DISEASE	INTERVENTION	COMPARISON	RESULTS
J Allergy Clin Immunol. 2015 Mar;135(3):745-52.e5. doi: 10.1016/j.jaci.2014.07.062		Case-Control
IN allergy, drugs, antibiotics, penicillin, cephalosporins	The Use of history of drug allergy to cephalosporins As Prognostic Item	Is equal Than not having a history of cephalosporin allergy	To predict the risk of suffering, when receiving cephalosporins, any allergic reaction (0.43 to 0.56%), anaphylaxis (2 cases in 100 000 exposed) or any serious adverse drug reactions (C.difficile and nephropathy most frequents)
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.
N Engl J Med. 2013 Dec 12;369(24):2304-12		Randomized Controlled Trial, Multicenter Study
IN anticoagulants, vitamin K antagonists, acenocoumarol, phenprocoumon	The Use of pharmacogenetic guided dosing, using CYP2C9 and VKORC1 genotype, combined with clinical information in an algorithm As Treatment, Acute	Is equal Than a dosing algorithm that included only clinical variables	To modify the percentage of time that the INR was in the therapeutic range in the first 12 weeks after initiation of therapy
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 Jun 21;378(25):e34. doi: 10.1056/NEJMoa1800389. Epub 2018 Jun 13		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%
N Engl J Med. 2023 Aug 27. doi: 10.1056/NEJMoa2306037. Epub ahead of print		Randomized Controlled Trial
IN atrial fibrillation, rate control strategy, heart failure, chronic, systolic, end-stage, referred for heart transplantation evaluation	The Use of rhythm-control therapy using atrial fibrillation ablation As Treatment, Acute	Is better Than guideline-directed medical therapy	To reduce at 18 months mortality (6% ablation VS 20% controls) and adverse outcomes (death, implantation of left ventricular assist device, or urgent heart transplantation)
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
Agency for Healthcare Research and Quality (US); 2019 Oct. Report No.: 19(20)-EHC024-EF		Systematic Review
IN chronic obstructive pulmonary disease, exacerbations	The Use of systematic use of systemic corticosteroids, antibiotics and titrated oxygen. Suggested benefit for chest physiotherapy As Treatment, Acute	Is better Than placebo	To increase rates of clinical cure rate and reduce clinical failure rate. Titrated oxygen reduces mortality compared with high flow oxygen.
N Engl J Med. 2018 May 3;378(18):1671-1680. doi: 10.1056/NEJMoa1713901		Randomized Controlled Trial, Multicenter Study
IN chronic obstructive pulmonary disease, stable	The Use of triple inhaled therapy (glucocorticoid - fluticasone, long-acting anticholinergics (LAAC) - umeclidinium, and a long-acting β2-agonist (LABA) - vilanterol) As Treatment, Chronic	Is better Than any dual therapy combination	To reduce the annual rate of moderate or severe exacerbations: 0.9 triple tt VS. 1.1 dual tt. Higher risk of pneumonia in dual or triple Tt taking glucocorticoids.
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. 2024 Apr 18;390(15):1372-1381. doi: 10.1056/NEJMoa2401479		Randomized Controlled Trial
IN coronary disease, acute coronary syndrome, myocardial infarction, ST-segment elevation, or without ST elevation, residual preserved left ventricular ejection fraction	The Use of long-term treatment with a beta-blocker (metoprolol or bisoprolol) As Treatment, Chronic	Is equal Than no treatment with beta-blockers	To modify, at 3.5 years, death from any cause (about 4% both groups) or new myocardial infarction (about 4.5% both groups)
Sci Rep. 2021 Nov 23;11(1):22777. doi: 10.1038/s41598-021-02321-z		Systematic Review
IN covid-19, SARS-CoV2, coronavirus	The Use of vaccine, mRNA-vaccines, BNT162b2 As Prevention, Primary	Is better Than vaccine, virus vector vaccines, Gam-COVID-Vac (Sputnik), Ad26.COV2.S (Janssen), recombinant protein vaccine, NVX-CoV23730 (Novavax), inactivated virus vaccine, CoronaVac (Sinovac), WIV04 (SinoPharm)	To protect against symptomatic COVID-19: P-scores probability of efficacy: BNT162b2 0.95, mRNA-1273 0.84, Gam-COVID-Vac 0.78, NVX-CoV23730 0.70, CoronaVac 0.57, BN02 0.42, WIV04 0.327, Ad26.COV2.S 0.20
N Engl J Med. 2021 Dec 16. doi: 10.1056/NEJMoa2116044. Epub ahead of print		Randomized Controlled Trial
IN covid-19, SARS-CoV2, coronavirus, first 5 days, mild to moderate disease, risk factors for severe disease, non hospitalized	The Use of molnupiravir, 800 mg twice daily for 5 days As Treatment, Acute	Is better Than placebo	To modestly reduce, at 29 days, hospitalization (7% molnup VS 14% placebo) and mortality (0.1% molnup VS 1.3% placebo). But it was not effective in patients with evidence of previous SARS-CoV-2 infection or low baseline viral load
N Engl J Med. 2020 Nov 5;383(19):1813-1826. doi: 10.1056/NEJMoa2007764		Randomized Controlled Trial, Multicenter Study
IN covid-19, SARS-CoV2, coronavirus, mild to moderate disease, lower respiratory tract involvement	The Use of remdesivir (200 mg I.V. loading dose on day 1, followed by 100 mg I.V. daily for up to 5 days) As Treatment, Acute	Is better Than placebo	To reduce median recovery time (10 days remdes VS 15 days placebo) and probably reduce mortality at 29 days (11% remdes VS 15% placebo, p non sig.)
JAMA Intern Med. 2020 Oct 20. doi: 10.1001/jamainternmed.2020.6820. [Epub ahead of print]		Randomized Controlled Trial, Multicenter Study
IN covid-19, SARS-CoV2, coronavirus, moderate to severe disease, pneumonia, respiratory failure	The Use of monoclonal antibodies, interleukin-6 receptor blockade, tocilizumab 8 mg/kg, on day 1 and on day 3 As Treatment, Acute	Is equal Than usual care alone	To modify mortality at day 28 (11% tocili VS 12% usual care). Tocilizumab seemed to reduce the need for (invasive or not) ventilatory support at day 14.
Lancet. 2021 May 1;397(10285):1637-1645. doi: 10.1016/S0140-6736(21)00676-0		Randomized Controlled Trial, Multicenter Study
IN covid-19, SARS-CoV2, coronavirus, moderate to severe disease, pneumonia, respiratory failure and evidence of systemic inflammation	The Use of monoclonal antibodies, interleukin-6 receptor blockade, tocilizumab 400 mg-800 mg IV (depending on weight) As Treatment, Acute	Is better Than usual treatment, including systemic corticosteroids	To reduce mortality at 28 days: 31% tociliz VS 35% usual Tt
JAMA. 2021 Dec 7;326(21):2161-2171. doi: 10.1001/jama.2021.20714		Randomized Controlled Trial
IN covid-19, SARS-CoV2, coronavirus, severe disease, pneumonia, respiratory failure	The Use of high-flow oxygen therapy through a nasal cannula As Treatment, Acute	Is better Than conventional oxygen therapy	To reduce at 28 days the need for intubation (34% high-flow VS 51% conventional) and time needed for clinical recovery (11 days high-flow VS 14 days conventional)
Neuropsychopharmacology. 2024 Dec 30. doi: 10.1038/s41386-024-02044-5. Epub ahead of print		Systematic Review
IN depression, unipolar, refractory	The Use of six treatments: electroconvulsive therapy (ECT), minocycline, theta-burst stimulation, repetitive transcranial magnetic stimulation (rTMS), ketamine, and aripiprazole As Treatment, Acute	Is better Than placebo or sham therapy	To increase depression response rate. ORs ranged from 1.9 for aripiprazole to 13 for electroconvulsive therapy
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
Diabetes Obes Metab. 2020 Dec 2. doi: 10.1111/dom.14281		Randomized Controlled Trial
IN diabetes mellitus, type 2, associated renal events	The Use of incretin enhancer, dipeptidyl peptidase 4 (DPP4) inhibitors As Treatment, Chronic	Is worse Than placebo, usual treatment or other treatments for diabetes	To modify renal disease: DPP-4 were associated with greater decline in eGFR (mean difference -1.1 ml/min). No differences in end-stage kidney disease or death from kidney causes or all-cause mortality
N Engl J Med. 2019 Jan 24;380(4):347-357		Randomized Controlled Trial, Multicenter Study
IN diabetes mellitus, type 2, patients with cardiovascular disease or at risk of	The Use of renal sodium-glucose cotransporter inhibitor, gliflozins, dapagliflozin, on top or in substitution of previous antidiabetes Tt As Treatment, Chronic	Is equal Than placebo	To modify major adverse cardiovascular events, cardiovascular death, all-cause death or renal events. Hospitalization for heart failure was less frequent with dapagliflozin but genital infections and ketoacidosis were more frequent
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.
N Engl J Med. 2023 Nov 2;389(18):1649-1659. doi: 10.1056/NEJMoa2303706		Randomized Controlled Trial, Multicenter Study
IN gastrointestinal bleeding, upper, lower, angiodysplasia, small-Intestine	The Use of thalidomide, 50 or 100 mg/d for 4 months As Treatment, Acute	Is better Than placebo	To reduce at 1 year the number of bleeding episodes at least 50%: 51 to 68% of patients with thalidomide VS. 16% placebo
Arch Surg. 2012 Mar;147(3):277-81		Systematic Review
IN hernia, inguinal, asymptomatic	The Use of watchful waiting As Treatment, Chronic	Is equal Than routine surgical repair	To symptoms at follow-up were not different but it existed a hight crossover ratio (23% to 72%) from watchful waiting to surgery : most patients will develop symptoms (mainly pain) over time and will require operation
N Engl J Med. 2021 Sep 30;385(14):1268-1279. doi: 10.1056/NEJMoa2111437		Randomized Controlled Trial, Multicenter Study
IN hypertension, essential, older adults (60 to 80 years of age)	The Use of intensive blood-pressure control: target SBP < 130 mmHg As Treatment, Chronic	Is better Than standard blood-pressure control: target SBP < 150 mmHg	To reduce, at 3.3 ans, combined cardiovascular events or death (3.5% intenisve VS 4.6% standard)
JAMA. 2018 10 02;320(13):1349-1359		Systematic Review, Cochrane Review
IN hypothyroidism, subclinical	The Use of levothyroxine, L-thyroxine As Treatment, Chronic	Is equal Than placebo or no treatment	To modify (follow-up range, 3-18 months) symptoms, or quality of life.
JAMA Intern Med. 2021 Aug 30:e214813. doi: 10.1001/jamainternmed.2021.4813. Epub ahead of print		Cohorts
IN kidney disease, chronic, eGFR threshold definition, older patients	The Use of an age adapted eGFR threshold for defining chronic kidney disease: 75, 60, and 45 mL/min/1.73 m2 for age < 40, 40 to 64, and > 65 years, respectively As Diagnostic Tool	Is better Than fixed eGFR threshold of 60 mL/min/1.73 m2	To better predict kidney failure (kidney replacement initiation or sustained eGFR <15 mL/min/1.73 m2 for >3 months) and death from kidney causes
N Engl J Med. 2023 May 11;388(19):1739-1754. doi: 10.1056/NEJMoa2213093		Randomized Controlled Trial
IN leukemia, chronic lymphocytic leukemia, fit patients, no	The Use of a combination of: time-lited B-cell lymphoma 2 (BCL2) inhibitor venetoclax + the anti-CD20 antibody obinutuzumab + ibrutinib, Bruton tyrosine kinase (BTK) inhibitor As Treatment, Acute	Is better Than chemoimmunotherapy (fludarabine–cyclophosphamide–rituximab or bendamustine–rituximab) or venetoclax + anti-CD20 antibody rituximab	To improve at 15 months patients with undetectable minimal residual disease: venetoclax-obinutuzumab-ibrutinib group 92% VS venetoclax-obinutuzumab group 87% VS chemoimmunotherapy 52%
Lancet. 2018 09 22;392(10152):1015-1035		Meta-Analysis
IN lifestyle and habits, alcohol	The Use of zero alcohol consumtion As Etiologic risk factor	Is better Than any alcohol consumtion	To be associate to lower atributable harm. Authors found a reduction of cardiovascualr disease and diabetes with lowest comsumtion but countered by an increase in cancers
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.
Emerg Med J. 2007 Sep;24(9):619-24		Clinical Trial (non-controlled, non-randomized)
IN medical thinking, errors, diagnostic, clinical decision support systems	The Use of Isabel, a novel web-based reminder system, which provides rapid diagnostic differential advice As Diagnostic Tool	Is useful Than no comparison here	To accurately predict the final diagnosis: the system displayed the final discharge diagnosis in 95% of inpatients, but only in 78% of cases within the first 10 suggestions
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)
Neurology. 2019 Mar 5;92(10):e1007-e1015. doi: 10.1212/WNL.0000000000007032		Diagnostic
IN neurologic disease, neuronal injury, multiple sclerosis	The Use of neurofilament proteins, blood neurofilament light chain As Diagnostic Tool	Is better Than clinical or radiological findings alone	To baseline, NfL levels (pg/mL) were higher in patients than in healthy controls (27-30 vs 17) and correlated with T2 lesion load and risk of worsening disability
JAMA Intern Med. 2018 Nov 12. doi: 10.1001/jamainternmed.2018.4869. [Epub ahead of print]		Randomized Controlled Trial
IN older people, acute hospitalization, exercise	The Use of exercise, individualized moderate-intensity resistance, balance, and walking exercises, in 2 daily sessions As Undefined	Is undefined Than usual hospital care, includING physical rehabilitation when needed	To improve, at hospital discharge, functional capacity: +2 points in Short Physical Performance Battery exercise VS +0 points usual care ; +2 points in Barthel Index VS -5 points usual care
JAMA. 2018 09 25;320(12):1259-1265		Randomized Controlled Trial, Multicenter Study
IN pain, abdominal, acute, appendicitis, uncomplicated, adults	The Use of antibiotics: ertapenem IV (1 g/d) for 3 days followed by 7 days of levofloxacin PO (500 mg once daily) and metronidazole PO (500 mg 3 times per day) As Treatment, Acute	Is better Than appendectomy	To reduce at 5 years the overall complications rate (7% antibiotics VS 24% appendectomy), despite a cumulative incidence of appendicitis recurrence of 39% in the antibiotics group
JAMA. 2024 Dec 10. doi: 10.1001/jama.2024.26244. Epub ahead of print		Randomized Controlled Trial, Multicenter Study
IN respiratory failure, acute, hypoxic, acutely ill adults, chronic obstructive pulmonary disease (COPD) exacerbation, heart failure, acute, acute cardiogenic pulmonary edema, COVID-19	The Use of high-flow nasal oxygen (HFNO) As Treatment, Acute	Is equal Than non-invasive ventilation	To modify endotracheal intubation or death at 7 days (39% HNFO VS 38% NIV all patients, 10% HNFO VS 21% NIV in cardiogenic pulmonary edema, 29% HNFO VS 26% NIV in COPD)
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
Lancet. 2015 Oct 31;386(10005):1747-53. doi: 10.1016/S0140-6736(15)61485-4		Randomized Controlled Trial
IN tachycardia, supraventricular, paroxysmal	The Use of modified Valsalva manoeuvre with leg elevation and supine positioning at the end of the strain As Treatment, Acute	Is better Than usual Vansalva manoeuvre	To achieve sinus rhythm: 43% modified Vansalva VS 17% usual Vansalva. No serious adverse events recorded.
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. 2020 04 23;382(17):1599-1607		Randomized Controlled Trial, Multicenter Study
IN thromboembolic disease, cancer patients, symptomatic or incidental proximal deep-vein thrombosis or pulmonary embolism	The Use of apixaban (10 mg twice daily for the first 7 days, followed by 5 mg twice daily) As Treatment, Acute	Is equal Than dalteparin (200 IU per kilogram of body weight once daily for the first month, followed by 150 IU per kilogram once daily)	To avoid, at 6 months, recurrent venous thromboembolism (6% apixaban VS 8% dalteparin) without increasing major bleeding (4% both). Results were less good for > 75 years (see Notes)
Lancet. 2014 Mar 8;383(9920):880-8		Randomized Controlled Trial, Multicenter Study
IN thromboembolic disease, deep venous thrombosis, post-thrombotic syndrome	The Use of active compression stockings As Treatment, Chronic	Is equal Than placebo (fake compression stockings)	To modify incidence of post-thrombotic syndrome at 2 years: 14% active stockings VS 13% placebo
Cochrane Database Syst Rev. 2017 09 26;9:CD004174		Systematic Review, Cochrane Review
IN thromboembolic disease, deep venous thrombosis, post-thrombotic syndrome	The Use of compression therapy, compression stockings As Treatment, Chronic	Is better Than no intervention	To reduce the incidence of post-thrombotic syndrome: RR 0.62, but no clear reduction in the incidence of severe PTS. Low-quality evidence because heterogeneity
N Engl J Med. 2021 May 6;384(18):1705-1718. doi: 10.1056/NEJMoa2033400		Randomized Controlled Trial
IN tuberculosis, pulmonary	The Use of 4-month regimen with rifapentine, isoniazid, pirazinamide and moxifloxacine As Treatment, Acute	Is equal Than standard 6-month regimen consisting of rifampin, isoniazid, pyrazinamide, and ethambutol	To avoid an unfavourable outcome at 12 months: 15.5% 6-month VS 14.6% 4-months and avoid severe adverse events (19% both groups)
Rev Med Interne. 2025 Jan 8:S0248-8663(24)01312-2. French. doi: 10.1016/j.revmed.2024.11.014		Cohorts
IN acidosis, lactic, drug-induced, metformin, diabetes mellitus, type 2, renal failure, acute	The Use of oral hypoglycemic agents, metformin As Etiologic risk factor	Is worse Than no metformin	To cause lactic acidosis, but only rarely (28 cases in 1370 hospit), always in cases of acute kidney failure and with reduced 7% mortality, if other causes of lactic acidosis (infarctus, sepsis ...) excluded
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)
Intensive Care Med. 2021 Apr 19:1–17. doi: 10.1007/s00134-021-06394-2. Epub ahead of print		Systematic Review
IN acute respiratory distress syndrome, adults, covid-19 and non-covid-19	The Use of corticosteroids for >7 days As Treatment, Acute	Is better Than placebo	To reduce mortality at 28 days: RR 0.82, Absolute Risk Reduction 8.0%. The effect was consistent between patients with COVID-19 and non-COVID-19, corticosteroid types, and dosage
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)
Science. 2021 Nov 19;374(6570):eabe7365. doi: 10.1126/science.abe7365		Review (Narrative)
IN aging, caloric intake, lifestyle and habits, diet	The Use of caloric restriction diets which avoid malnutrition, and (maybe) other particular "anti-aging" diets: intermittent fasting, fasting-mimicking diets, ketogenic diets, time-restricted feeding, protein restriction As Treatment, Chronic	Is better Than usual modern, western, diets	To very probably increase lifespan and reduce age-related diseases, but have to be proven in well conducted studies in humans
N Engl J Med. 2019 12 26;381(26):2541-2551		Review (Narrative)
IN aging, caloric intake, obesity, diabetes, cardiovascular disease	The Use of intermittent fasting, independently of caloric intake As Treatment, Chronic	Is better Than no fasting period	To improve general health, cognitive abilities, biomarkers of disease, reduce body fat and, in animals, prolong life span
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.
J Intern Med. 2017 May 4. doi: 10.1111/joim.12627. [Epub ahead of print]		Cohorts
IN aging, 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. 2023 Jan 19;186(2):243-278. doi: 10.1016/j.cell.2022.11.001		Review (Narrative)
IN aging, mechanisms	The Use of 12 tentative hallmarks: genomic instability, telomere attrition, epigenetic, loss of proteostasis, dis. macroautophagy, dereg. nutrient-sensing, mitochondrial dysf., cells senescence, stem cell exhaustion, chronic inflam., alt. intercellular communication As Etiologic risk factor	Is useful Than no comparison here	To help understand and study aging
Nature Aging. 16 May 2022 ;2:484–493. DOI: 10.1038/s43587-022-00220-0		Descriptive, Cross-Sectional Study
IN aging, mechanisms	The Use of epigenetic age, epigenetic clock As Prognostic Item	Is better Than chronological age	To nutrient sensing, mitochondrial function, stem cell exhaustion and altered cell–cell communication affect epigenetic aging, but not cellular senescence, telomere attrition and genomic instability
N Engl J Med. 2023 Jun 29;388(26):2422-33. doi: 10.1056/NEJMoa2300503		Case-Control
IN aging, mechanisms, long telomere syndrome, familial clonal hematopoiesis	The Use of excessively long telomeres As Etiologic risk factor	Is worse Than normal shortening telomeres with age	To favour multiples types of solid (melanoma, thyroid, brain, sarcoma, digestive, utotelial ..) and hemopoietic (B- and T-cell lymphoma, myeloid cancers) benign and malignant neoplasms
Nat Med. 2025 Feb 19. doi: 10.1038/s41591-024-03483-9. Epub ahead of print		Cohorts
IN aging, mechanisms, overall mortality, genetics, environment, exposures factors	The Use of 25 independent exposures combined (see abstract) As Etiologic risk factor	Is better Than polygenic indexes	To explain a greater amount of variation for premature mortality and proteomic age clock (6 to 49 % explained by exposome VS 10 to 26% by polygenic index, for selected diseases)
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
J Am Geriatr Soc. 2025 Apr 24. doi: 10.1111/jgs.19485. Epub ahead of print		Systematic Review
IN agitation, delirium, older patients, emergency department	The Use of benzodiazepines, particularly midazolam, also with escalating doses of lorazepam As Treatment, Acute	Is worse Than antipsychotics, quetiapine, haloperidol	To avoid severe adverse events (53% in midazolam, only 1 small study, VS 17% overall, OR 5.25). Quetiapine had a lower fequency of severe adverse events (OR 0.27)
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
Allergy Asthma Proc. 2019 Jan 1;40(1):57-61. doi: 10.2500/aap.2019.40.4184.		Clinical Trial (non-controlled, non-randomized)
IN allergy, drugs, antibiotics, penicillin, amoxicillin, history of benign rash, benign somatic symptoms, or unknown history associated with the last penicillin exposure >12 months ago	The Use of direct oral amoxicillin challenge without preliminary skin testing, monitored for 60 minutes after challenge and were discharged with instructions to call in the event of a delayed reaction As Treatment, Acute	Is useful Than No comparison done	To exclude true severe allergy to penicillin/amoxicillin: none of the patients challenged had an objective early or delayed reaction
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.
N Engl J Med. 2024 Aug 30. doi: 10.1056/NEJMoa2409134. Epub ahead of print		Randomized Controlled Trial, Multicenter Study
IN amyloidosis, TTR type, cardiomyopathy	The Use of RNA interference agent, vutrisiran, 25 mg SC every 12 weeks for up to 36 months As Treatment, Chronic	Is better Than placebo	To reduce death or cardiovascular events at 3 years: 50% vutrisiran VS 61% placebo. Also associated less of a decline in the walking distance
Cochrane Database Syst Rev. 2021 Dec 21;12(12):CD002042. doi: 10.1002/14651858.CD002042.pub5		Systematic Review, Cochrane Review
IN anemia, acute or chronic, bleeding or not, broad range of clinical contexts	The Use of a restrictive transfusion strategy in stable patients: if hemoglobin < 7 to 8 g/dL As Treatment, Acute	Is better Than a more liberal transfusion strategy	To decrease people exposed to red blood cell transfusion by 41%
BMJ. 2015 Mar 24;350(350):h1354		Systematic Review
IN anemia, acute, bleeding or not	The Use of a restrictive transfusion strategy As Treatment, Acute	Is equal Than a liberal transfusion strategy	To modify the risk of death, overall morbidity or myocardial infarction, while using less blood cells units per patient
Ann Intern Med. 2012 Jul 3;157(1):49-5		Consensus, Guideline
IN anemia, red blood cells transfusion	The Use of a restrictive transfusion strategy in stable patients: 7 to 8 g/dL, 8 g/dL or symptoms when preexisting cardiovascular disease. No data for acute coronary syndrom As Treatment, Acute	Is better Than a more liberal transfusion strategy	To use more effectively red blood cells transfusions
N Engl J Med. 2024 Jun 13. doi: 10.1056/NEJMoa2404360. Epub ahead of print		Randomized Controlled Trial, Multicenter Study
IN anemia, traumatic brain injury, moderate or severe	The Use of a restrictive strategy: transfusions initiated at Hgb ≤7 g/dL As Treatment, Acute	Is worse Than a liberal strategy: transfusions initiated at a hemoglobin level of ≤10 g/dL	To reduce unfavorable outcomes: 74% restrictive VS 68% liberal. Mortality was not different. Acute respiratory distress syndrome was more frequent with a liberal strategy: 3% VS 1%
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.
Forum Infectious Diseases. 2025 Jun;12(6):ofaf313, doi: 10.1093/ofid/ofaf313		Randomized Controlled Trial
IN antibiotics, cephalosporins, ceftriaxone, subcutaneous administration, clinical pharmacology	The Use of administering ceftriaxone as subcutaneous, same doses As Treatment, Acute	Is equal Than administering it intravenously	To achieve similar bioavailability (99%), concentrations and good probability of target attainment
Thromb Haemost. 2025 Jul 17. doi: 10.1055/a-2642-0241. Epub ahead of print		Cohorts
IN anticoagulants, direct oral anticoagulants, oral factor Xa inhibitors, bleeding risk, pulmonary embolism	The Use of RIETE score, composed of 6 items: recent major bleeding, creatinine>106 µmol/L, anemia, malignancy history, clinically-overt pulmonary embolism (NOT incidental PE finding), Age >75 As Prognostic Item	Is better Than other bleeding risk scores (HAS-BLED, ATRIA)	To better predict risk of major bleeding at 3 months: AUC 0.70 RIETE VS 0.68 HAS-BLED VS 0.68 ATRIA
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 Sep 22;375(12):1131-41. doi: 10.1056/NEJMoa1607887		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.
N Engl J Med. 2019 Feb 7. doi: 10.1056/NEJMoa1814051. [Epub ahead of print]		Randomized Controlled Trial, Multicenter Study
IN anticoagulants, oral factor Xa inhibitors, apixaban, rivaroxaban, patients with acute major bleeding, predominantly intracranial 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 useful Than no comparison group	To achieve a fast decrease of plasma anti-factor Xa activity (92% reduction) and obtain excellent or good hemostasis (82% of patients)
Circulation. 2024 Jan 23;149(4):279-289. doi: 10.1161/CIRCULATIONAHA.123.066485		Randomized Controlled Trial, Multicenter Study
IN anticoagulants, oral, patients on vitamin K antagonists for long time, older patients, frail, direct oral anticoagulants	The Use of switching vitamin K antagonists to direct oral anticoagulants, oral direct thrombin inhibitors, dabigatran, oral factor Xa inhibitors, apixaban, rivaroxaban As Treatment, Chronic	Is worse Than maintaining vitamin K antagonists	To modify major or clinically relevant nonmajor bleeding: HR 1.69 (p significant) on direct oral anticoagulants
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)
J Am Heart Assoc. 2018 Sep 18;7(18):e009766. doi: 10.1161/JAHA.118.009766		Meta-Analysis
IN anticoagulants, vitamin K antagonists, bleeding risk	The Use of HAS-BLED and HEMORR2HAGES As Diagnostic Tool	Is better Than other bleeding risk assessment tools	To accurately estimate risk of bleeding: HAS-BLED and HEMORR2HAGES have balanced sensitivity and specificity. European score, ABC, and mOBRI are high-sensitivity and ORBIT, ATRIA, Shireman, and GARFIELD-AF are high-specificity
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, older patients	The Use of Any of 3 most commonly employed scores: HAS-BLED, ATRIA and HEMORR2HAGES 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, older 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, older patients	The Use of outpatient bleeding risk index (OBRI): 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)
Lancet. 2006 Feb 4;367(9508):404-11		Meta-Analysis
IN anticoagulants, vitamin K antagonists, monitoring	The Use of patient self-monitoring of anticoagulation As Dosage Scheme	Is better Than standard monitoring by a health professional	To reduce thromboembolic events (OR 0.45, NNT aprox 38), all-cause mortality (OR 0.61, NNT aprox 67), and major haemorrhage (OR 0.65, NNT aprox 67)
Ann Intern Med. 2011 Apr 5;154(7):472-82		Meta-Analysis
IN anticoagulants, vitamin K antagonists, monitoring	The Use of patient self-monitoring of anticoagulation, with or without self-management As Dosage Scheme	Is better Than usual care and monitoring by a health professional	To reduce thromboembolic events (OR 0.58) and total mortality (OR 0.74), with no excess of major bleedings (OR 0.89)
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
N Engl J Med. 2008 Mar 6;358(10):999-1008		Descriptive
IN anticoagulants, vitamin K antagonists, warfarin	The Use of genetic variants of vitamin K epoxide reductase (VKORC1), the target of warfarin As Diagnostic Tool	Is better Than genetic variants of cytochrome P-450 2C9 (CYP2C9), which metabolises warfarin	To predict the time to the first INR within the therapeutic range or in excess
Circulation. 2007 Nov 27;116(22):2563-70		Randomized Controlled Trial
IN anticoagulants, vitamin K antagonists, warfarin	The Use of pharmacogenetic guided dosing, using CYP2C9 and VKORC1 genotype As Dosage Scheme	Is equal Than standard empirical dosing	To reduce time of out-of-range INR (31% genotyping VS 33% standard) or proportion of patients reaching therapeutic INR at day 5 or 8.
J Am Coll Cardiol. 2011 Feb 1;57(5):612-8		Cohorts
IN anticoagulants, vitamin K antagonists, warfarin	The Use of pharmacogenetic guided dosing, using CYP2C9 and VKORC1 genotype, combined with clinical information in a formal algorithm As Dosage Scheme	Is better Than methods using only clinical information (empiric or a formal clinical algorithm), or methods using only genetic data	To improve the proportion of patients whose predicted doses were within 20% of their actual therapeutic doses: 52% pharmacogenetic algorithm, 43% genetic data, 39% clinical algorithm, 37% empiric dosing.
N Engl J Med. 2005 Jun 2;352(22):2285-93		Clinical Trial (non-controlled, non-randomized)
IN anticoagulants, vitamin K antagonists, warfarin	The Use of vitamin K epoxide reductase complex 1 (VKORC1) haplotipes As Dosage Scheme	Is useful Than no comparison here	To stratify patients into low-, intermediate-, and high-dose warfarin groups
N Engl J Med. 2013 Dec 12;369(24):2283-93		Randomized Controlled Trial, Multicenter Study
IN anticoagulants, vitamin K antagonists, warfarin	The Use of pharmacogenetic guided dosing, a dosing algorithm that included both clinical variables and genotype data As Treatment, Acute	Is equal Than a dosing algorithm that included only clinical variables	To modify the percentage of time that the INR was in the therapeutic range from day 4 through day 28 of therapy
N Engl J Med. 2013 Dec 12;369(24):2294-303		Study type to be defined
IN anticoagulants, vitamin K antagonists, warfarin	The Use of pharmacogenetic guided dosing, using CYP2C9 and VKORC1 genotype, combined with clinical information in an algorithm As Treatment, Acute	Is better Than standard empirical dosing of warfarin	To improve the percentage of time that the INR was in the therapeutic range in the first 12 weeks after initiation of therapy: 67% with pharmacogenetics VS 60% clinical
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.
Clin Infect Dis. 1997;24(5):786-795		Meta-Analysis
IN antimicrobials, aminoglycosides	The Use of once-a-day dosing aminoglycosides As Dosage Scheme	Is Than	To
BMJ. 1996;312:338-345		Meta-Analysis
IN antimicrobials, aminoglycosides	The Use of once-a-day dosing aminoglycosides As Dosage Scheme	Is Than	To
Clin Infect Dis. 1997;24(5):796-809		Meta-Analysis
IN antimicrobials, aminoglycosides	The Use of once-a-day dosing aminoglycosides As Dosage Scheme	Is Than	To
Am J Med. 1998 Sep; 105(3):182-91		Randomized Controlled Trial
IN antimicrobials, aminoglycosides	The Use of once-a-day dosing, gentamicin As Dosage Scheme Scheme	Is better Than three-times-a-day dosing	To avoid renal toxicity, with equal clinical or microbiologic efficacy
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.
Am J Cardiol. 2019 Dec 15;124(12):1889-1893. doi: 10.1016/j.amjcard.2019.09.008		Meta-Analysis
IN arrhythmia	The Use of antiarrhythmics, amiodarone As Treatment, Chronic	Is worse Than placebo	To increase adverse effects (per 100 patients-year): pulmonary (amio 1,3% VS 0,7%), thyroid (amio 2% VS 0,4%), hepatic (amio 0,5% VS 0,2%), cardiac (amio 8% VS 4,5%), neurological (amio 1,4% VS 0,8%) and skin (amio 0,8% VS 0,2%)
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)
Chest. 1999 Sept;116(3):595-602		Randomized Controlled Trial
IN asthma	The Use of inhaled beta2 agonist, long-term fixed regular use As Treatment, Chronic	Is better Than placebo and inhaled beta2 agonist, as needed	To improving FEV1 and symptoms. No differences in the annual rate, timing, or duration of exacerbations.
Lancet. 2000 May 13;355(9216):1675-79		Randomized Controlled Trial
IN asthma	The Use of inhaled beta2 agonist, long-term fixed regular use As Treatment, Chronic	Is better Than placebo and inhaled beta2 agonist, as needed	To improving diurnal peak expiratory flow. No differences in the annual rate, timing, or duration of exacerbations.
Am J Med. 2010 Apr;123(4):322-8.e2		Meta-Analysis
IN asthma	The Use of inhaled long-acting beta2 agonist, long-term regular use As Treatment, Chronic	Is worse Than placebo or inhaled corticosteroids alone	To prevent asthma-related intubation or death: they increase the risk by 2 folds OR 2.10
Ann Intern Med. 2006 Jun 20;144(12):904-12. Epub 2006 Jun 5		Meta-Analysis
IN asthma	The Use of inhaled long-acting beta2-agonists As Treatment, Chronic	Is worse Than placebo	To prevent exacerbations: they increased hospitalisations by asthma exacerbation (OR, 2.6; absolute increase 0.7%) and life-threatening exacerbations (OR, 1.8)
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. 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. 2007 May 17;356(20):2040-52		Randomized Controlled Trial, Multicenter Study
IN asthma, mild	The Use of combination of inhaled corticosteroids and short-acting beta2-agonists (beclomethasone, albuterol) as on-demand reliever Tt As Treatment, Chronic	Is better Than short-acting b2-agonists on-demand alone	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
N Engl J Med. 2022 May 15. doi: 10.1056/NEJMoa2203163		Randomized Controlled Trial
IN asthma, moderate-to-severe, receiving inhaled glucocorticoid-containing maintenance treatment	The Use of combination of inhaled corticosteroids and short-acting beta2-agonists (beclomethasone, albuterol) as on-demand reliever Tt As Treatment, Chronic	Is better Than short-acting b2-agonists (albuterol) on-demand reliever alone	To reduce severe asthma exacerbations (43 per 100 patient/years combination VS 58 albuterol alone), reduce total inhaled corticosteroids use and improve quality-of-life scores
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. 2025 Jul 10;393(2):113-124. doi: 10.1056/NEJMoa2504544		Randomized Controlled Trial, Multicenter Study
IN asthma, persistent, mild, aged > 12 years old	The Use of as-needed use of albuterol-budesonide (doses of 2 inh. of 90 μg albuterol + 80 μg budesonide) As Treatment, Chronic	Is better Than usual treatment with a short-acting β2-agonist (SABA) with or without a low-dose inhaled glucocorticoid or leukotriene-receptor antagonist	To reduce severe exacerbations (5% of patients, 0.15 exacerbations/patient.year albuterol-budesonide VS 9% of patients, 0.33 exacerbations/patient.year controls)
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)
Heart. 2022 Aug 9:heartjnl-2022-321332. doi: 10.1136/heartjnl-2022-321332		Randomized Controlled Trial
IN atherosclerosis, cardiovascular disease, cardiovascular death	The Use of salt substitutes, potassium-enriched salt As Prevention, Primary	Is better Than regular common salt	To reduce blood pressure (-4,6 mean reduction in systolic BP), cardiovascular events (RR 0.89), cardiovascular mortality (RR 0.87) and total mortality (RR 0.89)
Eur Heart J. 2025 May 2:ehaf174. doi: 10.1093/eurheartj/ehaf174. Epub ahead of print		Meta-Analysis
IN atherosclerosis, cardiovascular disease, coronary disease, ischemic stroke, acute coronary syndrome	The Use of colchicine, low-dose (0.5 mg/day), long-term (1 to 3 years) As Treatment, Chronic	Is better Than placebo	To reduce major cardiovascular events (HR 0.75), particularly myocardial infarction, ischemic stroke and urgent coronary revascularizations. However, no differences in mortality
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
Eur Heart J. 2018 Dec 17. doi: 10.1093/eurheartj/ehy813.		Meta-Analysis
IN atherosclerosis, cardiovascular disease, primary prevention, all ages, all patients, diabetic and high cardiovascular risk patients	The Use of aspirin As Prevention, Primary	Is worse Than placebo	To modify all-cause mortality or cardiovascular events (lower incidence of myocardial infarction, but heterogeneous). Conversely, aspirin increased major bleeding (RR 1.5) and intracranial haemorrhage (RR 1.33)
N Engl J Med. 2018 Oct 18;379(16):1499-1508		Randomized Controlled Trial, Multicenter Study
IN atherosclerosis, cardiovascular disease, primary prevention, healthy older patients	The Use of aspirin, 100 mg daily As Prevention, Primary	Is worse Than placebo	To achieve any clinical benefit (composite of death, dementia or persistent physical disability 2.1%/year in both groups) and caused more major bleeding (3.8% aspirin VS 2.8% placebo)
N Engl J Med. 2018 10 18;379(16):1519-1528		Randomized Controlled Trial, Multicenter Study
IN atherosclerosis, cardiovascular disease, primary prevention, healthy older patients	The Use of aspirin, 100 mg daily As Prevention, Primary	Is worse Than placebo	To carry any benefit: it increased all-cause death (1.3 %/year aspirin VS 1.1%/year placebo, p significant), mainly caused by cancer.
Circulation. 2019 Sep 17;140(12):992-1003. doi: 10.1161/CIRCULATIONAHA.118.039415		Randomized Controlled Trial, Multicenter Study
IN atherosclerosis, cardiovascular disease, primary prevention, high cholesterol, older patients	The Use of cholesterol intestinal absortion inhibitors, ezetimibe, 10 mg once daily As Prevention, Primary	Is better Than usual care	To reduce at 4 years cardiovascular events (sudden cardiac death, acute coronary syndrome or stroke)
Am J Cardiol. 2023 Jan 15;187:62-73. doi: 10.1016/j.amjcard.2022.10.015		Systematic Review
IN atherosclerosis, cardiovascular disease, primary prevention, high cholesterol, older patients	The Use of statins As Prevention, Primary	Is equal Than comparison	To modify the rate of major cardiovascular events in this population, overall, while producing muscular, hepatic, and gastrointestinal adverse effects more frequently than in younger patients
JAMA. 2020 Jul 7;324(1):68-78. doi: 10.1001/jama.2020.7848		Cohorts
IN atherosclerosis, cardiovascular disease, primary prevention, high cholesterol, older patients	The Use of statins As Prevention, Primary	Is better Than no treatment with statins	To reduce at 7 years all-cause mortality (8%/year statins VS 10%/year not Tt) and cardiovascular events (6.6%/year statins VS 7%/year not Tt)
N Engl J Med. 2018 Oct 18;379(16):1529-1539. doi: 10.1056/NEJMoa1804988		Randomized Controlled Trial, Multicenter Study
IN atherosclerosis, cardiovascular disease, primary prevention, high risk patients, diabetes mellitus, type 2	The Use of aspirin, 100 mg daily As Treatment, Chronic	Is better Than placebo	To reduce at 7.4 years cardiovascular events (8.5% VS 9.5% placebo), but it increased major bleeding (4% aspirin VS 3% placebo), most of the excess being gastrointestinal bleeding and other extracranial bleeding.
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. 2007 Oct 11;357(15):1477-86		Randomized Controlled Trial, Multicenter Study
IN atherosclerosis, cardiovascular disease, primary prevention, 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
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.
BMJ. 2022 May 4;377:e069116. doi: 10.1136/bmj-2021-069116		Meta-Analysis
IN atherosclerosis, cardiovascular disease, primary prevention, secondary prevention	The Use of intensive LDL cholesterol-lowering treatment, using ezetimibe or proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, evolocumab, in addition to statins As Treatment, Chronic	Is better Than statins alone	To to further reduce in high-risk patients MI (ezetb 11 per 1000, PCSK9 16 per 1000) and stroke (ezetb 14 per 1000, PCSK9 21 per 1000) but not cardiovascular or all-cause mortality, nor in low-risk patients
Lancet Diabetes Endocrinol. 2020 Jan;8(1):36-49		Meta-Analysis
IN atherosclerosis, cardiovascular disease, primary prevention, secondary prevention	The Use of intensive LDL cholesterol-lowering treatment, using higher statin doses, ezetimibe or proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors As Treatment, Chronic	Is better Than lower statin doses or no cholesterol treatment	To reduce cardiovascular events: each 1 mmol/L reduction in LDL cholesterol was associated with a 19% relative reduction for major vascular events (RR 0·81), independently of basal cholesterol
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 Geriatr Soc. 2020 Jan 20. doi: 10.1111/jgs.16329. [Epub ahead of print]		Cohorts
IN atherosclerosis, cardiovascular disease, risk factors, older patients	The Use of traditional risk factors - specially blood pressure, total cholesterol, and diabetes - or the ACC/AHA Pooled Cohort Equations (PCE) risk model As Prognostic Item	Is useless Than no comparison here	To accurately predict actual rate of cardiovascular events in older patients : concordance index (similar to c-statistics) only 0.52 in persons > 85 years
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
Eur Heart J. 2025 Jul 14;46(27):2691-2701. doi: 10.1093/eurheartj/ehaf207		Cohorts
IN atherosclerosis, coronary disease, primary prevention, adults, no prior history of atherosclerotic disease	The Use of plasma total apolipoprotein B-containing lipoprotein particles (apoB-P) (comprise low-density lipoprotein (LDL), intermediate-density lipoprotein (IDL), very-low-density lipoprotein (VLDL), chylomicrons and remnants, and lipoprotein(a) (Lp(a)) As Diagnostic Tool	Is better Than plasma VLDL or LDL measures	To predict the risk to develop incident coronary artery disease: HR 1.33 apoB-P VS 1.24 LDL for one SD increase. Elevated count of Lp(a) adds additional risk (HR 1.18)
Thromb Haemost. 2022 May 16. doi: 10.1055/a-1853-2952		Randomized Controlled Trial
IN atherosclerosis, coronary disease, stroke, ischemic, peripheral arterial disease	The Use of antiplatelet drugs, P2Y12 inhibitors, clopidogrel As Prevention, Secondary	Is better Than antiplatelet drugs, aspirin	To slightly reduce the incidence of nonfatal myocardial infarction (OR 0.83, absolute risk reduction = 0.5% ?per year?) but no difference in stroke, all-cause mortality or major bleeding
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. 2006 Apr 20;354(16):1706-17. Epub 2006 Mar 12		Randomized Controlled Trial, Multicenter Study
IN atherosclerosis, coronary disease, stroke, ischemic, peripheral arterial disease, or multiple risk factors	The Use of long-term combined antiplatelet drugs, P2Y12 inhibitors, clopidogrel (75 mg/d) added to low-dose aspirin As Treatment, Chronic	Is equal Than antiplatelet drugs, low-dose aspirin (75 to 160 mg/d) alone	To reduce, at 2 years, cardiovascular events (myocardial infarction, stroke, or cardiovascular death): 6.8% clopidogrel plus aspirin VS 7.3% aspirin alone. Bleeding was not significantly different. Combined treatment worse for non-symptomatic patients
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 Treatment, Chronic	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.
Lancet. 2022 May 4:S0140-6736(22)00122-2. doi: 10.1016/S0140-6736(22)00122-2		Randomized Controlled Trial, Multicenter Study
IN atherosclerosis, stablished coronary disease, young patients	The Use of mediterranean diet, applied with the support of dietitians As Prevention, Secondary	Is better Than low-fat diet, applied with the support of dietitians	To reduce at 5-7 years major cardiovascular events: 2.8 per 100 persons/year mediterranean VS 3.7% per 100 p/y low-fat diet
J Am Coll Cardiol. 2005 Jun 7;45(11):1832-9		Meta-Analysis
IN atrial fibrillation	The Use of angiotensin converting enzyme (ACE) inhibitors or angiotensin II receptor blockers As Prevention, Primary	Is better Than placebo	To reduce the incidence of new onset atrial fibrillation (most cumulated studies: RRR of 28%) and reduce its recurrence after conversion (2 studies)
N Engl J Med. 2011 Mar 10;364(10):928-38		Randomized Controlled Trial, Multicenter Study
IN atrial fibrillation	The Use of angiotensin II receptor blockers, irbesartan As Treatment, Chronic	Is equal Than placebo	To reduce at 4 years cardiovascular events (stroke, myocardial infarction, or death): 5.4% per years in both groups. Neither it reduced AF recurrences in patients in sinus rhythm at baseline
N Engl J Med. 2011 Sep 8;365(10):883-91. Epub 2011 Aug 10		Randomized Controlled Trial, Multicenter Study
IN atrial fibrillation	The Use of anticoagulants, oral factor Xa inhibitors, rivaroxaban, 20 mg once daily As Treatment, Chronic	Is equal Than dose-adjusted warfarin	To reduce stroke or systemic embolism (2.1% per year rivaroxaban VS 2.4% warfarin), or cause clinically relevant bleeding, major or nonmajor (15% per year both)
Stroke. 2009 Apr;40(4):1410-6		Meta-Analysis
IN atrial fibrillation, anticoagulants, vitamin K antagonists, bleeding risk, elder patients, stroke, ischemic, cerebral infarction, embolic	The Use of age As Etiologic risk factor	Is useful Than -	To predict an increased risk of stroke (HR per decade 1.45), major bleeding (HR per decade 1.61) and cardiovascular events (HR per decade 1.45). However the relative benefit of warfarin for preventing stroke persisted, while that of aspirin decreased
Eur J Prev Cardiol. 2025 Mar 7:zwaf138. doi: 10.1093/eurjpc/zwaf138		Systematic Review
IN atrial fibrillation, asymptomatic, general population	The Use of prevalence of asymptomatic atrial fibrillation As Methodology procedure	Is useful Than no comparison	To plan screening interventions. The prevalence of asymptomatic AF was 27% (95%CI 22% to 33%), with large variability between studies depending of the characteristics of patients screened
Circulation. 2024 Dec 3;150(23):1837-1846. doi: 10.1161/CIRCULATIONAHA.124.071176		Randomized Controlled Trial, Multicenter Study
IN atrial fibrillation, asymptomatic, older people, general population	The Use of population screening campaigns, using ECG + NT-proBNP + prolonged ECG monitoring if high BNP As Prevention, Primary	Is equal Than no population screening	To improve atrial fibrillation detection rate at 5 years (2.4%) or reduce embolic complications ()
Lancet. 2021 Aug 27:S0140-6736(21)01698-6. doi: 10.1016/S0140-6736(21)01698-6		Randomized Controlled Trial, Multicenter Study
IN atrial fibrillation, asymptomatic, older people, previous stroke, ischemic, embolic, or at risk of stroke	The Use of systematic screening for atrial fibrillation at 75 years, using an implantable loop recorder, followed by oral anticoagulation if AF detected As Diagnostic Tool	Is better Than screening for atrial fibrillation only if symptoms	To modify, at 5 years, stroke or systemic embolism: 4.5% loop recorder VS 5.6% controls, p=0.11
Lancet. 2021 Aug 27:S0140-6736(21)01637-8. doi: 10.1016/S0140-6736(21)01637-8		Randomized Controlled Trial
IN atrial fibrillation, asymptomatic, older people, primary prevention of stroke, ischemic, embolic	The Use of systematic screening for atrial fibrillation at 75 years, using intermittent ECGs for 14 days, followed by oral anticoagulation if AF detected As Diagnostic Tool	Is better Than screening for atrial fibrillation only if symptoms	To slighty reduce, at 7 years, combined embolic events, severe bleeding or death: 5.5 events VS 5.7 per 100 person-years
N Engl J Med. 2024 Jan 11;390(2):107-117. doi: 10.1056/NEJMoa2310234		Randomized Controlled Trial
IN atrial fibrillation, detected by device, paroxysmal, non symptomatic	The Use of direct oral anticoagulants, anti-Xa, apixaban As Treatment, Chronic	Is better Than aspirin	To slightly reduce stroke or arterial embolism (0.8% per year apix VS 1.2% aspirin) but at the cost of increasing major bleedintg (1.7% per year apix VS 0.9% aspirin)
N Engl J Med. 2023 Sep 28;389(13):1167-1179. doi: 10.1056/NEJMoa2303062		Randomized Controlled Trial, Multicenter Study
IN atrial fibrillation, detected by device, paroxysmal, non symptomatic	The Use of direct oral anticoagulants, anti-Xa, edoxaban As Treatment, Chronic	Is worse Than placebo	To improve outcomes: it did not reduce embolisms (3.2% anticoag VS 4% placebo /an) and increased adverse outcomes (death or major bleeding: 6% anticoag VS 4.5% placebo)
J Am Coll Cardiol. 2024 Jul 23;84(4):354-364. doi: 10.1016/j.jacc.2024.05.002		Randomized Controlled Trial, Multicenter Study
IN atrial fibrillation, detected by device, paroxysmal, non symptomatic, CHAD2VASc2 > 4	The Use of direct oral anticoagulants, anti-Xa, apixaban As Treatment, Chronic	Is better Than aspirin, low dose	To reduce stroke rate (1%/year apixaban VS 2.25% aspirin) while not increasing much major bleeding (0.7%/year more major bleeding than aspirin)
N Engl J Med. 2004 Dec 2;351(23):2373-83		Clinical Trial (non-controlled, non-randomized)
IN atrial fibrillation, heart failure, non-pharmacological treatment	The Use of catheter ablation, radiofrequency As Treatment, Acute	Is good Than no comparison group in this trial	To restore and maintain sinus rhythm: after 12 months 70% of patients maintained SR. Improve ejection fraction in those patients with heart failure (average of plus 20% at 12 months)
N Engl J Med. 2018 02 01;378(5):417-427		Randomized Controlled Trial, Multicenter Study
IN atrial fibrillation, heart failure, reduced ejection fraction, non-pharmacological treatment	The Use of catheter ablation As Treatment, Acute	Is better Than medical-therapy only	To reduce mortality from any cause (13% ablation VS 25%), hospitalization for worsening heart failure (21% ablation VS 36%) or death from cardiovascular causes (11% ablation VS 22%)
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.
Circulation. 2011 May 31;123(21):2363-72		Randomized Controlled Trial, Multicenter Study
IN atrial fibrillation, non valvular, anticoagulants, oral direct thrombin inhibitors, bleeding risk, elder patients	The Use of oral direct thrombin inhibitors, dabigatran, 110 or 150 mg twice daily fixed dose As Treatment, Chronic	Is equal Than warfarin	To risk of major bleeding, in patients >75 years, with the 110mg dose (4.43% dabigatran VS 4.37% warfarin) but a trend to more bleedings with 150mg dose (5.1% dabigatran versus 4.4% warfarin). Both doses had less bleedings in <75 years old
JAMA. 2025 Aug 31. doi: 10.1001/jama.2025.14679. Epub ahead of print		Randomized Controlled Trial, Multicenter Study
IN atrial fibrillation, non valvular, no recurrence for ≥ 1 year after catheter ablation, stroke, ischemic, embolic	The Use of direct oral anticoagulants, oral factor Xa inhibitors, apixaban, rivaroxaban As Treatment, Chronic	Is worse Than discontinuing anticoagulation	To Anticoagulation increased, at 2 years, the composite oucome (stroke, systemic embolism or major bleeding): 2.2% anticoag VS 0.3% discontinuation, mainly because increased major bleeding: 1.4% VS 0%
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)
N Engl J Med. 2011 Sep 15;365(11):981-92		Randomized Controlled Trial, Multicenter Study
IN atrial fibrillation, non valvular, stroke, ischemic, cerebral infarction, embolic	The Use of anticoagulants, oral factor Xa inhibitors, apixaban, 5 mg twice daily As Treatment, Chronic	Is better Than warfarin	To reduce stroke or systemic embolism at 1.8 years (1.3% apixaban VS 1.6% warfarin) witout increasing major bleeding (2.1% apixaban VS 3.1% warfarin). Quite similar rate of all-cause death (3.5% apixaban VS 3.9% warfarin)
N Engl J Med. 2009 Sep 17;361(12):1139-51. Epub 2009 Aug 30		Randomized Controlled Trial, Multicenter Study
IN atrial fibrillation, non valvular, stroke, ischemic, cerebral infarction, embolic	The Use of oral direct thrombin inhibitors, dabigatran, 110 or 150 mg twice daily fixed dose As Treatment, Chronic	Is better Than warfarin, INR adjusted dose	To reduce at 2 years ischemic strokes (1.53% - 1.11% per year 110 - 150 mg dabigatran VS 1.69% warfarin), with similar major bleedings (2.71% - 3.36% per year) and less haemorrhagic strokes (0.10% per year dabigatran VS 0.38% warfarin)
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 decrease the number of strokes and systemic embolism (OR 0.89), decrease in the number of major bleedings (OR 0.76) an intracranial bleedings (OR 0.47)
JAMA Netw Open. 2020 Apr 1;3(4):e202175. doi: 10.1001/jamanetworkopen.2020.2175		Randomized Controlled Trial
IN atrial fibrillation, non valvular, stroke, ischemic, cerebral infarction, embolic, bleeding, major and non-major, renal failure, end-stage	The Use of anticoagulants, antivitamine K, warfarin As Treatment, Chronic	Is worse Than no anticoagulant treatment	To modify outcomes: no difference regarding ischemic stroke, major bleeding and overall mortality. Warfarin increased the risk of hemorrhagic stroke (HR 1.49)
Circulation. 2022 Dec 6;146(23):1735-1745. doi: 10.1161/CIRCULATIONAHA.121.054990		Randomized Controlled Trial, Multicenter Study
IN atrial fibrillation, non valvular, stroke, ischemic, cerebral infarction, embolic, bleeding, major and non-major, renal failure, end-stage	The Use of direct oral anticoagulants, oral factor Xa inhibitors, apixaban As Treatment, Chronic	Is worse Than anticoagulants, antivitamine K, warfarin, adjusted to INR 2-3	To reduce clinically relevant (major or non-major) bleeding (32% apix VS 26% warf) or death (26% apix VS 18% warf), both differences non significant. Equal rate of stroke/embolism (3%), much lower than bleeding
Circulation. 2022 Jan 25;145(4):242-255. doi: 10.1161/CIRCULATIONAHA.121.056355		Meta-Analysis
IN atrial fibrillation, non valvular, stroke, ischemic, cerebral infarction, embolic, death	The Use of direct oral anticoagulants, oral direct thrombin inhibitors, dabigatran, oral factor Xa inhibitors, apixaban, rivaroxaban As Treatment, Chronic	Is better Than vitamine K antagonists, warfarin	To reduce stroke / embolism (3.0% DOAs VS 3.7% warfarin), death (7.8% DOAs VS 8.4% warfarin) and intracranial bleeding (0.6% DOAs VS 1.4% warf) and major bleeding at lower doses (4.3% DOAs VS 5.9% warfarin)
Circulation. 2014 Jul 8;130(2):138-46		Randomized Controlled Trial, Multicenter Study
IN atrial fibrillation, non valvular, stroke, ischemic, cerebral infarction, embolic, older patients	The Use of anticoagulants, oral factor Xa inhibitors, rivaroxaban As Treatment, Chronic	Is equal Than vitamine K antagonists, warfarin	To modify, in patients > 75 years, stroke (2.29% rivaroxaban VS 2.85% warfarin per 100 patient-years) or major bleeding (4.86% rivaroxaban versus 4.40% warfarin per 100 patient-years). Older patients had more strokes and major bleedings than young ones
J Am Coll Cardiol. 2025 Aug 12;86(6):426-439. doi: 10.1016/j.jacc.2025.05.060		Meta-Analysis
IN atrial fibrillation, non valvular, stroke, ischemic, cerebral infarction, embolic, older patients, frail, stable on warfarin	The Use of switch from warfarin to a direct oral anticoagulants, oral factor Xa inhibitors, apixaban, edoxaban, rivaroxaban As Treatment, Chronic	Is equal Than maintaining antivitamine K anticoagulants, warfarin	To modify, at 27 months, combined stroke or systemic embolisms (HR 0.83), major bleedings (HR 1.06) or all-cause death (HR 0.95). DOAC reduced the risk of intracranial bleeding but increased gastrointestinal bleedings
N Engl J Med. 2011 Mar 3;364(9):806-17. Epub 2011 Feb 10		Randomized Controlled Trial, Multicenter Study
IN atrial fibrillation, non valvular, stroke, ischemic, cerebral infarction, embolic, patients not suitable for vitamine K antagonists, warfarin	The Use of anticoagulants, oral factor Xa inhibitors, apixaban As Treatment, Chronic	Is better Than aspirin	To reduce stroke or systemic embolism (1.6% per year apixaban VS 3.7% aspirin) while not increasing major bleeding (1.4% per year apixaban VS 1.2% aspirin)
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
JAMA Neurol. 2025 May 21:e251337. doi: 10.1001/jamaneurol.2025.1337. Epub ahead of print		Systematic Review
IN atrial fibrillation, non valvular, stroke, ischemic, cerebral infarction, embolic, under anticoagulation	The Use of oral anticoagulants As Treatment, Chronic	Is better Than no anticoagulant treatment	To but a significant risk of recurrence of ischemic stroke (3.75% per year) remained, as well as of all-type stroke (4.9% per year) still remained. If stroke recurrence despite anticoagulation the risk was higher (8.96% per year)
Ann Intern Med. 2025 Jul 1. doi: 10.7326/ANNALS-25-00253. Epub ahead of print		Systematic Review
IN atrial fibrillation, non-pharmacological treatment	The Use of catheter ablation As Treatment, Acute	Is better Than medical treatment	To reduce mortality (RR 0.73), and hospitalization for heart failure (RR 0.68). Also reduced risks for ischemic stroke after 30 days (RR 0.63) but increased it in the first 30 days, with a non-significant final effects on stroke
N Engl J Med. 2020 Aug 30. doi: 10.1056/NEJMoa2012883. [Epub ahead of print]		Randomized Controlled Trial, Multicenter Study
IN atrial fibrillation, older patients, high haemorrahgic risk, considered not to be appropriate candidates for oral anticoagulant therapy at usual doses, bleeding risk	The Use of low dose anticogulants, oral factor Xa inhibitors, edoxaban 15 mg/day As Treatment, Chronic	Is better Than placebo	To reduce annualized rate of stroke (2% edoxaban VS 7% placebo) but increasing major bleeding (3% edo VS 2%, mostly gastrointestinal). Mortality not modified
Lancet. 2007 Aug 11;370(9586):493-503		Randomized Controlled Trial, Multicenter Study
IN atrial fibrillation, older patients, not high haemorrahgic risk, not high stroke risk, anticoagulants, vitamin K antagonists, bleeding risk	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.
N Engl J Med. 2009 Apr 16;360(16):1606-17		Randomized Controlled Trial, Multicenter Study
IN atrial fibrillation, paroxysmal	The Use of angiotensin II receptor blockers (ARB), valsartan As Prevention, Secondary	Is equal Than placebo	To reduce recurrences of AF: 51.4% valsartan VS 52% placebo.
JAMA. 2005 Jun 1;293(21):2634-40		Randomized Controlled Trial, Multicenter Study
IN atrial fibrillation, paroxysmal, non-pharmacological treatment	The Use of catheter ablation, radiofrequency As Treatment, Acute	Is better Than chronic antiarrhythmic drug therapy	To reduce symptomatic AF recurrence (13% with ablation VS 63% with drugs) and hospitalizations (9% VS 54%). Pulmonary vein stenosis in 6% patients with ablation.
Am J Cardiol. 2023 Nov 30;213:63-68. doi: 10.1016/j.amjcard.2023.11.052		Systematic Review
IN atrial fibrillation, paroxysmal, non-pharmacological treatment, initial therapy, treatment-naive patients	The Use of initial rhythm-control strategy using atrial fibrillation catheter ablation As Treatment, Chronic	Is better Than initial rhythm-control strategy using antiarrhythmic drugs	To reduce at 1 year recurrences of AF (RR 0.54) but no significant difference in cardiovascular effects, adverse effects or mortality (central estimates were, in fact, worse for ablation)
JAMA. 2019 Apr 2;321(13):1261-1274. doi: 10.1001/jama.2019.0693		Randomized Controlled Trial, Multicenter Study
IN atrial fibrillation, paroxysmal, non-pharmacological treatment, older patients, at risk of stroke	The Use of catheter ablation, circumferential pulmonary vein ablation As Treatment, Chronic	Is equal Than standard rhythm and/or rate control drugs guided by contemporaneous guidelines (27.5% ultimately received catheter ablation)	To reduce cardiovascular events (death, disabling stroke, serious bleeding, or cardiac arrest): 8% ablation VS 9% controls (p NS)
J Am Coll Cardiol. 2006 Dec 5;48(11):2340-7		Randomized Controlled Trial
IN atrial fibrillation, paroxysmal, refractory, non-pharmacological treatment	The Use of catheter ablation, circumferential pulmonary vein ablation As Treatment, Chronic	Is better Than change to another antiarrhythmic drug	To reduce, at 1 year, recurrences of AF: 7% with ablation VS 65% with drugs. Ablation was repeated in 9% patients and 2 severe adverse effects.
JAMA. 2020 Dec 22;324(24):2497-2508. doi: 10.1001/jama.2020.23138		Randomized Controlled Trial
IN atrial fibrillation, permanent, rate control strategy	The Use of digoxin, mean dose 161 μg/d As Treatment, Chronic	Is better Than bisoprolol, mean dose, 3.2 mg/d	To at 12 months, digoxin did not modify physical quality of life or modify resting heart rate, but had less adverse events (25% of patients digoxin VS 64% bisoprol), improved NT-proBNP levels and improved some functional scores
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
J Am Coll Cardiol. 2005 Mar 1;45(5):705-11		Randomized Controlled Trial, Multicenter Study
IN atrial fibrillation, persistent, hypertension, primary	The Use of angiotensin II receptor blockers, losartan As Treatment, Chronic	Is better Than beta-blockers	To reduce cardiovascular events (composite of cardiovascular mortality, stroke, and myocardial infarction): 36/171 patients with losartan VS 67/171 patients with B-blokers, at aprox 4 years
N Engl J Med. 2006 Mar 2;354(9):934-41		Randomized Controlled Trial
IN atrial fibrillation, persistent, non-pharmacological treatment	The Use of catheter ablation, radiofrequency As Treatment, Acute	Is better Than cardioversion and chronic amiodarone	To reduce atrial fibrillation recurrence: 26% with ablation VS 42% amiodarone; and improve symptoms. Complications: atypical atrial flutter.
N Engl J Med. 2002 Dec 5;347(23):1834-40		Randomized Controlled Trial, Multicenter Study
IN atrial fibrillation, persistent, rate control strategy	The Use of rate control strategy As Treatment, Chronic	Is equal Than rhythm control strategy	To reduce a composite of cardiovascular and treatment-related events: 17.2% in rate-control VS 22.6% in rhythm-control
Ann Intern Med. 2004 Nov 2;141(9):653-61		Cost-Effectiveness
IN atrial fibrillation, persistent, rate control strategy	The Use of rate control strategy As Treatment, Chronic	Is better Than rhythm control strategy	To cost-effectiveness: rate control is always more effective and less costly
Arch Intern Med. 2005 Feb 14;165(3):258-62		Meta-Analysis
IN atrial fibrillation, persistent, rate control strategy	The Use of rate control strategy As Treatment, Chronic	Is equal Than rhythm control strategy	To reduce all-cause mortality at 2 to 3.5 years: 14.6% rhythm-control vs 13.0% rate-control. A trend existed in favour of rate-control: OR 0.87; 95%CI 0.74-1.02
Ann Intern Med. 2005 Sep 6;143(5):327-36		Meta-Analysis
IN atrial fibrillation, postoperative, cardiac surgery	The Use of antiarrhythmics, amiodarone As Prevention, Primary	Is better Than placebo	To decrease the incidence of atrial fibrillation or flutter (RR 0.64), ventricular arrhythmia (RR 0.42) and stroke (RR 0.39)
Eur Heart J. 2006 Jul;27(13):1584-91. Epub 2006 Jun 7		Randomized Controlled Trial
IN atrial fibrillation, postoperative, cardiac surgery	The Use of prophylaxis using antiarrhythmics, amiodarone, 600 mg oral single dose per day from Day-1 to Day7 plus IV perfusion during surgery As Prevention, Primary	Is better Than placebo	To reduce the incidence of post-operative AF: 85% with amiodarone VS 34% placebo. Also reduced hospitalization length of stay. Blood concentrations of amiodarone sig. differed between patients.
Cochrane Database Syst Rev. 2004 Oct 18;(4):CD003611		Systematic Review, Cochrane Review
IN atrial fibrillation, postoperative, cardiac surgery	The Use of several antiarrhythmics (amiodarone, sotalol, beta-blockers) and pacing As Prevention, Primary	Is better Than placebo	To reduce the incidence of atrial fibrillation (OR between 0.26 and 0.49) and possibly (non significant) reduces stroke and lenght of stay
Pharmacotherapy. 2007 Mar;27(3):360-8		Meta-Analysis
IN atrial fibrillation, postoperative, cardiac surgery	The Use of amiodarone, total doses > 3 grs, starting before or after surgery As Treatment, Acute	Is better Than placebo	To reduce the incidence of post-operative atrial fibrillation (OR 0.50)
N Engl J Med. 2002 Dec 5;347(23):1825-33		Randomized Controlled Trial, Multicenter Study
IN atrial fibrillation, rate control strategy	The Use of rate control strategy As Treatment, Chronic	Is better Than rhythm control	To reduce adverse drug effects and hospital admissions, while no difference in mortality (23.8% rate VS 21.3% rhythm control at 5 years)
Eur Heart J. 2005 Oct;26(19):2000-6. Epub 2005 May 4		Meta-Analysis
IN atrial fibrillation, rate control strategy	The Use of rate control strategy As Treatment, Chronic	Is better Than rhythm control strategy	To reduce a combined endpoint of all cause death and thromboembolic stroke (OR 0.84 (0.73, 0.98)). No difference in all-cause death, systemic embolism and major bleeding.
N Engl J Med. 2008 Jun 19;358(25):2667-77		Randomized Controlled Trial, Multicenter Study
IN atrial fibrillation, rate control strategy, heart failure, chronic, systolic	The Use of rate control strategy As Treatment, Chronic	Is equal Than rhythm control strategy	To modify death from cardiovascular causes (25% rate-control VS 27% rhythm-control) or reduce stroke (4% rate-control VS 3% rhythm-control) or worsening heart failure (31% rate-control VS 28% rhythm-control)
J Am Geriatr Soc. 2019 Jul 24. doi: 10.1111/jgs.16062. [Epub ahead of print]		Cohorts
IN atrial fibrillation, rate control strategy, older patients, falls, fall risk increasing drugs	The Use of anti-arrhythmic drugs, alone or combined with rate-control drugs As Treatment, Chronic	Is worse Than rate-control drugs alone	To it increased the incidence of falls or syncope: incidence rate ratio (IRR) 1.29 anti-arrhythmics alone, 1.46 combined with rate-control
N Engl J Med. 2020 Oct 1;383(14):1305-1316. doi: 10.1056/NEJMoa2019422		Randomized Controlled Trial, Multicenter Study
IN atrial fibrillation, recent-onset, early episode (diagnosed ≤1 year before)	The Use of early rhythm-control therapy with antiarrhythmic drugs or atrial fibrillation ablation (19% of patients at 2 years, 24% total)) As Treatment, Chronic	Is better Than usual care, including rhythm control in some symptomatic patients (15% at 2 years, of which 7% ablation)	To reduce, at 5 years, cardiovascular events (4%/year rhythm VS 5% rate-control), including death, hospitalizations for heart failure and stroke. Serious adverse events more frequent with rhythm-control (5% VS 1.4%).
N Engl J Med. 2022 Nov 7. doi: 10.1056/NEJMoa2212540		Randomized Controlled Trial
IN atrial fibrillation, recent-onset, early episode, initial therapy, non-pharmacological treatment	The Use of initial rhythm-control strategy using atrial fibrillation ablation As Treatment, Chronic	Is better Than initial rhythm-control strategy using antiarrhythmic drugs	To reduce at 3 years episodes of persistent AF (2% ablation VS 7% drugs), recurrences of AF (56% ablation VS 77% drugs), hospitalizations (5% VS 17%) and serious adverse events (5% VS 10%)
N Engl J Med. 2021 Jan 28;384(4):316-324. doi: 10.1056/NEJMoa2029554		Randomized Controlled Trial, Multicenter Study
IN atrial fibrillation, recent-onset, early episode, initial therapy, non-pharmacological treatment	The Use of initial rhythm-control strategy using atrial fibrillation ablation As Treatment, Chronic	Is better Than initial rhythm-control strategy using antiarrhythmic drugs	To avoid recurrence of atrial fibrillation at 1 year: 25% ablation VS 55% antiarrhythmic drugs. Similar, unfrequent serious adverse events.
N Engl J Med. 2019 Mar 18. doi: 10.1056/NEJMoa1900353. [Epub ahead of print]		Randomized Controlled Trial, Multicenter Study
IN atrial fibrillation, recent-onset, paroxysmal, hemodynamically stable	The Use of a wait-and-see approach (delayed-cardioversion): nitial treatment with rate-control medication only and delayed cardioversion if the atrial fibrillation did not resolve within 48 hours As Treatment, Acute	Is equal Than early cardioversion	To obtain sinus rhythm at 4 weeks (91% delayed-cardioversion VS 94% early-cardioversion) or reduce cardiovascular events (4% both groups, at 4 weeks)
Eur Heart J. 2006 Jan;27(2):216-21. Epub 2005 Oct 7		Randomized Controlled Trial
IN atrial fibrillation, refractory, non-pharmacological treatment	The Use of catheter ablation, radiofrequency AND and antiarrhythmic drugs (various) As Treatment, Chronic	Is better Than antiarrhythmic drug therapy alone (various drugs)	To prevent AF recurrence: 44% with ablation VS 91% without. Three (4.4%) major complications were related to ablation: stroke, pericardial effusion and a phrenic paralysis.
