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DISEASE INTERVENTION COMPARISON RESULTS
Eur Heart J. 2018 Apr 21;39(16):1330-1393 Consensus, Guideline
IN anticoagulants, oral direct thrombin inhibitors, dabigatran, oral factor Xa inhibitors, apixaban, rivaroxaban The Use of
guidelines for their use in practice
As Treatment, Chronic
Is useful Than
no comparison here
To optimize their use and effectiveness, and avoid bleeding complications
Circulation. 2018 Feb 28. doi: 10.1161/CIRCULATIONAHA.117.031658. [Epub ahead of print] Cohorts
IN anticoagulants, oral direct thrombin inhibitors, dabigatran, oral factor Xa inhibitors, apixaban, rivaroxaban, real-world data, very elderly patients The Use of
these 3 direct oral anticoagulants
As Treatment, Chronic
Is better Than
warfarin
To reduce the risk of intracranial bleeding (0.42 %/year DOAs VS 1.63 % warfarin) with similar effect in stroke and all-type major bleeding.
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.
N Engl J Med. 2018 Jun 13. doi: 10.1056/NEJMoa1800389. [Epub ahead of print] Randomized Controlled Trial, Multicenter Study
IN atherosclerosis, cardiovascular disease, primary prevention, high risk patients The Use of
Mediterranean diet supplemented with extra-virgin olive oil, or with mixed nuts
As Prevention, Primary
Is better Than
simple advice to reduce dietary fat
To reduce cardiovascular events (myocardial infarction, stroke, or cardiovascular death): medit. diet plus olive oil 3.8% VS medit. diet plus nuts 3.4% VS control group 4.4%
JAMA. 2013 Jul 17;310(3):270-9 Randomized Controlled Trial, Multicenter Study
IN cardiac arrest, immediate resuscitation, post-resuscitation care The Use of
combined treatment with vasopressin (20 IU) plus epinephrine (1 mg) each 3 minutes for 5 times, plus 40 mg methylprednisolone IV once, plus hydrocortisone (300 mg/d for 7 days) in patients with shock after resuscitation
As Treatment, Acute
Is better Than
repeated epinephrine (1 mg) alone, without vasopressin nor corticosteroids
To improve survival to hospital discharge with no or little neurological impairment: 14% combined treatment VS 5% epinephrine alone
Am J Cardiol. 2013 Jun 15;111(12):1701-7 Diagnostic
IN coronary disease, acute coronary syndrome, myocardial infarction, older patients The Use of
high-sensitive cardiac troponin, increased cutoff at 40-50 ng/L in older patients and renal failure
As Diagnostic Tool
Is better Than
standard cutoff at 14 ng/L
To better diagnose acute coronary syndrome: sensitivity 87% and specificity 87% at 50 ng/Lfor older patients
N Engl J Med. 2006 Mar 23;354(12):1231-42 Randomized Controlled Trial, Multicenter Study
IN depression, unipolar, refractory The Use of
bupropion-SR, sertraline, or venlafaxine-XR
As Treatment, Chronic
Is equal Than
each other
To improve depression after failure of SSRI (no remission or intolerance) : about 25% patients responded with all 3 treatments
Am J Psychiatry. 2007 May;164(5):739-52 Randomized Controlled Trial, Multicenter Study
IN depression, unipolar, refractory The Use of
cognitive therapy
As Treatment, Chronic
Is equal Than
pharmacologic treatment : sustained-release bupropion, buspirone or associating a second antidepressant
To improve depression after SSRI failure (no response or intolerance) : equal number of responders. Pharmacologic augmentation was more rapidly effective but has more adverse effects
Am J Psychiatry. 2011 Jul;168(7):681-8 Systematic Review
IN depression, unipolar, refractory, older patients The Use of
lithium, extended-release venlafaxine and selegiline
As Treatment, Chronic
Is better Than
placebo or other therapeutic options
To improve clinical response : overall 52% of aptients responded
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
Age Ageing. 2013 Mar;42(2):262-5 Descriptive, Cross-Sectional Study
IN elder people, comprehensive geriatric assessment, frailty scores The Use of
PRISMA-7, a short 7-items questionnaire
As Diagnostic Tool
Is better Than
other frailty measures : clinical judgement ot GP, polypharmacy or the Groningen frailty indicator (GFI)
To better diagnose frailty : sensitivity 85% and specificity 73% VS Fried criteria as glod standard
J Neurol Neurosurg Psychiatry. 2011 Aug;82(8):924-7 Randomized Controlled Trial, Multicenter Study
IN epilepsy, generalized, focal, newly diagnosed (first tonic-clonic seizure) The Use of
no treatment, unless seizure recurrs
As Treatment, Chronic
Is equal Than
starting treatment immediatly (carbamazepine, phenytoin, phenobarbital, or sodium valproate)
To modify mortality at 20 years: 10% no Tt VS 9% immediate Tt. Only the presence of aetiological factors for epilepsy predicted a higher mortality (HR 3.4). Most patients died from remote, non primarily neurological diseases.
JAMA. 2018 04 24;319(16):1705-1716 Systematic Review
IN falls, older people The Use of
exercise and multifactorial programs
As Treatment, Acute
Is better Than
no or others interventions
To reduce frequency of falls (IRR 0.79-0.89) and injurious falls (IRR, 0.81). Trials of vitamin D formulations (with or without calcium) showed mixed results
BMJ. 2017 Jun 6;357:j2353. doi: 10.1136/bmj.j2353 Cohorts
IN lifestyle and habits, alcohol The Use of
moderately (14-21 units/week) or high (>30 units/week) alcohol consumtion
As Etiologic risk factor
Is worse Than
no alcohol consumtion, or light drinking (1 - 7 units/week)
To predict hypoccampal atrophy at 30 years of follow-up (OR 6 high drinkers, OR 3.4 moderate drinkers)
Br J Sports Med. 2015 Jun;49(11):743-8 Cohorts
IN lifestyle and habits, exercise, old patients The Use of
regular exercise, 30 mins of moderate to vigorous physical activity per 6 days a week
As Prevention, Primary
Is better Than
sedentary, no physical activity
To reduce overall mortality (40% reduction from 73 to 85 years old, with a 5 years increase in lifetime)
Med Educ. 2010 Jan;44(1):94-100 Systematic Review
IN medical thinking, errors, diagnostic The Use of
encouraging both kinds of reasoning, system 1 (non-analytical) and system 2 (analytical)
As Methodology procedure
Is better Than
only attempting to be systematic and analytical
To improve physicians diagnostic accuracy: it yields small, but consistent, improvements. Errors result from multiple causes. Little evidence associates diagnostic errors with over-reliance on System 1 (non-analytical) reasoning.
Neurology. 2014 Jan 7;82(1):41-8 Randomized Controlled Trial
IN multiple sclerosis, first demyelinating attack The Use of
Bacille Calmette-Guerin (BCG) vaccine
As Treatment, Acute
Is better Than
placebo
To reduce at 6 months the number of CNS gadolinium-enhancing lesions and reduce at 5 years the probability of clinically definite multiple sclerosis (HR 0.52)
Cochrane Database Syst Rev. 2012;5(0):CD008165 Systematic Review, Cochrane Review
IN older patients, geriatric pharmacology, inappropriate prescription, multiple medications The Use of
multifaceted pharmaceutical care provided in a variety of settings
As Treatment, Acute
Is better Than
no intervention
To reduce inappropriate drug prescription and possibly (only 3 studies repporting) the number of adverse drug events (RR 0.65). Effect on hospital admissions (four studies) was conflicting.
Cochrane Database Syst Rev. 2018 Apr 10;4(XX):CD007094 Systematic Review, Cochrane Review
IN respiratory infection, upper airways, cough, children The Use of
honey
As Treatment, Acute
Is better Than
no treatment, placebo or diphenhydramine, and equal than dextromethorphan
To achieve better symptomatic relief of cough (mean extra reduction of 1 to 1.6 points in a 7-points Likert scale)
J Hosp Med. 2013 Sep;8(9):530-40 Meta-Analysis
IN sepsis, any bacterial infection, critically ill patients, respiratory tract infections The Use of
procalcitonin, treating with antibiotics according to serum procalcitonin levels
As Diagnostic Tool
Is better Than
empirical treatment with antibiotics
To reduced antibiotic duration by 2 days without increasing morbidity or mortality
N Engl J Med. 2017 Jun 08;376(23):2223-2234 Meta-Analysis
IN sepsis, septic shock The Use of
early, goal-directed therapy
As Treatment, Acute
Is equal Than
usual care
To reduce mortality at 90 days and 1 year
JAMA Intern Med. 2017 Apr 01;177(4):563-570 Cohorts
IN stroke, haemorrhagic, intracerebral hemorrhage, traumatic, patients with atrial fibrillation The Use of
resuming warfarin afterwards
As Treatment, Chronic
Is better Than
definitively stopping warfarin, no oral anticoagulant treatment
To reduce at 1 year stroke or systemic embolism (HR 0.5 warfarin) but increasing recurrent intracranial HRR (HR 1.3) with a final reduction in overall mortality (HR 0.5 in stroke HRR, HR 0.35 in traumatic HRR with warfarin)
N Engl J Med. 2018 02 22;378(8):708-718 Randomized Controlled Trial, Multicenter Study
IN stroke, ischemic, cerebral infarction, 6 to 16 h of onset, proximal arterial occlusion in the anterior cerebral circulation, volume of ischemic tissue on perfusion imaging to infarct volume of 1.8 or more The Use of
endovascular treatment: thrombectomy, late
As Treatment, Acute
Is better Than
standard care
To improve at 3 months functional independence (45% thrombectomy VS 17% controls). Mortality was also some improved (14% thrombectomy VS 26% controls, p=0.05)
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
N Engl J Med. 2006 Jun 15;354(24):2564-75. Epub 2006 May 21 Randomized Controlled Trial, Multicenter Study
IN acute respiratory distress syndrome, acute lung injury, adults The Use of
fluid restriction
As Treatment, Acute
Is better Than
liberal fluid administration
To improve oxygenation index and shorten the duration of mechanical ventilation (15.9 days restriction VS 13.4 liberal) But not to reduce mortality at 60 days (25.5% restriction VS 28.4% liberal, p .30)
Lancet. 2018 Apr 28;391(10131):1693-1705 Systematic Review
IN acutely ill adults, emergency care The Use of
conservative oxygen therapy with a SpO2 of 94-96% as objective
As Treatment, Acute
Is better Than
liberal oxygen therapy, with SpO2 > 96%
To reduce overall mortality at 30 days and longuer: liberal oxygen therapy increased mortality (RR 1.14 at 30 days)
J Intern Med. 2017 May 4. doi: 10.1111/joim.12627. [Epub ahead of print] Cohorts
IN ageing, maximum lifespan The Use of
length of life of centenarian people
As Undefined
Is useful Than
no comparison here
To mortality reaches a plateau at particularly old ages: 50% at 103 years old, with no improvement amongst centenarians in the past 30 years. Rise in life expectancy is driven by reductions in mortality below the age of 100.
Cell. 2013 Jun 6;153(6):1194-217 Review (Narrative)
IN aging The Use of
nine tentative hallmarks: genomic instability, telomere attrition, epigenetic alterations, loss of proteostasis, deregulated nutrient sensing, mitochondrial dysfunction, cellular senescence, stem cell exhaustion, and altered intercellular communication
As Etiologic risk factor
Is useful Than
no comparison here
To help understand and study aging
JAMA. 2008 Jan 2;299(1):39-52 Randomized Controlled Trial
IN aging, hormonal decline The Use of
testosterone supplementation
As Treatment, Chronic
Is equal Than
placebo
To modify at 6 months functional mobility, muscle strength, cognitive function or bone mineral density. Lean body mass increased and metabolic effects were mixed.
PLoS One. 2015;10(7):e0132909 Cohorts
IN aging, pathological, old people, multimobidity patterns The Use of
four multimorbidity patterns: Cardiovascular, Induced Dependency (around cognitive decline and dementia), Falls and Osteoarticular
As Etiologic risk factor
Is useful Than
no comparison done
To identify diseases and/or geriatric syndromes that cluster into patterns
N Engl J Med. 2017 06 29;376(26):2513-2522 Cohorts
IN air pollution, overall mortality The Use of
air pollution: fine particulate matter (particles with a mass median aerodynamic diameter of less than 2.5 μm [PM2.5]) and ozone
As Etiologic risk factor
Is useful Than
no or lower pollution
To predict overall mrotality in populations affected: Increases of 10 μg/m3 in PM2.5 and of 10 ppb in ozone were associated with (relative) increases in all-cause mortality of 7.3% and 1.1% respectively
N Engl J Med. 2007 Jun 7;356(23):2361-71 Cohorts
IN amyloidosis, AA type, associated to chronic inflammatory disorders The Use of
serum amyloid A (SAA) concentration during follow-up
As Prognostic Item
Is useful Than
-
To predict long term evolution: renal dysfunction - which was the predominant disease manifestation - and mortality if SAA was low-normal (< 4 mg)
N Engl J Med. 2007 Jun 7;356(23):2349-60 Randomized Controlled Trial
IN amyloidosis, AA type, associated to chronic inflammatory disorders The Use of
eprodisate, interfere with interactions between amyloidogenic proteins and glycosaminoglycans
As Treatment, Chronic
Is better Than
placebo
To reduce at 2 years progression of renal failure: 27% eprodisate VS 40% placebo.
Am J Med. 2008 Apr;121(4):324-331.e6 Systematic Review
IN ankle sprain, lateral The Use of
long-term clinical course
As Prognostic Item
Is useful Than
no comparison here
To know that 5 to 33% of patients still had pain at 1 year, and 5-25% staill at 3 years. Instability and re-sprain were also frequent: 3-34% of patients.
Chest. 2007 Oct;132(4):1131-9 Meta-Analysis
IN anticoagulants, heparins, low molecular weight heparins, unfractionated heparin The Use of
low molecular weight heparins
As Treatment, Acute
Is equal Than
unfractionated heparin
To risk of thrombocytopenia: 1.2% with LMWH VS 1.5% with UH. Severe heparin-induced thrombocytopenia with thrombosis was too low to make an adequate comparison.
Gastroenterology. 2013 Jul;145(1):105-112.e15 Systematic Review
IN anticoagulants, oral direct thrombin inhibitors, dabigatran, oral factor Xa inhibitors, apixaban, rivaroxaban, edoxaban The Use of
these direct oral anticoagulants
As Treatment, Chronic
Is worse Than
warfarin
To cause a higher risk of gastrointestinal bleeding: OR 1.58 dabigatran, 1.48 rivaroxaban, 1.23 apixaban (non-significant), 0.31 edoxaban (non-significant for superiority)
Stroke. 2017 Sep;48(9):2494-2503 Cohorts
IN anticoagulants, oral direct thrombin inhibitors, dabigatran, oral factor Xa inhibitors, apixaban, rivaroxaban, real-world data The Use of
these direct oral anticoagulants
As Treatment, Chronic
Is better Than
warfarin
To reduce mortality (for dabigatran and apixaban (HR 0.65 both)), achieve similar rate of ischemic stroke or embolism, reduce intracranial bleeding (all 3 drugs, HR 0.40 to 0.65) but increasing gastrointestinal bleeding (except apixaban)
N Engl J Med. 2015 Aug 6;373(6):511-20 Cohorts
IN anticoagulants, oral direct thrombin inhibitors, dabigatran, patients who had serious bleeding or required an urgent procedure The Use of
idarucizumab, an dabigatran-specific antibody fragment
As Treatment, Acute
Is better Than
no comparison done
To normalize hemostasis tests in 88 to 98% of the patients in minutes. One thrombotic event occurred within 72 hours after idarucizumab administration.
N Engl J Med. 2016 Aug 30;(): Clinical Trial (non-controlled, non-randomized)
IN anticoagulants, oral factor Xa inhibitors, apixaban, rivaroxaban, patients with acute major bleeding The Use of
andexanet alfa, a recombinant modified human factor Xa decoy protein, IV bolus and subsequent 2-hour infusion
As Treatment, Acute
Is good Than
no comparison group
To quickly reduce anti-factor Xa activity after administration (90% reduction) and achieve effective clinical hemostasis at 12h (79% of patients). However, thrombotic events in 18% patients at 30-day follow-up.
Am J Med. 2012 Nov;125(11):1095-102 Cohorts
IN anticoagulants, oral, vitamin K antagonists, novel anticoagulants The Use of
seven different scoring systems
As Etiologic risk factor
Is equal Than
physician, subjective assessment
To predict the risk of major bleeding at 12 months (6.8% globally) : c-statistics ranged 0.54 to 0.61
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)
Arch Intern Med. 2010 Sep 13;170(16):1433-41 Cohorts
IN anticoagulants, vitamin K antagonists, antiplatelet drugs, aspirin, clopidogrel, bleeding risk The Use of
aspirin and/or clopidogrel associated to warfarin
As Treatment, Chronic
Is worse Than
warfarin alone
To risk of fatal and nonfatal bleeding: 14% per patient-year with warfarin plus clopidogrel, 16% with warfarin plus aspirin plus clopidogrel
Circulation. 2012 Sep 4;126(10):1185-93 Cohorts
IN anticoagulants, vitamin K antagonists, antiplatelet drugs, aspirin, clopidogrel, bleeding risk The Use of
vitamin K antagonist (VKA) +aspirin +clopidogrel
As Treatment, Chronic
Is worse Than
vitamin K antagonist +1 antiplatelet, or dual antiplatelet therapy with aspirin +clopidogrel
To cause bleeding events, specially in the first 30-90 days: 23 events per 100 person-years with triple therapy, 20 with VKA +1 antiplatelet, 14 with dual antiplatelet. Triple therapy was not more effective than VKA +1 antiplatelet
Am J Med. 2010 Jul;123(7):638-645.e4 Systematic Review
IN anticoagulants, vitamin K antagonists, atrial fibrillation The Use of
frequency of use of anticoagulants, vitamin K antagonists
As Treatment, Chronic
Is worse Than
frequency of use recommended by guidelines
To oral anticoagulants are largely underused in patients with AF and previous AIT or stroke (<70% patients anticoagulated in 25/29 studies, range 19-81%)) or CHADS2 > 2 (<70% patients anticoagulated in 7/9 studies, range 39-92%)
N Engl J Med. 2015 Aug 27;373(9):823-33 Randomized Controlled Trial, Multicenter Study
IN anticoagulants, vitamin K antagonists, atrial fibrillation, periprocedure interruption of anticoagulation The Use of
no bridging anticoagulation, just stopping warfarin 5 days before the procedure and resuming it within 24 hours afterwards
As Treatment, Acute
Is better Than
bridging anticoagulation with full-dose low-molecular-weight heparin (LMWH)
To avoid major bleeding (1.3% just stop Vs 3.2% bridging) while having similar incidence of arterial thromboembolism (0.4% just stop VS 0.3% bridging)
Arch Intern Med. 2004 Oct 11;164(18):2044-50 Cohorts
IN anticoagulants, vitamin K antagonists, bleeding risk, elder patients The Use of
insufficient therapeutic education, polypharmacy, and INR above therapeutic range
As Etiologic risk factor
Is useful Than
no comparison done
To predict increase risk of bleeding: insufficient education ([OR, 8.83), polypharmacy (OR, 6.14), and INR above range (OR 1.08). Low rate of major bleeding despite frequent comobidities and cognitive impairment: 2.4 events per 1000 patient-months
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 Am Coll Cardiol. 2011 Jan 11;57(2):173-80 Cohorts
IN anticoagulants, vitamin K antagonists, bleeding risk, elder patients The Use of
HAS-BLED score: Hypertension, Abnormal Renal/Liver Function, Stroke, Bleeding History or Predisposition, Labile INR, Elderly, Drugs/Alcohol Concomitantly (1 point each, 0 = low risk, 1-2 = moderate, >=3 = high risk)
As Prognostic Item
Is better Than
other available scores
To predict risk of major haemorrhage under chronic warfarin: low risk 0.9% per patient-year, moderate 3.7%, high 6.7%.
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.
Lancet. 2016 Jun 04;387(10035):2302-2311 Randomized Controlled Trial, Multicenter Study
IN anticoagulants, vitamin K antagonists, direct oral anticoagulants, bleeding risk The Use of
a new bleeding risk score : ABC-bleeding : age, previous bleeding, haemoglobin, high-sensitivity cardiac troponin T and growth differentiation factor-15 (GDF-15)
As Prognostic Item
Is better Than
other bleeding risk scores, HAS-BLED, ORBIT
To predict the risk of major bleeding at 1 year for patients on warfarin, apixaban or dabigatran
Ann Intern Med. 2009 Mar 3;150(5):293-300 Randomized Controlled Trial, Multicenter Study
IN anticoagulants, vitamin K antagonists, excessive anticoagulation, without major bleeding The Use of
low dose oral vitamin K (1.25mg)
As Treatment, Acute
Is equal Than
placebo
To reduce any bleeding (15.8% vit VS 16.3% placebo) or major bleedings (2.5 % vit K VS 1.1% placebo)
Arch Intern Med. 2003 Nov 10;163(20):2469-73 Randomized Controlled Trial
IN anticoagulants, vitamin K antagonists, excessive anticoagulation, without major bleeding The Use of
oral vitamin K1 (2.5mg if INR 6-10, 5mg if INR > 10)
As Treatment, Acute
Is equal Than
intravenous vitamin K1 (0.5mg if INR 6-10, 1mg if INR > 10)
To correct INR: response to intravenous phytonadione was more rapid at 6 and 12 hours, but at 24 hours INR values were similar for both groups and more patients in the IV group were overcorrected (INR < 2: 8.7% in PO group VS 29% in IV group)
BMJ. 2002 Nov 9;325(7372):1073-5 Descriptive
IN anticoagulants, vitamin K antagonists, monitoring The Use of
INR values in excess
As Prognostic Item
Is useful Than
No control
To hight INRs are associated with an excess mortality. With an increase of 1 unit of INR above 2.5, the risks of death from cerebral bleeding (149 deaths / 42 451 patients) and from any cause were about doubled
Ann Intern Med. 2003 May 6;138(9):714-9 Randomized Controlled Trial
IN anticoagulants, vitamin K antagonists, warfarin, thromboembolic disease The Use of
higher starting dose: 10 mg/day
As Treatment, Acute
Is better Than
usual starting dose: 5 mg/day
To reduce time to achieve therapeutic INR at day 5 (83% with 10mg VS 46% with 5mg, overall reduction by 1.5 days). No significant differences in major bleeding, coagulation excess (INR > 5.0), recurrent events and survival.
N Engl J Med. 2006 Jun 8;354(23):2443-51 Cohorts
IN antihypertensive drugs, angiotensin converting enzyme (ACE) inhibitors, adverse effects, congenital malformations The Use of
angiotensin converting enzyme (ACE) inhibitors during pregnancy, first trimester
As Treatment, Chronic
Is worse Than
other antihypertensive drugs
To increase the risk of major congenital malformations (RR, 2.71; 95 %CI, 1.72 to 4.27) as compared with no exposure to antihypertensive medications.
Blood. 2018 Sep 27;132(13):1365-1371 Randomized Controlled Trial, Multicenter Study
IN antiphospholipid syndrome The Use of
anticoagulants, oral factor Xa inhibitors, rivaroxaban
As Treatment, Chronic
Is worse Than
anticoagulants, vitamin K antagonists, warfarin
To reduce major events (thromboembolic events or major bleeding): 19% rivaroxaban VS. 3% warfarin.
Lancet. 2017 07 29;390(10093):490-499 Cohorts
IN antiplatelet drugs, aspirin, bleeding risk The Use of
any anitplatelet drug, mainly aspirin (95% of included patients)
As Treatment, Chronic
Is worse Than
no antipaltelet therapy
To increase the risk of bleeding. Bleeding rate increased with age from 70 years on, specially major and life-threatening bleeding. Localizations, by frequency: gastrointestinal, genitourinary, intracranial, epistaxis, others
Arch Intern Med. 2010 Feb 22;170(4):321-31 Systematic Review
IN anxiety symptoms, patients with a chronic illness The Use of
exercise training
As Treatment, Chronic
Is better Than
no training
To to modestly improve anxiety symptoms: mean effect Delta 0.29
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.
