age
DISEASE INTERVENTION COMPARISON RESULTS
J Am Coll Cardiol. 2012 Aug 28;60(9):861-7 Cohorts
IN anticoagulants, vitamin K antagonists, bleeding risk The Use of
Any of 3 most commonly employed scores: HAS-BLED, ATRIA and HEMORR2 HAGES
As Prognostic Item
Is better Than
no using any risk score
To predict clinically relevant bleeding events, but only with modest performance, being HAS slightly better: c-index: 0.60 HAS-BLED, 0.55 HEMORR(2)AGES, 0.50 ATRIA
N Engl J Med. 2018 Mar 08;378(10):902-910 Randomized Controlled Trial, Multicenter Study
IN asthma, acute exacerbation The Use of
self-management plan including a temporary quadrupling of the dose of inhaled glucocorticoids when asthma control start to deteriorate
As Treatment, Acute
Is better Than
self-management plan without increase of inhaled corticosteroids
To reduce severe asthma exacerbations at 1 year: 45% with quadrupling VS 52% in the non-quadrupling. More local adverse events with quadrupling.
Ann Intern Med. 2017 Feb 07;166(3):191-200 Systematic Review
IN diabetes mellitus, type 2, comorbid conditions contraindicating metformin, kidney disease, chronic, liver failure, chronic, heart failure The Use of
oral hypoglycemic agents, metformin
As Treatment, Chronic
Is better Than
other diabetes treatments no using metformin
To reduce all-cause mortality (chronic kidney disease HR 0.77 ; chronic heart failure HR 0.78), cardiovascular mortality and rehosp because heart failure
Heart. 2018 Mar 23. doi: 10.1136/heartjnl-2017-312571. [Epub ahead of print] Systematic Review
IN therapeutics, adherence to drug treatment, cardiovascular disease The Use of
3 interventions: short message service, fixed-dose combination pill, community health worker intervention
As Treatment, Acute
Is better Than
usual care
To improve medication adherence: 44% to 99% in the intervention groups VS 13% to 96% in usual care groups
Arch Intern Med. 2000 Feb 28;160(4):470-8 Cohorts
IN anticoagulants, vitamin K antagonists The Use of
age > 75 years
As Prognostic Item
Is useful Than
-
To predict bleeding rate (9.9% elders VS 6.6% youngs)
J Thromb Haemost. 2016 Sep;14(9):1715-24 Cohorts
IN anticoagulants, vitamin K antagonists, bleeding risk, elder patients The Use of
Any of 3 most commonly employed scores: HAS-BLED, ATRIA and HEMORR2 HAGES
As Prognostic Item
Is bad Than
no comparison here
To predict major bleeding: All three scores were associated with major bleeding in the elderly, but had poor predictive abilities: C-statistics < 0.60 all. Only 2 (anemia and antiplatelet therapy) of the classical risk factors were associated with bleeding
J Gen Intern Med. 2005 Nov;20(11):1008-13 Cohorts
IN anticoagulants, vitamin K antagonists, bleeding risk, elder patients The Use of
outpatient bleeding risk index (BRI): 1 point for: age>65, history of stroke, history gastrointestinal bleeding, any of following (diabetes, recent myocardial infartion, anemia, creat>1.5mg/L)
As Prognostic Item
Is useful Than
intuitive assesment of bleeding risk
To predict risk of major haemorrhage under chronic warfarin: high-risk 10.6% per patient-year, intermediate 2.5%, and low-risk only 0.8% per year.
Ann Intern Med. 2011 Apr 5;154(7):472-82 Meta-Analysis
IN anticoagulants, vitamin K antagonists, monitoring The Use of
patient self-monitoring of anticoagulation, with or without self-management
As Dosage Scheme
Is better Than
usual care and monitoring by a health professional
To reduce thromboembolic events (OR 0.58) and total mortality (OR 0.74), with no excess of major bleedings (OR 0.89)
Arch Intern Med. 2006 Jul 10;166(13):1350-6 Systematic Review
IN aortic dissection, thoracic The Use of
transesophageal echocardiography, helical computed tomography (CT), and magnetic resonance imaging (IRM)
As Diagnostic Tool
Is equal Than
reference gold standard (angiography)
To diagnose this condition: sensitivity (98%-100%) and specificity (95%-98%) were comparable between all 3 imaging techniques. LR+ was some better for IRM (24) than for echography or CT (14) but without major clinical implications.
