Pub Date : 2017-06-01Epub Date: 2017-04-20DOI: 10.1136/ebmed-2017-110705
Richard Saitz
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 journals regularly, re-reported articles published in another journal as half of its content and added coverage beyond internal medicine. In the subsequent decade, it had published ‘notebook jottings’ on EBM, some of which reported on codified practices in the field.3 But it was time for the journal to branch out and for EBM the field to move from its establishment and definition to its real-life translation at the bedside.4 With a new editorial board, we aimed to support that transformation. We also aimed to be a home for EBMers, those who teach, study and practice EBM. To that end, we added a number of article types of relevance, beyond critically appraised articles and occasional musings. During the past 7 years, we published ∼1000 summaries and critical appraisals of original research studies selected systematically for clinical relevance and methodological strength. All were relatively brief but meaty enough at around 750 words to provide a bit of background and context, methods, main results (magnitude and precision), assessment of internal validity and applicability, and implications for research and practice, written by invited experts and edited by EBM-savvy clinician specialists in family medicine, internal medicine, obstetrics and gynaecology, and paediatrics. EBMers, EBM …
{"title":"<i>Evidence-Based Medicine</i> these 7 years: time for the editor to go on permanent sabbatical.","authors":"Richard Saitz","doi":"10.1136/ebmed-2017-110705","DOIUrl":"https://doi.org/10.1136/ebmed-2017-110705","url":null,"abstract":"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 journals regularly, re-reported articles published in another journal as half of its content and added coverage beyond internal medicine. In the subsequent decade, it had published ‘notebook jottings’ on EBM, some of which reported on codified practices in the field.3 But it was time for the journal to branch out and for EBM the field to move from its establishment and definition to its real-life translation at the bedside.4 With a new editorial board, we aimed to support that transformation. We also aimed to be a home for EBMers, those who teach, study and practice EBM. To that end, we added a number of article types of relevance, beyond critically appraised articles and occasional musings.\u0000\u0000During the past 7 years, we published ∼1000 summaries and critical appraisals of original research studies selected systematically for clinical relevance and methodological strength. All were relatively brief but meaty enough at around 750 words to provide a bit of background and context, methods, main results (magnitude and precision), assessment of internal validity and applicability, and implications for research and practice, written by invited experts and edited by EBM-savvy clinician specialists in family medicine, internal medicine, obstetrics and gynaecology, and paediatrics.\u0000\u0000EBMers, EBM …","PeriodicalId":12182,"journal":{"name":"Evidence-Based Medicine","volume":"22 3","pages":"79-80"},"PeriodicalIF":0.0,"publicationDate":"2017-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/ebmed-2017-110705","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34929059","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: 2017-03-20DOI: 10.1136/ebmed-2017-110668
M Hassan Murad, Reem A Mustafa, Holger J Schünemann, Shahnaz Sultan, Nancy Santesso
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 certainty in evidence when a meta-analysis has not been performed and data were summarised narratively.