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
J Am Geriatr Soc. 2014 May;62(5):857-64		Meta-Analysis
IN atrial fibrillation, thromboembolic disease, old patients, anticoagulants, oral direct thrombin inhibitors, dabigatran, oral factor Xa inhibitors, apixaban, rivaroxaban	The Use of anticoagulants, oral direct thrombin inhibitors, dabigatran, oral factor Xa inhibitors, apixaban, rivaroxaban As Treatment, Chronic	Is better Than warfarin	To prevent stroke or VTE recurrence: no numbers given in abstract
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
Science. 2023 Oct 13;382(6667):eadd7046. doi: 10.1126/science.add7046		Randomized Controlled Trial
IN basic sciences, central nervous system, brain, neurology	The Use of understanding the diversitiy and distribution in human brain of neurons, glia and other cell types As Undefined	Is useful Than no comparison done	To better understand neurological diseases, like brain cancers and neurodegenerative diseases
Nat Neurosci. 2013 Jan 28;16(2):139-45		Review (Narrative)
IN basic sciences, psychology, neurology, memory	The Use of understanding the effect of sleep in memory As Undefined	Is useful Than no comparison done	To brain performs during sleep a triage of wich information retain and consolidates these infos 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.
N Engl J Med. 2024 Nov 20. doi: 10.1056/NEJMoa2404991. Epub ahead of print		Randomized Controlled Trial, Multicenter Study
IN bloodstream infections, bacteremia, sepsis, including patients in the intensive care unit (UCI, 55% of patients)	The Use of antibiotic treatment for 7 days As Treatment, Acute	Is equal Than same antibiotic treatment for 7 days	To modify mortality at 3 months: 14.5% 7-days VS 16% 14-days
N Engl J Med. 2019 01 31;380(5):425-436		Randomized Controlled Trial, Multicenter Study
IN bone or joint infections	The Use of switch to oral antibiotic treatment after at least 7 days of IV antibiotics As Treatment, Acute	Is equal Than continuous IV antibiotic treatment for up to 6 weeks	To modify at 1 year treatment failure (13.2% oral VS 14.6% IV antibiotics)
N Engl J Med. 2025 Apr 24;392(16):1569-1581. doi: 10.1056/NEJMoa2411664		Randomized Controlled Trial, Multicenter Study
IN bronchiectasis, idiopathic, sequelae after lung infection	The Use of dipeptidyl peptidase 1 (DPP-1) inhibitors, targeting neutrophil serine proteases, brensocatib, 10 mg or 25 mg daily As Treatment, Chronic	Is better Than placebo	To reduce annual exacerbation rate (1.0 brensocatib VS 1.3 placebo) and, with the 25 mg dose, to reduce FEV1 declin (24 ml brensocatib 25mg VS 62 ml placebo)
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%)
Lancet. 2011 Jan 1;377(9759):31-41. Epub 2010 Dec 6		Meta-Analysis
IN cancer, all types, gastrointestinal cancers	The Use of aspirin, 75 mg daily or more, for more than 5 years As Prevention, Primary	Is better Than placebo	To reduce death due to all cancers (0.79) when treatment maintained for more than 5 years, specially for gastrointestinal cancers (OR 0.46) but also for brain, lung and prostate cancers.
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
JAMA Oncol. 2021 Nov 1;7(11):e214158. doi: 10.1001/jamaoncol.2021.4158		Randomized Controlled Trial
IN cancer, all types, solid, older patients	The Use of geriatrics-trained multidisciplinary team performing a geriatric assessment and implementing interventions based on prespecified thresholds built into the geriatric assessment,s domains As Treatment, Acute	Is better Than usual care, sending geriatric assessment results to treating oncologists for consideration	To reduce at 6 months grade 3 or higher chemotherapy-related toxic effects: 50% geriatric intervention VS 61% usual care. No differences in overal survival, chemotherapy dose modifications or unplanned hospitalizations
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
Lancet. 2010 Nov 20;376(9754):1741-50		Meta-Analysis
IN cancer, colorectal	The Use of aspirin dose, 75 mg daily or more, for more than 5 years As Prevention, Primary	Is better Than placebo	To reduce the 20-year risk of colon cancer incidence (HR 0.76) and mortality (HR 0.65), specially of proximal colon cancer.
N Engl J Med. 2003 Mar 6;348(10):883-90		Randomized Controlled Trial, Multicenter Study
IN cancer, colorectal	The Use of aspirin (325 mg daily) As Prevention, Secondary	Is better Than placebo	To prevent new colorectal adenomes in colonoscopy, at 12,8 months (17% in intv VS 27% in ctrl)
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
Lancet. 1999 Jan 30;353(9150):345-50		Randomized Controlled Trial
IN cancer, colorectal	The Use of Immunotherapy, individualized tumor vaccine, after resection As Treatment, Acute	Is better Than no treatment	To reduce any cancer recurrence at 5 years: 19.5% vaccine VS 31.7% no-vaccine
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.
N Engl J Med. 2022 Jun 16;386:2261-2272. doi: 10.1056/NEJMoa2200075		Randomized Controlled Trial
IN cancer, colorectal, non metastatic, stade II, adjuvant treatment	The Use of circulating tumor DNA (ctDNA) in blood, after surgery, to guide decision of adjuvant chemotherapy (oxaliplatin-based or fluoropyrimidine) As Treatment, Acute	Is better Than using standard clinicopathological features to guide decision of adjuvant chemotherapy	To reduce, at 2 years, the use of adjuvant chemotherapy (15% of patients in ctDNA guided VS 28% usual criteria) while not reducing recurrence-free survival (94% ctDNA VS 92% usual criteria)
Gastroenterology. 2004 Nov;127(5):1300-11		Diagnostic
IN cancer, colorectal, screening in asymptomatic average risk adults	The Use of computed tomographic colonography (virtual colonoscopy) As Diagnostic Tool	Is equal Than conventional direct optical colonoscopy	To detect colorectal polypes: sensitivity 90%, specificity 92%, positive predictive value 88%, negative predictive value 93.5%, in per-patient analysis.
N Engl J Med. 2007 Oct 4;357(14):1403-12		Diagnostic
IN cancer, colorectal, screening in asymptomatic average risk adults	The Use of computed tomographic colonography (virtual colonoscopy) As Diagnostic Tool	Is equal Than conventional direct optical colonoscopy	To detect advanced colorectal cancer (3.2% scan VS 3.4% colonoscopy) whilst having much less need of colonoscopy (8%), having no perforation and removing much less polyps.
CMAJ. 2005 Oct 11;173(8):877-81		Randomized Controlled Trial
IN cancer, colorectal, screening in asymptomatic average risk adults	The Use of computed tomographic colonography (virtual colonoscopy) As Diagnostic Tool	Is worse Than conventional direct optical colonoscopy	To screening: A CT colonography based strategy plus colonoscopy if abnormalities is less cost-effective: more costly and slight more deaths due to missed adenomas.
N Engl J Med. 2008 Sep 18;359(12):1207-17		Diagnostic
IN cancer, colorectal, screening in asymptomatic average risk adults	The Use of computed tomographic colonography (virtual colonoscopy) As Diagnostic Tool	Is good Than conventional direct optical colonoscopy	To detect adenomas and cancers > 10 mm: 90% sensibility, 89% specificity
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%)
JAMA. 2004 Apr 14;291(14):1713-9		Diagnostic
IN cancer, colorectal, screening in asymptomatic average risk adults	The Use of computed tomographic colonography (virtual colonoscopy) As Prevention, Primary	Is worse Than conventional direct optical colonoscopy	To detect colorectal polypes: sensitivity of virtual colonoscopy for detecting patients with lesions >= 6 mm: 39% (conventional colonoscopy 99%) Computed tomographic colonography missed 2 of 8 cancers.
N Engl J Med. 2003 Dec 4;349(23):2191-2200		Diagnostic
IN cancer, colorectal, screening in asymptomatic average risk adults	The Use of computed tomographic colonography (virtual colonoscopy) As Prevention, Primary	Is better Than conventional direct optical colonoscopy	To Screening: Sensitivity of virtual colonoscopy was 93.8% for polyps at least 10 mm in diameter, 93.9 % for 8 mm and 88.7% for 6 mm. Specificity was 96.0% for polyps at least 10 mm, 92.2% for 8 mm, and 79.6% for 6 mm. 2 malignant polips were detected
N Engl J Med. 2022 Oct 9. doi: 10.1056/NEJMoa2208375. Epub ahead of print		Randomized Controlled Trial
IN cancer, colorectal, screening in asymptomatic average risk adults	The Use of inviting patients to undergo a screening colonoscopy (42% did it) As Prevention, Primary	Is better Than usual care, no systematic colonoscopy	To reduce number of colorectal cancers (1% iinvited group VS 1.20% usual-care, NNT 455). No difference in death from colorectal cancer or from any cause
Lancet. 2005 Jan 22-28;365(9456):305-11		Diagnostic
IN cancer, colorectal, screening in asymptomatic high risk adults	The Use of computed tomographic colonography (virtual colonoscopy) As Diagnostic Tool	Is worse Than conventional direct optical colonoscopy	To detect colorectal polyps > 6mm: virtual CT: sens. 55%, spec. 89%, +LR 5, -LR 0.51 ; coloscopy: sens. 99%, spec. 99.6%, +LR 248, -LR 0.01 ; barium enema: sens. 41%, spec. 82%, +LR 4.8, -LR 0.58.
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.
N Engl J Med. 2008 Jun 19;358(25):2698-703		Descriptive
IN cancer, melanome, metastatic	The Use of autologous T-cell therapy, autologous CD4+ T cells against NY-ESO-1 As Treatment, Acute	Is better Than no treatment	To Results to be defined
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. 2023 Mar 11. doi: 10.1056/NEJMoa2214122. Epub ahead of print		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 at 15 years deaths from prostate cancer (3.1% monitoring group VS 2.2% prostatectomy VS 2.9% radiotherapy) or all-cause deaths (22% all) More disease progression with monitoring but 24% of men in this group required no prostate cancer treatment
N Engl J Med. 2023 Feb 23;388(8):719-732. doi: 10.1056/NEJMoa2214676		Randomized Controlled Trial, Multicenter Study
IN cancer, prostate, metastatic, BRCA1, BRCA2, or ATM alteration, castration-resistant to second-generation androgen-receptor pathway inhibitor	The Use of poly(ADP-ribose) polymerase (PARP) inhibitors, rucaparib As Treatment, Chronic	Is better Than standard Tt with either docetaxel or a second-generation androgen-receptor pathway inhibitor (abiraterone or enzalutamide)	To improve imaging-based progression-free survival: 10 months rucaparib VS 6 months standard treatment, with better results for BRCA tumors than for ATM ones
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%)
JAMA Oncol. 2024 Apr 5:e240734. doi: 10.1001/jamaoncol.2024.0734		Systematic Review
IN cancer, prostate, screening in healthy men	The Use of an MRI pathway sequential screening: PSA first, MRI is positive, PI-RADS score ≥3 cutoff for biopsy As Diagnostic Tool	Is better Than PSA-only screening (always biopsy if positive)	To diagnose clinically significant prostate cancer when results positive (OR 4) while reducing the number of biopsies (OR 0.28), without significant differences in the detection of clinically significant cancer
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. 1993 Dec 23;329(26):1918-1921		Randomized Controlled Trial
IN cardiac arrest	The Use of active compression-decompression As Treatment, Acute	Is Than	To
Anasthesiol Intensivmed Notfallmed Schmerzther. 1994 Dec;29(8):492-500		Randomized Controlled Trial
IN cardiac arrest	The Use of active compression-decompression As Treatment, Acute	Is Than	To
Circulation. 1997 Feb 18;95(4):955-961		Randomized Controlled Trial, Multicenter Study
IN cardiac arrest	The Use of active compression-decompression As Treatment, Acute	Is Than	To
J Cardiothorac Vasc Anesth.1996(Feb);10(2):178-186		Randomized Controlled Trial
IN cardiac arrest	The Use of active compression-decompression As Treatment, Acute	Is Than	To
N Engl J Med. 1999 Aug 19;341(8):569-75		Randomized Controlled Trial
IN cardiac arrest	The Use of active compression-decompression As Treatment, Acute	Is Than	To
Resuscitation. 1996 Dec;33(2):125-134		Randomized Controlled Trial
IN cardiac arrest	The Use of active compression-decompression As Treatment, Acute	Is Than	To
Med Klin (Munich). 1997 Jul 15;92(7):381-8		Randomized Controlled Trial
IN cardiac arrest	The Use of active compression-decompression As Treatment, Acute	Is Than	To
Resuscitation. 1999 Aug;41(3):249-56		Meta-Analysis
IN cardiac arrest	The Use of active compression-decompression As Treatment, Acute	Is Than	To
JAMA. 1995 Apr 26;273(16):1261-1268		Randomized Controlled Trial
IN cardiac arrest	The Use of active compression-decompression As Treatment, Acute	Is Than	To
Resuscitation. 1998 May;37(2):119-25		Controlled Clinical Trial
IN cardiac arrest	The Use of active compression-decompression As Treatment, Acute	Is Than	To
JAMA. 1994 May 11;271(18):1405-1411		Randomized Controlled Trial
IN cardiac arrest	The Use of active compression-decompression As Treatment, Acute	Is Than	To
JAMA. 1996 May 8;275(18):1417-1423		Randomized Controlled Trial
IN cardiac arrest	The Use of active compression-decompression As Treatment, Acute	Is Than	To
Resuscitation. 1999 Nov;42(3):163-72		Randomized Controlled Trial
IN cardiac arrest	The Use of active compression-decompression As Treatment, Acute	Is Than	To
J Am Coll Cardiol. 1994 Jul;24(1):201-209		Randomized Controlled Trial
IN cardiac arrest	The Use of active compression-decompression As Treatment, Acute	Is better Than standard manual chest compression	To improve return of spontaneous circulation and 24-h survival, but not survival to hospital discharge
Age Ageing. 2020 Jun 5:afaa104. doi: 10.1093/ageing/afaa104. Epub ahead of print		Cohorts
IN cardiac arrest, older patients, probability of survival, comprehensive geriatric assessment, frailty status	The Use of Clinical Frailty Scale (CFS, rockwood score) > 4 As Prognostic Item	Is better Than no frailty assessment	To predict probability of survival following resuscitation for cardiopulmonary arrest: no frail patient (CFS > 4) survived VS 26% of the non-frail (CFS ≤ 4) survived.
Crit Care Med. 2005 Feb;33(2):414-8		Meta-Analysis
IN cardiac arrest, post-resuscitation care	The Use of hypothermia, mild, immediatly after resuscitation As Treatment, Acute	Is better Than normothermia	To reduce death at 6 months (RR 1,44) and improve neurological recovery (RR 1,68; NNT 4 - 13)
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. 2022 Nov 24;387(21):1947-1956. doi: 10.1056/NEJMoa2207304		Randomized Controlled Trial, Multicenter Study
IN cardiac arrest, ventricular fibrillation, refractory, not resuscitated after 3 precordial shocks	The Use of Double sequential external defibrillation (DSED; rapid sequential shocks from two defibrillators) and vector-change (VC) defibrillation (switching defibrillation pads to an anterior-posterior position) As Treatment, Acute	Is better Than repeated conventional defibrillation	To improve survival to hospital discharge: 30% DSED vs 22% VC vs 13% conventional.
N Engl J Med. 1999 Sep 16;341(12):871-8		Randomized Controlled Trial
IN cardiac arrest, ventricular fibrillation, ventricular tachycardia, refractory, not resuscitated after 3 precordial shocks	The Use of amiodarone, 300 mg IV bolus As Treatment, Acute	Is better Than placebo	To improve survival to be admitted to the hospital (44% amiodarone VS 34% placebo). No significant difference in survival at hospital discharge
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.
Neurology. 2013 Jul 30;81(5):417-26. doi: 10.1212/WNL.0b013e31829d8761. Epub 2013 Jun 26		Cohorts
IN cerbrovascular disease, white matter lesions, motor function, older people, reserve hypothesis	The Use of higher education As Etiologic risk factor	Is better Than white matter lesions at MRI, a marker of vascular brain damage	To to predict better motor performances (measured by walking speed). White matter lesions were associated with slow WS only in the low education group. Anthropometric characteristics, parental education, general health, and cognition were also correlated
N Engl J Med. 2025 Oct 2;393(13):1269-1278. doi: 10.1056/NEJMoa2502098		Cohorts
IN children, tennagers, risk of hematologic cancer, radiation exposure	The Use of cumulative radiation doses from medical imaging (CT scans being main contributors: Mean dose delivered by 1 scan = 14 mGy) As Etiologic risk factor	Is useful Than no comparison	To to estimate increased risk of subsequent hematologic cancer (79% lymphoid): HR 1.82 with 15-20 mGy, HR 3.6 with 50-100 mGy. The excess incidence of hematologic cancers by 21 years of age among children exposed to > 30 mGy was 26 per 10,000
Nat Med. 2023 Dec;29(12):3111-3119. doi: 10.1038/s41591-023-02620-0		Cohorts
IN children, tennagers, young adults, risk of hematologic cancer, radiation exposure	The Use of cumulative radiation doses from medical imaging (CT scans being the main contributors) As Etiologic risk factor	Is useful Than no comparison here	To estimate increased risk of subsequent hematologic cancer: HR 1.96 per 100 mGy. Suggests that for every 10,000 children udergoing madical imaging, 1-2 will develop hematologic cancer
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.
JAMA. 2025 May 18:e257358. doi: 10.1001/jama.2025.7358. Epub ahead of print		Cohorts
IN chronic obstructive pulmonary disease	The Use of (1) major diagnostic category: 1 major criterion (FEV1/forced vital capacity ratio <0.70) + at least 1 of 5 minor criteria (emphysema or bronchial wall thickening on computed tomography, dyspnea, poor respiratory quality of life, chronic bronchitis) As Diagnostic Tool	Is better Than classic, spirometric only, diagnostic criteria	To predict all-cause mortality, respiratory cause-specific mortality, exacerbations, and annualized decline in FEV1
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():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
Thorax. 2013 Nov;68(11):1029-36		Cohorts
IN chronic obstructive pulmonary disease	The Use of inhaled corticosteroids, specially fluticasone, less budesonide As Treatment, Chronic	Is worse Than no inhaled corticosterois	To carry an increased risk of severe pneumonia (causing hospitalization or death) : RR 2.0 for fluticasone, 1.2 with budesonide
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
Ann Intern Med. 2001 Apr 3;134(7):600-620		Review (Narrative)
IN chronic obstructive pulmonary disease, exacerbations	The Use of bronchodilators, corticosteroids, antibiotics, and non-invasive positive-pressure ventilation As Treatment, Acute	Is better Than placebo or treatment not using it	To reduce death, need for intubation or reduce lenght of hospital stay.
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. 2001 Sep;56(9):708-712		Randomized Controlled Trial, Multicenter Study
IN chronic obstructive pulmonary disease, exacerbations	The Use of non-invasive ventilation As Treatment, Acute	Is better Than standard treatment without ventilatory support	To reduce mortality: median length of survival was 17 months in those treated with ventilation VS 13 months without
Lancet. 2000 Jun 3;355(9219):1931-1935		Randomized Controlled Trial, Multicenter Study
IN chronic obstructive pulmonary disease, exacerbations	The Use of non-invasive ventilation As Treatment, Acute	Is better Than standard treatment without ventilatory support	To reduce need for intubation (15% with ventilation VS 27% without) and reduce mortality (10% with ventilation VS 20% without)
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.
Lancet. 1999 Aug 7;354(9177):456-60		Randomized Controlled Trial
IN chronic obstructive pulmonary disease, exacerbations	The Use of systemic corticosteroids As Treatment, Acute	Is better Than placebo	To improve faster FEV1 and reduce lenght of hospital stay
N Engl J Med. 1999 Jun 24;340(25):1941-7		Randomized Controlled Trial, Multicenter Study
IN chronic obstructive pulmonary disease, exacerbations	The Use of systemic corticosteroids As Treatment, Acute	Is better Than placebo	To reduce treatment failure (death or mechanical ventilation or need to intensificate treatment): 23% with corticoids VS 33% without. Also, reduce lenght of hospital stay.
Cochrane Database Syst Rev. 2005;(1):CD001288		Systematic Review, Cochrane Review
IN chronic obstructive pulmonary disease, exacerbations	The Use of systemic corticosteroids As Treatment, Acute	Is better Than placebo	To reduce, at 1 month, treatment failure (NNT 9) and improve respiratory failure and breathlessness, but increased adverse effects (OR 2.3)
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.
Ann Intern Med. 2020 Feb 25. doi: 10.7326/M19-3007. [Epub ahead of print]		Systematic Review
IN chronic obstructive pulmonary disease, exacerbations, mild to severe exacerbation, in- and out-patients	The Use of antibiotics and systemic corticosteroids, but not aminophyllines, magnesium sulfate, anti-inflammatory agents, inhaled corticosteroids, and short-acting bronchodilators As Treatment, Acute	Is better Than no antibiotics, no systemic corticosteroids, usual care	To reduce treatment failure (antibiotics OR 0.54, systemic cortics OR 0.01)
Chest. 2007 Jan;131(1):9-19		Randomized Controlled Trial
IN chronic obstructive pulmonary disease, exacerbations, respiratory infection, lower airways	The Use of procalcitonin, treating with antibiotics according to serum procalcitonin levels As Diagnostic Tool	Is better Than systematic treatment with antibiotics	To identify patients with active respiratory infection and guide antibiotic use: it reduced antibiotic use (40% vs 72%) obtaining same clinical outcome at 14 days and rehospitalzation rate (21% vs 24%)
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
N Engl J Med. 2020 Jun 24. doi: 10.1056/NEJMoa1916046. Epub ahead of print		Randomized Controlled Trial
IN chronic obstructive pulmonary disease, moderate to severe	The Use of triple inhaled therapy (glucocorticoid - bumesonide, long-acting anticholinergics (LAAC) - glycopyrrolate, and a long-acting β2-agonist (LABA) - formoterol) As Treatment, Chronic	Is better Than any dual therapy combination	To reduce the annual rates of exacerbations: 1.1 with triple tt VS 1.2 and 1.4 with dual tt. Pneumonia was more frequent in regimens including corticosteroids: 2% VS 4% /year.
Am J Respir Crit Care Med. 2023 Aug 15;208(4):406-416. doi: 10.1164/rccm.202306-0944OC		Randomized Controlled Trial
IN chronic obstructive pulmonary disease, moderate to severe, symptomatic	The Use of selective dual phosphodiesterase PDE3 and 4 inhibitors, ensifentrine, inhaled, nebulized, in addition to other maintenance therapies As Treatment, Chronic	Is better Than placebo	To reduce at 6 months number of moderate or severe exacerbations (rate ratio 0.64), improve FEV1 and improve symptoms
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
Eur Heart J. 2020 Dec 7;41(46):4415-4422. doi: 10.1093/eurheartj/ehaa793		Systematic Review
IN chronic obstructive pulmonary disease, stable	The Use of cardioselective beta-blockers As Treatment, Chronic	Is better Than placebo or no beta-blocker tretament	To reduce overall mortality (HR 0.6) and exacerations (HR 0.7)
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.
Thorax. 2003 Nov;58(11):937-41		Meta-Analysis
IN chronic obstructive pulmonary disease, stable	The Use of corticosteroids, inhaled As Treatment, Chronic	Is better Than placebo	To reduce the rate of FEV1 decline (mean reduction 7.7 ml/year, and with high dose regimens 9.9 ml/year)
JAMA. 2008 Nov 26;300(20):2407-16		Meta-Analysis
IN chronic obstructive pulmonary disease, stable	The Use of corticosteroids, inhaled As Treatment, Chronic	Is equal Than placebo	To reduce overall mortality at 1 year (RR 0.86). Inhaled corticoids increased pneumonia rate (RR 1.34).
Lancet. 1999 May 29;353(9167):1819-23		Randomized Controlled Trial
IN chronic obstructive pulmonary disease, stable	The Use of corticosteroids, inhaled As Treatment, Chronic	Is equal Than placebo	To reduce the rate of decline in FEV1, reduce exacerbations or improve symptoms at 3 years.
Chest. 2010 Feb;137(2):318-25		Meta-Analysis
IN chronic obstructive pulmonary disease, stable	The Use of corticosteroids, inhaled As Treatment, Chronic	Is better Than placebo	To modestly reduce exacerbations rate (RR 0.82) across all levels of severity.
Cochrane Database Syst Rev. 2007;(2):CD002991		Systematic Review, Cochrane Review
IN chronic obstructive pulmonary disease, stable	The Use of corticosteroids, inhaled As Treatment, Chronic	Is better Than placebo	To temporarily (first 6 months) reduce the decline of FEV1 and reduce at long term rate of exacerbations (-0.26 /patient/year)
Chest. 2007 Mar;131(3):682-9		Meta-Analysis
IN chronic obstructive pulmonary disease, stable	The Use of corticosteroids, inhaled As Treatment, Chronic	Is better Than placebo	To increase, at 6 months, FEV1 (mean of 42 mL in men and 29 mL in women compared with placebo) and keep this difference afterwards
Lancet. 1998 Mar 14;351(9105):773-80		Randomized Controlled Trial
IN chronic obstructive pulmonary disease, stable	The Use of corticosteroids, inhaled As Treatment, Chronic	Is better Than placebo	To reduce excerbation rate at 6 months (32% in intv. VS 37% in ctrl.) and increase FEV1, symptoms and 6 min walking distance
BMJ. 2000 13 May;320(7245):1297-1303		Randomized Controlled Trial
IN chronic obstructive pulmonary disease, stable	The Use of corticosteroids, inhaled As Treatment, Chronic	Is better Than placebo	To reduce excerbation rate (0,99/year in intv. VS 1,32/year in ctrl.) and produce a small increase in FEV1. But it did not affect the rate of decline in FEV1
N Engl J Med. 1999 Jun 24;340(25):1948-53		Randomized Controlled Trial, Multicenter Study
IN chronic obstructive pulmonary disease, stable	The Use of corticosteroids, inhaled As Treatment, Chronic	Is better Than placebo	To reduce the rate of decline of post-bronchodilator FEV1 in the first 6 monts of treatment but but does not appreciably affect the long-term progressive decline.
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.
Am J Respir Crit Care Med. 2009 Oct 15;180(8):741-50		Randomized Controlled Trial, Multicenter Study
IN chronic obstructive pulmonary disease, stable	The Use of corticosteroids, inhaled (budesonide), combined with inhaled long-acting beta2 agonists (formoterol), added to inhaled long-acting anticholinergics (tiotropium) As Treatment, Chronic	Is better Than placebo plus tiotropium	To improve, at 3 months, VEMS (1.14 cortics/beta2 VS 1.08 placebo), improve respiratory symptoms and reduce exacerbations (8% cortics/beta2 VS 18% placebo)
N Engl J Med. 2007 Feb 22;356(8):775-89		Randomized Controlled Trial, Multicenter Study
IN chronic obstructive pulmonary disease, stable	The Use of corticosteroids, inhaled (fluticasone), alone or combined with inhaled long-acting beta2 agonists As Treatment, Chronic	Is equal Than placebo	To modify survival 3 years. There was a trend to better survival with combined inhaled corticosteroids plus lon-acting beta2 agonists but it did not reach sisnificance
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
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)
Cochrane Database Syst Rev. 2018 Dec 3;12(12):CD012620. doi: 10.1002/14651858.CD012620.pub2		Systematic Review, Cochrane Review
IN chronic obstructive pulmonary disease, stable, moderate to severe	The Use of combined long-acting β-agonist (LABA) + long-acting muscarinic antagonist (LAMA) As Treatment, Chronic	Is better Than combined LABA + inhaled corticosteroids, or monotherapy with LABA or LAMA alone	To reduce, at 6 to 12 months, exacerbations (HR 0.70 to 0.86). No clear difference in mortality, quality-of-life (QoL better than monotherapies) or dropouts due to adverse effects
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.
Br J Clin Pharmacol. 2004 Aug;58(2):119-33		Systematic Review
IN clinical pharmacology, obesity, body size descriptors for dosing	The Use of lean body weight (or an estimate) As Dosage Scheme	Is better Than total body weight	To estimate clearance and so adjust dosing of chronically administered drugs, in obese patients. Conversely, total body weight was the better estimate of volume of distribution, specially for lipophylic drugs
JAMA. 2020 Jan 7;323(1):70-81. doi: 10.1001/jama.2019.19003		Consensus Conference
IN clinical practice, clinical encounter, physician presence and connection with patient	The Use of 5 practices: prepare with intention; listen intently and completely; agree on what matters most; connect with the patient,s story; and explore emotional cues As Methodology procedure	Is better Than not employing them	To enhance physician presence and meaningful connection with patients in the clinical encounter
N Engl J Med. 2021 Jan 28;384(4):299-301. doi: 10.1056/NEJMp2027190		Review (Narrative)
IN clinical practice, cognition, attention load	The Use of considering and implementing clinical environments that optimize attention As Methodology procedure	Is better Than a focus on workload, time, resources or financial objectives	To to improved value, safety, satisfaction and outcomes, for patients and healthcare providers
Med Teach. 2023 Feb;45(2):123-127. doi: 10.1080/0142159X.2022.2126762		Review (Narrative)
IN clinical practice, cognition, attention load, multiple tasks, priorities, academic medicine	The Use of 5 key strategies: (1) Clarify Priorities, (2) Track Tasks Systematically, (3) Focus and Monotask, (4) Invest in Timesavers, and (5) Celebrate Successe As Methodology procedure	Is better Than no dedicated strategy	To improve doctors, productivity and professional satisfaction
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. doi: 10.1056/NEJMoa0910812		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 other comparative intervantions	To prevent and treat 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
Cochrane Database Syst Rev. 2011;1:CD006220		Systematic Review, Cochrane Review
IN cognitive impairment, age related, mild cognitive impairment	The Use of cognitive training As Prevention, Primary	Is better Than no intervention at all	To improve immediate and delayed verbal recall, but the improvements of specific training improvements observed did not exceed the improvement in active control conditions.
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
PLoS Med. 2014 Nov;11(11):e1001756		Systematic Review
IN cognitive impairment, age related, older people without cognitive impairment	The Use of computerized cognitive training, group based training As Prevention, Primary	Is better Than no cognitive training, or computerized unsupervised at-home training	To to modestly improve cognitive peformance (effect size 0.20 to 0.30), specially in working memory, processing speed and visuospacial skills. No significant effects in executive functions and attention
Cochrane Database Syst Rev. 2020 02 27;2(2):CD012277		Systematic Review, Cochrane Review
IN cognitive impairment, age related, older people without cognitive impairment	The Use of computerised cognitive training for 12 or more weeks As Treatment, Acute	Is equal Than active control or no training	To persistentently improve cognitive function: there were slight improvements in global cognitive function at the end of the intervention period but it did not persisted 1 year after
Cochrane Database Syst Rev. 2015;4:CD005381		Systematic Review, Cochrane Review
IN cognitive impairment, age related, older people without cognitive impairment	The Use of physical exercise, exercise training As Treatment, Acute	Is equal Than no exercise training	To improve cognitive function
Neurology. 2019 Jan 30. doi: 10.1212/WNL.0000000000007003. [Epub ahead of print]		Randomized Controlled Trial
IN cognitive impairment, age related, young people without cognitive impairment, lifestyle and habits, exercise	The Use of physical exercise, aerobic As Prevention, Primary	Is better Than stretching / toning	To increase cognitive executive function (β = 0.018 SD/y; p = 0.028; effect increasing with age) and increase cortical thickness left frontal region. Also increased aerobic capacity and decreased body mass index.
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
N Engl J Med. 2024 Oct 31;391(17):1561-1564. doi: 10.1056/NEJMp2405999		Review (Narrative)
IN condition or disease	The Use of intervention applied As -	Is - Than comparison	To results to obtain
N Engl J Med. 2023 Jun 29;388(26):2411-21. doi: 10.1056/NEJMoa2303048		Randomized Controlled Trial
IN condition or disease	The Use of very early anticoagulation: within 48 hours after a minor or moderate stroke, or on day 6 or 7 after a major stroke As Treatment, Acute	Is better Than later anticoagulation: day 3-4 after a minor stroke, day 6-7 after a moderate stroke, or day 12-14 after a major stroke	To probably (results statistically non significants) reduce at 30 days vascular events (stroke, TIA, systemic embolism, bleeding, vascular death): 3% early VS 4% late anticoagulation
N Engl J Med. 2020 Apr 9;382(15):1395-1407. doi: 10.1056/NEJMoa1915922		Randomized Controlled Trial
IN condition or disease	The Use of an initial invasive strategy (angiography and revascularization when feasible) As Treatment, Chronic	Is equal Than an initial conservative strategy of medical therapy alone and angiography if medical therapy failed	To modify, at 5 years, a composite of death and cardiovascular events (16% invasive VS 18% conservative, p NS) or mortality alone (exactly the same in both groups)
Cochrane Database Syst Rev. 2011 Mar 16;3:CD005967		Study type to be defined
IN Condition to be defined	The Use of artesunate, intravenous or intramuscular As Treatment, Acute	Is better Than quinine, intravenous	To reduce death (RR 0.61) in adults and children and in different parts of the world
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
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
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
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
JAMA. 2006 Jul 26;296(4):403-11		Diagnostic
IN coronary disease	The Use of coronary multidetector computed tomography As Diagnostic Tool	Is worse Than coronary angiography	To diagnose coronary stenosis of more than 50%: in patient-based analysis, 98% sensitivity for detecting at least 1 stenosis, 54% specificity, 50% positive predictive value, 99% negative predictive value. So, too much false positives.
Eur Heart J. 2011 Mar;32(5):637-45		Diagnostic
IN coronary disease	The Use of coronary multidetector computed tomography As Diagnostic Tool	Is worse Than coronary angiography	To detect significant coronary stenosis: sensib 100%, spec 85%, positive predict value 81%, negative predict value 100%. It detected all patients with atherosclerosis but misclassified some as severe stenosis
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.
J Am Coll Cardiol. 2010 Mar 9;55(10):1017-28		Cohorts
IN coronary disease	The Use of cardiac computed tomography angiography , and also, in addition, left ventricle ejection fraction As Prognostic Item	Is useful Than no comparison here	To predict increased risk of all-cause mortality or nonfatal myocardial infarction at 1.5 years: HR 3 when sever coronary disease detected.
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
Eur Heart J. 2005 Oct;26(20):2148-53. Epub 2005 Jun 23		Randomized Controlled Trial
IN coronary disease	The Use of coronary artery bypass surgery As Treatment, Chronic	Is equal Than percutaneous coronary angioplasty	To improve long-term survival: overall mortality was similar after 13 years. Time to first re-intervention was significantly shorter in angioplasty, but frequency of re-intervention was comparable (about 70%) and also symptomatic angina or dyspnoea.
Ann Intern Med. 2007 Nov 20;147(10):703-16		Systematic Review
IN coronary disease	The Use of coronary artery bypass surgery As Treatment, Chronic	Is equal Than percutaneous coronary intervention (angioplasty with/out stent)	To modify mortality at 10 years. Strokes were more common after CABG(1.2% CABG vs. 0.6% PCI) and repeated revascularization was more common after PCI (at 5 years 46.1% balloon angioplasty, 40.1% PCI with stents, and 9.8% CABG).
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.
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
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.
JAMA. 1999 Dec 1;282(21):2058-67		Meta-Analysis
IN coronary disease	The Use of vitamin K antagonists, added to aspirin, but not alone As Treatment, Chronic	Is better Than aspirin alone	To prevent myocardial infarction or stroke (risk reduction not given), but based in few studies (3 studies, 480 patients) and increasing bleeding risk by about 2 fold.
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.
N Engl J Med. 2011 Aug 25;365(8):699-708. [Epub 2011 Jul 24]		Randomized Controlled Trial, Multicenter Study
IN coronary disease, acute coronary syndrome	The Use of anticoagulants, oral factor Xa inhibitors, apixaban, 5 mg twice daily, in addition to double antiplatelet treatment As Treatment, Chronic	Is worse Than placebo	To improve results at 8 months: it increased major bleeding events (1.3% apixaban VS 0.5% placebo) and did not reduced cardiovascular events (7.5% apixaban VS 7.9% placebo)
N Engl J Med. 2012 Jan 5;366(1):9-19. Epub 2011 Nov 13		Randomized Controlled Trial, Multicenter Study
IN coronary disease, acute coronary syndrome	The Use of anticoagulants, oral factor Xa inhibitors, rivaroxaban, 2.5 or 5 mg twice daily, in addition to double antiplatelet treatment As Treatment, Chronic	Is better Than placebo	To reduce at 13 months cardiovascular events (cardiovascular death, myocardial infartion , stroke): 8.9% rivaroxaban VS 10.7% placebo. However, it increases major bleedings: 2.1% rivaroxaban VS 0.6% placebo
Circulation. 2020 Jul 14;142(2):150-160		Meta-Analysis
IN coronary disease, acute coronary syndrome	The Use of P2Y12 inhibitor, ticagrelor or prasugrel As Treatment, Chronic	Is better Than P2Y12 inhibitor, clopidogrel	To reduce, at an undefined time, cardiovascular mortality (HR 0.82) and all-cause mortality (HR, 0.83) but increased major bleeding (HR 1.27)
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 P2Y12 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
JAMA. 2020 06 16;323(23):2407-2416		Randomized Controlled Trial, Multicenter Study
IN coronary disease, acute coronary syndrome, after percutaneous coronary intervention	The Use of antiplatelet single theray with ticagrelor after dual antiplatelet Tt for 3 months As Treatment, Chronic	Is better Than long-term (1 year) dual antiplatelet therapy with aspirin + ticagrelor	To reduce, at 1 year, a composite of major bleeding and cardiac/cerebrovascular events: 4% in ticagrelor alone VS 6% dual therapy. Difference due to major bleeding. Cardiovascualr events were not different
N Engl J Med. 2019 Nov 21;381(21):2032-2042. doi: 10.1056/NEJMoa1908419		Randomized Controlled Trial, Multicenter Study
IN coronary disease, acute coronary syndrome, after percutaneous coronary intervention	The Use of antiplatelet single theray with ticagrelor after dual antiplatelet Tt for 3 months As Treatment, Chronic	Is better Than long-term (1 year) dual antiplatelet therapy with aspirin + ticagrelor	To reduce at 1 year clinical relevant bleeding (4% ticagrelor alone VS 7% dual antiplatelet) while combined all-cause mortality and cardiovascular events did not changed (4% both groups)
Lancet. 2024 May 11;403(10439):1866-1878. doi: 10.1016/S0140-6736(24)00473-2		Randomized Controlled Trial
IN coronary disease, acute coronary syndrome, after percutaneous coronary intervention, and drug-eluting stent	The Use of antiplatelet single theray with ticagrelor after very short dual antiplatelet Tt for 1 month As Treatment, Chronic	Is better Than long-term (1 year) dual antiplatelet therapy with aspirin + ticagrelor	To reduce at 1 year clinically relevant bleeding (2% ticagrelor VS 5% ticag+aspirin) without increase in major adverse cardiovascular or cerebrovascular events (3.6% both)
Am J Cardiol. 2020 Jan 1;125(1):19-28. doi: 10.1016/j.amjcard.2019.09.045		Meta-Analysis
IN coronary disease, acute coronary syndrome, after percutaneous coronary intervention, atrial fibrillation	The Use of dual antithrombotic therapy with one anticoagulant plus one antiplatelet As Treatment, Chronic	Is better Than triple antithrombotic therapy with vitamin K antagonist or direct oral anticoagulants plus dual antiplatelet	To reduce major bleeding (RR 0.64), while not showing any difference in rates of mortality, nonfatal myocardial infarction, stent thrombosis, and stroke
N Engl J Med. 2025 Aug 31. doi: 10.1056/NEJMoa2507980		Randomized Controlled Trial, Multicenter Study
IN coronary disease, acute coronary syndrome, after percutaneous coronary intervention, drug eluting stents	The Use of extremely short (2 to 4 days !) course of dual antiplatelet therapy, followed by monotherapy with a potent P2Y12 inhibitor (ticagrelor or prasugrel) As Treatment, Acute	Is equal Than dual antiplatelet therapy (aspirin and a potent P2Y12 inhibitor) for 12 months	To modify cardiovascular events (7% monotherapy VS 5% dual, p=0.11) while reducing major bleedings (2% monotherapy VS 5% dual, p significant)
JAMA. 2019 Jun 25;321(24):2414-2427. doi: 10.1001/jama.2019.8145		Randomized Controlled Trial, Multicenter Study
IN coronary disease, acute coronary syndrome, after percutaneous coronary intervention, drug eluting stents	The Use of very short (1 month) course of dual antiplatelet therapy, followed by clopidogrel monotherapy As Treatment, Acute	Is better Than long-term (1 year) dual antiplatelet therapy with aspirin + clopidogrel	To reduce a composite of cardiovascular major events (2% 1-month VS 2.5% 12-months) and major bleeding (0.4% 1-month VS 1.5% 12-months)
N Engl J Med. 2014 Dec 4;371(23):2155-66		Randomized Controlled Trial, Multicenter Study
IN coronary disease, acute coronary syndrome, after percutaneous coronary intervention, drug eluting stents	The Use of dual antiplatelet therapy (aspirin + P2Y12 inhibitor (clopidogrel or prasugrel)) for 30 months As Treatment, Chronic	Is worse Than dual antiplatelet therapy (aspirin + thienopyridine) for 12 months only	To improve all-cause mortality (2.0% 30 months VS 1.5% 12 months), even if it reduced cardiovascular events (4.3% 30 months VS 5.9% 12 months). Extended treatment increased major bleedings (2.5% vs 1.6%) but that did not explain the mortality difference
N Engl J Med. 2015 May 07;372(19):1791-800		Randomized Controlled Trial, Multicenter Study
IN coronary disease, acute coronary syndrome, after percutaneous coronary intervention, drug eluting stents	The Use of mantaining dual antiplatelet after 1 year with ticagrelor (90 mg twice daily or 60 mg twice daily) plus low-dose aspirin As Treatment, Chronic	Is better Than placebo plus low-dose aspirin	To reduce cardiovascular events (8% both doses ticagrelor VS 9% aspirin alone) but increasing major bleeding (2.5% ticagrelor VS 1% aspirin alone)
BMJ. 2019 Jun 28;365:l2222. doi: 10.1136/bmj.l2222.		Systematic Review
IN coronary disease, acute coronary syndrome, after percutaneous coronary intervention, drug eluting stents	The Use of short (≤6 months) course of dual antiplatelet therapy As Treatment, Chronic	Is better Than long term (12 months or longer) dual antiplatelet therapy	To improve bleeding and death: 12 months DAPT carried higher rates of any bleeding (OR 1.39), longer DAPT associated more major bleeding (OR 1.78) and non-cardiac death (OR 1.63). Cardiovascular events were similar
J Am Coll Cardiol. 2015 Mar 24;65(11):1092-102		Meta-Analysis
IN coronary disease, acute coronary syndrome, after percutaneous coronary intervention, drug eluting stents	The Use of short- (≤6 months) dual antiplatelet therapy As Treatment, Chronic	Is better Than long-term (1 year) dual antiplatelet therapy	To reduce bleeding (HR 0.66) while achieving similar rates of cardiac events (cardiac death, myocardial infarction, or definite/probable stent thrombosis: HR 1.11)
Circulation . 2020 Oct 13;142(15):1425-1436. doi: 10.1161/CIRCULATIONAHA.120.046308		Meta-Analysis
IN coronary disease, acute coronary syndrome, after percutaneous coronary intervention, drug eluting stents	The Use of short (≤6 months) or medium (6 months) course of dual antiplatelet therapy, followed by P2Y12 inhibitor monotherapy As Treatment, Chronic	Is better Than longer (12 months or longer) dual antiplatelet therapy treatment	To reduce major bleeding (-0.4 incident cases per 100 person-years VS 1 year dual Tt) while not modifying myocardial infarction (+0.4 incident cases per 100 person-years VS dual Tt > 1year, p NS)
N Engl J Med. 2025 Aug 31. doi: 10.1056/NEJMoa2508808		Randomized Controlled Trial, Multicenter Study
IN coronary disease, acute coronary syndrome, after percutaneous coronary intervention, drug eluting stents	The Use of very short (1 month) course of dual antiplatelet therapy, followed by monotherapy with a P2Y12 inhibitor As Treatment, Chronic	Is equal Than long-term (1 year) dual antiplatelet therapy	To modify at 1 year a composite of death, cardiovascular events or major bleedings (2% both groups). Combined moderate or severe bleedings were reduced with monotherapy: 3% VS 6%
N Engl J Med. 2017 Oct 19;377(16):1513-1524		Randomized Controlled Trial, Multicenter Study
IN coronary disease, acute coronary syndrome, after percutaneous coronary intervention, drug eluting stents, atrial fibrillation	The Use of dual treatment with dabigatran 110 mg twice daily plus an a P2Y12inhibitor (clopidogrel or ticagrelor) antiplatelet As Treatment, Chronic	Is better Than triple therapy with dose-adjusted vitamin K antagonist plus dual antiplatelet	To reduce at 14 months major or clinically relevant bleeding events (15% dabigatran 110mg VS 27% triple therapy) with no increase of cardiovascular events (13.7% dual-therapy VS 13.4% triple-therapy)
Lancet. 2013 Mar 30;381(9872):1107-15		Randomized Controlled Trial, Multicenter Study
IN coronary disease, acute coronary syndrome, after percutaneous coronary intervention, drug eluting stents, atrial fibrillation	The Use of dual treatment with INR adjusted warfarin plus clopidogrel As Treatment, Chronic	Is better Than triple therapy with dose-adjusted vitamin K antagonist plus dual antiplatelet (aspirin + clopidogrel)	To reduce at 1 year any bleeding event (19% dual Tt VS 44% triple Tt) with no increase in the rate of thrombotic events
N Engl J Med. 2016 Dec 22;375(25):2423-2434		Randomized Controlled Trial, Multicenter Study
IN coronary disease, acute coronary syndrome, after percutaneous coronary intervention, drug eluting stents, atrial fibrillation	The Use of low-dose rivaroxaban (15 mg /d) plus an P2Y12 inhibitor antiplatelet for 12 months OR very-low-dose rivaroxaban (2.5 mg twice daily) plus dual antiplatelet for 1, 6, or 12 months As Treatment, Chronic	Is better Than dose-adjusted vitamin K antagonist plus dual antiplatelet for 1, 6, or 12 months	To reduce clinically significant bleeding (17% rivaroxaban 15 + 1 antiplatelet, 18% rivaroxaban 2.5 + 2 antiplatelets, and 26.7% antivitamin K + 2 antiplatelets) while having similar rates of cardiovascular events (6.5%, 5.6% and 6% respectively)
N Engl J Med. 2021 Aug 28. doi: 10.1056/NEJMoa2108749		Randomized Controlled Trial
IN coronary disease, acute coronary syndrome, after percutaneous coronary intervention, drug eluting stents, patients at high risk for bleeding	The Use of very short (1 month) course of dual antiplatelet therapy, followed by monotherapy with either aspirin or a P2Y12 inhibitor As Treatment, Chronic	Is better Than long-term (1 year) dual antiplatelet therapy	To reduce, at 1 year, net adverse clinical events (death, stroke, myocardial infarction or major bleeding): 7.5% 1-month VS 7.7% long-term
N Engl J Med. 2019 Mar 17. doi: 10.1056/NEJMoa1817083. [Epub ahead of print]		Randomized Controlled Trial, Multicenter Study
IN coronary disease, acute coronary syndrome, after percutaneous coronary intervention, with or without drug eluting stents, atrial fibrillation	The Use of dual treatment with apixaban, usual dose, plus an a P2Y12inhibitor (clopidogrel or ticagrelor) antiplatelet As Treatment, Chronic	Is better Than dual treatment with antivitamine K antagonist + P2Y12inhibitor OR triple therapy with anticoagulant + P2Y12inhibitor + aspirin	To reduce major bleeding (10.5% apixaban VS 15% vitamin K antagonist VS 16% aspirin) with a lower incidence of death or hospitalization (23.5% apix vs 27% AVK) and a similar incidence of ischemic events
N Engl J Med. 2019 Dec 26;381(26):2497-2505. doi: 10.1056/NEJMoa1912388		Randomized Controlled Trial, Multicenter Study
IN coronary disease, acute coronary syndrome, after recent myocardial infarction	The Use of colchicine, 0.5 mg/day, on top of usual treatment As Treatment, Chronic	Is better Than placebo	To reduce, at about 2 years, cardiovascular events: 5.5% coclchicine VS 7% placebo
Circulation. 2019 Feb 5;139(6):775-786. doi: 10.1161/CIRCULATIONAHA.118.036248		Cohorts
IN coronary disease, acute coronary syndrome, atrial fibrillation, bleeding risk on antithrombotic treatment, older patients	The Use of triple antithrombotic therapy with vitamin K antagonist or direct oral anticoagulants plus dual antiplatelet As Treatment, Chronic	Is worse Than dual antithrombotic therapy with one anticoagulant plus one antiplatelet, or dual antiplatelet	To modify (it increases) bleeding risk (HR compared with warfarin monotherapy: 1.3 dual antiplatelet; 1.8 warfarin + 1 antiplatelet; 1.3 DOA + 1 antiplatelet; 3.7 warfarin + 2 antiplatelets; 2.3 DOA + 2 antiplatelets
N Engl J Med. 2004 Apr 8;350(15):1495-504		Randomized Controlled Trial, Multicenter Study
IN coronary disease, acute coronary syndrome, high or normal cholesterol	The Use of high dose statins, atorvastatin 80 mg/d As Treatment, Chronic	Is better Than standard dose statins, standard lipid lowering, pravastatin 40 mg/d	To reduce cardiovascular events (composite of death from any cause, myocardial infarction, hospitalization for unstable angina, revascularization and stroke): 22,4% at 2 years in intv. VS 26,3% in ctrl.
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
Ann Intern Med. 2005 Aug 16;143(4):241-50		Meta-Analysis
IN coronary disease, acute coronary syndrome, myocardial infarction	The Use of vitamin K antagonists, warfarin, added to aspirin As Treatment, Chronic	Is better Than aspirin alone, NOT compared to aspirin plus clopidrogel	To decrease the annual rate of myocardial infarction (0.022 vs. 0.041) and ischemic stroke (0.004 vs. 0.008) but not to reduce mortality. Major bleeding increased (0.015 vs. 0.006)
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%
Lancet. 2025 Aug 30. Epub ahead of print. DOI: 10.1016/S0140-6736(25)01592-2		Meta-Analysis
IN coronary disease, acute coronary syndrome, myocardial infarction, ST-segment elevation, or without ST elevation, residual mildly reduced left ventricular ejection fraction 40-50%	The Use of beta-blockers As Treatment, Chronic	Is better Than placebo or no beta-blocker therapy	To reduce the composite of all-cause death, new myocardial infarction, or heart failure: 3.3% per year beta_blockers VS 4.3% controls
N Engl J Med. 2025 Aug 30. Epub ahead of print. DOI: 10.1056/NEJMoa2504735		Randomized Controlled Trial, Multicenter Study
IN coronary disease, acute coronary syndrome, myocardial infarction, ST-segment elevation, or without ST elevation, residual preserved left ventricular ejection fraction > 40%	The Use of beta-blockers As Treatment, Chronic	Is equal Than no beta-blocker therapy (open-label trial)	To modify, after 3.7 years, death from any cause, reinfarction, or hospitalization for heart failure
N Engl J Med. 2025 Aug 30. Epub ahead of print. DOI: 10.1056/NEJMoa2505985		Randomized Controlled Trial, Multicenter Study
IN coronary disease, acute coronary syndrome, myocardial infarction, ST-segment elevation, or without ST elevation, residual preserved left ventricular ejection fraction > 40%	The Use of beta-blockers As Treatment, Chronic	Is better Than no beta-blocker therapy (open-label trial)	To reduce, at 3.5 years, death or major adverse cardiovascular events: 14% beta-blockersVS 16.3% controls. Difference mainly due to recurrent myocardial infarction: 5.0% VS 6.7%, no difference in deaths
Eur Heart J. 2025 Aug 30:ehaf673. doi: 10.1093/eurheartj/ehaf673. Epub ahead of print		Randomized Controlled Trial, Multicenter Study
IN coronary disease, acute coronary syndrome, myocardial infarction, ST-segment elevation, or without ST elevation, residual preserved left ventricular ejection fraction > 40%, women	The Use of beta-blockers As Treatment, Chronic	Is worse Than no beta-blocker therapy (open-label trial)	To They increased, at 3.7 years, the composite of death, new MI or heart failure hospitalization: 3.0% per year bet-blockers VS 2.1% controls. No significant differences were observed in men
J Am Coll Cardiol. 2024 Mar 5;83(9):904-914. doi: 10.1016/j.jacc.2024.01.002		Randomized Controlled Trial, Multicenter Study
IN coronary disease, acute coronary syndrome, myocardial infarction, ST-segment elevation, or without ST elevation, residual reduced left ventricular ejection fraction	The Use of angiotensin receptor neprilysin inhibitors (ARNIs), sacubitril / valsartan As Treatment, Chronic	Is equal Than angiotensin converting enzyme inhibitors (ACEI), ramipril	To modify occurrence of heart failure or cardiovascular death: 10% sacub. VS. 12% ramip. in STEMI (p non significant), 17% VS. 17% in NSTEMI
N Engl J Med. 2024 Apr 25;390(16):1455-1466. doi: 10.1056/NEJMoa2314051		Randomized Controlled Trial, Multicenter Study
IN coronary disease, acute coronary syndrome, myocardial infarction, ST-segment elevation, or without ST elevation, residual reduced left ventricular ejection fraction	The Use of renal sodium-glucose cotransporter inhibitor (SLGT2i), gliflozins, empagliflozin, 10 mg/d, in addition to recommended therapy As Treatment, Chronic	Is equal Than placebo	To modify, at 1.5 years, hospitalization for heart failure (4% empag VS 5% placebo) or death from any cause (5% empag VS 5.5% placebo)
JAMA Intern Med. 2025 Aug 1;185(8):966-975. doi: 10.1001/jamainternmed.2025.2058		Randomized Controlled Trial
IN coronary disease, acute coronary syndrome, older patients, aged ≥70 years	The Use of early invasive treatment As Treatment, Acute	Is equal Than conservative management	To modify all-cause death (RR 1.05). However, early invasive management reduced the risk of recurrent myocardial infarction (RR 0.78) or repeated coronary revasculariation (RR 0.43), at the cost of increasing major bleeding (RR 1.60)
N Engl J Med. 2025 Sep 11;393(10):973-982. doi: 10.1056/NEJMoa2502799		Randomized Controlled Trial, Multicenter Study
IN coronary disease, acute coronary syndrome, recent myocardial infarction, older patients, impaired physical performance	The Use of control of cardiovascular risk factors, dietary counseling, and exercise training As Treatment, Acute	Is better Than usual treatment	To reduce at 1 year unplanned hospitalization for cardiovascular causes: 9% rehab VS 18% controls. No clear effect in mortality: 4% rehab VS 6% controls
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.
Lancet. 2000 Jul 1;356(9223):9-16		Randomized Controlled Trial, Multicenter Study
IN coronary disease, acute coronary syndrome, unstable angina	The Use of routine invasive strategy (angiography and revascularization), first 10 days As Treatment, Acute	Is better Than non invasive startegy	To reduce, 1 year later, death (2.2% invasive VS 3.2% conservative) and reinfarction (9% invasive VS 12% conservative)
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.)
J Am Coll Cardiol. 2010 Mar 2;55(9):858-64		Randomized Controlled Trial, Multicenter Study
IN coronary disease, acute coronary syndrome, without ST elevation	The Use of early invasive strategy of coronary angiography and revascularization when feasible As Treatment, Acute	Is equal Than conservative strategy: coronary angiography and revascularization only if recurrent ischemia or on provocative testing	To modify at 5 years cumulative death or MI rates (22.3% early VS 18.1% conservative), or mortality.
JAMA. 2001 Nov 21; 286 (19):2405-12		Randomized Controlled Trial, Multicenter Study
IN coronary disease, acute coronary syndrome, without ST elevation	The Use of early invasive strategy of coronary angiography between 4 and 48 hours and revascularization when feasible As Treatment, Acute	Is better Than Conservative strategy: coronary angiography and revascularization only if recurrent ischemia at rest or on provocative testing	To reduce composite end point of death, MI, or rehospitalization for acute coronary syndrome at 6 months: 15.3% in intv. VS 25% in ctrl.
N Engl J Med. 2005 Sep 15;353(11):1095-104		Randomized Controlled Trial, Multicenter Study
IN coronary disease, acute coronary syndrome, without ST elevation	The Use of early invasive strategy of coronary angiography revascularization when feasible As Treatment, Acute	Is equal Than conservative strategy: coronary angiography and revascularization only if recurrent ischemia or on provocative testing	To reduce at 1 year a composite enpoint of death, nonfatal myocardial infarction, or rehospitalization for anginal symptoms: 22.7% in early invasive VS 21.2% with conservative strategy. Early invasive strategy associated more AMI but less rehospitalisations
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. 2008 Jul 2;300(1):71-80		Meta-Analysis
IN coronary disease, acute coronary syndrome, without ST elevation, biomarkers positive	The Use of early invasive strategy of coronary angiography revascularization when feasible As Treatment, Acute	Is better Than conservative strategy	To reduce death, myocardial infarction or readmission: 21% early invasive strategy VS 25.5% conservative.
JAMA Netw Open. 2024 Mar 4;7(3):e240809. doi: 10.1001/jamanetworkopen.2024.0809		Randomized Controlled Trial, Multicenter Study
IN coronary disease, acute coronary syndrome, without ST elevation, older patients, aged ≥70 years, frail	The Use of routine invasive strategy in the first 3 days: coronary angiography and revascularization if feasible As Treatment, Acute	Is equal Than conservative strategy: medical treatment with coronary angiography only if recurrent ischemia	To modify survival: mean survival time about 3.1 years both. Mortality curves intersected, displaying higher mortality to 1 year in the invasive group that shifted to a late benefit
N Engl J Med. 2024 Sep 1. doi: 10.1056/NEJMoa2407791. Epub ahead of print		Randomized Controlled Trial, Multicenter Study
IN coronary disease, acute coronary syndrome, without ST elevation, older patients, aged ≥75 years, frail	The Use of invasive strategy of coronary angiography and revascularization, within 3 to 7 days As Treatment, Acute	Is equal Than optimal medical therapy alone	To modify, at 4 years, cardiovascular death (15.8% invasive-strategy VS 14.2% conservative). It slightly reduced nonfatal myocardial infarction (12% invasive-strategy VS 15% conservative, 2ary outcome)
J Am Coll Cardiol. 2023 Nov 21;82(21):2021-2030. doi: 10.1016/j.jacc.2023.09.809		Randomized Controlled Trial
IN coronary disease, acute coronary syndrome, without ST elevation, older patients, aged ≥80 years	The Use of routine invasive strategy: coronary angiography with immediate evaluation for revascularization in the first 3 days As Treatment, Acute	Is better Than optimal medical therapy alone	To reduce at 5.3 years cardiovascular events (stroke, recurrent myocardial infarction [31% invasive VS 42% conserv] or need for urgent revascularization [13% invasive VS 28% conserv]) but not mortality (median survival 4.4 years both)
Lancet. 2006 Sep 16;368(9540):998-1004		Randomized Controlled Trial, Multicenter Study
IN coronary disease, acute coronary syndrome, without ST-segment elevation	The Use of early invasive strategy with coronary angiography and, if appropriate, revascularisation within 7 days As Treatment, Acute	Is better Than conservative strategy: non-invasive primarily medical strategy	To reduce at 5 years death or myocardial infarction: 19.9% invasive strategy VS 24.5% conservative strategy.
Ann Intern Med. 2008 Feb 5;148(3):186-96		Systematic Review
IN coronary disease, acute coronary syndrome, without ST-segment elevation	The Use of routine invasive strategy (angiography and revascularization) As Treatment, Acute	Is equal Than conservative strategy (ischaemia- or symptom-driven angiography)	To reduce mortality (RR 0.90, 0.80 to 1.14) or re-infarction (RR 0.86, 0.68 to 1.08)
Eur Heart J. 2012 Jan;33(1):51-60		Randomized Controlled Trial
IN coronary disease, acute coronary syndrome, without ST-segment elevation, women	The Use of routine invasive strategy (angiography and revascularization) As Treatment, Acute	Is worse Than conservative strategy (ischaemia- or symptom-driven angiography)	To routine invasive strategy increased death at 1 year in women (8.8% VS 1.1% in the RCT and OR 1.51 in the meta-analysis) and did NOT modify MI and stroke rates. Results in men are not always extapolable to women
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.
Ann Intern Med. 2010 May 18;152(10):630-9		Cohorts
IN coronary disease, chest pain	The Use of coronary multidetector computed tomography, computed tomography coronary angiography As Diagnostic Tool	Is better Than stress testing	To screen for coronary disease, specially in patients at intermediate pre-test probability (+ results indicated 93% need for coronary angiography and negative results indicated no need for further testing (1% + cases).
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%
Heart. 2010 Dec;96(24):1973-9		Diagnostic
IN coronary disease, chest pain, low to intermediate risk patients	The Use of coronary multidetector computed tomography, 64-slice CT coronary angiography As Diagnostic Tool	Is better Than exercise ECG testing (invasive coronariography as reference test)	To accurately diagnose significant coronary disease: sensitivity 100%, specificity 98.7%, positive and negative predictive values 92.9% and 100%, at the patient level (as opposed to analysis by coronary segment)
Health Technol Assess. 2008 May;12(17):iii-iv, ix-143		Systematic Review
IN coronary disease, clinically suspected	The Use of coronary multidetector computed tomography, 64-slice or higher As Diagnostic Tool	Is worse Than invasive coronary angiography	To diagnose suspected coronary disease: high negative predictive value 95 - 100%, less good positive predictive value, less detailed info. Useful to avoid unnecessary invasive angiography.
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
N Engl J Med. 2024 Aug 30. doi: 10.1056/NEJMoa2404204. Epub ahead of print		Randomized Controlled Trial, Multicenter Study
IN coronary disease, history of myocardial infarction, on long-term treatment with a beta-blocker	The Use of interruption or beta-blocker treatment As Treatment, Chronic	Is worse Than continuation of beta-blocker treatment	To modify at 3 years cardiovascular events: 24% interruption VS 21% continuation
J Am Coll Cardiol. 2007 Oct 9;50(15):1469-75		Diagnostic
IN coronary disease, intermediate and low risk symptomatic patients	The Use of coronary multidetector computed tomography As Diagnostic Tool	Is useful Than coronary angiography as gold standard	To diagnose significant coronary disease: see below pre and post-test probabilities of coronary disease for each strata of high, intermediate and low risk.
Eur Heart J. 2007 Dec;28(24):3034-41		Diagnostic
IN coronary disease, intermediate pre-test probability patients	The Use of 16 and 64-slice coronary multidetector computed tomography As Diagnostic Tool	Is worse Than coronary angiography as gold standard	To diagnose significant coronary disease: sensitivity 99%, specificity 75%, NPV 99%, PPV ?
N Engl J Med. 2011 May 5;364(18):1718-27. Epub 2011 Apr 4		Randomized Controlled Trial, Multicenter Study
IN coronary disease, left main coronary artery stenosis	The Use of coronary artery bypass surgery As Treatment, Acute	Is equal Than percutaneous stent implantation, sirolimus-eluting	To modify major cardiovascular events (death, infarction or stroke) at 2 years: 4.4% stent VS 4.7% surgery. Ischemia-driven target-vessel revascularization was more frequent in stent patients, however (9% VS 4%)
N Engl J Med. 2011 Apr 28;364(17):1607-16. Epub 2011 Apr 4		Randomized Controlled Trial, Multicenter Study
IN coronary disease, left ventricular dysfunction	The Use of coronary artery bypass surgery As Treatment, Acute	Is equal Than medical treatment alone	To modify mortality from any cause: 36% bypass VS 41% medical Tt (P=0.12). Bypass surgery reduced death from adjudicated cardiovascular cause and hospitalizations
N Engl J Med. 2011 Apr 28;364(17):1617-25. Epub 2011 Apr 4.		Randomized Controlled Trial, Multicenter Study
IN coronary disease, left ventricular dysfunction, ischemic but viable myocardium	The Use of coronary artery bypass surgery As Treatment, Acute	Is equal Than medical treatment alone	To modify mortality (no frequency figures given in abstract)
Lancet. 2009 Apr 4;373(9670):1190-7		Meta-Analysis
IN coronary disease, multivessel disease	The Use of coronary artery bypass surgery As Treatment, Acute	Is equal Than percutaneous coronary intervention (angioplasty with/out stent)	To reduce long-term (6 years) mortality (15% bypass VS 16% PCI). Bypass may reduce mortality in patients with diabetes or aged > 65 years
N Engl J Med. 2005 May 26;352(21):2174-83		Cohorts
IN coronary disease, multivessel disease (2 or 3 vessels)	The Use of coronary artery bypass surgery As Treatment, Chronic	Is better Than percutaneous stent implantation	To reduce death and revascularization at 3 years: rates?
Circulation. 2010 Sep 7;122(10):949-57		Randomized Controlled Trial
IN coronary disease, multivessel disease, stable angina	The Use of coronary artery bypass surgery As Treatment, Chronic	Is better Than percutaneous coronary intervention or medical treatment alone or	To reduce at 10 years: myocardial infarction (10% CABG VS 13% PCI VS 21% medical) and need for further revascularization, but there wer no significant difference in overall mortality (75% CABG or PCI, 69% medical Tt, p NS)
N Engl J Med. 2022 Sep 15;387(11):967-977. doi: 10.1056/NEJMoa2208275		Randomized Controlled Trial, Multicenter Study
IN coronary disease, myocardial infarction	The Use of polypill, fixed-dose combinations of drugs, 100 mg aspirin, 20-40 mg atorvastatin and 2.5-5-10 mg ramipril As Prevention, Secondary	Is better Than usual care	To reduce at 36 months cardiovascular events: 9.5% polypill VS 13% usual care. Medication adherence was higher in the polypill group. Adverse events were similar
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
N Engl J Med. 2002 Sep 26;347(13):969-74		Randomized Controlled Trial, Multicenter Study
IN coronary disease, myocardial infarction	The Use of vitamin K antagonists, warfarin, added to aspirin or alone As Treatment, Chronic	Is better Than aspirin alone	To reduce cardiovascular events (death, MI or ischemic stroke), rates per year: 3.5% warfarin plus aspirin VS 4.2% warfarin VS 5% aspirin.
N Engl J Med. 2023 Dec 28;389:2446-2456. doi: 10.1056/NEJMoa2307983		Randomized Controlled Trial, Multicenter Study
IN coronary disease, myocardial infarction, acute, anemia, bleeding or not	The Use of a restrictive transfusion strategy (transfuse if hemoglobin level was < 7-8 g/dL) As Treatment, Acute	Is equal Than a liberal transfusion strategy (transfuse if hemoglobin level was <10 g/dL)	To modify at 30 days new myocardial infarction (8.5% restric VS 7% liberal) or death (10% restric VS 8% liberal, p NS) or both combined (p = 0.07)
JAMA. 2021 Feb 9;325(6):552-560. doi: 10.1001/jama.2021.0135		Randomized Controlled Trial, Multicenter Study
IN coronary disease, myocardial infarction, acute, anemia, bleeding or not	The Use of a restrictive transfusion strategy (transfuse if hemoglobin level was <8 g/dL) As Treatment, Acute	Is equal Than a liberal transfusion strategy (transfuse if hemoglobin level was <10 g/dL)	To modify major cardiovascular events at 30 days: 11% restrictive VS 14% liberal (p NS). Much less packed red blood cells were transfused in the restrictive group
N Engl J Med. 1999 Aug 26;341(9):625-34		Randomized Controlled Trial
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 reduce mortality at 6 months: 50% with urgent revascularization vs. 63% conttrols
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
N Engl J Med. 2003 Nov 13;349(20):1893-906		Randomized Controlled Trial, Multicenter Study
IN coronary disease, myocardial infarction, heart failure, chronic, systolic	The Use of angiotensin II receptor blockers, valsartan, alone or combined with ACE inhibitors As Treatment, Chronic	Is equal Than angiotensin converting enzyme (ACE) inhibitors, captopril	To modify overall mortality (about 9.97% per year in valsartan, 9.75% per year in captopril and 9.63% per year with combined treatment) Combining valsartan + captopril did not increased survival but it did adverse events
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).
Circulation. 2010 Apr 6;121(13):1484-91		Randomized Controlled Trial, Multicenter Study
IN coronary disease, myocardial infarction, ST-segment elevation	The Use of early treatment with primary percutaneous coronary intervention, angioplasty As Treatment, Acute	Is better Than early primary fibrinolysis	To reduce at 8 years reinfarction (13% angioplasty VS 18.5% fibrinolysis ) and mortality (27% angioplasty VS 33% fibrinolysis )
JAMA. 2007 Nov 28;298(20):2399-405		Randomized Controlled Trial, Multicenter Study
IN coronary disease, myocardial infarction, ST-segment elevation	The Use of glucose-insulin-potassium infusion As Treatment, Acute	Is equal Than no this treatment	To improve death or heart failure: 6.2% in the GIK group VS 5.5% in the control group, p non significant.
Am J Cardiol. 2005 Oct 15;96(8):1053-8. Epub 2005 Aug 24		Randomized Controlled Trial
IN coronary disease, myocardial infarction, ST-segment elevation	The Use of glucose-insulin-potassium infusion As Treatment, Acute	Is better Than usual care (thrombolysis with streptokinase) alone	To reduce at 1 month major adverse cardiac events (death, reinfarction, serious arrhythmias and severe heart failure): 10% with gluc-insulin-K vs 32.5% without.
