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BMJ Evidence-Based Medicine
Number of Followers: 0  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 2515-446X - ISSN (Online) 2515-4478
Published by BMC (Biomed Central) Homepage  [310 journals]
  • Understanding Risk for Better Stroke Prevention
    • Authors: Saposnik G.
      Abstract: Commentary on: Amarenco P, Lavallée PC, Monteiro Tavares L, et al. Five-year risk of stroke after TIA or minor ischemic stroke. N Engl J Med. 2018;378:2182–2190 "Living at risk is jumping off the cliff and building your wings on the way down". Ray Bradbury (1920-2012) Context Over the last three decades, we learnt about the value of risk stratification tools (eg, ABCD2, Oxford TIA, among others) that may help guide management decisions.1 However, limited information is available on the recurrence of cardiovascular events, stroke, death 5 years after a transient ischaemic attack (TIA) or minor stroke.2 The TIAregistry.org prospectively included patients with a recent TIA or minor stroke to evaluate the short-term (3 months and 1 year) and long-term (5 years) outcomes.3 Methods The authors prospectively collected data on patients aged 18 years and older with a recent diagnosis of TIA or minor stroke (less than...
      Keywords: General Medicine
      PubDate: 2019-09-25T01:13:14-07:00
      DOI: 10.1136/bmjebm-2018-111089
      Issue No: Vol. 24, No. 5 (2019)
       
  • Pivmecillinam is more effective than ibuprofen in symptom resolution in
           women with uncomplicated urinary tract infection: antibiotic treatment for
           UTI is important
    • Authors: Bleidorn J.
      Abstract: Commentary on: Vik I, Bollestad M, Grude N, et al. Ibuprofen versus pivmecillinam for uncomplicated urinary tract infection in women—a double-blind, randomized non-inferiority trial. PLoS Med. 2018;15:e1002569. Context Uncomplicated urinary tract infection (UTI) is a common condition, and many affected women are treated with antibiotics. However, since complications are rare, the main treatment goal is to reduce symptoms.1 Several trials indicate that many patients recover with symptomatic treatment or delayed prescription,2 3 and reducing avoidable antibiotic prescriptions gains in importance to decrease resistance development.4 5 Against this background, Vik et al conducted this randomised controlled trial to assess non-inferiority of symptomatic treatment of uncomplicated UTI.6 Nearly simultaneously, similar trials assessed fosfomycin versus ibuprofen7 respectively norfloxacin versus diclofenac8 in treatment of uncomplicated UTI. Methods To assess whether symptomatic treatment with ibuprofen was non-...
      Keywords: Primary care
      PubDate: 2019-09-25T01:13:14-07:00
      DOI: 10.1136/bmjebm-2018-111084
      Issue No: Vol. 24, No. 5 (2019)
       
  • Single-dose fosfomycin is less effective than 5-day nitrofurantoin in
           women with uncomplicated urinary tract infection: closing the evidence gap
           for a new recommendation of an old antibiotic
    • Authors: Gagyor I.
      Abstract: Commentary on: Huttner A, Kowalczyk A, Turjeman A, et al. Effect of 5-day nitrofurantoin vs single-dose fosfomycin on clinical resolution of uncomplicated lower urinary tract infection in women: a randomized clinical trial. JAMA. 2018; 319:1781–1789. Context Uncomplicated urinary tract infection (UTI) is one of the most common indications for prescribing antibiotics in primary care. Although UTI is often self-limiting, most guidelines recommend antibiotics as the first-line treatment. Symptomatic treatment with pain killers has also been proven to be effective in women with uncomplicated UTI, even though this treatment strategy was still non-inferior to antibiotics.1–3 With increasing antibiotic resistance of UTI bacteria, determining the choice of the most effective and least harmful antibiotics has become crucial. In this context, antibiotics demonstrating low levels of resistance rates such as nitrofurantoin, pivmecillinam and fosfomycin have gained in importance. Nitrofurantoin has been used for several decades and its efficacy...
      Keywords: Primary care
      PubDate: 2019-09-25T01:13:14-07:00
      DOI: 10.1136/bmjebm-2018-111063
      Issue No: Vol. 24, No. 5 (2019)
       
