We are making some changes going forward to the Commentaries such that they are more structured and contain key features related to critical
appraisal of the evidence: http://ebm.bmj.com/content/15/4/103.full.
Some of what Dr. Bossano refers to (e.g. the use of absolute versus relative risks will be addressed by such changes.
We are making some changes going forward to the Commentaries such that they are more structured and contain key features related to critical
appraisal of the evidence: http://ebm.bmj.com/content/15/4/103.full.
Some of what Dr. Bossano refers to (e.g. the use of absolute versus relative risks will be addressed by such changes.
It's quite a while since I read EBM but I received an eTOC today and was pleased to discover I could read it via my NHS Athens login.
I couple of abstracts caught my including this one, because as a GP, LUTS and concern about PSA are relatively commonly seen.
The commentary seemed to have a lot of detail about prostate disease,
which was interesting but perhaps not entirely relevant to the paper it
was comm...
It's quite a while since I read EBM but I received an eTOC today and was pleased to discover I could read it via my NHS Athens login.
I couple of abstracts caught my including this one, because as a GP, LUTS and concern about PSA are relatively commonly seen.
The commentary seemed to have a lot of detail about prostate disease,
which was interesting but perhaps not entirely relevant to the paper it
was commenting upon.
I was very surprised to see RRRs and no ARRs in the summary of the
results, surely a mainstay of EBM is to provide both otherwise the
perception of the results is almost inevitably biased.
I turned to the abstract of the article (after perusing the full text
article re finasteride), unfortunaly the full text was not available.
What I discovered from the abstract was that the ARR seems to be about 5%
for all biopsy detected prostate cancer (about 25% placebo and 20%
dutasteride) which I guess is an NNT of 20 for 4 yrs, to prevent a
positive biopsy, so debatable to what extent this is a patient oriented
outcome.
What was puzzling is that the abstract also mentions that Gleason 7-10
biopsies were lower in years 1-4 of the study and the Gleason 8-10
biopsies were higher in years 3-4 (12 in dutasteride, 1 in placebo). I am
not really clear why the 2 different intervals and why the 2 different
Gleason ranges, but I would be concerned about the apparently higher
incidence of high grade biopsies with worst prognosis at 3 - 4 years.
The net result is I am not clear whether dutasteride has any patient
benefit or possibly even makes things worse.
It would have been nice if the commentary could have addressed this
question in more detail, because the tone of commentary is that
dutasteride is beneficial and I am unclear that the data shows this.
This is indeed an important finding on several levels, yet it remains
difficult in
translating this into clinical practice. I have found myself even more
ambivalent about suggesting SMBG to patients reasonably well-controlled on oral anti-diabetes medications.
In an effort to translate these findings, I propose the following
practical
suggestions.
1. For patients struggling to comply with health care...
This is indeed an important finding on several levels, yet it remains
difficult in
translating this into clinical practice. I have found myself even more
ambivalent about suggesting SMBG to patients reasonably well-controlled on oral anti-diabetes medications.
In an effort to translate these findings, I propose the following
practical
suggestions.
1. For patients struggling to comply with health care
recommendations, we
now know that SMBG does not need to be as high a priority in our
counseling.
2. For patients struggling to afford all the components necessary to
actually
perform SMBG (e.g., glucometer, strips, lancets), this now becomes an area
of
potential cost savings. Freeing up their limited discretionary income
might
allow them to afford a nutrition consultation, important medications or
other
expensive interventions with better evidentiary support.
3. For patients fully complying with SMBG, this might be a time to
allow them
to check their BG less frequently (e.g., Tuesday and Friday, fasting and
post-prandial, and prn for signs and symptoms of hypoglycemia and/or
hyperglycemia) instead of at their current rate.
Finally, since there is potential to have a critical study in the
future overturn
these recommendations, I am choosing to use caution both in how I explain
this study and in discontinuing anyone from SMBG.
Re: editorial BMJ 5th April 2008 Volume 336 pages 729-30: Improving uptake of MMR vaccine - Recognising and targeting between population groups are the
priorities
Dear Editor,
In the editorial on improving uptake of MMR vaccine, no mention was made
of the parents who decline MMR vaccination on ethical grounds.
The rubella vaccine component of MMR is derived from an aborted human
fetal cell line. The Takah...
Re: editorial BMJ 5th April 2008 Volume 336 pages 729-30: Improving uptake of MMR vaccine - Recognising and targeting between population groups are the
priorities
Dear Editor,
In the editorial on improving uptake of MMR vaccine, no mention was made
of the parents who decline MMR vaccination on ethical grounds.
The rubella vaccine component of MMR is derived from an aborted human
fetal cell line. The Takahasi rubella vaccine is a safe and effective
alternative. It is extremely difficult to access the Takahasi rubella
vaccine, grown on animal cell lines, due to import licence
restrictions. (Measles and mumps vaccines are not grown on aborted human
fetal cell lines. For those who can afford them, it is still possible to
have separate immunisations against measles and mumps.)
To achieve the goal of 95% immunisation several strategies should be
employed which also recognise diversity in the population. In 1994,Kenneth
Calman, then Health Minister, promised the Joint Faith Committee that an
ethical vaccine would be made available. However,as noted previously,
access to an ethical rubella vaccine has been made even more difficult.
Only coercive strategies to improve
completion of immunisation were mentioned in the article and the term
'..require legislative action..' (Ref 12) was used.
Are we now facing compulsory vaccination?
Ref 12 SalmonDA, TeretSP, MacIntyreCR, SalisburyD, BurgessMA,
Halsey NA. Compulsory vaccination and conscientious or philosophical exemptions:past present and future. Lancet 2006;367:436-42.
We are making some changes going forward to the Commentaries such that they are more structured and contain key features related to critical appraisal of the evidence: http://ebm.bmj.com/content/15/4/103.full. Some of what Dr. Bossano refers to (e.g. the use of absolute versus relative risks will be addressed by such changes.
Thanks
Richard Saitz, Editor.
Conflict of Interest:
...It's quite a while since I read EBM but I received an eTOC today and was pleased to discover I could read it via my NHS Athens login. I couple of abstracts caught my including this one, because as a GP, LUTS and concern about PSA are relatively commonly seen. The commentary seemed to have a lot of detail about prostate disease, which was interesting but perhaps not entirely relevant to the paper it was comm...
This is indeed an important finding on several levels, yet it remains difficult in translating this into clinical practice. I have found myself even more ambivalent about suggesting SMBG to patients reasonably well-controlled on oral anti-diabetes medications.
In an effort to translate these findings, I propose the following practical suggestions.
1. For patients struggling to comply with health care...
Re: editorial BMJ 5th April 2008 Volume 336 pages 729-30: Improving uptake of MMR vaccine - Recognising and targeting between population groups are the priorities
Dear Editor,
In the editorial on improving uptake of MMR vaccine, no mention was made of the parents who decline MMR vaccination on ethical grounds. The rubella vaccine component of MMR is derived from an aborted human fetal cell line. The Takah...