Stroke. 2009 Apr;40(4):1410-6 Meta-Analysis
IN atrial fibrillation, anticoagulants, vitamin K antagonists, bleeding risk, elder patients, stroke, ischemic, cerebral infarction, embolic The Use of
age
As Etiologic risk factor
Is useful Than
-
To predict an increased risk of stroke (HR per decade 1.45), major bleeding (HR per decade 1.61) and cardiovascular events (HR per decade 1.45). However the relative benefit of warfarin for preventing stroke persisted, while that of aspirin decreased
Eur Heart J. 2016 May 21;37(20):1582-90 Cohorts
IN atrial fibrillation, non valvular, stroke, ischemic, cerebral infarction, embolic The Use of
a new stroke risk score: ABC (Age, Biomarkers, Clinical history) combining: age, NT-proBNP, high-sensitivity troponine, prior stroke/transient ischaemic attack
As Prognostic Item
Is better Than
CHA2DS2-VASc score
To better predict the risk of stroke at a mean 2 years follow-up (c-indice 0.66 ABC vs. 0.58 CHA2DS2-VASc)
J Am Coll Cardiol. 2015 Jun 23;65(24):2614-23 Meta-Analysis
IN atrial fibrillation, non valvular, stroke, ischemic, cerebral infarction, embolic The Use of
percutaneous left atrial appendage closure
As Treatment, Chronic
Is equal Than
anticoagulants, antivitamine K, warfarin
To lodify all cause stroke or systemic embolism per year: 1.75% closure VS 1.87 warfarine. More ischemic but less hemorrhagic strokes with the device. Device had also less nonprocedural bleedings.
Lancet. 2009 May 2;373(9674):1532-42 Meta-Analysis
IN cancer, associated chronic anemia The Use of
erythropoietin analogs, recombinant human erythropoiesis-stimulating agents
As Treatment, Chronic
Is worse Than
placebo
To mortality (mean follow-up 6-8 months): 12% with erythropoietin VS 11% with placebo
J Clin Oncol. 2011 Sep 1;29(25):3457-6 Cohorts
IN cancer, chemotherapy, toxicity, risk estimation, older patients The Use of
a risk stratification schema (range 0 to 19) composed of age, anemia, renal failure, bad hearing, >1 fall last 6 months, needing help for taking medocs, reduced walking, decreased social life, polychemotherapy and using standard chemo dose
As Prognostic Item
Is better Than
no systematic assessment
To predict grade 3 (severe), grade 4 (life-threatening or disabling), or grade 5 (death) chemotherapy toxicity: low risk, 0 to 5 points = 30% incidence, intermediate 6 to 9 points = 52%, high risk 10 to 19 points = 83%
BMJ. 2006 Jul 8;333(7558):69-70. Epub 2006 Jun 21 Cohorts
IN cancer, colorectal, clinical presentation The Use of
new onset rectal bleeding in patients aged 45 or more
As Diagnostic Tool
Is useful Than
no comparison here
To investigate bowel: 5.7% of this patients had colorectal cancer, and 4.9% had colonic adenoma.
Arch Surg. 2005 Feb;140(2):183-9 Cohorts
IN cancer, colorectal, metastatic The Use of
prognostic factors: Dukes stage, number of metastases, carcino-embryonic antigen, alkaline phosphatase, and albumin
As Prognostic Item
Is good Than
-
To derive prognoses groups having different survival at 5 years: poor (0% survival), moderate (20% survival), good (62,5% survival)
J Clin Oncol. 2007 Aug 20;25(24):3582-8 Decision Model
IN cancer, prostate The Use of
a nomogram including age, ethnicity, family history, urinary symptoms, prostatic specific antigen (PSA), free:total PSA ratio, and digital rectal examination
As Diagnostic Tool
Is better Than
PSA alone
To detect patients with prostate cancer. 24% of patients with PSA < 4 ng/mL had prostate cancer.
