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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. 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%
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.
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
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 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%
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
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. 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
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
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.
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
Am J Med. 2008 Apr;121(4):324-331.e6		Systematic Review
IN ankle sprain, lateral	The Use of long-term clinical course As Prognostic Item	Is useful Than no comparison here	To know that 5 to 33% of patients still had pain at 1 year, and 5-25% staill at 3 years. Instability and re-sprain were also frequent: 3-34% of patients.
Chest. 2007 Oct;132(4):1131-9		Meta-Analysis
IN anticoagulants, heparins, low molecular weight heparins, unfractionated heparin	The Use of low molecular weight heparins As Treatment, Acute	Is equal Than unfractionated heparin	To risk of thrombocytopenia: 1.2% with LMWH VS 1.5% with UH. Severe heparin-induced thrombocytopenia with thrombosis was too low to make an adequate comparison.
Gastroenterology. 2013 Jul;145(1):105-112.e15		Systematic Review
IN anticoagulants, oral direct thrombin inhibitors, dabigatran, oral factor Xa inhibitors, apixaban, rivaroxaban, edoxaban	The Use of these direct oral anticoagulants As Treatment, Chronic	Is worse Than warfarin	To cause a higher risk of gastrointestinal bleeding: OR 1.58 dabigatran, 1.48 rivaroxaban, 1.23 apixaban (non-significant), 0.31 edoxaban (non-significant for superiority)
Stroke. 2017 Sep;48(9):2494-2503		Cohorts
IN anticoagulants, oral direct thrombin inhibitors, dabigatran, oral factor Xa inhibitors, apixaban, rivaroxaban, real-world data	The Use of these direct oral anticoagulants As Treatment, Chronic	Is better Than warfarin	To reduce mortality (for dabigatran and apixaban (HR 0.65 both)), achieve similar rate of ischemic stroke or embolism, reduce intracranial bleeding (all 3 drugs, HR 0.40 to 0.65) but increasing gastrointestinal bleeding (except apixaban)
N Engl J Med. 2015 Aug 6;373(6):511-20		Cohorts
IN anticoagulants, oral direct thrombin inhibitors, dabigatran, patients who had serious bleeding or required an urgent procedure	The Use of idarucizumab, an dabigatran-specific antibody fragment As Treatment, Acute	Is better Than no comparison done	To normalize hemostasis tests in 88 to 98% of the patients in minutes. One thrombotic event occurred within 72 hours after idarucizumab administration.
N Engl J Med. 2016 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)
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
Lancet. 2016 Jun 04;387(10035):2302-2311		Randomized Controlled Trial, Multicenter Study
IN anticoagulants, vitamin K antagonists, direct oral anticoagulants, bleeding risk	The Use of a new bleeding risk score : ABC-bleeding : age, previous bleeding, haemoglobin, high-sensitivity cardiac troponin T and growth differentiation factor-15 (GDF-15) As Prognostic Item	Is better Than other bleeding risk scores, HAS-BLED, ORBIT	To predict the risk of major bleeding at 1 year for patients on warfarin, apixaban or dabigatran
Ann Intern Med. 2009 Mar 3;150(5):293-300		Randomized Controlled Trial, Multicenter Study
IN anticoagulants, vitamin K antagonists, excessive anticoagulation, without major bleeding	The Use of low dose oral vitamin K (1.25mg) As Treatment, Acute	Is equal Than placebo	To reduce any bleeding (15.8% vit VS 16.3% placebo) or major bleedings (2.5 % vit K VS 1.1% placebo)
Arch Intern Med. 2003 Nov 10;163(20):2469-73		Randomized Controlled Trial
IN anticoagulants, vitamin K antagonists, excessive anticoagulation, without major bleeding	The Use of oral vitamin K1 (2.5mg if INR 6-10, 5mg if INR > 10) As Treatment, Acute	Is equal Than intravenous vitamin K1 (0.5mg if INR 6-10, 1mg if INR > 10)	To correct INR: response to intravenous phytonadione was more rapid at 6 and 12 hours, but at 24 hours INR values were similar for both groups and more patients in the IV group were overcorrected (INR < 2: 8.7% in PO group VS 29% in IV group)
BMJ. 2002 Nov 9;325(7372):1073-5		Descriptive
IN anticoagulants, vitamin K antagonists, monitoring	The Use of INR values in excess As Prognostic Item	Is useful Than No control	To hight INRs are associated with an excess mortality. With an increase of 1 unit of INR above 2.5, the risks of death from cerebral bleeding (149 deaths / 42 451 patients) and from any cause were about doubled
Ann Intern Med. 2003 May 6;138(9):714-9		Randomized Controlled Trial
IN anticoagulants, vitamin K antagonists, warfarin, thromboembolic disease	The Use of higher starting dose: 10 mg/day As Treatment, Acute	Is better Than usual starting dose: 5 mg/day	To reduce time to achieve therapeutic INR at day 5 (83% with 10mg VS 46% with 5mg, overall reduction by 1.5 days). No significant differences in major bleeding, coagulation excess (INR > 5.0), recurrent events and survival.
N Engl J Med. 2006 Jun 8;354(23):2443-51		Cohorts
IN antihypertensive drugs, angiotensin converting enzyme (ACE) inhibitors, adverse effects, congenital malformations	The Use of angiotensin converting enzyme (ACE) inhibitors during pregnancy, first trimester As Treatment, Chronic	Is worse Than other antihypertensive drugs	To increase the risk of major congenital malformations (RR, 2.71; 95 %CI, 1.72 to 4.27) as compared with no exposure to antihypertensive medications.
Blood. 2018 Sep 27;132(13):1365-1371		Randomized Controlled Trial, Multicenter Study
IN antiphospholipid syndrome	The Use of anticoagulants, oral factor Xa inhibitors, rivaroxaban As Treatment, Chronic	Is worse Than anticoagulants, vitamin K antagonists, warfarin	To reduce major events (thromboembolic events or major bleeding): 19% rivaroxaban VS. 3% warfarin.
Lancet. 2017 07 29;390(10093):490-499		Cohorts
IN antiplatelet drugs, aspirin, bleeding risk	The Use of any anitplatelet drug, mainly aspirin (95% of included patients) As Treatment, Chronic	Is worse Than no antipaltelet therapy	To increase the risk of bleeding. Bleeding rate increased with age from 70 years on, specially major and life-threatening bleeding. Localizations, by frequency: gastrointestinal, genitourinary, intracranial, epistaxis, others
Arch Intern Med. 2010 Feb 22;170(4):321-31		Systematic Review
IN anxiety symptoms, patients with a chronic illness	The Use of exercise training As Treatment, Chronic	Is better Than no training	To to modestly improve anxiety symptoms: mean effect Delta 0.29
Arch Intern Med. 2006 Jul 10;166(13):1350-6		Systematic Review
IN aortic dissection, thoracic	The Use of transesophageal echocardiography, helical computed tomography (CT), and magnetic resonance imaging (IRM) As Diagnostic Tool	Is equal Than reference gold standard (angiography)	To diagnose this condition: sensitivity (98%-100%) and specificity (95%-98%) were comparable between all 3 imaging techniques. LR+ was some better for IRM (24) than for echography or CT (14) but without major clinical implications.
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. 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)
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
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
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%)
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. 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
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 ()
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.
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)
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)
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
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)
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.
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 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. 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)
Arch Intern Med. 2006 Apr 10;166(7):719-28		Systematic Review
IN atrial fibrillation, rhythm control strategy	The Use of antiarrhythmic drugs, classes IA, IC, III As Treatment, Chronic	Is worse Than placebo or no treatment	To reduce mortality, class IA drugs (quinidine, dysopiramide) increased mortality (NNH 109) and the rest did not modify it. All drugs increased adverse effects and pro-arrhythmia (but amiodarone).
N Engl J Med. 2009 May 14;360(20):2066-78		Randomized Controlled Trial, Multicenter Study
IN atrial fibrillation, stroke, ischemic, embolic	The Use of antiplatelet drugs, adenosine diphosphate (ADP) receptor inhibitors, clopidogrel (75 mg/day) plus aspirin As Treatment, Chronic	Is better Than aspirin alone	To reduce major cardiovascular events, specially stroke (6.8% clopidogrel+aspirin VS 7.6% aspirin) but increased major haemorrhage (2% clopidogrel+aspirin VS 1.3% aspirin)
Lancet. 2006 Jun 10;367(9526):1903-12		Randomized Controlled Trial, Multicenter Study
IN atrial fibrillation, stroke, ischemic, embolic	The Use of antiplatelet drugs, adenosine diphosphate (ADP) receptor inhibitors, clopidogrel (75 mg/day) plus aspirin (75-100 mg/day) As Treatment, Chronic	Is worse Than oral anticoagulation (target INR 2.0-3.0)	To prevent embolic events (stroke, non-CNS systemic embolus, myocardial infarction, or vascular death): annual risk 3.93% with warfarin VS 5.60% with aspirin plus clopidogrel
Clin Infect Dis. 2002 Jun 1;34(11):1481-90. Epub 2002 May 13		Randomized Controlled Trial
IN bacterial infection, cocci gram positive, Staphylococcus aureus, methicillin resistant	The Use of oxazolidinones antibiotics, linezolid (600mg/12h) As Treatment, Acute	Is equal Than vancomycine	To achieve a clinical cure: 73.2% linezolid 73.1% vancomycin. Similar rates of adverse events.