{"title":"Rating the certainty in evidence in the absence of a single estimate of effect.","authors":"M Hassan Murad, Reem A Mustafa, Holger J Schünemann, Shahnaz Sultan, Nancy Santesso","doi":"10.1136/ebmed-2017-110668","DOIUrl":"https://doi.org/10.1136/ebmed-2017-110668","url":null,"abstract":"<p><p>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 certainty in evidence when a meta-analysis has not been performed and data were summarised narratively.</p>","PeriodicalId":12182,"journal":{"name":"Evidence-Based Medicine","volume":"22 3","pages":"85-87"},"PeriodicalIF":0.0,"publicationDate":"2017-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/ebmed-2017-110668","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34836211","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 : 2017-06-01Epub Date: 2017-03-29DOI: 10.1136/ebmed-2016-110651
Rachelle Buchbinder, David F Kallmes, Jeffrey G Jarvik, Richard A Deyo
Commentary on: Clark W, Bird P, Gonski P, et al . Safety and efficacy of vertebroplasty for acute painful osteoporotic fractures (VAPOUR): a multicentre, randomised, double-blind, placebo-controlled trial. Lancet 2016;388:1408–16. Percutaneous vertebroplasty was widely used in patients with symptomatic acute vertebral compression fractures until two placebo randomised controlled trials (RCTs) published in 2009 questioned its efficacy and safety.1 ,2 Consistent results across both trials indicated vertebroplasty was no more effective than placebo, while a combined individual patient metaanalysis failed to show an advantage for vertebroplasty for participants with fracture ≤6 weeks.3 Despite these data, some have suggested that there may be subgroups that would benefit from vertebroplasty. VAPOUR was a multicentre participant-blinded and outcome assessor-blinded RCT assessing the efficacy of vertebroplasty versus placebo in 120 participants with acute (<6 weeks), severely painful vertebral compression fractures.4 The primary outcome was the proportion of …
{"title":"Conduct and reporting of a vertebroplasty trial warrants critical examination.","authors":"Rachelle Buchbinder, David F Kallmes, Jeffrey G Jarvik, Richard A Deyo","doi":"10.1136/ebmed-2016-110651","DOIUrl":"https://doi.org/10.1136/ebmed-2016-110651","url":null,"abstract":"Commentary on: Clark W, Bird P, Gonski P, et al . Safety and efficacy of vertebroplasty for acute painful osteoporotic fractures (VAPOUR): a multicentre, randomised, double-blind, placebo-controlled trial. Lancet 2016;388:1408–16.\u0000\u0000Percutaneous vertebroplasty was widely used in patients with symptomatic acute vertebral compression fractures until two placebo randomised controlled trials (RCTs) published in 2009 questioned its efficacy and safety.1 ,2 Consistent results across both trials indicated vertebroplasty was no more effective than placebo, while a combined individual patient metaanalysis failed to show an advantage for vertebroplasty for participants with fracture ≤6 weeks.3 Despite these data, some have suggested that there may be subgroups that would benefit from vertebroplasty.\u0000\u0000VAPOUR was a multicentre participant-blinded and outcome assessor-blinded RCT assessing the efficacy of vertebroplasty versus placebo in 120 participants with acute (<6 weeks), severely painful vertebral compression fractures.4 The primary outcome was the proportion of …","PeriodicalId":12182,"journal":{"name":"Evidence-Based Medicine","volume":"22 3","pages":"106-107"},"PeriodicalIF":0.0,"publicationDate":"2017-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/ebmed-2016-110651","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34867793","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-2017-110719
Deepti Jacob, Priya Vijayvargiya, Michael Camilleri
Commentary on: Liu Z, Yan S, Wu J, et al . Acupuncture for Chronic Severe Functional Constipation: A Randomized Trial. Ann Intern Med 2016;165:761–9. Chronic idiopathic constipation has been reported in ~11% of south Asian populations.1 Pharmacological agents, such as the 5-HT4 receptor agonist, prucalopride, result not only in increased spontaneous bowel movements (SBMs) but also in increased adverse events in the Asian population.2 Therefore, alternative therapies are being researched. Multiple abdominal points (‘acupoints’) have been associated with stimulation of parasympathetic nerves (ST25, ST37, BL25, ST36 and TE6).3 A recent report evaluated the effects of electroacupuncture (EA) applied at ST25, SP14 and ST37 on severe chronic constipation (CC) in a randomised controlled trial (RCT). This was a randomised, parallel, sham-controlled trial comparing EA with …