JAMA. 2007 Apr 4;297(13):1478-88 Systematic Review
IN arthritis, acute, septic The Use of
synovial fluid white blood cell count > 50.000/mcl and polymorphonuclear count > 90%
As Diagnostic Tool
Is better Than
any clinical sign or smptom
To diagnose septic arthritis: respective LR+ of 7,7 and 3,4
JAMA. 2008 Mar 12;299(10):1166-78 Systematic Review
IN ascitis, portal hypertension, liver failure, spontaneous bacterial peritonitis The Use of
1) bedside inoculation of ascitic fluid into blood culture bottles and PMN count >250 cells/microL; 2) serum-ascites albumin gradient < 1.1 g/dL
As Diagnostic Tool
Is useful Than
no comparison
To diagnose: 1) spontaneous bacterial peritonitis (LR+ 9); 2) portal hypertension as ascitis cause (LR- 0.06)
N Engl J Med. 2007 May 17;356(20):2040-52 Randomized Controlled Trial, Multicenter Study
IN asthma The Use of
combination of inhaled corticosteroids and long-acting beta2-agonists (beclomethasone, albuterol) as on-demand reliever Tt
As Treatment, Chronic
Is better Than
only short-acting b2-agonists on-demand
To reduce at 6 months number of exacerbations (numbers not stated in abstract). But it was NOT better than regular inhaled corticoids plus on-demand or than regular combined treatment
Chest. 2006 Jan;129(1):15-26 Randomized Controlled Trial, Multicenter Study
IN asthma The Use of
inhaled short-acting beta2-agonist (salmeterol) as on-demand reliever Tt, added to usual treatment
As Treatment, Chronic
Is worse Than
placebo
To reduce, at 28 weeks, respiratory-related deaths (0.2% salbutamol VS 0.1% placebo)
Ann Intern Med. 2015 Sep 22; doi: 10.7326/M15-1059 [Epub ahead of print] Systematic Review
IN asthma The Use of
leukotriene antagonists
As Treatment, Chronic
Is better Than
placebo
To reduce the risk of exacerbations (RR 0.60) and increase FEV1. In 4 trials employed as add-on therapy to inhaled corticosteroids, the RR for exacerbation was 0.80 (CI, 0.60 to 1.07)
Am J Respir Crit Care Med. 2005 Jun 1;171(11):1231-6 Randomized Controlled Trial
IN asthma, acute exacerbation The Use of
corticosteroids, inhaled, fluticasone
As Treatment, Acute
Is better Than
parenteral IV corticosteroids
To improve PEF and FEV1 (30 to 46% more improvement with inhaled VS. IV corticosteroids) and reduce hospital admisions - all at 3 hours (very short term)
JAMA. 1999 Jun 9;281(22):2119-26 Randomized Controlled Trial
IN asthma, acute exacerbation The Use of
corticosteroids, inhaled, high dose, budesonide
As Treatment, Acute
Is better Than
placebo
To reducing symptoms and relapses, as unscheduled visits to physician, but not overall low rate of hospitalization. Improving quality of life.
BMJ. 1998 Oct 10;317:971-977 Meta-Analysis
IN asthma, acute exacerbation The Use of
inhaled anticholinergics added to inhaled beta-agonists
As Treatment, Acute
Is better Than
inhaled beta-agonists alone
To reduce the risk of hospital admission by 30% (RR 0.72, NNT 11) in children and adolescents with severe exacerbations
Am J Med. 1999 Oct;107:363-70 Meta-Analysis
IN asthma, acute exacerbation The Use of
inhaled anticholinergics added to inhaled beta-agonists
As Treatment, Acute
Is better Than
inhaled beta-agonists alone
To reducing hospitalization rate
N Engl J Med. 2012 Sep 2. [Epub ahead of print] Randomized Controlled Trial, Multicenter Study
IN asthma, persistent despite treatment with inhaled glucocorticoids and long-acting beta-agonists The Use of
inhaled long-acting anticholinergics, tiotropium
As Treatment, Chronic
Is better Than
placebo
To increase time to the first severe exacerbation (282 days vs. 226 days), and reduce risk of severe exacerbation (HR, 0.79). No deaths. Patients with cardiac disease were excluded: safety of tiotropium there?
N Engl J Med. 2005 Apr 14;352(15):1519-28 Randomized Controlled Trial
IN asthma, persistent, mild The Use of
as-needed corticosteroids, intermittent short-courses of inhaled or oral corticosteroids
As Treatment, Chronic
Is equal Than
as-needed inhaled corticoisteroids added to either daily inhaled corticosteroids or oral zafirlukast
To improve rate of asthma exacerbations or quality of life, taking much lesser doses of corticosteroids
Cochrane Database Syst Rev. 2013;2:CD009611 Systematic Review, Cochrane Review
IN asthma, persistent, mild The Use of
intermitent, as needed inhaled corticosteroids
As Treatment, Chronic
Is equal Than
daily inhaled corticosteroids, continuous
To modify the number of exacerbations, adverse effects, hospitalisations, emergency department visits or quality of life. In children, daily corticosteroid were associated with some lesser growth
N Engl J Med. 2011 May 5;364(18):1695-707 Randomized Controlled Trial
IN asthma, persistent, mild The Use of
leukotriene antagonists
As Treatment, Chronic
Is equal Than
inhaled glucocorticoid for first-line asthma-controller therapy, or a long-acting beta(2)-agonist as add-on therapy
To improve asthma-related quality of life at 2 months (MiniAQLQ score improvement of about 1 point) but not at 2 years (-0.11 points for leukotriene antag).
N Engl J Med. 2007 May 17;356(20):2027-39 Randomized Controlled Trial, Multicenter Study
IN asthma, persistent, mild The Use of
once daily inhaled corticosteroids
As Treatment, Chronic
Is better Than
leukotriene antagonist, once daily monlelukast
To reduce, at 4 months, treatment failure (20% inhaled corticoids VS 30% montelukast)
N Engl J Med. 2016 Sep;375(9):850-860 Randomized Controlled Trial, Multicenter Study
IN asthma, persistent, moderate to severe The Use of
long-acting beta(2)-agonists, formoterol added to inhaled corticoisteroids, budesonide
As Treatment, Chronic
Is better Than
inhaled corticoisteroids, budesonide alone
To reduce the number of exacerbations (HR 0.8) while not modifying the number of serious asthma-related events (<1%)
JAMA. 2013 Mar 27;309(12):1278-88 Systematic Review
IN asthma, rhinoconjunctivitis, allergic The Use of
sublingual immunotherapy
As Treatment, Chronic
Is better Than
placebo
To improves asthma symptoms (8 of 13 studies reported > 40% improvement)
JAMA. 2006 Feb 8;295(6):655-66 Randomized Controlled Trial, Multicenter Study
IN atherosclerosis, cardiovascular disease, primary prevention The Use of
intensive dietary intervention to reduce fat intake and increased intakes of vegetables, fruits, and grains
As Prevention, Primary
Is equal Than
providing diet-related education materials
To reduce at 8 years coronary heart disease (0.64% both groups), stroke (0.27%), in spite of mild reductions in fat intake and blood lipids
Cochrane Database Syst Rev. 2012;5:CD002137 Systematic Review, Cochrane Review
IN atherosclerosis, cardiovascular disease, primary prevention The Use of
reduction of dietary saturated fat by partially replacing by unsaturatef fats
As Prevention, Primary
Is better Than
no modification of diet
To modestly reduce cardiovascular events (RR 0.86) but not to reduce total or cardiovascular mortality
Cochrane Database Syst Rev. 2013;1:CD004816 Systematic Review, Cochrane Review
IN atherosclerosis, cardiovascular disease, primary prevention The Use of
statins
As Prevention, Primary
Is better Than
placebo
To reduce all cause mortality (OR 0,86), and cardiovascilar death and events (OR 0,73 to 0,78), after at least 1 year of treatment
BMJ. 2014;349(iss):g4379 Meta-Analysis
IN atherosclerosis, cardiovascular disease, primary prevention, high risk patients, high cholesterol The Use of
drug treatments targeted to increase high density lipoprotein: niacin, fibrates, and cholesteryl ester transfer protein (CETP) inhibitors
As Prevention, Primary
Is equal Than
placebo or no treatment
To modify cardiovascular events (all cause mortality, coronary heart disease mortality, non-fatal myocardial infarction, and stroke)
JAMA. 2014 Sep 17;312(11):1136-44 Systematic Review
IN atherosclerosis, cardiovascular disease, primary prevention, high risk patients, high cholesterol, older patients The Use of
statins
As Prevention, Primary
Is undefined Than
no statin treatment
To reduce cardiovascular events. No RCT in patients older than 80 years was found
Lancet. 2002 Nov 23;360(9346):1623-30 Randomized Controlled Trial, Multicenter Study
IN atherosclerosis, cardiovascular disease, primary prevention, high risk patients, high cholesterol, older patients The Use of
statins, pravastatin 40 mg/d
As Prevention, Primary
Is better Than
placebo
To to reduce at 3 years cardiovascular events: 14% pravastatine VS 16% placebo. Reduction was due to reduction in non-fatal myocardial infaction, no significant difference in stroke and death
J Am Coll Cardiol. 2013 Dec 3;62(22):2090-9 Meta-Analysis
IN atherosclerosis, cardiovascular disease, primary prevention, high risk patients, older patients The Use of
statins
As Prevention, Primary
Is better Than
placebo
To reduce myocardial infarction (RR 0.60) and stroke (RR 0.76) but it did not reduced mortality (either total or cardiovascular)
N Engl J Med. 2016 May 26;374(21):2021-31 Randomized Controlled Trial, Multicenter Study
IN atherosclerosis, cardiovascular disease, primary prevention, intermediate risk patients, normal or high cholesterol The Use of
statins, rosuvastatin 10 mg/day for > 5 years
As Prevention, Primary
Is better Than
placebo
To reduce cardiovascular events (cardiovascular death, nonfatal myocardial infarction or stroke) at 5.6 years: 3.7% rosuvastatin VS 4.8% placebo. No difference in mortality: 2.8-2.9% both. Muscle symptoms in 5.8% of patients on rosuvastatin.
JAMA Intern Med. 2017 Jul 01;177(7):955-965 Randomized Controlled Trial, Multicenter Study
IN atherosclerosis, cardiovascular disease, primary prevention, low to moderate risk patients, older patients The Use of
statin, pravastatin, 40 mg/d
As Prevention, Primary
Is equal Than
usual care
To modify, after 6 years, mortality or coronary disease
N Engl J Med. 2008 Nov 20;359(21):2195-207 Randomized Controlled Trial, Multicenter Study
IN atherosclerosis, cardiovascular disease, primary prevention, normal cholesterol, elevated C-reactive protein The Use of
statins, rosuvastatin
As Prevention, Primary
Is better Than
placebo
To reduce the incidence of major cardiovascular events at 2 years: 0.77% per year statin VS 1.4% per year placebo.
Cochrane Database Syst Rev. 2018 07 18;7:CD003177 Systematic Review, Cochrane Review
IN atherosclerosis, cardiovascular disease, primary prevention, secondary prevention The Use of
omega-3 fatty acids
As Treatment, Chronic
Is equal Than
placebo
To polyunsaturated fatty acids from oily fish had little or no effect on mortality or cardiovascular health (high-quality evidence). Alpha-linolenic acid from plants may slightly reduce CVD events and mortality (low-quality evidence)
J Am Coll Cardiol. 2005 Nov 15;46(10):1855-62. Epub 2005 Oct 24 Meta-Analysis
IN atherosclerosis, coronary disease, ischemic stroke, high or normal cholesterol The Use of
statins
As Treatment, Chronic
Is equal Than
interventions to primarily lower LDL cholesterol, if equal reduction
To The regression lines for non-statin and statin trials were similar and consistent with a one-to-one relationship between LDL-cholesterol lowering and coronary disease and stroke reduction.
Lancet. 2005 Oct 8;366(9493):1267-78. Epub 2005 Sep 27 Meta-Analysis
IN atherosclerosis, coronary disease, ischemic stroke, high or normal cholesterol The Use of
statins
As Treatment, Chronic
Is better Than
placebo
To reduce coronary and all-cause mortality (RRR 12%), and reduce major vascular events (vascular death, infarction, revascularization or stroke): RRR 21%.
Arch Intern Med. 2007 Jun 11;167(11):1122-9 Cohorts
IN atherosclerosis, coronary disease, ischemic stroke, peripheral arterial disease The Use of
chronic kidney disease measures (anemia, microalbuminuria, and GFR of <60 mL/min)
As Etiologic risk factor
Is useful Than
added to classical vascular risk factors
To idependently predict the risk of cardiovascular disease: OR about 1.30 for each one of the 3 measures, OR 1.98 for chronic kidney disease.
BMJ. 2002 Jan 12;324(7329):71-86 Meta-Analysis
IN atherosclerosis, coronary disease, ischemic stroke, peripheral arterial disease The Use of
antiplatelet drugs, aspirin, low-dose (75-150 mg/d), adenosine diphosphate (ADP) receptor inhibitors, clopidogrel
As Treatment, Chronic
Is better Than
placebo
To reduce recurrence of ischemic coronary and cerebral events, with absolute reductions of 3 to 4%, depending on specific conditions
Lancet. 1996 Nov 16;348(9038):1329-39 Randomized Controlled Trial, Multicenter Study
IN atherosclerosis, coronary disease, stroke, ischemic, peripheral arterial disease, or multiple risk factors The Use of
antiplatelet drugs, P2Y12 inhibitors, clopidogrel (75 mg/d)
As Treatment, Chronic
Is better Than
antiplatelet drugs, aspirin (325 mg/d)
To marginally reduce ischemic events (stroke, myocardial infarction or vascular death): 5.32% per year clopidogrel VS 5.83% per year aspirin, ARR 0.51% x year. Adverse effects was similar, i.e. intracraneal (0.33-0.47%) & GI bleeding (0.52-0.72%)
N Engl J Med. 2007 Oct 11;357(15):1477-86 Randomized Controlled Trial, Multicenter Study
IN atherosclerosis, hypercholesterolemic adults and NOT coronary disease The Use of
statins, pravastatin
As Prevention, Primary
Is better Than
placebo
To reduce death from cronory heart disease, at 5 years of treatment and 10 years after: 11.8% for the entire 15 years period with statin VS 15.5% placebo
Lancet. 2002 Jul 6;360(9326):7-22 Randomized Controlled Trial, Multicenter Study
IN atherosclerosis, normo-cholesterol adults with coronary disease, other occlusive arterial disease, or diabetes The Use of
statins, simvastatin, for 5 years
As -
Is better Than
placebo
To reduce coronary death rate (5.7% intv. / 6.9% cont.) and all-cause mortality (12.9% intv. / 14.7% cont.). Reduce major vascular events after the first year.
Lancet. 2005 Nov 26;366(9500):1849-61 Randomized Controlled Trial, Multicenter Study
IN atherosclerosis, normo-cholesterol adults with type 2 diabetes The Use of
fibrates, fenofibrate 200 mg daily
As Treatment, Chronic
Is equal Than
placebo
To prevent coronary events (combined myocardial infarction or coronary death: 5.9% with placebo VS 5.2% with fibrates) or to reduce total mortality.
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
Lancet. 2007 Aug 11;370(9586):493-503 Randomized Controlled Trial, Multicenter Study
IN atrial fibrillation, elder patients, not high haemorrahgic risk, not high stroke risk, anticoagulants, vitamin K antagonists, bleeding risk, elder patients The Use of
warfarin, antivitamin K
As Treatment, Chronic
Is better Than
aspirin
To reduce all-type strokes: 1.8% warfarin versus 3.8% aspirin. No increase at all in major haemorrhages.
Circulation. 2007 Jun 19;115(24):3050-6 Cohorts
IN atrial fibrillation, lone (no structural heart disease) The Use of
knowing natural history
As Prognostic Item
Is useful Than
no comparison here
To predict long-term (30 years) evolution : 30% progressed to permanent AF, mortality similar to general population, heart failure and stroke more frequent than general pop. but less than other AF, linked to HTA and comorbidities.
Eur Heart J. 2016 May 21;37(20):1582-90 Randomized Controlled Trial, Multicenter Study
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.
Cochrane Database Syst Rev. 2018 Mar 06;3:CD008980 Systematic Review, Cochrane Review
IN atrial fibrillation, non valvular, stroke, ischemic, cerebral infarction, embolic, all-cause mortality The Use of
direct oral anticoagulants, oral factor Xa inhibitors, apixaban, edoxaban, rivaroxaban, idraparinux
As Treatment, Chronic
Is better Than
oral anticoagulants, vitamin K antagonists, warfarin
To Results to be defined
Circulation. 2015 Jul 21;132(3):194-204 Systematic Review
IN atrial fibrillation, non valvular, stroke, ischemic, cerebral infarction, embolic, thromboembolic disease, old patients The Use of
anticoagulants, oral direct thrombin inhibitors, dabigatran, oral factor Xa inhibitors, apixaban, rivaroxaban, edoxaban
As Treatment, Chronic
Is equal Than
anticoagulants, antivitamine K, warfarin
To reduce thrombo-embolic events, but with different bleeding patterns: dabigatran was associated with a higher risk of gastrointestinal bleeding, risk of intracranial bleeding was lower, apixaban and edoxaban associated lower risk of major bleedings
N Engl J Med. 2010 Apr 15;362(15):1363-73 Randomized Controlled Trial, Multicenter Study
IN atrial fibrillation, permanent, rate control strategy The Use of
lenient rate control (resting heart rate <110 beats/min)
As Treatment, Chronic
Is equal Than
strict rate control (resting heart rate <80 beats/min and during moderate exercise <110 beats/min)
To modify at 2 years a composite of cardiovascular events: 12.9% lenient VS 14.9% strict (NS). Symptoms and adverse effects were also similar.
Heart. 2008 Feb;94(2):191-6. Epub 2007 May 4 Cohorts
IN atrial fibrillation, persistent The Use of
digitalis, digoxin
As Treatment, Chronic
Is worse Than
other rate control drugs
To modify mortality: 6.5% digitalis VS 4.1% non-digitalis, HR 1.53 after adjustement for other risk factors
JAMA. 2005 Feb 9;293(6):690-8 Randomized Controlled Trial, Multicenter Study
IN atrial fibrillation, persistent, non valvular, stroke, ischemic, cerebral infarction, embolic The Use of
anticoagulants, direct thrombin inhibitors, ximelagatran
As Treatment, Chronic
Is equal Than
warfarin
To prevent, at 20 months, stroke (of any type): 1.6% xime. VS 1.2% warf. Elevated liver enzymes (>3N): 6% xime. VS 0.8% warf. Major bleeding similar. Finally dropped due to hepatic toxicity.
Arch Intern Med. 2006 Apr 10;166(7):719-28 Systematic Review
IN atrial fibrillation, rhythm control strategy The Use of
antiarrhythmic drugs, classes IA, IC, III
As Treatment, Chronic
Is worse Than
placebo or no treatment
To reduce mortality, class IA drugs (quinidine, dysopiramide) increased mortality (NNH 109) and the rest did not modify it. All drugs increased adverse effects and pro-arrhythmia (but amiodarone).
N Engl J Med. 2009 May 14;360(20):2066-78 Randomized Controlled Trial, Multicenter Study
IN atrial fibrillation, stroke, ischemic, embolic The Use of
antiplatelet drugs, adenosine diphosphate (ADP) receptor inhibitors, clopidogrel (75 mg/day) plus aspirin
As Treatment, Chronic
Is better Than
aspirin alone
To reduce major cardiovascular events, specially stroke (6.8% clopidogrel+aspirin VS 7.6% aspirin) but increased major haemorrhage (2% clopidogrel+aspirin VS 1.3% aspirin)
Lancet. 2006 Jun 10;367(9526):1903-12 Randomized Controlled Trial, Multicenter Study
IN atrial fibrillation, stroke, ischemic, embolic The Use of
antiplatelet drugs, adenosine diphosphate (ADP) receptor inhibitors, clopidogrel (75 mg/day) plus aspirin (75-100 mg/day)
As Treatment, Chronic
Is worse Than
oral anticoagulation (target INR 2.0-3.0)
To prevent embolic events (stroke, non-CNS systemic embolus, myocardial infarction, or vascular death): annual risk 3.93% with warfarin VS 5.60% with aspirin plus clopidogrel
Clin Infect Dis. 2002 Jun 1;34(11):1481-90. Epub 2002 May 13 Randomized Controlled Trial
IN bacterial infection, cocci gram positive, Staphylococcus aureus, methicillin resistant The Use of
oxazolidinones antibiotics, linezolid (600mg/12h)
As Treatment, Acute
Is equal Than
vancomycine
To achieve a clinical cure: 73.2% linezolid 73.1% vancomycin. Similar rates of adverse events.
Cochrane Database Syst Rev. 2017 Sep 01;9:CD005186 Systematic Review, Cochrane Review
IN bacterial infection, nosocomial, any The Use of
multimodal interventions to improve hand hygiene compliance
As Prevention, Primary
Is equal Than
simpler interventions to increase hand hygiene compliance
To reduce colonization and infection rates: a few, low quality studies suggest complex interventions could at best slightly reduce infections
Nat Neurosci. 2013 Jan 28;16(2):139-45 Review (Narrative)
IN basic sciences, psychology, neurology, memory The Use of
sleep
As Undefined
Is good Than
Comparison to be defined
To perform a triage of wich information retain and consolidate this as a memory
Lancet. 2008 Jan 5;371(9606):57-63 Randomized Controlled Trial
IN behaviour problems, aggressive challenging behaviour, intellectual disability, not psychosis, not dementia The Use of
first-generation typical neuroleptics, haloperidol, second-generation atypical neuroleptics, risperidone
As Treatment, Acute
Is equal Than
placebo
To improve behaviour: aggression decreased substantially with all 3 treatments by 4 weeks, and placebo group showed the greatest change
Proc Natl Acad Sci U S A. 2007 Sep 18;104(38):15011-6 Descriptive
IN behaviour, regular, mate choices, cognitive process The Use of
women's physical attractiveness, men's overall desirability as a mate
As Prognostic Item
Is better Than
self-perceived, stated preferences in a mate
To predict the actual mate choice in speed dating
CMAJ. 1995 Sep 15;153(6):769-79 Randomized Controlled Trial
IN birth, non complicated, evidence based medicine, bias, physician beliefs influence in patient outcomes The Use of
physicians with favourably views of episiotomy
As Treatment, Acute
Is worse Than
physicians who viewed episiotomy very unfavorably
To reduce perineal trauma (intact perineum 12% in intv. VS 23% in ctrl.) and provide their patients satisfaction with the birth experience. The first stage of labour was 2.3 to 3.5 hours shorter and they used more frequently techniques to expedite labour.
Pediatrics. 2012 Jun;129(6):e1397-403 Randomized Controlled Trial
IN bronchiolitis, acute, viral, acute wheezing, preschool children The Use of
nebulized hypertonic 5% saline solution, 4 times a day
As Treatment, Acute
Is better Than
nebulized isotonic 0,9% saline solution
To reduce hospital adlission rates (62% hypertonic VS 92% isotonic) and lenght of stay at hospital (2 days hypertonic VS 3 days isotonic)
N Engl J Med. 2009 May 14;360(20):2079-89 Randomized Controlled Trial, Multicenter Study
IN bronchiolitis, acute, viral, infants The Use of
combination of nebulized epinephrine (3 ml of epinephrine in a 1:1000 solution, x2 days) and oral dexamethasone (1.0 mg/Kg 1st day and 0.6 mg/Kg for 5 days)
As Treatment, Acute
Is better Than
placebo, or any of both treatment alone
To reduce need for hospital admission: 17% combined Tt VS 26% placebo
Cochrane Database Syst Rev. 2008;(4):CD006458 Systematic Review, Cochrane Review
IN bronchiolitis, acute, viral, infants The Use of
nebulized hypertonic 3% saline solution
As Treatment, Acute
Is better Than
nebulized isotonic 0,9% saline solution
To reduce mean length of hospital stay (-0.94 days) and improve clinical score.
