26rft_id%253Dinfo%253Apmid%252F27919934%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx\u0000 [2]: /lookup/ijlink?linkType=ABST&journalCode=bmj&resid=355/dec05_12/i6253&atom=%2Febmed%2F22%2F3%2F98.atom","PeriodicalId":12182,"journal":{"name":"Evidence-Based Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/ebmed-2017-110680","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34885856","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 : 2017-06-01Epub Date: 2017-03-29DOI: 10.1136/ebmed-2016-110642
Robert Henderson
Commentary on: Wallentin L, Lindhagen L, Arnstrom 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. 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 findings, but this exposes patients to procedural risks and incurs significant costs. Other clinicians favour a ‘selective invasive strategy’, with coronary arteriography reserved for patients with recurrent myocardial ischaemia. Randomised trials of these treatment strategies suggest that a routine invasive strategy reduces the risk of recurrent ischaemia and death or recurrent myocardial infarction over 5 years.1 In the RITA-3 trial, a routine invasive strategy was also associated with lower cardiovascular …
{"title":"Early invasive strategy in patients with non-ST segment elevation acute coronary syndrome delays death or MI by 18 months.","authors":"Robert Henderson","doi":"10.1136/ebmed-2016-110642","DOIUrl":"https://doi.org/10.1136/ebmed-2016-110642","url":null,"abstract":"Commentary on: Wallentin L, Lindhagen L, Arnstrom 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.\u0000\u0000The 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 findings, but this exposes patients to procedural risks and incurs significant costs. Other clinicians favour a ‘selective invasive strategy’, with coronary arteriography reserved for patients with recurrent myocardial ischaemia.\u0000\u0000Randomised trials of these treatment strategies suggest that a routine invasive strategy reduces the risk of recurrent ischaemia and death or recurrent myocardial infarction over 5 years.1 In the RITA-3 trial, a routine invasive strategy was also associated with lower cardiovascular …","PeriodicalId":12182,"journal":{"name":"Evidence-Based Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/ebmed-2016-110642","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34867794","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 : 2017-06-01Epub Date: 2017-03-03DOI: 10.1136/ebmed-2016-110634
Philipp Dahm, Dragan Ilic, Timothy Wilt
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.[OpenUrl][1] 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. 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/observation to provide the evidence base for treating men with clinically localised PCA. The Scandinavian Prostate Cancer Group-4 (SPCG-4) trial randomised 695 men diagnosed in the pre-prostate-specific antigen (PSA) era, most had palpable disease, to surgery or observation.1 After a median follow-up of 13.4 years, surgery reduced PCA deaths by 44% (HR=0.56; 95% CI 0.41 to 0.77; absolute risk reduction=11 percentage points). All-cause mortality was reduced by 12.7 percentage points. Reductions were confined to men <65 years of age. The Prostate Cancer Intervention Versus Observation Trial (PIVOT) randomised 731 men from the early PSA era to RPX or observation.2 After a 10-year median follow-up, surgery did not reduce disease-specific mortality (HR=0.63; 95% CI 0.36 to 1.09). There was also no significant reduction for all-cause mortality. Absolute differences were 10 ng/mL or intermediate risk disease (p for interaction=0.11 for PCA mortality in both subgroups). The Prostate Testing … [1]: {openurl}?query=rft.jtitle%253DN%2BEngl%2BJ%2BMed%26rft.volume%253D375%26rft.spage%253D1415%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx
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Pub Date : 2017-06-01Epub Date: 2017-04-12DOI: 10.1136/ebmed-2017-110711
Luciano A Sposato, Gustavo Saposnik
Commentary on: Quinn GR, Severdija ON, Chang Y, et al . Wide variation in reported rates of stroke across cohorts of patients with atrial fibrillation. Circulation 2017;135:208–19.[OpenUrl][1][Abstract/FREE Full Text][2] Oral anticoagulants (OACs) substantially reduce stroke risk in patients with atrial fibrillation (AF); however, they remain globally underused.1 One of the main reasons is the difficulty in stratifying AF-related ischaemic stroke risk at the individual patient level.1 ,2 Among scores stratifying AF-related stroke risk, CHA2-DS2-Vasc prevails in most recent international AF guidelines.3 ,4 Still, it remains unknown whether AF-related stroke risk is stable across regions, international cohorts or within specific CHA2-DS2-Vasc score strata. This systematic review included only studies reporting ischaemic stroke rates for patients with AF not on OACs, and assessed … [1]: {openurl}?query=rft.jtitle%253DCirculation%26rft_id%253Dinfo%253Adoi%252F10.1161%252FCIRCULATIONAHA.116.024057%26rft_id%253Dinfo%253Apmid%252F27799272%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/ijlink?linkType=ABST&journalCode=circulationaha&resid=135/3/208&atom=%2Febmed%2F22%2F3%2F110.atom
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