Cochrane Database Syst Rev. 2017 Sep 01;9:CD005186		Systematic Review, Cochrane Review
IN bacterial infection, nosocomial, any	The Use of multimodal interventions to improve hand hygiene compliance As Prevention, Primary	Is equal Than simpler interventions to increase hand hygiene compliance	To reduce colonization and infection rates: a few, low quality studies suggest complex interventions could at best slightly reduce infections
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. 2009 May 2;373(9674):1532-42		Meta-Analysis
IN cancer, associated chronic anemia	The Use of erythropoietin analogs, recombinant human erythropoiesis-stimulating agents As Treatment, Chronic	Is worse Than placebo	To mortality (mean follow-up 6-8 months): 12% with erythropoietin VS 11% with placebo
N Engl J Med. 2007 Apr 12;356(15):1527-35		Randomized Controlled Trial, Multicenter Study
IN cancer, brain, glioblastoma	The Use of radiotherapy (focal, fractions of 1.8 Gy 5 days per week, total dose 50 Gy). As Treatment, Acute	Is better Than supportive care only	To improve survival: median 29 weeks radiotherapy VS 17 weeks supportive care
N Engl J Med. 2016 Apr 7;374(14):1344-55		Randomized Controlled Trial, Multicenter Study
IN cancer, brain, glioma (astrocytoma, oligoastrocytoma, or oligodendroglioma), low-grade	The Use of radiation therapy followed by six cycles of combination chemotherapy: procarbazine, lomustine (also called CCNU), and vincristine, all at the time of initial diagnosis As Treatment, Acute	Is better Than radiation therapy alone	To improve median overall survival (13.3 years radiation+chemo VS 7.8 years radiation only). Overall survival at 10 years: 60% combined Tt VS 40% radiation only
Cochrane Database Syst Rev. 2011;1(del):CD001877		Systematic Review, Cochrane Review
IN cancer, breast, screening	The Use of mammography As Diagnostic Tool	Is better Than no screening	To reduce, very modestly, mortality from breast cancer (NNT 2 000 throughout 10 years), at the cost of early overdiagnosis of bresat cancer (NNH 200) and many false positive findings (NNH 10)
BMJ. 2014;348():g366		Randomized Controlled Trial, Diagnostic
IN cancer, breast, women aged 40-59	The Use of mammography screening As Diagnostic Tool	Is equal Than physical breast examinations	To modify death from breast cancer after 15 years of follow-up: rates identical in both groups. More cancers were diagnosed in the mammography group resulting in less mortality rate in patients diagnosed with cancer
J Clin Oncol. 2011 Sep 1;29(25):3457-6		Cohorts
IN cancer, chemotherapy, toxicity, risk estimation, older patients	The Use of a risk stratification schema (range 0 to 19) composed of age, anemia, renal failure, bad hearing, >1 fall last 6 months, needing help for taking medocs, reduced walking, decreased social life, polychemotherapy and using standard chemo dose As Prognostic Item	Is better Than no systematic assessment	To predict grade 3 (severe), grade 4 (life-threatening or disabling), or grade 5 (death) chemotherapy toxicity: low risk, 0 to 5 points = 30% incidence, intermediate 6 to 9 points = 52%, high risk 10 to 19 points = 83%
PLoS One. 2011;6(6):e20456		Meta-Analysis
IN cancer, colorectal	The Use of high red meat and processed meat consumption As Etiologic risk factor	Is useful Than low red meat and processed meat consumption	To predict the risk of colorectal cancer : RR 1.22 for the highest versus the lowest intake, RR 1.14 for every 100 g/day increase in consumption
N Engl J Med. 2005 Dec 22;353(25):2654-66		Descriptive
IN cancer, colorectal	The Use of pathological signs of early metastatic invasion (venous emboli, lymphatic and perineural invasion) As Prognostic Item	Is useful Than no comparison	To predict survival: absence of early metastatic invasion was independently associated with increased survival. Tumours without early metastatic invasion had increased markers of T-cells migration, activation, and differentiation
BMJ. 2006 Jul 8;333(7558):69-70. Epub 2006 Jun 21		Cohorts
IN cancer, colorectal, clinical presentation	The Use of new onset rectal bleeding in patients aged 45 or more As Diagnostic Tool	Is useful Than no comparison here	To investigate bowel: 5.7% of this patients had colorectal cancer, and 4.9% had colonic adenoma.
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)
Am J Gastroenterol. 2008 Jun;103(6):1541-9		Systematic Review, Cochrane Review
IN cancer, colorectal, screening in asymptomatic average risk adults	The Use of fecal occult blood test (hemoccult) As Diagnostic Tool	Is better Than no screening	To slightly reduce death from colorectal cancer at 12-18 years (0.8% using hemoccult VS 1% no screening, NNT 617) while not reducing overall mortality (31%)
Gastroenterology. 2006 Aug;131(2):390-401; quiz 659-60		Systematic Review
IN cancer, gastroesophageal, clinical feautures	The Use of alarm features such as dysphagia, weight loss, or anemia As Diagnostic Tool	Is worse Than endoscopy	To diagnose upper GI malignancy: sensitivity varied from 0% to 83%, specificity 40% to 98%, with considerable heterogeneity between studies.
N Engl J Med. 2006 Jul 6;355(1):11-20		Randomized Controlled Trial, Multicenter Study
IN cancer, gastroesophageal, resectable	The Use of perioperative chemotherapy: 3 preoperative and 3 postoperative cycles of epirubicin and cisplatin plus a continuous intravenous infusion of fluorouracil for 21 days As Treatment, Acute	Is better Than surgery alone	To improve survival at 5 years: 36% perioperative chemotherapy VS 23% surgery alone.
Cochrane Database Syst Rev. 2000;2(2):CD002139		Systematic Review, Cochrane Review
IN cancer, lung, non-small cell	The Use of chemotherapy containing cisplatin As Treatment, Acute	Is better Than only supportive care, only surgery or only radiotherapy	To modestly improve survival: 10% absolute reduction of death at 1 year vs only supportive care
N Engl J Med. 2010 Jun 24;362(25):2380-8		Randomized Controlled Trial, Multicenter Study
IN cancer, lung, non-small-cell, advanced	The Use of gefitinib, EGFR tyrosine kinase inhibitor As Treatment, Acute	Is better Than carboplatin-paclitaxel chimiotherapy	To improve survival: 30 months gefitinib VS 24 carboplatin. Gefitinib had also less severe adverse effects.
N Engl J Med. 2010 Aug 19;363(8):733-42		Randomized Controlled Trial, Multicenter Study
IN cancer, lung, non-small-cell, advanced	The Use of early palliative care, integrated with standard oncologic care As Treatment, Chronic	Is better Than standard oncologic care alone	To improve quality of life and to improve survival (12 months early palliative VS 9 months standard) despite receiving less agressive end-of-life care.
Nat Genet. 2013 Sep 26;45(10):1127-1133		Descriptive
IN cancer, oncogenic signature classes	The Use of oncogenic signature classes: patterns of combined genetic and epigenetic features As Etiologic risk factor	Is useful Than no comparison here	To various defined oncogenic signature classes are characteristics of multiple cross-tissue groups of tumors
N Engl J Med. 2018 Apr 05;378(14):1313-1322		Randomized Controlled Trial
IN cancer, pleural, effusion	The Use of talc administered through an indwelling pleural catheter (4 g of talc slurry) As Treatment, Acute	Is better Than indwelling pleural catheter alone	To induce pleurodesis: 43% talc VS. 23% catheter only. No significant between-group differences in effusion size, inpatient days, mortality, or number of adverse events
J Clin Oncol. 2007 Aug 20;25(24):3582-8		Decision Model
IN cancer, prostate	The Use of a nomogram including age, ethnicity, family history, urinary symptoms, prostatic specific antigen (PSA), free:total PSA ratio, and digital rectal examination As Diagnostic Tool	Is better Than PSA alone	To detect patients with prostate cancer. 24% of patients with PSA < 4 ng/mL had prostate cancer.