{"title":"Abdominal electroacupuncture demonstrates an increase in complete spontaneous bowel movements.","authors":"Deepti Jacob, Priya Vijayvargiya, Michael Camilleri","doi":"10.1136/ebmed-2017-110719","DOIUrl":"https://doi.org/10.1136/ebmed-2017-110719","url":null,"abstract":"Commentary on: Liu Z, Yan S, Wu J, et al . Acupuncture for Chronic Severe Functional Constipation: A Randomized Trial. Ann Intern Med 2016;165:761–9.\u0000\u0000Chronic idiopathic constipation has been reported in ~11% of south Asian populations.1 Pharmacological agents, such as the 5-HT4 receptor agonist, prucalopride, result not only in increased spontaneous bowel movements (SBMs) but also in increased adverse events in the Asian population.2 Therefore, alternative therapies are being researched. Multiple abdominal points (‘acupoints’) have been associated with stimulation of parasympathetic nerves (ST25, ST37, BL25, ST36 and TE6).3 A recent report evaluated the effects of electroacupuncture (EA) applied at ST25, SP14 and ST37 on severe chronic constipation (CC) in a randomised controlled trial (RCT).\u0000\u0000This was a randomised, parallel, sham-controlled trial comparing EA with …","PeriodicalId":12182,"journal":{"name":"Evidence-Based Medicine","volume":"22 3","pages":"101"},"PeriodicalIF":0.0,"publicationDate":"2017-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/ebmed-2017-110719","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34991354","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-2017-110696
Karen Best, Maria Makrides
Commentary on: Bisgaard H, Stokholm J, Chawes BL, et al . Fish oil-derived fatty acids in pregnancy and wheeze and asthma in offspring. N Engl J Med 2016;375(26):2530–9. The incidence of asthma and wheezing disorders in developed countries has increased in recent decades.1 Profound changes in the type of fat consumed, particularly an increased intake of omega-6 (ω-6) relative to omega-3 (ω-3) fatty acids, parallel the increasing prevalence of asthma and other inflammatory diseases, leading to the hypothesis that imbalance of fats may be causally related. This randomised controlled trial (RCT) investigates the effect of prenatal ω-3 long-chain polyunsaturated fatty acids (LCPUFA) fish oil supplementation compared with control on symptoms of wheeze or asthma in the offspring between birth and 3 to 5 years of age. In this double-blind, placebo-controlled, parallel group RCT, pregnant women were randomised …
{"title":"Possible protective effect of prenatal omega-3 long-chain polyunsaturated fatty acids supplementation on persistent wheeze and asthma in early childhood.","authors":"Karen Best, Maria Makrides","doi":"10.1136/ebmed-2017-110696","DOIUrl":"https://doi.org/10.1136/ebmed-2017-110696","url":null,"abstract":"Commentary on: Bisgaard H, Stokholm J, Chawes BL, et al . Fish oil-derived fatty acids in pregnancy and wheeze and asthma in offspring. N Engl J Med 2016;375(26):2530–9.\u0000\u0000The incidence of asthma and wheezing disorders in developed countries has increased in recent decades.1 Profound changes in the type of fat consumed, particularly an increased intake of omega-6 (ω-6) relative to omega-3 (ω-3) fatty acids, parallel the increasing prevalence of asthma and other inflammatory diseases, leading to the hypothesis that imbalance of fats may be causally related. This randomised controlled trial (RCT) investigates the effect of prenatal ω-3 long-chain polyunsaturated fatty acids (LCPUFA) fish oil supplementation compared with control on symptoms of wheeze or asthma in the offspring between birth and 3 to 5 years of age.\u0000\u0000In this double-blind, placebo-controlled, parallel group RCT, pregnant women were randomised …","PeriodicalId":12182,"journal":{"name":"Evidence-Based Medicine","volume":"22 3","pages":"104"},"PeriodicalIF":0.0,"publicationDate":"2017-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/ebmed-2017-110696","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34991355","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-2016-110594
Else Charlotte Sandset, Urs Fischer