JAMA Pediatr. 2014 Jul 1;168(7):657-63 Randomized Controlled Trial
IN bronchiolitis, acute, viral, infants The Use of
nebulized hypertonic 3% saline solution (plus albuterol)
As Treatment, Acute
Is better Than
nebulized 0.9% normal saline solution (plus albuterol)
To reduce admissions to hospital: 29% hypertonic VS 43% normal saline.
BMJ. 2008 Mar 29;336(7646):701-4 Systematic Review
IN brucellosis The Use of
triple drug regimen with doxycycline, rifampicin and an aminoglycoside (gentamicin or streptomycin)
As Treatment, Acute
Is better Than
1 or 2 drugs regimen, or using quinolones instead doxycycline
To reduce rate of failure: relative risk 2.50 with doxycycline-strepto VS triple drug regimen
Am J Med. 2012 Jun;125(6):560-7 Systematic Review
IN cancer, all types The Use of
aspirin, 75 mg daily or more, for at least 2.8 years
As Prevention, Primary
Is better Than
placebo
To reduce cancer deaths (2% aspirin VS 2.6% placebo) and noncardiovascular mortality (2.3% VS 2.6%)
J Gerontol A Biol Sci Med Sci. 2016 Dec;71(12):1653-1660 Cohorts
IN cancer, all types, older patients The Use of
classificating patients in 4 classes: four classes: relatively healthy (LC1), malnourished (LC2), cognitive and mood impaired (LC3), and globally impaired (LC4)
As Prognostic Item
Is useful Than
no classification
To predict overall 1-year mortality and 6-month unscheduled admissions
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
N Engl J Med. 2007 Apr 12;356(15):1527-35 Randomized Controlled Trial, Multicenter Study
IN cancer, brain, glioblastoma The Use of
radiotherapy (focal, fractions of 1.8 Gy 5 days per week, total dose 50 Gy).
As Treatment, Acute
Is better Than
supportive care only
To improve survival: median 29 weeks radiotherapy VS 17 weeks supportive care
N Engl J Med. 2016 Apr 7;374(14):1344-55 Randomized Controlled Trial, Multicenter Study
IN cancer, brain, glioma (astrocytoma, oligoastrocytoma, or oligodendroglioma), low-grade The Use of
radiation therapy followed by six cycles of combination chemotherapy: procarbazine, lomustine (also called CCNU), and vincristine, all at the time of initial diagnosis
As Treatment, Acute
Is better Than
radiation therapy alone
To improve median overall survival (13.3 years radiation+chemo VS 7.8 years radiation only). Overall survival at 10 years: 60% combined Tt VS 40% radiation only
Cochrane Database Syst Rev. 2011;1(del):CD001877 Systematic Review, Cochrane Review
IN cancer, breast, screening The Use of
mammography
As Diagnostic Tool
Is better Than
no screening
To reduce, very modestly, mortality from breast cancer (NNT 2 000 throughout 10 years), at the cost of early overdiagnosis of bresat cancer (NNH 200) and many false positive findings (NNH 10)
BMJ. 2014;348():g366 Randomized Controlled Trial, Diagnostic
IN cancer, breast, women aged 40-59 The Use of
mammography screening
As Diagnostic Tool
Is equal Than
physical breast examinations
To modify death from breast cancer after 15 years of follow-up: rates identical in both groups. More cancers were diagnosed in the mammography group resulting in less mortality rate in patients diagnosed with cancer
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%
PLoS One. 2011;6(6):e20456 Meta-Analysis
IN cancer, colorectal The Use of
high red meat and processed meat consumption
As Etiologic risk factor
Is useful Than
low red meat and processed meat consumption
To predict the risk of colorectal cancer : RR 1.22 for the highest versus the lowest intake, RR 1.14 for every 100 g/day increase in consumption
N Engl J Med. 2005 Dec 22;353(25):2654-66 Descriptive
IN cancer, colorectal The Use of
pathological signs of early metastatic invasion (venous emboli, lymphatic and perineural invasion)
As Prognostic Item
Is useful Than
no comparison
To predict survival: absence of early metastatic invasion was independently associated with increased survival. Tumours without early metastatic invasion had increased markers of T-cells migration, activation, and differentiation
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.
Am J Gastroenterol. 2008 Jun;103(6):1541-9 Systematic Review, Cochrane Review
IN cancer, colorectal, screening in asymptomatic average risk adults The Use of
fecal occult blood test (hemoccult)
As Diagnostic Tool
Is better Than
no screening
To slightly reduce death from colorectal cancer at 12-18 years (0.8% using hemoccult VS 1% no screening, NNT 617) while not reducing overall mortality (31%)
Gastroenterology. 2006 Aug;131(2):390-401; quiz 659-60 Systematic Review
IN cancer, gastroesophageal, clinical feautures The Use of
alarm features such as dysphagia, weight loss, or anemia
As Diagnostic Tool
Is worse Than
endoscopy
To diagnose upper GI malignancy: sensitivity varied from 0% to 83%, specificity 40% to 98%, with considerable heterogeneity between studies.
N Engl J Med. 2006 Jul 6;355(1):11-20 Randomized Controlled Trial, Multicenter Study
IN cancer, gastroesophageal, resectable The Use of
perioperative chemotherapy: 3 preoperative and 3 postoperative cycles of epirubicin and cisplatin plus a continuous intravenous infusion of fluorouracil for 21 days
As Treatment, Acute
Is better Than
surgery alone
To improve survival at 5 years: 36% perioperative chemotherapy VS 23% surgery alone.
Cochrane Database Syst Rev. 2000;2(2):CD002139 Systematic Review, Cochrane Review
IN cancer, lung, non-small cell The Use of
chemotherapy containing cisplatin
As Treatment, Acute
Is better Than
only supportive care, only surgery or only radiotherapy
To modestly improve survival: 10% absolute reduction of death at 1 year vs only supportive care
N Engl J Med. 2010 Jun 24;362(25):2380-8 Randomized Controlled Trial, Multicenter Study
IN cancer, lung, non-small-cell, advanced The Use of
gefitinib, EGFR tyrosine kinase inhibitor
As Treatment, Acute
Is better Than
carboplatin-paclitaxel chimiotherapy
To improve survival: 30 months gefitinib VS 24 carboplatin. Gefitinib had also less severe adverse effects.
N Engl J Med. 2010 Aug 19;363(8):733-42 Randomized Controlled Trial, Multicenter Study
IN cancer, lung, non-small-cell, advanced The Use of
early palliative care, integrated with standard oncologic care
As Treatment, Chronic
Is better Than
standard oncologic care alone
To improve quality of life and to improve survival (12 months early palliative VS 9 months standard) despite receiving less agressive end-of-life care.
Nat Genet. 2013 Sep 26;45(10):1127-1133 Descriptive
IN cancer, oncogenic signature classes The Use of
oncogenic signature classes: patterns of combined genetic and epigenetic features
As Etiologic risk factor
Is useful Than
no comparison here
To various defined oncogenic signature classes are characteristics of multiple cross-tissue groups of tumors
N Engl J Med. 2018 Apr 05;378(14):1313-1322 Randomized Controlled Trial
IN cancer, pleural, effusion The Use of
talc administered through an indwelling pleural catheter (4 g of talc slurry)
As Treatment, Acute
Is better Than
indwelling pleural catheter alone
To induce pleurodesis: 43% talc VS. 23% catheter only. No significant between-group differences in effusion size, inpatient days, mortality, or number of adverse events
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. 2005 May 12;352(19):1977-84 Randomized Controlled Trial, Multicenter Study
IN cancer, prostate, early non-metastatic The Use of
radical prostatectomy
As Treatment, Acute
Is better Than
watchful waiting
To decrease - at 8 years - metatasis development, local progression, death due to prostate cancer (8.6% with surgery VS 14.4% waiting) and total mortality (24% with surgery VS 30.5% waiting)
Ann Intern Med. 2008 Mar 18;148(6):435-48 Systematic Review
IN cancer, prostate, early non-metastatic The Use of
radical prostatectomy
As Treatment, Acute
Is better Than
watchful waiting or external-beam radiation
To reduced at 10 years all-cause mortality (24% prostatectomy vs. 30% wacthful) or reduce at 5 years cancer recurrence
N Engl J Med. 2016 Oct 13;375(15):1425-1437 Randomized Controlled Trial, Multicenter Study
IN cancer, prostate, early non-metastatic The Use of
active monitoring
As Treatment, Chronic
Is better Than
radical prostatectomy, or external-beam radiotherapy
To preserve sexual, urinary and bowel functions: sexual and urinary function declined gradually. Prostatectomy was the worst on sexual function and urinary continence. Radiotherapy reduced sexual and bowel functions but did not impact continency
N Engl J Med. 2016 Oct 13;375(15):1415-1424 Randomized Controlled Trial, Multicenter Study
IN cancer, prostate, early non-metastatic The Use of
active monitoring only
As Treatment, Chronic
Is equal Than
radical prostatectomy, or external-beam radiotherapy
To change overral mortality and prostate-cancer-specific deaths at 10 years follow-up: 1.5/1000 persons-year active monitoring VS 1/1000 prostatectomy VS 0.7/1000 radiotherapy. More disease progression and metastases in monitoring only
N Engl J Med. 2003 Jul 17;349(3):215-24 Randomized Controlled Trial, Multicenter Study
IN cancer, prostate, primary prevention in healthy men The Use of
finasteride
As Prevention, Primary
Is better Than
placebo
To prevent development of prostate cancer (2,63%/year in intv VS 3,48%/year), benign prostatic hyperplasia (5,2% VS 8,7%) and have less urinary symptoms. But intv group had more sexual dysfunction and prostatic cancers were high grade more freq(6,4% vs 5,1%)
N Engl J Med. 2009 Mar 26;360(13):1310-9 Randomized Controlled Trial, Multicenter Study
IN cancer, prostate, screening in healthy men The Use of
screeing using annual PSA testing and digital rectal examination for 6 years
As Diagnostic Tool
Is equal Than
usual care, not routine screening
To modify mortality by prostatic cancer (2/10,000 person-years screening VS 1.7/10,000 controls) despite detecting more prostatic cancers (116/10,000 person-years screening VS 95/10,000 controls)
N Engl J Med. 2007 Oct 18;357(16):1579-88 Diagnostic
IN cancer, uterine, cervical, screening The Use of
testing for DNA of oncogenic human papillomaviruses
As Diagnostic Tool
Is better Than
Papanicolaou test
To identify high-grade cervical intraepithelial neoplasia: papillomaviruses DNA: sens 95%, spec 94%; Papanicolau sens 55%, spec 97%.
Lancet. 2005 Oct 22-28;366(9495):1435-42 Randomized Controlled Trial, Multicenter Study
IN candida, systemic infection, non-neutropenic patients The Use of
voriconazole
As Treatment, Acute
Is equal Than
amphotericin B followed by oral fluconazole
To achieve a successful clinical and bacteriological outcome : 65% voriconazole VS 71% amphotericine; 95% CI for difference -10.6% to 10.6%. Dicontinuation by adverse effects equal to amphot.
N Engl J Med. 2002 Feb 21;346(8):549-56 Randomized Controlled Trial, Multicenter Study
IN cardiac arrest, ventricular fibrillation The Use of
hypothermia, mild, immediatly after resuscitation
As Treatment, Acute
Is better Than
standard treatment with normothermia
To reduce mortality at 6 months (41% with hypothermia VS 55% if not)
N Engl J Med. 2008 Jan 3;358(1):9-17 Cohorts
IN cardiac arrest, ventricular fibrillation, in hospital The Use of
rapid defibrillation in less than 2 minutes
As Treatment, Acute
Is better Than
delayed defibrillation in more than 2 minutes
To increase survival to hospital discharge: 39% if in < 2 min VS 22% if not)
N Engl J Med. 2000 Jun 15;342(24):1778-85 Cohorts
IN cardiomyopathy, hypertrophic The Use of
magnitude of left ventricle hypertrophy
As Prognostic Item
Is useful Than
0
To predict the risk of sudden death
JAMA. 2011 Mar 2;305(9):913-22 Meta-Analysis
IN cardiovascular death, atherosclerosis, patients with a history of cardiovascular disease or diabetes but without hypertension The Use of
antihypertensive drugs, no information at all about which specific antihypertensive drugs were studied
As Treatment, Chronic
Is better Than
placebo
To reduce stroke (RR 0.77, NNT 129), myocardial infarction (RR 0.80, NNT 75), heart failure (RR 0.85, NNT 23), and all-cause mortality (RR 0.87, NNT 75)
Arch Intern Med. 2006 Dec 11-25;166(22):2446-54 Meta-Analysis
IN cardiovascular death, risk in critically ill patients The Use of
troponin T
As Prognostic Item
Is useful Than
no comparison here
To identify patients with an increased risk of death (OR, 2.5). Elevated troponin was found in a median of 43% of those patients.
Am J Cardiol. 2008 May 15;101(10):1437-43 Cohorts
IN cardiovascular death, risk in general population, asymptomatic middle-aged men The Use of
exercise test, stop exercise before reaching 85% of maximal heart rate (HR) and Increased HR at rest, attenuated HR increase or delayed HR recovery
As Prognostic Item
Is useful Than
no comparison
To predict increased risk of sudden death (HR 1.8), cardiac death (HR 1.4) and all-cause mortality (HR 1.3)
Arch Intern Med. 2007 Dec 10;167(22):2490-6 Cohorts
IN cardiovascular death, risk in general population, elderly patients The Use of
addition of: microalbuminuria, and estimated glomerular filtration rate of less than 75 mL/min/1.73 m(2)
As Prognostic Item
Is better Than
classic cardiovascular risk models not including renal function
To predict higher cardiovascular mortality at 8 years
Circulation. 2005 Nov 15;112(20):3088-96 Meta-Analysis
IN cardiovascular death, risk in kidney disease, chronic, end-stage The Use of
troponin T
As Prognostic Item
Is useful Than
no comparison here
To identify patients with higher risk of cardiac death and increased all-cause mortality (relative risk, 2.64)
JAMA. 2013 Sep 4;310(9):918-29 Randomized Controlled Trial, Multicenter Study
IN cardiovascular disease The Use of
polypill, fixed-dose combinations of drugs, 75 mg aspirin, 40 mg simvastatin, 10 mg lisinopril, and 50 mg atenolol
As Prevention, Primary
Is better Than
usual care
To improve medication adherence (86% polypill VS 65% usual) and statistically significant but small improvements in blood pressure and LDL-C
Cochrane Database Syst Rev. 2014;4:CD009868 Systematic Review, Cochrane Review
IN cardiovascular disease, cardiovascular death The Use of
polypill, fixed-dose combinations of drugs
As Treatment, Chronic
Is equal Than
Comparison to be defined
To cardiovascular mortality and cardiovascular events. Reductions in blood pressure and lipid parameters are generally lower than those previously projected.
N Engl J Med. 2006 Jun 8;354(23):2452-62 Randomized Controlled Trial
IN cholera The Use of
azithromycin (single 1-g dose of two 500-mg tablets)
As Treatment, Acute
Is better Than
ciprofloxacin (also a single 1-g dose of two 500-mg tablets)
To produce clinical success (stop watery stools within 48 hours after administration): 73% with azytro VS 27% with cipro. The lack of efficacy of ciprofloxacin may result from its diminished activity against strains in Bangladesh.
Fam Pract. 2009 Aug;26(4):260-8 Systematic Review
IN chronic obstructive pulmonary disease The Use of
clinical items: >45 years, dyspnoea, wheezing, current smoking and extensive smoking (>40 pack years), previous consult for wheezing, self-reported history of COPD, auscultatory wheezing, forced expiratory time, laryngeal height, prolonged expiration
As Diagnostic Tool
Is useful Than
spirometry as gold standard
To diagnose chronic obstructive pulmonary disease
Cochrane Database Syst Rev. 2014;3:CD010844 Systematic Review, Cochrane Review
IN chronic obstructive pulmonary disease The Use of
double inhaled therapy, combining long-acting beta-agonist and inhaled corticosteroids
As Treatment, Chronic
Is better Than
any single inhaled therapy: long-acting anticholinergic, long-acting beta-agonist or inhaled corticosteroids
To increase, at 1 year, FEV1 (+100 mL combined LABA+ICS) and a respiratory clinical score. LAA and LABA were roughly equivalent, ICS were more effective than placebo but less than the other long-term threatments
Cochrane Database Syst Rev. 2014;3():CD010115 Systematic Review, Cochrane Review
IN chronic obstructive pulmonary disease The Use of
inhaled corticosteroids, fluticasone, budesonide
As Treatment, Chronic
Is worse Than
Comparison to be defined
To carry an increased risk of severe pneumonia (causing hospitalization or death) : OR 1.8 for fluticasone, 1.6 with budesonide. The risk of any pneumonia event (i.e. less serious cases) was higher with fluticasone than with budesonide (OR 1.86
Canadian Agency for Drugs and Technologies in Health (CADTH). 2010 May;127:1-131 Systematic Review
IN chronic obstructive pulmonary disease The Use of
triple inhaled therapy combining long-acting anticholinergic, long-acting beta-agonist and inhaled corticosteroids
As Treatment, Chronic
Is better Than
dual combination therapy or monotherapy
To reduce the number of severe exacerbations leading to hospitalization and increase quality of life (compared to monotherapy), with a possible increase in the risk of pneumonia
Chest. 2005 Nov;128(5):3489-99 Randomized Controlled Trial, Multicenter Study
IN chronic obstructive pulmonary disease, emphysema The Use of
lung-volume-reduction surgery
As Treatment, Chronic
Is worse Than
physical training alone
To perioperative and at 1 year mortality risk: 7/53 patients death in the surgery group VS 1/53 patients in control (p non significant). Health status and FEV1 were improved after surgery at 1 year.
N Engl J Med. 2011 Aug 25;365(8):689-98 Randomized Controlled Trial, Multicenter Study
IN chronic obstructive pulmonary disease, exacerbations The Use of
long-term antibiotics, azithromycin 250 mg daily for 1 year
As Prevention, Secondary
Is better Than
placebo
To reduce (but only marginally) nuber of exacerbations (1.5 par year azytro VS 1.8 per year placebo. Hearing impairment was higher: 25% patients azytro VS 20% placebo
BMJ. 2011 Jun 14;342:d3215. doi: 10.1136/bmj.d3215 Systematic Review
IN chronic obstructive pulmonary disease, exacerbations The Use of
inhaled anticholinergics, long acting, tiotropium, using mist inhaler
As Treatment, Acute
Is worse Than
placebo
To mortality: increased with tiotropium (2.4%) VS placebo (1.7%). NNH = 124
Thorax. 2008 May;63(5):415-22 Meta-Analysis
IN chronic obstructive pulmonary disease, exacerbations The Use of
short-course antibiotic treatment (5 days or less)
As Treatment, Acute
Is equal Than
longer duration of antibiotic course
To achieve clinical and bacteriological cure (OR 1.0 and 1.05 respectively)
Chest. 2005 Jul;128(1):48-54 Randomized Controlled Trial
IN chronic obstructive pulmonary disease, exacerbations The Use of
smaller doses of short-acting inhaled beta2 agonists (albuterol, 2.5mg/4h)
As Treatment, Acute
Is equal Than
greater doses of the same drug (albuterol, 5mg/4h)
To increase FEV1 and peak expiratory flow rate, increase recovery rate, reduce hospital stay (trend to lower stay with higher doses: 6 vs 9 days, but not significant) or reduce side effects.
Chest. 2008 Mar;133(3):756-66 Systematic Review
IN chronic obstructive pulmonary disease, exacerbations The Use of
systemic corticosteroids, antibiotics, and noninvasive positive pressure ventilation
As Treatment, Acute
Is better Than
placebo or no use of that treatment
To reduce in-hospital mortality (antibiotics and ventilation) and reduce treatment failure (all, corticosteroids)
Cochrane Database Syst Rev. 2018 Oct 30;10:CD009764 Systematic Review, Cochrane Review
IN chronic obstructive pulmonary disease, exacerbations The Use of
long-term antibiotics, macrolides, for 3 to 12 months
As Treatment, Chronic
Is better Than
placebo
To reduce patients with exacerbations at 1 year (47% antibiotics VS 61% controls). No effect in hospital admissions, change in FEV1, serious adverse events or all-cause mortality.
Chest. 2001 Jun;119(6):1840-1849 Descriptive
IN chronic obstructive pulmonary disease, exacerbations, severe, requiring invasive mechanical ventilation The Use of
presence of comorbidities, APACHE, need for ventilation for > 72h or extubation failure
As Prognostic Item
Is useful Than
-
To predict higher in-hospital mortality
Chest. 2010 Sep 30;epub(epub):epub Cohorts
IN chronic obstructive pulmonary disease, in non-smokers The Use of
non-smokers, never smokers patients
As Etiologic risk factor
Is useful Than
no comparison
To though never smokers have much less risk of developing CPOD, they comprise 20-23% of all individuals with COPD. Asthma, age, lower education occupational exposure, childhood respiratory diseases and BMI alterations predicted COPD
Cochrane Database Syst Rev. 2005 Oct 19;(4):CD003566 Systematic Review, Cochrane Review
IN chronic obstructive pulmonary disease, stable The Use of
cardioselective beta-blockers
As Treatment, Chronic
Is equal Than
placebo
To modify respiratory function: no significant difference, at 3 months, in FEV1 or respiratory symptoms
BMJ. 2011 May 10;342:d2549. doi: 10.1136/bmj.d2549 Cohorts
IN chronic obstructive pulmonary disease, stable The Use of
cardioselective beta-blockers, given in addition to inhaled corticosteroid and long acting β agonist, with or without long acting antimuscarinic
As Treatment, Chronic
Is better Than
no beta-blockers use
To reduce all-cause mortality (22% relative reduction) and reduce hospital admissions due to respiratory disease.
N Engl J Med. 2000 Dec 28;343(26):1902-1909 Randomized Controlled Trial, Multicenter Study
IN chronic obstructive pulmonary disease, stable The Use of
corticosteroids, inhaled
As Treatment, Chronic
Is equal Than
placebo
To reduce the rate of decline of post-bronchodilator FEV1 at 3 years. It reduced the visits to a physician because of a respiratory illness (1.2% /year in intv. VS 2.1% /year in ctrl.) and reduced symptoms.
J Gen Intern Med. 2006 Oct;21(10):1011-9 Meta-Analysis
IN chronic obstructive pulmonary disease, stable The Use of
inhaled anticholinergics
As Treatment, Chronic
Is better Than
long acting beta2-agonists
To reduced severe exacerbations (RR 0.67, compared to placebo) and respiratory deaths (RR 0.27, compared to placebo) while beta2-agonists associated increased risk for respiratory deaths
Cochrane Database Syst Rev. 2006 Jul 19;3:CD006101 Systematic Review, Cochrane Review
IN chronic obstructive pulmonary disease, stable The Use of
inhaled anticholinergics, ipratropium bromide
As Treatment, Chronic
Is equal Than
long acting beta2-agonists
To to improve COPD symptoms and exercise tolerance, although beta2-agonists improved better morning PEF and FEV1. combination therapy was a little better than beta-2 agonists alone for symptoms.