J Clin Oncol. 2005 Jul 1;23(19):4322-9. Epub 2005 Mar 21 Decision Model
IN cancer, prostate The Use of
PSA>1.55 ng/mL or >0.165 ng/mL/cc(prostate volume), hypoechoic lesion, age>55y, prostate volume<44cc
As Diagnostic Tool
Is better Than
increase PSA alone
To select patients for prostatic biopsy in search of prostatic cancer: 31% sensibility and 96,6% specificity for prostatic cancer
N Engl J Med. 2008 Oct 9;359(15):1577-89 Randomized Controlled Trial, Multicenter Study
IN diabetes mellitus, type 2 The Use of
(moderately) intensive glucose control using insulin or oral hypoglycemic agents, sulfonylurea, metformin
As Treatment, Chronic
Is better Than
conventional treatment starting with diet
To reduce, at 10 years, any diabetes related point: 4.8% per year intensive VS 5.2% per year conventional (NNT 213). Also reduced mortality of any cause: 2.7%/year intensive VS 3.0%/year conventional (NNT 254)
N Engl J Med. 2006 Dec 7;355(23):2427-43 Randomized Controlled Trial, Multicenter Study
IN diabetes mellitus, type 2 The Use of
oral hypoglycemic agents, glitazones (rosiglitazone)
As Treatment, Chronic
Is better Than
oral hypoglycemic agents, metformin, sulphonylureas (glyburide)
To avoid, at 5 years, monotherapy failure: 15% rosiglitazone, 21% metformin, 34% glyburide. But rosiglitazone had more cardiovascular events (including heart failure) than glyburide (4.3% VS 2.8%) and mortality was the same with all treatments (2.1 to 2.3%)
N Engl J Med. 2007 June 14;356(24):2457-71. Epub 2007 May 21 Meta-Analysis
IN diabetes mellitus, type 2 The Use of
oral hypoglycemic agents, glitazones (rosiglitazone)
As Treatment, Chronic
Is worse Than
placebo or other hypoglycemic agents
To affect the incidence of myocardial infarction (OR 1.44) and cardiovascular death (OR 1.64)
Cochrane Database Syst Rev. 2006 Jan 25;(1):CD002967 Systematic Review, Cochrane Review
IN diabetes mellitus, type 2 The Use of
oral hypoglycemic agents, metformin
As Treatment, Chronic
Is equal Than
oral hypoglycemic agents, sulphonylureas
To the risk of lactic acidosis: 6.3 cases per 100,000 patient-years with metformin VS 7.8 cases per 100,000 patient-years.
Lancet. 1998 Sep 12;352(9131):854-65 Randomized Controlled Trial
IN diabetes mellitus, type 2 The Use of
oral hypoglycemic agents, metformin
As Treatment, Chronic
Is better Than
oral hypoglycemic agents, sulphonylureas (chlorpropamide, glibenclamide), or insulin
To reduce, at 10 years, diabetes related endpoint (7.5 events/1000 patients/year in metformine VS 12.7 others) and all-cause mortality (13.5 events/1000 patients/year in metformine group vs 20.6 others)
BMJ. 2007 Sep 8;335(7618):497 Systematic Review
IN diabetes mellitus, type 2 The Use of
oral hypoglycemic agents, metformin
As Treatment, Chronic
Is better Than
other oral hypoglycemic agents, sulphonylureas, glitazones
To reduce overall mortality and the risk of hospital admission for heart failure
PLoS Med. 2012;9(4):e1001204 Systematic Review
IN diabetes mellitus, type 2 The Use of
oral hypoglycemic agents, metformin
As Treatment, Chronic
Is equal Than
placebo, diet alone or other hypoglycemic agents
To modify all-cause mortality (RR 0.99), cardiovascular mortality (RR=1.05), myocardial infarctions (RR=0.90), all strokes (RR=0.76), peripheral vascular disease (RR=0.90), leg amputations (RR=1.04) or microvascular complications (RR=0.83)
Diabetes Obes Metab. 2017 Mar;19(3):329-335 Systematic Review
IN diabetes mellitus, type 2 The Use of
oral hypoglycemic agents, sulphonylureas
As Treatment, Chronic
Is worse Than
other oral hypoglycemic agents, metformin, dipeptidyl peptidase 4 (DPP4) inhibitors, sodium-glucose cotransporter-2 inhibitors, or insulin
To modify total and cardiovascular mortality. Total mortality was higher with sulphonylureas compared with metformin (HR 1.37), DPP-4 inh (HR 2.03), thiazolidinediones (HR 1.54) and insulin (HR 1.21). CV mortality was higher than SGLT-2 inh and GLP1 agonists
Lancet. 1998 Sep 12;352(9131):837-53 Randomized Controlled Trial
IN diabetes mellitus, type 2 The Use of
oral hypoglycemic agents, sulphonylureas (chlorpropamide, glibenclamide)
As Treatment, Chronic
Is equal Than
insulin
To reduce, at 10 years, diabetes related endpoint and mortality
Diabetes Care. 2011 Feb;34(2):308-13 Randomized Controlled Trial
IN diabetes mellitus, type 2, elderly patients, medical informatics, clinical decision support systems (for patients), telemedicine, remote monitoring (glucose) The Use of