Commentary on : Qureshi AI, Palesch YY, Barsan WG, et al. Intensive Blood-Pressure Lowering in Patients with Acute Cerebral Hemorrhage. N Engl J Med 2016;375:1033-43. Elevated blood pressure (BP) in acute intracerebral haemorrhage (ICH) is common and associated with poor outcome. High BP causes an expansion of the intracerebral haematoma, and the ‘Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial’ (INTERACT2) showed that moderate BP lowering <140 mm Hg is safe and likely to reduce death and major disability.1 The results of the INTERACT2 trial changed current guidelines.2 However, it is unclear whether very intensive BP lowering is of any further benefit for patients with ICH. The ‘Antihypertensive Treatment of Acute Cerebral Hemorrhage 2’ (ATACH-2) trial was a randomised, multicentre, open-label trial of intensive versus standard BP lowering …
{"title":"Intensive blood pressure lowering provides no additional benefits and results in more adverse events.","authors":"Else Charlotte Sandset, Urs Fischer","doi":"10.1136/ebmed-2016-110594","DOIUrl":"https://doi.org/10.1136/ebmed-2016-110594","url":null,"abstract":"Commentary on : Qureshi AI, Palesch YY, Barsan WG, et al. Intensive Blood-Pressure Lowering in Patients with Acute Cerebral Hemorrhage. N Engl J Med 2016;375:1033-43.\u0000\u0000Elevated blood pressure (BP) in acute intracerebral haemorrhage (ICH) is common and associated with poor outcome. High BP causes an expansion of the intracerebral haematoma, and the ‘Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial’ (INTERACT2) showed that moderate BP lowering <140 mm Hg is safe and likely to reduce death and major disability.1 The results of the INTERACT2 trial changed current guidelines.2 However, it is unclear whether very intensive BP lowering is of any further benefit for patients with ICH.\u0000\u0000The ‘Antihypertensive Treatment of Acute Cerebral Hemorrhage 2’ (ATACH-2) trial was a randomised, multicentre, open-label trial of intensive versus standard BP lowering …","PeriodicalId":12182,"journal":{"name":"Evidence-Based Medicine","volume":"22 3","pages":"102"},"PeriodicalIF":0.0,"publicationDate":"2017-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/ebmed-2016-110594","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35028912","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: 2017-06-03DOI: 10.1136/ebmed-2016-110579
Daniel J Cuthbertson, Victoria S Sprung
Commentary on : Zhang HJ, He J, Pan LL, et al . Effects of moderate and vigorous exercise on non-alcoholic fatty liver disease: a randomized clinical trial. JAMA Intern Med 2016;176:1074–82. Non-alcoholic fatty liver disease (NAFLD) is associated with an increased risk of liver morbidity and mortality, type 2 diabetes mellitus and cardiovascular disease (CVD). Lifestyle modification is the mainstay of treatment, with uncertainty regarding the effectiveness of drug therapy for patients with NAFLD.1 Exercise intervention studies demonstrate that exercise effectively reduces liver fat, even in the absence of significant weight loss. In free-living individuals, higher exercise frequency is associated with a lower risk NAFLD and higher rates of resolution of existing NAFLD over 5 years of follow-up.2 However, widespread implementation of exercise as a therapeutic modality …
{"title":"High-intensity exercise offers no additional benefit to moderate-intensity exercise in reducing liver fat in patients with non-alcoholic fatty liver disease.","authors":"Daniel J Cuthbertson, Victoria S Sprung","doi":"10.1136/ebmed-2016-110579","DOIUrl":"https://doi.org/10.1136/ebmed-2016-110579","url":null,"abstract":"Commentary on : Zhang HJ, He J, Pan LL, et al . Effects of moderate and vigorous exercise on non-alcoholic fatty liver disease: a randomized clinical trial. JAMA Intern Med 2016;176:1074–82.\u0000\u0000Non-alcoholic fatty liver disease (NAFLD) is associated with an increased risk of liver morbidity and mortality, type 2 diabetes mellitus and cardiovascular disease (CVD). Lifestyle modification is the mainstay of treatment, with uncertainty regarding the effectiveness of drug therapy for patients with NAFLD.1 Exercise intervention studies demonstrate that exercise effectively reduces liver fat, even in the absence of significant weight loss. In free-living individuals, higher exercise frequency is associated with a lower risk NAFLD and higher rates of resolution of existing NAFLD over 5 years of follow-up.2 However, widespread implementation of exercise as a therapeutic modality …","PeriodicalId":12182,"journal":{"name":"Evidence-Based Medicine","volume":"22 3","pages":"103"},"PeriodicalIF":0.0,"publicationDate":"2017-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/ebmed-2016-110579","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35057567","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: 2017-05-13DOI: 10.1136/ebmed-2017-110710