JAMA. 2005 Jan 26;293(4):437-46		Randomized Controlled Trial, Multicenter Study
IN coronary disease, myocardial infarction, ST-segment elevation	The Use of glucose-insulin-potassium infusion As Treatment, Acute	Is equal Than usual care alone	To reduce mortality, cardiogenic shock or reinfarction at 30 days
Eur Heart J. 2004 Dec;25(24):2187-94		Randomized Controlled Trial
IN coronary disease, myocardial infarction, ST-segment elevation	The Use of late (2 - 15 days after MI) routine percutaneous revascularization As Treatment, Acute	Is equal Than medical treatment alone, if patient stable	To reduce cardivascular events (composite of cardiac death, non-fatal MI, or ventricular tachyarrhythmia) at 3 years: 7.3% revascularization VS 8.7% controls
N Engl J Med. 2006 Apr 6;354(14):1477-88. Epub 2006 Mar 14		Randomized Controlled Trial, Multicenter Study
IN coronary disease, myocardial infarction, ST-segment elevation	The Use of low molecular weight heparins (LMWH), enoxaparin, for at least 2 days As Treatment, Acute	Is better Than unfractionated heparin (UFH), for the same time	To reduce, at 30 days, death or recurrent infarction: 9.9% enoxaparin VS 12% unfractionated heparin. Major bleeding were a little more frequent with enoxaparin (2.1%) than with UFH (1.4%)
Circulation. 2005 Dec 20;112(25):3855-67. Epub 2005 Dec 12		Meta-Analysis
IN coronary disease, myocardial infarction, ST-segment elevation	The Use of low molecular weight heparins (LMWH), for 4 to 8 days As Treatment, Acute	Is better Than placebo or unfractionated heparin (UFH)	To reduce, at 7 days, the risk of reinfarction (1.6% LMWH VS 2.2% placebo, NNT 167) and reduce death (7.8% LMWH VS 8.7% placebo, NNT 111)
Circulation. 2005 Dec 20;112(25):3846-54. Epub 2005 Nov 15		Randomized Controlled Trial, Multicenter Study
IN coronary disease, myocardial infarction, ST-segment elevation	The Use of low molecular weight heparins (LMWH), for 4 to 8 days As Treatment, Acute	Is better Than unfractionated heparin (UFH)	To reduce, at 30 days, cardiovascular death or recurrent myocardial infarction (6.9% with LMWH versus 11.5% with UFH)
JAMA. 2005 Jan 26;293(4):427-35		Randomized Controlled Trial, Multicenter Study
IN coronary disease, myocardial infarction, ST-segment elevation	The Use of low molecular weight heparins (LMWH), reviparin, for 7 days As Treatment, Acute	Is better Than placebo, added to usual medical care	To reduce cardivascular events (composite of death, reinfarction or stroke) at 30 days: 11,8% LMWH VS 13,6% controls; with reductions of 1,5% in mortality and 0,3% in reinfartion, non significant for stroke, 0,1% increase of severe bleeding.
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
N Engl J Med. 2005 Dec 29;353(26):2758-68		Randomized Controlled Trial, Multicenter Study
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, at 6 months, cardiovascular events (composite of death, reinfarction, stroke, or severe heart failure): 15.4% with rescue angioplasty VS 31.3% with repeated thrombolysis and 29.1% with conservative treatment
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. 2006 Dec 7;355(23):2395-407		Randomized Controlled Trial, Multicenter Study
IN coronary disease, myocardial infarction, total occlusion of the infarct-related artery	The Use of routine (3 to 28 days) invasive strategy, percutaneous coronary stenting As Treatment, Acute	Is equal Than optimal medical therapy and percutaneous intervention only if needed	To reduce, at 4 year, death or myocardial reinfarction: 17.2% invasive group VS 15.6% medical therapy
Lancet. 2005 Sep 10;366(9489):914-20		Randomized Controlled Trial, Multicenter Study
IN coronary disease, myocardial infarction, without ST-segment elevation	The Use of routine invasive strategy (angiography and revascularization) As Treatment, Acute	Is better Than conservative strategy (ischaemia- or symptom-driven angiography)	To reduce at 5 years: death or non-fatal myocardial infarction (16.6% in invasive VS 20% in conservative strategy). A trend to reduce death but not significant.
Am J Med. 2005 May;118(5):465-74		Meta-Analysis
IN coronary disease, myocardial infarction, without ST-segment elevation, unstable angina	The Use of routine invasive strategy As Treatment, Acute	Is better Than conservative strategy	To reduce rates of fatal or nonfatal re-infarction and hospital readmission, but not all-cause mortality.
N Engl J Med. 2020 Aug 31. doi: 10.1056/NEJMoa2021372. [Epub ahead of print]		Randomized Controlled Trial, Multicenter Study
IN coronary disease, stable	The Use of colchicine, 0.5 mg/day, on top of usual treatment As Treatment, Chronic	Is better Than placebo	To reduce, at 2 years, combined cardiovascular events: 7% colchicine VS 10% placebo. Death from all causes was higher with colchicine: 0.7% Vs 0.5% events/year, p not significant)
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
N Engl J Med. 1999 Jul 8;341(2):70-6		Randomized Controlled Trial
IN coronary disease, stable	The Use of high dose statins, atorvastatin 80 mg/d As Treatment, Chronic	Is better Than routine angioplasty, without statins	To reduce cardiovascular events (composite of coronary fatal and nonfatal events and stroke) at 18 months: 13.4% statin VS 20.9% angioplasty (mostly worsening angor)
N Engl J Med. 2007 Apr 12;356(15):1503-16. Epub 2007 Mar 26		Randomized Controlled Trial, Multicenter Study
IN coronary disease, stable	The Use of routine invasive strategy (angiography and revascularization) As Treatment, Chronic	Is equal Than optimal medical therapy alone	To reduce all-cause mortality or myocardial infarction, at 4.6 years: 19% routine PCI vs. 18.5% medical Tt alone. No difference in stroke or hospitalizations neither.
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.
JAMA. 2003 Mar 5;289(9):1117-23		Randomized Controlled Trial, Multicenter Study
IN coronary disease, stable angina, elderly patients	The Use of routine invasive strategy (angiography and revascularization) As Treatment, Chronic	Is equal Than optimal medical therapy alone	To modify 1-year mortality (11% invasive VS 8% medical, p NS) or modify death + nonfatal infarction (17% invasive VS 20% medical). Invasive approach had increased events early months, and medical management had more cardiac events after 6 months.
Circulation. 2007 Mar 6;115(9):1082-9		Randomized Controlled Trial, Multicenter Study
IN coronary disease, stable angina, multvessel disease	The Use of coronary artery bypass graft (CABG) As Treatment, Chronic	Is better Than naked percutaneous coronary intervention (PCI), or medical therapy alone	To reduce, at 5 years, myocardial infarction, or refractory angina requiring revascularization (21% CABG VS 33% PCI VS 36% medical). No differences in overall mortality between the 3 goups
N Engl J Med. 2005 Apr 7;352(14):1425-35		Randomized Controlled Trial
IN coronary disease, stable, normal cholesterol	The Use of high dose statins, atorvastatin 80 mg/d As Treatment, Chronic	Is better Than standard dose statins, atorvastatin 10 mg/d	To reduce cardiovascular events (cardiac death or arrest, AMI or stroke) at 5 years: 8,7% with 80mg/d VS 10,9% with 10mg/d, an ARR of 0,44% year
N Engl J Med. 2025 Aug 31. doi: 10.1056/NEJMoa2507532		Randomized Controlled Trial, Multicenter Study
IN coronary disease, stable, > 6 months after previous stent implantation, patients at high atherothrombotic risk	The Use of oral anticoagulation alone, direct oral anticoagulants or vitamin K antagonists As Treatment, Chronic	Is better Than dual antithrombotic therapy combining anticoagulant & aspirin	To obtain better results on cardiovascular events (12% anticoag alone VS 17% plus aspirin), deaths(8% VS 13%) and major bleedings (3% VS 10%)
J Am Coll Cardiol. 2021 Jul 6;78(1):14-23. doi: 10.1016/j.jacc.2021.04.083		Randomized Controlled Trial, Multicenter Study
IN coronary disease, stable, atherosclerotic vascular disease, peripheral artery disease, stable	The Use of combined antithrombotic Tt, anticoagulants, oral factor Xa inhibitors, rivaroxaban (2.5 mg twice daily) plus aspirin (100 mg once daily) As Treatment, Chronic	Is better Than aspirin (100 mg once daily) alone	To reduce, at 23 months, all-cause mortality (3.4% rivaxbn+aspirin VS 4% aspirin) and cardiovascular mortality (1.7% rivaxbn+aspirin VS 2.2% aspirin)
N Engl J Med. 2017 10 05;377(14):1319-1330		Randomized Controlled Trial, Multicenter Study
IN coronary disease, stable, atherosclerotic vascular disease, stable	The Use of anticoagulants, oral factor Xa inhibitors, rivaroxaban (2.5 mg twice daily) plus aspirin (100 mg once daily) As Treatment, Chronic	Is better Than rivaroxaban (5 mg twice daily) alone, or aspirin (100 mg once daily) alone	To reduce cardiovascular events (death, stroke or MI): 4.1% riva+aspirine VS 5.4% aspirine. But increased major bleeding: 3.1% VS 1.9%. Riva 5 mg/d alone did not better than aspirin and had more bleeding.
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)
N Engl J Med. 2024 Sep 1;391(22):2075-2086. doi: 10.1056/NEJMoa2407362		Randomized Controlled Trial, Multicenter Study
IN coronary disease, stable, atrial fibrillation	The Use of oral direct anticoagulants, anti-Xa, edoxaban alone As Treatment, Chronic	Is better Than dual antithrombotic therapy (edoxaban plus a single antiplatelet agent)	To reduce at 1 year a composite of death, cardiovascular events, embolism, major bleeding or clinically relevant nonmajor bleeding: 7% edoxaban VS 16% dual Tt. Difference due to bleeding events: 5% edoxaban VS 14% dual Tt
N Engl J Med. 2009 Jun 11;360(24):2503-15. Epub 2009 Jun 7		Randomized Controlled Trial, Multicenter Study
IN coronary disease, stable, diabetes mellitus, type 2	The Use of systematic prompt revascularization, either by percutaneous coronary intervention (PCI) or coronary-artery bypass grafting (CABG) As Treatment, Chronic	Is equal Than intensified medical therapy alone	To reduce at 5 years major cardiovascular events (77.2% revascularization VS 75.9% medical Tt). A reduction in cardiovascular events was observed with CABG in tri-troncular patients (22% revascularization VS 30% medical Tt)
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)
N Engl J Med. 2009 Mar 5;360(10):961-72		Randomized Controlled Trial, Multicenter Study
IN coronary disease, three-vessel disease, or left main coronary artery disease	The Use of coronary artery bypass surgery As Treatment, Acute	Is better Than percutaneous coronary intervention	To reduce at 12 months major cardiovascular events (12.4% surgery VS 17.8% percutaneous), mainly reducing the need for rvascularization (5.9% surgery VS 13.5% percutaneous). But more strokes with surgery: 2.2% VS 0.6% percutaneous.
N Engl J Med. 2011 Mar 17;364(11):1016-26		Randomized Controlled Trial, Multicenter Study
IN coronary disease, three-vessel or left main coronary artery disease	The Use of coronary artery bypass surgery As Treatment, Acute	Is better Than percutaneous coronary intervention with drug-eluting stents	To modestly improve symptoms of angina (difference in score: 1.7 points) and increase number of patients free from angina at 12 months: 76% surgery VS 71% PCI
N Engl J Med. 1999 Dec 16;341(25):1882-90		Randomized Controlled Trial
IN coronary disease, ventricular arrhythmia, sudden death	The Use of implantable cardioverter defibrillator As Treatment, Chronic	Is better Than antiarrhythmic drugs or no treatment	To reduce the risk of sudden death.
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
Cochrane Database Syst Rev. 2020 06 25;6():CD013652		Systematic Review, Cochrane Review
IN covid-19, SARS-CoV2, coronavirus	The Use of serology tests to detect the presence of antibodies to SARS-CoV-2: IgG, IgM, IgA, total antibodies and IgG/IgM ratio As Diagnostic Tool	Is useful Than no comparison done	To diagnose covid-19: low sensitivity during the 1st week since onset of symptoms (<30%), rising in the 2nd week and reaching the highest values in the 3d week. Sensitivity of tests beyond 35 days post-symptom unknown.
Lancet. 2020 Jun 27;395(10242):1973-1987. doi: 10.1016/S0140-6736(20)31142-9		Systematic Review
IN covid-19, SARS-CoV2, coronavirus	The Use of physical distancing, face masks, and eye protection As Prevention, Primary	Is better Than not taking any of those precautions	To greatly reduce the risk of contracting COVID-19: distancing OR 0.18, face mask OR 0.15, eye protection 0.22
N Engl J Med. 2021 Nov 4;385(19):1761-1773. doi: 10.1056/NEJMoa2110345		Randomized Controlled Trial, Multicenter Study
IN covid-19, SARS-CoV2, coronavirus	The Use of vaccine, mRNA-vaccines, BNT162b2 As Prevention, Primary	Is better Than placebo	To avoid at 6 months, symptomatic (91% effective) or severe (97% effective) COVID-19 infection. Mild decline of effectiveness over time for preventing symptomatic infection: from 96% at 2 months to 84% at 6 months
Engl J Med. 2022 Jan 12. doi: 10.1056/NEJMoa2115481. Epub ahead of print		Case-Control
IN covid-19, SARS-CoV2, coronavirus	The Use of vaccine, mRNA-vaccines, BNT162b2, adenovirus-base vaccines, ChAdOx1-S As Prevention, Primary	Is good Than no comparison	To prevent at 4-5 months hospitalization (protection: 95% ChAdOx1-S, 92% BNT162b2) or death (85% ChAdOx1-S, 92% BNT162b2), with little waning over time. But protection from infection waned at 5 months (44 and 66% respectively)
N Engl J Med. 2021 Dec 23;385(26):2413-2420. doi: 10.1056/NEJMoa2115624		Cohorts
IN covid-19, SARS-CoV2, coronavirus	The Use of vaccine, mRNA-vaccines, BNT162b2, booster dose (3 doses total) As Prevention, Primary	Is better Than vaccine, mRNA-vaccines, BNT162b2, without booster dose (just 2 doses)	To very slightly reduce, aftter 54 days, COVID-19 mortality (0.16 per 100,000 persons-day booster VS 3 per 100,000 persons-day no boost)
Centers for Disease Control and Prevention. Atlanta, September 23, 2021		Cohorts
IN covid-19, SARS-CoV2, coronavirus	The Use of vaccine, mRNA-vaccines, BNT162b2, booster dose (3 doses total) As Prevention, Primary	Is better Than vaccine, mRNA-vaccines, BNT162b2, without booster dose (just 2 doses)	To reduce COVID-19 hospitalizations: among people > 65 years: NNT 50 2-doses vaccin VS not vaccin, NNT 481 booster VS 2-doses; in 18 to 30 years, NNT 396 and 8738 respectively
N Engl J Med. 2021 Dec 23;385(26):2421-2430. doi: 10.1056/NEJMoa2115926		Cohorts
IN covid-19, SARS-CoV2, coronavirus	The Use of vaccine, mRNA-vaccines, BNT162b2, booster dose (3 doses total) As Prevention, Primary	Is better Than vaccine, mRNA-vaccines, BNT162b2, without booster dose (just 2 doses)	To reduce COVID severe disease (-5.4 severe cases 100,000 person-days in >60 years, -0.6 cases in 50-60 years) and mortality among those >60 years (-2 deaths per 100,000 person-days)
N Engl J Med. 2022 May 25. doi: 10.1056/NEJMoa2118946. Epub ahead of print		Cohorts
IN covid-19, SARS-CoV2, coronavirus	The Use of natural immunity, or hybrid immunity (infection + vaccine) As Prevention, Secondary	Is better Than immunity acquired by vaccine alone	To protect from infection for longuer time: after 1 year or more there were 30 infections per 100 000 persons previously infected VS 89 per 100 000 vaccinated with 2 doses
N Engl J Med. 2021 Feb 11;384(6):533-540. doi: 10.1056/NEJMoa2034545		Cohorts
IN covid-19, SARS-CoV2, coronavirus	The Use of previous proven infection (anti-spike antibodies in serology) As Prevention, Secondary	Is better Than no previous infection	To protect againts SARS-CoV2 reinfection at 6 months: 0.13 per 10,000 days at risk in serology(+) workers VS 1 per 10,000 days in serology(-) ones
Lancet. 2021 Mar 27;397(10280):1204-1212. doi: 10.1016/S0140-6736(21)00575-4		Cohorts
IN covid-19, SARS-CoV2, coronavirus	The Use of previous proven infection (positive PCR) As Prevention, Secondary	Is better Than no previous infection	To protect againts SARS-CoV2 reinfection at 6 months: 80% protection against repeated infection, but only 47% among people > 65 years. No evidence of waning protection over time
N Engl J Med. 2021 Dec 30;385(27):2585-2586. doi: 10.1056/NEJMc2110300		Cohorts
IN covid-19, SARS-CoV2, coronavirus	The Use of previous proven infection (positive PCR) As Prevention, Secondary	Is better Than no previous infection	To protect againts SARS-CoV2 reinfection at 1 year: 92% protection against beta variant and 98% against alpha variant
PLoS One. 2021 Mar 11;16(3):e0248132. doi: 10.1371/journal.pone.0248132		Systematic Review
IN covid-19, SARS-CoV2, coronavirus	The Use of several treatments: corticosteroids, tocilizumab, remdesivir, IV immunoglobin As Treatment, Acute	Is better Than placebo or usual treatment	To improve clinical outcomes of patients: death (corticosteroids), mechanical ventilation (corticosteroids, tocilizumab), serious adverse events (?) (corticosteroids, tocilizumab, remdesivir, IV immunoglobulin)
J Zhejiang Univ (Med Sci) 2020; 49(1): 0-0. DOI: 10.3785/j.issn.1008-9292.2020.03.03		Randomized Controlled Trial
IN covid-19, SARS-CoV2, coronavirus, mild disease	The Use of hydroxychloroquine, 400 mg per day for 5 days, plus conventional treatment As Treatment, Acute	Is equal Than conventional treatment alone	To negative viral RNA (4 days both) and improve clinical symptoms (1 to 3 days). There was less radiological progression in CT images in the HCQ group (33% VS 47% controls)
JAMA. 2020 Sep 15;324(11):1048-1057. doi: 10.1001/jama.2020.16349		Randomized Controlled Trial, Multicenter Study
IN covid-19, SARS-CoV2, coronavirus, mild disease, lower respiratory tract involvement, without respiratory failure	The Use of remdesivir (200 mg I.V. loading dose on day 1, followed by 100 mg I.V. daily for up to 5 days) As Treatment, Acute	Is equal Than placebo	To improve clinicla status at day 11 or improve mortality at day 28 (1-2% in all groups)
N Engl J Med. 2020 Nov 19;383(21):2041-2052. doi: 10.1056/NEJMoa2019014		Randomized Controlled Trial, Multicenter Study
IN covid-19, SARS-CoV2, coronavirus, mild to moderate disease	The Use of hydroxychloroquine, 400 mg per day for 7 days, with or without azithromycin, plus conventional treatment As Treatment, Acute	Is equal Than standard care alone	To modify clinical status at day 15. Prolongation of corrected QT interval and elevation of liver-enzyme levels were more frequent with hydroxychloroquine
JAMA Intern Med. 2020 Oct 20. doi: 10.1001/jamainternmed.2020.6615. [Epub ahead of print]		Randomized Controlled Trial, Multicenter Study
IN covid-19, SARS-CoV2, coronavirus, mild to moderate disease, pneumonia, without severe alveolo-arteriel gradient	The Use of monoclonal antibodies, interleukin-6 receptor blockade, tocilizumab (8 mg/kg up to a maximum of 800 mg, followed by a second dose after 12 hours) As Treatment, Acute	Is equal Than standard care alone	To modify clinical worsening at 14 days (28% tocili VS 27% standard care), need for intubation or death (2 patients tocili VS 1 patient standard care) at 30 days
medRxiv preprint : https://doi.org/10.1101/2020.03.22.2004075		Randomized Controlled Trial
IN covid-19, SARS-CoV2, coronavirus, moderate disease	The Use of hydroxychloroquine, 400 mg per day for 5 days, plus conventional treatment As Treatment, Acute	Is better Than conventional treatment alone	To reduce time to symptoms improvement and improve pneumonia at control CT (81% with HCQ VS 55% conventional Tt). All 4 patients progressing to severe disease had not received HCQ
JAMA. 2020 Apr 22. doi: 10.1001/jama.2020.6775. [Epub ahead of print]		Cohorts
IN covid-19, SARS-CoV2, coronavirus, moderate to severe disease	The Use of hydroxychloroquine, 600 mg twice on day 1, then 400 mg daily for a median of 5 days, plus conventional treatment As Treatment, Acute	Is equal Than conventional treatment alone	To modify rates of patients needing intubation or mortality
Ann Intern Med. 2021 Feb 9:M20-8148. doi: 10.7326/M20-8148. Epub ahead of print		Systematic Review
IN covid-19, SARS-CoV2, coronavirus, moderate to severe disease, hospitalized adults	The Use of remdesivir As Treatment, Acute	Is better Than placebo	To achieve a small reduction in the proportion of patients receiving mechanical ventilation (RR, 0.71) and moderate improvements in time to recovery and patients suffering serious harm. No differences in mortality
Eur J Pharmacol. 2021 Oct 19;914:174579. doi: 10.1016/j.ejphar.2021.174579. Epub ahead of print		Randomized Controlled Trial
IN covid-19, SARS-CoV2, coronavirus, mostly moderate to severe disease	The Use of corticosteroids, dexamethasone, methylprednisolone, hydrocortisone As Treatment, Acute	Is better Than placebo	To to reduce mortality: OR 0.52
N Engl J Med. 2022 Jun 15. doi: 10.1056/NEJMoa2203965. Epub ahead of print		Cohorts
IN covid-19, SARS-CoV2, coronavirus, omicron variant	The Use of natural immunity, or hybrid immunity (infection + vaccine) As Prevention, Secondary	Is better Than immunity acquired by vaccine alone	To protect from reinfection with omicron: 46% previous infec VS 1% 2-dose vaccine Vs 52% 3-dose vaccine VS 55% infection + 2-dose vaccine. All > 70% protection from severe infection
N Engl J Med. 2020 Mar 18. doi: 10.1056/NEJMoa2001282. [Epub ahead of print]		Randomized Controlled Trial
IN covid-19, SARS-CoV2, coronavirus, severe disease	The Use of lopinavir-ritonavir (400 mg and 100 mg, respectively) twice a day for 14 days As Treatment, Acute	Is equal Than standard care alone	To modify mortality at 28 days (19% lopinavir-ritonavir VS 25% standard), time to clinical improvement (16 days both) or reduce time with detectable viral RNA. Lopinavir-ritonavir reduce time in ICU and incresed digestive adverse effects
N Engl J Med. 2021 Feb 25;384(8):693-704. doi: 10.1056/NEJMoa2021436.		Randomized Controlled Trial, Multicenter Study
IN covid-19, SARS-CoV2, coronavirus, severe disease, patients receiving either invasive mechanical ventilation or oxygen alone	The Use of dexamethasone, 6 mg once daily for 10 days, PO or IV As Treatment, Acute	Is better Than usual care alone	To reduce mortality at 28 days, among patients receiving invasive mechanical ventilation (29% vs. 41%) and among those receiving oxygen without invasive ventilation (23% vs. 26%)
Lancet Respir Med. 2022 May 23:S2213-2600(22)00088-1. doi: 10.1016/S2213-2600(22)00088-1		Randomized Controlled Trial, Multicenter Study
IN covid-19, SARS-CoV2, coronavirus, severe disease, patients receiving supplemental oxygen, either with non-invasive ventilation or not	The Use of Janus-kinases (JAK) inhibitors, baricitinib, for 14 days As Treatment, Acute	Is equal Than dexamethasone for 10 days	To modify at 1 month mechanical ventilation-free survival (87% both) or improved clinical status. Reduced treatment-related adverse events: 4% bariticined VS 10% dexamethasone
N Engl J Med. 2020 Dec 10;383(24):2333-2344. doi: 10.1056/NEJMoa2028836		Randomized Controlled Trial
IN covid-19, SARS-CoV2, coronavirus, severe disease, pneumonia	The Use of monoclonal antibodies, interleukin-6 receptor blockade, tocilizumab (a single dose of 8 mg per kilogram of body weight) As Treatment, Acute	Is equal Than placebo	To modify need for intubation or death (HR 95%CI 0.38 to 1.81), disease worsening at 14 days (18% tocili VS 15% placebo) or patients needing O2 at 14 days (25% tocili VS 21% placebo)
N Engl J Med. 2021 Jan 7;384(1):20-30. doi: 10.1056/NEJMoa2030340		Randomized Controlled Trial, Multicenter Study
IN covid-19, SARS-CoV2, coronavirus, severe disease, pneumonia	The Use of monoclonal antibodies, interleukin-6 receptor blockade, tocilizumab (one or two doses of 8 mg per kilogram of body weight) As Treatment, Acute	Is better Than placebo	To reduce, at 28 days, need for mechanical ventilation (% not given separately, HR 0.56) but not to modify death (10% tociliz VS 9% placebo)
N Engl J Med. 2021 Feb 25. doi: 10.1056/NEJMoa2028700. Epub ahead of print		Randomized Controlled Trial, Multicenter Study
IN covid-19, SARS-CoV2, coronavirus, severe disease, severe pneumonia, respiratory failure	The Use of monoclonal antibodies, interleukin-6 receptor blockade, tocilizumab, single IV dose of 8 mg/Kg As Treatment, Acute	Is equal Than placebo	To modify mortality (19.5% both) or clinical status at 28 days.
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
JAMA. 2008 Aug 27;300(8):933-44		Meta-Analysis
IN critically ill patients	The Use of tight glucose control, intensive insulin therapy As Treatment, Acute	Is worse Than usual glycemic control	To to reduce hospital mortality (21.6% tight control VS 23.3% usual care) but increased hypoclycemia (13.7% tight control VS 2.5% usual care)
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.
N Engl J Med. 2006 Feb 2;354(5):449-61		Randomized Controlled Trial, Multicenter Study
IN critically ill patients, multiple-organ failure, non-surgical patients	The Use of intensive insulin therapy, insulin infusion to get glycaemia 4.4 to 6 mmol/L As Treatment, Acute	Is equal Than conventional treatment, insulin only if very high glycaemia (>12 mmol/L)	To affect mortality: 37.3% in conventional insuline VS 40% with intensive insuline.
N Engl J Med. 2001 Nov 8;345(19):1359-67		Randomized Controlled Trial
IN critically ill patients, multiple-organ failure, septic shock	The Use of intensive insulin therapy As Treatment, Acute	Is better Than conventional treatment, insulin only if very high glycaemia (>12 mmol/L)	To reduce mortality at 1 year: 4.6% with intensive VS 8% with conventional
PLoS One. 2016 Sep 27;11(9):e0162772. doi: 10.1371/journal.pone.0162772		Diagnostic
IN critically ill, emergency patients, medical thinking, decision making, cognition, physican,s feeling or gestalt	The Use of physician gestalt As Diagnostic Tool	Is equal Than ultrasound measurements of the inferior cava vein and caval index	To estimate volume depletion severity and predict a positive response to IV fluids: sensitivity 68% specificity 86% AUC 0.83 physician VS sensitivity 88% specificity 73% AUC 0.85
N Engl J Med. 2019 Nov 07;381(19):1809-1819		Randomized Controlled Trial, Multicenter Study
IN cystic fibrosis, heterozygous, single Phe508del mutation	The Use of combined triple therapy with cystic fibrosis transmembrane conductance regulator CFTR correctors: elexacaftor plus tezacaftor plus ivacaftor As Treatment, Chronic	Is better Than placebo	To reduce exacerbations and improve FEV1 and patients' quality of life scores
J Am Geriatr Soc. 2003 Feb;51(2):155-60		Randomized Controlled Trial
IN dehydration, older patients	The Use of subcutaneous rehydration As Treatment, Acute	Is equal Than intravenous rehydration	To efectiveness for low volumes (750 - 1,000 mL/day). Also equal for local and general adverse effects.
J Am Geriatr Soc. 2020 Dec;68(12):2937-2946. doi: 10.1111/jgs.16707		Systematic Review
IN dehydration, older patients	The Use of subcutaneous rehydration As Treatment, Acute	Is better Than intravenous rehydration	To reduce advere events (RR 0.69) and reduce the risk of agitation (RR 0.42). However, SC hydration delivered a lower volume and was less efficient at reducing serum osmolality
Ann Intern Med. 2019 Sep 3. doi: 10.7326/M19-1859. [Epub ahead of print]		Systematic Review
IN delirium, adults, hospitalized	The Use of antipsychotic drugs, neuroleptics, conventional, atypicals As Prevention, Primary	Is worse Than placebo	To modify delirium incidence or duration, hospital length of stay or mortality. Potentially harmful cardiac effects occurred more frequently
Ann Intern Med. 2019 Sep 3. doi: 10.7326/M19-1860. [Epub ahead of print]		Systematic Review
IN delirium, adults, hospitalized	The Use of antipsychotic drugs, neuroleptics, conventional, atypicals As Treatment, Acute	Is worse Than placebo	To modify sedation status, delirium duration, hospital length of stay or mortality. They associated more cardiac adverse events
Cochrane Database Syst Rev. 2018 06 18;6:CD005594		Systematic Review, Cochrane Review
IN delirium, adults, hospitalized	The Use of antipsychotic drugs, neuroleptics, conventional, atypicals As Treatment, Acute	Is equal Than placebo or nonantipsychotic drugs	To modify delirium severity, resolve symptoms, or alter mortality
Cochrane Database Syst Rev. 2019 Sep 3;9:CD011749. doi: 10.1002/14651858.CD011749.pub2		Systematic Review, Cochrane Review
IN delirium, adults, hospitalized, critically ill	The Use of alpha2 agonist dexmedetomidine As Treatment, Acute	Is better Than placebo	To shorten delirium duration (ratio of means RoM 0.58; 95% credible interval 0.26 to 1.27; moderate-quality evidence). No drug (including antipsychotics) modified physical restraint use, length of stay, long-term cognitive outcomes, or mortality
Age Ageing. 2018 Jan 1;47(1):61-68. doi: 10.1093/ageing/afx149		Diagnostic
IN delirium, dementia, older patients, emergency department	The Use of 4 ‘A’s Test (4AT): Alertness (0-2 points), Abbreviated mental test (age, date of brith, location, year), Attention (counting months of the year backwards) and Acute change 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
J Neurol Neurosurg Psychiatry. 2011 May;82(5):500-4		Cohorts
IN delirium, dementia, older patients, hospitalized	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%
J Am Med Dir Assoc. 2022 Jan;23(1):23-32.e27. doi: 10.1016/j.jamda.2021.09.008		Systematic Review
IN delirium, dementia, older patients, hospitalized	The Use of occurrence of delirium As Prognostic Item	Is worse Than no occurrence of delirium	To posterior evolution: patients with delirium had longer length of hospitalization, worse cognitive and functional outcomes, and a higher risk of institutionalization and mortality. Pooled prevalence of delirium was 49%
Age Ageing. 2011 Jan;40(1):23-9		Systematic Review
IN delirium, older 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.
Acad Emerg Med. 2023 Jun;30(6):616-625. doi: 10.1111/acem.14622		Diagnostic
IN delirium, older patients, emergency department	The Use of brain imaging, head computed tomography As Diagnostic Tool	Is useful Than in certain subgroups of patients. No systematic control group	To find acute structural brain pathologies (16% overall in older delirium patients), specially in patients with focal neurologic signs, but not if anticoagulant treatment
JAMA. 2010 Aug 18;304(7):779-86		Systematic Review
IN delirium, older patients, hospitalized	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, older patients, hospitalized	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
J Am Geriatr Soc. 2005 Oct;53(10):1658-66		Randomized Controlled Trial
IN delirium, older patients, hospitalized, postoperative	The Use of antipsychotic drugs, neuroleptics, conventional, haloperidol As Prevention, Primary	Is better Than placebo	To reduce duration of delirium (5.4days with haloperidol VS 12 days placebo) but not to reduce frequence of developpment (15% with haloperidol VS 16.5% placebo)
Crit Care Med. 2025 Aug 4. doi: 10.1097/CCM.0000000000006786. Epub ahead of print		Meta-Analysis
IN delirium, older patients, hospitalized, postoperative, prevention	The Use of acetylcholinesterase Inhibitors, AChEIs As Prevention, Primary	Is better Than placebo	To reduce delirium occurrence (RR 0.68). No effect observed in duration or severity
PLoS Med. 2017 Jun;14(6):e1002334		Cohorts
IN dementia, age related cognitive impairment	The Use of cognitive reserve, measured through education and midlife occupation As Etiologic risk factor	Is better Than other variables	To predict the risk of dementia (an age effect of 4, 15, and 26 years, for height, education, and midlife occupation, respectively) but rate of cognitive decline did not differ between reserve groups
Ann Intern Med. 2010 Aug 3;153(3):182-93		Systematic Review
IN dementia, age related cognitive impairment	The Use of cognitive training, physical exercise As Etiologic risk factor	Is better Than no training, no exercise	To help to maintain cognitive function over age
BMJ. 2012 Jan 05;344:d7622. doi: 10.1136/bmj.d7622		Cohorts
IN dementia, age related cognitive impairment	The Use of repeated cognitive tests, middle age As Etiologic risk factor	Is useful Than no comparison	To show that cognitive decline is already evident in middle age (age 45-49) in tests of memory, reasoning, vocabulary, and phonemic and semantic fluency,
BMJ. 2017 Jun 22;357(357):j2709		Cohorts
IN dementia, age related cognitive impairment	The Use of physical exercise As Prevention, Primary	Is equal Than sedentary life	To modify the risk of dementia: no evidence of a neuroprotective effect of physical activity. Previous findings may be attributable to reverse causation, that is, due to a decline in physical activity levels in the preclinical phase of dementia
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
JAMA Neurol. 2025 Jun 30:e251734. doi: 10.1001/jamaneurol.2025.1734. Epub ahead of print		Cohorts
IN dementia, age related cognitive impairment, alzheimer, brain amyloid-beta load, older people, centenarians, self-reported cognitively healthy	The Use of quantitative high amyloid-beta load in brain autopsy, Thal phase of progression, comparable with patients with alzheimer disease As Etiologic risk factor	Is useful Than no assessment of amyloid-beta load	To be associated with worse cognitive performance, specially for executive function. Note: 5 resilient centenarians maintained high cognitive performance despite having high Aβ loads
Neurology. 2023 Mar 27:10.1212/WNL.0000000000207156. doi: 10.1212/WNL.0000000000207156		Systematic Review
IN dementia, alzheimer	The Use of anti-amyloid beta (Aβ) drugs, anti-amyloid antibodies, secretase inhibitors As Treatment, Chronic	Is worse Than placebo or no treatment	To modify brain volume: secretase inhibitors accelerated hippocampus atrophy (mean diff: -37.1 µL), ARIA-inducing monoclonal antibodies accelerated ventricular enlargement (mean diff: +2.1mL)
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.
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)
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
Eur Heart J. 2013 Sep;34(33):2585-91. doi: 10.1093/eurheartj/eht182. Epub 2013 Jun 4		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 Apr;20(4):415-8. doi: 10.1038/nm.3466. Epub 2014 Mar 9		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
N Engl J Med. 2023 Jan 5;388(1):9-21. doi: 10.1056/NEJMoa2212948		Randomized Controlled Trial, Multicenter Study
IN dementia, alzheimer, early-stage, mild cognitive impairment	The Use of lecanemab, a humanized IgG monoclonal antibody with high affinity to amyloid-beta soluble protofibrils, 10 mg/Kg every 2 weeks As Treatment, Chronic	Is better Than placebo	To reduce progression of cognitive decline at 18 months: change in Clinical Dementia Rating-Sum of Boxes (CDR-SB, 0 to 18 points): +1.2 leca VS +1.7 placebo. 12% had amyloid-related imaging abnormalities with edema or effusions
J Prev Alzheimers Dis. 2025 Feb 25:100094. doi: 10.1016/j.tjpad.2025.100094. Epub ahead of print		Consensus Conference
IN dementia, alzheimer, early-stage, mild cognitive impairment	The Use of recommendations for using lecanemab, amyloid-beta soluble protofibrils high-affinity humanized monoclonal antibody As Treatment, Chronic	Is useful Than no comparison here	To appropriately use lecanemab and reduce the incidence of adverse events
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
Cochrane Database Syst Rev. 2019 Mar 20;3(no):CD003154		Systematic Review, Cochrane Review
IN dementia, alzheimer, moderate to severe	The Use of N-methyl D-aspartate receptor antagonists, memantine As Treatment, Chronic	Is better Than placebo	To achieve small clinical benefits: clinical global rating +0.21 CGR points; cognitive function +3.11 Severe Impairment Battery (SIB) points; activities of daily living +1.1 ADL19 points; and behaviour and mood: +1.84 NPI points
JAMA Intern Med. 2024 Jul 1;184(7):778-785. doi: 10.1001/jamainternmed.2024.0736		Cohorts
IN dementia, alzheimer, swallowing disturbance, oropharyngeal dysphagia	The Use of a diet of thick liquids As Treatment, Chronic	Is equal Than thin liquids	To modify hospital mortality (HR 0.92). Patients receiving thick liquids were more likely to have respiratory complications (OR, 1.73)
N Engl J Med. 2024 Feb 22;390(8):712-722. doi: 10.1056/NEJMoa2310168		Case-Control
IN dementia, alzheimer, very early-stage, before any clinical symptom appearing	The Use of amyloid-beta (Aβ)42 and tau protein in cerebrospinal fluid (CSF), hippocampal volume in MRI As Diagnostic Tool	Is better Than just clinical cognitive tests	To differenciate patients with stablished Alzheimer diagnose: (Aβ)42 started increasing 18 years before, tau-181 11 years, hippocampal volume 8 years and cognitve decline in CDR-SB 6 years before
N Engl J Med. 2005 Dec 1;353(22):2335-41		Cohorts
IN dementia, associated agitation, associated behavioural symptoms	The Use of antipsychotic drugs, neuroleptics, conventional As Treatment, Acute	Is worse Than antipsychotic drugs, neuroleptics, atypical	To mortality: relative risk 1.37 using conventional VS atypical antipsychotics. This increased risk existed in all subgroups.
Am J Psychiatry. 2007 Oct;164(10):1568-76; quiz 1623		Cohorts
IN dementia, associated agitation, associated behavioural symptoms	The Use of antipsychotic drugs, neuroleptics, conventional, atypicals As Treatment, Acute	Is worse Than psychiatric nonantipsychotic drugs	To increased mortality: 22.6%-29.1% with antipsychotics VS 14.6% with nonantipsychotics
JAMA. 2015 Sep 22-29;314(12):1242-54		Randomized Controlled Trial, Multicenter Study
IN dementia, associated agitation, associated behavioural symptoms	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, associated behavioural symptoms	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.
JAMA. 2005 Oct 19;294(15):1934-43		Meta-Analysis
IN dementia, associated agitation, associated behavioural symptoms	The Use of antipsychotic drugs, neuroleptics, atypical, olanzapine, quetiapine, risperidone As Treatment, Chronic	Is worse Than placebo	To mortality: 3.5% with atypical neuroleptics vs 2.3% with placebo.
JAMA Neurol. 2023 Nov 6:e233810. doi: 10.1001/jamaneurol.2023.3810. Epub ahead of print		Randomized Controlled Trial, Multicenter Study
IN dementia, associated agitation, associated behavioural symptoms	The Use of second-generation, atypical antipsychotics, brexpiprazole As Treatment, Chronic	Is better Than placebo	To achieve a greater improvement in Cohen-Mansfield Agitation Inventory score (mean change -23 points brexpi VS -17 points placebo) with no more treatment-emergent adverse events than placebo
Cochrane Database Syst Rev. 2013;3:CD007726		Systematic Review, Cochrane Review
IN dementia, associated agitation, associated behavioural 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
JAMA Netw Open. 2019 Mar 1;2(3):e190828. doi: 10.1001/jamanetworkopen.2019.0828		Systematic Review
IN dementia, associated agitation, behavioural and psychological symptoms	The Use of atypical antipsychotics, aripiprazole As Treatment, Acute	Is better Than other atypical antipsychotics, risperidone or (specially) olanzapine	To improve behavioural and psychological symptoms, while associating less deaths and cerebrovascular adverse events
J Am Geriatr Soc. 2025 Apr 28. doi: 10.1111/jgs.19489. Epub ahead of print		Randomized Controlled Trial
IN dementia, associated behavioural symptoms, inappropriate sexual behavior	The Use of hormonal pharmacological treatments (progestins and anti-androgens), non-pharmacological interventions (distraction, environmental modification) As Treatment, Chronic	Is better Than antipsychotics, antidepressants, or anticonvulsants	To resolve inappropriate sexual behavior (72% with combined pharmacological and non-pharmacological treatment)
BMC Med. 2025 Feb 25;23(1):82. doi: 10.1186/s12916-025-03851-3		Cohorts
IN dementia, depression, older patients, drug adverse effects, iatrogenic	The Use of antidepressant drugs use As Treatment, Chronic	Is worse Than no antidepressant use	To modify cognition: faster cognitive decline (- 0.30 points/year mean), in particular sertraline (- 0.25 points/year), escitalopram (- 0.76 points/year), and mirtazapine (- 0.19 points/year)
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.
Nature. 2025 Apr 2. doi: 10.1038/s41586-025-08800-x. Online ahead of print		Cohorts
IN dementia, herpes zoster virus, prevention	The Use of live-attenuated herpes zoster vaccination As Prevention, Primary	Is better Than no vaccination	To reduce incidence of dementia at 7 years: absolute reduction 3.5%, relative reduction 20% (with only 47% vaccinated on the vaccination cohort
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.
Arch Phys Med Rehabil. 2020 May;101(5):762-769. doi: 10.1016/j.apmr.2020.01.012		Randomized Controlled Trial
IN dementia, older patients	The Use of physical exercise, exercise training, whether strength (anaerobic) or aerobic intensive 4-week program As Treatment, Acute	Is good Than no control group without exercise	To increase cognitive function (mean increases of 1-2 points in MMSE and MoCA) and general physical status (mean increase 5 points in Barthel score)
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
Cochrane Database Syst Rev. 2021 Aug 13;8(8):CD013503. doi:		Systematic Review, Cochrane Review
IN dementia, severe, feeding disorder, swallowing disturbance	The Use of enteral tube feeding As Treatment, Chronic	Is equal Than oral feeding	To modify mortality, survival time, nutritional status, pain or quality of life. Data show increased risk of pneumonia and pressure ulcers with enteral tube feeding
Cochrane Database Syst Rev. 2018 Sep 24;9(9):CD011077. doi: 10.1002/14651858.CD011077.pub2		Systematic Review, Cochrane Review
IN dementia, swallowing disturbance	The Use of taking thick liquids, honey thick (,spoon thick,) As Treatment, Chronic	Is worse Than taking regular liquids with a chin down posture	To reduce pneumonia incidence at 3 months (1 single study), despite an immediate more positive impact on aspiration during videofluoroscopy
BMJ. 2021 Mar 24;372:n532. doi: 10.1136/bmj.n532		Systematic Review
IN dementia, symptoms of depression, without a diagnosis of a major depressive disorder	The Use of cognitive stimulation combined with a cholinesterase inhibitor, cognitive stimulation combined with exercise and social interaction, or massage and touch therapy As Treatment, Acute	Is better Than some antidepressant drug treatment	To improve Cornell scale of symptoms of depression: cognitive stim + exercise + social: -12 points; cognitive stim + AChI: -11 points; massage and touch: -9 points
Lancet Neurol. 2023 Mar;22(3):268-282. doi: 10.1016/S1474-4422(22)00431-8		Consensus Conference
IN demyelinating syndromes, acquired, myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD), encephalomyelitis, acute, optic neuritis, transverse myelitis	The Use of antibodies directed against myelin oligodendrocyte glycoprotein (MOG), MOG-IgG cell-based assays As Diagnostic Tool	Is useful Than no comparison	To identify patients that are distinct from multiple sclerosis and aquaporin-4-seropositive neuromyelitis optica spectrum disorder (AQP4+)
Br J Gen Pract. 2019 Mar;69(680):114-115. doi: 10.3399/bjgp19X701405		Review (Narrative)
IN depression, major	The Use of selective serotonine reuptake inhibitors (SSRI): escitalopram, paroxetine, or serotonin-norepinephrine reuptake inhibitors: venlafaxine, or other antidepressants: mirtazapine, agomelatine, nortriptyline As Treatment, Chronic	Is better Than other antidepressant drugs	To achieve a better effectiveness/tolerance ratio
JAMA. 2023 Sep 5;330(9):843-853. doi: 10.1001/jama.2023.14530		Randomized Controlled Trial
IN depression, major or moderate, of at least 60 days duration, not suicidal	The Use of psilocybin, single 25 mg oral dose, administered with psychological support, on top of current drug treatment (almost all patients had) As Treatment, Acute	Is better Than placebo (niacin)	To improve symptoms of depression at day 43 (mean difference in MADRS score compared to placebo: -12 points (score range 0-60). More participants had sustained response (but not remission) with psilocybin
Lancet. 2018 Apr 7;391(10128):1357-1366. doi: 10.1016/S0140-6736(17)32802-7		Systematic Review
IN depression, major, unipolar	The Use of selective serotonine reuptake inhibitors (SSRI): escitalopram, paroxetine, serotonin-norepinephrine reuptake inhibitors: venlafaxine, and other antidepressants: mirtazapine, agomelatine As Treatment, Chronic	Is better Than placebo and other antidepressants: clomipramine, fluoxetine, fluvoxamine, reboxetine, duloxetine, and trazodone	To improve depression response rates (OR 1.15 to 1.55) with fewer discontinuations: amitriptyline, clomipramine, duloxetine, fluvoxamine, reboxetine, trazodone, and venlafaxine had the highest dropout rates (OR 1.30 to 2.32)
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
N Engl J Med. 2021 Sep 30;385(14):1257-1267. doi: 10.1056/NEJMoa2106356		Randomized Controlled Trial, Multicenter Study
IN depression, unipolar, primary care	The Use of discontinuing antidepressant drugs As Treatment, Chronic	Is worse Than maintaining antidepressant drugs	To avoid relapse: 56% discontinuation VS 38% maintenance of antidepressants
N Engl J Med. 2023 Oct 5;389(14):1298-1309. doi: 10.1056/NEJMoa2304145		Randomized Controlled Trial, Multicenter Study
IN depression, unipolar, refractory	The Use of esketamine in nasal spray, flexible doses according to the summary of product characteristics, under medical supervision, 1-2 times/week, in augmentation of SSRI/SNRI As Treatment, Acute	Is better Than atypical antipsychotics, quetiapine, in augmentation of SSRI/SNRI	To improve at 32 weeks patients having remission of depression and no relapse (22% eske VS. 14% queti) reduce patients who discontinued Tt (23% eske. VS. 40% queti.)
N Engl J Med. 2023 May 24. doi: 10.1056/NEJMoa2302399. Epub ahead of print		Randomized Controlled Trial
IN depression, unipolar, refractory	The Use of ketamine, 0.5 mg/Kg of body weight, I.V. over 40 minutes, twice per week As Treatment, Acute	Is better Than electro-convulsive therapy	To obtain clinical response (>50% improvement in depression score): 55% ketamine VS 41% ECT. ECT was associated with impaired memory recall and musculoskeletal adverse effects
N Engl J Med. 2022 Nov 3;387(18):1637-1648. doi: 10.1056/NEJMoa2206443		Randomized Controlled Trial
IN depression, unipolar, refractory	The Use of psilocybin, single dose of 25 mg, under medical supervision As Treatment, Acute	Is better Than control: psilocybin, single dose of 1 mg	To ilmprove MADSR depression score and modestly increase sustained clinical responses at 12 weeks (20% psilocybin 25 mg VS. 10% controls) buy with more adverse events
N Engl J Med. 2023 Mar 23;388(12):1067-1079. doi: 10.1056/NEJMoa2204462		Randomized Controlled Trial, Multicenter Study
IN depression, unipolar, refractory, older patients	The Use of atypical antipsychotics, aripripazole, added to previous treatment (usually a selective serotonin receptors inhibitor) As Treatment, Chronic	Is better Than adding bupropion or switching to bupropion or nortriptyline	To improve psychological well-being secores (by 5 points/100 aripri VS 4 or 2) and achieve remission of depression: 29% aripri VS 28% bupro augmentation VS 19% switch
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. 2008 Jun 12;358(24):2560-72		Randomized Controlled Trial, Multicenter Study
IN diabetes mellitus, type 2	The Use of intensive glucose control As Treatment, Chronic	Is equal Than standard glucose control	To modify cardiovascular events: 18% intensive VS 20% standard. Increase of severe hypoglycaemia: 2.7% intensive VS 1.5% standard
N Engl J Med. 2006 Dec 7;355(23):2427-43		Randomized Controlled Trial, Multicenter Study
IN diabetes mellitus, type 2	The Use of oral hypoglycemic agents, glitazones (rosiglitazone) As Treatment, Chronic	Is better Than oral hypoglycemic agents, metformin, sulphonylureas (glyburide)	To avoid, at 5 years, monotherapy failure: 15% rosiglitazone, 21% metformin, 34% glyburide. But rosiglitazone had more cardiovascular events (including heart failure) than glyburide (4.3% VS 2.8%) and mortality was the same with all treatments (2.1 to 2.3%)
N Engl J Med. 2007 June 14;356(24):2457-71. Epub 2007 May 21		Meta-Analysis
IN diabetes mellitus, type 2	The Use of oral hypoglycemic agents, glitazones (rosiglitazone) As Treatment, Chronic	Is worse Than placebo or other hypoglycemic agents	To affect the incidence of myocardial infarction (OR 1.44) and cardiovascular death (OR 1.64)
Cochrane Database Syst Rev. 2006 Jan 25;(1):CD002967		Systematic Review, Cochrane Review
IN diabetes mellitus, type 2	The Use of oral hypoglycemic agents, metformin As Treatment, Chronic	Is equal Than oral hypoglycemic agents, sulphonylureas	To the risk of lactic acidosis: 6.3 cases per 100,000 patient-years with metformin VS 7.8 cases per 100,000 patient-years.
Lancet. 1998 Sep 12;352(9131):854-65		Randomized Controlled Trial
IN diabetes mellitus, type 2	The Use of oral hypoglycemic agents, metformin As Treatment, Chronic	Is better Than oral hypoglycemic agents, sulphonylureas (chlorpropamide, glibenclamide), or insulin	To reduce, at 10 years, diabetes related endpoint (7.5 events/1000 patients/year in metformine VS 12.7 others) and all-cause mortality (13.5 events/1000 patients/year in metformine group vs 20.6 others)
BMJ. 2007 Sep 8;335(7618):497		Systematic Review
IN diabetes mellitus, type 2	The Use of oral hypoglycemic agents, metformin As Treatment, Chronic	Is better Than other oral hypoglycemic agents, sulphonylureas, glitazones	To reduce overall mortality and the risk of hospital admission for heart failure
PLoS Med. 2012;9(4):e1001204		Systematic Review
IN diabetes mellitus, type 2	The Use of oral hypoglycemic agents, metformin As Treatment, Chronic	Is equal Than placebo, diet alone or other hypoglycemic agents	To modify all-cause mortality (RR 0.99), cardiovascular mortality (RR=1.05), myocardial infarctions (RR=0.90), all strokes (RR=0.76), peripheral vascular disease (RR=0.90), leg amputations (RR=1.04) or microvascular complications (RR=0.83)
Diabetes Obes Metab. 2017 Mar;19(3):329-335		Systematic Review
IN diabetes mellitus, type 2	The Use of oral hypoglycemic agents, sulphonylureas As Treatment, Chronic	Is worse Than other oral hypoglycemic agents, metformin, dipeptidyl peptidase 4 (DPP4) inhibitors, sodium-glucose cotransporter-2 inhibitors, or insulin	To modify total and cardiovascular mortality. Total mortality was higher with sulphonylureas compared with metformin (HR 1.37), DPP-4 inh (HR 2.03), thiazolidinediones (HR 1.54) and insulin (HR 1.21). CV mortality was higher than SGLT-2 inh and GLP1 agonists
Lancet. 1998 Sep 12;352(9131):837-53		Randomized Controlled Trial
IN diabetes mellitus, type 2	The Use of oral hypoglycemic agents, sulphonylureas (chlorpropamide, glibenclamide) As Treatment, Chronic	Is equal Than insulin	To reduce, at 10 years, diabetes related endpoint and mortality
JAMA. 2018 04 17;319(15):1580-1591		Meta-Analysis
IN diabetes mellitus, type 2	The Use of renal sodium-glucose cotransporter inhibitor, gliflozins and GLP-1 agonists, but NOT DPP-4 inhibitors As Treatment, Chronic	Is better Than placebo, or usual treatment	To reduce all-cause mortality (gliflozins absolute RD -1%, GLP-1 ag -0.6%), cardiovascular mortality and cardiac events. GLP-1 agonists associated with higher risk of withdrawal because of adverse events than gliflozins.
Lancet Diabetes Endocrinol. 2019 Nov;7(11):845-854		Systematic Review
IN diabetes mellitus, type 2	The Use of renal sodium-glucose cotransporter inhibitor, gliflozins, on top or in substitution of previous antidiabetes Tt As Treatment, Chronic	Is better Than placebo	To Reduce the risk of (composite outcome) dialysis, transplantation, or death due to kidney disease: RR 0.67. Also reduced end-stage kidney disease (RR 0·65), and acute kidney injury (RR 0.75)
BMJ. 2025 Aug 14;390:e083039. doi: 10.1136/bmj-2024-083039		Randomized Controlled Trial
IN diabetes mellitus, type 2	The Use of various drugs: sodium-glucose cotransporter-2 (SGLT-2) inhibitors, glucagon-like peptide-1 receptor agonists (GLP-1RAs), tirzepatide, finerenone, sulfonylureas, thiazolidinediones, insulin, dipeptidyl peptidase-4 inhibitors (DPP4-inh) As Treatment, Chronic	Is - Than each other (multiple comparisons made)	To modify various outcomes: clear cardiovascular and kidney benefits of SGLT-2i and GLP-1RAs. Not clear benefit, from this review, of metformin, or tirzepatide (except on body weight)
Am J Cardiol. 2012 Sep 15;110(6):826-33		Meta-Analysis
IN diabetes mellitus, type 2, associated cardiovascular events	The Use of incretin enhancer, dipeptidyl peptidase 4 (DPP4) inhibitors As Treatment, Chronic	Is better Than other oral diabetic medications or placebo	To reduce at about 4 years nonfatal myocardial infarction or acute coronary syndrome (RR 0.40) or any cardiovascular event (RR 0.48)
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
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
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
Ann Intern Med. 2024 Apr 19. doi: 10.7326/M23-1490. Epub ahead of print		Meta-Analysis
IN diabetes mellitus, type 2, inadequate glycemic control	The Use of sodium-glucose cotransporter-2 (SGLT2) inhibitors, or glucagon-like peptide-1 (GLP1) agonists As Treatment, Chronic	Is better Than dipeptidyl peptidase-4 (DPP4) inhibitors, long-acting insulins or placebo	To reduce mortality and major adverse cardiovascular events both. SGLT2 inhibitors reduce chronic kidney disease progression and heart failure hospitalization, and GLP1 agonists reduce stroke
N Engl J Med. 2023 Jun 1;388(22):2071-2085. doi: 10.1056/NEJMra2216691		Review (Narrative)
IN diabetes mellitus, type 2, insulin resistance	The Use of knowing the influence of adipocytes in regulating insulin sensitivity As Etiologic risk factor	Is useful Than no comparison here	To understand better the physio-pathology of diabetes type 2 and seek new possible therapies
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.
N Engl J Med. 2020 Dec 3;383(23):2219-2229. doi: 10.1056/NEJMoa2025845		Randomized Controlled Trial, Multicenter Study
IN diabetes mellitus, type 2, mild to moderate nephropathy, already treated with renin-angiotensin system blockers	The Use of aldosterone antagonists, finerenone, on top of treated with renin-angiotensin system blockade As Treatment, Chronic	Is better Than placebo	To improve at 2.6 years progression of kidney disease (kidney failure, 40% eGFR decrease or death from renal cause): 18% finerenone VS 21% placebo. Also reduction in cardiovascular events: 13% finer VS 15% placebo
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.
Arch Intern Med. 2009 Mar 23;169(6):616-25		Randomized Controlled Trial
IN diabetes mellitus, type 2, needing insulin	The Use of adding oral hypoglycemic agents, metformin, to insulin combination As Treatment, Chronic	Is better Than insulin monotherapy alone	To reduce macrovascular compications (NNT 16) but not microvascular complications.
N Engl J Med. 2007 Oct 25;357(17):1716-30		Randomized Controlled Trial
IN diabetes mellitus, type 2, needing insulin	The Use of addition of biphasic or prandial rapid (aspart) insulin to oral agents As Treatment, Chronic	Is better Than addition of basal slow (detemir) insulin to oral agents	To improve glycaemic control: 7.2% in prandial group VS 7.6% in the basal group, but increased hypoglycaemia and weight gain.
Diabetes Care. 2005 Feb;28(2):254-9		Randomized Controlled Trial
IN diabetes mellitus, type 2, needing insulin	The Use of long acting insulin (bedtime glargine insulin (Lantus-TM)) plus oral hypoglycemic agents combination As Treatment, Chronic	Is better Than insulin monotherapy (mixed NPH/rapid twice daily)	To control glycaemia (more patients reaching HgA1c < 7%: 46% combined treatment VS 29% insulin alone) and avoid hypoglycaemia.
N Engl J Med. 2009 Oct 29;361(18):1736-47		Randomized Controlled Trial, Multicenter Study
IN diabetes mellitus, type 2, needing insulin	The Use of long acting insulin (detemir), basal, once daily or short acting insulin (aspart), prandial, three times daily, added to oral hypoglycemic agents As Treatment, Chronic	Is better Than short acting insulin (aspart), biphasic, twice daily	To reduce number of patients having Hbg A1C < 6.5% (32% biphasic VS 43% basal VS 45% prandial) However, mean Hgb A1C was not different in all 3 groups (6.8 to 7.1%)
Cochrane Database Syst Rev. 2004 Oct 18;(4):CD003418		Systematic Review, Cochrane Review
IN diabetes mellitus, type 2, needing insulin	The Use of medium-long acting insulin (bedtime NPH) plus oral hypoglycemic agents combination As Treatment, Chronic	Is equal Than medium-long acting insulin monotherapy (NPH once or twice daily)	To control glycaemia and avoid hypoglycaemia. Better to control weight if metformin is used (less weight gain). Mortality or associated morbility (cardiac, renal, ocular...) were not evaluated.
Diabetes Obes Metab. 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.
N Engl J Med. 2020 Nov 26;383(22):2107-2116. doi: 10.1056/NEJMoa2022474		Randomized Controlled Trial, Multicenter Study
IN diabetes mellitus, type 2, needing insulin, inadequately controlled with metformin with or without a dipeptidyl peptidase 4 inhibitor	The Use of very long acting insulin analogue designed for once-weekly administration, insulin icodec As Treatment, Chronic	Is equal Than once-daily insulin glargine	To reduce glycated hemoglobin levels at 6 months (-1.3 icodec VS -1.2 glargine) while not increasing symptomatic hypoglycemia (icodec 0.53 events/patient VS glargine 0.46)
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.
N Engl J Med. 2017 Aug 17;377(7):644-657		Randomized Controlled Trial, Multicenter Study
IN diabetes mellitus, type 2, patients at high cardiovascular risk	The Use of renal sodium-glucose cotransporter inhibitor, gliflozins, canagliflozin, on top or in substitution of previous antidiabetes Tt As Treatment, Chronic	Is better Than placebo	To reduce cardiovascular events at 4.5 years: 27% gliflozin VS 31.5% placebo. It also reduced renal adverse outcomes but was associated with more toe / metatarsal amputations (6% gliflozin VS 3% placebo)
N Engl J Med. 2015 Nov 26;373(22):2117-28		Randomized Controlled Trial, Multicenter Study
IN diabetes mellitus, type 2, patients with cardiovascular disease	The Use of renal sodium-glucose cotransporter inhibitor, gliflozins, empagliflozin, on top or in substitution of previous antidiabetes Tt As Treatment, Chronic	Is better Than placebo	To reduce death from cardiovascular causes (3.7% empag VS 5.9% placebo), death from any cause (5.7% VS 8.3% placebo) and hospitalization for heart failure (2.7% VS 4.1% placebo)
Lancet Diabetes Endocrinol. 2019 Jun 10. doi: 10.1016/S2213-8587(19)30180-9. [Epub ahead of print]		Randomized Controlled Trial, Multicenter Study
IN diabetes mellitus, type 2, patients with cardiovascular disease or at risk of	The Use of renal sodium-glucose cotransporter inhibitor, gliflozins, dapagliflozin, on top or in substitution of previous antidiabetes Tt As Treatment, Chronic	Is better Than placebo	To reduce, at 3-4 years, sustained decline in renal function (eGFR) (1.4% dapaglif VS 2.6% placebo). In the first 6 months, the mean decrease in eGFR was larger in the dapagliflozin group
N Engl J Med. 2025 May 29;392(20):2001-2012. doi: 10.1056/NEJMoa2501006		Randomized Controlled Trial, Multicenter Study
IN diabetes mellitus, type 2, patients with cardiovascular disease, chronic kidney disease, or both	The Use of GLP-1 analogs, semaglutide, oral 3 to 7 to 14 mg once-daily, in addition to standard care As Treatment, Chronic	Is better Than placebo	To reduce, at 4 years, cardiovascular events (12%, 3.1 per 100 person-years semaglu VS 14%, 3.7 per 100 person-years placebo). Similar incidence of serious adverse events (48% VS 50%)
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)
N Engl J Med. 2009 Jan 8;360(2):129-39		Randomized Controlled Trial, Multicenter Study
IN diabetes mellitus, type 2, poor control with oral agents in monotherapy	The Use of intensive glucose control (strict glucose targets and rapid scalade in treatments) As Treatment, Chronic	Is equal Than standard treatment	To reduce cardiovascular events (HR 0.88). And hypoglycaemia was increased: 24% intensive VS 18% standard.
N Engl J Med. 2008 Jun 12;358(24):2545-59		Randomized Controlled Trial, Multicenter Study
IN diabetes mellitus, type 2, poor control with oral agents in monotherapy	The Use of intensive glucose control, targeting glycated hemoglobin < 6.0% As Treatment, Chronic	Is worse Than standard therapy, targeting glycated hemoglobin 7.0 to 7.9%	To modify, at 1 year, cardiovascular events, or overall mortality, which was increased in the intensive arm (5% intensive VS 4% standard, HR 1.22) Also intensive Tt increased hypoglycaemia: 10% VS 3.5%.
Diabetes Care. 2024 Jan 9:dc231332. doi: 10.2337/dc23-1332		Randomized Controlled Trial
IN diabetes mellitus, type 2, poor control with oral agents in monotherapy, poor control on metformin	The Use of second-line added treatment with GLP-1 analogs, liraglutide, or dipeptidyl peptidase 4 (DPP4) inhibitor, sitagliptine As Treatment, Chronic	Is better Than insulin, glargine, or oral sulfonylureas, glimepiride	To reduce a composite outcome of glycemic deterioration, weight gain, or hypoglycemia: 19 per 100 PTYs liraglutide, 26 sitagliptin, 29 glargine, 40 glimepiride
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
Eur Heart J Cardiovasc Pharmacother. 2025 Feb 8;11(1):94-104. doi: 10.1093/ehjcvp/pvae083		Systematic Review
IN diuretics, furosemide, subcutaneous, clinical pharmacology	The Use of subcutaneous furosemide, specially new pH-neutral preparations of subcutaneous furosemide As Treatment, Acute	Is equal Than conventional intravenous furosemide	To achieved similar diuresis, natriuresis, and bioavailability. SC conventional furosemide was associated with substantial skin irritation (3-23% of patients)
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%
Crit Care Med. 2020 Jun;48(6):912-918		Systematic Review
IN drugs, antibiotics, vancomycin, nephrotoxicity, acute kidney injury, critically ill adults	The Use of continuous IV administration of vancomycine As Treatment, Acute	Is better Than intermitent IV administration	To reduce acute kidney injury (OR 0.47) while increasing odds of attaining pharmacokinetic target (OR 2.6). No difference in mortality observed.
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
BMC Geriatr. 2014 May 15;14:64		Cohorts
IN elder patients, comprehensive geriatric assessment, overall mortality, comorbidity scores	The Use of commons components of geriatric assesment (age, sex, cognitive impairment and Barthel index) or the Geriatric Index of Comorbidity As Prognostic Item	Is better Than other widely used indices such as the Charlson Index	To predict 5-year mortality in hospitalized older patients
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. 2023 Jul;71(7):2052-2081. doi: 10.1111/jgs.18372		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 and improve quality of treatment in older patients
Arch Intern Med. 2003 Dec 8-22;163(22):2716-24		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 (that has not been proven)
Eur J Clin Pharmacol. 2021 Nov;77(11):1713-1724. doi: 10.1007/s00228-021-03145-6		Consensus Conference
IN elder patients, geriatric pharmacology, inappropriate prescription	The Use of The REMEDI[e]S tool : a seven-step algorithm (implicit criteria) + explicit criteria divided into 6 tables : drug duplications, omissions of medications, medications with unfavourable benefit/risk, unsuitable dose or duration, drug-disease, and interacti As Prevention, Primary	Is useful Than no comparison done	To potentially improve healthcare professionals, prescribing practices
Int J Clin Pharmacol Ther. 2008 Feb;46(2):72-83		Consensus Conference
IN elder patients, geriatric pharmacology, inappropriate prescription	The Use of the STOPP/START lists: medications that should be avoided (STOPP) or should be considered (START) in older patients As Prevention, Primary	Is useful Than no comparison done	To those lists are expected to be useful to reduce drug-related adverse events and improve quality of treatment in older patients (that has not been proven)
Eur Geriatr Med. 2023 Aug;14(4):625-632. doi: 10.1007/s41999-023-00777-y		Consensus Conference
IN elder patients, geriatric pharmacology, inappropriate prescription	The Use of updated STOPP/START lists: medications that should be avoided (STOPP) or should be considered (START) in older patients As Prevention, Primary	Is useful Than no comparison done	To those lists are expected to be useful to reduce drug-related adverse events and improve quality of treatment in older 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.
J Am Geriatr Soc. 2011 Aug;59(8):1444-51		Cohorts
IN elder people, overall mortality	The Use of a risk score calculated depending on the presence or absence of 11 factors (function, illnesses, behaviors, demographics) As Prognostic Item	Is useful Than no comparison here	To predict all cause mortality at 5 and 9 years follow-up: range 7% risk for scores of 0-1 to 92% risk for scores of ≥ 18
JAMA. 2012 Jan 11;307(2):182-92		Systematic Review
IN elder people, overall mortality	The Use of several (16 were found) prognostic indices / scores As Prognostic Item	Is useful Than no comparison done	To predict overall mortality in different patient groups, but further studies are needed to define which ones are useful in clinical decision-making
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.
JAMA Intern Med. 2023 Nov 6:e235961. doi: 10.1001/jamainternmed.2023.5961		Cohorts
IN emergency care, need of, older patients, needing hospital admission	The Use of waiting for hospital admission overnight in the emergency deparment, in a wheeled cot As Etiologic risk factor	Is worse Than been admitted to a hospital werd the same day	To predict an increased risk of death at 30 days (16% overnight VS 11% same day), increased risk of adverse events (adjusted RR 1.2) and increased lenght of hospital stay (9 vs 8 days)
Infection. 2022 Sep 24. doi: 10.1007/s15010-022-01927-3		Randomized Controlled Trial
IN encephalitis, infectious	The Use of knowing clinical characteristics and epidemiology As Diagnostic Tool	Is useful Than compared to younger patients	To Patients ≥ 65 years were more likely to present with coma, impaired consciousness, confusion, aphasia, and rash, but less likely to present fever, and headache. Listeria monocytogenes and VZV increased after 65 years
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. 2019 Jan 31;380(5):415-424. doi: 10.1056/NEJMoa1808312		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 Antimicrob Chemother. 2006 Apr;57(4):639-47		Meta-Analysis
IN endocarditis, bacterial, Staphylococcus aureus, Streptococcus viridans	The Use of beta lactam monotherapy As Treatment, Acute	Is equal Than beta lactam plus aminoglycoside combination therapy	To modify mortality, treatment failure or relapse. More nephrotoxicity when adding aminoglycosides.
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.
Cochrane Database Syst Rev. 2022 Apr 1;4(4):CD011412. doi: 10.1002/14651858.CD011412.pub4		Systematic Review, Cochrane Review
IN epilepsy	The Use of carbamazepine, lamotrigine and the newer drug eventrate for focal seizures; valproate, lamotrigine and eventrate for generalised epilepsy As Treatment, Chronic	Is better Than other drugs (gabapentine, carbamazepine, phenobarbitone ...)	To achieve the best profile in terms of treatment failure/withdrawal and seizure control
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.
Lancet. 2007 Mar 24;369(9566):1016-26		Randomized Controlled Trial, Multicenter Study
IN epilepsy, generalized, 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
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. 1998 Sep 17;339(12):792-8		Randomized Controlled Trial, Multicenter Study
IN epilepsy, generalized, status epilepticus	The Use of lorazepam (0.1 mg/kg) IV As Treatment, Acute	Is better Than - diazepam (0.15 mg/kg) + phenytoin, - phenobarbital (15 mg/kg), - or phenytoin (18 mg/kg)	To acute control of seizures (stop of seizures in 20 mins, no return in 40 mins, total follow-up 12h): lorazepam was successful in 65%. No diffs in recurrences for 12h after. In an intention-to-treat analysis, no significant differences among treatments.
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. 2020 Mar 20. doi: 10.1016/S0140-6736(20)30611-5. [Epub ahead of print]		Randomized Controlled Trial, Multicenter Study
IN epilepsy, generalized, status epilepticus, refractory to treatment with benzodiazepines	The Use of three intravenous anticonvulsive agents: levetiracetam, fosphenytoin, or valproate As Treatment, Acute	Is equal Than Comparison to be defined	To achieve seizure cessation and improved alertness at 1 hour: in about 45% of patients with all 3 drugs, a little less in older patients: 35 to 57%. Similar also in incidence of adverse effects.
N Engl J Med. 2019 Nov 28;381(22):2103-2113. doi: 10.1056/NEJMoa1905795		Randomized Controlled Trial, Multicenter Study
IN epilepsy, generalized, status epilepticus, refractory to treatment with benzodiazepines	The Use of three intravenous anticonvulsive agents: levetiracetam, fosphenytoin, or valproate As Treatment, Acute	Is equal Than each other of the three drugs	To achieve seizure cessation and improved alertness by 60 minutes: in 46% of patients with all three. Similar incidences of adverse events also.
Epilepsia. 2019 Nov;60(11):2245-2254. doi: 10.1111/epi.16366		Systematic Review
IN epilepsy, older patients	The Use of levetiracetam (Keppra(R)), lamotrigine (Lamictal(R)) and lacosamide (Vimpat(R)) As Treatment, Chronic	Is better Than carbamazepine, valproate or gabapentin	To be free of seizure at 6 and 12 months. They were better tolerated than carbamazepine, but less than valproate
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, drugs, 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.
