Some Studies That I like to Quote

Some Studies That I like to Quote - a song designed to get you thinking about the problem with strictly following cardiovascular guidelines/target shooting and NOT using evidence to help you and your patient make decisions. The lab coat logos are from top drug companies, top Rx medications and top guideline producers. Guidelines are useful but make sure you know the evidence or lack thereof.

Yes I know this is the "1,432nd parody" of a song called "Somebody That I Used To Know" by Gotye.

CREDITS

LYRICS AND VIDEO PRODUCTION BY: James McCormack

GREAT VOCALS BY: Shae Scotten and Liam Styles Chang -- 2 guys from a great band called Aivia from Victoria, BC - THANKS GUYS -- check them out at http://www.youtube.com/user/weareaivia

BACKING TRACK: Purchased and downloaded from http://www.karaoke-version.com

LYRICS -- if anybody wants the evidence/studies referred to in this video please email me at james.mccormack@ubc.ca

Guidelines made me feel so happy I could die
I told my patients it was good enough
To lower glucose make them unconscious
I put my 95 year-olds on a statin

I should have known all along that this was wrong
100 over 60 made them fall, they really fall
Stopping salt and fat did not make sense
I really should have looked at evidence
I didn't know that half of guidelines were just opinion

You say I need an RCT
One that actually shows a difference in a real outcome
I'm supposed to know the NNT, and discuss it with my patients
Are you kidding me?

Don't know what a p-value is
You say I need a Cochrane review to help me find some numbers
I hear some surrogates were wrong
And now I need some studies I'm supposed to quote

Now I need some studies I'm supposed to quote
Now I need some studies I'm supposed to quote




Now and then I think of all the things you had me measure
You had me thinking there was always something that was wrong
All that fibre was an adventure
Now I'm passing wicker furniture
Beta-blockers made me feel real slow
And now you telling me about some studies that you need to quote

But now I'm reading RCTs
You get a 1% reduction from a low dose statin




I know now that an A1C of less than 8 is good enough as long as you don't pee
Forget about your CRP
Just don't eat like a great fat pig and go get some activity
I think that I can help you now
I finally have some studies that I like to quote

Some studies
(That I like to quote)
Some studies
(Now I have some studies that I like to quote)

Some studies
(That I like to quote)
Some studies
(Now I have some studies that I like to quote)

(That I like to quote)
(That I like to quote)
(That I like to quote)
(Some studies)

For a spanish translation of the lyrics go to http://rafabravo.wordpress.com/2013/0...
Thanks to Rafael Bravo for doing this.

ANTI-T-N-F THERAPY NOT ASSOCIATED RISK DEVELOPING SHINGLES AUTO-IMMUNE INFLAMMATORY DISEASES

English: A hand affected by rheumatoid arthritis (Photo credit: Wikipedia)

Patients with rheumatoid arthritis and other inflammatory diseases are at increased risk for developing infections like shingles. Many of these patients take immunosuppressive drugs to treat the inflammation and pain associated with those diseases. A new study examined whether patients beginning anti-T-N-F therapy are at a higher risk for developing shingles infection. Catherine Dolf explains in this week's JAMA Report.
Note: in spite of I don´t read the original article, and reading another ones that show the opposite position, we could say that this article is not conclusive. Actually many ot these news drugs have at least  the same risk than older inmunosupressive drugs. And the reports of adverses effects is not shown in any publication for the FDA. Eventough you could find thousands of warnings of these news therapies in Medwatch or EMA.

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Estudio ONTARGET: Telmisartan, ramipril o ambos en pacientes con alto riesgo de eventos cardiovasculares

Structural diagram of ramipril. Created using ACD/ChemSketch 8.0 and Inkscape. (Photo credit: Wikipedia)

Fuente: Galo Sanchez

Silvia Redondo Muñoz[1] ha hecho el resumen de una evaluación GRADE, que hemos puesto a disposición de los interesados en la web de la Oficina (evalmed.es), en la pestaña “FORMACIÓN”, cuyas recomendaciones (válidas para este estudio) se recuadran más abajo.

Estudio ONTARGET: Telmisartan, ramipril o ambos en pacientes con alto riesgo de eventos cardiovasculares.