Thorax. 2006 Oct;61(10):854-62. Epub 2006 Jul 14 Meta-Analysis
IN chronic obstructive pulmonary disease, stable The Use of
inhaled anticholinergics, long acting, tiotropium
As Treatment, Chronic
Is better Than
placebo, ipratropium bromide, or long acting beta2-agonists
To reduce exacerbations (OR 0.73) and related hospitalisation (OR 0.68), but not to reduce mortality, all-cause or specific
Ann Intern Med. 2007 Nov 6;147(9):639-53 Systematic Review
IN chronic obstructive pulmonary disease, stable The Use of
long-acting beta2 agonists plus corticosteroids, inhaled and oxygen ; pulmonary rehabilitation
As Treatment, Chronic
Is better Than
placebo or inhaled corticosteroids alone and no oxygen
To reduce mortality (8.6% long-acting beta2 plus cortics VS 11% controls) (oxygen in resting hypoxemic patients RR 0.61). All lon-acting bronchodilators (B2 or tiatropium) reduced exacerbations and rehabilitation improved health status.
Lancet. 2008 Jun 14;371(9629):2013-8 Randomized Controlled Trial, Multicenter Study
IN chronic obstructive pulmonary disease, stable The Use of
mucolytics, carbocisteine
As Treatment, Chronic
Is better Than
placebo
To reduce exacerbation rate: 1.01 per patient per year with carbocisteine VS 1.35 placebo.
Lancet. 2005 Apr 30;365(9470):1552-60 Randomized Controlled Trial, Multicenter Study
IN chronic obstructive pulmonary disease, stable The Use of
mucolytics, N-acetylcysteine
As Treatment, Chronic
Is equal Than
placebo
To reduce yearly reduction in pulmonary function (FEV1 reduction 54ml VS 47ml/y) and the number of exacerbations per year (1.5 VS 1.29)
Chest. 2001 Jun;119(6):1661-70 Randomized Controlled Trial
IN chronic obstructive pulmonary disease, stable The Use of
theophylline, added to inhaled beta2-agonists
As Treatment, Chronic
Is better Than
inhaled beta2-agonists alone
To reduce - at 3 months - symptoms and dyspnea (53% in Theo+B2 VS 40% in B2 alone) and improve FEV1. Number of exacerbations was not significantly different and theophylline increased adverse effects.
N Engl J Med. 2017 Sep 07;377(10):923-935 Randomized Controlled Trial, Multicenter Study
IN chronic obstructive pulmonary disease, stable, early stage The Use of
inhaled anticholinergics, long acting, tiotropium
As Treatment, Chronic
Is better Than
placebo
To slightly improve at 2 years the FEV1 (mean difference 71 to 133 ml after bronchodilator use) and slightly reduce the decline of FEV1 after bronchodilator use (29 ml/year tiotrop VS 51 ml/year placebo)
N Engl J Med. 2011 Mar 24;364(12):1093-103 Randomized Controlled Trial, Multicenter Study
IN chronic obstructive pulmonary disease, stable, moderate to severe The Use of
inhaled anticholinergics, long acting, tiotropium
As Treatment, Chronic
Is better Than
long acting beta2-agonists, salmeterol
To reduce number of moderate or seve exarcerbations at 1 year: 0.64 tiotropium VS 0.72 salmeterol. the incidence of serious adverse events was similar.
Ann Intern Med. 2012 Dec 18;157(12):878-88 Systematic Review
IN clostridium difficile Infecion, diarrhea, acute, infectious, antibiotic-associated The Use of
probiotics, mainly different types of lactobacillus
As Prevention, Primary
Is better Than
placebo
To to reduce the incidence of Clostridium difficile-associated diarrhea in patients taking antibiotics: RR 0.34
N Engl J Med. 2011 Feb 3;364(5):422-31 Randomized Controlled Trial, Multicenter Study
IN clostridium difficile infecion, diarrhea, acute, infectious, antibiotic-associated The Use of
fidaxomicin, 200 mg twice daily for 10 days, new class of narrow spectrum non-absorbable macrocyclic antibiotic
As Treatment, Acute
Is better Than
oral vancomycin, 125 mg four times daily for 10 days
To reduce recurrence rates at 4 weeks (13% fidaxo VS 24% vanco) with non-inferior rates of initial clinical response (88% fidaxo VS 86% vanco)
AHRQ Comparative Effectiveness Reviews. 2016 Mar. Report No.: 16-EHC012-EF Systematic Review
IN clostridium difficile infecion, diarrhea, acute, infectious, antibiotic-associated The Use of
high strenght: various preventive intervantions, oral vancomycine, fidaxomicin. Low strenght: probiotics, fecal transplantation
As Treatment, Acute
Is better Than
comparison
To other comparative intervantions in preventing and treating acute symptomatic c. difficile infection
CADTH Technology Report. 2011 Jan 26; No. 136, publication 2775 Systematic Review
IN clostridium difficile Infecion, diarrhea, acute, infectious, antibiotic-associated The Use of
vancomycin, oral
As Treatment, Acute
Is better Than
metronidazole, oral
To increase cure rate of initial or recurrent episodes of severe C. difficile (relative reduction 27%), while having equal effectiveness in moderate episodes.
Health Technol Assess. 2013 Dec;17(57):1-140 Randomized Controlled Trial, Multicenter Study
IN clostridium difficile infecion, diarrhea, acute, infectious, antibiotic-associated, older people The Use of
probiotics, high-dose preparation of lactobacilli and bifidobacteria
As Treatment, Acute
Is equal Than
placebo
To modify incidence of antibiotic-associated diarrhea (10% both groups), including C. difficile infections (probiotic 0.8%, placebo 1.2%, p 0.35)
Aliment Pharmacol Ther. 2006 Jul 1;24(1):47-54 Meta-Analysis
IN coeliac disease The Use of
human recombinant tissue transglutaminase antibody
As Diagnostic Tool
Is better Than
endomysial antibody
To sreen asymptomatic people and for excluding coeliac disease in symptomatic individuals with a low pretest probability (i.e. <25%), if pretest probability >25%, biopsy should be preferred. Sensitivity 93%, specificity 98%.
Aliment Pharmacol Ther. 2008 Jun 1;27(11):1044-52 Systematic Review
IN coeliac disease The Use of
intake of a little amount of gluten (<10 mg/day)
As Etiologic risk factor
Is better Than
higher intake of gluten
To avoid cause significant histological abnormalities
Neurobiol Aging. 2014 Aug;35(8):1873-82 Descriptive
IN cognitive impairment, age related, older people without cognitive impairment The Use of
higher lifestyle cognitive activity and higher current physical activity
As Etiologic risk factor
Is better Than
lower lifestyle cognitive and physical activities
To be associated with lower volume of white matter lesion, higher neural integrity and higher global cognitive functioning
Cochrane Database Syst Rev. 2006 Oct 18;(4):CD003575 Systematic Review, Cochrane Review
IN collagenous colitis, diarrhea, chronic The Use of
budesonide, oral, enteral liberation formulation, 9 mg daily (entocort (r))
As Treatment, Chronic
Is better Than
placebo, or other therapeutics tested
To improve diarrhea and symptoms: NNT 2
Neurology. 2006 Jul 25;67(2):203-10 Systematic Review
IN coma, post-cardiac arrest, post-resuscitation care The Use of
several predictors: pupillary light response, corneal reflexes, motor responses to pain, myoclonus status epilepticus, serum neuron-specific enolase, and somatosensory evoked potential studies
As Diagnostic Tool
Is better Than
others clinical, biological and radiological findings
To accurately predict poor outcome in comatose patients after cardiopulmonary resuscitation
Cochrane Database Syst Rev. 2007;(4):CD006829 Systematic Review, Cochrane Review
IN Condition to be defined The Use of
combined long-acting beta2 agonists plus corticosteroids, inhaled
As Treatment, Chronic
Is better Than
long-acting beta-agonists alone
To reduce exacerbation rate (Rate Ratio 0.82) and improve quality of life. No difference in mortality or hospitalisations. Pneumonia more frequent with combined Tt (OR 1.62)
Chest. 2016 Mar;149(3):756-66 Systematic Review
IN Condition to be defined The Use of
various pharmacologic treatments, including pirfenidone and nintedanib
As Treatment, Chronic
Is equal Than
placebo
To modify respiratory-specific or all-cause mortality
N Engl J Med. 2009 Mar 26;360(13):1320-8 Study type to be defined
IN Condition to be defined The Use of
Intervention to be defined
As Undefined
Is undefined Than
Comparison to be defined
To Results to be defined
Cochrane Database Syst Rev. 2012;3(N):CD007176 Study type to be defined
IN Condition to be defined The Use of
Intervention to be defined
As Undefined
Is undefined Than
Comparison to be defined
To Results to be defined
Am J Med. 2009 Feb;122(2):152-61 Study type to be defined
IN Condition to be defined The Use of
Intervention to be defined
As Undefined
Is undefined Than
Comparison to be defined
To Results to be defined
BMJ. 2010;341(341):c3584 Study type to be defined
IN Condition to be defined The Use of
Intervention to be defined
As Undefined
Is undefined Than
Comparison to be defined
To Results to be defined
Eur Heart J. 2007 Oct;28(20):2485-90 Diagnostic
IN coronary disease The Use of
coronary multidetector computed tomography
As Diagnostic Tool
Is better Than
exercise electrocardiography, with coronary angiography as gold standard
To diagnose significant coronary disease: 91% sensitivity and 83% specificity of scan VS 73% sensitivity and 31% specificity of exercise ECG.
Ann Intern Med. 2000 Jun 6;132(11):862-70. Cohorts
IN coronary disease The Use of
stress test, treadmill exercise testing, in elderly persons
As Diagnostic Tool
Is equal Than
treadmill exercise testing, in younger persons
To predict overall survival and cardiac event-free survival. Workload achieved was the main exercise testing variable that was predictive of death.
Circulation. 2012 Jun 12;125(23):2873-91. Epub 2012 May 14 Meta-Analysis
IN coronary disease The Use of
drug-eluting stents, specially using everolimus, sirolimus and zotarolimus, but not those using paclitaxel
As Treatment, Acute
Is better Than
bare-metal stents
To reduce long-term need for revascularization and reduce myocardial infarction (RR 0.50), with no increase in the risk of any long-term safety outcomes, including stent thrombosis
Am J Med. 2009 Apr;122(4):356-65 Meta-Analysis
IN coronary disease The Use of
calcium channel blockers
As Treatment, Chronic
Is better Than
placebo, or mixed comparison placebo plus others treatments
To reduce angina and stroke, but not to reduce mortality (either all-cause or cardiovascular) nor to reduce myocardial infarction
N Engl J Med. 2007 Mar 8;356(10):1030-9 Meta-Analysis
IN coronary disease The Use of
drug-eluting stents, sirolimus
As Treatment, Chronic
Is equal Than
bare-metal stents
To reduce the overall risk of death, myocardial infarction and stent thrombosis.
N Engl J Med. 2007 Mar 8;356(10):998-1008 Meta-Analysis
IN coronary disease The Use of
drug-eluting stents, sirolimus, paclitaxel
As Treatment, Chronic
Is worse Than
bare-metal stents
To reduce stent thrombosis at 4 years (1.2 to 1.3% drug-eluting VS 0.6 to 0.9% bare-metal) Rates of death or myocardial infarction did not differ.
Lancet. 2007 Sep 15;370(9591):937-48 Meta-Analysis
IN coronary disease The Use of
drug-eluting stents, sirolimus, paclitaxel
As Treatment, Chronic
Is equal Than
bare-metal stents
To reduce the risk of death and myocardial infarction
Circulation. 2003 Feb 25;107(7):966-72 Randomized Controlled Trial
IN coronary disease, acute coronary syndrome The Use of
P2Y12 inhibitors, clopidogrel, added to aspirin, combined anti-platelet therapy
As Treatment, Acute
Is better Than
aspirin alone
To reduce ischemic events (cardiovascular death, myocardial infarction, or stroke) at 30 days (4.3% in intv. VS 5.4% in ctrl.) and at 12 months (5.2% in intv. VS 6.3% in ctrl.) No significant excess in life-threatening bleeds (but yes for total bleeds)
N Engl J Med. 2007 Nov 15;vol(issue):pag [Epub ahead of print Nov 4] Randomized Controlled Trial, Multicenter Study
IN coronary disease, acute coronary syndrome The Use of
P2Y12 inhibitors, prasugrel, added to aspirin, combined anti-platelet drugs
As Treatment, Acute
Is better Than
clopidogrel, added to aspirin, combined anti-platelet therapy
To reduce recurrence of myocardial infarction (7.4% for prasugrel VS 9.7% for clopidogrel) and a derived combined end-point of cardiovascular death and major events.
N Engl J Med. 2009 Sep 10;361(11):1045-57 Randomized Controlled Trial, Multicenter Study
IN coronary disease, acute coronary syndrome The Use of
P2Y12 inhibitors, ticagrelor, added to aspirin, combined anti-platelet therapy
As Treatment, Acute
Is better Than
clopidogrel, added to aspirin, combined anti-platelet drugs
To reduce at 12 months cardiovascular events (death from vascular causes, myocardial infarction, or stroke): 10% ticagrelor VS 12% clopidogrel. Ticagrelor increased minor bleedings but not major haemorrhages.
J Am Coll Cardiol. 2018 May 01;71(17):1869-1877 Randomized Controlled Trial, Multicenter Study
IN coronary disease, acute coronary syndrome The Use of
selecting the PY212 antiplatelet (clopidogrel, prasugrel, or ticagrelor) on the basis of a patient,s genetics, genotyping of ABCB1, CYP2C19*2, and CYP2C19*17
As Treatment, Chronic
Is better Than
selecting P2Y12 antiplatelet on clinical characteristics alone
To reduce at 1 year a composite endpoint of cardiovascular death and the first occurrence of nonfatal myocardial infarction, nonfatal stroke, and major bleeding: 16% pharmacogenomic VS 26% usual care
J Am Coll Cardiol. 2010 May 11;55(19):2096-106 Cohorts
IN coronary disease, acute coronary syndrome, myocardial infarction The Use of
copeptin, added to troponin
As Diagnostic Tool
Is better Than
troponin
To more accurately diagnose an acute coronary syndrome (c-statistics 0.93 copeptin + troponin VS 0.84 troponin alone) and to rule out coronary syndrome in the first 3 hours: 92% negative predictive value with copeptin + troponin
Cochrane Database Syst Rev. 2011;1:CD007038 Systematic Review, Cochrane Review
IN coronary disease, acute coronary syndrome, myocardial infarction The Use of
pentasacharide analogues, fondaparinux
As Treatment, Acute
Is better Than
low molecular weight heparins (LMWH), enoxaparin
To reduce the risk of all-cause mortality at 90 to 180 days (RR 0.89) while reducing minor bleeding
Eur Heart J. 2011 Jun;32(11):1379-89 Diagnostic
IN coronary disease, acute coronary syndrome, myocardial infarction, older patients The Use of
high-sensitive cardiac troponin assays
As Diagnostic Tool
Is better Than
standard cardiac troponin assay
To diagnose acute myocardial infarction: AUC 0.95 sensitive troponine VS 0.90 standard troponine. Best cut-offs in elderly patients differed clearly from younguer patients. Mild elevations are commont in non-infarctus elderly (20% patients)
Eur Heart J. 2013 Sep 11. [Epub ahead of print] Meta-Analysis
IN coronary disease, acute coronary syndrome, myocardial infarction, ST-segment elevation The Use of
intracoronary bone marrow cell therapy
As Treatment, Acute
Is better Than
placebo or no cell therapy
To improve (at a time not well defined) left ventricle ejection fraction (LVEF) : 2.5% mean increase, 5.3% when LVEF was < 40%
JAMA. 2006 Apr 5;295(13):1519-30. Epub 2006 Mar 14 Randomized Controlled Trial, Multicenter Study
IN coronary disease, acute coronary syndrome, ST-segment elevation The Use of
pentasacharide analogues, fondaparinux (2.5 mg/d) for 8 days
As Treatment, Acute
Is better Than
unfractionated heparin for 2 days, or placebo
To reduce at 30 days bad outcome (death or reinfarction): 9.7% fondaparinux VS 11.2% controls. No difference in bleeding.
N Engl J Med. 2001 Aug 16;345(7):494-502 Randomized Controlled Trial, Multicenter Study
IN coronary disease, acute coronary syndrome, without ST elevation The Use of
adenosine diphosphate (ADP) receptor inhibitors, clopidogrel, added to aspirin, combined anti-platelet therapy
As Treatment, Acute
Is better Than
aspirin alone
To reduce, at 1 year, ischemic events (cardiovascular death, myocardial infarction or stroke): 9.3% in intv VS 11.4% in ctrl. Increase major bleeds (3.7% in intv. VS 2.7% in ctrl.)
N Engl J Med. 2006 Apr 6;354(14):1464-76. Epub 2006 Mar 14 Randomized Controlled Trial, Multicenter Study
IN coronary disease, acute coronary syndrome, without ST elevation The Use of
pentasacharide analogues, fondaparinux (2.5 mg/d SC) for 6 days
As Treatment, Acute
Is equal Than
low molecular weight heparin (LMWH), enoxaparin 1 mg/Kg/12h
To reduce at 30 days bad outcome (death, reinfarction, or refractory ischemia): 8.0% fondaparinux VS 8.6% enoxaparin. Fondaparinux had fewer major haemorrhages: 3.1% VS 5.0% enoxaparin
JAMA. 2007 Jul 18;298(3):299-308 Cohorts
IN coronary disease, atherosclerosis The Use of
nonfasting triglycerides
As Etiologic risk factor
Is useful Than
no comparison here
To predict risk of developping coronary disease, myocardial infarction and death.
N Engl J Med. 1997 Dec 4;337(23):1648-53 Cohorts
IN coronary disease, chest pain, acute coronary syndrome The Use of
troponin I, troponin T
As Diagnostic Tool
Is better Than
CPK and ECG alone
To identify early patients at risk to develop myocardial infartion or death from cardiac causes: For the 34 total events (20 deaths, 14 infarctions), troponin I was positive in 32 and negative in 2. Troponin T was positive in 27 and negative in 7.
Lancet. 2012 Feb 4;379(9814):453-60 Diagnostic
IN coronary disease, chest pain, high risk patients The Use of
magnetic resonance imaging (MRI) of the heart, with adenosine stress
As Diagnostic Tool
Is better Than
single-photon emission computed tomography (SPECT), with adenosine stress, perfusion scintigraphy
To diagnose significant coronary disease (gold standard : coronary angiography) : IRM sensitivity 86%, specificity 83% ; SPECT sensitivity 66%, specificity 82%
J Am Coll Cardiol. 2008 Jan 1;51(1):37-45 Meta-Analysis
IN coronary disease, elderly patients The Use of
statins
As Prevention, Secondary
Is better Than
placebo
To reduce overall mortlity (15.6% statins VS 18.7% placebo, NNT 28), cardiac mortality, myocardial infarction and stroke
Eur Heart J. 2006 May;27(10):1230-7. Epub 2006 Apr 18 Cohorts
IN coronary disease, heart failure, stroke, cardiovascular death, risk in general population The Use of
brain natriuretic peptide (BNP), plasma N-terminal pro-A-type and pro-B-type natriuretic peptides (BNP)
As Prognostic Item
Is useful Than
no comparison here
To predict risk of death from cardiovascular causes: adjusted risk was 1.35-fold for each SD increment in multivariate analysis
Heart. 2009 Mar;95(3):198-202 Systematic Review
IN coronary disease, myocardial infarction The Use of
rutine oxygen
As Treatment, Acute
Is worse Than
room air
To improve mortality or clinical outcomes: the only one study found that high-flow O2 had non-sifnificant increased risk of death and higher enzyme levels
Eur Heart J. 2007 Dec;28(24):3012-9 Meta-Analysis
IN coronary disease, myocardial infarction The Use of
further reduction of resting heart rate using beta blockers (or calcium channel blockers)
As Treatment, Chronic
Is better Than
less important reduction of resting herat rate
To reduce cardiac mortality: each 10 b.p.m. reduction estimated to reduce the relative risk of cardiac death by 30%
J Am Coll Cardiol. 2014 Nov 18-25;64(20):2071-82 Randomized Controlled Trial, Multicenter Study
IN coronary disease, myocardial infarction The Use of
polypill, fixed-dose combinations of drugs
As Treatment, Chronic
Is better Than
same drugs given separately
To improve medication adherence : 51% polypill VS 41% drugs separately
JAMA. 2006 Jun 7;295(21):2511-5 Randomized Controlled Trial, Multicenter Study
IN coronary disease, myocardial infarction, cardiogenic shock The Use of
early invasive strategy, early revascularization, angioplasty or surgical
As Treatment, Acute
Is better Than
conservative strategy: initial medical stabilization and selective late revascularization
To to improve patient long term survival: at 6 years, overall survival rates were 32.8% in early revasc and 19.6% in initial medical Tt
PLoS Med. 2009 Apr 21;6(4):e1000057 Cohorts
IN coronary disease, myocardial infarction, non-Q, unrecognized The Use of
delayed-enhancement cardiac magnetic resonance
As Diagnostic Tool
Is better Than
ECG and cardiac enzymes
To diagnose recent non-Q myocardial infarction: 27% of patients suspected of ischemic heart disease. Unrecognized non-Q infarction carries a hight mortality: 26% at 2.2 years.
N Engl J Med. 2005 Mar 24;352(12):1179-89 Randomized Controlled Trial, Multicenter Study
IN coronary disease, myocardial infarction, ST-segment elevation The Use of
antiplatelet drugs, adenosine diphosphate (ADP) receptor inhibitors, clopidogrel (300-mg loading dose, 75 mg/d after) added to fibrinolysis plus aspirin plus heparin
As Treatment, Acute
Is better Than
standard antithrombotic Tt with fibrinolysis + aspirin + heparin alone (+ placebo)
To reduce at 30 days vascular events (cardiovascular death, recurrent infarction, revascularization because recurrent ischemia): 11,6% with clopidogrel VS 14,6% standard Tt, Major bleeding and intracranial hemorrhage similar in the two groups.
Lancet. 2005 Nov 5;366(9497):1607-21 Randomized Controlled Trial, Multicenter Study
IN coronary disease, myocardial infarction, ST-segment elevation The Use of
antiplatelet drugs, adenosine diphosphate (ADP) receptor inhibitors, clopidogrel (75 mg/d) added to standard Tt (aspirin 100%, fibrinolysis 50%, anticoagulant 75%)
As Treatment, Acute
Is better Than
aspirin alone and standard antithrombotic Tt
To To reduce at 30 days vascular events (death, recurrent infarction, stroke): 9,2% with clopidogrel VS 10,1% aspirin alone.
Lancet. 2005 Nov 5;366(9497):1622-32 Randomized Controlled Trial, Multicenter Study
IN coronary disease, myocardial infarction, ST-segment elevation The Use of
early intravenous beta-blockers (metoprolol, up to 15 mg IV then 200 mg oral daily
As Treatment, Acute
Is equal Than
placebo
To reduce at 30 days death (7.7% VS 7.8%) or death, reinfarction, or cardiac arrest combined (9.4% with metoprolol VS 9.9% with placebo).