Cochrane Database Syst Rev. 2021 Nov 25;11(11):CD009985. doi: 10.1002/14651858.CD009985.pub2		Systematic Review, Cochrane Review
IN errors, drugs, prescription, administration	The Use of medication reconciliation, Computerised physician order entry/clinical decision support systems, barcoding, feedback and dispensing systems in surgical wards As Treatment, Acute	Is better Than usual care	To reduce medication errors and adverse drug events (OR 0.3 to 0.6) but not mortality
In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 May 1		Review (Narrative)
IN errors, medicine	The Use of implement a culture that works toward recognizing safety challenges and implementing viable solutions, focusing on system improvement As Methodology procedure	Is better Than harboring a culture of blame, shame, and punishment	To reduce and prevent all types of error, avoidable or unavoidable, in the entire process of healthcare
N Engl J Med. 2024 Jan 18;390(3):193-197. doi: 10.1056/NEJMp2309554		Review (Narrative)
IN errors, medicine, resolution	The Use of communication and resolution programs As Treatment, Acute	Is better Than usual deny-and-defend responses	To improve outcomes for patients and professionnals, and reduce further errors in the future
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
Am J Epidemiol. 2014 Aug 15;180(4):446-8		Descriptive
IN evidence based medicine, bias, selective citation bias	The Use of reporting higher risk estimates or greater effect, being published in higher impact factor journals As Methodology procedure	Is better Than performing a higher-quality methodological study	To be cited more often by other authors in their publications
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%.
Current Directions in Psychological Science. 12 Nov 2020;29(6):583-5. doi: 10.1177/0963721420969364		Review (Narrative)
IN evidence based medicine, implementation, knowledge transfer, motivated reasoning, rejection of science	The Use of six psychological roots: (a) ideologies, (b) vested interests, (c) conspiracist worldviews, (d) fears and phobias, (e) personal-identity expression, and (f) social-identity needs As Etiologic risk factor	Is useful Than not taking in account the motivations of individuals	To understand the psychological origins of science-skeptical attitudes and rejection of science
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
Emerg Med J. 2019 Aug;36(8):485-492		Diagnostic
IN evidence based medicine, keeping up to date, clinical experience	The Use of longer time in medical practice As Prognostic Item	Is worse Than shorter time of medical practice	To accurately diagnose pneumonia (agreement with adjudication commitee 0.20 experienced VS 0.46 less-experienced) and to modify their initial diagnostic classification after CT scan (40% experienced VS 54% less-experienced)
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
Nature. 2021 Dec;600(7889):383-385. doi: 10.1038/d41586-021-03690-1		Review (Narrative)
IN evidence based medicine, keeping up to date, implementation, knowledge transfer	The Use of constantly updated evidence synthesis, living systematic reviews As Methodology procedure	Is useful Than compared to classic one-time systematic reviews	To better adapt therapeutics and decision making in healthcare, specially in matter with very active reseach
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
Cochrane Database Syst Rev. 2014 Apr 29;(4):MR000034		Systematic Review, Cochrane Review
IN evidence based medicine, non-randomized trials, observational studies, validity	The Use of observational studies (including retrospective cohorts, prospective cohorts, case-control designs, and cross-sectional designs) As Methodology procedure	Is equal Than randomized trials	To reach similar estimates of interventions effect: pooled Ratio of OR comparing effects from RCTs with effects from observational studies was 1.08 (95%CI 0.96 to 1.22).
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
N Engl J Med. 2000 Jun 22;342(25):1878-86		Meta-Analysis
IN evidence based medicine, randomization	The Use of randomized controlled trials As Methodology procedure	Is equal Than observational studies	To get an accurate estimation of real effects: the estimates of the treatment effects from observational studies and randomized, controlled trials were similar (in 17 of 19 different subjects)
N Engl J Med. 2000 Jun 22;342(25):1887-92		Descriptive
IN evidence based medicine, randomization	The Use of randomized controlled trials As Methodology procedure	Is equal Than observational studies	To get an accurate estimation real effects: average results of observational studies were remarkably similar to those of randomized controlled trials, with no systematic over-estimation
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.
CMAJ. 2021 Oct 12;193(40):E1561-E1567. doi: 10.1503/cmaj.210811		Randomized Controlled Trial
IN falls, head injury, older patients, intracranial bleeding, anticoagulants, direct oral anticoagulants, vitamin K antagonists, bleeding risk	The Use of vitamin K antagonists, warfarin As Treatment, Chronic	Is worse Than direct oral anticoagulants, or no anticoagulant treatment	To increase the risk of intracranial bleeding (HR 1.4 warfarine VS 0.9 DOACs VS no anticoagulation as reference) and needing neurosurgery
J Am Med Dir Assoc. 2018 Apr;19(4):371.e11-371.e17. doi: 10.1016/j.jamda.2017.12.098		Systematic Review
IN falls, older patients, fall risk increasing drugs	The Use of antipsychotics, tricyclic antidepressants, serotonin reuptake inhibitors and benzodiazepines As Etiologic risk factor	Is worse Than not taking those drugs	To increase risk of falling. ORs : antipsychotics 1.54, antidepressants 1.57, tricyclic antidepressants 1.41, selective serotonin reuptake inhibitors 2.02, benzodiazepines 1.42, long-acting benzodiazepines 1.81
J Am Med Dir Assoc. 2018 Apr;19(4):371.e1-371.e9. doi: 10.1016/j.jamda.2017.12.013		Systematic Review
IN falls, older patients, fall risk increasing drugs	The Use of loop diuretics, digoxin As Etiologic risk factor	Is worse Than not taking those drugs	To increase the risk of falling. ORs: loop diuretics 1.36, digoxin 2.06. Conversely, beta-blocking agents (OR 0.88) and statins (OR 0.80) were associated with a reduced risk of fallins
J Am Med Dir Assoc. 2018 Apr;19(4):372.e1-372.e8. doi: 10.1016/j.jamda.2017.12.099		Systematic Review
IN falls, older patients, fall risk increasing drugs	The Use of opioids, antiepileptics, polypharmacy and possibly anti-Parkinson drugs As Etiologic risk factor	Is worse Than not taking those drugs	To increase the risk of falling. ORs: opioids 1.60, anti-Parkinson drugs 1.54 (0.99-2.39); antiepileptics 1.55, polypharmacy 1.75
Age Ageing. 2023 Jun 1;52(6):afad079. doi: 10.1093/ageing/afad079		Case-Control
IN falls, older patients, fall risk increasing drugs	The Use of selective serotonin reuptake inhibitors, tricyclic antidepressants, antipsychotics, or use of three or more fall risk increasing drugs As Etiologic risk factor	Is worse Than not taking those drugs	To risk of falling: they were associated with increased risk of hospitalization with a fracture: cause or markers of more severe pathologies? Antihypertensive drugs not associated with falls
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
Age Ageing. 2022 Sep 2;51(9):afac205. doi: 10.1093/ageing/afac205		Consensus, Guideline
IN falls, older people	The Use of Opportunistic case-finding and Multidomain interventions tailored to individual’s risks factors As Treatment, Acute	Is better Than no systematic approach to fall risk in older adults	To reduce incidence and severity of falls
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)
Br J Anaesth. 2025 Jun;134(6):1756-1764. doi: 10.1016/j.bja.2024.12.045		Randomized Controlled Trial
IN fibromyalgia	The Use of motor cortex repetitive transcranial magnetic stimulation (rTMS), 10 Hz motor cortex (M1), 3000 pulses, 10 induction sessions over 2 weeks + maintenance As Treatment, Acute	Is better Than sham stimulation	To improve number of patients with >50% pain reduction at 8 weeks (40% rTMS VS 18% sham) or at 12 weeks (34% rTMS)
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.
N Engl J Med. 2025 Jul 17;393(3):255-266. doi: 10.1056/NEJMoa2503596		Randomized Controlled Trial, Multicenter Study
IN gastritis, gastroenteritis, acute, with vomiting, children	The Use of oral ondansetron, 6 doses to administer in response to ongoing vomiting during the first 48 hours As Treatment, Acute	Is better Than placebo	To reduce at 7 jours cases of moderate-to-severe gastroenteritis: 5% ondansetron VS 12.5% placebo. No meaninful difference in number of vomiting, patients needing intravenous fluids or adverse events
Ann Emerg Med. 2008 Jul;52(1):22-29.e6		Randomized Controlled Trial
IN gastritis, gastroenteritis, acute, with vomiting, failed oral rehydration therapy, children	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)
Gut. 2019 Feb 12. pii: gutjnl-2018-317807. doi: 10.1136/gutjnl-2018-317807. [Epub ahead of print]		Consensus, Guideline
IN gastrointestinal bleeding, lower	The Use of this structured guidelines As Treatment, Acute	Is useful Than No comparison done	To better manage patients with lower GI bleeding: stratify patients as stable or unstable, with major or minor bleeding. In unstable patients: urgent CT angiography as the first exploration, and upper endoscopy if no origin found
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
N Engl J Med. 2013 Jan 3;368(1):11-21		Randomized Controlled Trial, Multicenter Study
IN gastrointestinal bleeding, upper	The Use of a restrictive transfusion strategy: when hemoglobin < 7 g/dL As Treatment, Acute	Is better Than a liberal transfusion strategy: when hemoglobin < 9 g/dL	To increase, at 6 weeks, survival (95% restrictive strategy VS 91% liberal) and reduce rebleeding (10% restrictive strategy VS 16% liberal)
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
Gastroenterology. 2023 Dec 28:S0016-5085(23)05685-8. doi: 10.1053/j.gastro.2023.12.020. Online ahea		Randomized Controlled Trial, Multicenter Study
IN gastrointestinal bleeding, upper, lower, angiodysplasia, chronic, recurrent	The Use of octreotide, long-acting release, 40-mg intramuscular every 28 days As Treatment, Chronic	Is better Than standard care	To reduce need of tranfusion units (11 octeotride VS 21 control) and reduce endoscopic procedures (from 2.4 per year to 1.5 per year)
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.
J Am Coll Surg. 2009 Jul;209(1):25-40		Randomized Controlled Trial
IN gastrointestinal bleeding, upper, oesophageal varices	The Use of surgical emergency portacaval shunt As Treatment, Acute	Is better Than emergency endoscopic sclerotherapy	To permanently stop variceal bleeding (100% shunt VS 20% sclerosis), avoid future encephalopathy (15% shunt VS 35% sclerosis) and increase survival (figures?)
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.
N Engl J Med. 2010 Jun 24;362(25):2370-9		Randomized Controlled Trial, Multicenter Study
IN gastrointestinal bleeding, upper, oesophageal varices, liver failure, liver cirrhosis, Child-Pugh class B or C	The Use of early (first 72 h) transjugular intrahepatic portosystemic shunt (TIPS), after emergency sclerotherapy As Treatment, Acute	Is better Than emergency endoscopic sclerotherapy plus continuation of vasoactive drugs and long-term propanolol	To reduce rebleeding at 16 months (3% TIPS Vs 44% drugs only) and increase survival at 1 year (86% TIPS Vs 61% drugs only), with no more adverse events.
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
BMJ. 1992 Jan 18;304(6820):143-7		Randomized Controlled Trial
IN gastrointestinal bleeding, upper, peptic disease	The Use of proton pump inhibitors (PPIs), omeprazole (40 mg/12h) As Treatment, Acute	Is equal Than placebo	To reduce recurrent bleeding, need for transfusion, urgent surgery and death.
N Engl J Med. 1997 Apr 10;336(15):1054-8		Randomized Controlled Trial
IN gastrointestinal bleeding, upper, peptic disease	The Use of proton pump inhibitors (PPIs), omeprazole (40mg/12h) As Treatment, Acute	Is better Than placebo	To reduce persistent or recurrent bleeding (11% omeprazole VS 36% placebo), reduce need for transfusion and urgent surgery.
N Engl J Med. 2007 Apr 19;356(16):1631-40		Randomized Controlled Trial
IN gastrointestinal bleeding, upper, peptic disease	The Use of proton pump inhibitors (PPIs), omeprazole (80mg IV before endoscopy) As Treatment, Acute	Is equal Than placebo	To reduce recurrent bleeding, transfused blood, emergency endoscopy, emergency surgery or death at 30 days. Omeprazole reduced the need for endoscopic treatment (19% VS 28.4%) and hospital stay (slighty)
Arch Intern Med. 1998 Jan 12;158(1):54-8		Randomized Controlled Trial
IN gastrointestinal bleeding, upper, peptic disease, following endoscopic hemostasis	The Use of proton pump inhibitors (PPIs) As Treatment, Acute	Is better Than h2-antihistaminics, cimetidine	To reduce recurrent bleeding (4% with omeprazole VS 24% with cimetidine). Transfusion, hsopital stay and mortality were not different.
Am J Gastroenterol. 2006 Mar;101(3):500-5		Randomized Controlled Trial
IN gastrointestinal bleeding, upper, peptic disease, following endoscopic hemostasis	The Use of proton pump inhibitors (PPIs), high-dose omeprazole (40 mg/6h IV) As Treatment, Acute	Is better Than standard dose omeprazole (40 mg/24h) or cimetidine	To reduce rebleeding (9% high-dose omeprazole VS 33% cimetidine) and reduce blood transfusion. But it did not change: hospital stay, need for urgent operation, and death rate
N Engl J Med. 2000 Aug 3;343(5):310-6		Randomized Controlled Trial
IN gastrointestinal bleeding, upper, peptic disease, following endoscopic hemostasis	The Use of proton pump inhibitors (PPIs), omeprazole (high-dose IV continuous infusion) As Treatment, Acute	Is better Than placebo	To reduce recurrent bleeding (7%) omeprazole VS 22% placebo) There was a non significant trend to reduce surgery and death.
Am J Gastroenterol. 2020 Apr;115(4):548-554		Randomized Controlled Trial
IN gastrointestinal bleeding, upper, peptic disease, following endoscopic hemostasis	The Use of refeeding at 48 h As Treatment, Acute	Is better Than refeeding at 24 h	To reduce recurrent rebleeding, at 7 and 30 days: 4% with 48 refeeding VS 11% in the 24 group.
Cochrane Database Syst Rev. 2006 Jan 25;(1):CD002094		Systematic Review, Cochrane Review
IN gastrointestinal bleeding, upper, peptic disease, peptic ulcer	The Use of proton pump inhibitors (PPIs) As Treatment, Acute	Is better Than placebo or H(2)-receptor antagonists	To reduce rebleeding (10.6% with PPIs vs 17.3% in controls, OR 0,49) and surgical interventions (6.1% with PPI vs 9.3% in controls, OR 0,61) with no significant effect on mortality (3.8% both)
Resuscitation. 2013 Apr;84(4):465-70. doi: 10.1016/j.resuscitation.2012.12.016		Cohorts
IN general patient, hospitalized, clinical deterioration, critically ill patients	The Use of an early warning score, the NEWS, including blood pressure, heart rate, breath rate, oxygen saturation, temperature and alert state As Prognostic Item	Is better Than no score	To early recognize hospitalized patients who deteriorate and at risk of cardiac arrest, unanticipated ICU admission or death (AUROC 0.72)
JAMA Netw Open. 2020 May 1;3(5):e205191. doi: 10.1001/jamanetworkopen.2020.5191		Cohorts
IN general patient, hospitalized, clinical deterioration, critically ill patients	The Use of an early warning score, the NEWS, including blood pressure, heart rate, breath rate, oxygen saturation, temperature and alert state As Prognostic Item	Is better Than other early warning scores: MEWS, SIRS, BTF, qSOFA	To better discriminate those patients at risk for death and/or ICU transfer: AUROC 0.87
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)
N Engl J Med. 2025 Apr 3;392(13):1310-1319. doi: 10.1056/NEJMsa2408259		Cohorts
IN general population, USA and Europe, overall mortality	The Use of greater wealth status, and living in Europe, specially northern and western Europe As Prognostic Item	Is better Than lower wealth status	To estimate expected survival: HR for wealth quartiles 2, 3 or 4 were 0.80, 0.76 and 0.68 compared to quartile 1. Survival among the top wealth quartiles in northern and western Europe and southern Europe was higher than that among the wealthiest Americans
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
NEJM Catalyst September 28, 2021. DOI: 10.1056/CAT.21.0217		Review (Narrative)
IN health system management, emergency department crowding	The Use of misaligned health care economics, pressures to maintain impatient capacity > 90% As Etiologic risk factor	Is useful Than to understand the actual root of this problem	To Often seen as a local ED problem, the cause of ED crowding is misaligned health care economics that pressures hospitals to maintain inefficient high inpatient census levels
JAMA Netw Open. 2024 Aug 1;7(8):e2428769. doi: 10.1001/jamanetworkopen.2024.28769		Cohorts
IN health system management, working conditions, nurse staffing, patients/nurse ratio, mortality	The Use of low staffing, either nurses or nursing support, or a proportion >10% of temporary nurses As Methodology procedure	Is worse Than adequate nurse staffing	To affect inpatient mortality at 30 days: Risk of death was increased when low staffing (adjusted HR 1.08, p significant) or >10% temporary nurses
Lancet. 2014 May 24;383(9931):1824-30. doi: 10.1016/S0140-6736(13)62631-8		Cohorts
IN health system management, working conditions, nurse staffing, patients/nurse ratio, surgery, errors, mortality	The Use of more than 6 patients per nurse, lower nurse education (less than a bachelor degree) As Methodology procedure	Is worse Than the inverse	To affect inpatient mortality at 30 days: each patient added increased (relatively) mortality by 7%; every 10% increase in bachelor nurses decreased mortality by 7%
JAMA. 2002 Oct 23-30;288(16):1987-93. doi: 10.1001/jama.288.16.1987		Cohorts
IN health system management, working conditions, nurse staffing, patients/nurse ratio, surgery, errors, mortality, nurse burnout	The Use of more than 4 to 6 patients per nurse As Methodology procedure	Is worse Than less patients per nurse	To affect inpatient mortality at 30 days: each patient added increased (relatively) mortality by 7%; likelihood of job dissatisfaction by 15% and of burnout by 23%
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)
Circulation. 2018 Apr 17;137(16):1671-1683		Randomized Controlled Trial, Multicenter Study
IN heart failure, acute	The Use of N-terminal pro-brain natriuretic peptide (NT-proBNP) guided therapy As Treatment, Acute	Is equal Than usual treatment, clinically guided	To reduce at 3 months all-cause mortality or heart failure readmissions
Crit Care Med. 2021 Jun 24. doi: 10.1097/CCM.0000000000005174. Online ahead of print		Systematic Review
IN heart failure, acute	The Use of simultaneous IV administration of hypertonic saline solution and furosemide As Treatment, Acute	Is better Than IV furosemide alone	To reduce all-cause mortality (RR 0.55), hospital length of stay (mean difference, -3.28 days) and heart failure-related readmissions (RR 0.50)
Clin Cardiol. 2023 Aug;46(8):853-865. doi: 10.1002/clc.24033		Meta-Analysis
IN heart failure, acute	The Use of simultaneous IV administration of hypertonic saline solution and furosemide As Treatment, Acute	Is better Than IV furosemide alone	To improve urine output (mean 528 ml more), body weight reduction (mean -2.3 Kg) and reduce lenght of hospital stay (mean -3.6 days)
N Engl J Med. 2011 Mar 3;364(9):797-805. doi: 10.1056/NEJMoa1005419		Randomized Controlled Trial, Multicenter Study
IN heart failure, acute decompensation	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 Heart J. 2021 Sep;239:110-119. doi: 10.1016/j.ahj.2021.05.011		Cohorts
IN heart failure, acute decompensation	The Use of loops diuretics, furosemide, intravenously, intermitent bolus, or oral administration As Treatment, Acute	Is equal Than loops diuretics, furosemide, intravenously, continuous infusion	To modify weight change, total urine output, chenge in renal function, 30 day mortality or rehospitalisatioon. Oral administration produced lower weight loss and urine output but had less mortality and rehospitalisations at 30 days
Clin Res Cardiol. 2020 Apr;109(4):417-425. doi: 10.1007/s00392-019-01521-y. Epub 2019 Jun 29.		Randomized Controlled Trial
IN heart failure, acute decompensation of advanced chronic heart failure	The Use of loops diuretics, furosemide, intravenously, in continuous infusion (mean dose 200 mg/24h) As Treatment, Acute	Is better Than loops diuretics, furosemide, intravenously, in intermitent bolus	To improve congestive signs at 72 h: free from congestion (defined as jugular venous pressure of < 8 cm, with no orthopnea and with trace peripheral edema or no edema) in 48% continuous VS 25% intermittent
N Engl J Med. 2022 Aug 27. doi: 10.1056/NEJMoa2203094		Randomized Controlled Trial, Multicenter Study
IN heart failure, acute decompensation, both reduced and preserved left venticular ejection fraction	The Use of acetazolamide, a carbonic anhydrase inhibitor and mild diuretic, 500 mg once daily I.V. As Treatment, Acute	Is better Than placebo	To improve at 3 days successful decongestion (42% acetaz VS 30% placebo). All-cause death or rehospitalization for HF at 3 months did not change (30% acetaz VS 28% placebo)
Eur Heart J. 2022 Oct 18:ehac530. doi: 10.1093/eurheartj/ehac530		Randomized Controlled Trial
IN heart failure, acute decompensation, both reduced and preserved left venticular ejection fraction	The Use of renal sodium-glucose cotransporter inhibitor, gliflozins, empagliflozin, 10 mg/d, introduced at day 2 to 5, in addition to standard treatment, including loop diuretics As Treatment, Acute	Is better Than placebo	To to increase weight loss (-2 Kg extra with empag), reduce BNP and improve clinical decongestion at 15, 30 and 90 days. Impact on renal function not reported (?)
Lancet. 2022 Nov 4:S0140-6736(22)02076-1. doi: 10.1016/S0140-6736(22)02076-1		Randomized Controlled Trial, Multicenter Study
IN heart failure, acute decompensation, both reduced and preserved left venticular ejection fraction, immediately after hospitalization	The Use of up-titration of treatments to 100% of recommended doses within 2 weeks of discharge + 4 scheduled outpatient visits over the 2 months afterwards As Treatment, Acute	Is better Than usual care	To reduce re-hospitalizations for heart failure at 6 months (9.5% up-titration VS 17% usual) and improve QoL scores, but not mortality (8.5% up-titration VS 10% usual)
Circulation. 2022 Jul 26;146(4):289-298. doi: 10.1161/CIRCULATIONAHA.122.059038		Randomized Controlled Trial
IN heart failure, acute decompensation, mostly reduced ejection left venticular fraction	The Use of renal sodium-glucose cotransporter inhibitor, gliflozins, empagliflozin, 25 mg/d, in addition to standard treatment, including loop diuretics As Treatment, Acute	Is better Than standard treatment (including loop diuretics) alone	To at 5 days, increase cumulative urine output (difference estimation 2.2 L), with no change in renal function, and decrease NT-proBNP more (- 1800 empag VS -725 standard)
BMC Pulm Med. 2023 Nov 28;23(1):476. doi: 10.1186/s12890-023-02782-0		Systematic Review
IN heart failure, acute, acute cardiogenic pulmonary edema, respiratory failure, acute	The Use of high-flow nasal oxygen (HFNO) As Treatment, Acute	Is better Than conventional oxygen therapy	To reduce intubation rate (OR 0.29) and hospital stay (SMD: -0.94 days). No significant differences compared with non-invasive ventilation
J Am Coll Cardiol. 2024 Apr 9;83(14):1295-1306. doi: 10.1016/j.jacc.2024.02.009		Randomized Controlled Trial
IN heart failure, acute, both reduced and preserved left venticular ejection fraction, diabetes, type 2	The Use of renal sodium-glucose cotransporter inhibitor, gliflozins, empagliflozin, 10 mg/d, introduced at day 2 to 5, in addition to standard treatment, including loop diuretics As Treatment, Acute	Is better Than structured usual care with protocolized diuretic titration	To improve 24-hour natriuresis and urine output, and reduced total loop diuretic doses (560 mg dapa VS 800 mg usual care) but not to modify weight loss
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%)
Arch Cardiovasc Dis. 2024 Dec;117(12):705-714. doi: 10.1016/j.acvd.2024.10.004		Cross-Over
IN heart failure, acute, chronic, epidemiology	The Use of prevalence of hospitalizations for heart failure and mortality As Prevention, Secondary	Is useful Than not knowing them	To better adapt preventive measures : 2.6% of adult French population has HF, with 339 hospitalizations per 100,000 habitants, 10% death rate in hospital and 34% at 1 year
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.
N Engl J Med. 2021 Jul 15;385(3):203-216. doi: 10.1056/NEJMoa2026141		Randomized Controlled Trial, Multicenter Study
IN heart failure, acute, older patients, hospitalized for acute decompensation	The Use of physical rehabilitation, tailored, progressive, including four function domains (strength, balance, mobility, and endurance), started at hospital and conitnued for 36 outpatient sessions As Treatment, Acute	Is better Than usual care	To improve at 3 months the mean Short Physical Performance Battery: 8 points with rehab VS 7 with usual Tt. No sig changes in rehospitalization nor mortality rates.
JAMA. 2020 Nov 17;324(19):1948-1956. doi: 10.1001/jama.2020.19378.		Randomized Controlled Trial, Multicenter Study
IN heart failure, acute, older people	The Use of an early guideline-recommended care bundle including early IV nitrate boluses; management of precipitating factors, such as acute coronary syndrome, infection, or atrial fibrillation; and moderate dose of IV diuretics As Treatment, Acute	Is equal Than usual care	To significantly modify at 30 days all-cause mortality (8% bundle VS 10% usual), cardiovascular mortality (5% bundle VS 7% usual), unscheduled readmission (14% VS 16%) or median lengh of hospital stay (8 days both)
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)
Eur Heart J. 2025 May 18:ehaf218. doi: 10.1093/eurheartj/ehaf218. Epub ahead of print		Cohorts
IN heart failure, chronic	The Use of hospitalization for heart failure in the last 1 or 5 years, current use of loop diuretics and cardiology visit in previous year As Prognostic Item	Is better Than any other variable anlyzed	To predict mortality at 1 and 2 years. Overall, for the entire cohort: mortality at 1 year 16% (8 to 25% depending on risk groups), at 2 years 27% (13 to 39% depending on risk groups)
Circulation. 2009 Feb 3;119(4):515-23		Cohorts
IN heart failure, chronic	The Use of knowing long-term mortality As Prognostic Item	Is useful Than no comparison here	To be aware of the poor prognosis of patients hospitalised by decompensated HF: median survival 1.79 to 2.34 years.
Arch Intern Med. 2007 Mar 12;167(5):490-6		Cohorts
IN heart failure, chronic	The Use of knowing long-term mortality As Prognostic Item	Is useful Than no comparison here	To be aware of the poor prognosis of patients hospitalised by decompensated HF: 37.3% mortality at 1 year, 78.5% at 5 years.
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
Arch Intern Med. 2010 Mar 22;170(6):507-14		Meta-Analysis
IN heart failure, chronic	The Use of brain natriuretic peptide (BNP) guided therapy As Treatment, Chronic	Is better Than usual clinical care	To reduce all-cause mortality (RR 0.76). However, there was no reduction in mortality in patients > 75 years (RR, 0.94) and no reduction of all-cause hospitalization.
Eur Heart J. 2006 Jun;27(12):1431-1439. Epub 2006 May 18		Cohorts
IN heart failure, chronic	The Use of diuretics, long-term use As Treatment, Chronic	Is worse Than no diuretic treatment	To mortality (29% chronic diuretics VS 21% not diuretics) and hospitalisations by heart failure (23% diuretics VS 18% not diuretics)
Cochrane Database Syst Rev. 2016 Apr 4;4(4):CD003838. doi: 10.1002/14651858.CD003838.pub4		Systematic Review, Cochrane Review
IN heart failure, chronic	The Use of diuretics, long-term use As Treatment, Chronic	Is better Than placebo or other active treatments	To reduce the risk of death at 3 to 12 months (OR 0.24). Also reduced risk of worsening heart failure (OR 0.07) and improved exercise capacity
Health Technol Assess. 2019 May;23(25):1-98		Systematic Review
IN heart failure, chronic	The Use of exercise-based cardiac rehabilitation, for at least 3 weeks, non-pharmacological therapy As Treatment, Chronic	Is better Than no exercise intervention	To improve exercise capacity (6-min walk test, max VO2 uptake) and health-related quality of life (mean 5 points on Minnesota Living with Heart Failure Questionnaire score. No effect in mortality or re-hospitalisations
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
Heart Fail Rev. 2022 Jan;27(1):147-161. doi: 10.1007/s10741-020-09995-z		Systematic Review
IN heart failure, chronic	The Use of loop diuretics, long-term use As Treatment, Chronic	Is worse Than no diuretic treatment	To associated with increased mortality (RR 1.2) and more frequent hospitalizations for heart failure (RR 1.8)
Circ Heart Fail. 2023 Jan;16(1):e009879. doi: 10.1161/CIRCHEARTFAILURE.122.009879		Systematic Review
IN heart failure, chronic	The Use of sodium/salt restriction, prescribing a low sodium diet As Treatment, Chronic	Is equal Than no sodium/salt restriction	To modify hospitalization or all-cause death. Inconsistent results for symptoms and QoL, salt restriction might improve them
Arch Phys Med Rehabil. 2018 Dec;99(12):2570-2582		Systematic Review
IN heart failure, chronic	The Use of structured exercise training program, outpatient, non-pharmacological therapy As Treatment, Chronic	Is better Than no exercise prgram	To improve quality-of-life (QOL) (mean improvement 6 points in Minnesota Living with Heart Failure Questionnaire) and the 6-minute walk test
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
N Engl J Med. 2006 Jul 20;355(3):260-9		Cohorts
IN heart failure, chronic, diastolic (preserved ejection fraction)	The Use of age, female, history of hypertension and atrial fibrillation As Etiologic risk factor	Is useful Than no comparison here	To be associated to heart failure with preserved ejection fraction. Mortality at 1 year was not different from heart failure with reduced ejection fraction: 22% preserved VS 26% reduced.
N Engl J Med. 2006 Jul 20;355(3):251-9		Cohorts
IN heart failure, chronic, diastolic (preserved ejection fraction)	The Use of prevalence over time, mortality, presence of associated hypertension, atrial fibrillation, and diabetes As Etiologic risk factor	Is useful Than no comparison here	To underscore the importance of this disease: prevalence increased over a 15-year period, being presently 47% of all new heart failures. Mortality was the same that systolic heart failure and it did not improve over time
Eur J Heart Fail. 2009 Sep;11(9):855-62		Meta-Analysis
IN heart failure, chronic, diastolic (preserved ejection fraction)	The Use of long term mortality (fatal outcome) As Prognostic Item	Is better Than sytolic (impaired ejection fraction) heart failure	To know natural history and adapt therapy: death at 4 years was lower in case of diastolic (32%) than systolic (41%) heart failure.
N Engl J Med. 2014 Apr 10;370(15):1383-92		Randomized Controlled Trial, Multicenter Study
IN heart failure, chronic, diastolic (preserved ejection fraction)	The Use of aldosterone blockers, spironolactone As Treatment, Chronic	Is equal Than placebo	To modify clinical events (cardiovascular death or hospitalization for heart failure) at 3 years: 18.6% spironol. VS 20.4% placebo). Only hospitalizations for HF were reduced (12% spironol. VS 14.2% placebo) but not hospitalizations by any reason
Lancet. 2003 Sep 6;362(9386):777-81		Randomized Controlled Trial
IN heart failure, chronic, diastolic (preserved ejection fraction)	The Use of angiotensin II receptor blockers (candesartan) As Treatment, Chronic	Is better Than placebo	To reduce at 3 years admissions to hospital for heart failure (15,2% candesartan VS 18,4% placebo). Cardiovascular death did not differ. Primary composite outcome of both did neither differ
Eur Heart J. 2023 Aug 14;44(31):2982-2993. doi: 10.1093/eurheartj/ehad344		Randomized Controlled Trial
IN heart failure, chronic, diastolic (preserved ejection fraction)	The Use of angiotensin receptor neprilysin inhibitors (ARNIs), sacubitril/valsartan As Treatment, Chronic	Is better Than placebo	To reduce worsening heart failure (but nor mortality) in some subgroups of patients: recent of heart failure (RR 0.78) and those with LVEF ≤60% (RR 0.78)
JAMA Netw Open. 2022 Sep 1;5(9):e2231963. doi: 10.1001/jamanetworkopen.2022.31963		Meta-Analysis
IN heart failure, chronic, diastolic (preserved ejection fraction)	The Use of angiotensin receptor neprilysin inhibitors (ARNIs), sacubitril/valsartan, mineralocorticoid receptor antagonists (MRAs), and sodium-glucose cotransporter 2 (SGLT2) inhibitors As Treatment, Chronic	Is better Than placebo	To reduce hospitalization for heart failure: HR 0.71 iSGLT2, 0.76 ARNIs, 0.83 MRAs. No treatment modified mortality
N Engl J Med. 2019 Oct 24;381(17):1609-1620. doi: 10.1056/NEJMoa1908655		Randomized Controlled Trial, Multicenter Study
IN heart failure, chronic, diastolic (preserved ejection fraction)	The Use of angiotensin-neprilysin inhibitors, sacubitril, plus valsartan As Treatment, Chronic	Is equal Than valsartan	To modify mortality or hospitalizations for heart failure
J Am Coll Cardiol. 2009 Jan 13;53(2):184-92. doi: 10.1016/j.jacc.2008.09.031		Cohorts
IN heart failure, chronic, diastolic (preserved ejection fraction)	The Use of beta-blockers As Treatment, Chronic	Is equal Than no treatment with beta-blockers	To significantly influence mortality or rehospitalization
PLoS One. 2014;9(3):e90555		Meta-Analysis
IN heart failure, chronic, diastolic (preserved ejection fraction)	The Use of beta-blockers As Treatment, Chronic	Is better Than placebo or no treatment	To reduce all-cause mortality (RR 0.91). But no sig reduction of hospitalizations
Cochrane Database Syst Rev. 2021 May 22;5(5):CD012721. doi: 10.1002/14651858.CD012721.pub3		Systematic Review, Cochrane Review
IN heart failure, chronic, diastolic (preserved ejection fraction)	The Use of beta-blockers, aldosterone blockers, spironolactone and angiotensin receptor neprilysin inhibitors (ARNIs) but NOT angiotensin converting enzyme inhibitors, nor angiotensin receptor blockers As Treatment, Chronic	Is better Than placebo	To reduce hospitalizations for heart failure (aldosterone blockers RR 0.82, NNT 41 ; neprilysin inhibitors (ARNIs) RR 0.89) and possibly beta-blockers reduce cardiovascular mortality (RR 0.78, NNT 25), to be confirmed in larger studies
N Engl J Med. 2021 Aug 27. doi: 10.1056/NEJMoa2107038. Epub ahead of print		Randomized Controlled Trial, Multicenter Study
IN heart failure, chronic, diastolic (preserved ejection fraction)	The Use of renal sodium-glucose cotransporter inhibitor, gliflozins, empagliflozin, 10 mg/d, in addition to recommended therapy As Treatment, Chronic	Is better Than placebo	To reduce, at 26 months, hospitalizations for heart failure
J Am Coll Cardiol. 2023 May 9;81(18):1835-1878. doi: 10.1016/j.jacc.2023.03.393		Consensus Conference
IN heart failure, chronic, diastolic (preserved ejection fraction)	The Use of several diagnostic scores (H2FPEV) and treatments (gliflozins, aldosterone blockers, angiotensin receptor neprilysin antagonists (ARNIs)) As Treatment, Chronic	Is better Than placebo or no treatment	To improve diagnosis and reduce worsening herat failure episodes / rehospitalizations
Heart. 2018 Mar;104(5):407-415. doi: 10.1136/heartjnl-2017-311652		Meta-Analysis
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 equal Than placebo	To modify survival (except beta blockers, associated with reduced all-cause and cardiac deaths, (RR: 0.78) or reduce rehospitalizations or improve functional capacity
J Am Coll Cardiol. 2011 Apr 19;57(16):1676-86		Meta-Analysis
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 better Than placebo ou usual care without those treatments	To improve excercise tolerance (51 to 61 more seconds on treadmill excercise test) but not heart fonction (E/A ratio) nor mortality
Eur Heart J. 2006 Oct;27(19):2338-45		Randomized Controlled Trial, Multicenter Study
IN heart failure, chronic, diastolic (preserved ejection fraction), elder patients	The Use of angiotensin converting enzyme inhibitors (ACEI), perindopril As Treatment, Chronic	Is better Than placebo	To reduce at 1 year hospitalizations for heart failure (HR 0.63) and improve functional class. However, differences in primary combined outcome at 2 years were not significant
J Am Coll Cardiol. 2009 Jun 9;53(23):2150-8		Randomized Controlled Trial, Multicenter Study
IN heart failure, chronic, diastolic (preserved ejection fraction), elder patients	The Use of beta blockers, nebivolol (Temerit TM) As Treatment, Chronic	Is better Than placebo	To reduce, at 21 months, a composite of all-cause mortality or cardiovascular hospitalizations equally in patients with preserved EF and in those with reduced EF.
Circulation. 2006 Aug 1;114(5):397-403. Epub 2006 Jul 24		Randomized Controlled Trial, Multicenter Study
IN heart failure, chronic, diastolic (preserved ejection fraction), in sinus rhythm	The Use of digoxin As Treatment, Chronic	Is equal Than placebo	To modify death or hospitalization caused by heart failure: 21% with digoxin VS 24% placebo
J Am Coll Cardiol. 2022 Jul 5;80(1):1-18. doi: 10.1016/j.jacc.2022.04.040		Randomized Controlled Trial, Multicenter Study
IN heart failure, chronic, diastolic (preserved ejection fraction), older patients	The Use of renal sodium-glucose cotransporter inhibitor, gliflozins, empagliflozin, 10 mg/d, in addition to recommended therapy As Treatment, Chronic	Is better Than placebo	To reduce heart failure hospitalizations similarly in patients of all ages, including patients > 75-80 years
N Engl J Med. 2024 Sep 1. doi: 10.1056/NEJMoa2407107. Epub ahead of print		Randomized Controlled Trial, Multicenter Study
IN heart failure, chronic, diastolic (preserved ejection fraction), or mildly reduced ejection fraction	The Use of aldosterone blockers, steroidal mineralocorticoid receptor antagonists, finerenone, at a maximum dose of 20 mg or 40 mg once daily As Treatment, Chronic	Is better Than placebo	To improve at 3 years worsening heart failure events: 28% finerenone VS 34% placebo. No differences in mortality (about 8.5% both)
N Engl J Med. 2022 Sep 22;387(12):1089-1098. doi: 10.1056/NEJMoa2206286		Randomized Controlled Trial, Multicenter Study
IN heart failure, chronic, diastolic (preserved ejection fraction), or mildly reduced ejection fraction	The Use of renal sodium-glucose cotransporter inhibitor, gliflozins, dapagliflozin, 10 mg/d, in addition to recommended therapy As Treatment, Chronic	Is better Than placebo	To reduce at 2.3 years worsening heart failure (12% dapa VS 14.5% placebo), total events and symptom burden. But did not reduced mortality
Circ Heart Fail. 2022 Oct;15(10):e010080. doi: 10.1161/CIRCHEARTFAILURE.122.010080		Randomized Controlled Trial, Multicenter Study
IN heart failure, chronic, diastolic (preserved ejection fraction), or mildly reduced ejection fraction, older patients	The Use of renal sodium-glucose cotransporter inhibitor, gliflozins, dapagliflozin, 10 mg/d, in addition to recommended therapy As Treatment, Chronic	Is better Than placebo	To reduce at 2.3 years worsening heart failure at all ages, including in patients > 75 years (41% of all patients). Adverse events more frequent in older patients but with no differences with placebo
Lancet. 2024 Sep 21;404(10458):1119-1131. doi: 10.1016/S0140-6736(24)01733-1		Meta-Analysis
IN heart failure, chronic, diastolic (preserved ejection fraction), systolic (reduced ejection fraction)	The Use of aldosterone blockers, steroidal mineralocorticoid receptor antagonists, spironolactone, finerenone As Treatment, Chronic	Is better Than placebo	To reduce at 1-3 years heart failure hospitalisations: HR 0.66 in reduced EF, HR 0.87 in preserved EF. Reduction in all-cause mortality only in reduced EF (HR 0.73). Increase in hyperK+: 2.9% MRA vs 1.4% placebo
Eur Heart J. 2005 Feb;26(3):215-25		Randomized Controlled Trial, Multicenter Study
IN heart failure, chronic, diastolic (preserved ejection fraction), systolic, elder patients	The Use of beta blockers, nebivolol (Temerit TM) As Treatment, Chronic	Is better Than placebo	To reduce, at 21 months, a composite of death from all causes and cardiovascular hospital admission: 31% nebivolol VS 35% placebo. There were a non-significant reduction of death: 16% nebivolol VS 18% placebo.
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.
Lancet. 2022 Apr 9;399(10333):1391-1400. doi: 10.1016/S0140-6736(22)00369-5		Randomized Controlled Trial, Multicenter Study
IN heart failure, chronic, mostly systolic (reduced ejection fraction)	The Use of prescribing a low sodium diet: < 100 mmol (ie, <1500 mg/day or < 4.2 g of salt/day)) As Treatment, Chronic	Is equal Than maintaining current sodium intake (median 2073 mg/day = 5.25 g of salt/day)	To cardiovascular related hospitalisation, emergency department visits or all-cause death
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)
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
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. 2003 Sep 6;362(9386):767-71		Randomized Controlled Trial, Multicenter Study
IN heart failure, chronic, systolic	The Use of angiotensin II receptor blockers (candesartan), added to angiotensin converting enzyme inhibitors As Treatment, Chronic	Is better Than angiotensin converting enzyme (ACE) inhibitors alone	To reduce, at 3.5 years, cardiac events (cardiac death or hospital admission for heart failure): 38% with sartan added VS 42% with AECI alone
Lancet. 2003 Sep 6;362(9386):772-6		Randomized Controlled Trial, Multicenter Study
IN heart failure, chronic, systolic	The Use of angiotensin II receptor blockers (candesartan), as sustitute of non tolered angiotensin converting enzyme inhibitors As Treatment, Chronic	Is better Than placebo	To reducing combined outcome cardio-vascular death or hospital admission for heart failure (33% in intv. / 40% in cont. in 34 months)
Lancet. 2000 May 6;355(9215):1582-1587		Randomized Controlled Trial
IN heart failure, chronic, systolic	The Use of angiotensin II receptor blockers, losartan As Treatment, Chronic	Is equal Than angiotensin converting enzyme (ACE) inhibitors, captopril	To reduce, at about 2 years, all-cause mortality: 11.7% losartan VS 10.4% captopril. Losartan had less adverse effects: 9.7% discontinued Tt VS 14.7% with captopril, mainly becuase cought
Lancet. 1997 Mar 15;349(9054):747-52		Randomized Controlled Trial
IN heart failure, chronic, systolic	The Use of angiotensin II receptor blockers, losartan As Treatment, Chronic	Is equal Than angiotensin converting enzyme inhibitors (ACEI), captopril	To avoid worsening renal dysfunction, defined as a persistent increase in serum creatinine: 10.5% in each group. There was a significant difference in mortality, secondary end-point, not confirmed in the next trial ELITE-II.
N Engl J Med. 2014 Sep 11;371(11):993-1004. doi: 10.1056/NEJMoa1409077		Randomized Controlled Trial, Multicenter Study
IN heart failure, chronic, systolic	The Use of angiotensin-neprilysin inhibitors, sacubitril, plus valsartan As Treatment, Chronic	Is better Than enalapril	To reduce at 27 months all-cause mortality (17% sacubitril VS 20% enalap) hospitalization for heart failure and symptoms of herat failure.
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
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
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, non-pharmacological therapy As Treatment, Chronic	Is better Than no training	To reduce mortality, cardiac events, hospitalizations and improve quality of life
J Am Coll Cardiol. 2010 Feb 16;55(7):645-53		Randomized Controlled Trial, Multicenter Study
IN heart failure, chronic, systolic	The Use of N-terminal pro-brain natriuretic peptide (NT-proBNP) guided therapy, intensive patient management As Treatment, Chronic	Is better Than usual care or multidisciplinary heart-failure-specialized care	To reduce number of rehospitalizations because heart failure (28% BNP VS 40% multidisciplinary VS 61% usual care) and reduce death (22% both BNP and multidisciplinary VS 39% usual care)
JACC Heart Fail. 2022 Feb;10(2):73-84. doi: 10.1016/j.jchf.2021.09.004		Systematic Review
IN heart failure, chronic, systolic (reduced ejection fraction)	The Use of a combination of 4 drugs: angiotensin receptor-neprilysin inhibitors, beta-blockers, mineralocorticoid receptor antagonists and sodium glucose cotransporter-2 inhibitors As Treatment, Chronic	Is better Than any other combination of drugs, including angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, vericiguat, and omecamtiv-mecarbil	To improve survival: HR: 0.39; estimated additional number of life-years gained for a 70-year-old patient on this combination was 5.0 years (2.5-7.5 years) compared with no Tt.
N Engl J Med. 2025 Aug 29. doi: 10.1056/NEJMoa2415471		Randomized Controlled Trial, Multicenter Study
IN heart failure, chronic, systolic (reduced ejection fraction)	The Use of cardiac glycosides, digitoxin As Treatment, Chronic	Is better Than placebo	To reduce at 1.5 years the combined risk of hospitalization for heart failure: (28% digitoxin VS 30% placebo) or death (27% digitoxin VS 29.5% placebo)
J Am Coll Cardiol. 2017 Nov 14;70(20):2476-2486. doi: 10.1016/j.jacc.2017.08.074		Randomized Controlled Trial
IN heart failure, chronic, systolic (reduced ejection fraction), diastolic (preserved ejection fraction)	The Use of age as a major factor, but not ejection fraction As Prognostic Item	Is better Than others factors	To predict median survival and mortality at years. Cardiovascular and heart failure readmission rates were higher in those with reduced ejection fraction
JAMA. 2025 Mar 30:e253833. doi: 10.1001/jama.2025.3833. Epub ahead of print		Randomized Controlled Trial, Multicenter Study
IN heart failure, chronic, systolic, associated iron deficiency	The Use of ferric carboxymaltose, 2000 mg followed by 500 mg every 4 months As Treatment, Chronic	Is equal Than placebo	To modify the multiple primary ourcome of time to death or to heart failure hospitalization (25% ferric VS 30% placebo, HR 0.79, p 0.04) or total heart failure hospitalizations or subgroup transferrin sat <20%
Ann Intern Med. 2004 Nov 2;141(9):693-704		Meta-Analysis
IN heart failure, chronic, systolic, coronary disease, acute myocardial infarction	The Use of angiotensin II receptor blockers, added to or replacing angiotensin converting enzyme (ACE) inhibitors As Treatment, Chronic	Is equal Than angiotensin converting enzyme (ACE) inhibitors alone	To modify all-cause mortality or heart failure hospitalization.
N Engl J Med. 2005 Apr 14;352(15):1539-49		Randomized Controlled Trial, Multicenter Study
IN heart failure, chronic, systolic, having intraventricular conduction delays (QRS > 120 msec), non-pharmacological treatment	The Use of cardiac-resynchronization by biventricular stimulation with a pacemaker As Treatment, Chronic	Is better Than optimal pharmacologic therapy	To reduce hospitalisation for major cardiovascular event or death: 16%per year in resynchr. vs. 22,5% per year in non-resynchr. Included a significant reduction in mortality.
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 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. 2010 Dec 16;363(25):2385-95		Randomized Controlled Trial, Multicenter Study
IN heart failure, chronic, systolic, mild, having intraventricular conduction delays (QRS > 120 msec), non-pharmacological treatment	The Use of cardiac-resynchronization by biventricular stimulation added to an implantable cardioverter-defibrillator As Treatment, Chronic	Is better Than implantable cardioverter-defibrillator alone	To reduce at 40 months death or rehospitalization (40% resync VS 33% control) and reduce death (HR 0.75)
N Engl J Med. 2009 Oct 1;361(14):1329-38		Randomized Controlled Trial, Multicenter Study
IN heart failure, chronic, systolic, mild, having intraventricular conduction delays (QRS > 130 msec), non-pharmacological treatment	The Use of cardiac-resynchronization by biventricular stimulation with a pacemaker As Treatment, Chronic	Is better Than medical treatment	To reduce heart failure events at 2.5 years (10% resynchronization VS 18% no-resync). Mortality was unchanged.
N Engl J Med. 2014 May 1;370(18):1694-701		Randomized Controlled Trial, Multicenter Study
IN heart failure, chronic, systolic, mild, having left bundle-branch block, non-pharmacological treatment	The Use of cardiac-resynchronization by biventricular stimulation added to an implantable cardioverter-defibrillator As Treatment, Chronic	Is better Than implantable cardioverter-defibrillator alone	To reduce mrotality at 7 years: 18% resync VS 29% controls
N Engl J Med. 2020 May 14;382(20):1883-1893		Randomized Controlled Trial, Multicenter Study
IN heart failure, chronic, systolic, moderate to severe, after recent hospitalization	The Use of vericiguat, 10 mg once/day, an oral soluble guanylate cyclase stimulator, on top of guideline-based medical therapy As Treatment, Chronic	Is better Than placebo, plus guideline-based medical therapy	To reduce, at 11 months, hospitalizations for heart failure (27% vericiguat VS 30% placebo). There was no difference in mortality, nor in adverse events, including hypotension and syncope
JAMA. 2004 Dec 15;292(23):2874-9		Meta-Analysis
IN heart failure, chronic, systolic, non-pharmacological treatment, nonischemic cardiomyopathy	The Use of implantable cardioverter defibrillator As Treatment, Chronic	Is better Than best medical treatment only	To reduce overall mortality: 30% RRR in time of follow-up not precised
JAMA. 2009 Jan 28;301(4):383-92		Randomized Controlled Trial, Multicenter Study
IN heart failure, chronic, systolic, older patients	The Use of brain natriuretic peptide (BNP) guided therapy As Treatment, Chronic	Is equal Than symptom-guided therapy	To improve survival free of all-cause hospitalization at 18 months: 41% BNP-guided VS 40% symptom-guided.
J Am Coll Cardiol. 2011 Oct 25;58(18):1881-9		Randomized Controlled Trial
IN heart failure, chronic, systolic, older patients	The Use of N-terminal pro-brain natriuretic peptide (NT-proBNP) guided therapy, objective < 1.000 ng/ml As Treatment, Chronic	Is better Than symptom-guided therapy	To total cardiovascular events (OR 0.44) and improve quality of life. No age interaction was found, with elderly patients benefitting similarly
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. 2019 Nov 21;381(21):1995-2008. doi: 10.1056/NEJMoa1911303		Randomized Controlled Trial, Multicenter Study
IN heart failure, chronic, systolic, patients with and without diabetes	The Use of renal sodium-glucose cotransporter inhibitor, gliflozins, dapagliflozin, 10 mg/d, in addition to recommended therapy As Treatment, Chronic	Is better Than placebo	To reduce, at 18 months, worsening heart failure leading to hospital treatment (10% gliflozin VS 14% placebo) and cardiovascular death (9.5% gliflozin VS 11.5% placebo)
N Engl J Med. 2020 Oct 8;383(15):1413-1424. doi: 10.1056/NEJMoa2022190		Randomized Controlled Trial, Multicenter Study
IN heart failure, chronic, systolic, reduced left-ventricle ejection fraction, patients with and without diabetes	The Use of renal sodium-glucose cotransporter inhibitor, gliflozins, empagliflozin, 10 mg/d, in addition to recommended therapy As Undefined	Is undefined Than Comparison to be defined	To reduce hospitalizations for heart failure (11% empagli VS 16% placebo) and reduce annual decline of GFR, but not to reduce cardiovascular death (10-11% both groups)
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
N Engl J Med. 2004 May 20;350(21):2140-50		Randomized Controlled Trial, Multicenter Study
IN heart failure, chronic, systolic, severe, having intraventricular conduction delays (QRS > 120 msec), non-pharmacological treatment	The Use of cardiac-resynchronization by biventricular stimulation with a pacemaker As Treatment, Chronic	Is better Than optimal pharmacologic therapy alone (diuretics, ACE inhibitors, beta-blockers, and spironolactone)	To decrease the combined end point "death from any cause or hospitalization" and, when combined with an implantable defibrillator, decrease mortality. Difference not quantified in abstract.
N Engl J Med. 2005 Jan 20;352(3):225-237		Randomized Controlled Trial, Multicenter Study
IN heart failure, chronic, systolic, severe, non-pharmacological treatment, both ischemic and nonischemic cardiomyopathy	The Use of implantable cardioverter defibrillator As Treatment, Chronic	Is better Than amiodarone or placebo	To reduce mortality: 22% with defibrillator VS 29% with placebo at 46 months, absolute reduction 1,85% per year
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 Oct 6;353(14):1471-80		Cost-Effectiveness
IN heart failure, chronic, systolic, sudden death, non-pharmacological treatment	The Use of implantable cardioverter defibrillator As Treatment, Chronic	Is better Than conventional medical treatment, including antiarrhythmic drugs or not	To add between 1 and 3 quality-adjusted life-years (QALY) in 6 trials and no effective in 2 trials. Cost per QALY less than 100,000 dollars
J Clin Med. 2020 Feb 12;9(2):501. doi: 10.3390/jcm9020501		Cohorts
IN heart failure, chronic, very older people, octogenarians	The Use of guideline-directed Tt (renin-angiotensin system inhibitors, beta-blockers, and aldosterone antagonists), knowing long-term mortality As Treatment, Chronic	Is better Than no guideline directed therapy	To improving survival at 6 months in reduced EF HF. For those with preserved EF, angiotensin receptor blocker use reduced HF hospitalizations (OR 0.2). Mortality was much greater than younger patients
N Engl J Med. 2019 Nov 16. doi: 10.1056/NEJMoa1911425. [Epub ahead of print]		Randomized Controlled Trial, Multicenter Study
IN heart valve disease, aortic stenosis, after transcatheter aortic-valve replacement (TAVI)	The Use of anticoagulants, oral factor Xa inhibitors, rivaroxaban, 10 mg once daily (with aspirin for the first 3 months) As Treatment, Acute	Is worse Than aspirin, low dose, 75 to 100 mg/d (with clopidogrel for the first 3 months)	To modify outcomes: rivaroxaban increased death or thromboembolic events (10% VS 7% aspirin) and major bleeding (4% VS 3% aspirin)
N Engl J Med. 2020 Aug 30. doi: 10.1056/NEJMoa2017815. [Epub ahead of print]		Randomized Controlled Trial, Multicenter Study
IN heart valve disease, aortic stenosis, after transcatheter aortic-valve replacement (TAVI)	The Use of dual antiplatelet treatment with aspirin plus clopidogrel for 3 months As Treatment, Chronic	Is worse Than single antiplatelet treatment with aspirin only for 3 months	To modify bleeding events (27% dual Tt VS 15% aspirin) with no change in combined cardiovascular events at 1 year (10% both groups)
N Engl J Med. 2020 Jan 9;382(2). doi: 10.1056/NEJMoa1912846. Epub 2019 Nov 16		Randomized Controlled Trial, Multicenter Study
IN heart valve disease, aortic stenosis, asymptomatic patients, very severe (aortic-valve area ≤0.75 cm2 with aortic jet velocity of ≥4.5 m.s or mean transaortic gradient of ≥50 mm Hg)	The Use of surgical aortic-valve replacement before becoming asymptomatic As Treatment, Acute	Is better Than conservative care, medical treatment and wait until symptoms develop	To reduce, at 4 years, all-cause mortality: 7% early surgery VS 15% conservative care
N Engl J Med. 2010 Oct 21;363(17):1597-607		Randomized Controlled Trial, Multicenter Study
IN heart valve disease, aortic stenosis, surgical high-risk patients	The Use of transcatheter aortic-valve replacement (TAVI) As Treatment, Acute	Is better Than standard therapy (including balloon aortic valvuloplasty)	To reduce all-cause death at 1 year: 31% TAVI VS 51% standard therapy. Also reduced hospitalizations and cardiac symptoms. Higher incidence of major strokes and vascular complications at 1 month, tought.
N Engl J Med. 2011 Jun 9;364(23):2187-98		Randomized Controlled Trial, Multicenter Study
IN heart valve disease, aortic stenosis, surgical high-risk patients	The Use of transcatheter aortic-valve replacement (TAVI) As Treatment, Acute	Is equal Than surgical aortic-valve replacement	To modify all-cause mortality at 1 year (24% transcatheter VS 27% surgical, p=0.44). At 30 days, major vascular events (inculding stroke) were more frequent with transcatheter (11%) than surgical (3%) method.
Am J Cardiol. 2020 Jan 28. doi: 10.1016/j.amjcard.2020.01.017. [Epub ahead of print]		Meta-Analysis
IN heart valve disease, aortic stenosis, surgical low-risk patients	The Use of transcatheter aortic-valve replacement (TAVI) As Treatment, Acute	Is better Than surgical aortic-valve replacement	To reduce, at 12 months, all-cause mortality (RR: 0.45), life threatening/disabling bleeding (RR: 0.29), acute kidney injury (RR: 0.28) and atrial fibrillation (RR: 0.27). No effect observed (few events) in stroke or myocardial infarction.
Arch Intern Med. 2007 Jan 22;167(2):117-24		Meta-Analysis
IN heart valve disease, mechanical heart valve, atrial fibrillation, coronary disease	The Use of aspirin, added to vitamin K antagonists, warfarin As Treatment, Chronic	Is better Than vitamin K antagonists, warfarin, alone	To reduce arterial thromboembolism, but only in patients with mechanical heart valve (OR 0.27) and not for coronary disease or atrial fibrillation. There was not differences in all-cause mortality and major bleeding was higher (OR 1.43)
N Engl J Med. 2013 Sep 26;369(13):1206-14		Randomized Controlled Trial, Multicenter Study
IN Heart valve disease, mechanical heart valves	The Use of anticoagulants, oral direct thrombin inhibitors, dabigatran, 150, 220, or 300 mg twice daily, based on kidney function As Treatment, Chronic	Is worse Than vitamin K antagonists, warfarin	To modify outcomes: dabigatran increased stroke (5% VS 0% warfarin) and major bleeding (4% VS 2% warfarin). All patients with major bleeding had pericardial bleeding.
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	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)
N Engl J Med. 2023 Mar 5. doi: 10.1056/NEJMoa2300213		Randomized Controlled Trial, Multicenter Study
IN heart valve disease, mitral regurgitation, secondary, moderately severe-to-severe or severe, heart failure	The Use of percutaneous repair, percutaneous implantation of a clip that approximates the mitral leaflets As Treatment, Acute	Is better Than no valve repair, best medical therapy only	To reduce annual rate of hospitalization for heart failure (33% mitraclip VS 57% control) and mortality at 5 years (57% mitraclip VS 67% control)
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
Ann Surg. 2017 Mar 27. doi: 10.1097/SLA.0000000000002243. [Epub ahead of print]		Randomized Controlled Trial, Multicenter Study
IN hernia, inguinal, asymptomatic or minimally symptomatic	The Use of watchful waiting As Treatment, Chronic	Is worse Than elective surgical repair	To modify 4-point pain/discomfort score at 2 years: 0.58 watchful VS 0.35 surgery. 34% watchful patients underwent surgery. 2% had acute hernia complications.
JAMA. 2006 Jan 18;295(3):285-92		Randomized Controlled Trial, Multicenter Study
IN hernia, inguinal, minimally symptomatic	The Use of watchful waiting As Treatment, Chronic	Is equal Than routine surgical repair	To improve pain and discomfort interfering with usual activities at 2 years: 5.1% waiting VS 2.2% repair. 1.8/1000 patients-years in waiting group have incarceration.
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)
N Engl J Med. 2020 Mar 4. doi: 10.1056/NEJMoa1909512. [Epub ahead of print]		Randomized Controlled Trial, Multicenter Study
IN HIV infection, chronic therapy	The Use of monthly (IM) injections of long-acting cabotegravir (HIV-1 integrase strand-transfer inhibitor) plus rilpivirine (nonnucleoside reverse-transcriptase inhibitor) As Treatment, Chronic	Is equal Than daily oral highly active antiretroviral therapy (HAAR), 3 drugs: dolutegravir-abacavir-lamivudine	To achieve viral suppression at 2 years: patients with HIV-1 RNA of less than 50 copies / mL: 94% monthly injections VS 93% oral therapy. Adverse effects of injectable Tt: pain at the injection site, liver toxicity
N Engl J Med. 2020 Mar 4. doi: 10.1056/NEJMoa1904398. [Epub ahead of print]		Randomized Controlled Trial, Multicenter Study
IN HIV infection, chronic therapy	The Use of monthly (IM) injections of long-acting cabotegravir (HIV-1 integrase strand-transfer inhibitor) plus rilpivirine (nonnucleoside reverse-transcriptase inhibitor) As Treatment, Chronic	Is equal Than standard oral oral highly active antiretroviral therapy (HAAR)	To achieve viral suppression at 2 years: patients with HIV-1 RNA of less than 50 copies / mL: 92.5% monthly injections VS 95.5% oral therapy. Adverse effects of injectable Tt: pain at the injection site
N Engl J Med. 2024 Jul 24. doi: 10.1056/NEJMoa2407001. Epub ahead of print.		Randomized Controlled Trial, Multicenter Study
IN HIV infection, drug preexposure prophylaxis, non infected women	The Use of antiviral capside inhibitors, lenacapavir, subcutaneous injection every 6 months As Prevention, Primary	Is better Than daily oral emtricitabine-tenofovir, or no treatment	To avoid acquiring HIV infection: 0% lenacapavir VS 1.7 per 100 person-years emtricitabine-tenofovir VS 2.4 per 100 person-years no treatment
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. 2010 Jul 15;363(3):257-65		Randomized Controlled Trial, Multicenter Study
IN HIV infection, initial therapy	The Use of early initiation of antiretroviral therapy at CD4+ count < 350 and > 200, in asymptomatic patients As Treatment, Chronic	Is better Than late intiation of therapy at CD4+ count < 200	To reduce at 21 months death (1.5% early Tt VS 5.6% late Tt) and cases of active tuberculosis (4.4% early Tt VS 8.8% late Tt)
N Engl J Med. 2009 Apr 30;360(18):1815-26		Cohorts
IN HIV infection, initial therapy	The Use of early initiation of antiretroviral therapy at CD4+ count > 350 or > 500, in asymptomatic patients As Treatment, Chronic	Is better Than deferred therapy until the CD4+ count fell below 350 or 500 cells/mm3	To reduce risk of death at long term (RR is the deferred group 1.69 to 1.94)
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.
N Engl J Med. 2018 Apr 19;378(16):1509-1520 RETRACTED ARTICLE !		Cohorts
IN hypertension, essential	The Use of 24-hour ambulatory blood pressure measure As Prognostic Item	Is better Than blood pressure measured in the clinic	To RETRACTED ARTICLE ! to predict at 5 years all-cause and cardiovascular mortality (HR 1.6 if HTA at 24-hour measure VS HR 1.02 if HTA at clinic measure)
JAMA Cardiol. 2023 Jun 1;8(6):606-611. doi: 10.1001/jamacardio.2023.0720		Systematic Review
IN hypertension, essential	The Use of first line Tt with a single pill containing low doses triple or quadruple combination therapy: As Treatment, Chronic	Is better Than first line Tt using monotherapy or several pills	To obtain a higher proportion of participants achieving BP less than 140/90 mm Hg at 4 to 12 weeks (66% polypill vs 46% usual care) and a greater mean reduction in SBP (mean reduction, -7.4 mm VS monotherapy or usual care)
Lancet. 2021 Sep 18;398(10305):1043-1052. doi: 10.1016/S0140-6736(21)01922-X		Randomized Controlled Trial, Multicenter Study
IN hypertension, essential	The Use of first line Tt with a single pill containing quarter doses quadruple combination therapy: irbesartan at 37,5 mg, amlodipine 1,25 mg, indapamide 0,625 mg, and bisoprolol 2,5 mg As Treatment, Chronic	Is better Than first line Tt using monotherapy with irbesartan 150 mg	To results to obtain
Lancet. 1998 Jun 13;351(9118):1755-62		Randomized Controlled Trial, Multicenter Study
IN hypertension, essential	The Use of intensive blood-pressure control As Treatment, Chronic	Is better Than standar blood-pressure control	To rate of cardiovascular events
Lancet. 2018 Mar 10;391(10124):949-959		Randomized Controlled Trial, Multicenter Study
IN hypertension, essential	The Use of self-monitored blood pressure, with or without telemonitoring As Treatment, Chronic	Is better Than usual care, clinic blood pressure	To achieve lower blood pressure
Eur Heart J. 2019 Oct 22. pii: ehz754. doi: 10.1093/eurheartj/ehz754		Randomized Controlled Trial, Multicenter Study
IN hypertension, essential	The Use of taking hypertension medications at bedtime As Treatment, Chronic	Is better Than taking hypertension medications upon awakening	To improve blood pressure control and reduce cardiovascular events (adjusted HR 0.55), including CVD death, myocardial infarction, heart failure, or stroke
Lancet. 2022 Oct 22;400(10361):1417-1425. doi: 10.1016/S0140-6736(22)01786-X		Randomized Controlled Trial
IN hypertension, essential	The Use of taking hypertension medications in the evening (20:00-00:00 h) As Treatment, Chronic	Is equal Than taking hypertension medications in the morning	To modify at 5 years cardiovascular events (vascular death, myocardial infarction or stroke) : 3.5%, 0.7 events per 100 patient-years
N Engl J Med. 2008 Dec 4;359(23):2417-28		Randomized Controlled Trial, Multicenter Study
IN hypertension, essential, high cardiovascular risk patients	The Use of combination of angiotensin-converting-enzyme (ACE) inhibitor, benazepril, plus a dihydropyridine calcium-channel blocker, amlodipine As Treatment, Chronic	Is better Than combination of an ACE inhibitor plus a thiazide diuretic	To reduce composite major cardivascular events at 3 years: 9.6% ACEI+amlodipine VS 11.8% ACEI+thiazide.
N Engl J Med. 2015 Nov 26;373(22):2103-16		Randomized Controlled Trial, Multicenter Study
IN hypertension, essential, non-diabetic patients	The Use of intensive blood-pressure control: target SBP < 120 mmHg As Treatment, Chronic	Is better Than standard blood-pressure control: target SBP < 140 mmHg	To reduce cardiovascular events (1.65% per year intensive Tt VS 2.2% per year standard Tt) and all-cause mortality (HR 0.73). The reduction in cardiovascular events (including death) was more pronounced in patients > 75 years old (HR 0.67)
Cochrane Database Syst Rev. 2024 Dec 17;12(12):CD011575. doi: 10.1002/14651858.CD011575.pub3		Systematic Review, Cochrane Review
IN hypertension, essential, older adults	The Use of a more intensive blood-pressure control: target SBP < 140 mmHg As Treatment, Chronic	Is better Than usual blood-pressure target in elderly: SBP < 150-160 mmHg	To further reduce, at 2 to 4 years, stroke (RR 1.33) and serious cardiovascular adverse events (RR 1.25), while not increasing withdrawals due to adverse effects (RR 0.99)
J Am Geriatr Soc. 2022 Feb 9. doi: 10.1111/jgs.17684. Epub ahead of print		Meta-Analysis
IN hypertension, essential, older adults	The Use of more intensive hypertension treatment As Treatment, Chronic	Is better Than classical blood pressure control objectives	To prevent 1 stroke for 200 persons (ARR = 0.5%) after 1.7 years receiving more intensive hypertensive treatment
JAMA Netw Open. 2025 May 1;8(5):e2513812. doi: 10.1001/jamanetworkopen.2025.13812		Randomized Controlled Trial, Multicenter Study
IN hypertension, essential, older adults, frail	The Use of taking hypertension medications at bedtime As Treatment, Chronic	Is equal Than taking hypertension medications in the morning	To modify mortality or either hospitalization or emergency department visits for acute cardiovascular events
Cochrane Database Syst Rev. 2022 Nov 18;11(11):CD010315. doi: 10.1002/14651858.CD010315.pub5		Systematic Review, Cochrane Review
IN hypertension, essential, patients with a history of cardiovascular disease	The Use of a more intensive blood-pressure control: target SBP < 135 mmHg As Treatment, Chronic	Is equal Than standard blood pressure targets 140 to 160 mmHg	To modify, at 3.6 years, total or cardiovascular mortality, nor serious adverse events
N Engl J Med. 2021 Nov 5. doi: 10.1056/NEJMoa2110730. Epub ahead of print		Randomized Controlled Trial
IN hypertension, essential, poorly controlled, chronic kidney disease, stage 4	The Use of chlorthalidone, initial dose of 12.5 mg/day, increased every 4 weeks if needed to a maximum dose of 50 mg/day As Treatment, Chronic	Is better Than placebo	To improve systolic blood pressure control: mean between-group difference -10.5 mmHg. HypoK+, reversible increases in serum creatinine, hyperglycemia and hyperuricemia more frequent with chlorthalidone
BMJ. 2009 May 19;338:b1665. doi: 10.1136/bmj.b1665		Meta-Analysis
IN hypertension, primary	The Use of 5 main classes of blood pressure lowering drugs: thiazides, beta blockers, angiotensin converting enzyme inhibitors, angiotensin receptor blockers, and calcium channel blockers As Treatment, Chronic	Is better Than placebo	To Prevent cardiac ischemic events, heart failure and stroke. Beta-blockers prevent better cardiac ischemis events after a myocardial infarction. Calcium antagonist had a marginal advantage for preventing stroke.
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
Ann Intern Med. 2008 Jan 1;148(1):16-29		Systematic Review
IN hypertension, primary	The Use of angiotensin II receptor blockers (ARBs) As Treatment, Chronic	Is equal Than angiotensin converting enzyme (ACE) inhibitors	To control blood pressure and to prevent death, cardiovascular events and kidney and heart disease. ACE inhibitors have higher rates of cough.
Lancet. 2002 Mar 23;359(9311):995-1003		Randomized Controlled Trial, Multicenter Study
IN hypertension, primary	The Use of angiotensin II receptor blockers, losartan As Treatment, Chronic	Is better Than beta blockers, atenolol	To reducing major cardiovascular events (death, myocardial infarction, or stroke): 23.8 per 1000 PYs in intv. / 27.9 per 1000 PYs in cont. Losartan reduces strokes and cardiovascular deaths but not myocardial infarction.