J Clin Oncol. 2005 Jul 1;23(19):4322-9. Epub 2005 Mar 21		Decision Model
IN cancer, prostate	The Use of PSA>1.55 ng/mL or >0.165 ng/mL/cc(prostate volume), hypoechoic lesion, age>55y, prostate volume<44cc As Diagnostic Tool	Is better Than increase PSA alone	To select patients for prostatic biopsy in search of prostatic cancer: 31% sensibility and 96,6% specificity for prostatic cancer
N Engl J Med. 2005 May 12;352(19):1977-84		Randomized Controlled Trial, Multicenter Study
IN cancer, prostate, early non-metastatic	The Use of radical prostatectomy As Treatment, Acute	Is better Than watchful waiting	To decrease - at 8 years - metatasis development, local progression, death due to prostate cancer (8.6% with surgery VS 14.4% waiting) and total mortality (24% with surgery VS 30.5% waiting)
Ann Intern Med. 2008 Mar 18;148(6):435-48		Systematic Review
IN cancer, prostate, early non-metastatic	The Use of radical prostatectomy As Treatment, Acute	Is better Than watchful waiting or external-beam radiation	To reduced at 10 years all-cause mortality (24% prostatectomy vs. 30% wacthful) or reduce at 5 years cancer recurrence
N Engl J Med. 2016 Oct 13;375(15):1425-1437		Randomized Controlled Trial, Multicenter Study
IN cancer, prostate, early non-metastatic	The Use of active monitoring As Treatment, Chronic	Is better Than radical prostatectomy, or external-beam radiotherapy	To preserve sexual, urinary and bowel functions: sexual and urinary function declined gradually. Prostatectomy was the worst on sexual function and urinary continence. Radiotherapy reduced sexual and bowel functions but did not impact continency
N Engl J Med. 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.
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.
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)
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. 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
Chest. 2005 Nov;128(5):3489-99		Randomized Controlled Trial, Multicenter Study
IN chronic obstructive pulmonary disease, emphysema	The Use of lung-volume-reduction surgery As Treatment, Chronic	Is worse Than physical training alone	To perioperative and at 1 year mortality risk: 7/53 patients death in the surgery group VS 1/53 patients in control (p non significant). Health status and FEV1 were improved after surgery at 1 year.
N Engl J Med. 2011 Aug 25;365(8):689-98		Randomized Controlled Trial, Multicenter Study
IN chronic obstructive pulmonary disease, exacerbations	The Use of long-term antibiotics, azithromycin 250 mg daily for 1 year As Prevention, Secondary	Is better Than placebo	To reduce (but only marginally) nuber of exacerbations (1.5 par year azytro VS 1.8 per year placebo. Hearing impairment was higher: 25% patients azytro VS 20% placebo
BMJ. 2011 Jun 14;342:d3215. doi: 10.1136/bmj.d3215		Systematic Review
IN chronic obstructive pulmonary disease, exacerbations	The Use of inhaled anticholinergics, long acting, tiotropium, using mist inhaler As Treatment, Acute	Is worse Than placebo	To mortality: increased with tiotropium (2.4%) VS placebo (1.7%). NNH = 124
Thorax. 2008 May;63(5):415-22		Meta-Analysis
IN chronic obstructive pulmonary disease, exacerbations	The Use of short-course antibiotic treatment (5 days or less) As Treatment, Acute	Is equal Than longer duration of antibiotic course	To achieve clinical and bacteriological cure (OR 1.0 and 1.05 respectively)
Chest. 2005 Jul;128(1):48-54		Randomized Controlled Trial
IN chronic obstructive pulmonary disease, exacerbations	The Use of smaller doses of short-acting inhaled beta2 agonists (albuterol, 2.5mg/4h) As Treatment, Acute	Is equal Than greater doses of the same drug (albuterol, 5mg/4h)	To increase FEV1 and peak expiratory flow rate, increase recovery rate, reduce hospital stay (trend to lower stay with higher doses: 6 vs 9 days, but not significant) or reduce side effects.
Chest. 2008 Mar;133(3):756-66		Systematic Review
IN chronic obstructive pulmonary disease, exacerbations	The Use of systemic corticosteroids, antibiotics, and noninvasive positive pressure ventilation As Treatment, Acute	Is better Than placebo or no use of that treatment	To reduce in-hospital mortality (antibiotics and ventilation) and reduce treatment failure (all, corticosteroids)
Cochrane Database Syst Rev. 2018 Oct 30;10:CD009764		Systematic Review, Cochrane Review
IN chronic obstructive pulmonary disease, exacerbations	The Use of long-term antibiotics, macrolides, for 3 to 12 months As Treatment, Chronic	Is better Than placebo	To reduce patients with exacerbations at 1 year (47% antibiotics VS 61% controls). No effect in hospital admissions, change in FEV1, serious adverse events or all-cause mortality.
Chest. 2001 Jun;119(6):1840-1849		Descriptive
IN chronic obstructive pulmonary disease, exacerbations, severe, requiring invasive mechanical ventilation	The Use of presence of comorbidities, APACHE, need for ventilation for > 72h or extubation failure As Prognostic Item	Is useful Than -	To predict higher in-hospital mortality
Chest. 2010 Sep 30;epub(epub):epub		Cohorts
IN chronic obstructive pulmonary disease, in non-smokers	The Use of non-smokers, never smokers patients As Etiologic risk factor	Is useful Than no comparison	To though never smokers have much less risk of developing CPOD, they comprise 20-23% of all individuals with COPD. Asthma, age, lower education occupational exposure, childhood respiratory diseases and BMI alterations predicted COPD
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
N Engl J Med. 2000 Dec 28;343(26):1902-1909		Randomized Controlled Trial, Multicenter Study
IN chronic obstructive pulmonary disease, stable	The Use of corticosteroids, inhaled As Treatment, Chronic	Is equal Than placebo	To reduce the rate of decline of post-bronchodilator FEV1 at 3 years. It reduced the visits to a physician because of a respiratory illness (1.2% /year in intv. VS 2.1% /year in ctrl.) and reduced symptoms.
J Gen Intern Med. 2006 Oct;21(10):1011-9		Meta-Analysis
IN chronic obstructive pulmonary disease, stable	The Use of inhaled anticholinergics As Treatment, Chronic	Is better Than long acting beta2-agonists	To reduced severe exacerbations (RR 0.67, compared to placebo) and respiratory deaths (RR 0.27, compared to placebo) while beta2-agonists associated increased risk for respiratory deaths
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
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
Neurobiol Aging. 2014 Aug;35(8):1873-82		Descriptive
IN cognitive impairment, age related, older people without cognitive impairment	The Use of higher lifestyle cognitive activity and higher current physical activity As Etiologic risk factor	Is better Than lower lifestyle cognitive and physical activities	To be associated with lower volume of white matter lesion, higher neural integrity and higher global cognitive functioning
Cochrane Database Syst Rev. 2006 Oct 18;(4):CD003575		Systematic Review, Cochrane Review
IN collagenous colitis, diarrhea, chronic	The Use of budesonide, oral, enteral liberation formulation, 9 mg daily (entocort (r)) As Treatment, Chronic	Is better Than placebo, or other therapeutics tested	To improve diarrhea and symptoms: NNT 2
Neurology. 2006 Jul 25;67(2):203-10		Systematic Review
IN coma, post-cardiac arrest, post-resuscitation care	The Use of several predictors: pupillary light response, corneal reflexes, motor responses to pain, myoclonus status epilepticus, serum neuron-specific enolase, and somatosensory evoked potential studies As Diagnostic Tool	Is better Than others clinical, biological and radiological findings	To accurately predict poor outcome in comatose patients after cardiopulmonary resuscitation
Cochrane Database Syst Rev. 2007;(4):CD006829		Systematic Review, Cochrane Review
IN Condition to be defined	The Use of combined long-acting beta2 agonists plus corticosteroids, inhaled As Treatment, Chronic	Is better Than long-acting beta-agonists alone	To reduce exacerbation rate (Rate Ratio 0.82) and improve quality of life. No difference in mortality or hospitalisations. Pneumonia more frequent with combined Tt (OR 1.62)
Chest. 2016 Mar;149(3):756-66		Systematic Review
IN Condition to be defined	The Use of various pharmacologic treatments, including pirfenidone and nintedanib As Treatment, Chronic	Is equal Than placebo	To modify respiratory-specific or all-cause mortality
N Engl J Med. 2009 Mar 26;360(13):1320-8		Study type to be defined
IN Condition to be defined	The Use of Intervention to be defined As Undefined	Is undefined Than Comparison to be defined	To Results to be defined
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
Cochrane Database Syst Rev. 2012;3(N):CD007176		Study type to be defined
IN Condition to be defined	The Use of Intervention to be defined As Undefined	Is undefined Than Comparison to be defined	To Results to be defined
Am J Med. 2009 Feb;122(2):152-61		Study type to be defined
IN Condition to be defined	The Use of Intervention to be defined As Undefined	Is undefined Than Comparison to be defined	To Results to be defined
Eur Heart J. 2007 Oct;28(20):2485-90		Diagnostic
IN coronary disease	The Use of coronary multidetector computed tomography As Diagnostic Tool	Is better Than exercise electrocardiography, with coronary angiography as gold standard	To diagnose significant coronary disease: 91% sensitivity and 83% specificity of scan VS 73% sensitivity and 31% specificity of exercise ECG.