remote clinical decision support system to monitore glucose and adapt treatment by messages to mobile phone
As Treatment, Chronic
Is better Than
usual self-monitored blood glucose or routine care without blood glucose daily monitoring
To improve number of patients with HgbA1C <7% without hypoglycemia at 6 months: 31% u-healthcare, 23% self-monitoring, and 14% routine care
N Engl J Med. 2002 Feb 7;346(6):393-403 Randomized Controlled Trial, Multicenter Study
IN diabetes mellitus, type 2, glucose intolerance The Use of
lifestyle-modification program, oral hypoglycemic agents, metformine
As Prevention, Primary
Is better Than
placebo
To reduce incidence of diabetes (in per 100 person-years): 11.0% placebo, 7.8% metformin, and 4.8% lifestyle group
Am J Cardiol. 2010 Oct 1;106(7):1006-10 Cohorts
IN diabetes mellitus, type 2, heart failure, chronic The Use of
oral hypoglycemic agents, metformin
As Treatment, Chronic
Is better Than
oral hypoglycemic agents, sulphonylureas
To reduce deaths
Lancet. 2005 Oct 8;366(9493):1279-89 Randomized Controlled Trial, Multicenter Study
IN diabetes mellitus, type 2, macrovascular complications The Use of
oral hypoglycemic agents, glitazones (pioglitazone), in addition to pre-existing glucose-lowering drugs
As Treatment, Chronic
Is worse Than
placebo, in addition to pre-existing glucose-lowering drugs
To reduce, at 3 years, a composite outcome of vascular events (all-cause mortality, stroke, acute coronary syndrome, coronary or leg revascularization, amputation: HR 0.90) and heart failure increased: 6% glitazone VS 4% ctrl
N Engl J Med. 2008 Feb 7;358(6):580-91 Randomized Controlled Trial
IN diabetes mellitus, type 2, microalbuminuria, cardiovascular disease The Use of
intensified multifactorial intervention: tight glucose control plus use of renin-angiotensin system blockers, aspirin, and lipid-lowering agents (statins)
As Treatment, Chronic
Is better Than
usual (conventional) therapy
To reduce, at 13 years, all-cause mortality (30% multifactorial Tt VS 50% usual Tt), cardiovascular events (HR 0.54) and advenced reanl disease.
Arch Intern Med. 2009 Mar 23;169(6):616-25 Randomized Controlled Trial
IN diabetes mellitus, type 2, needing insulin The Use of
adding oral hypoglycemic agents, metformin, to insulin combination
As Treatment, Chronic
Is better Than
insulin monotherapy alone
To reduce macrovascular compications (NNT 16) but not microvascular complications.
N Engl J Med. 2007 Oct 25;357(17):1716-30 Randomized Controlled Trial
IN diabetes mellitus, type 2, needing insulin The Use of
addition of biphasic or prandial rapid (aspart) insulin to oral agents
As Treatment, Chronic
Is better Than
addition of basal slow (detemir) insulin to oral agents
To improve glycaemic control: 7.2% in prandial group VS 7.6% in the basal group, but increased hypoglycaemia and weight gain.
Diabetes Care. 2005 Feb;28(2):254-9 Randomized Controlled Trial
IN diabetes mellitus, type 2, needing insulin The Use of
long acting insulin (bedtime glargine insulin (Lantus-TM)) plus oral hypoglycemic agents combination
As Treatment, Chronic
Is better Than
insulin monotherapy (mixed NPH/rapid twice daily)
To control glycaemia (more patients reaching HgA1c < 7%: 46% combined treatment VS 29% insulin alone) and avoid hypoglycaemia.
N Engl J Med. 2009 Oct 29;361(18):1736-47 Randomized Controlled Trial, Multicenter Study
IN diabetes mellitus, type 2, needing insulin The Use of
long acting insulin (detemir), basal, once daily or short acting insulin (aspart), prandial, three times daily, added to oral hypoglycemic agents
As Treatment, Chronic
Is better Than
short acting insulin (aspart), biphasic, twice daily
To reduce number of patients having Hbg A1C < 6.5% (32% biphasic VS 43% basal VS 45% prandial) However, mean Hgb A1C was not different in all 3 groups (6.8 to 7.1%)
Cochrane Database Syst Rev. 2004 Oct 18;(4):CD003418 Systematic Review, Cochrane Review
IN diabetes mellitus, type 2, needing insulin The Use of
medium-long acting insulin (bedtime NPH) plus oral hypoglycemic agents combination
As Treatment, Chronic
Is equal Than
medium-long acting insulin monotherapy (NPH once or twice daily)
To control glycaemia and avoid hypoglycaemia. Better to control weight if metformin is used (less weight gain). Mortality or associated morbility (cardiac, renal, ocular...) were not evaluated.