Lancet. 2005 Oct 29-Nov 4;366(9496):1545-53		Meta-Analysis
IN hypertension, primary	The Use of beta blockers As Treatment, Chronic	Is worse Than other first choice antihypertensives	To prevent stroke (RR 16% higher with beta-blockers than other drugs), myocardial infarction or overall mortality (no significant difference in AMI and mortality compared with placebo)
Cochrane Database Syst Rev. 2012 Nov 14;11:CD002003. doi: 10.1002/14651858.CD002003.pub4		Systematic Review, Cochrane Review
IN hypertension, primary	The Use of beta blockers, mainly atenolol As Treatment, Chronic	Is worse Than placebo or other first choice antihypertensives	To modify the risk of total mortality or coronary disease (not different to placebo), stroke (reduced compared to placebo but increased compared to CCB and RAS inhibitors)
Lancet. 2000 Dec 9;356(9246):1949-54		Meta-Analysis
IN hypertension, primary	The Use of calcium channel blockers, first-generation As Treatment, Chronic	Is worse Than diuretics, beta blockers, angiotensin converting enzyme inhibitors, or clonidine	To acute myocardial infarction (OR 1,26 [95% CI 1·11-1·43]), congestive heart failure (OR 1·25 [1·07-1·46]), and major cardiovascular events (OR 1·10 [1·02-1·18])
JAMA. 2002 Dec 18;288(23):2981-97		Randomized Controlled Trial, Multicenter Study
IN hypertension, primary	The Use of diuretics, thiazides, chlortalidone As Treatment, Chronic	Is better Than angiotensin converting enzyme inhibitor (lisinopril), calcium channel blockers (amlodipine)	To prevent cardiovascular events: total and cardiovascular mortality did not differ. Higher rate of heart failure with amlodipine (10.2% vs 7.7% at 6 years). Higher rate of combined cardiovascular events with lisinopril (33.3% vs 30.9%)
J Am Coll Cardiol. 2011 Feb 1;57(5):590-600		Meta-Analysis
IN hypertension, primary	The Use of diuretics, thiazides, hydrochlorothiazide, low dose 12,5 -25mg /day, first line treatment As Treatment, Chronic	Is worse Than diuretics, thiazides, hydrochlorothiazide, higher dose 50 mg /day, or other 1st line anti-hypertensive drugs	To reduce mean blood pressure: 6.5 mmHg systolic /4.5 diastolic with 25 mg/day VS 12.0/5.4 mm Hg reduction with 50 mg/day.
Cochrane Database Syst Rev. 2018 04 18;4(00000):CD001841		Systematic Review, Cochrane Review
IN hypertension, primary	The Use of low-dose thiazide diuretics, angiotensin converting enzyme inhibitors (ACEI), and calcium channel blockers As Treatment, Chronic	Is better Than high-dose thiazide diuretics, beta blockers	To reduce all-cause mortality, stroke and cardiovascular events
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.
Lancet. 2015 Nov 21;386(10008):2059-2068. doi: 10.1016/S0140-6736(15)00257-3		Cross-Over
IN hypertension, primary, drug-resistant, uncontrolled on 3 drugs	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
N Engl J Med. 2008 May 1;358(18):1887-98		Randomized Controlled Trial, Multicenter Study
IN hypertension, primary, elder patients	The Use of diuretic, indapamide, plus, if needed, angiotensin converting enzyme inhibitors (ACEI), perindopril As Treatment, Chronic	Is better Than placebo	To reduce mortality, cardiovascular mortality and stroke (absolute risk reduction not reported in abstract)
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. 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)
Cochrane Database Syst Rev. 2014 Dec 18;2014(12):CD009217. doi: 10.1002/14651858.CD009217.pub3		Systematic Review, Cochrane Review
IN hypertension, primary, or healthy people (normotensive)	The Use of advice on reducing dietary salt As Prevention, Primary	Is better Than no advice on dietary salt	To probably (marginally non-significant) reduce CV events (HTA: RR 0.76 (0.57 to 1.01), normoTA: RR 0.71 (0.42 to 1.20)), CV mortality (HTA: RR 0.67 (0.45 to 1.01)) and all-cause mortality (normoTA: RR 0.67, (0.40 to 1.12)), HTA RR 1.00)
J Am Coll Cardiol. 2005 Mar 1;45(5):712-9		Randomized Controlled Trial, Multicenter Study
IN hypertension, primary, ventricular hypertrophy, atrial fibrillation	The Use of angiotensin II receptor blockers, losartan As Treatment, Chronic	Is better Than beta-blockers	To prevent development of new-onset atrial fibrillation: AF occurred in 6.8/1,000 person-years with losartan VS 10.1 with B-blockers.
N Engl J Med. 2009 Nov 12;361(20):1953-62		Randomized Controlled Trial, Multicenter Study
IN hypertension, secondary, kidney disease, chronic, renal artery stenosis, atherosclerotic	The Use of renal artery revascularization As Treatment, Chronic	Is equal Than medical therapy alone	To modify significantly progression of renal failure, blood pressure, renal events, major cardiovascular events or death. There were aprox 5% of serious complications in the revascularization group.
N Engl J Med. 2014 Jan 2;370(1):13-22		Randomized Controlled Trial, Multicenter Study
IN hypertension, secondary, kidney disease, chronic, renal artery stenosis, atherosclerotic, older patients	The Use of renal artery revascularization, stenting As Treatment, Chronic	Is equal Than medical therapy alone	To modify at 3.5 years death or cardivascular or renal events (myocardial infarction, stroke, heart failure, progressive renal insufficiency, renal-replacement therapy): 35% both treatments. Systolic blood pressure were lower in stenting group
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.
Ann Intern Med. 2006 Dec 19;145(12):901-12. Epub 2006 Oct 24		Systematic Review
IN hypertension, secondary, renal artery stenosis, atherosclerotic	The Use of renal artery revascularization, angioplasty As Treatment, Chronic	Is equal Than aggressive medical therapy	To improve mortality, cardiovascular events, or renal failure, but the evidence found was weak and no study directly compared revascularization with medical Tt.
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
JAMA Intern Med. 2020 Oct 26:e205519. doi: 10.1001/jamainternmed.2020.5519. Online ahead of print		Randomized Controlled Trial
IN hyponatremia, severe, symptomatic	The Use of hypertonic saline in rapid intermittent bolus: 3% saline 2 ml/Kg bolus, repeated at 1, 6, 12, 18 and 24 hours as needed As Treatment, Acute	Is better Than hypertonic 3% saline in slow continuous infusion therapy	To correct natremia at 1 hour (32% bolus VS 18% continuous) while avoiding overcorrection (17% bolus VS 24% continuous)
Cochrane Database Syst Rev. 2007;(3):CD003419		Systematic Review, Cochrane Review
IN hypothyroidism, subclinical	The Use of levothyroxine, L-thyroxine As Treatment, Chronic	Is equal Than placebo or no treatment	To improve symptoms, mood or quality of life. No study assessed mortality. 1 study showed a significant improvement in cognitive function.
N Engl J Med. 2017 06 29;376(26):2534-2544		Randomized Controlled Trial, Multicenter Study
IN hypothyroidism, subclinical, older patients	The Use of levothyroxine, L-thyroxine As Treatment, Chronic	Is equal Than placebo	To improve the Hypothyroid Symptoms score and Tiredness score (range0 to 100, with higher scores indicating more symptoms) at 1 year: mean change +0.2 points both, L-thyroxine and placebo
Cochrane Database Syst Rev. 2019 09 05;9(9):CD001869		Systematic Review, Cochrane Review
IN idiopathic facial paralysis, Bell,s palsy	The Use of combined corticosteroid and antiviral treatment As Treatment, Acute	Is better Than placebo or corticosteroids alone	To reduce patients with long-term sequelae (RR 0.56). The effect of combined therapy compared with corticosteriods alone in recovery at 6 months is not clear.
Pain Physician. 2018 Nov;21(6):559-569		Meta-Analysis
IN idiopathic facial paralysis, Bell,s palsy	The Use of combined corticosteroid and antiviral treatment As Treatment, Acute	Is better Than placebo, or either treatment alone	To achieve full recovery (OR 3.2). Results only significant in network meta-analysis but not in direct meta-analysis
Cochrane Database Syst Rev. 2016 Jul 18;7:CD001942. doi: 10.1002/14651858.CD001942.pub5		Systematic Review, Cochrane Review
IN idiopathic facial paralysis, Bell,s palsy	The Use of corticosteroids As Treatment, Acute	Is better Than placebo or no corticosteroids	To reduce number of patients with incomplete recovery at 6 months: 17% corticosteriods VS 28% 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.
N Engl J Med. 2007 Oct 18;357(16):1598-607		Randomized Controlled Trial, Multicenter Study
IN idiopathic facial paralysis, Bell,s palsy	The Use of corticosteroids, prednisolone, 10 days short course As Treatment, Acute	Is better Than placebo or 10 days acyclovir	To recover facial function at 3 months: 83% prednisolone VS 64% not receiving it.
Lancet Neurol. 2008 Nov;7(11):993-1000		Randomized Controlled Trial
IN idiopathic facial paralysis, Bell,s palsy	The Use of corticosteroids, prednisolone, 10 days short course (60 mg x 5 days and fast reduction) As Treatment, Acute	Is better Than placebo, or 7 days valaciclovir	To shorten the time to complete recovery: times not stated.
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.
Lancet. 2020 Jan 4;395(10217):42-52. doi: 10.1016/S0140-6736(19)32982-4		Randomized Controlled Trial, Multicenter Study
IN influenza, adults, children, primary care, older patients	The Use of oseltamivir plus usual care As Treatment, Acute	Is better Than usual care alone	To improve time to recovery (return to usual activities): overall 1 day shorter, increasing up to 3 days shorter in patients > 65 years who had more severe illness, comorbidities, and longer previous illness duration
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
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. 2025 Feb 27;2(2):CD005187. doi: 10.1002/14651858.CD005187.pub6		Systematic Review, Cochrane Review
IN influenza, adults, older patients living in institutions	The Use of programs favoring influenza vaccination of healthcare workers As Prevention, Primary	Is equal Than no programs and spontaneous vaccination of professionnals	To modify the incidence of influenza, lower respiratory tract infection, admission to hospital for respiratory illness or death from respiratory illness. However, it was associated with a reduction of all-cause mortality (RR 0.69)
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.
Thorax. 2024 Dec 25:thorax-2024-222636. doi: 10.1136/thorax-2024-222636. Epub ahead of print		Systematic Review
IN interstitial lung disease, non-idiopathic pulmonary fibrosis, acute exacerbation	The Use of high-dose corticosteroid therapy (>1.0 mg/kg prednisolone), with early tapering (>10% reduction within 2 weeks) As Treatment, Acute	Is better Than placebo or no corticosteroid treatment	To reduce mortality at 3 months (HR HR 0.22). Early tapering of corticosteroids reduced in-hospital mortality
N Engl J Med. 2025 May 19. doi: 10.1056/NEJMoa2503643. Epub ahead of print		Randomized Controlled Trial, Multicenter Study
IN interstitial lung disease, non-idiopathic pulmonary fibrosis, progressive pulmonary fibrosis	The Use of phosphodiesterase 4B inhibitor with antifibrotic properties: nerandomilast, 9 or 18 mg twice daily PO As Treatment, Chronic	Is better Than placebo	To reduce rate of FVC decrease at 1 year: -99 to -85 ml nerando. VS -166 ml placebo. Also reduced all-cause mortality: 6 to 8% nerando VS 13% placebo. Frequent diarrhea: 37% of patients
N Engl J Med. 1999 Jul 15;341(3):137-41		Randomized Controlled Trial
IN intestinal obstruction, paralytic ileus, colonic pseudo-obstruction, Ogilvie syndrome	The Use of neostigmine, 2 mg IV As Treatment, Acute	Is better Than placebo	To induce clinical response, with passage of flatus or stool, and reduce abdominal distention
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
Gut. 2022 Apr 28:gutjnl-2021-325821. doi: 10.1136/gutjnl-2021-325821		Randomized Controlled Trial, Multicenter Study
IN irritable bowel syndrome, primary care	The Use of a low fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP) diet As Treatment, Chronic	Is better Than musculotropic spasmolytics (eg, otilonium bromide)	To improve a 6 months IBS Symptom Severity Score and the proportion of responders (improvement ≥50 points): 71% FODMAP diet VS 61% spasmolytics
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 ?
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)
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
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)
N Engl J Med. 2021 Nov 5. doi: 10.1056/NEJMoa2113380. Epub ahead of print		Randomized Controlled Trial, Multicenter Study
IN kidney disease, chronic, associated anemia, erythropoiesis-stimulating agents	The Use of erythropoiesis-stimulating agents, oral, hypoxia-inducible factor prolyl hydroxylase inhibitors, daprodustat As Treatment, Chronic	Is equal Than subcutaneous darbepoetin alfa	To reduce at 2 years major cardiovascular events: 19% in both groups. Similar increases in Hgb levels too: +0.7 g/dL
Cochrane Database Syst Rev. 2007;(4):CD002181		Systematic Review, Cochrane Review
IN kidney disease, chronic, diabetic	The Use of low protein diet (ranging from 0.7 to 1.1 g/kg/day) As Treatment, Chronic	Is better Than usual protein diet	To possibly slightly slow progression to renal failure but not statistically significantly so.
Ann Intern Med. 1996 Apr 1;124(7):627-32		Meta-Analysis
IN kidney disease, chronic, diabetic and non diabetic	The Use of low protein diet As Treatment, Chronic	Is better Than usual protein diet	To reduce the risk for renal failure or death (RR 0.67)
Cochrane Database Syst Rev. 2006 Apr 19;(2):CD001892		Randomized Controlled Trial
IN kidney disease, chronic, diabetic and non diabetic	The Use of low protein diet As Treatment, Chronic	Is better Than usual protein diet	To reduce mortality of renal cause: 13.5% lox protein VS 19.4% usual or high protein.
N Engl J Med. 1994 Mar 31;330(13):877-84		Randomized Controlled Trial, Multicenter Study
IN kidney disease, chronic, diabetic and non diabetic	The Use of low protein diet (0.58 g/Kg/day) or very low protein diet As Treatment, Chronic	Is equal Than usual protein diet	To slow decline in renal function over time
Lancet. 2008 Aug 16;372(9638):547-53		Randomized Controlled Trial, Multicenter Study
IN kidney disease, chronic, diabetic, atherosclerose	The Use of combination of angiotensin converting enzyme inhibitor (ACEI, ramipril) plus angiotensin II receptor blockers (ARB, telmisartan) As Prevention, Primary	Is worse Than either angiotensin converting enzyme inhibitor (ACEI) or angiotensin II receptor blockers (ARB) alone	To reduce the development of new renal failure or death in these high-risk patients: 14.5% combined ACEI+ARB versus 13.5% either ACEI or ARB alone
Kidney Int. 2025 Jun;107(6):1076-1087. doi: 10.1016/j.kint.2025.02.025		Cohorts
IN kidney disease, chronic, eGFR threshold definition, older patients, european, healthy aging, eGFR reference values	The Use of appropriate, age-adjusted, reference values for estimated glomerular filtration rate (eGFR) As Diagnostic Tool	Is better Than applying the same eGFR reference values to all adult patients, yong and older	To more accurately determine abnormal and normal kidney function in older patients: in men/women aged 80 years old, the 5th, 50th and 95th eGFR percentiles were 49/46, 66/63 and 84/81 ml/min per 1.73 m2
Ann Intern Med. 2006 Aug 15;145(4):247-54		Cohorts
IN kidney disease, chronic, glomerular filtration estimation	The Use of 4-variable Modification of Diet in Renal Disease (MDRD) equation As Diagnostic Tool	Is better Than Cockcroft-Gault equation	To estimate measured (125I-iothalamate) glomerular filtration rate with less than 30% error: 90% MDRD VS 60% Cockcroft VS 83% corrected Cockcroft
N Engl J Med. 2013 Sep 5;369(10):932-43		Meta-Analysis
IN kidney disease, chronic, glomerular filtration estimation	The Use of cystatin C, alone or added to creatinine, to estimate glomerular filtration rate As Diagnostic Tool	Is better Than creatinine alone	To better predict risk of death or end-stage renal disease. More patients had an estimated GFR < 60 ml/min using cystatine than using creatinine (13.7% vs. 9.7%)
J Am Soc Nephrol. 2005 Feb;16(2):459-66		Cohorts
IN kidney disease, chronic, glomerular filtration estimation	The Use of Modification of Diet in Renal Disease (MDRD) equation As Diagnostic Tool	Is better Than Cockcroft-Gault equation	To estimate measured (125I-iothalamate) glomerular filtration rate with less than 30% error: 71% MDRD equation VS 60% Cockcroft
Clin J Am Soc Nephrol. 2009 May;4(5):899-906		Cohorts
IN kidney disease, chronic, glomerular filtration estimation	The Use of Modification of Diet in Renal Disease (MDRD) equation As Diagnostic Tool	Is equal Than Cockcroft-Gault equation	To estimate measured (inuline) glomerular filtration rate rate with less than 30% error: 69% MDRD equation VS 71% Cockcroft
J Am Geriatr Soc. 2009 Sep;57(9):1638-43		Diagnostic
IN kidney disease, chronic, glomerular filtration estimation, elderly patients	The Use of Cockcroft-Gault equation As Diagnostic Tool	Is better Than Modification of Diet in Renal Disease (MDRD) equation	To estimate measured 24-hour creatinine clearance (CrCl): Cockcroft slightly underestimates CrCl, and MDRD strongly overestimates it.
J Nephrol. 2010 May-Jun;23(3):306-13		Diagnostic
IN kidney disease, chronic, glomerular filtration estimation, elderly patients	The Use of measured 24-hour creatinine clearance, Modification of Diet in Renal Disease (MDRD) equation, Mayo Clinic quadratic equation As Diagnostic Tool	Is bad Than no gold standard comparison done	To accurately estimate glomerular filtration rate: values derived by MDRD and MCQ equations and CrCl significantly differed from each other in patients > 85 years.
Age Ageing. 2010 Sep;39(5):542-8		Systematic Review
IN kidney disease, chronic, glomerular filtration estimation, elderly patients	The Use of Modification of Diet in Renal Disease (MDRD) equation As Diagnostic Tool	Is equal Than Cockcroft-Gault equation, serum cystatin C	To accurately estimate (measured by a standard) glomerular fiiltration rate. All 3 methods better than serum creatinine alone, or than other equations.
Nephron Clin Pract. 2005;101(1):c1-8		Diagnostic
IN kidney disease, chronic, glomerular filtration estimation, elderly patients	The Use of Modification of Diet in Renal Disease (MDRD) equation As Diagnostic Tool	Is better Than Cockcroft-Gault or Baracskay equations	To accurately estimated (inulin measured) glomerular filtration rate. All equation had low accuracy and precision and underestimated actual FGR, the MDRD the less. All did better, however, than using serum creatinine alone.
J Am Geriatr Soc. 2003 Jul;51(7):1012-7		Diagnostic
IN kidney disease, chronic, glomerular filtration estimation, elderly patients	The Use of Modification of Diet in Renal Disease (MDRD) equation As Diagnostic Tool	Is equal Than Cockcroft-Gault or Baracskay equations	To accurately estimate (51Cromium-EDTA measured) glomerular filtration rate. MDRD was more accurate but Cockcroft was more precise and overall performance was similar for both
Am J Kidney Dis. 2005 Aug;46(2):242-52		Diagnostic
IN kidney disease, chronic, glomerular filtration estimation, ill hospitalized patients	The Use of 6-variable Modification of Diet in Renal Disease (MDRD) equation As Diagnostic Tool	Is better Than Cockcroft-Gault equation	To estimate measured (125I-iothalamate) glomerular filtration rate with less than 50% error: 55% MDRD equation VS 40% Cockcroft. However, overall accuracy and precission of both equations in ill hospitalized patients was poor
Ann Intern Med. 2001 Jul 17;135(2):73-87		Meta-Analysis
IN kidney disease, chronic, non diabetic	The Use of angiotensin converting enzyme inhibitors (ACEI) As Treatment, Chronic	Is better Than antihypertensive regimens not including ACEI	To reduce progression to end-stage renal failure (RR 0.7). The higher the uninary protein excrection, the higher the benefit.
Lancet. 1999 Jul 31;354(9176):359-64		Randomized Controlled Trial
IN kidney disease, chronic, non diabetic	The Use of angiotensin converting enzyme inhibitors (ACEI), ramipril As Treatment, Chronic	Is better Than placebo plus conventional antihypertensive therapy	To reduce progression to end-stage renal failure: 9% ACEI VS 20% controls
Lancet. 2003 Jan 11;361(9352):117-24		Randomized Controlled Trial
IN kidney disease, chronic, non diabetic	The Use of combination of angiotensin converting enzyme inhibitor (trandolapril) plus angiotensin II receptor blockers (losartan) As Treatment, Chronic	Is better Than monotherapy with either of both drugs. No comparison with placebo, however.	To reducing combined endpoint of doubling of serum creatinine concentration or end-stage renal disease (11% combined Tt / 23% both monotherapies)
N Engl J Med. 2006 Jan 12;354(2):131-40		Randomized Controlled Trial
IN kidney disease, chronic, non diabetic, severe	The Use of angiotensin converting enzyme inhibitor, benazepril (20 mg/d) As Treatment, Chronic	Is better Than placebo	To reduce progession (doubling initial creatinine or end-stage renal failure) at 3.4 years: 60% with placebo VS 41% using benazepril. Hypertension control was similar, proteinuria was reduced
N Engl J Med. 2020 10 08;383(15):1436-1446		Randomized Controlled Trial, Multicenter Study
IN kidney disease, chronic, renal failure, mild, stage 3, diabetic and not diabetic	The Use of renal sodium-glucose cotransporter inhibitor, gliflozins, dapagliflozin, 10 mg/d As Treatment, Chronic	Is better Than placebo	To reduce at 2.4 years a composite progression of renal failure or death (9% gliflozin VS 14.5% placebo) and reduce death (5% gliflozin VS 7% placebo)
N Engl J Med. 2025 Jun 5. doi: 10.1056/NEJMoa2410659. Epub ahead of print		Randomized Controlled Trial, Multicenter Study
IN kidney disease, chronic, renal failure, mild, stages 2-3, diabetes, type 2	The Use of a combination of finerenone 10 or 20 mg / day (mineralocorticoid receptor antagonist) and empagliflozin 10 mg / day (SGLT2 inhibitor), on top of a renin-angiotensin system inhibitor As Treatment, Chronic	Is better Than either finerenone or empagliflozin alone	To reduce the urinary albumin-to-creatinine ratio at 6 months: ratio was 30% lower with combined treatment than with finerenone or empagli alone. No difference in adverse events incidence
Ann Intern Med. 2024 Aug 20. doi: 10.7326/M23-3028. Epub ahead of print		Cohorts
IN kidney disease, chronic, renal failure, very severe, stage 5, estimated glomerular filtration rate < 12 mL/min older patients	The Use of dialysis As Treatment, Chronic	Is equal Than conventional medical management	To modify survival at 3 years (mean survival 770 days dialysis VS 761 days medical, p NS). If late start of dialysis totally excluded, medical group lived 78 fewer days, but stayed more days at home
Arch Intern Med. 2011 Mar 14;171(5):396-403		Cohorts
IN kidney disease, chronic, renal failure, very severe, stage 5, fit patients	The Use of early start of hemodialysis, with estimated glomerular filtration rate > 10 mL/min/1.73 m(2) As Treatment, Chronic	Is worse Than later start of hemodialysis, with estimated glomerular filtration rate < 10 mL/min/1.73 m(2)	To modify death at 1 year: HR for death was 1.5 to 2.2 in patients with GFR > 10 mL/min
Ann Intern Med. 2008 Jan 1;148(1):30-48		Meta-Analysis
IN kidney disease, chronic, with proteinuria, diabetic and non diabetic	The Use of combination of an angiotensin converting-enzyme (ACE) inhibitor AND an angiotensin II-receptor blocker (ARB) As Treatment, Chronic	Is better Than either ACE inhibitor or ARBs alone	To further reduced proteinuria at 6 to 12 months: ratio of means for combination therapy 0.76. When compared, ARBs and ACE inhibitors reduced proteinuria to a similar degree.
J Am Soc Nephrol. 2007 Jun;18(6):1889-1898. Epub 2007 May 9		Randomized Controlled Trial
IN kidney disease, chronic, with proteinuria, non diabetic	The Use of uptitration to maximal doses of angiotensin converting enzyme inhibitors (ACEI, benazepril ) or angiotensin II receptor blockers (ARB, losartan) As Treatment, Chronic	Is better Than usual doses of both drugs	To reduce, at 3.7 years, doubling creatinine or end-stage renal failure.
Ann Emerg Med. 2001 Jan;37(1):75-87		Review (Narrative)
IN knowledge transfer, graphics use	The Use of depiction of by-subject data, signification of pairing when present, symbols to identify relevant subgroups and small multiples (an array of similar graphics each depicting one group) As Methodology procedure	Is useful Than not using them	To provide the reader with optimum access to the relevant aspects of the data when presenting experimental data.
JAMA. 2008 Sep 10;300(10):1181-96		Meta-Analysis
IN knowledge transfer, internet use	The Use of internet based learning As Undefined	Is equal Than traditional learning methods	To improve or increase knowledge, skills and behaviours. Non-significant effect or small effect compared to traditional non-internet methods, but large effect size compared with no intervention.
Proc Natl Acad Sci U S A. 2014 Jun 10;111(23):8410-5		Meta-Analysis
IN learning, teaching, pedagogy	The Use of active learning techniques: group problem-solving, worksheets or tutorials completed during class, use of personal response systems with or without peer instruction, and studio or workshop course designs As Treatment, Acute	Is better Than lecturing, pasive learning	To increase student performance on examinations (by 0.5 SD in avarage) and reduce failure rates (RR 1.5 for failing in exam with lecturing)
Cogn Res Princ Implic. 2024 Jul 6;9(1):44. doi: 10.1186/s41235-024-00567-5		Cohorts
IN learning, teaching, pedagogy, cognition	The Use of only studying techniques supported by cognitive research: high elaborative study (monitoring comprehension, association, processing) and retrieval practice (self-assessment) As Methodology procedure	Is better Than other common, but low elaboration, studying techniques: rereading, highlighting-copying, rote learning	To obtain better academic results and have more positive attitudes toward learning
N Engl J Med. 2025 Jun 15. doi: 10.1056/NEJMoa2504341. Epub ahead of print		Randomized Controlled Trial, Multicenter Study
IN leukemia, chronic lymphocytic leukemia	The Use of a combination of: B-cell lymphoma 2 (BCL2) inhibitor venetoclax + ibrutinib, Bruton tyrosine kinase (BTK) inhibitor, guided by measurable residual disease in bone marrow As Treatment, Acute	Is better Than ibrutinib alone, or chemoimmunotherapy (fludarabine + cyclophosphamide + anti-CD20 antibody rituximab	To improve, at 5 years, survival (95% ibrut+veneto VS 90% ibrut alone) and progression-free survival (94% ibrut+veneto VS 79% ibrut VS 58% FCR)
N Engl J Med. 2015 Dec 17;373(25):2425-37		Randomized Controlled Trial, Multicenter Study
IN leukemia, chronic lymphocytic leukemia	The Use of ibrutinib, Bruton tyrosine kinase (BTK) inhibitor As Treatment, Chronic	Is better Than chlorambucil	To improve progression-free survival (median, not reached with ibrutinib vs. 18.9 months chlorambucil) and improve survival at 2 years (98% ibrutinib VS 85% chlorambucil)
N Engl J Med. 2006 Dec 7;355(23):2408-17		Randomized Controlled Trial
IN leukemia, chronic myeloid leukemia	The Use of imatinib, BCR-ABL tyrosine kinase inhibitor As Treatment, Chronic	Is better Than interferon alfa plus cytarabine	To improve survival at 5 years: 89% with imatinib VS ? with interferon plus cytarabine.
Arch Intern Med. 2000 Jun 12;160(11):1621-1628		Cohorts
IN lifestyle and habits	The Use of physical activity As Prevention, Primary	Is better Than being sedentary	To reduce all-cause mortality
JAMA Netw Open. 2022 Mar 1;5(3):e223849. doi: 10.1001/jamanetworkopen.2022.3849		Cohorts
IN lifestyle and habits, alcohol	The Use of any alcohol comsumption, even light As Etiologic risk factor	Is worse Than no alcohol intake at all	To increase risk of hypertension and coronary artery disease
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)
Nat Commun. 2022 Mar 4;13(1):1175. doi: 10.1038/s41467-022-28735-5		Cross-Over
IN lifestyle and habits, alcohol	The Use of very low alcohol comsumption : just 1 to 2 units/day (1 unit = 10 ml = 8 g of alcohol) As Etiologic risk factor	Is worse Than no alcohol intake at all	To any alcohol comsumption have a negative correlation with total and regional (frontal, parietal) gray and white matter in the brain at MRI, which increases exponentially with the level of comsumption
Lancet. 2018 04 14;391(10129):1513-1523		Meta-Analysis
IN lifestyle and habits, alcohol	The Use of very low alcohol consumtion, 100 g per week of alcohol (12·5 units per week) or lower As Etiologic risk factor	Is better Than higher alcohol consumtion or no alcohol intake	To associate a lower all-cause mortality. no association, however, with reduced cardiovascular mortality
J Gen Intern Med. 2008 Jun;23(6):723-6		Cohorts
IN lifestyle and habits, cognitive abilities, health literacy	The Use of low health literacy, low cognitive abilities (delayed recall of 3 items and inability to serial subtract numbers) As Prognostic Item	Is useful Than no comparison	To predict overall mortality: low health literacy HR 1.5, low cognitive capacity HR 1.74,
J Clin Epidemiol. 1999 Apr;52(4):329-35		Randomized Controlled Trial
IN lifestyle and habits, diet	The Use of frequent salad vegetable consumption As -	Is good Than -	To reduce risk of developping diabetes of type 2
Am J Clin Nutr. 2008 Apr;87(4):964-9		Cohorts
IN lifestyle and habits, diet	The Use of frequent egg consumption (> 7 eggs/week) As Etiologic risk factor	Is worse Than less frequent eggs consumption	To the risk of death, which is increased to HR 1.23. But egg consumption was not associated to the risk of myocardial infarction or stroke.
JAMA. 2019 03 19;321(11):1081-1095		Cohorts
IN lifestyle and habits, diet	The Use of higher dietary egg or cholesterol comsumption As Etiologic risk factor	Is worse Than les frequent egg or cholesterol comsumption	To increase, at 17.5 years, the risk of cardiovascular disease (ARD +3% for each additionnal 300 mg of cholesterol) or death (ARD +4%). Risk associated with eggs was no more significant after adjusting for total cholesterol daily intake
BMJ. 2023 Mar 29;380:e072003. doi: 10.1136/bmj-2022-072003		Systematic Review
IN lifestyle and habits, diet	The Use of mediterranean dietary programmes (and with some less effect, low fat diets) As Prevention, Primary	Is better Than minimal or no intervention, or modified fat, Ornish or Pritikin diats	To reduce overall mortality (OR 0.72, 1.7% less death in 5 years in patients at intermediate risk), cardiovascular mortality (OR 0.55), stroke (OR 0.65) and myocardial infarction
BMJ. 1996 Sep 28;313(7060):775-9		Cohorts
IN lifestyle and habits, diet	The Use of vegetarian diet As Prognostic Item	Is better Than usual occidental diet	To reduce overall mortality
Epidemiology. 1992 Sep;3(5):395-401		Cohorts
IN lifestyle and habits, diet	The Use of vegetarian diet As Prognostic Item	Is better Than usual occidental diet	To reduce overall mortality
Public Health Nutr. 1998 Mar;1(1):33-41		Meta-Analysis
IN lifestyle and habits, diet	The Use of vegetarian diet As Prognostic Item	Is better Than usual occidental diet	To reduce cardiovascular mortality
BMJ. 1994 Jun 25;308(6945):1667-70		Cohorts
IN lifestyle and habits, diet	The Use of vegetarian diet As Prognostic Item	Is better Than usual occidental diet	To reduce mortality due to ischemic heart disease or cancer
N Engl J Med. 2021 Sep 16;385(12):1067-1077. doi: 10.1056/NEJMoa2105675		Randomized Controlled Trial, Multicenter Study
IN lifestyle and habits, diet, 60 years of age or older, hypertension, or history of stroke	The Use of potassium-enriched salt, using a salt substitute (75% sodium chloride and 25% potassium chloride by mass) As Treatment, Chronic	Is better Than regular sodium salt	To reduce, at 4,7 years, stroke (2.9 VS 3.4 per 100 patients/year), cardiovascular events (4.9 VS 5.6 per 100 patients/year) and all-cause death (3.9 VS 4.5 per 100 patients/year)
JAMA Intern Med. 2015 May;175(5):755-66		Cohorts
IN lifestyle and habits, diet, cardiovascular death	The Use of frequent nut consumption, particularly peanuts As Etiologic risk factor	Is useful Than no such consumption	To reduce, after adjustement, overall mortality (HR 0.80) and specially cardiovascular mortality
Nat Med. 2025 May;31(5):1644-1652. doi: 10.1038/s41591-025-03570-5		Cohorts
IN lifestyle and habits, diet, healthy aging	The Use of Higher intakes of fruits, vegetables, whole grains, unsaturated fats, nuts, legumes and low-fat dairy products As Prevention, Primary	Is better Than higher intakes of trans fats, sodium, sugary beverages and red or processed meats (or both)	To achieve healthy aging at 70 or 75 years old (only 9% of the whole cohort): OR 1.45 to 1.86 for achieving healthy aging free from 11 frequent chronic diseases
Am J Clin Nutr. 2006 Jun;83(6):1289-96		Randomized Controlled Trial
IN lifestyle and habits, diet, older patients	The Use of potassium-enriched salt As Treatment, Chronic	Is better Than regular sodium salt	To reduce cardivascular mortality: 13.1 per 1000 persons/year with potassium salt VS 20.5 per 1000 with regular salt
Br J Sports Med. 2022 Jul 10:bjsports-2021-105195. doi: 10.1136/bjsports-2021-105195		Cohorts
IN lifestyle and habits, exercise, diet, overall mortality, cardiovascular mortality	The Use of moderate to vigorous physical activity, and better quality diet index, but with no additive or multiplicative interactions between both As Prevention, Primary	Is better Than lower physical activity, worse quality diet or both	To reduce cardiovascular mortality (exercise HR 0.85 to 0.95), all-cause mortality (exercise HR 0.87 to 0.91) and related cancer mortality (exercise HR 0.86 to 0.94, diet HR 0.86)
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)
Br J Sports Med. 2020 Dec;54(24):1499-1506. doi: 10.1136/bjsports-2020-103270		Meta-Analysis
IN lifestyle and habits, exercise, overall mortality	The Use of 30-40 mins of moderate-to-vigorous intensity physical activity / day As Prevention, Primary	Is better Than lower time of physical activity	To attenuate the association between sedentary time and risk of death. People in the lowest tier of physical activity has a greater risk of all-cause death: from a RR 1.65 if the lower sitting time tier to RR 2.65 in the hihgest sitting time tier.
JAMA. 2020 Mar 24;323(12):1151-1160. doi: 10.1001/jama.2020.1382		Cohorts
IN lifestyle and habits, exercise, overall mortality	The Use of taking more steps everyday, more than 8 000 steps/day As Prevention, Primary	Is better Than taking less steps everyday	To reduce all-cause mortality at 10 years: 77 per 1000 person-years if < 4000 steps/d VS 21/1000 if 4000 to 7999 steps/d VS 7/1000 if 8000 to 11 999 steps/d VS 5/1000 if more than 12 000 steps/d
J Am Coll Cardiol. 2008 Dec 16;52(25):2156-62		Cohorts
IN lifestyle and habits, mind-body relations, stress, coronary disease, cardiovascular death	The Use of psychological distress As Etiologic risk factor	Is useful Than no comparison here	To identify patients with higher risk of cardiovascular events (HR 1.54 if psych distress) Most of the increased risk was explained by behavior: those patients had more cigarrette smoking, alcohol intake, less activity.
BMJ. 1999 Aug 21;319(7208):478-83		Cohorts
IN lifestyle and habits, psycho-somatic disorders	The Use of regular exercise, social activity, productive activities As Prevention, Primary	Is better Than no doing so	To improve survival
Nicotine Tob Res. 2025 Mar 15:ntaf067. doi: 10.1093/ntr/ntaf067. Epub ahead of print		Cohorts
IN lifestyle and habits, tobacco, e-cigarette, chronic obstructive pulmonary disease, hypertension	The Use of exclusive e-cigarette use, or dual use with combustible cigarettes As Etiologic risk factor	Is worse Than no use of any kind of cigarettes	To increase the risk of developping CPOD (HR 2.3, all ages) or hypertension (HR 1.4, if age 30 to 70). Dual use was associated with higher risks than exclusive e-cigarette use but lower than only combustible cigarette use
Health Technol Assess. 2010 Mar;14(14):1-210, iii-iv		Randomized Controlled Trial, Multicenter Study
IN limb ischaemia, acute, severe, infrainguinal disease	The Use of early bypass As Treatment, Acute	Is better Than early angioplasty	To improve late survival without amputation at periods of more than 2 years (HR 0.85). Bypass carried more morbidity in the first 1 month but less reinterventions afterwards.
Gastroenterology. 1996 Oct;111(4):1002-10		Randomized Controlled Trial
IN liver failure, chronic, cirrhosis, ascitis	The Use of dextran 70 or polygeline as plasma expanders in total paracentesis As Treatment, Acute	Is worse Than albumine	To avoid reactive increase in plasma renin (34% dextran, 38% polygeline, 18.5% albumin)
N Engl J Med. 2000 Jun 8;342(23):1701-7		Randomized Controlled Trial
IN liver failure, chronic, cirrhosis, ascitis, refractory	The Use of paracentesis, shunt porto-cava transyugular As Treatment, Chronic	Is better Than repeated large-volume paracentesis	To reduce recurrent ascitis and possibly to increase survival.
Radiology. 2008 Jul;248(1):132-9		Diagnostic
IN liver failure, chronic, cirrhosis, esophageal varices	The Use of duplex Doppler ultrasound measuring splenoportal index (SPI): splenic index divided by mean portal vein velocity As Diagnostic Tool	Is good Than screening endoscopy as gold standard	To predict the presence or absence of esophageal varices: 91% positive predictive value, 94% negative predictive value.
Hepatology. 1999 Jun;29(6):1655-61		Meta-Analysis
IN liver failure, chronic, cirrhosis, hospitalized by gastrointestinal bleeding, spontaneous bacterial peritonitis prevention	The Use of short-term (7-10 days) antibiotic prophylaxis As -	Is better Than placebo or no treatment	To reduce any infection (RRR 32%) and improve survival (RRR 9%)
Gastroenterology. 2007 Sep;133(3):818-24		Randomized Controlled Trial
IN liver failure, chronic, cirrhosis, severe (Child C), spontaneous bacterial peritonitis	The Use of fluoroquinolones, norfloxacin As Prevention, Primary	Is better Than placebo	To reduce at 1 year spontaneous bacterial peritonitis (7% norfloxacine vs 61% placebo), hepatorenal syndrome (28% norfloxacine vs 41% placebo) and death (40% norfloxacine VS 52% placebo)
Aliment Pharmacol Ther. 2006 Jan 1;23(1):75-84		Randomized Controlled Trial
IN liver failure, chronic, cirrhosis, spontaneous bacterial peritonitis	The Use of fluoroquinolones, ciprofloxacin (initially IV but soon PO) As Treatment, Acute	Is equal Than cephalosporins, ceftazidime IV	To resolve peritonitis: 80% with cipro. VS 84% with cefta. Patients on cipro. could be discharged from hospital sooner.
J Hepatol. 1998 Sep;29(3):430-6		Randomized Controlled Trial
IN liver failure, chronic, cirrhosis, spontaneous bacterial peritonitis	The Use of fluoroquinolones, norfloxacin (400 mg/d) As Treatment, Chronic	Is better Than placebo	To reduce, at 6 months, spontaneous peritonitis: 2% with norfloxacin VS 17% placebo
N Engl J Med. 2010 Mar 25;362(12):1071-81		Randomized Controlled Trial
IN liver failure, chronic, portal hypertension, hepatic encephalopathy	The Use of minimally absorbed antibiotics, rifaximin 550 mg twice daily As Treatment, Chronic	Is better Than placebo	To reduce recurrence of encephalopathy at 6 months: 22% rifaximin VS 46% placebo. Similar incidence of adverse events.
Arthritis Rheum. 2002 Aug;46(8):2121-31		Randomized Controlled Trial, Multicenter Study
IN lupus, systemic, with renal involvement, proliferative nephritis	The Use of low-dose IV cyclophosphamide (cumulative dose 3 gm), followed by azathioprine As Treatment, Acute	Is equal Than high-dose IV cyclophosphamide, followed by azathioprine	To reduce treatment failure at 40 months: 16% low-dose VS 20% high-dose (p NS). Renal remission achieved in 71% low-dose and 54% high-dose (p NS).
J Am Soc Nephrol. 2009 May;20(5):1103-12		Randomized Controlled Trial, Multicenter Study
IN lupus, systemic, with renal involvement, proliferative nephritis	The Use of mycophenolate mofetil, target dose 3 g/d As Treatment, Acute	Is equal Than high-dose IV cyclophosphamide, 0.5 to 1.0 g/m(2) in monthly pulses	To improve at 6 months clinical response: 56% mycophenolate VS 53% cyclophosphamide
N Engl J Med. 1996 Jul 11;335(2):76-83		Randomized Controlled Trial
IN malaria, plasmodium falciparum, severe	The Use of artemether, artesunate, intramuscular As Treatment, Acute	Is equal Than quinine, intramuscular	To reduce mortality (13% artemether VS 17% quinine, p NS), reduce coma duration or reduce hospital stay.
Lancet. 2005 Aug 27-Sep 2;366(9487):717-25		Randomized Controlled Trial, Multicenter Study
IN malaria, plasmodium falciparum, severe	The Use of artesunate, intravenous (2.4 mg/kg as a bolus at 0, 12, and 24 h) As Treatment, Acute	Is better Than intravenous quinine (20 mg salt /kg loading dose over 4 h, then 10 mg/kg /8h over 2-8 h)	To reduce mortality (15% artesunate VS 22% quinine) while having a better tolerance (hypoglycaemia with quinidine, RR 3.2)
Lancet. 2023 Feb 18;401(10376):568-576. doi: 10.1016/S0140-6736(22)02469-2		Randomized Controlled Trial, Multicenter Study
IN malnutrition, critically ill patients at risk of	The Use of high-dose protein (≥2·2 g/kg per day) As Treatment, Acute	Is worse Than usual dose protein (≤1·2 g/kg per day)	To be alive at hospital discharge: 46% high-dose VS 50% usual-dose. Higher protein provision was particularly harmful in patients with acute kidney injury and higher organ failure scores
Cochrane Database Syst Rev. 2009;(2):CD003288		Systematic Review, Cochrane Review
IN malnutrition, older people at risk	The Use of nutritional supplements, extra protein and energy apports As Prevention, Primary	Is better Than placebo	To gain weight (just +2.2% weighted mean difference) and reduce mortality in undernourished patients (RR 0.79) but not in all patients.
Am J Med. 2006 Aug;119(8):693-9		Randomized Controlled Trial
IN malnutrition, older people during acute illness	The Use of oral nutritional supplements (per day: 400 ml, extra 995 kcal, 100% reference vitamins and minerals) As Treatment, Acute	Is better Than usual hospital diet alone, plus placebo	To slightly reduce hospital stay (9.4 days suplement VS 10.1 days placebo), and reduce at 6 months non-elective readmissions (29% suplement VS 40% placebo), but trend to higher mortality at 6 months.
J Am Geriatr Soc . 2024 Jul;72(7):2206-2218. doi: 10.1111/jgs.18799. Epub 2024 Feb		Systematic Review
IN malnutrition, sarcopenia, older patients, hospitalized	The Use of longuer (>2 weeks) high-protein supplementation As Treatment, Acute	Is better Than shorter supplementation, or carbohydrate supplementation	To improve lean mass, body mass index, triceps skinfold, and mid-upper arm circumference. And possibly to improve physical function (only 1 study) and cognition (2 studies)
N Engl J Med. 2013 Jan 31;368(5):425-35		Randomized Controlled Trial, Multicenter Study
IN malnutrition, severe, children	The Use of antibiotics, amoxicillin or cefdinir for 7 days, in addition to ready-to-use therapeutic food As Treatment, Acute	Is better Than placebo	To improve recovery from malnutrition (89% with amox VS 85% control) and reduce mortality (5% amox VS 7.4% control)
JAMA. 2000 Sep 13;284(10):1256-62		Cohorts
IN medical career, coronary disease, acute coronary syndrome, acute myocardial infarction	The Use of admission to teaching hospital As Etiologic risk factor	Is better Than admission to non-teaching hospital	To better quality of care (based on 3 of 4 quality indicators) and lower mortality
Nature. 2024 Sep 25. doi: 10.1038/s41586-024-07930-y. Epub ahead of print		Descriptive
IN medical informatics, artificial intelligence	The Use of recent more powerful large language models As Methodology procedure	Is worse Than older, less powerful large language models	To while stability to different natural phrasings of the same question is improved, more powerful language models do not avoid answering questions, even if very difficult and, paradoxaly, do not secure areas of low difficulty
JAMA. 2005 Mar 9;293(10):1223-38		Systematic Review
IN medical informatics, clinical decision support systems	The Use of computerized clinical decision support systems (CDSSs), a variety of As Diagnostic Tool	Is better Than no computerized system use	To improve practicioners performance, but effect on patients outcomes are understudied and inconsistent:22 trials of 100 reported 1 or more patients outcome, only 7 (13%) found improvement
J Hosp Med. 2012 Feb;7(2):85-90. doi: 10.1002/jhm.944		Cohorts
IN medical informatics, clinical decision support systems	The Use of computerized clinical knowledge management systems, UpToDate.com As Diagnostic Tool	Is better Than not using UpToDate	To marginally reduce length of stay (5.6 days UpToD vs 5.7 days controls) and in-hospital mortality for 3 common conditions (-0.1% to -0.6% mortality reduction) but not for other 3. Benefit only in smaller and non-teaching hospitals
BMJ. 2005 Apr 2;330(7494):765		Systematic Review
IN medical informatics, clinical decision support systems	The Use of 4 features: automatic provision of decision support as part of clinician workflow, recommendations rather than just assessments, at the time and location of decision making, and computer based As Methodology procedure	Is useful Than no comparison	To improve clinical practice and patient care
JAMA Netw Open. 2019 Dec 2;2(12):e1917094. doi: 10.1001/jamanetworkopen.2019.17094		Randomized Controlled Trial
IN medical informatics, clinical decision support systems	The Use of a computerized clinical decision support system (CDSS), hospital based, providing patient-specific recommendations at the point of care As Treatment, Chronic	Is equal Than usual care	To modify the length of hospital stay (median 8 days both) or in-hospital all-cause mortality. Targeted messages led to a change in practice in approximately 4 of 100 patients.
Cochrane Database Syst Rev. 2008;(3):CD002894		Systematic Review, Cochrane Review
IN medical informatics, clinical decision support systems	The Use of computerized advice on drug, computer treatment prescription support As Treatment, Chronic	Is better Than no computerized system	To improve some aspects of prescription (increase initial drug dose, and drug concentrations, reduce risk of toxic drug levels and reduce length of hospital stay) but not others (no change in adverse events)
JAMA Netw Open. 2024 Oct 1;7(10):e2440969. doi: 10.1001/jamanetworkopen.2024.40969		Randomized Controlled Trial, Diagnostic
IN medical informatics, clinical decision support systems, artificial intelligence	The Use of artificial intelligence (AI), chatbots, large language models, ChatGPT-4, as diagnostic help for clinicians As Diagnostic Tool	Is equal Than conventional medical information sources, as diagnostic help for clinicians	To modify diagnostic performance on clinical vignettes. However, ChatGPT-4 alone was better than physicians in finding the right diagnostic (71% AI VS 63% physicians)
Eur Arch Otorhinolaryngol. 2024 Apr;281(4):2145-2151. doi: 10.1007/s00405-023-08423-w		Controlled Trial (non-randomized)
IN medical informatics, clinical decision support systems, artificial intelligence	The Use of artificial intelligence (AI), chatbots, large language models, ChatGPT-3.5 As Methodology procedure	Is worse Than human written medical structured text, UpToDate®	To obtain answers to clinical questions with accuracy (mean 0.25 in a scale of 0-2 with ChatGPT) and usefulness (mean 1.0 ChatGPT VS 2.63 UpToDate in a scale of 1-3). ChatGPT 3.5 was limited to 2021
NPJ Digit Med. 2025 Mar 22;8(1):175. doi: 10.1038/s41746-025-01543-z		Systematic Review
IN medical informatics, clinical decision support systems, artificial intelligence, generative, diagnosis	The Use of generative artificial intelligence models As Diagnostic Tool	Is equal Than human physicians, non expert, but often worse than expert physicians	To modify diagnostic accuracy on vignette medical cases: 52% overall
NEJM AI. 2024 Oct 17;1(11):10.1056/AIcs2400502. doi: 10.1056/AIcs2400502		Controlled Trial (non-randomized)
IN medical informatics, clinical decision support systems, artificial intelligence, large language models, diagnosis	The Use of multiple large language models combined As Diagnostic Tool	Is better Than any single large language model	To improve diagnostic accuracy: TOP-5 accuracy for three LLMs: 75.3% VS average of single LLMs: 59.0%. However, note that TOP-5 accuracy for GPT-4 = 72.0%
JAMA. 2023 Dec 19;330(23):2275-2284. doi: 10.1001/jama.2023.22295		Randomized Controlled Trial
IN medical informatics, clinical decision support systems, artificial intelligence, machine learning, diagnosis	The Use of non-biased artificial intelligence model in support to clinical diagnosis of 3 conditions: pneumonia, heart failure, and chronic obstructive pulmonary disease As Diagnostic Tool	Is better Than clinical diagnosis alone and, ever more, than biased artificial intelligence models	To improve diagnostic acccuracy on clinical vignettes: 73% clinical alone VS 76% with AI predictions support VS 77.4% with AI support + explanations VS 62-64% with biased AI models support
Cochrane Database Syst Rev. 2009;(3):CD001096		Systematic Review, Cochrane Review
IN medical informatics, clinical decision support systems, computer reminders	The Use of on-screen, point-of-care computer reminders As Treatment, Chronic	Is better Than no computer reminders	To only slightly improve adherente to helth processes (median improvement 4.2%)
JAMA Intern Med. 2016 Dec 1;176(12):1860-1861. doi: 10.1001/jamainternmed.2016.6001		Clinical Trial (non-controlled, non-randomized)
IN medical informatics, clinical decision support systems, diagnosis	The Use of computer symptoms checkers, artificial intelligence As Diagnostic Tool	Is worse Than physicians, human (trained) intelligence	To find the correct diagnosis - on clinical vignettes - in the top 3 diagnoses listed (84% physicians vs 51% computer)
CMAJ. 2019 Dec 2;191(48):E1332-E1335. doi: 10.1503/cmaj.190506		Review (Narrative)
IN medical informatics, clinical decision support systems, diagnosis, medical thinking, diagnostic reasoning, cognition	The Use of artificial intelligence, machine learning As Diagnostic Tool	Is worse Than human intelligence	To accurately reach a general diagnostic decision. Currently only effective for highly targeted tasks
BMJ. 2021 Oct 20;375:n2281. doi: 10.1136/bmj.n2281		Systematic Review
IN medical informatics, clinical decision support systems, machine learning, diagnosis, prognostic	The Use of current machine learning based diagnostic / prediction models As Diagnostic Tool	Is bad Than no comparison here	To make accurate diagnostic / predictions: most studies on these models show poor methodological quality and are at high risk of bias
JAMA Netw Open. 2019 Aug 2;2(8):e199609. doi: 10.1001/jamanetworkopen.2019.9609		Descriptive, Cross-Sectional Study
IN medical informatics, electronic health records	The Use of electronic health record system bad design and use As Etiologic risk factor	Is bad Than no comparison	To several EHR design were associated with stress and burnout: excessive data entry requirements, long cut-and-pasted notes, inaccessibility of information from multiple sources, notes geared toward billing, interference with work-life balance
N Engl J Med. 2009 Apr 16;360(16):1628-38		Descriptive
IN medical informatics, electronic health records, hospital information systems	The Use of actual rate of use of electronic health records As Methodology procedure	Is worse Than ideal recommendations	To use of electronic health records and information systems is low in USA hospitals: 8% basic systems, 1.5% comprehensive systems, 17% treatment order entry. Many use laboratory and radiology results systems.
N Engl J Med. 2023 Mar 30;388(13):1201-1208. doi: 10.1056/NEJMra2302038		Review (Narrative)
IN medical informatics, information thechnologies, artificial intelligence, assistants for clinical practice	The Use of artificial intelligence, machine learning, natural-language processing, general purpose AI, chatbots As Methodology procedure	Is better Than previous informatic tools	To provide help for clinical tasks: interpretating images, suggesting clinical questions to ask, suggesting possible diagnostics, managing medical records, navigating big dataset or medical information body
N Engl J Med. 2023 Mar 30;388(13):1233-1239. doi: 10.1056/NEJMsr2214184		Review (Narrative)
IN medical informatics, information thechnologies, artificial intelligence, assistants for clinical practice	The Use of artificial intelligence, natural-language processing, general purpose AI, chatbots, chat GPT-4 As Methodology procedure	Is useful Than previous informatic tools	To provide help for clinical tasks: redacting clinical notes, synthetizing medical history, seraching and/or synthetizing relevant medical information
N Engl J Med. 2023 Sep 28;389(13):1211-1219. doi: 10.1056/NEJMra2212850		Review (Narrative)
IN medical informatics, information thechnologies, artificial intelligence, clinical research	The Use of artificial intelligence, machine learning As Methodology procedure	Is undefined Than classical medical statistics methods	To both artificial intelligence algorhythms and classical medical statistics have advantages and inconvenients that must be known. A “human-in-the-loop” development of AI shows promise
NEJM AI 2025 July 15;2(8) DOI: 10.1056/AIcs2401155		Descriptive, Cross-Sectional Study
IN medical informatics, keeping up-to-date medical knowledge systems, artificial intelligence	The Use of large language models (LLM), GPT-4o, Gemini 1.5 Pro, Llama 3.1, even fine-tuned As Methodology procedure	Is bad Than no comparison here	To integrate relevant information from new FDS drug approvals, patient records, and updated medical guidelines
_TODO tasks list. CLL 2006.08.07		Descriptive
IN medical informatics, tasks TODO	The Use of listing of task pending to be implemented in this application As Methodology procedure	Is better Than random remenbering	To continuosly improve this application
JAMA. 2000 Oct 11;284(14):1843-9		Review (Narrative)
IN medical informatics, web based, tools for medical research	The Use of central database, through a secure Web site, for collecting data As Methodology procedure	Is better Than conventional systems of paper records	To collect and maintain information for scientific studies more efficiently and securely
BMC Med Inform Decis Mak. 2005 Jun 16;5(1):15		Descriptive
IN medical informatics, web based, tools for medical research	The Use of scientific writing in virtual interdisciplinary groups As Methodology procedure	Is better Than conventional writing using mail and e-mail	To simplify writing of manuscrips by multiple co-authors, with good usability
Lancet. 2016 Jun 4;387(10035):2323-2330. doi: 10.1016/S0140-6736(16)00620-6		Cohorts
IN medical profession, clinical practice, current evolution	The Use of general practitioners, patient-facing clinical workload is constantly increasing As Undefined	Is bad Than compared with workload years before	To a substantial increase in practice consultation rates, average consultation duration, and total patient-facing clinical workload in English general practice. English primary care as currently delivered could be reaching saturation point
JAMA. 2023 Dec 26;330(24):2365-2375. doi: 10.1001/jama.2023.23147		Case-Control
IN medical profession, health care system	The Use of private equity acquisitions of hospitals As Etiologic risk factor	Is worse Than hospitals not acquired by private equity	To control hospital-acquired adverse events: they increased after acquisition by 5 additional hospital-acquired conditions per 10 000 hospitalizations, mainly falls, central line-associated infections and surgical site infections
Ann Emerg Med. 2024 Mar 25:S0196-0644(24)00099-4. doi: 10.1016/j.annemergmed.2024.02.009		Diagnostic
IN medical thinking, decision making, cognition, physican,s feeling or gestalt, sepsis, critically ill, emergency patients	The Use of early physician gestalt (first 15 minutes) As Diagnostic Tool	Is better Than several score (SIRS, SOFA, qSOFA, MEWS) and a logistic regression machine learning model using LASSO for variable selection	To accurately diagnose sepsis in critically ill adult patients: AUC 0.90 VS AUC 0.66 - 0.84
Med Decis Making. 2023 Feb;43(2):183-190. doi: 10.1177/0272989X221121343		Controlled Trial (non-randomized)
IN medical thinking, decision making, diagnosis, cognition, errors	The Use of taking an available simple diagnosis As Diagnostic Tool	Is worse Than exploring alternative hypothesis	To lead individuals toward premature closure and a failure to fully consider additional severe diseases
BMJ Qual Saf. 2018 Aug;27(8):655-663. doi: 10.1136/bmjqs-2017-007333		Cross-Over
IN medical thinking, decision making, prescription, cognition, interruptions, errors	The Use of Interruptions, multitasking and poor sleep while prescribing, junior doctor, increasing doctors' age As Etiologic risk factor	Is worse Than no interruption, focused single task and adequate sleep	To largely increase the risk of error of prescription: RR 2.8 if interrupted, RR 1.9 if multitasking; RR 16.4 (!!!) if below-average sleep
BMJ Qual Saf. 2022 Dec;31(12):899-910. doi: 10.1136/bmjqs-2022-014865		Systematic Review
IN medical thinking, diagnostic reasoning, cognition	The Use of cognitive reasoning tools : general or specific checklists, reflective reasoning tools, computerised decision support system As Diagnostic Tool	Is better Than usual diagnostic reasoning	To modestly improve diagnostic performance: effect size 0.20
Med Educ. 2008 May;42(5):468-75. doi: 10.1111/j.1365-2923.2008.03030.x		Clinical Trial (non-controlled, non-randomized)
IN medical thinking, diagnostic reasoning, cognition	The Use of cognitive reasoning tools: reflective reasoning: asks to think of several differential diagnoses and note information from the case that confirms or contradicts them, or that would have been expected. Finally, rank the diagnoses from most to least likely As Methodology procedure	Is better Than non-analytical reasoning	To improve diagnostic accuracy in complex cases (but not in simple, routine ones)
BMJ. 2022 Jan 5;376:e064389. doi: 10.1136/bmj-2021-064389		Review (Narrative)
IN medical thinking, diagnostic reasoning, cognition	The Use of Increased knowledge about the cognitive psychology of the diagnostic process As Methodology procedure	Is useful Than no comparison	To avoid pitfalls inherent in the diagnostic process and help clinical teachers, learners and clinicians to improve the accuracy of their diagnostic reasoning
J Gen Intern Med. 2022 Nov;37(15):3823-3831. doi: 10.1007/s11606-021-07352-w		Randomized Controlled Trial
IN medical thinking, diagnostic reasoning, cognition, clinical practice	The Use of gut feelings for cancer and other serious diseases As Diagnostic Tool	Is useful Than No comparison here	To help (partially) diagnosis: gut sense of alarm had a sensitivity of 59% for cancer and other serious diseases, a specificity 79%, positive predictive value 12% and negative predictive value 98%
Diagnosis (Berl). 2023 Apr 21;10(3):205-214. doi: 10.1515/dx-2022-0120		Systematic Review
IN medical thinking, diagnostic reasoning, cognition, cognitive biases, errors	The Use of knowing : availability bias, confirmation bias, anchoring and premature closure / Contributing factors / Debiasing As Prevention, Primary	Is useful Than no comparison here	To are the most frequent cognitive biases found in clinical practice. Proposed contributing features were years of practice, stressors, and practice setting. All trials studying debiasing reported weak or equivocal efficacy
BMJ. 2009 Apr 20;338:b946. doi: 10.1136/bmj.b946.		Descriptive
IN medical thinking, diagnostic strategies	The Use of some usual diagnostic strategies As Methodology procedure	Is useful Than no comparison here	To get a diagnosis accurately and efficiently.
N Engl J Med. 2004 Oct 28;351(18):1849-59		Cohorts
IN meningitis, acute, bacterial	The Use of presence of 2 of 4 symptoms (headache, fever, neck stiffness, altered mental status) and of some signs (systemic compromise, low level of consciousness) As -	Is useful Than -	To diagnostic: 95% of patients had at least 2 of those 4 symptoms. Mortality (21%) or unfavorable outcome (34%) more frequent if: advanced age, otitis or sinusitis, low level of conciousness, thrombocytopenia, S. pneumoniae, positive blood culture
Cochrane Database Syst Rev. 2010;9:CD004405		Systematic Review, Cochrane Review
IN meningitis, acute, bacterial	The Use of systemic corticosteroids, administered with antibiotics As Treatment, Acute	Is better Than placebo	To reduce severe hearing loss (RR 0.67), any hearing loss and long term neurological sequellae (RR 0.83), but not overall mortality (non-significant trend, RR 0.92), specially in high-income countries
N Engl J Med. 2002 Nov 14;347(20):1549-56		Randomized Controlled Trial, Multicenter Study
IN meningitis, acute, bacterial	The Use of systemic corticosteroids, dexametasona (10 mg/6h IV x 4 days) As Treatment, Acute	Is better Than placebo	To reduce combined outcome "mortality and neurological damage" at 8 weeks, specially if pneumococcal etiology. Not quantified in the abstract.
Lancet Neurol. 2010 Mar;9(3):254-63		Meta-Analysis
IN meningitis, acute, bacterial	The Use of systemic corticosteroids, dexamethasone As Treatment, Acute	Is equal Than placebo	To reduce mortality (26.5% dexamet VS 27.2% placebo) or severe neurological sequellae (42.3%dexamet VS 44.3% placebo). However, dexamethasone reduced hearing loss in survivors (24%vs 29.5%)
N Engl J Med. 2007 Dec 13;357(24):2431-40		Randomized Controlled Trial
IN meningitis, acute, bacterial	The Use of systemic corticosteroids, dexamethasone As Treatment, Acute	Is equal Than placebo	To to reduce, at 6 months, mortality and disability in all patients. In patients with confirmed bacterial meningitis there were a reduction at 6 months in mortality (RR 0.43)
N Engl J Med. 2007 Dec 13;357(24):2441-50		Randomized Controlled Trial
IN meningitis, acute, bacterial	The Use of systemic corticosteroids, dexamethasone (16 mg twice daily for 4 days) As Treatment, Acute	Is equal Than placebo	To reduce at 40 days mortality ordisability, either in all patients or in patients with proven pneumococcal meningitis.
N Engl J Med. 2004 Oct 21;351(17):1741-51		Randomized Controlled Trial, Multicenter Study
IN meningitis, tuberculous	The Use of corticosteroids, dexamethasone As Treatment, Acute	Is better Than placebo	To reduce mortality (relative risk, 0.69) but not residual severe disability (18% in dexam. VS 14% in controls). Reduce serious adverse effects (9% in dexam. VS 16% controls)
J Bone Joint Surg Am. 2005 May;87(5):955-62		Diagnostic
IN meniscal tears	The Use of Thessaly test ("do the twist") at 20° knee flexion As Diagnostic Tool	Is better Than other clinical examination maneuvres	To screening for meniscal tears (sensitivity 90%, specificity 96%, LR+ 25, LR- 0.10), reducing the need for MRI
JAMA. 2003 Jun 25;289(24):3243-53		Randomized Controlled Trial, Multicenter Study
IN menopause	The Use of hormonal replacement therapy, estrogen plus progestin As Treatment, Chronic	Is worse Than placebo	To affect incidence of breast cancer (about 4,8 cases/1000 patients/year in intervention vs. 3,8 cases/1000 patients/year in controls)
N Engl J Med. 2003 May 8;348(19):1839-1854		Randomized Controlled Trial
IN menopause	The Use of hormonal sustitution, estrogen plus progestin As Treatment, Chronic	Is equal Than placebo	To modify health-related quality of life
JAMA. 2003 May 28;289(20):2651-62		Randomized Controlled Trial, Multicenter Study
IN menopause, dementia	The Use of hormonal replacement therapy, estrogen plus progestin As Treatment, Chronic	Is worse Than placebo	To modify incidence of demence (4,43 cases/1000 patients/year in intervention VS 2,25 cases/1000 patients/year in control)
Am J Cardiol. 2008 Sep 15;102(6):689-92		Cohorts
IN metabolic syndrome, coronary disease, overall mortality	The Use of number of metabolic Sd factors: central obesity, hypertension, high-density lipoprotein cholesterol, triglycerides, impaired glucose metabolism As Etiologic risk factor	Is useful Than no comparison	To predict the risk of cardivascular and all-cause death
Br J Psychiatry. 2011 May;198(5):351-6		Randomized Controlled Trial
IN mild cognitive impairment, with amnesia	The Use of lithium (0.25-0.5 mmol/l) As Treatment, Chronic	Is better Than placebo	To decrease, at 1 year, CSF concentrations of P-tau and improve performance in ADAS cognitive subscale and attention tasks
Arch Intern Med. 1999 Oct 25;159(19):2273-8		Randomized Controlled Trial
IN mind-body relations, coronary disease, acute coronary syndrome	The Use of remote intercessory prayer, praying for others As Treatment, Acute	Is better Than no praying, usual care group	To reduce a particular score of the hospital course of patients. No influence observed in mortality or length of stay in ICU or in hospital.
Lancet. 2005 Jul 16-22;366(9481):211-7		Randomized Controlled Trial
IN mind-body relations, coronary disease, percutaneous coronary intervention, elective	The Use of remote intercessory prayer, praying for others, MIT therapy: music, imagery and touching As Treatment, Acute	Is equal Than none of those treatments	To reduce mortality, major adverse effects of coronary intervention or readmission to hospital at 6 months
N Engl J Med. 2005 Feb 10;352(6):539-48		Descriptive
IN mind-body relations, emotional stress as cause of acute cardiogenic pulmonary edema, shock, cardiogenic	The Use of emotional stress As Etiologic risk factor	Is - Than -	To precipitate severe, reversible left ventricular dysfunction in patients without coronary disease by exaggerated sympathetic stimulation
Nat Rev Neurol. 2025 Jun;21(6):297-311. doi: 10.1038/s41582-025-01072-z		Review (Narrative)
IN mind-body relations, near-death experiences, consciousness	The Use of a neuroscientific model of near-death expériences As Etiologic risk factor	Is useful Than no model, or purely mystical models	To explain the repetitive characteristics of near-death experiences
N Engl J Med. 2001 May 24;344(21):1594-602		Systematic Review
IN mind-body relations, placebo effect	The Use of placebo As -	Is equal Than no treatment	To improve any outcome, with the only exception of modest improvements in continuous subjective ourcomes
Lancet. 2010 Feb 20;375(9715):686-95		Review (Narrative)
IN mind-body relations, placebo effect	The Use of placebo As Treatment, Acute	Is useful Than no comparison done	To improve patients outcomes: placebo effects are real and genuine psychobiological events that should be studied and understood
Br J Urol. 1998 Mar;81(3):383-7		Randomized Controlled Trial
IN mind-body relations, placebo effect	The Use of placebo As Treatment, Chronic	Is useful Than no comparison	To improve maximum urinary flow rate (1.4 mL/s over baseline) and total symptom score improved (-2.9 points) in the firsts 2 to 5 months, that remains after 2 years. 13.2% of patients discontinued placebo because of significant adverse reactions.
N Engl J Med. 2020 Feb 6;382(6):554-561. doi: 10.1056/NEJMra1907805		Review (Narrative)
IN mind-body relations, placebo effect, nocebo effect	The Use of acknowledging placebo and nocebo effects As Treatment, Acute	Is useful Than ignoring them	To placebo and nocebo effects are powerful, pervasive, and common in clinical practice. Strategies to promote placebo effects and to prevent nocebo effects can improve therapeutic outcomes.