  • Intracerebral haemorrhage is hard to stop, and must be attacked before,
           during and after
    • Authors: Tirschwell D. L.
      Abstract: Commentary on: Sprigg N, Flaherty K, Appleton JP, et al. Tranexamic acid for hyperacute primary IntraCerebral Haemorrhage (TICH-2): an international randomised, placebo-controlled, phase 3 superiority trial. Lancet 2018;391:2107–2115. Context  Intracerebral haemorrhage (ICH) is a substantial public health problem. While ischaemic stroke is commonly accepted as the majority of the burden of stroke, this is a western bias. In many Asian and lower-income countries, ICH represents an increased and even majority proportion of the stroke burden. Despite substantive advancements in the treatment of acute ischaemic stroke (eg, intravenous tissue plasminogen activator and mechanical thrombectomy), no acute interventions have been shown to be unequivocally effective for improving ICH outcomes. Given that much of the global burden of ICH occurs in lesser resourced environments, inexpensive and easily applied treatments for ICH are sorely needed. Methods TICH-2 was an international, placebo-controlled, blinded randomised trial in acute non-traumatic ICH, with last known...
      Keywords: Primary care
      PubDate: 2019-09-25T01:13:14-07:00
      DOI: 10.1136/bmjebm-2018-111083
      Issue No: Vol. 24, No. 5 (2019)
       
  • CT coronary angiography does not reduce mortality or myocardial infarction
           in low-risk patients with acute chest pain
    • Authors: Adamson, P. D; Than, M. P.
      Abstract: Commentary on: Gongora CA, Bavishi C, Uretsky S, et al. Acute chest pain evaluation using coronary computed tomography angiography compared with standard of care: a meta-analysis of randomised clinical trials. Heart 2018;104:215–21. Context In the assessment of low-risk patients with suspected acute coronary syndrome, the routine use of non-invasive testing has been recommend by international clinical guidelines. However, limited evidence from randomised controlled trials (RCTs) exists to support such recommendations. Although a number of trials have tested the safety and efficacy of CT coronary angiography (CTCA) in this setting, most were underpowered to demonstrate benefits with regards to hard clinical endpoints. Methods The authors undertook a meta-analysis of RCTs published prior to March 2017 comparing CTCA with standard care in the assessment of patients with acute chest pain.1 Standard care varied across the trials but always incorporated non-invasive functional testing—that is, exercise ECG, stress...
      Keywords: Emergency care
      PubDate: 2019-09-25T01:13:14-07:00
      DOI: 10.1136/bmjebm-2018-111090
      Issue No: Vol. 24, No. 5 (2019)
       
  • Individuals with high-risk adenomas are at elevated risk for colorectal
           cancer
    • Authors: Anderson J. C.
      Abstract: Commentary on: Click B, Pinsky PF, Hickey T, et al. Association of colonoscopy adenoma findings with long-term colorectal cancer incidence. JAMA 2018;319:2021–2031. Context Currently, in part due to lack of data, endoscopists recommend intervals that are shorter than those suggested by guidelines.1 2 Thus, data regarding long-term colorectal cancer (CRC) risk for index adenomas are crucial for endoscopists in managing adenoma surveillance. Specifically, how does the long-term CRC risk for advanced adenomas compare with that for non-advanced adenomas or normal exams' Methods The current paper3 analyses the long-term data from the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial prospective cohort study. The trial, which started in 1993, enrolled adults aged 55–74 years who were randomised to having a flexible sigmoidoscopy at baseline and at year 3 or year 5 versus having usual care. Those with a polyp on flexible sigmoidoscopy...
      Keywords: General Medicine
      PubDate: 2019-09-25T01:13:14-07:00
      DOI: 10.1136/bmjebm-2018-111087
      Issue No: Vol. 24, No. 5 (2019)
       
  • Is there a prospect for mass drug administration of azithromycin to reduce
           child mortality in sub-Saharan Africa'
    • Authors: Amouzou A.
      Abstract: Commentary on: Keenan JD, Bailey RL, West Sk, et al. Azithromycin to reduce childhood mortality in sub-Saharan Africa. N Engl J Med 2018;378:1583–92. Context A recent study by Keenan and colleagues found positive effects of mass distribution of azithromycin (MDA) in children aged 1–59 months in reducing mortality rates in three countries in sub-Saharan Africa.1 Ending preventable child death remains an important goal for a sustainable development in low/middle-income countries. Effective strategies for accelerated reduction in child mortality are needed. The MDA for elimination of trachoma provided hints on possible effectiveness of the strategy in reducing child mortality. Keenan and his colleagues designed a community trial to test the strategy within few districts in Malawi, Niger and Tanzania. Methods The study used a blinded cluster randomised trial with MDA in intervention area and placebo in control area in one district in Malawi, and two...
      Keywords: Maternal and child health
      PubDate: 2019-09-25T01:13:14-07:00
      DOI: 10.1136/bmjebm-2018-111135
      Issue No: Vol. 24, No. 5 (2019)
       