Ann Intern Med. 2000 Jun 6;132(11):862-70.		Cohorts
IN coronary disease	The Use of stress test, treadmill exercise testing, in elderly persons As Diagnostic Tool	Is equal Than treadmill exercise testing, in younger persons	To predict overall survival and cardiac event-free survival. Workload achieved was the main exercise testing variable that was predictive of death.
Circulation. 2012 Jun 12;125(23):2873-91. Epub 2012 May 14		Meta-Analysis
IN coronary disease	The Use of drug-eluting stents, specially using everolimus, sirolimus and zotarolimus, but not those using paclitaxel As Treatment, Acute	Is better Than bare-metal stents	To reduce long-term need for revascularization and reduce myocardial infarction (RR 0.50), with no increase in the risk of any long-term safety outcomes, including stent thrombosis
Am J Med. 2009 Apr;122(4):356-65		Meta-Analysis
IN coronary disease	The Use of calcium channel blockers As Treatment, Chronic	Is better Than placebo, or mixed comparison placebo plus others treatments	To reduce angina and stroke, but not to reduce mortality (either all-cause or cardiovascular) nor to reduce myocardial infarction
N Engl J Med. 2007 Mar 8;356(10):1030-9		Meta-Analysis
IN coronary disease	The Use of drug-eluting stents, sirolimus As Treatment, Chronic	Is equal Than bare-metal stents	To reduce the overall risk of death, myocardial infarction and stent thrombosis.
N Engl J Med. 2007 Mar 8;356(10):998-1008		Meta-Analysis
IN coronary disease	The Use of drug-eluting stents, sirolimus, paclitaxel As Treatment, Chronic	Is worse Than bare-metal stents	To reduce stent thrombosis at 4 years (1.2 to 1.3% drug-eluting VS 0.6 to 0.9% bare-metal) Rates of death or myocardial infarction did not differ.
Lancet. 2007 Sep 15;370(9591):937-48		Meta-Analysis
IN coronary disease	The Use of drug-eluting stents, sirolimus, paclitaxel As Treatment, Chronic	Is equal Than bare-metal stents	To reduce the risk of death and myocardial infarction
Circulation. 2003 Feb 25;107(7):966-72		Randomized Controlled Trial
IN coronary disease, acute coronary syndrome	The Use of P2Y12 inhibitors, clopidogrel, added to aspirin, combined anti-platelet therapy As Treatment, Acute	Is better Than aspirin alone	To reduce ischemic events (cardiovascular death, myocardial infarction, or stroke) at 30 days (4.3% in intv. VS 5.4% in ctrl.) and at 12 months (5.2% in intv. VS 6.3% in ctrl.) No significant excess in life-threatening bleeds (but yes for total bleeds)
N Engl J Med. 2007 Nov 15;vol(issue):pag [Epub ahead of print Nov 4]		Randomized Controlled Trial, Multicenter Study
IN coronary disease, acute coronary syndrome	The Use of P2Y12 inhibitors, prasugrel, added to aspirin, combined anti-platelet drugs As Treatment, Acute	Is better Than clopidogrel, added to aspirin, combined anti-platelet therapy	To reduce recurrence of myocardial infarction (7.4% for prasugrel VS 9.7% for clopidogrel) and a derived combined end-point of cardiovascular death and major events.
N Engl J Med. 2009 Sep 10;361(11):1045-57		Randomized Controlled Trial, Multicenter Study
IN coronary disease, acute coronary syndrome	The Use of P2Y12 inhibitors, ticagrelor, added to aspirin, combined anti-platelet therapy As Treatment, Acute	Is better Than clopidogrel, added to aspirin, combined anti-platelet drugs	To reduce at 12 months cardiovascular events (death from vascular causes, myocardial infarction, or stroke): 10% ticagrelor VS 12% clopidogrel. Ticagrelor increased minor bleedings but not major haemorrhages.
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
J Am Coll Cardiol. 2010 May 11;55(19):2096-106		Cohorts
IN coronary disease, acute coronary syndrome, myocardial infarction	The Use of copeptin, added to troponin As Diagnostic Tool	Is better Than troponin	To more accurately diagnose an acute coronary syndrome (c-statistics 0.93 copeptin + troponin VS 0.84 troponin alone) and to rule out coronary syndrome in the first 3 hours: 92% negative predictive value with copeptin + troponin
Cochrane Database Syst Rev. 2011;1:CD007038		Systematic Review, Cochrane Review
IN coronary disease, acute coronary syndrome, myocardial infarction	The Use of pentasacharide analogues, fondaparinux As Treatment, Acute	Is better Than low molecular weight heparins (LMWH), enoxaparin	To reduce the risk of all-cause mortality at 90 to 180 days (RR 0.89) while reducing minor bleeding
Eur Heart J. 2011 Jun;32(11):1379-89		Diagnostic
IN coronary disease, acute coronary syndrome, myocardial infarction, older patients	The Use of high-sensitive cardiac troponin assays As Diagnostic Tool	Is better Than standard cardiac troponin assay	To diagnose acute myocardial infarction: AUC 0.95 sensitive troponine VS 0.90 standard troponine. Best cut-offs in elderly patients differed clearly from younguer patients. Mild elevations are commont in non-infarctus elderly (20% patients)
Eur Heart J. 2013 Sep 11. [Epub ahead of print]		Meta-Analysis
IN coronary disease, acute coronary syndrome, myocardial infarction, ST-segment elevation	The Use of intracoronary bone marrow cell therapy As Treatment, Acute	Is better Than placebo or no cell therapy	To improve (at a time not well defined) left ventricle ejection fraction (LVEF) : 2.5% mean increase, 5.3% when LVEF was < 40%
JAMA. 2006 Apr 5;295(13):1519-30. Epub 2006 Mar 14		Randomized Controlled Trial, Multicenter Study
IN coronary disease, acute coronary syndrome, ST-segment elevation	The Use of pentasacharide analogues, fondaparinux (2.5 mg/d) for 8 days As Treatment, Acute	Is better Than unfractionated heparin for 2 days, or placebo	To reduce at 30 days bad outcome (death or reinfarction): 9.7% fondaparinux VS 11.2% controls. No difference in bleeding.
N Engl J Med. 2001 Aug 16;345(7):494-502		Randomized Controlled Trial, Multicenter Study
IN coronary disease, acute coronary syndrome, without ST elevation	The Use of adenosine diphosphate (ADP) receptor inhibitors, clopidogrel, added to aspirin, combined anti-platelet therapy As Treatment, Acute	Is better Than aspirin alone	To reduce, at 1 year, ischemic events (cardiovascular death, myocardial infarction or stroke): 9.3% in intv VS 11.4% in ctrl. Increase major bleeds (3.7% in intv. VS 2.7% in ctrl.)
N Engl J Med. 2006 Apr 6;354(14):1464-76. Epub 2006 Mar 14		Randomized Controlled Trial, Multicenter Study
IN coronary disease, acute coronary syndrome, without ST elevation	The Use of pentasacharide analogues, fondaparinux (2.5 mg/d SC) for 6 days As Treatment, Acute	Is equal Than low molecular weight heparin (LMWH), enoxaparin 1 mg/Kg/12h	To reduce at 30 days bad outcome (death, reinfarction, or refractory ischemia): 8.0% fondaparinux VS 8.6% enoxaparin. Fondaparinux had fewer major haemorrhages: 3.1% VS 5.0% enoxaparin
JAMA. 2007 Jul 18;298(3):299-308		Cohorts
IN coronary disease, atherosclerosis	The Use of nonfasting triglycerides As Etiologic risk factor	Is useful Than no comparison here	To predict risk of developping coronary disease, myocardial infarction and death.
N Engl J Med. 1997 Dec 4;337(23):1648-53		Cohorts
IN coronary disease, chest pain, acute coronary syndrome	The Use of troponin I, troponin T As Diagnostic Tool	Is better Than CPK and ECG alone	To identify early patients at risk to develop myocardial infartion or death from cardiac causes: For the 34 total events (20 deaths, 14 infarctions), troponin I was positive in 32 and negative in 2. Troponin T was positive in 27 and negative in 7.