Pain. 2023 Aug 2. doi: 10.1097/j.pain.0000000000003000. Epub ahead of print		Meta-Analysis
IN mind-body relations, placebo effect, nocebo effect, diabetes, type 2, diabetic neuropathy	The Use of placebo As Treatment, Chronic	Is better Than no treatment at all	To improve pain: mean placebo response was -1.54 change in pain intensity from baseline, pooled 50% response rate was 25%. But also increased adverse effects: overall % of patients with adverse events in placebo arms was 53%
Cochrane Database Syst Rev. 2006 Apr 19;(2):CD000978		Systematic Review, Cochrane Review
IN mucositis, oral, chemotherapy related	The Use of ice chips As Treatment, Acute	Is better Than no treatment, and equal to other effective treatments: amifostine, antibiotic pastille, hydrolytic enzymes	To either prevent or reducve the severity of mucositis: RR = 0.63, NNT 3 to 7
N Engl J Med. 2020 Jan 9;382(2):152-162. doi: 10.1056/NEJMsa1906848		Randomized Controlled Trial
IN multimorbidity, patients with medically and socially complex conditions, frequent hospitalization, "superutilizers"	The Use of hotspotting, coordination of care by a team of nurses, social workers, and community health workers visiting patients at home As Treatment, Chronic	Is equal Than usual care	To reduce hospital readmissions at 6 months: 62% in both intervention and control groups
N Engl J Med. 2007 Jun 21;356(25):2582-90		Cohorts
IN multiple myeloma, asymptomatic	The Use of knowledge of natural history As Prognostic Item	Is useful Than -	To plan followup and therapy: symptomatic multiple myeloma or amyloidosis developed in 10%/year first 5 years, and 1-3%/year afterwards
Blood. 2016 Mar 3;127(9):1102-8		Randomized Controlled Trial
IN multiple myeloma, newly diagnosed, elder patients	The Use of alkylator-free doublet lenalidomide + low-dose dexamethasone As Treatment, Chronic	Is equal Than alkylator-containing triplets melphalan-prednisone-lenalidomide or cyclophosphamide-prednisone-lenalidomide	To modify progression-free survival or overall survival at 4 years (67% triplets VS 58% doublet, P = 0.70), with less neutropenia (30-64% triplets VS 25% doublet)
N Engl J Med. 2005 Jun 16;352(24):2487-98		Randomized Controlled Trial, Multicenter Study
IN multiple myeloma, relapsed after first-line therapy	The Use of proteasome inhibitors, bortezomib, IV sequential cycles As Treatment, Acute	Is better Than high-dose dexamethasone, PO sequential cycles	To induce a response (38% bortezomib VS 18% dexam) and improve survival at 1 year (80% bortezomib VS 66% dexam). Adverse events: 75% bortezomib VS 60% dexam
N Engl J Med. 2007 Nov 22;357(21):2123-32		Randomized Controlled Trial
IN multiple myeloma, relapsed or refractory	The Use of lenalidomide, thalidomide analogue, 25 mg/month per os, plus dexamethasone As Undefined	Is undefined Than placebo, plus dexamethasone	To produce complete or partial response (60% lenalidomide VS 24% placebo) and increase survival
N Engl J Med. 2007 Nov 22;357(21):2133-42		Randomized Controlled Trial
IN multiple myeloma, relapsed or refractory	The Use of lenalidomide, thalidomide analogue, 25 mg/month per os, plus dexamethasone As Undefined	Is undefined Than placebo, plus dexamethasone	To induce complete or partial response (61% lenalidomide VS 20% placebo) and increase survival (27 months lenalidomide VS 20 months placebo)
Science . 2022 Jan 21. doi: 10.1126/science.abj8222. Online ahead of print		Randomized Controlled Trial
IN multiple sclerosis	The Use of Epstein-Barr virus infection As Etiologic risk factor	Is useful Than comparison	To infection with EBV increases greatly the risk of developping multiple sclerosis, and virtually all affected patients have had EBV infection
Cochrane Database Syst Rev. 2007 Oct 17;(4):CD003982		Systematic Review, Cochrane Review
IN multiple sclerosis	The Use of azathioprine As Treatment, Chronic	Is better Than placebo	To reduce, at 1 to 3 years, the number of patients who had relapses (relative risk reduction=20%) and who progresssed
Ann Neurol. 2010 Oct;68(4):494-502		Randomized Controlled Trial, Multicenter Study
IN multiple sclerosis	The Use of dalfampridine (4-aminopyridine), extended-release 10mg twice daily, voltage-dependent potassium channel blocker improving in demyelinated pathways As Treatment, Chronic	Is better Than placebo	To Increase walking ability at 9 weeks (number of patients showing consistent improvement: 43% dalfam VS 9% placebo)
Neurology. 1998 Aug;51(2):529-34		Randomized Controlled Trial
IN multiple sclerosis, acute attack	The Use of high dose corticosteroids, oral methylprednisolone (500 mg/day for 5 days, 10-day tapering period) As Treatment, Acute	Is better Than placebo	To improve symptoms scores at 1 to 8 weeks
N Engl J Med. 2000 Sep 28;343(13):898-904		Randomized Controlled Trial, Multicenter Study
IN multiple sclerosis, first demyelinating attack	The Use of interferon beta, 30 µg/week IM As Treatment, Chronic	Is better Than placebo	To reduce at 3 years the development of definite clinical multiple sclerosis
N Engl J Med. 2008 Feb 14;358(7):676-88		Randomized Controlled Trial
IN multiple sclerosis, relapsing-remitting	The Use of rituximab, CD20 B lymphocyte depletion, 1 gr IV days 1 and 15 As Treatment, Acute	Is better Than placebo	To reduce relapses at 48 weeks: 20.3% rituximab VS 40.0% placebo
Lancet. 1998 Nov 7;352(9139):1498-504		Randomized Controlled Trial
IN multiple sclerosis, relapsing-remitting	The Use of interferon beta, 22 or 44 microg SC 3 times a week As Treatment, Chronic	Is better Than placebo	To reduce, at 2 years, number of relapses (2.56 with placebo VS 1.82 with interferon 22 microg VS 1.72 with 44 microg
N Engl J Med. 2003 Jan 2;348(1):15-23		Randomized Controlled Trial, Multicenter Study
IN multiple sclerosis, relapsing-remitting	The Use of natalizumab, inhibition of lymphocyte surface vascular adhesive protein integrin, every 28 days for 6 months As Treatment, Chronic	Is better Than placebo	To reduce at 6 months number of new brain lesions on MRI
Lancet. 1998 Nov 7;352(9139):1491-7		Randomized Controlled Trial
IN multiple sclerosis, secondary progressive	The Use of interferon beta, 8 million IU SC every other day As Treatment, Chronic	Is better Than placebo	To delay time to progression of disability and time to become wheelchair-bound
Neurology. 2007 Mar 13;68(11):837-41		Randomized Controlled Trial
IN myasthenia gravis	The Use of Intravenous immunoglobulin (2 g/kg single infusion) As Treatment, Acute	Is better Than placebo	To improve the Quantitative Myasthenia Gravis (QMG) Score for Disease Severity at 4 weeks (how much?)
J Am Soc Nephrol. 2007 Jun;18(6):1899-904		Randomized Controlled Trial
IN nephrotic syndrome, idiopathic membranous nephropathy	The Use of 6-mo course of alternating corticosteroids (prednisolone) and cyclophosphamide As Treatment, Acute	Is better Than supportive treatment only	To achieve initial complete remission (32% pred/cyclo VS 11% controls) and reduce need for dyalisis at 10 years (11% pred/cyclo VS 35% controls)
Nat Rev Neurol. 2018 Oct;14(10):577-589. doi: 10.1038/s41582-018-0058-z		Review (Narrative)
IN neurologic disease, neuronal injury, multiple sclerosis, dementia, stroke, traumatic brain injury, amyotrophic lateral sclerosis	The Use of neurofilament proteins, in cerebrospinal fluid (CSF) but also in blood, blood neurofilament light chain As Diagnostic Tool	Is better Than clinical findings, radiological markers	To asses the extension of neuroaxonal damage in a diversity of neurological diseases, serving as a biomarker of disease activity and severity
Eur J Neurol. 2011 Jan;18(1):19-e3		Review (Narrative)
IN neurologic paraneoplastic syndromes, autoimmune, limbic encephalitis, peripheral neuropathy, opsoclonus-myoclonus syndrome, Lambert-Eaton myasthenic syndrome, cancer	The Use of anti-neuronal and anti-onconeuronal circulating auto-antibodies As Diagnostic Tool	Is better Than usual clinical and EMG diagnosis	To diagnose a variety of neurologic paraneoplasic syndromes. The type of antibodies help to determine the type of underlying malignancy to search for
Autoimmune Dis. 2019 Jul 9;2019:2135423. doi: 10.1155/2019/2135423		Review (Narrative)
IN neurologic paraneoplastic syndromes, autoimmune, limbic encephalitis, peripheral neuropathy, opsoclonus-myoclonus syndrome, Lambert-Eaton myasthenic syndrome, cancer	The Use of anti-neuronal and anti-onconeuronal circulating auto-antibodies As Diagnostic Tool	Is better Than usual clinical and EMG diagnosis	To diagnose a variety of neurologic paraneoplasic syndromes. The type of antibodies help to determine the type of underlying malignancy to search for
Ann Intern Med. 2001 Sep 18;135(6):412-22		Randomized Controlled Trial, Multicenter Study
IN neutropenia, chemotherapy induced, febrile	The Use of itraconazol As Treatment, Acute	Is equal Than IV anfotericina	To reduce fungal infections, infectious complications or mortality
Cochrane Database Syst Rev. 2010;11:CD005197		Systematic Review, Cochrane Review
IN neutropenia, chemotherapy induced, febrile, empirical antibiotics	The Use of beta lactam monotherapy with anti-pseudomonal drugs, piperacillin-tazobactam As Treatment, Acute	Is undefined Than other beta-lactams antibiotics	To reduce the risk of death (RR 0.56). Carbapenems had same mortality and less clinical failure but more C. difficile superinfections
N Engl J Med. 1999 Jul 29;341(5):312-8		Randomized Controlled Trial
IN neutropenia, chemotherapy induced, febrile, empirical antibiotics	The Use of oral antibiotics, amoxicillin-clavulanate, ciprofloxacin As Treatment, Acute	Is equal Than intravenous antibiotics	To resolve fever and reduce mortality
N Engl J Med. 1999 Jul 29;341(5):305-11		Randomized Controlled Trial
IN neutropenia, chemotherapy induced, febrile, empirical antibiotics	The Use of oral antibiotics, amoxicillin-clavulanate, ciprofloxacin As Treatment, Acute	Is equal Than intravenous antibiotics	To resolve fever and reduce mortality
Cochrane Database Syst Rev. 2004 Oct 18;(4):CD003992		Systematic Review, Cochrane Review
IN neutropenia, chemotherapy induced, febrile, empirical antibiotics	The Use of oral antibiotics, quinolones alone or combined, in non severelly ill patients (not having: leukaemia, haemodynamical instability, organ failure, pneumonia, infection of a central line or a severe soft-tissue infection) As Treatment, Acute	Is equal Than intravenous antibiotics	To reduce mortality, treatment failure rates or adverse events
Ann Intern Med. 2005 Jun 21;142(12 Pt 1):979-95		Meta-Analysis
IN neutropenia, chemotherapy induced, non febrile	The Use of antibiotic prophylaxis, mainly quinolones As Treatment, Acute	Is better Than placebo or no treatment	To reduce infections and infection-related as well as all-cause mortality (RR 0.67; 95%CI 0.55 to 0.8)
N Engl J Med. 2005 Sep 8;353(10):977-87		Randomized Controlled Trial
IN neutropenia, chemotherapy induced, non febrile	The Use of quinolones, oral levofloxacin (500 mg/d) As Treatment, Acute	Is equal Than placebo	To reduce febrile episodes (65% with levofox.VS 85% with placebo). Mortality and tolerability were similar in both groups. Effect in long-term development of resistances unknown.
N Engl J Med. 2005 Sep 8;353(10):988-98		Randomized Controlled Trial
IN neutropenia, chemotherapy induced, non febrile	The Use of quinolones, oral levofloxacin (500 mg/d) As Treatment, Acute	Is better Than placebo	To reduce febrile episodes (10.8% with levofox.VS 15% with placebo), reduce hospitalizations and reduce severe infection. Death was unchanged (<1% both) Effect in long-term development of resistances unknown.
Lancet Diabetes Endocrinol. 2025 Jan 9:S2213-8587(24)00316-4. doi: 10.1016/S2213-8587(24)00316-4		Consensus, Guideline
IN obesity	The Use of defining diagnostic criteria for obesity, preclinical obesity and clinical obesity As Diagnostic Tool	Is useful Than no comparison here	To separate obesity (excess adiposity without health impact), preclinical obesity (with increased risk of organ damage) and clinicla obesity (with organ or functional repercussion)
N Engl J Med. 2006 Aug 24;355(8):763-78. Epub 2006 Aug 22		Cohorts
IN obesity	The Use of body mass index (BMI, weight in Kg/ square of height in m) As Etiologic risk factor	Is useful Than no comparison here	To predict risk of death, at 10 years: relative increasing of 20 to 40% with overweight, RR 2.0 to 3.0 in obese persons.
N Engl J Med. 2006 Aug 24;355(8):779-87. Epub 2006 Aug 22		Cohorts
IN obesity	The Use of body mass index (BMI, weight in Kg/ square of height in m) As Etiologic risk factor	Is useful Than no comparison here	To predict risk of death, at 12 years: J-shaped association with the BMI, with lowest risk at BMI 23 to 25 and increase in underweight, overweight, and obese people.
Ann Intern Med. 2003 Jan 7;138(1):24-32		Cohorts
IN obesity	The Use of body mass index (BMI, weight in Kg/ square of height in m) As Prognostic Item	Is useful Than no comparison	To predict increased risk of death and disease: forty year people lost 6 to 7 years of life expectancy because of obesity, magnitude similar to smoking.
N Engl J Med. 2005 Nov 17;353(20):2121-34		Randomized Controlled Trial
IN obesity	The Use of cannabinoid-1 receptor (CB1) blockers, rimonabant 20mg/day, added to hypocaloric diet As Treatment, Chronic	Is better Than hypocaloric diet plus placebo	To reduce weight at 1 year: mean 6.9 Kg rimonabant VS 1.5 Kg placebo. At 5 mg, the drug was not better than placebo. 36-40% of patients abandoned therapy in all groups. Most frequent adverse events: depression, anxiety, and nausea.
N Engl J Med. 2005 Nov 17;353(20):2111-20		Randomized Controlled Trial
IN obesity	The Use of lifestyle modification and drugs (sibutramine 15mg/day) together As Treatment, Chronic	Is better Than lifestyle modification or drugs (sibutramine) each alone	To reduce weight at one year: mean 12 Kg with combined Tt VS 5 Kg lifestyle modifs VS 6.7 Kg sibutramine.
N Engl J Med. 2021 May 6;384(18):1719-1730. doi: 10.1056/NEJMoa2028198		Randomized Controlled Trial, Multicenter Study
IN obesity, body mass index (BMI) 32 to 43	The Use of GLP-1 analogs, liraglutide 3.0 mg per day, plus a moderate-to-vigorous-intensity exercise program As Treatment, Chronic	Is better Than placebo, usual activity or moderate-to-vigorous-intensity exercise program alone	To achieve and maintain weight loss at 1 year: liraglutide+exercise -9.5 kg VS liraglutide -6.8 kg VS exercise -4.1 kg
eClinical Medicine. 2024, in press. Doi: 10.1016/j.eclinm.2024.102475		Randomized Controlled Trial
IN obesity, body mass index (BMI) 32 to 43	The Use of maintaining moderate-to-vigorous exercise after finishing combined treatment with GLP-1 analogs, liraglutide 3.0 mg per day, plus exercise program As Treatment, Chronic	Is better Than not maintaining exercise	To limit loss regain 1 year after stopping liraglutide: 3.5 Kg liraglutide+exerc, 5.4 Kg exerc alone, 7.6 Kg placebo and 8.7 Kg liraglutide alone
Arch Intern Med. 2007 Jun 25;167(12):1277-83		Randomized Controlled Trial
IN obesity, diets	The Use of daily use of a portion control plate As Treatment, Chronic	Is better Than usual dietary teaching	To loss at 6 months more weight: mean 2.1 Kg portion plate VS 0.1 Kg usual care
N Engl J Med. 2008 Jul 17;359(3):229-41		Randomized Controlled Trial
IN obesity, diets	The Use of low-carbohydrate diet, or low-carbohydrate Mediterranean diet As Treatment, Chronic	Is better Than low-fat diet	To loss weight at 1 year: 4.4 - 4.7 Kg low-carbohydrate VS 2.9 Kg low-fat
JAMA. 2007 Mar 7;297(9):969-77		Randomized Controlled Trial
IN obesity, diets	The Use of low-carbohydrate, high-protein, high-fat diet (Atkins diet) As Treatment, Chronic	Is better Than low-fat, high-carbohydrate diets	To weight loss at 12 months: -4.7 kg with Atkins diet VS -1.6 to -2.6 with other diets
N Engl J Med. 2011 Mar 31;364(13):1218-29		Randomized Controlled Trial
IN obesity, diets, lifestyle and habits, elderly adults	The Use of weight management (diet) plus exercise program As Treatment, Chronic	Is better Than no treatment, weight management (diet) alone or exercise program alone	To improve at 1 year physical status scores: increases from baseline of 21% diet+exercise VS 12% diet VS 15% exercise
Science. 2005 Jan 28;307(5709):584-6		Case-Control
IN obesity, lifestyle and habits, posture and movement	The Use of nonexercise activity thermogenesis, posture and movements in routines of daily life As Prognostic Item	Is useful Than no comparison	To predict tendency to obesity: obese individuals were seated, on average, 2 hours longer per day than lean individuals.
Lancet. 2009 Mar 28;373(9669):1083-96		Systematic Review
IN obesity, malnutrition	The Use of body mass index (BMI, weight in Kg/ square of height in m) As Prognostic Item	Is useful Than No comparison here	To predict risk of years: J-shaped association, with lowest risk at BMI 22.5 to 25 and progressive increase in underweight and overweight people
Health Technol Assess. 2009 Sep;13(41):1-190, 215-357, iii-iv		Systematic Review
IN obesity, moderate to severe, surgical treatment	The Use of bariatric surgery, specially gastric bypass, more than banded gastroplasty or adjustable gastric banding As Undefined	Is undefined Than Comparison to be defined	To increase weight loss at long-term (until 10 years) and reduce obesity-associated diabetes and comorbidities.
Ann Intern Med. 2006 May 2;144(9):625-33		Randomized Controlled Trial, Multicenter Study
IN obesity, moderate, surgical treatment	The Use of surgery, laparoscopic adjustable gastric band As Treatment, Chronic	Is better Than program of very-low-calorie diet, pharmacotherapy, and lifestyle change	To reduce weight at 2 years: mean loss 21.6% with surgery VS 5.5% with diet and drugs. Also improved quality of life.
Eur Heart J. 2010 Mar;31(6):737-46		Cohorts
IN obesity, normal weight, cardiovascular death	The Use of high body fat (>33% in women, >24% in men) in normal weight people As Prognostic Item	Is useful Than not increased total body fat	To predict increased risk of dislipidemia, metabolic syndrome, hypertension and, in women, increased cardiovascular mortality (HR 2.2)
Diabetes Obes Metab. 2025 Feb;27(2):920-932. doi: 10.1111/dom.16092		Meta-Analysis
IN obesity, overweight, caloric intake	The Use of intermittent fasting, time-restricted eating, or modified alternate-day fasting As Treatment, Chronic	Is better Than no fasting	To increase weight loss, fat mass reduction, decreased fasting insulin and glycosylated haemoglobin levels, better lipid profile and lower blood pressure
BMJ. 2025 Jun 18;389:e082007. doi: 10.1136/bmj-2024-082007		Meta-Analysis
IN obesity, overweight, caloric intake, cardiovascular disease, liver disease	The Use of intermittent fasting strategies As Treatment, Chronic	Is equal Than continuous energy restriction diet	To reduce body weight: -1,7 Kg to -3,4 Kg in average. Alternate day fasting better than whole day fasting better than time restricted fasting
N Engl J Med. 2021 Mar 18;384(11):989. doi: 10.1056/NEJMoa2032183		Randomized Controlled Trial, Multicenter Study
IN obesity, without diabetes, body mass index (BMI) ≥ 30	The Use of GLP-1 analogs, semaglutide, 2.4 mg SC once-weekly, as an adjunct to lifestyle intervention As Treatment, Chronic	Is better Than placebo plus lifestyle intervention	To have a greater reduction in body weight at 68 weeks (-15% semaglutide VS -2.4% placebo). Nausea and diarrhea were the most common adverse events, typically transient, but 5% discontinued Tt
N Engl J Med. 2025 Sep 18;393(11):1077-1087. doi: 10.1056/NEJMoa2500969		Randomized Controlled Trial, Multicenter Study
IN obesity, without diabetes, body mass index (BMI) ≥ 30, or overweight (BMI 27 to 30) with associated condition	The Use of GLP-1 analogs, semaglutide, oral 25 mg once-daily, as an adjunct to lifestyle intervention As Treatment, Chronic	Is better Than placebo	To at 1.5 years, loss body weight (mean 14% of body weight semaglu VS 2% placebo) and achieving ≥ 10% of body weight loss (63% of patients on semaglu VS 14% placebo)
N Engl J Med. 2025 Sep 16. doi: 10.1056/NEJMoa2511774. Epub ahead of print		Randomized Controlled Trial, Multicenter Study
IN obesity, without diabetes, body mass index (BMI) ≥ 30, or overweight (BMI 27 to 30) with associated condition	The Use of nonpeptide GLP-1 receptor agonists, orforglipron, oral, 6, 12 or 36 mg once daily As Treatment, Chronic	Is better Than placebo	To at 1.5 years, loss body weight (mean 8-11% of body weight glipron VS 2% placebo) and achieving ≥ 10% of body weight loss (55% of patients on glipron VS 13% placebo)
N Engl J Med. 2023 Sep 7;389(10):877-888. doi: 10.1056/NEJMoa2302392		Randomized Controlled Trial, Multicenter Study
IN obesity, without diabetes, body mass index (BMI) ≥ 30, or overweight (BMI 27 to 30) with associated condition	The Use of nonpeptide GLP-1 receptor agonists, orforglipron, oral, daily As Treatment, Chronic	Is better Than placebo	To loss body weight (mean 13% of body weight at 9 months glipron VS 2% placebo) and achieving ≥ 10% of body weight loss (60% of patients on glipron VS 9% placebo)
N Engl J Med. 2023 Nov 11. doi: 10.1056/NEJMoa2307563. Epub ahead of print		Randomized Controlled Trial, Multicenter Study
IN obesity, without diabetes, body mass index (BMI) ≥ 30, or overweight (BMI 27 to 30), with associated condition, cardiovascular disease antécedents	The Use of GLP-1 analogs, semaglutide, 2.4 mg SC once-weekly, as an adjunct to lifestyle intervention As Treatment, Chronic	Is better Than placebo	To reduce at 3 years cardiovascular events (6.5% semag VS 8% placebo) and all-cause mortality (4.3% semag VS 5.2% placebo) but increasing withdrawals due to adverse effects (17% semag VS 8% placebo)
Age Ageing. 2022 Apr 1;51(4):afac081. doi: 10.1093/ageing/afac081		Systematic Review
IN older adults, admitted to hospital with acute medical disease	The Use of admission to a acute geriatric unit As Treatment, Acute	Is better Than admission to conventional or other specialty acute unit	To reduce functional decline at 6-month follow-up (RR 0.79) and increase probability of living at home at 3-month follow-up (RR 1.06). No differences in mortality
Cochrane Database Syst Rev. 2017 Sep 12;9:CD006211. doi: 10.1002/14651858.CD006211.pub3		Systematic Review, Cochrane Review
IN older patients, comprehensive geriatric assessment	The Use of comprehensive, multidimensional geriatric assessment As Diagnostic Tool	Is better Than usual general medical care	To increase a patient,s likelihood of being in their own home at 12 months (OR 1.06), with no difference in mortality or in dependency
Geriatr Psychol Neuropsychiatr Vieil. 2024 Mar 1;22(1):11-17. French. doi: 10.1684/pnv.2024.1149		Review (Narrative)
IN older patients, comprehensive geriatric assessment, acute hospital care	The Use of multidimensional assessment carried out with interRAI tools, an operationalization of the International Classification of Functioning, Disability and Health As Diagnostic Tool	Is better Than classic comprehensive geriatric assessment	To better identify clinical needs, design a personalized care plan adapted to the strengths and weaknesses of health organizations and offer a universal common language
PLoS One. 2012;7(1):e29090		Cohorts
IN older 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)
PLoS One. 2022 Sep 29;17(9):e0275456. doi: 10.1371/journal.pone.0275456		Randomized Controlled Trial
IN older patients, geriatric pharmacology, inappropriate prescription	The Use of PILA (patient-in-focus listing approach) tools: STOPP/START v.2 or Amsterdam tool As Prevention, Primary	Is better Than DOLA (drug-oriented listing approach) tools: PRISCUS list, Beers criteria v.2019 and the EU(7)-PIM list	To identify the highest number of potentially inappropriate prescriptions: a mean of 3.4 cases per patient with STOPP/START and 2.5 per patient with Amsterdan
Cochrane Database Syst Rev. 2023 Oct 11;10(10):CD008165. doi: 10.1002/14651858.CD008165.pub5		Systematic Review, Cochrane Review
IN older patients, geriatric pharmacology, inappropriate prescription, multiple medications	The Use of interventions to improve appropriate polypharmacy, such as reviews of patients, prescriptions or pharmaceutical care As Prevention, Primary	Is equal Than no intervention	To reduce potential prescribing omissions (SMD -0.48), reduce the number of potentially inappropriate medications (SMD -0.19) or reduce hospital admissions (data not pooled)
Fam Pract. 2017 Aug 1;34(4):437-445. doi: 10.1093/fampra/cmx007		Randomized Controlled Trial, Multicenter Study
IN older 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
J Am Geriatr Soc. 2021 Feb 12. doi: 10.1111/jgs.17041. Online ahead of print		Randomized Controlled Trial
IN older patients, geriatric pharmacology, inappropriate prescription, multiple medications	The Use of medication review, but only in combination with medication reconciliation and patient education As Treatment, Acute	Is better Than not doing medication review	To reduce all-cause hospital readmission (RR 0.45). Medication review in isolation did not significantly influence hospital readmissions (RR 1.06)
JAMA Intern Med. 2025 Aug 1;185(8):926-935. doi: 10.1001/jamainternmed.2025.2015		Randomized Controlled Trial
IN older patients, geriatric pharmacology, inappropriate prescription, multiple medications, diabetes, type 2	The Use of physician academic detailing plus patient previsit activation for deprescribing insulin and/or sulfonylurea As Prevention, Primary	Is equal Than no intervention for deprescribing	To modify, at 6 months, the frequency of severe self-reported hypoglycemia: 5% intervention VS 6.5% no intervention (p non significant), despite deprescribing medication in more patients (16% intervention VS 9% no intervention)
JAMA Netw Open. 2025 Jun 2;8(6):e2517965. doi: 10.1001/jamanetworkopen.2025.17965		Systematic Review
IN older patients, geriatric pharmacology, inappropriate prescription, primary care, community, long-term care facilities	The Use of existing interventions to address potentially inappropriate prescribing As Prevention, Primary	Is equal Than no intervention	To reduce adverse drug reactions, injurious falls, quality of life, medical visits, emergency department admissions, hospitalizations or all-cause mortality. They reduced the number of medications prescribed by approximately 0.5 fewer medications per patient
BMJ Public Health. 2025 Mar 23;3(1):e001941. doi: 10.1136/bmjph-2024-001941		Diagnostic
IN older people, comprehensive geriatric assessment, frailty scores	The Use of bFRAil, a biological frailty score based on CRP, haemoglobin, albumin and vitamin D As Diagnostic Tool	Is useful Than compared with the Hospital Frailty Risk Score as reference (a validated score elaborated from electronic healthcare data)	To screen for frailty (area under ROC curve 0.78, NPV 84%) compared to Hospital Frailty Risk Score as reference
Age Ageing. 2013 Mar;42(2):262-5		Descriptive, Cross-Sectional Study
IN older people, comprehensive geriatric assessment, frailty scores	The Use of PRISMA-7, a short 5-items questionnaire (+ age & sex) that can be auto-administered As Diagnostic Tool	Is better Than other frailty measures : clinical judgement of GP, polypharmacy or the Groningen frailty indicator (GFI)	To better screen for frailty in primary care: sensitivity 85% and specificity 73% VS Fried criteria as gold standard
Lancet. 2012 Jul 7;380(9836):37-43		Descriptive, Cross-Sectional Study
IN older people, multimorbidity	The Use of knowing prevalence and distribution of multimobidity As Diagnostic Tool	Is useful Than not caring about	To plan for adaptations in health care, research and medical education to real practice: 42% of all patients had >1 morbidity, 23% were multimorbid. Multimorbidity increased substantially with age and was present in most people >65 years
Aging Cell. 2019 Feb;18(1):e12880. doi: 10.1111/acel.12880		Randomized Controlled Trial
IN older people, non-diabetic patients, insulin sensitivity, cardiorespiratory fitness	The Use of oral hypoglycemic agents, metformin As Treatment, Acute	Is worse Than placebo	To improve insulin sensitivity and cardiorespiratory fitness after exercise: metformin attenuated the increase in whole-body insulin sensitivity, skeletal muscle mitochondrial respiration and VO2 max after exercise
JAMA. 2021 Oct 19;326(15):1504-1515. doi: 10.1001/jama.2021.15255		Cohorts
IN opioids, codeine, tramadol	The Use of opioids, tramadol As Treatment, Chronic	Is worse Than opioids, codeine	To tramadol was associated with increased mortality (1.3 per 100 person-years tramadol vs 0.6 codeine) as well as increased cardiovascular events and fractures. No differences in falls, delirium, constipation or dependence
Br J Anaesth. 2011 Sep;107(3):319-28		Meta-Analysis
IN opioids, hydromorphone	The Use of hydromorphone As Treatment, Acute	Is equal Than morphine	To clinical effectiveness : hydromorphone provided slightly better clinical analgesia for acute pain (adequate dose equivalence ?) but no significant difference in side effects
Neurology. 1997 Nov;49(5):1404-13		Cohorts
IN optic neuritis, multiple sclerosis	The Use of natural history, risk after isolated optic neuritis As Prognostic Item	Is useful Than 0	To predict isk of developing definite clinical multiple sclerosis
Ann Intern Med. 2020 Sep 10. doi: 10.7326/M20-4298. [Epub ahead of print]		Meta-Analysis
IN orthostatic hypotension, hypertensive patients	The Use of more intensive BP goal on active pharmacological treatment As Treatment, Chronic	Is better Than less intensive BP goals	To reduce the risk of orthostatic hypotension (OR 0.93)
Ann Intern Med. 2000 Feb 1;132(3):173-81		Randomized Controlled Trial
IN osteoarthritis	The Use of exercise, physical therapy, kinesitherapy As Treatment, Chronic	Is better Than no treatment	To improve, at 8 weeks, the 6-minute walk distance and WOMAC score and to reduce (secondary endpoint) at 1 year need for knee arthroplasty: 20% in placebo VS 5% with physical therapy
Cochrane Database Syst Rev. 2001;2:CD00?		Systematic Review, Cochrane Review
IN osteoarthritis	The Use of hialuronic acid derivatives, glucosamine As Treatment, Chronic	Is better Than placebo	To outcomes evaluated not available in the abstract
N Engl J Med. 2006 Feb 23;354(8):795-808		Randomized Controlled Trial, Multicenter Study
IN osteoarthritis	The Use of hialuronic acid derivatives, glucosamine, chondroitin As Treatment, Chronic	Is equal Than placebo	To reduce pain more than 20% at 24 weeks: 60% in placebo VS 64%-66% with the study drugs or both combined. Celecoxib was significantly better than placebo: pain reduced in 70%
JAMA. 2000 Mar 15;283(11):1469-75		Meta-Analysis
IN osteoarthritis	The Use of hialuronic acid derivatives, glucosamine, chondroitin As Treatment, Chronic	Is better Than placebo	To improve pain or functional status
J Rheumatol. 2004 Oct;31(10):2002-12		Randomized Controlled Trial
IN osteoarthritis	The Use of topical diclofenac, topical NSAIDs As Treatment, Chronic	Is equal Than oral diclofenac 150 mg/d, oral NSAIDs	To improve pain and physical function, measured by WOMAC and PGA scales. Topical diclofenac had significantly less gastrointestinal, hepatic and renal adverse events, either minor or severe.
N Engl J Med. 2020 04 09;382(15):1420-1429		Randomized Controlled Trial
IN osteoarthritis, knee	The Use of exercise, physical therapy, kinesitherapy As Treatment, Acute	Is better Than intra-articular glucocorticoid injection	To improve symptoms at 1 year: WOMAC score reduction -71 points physical therapy VS -52 points glucocorticoid injection
Cochrane Database Syst Rev. 2019 Feb 25;2:CD013273		Systematic Review, Cochrane Review
IN osteoarthritis, knee, hip	The Use of paracetamol As Treatment, Chronic	Is equal Than placebo	To improve symtoms: mean reduction in pain VS palcebo: 3.2 points on 100 EVA scale; mean improvement in physical function: 2.9 points on a 100 scale.
BMJ. 2021 Oct 12;375:n2321. doi: 10.1136/bmj.n2321		Randomized Controlled Trial
IN osteoarthritis, knee, hip	The Use of topical nonsteroidal antiinflammatory drugs (NSAIDs) As Treatment, Chronic	Is better Than placebo, oral NSAIDs, opioids, or paracetamol	To first line pharmacological treatment for reducing pain and avoid adverse events (oral NSAIDS slaighty more effective but more adverse events). Opioids: their risk of harm outweighs the clinical benefit
Ann Intern Med. 2024 Jul 30. doi: 10.7326/M24-0303. Epub ahead of print		Randomized Controlled Trial
IN osteoarthritis, knee, older people	The Use of methotrexate once weekly (6-week escalation 10 to 25 mg), added to usual analgesia As Treatment, Chronic	Is better Than placebo	To improve visual analogic scale for pain at 6 months (-1.3 points MTX VS -0.6 placebo). Knee stiffness was also significantly reduced. Serious adverse events were rare and similar in both groups
Health Technol Assess. 2008 May;12(22):1-176		Randomized Controlled Trial, Multicenter Study
IN osteoarthritis, knee, older people	The Use of topical ibuprofen, topical NSAIDs As Treatment, Chronic	Is equal Than oral ibuprofen, oral NSAIDs	To improve pain and symptoms, measured by WOMAC and SF-36. Oral NSAIDs appear to produce more minor adverse effects
J Rheumatol. 2014 Jan;41(1):53-9		Randomized Controlled Trial
IN osteoarthritis, knee, with inflammation, older people	The Use of low dose corticosteroids, 7.5 mg/day of prednisolone, for 6 weeks As Treatment, Chronic	Is better Than placebo	To improve symptoms: pain, physical function, walk distance and patient global status improved with prednisolone
J Rheumatol. 2010 Jun;37(6):1236-43		Systematic Review
IN osteoarthritis, older people, topical NSAIDs	The Use of topical nonsteroidal antiinflammatory drugs (NSAIDs) As Treatment, Chronic	Is worse Than placebo	To induce adverse effets : 17% patients reported systemic adverse effects, with several cases of warfarin potentiation
Cochrane Database Syst Rev. 2009;(3):CD004439		Systematic Review, Cochrane Review
IN osteomyelitis, adults	The Use of oral antibiotics As Treatment, Chronic	Is equal Than parenteral antibiotics	To increase remission rate at 12 months (OR 0.94)
Age Ageing. 2023 Sep 1;52(9):afad172. doi: 10.1093/ageing/afad172		Consensus Conference
IN osteoporosis, after hip fracture	The Use of bisphosphonates, zoledronate, IV infusion (5 or 4 mg starting early after surgery), with supplemental vitamin D As Treatment, Acute	Is better Than no immediate prescription of treatment for osteoporosis	To reduce the (very hihg) risk of a new fracture (experts consensus)
N Engl J Med. 2007 Nov 1;357(18):1799-809		Randomized Controlled Trial, Multicenter Study
IN osteoporosis, after hip fracture	The Use of bisphosphonates, zoledronate, yearly IV infusion (5 mg starting 3 months after surgery), with supplemental vitamin D and calcium As Treatment, Chronic	Is better Than placebo, with supplemental vitamin D and calcium	To reduce any (vertebral or not) new fracture: 8.6% in the zoledronic acid group VS 13.9% in the placebo.
N Engl J Med. 2006 Aug 17;355(7):675-84		Randomized Controlled Trial
IN osteoporosis, glucocorticoid-induced	The Use of bisphosphonates, alendronate (10 mg daily) As Prevention, Primary	Is better Than vitamin D, alfacalcidol (1-alfa-hidroxicoleclaciferol)	To prevent, at 18 months, new vertebral fractures (3% alendronate VS 8% alfacalcidiol) and increase bone density (+2% alendronate VS -1.9% alfacalcidol)
JAMA. 2005 May 11;293(18):2257-64		Meta-Analysis
IN osteoporosis, older people	The Use of vitamin D supplementation, high dose (700-800 IU/d), with or without calcium supplementation As Prevention, Primary	Is better Than calcium supplementation alone or placebo	To reduce the risk of hip fracture (RR, 0.74; 95%CI, 0.61-0.88) and any nonvertebral fracture (RR 0.77; 95%CI, 0.68-0.87)
N Engl J Med. 2012 Jul 5;367(1):40-9		Meta-Analysis
IN osteoporosis, older people	The Use of vitamin D supplementation, high dose (>800 IU/d), with or without calcium supplementation As Treatment, Chronic	Is better Than placebo	To reduce the risk of hip (HR 0.7) and any nonvertebral (HR 0.86) fracture
BMJ. 2009 Oct 1;339:b3692. doi: 10.1136/bmj.b3692		Meta-Analysis
IN osteoporosis, older people, falls	The Use of supplemental vitamin D, high dose (700-1000 IU per day) As Treatment, Chronic	Is better Than placebo, or lower doses	To reduce risk of falling (RR 0.81)
Lancet Diabetes Endocrinol. 2014 Jul;2(7):573-80		Meta-Analysis
IN osteoporosis, older people, falls	The Use of supplemental vitamin D, any dose As Treatment, Chronic	Is equal Than placebo or no supplementation	To reduce the risk of falling (any difference > 10% in the incidence of falls excluded)
Ann Intern Med. 2020 Dec 1. doi: 10.7326/M20-3812. Online ahead of print		Randomized Controlled Trial
IN osteoporosis, older people, falls	The Use of supplemental vitamin D, high dose (1000 IU per day or higher) As Treatment, Chronic	Is equal Than supplemental vitamin D, low dose (200 IU per day)	To reduce number of falls. Even more, analysis suggests falls with adverse outcomes (fracture or hospitalization) could be more frequent in the high-dose group VS the 200-IU/d group (HR aprox 2.0, p = NS)
Lancet. 2005 May 7;365(9471):1621-8		Randomized Controlled Trial, Multicenter Study
IN osteoporosis, older people, previous fracture	The Use of vitamin D3 supplementation, high dose (800 IU/d), or calcium supplementation, or both combined As Treatment, Chronic	Is equal Than placebo	To reduce incidence of new fractures: overall 13% in all groups at 2 years, 26% of all fractures being hip fractures
JAMA Netw Open. 2019 Dec 02;2(12):e1917789		Systematic Review
IN osteoporosis, postmenopausal, both with and without fracture	The Use of daily combined supplementation with vitamin D (400-800 IU/d) and calcium (1000-1200 mg/d), but not vitamine D alone nor intermitent supplementation As Treatment, Chronic	Is better Than placebo or no supplementation	To reduce any fracture (RR 0.94) and hip fractures (RR 0.84)
N Engl J Med. 2001 May 10;344(19):1434-41		Randomized Controlled Trial, Multicenter Study
IN osteoporosis, postmenopausal, previous fracture	The Use of subcutaneous daily teriparatide (biosynthetic human parathyroid hormone 1-34) As Treatment, Chronic	Is better Than placebo	To reduce, at 21 months, vertebral (14% placebo VS 4-5% teriparatide) and non-vertebral fractures (6% placebo VS 3% teriparatide)
N Engl J Med. 2006 Feb 16;354(7):669-83		Randomized Controlled Trial, Multicenter Study
IN osteoporosis, postmenopausal, without fracture	The Use of calcium (1 g/d) plus vitamin D3 (400 UI/d) supplementation As Prevention, Primary	Is equal Than placebo	To reduce, at 7 years, hip or vertebral fractures or any fracture (HR 0.96), in spite of a slight increase in bone density (1%), and produced more renal calculi (HR 1.17)
N Engl J Med. 2009 Aug 20;361(8):756-65. doi: 10.1056/NEJMoa0809493		Randomized Controlled Trial, Multicenter Study
IN osteoporosis, postmenopausal, without fracture	The Use of human monoclonal antibody to the receptor activator of nuclear factor-kappaB ligand (RANKL), denosumab, 60 mg SC every 6 months As Treatment, Chronic	Is better Than placebo	To reduce, at 3 years, new vertebral fractures (2.3% denosumab vs 7.2% placebo) or hip fracture (0.7% denosuma VS 1.2% placebo)
N Engl J Med. 2010 Feb 25;362(8):686-96		Randomized Controlled Trial, Multicenter Study
IN osteoporosis, postmenopausal, without fracture	The Use of strogen receptor modulators, lasofoxifene 0.5 mg daily As Treatment, Chronic	Is better Than placebo	To reduce at 5 years risk of vertebral fracture (13/1000 person-years lasofoxifene VS 22 placebo), non-vertebral fracture (19 VS 24), ER-positive breast cancer (0.3 VS 1.7) and coronary events (5 VS 7.5). But increased thromboembolic events (3.8 VS 1.4)
Lancet. 2007 Aug 25;370(9588):657-66		Meta-Analysis
IN osteoporosis, postmenopausal, without fracture, older people	The Use of calcium, with or without vitamin D supplementation As Treatment, Chronic	Is better Than placebo	To reduce fractures (of any site): 12% calcium plus vit D VS 12.7% placebo
Cochrane Database Syst Rev. 2010;(1):CD004740		Systematic Review, Cochrane Review
IN otitis externa, acute	The Use of antimicrobials or antibiotics with/without steroids topical drops, for 7 to 14 days depending on symptoms As Treatment, Acute	Is better Than placebo	To achieve clinical cure.
JAMA. 2010 Nov 17;304(19):2161-9		Systematic Review
IN otitis media, acute, non severe	The Use of immediate use of antibiotics, ampicillin, amoxicillin As Treatment, Acute	Is better Than placebo, or delayed antibiotic use	To improve short-term clinical success: 90% immediate VS 75% delayed. But amoxicillin increased rash and diarrhea. Ampi/amoxicillin did equal than cephalosporins or other antibiotics.
JAMA. 2007 Feb 28;297(8):842-57		Systematic Review
IN oxidative stress, overall mortality	The Use of antioxidant supplements: beta carotene, vitamin A, and vitamin E, but not vitamin C or selenium As Treatment, Chronic	Is worse Than placebo	To reduce death, in fact they may increase mortality: RR 1.04 to 1.16. Vitamin C and selenium had no significant effect on mortality.
Arch Intern Med. 2007 Sep 10;167(16):1730-7		Meta-Analysis
IN oxidative stress, overall mortality	The Use of antioxidant supplements: vitamin D, ordinary doses (mean 500 UI/day) As Treatment, Chronic	Is better Than placebo	To reduce overall mortality: relative risk 0.93, mortality 8.2% vitD VS 8.5% placebo
Cochrane Database Syst Rev. 2014 Jan 10;(1):CD007470. doi: 10.1002/14651858.CD007470.pub3		Systematic Review, Cochrane Review
IN oxidative stress, overall mortality, elder patients	The Use of vitamin D, vitamin D(3) (cholecalciferol) As Treatment, Chronic	Is better Than placebo	To reduce at 2 years all-cause mortality (RR 0.97, 95%CI 0.94 to 1.00) but increased the risk of nephrolithiasis (RR 1.17). Patients were predominantly elderly women who are mainly in institutions
Am J Clin Nutr. 2013 Apr;97(4):782-93. doi: 10.3945/ajcn.112.047712		Cohorts
IN oxidative stress, overall mortality, older patients	The Use of baseline vitamin D 25(OH)D levels As Prognostic Item	Is useful Than no comparison	To be independently associated with cardiovascular (HR 1.4), cancer (HR 1.4) and all-cause mortality (HR 1.71) at 9.5 years, in subjects with levels less than 30 nmol/L
N Engl J Med. 2005 Sep 1;353(9):898-908		Randomized Controlled Trial
IN Paget, bone disease	The Use of bisphosphonates, zoledronate, single IV infusion (5 mg every 2 months) As Treatment, Acute	Is better Than bisphosphonates, risedronate, daily oral administration for 2 months	To normalize alkaline phosphatase levels: 89% with zoledronate VS 58% with risedronate. Pain scores and quality of life improved similarly in both groups.
Ann Emerg Med. 2006 Aug;48(2):150-60, 160.e1-4		Randomized Controlled Trial
IN pain, abdominal, acute	The Use of morphine As Treatment, Acute	Is better Than placebo	To relieve pain without interfere with diagnostic work: clinically important diagnostic accuracy 86% morphine VS 85% placebo.
Acad Emerg Med. 2013 Nov;20(11):1087-100		Systematic Review
IN pain, abdominal, acute, acute mesenteric ischemia	The Use of computed tomography (CT) angiography As Diagnostic Tool	Is better Than any other test: lactate, D-dimer, clinical findings	To accurately diagnose mesenteric ischemia : for CT angiography sensitivity 94%, specificity 95%, LR+ 17.5, LR- 0.09
Radiology. 2008 Oct;249(1):97-106		Meta-Analysis
IN pain, abdominal, acute, appendicitis	The Use of computed tomography (CT) As Diagnostic Tool	Is better Than ultrasonography (US)	To diagnose acute appendicitis: LR+ 9.3 CT versus 4.5 US and LR- 0.10 CT versus 0.27 US.
Radiology. 2006 Oct;241(1):83-94. Epub 2006 Aug 23		Meta-Analysis
IN pain, abdominal, acute, appendicitis	The Use of computed tomography (CT) As Diagnostic Tool	Is better Than ultrasonography (US)	To diagnose acute appendicitis. In adults: sensibility 94% with CT VS 83% US, specificity 94% CT VS 93%.
N Engl J Med. 1998 Jan 15;338(3):141-6		Randomized Controlled Trial
IN pain, abdominal, acute, appendicitis	The Use of computed tomography (CT) of the appendix As Diagnostic Tool	Is better Than clinical examination and labwork only	To to diagnose appendicitis: 98% sensitivity, specificity, positive and negative predictive values. It is cost-saving.
JAMA. 2007 Jul 25;298(4):438-51		Systematic Review
IN pain, abdominal, acute, appendicitis	The Use of fever, rebound tenderness, midabdominal pain migrating to the right lower quadrant and a white blood cell count above 10,000 As Diagnostic Tool	Is useful Than no comparison here	To select children for immediate surgical evaluation or further diagnosis evaluation of appenditis (see LR+ and LR- in abstract)
JAMA. 1999 Sep 15;282(11):1041-6		Cohorts
IN pain, abdominal, acute, appendicitis	The Use of ultrasonography and computed tomography with rectal contrast if undefined As Diagnostic Tool	Is useful Than no standard conparison	To diagnose appendicitis: this protocol had a 94% sensitivity, 94% specificity, 90% positive predictive value and 97% negative predictive value.
Br J Surg. 2009 May;96(5):473-81		Randomized Controlled Trial, Multicenter Study
IN pain, abdominal, acute, appendicitis, adults	The Use of antibiotics: cefotaxime and metronidazole IV first, then ciprofloxacine and metronidazole PO As Treatment, Acute	Is better Than appendicectomy, open or laparoscopy	To reduce major complications: 5.4% antibiotics VS 10.8% surgery by intention to treat, 2% antibiotics VS 10% surgery per protocol. 7% of patients on antibiotics need acute surgery, and 9% had recurrence at 1 year.
Br J Surg. 1995 Feb;82(2):166-9		Randomized Controlled Trial
IN pain, abdominal, acute, appendicitis, adults	The Use of antibiotics: IV for 2 days, then PO for 10 days As Treatment, Acute	Is better Than appendicectomy, open or laparoscopy	To avoid surgery and complications: 1 of 20 patients on antibiotics needed acute surgery, 7 patients recurred appendicitis at 1 year.
J Pediatr. 2008 Aug;153(2):278-82		Diagnostic
IN pain, abdominal, acute, appendicitis, children	The Use of paediatric appendicitis score (PAS): 2 points for: right lower quadrant Tenderness, Cought/percussion/hoping tenderness; 1 point for: Migration of pain, Anorexia, Nausea/vomiting, Fever>38°, Leucocytosis>10 000, Neutrophilia> 7 500. As Diagnostic Tool	Is useful Than final diagnosis as gold standard	To categorise risk of appendicitis: low risk (score 0-2, 3% appendicitis), medium risk (score 3-6, 45% appendicitis, further testing recommended) and high risk (score 7-10, 75% appendicitis)
JAMA Pediatr. 2017 May 01;171(5):426-434		Meta-Analysis
IN pain, abdominal, acute, appendicitis, children	The Use of antibiotic treatment As Treatment, Acute	Is equal Than appendectomy	To obtain clinical success (91% on antibiotics). But appendicitis with appendicolith had a high failure rate: probably surgery better in this case
World J Surg. 2006 Jun;30(6):1033-7		Randomized Controlled Trial
IN pain, abdominal, acute, appendicitis, non perforated, adults	The Use of antibiotics: IV for 2 days, then PO for 10 days As Treatment, Acute	Is better Than appendicectomy, open or laparoscopy	To reduce surgery and complications: 14% of patients on antibiotics needed acute surgery, 14% more patients had appendicitis recurrence at 1 year.
Radiology. 2008 Jan;246(1):142-7		Diagnostic
IN pain, abdominal, acute, appendicitis, perforation	The Use of Multi-detector row computed tomography (CT) with intravenous contrast and without oral contrast As Diagnostic Tool	Is good Than no comparison here (operatory diagnosis gold standard)	To asses if appendix is perforated (defect in the enhancing appendiceal wall): sensitivity 95%, specificity 97%, accuracy 69%
N Engl J Med. 2020 Oct 5. doi: 10.1056/NEJMoa2014320. [Epub ahead of print]		Randomized Controlled Trial, Multicenter Study
IN pain, abdominal, acute, appendicitis, uncomplicated, adults	The Use of antibiotic therapy (10-day course) As Treatment, Acute	Is equal Than systematic appendectomy	To modify health status at 30 days. However, complications were more common in the antibiotics group than in the appendectomy group (8% vs. 3.5%), mostly attributable to to those with an appendicolith (20% vs. 4%)
Emerg Med J. 2023 Jul;40(7):499-508. doi: 10.1136/emermed-2022-212869		Systematic Review
IN pain, acute, any cause, emergency department	The Use of paracetamol (acetaminophen), I.V. adminsitration As Treatment, Acute	Is equal Than non-steroidal anti-inflammatory drugs (NSAIDs) or opiates/opioids, I.V. or I.M. administration	To reduce pain at 30 and 60 mins (max mean diff -0.27 EVA points, NS). More rescue analgesia was needed, however, after paracetamol than after NSAIDs
JAMA. 2018 Mar 06;319(9):872-882		Randomized Controlled Trial, Multicenter Study
IN pain, back, hip or knee osteoarthritis, chronic	The Use of opioids analgesics, immediate-release morphine, oxycodone, hydrocodone/acetaminophen As Treatment, Chronic	Is worse Than non-opioids analgesics, acetaminophen, NSAIDs	To reduce pain intensity (better reduction with non-opioids), modify pain-related function (equal in both groups) or reduce adverse drugs events (more common with opioids)
JAMA Intern Med. 2013 Nov 25;():		Diagnostic
IN pain, chest, acute, assessing coronary syndrome	The Use of any clinical characteristic, either in women or in men As Diagnostic Tool	Is bad Than no comparison here	To The accuracy of most clinical pain characteristics in the diagnosis of AMI was low in women and men, with likelihood ratios close to 1
JAMA. 2005 Nov 23;294(20):2623-9		Systematic Review
IN pain, chest, acute, assessing coronary syndrome	The Use of some clinical characteristics: radiated to shoulders or to arms, precipitated by exertion As Diagnostic Tool	Is useful Than no comparison	To increase probability of acute coronary syndrom (LR+ 2.3-4.7). Other features decrease this probability: pain that is stabbing, pleuritic, positional, or reproducible by palpation (LR- 0.2-0.3). Further diagnostic testing are always needed
Eur Heart J. 2007 Jan;28(2):204-11		Randomized Controlled Trial, Diagnostic
IN pain, chest, acute, assessing coronary syndrome when non-diagnostic electrocardiogram and negative troponin	The Use of stress echocardiography As Diagnostic Tool	Is better Than exercise ECG	To risk stratification of patients, specially of low-risk patients (77% echo VS 33% exercise ECG), with no signif. difference in cardiac event rate at follow-up (5% echo VS 3% exercise ECG)
Circulation. 2012 Jul 3;126(1):31-40		Diagnostic
IN pain, chest, acute, assessing coronary syndrome, first hour	The Use of high-sensitive cardiac troponin, combining absolute inital value with changes in the first hour As Diagnostic Tool	Is better Than standard cardiac troponin	To discriminates between patients with acute myocardial infarction and those with cardiac noncoronary disease (ROC 0.92)
J Am Coll Cardiol. 2007 Feb 27;49(8):863-71		Randomized Controlled Trial, Diagnostic
IN pain, chest, acute, ruling out coronary disease	The Use of coronary multidetector computed tomography As Diagnostic Tool	Is better Than standard diagnostic evaluation of low-risk acute chest pain	To exclude or identify coronary disease as the source of chest pain: scan alone immediately did it in 75% of patients and reduced time to diagnosis.
Circulation. 2006 Nov 21;114(21):2251-60. Epub 2006 Oct 30		Diagnostic
IN pain, chest, acute, ruling out coronary disease	The Use of coronary multidetector computed tomography, added to clinical estimate As Diagnostic Tool	Is better Than clinical estimate only	To accurately rule out an acute coronary syndrome if not significant coronary stenosis found (negative predictive value, 100%).
Oxycodone for cancer-related pain. Cochrane Database Syst Rev. 2022 Jun 9;6(6):CD003870. doi: 10.100		Systematic Review, Cochrane Review
IN pain, chronic, cancer	The Use of opioids, oxycodone As Treatment, Chronic	Is equal Than opioids, morphine	To achieve overall patients, relief: morphine was marginally better for reduce pain intensity (-0.25 VAS points) but oxycodone induced less constipation (RR 0.75), vomiting (RR 0.81) and hallucinations
Cochrane Database Syst Rev. 2023 May 10;5(5):CD014682. doi: 10.1002/14651858.CD014682.pub2		Systematic Review, Cochrane Review
IN pain, chronic, fibromyalgia, neuropathic, musculoskeletal	The Use of serotonin noradrenalin reuptake inhibitors, duloxetine, milnacipram As Treatment, Chronic	Is better Than placebo, pregabaline, selective serotonin reuptake inhibitors, and tricyclic antidepressants	To achieve substantial pain relief (odds ratio 1.9) and improve continuous pain intensity
JAMA. 2006 Sep 13;296(10):1274-83		Systematic Review
IN pain, headache, classic migraine	The Use of some clinical signs: POUNDing: Pulsating, duration of 4-72 hOurs, Unilateral, Nausea, Disabling As Diagnostic Tool	Is useful Than no direct comparison here	To help diagnosis migraine and decide if to ask neuroimaging tests: if 4 of the 4 POUNDing criteria LR+ =24, if 3 criteria LR+ =3.5 . Other signs associated with serious intracranial abnormality: see abstract.
BMJ. 2008 Jun 14;336(7657):1359-61		Meta-Analysis
IN pain, headache, classic migraine	The Use of dexamethasone, single 10 to 24 mg IV dose As Treatment, Acute	Is better Than placebo	To reduce early recurrence (<72h) of migraine: relative risk 0.74 (0.60 to 0.90)
JAMA. 2007 Apr 4;297(13):1443-54		Randomized Controlled Trial
IN pain, headache, classic migraine	The Use of NSAID (naproxen 500 mg) plus sumatriptan (85 mg) As Treatment, Acute	Is better Than than either NSAID or triptan alone, or placebo	To increase headache relief at 2 hours: 60% combination VS 29% monotherapies VS 28% placebo
Neurology. 2002 Jun 11;58(11):1660-5		Randomized Controlled Trial, Multicenter Study
IN pain, headache, classic migraine	The Use of NSAIDs, ketoprofen As Treatment, Acute	Is equal Than triptans, zolmitriptan	To relief pain at 2 hours: 63% ketoprofen VS 66% triptan
JAMA. 2000 Nov 22;284(20):2599-2605		Randomized Controlled Trial
IN pain, headache, classic migraine	The Use of stratified care: aspirin if mild migraine, triptan (zolmitriptan) if severe As Treatment, Acute	Is better Than step care across attacks or whithin attacks: start always with aspirin and triptan if failure	To improve headache response and disability time
Cochrane Database Syst Rev. 2025 Mar 27;3(3):CD014691. doi: 10.1002/14651858.CD014691.pub2		Randomized Controlled Trial
IN pain, low back, acute, chronic	The Use of spinal manipulation, acupuncture, advice to stay active, exercise thérapies, multidisciplinary thérapies, and psychological therapies As Treatment, Acute	Is better Than no treatment or usual treatment	To modestly reduce pain and improve function
Ann Intern Med. 2017 Jul 18;167(2):85-94		Randomized Controlled Trial, Multicenter Study
IN pain, low back, chronic	The Use of non-pharmacological treatment, alternative therapies, yoga As Treatment, Acute	Is equal Than physical therapy	To improve pain and function (Roland Morris Disability Questionnaire) at 3 months and 1 year
Pain. 2008 May;136(1-2):150-7		Randomized Controlled Trial
IN pain, neuropathic, central nervous system cause	The Use of pregabalin, flexible-dose regimen As Treatment, Chronic	Is better Than placebo	To reduce mean pain score at 1 month
Lancet Neurol. 2015 Feb;14(2):162-73		Systematic Review
IN pain, neuropathic, peripheral nervous system cause	The Use of tricyclic antidepressants, serotonin-noradrenaline reuptake inhibitors - duloxetine, pregabalin, and gabapentin As Treatment, Chronic	Is better Than lidocaine patches, capsaicin high-concentration patches, tramadol or strong opioids	To reduce pain with less adverse effects. NNTs were: 6.4 duloxetine, 7.7 pregabalin; 7.2 gabapentin.
Lancet. 2009 Oct 10;374(9697):1252-61		Cross-Over
IN pain, neuropathic, peripheral nervous system cause, diabetic polyneuropathy, postherpetic neuralgia	The Use of nortriptyline and gabapentin combined As Treatment, Chronic	Is better Than gabapentin or nortriptyline alone	To reduce pain score: 5.4 at baseline VS 3.2 gabapentin VS 2.9 nortryptiline VS 2.3 combination
Lancet. 2010 Sep 4;376(9743):784-93		Randomized Controlled Trial, Multicenter Study
IN palliative care, dyspnea, advanced cancer, advanced chronic obstructive pulmonary disease	The Use of oxygen, via a concentrator, nasal cannula, at 2 L per min As Treatment, Acute	Is equal Than room air, via a concentrator, nasal cannula	To relieve subjective breathlessness, measured in a 0-10 numerical rating scale: it changed about -0.5 points in both groups.
Cochrane Database Syst Rev. 2010;(1):CD007354		Systematic Review, Cochrane Review
IN palliative care, dyspnea, advanced cancer, advanced chronic obstructive pulmonary disease	The Use of benzodiazepines As Treatment, Chronic	Is equal Than placebo	To relief breathlessness
Ann Surg. 1985 May;201(5):656-65		Clinical Trial (non-controlled, non-randomized)
IN pancreatitis, acute	The Use of Balthazar score, early computed tomography As Prognostic Item	Is better Than no initial CT imaging	To predict the risk of developping pancreatic abcesses (12% grade C, 17% grade D, 60% grade E) and death (all in grades D or E)
Am J Gastroenterol. 2008 Jan;103(1):104-10		Meta-Analysis
IN pancreatitis, acute, severe	The Use of intravenous antibiotics As Treatment, Acute	Is equal Than placebo	To reduce infection of pancreatic necrosis (17.8% antibiotics VS 22.9% control, non sig.) or mortality (9.3% antibiotics VS 15.2% control, non sig.)
Am J Gastroenterol. 2006 Jun;101(6):1348-53		Randomized Controlled Trial
IN pancreatitis, acute, severe	The Use of antibiotics (meropenem 500 mg t.i.d.) at admission As Treatment, Chronic	Is better Than antibiotics after the demonstration of necrosis at computed tomography (CT)	To reduce pancreatic infection (13.3% antibiotic at admission VS 31% antibiotic on need) and extrapancreatic infection (16.6% antibiotic at admission VS 44.8% antibiotic on need). Warning: % of pancreatic necrosis at 48H was very different between groups.
N Engl J Med. 2006 Aug 31;355(9):896-908		Randomized Controlled Trial, Multicenter Study
IN parkinson disease, primary, advanced	The Use of neurostimulation of the subthalamic nucleus, added to drugs As Treatment, Chronic	Is better Than drugs alone	To improve, at 6 months, qualiy of life and symptoms (PDQ-39 and UPDRS-III scales). Also to improve serious adverse events: 13% stimulation (including 1 dath) VS 4% drugs.
N Engl J Med. 2012 Feb 9;366(6):511-9		Randomized Controlled Trial, Multicenter Study
IN parkinson disease, primary, mild to moderate	The Use of tai chi As Treatment, Chronic	Is better Than resistance training, or stretching	To improve postural control (better maximum excursion and directional control) and reduce falls
Lancet Neurol. 2010 Feb;9(2):149-58		Diagnostic
IN parkinsonism, parkinson disease, multiple system atrophy, progressive supranuclear palsy	The Use of automated image-based pattern analysis of fluorine-18-labelled-fluorodeoxyglucose-PET (positron emission tompgraphy) As Diagnostic Tool	Is equal Than final diagnosis after clinical followup at 2.5 years	To differenciate precociously, in patients with parkinsonism between primary parkinson disease, multiple system atrophy and progressive supranuclear palsy
JAMA. 2007 Apr 25;297(16):1810-8		Systematic Review
IN pericardial effusion, cardiac tamponade	The Use of dyspnea, tachycardia, pulsus paradoxus, elevated jugular venous pressure, and cardiomegaly on chest radiograph As Diagnostic Tool	Is useful Than no comparison here	To detect cardiac tamponade, respective sensibilities, by order: (88%), (77%), (82%), (76%), and (89%)
Circulation. 2005 Sep 27;112(13):2012-6		Randomized Controlled Trial
IN pericarditis, acute, various etiologies	The Use of colchicine, added to conventional therapy (aspirin or corticosteroids) As Treatment, Acute	Is better Than placebo, added to conventional therapy (aspirin or corticoids)	To reduce recurrence rate at 18 months (10.7% with colchicine VS 32% without) and symptoms persistence at 3 days (12% with colchicine VS 37% without)
Am J Cardiol. 2007 Sep 15;100(6):1026-8		Systematic Review
IN pericarditis, idiopathic, recurrent	The Use of knowing that natural history is benign As Prognostic Item	Is useful Than no comparison here	To predict evolution: 3.5% cardiac tamponade and 0% constrictive pericarditis at 5 years.
J Am Dent Assoc. 2015 Jul;146(7):525-35		Consensus, Guideline
IN periodontal disease, chronic	The Use of scaling and root planing (regular deep cleaning), as the initial nonsurgical treatment As Treatment, Chronic	Is better Than no treatment	To improve, moderately, periodontal disease evolution (improvement of 0.6 mm in sulcus). Subantimicrobial-dose doxycycline, chlorhexidine chips and photodynamic therapy could have also a modest effect (recom strength weak)
Ann Intern Med. 2006 May 2;144(9):660-4		Randomized Controlled Trial
IN peripheral arterial disease	The Use of angiotensin-converting enzyme (ACE) inhibitor, ramipril 10mg/d As Treatment, Chronic	Is better Than placebo	To improve, at 24 weeks, maximum walking time during a standard treadmill test: improved by 451 seconds with ramipril VS no change with placebo.
BMJ. 2007 Jun 16;334(7606):1257		Systematic Review
IN peripheral arterial disease, lower extremities	The Use of magnetic resonance angiography As Diagnostic Tool	Is better Than computed tomography angiography OR duplex ultrasonography AND preferred by patients over contrast angiography	To diagnose stenosis > 50%: sensitivity 95% specificity 97% for MRI VS sens 91% spec 91% for CT VS sens 88% spec 96% for duplex.
JAMA. 2006 Feb 1;295(5):536-46		Systematic Review
IN peripheral arterial disease, lower extremities	The Use of presence of claudication, any arterial bruit or pulse abnormality, cool skin As Diagnostic Tool	Is useful Than duplex sonography, or angiogram, as gold standard	To diagnose this disease
JAMA. 2009 Jan 28;301(4):415-24		Systematic Review
IN peripheral arterial disease, lower extremities, intermittent claudication	The Use of computed tomography angiography As Diagnostic Tool	Is useful Than comparison: intra-arterial digital subtraction angiography	To detect stenosis >50% or occlusion: 95% sensitivity, 96% specificity.
Cochrane Database Syst Rev. 2008;(2):CD001368		Systematic Review, Cochrane Review
IN peripheral arterial disease, lower extremities, intermittent claudication	The Use of naftidrofuryl, a vasoactive agent As Treatment, Chronic	Is better Than placebo	To improve symptoms, increasing pain-free walking distance
Clin Infect Dis. 2018 Jan 18;66(3):346-354		Meta-Analysis
IN pneumonia, community-acquired, hospitalized patients	The Use of corticosteroids As Treatment, Acute	Is better Than Placebo	To reduce time to clinical stability and length of hospital stay by approximately 1 day, but increasing hyperglycemia (22% VS 12%) and pneumonia-related rehospitalization (5% VS 3%). No effect on deaths (5% corticoids VS 6% placebo)
JAMA. 2015 Feb 17;313(7):677-86		Randomized Controlled Trial
IN pneumonia, community-acquired, hospitalized patients, treatment failure	The Use of corticosteroids, methylprednisolone 0.5 mg/kg /12h IV As Treatment, Acute	Is better Than placebo	To reduce treatment failure (wide combined outcome): 13% coticosteroids VS 31% placebo. In-hospital mortality did not significantly differ: 10% corticosteroids VS 15% placebo
Cochrane Database Syst Rev. 2017 12 13;12:CD007720		Systematic Review, Cochrane Review
IN pneumonia, community-acquired, severe, hospitalized patients	The Use of corticosteroids As Treatment, Acute	Is better Than Placebo	To reduce all-cause deaths in adults with severe pneumonia (RR 0.6) and early clinical failure (RR 0.3 severe PNP, 0.7 non-severe), time to clinical cure and length of hospital stay. Hyperglycemia was more frequent (RR 1.2)
JAMA. 2024 Jul 23;332(4):318-328. doi: 10.1001/jama.2024.6096		Review (Narrative)
IN pneumonia, community-acquired, severe, hospitalized patients, COVID-19 or not, Pneumocystis pneumonia, acute respiratory distress syndrome, adults	The Use of low-dose corticosteroids, hydrocortisone equivalent ≤ 400 mg/day for 8 days or fewer As Treatment, Acute	Is better Than placebo or no treatment with corticoids	To reduce mortality: 23% vs 26% in COVID, 10% vs 16% in bacterial pneumonia, 13% vs 25% in Pneumocystis pneumonia, 34% vs 45% in adults acute respiratory distress
N Engl J Med. 2023 Mar 21. doi: 10.1056/NEJMoa2215145		Randomized Controlled Trial, Multicenter Study
IN pneumonia, community-acquired, severe, intensive care unit (ICU)	The Use of corticosteroids, hydrocortisone 200 mg/d for 4 - 8 days as determined by clinical improvement, followed by tapering for a total of 8 - 14 days As Treatment, Acute	Is better Than placebo	To reduce at 28 days death (6% cortisone VS 12% placebo) and endotracheal intubation (18% cortisone VS 29% placebo). Infections and gastrointestinal bleeding were similar in the two groups
Thorax. 2003 May;58(5):377-82		Cohorts
IN pneumonia, community-adquired	The Use of CURB65 and CRB65 scores (1 point each for Confusion, Urea >7 mmol/l, Respiratory rate >30/min, low systolic (<90 mmHg) or diastolic (<60 mmHg) Blood pressure), age >65 years As Prognostic Item	Is useful Than no comparison done	To accurately predict risk of mortality at 30 days: score 0, 0.7%; score 1, 3%; score 2, 3%; score 3, 17%; score 4, 41% and score 5, 57%
N Engl J Med. 1997 Jan 23;336(4):243-50		Cohorts
IN pneumonia, community-adquired	The Use of Pneumonia Severity Index (PSI) based on age, coexisting disease, abnormal physical findings (respiratory rate > 30, temperature > 40°C), and abnormal laboratory findings (pH <7.35, urea > 11 mmol/L, sodium <130 mmol/L) As Prognostic Item	Is useful Than (no comparison)	To accurately predict risk of mortality at 30 days: 0.4% in class I, 0.7% class II, 1-2.8% class III
JAMA. 1996 Jan 10;275(2):134-41		Meta-Analysis
IN pneumonia, community-adquired	The Use of several clinical prognostic factors As Prognostic Item	Is useful Than -	To predict mortality (14%, 36% in ICU patients, 5% others). 10 factors associated with worse prog. see text, the most important (OR): hypothermia (5), hypotension (4.8), neurologic or neoplastic disease (4.6), multilobar infiltrate (3), tachypnea (2.9)
Am J Respir Crit Care Med. 2019 Oct 01;200(7):e45-e67		Consensus, Guideline
IN pneumonia, community-adquired	The Use of guidelines As Treatment, Acute	Is useful Than not using it	To improve standard of care and patients' oucomes
Thorax. 2010 Oct;65(10):878-83		Systematic Review
IN pneumonia, community-adquired, hospitalized patients	The Use of Pneumonia Severity Index (PSI) As Prognostic Item	Is equal Than CURB65 and CRB65	To predict risk of death at 30 days (ROC 0.80). PSI was better for identifying low risk patients: classes I and II had a negative LR of 0.08 for mortality.
Arch Intern Med. 1999 Nov 22;159(21):2562-2572		Randomized Controlled Trial
IN pneumonia, community-adquired, hospitalized patients	The Use of initial empiric antibiotic regimen with: 2nd or 3rd-generation cephalosporin plus macrolide, or a fluoroquinolone alone As Treatment, Acute	Is better Than non-pseudomonal 3rd-generation cephalosporin alone	To reducing mortality at 7 and 30 days
Cochrane Database Syst Rev. 2005 Apr 18;(2):CD004418		Systematic Review, Cochrane Review
IN pneumonia, community-adquired, hospitalized patients	The Use of initial empiric antibiotic regimen with: atypical pathogens coverage As Treatment, Acute	Is equal Than classic only typical pathogen coverage by default	To modify mortality, clinical success rate or adverse events.
Arch Intern Med. 2005 Sep 26;165(17):1992-2000		Meta-Analysis
IN pneumonia, community-adquired, hospitalized patients	The Use of initial empiric antibiotic regimen with: atypical pathogens coverage: macrolide or quinolone As Treatment, Acute	Is equal Than classic only typical pathogen coverage by default: beta-lactam	To reduce mortality or adverse effects
Cochrane Database Syst Rev. 2012 Sep 12;2012(9):CD004418. doi: 10.1002/14651858.CD004418.pub4		Systematic Review, Cochrane Review
IN pneumonia, community-adquired, hospitalized patients	The Use of initial empiric antibiotic regimen with: atypical pathogens coverage: macrolide, quinolone, tetracyclines, chloramphenicol, streptogramins or ketolides As Treatment, Acute	Is equal Than regimens without atypical antibiotic coverage	To modify mortality (RR 1.14). Conclusion relates mostly to the comparison of quinolone monotherapy to beta-lactams
Chest. 2003 May;123(5):1503-11		Randomized Controlled Trial
IN pneumonia, community-adquired, hospitalized patients	The Use of initial empiric antibiotic regimen with: dual therapy combining any beta-lactamic or fluoroquinolone with macrolide, As Treatment, Acute	Is better Than monotherapy with either antibiotic	To reducing 30-day mortality (2,5-3% intv. VS 6-12% ctrl. depending on wich monotherapy) and reducing hospital length of stay
Clin Infect Dis. 2012 Aug;55(3):371-80. doi: 10.1093/cid/cis414		Systematic Review
IN pneumonia, community-adquired, hospitalized patients	The Use of initial empiric treatment including a macrolide As Treatment, Acute	Is better Than other treatment regimens	To reduce mortality (4% macrolides VS 6.5% others). However, no differences when analysing only RCTs or to patients treated with guideline-concordant antibiotics (macrolide/beta-lactam VS fluoroquinolones)
Lancet. 2015 Sep 12;386(9998):1057-65		Randomized Controlled Trial, Multicenter Study
IN pneumonia, community-adquired, hospitalized patients, children < 5 years old, respiratory failure, acute	The Use of bubble continuous positive airway pressure As Treatment, Acute	Is better Than standard low-flow or high-flow oxygen therapy	To reduce treatment failure (6% bubble pressure VS 24% O2 alone) and mortality (4% bubble pressure VS 15% O2 alone)
BMJ. 2006 Jun 10;332(7554):1355		Randomized Controlled Trial, Multicenter Study
IN pneumonia, community-adquired, hospitalized patients, duration of antibiotic treatment	The Use of discontinuing antibiotic treatment (amoxi 3 IV gr/day) after 3 days As Treatment, Acute	Is equal Than discontinuing antibiotic treatment after 8 days	To obtain clinical success rate at day 10 (93% both groups) and day 28 (90% stop at 3 days VS 88% stop at 10 days)
N Engl J Med. 2015 Apr 2;372(14):1312-23		Randomized Controlled Trial, Multicenter Study
IN pneumonia, community-adquired, hospitalized patients, old patients	The Use of beta-lactam monotherapy, as intitial empiric antibiotic As Treatment, Acute	Is better Than beta-lactam + macrolide combination, and equal as fluoroquinolone	To reduce mortality at 90 days: 9.0% with beta-lactam monotherapy, 11.1% beta-lactam-macrolide combination, and 8.8% fluoroquinolone monotherapy.