  • Biomarkers of acute kidney injury: mixed results and huge heterogeneity of
           reporting
    • Authors: Gayat E.
      Abstract: Commentary on: Hall PS, Mitchell ED, Smith AF, et al. The future for diagnostic tests of acute kidney injury in critical care: evidence synthesis, care pathway analysis and research prioritisation. Health Technol Assess. 2018;22:1–274. Context Acute kidney injury (AKI) is a common condition in hospitalised patients and is associated with worse short-term and long-term outcome. The delay in the diagnosis of AKI has been proven to be associated with morbidity and mortality. One of the challenges clinicians face is the early detection of AKI. Another difficulty is the lack of a consensual definition of AKI. Expert consensus seems to be emerging,1 but recent literature review shows that the definitions used in the published articles remain multiple and heterogeneous.2 While many urinary and serum proteins have been investigated as potential biomarkers for the early diagnosis or prediction of AKI or to identify patients at high risk,...
      Keywords: Emergency care
      PubDate: 2019-09-25T01:13:14-07:00
      DOI: 10.1136/bmjebm-2018-111152
      Issue No: Vol. 24, No. 5 (2019)
       
  • Redefining disease definitions and preventing overdiagnosis: time to
           re-evaluate our priorities
    • Authors: Heneghan, C; Mahtani, K. R.
      Pages: 163 - 164
      Abstract: In their paper, Ray Moynihan and colleagues1 analyse the problems of disease thresholds and their impact on expanding disease definitions, overdiagnosis, overtreatment and wasted resources. The group calls for a new approach to developing disease definitions that includes being primary care led, people-centred, independent of commercial interests and informed by better guidelines. The authors highlight several concerns with the current approach to disease definitions. For example, approximately half of the older population are defined as having chronic kidney disease, yet many are asymptomatic with no negative impact on their day-to-day living. New thresholds for gestational diabetes have meant the prevalence has doubled, without a clear indication of the outcomes that may be affected. Furthermore, new hypertension guidelines have labelled half of the adult population as hypertensive. Changing definitions place a considerable burden on patients and an overly stretched healthcare system that is required to manage these ‘phantom conditions’....
      Keywords: Editor's choice, Primary care
      PubDate: 2019-09-25T01:13:14-07:00
      DOI: 10.1136/bmjebm-2019-111219
      Issue No: Vol. 24, No. 5 (2019)
       
  • Evidence-based medicine: clinicians are taught to say it but not taught to
           think it
    • Authors: Braithwaite R. S.
      Pages: 165 - 167
      Abstract: Preparing for my decennial recertification exam in internal medicine opened my eyes to a startling disconnect in how evidence-based medicine (EBM) is communicated to practising clinicians compared with how it is implemented by expert panels and EBM authorities. Indeed, sources of continuing clinical education often omit basic tenets of EBM, in particular how to integrate the best available evidence with clinical expertise.1–3 This disconnect is mystifying: why should education experts well versed in EBM use communication templates disjointed from EBM to communicate evidence for practising medicine' For example, a common source of preparation for the American Board of Internal Medicine recertification exam is the Medical Knowledge Self-Assessment Program (MKSAP) published by the American College of Physicians.4 Even though the American College of Physicians prioritises the mission of teaching and implementing EBM,5 two advisements from the 2017 MKSAP illustrate how...
      Keywords: Open access
      PubDate: 2019-09-25T01:13:14-07:00
      DOI: 10.1136/bmjebm-2018-110970
      Issue No: Vol. 24, No. 5 (2019)
       