Lancet. 2012 Feb 4;379(9814):453-60		Diagnostic
IN coronary disease, chest pain, high risk patients	The Use of magnetic resonance imaging (MRI) of the heart, with adenosine stress As Diagnostic Tool	Is better Than single-photon emission computed tomography (SPECT), with adenosine stress, perfusion scintigraphy	To diagnose significant coronary disease (gold standard : coronary angiography) : IRM sensitivity 86%, specificity 83% ; SPECT sensitivity 66%, specificity 82%
J Am Coll Cardiol. 2008 Jan 1;51(1):37-45		Meta-Analysis
IN coronary disease, elderly patients	The Use of statins As Prevention, Secondary	Is better Than placebo	To reduce overall mortlity (15.6% statins VS 18.7% placebo, NNT 28), cardiac mortality, myocardial infarction and stroke
Eur Heart J. 2006 May;27(10):1230-7. Epub 2006 Apr 18		Cohorts
IN coronary disease, heart failure, stroke, cardiovascular death, risk in general population	The Use of brain natriuretic peptide (BNP), plasma N-terminal pro-A-type and pro-B-type natriuretic peptides (BNP) As Prognostic Item	Is useful Than no comparison here	To predict risk of death from cardiovascular causes: adjusted risk was 1.35-fold for each SD increment in multivariate analysis
Heart. 2009 Mar;95(3):198-202		Systematic Review
IN coronary disease, myocardial infarction	The Use of rutine oxygen As Treatment, Acute	Is worse Than room air	To improve mortality or clinical outcomes: the only one study found that high-flow O2 had non-sifnificant increased risk of death and higher enzyme levels
Eur Heart J. 2007 Dec;28(24):3012-9		Meta-Analysis
IN coronary disease, myocardial infarction	The Use of further reduction of resting heart rate using beta blockers (or calcium channel blockers) As Treatment, Chronic	Is better Than less important reduction of resting herat rate	To reduce cardiac mortality: each 10 b.p.m. reduction estimated to reduce the relative risk of cardiac death by 30%
JAMA. 2006 Jun 7;295(21):2511-5		Randomized Controlled Trial, Multicenter Study
IN coronary disease, myocardial infarction, cardiogenic shock	The Use of early invasive strategy, early revascularization, angioplasty or surgical As Treatment, Acute	Is better Than conservative strategy: initial medical stabilization and selective late revascularization	To to improve patient long term survival: at 6 years, overall survival rates were 32.8% in early revasc and 19.6% in initial medical Tt
PLoS Med. 2009 Apr 21;6(4):e1000057		Cohorts
IN coronary disease, myocardial infarction, non-Q, unrecognized	The Use of delayed-enhancement cardiac magnetic resonance As Diagnostic Tool	Is better Than ECG and cardiac enzymes	To diagnose recent non-Q myocardial infarction: 27% of patients suspected of ischemic heart disease. Unrecognized non-Q infarction carries a hight mortality: 26% at 2.2 years.
N Engl J Med. 2005 Mar 24;352(12):1179-89		Randomized Controlled Trial, Multicenter Study
IN coronary disease, myocardial infarction, ST-segment elevation	The Use of antiplatelet drugs, adenosine diphosphate (ADP) receptor inhibitors, clopidogrel (300-mg loading dose, 75 mg/d after) added to fibrinolysis plus aspirin plus heparin As Treatment, Acute	Is better Than standard antithrombotic Tt with fibrinolysis + aspirin + heparin alone (+ placebo)	To reduce at 30 days vascular events (cardiovascular death, recurrent infarction, revascularization because recurrent ischemia): 11,6% with clopidogrel VS 14,6% standard Tt, Major bleeding and intracranial hemorrhage similar in the two groups.
Lancet. 2005 Nov 5;366(9497):1607-21		Randomized Controlled Trial, Multicenter Study
IN coronary disease, myocardial infarction, ST-segment elevation	The Use of antiplatelet drugs, adenosine diphosphate (ADP) receptor inhibitors, clopidogrel (75 mg/d) added to standard Tt (aspirin 100%, fibrinolysis 50%, anticoagulant 75%) As Treatment, Acute	Is better Than aspirin alone and standard antithrombotic Tt	To To reduce at 30 days vascular events (death, recurrent infarction, stroke): 9,2% with clopidogrel VS 10,1% aspirin alone.
Lancet. 2005 Nov 5;366(9497):1622-32		Randomized Controlled Trial, Multicenter Study
IN coronary disease, myocardial infarction, ST-segment elevation	The Use of early intravenous beta-blockers (metoprolol, up to 15 mg IV then 200 mg oral daily As Treatment, Acute	Is equal Than placebo	To reduce at 30 days death (7.7% VS 7.8%) or death, reinfarction, or cardiac arrest combined (9.4% with metoprolol VS 9.9% with placebo).
Eur Heart J. 2011 Jan;32(1):51-60		Randomized Controlled Trial
IN coronary disease, myocardial infarction, ST-segment elevation, elder patients	The Use of primary percutaneous coronary intervention As Treatment, Acute	Is equal Than fibrinolysis	To significantly reduce cardiovascular events (all-cause mortality, re-infarction, or disabling stroke) at 30 days: 19% pPCI VS. 25% fibrinolysis. A pooled analysis with other 2 trials showed, however, a significant reduction of cardiovascular events
J Am Coll Cardiol. 2007 Jan 30;49(4):422-30		Meta-Analysis
IN coronary disease, myocardial infarction, ST-segment elevation, failed thrombolysis	The Use of rescue emergency angioplasty after failed thrombolytic therapy As Treatment, Acute	Is better Than repeated thrombolysis or conservative treatment	To reduce heart failure (RR 0.73) and reinfarction (RR 0.58), but associated with increased risk of stroke (RR 4.98)
N Engl J Med. 2011 Dec 1;365(22):2078-87. Epub 2011 Nov 15		Clinical Trial (non-controlled, non-randomized)
IN coronary disease, stable	The Use of high dose statins, atorvastatin 80 mg daily, or rosuvastatin 40 mg daily As Treatment, Chronic	Is useful Than no comparison done	To induced regression of atherome plaques (decrease percent atheroma volume (by about 1%) and total atheroma volume) measured by serial intravascular ultrasonography at 4.5 years
Lancet. 1992 Dec 12;340(8833):1421-5		Randomized Controlled Trial, Multicenter Study
IN coronary disease, stable angina	The Use of aspirin, low dose (75 mg/d) As Treatment, Chronic	Is better Than placebo	To reduce major cardiovascular events (34% relative reduction)
JAMA. 1999 May 26;281(20):1927-36		Meta-Analysis
IN coronary disease, stable angina	The Use of beta blockers As Treatment, Chronic	Is better Than calcium channel blockers	To reduce number of angina episodes (OR 0.31). But no significant differences in rates of death or myocardial infarction.
Lancet. 2003 Sep 6;362(9386):782-8		Randomized Controlled Trial, Multicenter Study
IN coronary disease, stable, normal left ventricular function, most patients previous myocardial infarction and revascularization	The Use of angiotensin converting enzyme (ACE) inhibitors, perindopril 8 mg/d, added to standard treatment As Treatment, Chronic	Is better Than placebo	To reduce cardiac events (cardiovascular death, myocardial infarction, or cardiac arrest): 8% perindopril VS 10% placebo
N Engl J Med. 2004 Nov 11;351(20):2058-68		Randomized Controlled Trial, Multicenter Study
IN coronary disease, stable, normal left ventricular function, most patients previous revascularization	The Use of angiotensin converting enzyme (ACE) inhibitors, trandolapril (4 mg/d), added to standard treatment As Treatment, Chronic	Is equal Than placebo	To reduce cardiac events (death from cardiovascular causes, myocardial infarction, or coronary revascularization): 21.9% in trandolapil VS 22.5% in placebo - at 5 years (so, aprox. 4.4% per year event rate)
Lancet. 2008 Sep 6;372(9641):807-16		Randomized Controlled Trial, Multicenter Study
IN coronary disease, stable, reduced left ventricular function	The Use of ivabradine, added to beta-blockers As Treatment, Chronic	Is equal Than placebo	To reduce a composite outcome (cardiovascular deah, myocardial infarction or worsening heart failure) at 20 months. It improved a secondary endpoint (myocardial infarction) but not main endpoint, in one subgroup analysis (patients with heart rate > 70 bpm)
Arch Intern Med. 2008 May 26;168(10):1034-46		Review (Narrative)
IN corticosteroids, systemic, for infections	The Use of systemic corticosteroids As Treatment, Acute	Is better Than placebo	To improve outcomes or accelerate symptom resolution in a variety of bacterial, tuberculous and viral infections
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. 2009 Mar 26;360(13):1283-97		Randomized Controlled Trial, Multicenter Study
IN critically ill patients	The Use of tight glucose control (target < 6 mmol/L), intensive insulin therapy As Treatment, Acute	Is worse Than conventional glycemic control (target < 10 mmol/L)	To modify overall mortality at 3 months: 27.5% intensive VS 24.9% conventional
N Engl J Med. 2008 Jul 3;359(1):7-20. Epub 2008 May 20		Randomized Controlled Trial, Multicenter Study
IN critically ill patients, acute kidney injury	The Use of intensive renal-replacement therapy: intermittent hemodialysis 6 days/week if hemodynamically stables, 35 ml/Kg continuous venovenous hemodiafiltration if hemodynamically unstable As Treatment, Acute	Is worse Than less-intensive renal-replacement therapy: intermittent hemodialysis 3 days/week if hemodynamically stables, 20 ml/Kg continuous venovenous hemodiafiltration if hemodynamically unstable	To reduce death (53.6% intensive VS 51.5% less-intensive), reduce the duration of renal-replacement therapy or increase the rate of recovery of kidney function or nonrenal organ failure.
