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Archive for the ‘Evidence Based Medicine’ Category

Speak from the Evidence on Rounds

Posted by medliorator on August 20, 2009

ScreenHunter_02 Aug. 20 22.54

Look sharp on rounds by speaking from the evidence regarding your patient.  EBOC delivers bite-sized factoids that summarize key findings in literature and keep your team up to date.


Sickle cell crisis

Many patients are regular attenders (b) – contact their regular physician and ask how they are normally treated (d)

  • 30% of patients with sickle cell disease are admitted to hospital each year (c) ,  but a third of all the crises happen in 5% of patients (b)
  • Genotype is important: patients with SS anaemia and S-beta 0 thalassaemia are more likely to have crises than others (c).

Evidence-Based On-Call [EBOC]

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How to Use Medical Literature to Solve Patient Problems

Posted by medliorator on February 9, 2009

When using medical literature to solve patient problems and provide better care, consult this guide for appropriate use of an article dealing with therapeutic interventions and preventive interventions.

Table 1: Users’ Guides for an Article About Therapy

I. Are the results of the study valid?

  • Primary Guides:
    • Was the assignment of patients to treatments randomized?
    • Were all patients who entered the trial properly accounted for and attributed at its conclusion?
    • Was followup complete?
    • Were patients analyzed in the groups to which they were randomized?
  • Secondary Guides:
    • Were patients, health workers, and study personnel “blind” to treatment?
    • Were the groups similar at the start of the trial?
    • Aside from the experimental intervention, were the groups treated equally?

II. What were the results?

  • How large was the treatment effect?
  • How precise was the estimate of the treatment effect?

III. Will the results help me in caring for my patients?

  • Can the results be applied to my patient care?
  • Were all clinically important outcomes considered?
  • Are the likely treatment benefits worth the potential harms and costs?

How to Use an Article About Therapy or Prevention [Centre for Health Evidence]

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Holiday Medical Myths Debunked

Posted by medliorator on January 15, 2009

BMJ 2008;337:a2769

You can cure a hangover

A systematic review of randomised trials evaluating medical interventions for preventing or treating hangovers found no effective interventions in either traditional or complementary medicine.

Suicides increase over the holidays

there is no good scientific evidence to suggest a holiday peak in suicides… Studies of suicide rates from India also show peaks in April and May. Studies from the US reflect this pattern, with lower rates in November and December than in typically warmer months.

Nocturnal feasting makes you fat

In a study of over 2500 patients, eating at night was not associated with weight gain, but eating more than three times a day was linked to being overweight or obese.  Studies have connected skipping breakfast with gaining more weight, but this is not because breakfast skippers eat more at night.  Breakfast skippers eat more during the rest of the day. Records of calorie intake suggest that those who eat breakfast maintain healthy weights because their calorie intake is more evenly distributed over the day

Festive medical myths [BMJ]

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Confronting Unscientific Beliefs

Posted by medliorator on July 24, 2008

by Steven Novella:

It is not the place of the physician to validate or refute personal religious beliefs.
Non-religious ideological beliefs are the same. The point is that the physician cannot impose their value system onto their patient.

Most experienced clinicians already know to avoid dismissive, insulting, or judgmental statements. In confronting unscientific medical beliefs, it is easy to do so. Simply confine your opinions to the scientific evidence. For example, if a patient asks me about acupuncture for migraine headaches I simply tell them that I have reviewed the published literature which does not support the use of acupuncture for migraines. I therefore do not recommend it. I am then happy to discuss the evidence with the patient as much as they desire. But almost always patients appreciate the fact that I have taken the time to actually read the literature and they respect my opinion.

Sometimes patients ask me about treatments that I believe to be fraudulent and exploitive – for example I am frequently asked about whether or not it is worth it to fly to China to get stem-cell therapy. In these cases I tell my patients, in a very factual and dry manner, that such clinics are fraudulent. What evidence we have shows that their treatments are not safe and that they do not work. In my opinion the people operating the clinic are committing fraud to steal money away from desperate patients. To do anything less is to fail to properly inform a patient.

It is profoundly misguided and harmful to fail to confront pseudoscience or bad science in medicine out of fear of offending a patient.
Given the medical environment today, clinicians are obligated to have a working knowledge not only of science-based medicine but of the unscientific practices and claims with which their patients may be faced. We are obligated, as part of good practice, to know the literature and the nature of unscientific claims and to help our patients navigate through them.

A Guide for Confronting Patients [Science-Based Medicine]

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