  • Qualitative research as evidence: expanding the paradigm for
           evidence-based healthcare
    • Authors: Williams, V; Boylan, A.-M, Nunan, D.
      Pages: 168 - 169
      Abstract: Writing in the BMJ, David Sackett and John Wennberg pointed out over 20 years ago we need to stop ‘squabbling over the best methods’ and focus on the research question, since it is the nature of the question that determines the best research design to answer it.1 Yet, the majority of evidence hierarchies and ‘levels’2 still do not include qualitative methodologies, and Evidence-based Health Care  (EBHC) still largely focuses on the positivist perspective of generating and applying knowledge in healthcare practice.3 Despite its lack of prominence in EBHC, qualitative research in healthcare has increasingly been conducted and published since Sackett and Wennberg’s editorial, and the publication of qualitative evidence syntheses have doubled in the past decade.4 The argument for qualitative research within EBHC has been made for over 20 years,5 including a series of educational articles in the BMJ
      PubDate: 2019-09-25T01:13:14-07:00
      DOI: 10.1136/bmjebm-2018-111131
      Issue No: Vol. 24, No. 5 (2019)
       
  • Reforming disease definitions: a new primary care led, people-centred
           approach
    • Authors: Moynihan, R; Brodersen, J, Heath, I, Johansson, M, Kuehlein, T, Minue-Lorenzo, S, Petursson, H, Pizzanelli, M, Reventlow, S, Sigurdsson, J, Stavdal, A, Treadwell, J, Glasziou, P.
      Pages: 170 - 173
      Abstract: Expanding disease definitions are causing more and more previously healthy people to be labelled as diseased, contributing to the problem of overdiagnosis and related overtreatment. Often the specialist guideline panels which expand definitions have close tis to industry and do not investigate the harms of defining more people as sick. Responding to growing calls to address these problems, an international group of leading researchers and clinicians is proposing a new way to set diagnostic thresholds and mark the boundaries of condition definitions, to try to tackle a key driver of overdiagnosis and overtreatment. The group proposes new evidence-informed principles, with new process and new people constituting new multi-disciplinary panels, free from financial conflicts of interest. Introduction Expanding definitions of disease are causing too many people to be diagnosed and treated unnecessarily, producing harm and waste, posing a major threat to human health and the sustainability...
      Keywords: Editor's choice
      PubDate: 2019-09-25T01:13:14-07:00
      DOI: 10.1136/bmjebm-2018-111148
      Issue No: Vol. 24, No. 5 (2019)
       
  • Overdiagnosis paradigm: not suitable for decreasing the overuse of
           antibiotics
    • Authors: Cordoba, G; Llor, C.
      Pages: 174 - 176
      Abstract: This paper summarises the discussion during the workshop on ‘Overdiagnosis and overtreatment of infectious diseases in general practice. How and where to break the endless loop'’ The workshop was organised as part of the overdiagnosis conference carried out in August 2018 in Copenhagen, Denmark. During the workshop, participants from all over the world reflected on the challenges of embracing the overdiagnosis paradigm as a tool to advance understanding and to find solutions to the unnecessary use of antibiotics in primary health care. It was concluded that the narrow view of the overdiagnosis paradigm does not provide theoretical resources to address the problem of the inherent connection between diagnostic error and treatment decision. In contrast to the overdiagnosis paradigm, the too much medicine paradigm is an umbrella term suitable to frame actions that recognise the complexity of the decision-making process during the consultation and its impact on overtreatment.
      Keywords: Open access
      PubDate: 2019-09-25T01:13:14-07:00
      DOI: 10.1136/bmjebm-2018-111146
      Issue No: Vol. 24, No. 5 (2019)
       