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
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
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,
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)
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
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%.
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
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.
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
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.
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
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+)
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
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
Ann Intern Med. 2006 Nov 7;145(9):665-75		Meta-Analysis
IN diabetes mellitus	The Use of inhaled insulin, premeal, plus once/day lente subcutaneous insulin As Treatment, Chronic	Is worse Than conventional multiple times/day subcutaneous insulin	To decrease hemoglobin A1c (weighted mean difference, 0.08%, favouring SC insulin) but same number of patients achieved HgA1c < 7%. Hypoglycemia was equally frequent. Inhaled insulin induces cough and mild decrease in pulmonary function testing.
Cochrane Database Syst Rev. 2006 Apr 19;(2):CD003287		Systematic Review, Cochrane Review
IN diabetes mellitus	The Use of short acting insulin analogues As Treatment, Chronic	Is equal Than standard insulin	To achieve glycemic control or modify HbA1c levels: 0 to -0.1% weighted mean difference. The WMD of the overall mean hypoglycaemic episodes per patient per month was -0.2. No study investigated long term effects on mortality or diabetic complications.
Diabetes Care. 2006 Nov;29(11):2365-70		Randomized Controlled Trial
IN diabetes mellitus, associated peripheral neuropathy	The Use of alpha-lipoic acid (ALA) As Treatment, Chronic	Is better Than placebo	To improve symptoms: significative reduction in specific symptom scores with all doses compared to placebo, specially stabbing and burning pain. Side effects: nausea, vomiting, and vertigo
Diabetes Care. 2006 Jul;29(7):1538-44		Randomized Controlled Trial, Multicenter Study
IN diabetes mellitus, associated peripheral neuropathy	The Use of epalrestat, an aldose reductase inhibitor As Treatment, Chronic	Is better Than placebo	To improve symptoms (numbness, sensory abnormality, and cramping) and reduce EMG progession, at 3 years.
Pharmacotherapy. 2008 May;28(5):646-55		Review (Narrative)
IN diabetes mellitus, associated peripheral neuropathy	The Use of epalrestat, an aldose reductase inhibitor, 50 mg 3 times/day As Treatment, Chronic	Is better Than placebo	To motor and sensory nerve conduction velocity and subjective neuropathy symptoms
N Engl J Med. 2008 Oct 2;359(14):1464-76		Randomized Controlled Trial, Multicenter Study
IN diabetes mellitus, type 1	The Use of continuous glucose monitoring, added to intensive insulin Tt As Diagnostic Tool	Is equal Than usual monitoring with a capilar blood glucose meter	To improve glycemic control at 26 weeks: HbA1C was improved by -0.50% in adults patients but not in younger and children.
N Engl J Med. 2003 Jun 5;348(23):2285-93		Cohorts
IN diabetes mellitus, type 1	The Use of persistent microalbuminuria As Prognostic Item	Is useful Than no comparison	To predict renal impairment, but it does not imply inexorably progressive nephropathy: regression of proteinuria is frequent if: HbAc1 < 1%, well controlled blood pressure and both cholmesterol and triglyc normal
Cochrane Database Syst Rev. 2010;(1):CD005103		Systematic Review, Cochrane Review
IN diabetes mellitus, type 1	The Use of continuous subcutaneous insulin infusion As Treatment, Chronic	Is better Than multiple insulin injections	To to improve glycemic control and HgbA1C (WMD -0.3%) and quality of life, but no reilable data about long-term morbidity and mortality exist
N Engl J Med. 2005 Dec 22;353(25):2643-53		Randomized Controlled Trial, Multicenter Study
IN diabetes mellitus, type 1, cardiovascular complications	The Use of Intensive insulin therapy during 6.5 years: 3 or more daily injections or insulin pump, with > 4 daily glucose measurements As Treatment, Chronic	Is better Than conventional therapy: one or two daily injections of insulin	To reduce, after 17 years, cardiovascular events (angor, myocardial infarction, coronary revascularization, stroke or cardiovascular death): 52 patients of 730 in conventional VS 31 of 711 in intensive
N Engl J Med. 2008 Oct 9;359(15):1577-89		Randomized Controlled Trial, Multicenter Study
IN diabetes mellitus, type 2	The Use of (moderately) intensive glucose control using insulin or oral hypoglycemic agents, sulfonylurea, metformin As Treatment, Chronic	Is better Than conventional treatment starting with diet	To reduce, at 10 years, any diabetes related point: 4.8% per year intensive VS 5.2% per year conventional (NNT 213). Also reduced mortality of any cause: 2.7%/year intensive VS 3.0%/year conventional (NNT 254)
N Engl J Med. 2006 Dec 7;355(23):2427-43		Randomized Controlled Trial, Multicenter Study
IN diabetes mellitus, type 2	The Use of oral hypoglycemic agents, glitazones (rosiglitazone) As Treatment, Chronic	Is better Than oral hypoglycemic agents, metformin, sulphonylureas (glyburide)	To avoid, at 5 years, monotherapy failure: 15% rosiglitazone, 21% metformin, 34% glyburide. But rosiglitazone had more cardiovascular events (including heart failure) than glyburide (4.3% VS 2.8%) and mortality was the same with all treatments (2.1 to 2.3%)
N Engl J Med. 2007 June 14;356(24):2457-71. Epub 2007 May 21		Meta-Analysis
IN diabetes mellitus, type 2	The Use of oral hypoglycemic agents, glitazones (rosiglitazone) As Treatment, Chronic	Is worse Than placebo or other hypoglycemic agents	To affect the incidence of myocardial infarction (OR 1.44) and cardiovascular death (OR 1.64)
Cochrane Database Syst Rev. 2006 Jan 25;(1):CD002967		Systematic Review, Cochrane Review
IN diabetes mellitus, type 2	The Use of oral hypoglycemic agents, metformin As Treatment, Chronic	Is equal Than oral hypoglycemic agents, sulphonylureas	To the risk of lactic acidosis: 6.3 cases per 100,000 patient-years with metformin VS 7.8 cases per 100,000 patient-years.
Lancet. 1998 Sep 12;352(9131):854-65		Randomized Controlled Trial
IN diabetes mellitus, type 2	The Use of oral hypoglycemic agents, metformin As Treatment, Chronic	Is better Than oral hypoglycemic agents, sulphonylureas (chlorpropamide, glibenclamide), or insulin	To reduce, at 10 years, diabetes related endpoint (7.5 events/1000 patients/year in metformine VS 12.7 others) and all-cause mortality (13.5 events/1000 patients/year in metformine group vs 20.6 others)
BMJ. 2007 Sep 8;335(7618):497		Systematic Review
IN diabetes mellitus, type 2	The Use of oral hypoglycemic agents, metformin As Treatment, Chronic	Is better Than other oral hypoglycemic agents, sulphonylureas, glitazones	To reduce overall mortality and the risk of hospital admission for heart failure
PLoS Med. 2012;9(4):e1001204		Systematic Review
IN diabetes mellitus, type 2	The Use of oral hypoglycemic agents, metformin As Treatment, Chronic	Is equal Than placebo, diet alone or other hypoglycemic agents	To modify all-cause mortality (RR 0.99), cardiovascular mortality (RR=1.05), myocardial infarctions (RR=0.90), all strokes (RR=0.76), peripheral vascular disease (RR=0.90), leg amputations (RR=1.04) or microvascular complications (RR=0.83)
Lancet. 1998 Sep 12;352(9131):837-53		Randomized Controlled Trial
IN diabetes mellitus, type 2	The Use of oral hypoglycemic agents, sulphonylureas (chlorpropamide, glibenclamide) As Treatment, Chronic	Is equal Than insulin	To reduce, at 10 years, diabetes related endpoint and mortality
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)
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.
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.
N Engl J Med. 2009 Oct 29;361(18):1736-47		Randomized Controlled Trial, Multicenter Study
IN diabetes mellitus, type 2, needing insulin	The Use of long acting insulin (detemir), basal, once daily or short acting insulin (aspart), prandial, three times daily, added to oral hypoglycemic agents As Treatment, Chronic	Is better Than short acting insulin (aspart), biphasic, twice daily	To reduce number of patients having Hbg A1C < 6.5% (32% biphasic VS 43% basal VS 45% prandial) However, mean Hgb A1C was not different in all 3 groups (6.8 to 7.1%)
Diabetes Obes Metab. 2009 Jan;11(1):53-9		Meta-Analysis
IN diabetes mellitus, type 2, needing insulin	The Use of short acting insulin analogues (lispro, aspart or glulisine) As Treatment, Chronic	Is better Than regular human insulin	To improve glucemic control: reduced HbA1c by 0.4%. No differences in severe hypoglycaemia.