Diabetes Obes Metab. 2014 Nov;16(11):1165-73 Case-Control
IN diabetes mellitus, type 2, non-diabetic patients, overall mortality The Use of
oral hypoglycemic agents, metformin
As Treatment, Chronic
Is better Than
oral hypoglycemic agents, sulphonylurea
To reduce overall mortality: 14.4 /1000 metformin VS 15.2 /1000 matched non-diabetics VS 51 /1000 sulphonylurea.
Clin Ther. 2008 Nov;30(11):1976-87 Randomized Controlled Trial, Multicenter Study
IN diabetes mellitus, type 2, poor control with oral agents The Use of
long acting insulin, insulin detemir (Levemir-TM), basal, once or twice daily, added to oral hypoglycemic agents
As Treatment, Chronic
Is equal Than
long acting insulin, insulin glargine (Lantus-TM), basal, once daily, added to oral hypoglycemic agents
To modify at 1 year HbA1C (about 7% both) or modify number of hypoglycemia. Insulin detemir assodiated a lower weight gain (2.8Kg detemir VS 3.8 kg glargine)
BMC Geriatr. 2014 May 15;14:64 Cohorts
IN elder patients, comprehensive geriatric assessment, overall mortality, comorbidity scores The Use of
commons components of geriatric assesment (age, sex, cognitive impairment and Barthel index) or the Geriatric Index of Comorbidity
As Prognostic Item
Is better Than
other widely used indices such as the Charlson Index
To predict 5-year mortality in hospitalized older patients
N Engl J Med. 2011 Nov 24;365(21):2002-12 Cohorts
IN elder patients, geriatric pharmacology, drug adverse effects The Use of
four common, appropriate, medication classes: warfarin, insulins, oral antiplatelet drugs, and oral hypoglycemic agents
As Etiologic risk factor
Is useful Than
no comparison here
To be implicated, alone or in combination, in 2/3 of hospitalizations of elder patients because drug adverse events: warfarin (33.3%), insulins (13.9%), oral antiplatelet agents (13.3%), and oral hypoglycemic agents (10.7%)
Implement Sci. 2012;7:50 Review (Narrative)
IN evidence based medicine, implementation, knowledge transfer The Use of
systematic reviews and other syntheses as the basic unit of knowledge transfer, identifying key messages for different audiences, assessing likely barriers and facilitators
As Methodology procedure
Is useful Than
no comparison done
To improve translation into healthcare practice of research findings
Ann Intern Med. 2005 Feb 15;142(4):260-73 Systematic Review
IN evidence based medicine, keeping up to date, clinical experience The Use of
longer time in medical practice, longer time after medical graduation, older age
As Prognostic Item
Is worse Than
shorter time of medical practice after graduation
To provide good-quality care: physicians with more experience may paradoxaxically be at risk for providing lower-quality care. In some studies, patient mortality was greater
Arch Intern Med. 2007 Jun 25;167(12):1291-6 Cohorts
IN gastrointestinal bleeding, upper The Use of
APACHE II score of 11 or greater, esophageal varices, stigmata of recent hemorrhage and unstable comorbidity on admission
As Prognostic Item
Is useful Than
-
To predict poor oucome (rebleeding, need for surgery, new or worsening comorbidity or death): if none of these factors only 6.2% had poor outcome
World J Surg. 1990 Mar-Apr;14(2):262-9 Descriptive
IN gastrointestinal bleeding, upper, peptic disease The Use of
age over 60 years, previous medical illness, shock on admission, large ulcer size, and endoscopic stigmata of hemorrhage
As Prognostic Item
Is useful Than
-
To predict an increased risk of rebleeding and mortality
Endoscopy. 1998 Aug;30(6):513-8 Clinical Trial
IN gastrointestinal bleeding, upper, peptic disease The Use of
endoscopic stigmata of hemorrhage
As Prognostic Item
Is useful Than
-
To predict re-bleeding: 39% of ulcers with visible vessels, 29% with adherent clots, 13% with dots, 5% with clean base
Gut. 1994 Jun;35(6):746-9 Clinical Trial
IN gastrointestinal bleeding, upper, peptic disease The Use of
endoscopic stigmata of hemorrhage, shock at admission
As Prognostic Item
Is useful Than
-
To predict risk of rebleeding, 94% of rebleedings were in the first 96 hours
N Engl J Med. 1981 Oct 15;305(16):915-6 Cohorts
IN gastrointestinal bleeding, upper, peptic disease The Use of
endoscopic stignmata of recent hemorrhage, specially ulcers with visible vessels
As Prognostic Item
Is useful Than
-
To predict an increased risk of rebleeding