  • Commitments by the biopharmaceutical industry to clinical trial
           transparency: the evolving environment
    • Authors: Baronikova, S; Purvis, J, Southam, E, Beeso, J, Panayi, A, Winchester, C.
      Pages: 177 - 184
      Abstract: Clinical trial sponsors have ethical obligations to register protocols, report study results and comply with applicable legal requirements. To evaluate public commitments to trial disclosure and rates of disclosure by members and non-members of the European Federation of Pharmaceutical Industries and Associations (EFPIA) and/or the Pharmaceutical Research and Manufacturers of America (PhRMA). Websites of the top 50 biopharmaceutical companies by 2015 sales were searched for statements relating to trial data disclosure. Disclosure of trial results completed by biopharmaceutical industry and non-industry sponsors of at least 30 trials (2006–2015) was assessed using TrialsTracker. Among the top 50 companies, 30 were EFPIA/PhRMA members and 20 were non-members, of which 26 and none, respectively, had a statement on their website committing to the disclosure of trials data. Of 29 377 trials in TrialsTracker, 9511 were industry sponsored (69 companies) and 19 866 were non-industry sponsored (254 institutions). The overall mean disclosure rate was 55%, with higher rates for industry (74%) than for non-industry sponsors (46%). Of the 30 companies within the top 50 with data in TrialsTracker, the mean disclosure rate was 76% (77% for EFPIA/PhRMA members [n=25] vs 67% for non-members [n=5]). Most of the top 50 biopharmaceutical companies have publicly committed to the disclosure of trial data. Industry sponsors have responded to the ethical and legal demands of trial disclosure by disclosing three quarters of their trials compared with less than half for non-industry sponsors. Further improvements in clinical trial disclosure are needed.
      Keywords: Open access
      PubDate: 2019-09-25T01:13:14-07:00
      DOI: 10.1136/bmjebm-2018-111145
      Issue No: Vol. 24, No. 5 (2019)
       
  • Assessing assumptions for statistical analyses in randomised clinical
           trials
    • Authors: Nielsen, E. E; Norskov, A. K, Lange, T, Thabane, L, Wetterslev, J, Beyersmann, J, de Una-Alvarez, J, Torri, V, Billot, L, Putter, H, Winkel, P, Gluud, C, Jakobsen, J. C.
      Pages: 185 - 189
      Abstract: In order to ensure the validity of results of randomised clinical trials and under some circumstances to optimise statistical power, most statistical methods require validation of underlying statistical assumptions. The present paper describes how trialists in major medical journals report tests of underlying statistical assumptions when analysing results of randomised clinical trials. We also consider possible solutions how to improve current practice by adequate reporting of tests of underlying statistical assumptions. We conclude that there is a need to reach consensus on which underlying assumptions should be assessed, how these underlying assumptions should be assessed and what should be done if the underlying assumptions are violated.
      PubDate: 2019-09-25T01:13:14-07:00
      DOI: 10.1136/bmjebm-2019-111174
      Issue No: Vol. 24, No. 5 (2019)
       
  • Conducting one-stage IPD meta-analysis: which approach should I
           choose'
    • Authors: Fanshawe, T. R; Perera, R.
      Pages: 190 - 190
      Abstract: Alternative methods for dealing with within trial clustering have been proposed for conducting individual participant data (IPD) ‘one-stage’ meta-analysis. Does it matter which one is used' Will it affect the estimates and their precision'  Tom Fanshawe and Rafael Perera Meta-analysis of studies using IPD is increasingly common and is likely to grow in popularity as a result of increased data sharing with repositories for collaborative data sharing become more established. IPD meta-analysis allows systematic reviews to pool data, beyond what is possible based only on the summary statistics, for example, intervention effects, reported in published papers and also provides the opportunity of fitting appropriate statistical methods to obtain summary estimates. Two-stage and one-stage meta-analyses are the commonly used statistical approaches in IPD. In the ‘two-stage’ meta-analysis, the analyst derives summary estimates from the IPD for each study and then pools them together along similar lines as in a standard...
      Keywords: General Medicine
      PubDate: 2019-09-25T01:13:14-07:00
      DOI: 10.1136/bmjebm-2018-111127
      Issue No: Vol. 24, No. 5 (2019)
       
  • Can drinking more water prevent urinary tract infections' The evidence
           says yes
    • Authors: Plüddemann A.
      Pages: 191 - 192
      Abstract: Although it is widely recommended to drink more water to prevent recurring urinary tract infections (UTIs), there has been no clear clinical evidence to support this recommendation. This is the first randomised controlled trial that shows the benefits of drinking more water to prevent these infections. EBM verdict EBM Verdict on: Effect of increased daily water intake in premenopausal women with recurrent urinary tract infections: a randomized clinical trial. JAMA Intern Med 2018; 178(11):1509–1515. doi: 10.1001/jamainternmed.2018.4204.
      Increasing daily fluid intake to more than 1.5 L per day is a safe and inexpensive intervention that can potentially reduce cystitis frequency and antimicrobial use by approximately 50% and should therefore be recommended in healthy women. Practically, this could be achieved by, for example, drinking an additional two glasses of water with each meal. To prevent recurrent UTIs, the National Health Service (NHS) recommends to ‘drink plenty of fluids’,
      Keywords: General Medicine
      PubDate: 2019-09-25T01:13:14-07:00
      DOI: 10.1136/bmjebm-2018-111143
      Issue No: Vol. 24, No. 5 (2019)
       