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)
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)
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
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
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%)
Age Ageing. 2011 Mar;40(2):150-62		Systematic Review
IN elder patients, geriatric pharmacology, inappropriate prescription, optimising prescription, care homes	The Use of education including academic detailing, multi-faceted educational approaches As Prevention, Primary	Is better Than no intervention, pharmacist medication reviews, computerised clinical decision support systems (CDSSs)	To reduce the number of inappropriate prescriptions. Lack of studies on patients outcomes.
J Am Geriatr Soc. 2007 May;55(5):658-65		Randomized Controlled Trial
IN elder patients, geriatric pharmacology, inappropriate prescription, optimising prescription, hospital	The Use of pharmaceutical care by a clinical pharmacist As Treatment, Acute	Is better Than usual prescription (only physician)	To improve the appropriateness of prescribing on admission, at discharge, and 3 months after.
Cochrane Database Syst Rev. 2005 Apr 18;(2):CD003235		Systematic Review, Cochrane Review
IN electrolyte disturbances, hyperkalaemia	The Use of IV insulin-and-glucose, inhaled beta-agonists As Treatment, Acute	Is better Than no treatment	To to reduce K blood levels at 4 hours. No data on mortality or arrhythmias available. Results for IV bicarbonate were inconsistent.
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 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.
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.
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
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
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
Lancet. 2009 Jan 3;373(9657):42-7		Cohorts
IN gastrointestinal bleeding, upper, low risk patients	The Use of GBS score = 0 (normal urea, normal Hgb, PAS>120, pulse<100, no melena, no syncope, no liver disease, no heart failure) As Prognostic Item	Is better Than no score	To identify patients no needing admission to hospital: 12.4% of all bleeding patients
Cochrane Database Syst Rev. 2008;(3):CD000193		Systematic Review, Cochrane Review
IN gastrointestinal bleeding, upper, oesophageal varices	The Use of somatostatin analogues As Treatment, Acute	Is equal Than placebo	To reduce rebleeding 5 (RR 0.84) or mortality (RR 0.97). Need for transfusion was reduced in 0.7 units par patient.
Gastroenterology. 2015 Sep;149(3):660-668.e1		Randomized Controlled Trial, Multicenter Study
IN gastrointestinal bleeding, upper, oesophageal varices, liver failure, liver cirrhosis, Child-Pugh class A or B	The Use of small-diameter covered stent, transjugular intrahepatic portosystemic shunt (TIPS) As Treatment, Acute	Is equal Than medical reduction of portal pressure (propranolol and isosorbide-5-mononitra)	To improve results at 2 years : TIPS reduced variceal rebleeding (7% TIPS VS 27% medical) but increased encephalopathy (18% TIPS vs 8% medical) and had no effect in survival and quality of life.
World J Surg. 1990 Mar-Apr;14(2):262-9		Descriptive
IN gastrointestinal bleeding, upper, peptic disease	The Use of age over 60 years, previous medical illness, shock on admission, large ulcer size, and endoscopic stigmata of hemorrhage As Prognostic Item	Is useful Than -	To predict an increased risk of rebleeding and mortality
N Engl J Med. 1981 Oct 15;305(16):915-6		Cohorts
IN gastrointestinal bleeding, upper, peptic disease	The Use of endoscopic stignmata of recent hemorrhage, specially ulcers with visible vessels As Prognostic Item	Is useful Than -	To predict an increased risk of rebleeding
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.
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
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)
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.
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)
Circulation. 2006 Mar 21;113(11):1424-33		Cohorts
IN heart failure, chronic	The Use of knowing long-term mortality, a mathematical multivariate model (Seattle Heart Failure Model) including 14 continuous variables and 10 categorical values As Prognostic Item	Is useful Than simple clinical judgement	To to make individual estimations of 1, 2 and 3 years mortality. Overall ROC area under the curve was 0.73
Arch Cardiovasc Dis. 2014 Mar;107(3):158-68		Cohorts
IN heart failure, chronic	The Use of knowing long-term mortality, stratified by ages, in France As Prognostic Item	Is useful Than no comparison here	To be aware of the poor prognosis of patients hospitalised by decompensated HF: 29% mortality at 1 year, 40% at 2 years. Incrased age carried increased mortality
Cochrane Database Syst Rev. 2012;9:CD002752		Systematic Review, Cochrane Review
IN heart failure, chronic	The Use of follow-up after discharge, case management with telephone calls and visits led by a heart failure specialist nurse As Treatment, Chronic	Is better Than multidisciplinary, clinic-based interventions	To reduce all cause mortality (OR 0.66) and readmissions (OR 0.47) at 12 months. Clinic-based follow-up reduced only readmissions and not mortality
J Am Coll Cardiol. 2012 Oct 2;60(14):1239-48		Randomized Controlled Trial, Multicenter Study
IN heart failure, chronic	The Use of follow-up after discharge, home-based multidiscipinary intervention, lead by a trained nurse As Treatment, Chronic	Is equal Than a specialized heart failure clinic-based follow up after hospital discharge	To modify, at 12-18 months, re-hospitalizations (67-69% both) or death (22-28%). But home-based interventions cumulated less days at hospital and lower costs
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
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
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. 1997 Feb 8;349(9049):375-80		Randomized Controlled Trial
IN heart failure, chronic, systolic	The Use of beta blockers, carvedilol As Treatment, Chronic	Is better Than placebo	To reduce death or hospitalization
N Engl J Med. 1996 May 23;334(21):1349-55		Randomized Controlled Trial
IN heart failure, chronic, systolic	The Use of beta blockers, carvedilol As Treatment, Chronic	Is better Than placebo	To reduces the risk or death and of hospitalization
JAMA. 2000 Mar 8;283(10):1295-302		Randomized Controlled Trial
IN heart failure, chronic, systolic	The Use of beta blockers, metoprolol As Treatment, Chronic	Is better Than placebo	To reduce all-cause death or hospital admission: metoprolol 32% vs. placebo 38%
N Engl J Med. 1996 Oct 10;335(15):1107-14		Randomized Controlled Trial
IN heart failure, chronic, systolic	The Use of calcium channel blockers, amlodipino As Treatment, Chronic	Is equal Than placebo	To modify mortality
Arch Intern Med. 2007 Oct 8;167(18):1930-6		Meta-Analysis
IN heart failure, chronic, systolic	The Use of combined Tt with angiotensin II receptor blocker (ARB) and angiotensin converting enzyme (ACE) inhibitors As Treatment, Chronic	Is worse Than ACE inhibitor alone	To frequency of side effects: it increased worsening renal function (4.7% combined VS 3.0% alone), hyperkalemia (3.4% combined VS 0.9% alone) and symptomatic hypotension (2.4% VS 1.6% in heart failure and 18% VS 12% in coronary disease)
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)
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. 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
N Engl J Med. 1997 Feb 20;336(8):525-33		Randomized Controlled Trial, Multicenter Study
IN heart failure, chronic, systolic, patients in sinus rhyhtm	The Use of digoxin As Treatment, Chronic	Is better Than placebo	To reduce hospitalizations for worsening heart failure or by any cause, but mortality remained inchanged.
N Engl J Med. 1999 Sept 2;341(10):709-17		Randomized Controlled Trial
IN heart failure, chronic, systolic, severe	The Use of aldosterone blockers, spironolactone, added to loop diuretics and ACEI As Treatment, Chronic	Is better Than placebo	To reduce overall mortality, at 2 years: 35% in intv. VS 46% in ctrl. Reduce cardiac hospitalizations and significantly improve NYHA class
Lancet. 2010 Sep 11;376(9744):875-85		Randomized Controlled Trial, Multicenter Study
IN heart failure, chronic, systolic, sinus rhythm and heart rate > 70 bpm	The Use of ivabradine, eventually on top of beta-blockers As Treatment, Chronic	Is better Than placebo	To reduce hospitalisations for heart failure at 2 years (16% ivabradine VS 21% placebo) and possibly deaths due to heart failure (3% ivabradine VS 5% placebo) but not cardiovascular mortality.
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. 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
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.