Arch Cardiovasc Dis. 2014 Mar;107(3):158-68 Cohorts
IN heart failure, chronic The Use of
knowing long-term mortality, stratified by ages, in France
As Prognostic Item
Is useful Than
no comparison here
To be aware of the poor prognosis of patients hospitalised by decompensated HF: 29% mortality at 1 year, 40% at 2 years. Incrased age carried increased mortality
Cochrane Database Syst Rev. 2012;9:CD002752 Systematic Review, Cochrane Review
IN heart failure, chronic The Use of
follow-up after discharge, case management with telephone calls and visits led by a heart failure specialist nurse
As Treatment, Chronic
Is better Than
multidisciplinary, clinic-based interventions
To reduce all cause mortality (OR 0.66) and readmissions (OR 0.47) at 12 months. Clinic-based follow-up reduced only readmissions and not mortality
N Engl J Med. 2006 Jul 20;355(3):260-9 Cohorts
IN heart failure, chronic, diastolic (preserved ejection fraction) The Use of
age, female, history of hypertension and atrial fibrillation
As Etiologic risk factor
Is useful Than
no comparison here
To be associated to heart failure with preserved ejection fraction. Mortality at 1 year was not different from heart failure with reduced ejection fraction: 22% preserved VS 26% reduced.
Eur J Heart Fail. 2010 Sep;12(9):936-42 Systematic Review
IN heart failure, chronic, mild anemia The Use of
erythropoiesis-stimulating agents, erythropoietin
As Treatment, Chronic
Is equal Than
placebo
To to modify overall mortality (RR 1.03) or worsening heart failure (RR 0.95)
Cochrane Database Syst Rev. 2010;1(1):CD007613 Systematic Review, Cochrane Review
IN heart failure, chronic, mild anemia The Use of
erythropoiesis-stimulating agents, supplemented by iron therapy
As Treatment, Chronic
Is better Than
placebo
To improve 6-minute walk distance (WMD 69 metres) and exercise capacity. Mean increase in Hgb was 1.98 g/dL. Also, lower rate of heart failure decompensations and a possible benefit in mortality.
J Am Coll Cardiol. 2010 Feb 16;55(7):645-53 Randomized Controlled Trial, Multicenter Study
IN heart failure, chronic, systolic The Use of
N-terminal pro-brain natriuretic peptide (NT-proBNP) guided therapy, intensive patient management
As Treatment, Chronic
Is better Than
usual care or multidisciplinary heart-failure-specialized care
To reduce number of rehospitalizations because heart failure (28% BNP VS 40% multidisciplinary VS 61% usual care) and reduce death (22% both BNP and multidisciplinary VS 39% usual care)
Ann Intern Med. 2010 Jul 6;153(1):23-33 Systematic Review
IN kidney disease, chronic, associated anemia, erythropoiesis-stimulating agents The Use of
erythropoiesis-stimulating agents, erythropoietin, targeting higher hemoglobin levels
As Treatment, Chronic
Is worse Than
targeting lower hemoglobin levels
To increase risks for stroke (RR 1.5), hypertension (RR 1.7), and vascular access thrombosis (RR 1.3) and probably increases risks for death (RR 1.09, p NS)
Lancet. 2005 Jul 16-22;366(9481):211-7 Randomized Controlled Trial
IN mind-body relations, coronary disease, percutaneous coronary intervention, elective The Use of
remote intercessory prayer, praying for others, MIT therapy: music, imagery and touching
As Treatment, Acute
Is equal Than
none of those treatments
To reduce mortality, major adverse effects of coronary intervention or readmission to hospital at 6 months
Ann Neurol. 2010 Oct;68(4):494-502 Randomized Controlled Trial, Multicenter Study
IN multiple sclerosis The Use of
dalfampridine (4-aminopyridine), extended-release 10mg twice daily, voltage-dependent potassium channel blocker improving in demyelinated pathways
As Treatment, Chronic
Is better Than
placebo
To Increase walking ability at 9 weeks (number of patients showing consistent improvement: 43% dalfam VS 9% placebo)
N Engl J Med. 2011 Mar 31;364(13):1218-29 Randomized Controlled Trial
IN obesity, diets, lifestyle and habits, elderly adults The Use of
weight management (diet) plus exercise program
As Treatment, Chronic
Is better Than
no treatment, weight management (diet) alone or exercise program alone
To improve at 1 year physical status scores: increases from baseline of 21% diet+exercise VS 12% diet VS 15% exercise
Lancet Neurol. 2010 Feb;9(2):149-58 Diagnostic
IN parkinsonism, parkinson disease, multiple system atrophy, progressive supranuclear palsy The Use of