Eur Heart J. 2011 Jan;32(1):51-60 Randomized Controlled Trial
IN coronary disease, myocardial infarction, ST-segment elevation, elder patients The Use of
primary percutaneous coronary intervention
As Treatment, Acute
Is equal Than
fibrinolysis
To significantly reduce cardiovascular events (all-cause mortality, re-infarction, or disabling stroke) at 30 days: 19% pPCI VS. 25% fibrinolysis. A pooled analysis with other 2 trials showed, however, a significant reduction of cardiovascular events
J Am Coll Cardiol. 2007 Jan 30;49(4):422-30 Meta-Analysis
IN coronary disease, myocardial infarction, ST-segment elevation, failed thrombolysis The Use of
rescue emergency angioplasty after failed thrombolytic therapy
As Treatment, Acute
Is better Than
repeated thrombolysis or conservative treatment
To reduce heart failure (RR 0.73) and reinfarction (RR 0.58), but associated with increased risk of stroke (RR 4.98)
N Engl J Med. 2011 Dec 1;365(22):2078-87. Epub 2011 Nov 15 Clinical Trial (non-controlled, non-randomized)
IN coronary disease, stable The Use of
high dose statins, atorvastatin 80 mg daily, or rosuvastatin 40 mg daily
As Treatment, Chronic
Is useful Than
no comparison done
To induced regression of atherome plaques (decrease percent atheroma volume (by about 1%) and total atheroma volume) measured by serial intravascular ultrasonography at 4.5 years
Lancet. 1992 Dec 12;340(8833):1421-5 Randomized Controlled Trial, Multicenter Study
IN coronary disease, stable angina The Use of
aspirin, low dose (75 mg/d)
As Treatment, Chronic
Is better Than
placebo
To reduce major cardiovascular events (34% relative reduction)
JAMA. 1999 May 26;281(20):1927-36 Meta-Analysis
IN coronary disease, stable angina The Use of
beta blockers
As Treatment, Chronic
Is better Than
calcium channel blockers
To reduce number of angina episodes (OR 0.31). But no significant differences in rates of death or myocardial infarction.
Circulation. 2014 Apr 15;129(15):1577-85 Cohorts
IN coronary disease, stable, atrial fibrillation The Use of
anticoagulation alone, vitamin K antagonists
As Treatment, Chronic
Is equal Than
bi-therapy combining anticoagulant (vitamin K antagonist) + an antiplatelet
To modify at 3 years the risk of myocardial infarction, cardiac death or thromboembolism, while the risk of bleeding was higher with bi-therapy (HR 1.5)
Lancet. 2003 Sep 6;362(9386):782-8 Randomized Controlled Trial, Multicenter Study
IN coronary disease, stable, normal left ventricular function, most patients previous myocardial infarction and revascularization The Use of
angiotensin converting enzyme (ACE) inhibitors, perindopril 8 mg/d, added to standard treatment
As Treatment, Chronic
Is better Than
placebo
To reduce cardiac events (cardiovascular death, myocardial infarction, or cardiac arrest): 8% perindopril VS 10% placebo
N Engl J Med. 2004 Nov 11;351(20):2058-68 Randomized Controlled Trial, Multicenter Study
IN coronary disease, stable, normal left ventricular function, most patients previous revascularization The Use of
angiotensin converting enzyme (ACE) inhibitors, trandolapril (4 mg/d), added to standard treatment
As Treatment, Chronic
Is equal Than
placebo
To reduce cardiac events (death from cardiovascular causes, myocardial infarction, or coronary revascularization): 21.9% in trandolapil VS 22.5% in placebo - at 5 years (so, aprox. 4.4% per year event rate)
Lancet. 2008 Sep 6;372(9641):807-16 Randomized Controlled Trial, Multicenter Study
IN coronary disease, stable, reduced left ventricular function The Use of
ivabradine, added to beta-blockers
As Treatment, Chronic
Is equal Than
placebo
To reduce a composite outcome (cardiovascular deah, myocardial infarction or worsening heart failure) at 20 months. It improved a secondary endpoint (myocardial infarction) but not main endpoint, in one subgroup analysis (patients with heart rate > 70 bpm)
Arch Intern Med. 2008 May 26;168(10):1034-46 Review (Narrative)
IN corticosteroids, systemic, for infections The Use of
systemic corticosteroids
As Treatment, Acute
Is better Than
placebo
To improve outcomes or accelerate symptom resolution in a variety of bacterial, tuberculous and viral infections
N Engl J Med. 2009 Mar 26;360(13):1283-97 Randomized Controlled Trial, Multicenter Study
IN critically ill patients The Use of
tight glucose control (target < 6 mmol/L), intensive insulin therapy
As Treatment, Acute
Is worse Than
conventional glycemic control (target < 10 mmol/L)
To modify overall mortality at 3 months: 27.5% intensive VS 24.9% conventional
N Engl J Med. 2008 Jul 3;359(1):7-20. Epub 2008 May 20 Randomized Controlled Trial, Multicenter Study
IN critically ill patients, acute kidney injury The Use of
intensive renal-replacement therapy: intermittent hemodialysis 6 days/week if hemodynamically stables, 35 ml/Kg continuous venovenous hemodiafiltration if hemodynamically unstable
As Treatment, Acute
Is worse Than
less-intensive renal-replacement therapy: intermittent hemodialysis 3 days/week if hemodynamically stables, 20 ml/Kg continuous venovenous hemodiafiltration if hemodynamically unstable
To reduce death (53.6% intensive VS 51.5% less-intensive), reduce the duration of renal-replacement therapy or increase the rate of recovery of kidney function or nonrenal organ failure.
J Neurol Neurosurg Psychiatry. 2011 May;82(5):500-4 Cohorts
IN delirium, dementia, hospitalized older patients The Use of
any error in identifying the year, month, day of the month or day of the week; and an error of >1 h in identifying the time of day
As Diagnostic Tool
Is useful Than
full cognitive assesment as reference
To diagnose dementia or delirium: error identifying the year sensitivity 86% and specificity 94%; error in either year or month sensitivity 95% and specificity 86%
Age Ageing. 2011 Jan;40(1):23-9 Systematic Review
IN delirium, elder patients The Use of
opioids, benzodiazepines, dihydropyridines calcium channel blockers, antihistamines and possibly (uncertain) H(2) antagonists, tricyclic antidepressants, antiparkinson medications, steroids, non-steroidal anti-inflammatory drugs and antimuscarinics
As Etiologic risk factor
Is worse Than
not taking those drugs
To increase risk of delirium: opioids OR 2.5, benzodiazepines OR 3.0, dihydropyridines OR 2.4, antihistamines OR 1.8.
JAMA. 2010 Aug 18;304(7):779-86 Systematic Review
IN delirium, hospitalized older patients The Use of
several bedsides tools, specially the Confusion Assessment Method (CAM)
As Diagnostic Tool
Is good Than
DSM-MD diagnoses definition as gold standard
To diagnose delirium. For CAM test: 2 to 5 minutes to be done, positive LR 9.6, negative LR 0.16.
Age Ageing. 2012 May 15. [Epub ahead of print] Randomized Controlled Trial
IN delirium, hospitalized older patients The Use of
non-pharmacological intervention: providing a clock and calendar, avoiding sensory deprivation (glasses, denture, hearing aids), familiar objects in the room, reorientation by family members, extended visitation times (5 h)
As Treatment, Acute
Is better Than
standard management
To reduce occurrence of delirium at any time during the hospitalisation: 6% intervention VS 13% controls
Arch Intern Med. 2007 Jan 8;167(1):21-30 Systematic Review
IN dementia, age related cognitive impairment The Use of
folic acid supplementation, alone or combined with vitamin B6, B12
As Treatment, Chronic
Is equal Than
placebo
To reduce age related cognitive impairment: only 1 of 3 trials found a benefit but in patients with low baseline serum folate levels. In 1 trial of folic combined vith B vitamins, placebo group did better
Lancet. 2007 Jan 20;369(9557):208-16 Randomized Controlled Trial, Multicenter Study
IN dementia, age related cognitive impairment, adults with raised homocysteine The Use of
folic acid supplementation, 800 mug daily, long term
As Treatment, Chronic
Is better Than
placebo
To reduce age related cognitive impairment, at 3 years: memory, sensorimotor speed and information processing speed improved slighty in treated patients while decreased slightly in controls
Cochrane Database Syst Rev. 2018 06 18;6:CD001190 Systematic Review, Cochrane Review
IN dementia, alzheimer The Use of
cholinesterase inhibitors, donepezil
As Treatment, Chronic
Is better Than
placebo
To experience small benefits in cognitive function, activities of daily living and clinician-rated global clinical state.
Curr Med Res Opin. 2005 Aug;21(8):1317-27 Randomized Controlled Trial
IN dementia, alzheimer The Use of
cholinesterase inhibitors, rivastigmine
As Treatment, Chronic
Is equal Than
cholinesterase inhibitors, donepezil
To modify the measures of cognition and behaviour (main endpoint: Severe Impairment Battery, not significant different). Rivastigmine showed significant results in some secondary and subgroup analysis
Arch Neurol. 1998 Nov;55(11):1409-15 Meta-Analysis
IN dementia, alzheimer The Use of
ginkgo biloba
As Treatment, Chronic
Is better Than
placebo
To improve, marginally (3% in ADAS-cog scale), cognitive function
JAMA. 1997 Oct 22-29;278(16):1327-32 Randomized Controlled Trial
IN dementia, alzheimer The Use of
ginkgo biloba
As Treatment, Chronic
Is better Than
placebo
To improve at 6 to 12 months ADAS-Cog score (1.4 points better than placebo)
Eur Heart J. 2013 Jun 4. [Epub ahead of print] Cohorts
IN dementia, alzheimer, coronary disease, acute coronary syndrome, myocardial infarction, older patients The Use of
cholinesterase inhibitors
As Treatment, Chronic
Is better Than
no cholinesterase inhibitors
To reduce the risk of myocardial infarction (HR 0.62) and death (HR 0.64). Patients taking the highest doses recommended had the lowest risk of MI or death
J Neurol Neurosurg Psychiatry. 2011 Mar;82(3):240-6 Diagnostic
IN dementia, alzheimer, cortical dementias, frontotemporal dementia, semantic dementia The Use of
cerebrospinal fluid biomarkers, beta-amyloid 1-42 (Aβ 42), total tau protein and phosphorylated tau protein
As Diagnostic Tool
Is useful Than
no comparison done
To distinguish Alzheimer from frontotemporal or semantic dementia: the best marker was Phosphorylated-Tau/Aβ(42) ratio, with sensitivity 92-98% and specificity 84-92%.
Nat Med. 2014 Mar 9. doi: 10.1038/nm.3466. [Epub ahead of print] Controlled Trial (non-randomized)
IN dementia, alzheimer, early-stage The Use of
a set of 10 specific plasma phospholipids, reflecting cell membrane integrity
As Diagnostic Tool
Is useful Than
no comparison done
To predict clinical development of either amnestic mild cognitive impairment or Alzheimer,s disease in a 2-3 year
Arch Neurol. 2004 Dec;61(12):1852-6 Randomized Controlled Trial, Multicenter Study
IN dementia, alzheimer, early-stage The Use of
cholinesterase inhibitors, donepezil
As Treatment, Chronic
Is better Than
placebo
To improve different cognitive scores, at 6 months: ADAS (by 2.3 points), MMS (by 1.4 points) and Computerized Memory Battery Test, having few adverse events
JAMA. 2009 Jul 22;302(4):385-93 Diagnostic
IN dementia, alzheimer, early-stage, mild cognitive impairment The Use of
cerebrospinal fluid biomarkers: beta-amyloid(1-42) (Abeta42), total tau protein (T-tau), and tau phosphorylated-threonine 181 (P-tau)
As Diagnostic Tool
Is useful Than
final diagnostic after 4 year follow-up as standard
To help diagnose Alzheimer's: sensitivity 83%, specificity 72%, predictive positive value 62%, negative value 88% (for the 3 markers combined)
Arch Neurol. 2010 Aug;67(8):949-56 Diagnostic
IN dementia, alzheimer, early-stage, mild cognitive impairment The Use of
cerebrospinal fluid biomarkers: beta-amyloid(1-42) (Abeta42), total tau protein (T-tau), and tau phosphorylated-threonine 181 (P-tau)
As Diagnostic Tool
Is useful Than
final diagnostic after follow-up or autopsy as standards
To help diagnosign Alzheimer's disease: typical biomarker signature found in 90%, 72%, and 36% of Alzh, mild cognitive impairment, and cognitively normal groups, respectively. Very high sesitivity (lower spec.) to predict evol to Alzh in MCI patients
J Am Geriatr Soc. 2011 Sep;59(9):1705-10 Diagnostic
IN dementia, alzheimer, mild cognitive impairment The Use of
neuropsychological tests and structural magnetic resonance imaging (MRI)
As Diagnostic Tool
Is better Than
measurement of amyloid-beta and tau in cerebrospinal fluid (CSF) or [18F]fluorodeoxyglucose positron emission tomography (FDG-PET)
To diagnose alzheimer,s disease: neuropsychological tests and MRI were the most informative techniques, with 84% and 82% correct classifications. FDG-PET and CSF assessments had 76% and 73% correct classifications
N Engl J Med. 2012 Mar 8;366(10):893-903 Randomized Controlled Trial
IN dementia, alzheimer, moderate to severe The Use of
maintaining cholinesterase inhibitors, donepezil
As Treatment, Chronic
Is better Than
stopping donepezil or changing for memantine
To improve cognitive measures at 1 year: SMMSE score higher by 1.9 points and BADLS score lower (indicating less impairment) by 3.0 points, than stopping donezepil
JAMA. 2015 Sep 22-29;314(12):1242-54 Randomized Controlled Trial, Multicenter Study
IN dementia, associated agitation or delirium The Use of
dextromethorphan-quinidine combination
As Treatment, Acute
Is better Than
placebo
To reduce the Neuropsychiatric Inventory (NPI) Agitation/Aggression domain score : 3.8 with dextromethorfan VS 5.3 with placebo after treatment
N Engl J Med. 2006 Oct 12;355(15):1525-38 Randomized Controlled Trial, Multicenter Study
IN dementia, associated agitation or delirium The Use of
antipsychotic drugs, neuroleptics, atypical, olanzapine, quetiapine, risperidone
As Treatment, Chronic
Is equal Than
placebo
To improve the Clinical Global Impression of Change (CGIC) scale at 12 weeks: 32% of patients on olanzapine, 26% quetiapine, 29% risperidone, and 21% placebo (P=0.22). Time to the discontinuation of treatment for any reason was also similar.
Cochrane Database Syst Rev. 2013;3:CD007726 Systematic Review, Cochrane Review
IN dementia, associated agitation or delirium, associated behavioural and psychological symptoms The Use of
withdrawal of chronic antipsychotic drugs
As Treatment, Chronic
Is equal Than
continuation of chronic antipsychotic drugs
To modify behavioural and psychological symptoms : no difference in 8 of 9 studies. Patients with more severe symptoms of that responded well to antipsychotics may benefit from keeping their treatment
Age Ageing. 2017 Sep 1:1-7. doi: 10.1093/ageing/afx149. [Epub ahead of print] Diagnostic
IN dementia, delirium, elder patients, emergency department The Use of
4AT test
As Diagnostic Tool
Is useful Than
no comparison here
To accurately screen for dementia or delirium: negative predictive value 0.99 for delirium and 0.94 for dementia
BMJ. 2010 Aug 5;341:c3584. doi: 10.1136/bmj.c3584 Cohorts
IN dementia, diagnosed in primary care The Use of
diagnosis of dementia
As Prognostic Item
Is worse Than
not having dementia
To predict median survival after initial diagnosis: 6.7 years in 60-70 years old, falling to 1.9 years in >90 years old, overall 2.5 to 4 times higher mortality than matched controls. Higher risk of death in the first year after diagnosis.
Ann Neurol. 2012 Jul;72(1):41-52 Randomized Controlled Trial, Multicenter Study
IN dementia, Lewy bodies The Use of
cholinesterase inhibitors, donepezil
As Treatment, Chronic
Is better Than
placebo
To improve at 3 months MMSE (mean difference: 2-4 points), other cognitive scores and caregiver burden scale
Lancet. 2000 Dec 16;356(9247):2031-6 Randomized Controlled Trial
IN dementia, Lewy bodies The Use of
cholinesterase inhibitors, rivastigmine
As Treatment, Chronic
Is equal Than
placebo
To modify the main endpoint (NPI, Neuropsychiatric Inventory score) in the intention to treat population. Several secondary and subgroup outcomes were modestly improved. Rivastigmine increased nausea, vomiting and anorexia.
Lancet Neurol. 2010 Oct;9(10):969-77 Randomized Controlled Trial, Multicenter Study
IN dementia, Lewy bodies, Parkinson associated The Use of
N-methyl D-aspartate receptor antagonists, memantine
As Treatment, Chronic
Is better Than
placebo
To slightly improve ADCS score (-0.6 points) at 6 months in Lewy bodies patients, but not in Parkinson patients.
JAMA. 2007 Jun 6;297(21):2391-404 Systematic Review
IN dementia, screening The Use of
reports that the patient has memory loss, Mini-Mental State Examination (MMSE), Memory Impairment Screen (MIS) and Clock drawings
As Diagnostic Tool
Is useful Than
-
To diagnose dementia: report of memory loss LR+ 6.5 LR- ? ; MMSE LR+ 6.3 LR- 0.19 ; MIS LR+ 33 LR- 0.08
J Am Geriatr Soc. 2011 Mar;59(3):463-72 Systematic Review
IN dementia, severe, feeding disorder The Use of
high-calorie supplements
As Treatment, Chronic
Is equal Than
assisted feeding, or modified foods to promote weight gain
To promote weight gain. No summary measures provided in the abstract
Int J Nurs Stud. 2013 Jan 19. doi: 10.1016/j.ijnurstu.2012.12.021. [Epub ahead of print] Meta-Analysis
IN dementia, severe, feeding disorder The Use of
nutritional supplements,
As Treatment, Chronic
Is better Than
other interventions: training/education programs, feeding assistance
To increase food intake, body weight and BMI (no quantitative results in the abstract). But the quality of the evidence was moderate
Lancet. 2009 Feb 28;373(9665):746-58 Meta-Analysis
IN depression, major, unipolar The Use of
selective serotonine reuptake inhibitors (SSRI), escitalopram, sertraline and others antidepressants: mirtazapine, venlafaxine,
As Treatment, Acute
Is better Than
duloxetine, fluoxetine, fluvoxamine, paroxetine, and reboxetine
To improve antidepressant effectiveness (OR 1.27 to 2.03) with fewer discontinuations.
N Engl J Med. 2017 06 29;376(26):2523-2533 Randomized Controlled Trial
IN depression, unipolar The Use of
transcranial direct-current stimulation (tDCS)
As Treatment, Acute
Is worse Than
escitalopram, selective serotonin reuptake inhibitors (SSRIs) but it was better than placebo
To improve Hamilton Depression Rating Scale (range, 0 to 52, with higher scores indicating more depression) at 10 weeks: tDCS -9 points, escitalopram -11 points and placebo -6 points
Cochrane Database Syst Rev. 2010;(4):CD006117 Systematic Review, Cochrane Review
IN depression, unipolar The Use of
sertraline, selective serotonin reuptake inhibitors (SSRIs)
As Treatment, Chronic
Is better Than
tricyclics, heterocyclics, other selective serotonin reuptake inhibitors (SSRIs) and newer agents, mirtazapine
To improve efficacy (better than fluoxetine) or tolerability (better than amitriptyline, imipramine, paroxetine and mirtazapine). But less effective than mirtazapine.
Cochrane Database Syst Rev. 2006;(1):CD003491 Systematic Review, Cochrane Review
IN depression, unipolar, older patients The Use of
selective serotonin reuptake inhibitors (SSRIs)
As Treatment, Chronic
Is better Than
tricyclic and tricyclic-related antidepressants
To reduce the number of patients who withdrawn by adverse effects (RR 1.30 with SSRIs) while being equally effective.
Br J Gen Pract. 2011 Dec;61(593):e808-20 Meta-Analysis
IN depression, unipolar, patients with chronic physical diseases The Use of
two stem questions: low mood and loss of interest
As Diagnostic Tool
Is better Than
more complex questionnaries, including Geriatric Depression Scale - 15 and 30
To detect depression in patients with chronic physical diseases: sensib 98%, specif 88%, LR+ 6.8 LR- 0.02. Two step questions was as performant or better than others and much easier
Ann Intern Med. 2006 Nov 7;145(9):665-75 Meta-Analysis
IN diabetes mellitus The Use of
inhaled insulin, premeal, plus once/day lente subcutaneous insulin
As Treatment, Chronic
Is worse Than
conventional multiple times/day subcutaneous insulin
To decrease hemoglobin A1c (weighted mean difference, 0.08%, favouring SC insulin) but same number of patients achieved HgA1c < 7%. Hypoglycemia was equally frequent. Inhaled insulin induces cough and mild decrease in pulmonary function testing.
Cochrane Database Syst Rev. 2006 Apr 19;(2):CD003287 Systematic Review, Cochrane Review
IN diabetes mellitus The Use of
short acting insulin analogues
As Treatment, Chronic
Is equal Than
standard insulin
To achieve glycemic control or modify HbA1c levels: 0 to -0.1% weighted mean difference. The WMD of the overall mean hypoglycaemic episodes per patient per month was -0.2. No study investigated long term effects on mortality or diabetic complications.
Diabetes Care. 2006 Nov;29(11):2365-70 Randomized Controlled Trial
IN diabetes mellitus, associated peripheral neuropathy The Use of
alpha-lipoic acid (ALA)
As Treatment, Chronic
Is better Than
placebo
To improve symptoms: significative reduction in specific symptom scores with all doses compared to placebo, specially stabbing and burning pain. Side effects: nausea, vomiting, and vertigo
Diabetes Care. 2006 Jul;29(7):1538-44 Randomized Controlled Trial, Multicenter Study
IN diabetes mellitus, associated peripheral neuropathy The Use of
epalrestat, an aldose reductase inhibitor
As Treatment, Chronic
Is better Than
placebo
To improve symptoms (numbness, sensory abnormality, and cramping) and reduce EMG progession, at 3 years.
Pharmacotherapy. 2008 May;28(5):646-55 Review (Narrative)
IN diabetes mellitus, associated peripheral neuropathy The Use of
epalrestat, an aldose reductase inhibitor, 50 mg 3 times/day
As Treatment, Chronic
Is better Than
placebo
To motor and sensory nerve conduction velocity and subjective neuropathy symptoms
N Engl J Med. 2008 Oct 2;359(14):1464-76 Randomized Controlled Trial, Multicenter Study
IN diabetes mellitus, type 1 The Use of
continuous glucose monitoring, added to intensive insulin Tt
As Diagnostic Tool
Is equal Than
usual monitoring with a capilar blood glucose meter
To improve glycemic control at 26 weeks: HbA1C was improved by -0.50% in adults patients but not in younger and children.
N Engl J Med. 2003 Jun 5;348(23):2285-93 Cohorts
IN diabetes mellitus, type 1 The Use of
persistent microalbuminuria
As Prognostic Item
Is useful Than
no comparison
To predict renal impairment, but it does not imply inexorably progressive nephropathy: regression of proteinuria is frequent if: HbAc1 < 1%, well controlled blood pressure and both cholmesterol and triglyc normal
Cochrane Database Syst Rev. 2010;(1):CD005103 Systematic Review, Cochrane Review
IN diabetes mellitus, type 1 The Use of
continuous subcutaneous insulin infusion
As Treatment, Chronic
Is better Than
multiple insulin injections
To to improve glycemic control and HgbA1C (WMD -0.3%) and quality of life, but no reilable data about long-term morbidity and mortality exist
N Engl J Med. 2005 Dec 22;353(25):2643-53 Randomized Controlled Trial, Multicenter Study
IN diabetes mellitus, type 1, cardiovascular complications The Use of
Intensive insulin therapy during 6.5 years: 3 or more daily injections or insulin pump, with > 4 daily glucose measurements
As Treatment, Chronic
Is better Than
conventional therapy: one or two daily injections of insulin
To reduce, after 17 years, cardiovascular events (angor, myocardial infarction, coronary revascularization, stroke or cardiovascular death): 52 patients of 730 in conventional VS 31 of 711 in intensive
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)
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
JAMA. 2009 Apr 15;301(15):1547-55 Randomized Controlled Trial, Diagnostic
IN diabetes mellitus, type 2, asymptomatic for coronary disease The Use of
routine screening for coronary artery disease, adenosine-stress radionuclide myocardial perfusion imaging
As Diagnostic Tool
Is equal Than
non screening
To reduce cardiac death or nonfatal myocardial infarction at 5 years: 2.7% screened patients VS 3% non-screened.