  • Network meta-analysis for diagnostic tests
    • Authors: OSullivan J. W.
      Pages: 192 - 193
      Abstract: Network meta-analysis (NMA) has enabled the comparison of numerous interventions in the absence of direct head-to-head randomised controlled trials. A new technique describes NMA for diagnostic tests, an approach that can facilitate a similar comparison between different diagnostic tests at different diagnostic thresholds. Globally, the provision of healthcare is aided by clinical practice guidelines.1 Healthcare organisations, such as the UK’s National Institute for Health and Care Excellence (NICE), routinely provide healthcare workers with advice about what works for which patients in which particular setting. To do this, NICE, as does the WHO and various American professional societies, conducts systematic reviews and meta-analyses on the available evidence. The recent methodological creation of NMA has enabled these organisations to explicitly compare the effectiveness of different interventions even if they have not been directly compared in the same randomised controlled trial. NMA has facilitated organisations to determine, for instance, that apixaban 5 mg...
      Keywords: General Medicine
      PubDate: 2019-09-25T01:13:14-07:00
      DOI: 10.1136/bmjebm-2019-111179
      Issue No: Vol. 24, No. 5 (2019)
       
  • Catheter ablation in atrial fibrillation
    • Authors: Mills M. T.
      Pages: 193 - 194
      Abstract: EBM Verdict EBM Verdict on: Effect of catheter ablation vs antiarrhythmic drug therapy on mortality, stroke, bleeding, and cardiac arrest among patients with atrial fibrillation: the CABANA Randomized Clinical Trial. JAMA 2019 Mar 15. doi: 10.1001/jama.2019.0693.
      The Catheter Ablation versus Antiarrhythmic Drug Therapy for Atrial Fibrillation trial is the largest randomised trial to study the effects of catheter ablation on morbidity and mortality in atrial fibrillation (AF). Although catheter ablation can reduce AF recurrence and ameliorate the quality of life of patients with AF, the effect of the procedure on long-term clinical outcomes does not differ from that observed with optimal pharmacological therapy. These findings should facilitate shared decision making between patients and physicians. Catheter ablation in atrial fibrillation is effective at restoring sinus rhythm. Until recently, the prognostic effects of ablation have been unknown. The recent Catheter Ablation versus Antiarrhythmic Drug Therapy for Atrial Fibrillation...
      Keywords: General Medicine
      PubDate: 2019-09-25T01:13:14-07:00
      DOI: 10.1136/bmjebm-2019-111205
      Issue No: Vol. 24, No. 5 (2019)
       
  • Routine fluoxetine in stroke
    • Authors: Heneghan, C; Mahtani, K. R.
      Pages: 195 - 196
      Abstract: A recent UK trial addressed whether routine use of fluoxetine in patients who had a stroke improved motor recovery at 6 months. EBM Verdict EBM Verdict on: Effects of fluoxetine on functional outcomes after acute stroke (FOCUS): a pragmatic, double-blind, randomised, controlled trial. FOCUS Trial Collaboration. Lancet 2019;393:265–74. doi: 10.1016/S0140-6736(18)32823-X.
      Fluoxetine 20 mg after an acute stroke does not improve functional outcomes. Although it appears to have some beneficial impact on the occurrence of depression (NNT 27), treatment decisions need to be balanced against the potential increase in bone fractures among the treated group (NNH 68). Stroke is a debilitating life-changing event that causes considerable mortality and morbidity. An ageing and growing population are thought to be some of the factors contributing to a rise in the incidence. However, improved management of acute stroke and better treatment of modifiable risk factors have led to an increase in...
      Keywords: General Medicine
      PubDate: 2019-09-25T01:13:14-07:00
      DOI: 10.1136/bmjebm-2019-111188
      Issue No: Vol. 24, No. 5 (2019)
       