Yusuf S., Phil. D., Teo K.K., Pogue J., Dyal L., Copland I. and the ONTARGET Investigators. Telmisartan, ramipril, or both in patients at high risk for vascular events. N Engl J Med 2008;358:1547-59.

Los IECA reducen la mortalidad, IAM, ACV e insuficiencia cardiaca y disfunción del ventrículo izquierdo en pacientes con enfermedad CV previa o en diabéticos de alto riesgo. Pero no ejercen un bloqueo completo de la producción de toda la angiotensina II y se cree que su bloqueo completo podría ser más efectivo. Además los IECA sea asocian con tos y angioedema como consecuencia reducir la degradación de la bradiquinina.

     El ONTARGET pretende averiguar si en esta población de alto riesgo telmisartán puede ser una alternativa a ramipril, dado su conocido comportamiento en el estudio HOPE.

RECOMENDACIONES GRADE (VÁLIDAS SÓLO PARA ESTE ESTUDIO)

Para pacientes de 66 años (DE 7,2) con al menos una de las siguientes condiciones: enfermedad coronaria, enfermedad arterial periférica, enfermedad cerebrovascular o diabetes con afectación de órganos diana, basándonos en lo observado en este estudio, en la calidad de la evidencia y la magnitud y precisión de sus resultados, hacemos:

1º Una recomendación débil en contra de utilizar telmisarán en lugar de ramipril, salvo que estos pacientes presenten una tos que motive el abandono del IECA.

Justificación:

A) BENEFICIOS Y RIESGOS AÑADIDOS: En los pacientes sin tos, telmisartán no ofrece ningún beneficio frente a ramipril en las variables de resultados en salud. En los efectos adversos que motivan el abandono del tratamiento, telmisartán presenta en 4,66 años: a) más casos de hipotensión que ramipril, con un NND 106 (72 a 201), cuya magnitud de efecto estimamos baja a muy baja; y b) menos casos de angioedema, con un NNT 573 (322 a 3847), cuya magnitud de efecto estimamos es aún más baja.

B) INCONVENIENTES: No hay diferencias en tomar una pastilla de uno u otro fármaco.

C) COSTES: Telmisartán 80 mg: 260 euros/año; Ramipril 10 mg: 137 euros/año.

2º Una recomendación fuerte en contra de utilizar la terapia combinada de “telmisartán más ramipril” en lugar de “ramipril solo”.

Justificación:

A) BENEFICIOS Y RIESGOS AÑADIDOS: La terapia combinada de telmisartán más ramipril  no ofrece ningún beneficio frente a ramipril en las variables de resultados en salud. En 4,66 años se encontró un aumento del riesgo en el abandono de tratamiento por: a) Deterioro renal, NND 30 (23 a 42); b) Insuficiencia renal que requiere diálisis, NND 246 (145 a 867); c) Hipotensión, NND 33 (28 a 40); y d) Síncope, NND 602 (313 a 37968).

B) INCONVENIENTES: En contra de la terapia combinada al tener que tomar una pastilla adicional.

C) COSTES: Telmisartán 80 mg más Ramipril 10 mg: 397 euros/año. Ramipril 10 mg: 137 euros/año.

NOTA ACLARATORIA: Reseñamos que estamos haciendo una recomendación para lo sucedido en este ensayo clínico, y no una generalización propia de una revisión sistemática.

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Universal Screening and Drug Treatment of Dyslipidemia in Children and Adolescents

Logo of the United States National Heart, part of the National Institutes of Health. The logo depicts a red heart, surrounded by two white lungs, encased in a red blood cell. It was introduced in September 2006, replacing the previous logo which had been used for nearly 30 years. For more information, see here and here. (Photo credit: Wikipedia)

Universal Screening and Drug Treatment of Dyslipidemia in Children and Adolescents
JAMA. 2012;307(3):257-258. doi:10.1001/jama.2011.1916.

In late 2011, an Expert Panel convened by the National Heart, Lung, and Blood Institute (NHLBI), of which we were members, released a set of integrated guidelines for cardiovascular health in youth comprising numerous clinically useful recommendations.¹ However, one new recommendation, about which the 2 of us disagree, merits further scrutiny: to perform lipid screening on all children at 9 to 11 years of age, followed by a comprehensive scheme for further evaluation and treatment. Just 4 years previously, the US Preventive Services Task Force (USPSTF) concluded that evidence is insufficient to recommend for or against screening for lipid disorders in childhood.² Both of the guideline committees used an explicit evidence-based approach to answer key questions, with extensive literature searches, critical review of relevant studies, and analogous grading schemes. How could the 2 guidelines be so different? The evidence base has advanced in 4 years, but not enough to explain such a discrepancy. What is a clinician who cares for children to do in the face of this ambiguity?