JAMA. 2008 Apr 9;299(14):1678-89 Randomized Controlled Trial, Multicenter Study
IN diabetes mellitus, type 2, atherosclerosis, normo-cholesterol adults The Use of
aggressive targets of low-density lipoprotein cholesterol (LDL) < 70 mg/dL and systolic blood pressure < 115 mmHg
As Treatment, Chronic
Is better Than
standard targets of LDL < 100 mg/dL and systolic blood pressure < 130 mmHg
To reduce common carotid artery intimal medial thickness and left ventricular mass index at 1 year. Clinical cardivascular events did not differed
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
Int J Clin Pract. 2011 Mar;65(3):308-13 Cohorts
IN diabetes mellitus, type 2, elderly patients, previously not known diabetic, newly recognised fasting hyperglycaemia, at hospital admission because acute ilness The Use of
fasting hyperglycaemia
As Prognostic Item
Is useful Than
no monitoring of fasting glycaemia
To predict risk of in-hospital mortality: 8% when glucose < 126 mg/dl, 18% when glucose 126-180 mg/dl, 32% when glucose > 180 mg/dl
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
N Engl J Med. 2012 Jun 11. [Epub ahead of print] Randomized Controlled Trial, Multicenter Study
IN diabetes mellitus, type 2, glucose intolerance, high risk for cardiovascular events The Use of
n-3 fatty acids, 1g capsule of ethyl esters of n-3 fatty acids
As Treatment, Chronic
Is equal Than
placebo
To modify major vascular events (16.3-16.5%) or cardiovascular mortality (9% both)
Lancet. 2006 Nov 11;368(9548):1673-9 Randomized Controlled Trial
IN diabetes mellitus, type 2, glucose intolerance, in overweight people The Use of
lifestyle-modification program: weight loss, reduce intake of fat, and increase physical activity
As Prevention, Primary
Is better Than
usual generic recommendations
To reduce incidence of diabetes (in per 100 person-years): 4.3 in lifestyle change VS 7.4 in controls.
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.
Diabetes Obes Metab. 2010 Mar;12(3):252-61 Randomized Controlled Trial, Multicenter Study
IN diabetes mellitus, type 2, naive patients The Use of
incretin enhancer, dipeptidyl peptidase 4 (DPP4) inhibitors, sitagliptin, 100mg once-daily
As Treatment, Chronic
Is worse Than
metformin, 1000 mg twice-daily
To reduce HbA1C: -0.43% sitagliptin VS -0.57% metformin. Sitagliptin caused less gastrointestinal symptoms (12%) than metformine (21%), less hypoglycemia (1.7% VS 3.3%) and patients lost less weight (-0.6Kg VS -1.9Kg metformin)
Diabetes Care. 2010 Oct;33(10):2217-24 Randomized Controlled Trial, Multicenter Study
IN diabetes mellitus, type 2, naive patients The Use of
renal sodium-glucose cotransporter inhibitor, dapagliflozin, in monotherapy
As Treatment, Chronic
Is better Than
placebo
To reduce at 6 months HgA1C levels: -0.23 placebo VS -0.6 to 0.9 dapagliflozin depending on dose. More urinary tract infections and genital infection with dapagliflozin: 10%. No 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%)
Diabetes Obes Metab. 2009 Jan;11(1):53-9 Meta-Analysis
IN diabetes mellitus, type 2, needing insulin The Use of
short acting insulin analogues (lispro, aspart or glulisine)
As Treatment, Chronic
Is better Than
regular human insulin
To improve glucemic control: reduced HbA1c by 0.4%. No differences in severe hypoglycaemia.
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.
JAMA. 2007 Jul 11;298(2):194-206 Systematic Review
IN diabetes mellitus, type 2, poor control with oral agents The Use of
incretin mimetic (glucagonlike peptide 1 (GLP-1) analogue), incretin enhancer (dipeptidyl peptidase 4 (DPP4) inhibitor)
As Treatment, Chronic
Is better Than
placebo, and noninferior to other hypoglycemic agents
To lower, at some weeks or months, hemoglobin A1C (weighted mean difference, -0.97%) with a favorable weight-change profile (loss or no increase)
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)
Lancet. 2007 Sep 8;370(9590):829-40 Randomized Controlled Trial, Multicenter Study
IN diabetes mellitus, type 2, with or without arterial hypertension or proteinuria The Use of
fixed combination of perindopril and indapamide
As Treatment, Chronic
Is better Than
placebo
To reduce combined micro and macrovascular complications (15.5% treated VS 16.8% placebo) and cardiovascular and overall mortality (7.3% treated VS 8.5% placebo)
N Engl J Med. 2011 Mar 10;364(10):907-17 Randomized Controlled Trial, Multicenter Study
IN diabetes mellitus, type 2, without proteinuria The Use of
angiotensin II-receptor blocker, olmesartan 40 mg /24h
As Treatment, Chronic
Is better Than
placebo
To reduce at 3.2 years the number of patients with microalbuminuria: 8.2% olmesartan VS 9.8% placebo
Pharmacotherapy. 2010 Feb;30(2):119-26 Meta-Analysis
IN diarrhea, acute, infectious, antibiotic-associated The Use of
fermented milk with Lactobacillus
As Prevention, Primary
Is better Than
placebo
To prevent development of diarrhea in patients on antibiotic treatment: RR 0.35
Can J Gastroenterol. 2007 Nov;21(11):732-6 Randomized Controlled Trial
IN diarrhea, acute, infectious, antibiotic-associated The Use of
fermented milk with Lactobacillus acidophilus and casei, daily
As Prevention, Primary
Is better Than
placebo
To reduce diarrhea in patients on antibiotic treatment: 16% lactobacillus VS 36% placebo
Clin Infect Dis. 2008 Oct 15;47(8):1007-14 Systematic Review
IN diarrhea, acute, infectious, traveler The Use of
adjunctive loperamide plus antibiotics
As Treatment, Acute
Is better Than
antibiotics alone
To improve frequency of early clinical cure at 48/72H: OR 2.2
N Engl J Med. 2005 Nov 10;353(19):2001-11 Randomized Controlled Trial
IN Down syndrome, screening in pregnant women The Use of
stepwise sequential screening or fully integrated screening
As Diagnostic Tool
Is better Than
first-trimester combined screening OR second-trimester quadruple screening alones
To detect fetuses with Down syndrome: first-trimester combined screening 87%, second-trimester quadruple screening 81%, stepwise sequential screening 95%, fully integrated screening (with first-trimester measurements done at 11 weeks) 96%
Gut. 1999 Aug;45(2):186-90 Randomized Controlled Trial
IN dyspepsia, ulcer-like, helicobacter pylori infection The Use of
empirical Helicobacter pylori eradication, without any diagnostic test
As -
Is better Than
endoscopy and eradication if positive
To improve dyspepsia and quality of life measure
BMJ. 2002 Apr 27;324(7344):999-1002 Randomized Controlled Trial
IN dyspepsia, ulcer-like, helicobacter pylori infection The Use of
non-invasive strategy, urea breath test only and treatment if positive (7 days course of omeprazol, clarithromycin and amoxicillin)
As Diagnostic Tool
Is equal Than
invasive strategy, endoscopy plus urea breath test
To reduce dyspepsia severity score at one year and detect other diseases than H pylori
Am J Gastroenterol. 2006 Jun;101(6):1200-8 Randomized Controlled Trial
IN dyspepsia, ulcer-like, helicobacter pylori infection The Use of
testing for helicobacter pylori and eradication when positive
As Treatment, Chronic
Is better Than
initial proton pump inhibitors (PPI) treatment for everybody
To reduce number of endoscopies needed and low costs at 1 year
Cochrane Database Syst Rev. 2011;0(7):CD006211 Systematic Review, Cochrane Review
IN elder patients, comprehensive geriatric assessment The Use of
comprehensive geriatric assessment
As Diagnostic Tool
Is better Than
general medical care
To increase a patient,s likelihood of being alive and in their own home at 12 months (OR 1.16) and reduce its risk of suffer death or deterioration (OR 0.76). The effect was more marked for wards than for teams
PLoS One. 2012;7(1):e29090 Cohorts
IN elder patients, comprehensive geriatric assessment, overall mortality, frailty scores The Use of
Multidimensional Prognostic Index as frailty index (calculated from scoring 8 domains: ADL, IADL, cognition, comorbidity, nutrition, number of drugs, co-habitation status) low risk if MPI<0.33, high risk if >0.66
As Prognostic Item
Is better Than
other tools to measure frailty: the cumulative deficits model, based on a comprehensive geriatric assessment
To predict mortality at 1 month and 1 year: HR = 2 for MPI = 0.33-0.66, HR = 5.7 for MPI >0.66 (MPI <0.33 was the reference HR=1)
Arch Intern Med. 2010 Jul 12;170(13):1142-8 Cohorts
IN elder patients, geriatric pharmacology, drug adverse effects The Use of
a score combining: number of drugs and a history of adverse drug reaction as the strongest predictors, followed by heart failure, liver disease, presence of 4 or more conditions, and renal failure
As Etiologic risk factor
Is useful Than
no systematized evaluation
To predict the risk of an adverse drug reaction: from 2% if 0-1 points to 25% when all factors present (8 points or more). The number of drugs were the most important single factor: risk doubled when => 5 drugs used, quadrupled when => 8 drugs
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%)
J Am Geriatr Soc. 2015 Nov;63(11):2227-46 Consensus Conference
IN elder patients, geriatric pharmacology, inappropriate prescription The Use of
the Beers list: medications that should generally be avoided in persons > 65 years
As Prevention, Primary
Is useful Than
no comparison done
To this list is expected to be useful to reduce drug-related adverse events in older patients
Fam Pract. 2017 Feb 23. doi: 10.1093/fampra/cmx007. [Epub ahead of print] Randomized Controlled Trial, Multicenter Study
IN elder patients, geriatric pharmacology, inappropriate prescription, multiple medications The Use of
clinical medication reviews
As Treatment, Acute
Is equal Than
not doing medication reviews
To modify QoL or the presence of self-reported geriatric problems
JAMA. 2010 Oct 13;304(14):1592-601 Review (Narrative)
IN elder patients, geriatric pharmacology, inappropriate prescription, multiple medications The Use of
an structured and systematic approach: review corrent medication use, match drugs to patients conditions and goals, asses drugs to be discontinued, asses potentially beneficial drugs to be introduced, reduce pill and doses burden
As Treatment, Chronic
Is good Than
-
To improve medication regimens and improve clinical outcomes of patients
Age Ageing. 2011 Mar;40(2):150-62 Systematic Review
IN elder patients, geriatric pharmacology, inappropriate prescription, optimising prescription, care homes The Use of
education including academic detailing, multi-faceted educational approaches
As Prevention, Primary
Is better Than
no intervention, pharmacist medication reviews, computerised clinical decision support systems (CDSSs)
To reduce the number of inappropriate prescriptions. Lack of studies on patients outcomes.
J Am Geriatr Soc. 2007 May;55(5):658-65 Randomized Controlled Trial
IN elder patients, geriatric pharmacology, inappropriate prescription, optimising prescription, hospital The Use of
pharmaceutical care by a clinical pharmacist
As Treatment, Acute
Is better Than
usual prescription (only physician)
To improve the appropriateness of prescribing on admission, at discharge, and 3 months after.
Cochrane Database Syst Rev. 2005 Apr 18;(2):CD003235 Systematic Review, Cochrane Review
IN electrolyte disturbances, hyperkalaemia The Use of
IV insulin-and-glucose, inhaled beta-agonists
As Treatment, Acute
Is better Than
no treatment
To to reduce K blood levels at 4 hours. No data on mortality or arrhythmias available. Results for IV bicarbonate were inconsistent.
N Engl J Med. 2012 Jun 28;366(26):2466-73 Randomized Controlled Trial
IN endocarditis, bacterial, left sided, large vegetations The Use of
early surgery, urgent (<48 h)
As Treatment, Acute
Is better Than
conventional treatment, including differred surgery if needed (77% of patients finally)
To reduce at 6 weeks in-hospital death or embolic events (3% early surgery VS 23% conventional). No difference in mortality at 6 months (3% early surgery VS 5% conventional)
N Engl J Med. 2018 Aug 28. doi: 10.1056/NEJMoa1808312. [Epub ahead of print] Randomized Controlled Trial, Multicenter Study
IN endocarditis, bacterial, left sided, stable The Use of
switch to oral antibiotic treatment after at least 10 days of IV antibiotics
As Treatment, Acute
Is equal Than
continuous IV antibiotic treatment for up to 6 weeks
To modify at 6 months composite of all-cause mortality, cardiac surgery, embolism or relapse: 12% with all IV Tt VS 9% with switch to oral Tt.
J Neurol Sci. 1997 Mar 20;147(1):89-92 Clinical Trial (non-controlled, non-randomized)
IN epilepsy The Use of
oral loading dose of phenytoin: 15 mg/Kg single dose
As Treatment, Acute
Is useful Than
no comparison done
To obtain therapeutic serum concentrations (i.e. >10 mcg/mL) at and average time of 2.6 hours, with pic concentrations at 7.25 hours. Few, non-severe, adverse events.
Acad Emerg Med. 2004 Mar;11(3):244-52 Randomized Controlled Trial
IN epilepsy The Use of
oral loading dose of phenytoin: 20 mg/Kg in divided doses of 400 mg/2 hours
As Treatment, Acute
Is equal Than
IV loading dose of phenytoin
To obtain therapeutic serum concentrations (i.e. >10 mcg/mL): oral load took more time to reach it (5.5 h VS 0.25 h) but produced less adverse events, with 0 arrhythmia and 0 hypotension in oral loading.
Lancet. 2007 Mar 24;369(9566):1016-26 Randomized Controlled Trial, Multicenter Study
IN epilepsy, generalized onset, or seizures difficult to classify The Use of
valproate
As Treatment, Chronic
Is better Than
topiramate, lamotrigine (Lamictal(R))
To achieve a better combination of time to treatment failure and time to one-year remission
J Neurol Neurosurg Psychiatry. 2012 Nov;83(11):1093-8 Randomized Controlled Trial, Multicenter Study
IN epilepsy, generalized, focal, newly diagnosed The Use of
levetiracetam (Keppra(R)) 2000 mg/d
As Treatment, Chronic
Is equal Than
lamotrigine (Lamictal(R)) 200 mg/d
To modify at 6 months the proportion of seizure-free patients (45% levetir. VS 48% lamotrig.) and of patients with adverse effects (74% VS 70%)
Neurology. 1997 Oct;49(4):991-8 Randomized Controlled Trial, Multicenter Study
IN epilepsy, generalized, focal, newly diagnosed (first tonic-clonic seizure) The Use of
no treatment, unless seizure recurrs
As Treatment, Chronic
Is equal Than
starting treatment immediatly (carbamazepine, phenytoin, phenobarbital, or sodium valproate)
To modify the probability of long-term remission et 2 years (60% no Tt VS 68% immediate Tt). 50% of patients who were not treated never experienced a second seizure.
Cochrane Database Syst Rev. 2005 Oct 19;(4):CD003723 Systematic Review, Cochrane Review
IN epilepsy, generalized, status epilepticus The Use of
lorazepam
As Treatment, Acute
Is better Than
diazepam or phenytoin alone
To stop seizures and reducing the risk of continuation of status epilepticus requiring a different drug or general anaesthesia (RR 0.63 and 0.64, compared to diacepam and phenytoin)
N Engl J Med. 2001 Aug 30;345(9):631-7 Randomized Controlled Trial
IN epilepsy, generalized, status epilepticus The Use of
lorazepam IV (2 mg, repeated once if needed)
As Treatment, Acute
Is better Than
diazepam (5 mg), or placebo
To terminate out-of-hospital status epilepticus on arrival at hospital (59% lorazepam, 43% diacepam, 21% placebo) with less cardiorespiratory complications (10% both benzodiacepines, 22% placebo)
Lancet. 2007 Mar 24;369(9566):1000-15 Randomized Controlled Trial, Multicenter Study
IN epilepsy, partial The Use of
lamotrigine (Lamictal(R))
As Treatment, Chronic
Is better Than
carbamazepine, gabapentin, oxcarbazepine (Trileptal(R)), or topiramate
To achieve a better time to treatment failure - so better tolerated/effective. But for one-year remission, carbamazepine was the best over all others.
Pediatrics. 2005 Dec;116(6):1299-302 Randomized Controlled Trial
IN errors, prescription The Use of
preprinted order sheets
As Treatment, Acute
Is better Than
regular blank order sheets
To reduce prescription errors: drug errors were identified in 16.6% orders using the regular form VS 9.8% on the new form.
BMJ. 2000 Jun 24;320(7251):1720-3 Review (Narrative)
IN evidence based medicine, bias, interpretation, diabetes mellitus, type 2 The Use of
care with interpretation and dissemination of results
As Methodology procedure
Is good Than
-
To not introduce bias - intentional or not - in traslating results of research to practice
Brain. 2000 Sep;123(Pt 9):1964-1969 Descriptive
IN evidence based medicine, bias, publication The Use of
reproducibility of peer review of papers submitted for publication
As Methodology procedure
Is bad Than
-
To "guarantee" quality of published studies: Agreement between reviewers was not good, and was not convincingly better than chance for either journal for acceptance, revision or rejection, or high, medium or low priority
N Engl J Med. 2008 Jan 17;358(3):252-60 Descriptive
IN evidence based medicine, bias, publication The Use of
restricted publication of trials when results are negative
As Methodology procedure
Is bad Than
---
To provide an unbiased assessment of the effectiveneness : 31% of FDA registered trials on antidepressants were not published, 94% of published trials but only 51% of FDA-registered trials showed positive results.
JAMA. 1999 Mar 24-31;281(12):1110-1 Descriptive
IN evidence based medicine, bias, reporting results The Use of
abstracts of medical publisehd articles
As Methodology procedure
Is bad Than
---
To acurately get the data: 18% to 68% of abstract had data different from or inexistent in full text
Int J Geriatr Psychiatry. 2009 Sep;24(9):990-1001 Meta-Analysis
IN evidence based medicine, clinical trials, older people, depression The Use of
knowing high attrition rates exists
As Methodology procedure
Is useful Than
no comparison here
To overall 27.3% attrition rate in randomized trials on antidepressants in elderly. Higher rates if : more severe depression, smaller sample size, unbalanced allocation of treatments, longer duration, studies in USA
BMJ. 2004 Oct 30;329(7473):1017 Systematic Review
IN evidence based medicine, effectiveness of The Use of
clinically integrated teaching of evidence based medicine
As Methodology procedure
Is better Than
standalone (classrooms) teaching of evidence based medicine
To improve not only knowledge but also skills, attitudes and behaviour. But no one study evaluated petient,s health outcomes.
BMC Emerg Med. 2007 Aug 8;7(1):10 [Epub ahead of print] Clinical Trial (non-controlled, non-randomized)
IN evidence based medicine, effectiveness of, critical care setting The Use of
introducing 4 evidence-based protocols
As Treatment, Chronic
Is better Than
practice before introduction
To reduce severity-adjusted mortality: 19.3% in the pre-protocol period VS 16.9% in the post-protocol period.
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
N Engl J Med. 2008 May 1;358(18):1929-40 Randomized Controlled Trial, Multicenter Study
IN evidence based medicine, implementation, knowledge transfer, birth, non complicated The Use of
multifaceted educational intervention combining: opinion leaders, interactive workshops, training of manual skills, detailing visits with attendants, reminders, and feedback
As Treatment, Chronic
Is better Than
no intervantion
To change practice in real setting: use of prophylactic oxytocin increased from 2.1% at baseline to 83.6%, reducing the rate of postpartum hemorrhage, and use of episiotomy decreased from 41.1% to 29.9%.
JAMA. 2006 Apr 19;295(15):1801-8 Descriptive
IN evidence based medicine, keeping up to date The Use of
an organized system (MORE) of second order of clinical peer review for journal articles
As Methodology procedure
Is better Than
individual reading of multiple journals
To select relevant published journal articles according to the interests of a broad range of clinical disciplines
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
BMJ. 2004 Oct 30;329(7473):1013 Descriptive
IN evidence based medicine, keeping up to date, tacit knowledge, knowledge in practice The Use of
knowing how physicians derive healthcare decisions: relying in mindlines obtained trought formal and informal networking in a community of practice
As Methodology procedure
Is useful Than
not recognizing how actually knowledge is incorporated
To improve ways of conveying evidence to clinicans in their practice
Lancet. 2000 Jun 10;355(9220):2027-31 Diagnostic
IN evidence based medicine, medical thinking, clinical diagnosis diagnostic accuracy The Use of
necropsy, autopsy
As Diagnostic Tool
Is better Than
no autopsy
To undercover unsuspected diagnostics and assess performance of clinicians for diagnosing : 14% clinical diagnostics are wrong (greatly improved from a 30% in 1970)
PLoS Med. 2009 Jul 21;6(7):e1000097 Consensus Conference
IN evidence based medicine, meta-analysis The Use of
the PRISMA statement: a checklist plus a flow diagram
As Methodology procedure
Is useful Than
no use of any recommendation
To improve the quality of meta-analysis and their reports
Lancet. 1999 Nov 27;354(9193):1896-900 Consensus Conference
IN evidence based medicine, meta-analysis The Use of
the QUOROM statement: a checklist plus a flow diagram
As Methodology procedure
Is useful Than
-
To improve the quality of meta-analysis and their reports
Health Technol Assess. 2005 Jul;9(26):1-134, iii-iv Systematic Review
IN evidence based medicine, meta-analysis, indirect comparisons The Use of
indirect comparisons, using
As Methodology procedure
Is worse Than
conventional direct comparisons
To estimate the true effect of an intervention. Without direct evidence, indirect comparisons can be useful, adjusting with a random effect model, but more risk of bias
CMAJ. 2009 Oct 13;181(8):488-93 Review (Narrative)
IN evidence based medicine, meta-analysis, indirect comparisons, treatment networks, multiple meta-analyses The Use of
treatment networks, multiple meta-analyses
As Methodology procedure
Is better Than
conventional single comparison direct meta-analysis
To provide a broader view of the therapeutic possibilities of a disease and the relative effectiveness of multiple treatments
BMC Med Res Methodol. 2007;7(7):40 Descriptive
IN evidence based medicine, meta-analysis, software employed The Use of
six dedicated programs: Comprehensive Meta-analysis (CMA), MetAnalysis, MetaWin, MIX (free), RevMan (free), and WEasyMA
As Undefined
Is useful Than
-
To perform meta-analysis, the choice of program depending of the needs and characteristics of the authors.
JAMA. 2003 May 21;289(19):2554-9 Descriptive
IN evidence based medicine, methodology, outcomes, composite outcomes The Use of
Intervention to be defined
As Methodology procedure
Is bad Than
-
To correctly interpret results. Reporting of composite outcomes is generally inadequate, implying that the results apply to all the individual components.
Cochrane Database Syst Rev. 2011;3:CD006776 Systematic Review, Cochrane Review
IN evidence based medicine, methodology, presenting information about risk, knowledge transfert The Use of
natural frequencies, absolute frequencies, absolute risk reduction (ARR)
As Methodology procedure
Is better Than
probabilities, relative risk, relative risk reduction (RRR), number needed to treat (NNT)
To better understand information about risks. Relative risk reduction, compared with absolute risk reduction and number needed to treat, may be perceived to be larger and is more likely to be persuasive.
Control Clin Trials. 1996 Feb;17(1):1-12 Meta-Analysis
IN evidence based medicine, methodology, quality scores The Use of
score (Jadad) to assess the quality of reports of randomized clinical trials
As -
Is good Than
-
To scoring consistently trials by all the raters
JAMA. 1999 Sep 15;282(11):1054-60 Descriptive
IN evidence based medicine, methodology, quality scores The Use of
scores of the quality of clinical trials
As -
Is worse Than
assessing individually relevant methodological aspects
To to identify trials of high quality for meta-analysis
BMJ. 2005 May 21;330(7501):1179 Diagnostic
IN evidence based medicine, methodology, searching strategy The Use of
specific combinations of terms, search strategy for randomized controlled trials
As Methodology procedure
Is better Than
other search strategies
To maximize either sensibility or specificity when searching PubMed for good quality RCTs.