Am J Respir Crit Care Med. 2006 Jul 1;174(1):84-93. Epub 2006 Apr 7		Randomized Controlled Trial
IN pneumonia, community-adquired, respiratory infection, lower airways	The Use of procalcitonin, antibiotics use according to procalcitonin (in mug/L): strongly discouraged < 0.1; discouraged < 0.25; encouraged > 0.25; strongly encouraged > 0.5 As Diagnostic Tool	Is better Than systematic treatment with antibiotics	To identify patients with severe infection and guide antibiotic use: it reduced antibiotic use (85% vs 99%) and duration (5 vs 12 days) obtaining same outcome (success rate 83%)
N Engl J Med. 2018 07 19;379(3):236-249		Randomized Controlled Trial
IN pneumonia, community-adquired, respiratory infection, lower airways	The Use of procalcitonin, treating with antibiotics according to serum procalcitonin levels As Diagnostic Tool	Is equal Than usual care, without procalcitonin	To modify the use of antibiotics (59% boths), the number of antibiotic-days (mean 4.2) or the proportion of patients with adverse outcomes (12-13%)
Ann Emerg Med. 2008 Jan;51(1):91-100, 100.e1		Meta-Analysis
IN pneumothorax, spontaneous	The Use of needle aspiration, repeated if needed As Treatment, Acute	Is better Than tube thoracostomy	To reduce need for hospitalization (RR 0.26) and hospital stay (mean diff. -2.5 days ), while having similar failure and recurrence rates
J Neurol Neurosurg Psychiatry. 2010 Nov;81(11):1194-9		Randomized Controlled Trial
IN polyneuropathy, polyradiculoneuropathy, chronic inflammatory demyelinating	The Use of human immune globulin, intravenou, every 3 weeks for up to 24 weeks As Treatment, Acute	Is better Than placebo	To improve several "minimum clinically important differences" on quality of life scores, disability scores and impairment scores
N Engl J Med. 2017 Jun 28. doi: 10.1056/NEJMoa1704559. [Epub ahead of print]		Randomized Controlled Trial, Multicenter Study
IN preeclampsia	The Use of aspirin, 150 mg/day As Treatment, Chronic	Is better Than placebo	To reduce delivery with preeclampsia before 37 weeks of gestation: 1.6% aspirin VS. 4.3% placebo. No differences in the incidence of neonatal adverse outcomes.
N Engl J Med. 2005 Aug 25;353(8):761-9		Randomized Controlled Trial, Multicenter Study
IN pregnancy faiure, incomplete spontaneous abortion, first-trimester	The Use of misoprostol, vaginal (800 mcg) As Treatment, Acute	Is equal Than vacuum aspiration, surgical treatment	To safely expulsion of any rest: <1% haemorrhage or endometritis in both group. Only 16% failures with misoprostol requiring vacuum aspiration
Ann Intern Med. 2013 Jul 2;159(1):28-38		Systematic Review
IN pressure ulcers, bedriden patients	The Use of advanced static support surfaces, alternating-air mattresses As Treatment, Acute	Is better Than regular mattresses	To reduce incidence of pressure ulcers (RR 0.20 to 0.60). Alternating-air mattresses are no more effective than advanced static supports
Acad Emerg Med. 2018 Aug 21. doi: 10.1111/acem.13558. [Epub ahead of print]		Systematic Review
IN procedures, lumbar puncture	The Use of ultrasound assistance: identifying the location and trajectory for the LP procedure As Diagnostic Tool	Is better Than usual landmark-based LP, without ultrasound assistance	To improve success rate (90% ultrasound VS 81% landmark), time to successful LP, patient pain scores
N Engl J Med. 2001 Dec 13;345(24):1727-33		Diagnostic
IN procedures, lumbar puncture	The Use of various clinical features, in history and examination As Diagnostic Tool	Is useful Than performing cranial CT to everybody	To identifying patients at risk of having intracranial lesions that may contraindicate lumbar: LR- 0.10 if any of the features present (see abstract below)
JAMA. 2006 Oct 25;296(16):2012-22		Systematic Review
IN procedures, lumbar puncture	The Use of some measures (small-gauge, atraumatic needles, reinsertion of the stylet , no need of bed rest) and some test on CSF (leucocyte>500, glucose ratio<0.4, lactates>3.5mmol/L) As Prevention, Primary	Is useful Than not using that procedures or test	To avoid post-punction headache (set of measures) and diagnose bacterial meningitis (test on CSF)
J Neurol Neurosurg Psychiatry. 2008 May;79(5):553-8		Randomized Controlled Trial
IN procedures, lumbar puncture, post puncture headache	The Use of epidural blood patch As Treatment, Acute	Is better Than usual conservative treatment	To reduce headache at 24 h (58% blood patch VS 90% conservative Tt) and at 7 days (16% blood patch VS 86% conservative Tt)
Int J Clin Pract. 2008 Oct;62(10):1547-59		Meta-Analysis
IN prostatic hyperplasia, benign, cardiovascular death	The Use of alpha1-adrenergic receptor blockers, alfuzosin, terazosin, doxazosin, tamsulosin As Treatment, Chronic	Is worse Than placebo	To modify cardivascular events: they increased it (OR 1.4 to 3.7)
Neuroimage. 2002 Jun;16(2):331-48		Meta-Analysis
IN psyche, emotion, neuroanatomy	The Use of neuroimaging studies: positron emission tomography (PET), functional magnetic resonance imaging (fMRI) As Diagnostic Tool	Is useful Than no comparison here	To understand the anatomic structures related to emotions
Science. 2004 Feb 20;303(5661):1162-7		Clinical Trial (non-controlled, non-randomized)
IN psyche, pain, expectations modulation, mind-body relations, placebo effect	The Use of placebo As Treatment, Acute	Is better Than no intervention	To reduce pain associated with increased activity during anticipation of pain in the prefrontal cortex, which decrease activity in pain-sensitive brain regions
N Engl J Med. 2007 Nov 1;357(18):1829-33		Descriptive
IN psyche, perception, out-of-body experience	The Use of brain activation at the temporoparietal junction on the right side As Undefined	Is undefined Than -	To cause the disembodiment sensation that is part of the out-of-body experience
N Engl J Med. 2025 Sep 30. doi: 10.1056/NEJMoa2508170. Epub ahead of print		Randomized Controlled Trial, Multicenter Study
IN pulmonary arterial hypertension, patients diagnosed less than 1 year earlier, functional class II or III, and receiving double or triple background therapy	The Use of activin-signaling inhibitors, subcutaneous sotatercept, 0.3 mg/Kg escalated to target dose 0.7 mg/Kg, every 21 days As Treatment, Chronic	Is better Than placebo	To reduce at 13 months a composite clinical worsening: 11% sota VS 37% placebo, mainly because of deteriorationin exercise testing due to pulmonary hypertension. No difference in mortality (about 4% both)
N Engl J Med. 2012 May 24;366(21):1968-77		Randomized Controlled Trial, Multicenter Study
IN pulmonary fibrosis, idiopathic	The Use of a combination of prednisone, azathioprine, and N-acetylcysteine As Treatment, Chronic	Is worse Than placebo	To modify the outcomes : combination-therapy group, as compared with the placebo group, had an increased rate of death (8 vs. 1%) and hospitalization (23 vs. 7%)
Lancet Respir Med. 2017 01;5(1):33-41		Meta-Analysis
IN pulmonary fibrosis, idiopathic	The Use of fibrosis inhibitor, hedgehog signaling pathway inhibitor, pirfenidone As Treatment, Chronic	Is better Than placebo	To reduce disease progression and mortality (HR 0.5) at 1 and 2 years.
N Engl J Med. 2019 Oct 31;381(18):1718-1727. doi: 10.1056/NEJMoa1908681		Randomized Controlled Trial, Multicenter Study
IN pulmonary fibrosis, idiopathic, or hypersensitivity pneumonitis, or rheumatoid arthritis, or systemic sclerosis, or mixed connective tissue disease	The Use of intracellular inhibitor of multiple tyrosine kinases (PDGFR, FGFR, VEGFR, Lck, Lyn, src), nintedanib As Treatment, Chronic	Is better Than placebo	To reduce decline in lung capacity (FVC): -80 ml/year nintedanib VS. -188 ml/year placebo. But increased adverse effects, aminly diarrhea (67% of patients) and transaminase increases
N Engl J Med. 2021 Jan 13. doi: 10.1056/NEJMoa2008470. Online ahead of print		Randomized Controlled Trial, Multicenter Study
IN pulmonary hypertension, secondary, patients with interstitial lung disease	The Use of inhaled prostaglandin analogs, treprostinil As Treatment, Chronic	Is better Than placebo	To improve, at 3 months, 6-minute walk distance test (mean improvement 31 m) and reduce clinical worsening (23% treprostinil VS 33% placebo). Adverse events: cough, headache, dyspnea, dizziness, nausea, fatigue, and diarrhea.
Ann Intern Med. 2008 Jun 3;148(11):810-9		Diagnostic
IN renal failure, acute	The Use of urinary neutrophil gelatinase-associated lipocalin (NGAL) As Diagnostic Tool	Is better Than cretinin or urea or other urinary proteins	To distingish acute from chronic kidney injury: sensitivity 90% and specificity 99.5% for detecting acute injury, at a cutoff value of 130 microg/g creatinine.
J Am Soc Nephrol. 2008 May;19(5):1034-40		Randomized Controlled Trial, Multicenter Study
IN renal failure, acute, critically ill patients	The Use of renal tubule cells assist device (a conventional hemofilter lined by monolayers of renal cells) As Treatment, Acute	Is better Than conventional continuous renal replacement therapy, continuous venovenous hemofiltration	To reduce death at 28 days: 33% with renal tubule cells device VS 61% conventional hemofiltration
N Engl J Med. 2006 Jun 29;354(26):2773-82		Randomized Controlled Trial, Multicenter Study
IN renal toxic damage, radiologic contrast	The Use of high dose acetylcysteine (1200 mg IV, then 1200 mg orally/12h for 2 days) As Treatment, Acute	Is better Than standard dose acetylcysteine (600 mg IV, then 600 mg orally/12h for 2 days) or placebo	To prevent acute increases in creatinine following primary angioplasty: 8% double dose VS 15% standard dose VS 33% placebo. And to reduce in-hospital mortality: 3% double dose VS 4% standard dose VS 11% placebo
Arch Intern Med. 2002 Feb 11;162(3):329-36		Randomized Controlled Trial
IN renal toxic damage, radiologic contrast	The Use of isotonic (0.9% saline) hydration As Treatment, Acute	Is better Than half-isotonic (0.45% sodium chloride plus 5% glucose) hydration	To reduce acute increases in creatinine (0.7% isotonic VS 2% half-isotonic hydration)
J Am Coll Cardiol. 2007 Sep 11;50(11):1015-20		Randomized Controlled Trial
IN renal toxic damage, radiologic contrast, high risk patients with advanced renal failure	The Use of prophylactic hemodialysis, added to fluid supplementation As Treatment, Acute	Is better Than fluid supplementation alone	To reduce impairment of renal function and need for therapeutic dyalisis, temporary (2.4% prophylactic dyalisis VS 35% control) or permanent dyalisis (0% prophylaxis VS 13% control)
Heart. 2005 Jun;91(6):774-8		Randomized Controlled Trial
IN renal toxic damage, radiologic contrast, low to moderate risk patients	The Use of acetylcysteine As Treatment, Acute	Is equal Than placebo	To prevent increase of serum cretinine with contrast agent when having a coronary angiography or procedure: about 10% both groups
Circulation. 2011 Sep 13;124(11):1250-9		Randomized Controlled Trial, Multicenter Study
IN renal toxic damage, radiologic contrast, moderate to high risk patients	The Use of acetylcysteine 1200 mg, orally twice daily for 2 doses before and 2 doses after the procedure As Treatment, Acute	Is equal Than placebo	To modufy the incidence of contrast-induced acute kidney injury: 12.7% for both treatment and placebo
N Engl J Med. 2017 Nov 12. doi: 10.1056/NEJMoa1710933. [Epub ahead of print]		Randomized Controlled Trial, Multicenter Study
IN renal toxic damage, radiologic contrast,high risk patients	The Use of IV 1.26% sodium bicarbonate and/or 5 days of oral acetylcysteine As Treatment, Acute	Is equal Than IV 0.9% sodium chloride and/or placebo	To modify at 3 months a composite of death, need for dialysis, or a persistent 50% creatinine increase from baseline: 4% bicarbonate, 5% saline, 5% acetylcysteine, 5% placebo.
Crit Care Med. 2002 Mar;30(3):555-62		Meta-Analysis
IN respiratory failure, acute	The Use of non-invasive ventilation As Treatment, Acute	Is better Than standard medical therapy	To reduce mortality (8%), reduce need for mechanical ventilation (19%) and shorten hospital length of stay (2.74 days)
Ann Intern Med. 2021 Apr 27. doi: 10.7326/M20-5504		Systematic Review
IN respiratory failure, acute, dyspnea, acute	The Use of point-of-care ultrasonography (POCUS), added to a standard diagnostic pathway As Diagnostic Tool	Is better Than standard diagnostic pathway alone	To increase the number of correct diagnoses in patients with dyspnea. However, in-hospital mortality and length of hospital stay did not differ significantly
N Engl J Med. 2021 Jan 20. doi: 10.1056/NEJMoa2032510. Online ahead of print		Randomized Controlled Trial, Multicenter Study
IN respiratory failure, acute, hypoxic, acutely ill adults, emergency care	The Use of oxygen therapy targeting a Pao2 of 60 mm Hg As Treatment, Acute	Is equal Than oxygen therapy targeting a Pao2 of 90 mm Hg	To modify death at 3 months (42% in both groups). No difference neither in days that patients were alive without life support, episodes of shock, myocardial ischemia, ischemic stroke, or intestinal ischemia
Arch Pediatr Adolesc Med. 2007 Dec;161(12):1140-6		Randomized Controlled Trial
IN respiratory infection, upper airways, cough	The Use of buckwheat honey As Treatment, Acute	Is better Than dextromethorphan or placebo	To achieve symptomatic relief of nocturnal cough and increase sleep quality
J Rheumatol. 2006 Aug;33(8):1476-81		Randomized Controlled Trial
IN rheumatoid arthritis	The Use of anti-cyclic citrullinated peptide antibodies (anti-CCP) As Diagnostic Tool	Is better Than anti-Sa antibodies	To diagnose rheumatoid arthritis: anti-CCP sensibility 72%, specificity 94% VS anti-SSa sensibility 44%, specificity 96%
Ann Rheum Dis. 2013 Jun;72(6):804-14		Consensus Conference
IN rheumatoid arthritis	The Use of ultrasound, or MRI to image joints As Diagnostic Tool	Is better Than clinical examination, or conventional radiography	To to detect active inflammation, better detect bone and joint damage, so assess respônse to therapy and predict future evolution of the disease
Ann Intern Med. 2007 Mar 20;146(6):406-15		Randomized Controlled Trial, Multicenter Study
IN rheumatoid arthritis	The Use of initial combination therapy, with tapered high-dose prednisone, or with infliximab As Treatment, Chronic	Is better Than sequential monotherapy, or step-up combination therapy	To improve mean functional ability score and reduce progression of joint damage
Ann Intern Med. 2008 Jan 15;148(2):124-34		Systematic Review
IN rheumatoid arthritis	The Use of several syntetic disease-modifying drugs (methotrexate, leflunomide, and sulfasalazine) and several anti-tumor necrosis factor antibodies/drug (adalimumab, etanercept, and infliximab) As Treatment, Chronic	Is equal Than each other	To clinically improve patients at long-term. When monotherapy failed, combination therapy with antit-umor necrosis factor antibodies/drug and MTX or with two synthetic DMARDs improved response rates.
N Engl J Med. 2017 02 16;376(7):652-662		Randomized Controlled Trial, Multicenter Study
IN rheumatoid arthritis, active despite methotrexate therapy	The Use of baricitinib, thyrosin kinase inhibitors, Janus kinases JAK1 and JAK2 inhibitor As Treatment, Chronic	Is better Than placebo, or adalimumab, an anti-tumor necrosis factor α (TNFalpha) monoclonal antibody	To achieve clinical improvement at 3 moths: 70% patients on baricitinib, 61% adalimumab, 40% placebo. Adverse events, including infections, were more frequent with baricitinib and adalimumab
N Engl J Med. 2010 Sep 30;363(14):1303-12		Randomized Controlled Trial, Multicenter Study
IN rheumatoid arthritis, active despite methotrexate therapy	The Use of R788, spleen tyrosine kinase (Syk) inhibitor As Treatment, Chronic	Is better Than placebo	To improve at 6 months clinical response (ACR 20 response in 57-67% with R788 VS 35% placebo). Adverse events included diarrhea, hypertension, and neutropenia
Ann Rheum Dis. 2008 Jan;67(1):48-51		Diagnostic
IN rheumatoid arthritis, in patients with arthritis unclassified after standard evaluation	The Use of magnetic resonance imaging (MRI), bone scintigraphy As Diagnostic Tool	Is better Than plain radiographies	To accurately classify patients as rheumatoid arthritis and non-rheumatoid arthritis: specificity 100% in this study
Ann Rheum Dis. 2012 Jul;71(7):1128-33		Case-Control
IN rheumatoid arthritis, older patients, iatrogenic immunodepression, corticosteroids induced	The Use of systemic corticosteroids, current dose, even very low doses (5 mg/day prednisolone), total cumulative dose in last 2 years As Etiologic risk factor	Is worse Than no corticosteroids treatment	To increase risk of serious infection: weighted cumulative dose better predicted risk. A current user of 5 mg/day of prednisolone had a RR 1.30 to 2 of serious infection, depending on cumulative dose
Ann Intern Med. 2020 Dec 1;173(11):870-878. doi: 10.7326/M20-1594		Cohorts
IN rheumatoid arthritis, older patients, iatrogenic immunodepression, corticosteroids induced	The Use of systemic corticosteroids, current dose, even very low doses (5 mg/day prednisolone) As Treatment, Chronic	Is worse Than no corticosteroid treatment	To increase risk of serious infection: 9% per year no cortics VS 11% cortics < 5mg/d VS 14% cortics 5-10 mg/d VS 18% cortics > 10 mg/d
N Engl J Med. 2025 Jul 17;393(3):231-242. doi: 10.1056/NEJMoa2501443		Randomized Controlled Trial, Multicenter Study
IN sarcoidosis, pulmonary, no previous treatment	The Use of methotrexate according to a prespecified treatment schedule As Treatment, Acute	Is equal Than prednisone	To achieve at 6 months equal improvement in forced vital capacity (FVC) with similar incidence of adverse events (but of different nature: MTX nausea, fatigue, and abnormal liver tests, PRED weight gain, insomnia, and increased appetite)
Age Ageing. 2019 Jan 1;48(1):16-31. doi: 10.1093/ageing/afy169		Consensus, Guideline
IN sarcopenia, adults	The Use of new diagnostic criteria for sarcopenia, considered a muscle disease (muscle failure), with low muscle strength overtaking the role of low muscle mass As Diagnostic Tool	Is better Than old diagnostic criteria	To improve the performance in diagnosing sarcopenia
N Engl J Med. 2017 03 23;376(12):1111-1120		Randomized Controlled Trial, Multicenter Study
IN sciatica, acute or persistent, pain, neuropathic, peripheral nervous system cause	The Use of pregabalin As Treatment, Acute	Is equal Than placebo	To reduce, at week 8 or at 1 year, a score of leg-pain intensity, disability, back-pain intensity, or quality-of-life measures
N Engl J Med. 2006 Jun 22;354(25):2667-76		Descriptive
IN scleroderma	The Use of stimulatory autoantibodies to the platelet-derived growth factor (PDGF) receptor As Diagnostic Tool	Is useful Than no comparison here	To be a specific hallmark of scleroderma and to have a causal role in the pathogenesis of this disease. This antibodies were found in all the patients with scleroderma
N Engl J Med. 2006 Jun 22;354(25):2655-66		Randomized Controlled Trial, Multicenter Study
IN scleroderma, with related interstitial lung disease	The Use of cyclophosphamide (< or =2 mg/Kg/day for 1 year) As Treatment, Chronic	Is better Than placebo	To slightly improve respiratory function: an increase of 2.53% in forced vital capacity. Also improved dyspnoea and health-related quality of life, but increased adverse effects.
BMJ. 2004 Mar 20;328(7441):668		Meta-Analysis
IN sepsis	The Use of empirical antibiotics, beta lactam monotherapy As Treatment, Acute	Is better Than beta lactam plus aminoglycoside combination therapy	To reduce the risk for adverse events (nephrotoxicity ) and reduce the risk of clinical failure, while no difference in all cause fatality
Cochrane Database Syst Rev. 2014 Jan 7;2014(1):CD003344. doi: 10.1002/14651858.CD003344.pub3		Systematic Review, Cochrane Review
IN sepsis	The Use of iempirical antibiotics, beta lactam monotherapy As Treatment, Acute	Is better Than beta lactam plus aminoglycoside combination therapy	To improve global outcome: no differences in mortality or clinical failure, but less nephrotoxicity (RR 0.30) than aminoglycosides combination
N Engl J Med. 2017 Jun 08;376(23):2235-2244		Cohorts
IN sepsis	The Use of more rapid administration of antibiotics and rapid completion of a 3-hour bundle of sepsis care (i.e., blood cultures, broad-spectrum antibiotic agents, and lactate measurement) As Treatment, Acute	Is better Than more delayed administration of antibiotics and completion of a bundle of sepsis care	To reduce in-hospital mortality (OR 1.04 per hour). More rapid administration of fluid bolus had no influence in mortality
J Intensive Care. 2020 Oct 6;8:77. doi: 10.1186/s40560-020-00490-z		Randomized Controlled Trial
IN sepsis	The Use of Prolonged β-lactam IV infusion, after a loading dose As Treatment, Acute	Is better Than intermittent β-lactam infusion	To attain clinical cure (RR 0.84) but not to clearly modify mortality (RR 0.69 but not significant), except for studies published after 2015 (RR 0.66 and significant)
Ann Intensive Care. 2024 Feb 18;14(1):30. doi: 10.1186/s13613-024-01263-9		Meta-Analysis
IN sepsis	The Use of Prolonged β-lactam IV infusion, after a loading dose As Treatment, Acute	Is better Than intermittent β-lactam infusion	To reduce short-term mortality (RR 0.83) and improve clinical success (RR 1.16), without increasing adverse events
Lancet. 2010 Feb 6;375(9713):463-74		Randomized Controlled Trial, Multicenter Study
IN sepsis, any bacterial infection, critically ill patients	The Use of procalcitonin, treating with antibiotics according to serum procalcitonin levels As Diagnostic Tool	Is equal Than empirical treatment with antibiotics according with guidelines	To modify mortality at 60 days (30% procalcitonine VS 26% standard care, p=NS) while increasing the number of days without antibiotic (14 days procalcitonine VS 11.6 days standard care)
Age Ageing. 2021 Sep 11;50(5):1546-1556. doi: 10.1093/ageing/afab078		Meta-Analysis
IN sepsis, any bacterial infection, critically ill patients, respiratory tract infections, pneumonia	The Use of procalcitonin guided therapy, treating with antibiotics according to serum procalcitonin levels As Diagnostic Tool	Is better Than empirical treatment with antibiotics, not procalcitonin guided	To reduce antibiotic duration by 2 days at all age groups without increasing morbidity or mortality at 30 days
JAMA. 2012 Aug 1;308(5):502-11		Meta-Analysis
IN sepsis, bacteremia	The Use of blood cultures guided by clinical sttings : shock, shaking chills, or systemic inflammatory response sd (fever >38ºC, tachycardia, tachypnea, pCO2<32, leucocytosis) As Diagnostic Tool	Is better Than liberally ordered blood cultures, specially in patients with isolated fever or leukocytosis	To yield true-positive results and identify a germ
Lancet Infect Dis. 2007 Mar;7(3):210-7		Systematic Review
IN sepsis, critically ill patients	The Use of procalcitonin As Diagnostic Tool	Is bad Than no comparison here	To accurately differentiate sepsis from other non-infectious causes of systemic inflammatory response: both sensibility and specificity 71%
Lancet Infect Dis. 2013 May;13(5):426-35		Systematic Review
IN sepsis, critically ill patients	The Use of procalcitonin As Diagnostic Tool	Is good Than no comparison here	To accurately diagnose sepsis: sensitivity 0.77, specificity 0.79, area under ROC curve 0.85
Crit Care Med. 2011 Feb;39(2):386-91		Meta-Analysis
IN sepsis, septic shock	The Use of colloid albumin-containing solutions As Treatment, Acute	Is better Than other fluid, colloid or crystalloids solutions	To reduce death: 0.82, 95%CI 0.67-1.0. Some doubts about the validity of included studies: see the accompanying editorial
Crit Care Med. 1995 Aug;23(8):1430-9		Systematic Review
IN sepsis, septic shock	The Use of corticosteroids As Treatment, Acute	Is worse Than placebo	To reduce mortality: trend toward increased mortality (relative risk 1.13, p NS) with corticosteroids
Ann Intern Med. 2004 Jul 6;141(1):47-56		Meta-Analysis
IN sepsis, septic shock	The Use of corticosteroids, 7 days course of lower doses (1 200 mg hydrocortisone equivalents) As Treatment, Acute	Is better Than placebo orshort course of high-dose corticosteroids	To reduce mortality (relative benefit 1.23) and improve shock reversal (relative benefit 1.71)
JAMA. 2009 Jun 10;301(22):2362-75		Meta-Analysis
IN sepsis, septic shock	The Use of corticosteroids, a several days course of low dose As Treatment, Acute	Is better Than placebo	To reduce 28-day mortality: 37.5% corticoids VS 44% placebo. Corticoids increased hyperglycaemia and hyponatremia, but not superinfection or gastroduocenal bleeding.
N Engl J Med. 2008 Jan 10;358(2):111-24		Randomized Controlled Trial, Multicenter Study
IN sepsis, septic shock	The Use of corticosteroids, hydrocortisone (50 mg/6h for 5 days and tapering) As Treatment, Acute	Is equal Than placebo	To reduce mortality at 4 weeks (39% hydrocortisone VS 36% placebo)
N Engl J Med. 2018 Mar 1;378(9):809-818		Randomized Controlled Trial, Multicenter Study
IN sepsis, septic shock	The Use of corticosteroids, hydrocortisone plus fludrocortisone for 7 days (hydrocortisone 50mg IV /6 hours, fludrocortisone 50μg /d PO/SNG) As Treatment, Acute	Is better Than placebo	To reduce death at 3 months: 43% cortics VS 49% placebo. Rate of serious adverse events did not differ significantly, except hyperglycemia.
N Engl J Med. 2001 Nov 8;345(19):1368-77		Randomized Controlled Trial
IN sepsis, septic shock	The Use of early goal-directed therapy for 6 h (transfusion, dobutamine directed by central venous oxygen saturation) added to standard therapy As Treatment, Acute	Is better Than standard therapy (crystalloid and vaso-pressor / dilators drugs directed by arterial pressure)	To reduce in-hospital mortality (30.5% in intv. VS 46.5% in ctrl.). Improve central venous oxygen saturation, acidosis and APACHE score
Chest. 2024 Jul 5:S0012-3692(24)04581-1. doi: 10.1016/j.chest.2024.05.042		Randomized Controlled Trial
IN sepsis, septic shock	The Use of early use of norepinephrine As Treatment, Acute	Is better Than late treatment with norepinephrine	To reduce pulmonary edema (OR, 0.43) and days on mechanical ventilation (mean diff 4 days) but not to improve overall mortality (maybe in certain subgroups)
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
N Engl J Med. 2014 Apr 24;370(17):1583-93. Epub 2014 Mar 18		Randomized Controlled Trial, Multicenter Study
IN sepsis, septic shock	The Use of high blood pressure target, mean BP of 80 to 85 mmHg As Treatment, Acute	Is equal Than low blood pressure target, mean BP of 65 to 70 mmHg	To modify mortality at 1 month (37% high BP VS 34% low BP) or at 3 months (44% high BP VS 42% low BP)
N Engl J Med. 2008 Jan 10;358(2):125-39		Randomized Controlled Trial, Multicenter Study
IN sepsis, septic shock	The Use of intensive insulin therapy OR colloid (pentastarch, HES) for fluid resuscitation As Treatment, Acute	Is worse Than conventional insulin therapy OR cristalloids (Ringer lactate) for fluid resuscitation	To reduce mortality at 4 weeks. Intensive insulin increased hypoglycemias and HES increased ranal failure.
N Engl J Med. 2014 May 1;370(18):1683-93		Randomized Controlled Trial, Multicenter Study
IN sepsis, septic shock	The Use of protocol-based care, early goal-directed therapy protocol (fluids, vasopressors, and blood transfusions adjusted to central hemodynamic targets), or a protocol standard therapy (did not require central venous catheter, inotropes, or blood transfusion) As Treatment, Acute	Is equal Than usual care	To modify mortality at 2 months (21% EGDT, 18% protocol-based, 19% usual care) or at 1 year
Crit Care Med. 2006 Jun;34(6):1589-96		Cohorts
IN sepsis, septic shock	The Use of quick administration of effective antibiotics, in the first hour As Treatment, Acute	Is better Than delayed administration of antibiotics	To reduce in-hospital mortality: 20.1% when antibiotics in 1 hr, increasing 7.6% each hr after over 6 hrs
N Engl J Med. 2022 Jun 30;386(26):2459-2470. doi: 10.1056/NEJMoa2202707		Randomized Controlled Trial, Multicenter Study
IN sepsis, septic shock	The Use of restrictive, low-volume IV fluid resuscitation: after 1L initial administration, IV fluid only if hypoTA, hypoperfusion or dehydration with abnormal losses As Treatment, Acute	Is equal Than liberal IV fluid resuscitation (usual care)	To modify, at 3 months, mortality (42% both groups), serious adverse events (29-31%) or days alive
Crit Care Med. 2008 Oct;36(10):2734-9		Systematic Review
IN sepsis, septic shock	The Use of structured therapy targeting predefined hemodynamic end points, quantitative resuscitation As Treatment, Acute	Is better Than conventional resuscitation, not predefined hemodynamic targets	To decrease mortality: OR 0.64. Late studies did not found sig difference.
Cochrane Database Syst Rev. 2025 Jun 5;6(6):CD002243. doi: 10.1002/14651858.CD002243.pub5		Systematic Review, Cochrane Review
IN sepsis, septic shock, children, adults	The Use of corticosteroids on top of usual care (antimicrobials, fluid replacement and vasopressor therapy as needed) As Treatment, Acute	Is better Than placebo or no corticosteroids	To reduce length of intensive care unit stay (MD -0.9 days) and mortality at 28 days (RR 0.89) and did not increased the risk of muscle weakness or superinfection
Am J Respir Crit Care Med. 2019 May 01;199(9):1097-1105		Randomized Controlled Trial
IN sepsis, septic shock, sepsis with hypotension	The Use of early use of norepinephrine As Treatment, Acute	Is better Than usual care	To improve shock control at 6h (76% norepi VS 48% usual) and possibly reduce mortality at 1 month (16% norepi VS 22% usual, p 0.15)
Crit Care Med. 2019 Jul;47(7):951-959. doi: 10.1097/CCM.0000000000003779		Randomized Controlled Trial
IN sepsis, septic shock, severe sepsis	The Use of restrictive, low-volume IV fluid resuscitation, ≤ 60 mL/kg of IV fluid for the first 72 hours As Treatment, Acute	Is equal Than high-volume IV fluid resuscitation (usual care)	To modify mortality at 30 days (22% both strategies). No differences neither in the rate of new organ failure, hospital or ICU length of stay, or serious adverse events.
JAMA. 2023 Jun 13;329(22):1967-1980. doi: 10.1001/jama.2023.7560		Review (Narrative)
IN sepsis, septic shock, severe sepsis	The Use of unstructured clinical care, administering at least 1 L of fluid, balanced colloids, further fluids only if persistent hypoperfusion or hypoTA responsive to fluids, and removing excess fluids with diuretics after resuscitation As Treatment, Acute	Is equal Than goal-oriented therapy: using more liberal fluids or vasopressors to attaint pre-stablished central venous pressures, mean arterial blood pressures or central venous oxygen saturations	To modify mortality (14 to 42% depending of the setting, initial severity and presence of respiratory distress)
JAMA. 2023 May 21:e238812. doi: 10.1001/jama.2023.8812. Epub ahead of print		Randomized Controlled Trial, Multicenter Study
IN serious illness, critically ill patients	The Use of a 1-page, patient-specific intervention (Jumpstart Guide) to prompt and guide goals-of-care discussions As Treatment, Acute	Is better Than usual care	To increase the number of patients with documented goals-of-care discussions at 30 days: 35% with prompt VS 30% usual care
Crit Care Med. 1999 Jan;27(1):200-10		Meta-Analysis
IN shock	The Use of isotonic crystalloids As Treatment, Acute	Is equal Than colloid for fluid resuscitation	To modify mortality, pulmonary edema incidence or length of stay in intensive care unit
Cochrane Database Syst Rev. 2007 Oct 17;(4):CD000567		Systematic Review, Cochrane Review
IN shock, critically ill patients	The Use of crystalloids solutions As Treatment, Acute	Is equal Than colloid solutions (albumin, HAS, dextran)	To improve survival (RR 0.88 to 1.24)
CMAJ. 2011 Feb 22;183(3):303-7		Case-Control
IN shock, hypotension, drug adverse effects, drug interactions, macrolide antibiotics	The Use of in patients taking calcium channel antagonists, macrolide antibiotics, clarithromycin, erythromycin, which inhibits cytochrome P450 isoenzyme 3A4 As Treatment, Acute	Is worse Than using azithromycin, which does not inhibit cytochrome P450 3A4	To risk of inducing severe hypotension and shock: OR 5.8 erythromycin, OR 3.7 clarithromycin
Ann Surg. 2011 Mar;253(3):431-41		Randomized Controlled Trial, Multicenter Study
IN shock, trauma, blunt, penetrating	The Use of isotonic normal saline As Treatment, Acute	Is better Than hypertonic saline 7.5% solution, alone or with colloids (dextran)	To reduce mortality at 28 days in the subgroup of patients not receiving blood transfusion (5% normal saline VS 10% hypertonic+dextran VS 12% hypertonic saline). Overall survival at 28 days were eqaul in all treatment groups: about 74%
N Engl J Med. 2005 Nov 10;353(19):2025-33		Randomized Controlled Trial
IN sleep apnea, central, with heart failure	The Use of continuous positive airway pressure (CPAP) As Treatment, Chronic	Is equal Than no CPAP	To reduce at 18 months mortality and heart transplantation: 25% with CPAP vs 24.6% without. No difference neither to reduce hospitalizations or improve quality of life in spite of reducing desturations and improving slightly ejection fraction
Cochrane Database Syst Rev. 2023 May 5;5(5):CD006103. doi: 10.1002/14651858.CD006103.pub8		Randomized Controlled Trial
IN smoking, addictions, substance use disorders	The Use of Nicotine receptor partial agonists, varencicline, cytisine As Treatment, Chronic	Is better Than placebo, bupropion, or nicotine replacement therapy	To increase the odds of quitting smoking for 6 months or more (OR 2.3) while increasing adverse effects compared with placebo (OR 1.2)
Lancet. 2005 Aug 20-26;366(9486):643-8		Randomized Controlled Trial, Multicenter Study
IN spinal cord injury, vertebral bone metastases	The Use of direct decompressive surgery As Treatment, Acute	Is better Than corticosteroids and radiotherapy	To improve number of patients able to walk at the end of treatment: 84% with surgery VS 57% with radiation
N Engl J Med. 2007 May 31;356(22):2257-70		Randomized Controlled Trial
IN spinal stenosis, lumbar, osteoarthritis, spondylolisthesis	The Use of surgery, decompressive laminectomy, with or without fusion As Treatment, Chronic	Is equal Than usual conservative care	To modify pain or physical function at 2 years
JAMA. 2010 Dec 15;304(23):2628-36		Systematic Review
IN spinal stenosis, lumbar, symptomatic	The Use of no pain when seated, improvement when bending forward, bilateral buttock or leg pain, and neurogenic claudication As Diagnostic Tool	Is better Than other clinical symptoms and signs	To make a diagnosis of lumbar spinal stenosis: no pain when seated LR+ 7.4, improvement when bending forward LR+ 6.4, bilateral buttock or leg pain LR+ 6.3, neurogenic claudication LR+ 3.7
N Engl J Med. 2008 Feb 21;358(8):794-810		Randomized Controlled Trial, Multicenter Study
IN spinal stenosis, lumbar, symptomatic	The Use of decompressive surgery As Treatment, Acute	Is better Than usual nonsurgical care	To improve, at 1 and 2 years, bodily pain and physical function
JAMA. 2005 May 18;293(19):2391-402		Systematic Review
IN stroke	The Use of 3 acute clinical findings: facial paresis, arm drift, or abnormal speech As Diagnostic Tool	Is useful Than no comparison	To know if a patient is having a stroke: presence of 1 or more of this 3 signs gives a LR of stroke 5.5, the absence of all the 3 gives a LR 0.39
Lancet. 2007 Jan 27;369(9558):293-8		Diagnostic
IN stroke	The Use of magnetic resonance imaging (MRI) As Diagnostic Tool	Is better Than computed tomography (CT)	To diagnose early an stroke (ischemic or haemorragic) in emergency settings: sensitivity 83% with MRI VS only 26% with CT (mainly because not detecting ischemic stroke)
Lancet Neurol. 2009 Apr;8(4):355-69		Systematic Review
IN stroke	The Use of stroke incidence and early case fatality As Prognostic Item	Is useful Than no comparison here	To plan better prevention and early care of stroke
Health Technol Assess. 2017 Sep;21(54):1-120		Randomized Controlled Trial, Multicenter Study
IN stroke	The Use of frequent higher dose very early mobilization, starting within 24 hours As Treatment, Acute	Is worse Than very early mobilization, first 24 hours	To modify good recovery [modified Rankin scale of 0-2] at 3 months: 46% more frequent early mob VS 50% early mob. No differences in mortality and QoL
Cochrane Database Syst Rev. 2013;9:CD000197		Systematic Review, Cochrane Review
IN stroke	The Use of stroke unit, organised inpatient care for stroke As Treatment, Acute	Is better Than inpatient care at non-specialized units	To reduceat 1 year mortality (OR 0.87) and death or dependency (OR 0.79). Outcomes were independent of patient age.
Lancet. 2015 Jul 4;386(9988):46-55. doi: 10.1016/S0140-6736(15)60690-0		Randomized Controlled Trial
IN stroke	The Use of very early mobilization, first 24 hours As Treatment, Acute	Is worse Than delayed mobilization	To achieve a favourable outcome (Rankin Scale score of 0-2) at 3 months: 46% very early VS 50% delayed.
Stroke. 2011 Jan;42(1):153-8		Randomized Controlled Trial
IN stroke	The Use of very early mobilization, first 24 hours As Treatment, Acute	Is better Than delayed mobilization	To improve functional status (Barthel index) at 3 months and reduce time to return to walking
Stroke. 2011 Mar;42(3):681-6		Randomized Controlled Trial
IN stroke	The Use of additional exercise therapy delivered by the patients' family, lower limbs exercise, added to routine physiotherapy As Treatment, Chronic	Is better Than routine physiotherapy alone	To improve walking at 3 months, as well as integration in family and community
Stroke. 2010 Jan;41(1):136-40. Epub 2009 Nov 25		Systematic Review
IN stroke	The Use of strength training As Treatment, Chronic	Is better Than no such treatment	To improve strength and function of upper limbs, but with no change in daily life activities.
J Neurol Neurosurg Psychiatry. 2011 Feb;82(2):136-43		Meta-Analysis
IN stroke	The Use of very late physiotherapy, more than 6 months after stroke As Treatment, Chronic	Is better Than no treatment	To improve function, specially walking: mean improvement of 20m in long-distance walking
N Engl J Med. 2008 May 15;358(20):2127-37		Randomized Controlled Trial
IN stroke, haemorrhagic, intracerebral hemorrhage	The Use of recombinant activated factor VII As Treatment, Acute	Is equal Than placebo	To reduce poor outcome (severe disability or death) at 90 days: 26-29% with FVIIa VS 24% placebo. Despite a significant reduction in growth in volume of the haemorrhage
Lancet Neurol. 2025 Jul;24(7):571-579. doi: 10.1016/S1474-4422(25)00160-7		Meta-Analysis
IN stroke, haemorrhagic, intracerebral hemorrhage, hypertension in the early acute phase	The Use of intensive (target systolic BP <140 mm Hg within 1 h) blood pressure-lowering treatment using locally available drugs, in the first 3h after symptoms onset As Treatment, Acute	Is better Than guideline-recommended (target systolic BP <180 mm Hg within 1 h) blood pressure treatment	To reduce chances of poor final physical function (modified Rankin 3-6) (OR 0.85), reduce mortality (OR 0.83) and serious adverse events (0.84). There was no effect, however, in haematoma growth on CT
Cochrane Database Syst Rev. 2008;(4):CD000200		Systematic Review, Cochrane Review
IN stroke, haemorrhagic, intracerebral hemorrhage, supratentorial	The Use of intracranial surgery, including: craniotomy, stereotactic endoscopic evacuation or stereotactic aspiration As Treatment, Acute	Is better Than medical treatment alone	To reduce the odds of being dead or dependent (OR 0.71). Results not robust: sensitive to the losses to follow up in the largest trial.
Stroke. 2012 Jun;43(6):1496-504		Meta-Analysis
IN stroke, haemorrhagic, intracerebral hemorrhage, supratentorial, superficial	The Use of surgery, when done early (first 8 h), in patients not very older (50 to 70 y); not in coma (Glasgow > 9), with superficial hematoma and not intraventricular bleeding As Treatment, Acute	Is better Than medical treatment	To "improve outcome" (?)
Lancet. 2025 Mar 15;405(10482):927-936. doi: 10.1016/S0140-6736(25)00333-2		Randomized Controlled Trial, Multicenter Study
IN stroke, haemorrhagic, intracerebral hemorrhage, traumatic, patients with atrial fibrillation	The Use of anticoagulation using direct oral anticoagulants As Treatment, Chronic	Is undefined Than not anticoagulation	To reduce ischaemic stroke (0.8 per 100 patient-years anticoagulants VS 8.6 no Tt) but increased intracerebral haemorrhage (5 per 100 patient-years anticoagulants VS 0.8 no Tt)
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)
Cochrane Database Syst Rev. 2023 Jan 26;1(1):CD012144. doi: 10.1002/14651858.CD012144.pub3		Systematic Review, Cochrane Review
IN stroke, haemorrhagic, intracranial hemorrhage, indication of antiplatelet or anticoagulant therapy	The Use of full-dose oral anticoagulant treatment As Treatment, Chronic	Is worse Than avoiding anticoagulation	To increase, at 1 to 3 years, the risk of recurrent intracranial hemorrhage (RR 2.4) but it reduced cardiovascular events (RR 0.61). No differences found in death and functional status. Antiplatelet Tt showed no difference in any outcome
JAMA Neurol. 2021 Oct 1;78(10):1179-1186. doi: 10.1001/jamaneurol.2021.2956		Randomized Controlled Trial, Multicenter Study
IN stroke, haemorrhagic, intracranial hemorrhage, indication of antiplatelet therapy	The Use of resuming antiplatelet therapy As Treatment, Chronic	Is equal Than avoiding antiplatelet therapy	To modify recurrence rate of intracranial hemorrhage (8% antiplatelet VS 9% control, p NS) or modify major vascular events (27% antiplatelet VS 33% control, p 0.14)
Heart. 2023 Jun 15:heartjnl-2023-322492. doi: 10.1136/heartjnl-2023-322492. Epub ahead of print		Meta-Analysis
IN stroke, haemorrhagic, intracranial hemorrhage, patients with atrial fibrillation	The Use of iniitiating or resuming oral anticoagulant treatment afterwards As Treatment, Chronic	Is better Than no anticoagulant treatment	To reduce ischaemic stroke / systemic thromboembolism (HR 0.54) and all-cause death (HR 0.38). Anticoagulants increased major bleeding (HR 1.66) but not intracranial hemorrage (HR 0.85)
Ann Neurol. 2020 Mar 18. doi: 10.1002/ana.25716. [Epub ahead of print]		Controlled Trial (non-randomized)
IN stroke, hypertension in the early acute phase	The Use of a systolic blood pressure (SBP) goal of < 140 mmHg in the first 24 hours after successful revascularization As Treatment, Acute	Is better Than an SBP goal of < 180 mmHg in the first 24 hours	To improve at 3 months good functional outcome (Rankin 0-2: 52% lower SBP goal VS 44% higher SBP) and mortality (16% lower SBP goal VS 21% higher SBP)
Stroke. 2003 Jul;34(7):1699-703		Randomized Controlled Trial
IN stroke, hypertension in the early acute phase	The Use of modest blood pressure reduction by angiotensin II receptor blockers, candesartan As Treatment, Acute	Is better Than no treatment of hypertension	To reduce cumulative 12-month mortality and reduce vascular events. No cardio-cerebrovascular event occurred as a result of hypotension
Lancet. 2011 Feb 26;377(9767):741-50		Randomized Controlled Trial, Multicenter Study
IN stroke, hypertension in the early acute phase	The Use of modest blood pressure reduction by angiotensin II receptor blockers, candesartan As Treatment, Acute	Is worse Than placebo	To modify death or cardiovascular events at 6 months or to modify functional outcome: higher risk of poor functional outcome with candesartan: OR 1.17.
Health Technol Assess. 2009 Jan;13(9):iii, ix-xi, 1-73		Randomized Controlled Trial
IN stroke, hypertension in the early acute phase	The Use of oral and sublingual lisinopril, oral and intravenous labetalol As Treatment, Acute	Is better Than placebo	To reduce mortality at 3 months, but not mortality or dependence at 2 weeks
Cochrane Database Syst Rev. 2014 Oct 28;2014(10):CD000039. doi: 10.1002/14651858.CD000039.pub3		Systematic Review, Cochrane Review
IN stroke, hypertension in the early acute phase	The Use of various antihypertensive treatments (CCBs, ACEI, ARA, beta blockers and NO donors) As Treatment, Acute	Is equal Than placebo	To modify mortality or functional outcome
BMJ. 2023 Oct 9;383:e076448. doi: 10.1136/bmj-2023-076448		Randomized Controlled Trial, Multicenter Study
IN stroke, hypertension in the early acute phase, not revascularized	The Use of antihypertensive Tt. immediately, aimed at reducing systolic blood pressure by 10%-20% in 24h and a blood pressure <140/90 mm Hg in 7 days As Treatment, Acute	Is equal Than discontinue antihypertensive medications for 7 days if they were taking them, and then receive Tt. on day 8	To modify the odds of dependency or death at 90 days. However, worsened functional outcomes for patients without previous hypertension in subgroup analysis (OR 1.35) (see Notes)
Stroke. 2005 Jun;36(6):1218-26. Epub 2005 May 5		Randomized Controlled Trial, Multicenter Study
IN stroke, hypertension, primary	The Use of angiotensin II receptor blockers, eprosartan As Treatment, Chronic	Is better Than calcium antagonist, nitrendipine	To reduce a composite of total mortality and all cardiovascular and cerebrovascular events: 283 total events with sartan VS 366 with nitrendipine at 2.5 years.
Lancet. 2001 Sep 29;358(9287):1033-41		Randomized Controlled Trial, Multicenter Study
IN stroke, hypertension, primary, non-hypertensive patients	The Use of angiotensin converting enzyme inhibitors (perindopril, 4 mg/d), plus discretional indapamide As Prevention, Secondary	Is better Than placebo	To reduce stroke (either ischemic or haemorrhagis) at 4 years: 10% with perindopril VS 14% with placebo. Also, it reduced major vascular events, but not mortality.
Stroke. 2001 Dec 1;32(12):2735-40		Descriptive
IN stroke, ischemic	The Use of classifying stroke subtype according to mechanism, using the TOAST schemes As Diagnostic Tool	Is useful Than not classifying stroke subtype	To better know the aetiology of stroke and plan for more adapted care. Causes : cardioembolism, 30% ; small-artery occlusion, 26% ; and large-artery atherosclerosis, 15% ; undetermined cause, 29%
Stroke. 2010 Aug;41(8):1579-86		Descriptive
IN stroke, ischemic	The Use of classifying stroke subtype according to mechanism, using various schemes (TOAST, ASCO, CSS) As Diagnostic Tool	Is useful Than not classifying stroke subtype	To better know the aetiology of stroke and plan for more adapted care. Cardioembolism: 34%. Undetermined cause in 26 to 39% of all ischemic strokes.
Stroke. 2019 Dec;50(12):e344-e418		Consensus, Guideline
IN stroke, ischemic	The Use of emergency stroke protocols and units, alteplase, mechanical thrombectomy, aspirin, dual antiplatelet in selected patients, statins, maintaining BP under 180/110 mmHg As Treatment, Acute	Is better Than placebo or no treatment	To improve final outcomes. Very specific and extensive guidelines, see details
Arch Intern Med. 1999 Jun 14;159:1248-53		Meta-Analysis
IN stroke, ischemic	The Use of antiplatelet drugs, low dose aspirin (>50 mg/d) As Treatment, Chronic	Is equal Than antiplatelet drugs, higher doses of aspirin	To reduce recurrent stroke
BMJ. 1998 Nov 28;317(7171):1477-1480		Meta-Analysis
IN stroke, ischemic, carotid stenosis, asymptomatic	The Use of carotid endarterectomy As Prevention, Primary	Is better Than deferral of endarterectomy to symptoms	To reduce stroke at long term: a 2% absolute risk reduction over about 3.1 years. Stroke and death in the 30-day perioperative period were increased.
Lancet. 2004 May 8;363(9420):1491-502		Randomized Controlled Trial, Multicenter Study
IN stroke, ischemic, carotid stenosis, asymptomatic	The Use of carotid endarterectomy As Prevention, Primary	Is better Than indefinite deferral of endarterectomy to symptoms	To reduce stroke at 5 years: 6.4% intv. VS 11.8% ctrl. for all strokes, 3.5% intv. VS 6.1% ctrl. for fatal or disabling strokes. Risk of stroke or death within 30 days of endarterectomy was 3.1%.
Cochrane Database Syst Rev. 2005 Oct 19;(4):CD001923		Systematic Review, Cochrane Review
IN stroke, ischemic, carotid stenosis, asymptomatic	The Use of carotid endarterectomy As Treatment, Acute	Is better Than medical treatment alone	To reduce strokes at 3 years (combined outcome of perioperative death or any stroke, operative or later): RR 0.69, ARR 1% per year, having a 3% of perioperative death or stroke.
Ann Intern Med. 2014 Jul 8. doi: 10.7326/M14-0530. [Epub ahead of print]		Systematic Review
IN stroke, ischemic, carotid stenosis, asymptomatic	The Use of screening with the objective of performing carotid endarterectomy or stenting As Treatment, Chronic	Is useless Than no screening	To modify overall risk of stroke: absolute reduction of 5.5% in 5 years with endarterectomy VS medical Tt, with 3.3% perioperative stroke or death. No trials compared screening with no screening or assessed intensification of medical Tt
N Engl J Med. 2004 Oct 7;351(15):1493-501		Randomized Controlled Trial
IN stroke, ischemic, carotid stenosis, asymptomatic (80%) or symptomatic (50%)	The Use of carotid-artery stenting with an emboli-protection device As Treatment, Acute	Is better Than endarterectomy	To reduce major cardiovascular events at 1 year (death, stroke or perioperatory infarction): 12.2% stent VS 20.1% endarcterectomy, p NS
Cochrane Database Syst Rev. 2012;9:CD000515		Systematic Review, Cochrane Review
IN stroke, ischemic, carotid stenosis, asymptomatic or symptomatic	The Use of carotid artery stenting As Treatment, Acute	Is worse Than surgical carotid endarterectomy	To modify the risk of peri-procedural stroke or death (OR 1.7), specially in older patients (OR 2.2). Death or major or disabling stroke did not differ. Less risk of myocardial infarction with stenting (OR 0.44)
Lancet Neurol. 2025 May;24(5):389-399. doi: 10.1016/S1474-4422(25)00107-3		Randomized Controlled Trial, Multicenter Study
IN stroke, ischemic, carotid stenosis, asymptomatic or symptomatic (50%), low-to-intermediate predicted risk of stroke	The Use of optimised medical therapy alone As Treatment, Chronic	Is equal Than revascularisation added to optimised medical therapy	To modify, at 2 years, cardiovascular or periprocedural death or vascular brain or heart events: 11·4% wins OMT alone, 11·3% wins OMT plus revascularisation, and 77·3% ties between groups (win ratio 1·01)
J Vasc Surg. 2011 Mar;53(3):792-7		Systematic Review
IN stroke, ischemic, carotid stenosis, asymptomatic or symptomatic (80%)	The Use of carotid artery stenting As Treatment, Acute	Is worse Than surgical carotid endarterectomy	To modify outcomes: stenting increased the risk of stroke (RR 1.45) and death (1.5 to 2.5), even if it reduced the risk of perioperative myocardial infarction (0.40)
Lancet Neurol. 2008 Oct;7(10):885-92		Randomized Controlled Trial
IN stroke, ischemic, carotid stenosis, symptomatic	The Use of carotid artery stenting As Treatment, Acute	Is worse Than carotid endarterectomy	To reduce overall frequency of early and late (at 4 years) strokes: 11% stent VS 6.2% endarterectomy, largely accounted for by the higher periprocedural (within 30 days of the procedure) stroke risk of stenting
Eur Heart J. 2008 Jan;29(1):113-9		Meta-Analysis
IN stroke, ischemic, carotid stenosis, symptomatic	The Use of carotid artery stenting As Treatment, Chronic	Is equal Than carotid endarterectomy	To reduce at 1 month mortality or stroke
Cochrane Database Syst Rev. 2004;(3):CD000024		Systematic Review, Cochrane Review
IN stroke, ischemic, cerebral infarction	The Use of unfractionated heparin (UFH), low-molecular-weight heparins (LMWH) As Treatment, Acute	Is equal Than antiplatelet drugs, aspirin	To reduce recurrent stroke: anticoagulants were associated with 9/1000 fewer recurrent ischaemic strokes (OR 0.76, 0.65 to 0.88), but were also associated with a similar 9/1000 increase in symptomatic intracranial haemorrhages (OR 2.52, 1.92 to 3.30)
N Engl J Med. 2025 Apr 3;392(13):1288-1296. doi: 10.1056/NEJMoa2413344		Randomized Controlled Trial, Multicenter Study
IN stroke, ischemic, cerebral infarction, 4.5 to 24 h of onset, posterior cerebral circulation	The Use of thrombolysis, recombinant tissue plasminogen activator (rt-PA), alteplase (0.9 mg per kilogram of body weight; maximum dose, 90 mg) As Treatment, Acute	Is better Than standard medical treatment	To imcrease number of patients having functional independence at 90 days (90% alteplase VS 73% standard). Symptomatic intracranial hemorrhage within 36 hours : 1.7% alteplase VS 0.9% standard Tt
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)
N Engl J Med. 2024 Jun 14. doi: 10.1056/NEJMoa2402980. Epub ahead of print		Randomized Controlled Trial, Multicenter Study
IN stroke, ischemic, cerebral infarction, 6 to 24 h of onset, middle cerebral artery or internal carotid artery, salvageable tissue on perfusion imaging	The Use of thrombolysis, fibrinolysis, recombinant tissue plasminogen activator (rt-PA), tenecteplase 0.25 mg per kilogram of body weight, up to 25 mg, up to 24 h after symptoms onset, and no access to thrombectomy As Treatment, Acute	Is better Than medical care, without thrombectomy	To improve, at 3 months, proportion of patients with good functional status (Rankin scale 0 or 1): 33% thrombolysis VS 24% controls. No change in mortality: 13% both
N Engl J Med. 2024 Feb 22;390(8):701-711. doi: 10.1056/NEJMoa2310392		Randomized Controlled Trial, Multicenter Study
IN stroke, ischemic, cerebral infarction, 6 to 24 h of onset, middle cerebral artery or internal carotid artery, salvageable tissue on perfusion imaging	The Use of thrombolysis, fibrinolysis, recombinant tissue plasminogen activator (rt-PA), tenecteplase 0.25 mg per kilogram of body weight, up to 25 mg, up to 24 h afterbectomy symptoms onset, added to thrombectomy As Treatment, Acute	Is equal Than endovascular thrombectomy alone	To modify functional status (Rankin scale) at 3 months
N Engl J Med. 2018 01 04;378(1):11-21		Randomized Controlled Trial, Multicenter Study
IN stroke, ischemic, cerebral infarction, 6 to 24 h of onset, proximal arterial occlusion in the anterior cerebral circulation, mismatch between deficit and Infarct	The Use of endovascular treatment: thrombectomy, late As Treatment, Acute	Is better Than standard care	To improve at 3 months functional independence (49% thrombectomy VS 13% controls). Mortality was not different (19% thrombectomy VS 18% controls)
N Engl J Med. 2022 Oct 13;387(15):1361-1372. doi: 10.1056/NEJMoa2206317		Randomized Controlled Trial, Multicenter Study
IN stroke, ischemic, cerebral infarction, basilar artery occlusion, first 12 h of onset	The Use of endovascular treatment: thrombectomy As Treatment, Acute	Is better Than best medical care	To improve at 90 days good functional status (modified Rankin score 0 to 3: 46% thrombectomy VS 23% medical care) and mortality (37% thrombectomy VS 55% medical care)
N Engl J Med. 2022 Oct 13;387(15):1373-1384. doi: 10.1056/NEJMoa2207576		Randomized Controlled Trial
IN stroke, ischemic, cerebral infarction, basilar artery occlusion, first 24 h of onset	The Use of endovascular treatment: thrombectomy As Treatment, Acute	Is better Than usual medical care	To improve at 90 days good functional status (modified Rankin score 0 to 3: 46% thrombectomy VS 24% medical care) and mortality (31% thrombectomy VS 42% medical care)
Lancet. 2000 Apr 8;355(9211):1205-10		Randomized Controlled Trial, Multicenter Study
IN stroke, ischemic, cerebral infarction, embolic	The Use of heparin, low molecular weight, dalteparin full-dose (100 IU/Kg/12h) As Treatment, Acute	Is equal Than aspirin	To reduce recurrent ischaemic stroke (8.5% LMWH vs 7.5% aspirin), cerebral haemorrhage or death during the first 14 days. Death and functional outcome at 3 months were also equals,
Stroke. 2007 Feb;38(2):423-30		Meta-Analysis
IN stroke, ischemic, cerebral infarction, embolic	The Use of unfractionated heparin, low-molecular-weight heparins (LMWH), or heparinoids As Treatment, Acute	Is equal Than aspirin or placebo	To reduce death or disability at final follow up (73.5% heparin VS 73.8% aspirin). Heparins non-significantly reduced early recurrent ischemic stroke but significantly increased symptomatic intracranial bleeding .
Stroke. 2007 Nov;38(11):2935-40		Meta-Analysis
IN stroke, ischemic, cerebral infarction, embolic, atrial fibrillation	The Use of noninvasive cardiac monitoring, Holter ECG monitoring, event loop recording, prolonged cardiac monitoring As Diagnostic Tool	Is bad Than no comparison here	To detect new atrial fibrillation: in 4.6% of consecutive patients with ischemic stroke
Lancet. 1994 Mar 19;343(8899):687-91		Randomized Controlled Trial
IN stroke, ischemic, cerebral infarction, embolic, atrial fibrillation	The Use of vitamin K antagonists, warfarin As Treatment, Chronic	Is equal Than aspirin	To prevent stroke, when considered all types of stroke. Disabling stroke happened in 4.3% older patients with aspirin VS 4.6% with warfarin (per year). Warfarin was better to decrease ischemic stroke in patients > 75 years old
JAMA. 2002 Nov 20;288(19):2441-8		Meta-Analysis
IN stroke, ischemic, cerebral infarction, embolic, atrial fibrillation	The Use of vitamin K antagonists, warfarin As Treatment, Chronic	Is better Than aspirin	To decrease stroke (of any type): 2.4% per year with warfarin VS. 4.5% with aspirin. But modestly increased major bleeding: 2.2 VS. 1.3% per year. Overall all-cause mortality did not differ
Cochrane Database Syst Rev. 2005 Jul 20;(3):CD001927		Systematic Review, Cochrane Review
IN stroke, ischemic, cerebral infarction, embolic, atrial fibrillation, non valvular	The Use of vitamin K antagonists, warfarin As Treatment, Chronic	Is better Than no anticoagulant nor antiaggregant treatment	To reduce all strokes (ARR 2.5% per year), reduce disabling or fatal stroke (ARR 1.2% per year) and reduce death (OR 0.69)
N Engl J Med. 2018 06 07;378(23):2191-2201		Randomized Controlled Trial, Multicenter Study
IN stroke, ischemic, cerebral infarction, embolic, undetermined source	The Use of anticoagulants, oral factor Xa inhibitors, rivaroxaban, 15 mg/d As Treatment, Chronic	Is worse Than aspirin 100 mg/d	To reduce at 11 months recurrent (ischemic or hemorrhagic) stroke (5% both Tts) while increasing major bleeding (2% rivarox VS 1% aspirin)
N Engl J Med. 2008 Sep 25;359(13):1317-29		Randomized Controlled Trial, Multicenter Study
IN stroke, ischemic, cerebral infarction, first 3-4 h of onset	The Use of thrombolysis, alteplase, 3 to 4.5 hours after the onset of symptoms As Treatment, Acute	Is better Than placebo	To improve number of patients in Rankin scale 0 or 1 at 3 months: 52.4% alteplase VS 45.2% placebo. Intracranial haemorrhage was more frequent. Mortality was not sig different: 7.7% alteplase VS 8.4% placebo
Lancet. 2012 Jun 23;379(9834):2364-72		Systematic Review
IN stroke, ischemic, cerebral infarction, first 3-6 h of onset, elder patients	The Use of thrombolysis, alteplase, recombinant tissue plasminogen activator (rt-PA) As Treatment, Acute	Is better Than no thrombolysis	To increase the number of patients being alive and independent (46% r-tPa VS 42% controls) specially when treated in the first 3 hours (41% VS 31%). But did not reduced mortality, in fact it increased it initially
Lancet. 2012 Jun 23;379(9834):2352-63		Randomized Controlled Trial, Multicenter Study
IN stroke, ischemic, cerebral infarction, first 4-5 h of onset, elder patients	The Use of thrombolysis, recombinant tissue plasminogen activator (rt-PA) As Treatment, Acute	Is equal Than placebo	To modify the number of patients alive and independent at 6 months: 37% with r-tPa VS 35% controls. Equally effective in patients > 80 years old
N Engl J Med. 2017 04 06;376(14):1341-1349		Randomized Controlled Trial, Multicenter Study
IN stroke, ischemic, cerebral infarction, first 6 h of onset, proximal arterial occlusion in the anterior cerebral circulation	The Use of endovascular treatment: thrombectomy plus stenting, on top of thrombolysis As Treatment, Acute	Is better Than thrombolysis alone	To improve, at 2 years, overall mortality (26% endovascular VS 31% thrombolysis alone), distribution of outcomes on the modified Rankin scale and QoL (mean 0.48 endovascular VS 0.38 not endovasc)
N Engl J Med. 2015 Jan 1;372(1):11-20		Randomized Controlled Trial, Multicenter Study
IN stroke, ischemic, cerebral infarction, first 6 h of onset, proximal arterial occlusion in the anterior cerebral circulation	The Use of intraarterial treatment: thrombectomy plus stenting, on top of thrombolysis As Treatment, Acute	Is better Than thrombolysis alone	To improve functional independence (modified Rankin score, 0 to 2) at 3 months: 33% intrarterial Tt VS 19% thrombolysis alone. No significant differences in mortality or the occurrence of symptomatic intracerebral hemorrhage.
N Engl J Med. 2024 May 9;390(18):1677-1689. doi: 10.1056/NEJMoa2314063		Randomized Controlled Trial, Multicenter Study
IN stroke, ischemic, cerebral infarction, first 6.5 h of onset, proximal arterial occlusion in the anterior cerebral circulation, large infarction	The Use of endovascular treatment: thrombectomy, 35% of the patients also received thrombolysis As Treatment, Acute	Is better Than medical care, without thrombectomy	To improve at 90 days the median modified Rankin scale score (4 thrombectomy VS 6 controls) and reduce mortality (36% thrombectomy VS 55% controls)
N Engl J Med. 2023 Feb 10. doi: 10.1056/NEJMoa2213379		Randomized Controlled Trial, Multicenter Study
IN stroke, ischemic, cerebral infarction, large, anterior circulation, first 24 h of onset	The Use of endovascular treatment: thrombectomy As Treatment, Acute	Is better Than best medical care	To obtain better functional Rankin scores at 3 months: score 0-2 in 30% thrombectomy VS 12% medical. More intracranial haemorrhages: 6% thrombectomy VS 3% medical. Mortality was not different: 21% both
N Engl J Med. 2023 Feb 10. doi: 10.1056/NEJMoa2214403		Randomized Controlled Trial, Multicenter Study
IN stroke, ischemic, cerebral infarction, large, internal carotid artery or middle cerebral artery 1st segment occlusion , first 24 h of onset	The Use of endovascular treatment: thrombectomy As Treatment, Acute	Is better Than best medical care	To obtain better Rankin scores and achieve functional independence (20% thrombectomy VS 7% medical) at the cost of more arterial access site complications (20-25%). Only 1 Symptomatic intracranial hemorrhage
Stroke. 2007 Sep;38(9):2518-25		Randomized Controlled Trial
IN stroke, ischemic, cerebral infarction, massive, life-threatening	The Use of decompressive surgery by hemicraniectomy As Treatment, Acute	Is better Than conservative medical care	To reduce mortality at 30 days (12% hemicraniectomy VS 53% conservative care) and probably improve proportion of patients with better status functional status at 12 monts (47% surgery VS 27% conservative, p=0.23)
Stroke. 2007 Sep;38(9):2506-17		Randomized Controlled Trial, Multicenter Study
IN stroke, ischemic, cerebral infarction, massive, life-threatening	The Use of surgery, decompressive craniectomy As Treatment, Acute	Is better Than conservative medical care	To reduce death (52% absolute reduction) and probably improve proportion of patients with better status functional status at 12 monts (50% surgery VS 22% conservative, p=0.10)
Cochrane Database Syst Rev. 2012;1:CD003435		Systematic Review, Cochrane Review
IN stroke, ischemic, cerebral infarction, massive, life-threatening, 60 years of age or younger	The Use of surgery, decompressive craniectomy As Treatment, Acute	Is better Than conservative medical care	To reduced the risk of death at the end of follow-up (OR 0.19) and the risk of death or severe disability (Rankin > 4) at 12 months (OR 0.26)
Neurology. 2022 May 10;98(19):e1942-e1952. doi: 10.1212/WNL.0000000000200227		Meta-Analysis
IN stroke, ischemic, cerebral infarction, no apparent atrial fibrillation initially	The Use of prolonged poststroke cardiac rhythm monitoring As Diagnostic Tool	Is better Than conventional ECG screening at the discretion of the attending doctor	To improve number of patients with AF detected and anticoagulation initiated (RR 3.9) and reduce recurrent stroke (RR 0.3 to 0.7)
JAMA. 2008 May 28;299(20):2391-400		Randomized Controlled Trial
IN stroke, ischemic, cerebral infarction, poststroke depression	The Use of selective serotonine reuptake inhibitors (SSRI), escitalopram As Prevention, Primary	Is better Than placebo	To reduce incidence of poststroke depression: 8.5% escitalopram VS 22% placebo
J Stroke Cerebrovasc Dis. 2012 May 1. [Epub ahead of print]		Systematic Review
IN stroke, ischemic, cerebral infarction, poststroke depression	The Use of selective serotonine reuptake inhibitors (SSRI), for at least 1 year As Prevention, Primary	Is better Than placebo	To reduce incidence of poststroke depression (OR 0.34)
Circulation. 2022 Oct 4;146(14):1056-1066. doi: 10.1161/CIRCULATIONAHA.122.060666		Randomized Controlled Trial, Multicenter Study
IN stroke, ischemic, cerebral infarction, small to medium sized, transient ischemic attack, atrial fibrillation	The Use of early anticoagulation (starting first 4 days) with direct oral anticoagulants As Treatment, Acute	Is equal Than delayed (5-10 days) initiation with direct oral anticoagulants	To at 3 months, combined cerebrovascular events (stroke, hemorrhage or all-cause death): 7% early VS 9% delayed (P non sig. for superiority). No patient in either group had symptomatic intracerebral hemorrhage
Stroke. 2021 Apr;52(4):1164-1171. doi: 10.1161/STROKEAHA.120.030042		Randomized Controlled Trial
IN stroke, ischemic, cerebral infarction, small to medium sized, transient ischemic attack, atrial fibrillation	The Use of early anticoagulation (starting firts 3 to 7 days) with direct oral anticoagulants, anti-Xa, apixaban As Treatment, Acute	Is better Than later (starting after 14 jours) oral anticoagulation with warfarin	To probably (results statistically non significants) reduce recurrent strokes/TIA (15% apix VS 19% warf), death (5% apix VS 8.5% warf) and symptomatic hemorrhages (0% apix VS 2% warf)
N Engl J Med. 2008 Sep 18;359(12):1238-51		Randomized Controlled Trial, Multicenter Study
IN stroke, ischemic, cerebral infarction, thrombotic	The Use of aspirin plus extended-release dipyridamole (25 mg/200mg twice daily) As Prevention, Secondary	Is worse Than clopidrogel (75 mg once daily)	To reduce at 2.5 years recurrent ischemic stroke (9% aspirin VS 8.8% clopid) or cardiovascular events (13.1% both groups) and there were more haemorrhagic events (4.1% aspirin VS 3.6% clopid)
Stroke. 2000 Jun;31(6):1240-9		Meta-Analysis
IN stroke, ischemic, cerebral infarction, thrombotic	The Use of antiplatelet drugs, aspirin As Treatment, Acute	Is better Than placebo	To reduce early death or recurrent stroke (either ischemic or haemorrhagic): 8.2% aspirin versus 9.1% placebo.