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AVC en Pediatria Basada en la Evidencia: González de Dios J, Molina Arias M. Resultados de los corticoides prenatales en el límite de la viabilidad. Evid Pediatr. 2012;8:12.

JAMA. 2011 Dec 7;306(21):2348-58.

Association of antenatal corticosteroids with mortality and neurodevelopmental outcomes among infants born at 22 to 25 weeks' gestation.

Carlo WA, McDonald SA, Fanaroff AA, Vohr BR, Stoll BJ, Ehrenkranz RA, Andrews WW, Wallace D, Das A, Bell EF, Walsh MC, Laptook AR, Shankaran S,Poindexter BB, Hale EC, Newman NS, Davis AS, Schibler K, Kennedy KA, Sánchez PJ, Van Meurs KP, Goldberg RN, Watterberg KL, Faix RG, Frantz ID 3rd,Higgins RD; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network.

Collaborators (198)

Source

Department of Pediatrics, University of Alabama, 9380 Women and Infants Center, 1700 Sixth Ave S, Birmingham, AL 35249, USA. wcarlo@peds.uab.edu

Abstract

CONTEXT:

Current guidelines, initially published in 1995, recommend antenatal corticosteroids for mothers with preterm labor from 24 to 34 weeks' gestational age, but not before 24 weeks due to lack of data. However, many infants born before 24 weeks' gestation are provided intensive care.

OBJECTIVE:

To determine if use of antenatal corticosteroids is associated with improvement in major outcomes for infants born at 22 and 23 weeks' gestation.

DESIGN, SETTING, AND PARTICIPANTS:

Cohort study of data collected prospectively on inborn infants with a birth weight between 401 g and 1000 g (N = 10,541) born at 22 to 25 weeks' gestation between January 1, 1993, and December 31, 2009, at 23 academic perinatal centers in the United States. Certified examiners unaware of exposure to antenatal corticosteroids performed follow-up examinations on 4924 (86.5%) of the infants born between 1993 and 2008 who survived to 18 to 22 months. Logistic regression models generated adjusted odds ratios (AORs), controlling for maternal and neonatal variables.

MAIN OUTCOME MEASURES:

Mortality and neurodevelopmental impairment at 18 to 22 months' corrected age.

RESULTS:

Death or neurodevelopmental impairment at 18 to 22 months was significantly lower for infants who had been exposed to antenatal corticosteroids and were born at 23 weeks' gestation (83.4% with exposure to antenatal corticosteroids vs 90.5% without exposure; AOR, 0.58 [95% CI, 0.42-0.80]), at 24 weeks' gestation (68.4% with exposure to antenatal corticosteroids vs 80.3% without exposure; AOR, 0.62 [95% CI, 0.49-0.78]), and at 25 weeks' gestation (52.7% with exposure to antenatal corticosteroids vs 67.9% without exposure; AOR, 0.61 [95% CI, 0.50-0.74]) but not in those infants born at 22 weeks' gestation (90.2% with exposure to antenatal corticosteroids vs 93.1% without exposure; AOR, 0.80 [95% CI, 0.29-2.21]). If the mothers had received antenatal corticosteroids, the following events occurred significantly less in infants born at 23, 24, and 25 weeks' gestation: death by 18 to 22 months; hospital death; death, intraventricular hemorrhage, or periventricular leukomalacia; and death or necrotizing enterocolitis. For infants born at 22 weeks' gestation, the only outcome that occurred significantly less was death or necrotizing enterocolitis (73.5% with exposure to antenatal corticosteroids vs 84.5% without exposure; AOR, 0.54 [95% CI, 0.30-0.97]).

CONCLUSION:

Among infants born at 23 to 25 weeks' gestation, antenatal exposure to corticosteroids compared with nonexposure was associated with a lower rate of death or neurodevelopmental impairment at 18 to 22 months.

PMID:

 

22147379

 

[PubMed - indexed for MEDLINE]

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