Am J Public Health. 2004 Mar;94(3):361-6 Consensus Conference
IN evidence based medicine, non-randomized trials The Use of
TREND statement, a checklist for reporting
As Methodology procedure
Is useful Than
no comparison here
To improve quality of reporting of non-randomized trials using health interventions
Lancet. 2002 Feb 9;359(9305):515-9 Review (Narrative)
IN evidence based medicine, randomization The Use of
proper randomization method
As Methodology procedure
Is better Than
no randomization, or inadequate randomization
To achieve scientific accuracy and credibility
Cochrane Database Syst Rev. 2011;(4):MR000012 Systematic Review, Cochrane Review
IN evidence based medicine, randomization The Use of
randomized controlled trials, and concealed allocation
As Methodology procedure
Is worse Than
observational studies, or uncocealed allocation
To get an accurate estimation of real effects: randomised and non-randomised studies sometimes differed in both ways: either random. or non-random. yielded larger estimates of effet. Trials with inadequate allocation concealment yielded larger estimates
BMJ. 2010 Mar 23;340:c332. doi: 10.1136/bmj.c332. Consensus Conference
IN evidence based medicine, randomized controlled trials The Use of
CONSORT statement: : a checklist plus a flow diagram
As Methodology procedure
Is better Than
no use of any recommendation
To improve the quality of randomizes controlled trials and their reports
Cochrane Database Syst Rev. 2008;(3):MR000009 Systematic Review, Cochrane Review
IN evidence based medicine, randomized controlled trials, participating in The Use of
participating in a randomized controlled trials
As Treatment, Chronic
Is equal Than
receiving the same treatment outside a RCT
To modify patients clinical outcomes: they are similar
Lancet. 2002 May 11;359(9318):1686-9 Review (Narrative)
IN evidence based medicine, statistics, survival analysis The Use of
adequate display and interpretation of survival plots, Kaplan-Meier
As Methodology procedure
Is good Than
-
To avoid false interpretation of the results of an study
J Fam Pract. 2004 Feb;53(2):111-20 Randomized Controlled Trial
IN evidence based medicine, strength of recommendations The Use of
an scale (SORT) to grade strength of recommendations, as based in available evidence
As -
Is useful Than
-
To try to unify scales to grade strength of recommendations
BMJ. 2008 May 10;336(7652):1049-51 Consensus, Guideline
IN evidence based medicine, strength of recommendations The Use of
GRADE system, rating strength of recommendations and quality of evidence, simple ways
As Methodology procedure
Is useful Than
no comparison here
To guide the reader of guidelines, increasing its usefullness
Chest. 2006 Jan;129(1):174-81 Consensus Conference
IN evidence based medicine, strength of recommendations The Use of
GRADE system, rating strength of recommendations and quality of evidence, simple ways
As Methodology procedure
Is useful Than
no formal assesing of the stength of recommandation
To guide the reader of guidelines, increasing its usefullness
JAMA. 1999 May 26;281(20):1900-5 Descriptive
IN evidence based medicine, validity of publications, guidelines The Use of
guidelines, methodological standards for evaluate its quality
As Methodology procedure
Is good Than
0
To know validity of guidelines: those published in the peer-reviewed medical literature during the past decade do not adhere well to established methodological standards, specially in the identification, evaluation, and synthesis of the scientific evidence.
JAMA. 1992 Jul 8;268 (2):240-248 Meta-Analysis
IN evidence based medicine, validity of publications, narrative review The Use of
experts recommendations given in narrative review articles
As Methodology procedure
Is worse Than
objective meta-analysis
To accurately follow cumulative scientific evidence: review articles often failed to mention important advances or exhibited delays, treatments that have no effect on mortality or are potentially harmful continued to be recommended.
Cochrane Database Syst Rev. 2012 Sep 12;(9):CD007146 Systematic Review, Cochrane Review
IN falls, older people The Use of
group and home-based exercise programmes, home safety interventions, Tai Chi, multifactorial assessment and intervention programmes
As Treatment, Chronic
Is better Than
no or others interventions
To reduce risk of falling and/or rate of falls (RR 0.70 to 0.85 depending on the intervention)
Health Technol Assess. 2009 May;13(27):iii-iv, ix-x, 1-163 Randomized Controlled Trial
IN fever, any origin, children The Use of
ibuprofen
As Treatment, Acute
Is better Than
paracetamol
To reduce fever faster (23 minutes feaster) and increase time without fever (55 more minutes without)
Pain. 2010 Nov;151(2):530-9 Randomized Controlled Trial
IN fibromyalgia The Use of
non-pharmacological treatment, alternative therapies, yoga of awareness
As Treatment, Chronic
Is better Than
wait-listed standard care
To improve at 8 weeks symptoms and functioning: pain, fatigue, mood, acceptance and coping strategies.
Ann Emerg Med. 2008 Jul;52(1):22-29.e6 Randomized Controlled Trial
IN gastritis, gastroenteritis, acute, with vomiting, failed oral rehydration therapy The Use of
oral ondansetron
As Treatment, Acute
Is better Than
placebo
To allow retake of oral rehydration and reduce need of IV hydration (22% ondansetron VS 54% placebo) and avoid hospital admission (6% ondansetron VS 13% placebo)
Gastroenterology. 2007 Mar;132(3):855-62; quiz 1164-5 Randomized Controlled Trial, Diagnostic
IN gastrointestinal bleeding, obscure origin The Use of
intestinal capsule endoscopy
As Diagnostic Tool
Is better Than
push enteroscopy, upper and lower
To identify a bleeding source, as first-line exploration: 50% capsule VS 26% enteroscopy
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
Am J Gastroenterol. 2008 Oct;103(10):2625-32 Systematic Review
IN gastrointestinal bleeding, upper The Use of
hemodynamic instability, comorbid illness, active bleeding at endoscopy, posterior duodenal or lesser gastric curvature ulcer
As Prognostic Item
Is useful Than
no comparison here
To predict the risk of rebleeding after endoscopy: OR 1.9 to 2.7
Lancet. 2009 Jan 3;373(9657):42-7 Cohorts
IN gastrointestinal bleeding, upper, low risk patients The Use of
GBS score = 0 (normal urea, normal Hgb, PAS>120, pulse<100, no melena, no syncope, no liver disease, no heart failure)
As Prognostic Item
Is better Than
no score
To identify patients no needing admission to hospital: 12.4% of all bleeding patients
Cochrane Database Syst Rev. 2008;(3):CD000193 Systematic Review, Cochrane Review
IN gastrointestinal bleeding, upper, oesophageal varices The Use of
somatostatin analogues
As Treatment, Acute
Is equal Than
placebo
To reduce rebleeding 5 (RR 0.84) or mortality (RR 0.97). Need for transfusion was reduced in 0.7 units par patient.
Gastroenterology. 2015 Sep;149(3):660-668.e1 Randomized Controlled Trial, Multicenter Study
IN gastrointestinal bleeding, upper, oesophageal varices, liver failure, liver cirrhosis, Child-Pugh class A or B The Use of
small-diameter covered stent, transjugular intrahepatic portosystemic shunt (TIPS)
As Treatment, Acute
Is equal Than
medical reduction of portal pressure (propranolol and isosorbide-5-mononitra)
To improve results at 2 years : TIPS reduced variceal rebleeding (7% TIPS VS 27% medical) but increased encephalopathy (18% TIPS vs 8% medical) and had no effect in survival and quality of life.
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
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
N Engl J Med. 2007 Nov 1;357(18):1821-8 Diagnostic
IN general population, asymptomatic The Use of
magnetic resonance imaging (MRI) of the brain
As Diagnostic Tool
Is good Than
no comparison here
To detect incidental findings: asymptomatic brain infarcts in 7.2%; cerebral aneurysms in 1.8%; meningiomas in 1.6%.
Cochrane Database Syst Rev. 2012 Oct 17;10():CD009009 Systematic Review, Cochrane Review
IN general population, asymptomatic, overall mortality The Use of
general health checks
As Diagnostic Tool
Is equal Than
no doing general heatlh checks
To modify total mortality (RR 0.99), cardiovascular mortality (RR 1.03) or cancer mortality (RR 1.01)
Cochrane Database Syst Rev. 2012;7:CD002063 Systematic Review, Cochrane Review
IN Guillain-Barré syndrome The Use of
intravenous immunoglobulin, administered in the first two weeks after onset
As Treatment, Acute
Is equal Than
plasma exchange (no adequate studies comparing with placebo)
To improve disability scales
J Eval Clin Pract. 2009 Feb;15(1):55-61 Diagnostic
IN heart failure The Use of
clinical criteria, Framingham criteria
As Diagnostic Tool
Is useful Than
no comparison done
To diagnose heart failure: more sensitive (92%) than specific (79%), best at ruling out heart failure (LR- 0.1), worse to confirm heart failure (LR+ 4.3)
N Engl J Med. 2011 Mar 3;364(9):797-805 Randomized Controlled Trial, Multicenter Study
IN heart failure, acute The Use of
loops diuretics, furosemide, intravenously, at low dose, in bolus every 12h
As Treatment, Acute
Is equal Than
loops diuretics, furosemide, intravenously, at high dose, or in continuous infusion
To improve symptoms of heart failure or avoid adverse renal events. High-dose strategy associated greater diuresis and better secondary outcomes but also transient worsening of renal function
Am J Cardiol. 1988 Mar 25;61(9):22E-27E Randomized Controlled Trial
IN heart failure, acute, cardiogenic pulmonary edema The Use of
nitrates, IV isosorbide-5-mononitrate
As Treatment, Acute
Is useful Than
not controlled
To survive, improve dyspnea, avoid mechanical ventilation
N Engl J Med. 2008 Jul 10;359(2):142-51 Randomized Controlled Trial, Multicenter Study
IN heart failure, acute, cardiogenic pulmonary edema The Use of
noninvasive ventilation, either continuous positive airway pressure (CPAP), or noninvasive intermittent positive-pressure ventilation (NIPPV)
As Treatment, Acute
Is equal Than
simple oxygen supplementation
To modify mortality or need for intubation at 7 days. Noninvasive ventilation improved dyspnea in more patients at 1 hour.
Lancet. 1998 Feb 7;351(9100):389-93 Randomized Controlled Trial
IN heart failure, acute, cardiogenic pulmonary edema The Use of
vasodilators IV, high-dose nitrates IV + low-dose furosemide
As Treatment, Acute
Is better Than
diuretics only, high-dose furosemide + low-dose nitrate
To reduce need for mechanical ventilation (13% patients in high-nitrites VS 40% in high-furosemide) and reduce myocardial infarction (17% VS 37%)
J Am Coll Cardiol. 2005 Aug 2;46(3):425-31 Randomized Controlled Trial, Multicenter Study
IN heart failure, acute, coronary disease, myocardial infarction The Use of
aldosterone blockers, eplerone, 25 mg/day initiated 3 to 14 days after AMI
As Treatment, Chronic
Is better Than
placebo
To reduce at 30 days all-cause mortality (3.2% with eplerone VS 4.6% with placebo), reduce cardiovascular mortality and reduce hospitalizations.
Acad Emerg Med. 2016 Mar;23(3):223-42 Systematic Review
IN heart failure, acute, dyspnea diagnosis The Use of
auscultation of S3 on physical examination, lung ultrasound, bedside echocardiography, and brain natriuretic peptide (BNP)
As Diagnostic Tool
Is good Than
no comparison done
To diagnose acute heart failure as a cause of dyspnea in adult patients in the emergency deparment. LR+ and - varied (see text)
N Engl J Med. 2002 Jul 18;347(3):161-7 Diagnostic
IN heart failure, acute, dyspnea diagnosis The Use of
brain natriuretic peptide (BNP)
As Diagnostic Tool
Is useful Than
gold standard: clinical diagnosis of heart failure, made by a cardiologist
To diagnose heart failure in patients who came to the emergency department with acute dyspnea: at a cutoff of 100 pg/ml sensitivity 90%, specificity 76%; at a cutoff of 50 pg/ml sensitivity 97%
N Engl J Med. 2004 Feb 12;350(7):647-54 Randomized Controlled Trial, Diagnostic
IN heart failure, acute, dyspnea diagnosis The Use of
brain natriuretic peptide (BNP), added to standard diagnostic strategy
As Diagnostic Tool
Is better Than
standard diagnostic strategy
To diagnose heart failure in patients who came to the emergency department with acute dyspnea, so reducing the need for hospitalization (75% in intv. VS 65% in ctrl.) and reducing median time to discharge (8 days in intv. VS 11 days in ctrl)
JAMA. 2005 Oct 19;294(15):1944-56 Systematic Review
IN heart failure, acute, dyspnea diagnosis The Use of
several clinical signs (history of heart failure, paroxysmal nocturnal dyspnea, 3rd heart sound), chest radiography and ECG
As Diagnostic Tool
Is useful Than
no comparison
To differentiate heart failure from other causes of dyspnea in the emergency department (LR+ 3.8 to 5.8). B-type natriuretic petide was the best to exclude heart failure (LR- 0.11) but not to affirm it.
Eur Heart J. 2009 Sep;30(18):2186-92 Randomized Controlled Trial
IN heart failure, acute, systolic The Use of
maintaining previous Tt with beta blockers
As Treatment, Acute
Is equal Than
stoping it during the acute phase of decompensation
To improve dyspnoea and symptoms at 3 days (92.8% maintain VS 92.3% stop), at 8 days and death at 3 months. More patients continuing beta-blockers received it 3 months after (90% VS 76% when stoped)
Circulation. 2006 Mar 21;113(11):1424-33 Cohorts
IN heart failure, chronic The Use of
knowing long-term mortality, a mathematical multivariate model (Seattle Heart Failure Model) including 14 continuous variables and 10 categorical values
As Prognostic Item
Is useful Than
simple clinical judgement
To to make individual estimations of 1, 2 and 3 years mortality. Overall ROC area under the curve was 0.73
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
J Am Coll Cardiol. 2012 Oct 2;60(14):1239-48 Randomized Controlled Trial, Multicenter Study
IN heart failure, chronic The Use of
follow-up after discharge, home-based multidiscipinary intervention, lead by a trained nurse
As Treatment, Chronic
Is equal Than
a specialized heart failure clinic-based follow up after hospital discharge
To modify, at 12-18 months, re-hospitalizations (67-69% both) or death (22-28%). But home-based interventions cumulated less days at hospital and lower costs
BMJ. 2000 Jul 22;321(7255):215-8 Randomized Controlled Trial
IN heart failure, chronic, diastolic (preserved ejection fraction) The Use of
seeking alternative diagnoses
As Diagnostic Tool
Is useful Than
-
To many patients with a diagnosis of heart failure but preserved left ventricular systolic function have an alternative explanation for their symptoms: obesity, lung disease, and myocardial ischaemia mostly
Cochrane Database Syst Rev. 2018 06 28;6():CD012721 Systematic Review, Cochrane Review
IN heart failure, chronic, diastolic (preserved ejection fraction) The Use of
various medical treatments: angiotensin converting enzyme inhibitors (ACEI), angiotensin II receptor blockers (ARB), beta blockers, aldosterone blockers, spironolactone
As Treatment, Chronic
Is undefined Than
placebo
To Aldosterone blockers reduce heart failure hospitalisations (11% aldost blockers VS 14% controls). Beta-blockers might reduce cardiovascular mortality (15% BB VS 19% placebo) but inconsistent evidence. ACEI and ARB did not seem to have any effect
Heart. 2017 Aug 5. doi: 10.1136/heartjnl-2017-311652. [Epub ahead of prin Systematic Review
IN heart failure, chronic, diastolic (preserved ejection fraction) The Use of
various medical treatments: angiotensin converting enzyme inhibitors (ACEI), angiotensin II receptor blockers (ARB), beta blockers, others
As Treatment, Chronic
Is equal Than
placebo ou usual care without those treatments
To modify mortality, with the exception of beta-blockers (RR 0.78). Trend to improve, but non consistent results, exercise capacity and quality of life
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.
Arch Intern Med. 2000 Mar 27;160(6):777-784 Case-Control
IN heart failure, chronic, systolic The Use of
nonsteroidal anti-inflammatory drugs (NSAIDs)
As Etiologic risk factor
Is worse Than
not using NSAIDs
To decompensate congestive heart failure requiring hospitalisation: OR 2.1
Arch Intern Med. 2002 Feb 11;162(3):265-70 Case-Control
IN heart failure, chronic, systolic The Use of
nonsteroidal anti-inflammatory drugs (NSAIDs)
As Etiologic risk factor
Is worse Than
not using NSAIDs
To decompensate previously existing heart failure (RR 3.8) but not to develop a first heart failure (RR 1.1)
J Am Coll Cardiol. 2007 Mar 6;49(9):963-71 Randomized Controlled Trial, Multicenter Study
IN heart failure, chronic, systolic The Use of
beta blockers, carvedilol
As Treatment, Acute
Is better Than
beta blockers, metoprolol
To reduce myocardial infarction (HR 0.71), unstable angina (HR 0.71) and fatal infarction or stroke (HR 0.46)
Lancet. 2000 May 6;355(9215):1575-1581 Meta-Analysis
IN heart failure, chronic, systolic The Use of
angiotensin converting enzyme inhibitors (ACEIs)
As Treatment, Chronic
Is better Than
placebo
To reduce at 3 years death (23% ACEI VS 27% placebo), reinfarction or rehospitalisation
Lancet. 1997 Feb 8;349(9049):375-80 Randomized Controlled Trial
IN heart failure, chronic, systolic The Use of
beta blockers, carvedilol
As Treatment, Chronic
Is better Than
placebo
To reduce death or hospitalization
N Engl J Med. 1996 May 23;334(21):1349-55 Randomized Controlled Trial
IN heart failure, chronic, systolic The Use of
beta blockers, carvedilol
As Treatment, Chronic
Is better Than
placebo
To reduces the risk or death and of hospitalization
JAMA. 2000 Mar 8;283(10):1295-302 Randomized Controlled Trial
IN heart failure, chronic, systolic The Use of
beta blockers, metoprolol
As Treatment, Chronic
Is better Than
placebo
To reduce all-cause death or hospital admission: metoprolol 32% vs. placebo 38%
N Engl J Med. 1996 Oct 10;335(15):1107-14 Randomized Controlled Trial
IN heart failure, chronic, systolic The Use of
calcium channel blockers, amlodipino
As Treatment, Chronic
Is equal Than
placebo
To modify mortality
Arch Intern Med. 2007 Oct 8;167(18):1930-6 Meta-Analysis
IN heart failure, chronic, systolic The Use of
combined Tt with angiotensin II receptor blocker (ARB) and angiotensin converting enzyme (ACE) inhibitors
As Treatment, Chronic
Is worse Than
ACE inhibitor alone
To frequency of side effects: it increased worsening renal function (4.7% combined VS 3.0% alone), hyperkalemia (3.4% combined VS 0.9% alone) and symptomatic hypotension (2.4% VS 1.6% in heart failure and 18% VS 12% in coronary disease)
Circulation. 1999 Mar 9;99:1173-82 Randomized Controlled Trial
IN heart failure, chronic, systolic The Use of
exercise training, 2-3 times/week, 1 hour sessions, combining stretching and indoor cycling
As Treatment, Chronic
Is better Than
no training
To reduce mortality, cardiac events, hospitalizations and improve quality of life
BMJ. 2013 Jan 28;346:f360. doi: 10.1136/bmj.f360. Meta-Analysis
IN heart failure, chronic, systolic, kidney disease, chronic, diabetic and non diabetic The Use of
combined Tt with angiotensin II receptor blocker (ARB) and angiotensin converting enzyme (ACE) inhibitors
As Treatment, Chronic
Is worse Than
monotherapy with either angiotensin converting enzyme (ACE) inhibitors or angiotensin II receptor blocker (ARB) alone
To increase adverse events (hyperkalaemia, hypotension, renal failure, RR 1.27 to 1.55) while not modifying mortality. Dual therapy reduced admissions to hospital for heart failure (RR 0.82)
N Engl J Med. 2011 Jan 6;364(1):11-21 Randomized Controlled Trial, Multicenter Study
IN heart failure, chronic, systolic, mild The Use of
diuretics, aldosterone blockers, eplerenone, added to recommended therapy
As Treatment, Chronic
Is better Than
placebo
To reduce at 2 years deaths (12.5% eplerenone VS 15.5% placebo) and hospitalizations for heart failure and for any cause. Hyperkaliemia in 12% epleren VS 7% placebo.
N Engl J Med. 1997 Feb 20;336(8):525-33 Randomized Controlled Trial, Multicenter Study
IN heart failure, chronic, systolic, patients in sinus rhyhtm The Use of
digoxin
As Treatment, Chronic
Is better Than
placebo
To reduce hospitalizations for worsening heart failure or by any cause, but mortality remained inchanged.
N Engl J Med. 1999 Sept 2;341(10):709-17 Randomized Controlled Trial
IN heart failure, chronic, systolic, severe The Use of
aldosterone blockers, spironolactone, added to loop diuretics and ACEI
As Treatment, Chronic
Is better Than
placebo
To reduce overall mortality, at 2 years: 35% in intv. VS 46% in ctrl. Reduce cardiac hospitalizations and significantly improve NYHA class
Lancet. 2010 Sep 11;376(9744):875-85 Randomized Controlled Trial, Multicenter Study
IN heart failure, chronic, systolic, sinus rhythm and heart rate > 70 bpm The Use of
ivabradine, eventually on top of beta-blockers
As Treatment, Chronic
Is better Than
placebo
To reduce hospitalisations for heart failure at 2 years (16% ivabradine VS 21% placebo) and possibly deaths due to heart failure (3% ivabradine VS 5% placebo) but not cardiovascular mortality.
N Engl J Med. 2005 Mar 3;352(9):875-83 Cohorts
IN heart valve disease, mitral regurgitation, asymptomatic The Use of
effective regurgitant orifice, echographically measured
As Diagnostic Tool
Is good Than
-
To estimate mortality risk: 40% mortality at 5 years if orifice > 40 mm2. Other, less powerful, risk factors for mortality: cardiac surgery (idependently reduces deaths), age, presence of diabetes
N Engl J Med. 2011 Apr 4. [Epub ahead of print] Randomized Controlled Trial, Multicenter Study
IN heart valve disease, mitral regurgitation, moderately severe or severe (grade 3+ or 4) The Use of
percutaneous repair, percutaneous implantation of a clip that approximates the mitral leaflets
As Treatment, Acute
Is equal Than
surgery, surgical repair
To modify at 1 year mortality (6% both), NYHA class or quality of life measures. Percutaneous repair have less major adverse effets (15% VS 48% surgery) but needed more often re-surgery for valve disfunction (20% VS 2% surgery)
Am J Med. 2010 Oct;123(10):913-921.e1 Descriptive, Cross-Sectional Study
IN heart valve disease, systolic murmurs The Use of
distribution on the chest wall with respect to the 3rd left parasternal space
As Diagnostic Tool
Is better Than
other clinical examination points
To diagnose aetiology of systolic murmurs. However, classic physical findings could not distinguist severe from non-severe valve stenosis ans were absent in many patients with significant cardiac lesions
Cochrane Database Syst Rev. 2018 Mar 15;3:CD012080 Systematic Review, Cochrane Review
IN helicobacter pylori infection The Use of
non-invasive test, (13C) or (14C)-urea breath test
As Diagnostic Tool
Is better Than
other non-invasive tests, serology, or stool antigen test
To correctly diagnose H.pylori infection: DOR: 150 breath, 47 serology, 45 stool Ag ; Sensitivity at a 90% specificity: 93% breath, 84% serology, 83% stool Ag.