Lancet. 1997 Jun 7;349(9066):1641-1649		Randomized Controlled Trial, Multicenter Study
IN stroke, ischemic, cerebral infarction, thrombotic	The Use of antiplatelet drugs, aspirin As Treatment, Acute	Is better Than placebo	To reduce death at 1 month: 3.3% with aspirin VS 3.9% placebo
Lancet. 1997 May 31;349(9065):1569-1581		Randomized Controlled Trial, Multicenter Study
IN stroke, ischemic, cerebral infarction, thrombotic	The Use of antiplatelet drugs, aspirin 300 mg/d As Treatment, Acute	Is better Than placebo or unfractionated heparin (UFH), either low or full-dose	To reduce at 14 days recurrent ischaemic strokes (2.8% aspirin VS 3.9% placebo) or death plus non-fatal recurrent stroke (11.3% aspirin vs 12.4% placebo)
Ann Intern Med. 1986 Dec;105(6):825-828		Randomized Controlled Trial
IN stroke, ischemic, cerebral infarction, thrombotic	The Use of heparin, unfractionated, continuous intravenous heparin As Treatment, Acute	Is equal Than placebo	To modify the incidence of stroke progression, final functional status or mortality (more long-term mortality in patients who had received heparin)
N Engl J Med. 1995 Dec 14;333(24):1588-1593		Randomized Controlled Trial, Multicenter Study
IN stroke, ischemic, cerebral infarction, thrombotic	The Use of low molecular weight heparins (LMWH), nadroparin (4100 anti-factor Xa IU twice daily for 10 days) As Treatment, Acute	Is better Than placebo	To reduce death or dependance at 6 months: 45% high-dose nadroparin VS 52% low-dose nadroparin VS 65% with placebo
N Engl J Med. 2014 Jun 26;370(26):2478-86		Randomized Controlled Trial, Multicenter Study
IN stroke, ischemic, cerebral infarction, transient ischemic attack, cryptogenic, embolic, atrial fibrillation	The Use of insertable cardiac monitor (96% of patients kept it after 12 months), prolonged cardiac monitoring As Diagnostic Tool	Is better Than conventional ECG follow-up at the discretion of usual doctor	To detect atrial fibrillation at 12 months : 12% of patietns with insertable monitor VS 2% in controls. Insertable monitors had to be removed in 2.4% patients because infection or local inflammation.
N Engl J Med. 2014 Jun 26;370(26):2467-77		Randomized Controlled Trial, Multicenter Study
IN stroke, ischemic, cerebral infarction, transient ischemic attack, cryptogenic, embolic, atrial fibrillation	The Use of ambulatory ECG monitoring with a 30-day event-triggered recorder (attached to a dry-electrode (nonadhesive) belt worn around the chest), prolonged cardiac monitoring As Diagnostic Tool	Is better Than ambulatory 24-hour ECG monitoring	To detect atrial fibrillation episodes at 3 months : 16% in 30-days monitoring VS 3% with 24-hour monitoring
JAMA. 2021 Jun 1;325(21):2160-2168. doi: 10.1001/jama.2021.6128		Randomized Controlled Trial
IN stroke, ischemic, cerebral infarction, transient ischemic attack, cryptogenic, embolic, atrial fibrillation	The Use of an implantable loop recorder cardiac ECG monitor for 12 months, prolonged cardiac monitoring As Diagnostic Tool	Is better Than conventional external loop recorder cardiac ECG monitor for 30 days	To detect atrial fibrillation at 12 months: 15% of patients with implantable recorder VS. 5% of patients with external recorder
Lancet Neurol. 2011 Feb;10(2):123-30		Randomized Controlled Trial, Multicenter Study
IN stroke, ischemic, cerebral infarction, with hemiplegia or hemiparesis	The Use of fluoxetine, 20 mg once daily for 3 months, antidepressant, selective serotonine reuptake inhibitors (SSRI) As Treatment, Acute	Is better Than placebo	To achieve a better motor recovering at 3 months: adjusted mean of 34 more points in the Fugl-Meyer motor scale
Health Technol Assess. 2020 May;24(22):1-94. doi: 10.3310/hta24220		Randomized Controlled Trial, Multicenter Study
IN stroke, ischemic, cerebral infarction, with hemiplegia or hemiparesis	The Use of fluoxetine, 20 mg once daily for 6 months, antidepressant, selective serotonine reuptake inhibitors (SSRI) As Treatment, Acute	Is equal Than placebo	To improve at 6 months motor recovery: Rankin scores distribution equal in both Tt groups. Patients on fluoxetine had fewer episodes of depression (13% VS 17%) but had more bone fractures (3% VS 1.5%)
Stroke. 2015 Apr;46(4):1014-23		Meta-Analysis
IN stroke, ischemic, lacunar	The Use of any single antiplatelet agent, aspirin, ticlodipine As Treatment, Chronic	Is better Than placebo	To reduce ischemic stroke (RR 0.48) and any stroke (RR 0.77) but not myocardial infarction or death
Neurology. 2000 Feb 8;54(3):660-6		Randomized Controlled Trial
IN stroke, ischemic, lacunar, carotid stenosis	The Use of diabetes, hiperlipidemia As Etiologic risk factor	Is better Than arterial hypertension, carotid stenosis	To predict development of lacunar disease
N Engl J Med. 2012 Aug 30;367(9):817-25		Randomized Controlled Trial, Multicenter Study
IN stroke, ischemic, lacunar, recent	The Use of long-term combined antiplatelet drugs, P2Y12 inhibitors, clopidogrel (75 mg/d) added to aspirin (325 mg/d) As Treatment, Chronic	Is equal Than aspirin alone	To modify the the risk of recurrent stroke: 2.5% per year dual therapy VS 2.7% per year aspirin alone
JAMA Neurol. 2024 Mar 11:e240146. doi: 10.1001/jamaneurol.2024.0146. Epub ahead of print		Randomized Controlled Trial, Multicenter Study
IN stroke, ischemic, minor or moderate cerebral infarction, acute	The Use of initial treatment (started in 48h) with combined antiplatelet drugs, P2Y12 inhibitors, clopidogrel, plus aspirin As Treatment, Acute	Is better Than aspirin alone	To reduce early neurologic deterioration at 7 days: 5% dual treat. VS. 7% aspirine alone. Similar number of bleeding events
N Engl J Med. 2020 Jul 16;383(3):207-217. doi: 10.1056/NEJMoa1916870		Randomized Controlled Trial
IN stroke, ischemic, minor or moderate cerebral infarction, recents	The Use of short-term (1 month) treatment with combined antiplatelet drugs, P2Y12 inhibitors, ticagrelor, plus aspirin As Treatment, Acute	Is better Than aspirin alone	To reduce at 1 month stroke recurrence: 5.5% dual Tt VS 6.6% aspirn alone. But the incidence of disability did not differ significantly. Severe bleeding was more frequent with ticagrelor: 0.5% VS 0.1%
N Engl J Med. 2021 Dec 30;385(27):2520-2530. doi: 10.1056/NEJMoa211174		Randomized Controlled Trial, Multicenter Study
IN stroke, ischemic, minor or moderate cerebral infarction, transient ischemic attack, CYP2C19 loss-of-function carriers	The Use of antiplatelets, P2Y12 inhibitors, ticagrelor As Treatment, Chronic	Is better Than antiplatelets, P2Y12 inhibitors, clopidogrel	To reduce at 3 months recurrent stroke: 6.0% ticagrelor VS 7.6% clopidogrel. Ticagrelor caused more bleeding events but same number of moderate to severe bleeding (0.3%)
Lancet. 2004 Jul 24;364(9431):331-7		Randomized Controlled Trial, Multicenter Study
IN stroke, ischemic, thrombotic, recidivant, high-risk patients	The Use of long-term combined anti-platelet drugs, P2Y12 inhibitors, clopidogrel, added to aspirin, As Treatment, Chronic	Is worse Than only one antipletelet drug, clopidogrel	To reduce new stroke or overall ischemic events (10.5 % per year in intv. VS 11.1 % per year in ctrl.) And increased bleedings, included life-threatening bleedings (1.73 % per year in intv. VS 0.86 % per year in ctrl.)
Stroke. 2012 Apr;43(4):1058-66. Epub 2012 Jan 26		Meta-Analysis
IN stroke, ischemic, thrombotic, transient ischemic attack	The Use of long-term combined antiplatelet drugs, P2Y12 inhibitors, clopidogrel (75 mg/d) plus low-dose aspirin As Prevention, Secondary	Is equal Than aspirin alone	To reduce stroke recurrence (aspirin+clopidogrel VS aspirin alone : RR 0.67, 95%CI 0.37-1.23). However, a strong trend to reduce combined major cardiovascular events or death (OR 0.68, 95%CI 0.45-1.03, p=0.07).
JAMA. 2025 Mar 26:e252033. doi: 10.1001/jama.2025.2033. Epub ahead of print		Systematic Review
IN stroke, ischemic, transient ischemic attack, cerebral infarction, minor	The Use of knowing the long-term risk of stroke after a TIA or minor stroke As Prognostic Item	Is useful Than not knowing it	To adapt long-term management of patients. The pooled rate of stroke per 100 person-years was 5.9% in the 1st year, 1.8% annually in the 2nd through 5th years. The cumulative incidence was 13% and 20% at 5 and 10 years
Lancet. 2007 Oct 20;370(9596):1432-42		Clinical Trial (non-controlled, non-randomized)
IN stroke, ischemic, transient ischemic attack, cerebral infarction, minor	The Use of urgent assessment and immediate treatment with antiplatelets (aspirin or clopidogrel or both), statin and antihypertensive drugs As Treatment, Acute	Is better Than usual delay in assessment and treatment	To reduce at 3 months any stroke recurrence: 2.1% with early Tt VS 10.3% with usual delay
Stroke. 2010 Sep;41(9):1907-13		Cohorts
IN stroke, ischemic, transient ischemic attack, cerebral infarction, minor, risk of evolving to stroke (severe)	The Use of presence of brain infarction on imaging, diffusion-weighted MRI, new or old infarction in CT As Prognostic Item	Is better Than not using brain imaging	To better predict risk of new stroke at 7 days: OR 15 if recent infarction at MRI, OR 4 if new or recent stroke at CT. Combined with ABCD2 score (1 to 3 more points) it increased predictive power
J Neurol Neurosurg Psychiatry. 2008 Nov;79(11):1218-23		Meta-Analysis
IN stroke, ischemic, transient ischemic attack, cerebral infarction, thrombotic	The Use of antiplatelet drugs, aspirin plus dipyridamole combined As Treatment, Chronic	Is better Than aspirin alone	To reduce recurrent stroke (HR 0.78) and cardiovascular events (HR 0.82)
Stroke. 2008 Apr;39(4):1358-63		Meta-Analysis
IN stroke, ischemic, transient ischemic attack, cerebral infarction, thrombotic	The Use of antiplatelet drugs, aspirin, dipyridamole As Treatment, Chronic	Is better Than aspirin alone	To reduce cardivascular events (stroke, myocardial infarction, or vascular death): RR 0.77
N Engl J Med. 1991 Oct 31;325(18):1261-6		Randomized Controlled Trial
IN stroke, ischemic, transient ischemic attack, cerebral infarction, thrombotic	The Use of antiplatelet drugs, low dose aspirin (30 mg/d) As Treatment, Chronic	Is equal Than antiplatelet drugs, higher dose aspirin (300 mg/d)	To reduce, at 2.6 years, recurrent cardiovascular events (stroke myocardial infarction or vascular death): 14.7% with low dose VS 15.2% higher dose
N Engl J Med. 2023 Dec 28;389(26):2413-2424. doi: 10.1056/NEJMoa2309137		Randomized Controlled Trial
IN stroke, ischemic, transient ischemic attack, or minor cerebral infarction, acute	The Use of acute combined antiplatelet drugs, P2Y12 inhibitors, clopidogrel (75 mg/d) plus low-dose aspirin, starting in < 72 hours of symptoms onset, for 3 months As Treatment, Acute	Is better Than aspirin alone	To reduce, at 90 days, recurrent strokes (7% combined VS 9% aspirin alone), with a little increase of moderate-to-severe bleeding (0.9% combined VS 0.4% aspirin alone)
Stroke. 2019 Apr;50(4):947-953		Meta-Analysis
IN stroke, ischemic, transient ischemic attack, or minor cerebral infarction, recents	The Use of short-term (1 month) treatment with combined antiplatelet drugs, P2Y12 inhibitors, clopidogrel, plus aspirin As Treatment, Acute	Is better Than longer treatments with combined antiplatelet drugs	To reduce subsequent ischemic stroke (RR 0.53) and cardiovascular events (RR 0.68), with lower bleeding rate than longer dual antiplatelet treatments
N Engl J Med. 2018 Jul 19;379(3):215-225. doi: 10.1056/NEJMoa1800410		Randomized Controlled Trial, Multicenter Study
IN stroke, ischemic, transient ischemic attack, or minor cerebral infarction, recents	The Use of short-term combined antiplatelet drugs, P2Y12 inhibitors, clopidogrel (initial dose of 300 mg, followed by 75 mg/day) plus aspirin (50-300 mg/day) for 90 days As Treatment, Acute	Is better Than aspirine alone	To reduce, at 3 months, major ichemic events (5% clopidogrel+aspirin VS 6.5% aspirine alone), but increasing the rate of major haemorrage (0.9% combined VS 0.4% aspirin alone)
N Engl J Med. 2013 Jul 4;369(1):11-9		Randomized Controlled Trial, Multicenter Study
IN stroke, ischemic, transient ischemic attack, or minor cerebral infarction, recents	The Use of short-term combined antiplatelet drugs, P2Y12 inhibitors, clopidogrel (initial dose of 300 mg, followed by 75 mg/day) plus aspirin (75 mg/day) for 90 days As Treatment, Acute	Is better Than aspirine alone	To reduce, at 3 months, stroke (8% clopidogrel+aspirin VS 12% aspirine alone), while having similar rate of major haemorrage (0.3% both)
Stroke. 2021 Jun;52(6):e217-e223. doi: 10.1161/STROKEAHA.120.033033		Meta-Analysis
IN stroke, ischemic, transient ischemic attack, or minor or moderate cerebral infarction, recents	The Use of short-term (3 months) treatment with combined antiplatelet drugs, P2Y12 inhibitors, clopidogrel, plus aspirin As Treatment, Acute	Is better Than placebo	To reduce the risk of recurrent stroke (RR, 0.76) and cardiovascular events (RR, 0.76) but at the cost of a higher risk of major bleeding events (RR, 2.22)
Stroke. 2010 Apr;41(4):667-73		Systematic Review
IN stroke, ischemic, transient ischemic attack, risk of evolving to stroke	The Use of ABCD and ABCD2 modified scores: age, hypertension, clinical deficit, duration of symptoms (and diabetes) As Prognostic Item	Is useful Than no comparison	To predict risk of stroke at 7 days: AUC 0.72 for both scores. However, predictive value varied significantly between studies
Stroke. 2006 Dec;37(12):2892-7		Cohorts
IN stroke, ischemic, transient ischemic attack, risk of evolving to stroke	The Use of ABCD score: age, hypertension, clinical deficit and duration of symptoms As Prognostic Item	Is useful Than no comparison	To identify patients at high-risk of having an stroke in the following 30 days: 0% risk if score < 3; 3.5% and 7.6% scores 3 and 4; 21% score = 5; 31% score = 6.
Lancet. 2005 Jul 2;366(9479):29-36		Randomized Controlled Trial
IN stroke, ischemic, transient ischemic attack, risk of evolving to stroke	The Use of ABCD score: age, hypertension, clinical deficit and duration of symptoms As Prognostic Item	Is useful Than no comparison	To identify patients at high-risk of having an stroke in the next 7 days: 0.4% risk if score < 5, 12% if = 5, 31% if = 6.
Stroke. 2010 May;41(5):844-50		Cohorts
IN stroke, ischemic, transient ischemic attack, risk of evolving to stroke	The Use of ABCD2 modified score (age, hypertension, clinical deficit, duration of symptoms and diabetes) or carotid stenosis As Prognostic Item	Is useless Than no comparison	To accurately predict risk of stroke at 90 days in confirmed cases of TIA: 24% of patients with TIA recurrence or stroke had low ABCD2 scores. Presence and severity of carotid stenosis was more predictive.
Ann Emerg Med. 2011 Jan;57(1):46-51		Cohorts
IN stroke, ischemic, transient ischemic attack, risk of evolving to stroke	The Use of ABCD2 modified score, in patients undergoing systematicaly central nervous system and carotid artery imaging As Prognostic Item	Is useless Than no comparison	To predict risk of stroke at 7 nor at 90 days: 2.1% in the low-risk group, 2.1% in the intermediate-risk group, and 3.6% in the high-risk group.
Lancet. 2007 Jan 27;369(9558):283-92		Cohorts
IN stroke, ischemic, transient ischemic attack, risk of evolving to stroke	The Use of ABCD2 modified score: age, hypertension, clinical deficit, duration of symptoms and diabetes As Prognostic Item	Is useful Than no comparison here	To identify patients at high-risk of having an stroke in the following 2 days: 1% risk if score 1-3; 4.1% score 4-5; 8.1% score 6-7. Also good stratification at 7 and 90 days.
Stroke. 2009 Sep;40(9):3091-5		Diagnostic
IN stroke, ischemic, transient ischemic attack, risk of evolving to stroke	The Use of ABCD2 modified score: age, hypertension, clinical deficit, duration of symptoms and diabetes As Prognostic Item	Is useless Than no comparison here	To discriminate between patients needing or not urgent treatment: 20% of patients with an score < 4 required consideration for emergency treatment, sensibility 62%
Arch Intern Med. 2007 Dec 10;167(22):2417-22		Systematic Review
IN stroke, ischemic, transient ischemic attack, risk of evolving to stroke	The Use of accurate knowledge of the early risk of stroke As Prognostic Item	Is useful Than no comparison here	To predict risk of stroke (3.5%, 8.0%, and 9.2% at 2, 30, and 90 days after TIA, respectively) and adapt therapeutics
N Engl J Med. 2008 Sep 18;359(12):1225-37		Randomized Controlled Trial, Multicenter Study
IN stroke, ischemic, with or without hypertension	The Use of angiotensin II receptor blockers, telmisartan As Treatment, Chronic	Is equal Than placebo	To reduce at 2.5 years recurrent stroke (8.7% telmisartan VS 9.2% placebo) or cardiovascular events (13.5% telmisartan VS 14..4% placebo)
N Engl J Med. 2006 Aug 10;355(6):549-59		Randomized Controlled Trial, Multicenter Study
IN stroke, normal cholesterol	The Use of high dose statins, atorvastatin 80 mg/d As Treatment, Chronic	Is better Than placebo	To sligthly reduce incidence of stroke (all types) at 5 years: 11.2% in statin VS 13.1% in controls. Also reduce major cardiovascular events (ARR of 3.5% at 5 years) but not to modify mortality.
Arch Phys Med Rehabil. 2022 Jul;103(7):1422-1435. doi: 10.1016/j.apmr.2022.03.012		Systematic Review
IN stroke, poststroke cognitive impairment	The Use of physiotherapy, including virtual reality rehabilitation training As Treatment, Acute	Is better Than conventional rehabilitation training	To improve cognitive and functional scores
Lancet. 2005 Feb 26;365(9461):764-72		Randomized Controlled Trial
IN stroke, severe, swallowing disturbance	The Use of early enteral tube feeding (in the first 7 days) As Treatment, Acute	Is equal Than no tube feeding for more than 7 days	To reduce mortality (relative risk reduction of only 6%, not significant) or reduce poor outcome at 6 months. Percutaneous endoscopic gastrostomy was NOT better than nasogastric tube.
Lancet. 2005 Sep 3-9;366(9488):809-17		Randomized Controlled Trial, Multicenter Study
IN subarachnoid hemorrhage, intracranial aneurysm, stroke, haemorrhagic	The Use of endovascular coiling As Treatment, Acute	Is better Than neurosurgical clipping	To reduce at 1 year, combined mortality or dependence: 23.5% with endovascular VS 30.9% with neurosurgery
N Engl J Med. 1998 Dec 10;339(24):1725-33		Descriptive
IN subarachnoid hemorrhage, intracranial aneurysm, unruptured, stroke, haemorrhagic	The Use of size of unruptured aneurysm and previous history of subarachnoid haemorrage As Prognostic Item	Is useful Than 0	To predict risk of rupure and so decide preventive surgery or not: risk of rupture of aneurysms < 10 mm which never bleed is 0.05 %/year, much lesser than surgery risk.
J Neurosurg. 2010 Mar;112(3):681-8		Randomized Controlled Trial
IN subarachnoid hemorrhage, stroke, haemorrhagic	The Use of high-dose methylprednisolone (1 gr/day x 3 days) As Treatment, Acute	Is better Than placebo	To reduce poor functional outcome at 1 year: 15% of patients with methylprednisolone VS 34% placebo. However, methylprednisolone did not reduce symptomatic vasospasm.
Ann Surg . 2014 Mar;259(3):449-57. doi: 10.1097/SLA.0000000000000255		Systematic Review
IN subdural hematoma, chronic	The Use of adjuvant use of corticosteroids, added to surgery As Treatment, Acute	Is worse Than no medical treatment added	To modify morbidity : corticosteroids increases it (OR 1.97). Percutaneous bedside twist-drill drainage produced results not different than operating room burr hole evacuation. Drains following drainage reduced recurrences (OR 0.46)
N Engl J Med. 2020 Dec 31;383(27):2616-2627. doi: 10.1056/NEJMoa2020473. Epub 2020 Dec 16		Randomized Controlled Trial, Multicenter Study
IN subdural hematoma, chronic, after surgical drainage	The Use of corticosteroids, oral dexamethasone, starting at 8 mg twice daily, added to surgery (decision to evacuate made by the attending clinician) As Treatment, Acute	Is worse Than placebo	To modify patients with good functional status (Rankin scale 0 to 3) at 6 months: 84% with dexa VS 90% with placebo. Repeat surgery was less frequent with dexamethasone (2% VS 7% placebo)
N Engl J Med. 2023 Jun 15;388(24):2230-2240. doi: 10.1056/NEJMoa2216767		Randomized Controlled Trial, Multicenter Study
IN subdural hematoma, chronic, symptomatic	The Use of dexamethasone, in a 19-day tapering course As Treatment, Acute	Is worse Than surgery, burr-hole drainage	To modify at 3 months the number of patients with good functional outcome: OR 0.55
N Engl J Med. 2024 Nov 20. doi: 10.1056/NEJMoa2409845		Randomized Controlled Trial, Multicenter Study
IN subdural hematoma, chronic, symptomatic	The Use of middle meningeal artery embolization, as an adjunct to standard treatment As Treatment, Acute	Is better Than standard treatment, either surgical (53% of patients) or nonsurgical	To reduce composite adverse outcomes (recurrent or residual hematoma > 10mm, stroke, myocardial infarction or neurologic death) at 6 months: 16% embolization VS 36% control.
Medicine (Baltimore). 2019 Jan;98(1):e13972. doi: 10.1097/MD.0000000000013972		Randomized Controlled Trial
IN subdural hematoma, chronic, with indication to antithrombotic treatment	The Use of resume antithrombotic therapy, either antiplatelet or anticoagulation As Treatment, Chronic	Is worse Than not resuming antithrombotic drugs	To increase recurrence of subdural hematoma: 17% antithromb. VS 12% controls. No significant differences between antiplatelet or anticoagulation treatment
JAMA. 2005 Oct 26;294(16):2035-42		Randomized Controlled Trial, Multicenter Study
IN surgery, colorectal, surgical infection	The Use of oxygen, perioperative supplementation (80% FiO2) As Treatment, Acute	Is better Than standard oxygen (30% FiO2)	To reduce surgical-site infection (24.4% with 80%O2 VS 14.9% with 30%O2) No difference in return of bowel function, ambulation, suture removal, and duration of hospitalization.
N Engl J Med. 2017 11 30;377(22):2133-2144		Randomized Controlled Trial, Multicenter Study
IN surgery, major, cardiac, bleeding or not	The Use of a restrictive transfusion strategy (transfuse if hemoglobin level was <7.5 g/dL) As Treatment, Acute	Is equal Than a liberal transfusion strategy (transfuse if hemoglobin level was <9.5 g/dL)	To modify a composite outcome (death, myocardial infarction, stroke, or new-onset renal failure with dialysis) at 28 days (11% restrictive VS 12% liberal)
N Engl J Med. 2009 Jan 29;360(5):491-9		Controlled Trial (non-randomized)
IN surgery, major, non cardiac	The Use of a 19-item surgical safety checklist As Treatment, Acute	Is better Than not doing the checklist	To reduce death (1.5% before the checklist VS 0.8% afterward) and inpatient complications (11.0% before the checklist VS 7.0% afterward)
Eur J Anaesthesiol. 2025 Jan 1;42(1):1-35. doi: 10.1097/EJA.0000000000002069		Consensus, Guideline
IN surgery, major, non cardiac, elective	The Use of guidelines for a tailored assessment of patient,s fitness to undergo procedures requiring general anaesthesia As Prevention, Primary	Is useful Than no comparison here	To reduce perioperative complications and mortality
J Am Coll Surg. 2011 Aug;213(2):212-217.e10		Clinical Trial (non-controlled, non-randomized)
IN surgery, major, non cardiac, medical emergency, crisis	The Use of crisis checklists for the operating room As Treatment, Acute	Is better Than working on memory alone	To reduction in failure of adherence to critical steps in management (RR = 0.15)
Lancet. 2008 May 31;371(9627):1839-47		Randomized Controlled Trial, Multicenter Study
IN surgery, major, non cardiac, surgical risk	The Use of beta blockers, metoprolol, peri-operative As Prevention, Primary	Is worse Than placebo	To reduce perioperative mortality (3.1% beta-blocker VS 2.3% placebo) or reduce stroke (1% beta-blocker VS 0.5% placebo), even if it reduced myocardial infarction (4.2% beta-blocker VS 5.7% placebo)
Eur J Cardiothorac Surg. 1999 Jun;15(6):816-23		Cohorts
IN surgical risk, cardiac surgery	The Use of a number of clinical and biological predictors As Prognostic Item	Is useful Than 0	To predict risk of peri-operative mortality when cardiac surgery
Arch Surg. 2009 Jan;144(1):69-76		Review (Narrative)
IN surgical risk, haemorrhagic risk, antiplatelet drugs	The Use of antiplatelet drugs, aspirin, clopidogrel, perioperative use As Treatment, Acute	Is better Than withdraw aspirin	To avoid cardiovascular events: 10% risk if antiplatelet drugs withdawn. Aspirin should be maintained. Clopidogrel should be stopped, except if recent drug-eluting stent implantation.
Eur Heart J. 2008 Apr;29(8):1057-71		Meta-Analysis
IN surgical risk, haemorrhagic risk, aspirin, cardiac surgery	The Use of antiplatelet drugs, aspirin, pre-operative use As Treatment, Acute	Is worse Than placebo	To haemorrhage: pre-operative aspirin increased post-operative bleeding (Mean difference, 104.9 mL) and reoperation (OR 2.52)
Circulation. 2011 Feb 15;123(6):577-83		Cohorts
IN surgical risk, haemorrhagic risk, aspirin, cardiac surgery	The Use of early discontinuation of aspirin, 6 or more days before surgery As Treatment, Acute	Is better Than late discontinuation of aspirin, less than 5 days before surgery	To reduce perioperative bleeding and needs of transfusion (26% early VS. 30% late) while no difference in cardiovascular events (in-hospital mortality, myocardial infarction, and stroke) 1.7% early VS. 1.8% late
Cochrane Database Syst Rev. 2010;11:CD008096		Systematic Review, Cochrane Review
IN swallowing disturbance, enteral feeding	The Use of percutaneous endoscopic gastrostomy As Treatment, Chronic	Is better Than nasogastric tube	To reduce procedure failures (OR 0.24)
JAMA Intern Med. 2020 Mar 23. doi: 10.1001/jamainternmed.2020.0288. [Epub ahead of print]		Cohorts
IN syncope	The Use of Canadian Syncope Risk Score (CSRS), ranging from -3 to 11 points. See at: www.mdcalc.com/canadian-syncope-risk-score As Prognostic Item	Is useful Than no comparison done	To accurately discriminate patients at very low risk of any serious outcome at 30 days: 0.3% in the very low risk group, increasing progressively up to 51.3% in the very-high-risk group
Ann Emerg Med. 2006 May;47(5):448-54		Cohorts
IN syncope	The Use of San Francisco Syncope Rule (presence of any of: 1) history of heart failure; 2) Hematocrit <30%; 3) abnormal ECG; 4) complaint of dyspnea; and 5 ) systolic blood pressure <90 mmHg As Prognostic Item	Is useful Than no comparison here	To rule out patients with a high risk of serious outcome in the following 30 days: sensitivity 98%, specificity 56%, LR+ 2.2, LR- 0.03
Ann Emerg Med. 2007 Apr;49(4):420-7, 427.e1-4		Cohorts
IN syncope	The Use of San Francisco Syncope Rule (presence of any of: 1) history of heart failure; 2) Hematocrit <30%; 3) abnormal ECG; 4) complaint of dyspnea; and 5 ) systolic blood pressure <90 mmHg As Prognostic Item	Is useful Than no comparison performed	To rule out patients with a high risk of serious outcome in the following 7 days: sensitivity 89%, specificity 42%
Am J Med. 2007 Jan;120(1):54-62		Meta-Analysis
IN syncope, vasovagal, refractory	The Use of cardiac pacing, permanent pace-maker As Treatment, Chronic	Is equal Than placebo blinded intervention	To prevent new episodes of syncope (OR 0.9). In unblinded studies, the expectation caused by the implantation of a pacemaker reduced recurrent syncopes (OR 0.1)
N Engl J Med. 2006 Sep 7;355(10):1018-28. Epub 2006 Aug 14		Descriptive
IN systemic inflammatory response, cytokine storm, anti-CD28 antibody	The Use of anti-CD28 monoclonal antibody TGN1412 As Treatment, Acute	Is worse Than no treatment	To directly stimulate T cells and improve immune response: the drug causes multiple cytokine-release leading to severe disease in all tested patients. That can improve our understanding of systemic inflammatory response.
Cochrane Database Syst Rev. 2006 Oct 18;(4):CD005154		Systematic Review, Cochrane Review
IN tachycardia, supraventricular, paroxysmal	The Use of adenosine As Treatment, Acute	Is equal Than verapamil, calcium channel antagonists	To reverse the tachycardia, avoid relapse after reversion, and avoid major adverse events. Minor but unpleasant side effects more frequent with adenosine: 11% VS 0.6%. Hypotension only with verapamil: 1.8%
N Engl J Med. 2010 Dec 9;363(24):2301-9. Epub 2010 Nov 16		Randomized Controlled Trial, Multicenter Study
IN telemedicine, remote monitoring, heart failure, chronic	The Use of a telephone-based interactive voice-response system that collected daily information about symptoms and weight As Treatment, Chronic	Is equal Than usual care alone	To reduce the combined endpoint of death or admission to hospital (either for heart failure or for any reason) at 6 months: 52.3% telemon VS 51.5% usual care
Lancet. 2011 Feb 19;377(9766):658-666		Randomized Controlled Trial, Multicenter Study
IN telemedicine, remote monitoring, heart failure, chronic	The Use of implantable haemodynamic monitoring devices, wireless pulmonary artery pression recorder As Treatment, Chronic	Is better Than usual specialized care for heart failure	To reduce heart-failure-related hospitalisation at 6 and at 15 months: 39% relative reduction (153 episodes in 270 patients wireless device VS 253 in 280 patients control)
J Am Coll Cardiol. 2009 Oct 27;54(18):1683-94		Meta-Analysis
IN telemedicine, remote monitoring, heart failure, chronic	The Use of remote patient monitoring, regular structured telephone contact, or transfer of physiological data using scpecific devices As Treatment, Chronic	Is better Than usual care, with in-person visit	To reduce, at 6 or 12 months, death (RR 0.83) and hospitalizations (RR 0.93)
Cochrane Database Syst Rev. 2010 Aug 4;8:CD007228		Systematic Review, Cochrane Review
IN telemedicine, remote monitoring, heart failure, chronic	The Use of structured telephone support, or telemonitoring (transfer of physiological data using scpecific devices) As Treatment, Chronic	Is better Than usual care	To reduce death (RR 0.66 telemonitoring, RR 0.88 and p=NS telephone) and reduce heart failure related hospitalizations (RR 0.77 telemonitoring, RR 0.79 telephone)
N Engl J Med. 2022 Apr 14;386(15):1409-1420. doi: 10.1056/NEJMoa2108447		Randomized Controlled Trial
IN tendon rupture, Achilles,	The Use of nonoperative, conservative treatment As Treatment, Acute	Is equal Than surgical repair, either open repair or minimally invasive surgery	To modify at 1 year functional scores, physical performance and patient-reported physical function. There were more re-ruptures with nonoperative Tt: (6% VS 0.6% surgical) but more nerve lesions with surgery (5% VS 0.6%)
BMJ. 2006 Jul 1;333(7557):15. Epub 2006 Jun 21		Meta-Analysis
IN therapeutics, adherence to drug treatment	The Use of good adherence to drug therapy As Treatment, Chronic	Is better Than poor adherence	To reduce mortality: OR 0.56. Good adherence to placebo was also associated with lower mortality (OR 0.56)
Cochrane Database Syst Rev. 2005 Oct 19;(4):CD000011		Systematic Review, Cochrane Review
IN therapeutics, adherence to drug treatment	The Use of several interventions combining education, reminders, reinforcement As Treatment, Chronic	Is useful Than no comparison here	To improve patient compliance with drug treatment, but only moderately
N Engl J Med. 2010 Feb 18;362(7):600-13		Randomized Controlled Trial, Multicenter Study
IN thrombocytopenia	The Use of low dose of prophylactic platelets transfusions: 1.1x10(11)/m2 body-surface area As Treatment, Acute	Is equal Than medium (2.2x10(12)) and high dose (4.4x10(12)) prophylactic platelets tranfusions	To prevent grade 2 bleeding: 71% low-dose, 69% medium-deose, 70% high-dose. Bleeding occurred mostly at platelets < 5.000/ml (25% of these days)
N Engl J Med. 2010 Nov 11;363(20):1889-99		Randomized Controlled Trial, Multicenter Study
IN thrombocytopenia, immune thrombocytopenic purpura	The Use of thrombopoietin mimetics, romiplostim, weekly subcutaneous injection As Treatment, Chronic	Is better Than standard of care	To reduce treatment failure at 1 year (11% romiplostim, 30% standard care) and so reduce splenectomy, bleeding events and blood transfusions.
N Engl J Med. 2007 Nov 29;357(22):2237-47		Randomized Controlled Trial
IN thrombocytopenia, immune thrombocytopenic purpura, chronic idiopathic, refractory	The Use of oral thrombopoietin-receptor agonists, eltrombopag As Treatment, Chronic	Is better Than placebo	To increase, at 43 days, patients with platelet count above 50.000 (28%, 70% and 81% with 30mg, 50mg and 75 mg eltrombopag VS 11% placebo)
Lancet. 1999 Jan 16;353(9148):190-5		Cohorts
IN thromboembolic disease	The Use of strategy combining clinical assessment, D dimer, ultrasonography, and lung scan As Diagnostic Tool	Is useful Than -	To non-invasive diagnose of thromboembolic disease. The 3-month thromboembolic risk, without treatment, in patients this strategy ruled out the disease was 1.8%.
N Engl J Med. 2013 Aug 29;369(9):799-808		Randomized Controlled Trial, Multicenter Study
IN thromboembolic disease	The Use of anticoagulants, oral factor Xa inhibitors, apixaban, 10 mg twice daily for 7 days, then 5 mg twice daily for 6 months As Treatment, Acute	Is equal Than full dose LMWH enoxaparin initially, followed by warfarin	To reduce recurrent symptomatic venous thromboembolism or related death: 2.3% apixaban VS 2.7% enoxaparin+warfarin, p NS. Less major bleedings with apixaban: 0.6% apixaban VS 1.8% enoxaparin+warfarin
Int J Cardiol. 2009 Sep 11;137(1):37-41		Meta-Analysis
IN thromboembolic disease	The Use of early ambulation As Treatment, Acute	Is equal Than bed rest	To reduce incidence of new embolism: non-significant trend to lower incidence and to lower mortality
N Engl J Med. 2009 Dec 10;361(24):2342-52		Randomized Controlled Trial, Multicenter Study
IN thromboembolic disease	The Use of oral direct thrombin inhibitors, dabigatran, 150 mg twice daily fixed dose As Treatment, Chronic	Is equal Than warfarin, INR adjusted dose	To modify at 6 months recurrent thromboembolisms (2.4% dabigatran VS 2.1% warfarin) or major bleedings (1.6% dabigatran VS 1.9% warfarin)
Ann Intern Med. 2007 Feb 6;146(3):211-22		Systematic Review
IN thromboembolic disease	The Use of short and long term low molecular weight heparin (LMWH), anticoagulation beyond 12 months for patients without provoking factor, compression stockings As Treatment, Chronic	Is better Than unfractionated heparin, shorter duration of anticoagulation, vena cava filter	To reduce short and long term recurrence of thromboembolism, and associated complications
N Engl J Med. 2003 Jul 10;349(2):146-53		Randomized Controlled Trial, Multicenter Study
IN thromboembolic disease, cancer patients	The Use of long term low molecular weight heparin (LMWH), dalteparin As Treatment, Chronic	Is better Than vitamin K antagonists, warfarin	To prevent thromboembolic recurrences at 6 months: 9% dalteparin VS 17% warfarin. No sig effect in mortality: 39% dalteparin VS 41% warfarin.
Cochrane Database Syst Rev. 2014 Jul 8;7:CD006650		Systematic Review, Cochrane Review
IN thromboembolic disease, cancer patients	The Use of long term low molecular weight heparins (LMWH) As Treatment, Chronic	Is better Than anticoagulants, oral, vitamin K antagonists, warfarin	To reduce recurrences of thromboembolism (HR 0.47) but no difference in survival (HR 0.96). No difference either in bleeding and thrombocitopenia
N Engl J Med. 2019 Feb 21;380(8):711-719. doi: 10.1056/NEJMoa1814468.		Randomized Controlled Trial, Multicenter Study
IN thromboembolic disease, cancer patients, at intermediate-to-high risk for thromboembolism (Khorana score, ≥2)	The Use of direct oral anticoagulants, anti-Xa, apixaban, 2.5 mg twice daily, for 6 months As Prevention, Primary	Is better Than placebo	To reduce venous thromboembolism: 4% apixaban VS 10% placebo. Major bleeding was increase, however: 3.5% apixaban VS 2% placebo.
N Engl J Med. 2019 Feb 21;380(8):720-728. doi: 10.1056/NEJMoa1814630		Randomized Controlled Trial, Multicenter Study
IN thromboembolic disease, cancer patients, at intermediate-to-high risk for thromboembolism (Khorana score, ≥2)	The Use of direct oral anticoagulants, anti-Xa, rivaroxaban, 10 mg/daily, for 6 months As Prevention, Primary	Is equal Than placebo	To reduce thromboembolic events: 6% rivaroxaban VS 9% placebo (95%CI 0.40 to 1.09; P = 0.10). Major bleeding occurred in 2% with rivaroxaban and in 1% with placebo.
JAMA. 2023 Jun 2. doi: 10.1001/jama.2023.7843. Epub ahead of print		Randomized Controlled Trial, Multicenter Study
IN thromboembolic disease, cancer patients, invasive solid tumor, lymphoma, multiple myeloma, or chronic lymphocytic leukemia	The Use of direct oral anticoagulants, anti-Xa, anti-IIa, apixaban, rivaroxaban, edoxaban, dabigatran As Treatment, Chronic	Is equal Than low-molecular-weight heparins (LMWH)	To avoid recurrent venous thromboembolism (6% DOAC VS 9% LMWH, difference statistically NS) with equal incidence of major bleeding (5-6%)
N Engl J Med. 2018 02 15;378(7):615-624		Randomized Controlled Trial, Multicenter Study
IN thromboembolic disease, cancer patients, symptomatic or incidental proximal deep-vein thrombosis or pulmonary embolism	The Use of direct oral anticoagulants, anti-Xa, edoxaban, 60 mg once daily As Treatment, Chronic	Is equal Than long term low molecular weight heparin (LMWH), dalteparin	To modify, at 1 year, the rate of recurrent venous thromboembolism (8% edox VS 11% dalte, p = NS) or major bleeding (7% edox VS 4% dalte, p = NS
Circulation. 2008 Jan 1;117(1):93-102. Epub 2007 Dec 17		Meta-Analysis
IN thromboembolic disease, cardiovascular risk	The Use of classic cardiovascular risk factors: obesity, hypertension, diabetes, smoking and hyper-cholesterolemia As Etiologic risk factor	Is useful Than in addition to classical risk factors for venous thrombosis	To predict an incresed risk of VTE: 2.33 for obesity, 1.51 for hypertension, 1.42 for diabetes mellitus, 1.18 for smoking and 1.16 for hyper-cholesterolemia
BMJ. 1998 Oct 17;317:1037-1040		Randomized Controlled Trial
IN thromboembolic disease, deep venous thrombosis	The Use of D dimer As -	Is useful Than -	To avoid serial control leg ultrasonography: when both ultrasonography and D dimers are negatives thromboembolic complications at 3 months were 0.17%
Ann Intern Med. 2005 Jul 19;143(2):129-39		Meta-Analysis
IN thromboembolic disease, deep venous thrombosis	The Use of several clinical features As Diagnostic Tool	Is useful Than no comparison here	To rule in DVT: malignancy (LR, 2.71), previous DVT (LR, 2.25), recent immobilization (LR, 1.98), difference in calf diameter (LR, 1.80), and recent surgery (LR, 1.76)
Ann Intern Med. 1996 Jul 1;125(1):1-7		Cohorts
IN thromboembolic disease, deep venous thrombosis	The Use of knowing natural history As Prognostic Item	Is useful Than no comparison here	To 8.6% recurrence, most DVT, at 6 months, 24.5% at 5 years
N Engl J Med. 2010 Dec 23;363(26):2499-510		Randomized Controlled Trial, Multicenter Study
IN thromboembolic disease, deep venous thrombosis	The Use of anticoagulants, oral factor Xa inhibitors, rivaroxaban, 15 mg twice daily for 3 weeks, followed by 20 mg once daily As Treatment, Acute	Is equal Than acute LMWH (enoxaparin) followed by a vitamin K antagonist	To modify recurrent venous thromboembolism (2.1% rivaroxaban VS 3% enoxaparin plus warfarin) or clinically ssignificant bleeding (8% both groups)
BMJ. 1994 Jul 30;309(6950):299-304		Meta-Analysis
IN thromboembolic disease, deep venous thrombosis	The Use of heparin, low molecular weight As Treatment, Acute	Is better Than heparin, unfractionated	To reduce thrombus extension and recurrence
Am J Med. 2007 Jan;120(1):72-82		Randomized Controlled Trial
IN thromboembolic disease, deep venous thrombosis, long-term treatment, low molecular weight heparins	The Use of long-term low molecular weight heparins, tinzaparin, body-weight adjusted, for 3 months As Treatment, Chronic	Is equal Than vitamin K antagonists, for 3 months	To prevent recurrent venous thromboembolism at 3 (4.9% tinzaparin VS 5.7% vit K antagonists) Mortality and major bleedings were also similar.
J Gen Intern Med. 2006 Dec;21(12):1282-7		Controlled Trial (non-randomized)
IN thromboembolic disease, deep venous thrombosis, medical patients, elderly patients	The Use of graduated compression stockings As Prevention, Primary	Is equal Than no using compression stockings	To reduce rates of proximal deep vein thrombosis: 5.7% stockings users VS 5.2% nonusers
Chest. 2008 Jan;133(1):149-55		Meta-Analysis
IN thromboembolic disease, deep venous thrombosis, prophylaxis, stroke, ischemic	The Use of low-molecular-weight heparins (LMWH) As Prevention, Primary	Is better Than unfractionated heparin (UFH)	To reduce proximal deep venous thrombosis (OR 0.54) and pulmonary embolism (OR 0.26). Bleeding and mortality were equal.
Lancet. 2025 Mar 1;405(10480):725-735. doi: 10.1016/S0140-6736(24)02842-3		Randomized Controlled Trial, Multicenter Study
IN thromboembolic disease, deep venous thrombosis, pulmonary embolism, high-risk of recurrence	The Use of extended anticoagulation with a reduced dose of apixaban (2·5 mg twice daily) or rivaroxaban (10 mg once daily) As Treatment, Chronic	Is better Than extended anticoagulation with full dose of apixaban (5 mg twice daily) or rivaroxaban (20 mg once daily)	To reduce at 5 years major or clinically relevant bleeding (10% reduced-dose VS 15% full-dose) but had slightly more recurrences (2.2% reduced-dose VS 1.8% full-dose)
Cochrane Database Syst Rev. 2014 Dec 17;(12):CD001484		Systematic Review, Cochrane Review
IN thromboembolic disease, deep venous thrombosis, surgical patients	The Use of graduated compression stockings, applied on the day of surgery and worn up until discharge or until the patients were fully mobile As Treatment, Acute	Is better Than no stockings	To reduce the incidence of all (proximal and distal) DVT: 9% stockings VS 21% without. Good quality studies.
N Engl J Med. 2006 Oct 26;355(17):1780-9		Randomized Controlled Trial
IN thromboembolic disease, idiopathic	The Use of D dimer, determination 1 month after stopping anticoagulation, duration of therapy As Prognostic Item	Is useful Than 0	To decide continuation of anticoagulation: recurrences ocurred in 6.2% with normal D-dimers, 15% with elevated D-dimers not anticoagulated, 2.9% with elevated D-dimers but continuing anticoagulation
JAMA. 2003 Aug 27;290(8):1071-4		Cohorts
IN thromboembolic disease, idiopathic	The Use of D dimer, determination after 3 months of anticoagulation, duration of therapy As Prognostic Item	Is useful Than -	To predict long-term risk of recurrence - at 2 years: 2.35% per year if D dimers < 250 ng/L VS 5.75% per year if greater
Ann Intern Med. 2008 Oct 7;149(7):481-90, W94		Systematic Review
IN thromboembolic disease, idiopathic	The Use of D dimer, determination after 3 or more months of anticoagulation, duration of therapy As Prognostic Item	Is useful Than no comparison here	To predict the risk of recurrences: annual 3.5% when D-dimer normal VS 8.9% when D-dimer increased
N Engl J Med. 2013 Feb 21;368(8):699-708		Randomized Controlled Trial, Multicenter Study
IN thromboembolic disease, idiopathic	The Use of anticoagulants, oral factor Xa inhibitors, apixaban, 2.5 or 5 mg twice daily, extended treatment for one year after 6-12 months As Treatment, Chronic	Is better Than non extended treatment, only 6-12 months, placebo afterwards	To reduce new episodes of symptomatic venous thromboembolism (1.7% apixaban both doses VS 8.8% placebo). Apixaban increased nonmajor bleeding (3-4% apixaban VS 2% placebo) but not major bleeding (0.2% apixaban VS 0.5% placebo)
Ann Intern Med. 2006 Jun 6;144(11):812-21		Randomized Controlled Trial, Multicenter Study
IN thromboembolic disease, low probablility patients	The Use of a negative D dimer As Diagnostic Tool	Is equal Than further additional testing 1 and 2 weeks after	To exclude thromboembolic disease and avoid symptomatic events at 6 months follow-up: 0 of 41 patients with no additional testing, 1 of 41 patients with additional testing
Am J Med. 2006 Jan;119(1):54-9		Randomized Controlled Trial, Multicenter Study
IN thromboembolic disease, medical patients	The Use of low molecular weight heparin (LMWH), enoxaparin 40 mg/d As Prevention, Primary	Is equal Than placebo	To reduce mortality at 3 months (9.3% LMWH VS 10% placebo) or symptomatic thromboembolic disease (5 patients with enoxaparin VS 8 patients with placebo)
N Engl J Med. 1999 Sep 9;341(11):793-800		Randomized Controlled Trial, Multicenter Study
IN thromboembolic disease, medical patients	The Use of low molecular weight heparin (LMWH), enoxaparin 40 mg/d As Prevention, Primary	Is better Than placebo	To prevent deep vein thrombosis (5.5% LMWH VS 14.9% placebo). But mortality was not different.
N Engl J Med. 2011 Dec 8;365(23):2167-77. Epub 2011 Nov 13		Randomized Controlled Trial, Multicenter Study
IN thromboembolic disease, medical patients	The Use of anticoagulants, oral factor Xa inhibitors, apixaban, 2.5 mg twice daily for 30 days As Treatment, Acute	Is worse Than low molecular weight heparin (LMWH), enoxaparin 40 mg/d for 6-14 days	To improve outcomes at 30 days: thromboembolic events were similar (2.7% apixaban VS 3% enoxaparin, p=0.44) and major bleeding increased (0.5% apixaban VS 0.2% enoxaparin, p=0.04)
Thromb Haemost. 2004 Mar;91(3):538-43		Randomized Controlled Trial
IN thromboembolic disease, medical patients, prolonged immobilization	The Use of prolonged immobilization in bed for > 3 months, in elderly As Etiologic risk factor	Is equal Than normal mobility	To incidence of symptomatic venous thromboembolic events: 14 per 1000 patients/year in immobilized VS 15.8 in mobile residents
Chest. 1996 Jan;109(1):78-81		Randomized Controlled Trial
IN thromboembolic disease, pulmonary embolism	The Use of arterial blood gas analysis As Diagnostic Tool	Is useless Than gold standard: final diagnosis of PE	To exclude PE if normal results: in 38% of patients with normal pO2 and pCO2 a pulmonary embolism existed.
Chest. 2000 July;118(1):33-38		Randomized Controlled Trial
IN thromboembolic disease, pulmonary embolism	The Use of chest radiograph As Diagnostic Tool	Is useless Than no comparison	To contribute to the diagnosis of pulmonary embolism with any specific finding
Am J Respir Crit Care Med. 1999 Mar;159(3):864-71		Randomized Controlled Trial
IN thromboembolic disease, pulmonary embolism	The Use of clinical features: sudden onset dyspnea, chest pain, and fainting As Diagnostic Tool	Is useful Than gold standard: lung angiography	To diagnose PE: one of those 3 symptoms plus ECG or Rx abnormalities was present in 80% of patients with proven PE, only in 7% of patients not having PE.
Am J Respir Crit Care Med. 1997 Aug;156(2 Pt 1):492-496		Randomized Controlled Trial
IN thromboembolic disease, pulmonary embolism	The Use of D dimer As Diagnostic Tool	Is useful Than -	To rule out pulmonary embolism if negative test (D dimer < 500 micrograms/L): sensitivity 99.5%, negative predictive value 99%, specificity only 41%
BMJ. 2005 Jul 30;331(7511):259		Meta-Analysis
IN thromboembolic disease, pulmonary embolism	The Use of D dimer, lung scan, spiral CT, ultrasonography of leg veins As Diagnostic Tool	Is useful Than final diagnosis of PE as gold standard	To rule in PE: high probability ventilation perfusion scan (LR 18), spiral CT (LR 24.1), and ultrasonography of leg veins (LR 16.2). Rule out PE: normal lung scan LR 0.05, neg. spiral CT + neg. ultrasonography LR 0.04, normal d-dimer LR 0.08
JAMA. 2007 Dec 19;298(23):2743-53		Randomized Controlled Trial, Diagnostic
IN thromboembolic disease, pulmonary embolism	The Use of helical computed tomographic (CT) angiography As Diagnostic Tool	Is better Than ventilation/perfusion lung scan	To diagnose pulmonary embolism: CT diagnosed more emboli (19% VS 14%) and patiens with a negative CT had a non-significant trend to less symptomatic embolism or thrombosis (0.4% VS 1%) in follow-up
Ann Intern Med. 2001 Jul 17;135(2):88-97		Diagnostic
IN thromboembolic disease, pulmonary embolism	The Use of helical CT As Diagnostic Tool	Is useful Than 0	To sensitivity of helical CT was 70% and specificity was 91%. In 12 patients (4%), 2 of whom had PE, helical CT was inconclusive
Arch Intern Med. 2000 Feb 14;160(3):293-8		Meta-Analysis
IN thromboembolic disease, pulmonary embolism	The Use of helical CT As Diagnostic Tool	Is useful Than gold standard: lung angiography	To sensitivity of CT ranged from 64% to 93%, specificity ranged from 89% to 100%
Radiology. 2005 Mar;234(3):740-8		Meta-Analysis
IN thromboembolic disease, pulmonary embolism	The Use of helical CT angiography As Diagnostic Tool	Is better Than ventilation-perfusion (V-P) scanning	To diagnose PE: 86% sensitivity, 94% specificity
Ann Intern Med. 1997 May 15;126(10):775-781		Randomized Controlled Trial
IN thromboembolic disease, pulmonary embolism	The Use of ultrasonography of leg veins As Diagnostic Tool	Is useful Than gold standard: final diagnosis by perfusion lung scan or angiography	To reduce the number of lung angiographies (by 9%) when perfusion lung scan inconclusive.
JAMA. 1990 May 23;263(20):2753-2759		Randomized Controlled Trial
IN thromboembolic disease, pulmonary embolism	The Use of ventilation/perfusion lung scan As Diagnostic Tool	Is useful Than gold standard: pulmonary angiography	To diagnose pulmonary embolism (overall: sensitivity, 98%; specificity, 10%) High-probabilty scan: sens., 41%; spec., 97%
Thorax. 2009 Oct;64(10):869-75		Meta-Analysis
IN thromboembolic disease, pulmonary embolism	The Use of B-type natriuretic peptides (BNP and NT-proBNP) and troponins As Prognostic Item	Is useful Than no comparison here	To identify patients at higher risk of all-cause mortality, mortality by pulmonary embolism and serious adverse events (OR 5 to 7)
Lancet. 1999 Apr 24;353(9162):1386-9		Descriptive
IN thromboembolic disease, pulmonary embolism	The Use of clinical features: As Prognostic Item	Is useful Than no comparison here	To predict mortality: overall rate at 3 months 15.3%, higher if age > 70, cancer, heart failure, COPD, or if at presentation existed hypotension, tachypnoea or right ventricular hypokinesis on echography
Circulation. 2007 Jul 24;116(4):427-33. Epub 2007 Jul 2		Meta-Analysis
IN thromboembolic disease, pulmonary embolism	The Use of troponin As Prognostic Item	Is useful Than no comparison here	To identify patients at high risk of short-term death (19.7% when elevated VS 3.7% when not)
N Engl J Med. 2012 Apr 5;366(14):1287-97		Randomized Controlled Trial, Multicenter Study
IN thromboembolic disease, pulmonary embolism	The Use of anticoagulants, oral factor Xa inhibitors, rivaroxaban, 15 mg twice daily for 3 weeks, followed by 20 mg once daily As Treatment, Acute	Is equal Than acute heparins LMWH (enoxaparin) followed by a vitamin K antagonist	To reduce recurrence of thromboembolic events at 6 -12 months (2,1% rivarox VS 2,8% warfarin) while not increasing clinically significant bleeding (10% rivarox VS 11% warfarin)
Arch Intern Med. 2000 Jan 24;160(2):229-36		Randomized Controlled Trial
IN thromboembolic disease, pulmonary embolism	The Use of heparin, low molecular weight As Treatment, Acute	Is - Than 0	To 0
N Engl J Med. 1997 Sep 4;337(10):663-669		Randomized Controlled Trial
IN thromboembolic disease, pulmonary embolism	The Use of heparin, low molecular weight As Treatment, Acute	Is - Than 0	To 0
Chest. 2005 Sep;128(3):1601-10		Cost-Effectiveness
IN thromboembolic disease, pulmonary embolism, anticoagulants, low molecular weight heparins	The Use of heparin, low molecular weight As Treatment, Acute	Is better Than unfractionated heparin	To for impatients LMWH were only marginally more expensive (dollar 13,001 LMWH vs dollar 12,780 UFH) but yielded more QUALYs (7.677 QALYs vs 7.493 QALYs).
Thromb Res. 2018 Jul;167:37-43. doi: 10.1016/j.thromres.2018.05.008		Randomized Controlled Trial
IN thromboembolic disease, pulmonary embolism, medical thinking, decision making, cognition, physican,s feeling or gestalt,	The Use of physician gestalt As Prognostic Item	Is worse Than Hestia criteria (HC) score, but better than Pulmonary Embolism Severity Index (PESI) and simplified PESI (sPESI)	To identify patients with pulmonary embolism that can be discharged early and safely from hospital: 33% physician VS 42% Hestia VS 18-24% PESI. Severe adverse events at 1 month after discharge: 2.6 - 2.8%
JAMA. 2005 May 18;293(19):2352-61		Cohorts
IN thromboembolic disease, risk factors for recurrence, thrombophilia	The Use of patient,s clinical characteristics As Prognostic Item	Is better Than routine screening for thrombophilia	To predict risk of thromboembolic recurrence: highest risk if: man (HR 2,7), initial thrombotic event not provoked (HR 1,9), anticoagulation deficiencies of prot C, S or antithrombin (HR 1,8), Fact V Leyden had a HR or only 1,2.
N Engl J Med. 2010 Sep 23;363(13):1222-32		Randomized Controlled Trial, Multicenter Study
IN thromboembolic disease, superficial venous thrombosis, legs	The Use of anticoagulants, pentasacharide analogues, fondaparinux 2.5 mg/d for 45 days As Treatment, Acute	Is better Than placebo	To reduce pulmonary embolism or deep-vein thrombosis (1.3% placebo VS 0.2% fondap) and a combined endpoint of thromboembolic events (6% placebo VS 1% fondap).
J Trauma. 2009 Feb;66(2):346-52		Cohorts
IN trauma	The Use of Assessment of Blood Consumption (ABC): penetrating mechanism, positive focused assessment sonography for trauma (FAST), arrival systolic blood pressure =< 90 mm Hg, and arrival heart rate > 120 bpm As Prognostic Item	Is equal Than more complex clinical plus laboratory scores: TASH and McLaughlin)	To predict need for massive transfussion: ABC score => 2 was 75% sensitive and 86% specific. No differences with more complex scores.
N Engl J Med. 2023 Jun 14. doi: 10.1056/NEJMoa2215457. Epub ahead of print		Randomized Controlled Trial, Multicenter Study
IN trauma, severe, at risk of trauma-induced coagulopathy	The Use of tranexamic acid, bolus of 1 g before hospital admission, followed by a 1-g infusion over 8 hours As Treatment, Acute	Is better Than placebo	To improve survival at 6 months (17% tranxenamic VS 22% placebo). However, no change in number of patients with favorable functional outcome (54%) both
N Engl J Med. 2006 Jan 12;354(2):119-30		Descriptive
IN traveler infections, geographic area	The Use of travel destination As Etiologic risk factor	Is useful Than -	To guide diagnostic approaches and empiric therapies. Sub-Saharan Africa and Central America: malaria, rickettsia. Southeast Asia: dengue, malaria, thyphoid. diarrhea. South America: dermatologic problems.
Chest. 1998 May;113(5):1190-4		Diagnostic
IN tuberculosis	The Use of PCR As Diagnostic Tool	Is worse Than culture as gold standard	To diagnose tuberculosis in various specimens: sensibility 76.4%, specificity 99.8%, positive PV 92.8%, and negative PV 99.2%
Cochrane Database Syst Rev. 2007 Oct 17;(4):CD001876		Systematic Review, Cochrane Review
IN tuberculosis, pleural	The Use of oral corticosteroids, As Treatment, Acute	Is equal Than placebo	To reduce mortality or improve final respiratory function.
Chest. 2007 Sep;132(3):959-65		Diagnostic
IN tuberculosis, pulmonary	The Use of whole-blood interferon-gamma assay (QuantiFERON-TB), or interferon-gamma enzyme-linked immunospot assay (T SPOT.TB) As Diagnostic Tool	Is better Than tuberculin skin test	To diagnose active pulmonary tuberculosis: sensibility: 89% QuantiFERON, 92% T SPOT; specificity: 49% QuantiFERON, 47% T SPOT; negative predictive value: 84% QuantiFERON, 87% T SPOT, 64% tuberculine
Cochrane Database Syst Rev. 2014 Nov 12;2014(11):CD011370. doi: 10.1002/14651858.CD011370		Systematic Review, Cochrane Review
IN tuberculosis, pulmonary	The Use of oral corticosteroids As Treatment, Acute	Is better Than placebo or no treatment	To improve increase clinical improvement within 1 month (RR 1.16, low quality) and weight gain, but NOT to reduce mortality nor increase sputum conversion
Int J Tuberc Lung Dis. 1999 Jan;3(1):47-54		Randomized Controlled Trial
IN tuberculosis, pulmonary, severe, persistent fever	The Use of oral corticosteroids, prednisone 40mg/d decreasing over 40 days As Prognostic Item	Is better Than placebo	To decrease fever, improve weight gain and achieve Rx regression faster
N Engl J Med 2022 Dec 22;387:2331-2343. DOI: 10.1056/NEJMoa2117166		Randomized Controlled Trial, Multicenter Study
IN tuberculosis, resistant, rifampin-resistant	The Use of a 24-week regimen of bedaquiline, pretomanid, linezolid, and moxifloxacin As Treatment, Chronic	Is better Than 9-to-20-month standard-care regimen	To reduce bad outcome (death, treatment failure, discontinuation or recurrence of tuberculosis): 4% short regime VS 12% standard. With less severe events: 19% short VS 59% standard
N Engl J Med. 2022 Sep 1;387(9):810-823. doi: 10.1056/NEJMoa2119430		Randomized Controlled Trial
IN tuberculosis, resistant, rifampin-resistant, extensively drug-resistant	The Use of a 26-weeks 3-drug regimen: bedaquiline (200 mg/d for 8 weeks, then 100 mg/d for), pretomanid (200 mg/d for 26 weeks) and linezolid (600 mg/d for 26 weeks) As Treatment, Chronic	Is better Than a different linezolide regimen: 1200 mg/d or just 9-weeks of linezolide	To reduce unfavorable outcomes (treatment failure, disease relapse or death): 9% test regimen VS 16-7% others, while reducing severe adverse effects: peripheral neuropathy (24%), myelosuppression (2%)
Ann Intern Med. 2012 Jun 19;156(12):861-74		Systematic Review
IN urinary incontinence, women	The Use of diverse drugs for urgency urinary incontinence: fesoterodine, tolterodine, oxybutynin, solifenacin, trospium As Treatment, Chronic	Is bad Than placebo	To only marginally reducing incontinency (10 to 13% of treated women) while producing adverse effects (withdrawal in 3 to 6%)
JAMA. 2021 Jul 27;326(4):324-331. doi: 10.1001/jama.2021.9899		Randomized Controlled Trial
IN urinary tract infection, men, prostatitis, afebrile, uncomplicated	The Use of short course, antibiotics, ciprofloxacin or trimethoprim/sulfamethoxazole, for 7 days As Treatment, Acute	Is equal Than longer course, antibiotics, ciprofloxacin or trimethoprim/sulfamethoxazole, for 14 days	To resolve symptoms at 14 days after end of treatment (90% both groups) and avoid recurrence at 28 days (10% 7-day VS 14% 14-day, p NS)
Lancet. 2006 Sep 30;368(9542):1171-9		Meta-Analysis
IN urolithiasis, acute renal colic	The Use of alpha-blockers, calcium-channel blockers As Treatment, Acute	Is better Than placebo	To facilitate urinary stone passage: 65% (absolute risk reduction=0.31 95% CI 0.25-0.38) greater likelihood of stone passage.
Ann Emerg Med. 2007 Nov;50(5):552-63		Systematic Review
IN urolithiasis, acute renal colic	The Use of alpha-blockers, calcium-channel blockers As Treatment, Acute	Is better Than standard medical therapy	To improved spontaneous stone expulsion: alpha-antagonist RR 1.59 and NNT 3.3; calcium channel blocker RR 1.50 and NNT 3.9
Am J Emerg Med. 2022 Aug;58:245-250. doi: 10.1016/j.ajem.2022.05.054		Randomized Controlled Trial
IN urolithiasis, acute renal colic	The Use of dexamethasone, 8 mg single dose + ketorolac, 30 mg As Treatment, Acute	Is better Than ketorolac alone	To reduce, at 30 mins, visual pain scores and need for opioids (35% dexa VS 58% ketorolac alone)
BMJ. 2004 Jun 12;328(7453):1401		Systematic Review
IN urolithiasis, acute renal colic	The Use of non-steroidal anti-inflammatory drugs (NSAIDs) (diclofenac, ketorolac, indomethacin) As Treatment, Acute	Is better Than opioids (mostly pethidine)	To greater reduce pain scores, decrease probability to require rescue analgesia, reduce incidence of adverse events
Ann Rheum Dis. 2023 Mar 23:ard-2022-223559. doi: 10.1136/ard-2022-223559		Randomized Controlled Trial, Multicenter Study
IN vasculitis, ANCA-associated, following induction of remission	The Use of rituximab, anti CD20 B lymphocyte antibody, 1000 mg every 4 months, through month 20 As Treatment, Chronic	Is better Than azathioprine, 2 mg/kg/day, tapered after month 24	To reduce, at 48 months, relapses (50% ritux VS 65% azath) and avoid severe adverse events (22% ritux VS 36% azath)
Clin J Am Soc Nephrol. 2014 Jun 26. pii: CJN.00100114. [Epub ahead of print]		Randomized Controlled Trial, Multicenter Study
IN vasculitis, ANCA-associated, involving the kidneys or another vital organ	The Use of switch from cyclophosphamide to azathioprine after 3-6 months As Treatment, Chronic	Is worse Than long-term Tt with cyclophosphamide for 12 months	To it increased the risk of relapse (HR 1.63, 44% all patients), and end-stage kidney disease (1.76, 9% all patients). No differences in mortality (HR 0.75, 15% all patients)
N Engl J Med. 2010 Jul 15;363(3):211-20		Randomized Controlled Trial, Multicenter Study
IN vasculitis, ANCA-associated, severe	The Use of rituximab, anti CD20 B lymphocyte antibody, 375 mg per square meter of body-surface area per week for 4 weeks As Treatment, Acute	Is equal Than standard IV cyclophosphamide induction regimens, followed by azathioprine	To increase, at 12 months, sustained remission (76% ritux VS 82% cycloph) or reduce mortality (18% both groups)
N Engl J Med. 2021 Feb 18;384(7):599-609. doi: 10.1056/NEJMoa2023386		Randomized Controlled Trial, Multicenter Study
IN vasculitis, ANCA-associated, severe	The Use of C5a receptor inhibitors, avacopan, 30 mg twice daily, after initial treatment with cyclophosphamide (followed by azathioprine) or rituximab As Treatment, Chronic	Is better Than prednisone on a tapering schedule	To achieve sustained remission at 1 year (66% avacopan VS 55% prednisone). Complete remission at 6 months (70-72%) and adeverse events (37-39%) wer not different
N Engl J Med. 2008 Dec 25;359(26):2790-803		Randomized Controlled Trial, Multicenter Study
IN vasculitis, ANCA-associated, Wegener,s granulomatosis, microscopic polyangiitis	The Use of azathioprine As Treatment, Chronic	Is better Than methotrexate	To prevent, at 29 months, relapses after remission (36.5% azat VS 33.3% methot) while avoiding adverse events requiring withdrawal (11% azat VS 19% methot)
N Engl J Med. 2025 May 29;392(20):2013-2024. doi: 10.1056/NEJMoa2413449		Randomized Controlled Trial, Multicenter Study
IN vasculitis, giant-cell arteritis, Horton,s disease	The Use of selective Janus kinase (JAK) inhibitors, upadacitinib, 15 mg orally once daily, plus a 26-week glucocorticoid taper As Treatment, Chronic	Is better Than placebo	To improve at 1 year sustained remission rates: 46% upadacitinib VS 29% placebo
Medicine (Baltimore). 2011 Jan;90(1):19-27		Cohorts
IN vasculitis, systemic necrotizing, Wegener granulomatosis, microscopic polyangiitis, Churg-Strauss, polyarteritis nodosa	The Use of revised Five-Factor Score (FFS): age >65 years, cardiac symptoms, gastrointestinal involvement, renal insufficiency, no ear-nose-and-throat symptoms (1 point each) As Prognostic Item	Is useful Than no comparison done	To predict mortality at 5 years: 9% score 0 VS 21% score 1 VS 40% score 2 or more
N Engl J Med. 2007 May 31;356(22):2245-56		Randomized Controlled Trial
IN vertebral disc herniation, sciatica, persistent	The Use of systematic early lumbar disk (microdiskectomy) surgery As Treatment, Acute	Is equal Than prolonged conservative treatment with surgery later if needed	To achieve perceived recovery at 1 year: 95% both groups. Early surgery patients had a faster perceived recovery
BMJ. 2008 Jun 14;336(7657):1355-8		Randomized Controlled Trial, Multicenter Study
IN vertebral disc herniation, sciatica, persistent	The Use of systematic early surgery (removal of disc herniation) As Treatment, Acute	Is equal Than maintaining conservative treatment, with surgery later if needed	To improve long-term (at 2 years) disability and leg and low back pain, despite initial (at 3 months) larger reductions in disability and pain with surgery.
J Am Geriatr Soc. 2009 Sep;57(9):1595-603		Cohorts
IN vitamin deficiency, vitamin D, overall mortality, oxidative stress	The Use of baseline vitamin D 25(OH)D levels As Prognostic Item	Is useful Than no comparison here	To be independently associated with all-cause mortality at 7 years: HR 1.8 for subjects with levels less than 25.0 nmol/L
Cochrane Database Syst Rev. 2008;(1):CD003861		Systematic Review, Cochrane Review
IN wounds	The Use of tap water As Treatment, Acute	Is better Than sterile solutions (saline, boiled water or others)	To clean wounds and reduce infection rate: 4.4% tap water VS 7% sterile saline