Marc R Larochelle
Commentary on: Deyo RA, Hallvik SE, Hildebran C, et al . Association between initial opioid prescribing patterns and subsequent long-term use among opioid-naive patients: a statewide retrospective cohort study. J Gen Intern Med 2017;32(1):21-7. A recent systematic review of long-term opioid use for chronic pain found that evidence is lacking to support benefit from long-term opioid therapy, and evidence supports a dose-dependent risk of opioid-related harms including overdose and death.1 Despite the evidence, an estimated 5 to 8 million Americans receive long-term opioid therapy.2 Understanding the transition from acute or episodic use of opioids to long-term opioid use may help design interventions to reduce the incidence of long-term opioid use. This study sought to analyse the association between prescribing patterns in the first 30 days of opioid receipt among formerly opioid-naive subjects and transitioning to long-term opioid use. …
{"title":"Among opioid-naive patients receiving opioids, more intensive opioid prescribing in the first month is associated with transition to long-term opioid use.","authors":"Marc R Larochelle","doi":"10.1136/ebmed-2017-110710","DOIUrl":"https://doi.org/10.1136/ebmed-2017-110710","url":null,"abstract":"Commentary on: Deyo RA, Hallvik SE, Hildebran C, et al . Association between initial opioid prescribing patterns and subsequent long-term use among opioid-naive patients: a statewide retrospective cohort study. J Gen Intern Med 2017;32(1):21-7.\u0000\u0000A recent systematic review of long-term opioid use for chronic pain found that evidence is lacking to support benefit from long-term opioid therapy, and evidence supports a dose-dependent risk of opioid-related harms including overdose and death.1 Despite the evidence, an estimated 5 to 8 million Americans receive long-term opioid therapy.2 Understanding the transition from acute or episodic use of opioids to long-term opioid use may help design interventions to reduce the incidence of long-term opioid use. This study sought to analyse the association between prescribing patterns in the first 30 days of opioid receipt among formerly opioid-naive subjects and transitioning to long-term opioid use. …","PeriodicalId":12182,"journal":{"name":"Evidence-Based Medicine","volume":"22 3","pages":"112"},"PeriodicalIF":0.0,"publicationDate":"2017-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/ebmed-2017-110710","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34993042","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: 2017-03-27DOI: 10.1136/ebmed-2016-110650
Salvatore Gentile, Maria Luigia Fusco
Commentary on: Grzeskowiak LE, Morrison JL, Henriksen TB, et al . Prenatal antidepressant exposure and child behavioural outcomes at 7 years of age: a study within the Danish National Birth Cohort. BJOG 2016;123:1919–28. The effect of prenatal antidepressant exposure or untreated maternal depression on child behaviour is an emerging field of research in perinatal psychiatry. This study attempts to clarify the impact of prenatal antidepressant exposure on long-term child outcomes, accounting for antenatal maternal factors, including depression. This study was conducted using data from 49 178 mother–child dyads enrolled in the Danish National Birth Cohort—a nationwide longitudinal follow-up study of pregnant women and their children. The overall cohort includes more than 100 000 women who were pregnant between 1996 and 2002. Maternal depression and medication use was assessed via self-report using computer-assisted telephone interviews conducted during pregnancy. Children were categorised as: born to depressed women who took antidepressants during pregnancy (n=210); born to untreated depressed women (n=231) and …