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
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. 2008 May 15;358(20):2095-106		Randomized Controlled Trial, Multicenter Study
IN HIV infection, initial therapy	The Use of highly active antiretroviral therapy (HAAR), 3 drugs, efavirenz (Sustiva(R)) + 2 nucleoside reverse-transcriptase inhibitors (NRTIs) (ex. Combivir(R) or Kivexa(R)) As Treatment, Chronic	Is better Than lopinavir-ritonavir + two NRTIs OR efavirenz + lopinavir-ritonavir	To achieve undetectable HIV viral load at 2 years (89% efavirenz+2NRTIs VS 77% lopinavir+2NRTIs VS 83% efavirenz+lopinavir) and avoid resistance mutations
N Engl J Med. 2003 Dec 11;349(24):2293-303		Randomized Controlled Trial, Multicenter Study
IN HIV infection, initial therapy	The Use of highly active antiretroviral therapy (HAAR), 3 drugs, zidovudine + lamivudine + efavirenz (Combivir(R) + Sustiva(R)) As Treatment, Chronic	Is better Than zidovudine + lamivudine + nelfinavir, didanosine + stavudine + either efavirenz or nelfinavir	To reducing or delaying virologic failures at 2,3 years
N Engl J Med. 2003 Dec 11;349(24):2304-15		Randomized Controlled Trial, Multicenter Study
IN HIV infection, initial therapy	The Use of highly active antiretroviral therapy (HAAR), 4 drugs, zidovudine + lamivudine + efavirenz + nelfinavir, OR didanosine + stavudine + efavirenz + nelfinavir As Treatment, Chronic	Is equal Than two consecutive 3 drug regimens, specially zidovudine + lamivudine + efavirenz	To reducing the occurrence of regimen failures or prolonging the time to failure, at 2,3 years
Lancet. 2006 Aug 5;368(9534):466-75		Randomized Controlled Trial, Multicenter Study
IN HIV infection, multidrug-resistant	The Use of non-peptidic protease inhibitors, tipranavir, boosted by ritonavir, plus optimised background regimen As Treatment, Chronic	Is better Than other selected protease inhibitors, also ritonavir-boosted, also plus optimised regimen	To achieve and maintain a reduction in viral load of 1 log(10) copies per mL or greater, at 48 weeks: 33.6% with tipranavir VS 15.3% other protease inhibitors
Ann Intern Med. 2000 Sep 19;133(6):401-410		Cohorts
IN HIV infection, natural history	The Use of absence of immunologic response (increase of CD4+ count) after 6 months of HAART As Prognostic Item	Is better Than no response or only virologic response (decrease in HIV viral load)	To predict death or progression to AIDS 18 months after: RR 3.4 in conresponders, RR 2 if only virologic response.
Lancet. 2000 Apr 1;355(9210):1131-37		Cohorts
IN HIV infection, natural history	The Use of natural history, without highly-active antiretroviral therapy As Prognostic Item	Is useful Than no comparison	To Median survival varied from 12.5 years for those aged 15-24 years at seroconversion to 7.9 years for those aged 45-54 years at seroconversion. For development of AIDS the corresponding values were 11.0 years and 7.7 years
N Engl J Med. 1999 Apr 1;340(13):977-87		Randomized Controlled Trial
IN HIV infection, pregnant women and perinatal transmission	The Use of elective cesarean section and antiretroviral therapy during the prenatal, intrapartum, and neonatal periods As Treatment, Acute	Is better Than other modes of delivery, and the absence of antiretroviral therapy	To reduce perinatal transmission of HIV to child: decreased by 50% by elective cesarean, by 87% when cesarean and antiretroviral therapy combined.
JAMA. 2000 Apr 19; 283(15):1967-75		Randomized Controlled Trial, Multicenter Study
IN hypertension, primary	The Use of alpha-blockers, doxazosin As Treatment, Chronic	Is worse Than diuretics (chlortalidone)	To stroke, combined cardivascular events and heart failure
Eur Heart J. 2012 Aug;33(16):2088-97		Meta-Analysis
IN hypertension, primary	The Use of angiotensin converting enzyme inhibitors (ACEI) As Treatment, Chronic	Is better Than placebo, and probably better than angiotensin II receptor blockers (ARBs)	To reduce all-cause mortality (20.4 deaths per 1000 patient-years with ACEIs VS 24.2 placebo). No significant mortality reduction appeared with ARB treatment
Ann Intern Med. 2004 Oct 19;141(8):614-27		Systematic Review
IN hypertension, primary, black patients	The Use of some drugs: calcium-channel blockers, diuretics, angiotensin II receptor blockers, central sympatholytics, alpha-blockers As Treatment, Chronic	Is better Than placebo	To reduce blood pressure. Effect in cardiovascular outcomes less clear. Beta-blockers and angiotensin-converting enzyme inhibitors (ACEI) were not better then placebo.
Cochrane Database Syst Rev. 2009;(4):CD000028		Systematic Review, Cochrane Review
IN hypertension, primary, elder patients	The Use of several drugs, specially thiazide diuretics As Treatment, Chronic	Is better Than placebo	To reduce total cardiovascular morbidity and mortality (RR 0.72 to 0.75). Total mortality was reduced in patients 60-80 years but not in patients > 80 years.
Lancet. 2002 Dec 14;360(9349):1903-13		Meta-Analysis
IN hypertension, primary, elder people, epidemiology	The Use of blood pressure (BP) As Prognostic Item	Is useful Than no comparison	To predict, at all ages, risk of cardiovascular event and death (both cardiovascular and overall): going up from BP 115/75 mmHg, there is a continuous (non-linear) correlation between BP and cardiovascular risk, at all ages.
Cochrane Database Syst Rev. 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)
Ann Intern Med. 2004 Nov 2;141(9):674-82		Randomized Controlled Trial
IN hypertension, secondary, renal artery stenosis	The Use of computed tomographic angiography, or magnetic resonance angiography As Diagnostic Tool	Is worse Than digital subtraction angiography	To diagnosis renal artery stenosis: both had a good specificity (CT 92%, MRI 84%) but a less good sensibility (CT 64%, MRI 62%), so they can not accurately rule out a significant stenosis.
Cochrane Database Syst Rev. 2005 Apr 18;(2):CD003420		Systematic Review, Cochrane Review
IN hyperthyroidism, Graves disease	The Use of antithyroid drugs, low-dose 12 month regimen As Treatment, Chronic	Is better Than antithyroid drugs, high dose 6 months regimen	To was eqaul to control hyperthyroidism and reduce recurrence after stopping (30 to 55% in fdifferent studies) but produced less adverse events (9% withdrawals with low dose VS 16% high dose)
Am J Kidney Dis. 2010 Aug;56(2):325-37		Systematic Review
IN hyponatremia, euvolemic and hypervolemic patients, syndrome of inappropriate antidiuretic hormone secretion (SIADH)	The Use of vasopressin receptor antagonists, tolvaptan, with or without fluid restriction As Treatment, Acute	Is better Than placebo or no treatment, with or without fluid restriction	To improve normalization of natremia, both early and late (RR 3.15). However, no clinical outcomes (hospital stay, quality of life) were assessed
Am J Kidney Dis. 2013 Jul;62(1):67-72		Cohorts
IN hyponatremia, hypovolemic, diuretics	The Use of diuretics, thiazides As Treatment, Chronic	Is worse Than no exposure to thiazides	To carry a higher risk of hyponatremia : overall HR = 5.0. Lower age and lower body mass index increased the risk
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. 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.
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
PLoS One. 2017;12(1):e0163586		Systematic Review
IN influenza, adults, older patients living in institutions	The Use of influenza vaccination of healthcare workers As Prevention, Primary	Is equal Than no vaccination or spontaneous vaccination	To realistically reduce the risk of influenza complications in patients cared for
Cochrane Database Syst Rev. 2016 Jun 2;(6):CD005187		Systematic Review, Cochrane Review
IN influenza, adults, older patients living in institutions	The Use of influenza vaccination of healthcare workers As Prevention, Primary	Is equal Than no vaccination or spontaneous vaccination	To reduce laboratory-proven influenza or the number of residents admitted to hospital for respiratory illness. Probable reduction in lower respiratory tract infection in residents of 4-6%. Mortality not pooled because high risk of bias & high heterogeneity
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 ?
Am J Cardiol. 2014 Jun 6. [Epub ahead of print]		Meta-Analysis
IN kidney disease, chronic	The Use of statins As Treatment, Chronic	Is better Than placebo	To reduce progression of renal failure and reduce proteinuria
Eur Heart J. 2013 Jun;34(24):1807-17. Epub 2013 Mar 6.		Meta-Analysis
IN kidney disease, chronic	The Use of statins As Treatment, Chronic	Is better Than placebo	To reduce major cardiovascular events (RR 0.77) and all-cause death (RR 0.91)
Ann Intern Med. 2010 Jul 6;153(1):23-33		Systematic Review
IN kidney disease, chronic, associated anemia, erythropoiesis-stimulating agents	The Use of erythropoiesis-stimulating agents, erythropoietin, targeting higher hemoglobin levels As Treatment, Chronic	Is worse Than targeting lower hemoglobin levels	To increase risks for stroke (RR 1.5), hypertension (RR 1.7), and vascular access thrombosis (RR 1.3) and probably increases risks for death (RR 1.09, p NS)
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
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
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%)
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
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
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
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. 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.
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
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
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
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)
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 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
_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
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%
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
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):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)
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
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
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 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. 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.
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)
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
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
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
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.
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
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
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)
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. 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)
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.
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
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.
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)
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)
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
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
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)
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
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.
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.
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
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)
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
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. 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.
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
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. 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
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)
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
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)
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
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
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
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.
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
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
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" (?)
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
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
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)
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
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)
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)
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
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.
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. 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%)
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
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
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
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.
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.
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.
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
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
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. 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
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.
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)
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)
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).
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%
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
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)
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)
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
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