Am J Gastroenterol. 2006 Apr 3;101(4):848-863. Epub 2006 Feb 22 Systematic Review
IN helicobacter pylori infection, bleeding peptic ulcer The Use of
(13)C-urea breath test
As Diagnostic Tool
Is better Than
all other diagnostic test
To diagnose H. pylori infection in bleeding patients: the better combination of LR+ (9.5) and LR- (0.11). Methods based in biopsy (urease test, histology, or culture) have better specificity but less sensitivity. Serology and stool antigen test are worse.
Aliment Pharmacol Ther. 2006 Jan 1;23(1):35-44 Systematic Review
IN helicobacter pylori infection, resistance The Use of
eradication using levofloxacin plus amoxicillin plus proton pump inhibitors for 10 days
As Treatment, Acute
Is better Than
quadruple therapy regimens
To eradicate H. pylori: 81% levofloxacin VS 70% quadruple therapy. And few adverse effects: 19% vs. 44%
N Engl J Med. 2008 Jan 17;358(3):221-30 Cohorts
IN hemochromatosis, hereditary, C282Y mutation The Use of
C282Y homozygocity
As Prognostic Item
Is useful Than
no comprison here
To predict the risk of developing disease related to iron overload: 28.4% of men and only 1.2% of women C282Y homozygotes.
Cochrane Database Syst Rev. 2009 Oct 7;(4):CD007339 Systematic Review, Cochrane Review
IN hepatitis, acute, alcoholic, severe The Use of
pentoxifylline 400 mg/8h PO for 4 weeks
As Treatment, Acute
Is better Than
placebo
To possibly (high risk of bias in several of the trials) reduce at 1-3 months all-cause mortality (RR 0.64) and mortality due to hepatorenal syndrome (RR 0.40)
World J Gastroenterol. 2009 Apr 7;15(13):1613-9 Randomized Controlled Trial
IN hepatitis, acute, alcoholic, severe The Use of
pentoxifylline for 4 weeks
As Treatment, Acute
Is better Than
corticosteroids, prednisolone
To reduce at 3 months all-cause death (15% pentoxi VS 35% cortics) specially because of fewer hepato-renal syndromes
N Engl J Med. 2010 May 6;362(18):1675-85 Randomized Controlled Trial
IN hepatitis, nonalcoholic steatohepatitis, chronic, non diabetic patients The Use of
vitamin E, 800 IU daily
As Treatment, Chronic
Is better Than
placebo
To increase number of patients improving a composite histologic score at 2 years: 43% vitE VS 19% placebo). Pioglitazone did not improve this outcome.
Gastroenterology. 2010 Oct;139(4):1218-29 Meta-Analysis
IN hepatitis, virus, B, chronic The Use of
oral nucleoside analogues, entecavir, tenofovir
As Treatment, Chronic
Is better Than
other antivirals, lamivudine, pegylated interferon
To induce at 1 year undetectable levels of HBV DNA: 88% tenofovir, 61% entecavir
N Engl J Med. 2006 Mar 9;354(10):1011-20 Randomized Controlled Trial, Multicenter Study
IN hepatitis, virus, B, chronic, HBeAg-negative The Use of
nucleoside analogues, entecavir 0.5 mg/d
As Treatment, Chronic
Is better Than
nucleoside analogues, lamivudine (3TC)
To obtain histological improvement at 1 year (70% entecavir VS 61% 3TC), undetectable serum HBV DNA (90% entecavir VS 72% 3TC) or normalize ASAT
N Engl J Med. 2006 Mar 9;354(10):1001-10 Randomized Controlled Trial, Multicenter Study
IN hepatitis, virus, B, chronic, HBeAg-positive The Use of
nucleoside analogues, entecavir 0.5 mg/d
As Treatment, Chronic
Is better Than
nucleoside analogues, lamivudine (3TC)
To obtain histological improvement at 1 year (72% entecavir VS 62% 3TC), undetectable serum HBV DNA (67% entecavir VS 36% 3TC) or normalize ASAT
JAMA. 2006 Jan 4;295(1):65-73 Cohorts
IN hepatitis, virus, B, chronic, hepatocellular carcinoma The Use of
serum hepatitis B virus (HBV) DNA level
As Etiologic risk factor
Is useful Than
no comparison
To predit the risk of developping hepatocellular carcinoma, at study entry, in a dose-response relationship: cumulative incidence at 12 years: HBV DNA indetectable 1.3% VS DNA > 1 million copies/mL 14.9%
Health Technol Assess. 2006 Jul;10(21):1-113, iii Randomized Controlled Trial, Multicenter Study
IN hepatitis, virus, C, all genotypes, chronic, mild The Use of
interferon-alpha and ribavirin for 48 weeks
As Treatment, Chronic
Is better Than
no treatment
To obtain sustained virological response (overall about 33%) and improve quality of life, except forpatients with genotype 1 aged > 65 years.
N Engl J Med. 2014 Jan 16;370(3):211-21 Clinical Trial (non-controlled, non-randomized)
IN hepatitis, virus, C, all genotypes, chronic, previously untreated or after treatment failure The Use of
daclatasvir 60 mg/day (HCV NS5A replication complex inhibitor) plus sofosbuvir 400 mg/day (nucleotide analogue HCV NS5B polymerase inhibitor)
As Treatment, Chronic
Is useful Than
thera are no valid control in this trial
To obtain sustained virologic response at 3 months: > 90% of patients in all genotypes and categories responded. The most common adverse events were fatigue, headache, and nausea
N Engl J Med. 2014 Apr 17;370(16):1483-93 Randomized Controlled Trial, Multicenter Study
IN hepatitis, virus, C, genotype 1, chronic, after treatment failure The Use of
ledipasvir (HCV NS5A replication complex inhibitor) plus sofosbuvir (nucleotide analogue HCV NS5B polymerase inhibitor) for 12 weeks
As Treatment, Acute
Is equal Than
ledipasvir + sofosbuvir + ribavirine for 12 weeks, or ledipasvir + sofosbuvir for 24 weeks
To obtain sustained virologic response at 3 months: 94% to 99% of patients
N Engl J Med. 2014 May 15;370(20):1889-98 Randomized Controlled Trial, Multicenter Study
IN hepatitis, virus, C, genotype 1, chronic, previously untreated The Use of
ledipasvir (HCV NS5A replication complex inhibitor) plus sofosbuvir (nucleotide analogue HCV NS5B polymerase inhibitor) for 12 weeks
As Treatment, Acute
Is equal Than
ledipasvir + sofosbuvir + ribavirine for 12 weeks, or ledipasvir + sofosbuvir for 24 weeks
To obtain a sustained virologic response at 3 months: 97% to 99% of patients
N Engl J Med. 2012 Sep 27;367(13):1237-44 Review (Narrative)
IN hepatitis, virus, E The Use of
knowing the existence of hepatitis E and characteristics
As -
Is useful Than
0
To diagnose and manage adequatelly this disease
N Engl J Med. 2006 Nov 30;355(22):2283-96 Randomized Controlled Trial, Multicenter Study
IN HIV infection The Use of
episodic antiretroviral therapy guided by CD4 count: stop when >350 until <250
As Treatment, Chronic
Is worse Than
continuous antiretroviral therapy
To reduce, at 16 months, opportunistic diseases (3.3 /100 person-years with episodic Tt VS 1.3 with continuous Tt, HR 2.6) or to reduce death (HR 1.8)
Lancet Infect Dis. 2010 Apr;10(4):251-61 Systematic Review
IN HIV infection, immune reconstitution inflammatory syndrome The Use of
CD4 cell count, type of oportunistic associated infection
As Etiologic risk factor
Is useful Than
no comparison here
To predict the risk of IRIS: 16% of all patients starting a HAART developed it, more frequent the fewer CD4 and in citomegalovirus, cryptoccocus and tuberculosis infections.
N Engl J Med. 2008 May 15;358(20):2095-106 Randomized Controlled Trial, Multicenter Study
IN HIV infection, initial therapy The Use of
highly active antiretroviral therapy (HAAR), 3 drugs, efavirenz (Sustiva(R)) + 2 nucleoside reverse-transcriptase inhibitors (NRTIs) (ex. Combivir(R) or Kivexa(R))
As Treatment, Chronic
Is better Than
lopinavir-ritonavir + two NRTIs OR efavirenz + lopinavir-ritonavir
To achieve undetectable HIV viral load at 2 years (89% efavirenz+2NRTIs VS 77% lopinavir+2NRTIs VS 83% efavirenz+lopinavir) and avoid resistance mutations
N Engl J Med. 2003 Dec 11;349(24):2293-303 Randomized Controlled Trial, Multicenter Study
IN HIV infection, initial therapy The Use of
highly active antiretroviral therapy (HAAR), 3 drugs, zidovudine + lamivudine + efavirenz (Combivir(R) + Sustiva(R))
As Treatment, Chronic
Is better Than
zidovudine + lamivudine + nelfinavir, didanosine + stavudine + either efavirenz or nelfinavir
To reducing or delaying virologic failures at 2,3 years
N Engl J Med. 2003 Dec 11;349(24):2304-15 Randomized Controlled Trial, Multicenter Study
IN HIV infection, initial therapy The Use of
highly active antiretroviral therapy (HAAR), 4 drugs, zidovudine + lamivudine + efavirenz + nelfinavir, OR didanosine + stavudine + efavirenz + nelfinavir
As Treatment, Chronic
Is equal Than
two consecutive 3 drug regimens, specially zidovudine + lamivudine + efavirenz
To reducing the occurrence of regimen failures or prolonging the time to failure, at 2,3 years
Lancet. 2006 Aug 5;368(9534):466-75 Randomized Controlled Trial, Multicenter Study
IN HIV infection, multidrug-resistant The Use of
non-peptidic protease inhibitors, tipranavir, boosted by ritonavir, plus optimised background regimen
As Treatment, Chronic
Is better Than
other selected protease inhibitors, also ritonavir-boosted, also plus optimised regimen
To achieve and maintain a reduction in viral load of 1 log(10) copies per mL or greater, at 48 weeks: 33.6% with tipranavir VS 15.3% other protease inhibitors
Ann Intern Med. 2000 Sep 19;133(6):401-410 Cohorts
IN HIV infection, natural history The Use of
absence of immunologic response (increase of CD4+ count) after 6 months of HAART
As Prognostic Item
Is better Than
no response or only virologic response (decrease in HIV viral load)
To predict death or progression to AIDS 18 months after: RR 3.4 in conresponders, RR 2 if only virologic response.
Lancet. 2000 Apr 1;355(9210):1131-37 Cohorts
IN HIV infection, natural history The Use of
natural history, without highly-active antiretroviral therapy
As Prognostic Item
Is useful Than
no comparison
To Median survival varied from 12.5 years for those aged 15-24 years at seroconversion to 7.9 years for those aged 45-54 years at seroconversion. For development of AIDS the corresponding values were 11.0 years and 7.7 years
N Engl J Med. 1999 Apr 1;340(13):977-87 Randomized Controlled Trial
IN HIV infection, pregnant women and perinatal transmission The Use of
elective cesarean section and antiretroviral therapy during the prenatal, intrapartum, and neonatal periods
As Treatment, Acute
Is better Than
other modes of delivery, and the absence of antiretroviral therapy
To reduce perinatal transmission of HIV to child: decreased by 50% by elective cesarean, by 87% when cesarean and antiretroviral therapy combined.
JAMA. 2000 Apr 19; 283(15):1967-75 Randomized Controlled Trial, Multicenter Study
IN hypertension, primary The Use of
alpha-blockers, doxazosin
As Treatment, Chronic
Is worse Than
diuretics (chlortalidone)
To stroke, combined cardivascular events and heart failure
Eur Heart J. 2012 Aug;33(16):2088-97 Meta-Analysis
IN hypertension, primary The Use of
angiotensin converting enzyme inhibitors (ACEI)
As Treatment, Chronic
Is better Than
placebo, and probably better than angiotensin II receptor blockers (ARBs)
To reduce all-cause mortality (20.4 deaths per 1000 patient-years with ACEIs VS 24.2 placebo). No significant mortality reduction appeared with ARB treatment
Lancet. 2015 Sep 18; doi: 10.1016/S0140-6736(15)00257-3 [Epub ahead of print] Cross-Over
IN hypertension, primary The Use of
spironolactone, 25-50 mg/d
As Treatment, Chronic
Is better Than
bisoprolol (5-10 mg/d) or doxazosin modified release (4-8 mg/d)
To reduce averaged home systolic blood pressure at 12 weeks : - 9 mmHg reduction VS placebo, - 4 mmHg reduction VS bisoprolol
Ann Intern Med. 2004 Oct 19;141(8):614-27 Systematic Review
IN hypertension, primary, black patients The Use of
some drugs: calcium-channel blockers, diuretics, angiotensin II receptor blockers, central sympatholytics, alpha-blockers
As Treatment, Chronic
Is better Than
placebo
To reduce blood pressure. Effect in cardiovascular outcomes less clear. Beta-blockers and angiotensin-converting enzyme inhibitors (ACEI) were not better then placebo.
Cochrane Database Syst Rev. 2009;(4):CD000028 Systematic Review, Cochrane Review
IN hypertension, primary, elder patients The Use of
several drugs, specially thiazide diuretics
As Treatment, Chronic
Is better Than
placebo
To reduce total cardiovascular morbidity and mortality (RR 0.72 to 0.75). Total mortality was reduced in patients 60-80 years but not in patients > 80 years.
Lancet. 2002 Dec 14;360(9349):1903-13 Meta-Analysis
IN hypertension, primary, elder people, epidemiology The Use of
blood pressure (BP)
As Prognostic Item
Is useful Than
no comparison
To predict, at all ages, risk of cardiovascular event and death (both cardiovascular and overall): going up from BP 115/75 mmHg, there is a continuous (non-linear) correlation between BP and cardiovascular risk, at all ages.
Cochrane Database Syst Rev. 2011 Jul 6;(7):CD009217 Systematic Review, Cochrane Review
IN hypertension, primary, heart failure, healthy people The Use of
reduced dietary salt
As Treatment, Chronic
Is equal Than
maintaining same dietary salt
To reduce all cause mortality in both normotensive (RR 0.67, 95%CI: 0.40 to 1.12) and hypertensive patients (RR 0.97, 95%CI: 0.83 to 1.13)
Cochrane Database Syst Rev. 2012;8:CD006742 Systematic Review, Cochrane Review
IN hypertension, primary, mild (TAS 140-159, TAD 90-99), no previous cardiovascular event (primary prevention) The Use of
any antihypertensive drug therapy
As Treatment, Chronic
Is worse Than
placebo
To it do not significantly modify mortality, coronary syndrome, stroke or total cardiovascular events but it increased withdrawals due to adverse effects (9% more patients on active Tt)
Ann Intern Med. 2004 Nov 2;141(9):674-82 Randomized Controlled Trial
IN hypertension, secondary, renal artery stenosis The Use of
computed tomographic angiography, or magnetic resonance angiography
As Diagnostic Tool
Is worse Than
digital subtraction angiography
To diagnosis renal artery stenosis: both had a good specificity (CT 92%, MRI 84%) but a less good sensibility (CT 64%, MRI 62%), so they can not accurately rule out a significant stenosis.
Cochrane Database Syst Rev. 2005 Apr 18;(2):CD003420 Systematic Review, Cochrane Review
IN hyperthyroidism, Graves disease The Use of
antithyroid drugs, low-dose 12 month regimen
As Treatment, Chronic
Is better Than
antithyroid drugs, high dose 6 months regimen
To was eqaul to control hyperthyroidism and reduce recurrence after stopping (30 to 55% in fdifferent studies) but produced less adverse events (9% withdrawals with low dose VS 16% high dose)
Am J Kidney Dis. 2010 Aug;56(2):325-37 Systematic Review
IN hyponatremia, euvolemic and hypervolemic patients, syndrome of inappropriate antidiuretic hormone secretion (SIADH) The Use of
vasopressin receptor antagonists, tolvaptan, with or without fluid restriction
As Treatment, Acute
Is better Than
placebo or no treatment, with or without fluid restriction
To improve normalization of natremia, both early and late (RR 3.15). However, no clinical outcomes (hospital stay, quality of life) were assessed
Am J Kidney Dis. 2013 Jul;62(1):67-72 Cohorts
IN hyponatremia, hypovolemic, diuretics The Use of
diuretics, thiazides
As Treatment, Chronic
Is worse Than
no exposure to thiazides
To carry a higher risk of hyponatremia : overall HR = 5.0. Lower age and lower body mass index increased the risk
BMJ. 2009 Sep 7;339:b3354. doi: 10.1136/bmj.b3354 Meta-Analysis
IN idiopathic facial paralysis, Bell,s palsy The Use of
antivirals, aded to corticosteroids
As Treatment, Acute
Is equal Than
corticosteroids alone
To improve numbers of at least partial facial muscle recovery: OR 1.5
Cochrane Database Syst Rev. 2010 Mar 17;(3):CD001942. doi: 10.1002/14651858.CD001942.pub4. Systematic Review, Cochrane Review
IN idiopathic facial paralysis, Bell,s palsy The Use of
corticosteroid
As Treatment, Acute
Is better Than
placebo or no corticosteroids
To reduce number of patients with incomplete recovery: 23% corticosteriods VS 33% placebo
JAMA. 2009 Sep 2;302(9):985-93 Meta-Analysis
IN idiopathic facial paralysis, Bell,s palsy The Use of
corticosteroids
As Treatment, Acute
Is better Than
placebo, or antiviral agents alone
To reduce at long term (>4 months) unsatisfactory facial recovery (RR 0.69, NNT 11) Association of corticosteroids with antiviral may produce additinal benefit.
Am J Med. 2013 Apr;126(4):336-41 Randomized Controlled Trial
IN idiopathic facial paralysis, Bell,s palsy, severe The Use of
combined corticosteroid and antiviral treatment (prednisolone for 10 days starting 60 mg/d + famciclovir 750 mg/d for 7 days)
As Treatment, Acute
Is better Than
steroids alone
To improve chances of good recovery (complete or near complete): 83% combined treatment VS 66% steroids alone
N Engl J Med. 2016 Mar 17;374(11):1053-64 Randomized Controlled Trial
IN inappropriate prescription, optimising prescription, primary care The Use of
a complex intervention combining professional education, informatics, and financial incentives to review patients and charts
As Treatment, Chronic
Is better Than
usual practice
To reduced the rate of high-risk prescribing of antiplatelet medications and NSAIDs (3.7% intervention VS 2.2% control) and reduce the rate of hospitalizations for gastrointestinal bleeding and heart failure.
Proc Biol Sci. 2010 Jun 30. [Epub ahead of print] Descriptive
IN infectious diseases intensity, average national cognitive ability, average national intelligence The Use of
infectious disease burden, measure in disability-adjusted life years caused by 28 common infectious diseases
As Etiologic risk factor
Is useful Than
no comparison
To predict average national intelligence and cognitive ability scores: r = 0.76 to 0.82 positive correlation.
N Engl J Med. 2015 Mar 19;372(12):1104-13 Randomized Controlled Trial, Multicenter Study
IN inflammatory bowel disease, crohn The Use of
SMAD7 (an inhibitor of TGF-β1 signaling) antisense oligonucleotide, mongersen
As Treatment, Chronic
Is better Than
placebo
To reach clinical remission at day 15: 55% with 40-mg/d morgensen, 65% with 160-mg/d mongersen, 12% with 10-mg/d and 10% placebo.
Cochrane Database Syst Rev. 2006 Apr 19;(2):CD000544 Systematic Review, Cochrane Review
IN inflammatory bowel disease, ulcerative colitis The Use of
5-aminosalicylic acid (5-ASA)
As Treatment, Chronic
Is worse Than
sulfasalazine
To to maintain clinical or endoscopic remission: OR 1.29 (95%CI, 1.05 to 1.57), NNT negative (-19) for the comparison 5-ASA versus salazopirine
N Engl J Med. 1994 Jun 30;330(26):1841-5 Randomized Controlled Trial
IN inflammatory bowel disease, ulcerative colitis, severe, refractory to 7 days corticosteroid therapy The Use of
cyclosporine (4 mg/Kg.day), added to standard treatment
As Treatment, Acute
Is better Than
placebo
To increase responses (symptomatic improvement, oral medication and hospital discharge): 9 of 11 patients with cyclosporine, 0 of 9 patient with placebo
Chest. 2017 May;151(5):1069-1080 Randomized Controlled Trial
IN influenza A/H3N2, adults, old patients The Use of
a 2-day combination of clarithromycin 500 mg, naproxen 200 mg, and oseltamivir 75 mg twice daily, followed by 3 days of oseltamivir
As Treatment, Acute
Is better Than
oseltamivir 75 mg twice daily without placebo for 5 days
To reduce mortality at 30 (0.9% combination VS 8.2% oseltamivir alone) and 90 days (1.9% combination VS 10% oseltamivir alone)
JAMA. 2009 Nov 4;302(17):1872-9 Descriptive
IN influenza A/H1N1, critically ill patients The Use of
some clinical characteristics: being young (30% children), rapid evolution (4 days from beguining)
As Prognostic Item
Is useful Than
no comparison here
To be associated with critical ilness (severe hypoxemia, multisystem organ failure) and mortality despite prolonged mechanical ventilation, and use of rescue therapies: 17.3% at 3 months.
PLoS One. 2017;12(1):e0163586 Systematic Review
IN influenza, adults, older patients living in institutions The Use of
influenza vaccination of healthcare workers
As Prevention, Primary
Is equal Than
no vaccination or spontaneous vaccination
To realistically reduce the risk of influenza complications in patients cared for
Cochrane Database Syst Rev. 2016 Jun 2;(6):CD005187 Systematic Review, Cochrane Review
IN influenza, adults, older patients living in institutions The Use of
influenza vaccination of healthcare workers
As Prevention, Primary
Is equal Than
no vaccination or spontaneous vaccination
To reduce laboratory-proven influenza or the number of residents admitted to hospital for respiratory illness. Probable reduction in lower respiratory tract infection in residents of 4-6%. Mortality not pooled because high risk of bias & high heterogeneity
BMJ. 2010 Jun 9;340:c2843. doi: 10.1136/bmj.c2843. Review (Narrative)
IN interstitial lung disease The Use of
detailed clinical history, chest x-ray, pulmonary function tests, high resolution computed tomography and for some patients bronchoscopy and/or pulmonary biopsy
As Diagnostic Tool
Is useful Than
no comparison
To accurately diagnose an evolving interstitial lung disease.
Crit Care Med. 2011 Mar;39(3):554-9 Meta-Analysis
IN intracranial elevated pressure The Use of
hypertonic saline, 3% to 7.5% sodium, dose: 2 to 5 mosm/Kg or about 250 mosm
As Treatment, Acute
Is better Than
mannitol 20%, equivalent dose in mosm
To modestly improve control of intracranial elevated pressure: RR 1.2 (1.0-1.33) or a mean additional intracranial pressure reduction of 2.0 mm Hg
N Engl J Med. 2011 Jan 6;364(1):22-32 Randomized Controlled Trial
IN irritable bowel syndrome, without constipation The Use of
oral non-absorbable antibiotics, rifaximin, for 2 weeks
As Treatment, Acute
Is better Than
placebo
To reduce symptoms at 4 weeks after treatment. And longer after ?
Am J Cardiol. 2014 Jun 6. [Epub ahead of print] Meta-Analysis
IN kidney disease, chronic The Use of
statins
As Treatment, Chronic
Is better Than
placebo
To reduce progression of renal failure and reduce proteinuria
Eur Heart J. 2013 Jun;34(24):1807-17. Epub 2013 Mar 6. Meta-Analysis
IN kidney disease, chronic The Use of
statins
As Treatment, Chronic
Is better Than
placebo
To reduce major cardiovascular events (RR 0.77) and all-cause death (RR 0.91)
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)