{"title":"In children 7 years of age, prenatal antidepressant exposure is not associated with increased risk of poor behavioural outcomes after adjusting for maternal factors including antenatal mood.","authors":"Salvatore Gentile, Maria Luigia Fusco","doi":"10.1136/ebmed-2016-110650","DOIUrl":"https://doi.org/10.1136/ebmed-2016-110650","url":null,"abstract":"Commentary on: Grzeskowiak LE, Morrison JL, Henriksen TB, et al . Prenatal antidepressant exposure and child behavioural outcomes at 7 years of age: a study within the Danish National Birth Cohort. BJOG 2016;123:1919–28.\u0000\u0000The effect of prenatal antidepressant exposure or untreated maternal depression on child behaviour is an emerging field of research in perinatal psychiatry. This study attempts to clarify the impact of prenatal antidepressant exposure on long-term child outcomes, accounting for antenatal maternal factors, including depression.\u0000\u0000This study was conducted using data from 49 178 mother–child dyads enrolled in the Danish National Birth Cohort—a nationwide longitudinal follow-up study of pregnant women and their children. The overall cohort includes more than 100 000 women who were pregnant between 1996 and 2002. Maternal depression and medication use was assessed via self-report using computer-assisted telephone interviews conducted during pregnancy. Children were categorised as: born to depressed women who took antidepressants during pregnancy (n=210); born to untreated depressed women (n=231) and …","PeriodicalId":12182,"journal":{"name":"Evidence-Based Medicine","volume":"22 3","pages":"113-114"},"PeriodicalIF":0.0,"publicationDate":"2017-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/ebmed-2016-110650","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34860031","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: 2017-05-16DOI: 10.1136/ebmed-2017-110694
Marcelle D Smit, Isabelle C Van Gelder
Commentary on: Hernandez I, Zhang Y, Brooks MM, et al . Anticoagulation use and clinical outcomes after major bleeding on dabigatran or warfarin in atrial fibrillation. Stroke 2017;48:159–66. Anticoagulation decreases the risk of stroke and other thromboembolic complications in patients with atrial fibrillation (AF) at the cost of an increased risk of major bleeding. If patients experience an anticoagulation-related major bleeding complication, the clinician faces the dilemma of whether to resume anticoagulation treatment or not. Evidence-based recommendations are lacking,1 and there is a wide variation in treatment of these patients, with anticoagulants, antiplatelets or no anticoagulation at all, while there is even less experience with non-vitamin K oral anticoagulants (NOACs), such as dabigatran. This study aimed to (1) evaluate anticoagulation use after a major bleeding event on dabigatran or warfarin and (2) compare outcomes between patients discontinuing anticoagulation and those restarting dabigatran or warfarin. This was …
{"title":"Resumption of anticoagulation after major bleeding decreases the risk of stroke in patients with atrial fibrillation.","authors":"Marcelle D Smit, Isabelle C Van Gelder","doi":"10.1136/ebmed-2017-110694","DOIUrl":"https://doi.org/10.1136/ebmed-2017-110694","url":null,"abstract":"Commentary on: Hernandez I, Zhang Y, Brooks MM, et al . Anticoagulation use and clinical outcomes after major bleeding on dabigatran or warfarin in atrial fibrillation. Stroke 2017;48:159–66.\u0000\u0000Anticoagulation decreases the risk of stroke and other thromboembolic complications in patients with atrial fibrillation (AF) at the cost of an increased risk of major bleeding. If patients experience an anticoagulation-related major bleeding complication, the clinician faces the dilemma of whether to resume anticoagulation treatment or not. Evidence-based recommendations are lacking,1 and there is a wide variation in treatment of these patients, with anticoagulants, antiplatelets or no anticoagulation at all, while there is even less experience with non-vitamin K oral anticoagulants (NOACs), such as dabigatran. This study aimed to (1) evaluate anticoagulation use after a major bleeding event on dabigatran or warfarin and (2) compare outcomes between patients discontinuing anticoagulation and those restarting dabigatran or warfarin.\u0000\u0000This was …","PeriodicalId":12182,"journal":{"name":"Evidence-Based Medicine","volume":"22 3","pages":"107-108"},"PeriodicalIF":0.0,"publicationDate":"2017-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/ebmed-2017-110694","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35001939","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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