automated image-based pattern analysis of fluorine-18-labelled-fluorodeoxyglucose-PET (positron emission tompgraphy)
As Diagnostic Tool
Is equal Than
final diagnosis after clinical followup at 2.5 years
To differenciate precociously, in patients with parkinsonism between primary parkinson disease, multiple system atrophy and progressive supranuclear palsy
Cochrane Database Syst Rev. 2008;(2):CD001368 Systematic Review, Cochrane Review
IN peripheral arterial disease, lower extremities, intermittent claudication The Use of
naftidrofuryl, a vasoactive agent
As Treatment, Chronic
Is better Than
placebo
To improve symptoms, increasing pain-free walking distance
N Engl J Med. 1997 Jan 23;336(4):243-50 Cohorts
IN pneumonia, community-adquired The Use of
Pneumonia Severity Index (PSI) based on age, coexisting disease, abnormal physical findings (respiratory rate > 30, temperature > 40°C), and abnormal laboratory findings (pH <7.35, urea > 11 mmol/L, sodium <130 mmol/L)
As Prognostic Item
Is useful Than
(no comparison)
To accurately predict risk of mortality at 30 days: 0.4% in class I, 0.7% class II, 1-2.8% class III
Cochrane Database Syst Rev. 2005 Apr 18;(2):CD004418 Systematic Review, Cochrane Review
IN pneumonia, community-adquired, hospitalized patients The Use of
initial empiric antibiotic regimen with: atypical pathogens coverage
As Treatment, Acute
Is equal Than
classic only typical pathogen coverage by default
To modify mortality, clinical success rate or adverse events.
Arch Intern Med. 2005 Sep 26;165(17):1992-2000 Meta-Analysis
IN pneumonia, community-adquired, hospitalized patients The Use of
initial empiric antibiotic regimen with: atypical pathogens coverage: macrolide or quinolone
As Treatment, Acute
Is equal Than
classic only typical pathogen coverage by default: beta-lactam
To reduce mortality or adverse effects
Am J Respir Crit Care Med. 2006 Jul 1;174(1):84-93. Epub 2006 Apr 7 Study type to be defined
IN pneumonia, community-adquired, respiratory infection, lower airways The Use of
procalcitonin, antibiotics use according to procalcitonin (in mug/L): strongly discouraged < 0.1; discouraged < 0.25; encouraged > 0.25; strongly encouraged > 0.5
As Diagnostic Tool
Is better Than
systematic treatment with antibiotics
To identify patients with severe infection and guide antibiotic use: it reduced antibiotic use (85% vs 99%) and duration (5 vs 12 days) obtaining same outcome (success rate 83%)
Ann Rheum Dis. 2013 Jun;72(6):804-14 Consensus Conference
IN rheumatoid arthritis The Use of
ultrasound, or MRI to image joints
As Diagnostic Tool
Is better Than
clinical examination, or conventional radiography
To to detect active inflammation, better detect bone and joint damage, so assess respônse to therapy and predict future evolution of the disease
N Engl J Med. 2017 Jun 08;376(23):2235-2244 Cohorts
IN sepsis The Use of
more rapid administration of antibiotics and rapid completion of a 3-hour bundle of sepsis care (i.e., blood cultures, broad-spectrum antibiotic agents, and lactate measurement)
As Treatment, Acute
Is better Than
more delayed administration of antibiotics and completion of a bundle of sepsis care
To reduce in-hospital mortality (OR 1.04 per hour). More rapid administration of fluid bolus had no influence in mortality
Stroke. 2015 Apr;46(4):1014-23 Meta-Analysis
IN stroke, ischemic, lacunar The Use of
any single antiplatelet agent, aspirin, ticlodipine
As Treatment, Chronic
Is better Than
placebo
To reduce ischemic stroke (RR 0.48) and any stroke (RR 0.77) but not myocardial infarction or death
Stroke. 2010 Apr;41(4):667-73 Systematic Review
IN stroke, ischemic, transient ischemic attack, risk of evolving to stroke The Use of
ABCD and ABCD2 modified scores: age, hypertension, clinical deficit, duration of symptoms (and diabetes)
As Prognostic Item
Is useful Than
no comparison
To predict risk of stroke at 7 days: AUC 0.72 for both scores. However, predictive value varied significantly between studies
Stroke. 2006 Dec;37(12):2892-7 Cohorts
IN stroke, ischemic, transient ischemic attack, risk of evolving to stroke The Use of
ABCD score: age, hypertension, clinical deficit and duration of symptoms
As Prognostic Item
Is useful Than
no comparison
To identify patients at high-risk of having an stroke in the following 30 days: 0% risk if score < 3; 3.5% and 7.6% scores 3 and 4; 21% score = 5; 31% score = 6.