  • Single or dual antiplatelet therapy after a transient ischaemic attack or
           minor ischaemic stroke'
    • Authors: Mahtani, K. R; Heneghan, C, Aronson, J.
      Pages: 196 - 197
      Abstract: A recent systematic review provides evidence on the antiplatelet treatment needed after these types of stroke. Why is this important' An average 55-year-old man has a 1 in 6 risk of stroke during his lifetime; a woman’s risk is 1 in 5.1 A significant proportion will suffer long-term functional, cognitive and psychological disabilities. Stroke also has a significant impact on health service providers. One economic evaluation has estimated that an average patient may need £50 000 worth of health and social care in the 5 years after an acute stroke.2 In a transient ischaemic attack (TIA) symptoms resolve within 24 hours. However, a TIA puts patients at high risk (up to 8% within 7 days) of a subsequent stroke.3 Clinical prediction tools, such as the ABCD2 score, can help risk stratify those most likely to go on and have a stroke.4 5
      Keywords: Emergency care
      PubDate: 2019-09-25T01:13:14-07:00
      DOI: 10.1136/bmjebm-2019-111160
      Issue No: Vol. 24, No. 5 (2019)
       
  • Evidence from large Danish cohort does not support an association between
           the MMR vaccine and autism: facts in a post-truth world
    • Authors: Campbell-Scherer D.
      Pages: 198 - 199
      Abstract: In a cohort of 657 461 children born in 1999–2010, no association between the measles mumps and rubella (MMR) vaccination and autism was observed. Despite this, it is unclear whether increasing medical evidence and facts about the lack of association between the MMR vaccination and autism will have beneficial impact in easing the minds of parents and preventing unnecessary deaths. Prior to the availability of a measles vaccination in 1963, the majority of children contracted measles by the age of 15. Approximately 3–4 million US citizens were infected annually, with about 400–500 deaths, 48 000 hospitalisations and 1000 cases of encephalitis due to measles.1 Lofty aims were the complete eradication of measles by the early 1980s; the goal was finally achieved in the USA in 2000. This was due to a highly effective programme for vaccination. This success was at a time when the population believed in institutions, collective action...
      Keywords: Primary care
      PubDate: 2019-09-25T01:13:14-07:00
      DOI: 10.1136/bmjebm-2019-111212
      Issue No: Vol. 24, No. 5 (2019)
       
  • Muscle strength training for reversing frailty: how strong is the
           evidence'
    • Authors: Nunan D.
      Pages: 199 - 200
      Abstract: A recent systematic review assessing interventions to delay or reverse frailty found a combination of muscle strength training, and protein supplementation was the most effective intervention and the easiest to implement in primary care. The quality of data, however, leaves some uncertainties about the evidence. Though definitions differ, frailty is seen as a distinct, yet multidimensional, health state where a minor event can trigger major changes in health from which the individual may fail to return to their previous level of health. Frailty is underpinned by ageing-related degeneration across multiple physiological systems.1 2 Estimates of its prevalence in community-dwelling older adults range from 5% to 17%.3 The importance of frailty as a risk factor is its association with other adverse health outcomes including falls and mobility decline resulting in dependency, need for long-term care and mortality.4 A need for care and...
      Keywords: Primary care
      PubDate: 2019-09-25T01:13:14-07:00
      DOI: 10.1136/bmjebm-2019-111181
      Issue No: Vol. 24, No. 5 (2019)
       
  • Absolute effects of statins in the elderly
    • Authors: Heneghan, C; Mahtani, K. R.
      Pages: 200 - 202
      Abstract: The effects of statins in the elderly are better informed by absolute effects and the number needed to evaluate the benefit to harm balance. Such an approach enables patients to make more informative choices. Statins have proved to be a controversial topic. Thirty years after their approval, uncertainties remain about the benefit to harm balance in primary prevention of cardiovascular events, particularly in low-risk individuals and in the elderly. A recent meta-analysis of 28 trials including 14 483 (8%) participants older than 75 years aimed to reduce the uncertainties in statins in this older age group.1 After an average of 4.9 years of follow-up outcomes reported include major coronary events (non-fatal myocardial infarction or coronary death), coronary revascularisation (angioplasty or bypass grafting), stroke (subdivided by type), site-specific cancers and cause-specific mortality. Major vascular events were defined post hoc as a composite of major coronary events, coronary revascularisation and...
      Keywords: Primary care
      PubDate: 2019-09-25T01:13:14-07:00
      DOI: 10.1136/bmjebm-2019-111189
      Issue No: Vol. 24, No. 5 (2019)
       
 
 
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