Lancet. 2005 Jul 2;366(9479):29-36 Randomized Controlled Trial
IN stroke, ischemic, transient ischemic attack, risk of evolving to stroke The Use of
ABCD score: age, hypertension, clinical deficit and duration of symptoms
As Prognostic Item
Is useful Than
no comparison
To identify patients at high-risk of having an stroke in the next 7 days: 0.4% risk if score < 5, 12% if = 5, 31% if = 6.
Stroke. 2010 May;41(5):844-50 Cohorts
IN stroke, ischemic, transient ischemic attack, risk of evolving to stroke The Use of
ABCD2 modified score (age, hypertension, clinical deficit, duration of symptoms and diabetes) or carotid stenosis
As Prognostic Item
Is useless Than
no comparison
To accurately predict risk of stroke at 90 days in confirmed cases of TIA: 24% of patients with TIA recurrence or stroke had low ABCD2 scores. Presence and severity of carotid stenosis was more predictive.
Lancet. 2007 Jan 27;369(9558):283-92 Cohorts
IN stroke, ischemic, transient ischemic attack, risk of evolving to stroke The Use of
ABCD2 modified score: age, hypertension, clinical deficit, duration of symptoms and diabetes
As Prognostic Item
Is useful Than
no comparison here
To identify patients at high-risk of having an stroke in the following 2 days: 1% risk if score 1-3; 4.1% score 4-5; 8.1% score 6-7. Also good stratification at 7 and 90 days.
Stroke. 2009 Sep;40(9):3091-5 Diagnostic
IN stroke, ischemic, transient ischemic attack, risk of evolving to stroke The Use of
ABCD2 modified score: age, hypertension, clinical deficit, duration of symptoms and diabetes
As Prognostic Item
Is useless Than
no comparison here
To discriminate between patients needing or not urgent treatment: 20% of patients with an score < 4 required consideration for emergency treatment, sensibility 62%
N Engl J Med. 1998 Dec 10;339(24):1725-33 Descriptive
IN subarachnoid hemorrhage, intracranial aneurysm, unruptured, stroke, haemorrhagic The Use of
size of unruptured aneurysm and previous history of subarachnoid haemorrage
As Prognostic Item
Is useful Than
0
To predict risk of rupure and so decide preventive surgery or not: risk of rupture of aneurysms < 10 mm which never bleed is 0.05 %/year, much lesser than surgery risk.
Ann Emerg Med. 2009 Dec;54(6):769-778.e1-5 Study type to be defined
IN syncope, elder people The Use of
a syncope risk score: 1 point any of: age > 90, male sex, history of arrhythmia, triage systolic blood pressure > 160 mm Hg, abnormal ECG, and abnormal troponin I ; -1 point for near (incomplete) syncope
As Prognostic Item
Is useful Than
no comparison done
To predict risk of serious event at 30 days: 2.5% in low (-1 or 0 points), 3.3% in intermediate (1-2 points) and 20% in high (3-6 points) risk patients
Medicine (Baltimore). 2011 Jan;90(1):19-27 Cohorts
IN vasculitis, systemic necrotizing, Wegener granulomatosis, microscopic polyangiitis, Churg-Strauss, polyarteritis nodosa The Use of
revised Five-Factor Score (FFS): age >65 years, cardiac symptoms, gastrointestinal involvement, renal insufficiency, no ear-nose-and-throat symptoms (1 point each)
As Prognostic Item
Is useful Than
no comparison done
To predict mortality at 5 years: 9% score 0 VS 21% score 1 VS 40% score 2 or more