Chapter 19
Applying the Results of Systematic Reviews at the Bedside
Finlay A McAlister,
Finlay A McAlister
Search for more papers by this authorFinlay A McAlister,
Finlay A McAlister
Search for more papers by this authorBook Editor(s):Matthias Egger,
George Davey Smith,
Douglas G Altman,
Matthias Egger
Senior Lecturer in Epidemiology and Public Health Medicine, Division of Health Services, Research and MRC Health Services Research Collaboration, Department of Social Medicine, University of Bristol, UK
Search for more papers by this authorGeorge Davey Smith
Professor of Clinical Epidemiology, Division of Epidemiology and MRC Health Services Research Collaboration, Department of Social Medicine, University of Bristol, UK
Search for more papers by this authorDouglas G Altman
Professor of Statistics in Medicine, ICRF Medical Statistics, Group, Centre for Statistics in Medicine, Institute of Health Sciences, University of Oxford, UK
Search for more papers by this authorSummary
This chapter contains section titled:
-
Summary Points
-
Determining the Applicability of the Evidence to an Individual Patient
-
Determining the Feasibility of the Intervention in a Particular Setting
-
Determining the Benefit: Risk Ratio in an Individual Patient
-
Incorporating Patient Values and Preferences
-
Conclusion
-
Acknowledgements
References
- Sackett DL, Richardson WS, Rosenberg W, Haynes RB., Evidence-based medicine. How to practice and teach EBM. London: Churchill Livingstone, 1997.
- Sackett DL., Applying overviews and meta-analyses at the bedside. J Clin Epidemiol 1995; 48: 61–6.
- Dans AL, Dans LF, Guyatt GH, Richardson, S., Users' guides to the medical literature. XIV. How to decide on the applicability of clinical trial results to your patient. JAMA 1998; 279: 545–9.
- Glasziou P, Guyatt GH, Dans AL, Dans LF, Straus S, Sackett DL., Applying the results of trials and systematic reviews to individual patients [EBM Note]. Evidence-Based Med 1998; 3: 165–6.
- Yusuf S, Sleight P, Held P, McMahon S., Routine medical management of acute myocar-dial infarction. Lessons from overviews of recent randomized controlled trials. Circulation 1990; 82 (suppl II): II- 117–34.
- Rogers WJ, Bowlby LJ, Chandra NC, et al. Treatment of myocardial infarction in the United States (1990–1993). Observations from the National Registry of Myocardial Infarction. Circulation 1994; 90: 2103–14.
- Gottlieb SS, McCarter RJ, Vogel RA., Effect of beta-blockade on mortality among high-risk and low-risk patients after myocardial infarction. N Engl J Med 1998; 339: 489–97.
- Vasan RS, Benjamin EJ, Levy D., Prevalence, clinical features, and prognosis of diastolic heart failure: an epidemiologic perspective. J Am Coll Cardiol 1995; 26: 1565–74.
- Senni M, Tribouilloy CM, Rodeheffer RJ, et al. Congestive heart failure in the community. A study of all incident cases in Olmsted County, Minnesota, in 1991. Circulation 1998; 98: 2282–9.
- Garg R, Yusuf S, Collaborative Group on ACE Inhibitor Trials. Overview of randomized trials of angiotensin-converting enzyme inhibitors on mortality and morbidity in patients with heart failure. JAMA 1995; 273: 1450–6.
- McAlister FA, Teo KK, Taher M, et al. Insights into the contemporary epidemiology and outpatient management of congestive heart failure. Am Heart J 1999; 138: 87–94.
- Schaefer O., Adverse reactions to drugs and metabolic problems perceived in Northern Canadian Indians and Eskimos. Progr Clin Biol Res 1986; 214: 77–83.
- Ward J, Brenneman G, Letson GW, Heyward WL., Limited efficacy of a Haemophilus type B conjugate vaccine in Alaska Native infants: the Alaska H. influenzae Vaccine Study Group. N Engl J Med 1990; 323: 1415–6.
- Martino E, Safran M, Aghini-Lombardi F, et al. Environmental iodine intake and thyroid dysfunction during chronic amiodarone therapy. Ann Intern Med 1984; 101: 28–34.
- Fihn SD, McDonell M, Martin D, et al. Risk factors for complications of chronic anti-coagulation. A multicenter study. Ann Intern Med 1993; 118: 511–20.
- Levine MN, Raskob G, Landefeld S, Kearon C., Hemorrhagic complications of anticoagulant treatment. Chest 1998; 114 (suppl): 511S–523S.
- McKenna CJ, Galvin J, McCann HA, Sugrue DD., Risks of long-term oral anticoagulation in a non-trial medical environment. Irish Med J 1996; 89: 144–5.
- Palareti G, Leali N, Coccheri S, et al. Bleeding complications of oral anticoagulant treatment: an inception cohort, prospective collaborative study (ISCOAT). Lancet 1996; 348: 423–8.
- McAlister FA, Taylor L, Teo KK, et al. The treatment and prevention of coronary heart disease in Canada: do older patients receive efficacious therapies? J Am Geriatr Soc 1999; 47: 811–18.
- Fibrinolytic Therapy Trialists Collaborative Group. Indications for fibrinolytic therapy in suspected acute myocardial infarction: collaborative overview of early mortality and major morbidity results from all randomised trials of more than 1000 patients. Lancet 1994; 343: 311–22.
- Risk factors for stroke and efficacy of antithrombotic therapy in atrial fibrillation. Analysis of pooled data from five randomized controlled trials. Arch Intern Med 1994; 154: 1449–57.
- Benavente O, Moher D, Pham B., Carotid endarterectomy for asymptomatic carotid stenosis: a meta-analysis. BMJ 1998; 317: 1477–80.
- Barnett HJ, Eliasziw M, Meldrum HE, Taylor DW., Do the facts and figures warrant a 10fold increase in the performance of carotid endarterectomy on asymptomatic patients? Neurology 1996; 46: 603–8.
- Laupacis A, Sackett DL, Roberts RS., An assessment of clinically useful measures of the consequences of treatment. N Engl J Med 1988; 318: 1728–33.
- Sackett DL, Haynes RB., Summarising the effects of therapy: a new table and some more terms [EBM Note]. Evidence-Based Med 1997; 2: 103–4.
- McQuay HJ, Moore RA., Using numerical results from systematic reviews in clinical practice. Ann Intern Med 1997; 126: 712–20.
- Collins R, Peto R, MacMahon S, et al. Blood pressure, stroke, and coronary heart disease. Part 2, short-term reductions in blood pressure: overview of randomised drug trials in their epidemiological context. Lancet 1990; 335: 827–38.
- Sackett DL, Deeks JJ, Altman DG., Down with odds ratios![EBM Note]. Evidence-Based Med 1996; 1: 164–6.
- Antiplatelet Trialists' Collaboration. Collaborative overview of randomised trials of antiplatelet therapy – I: Prevention of death, myocardial infarction, and stroke by prolonged antiplatelet therapy in various categories of patients. BMJ 1994; 308: 81–106.
- Yusuf S, Wittes J, Probstfield J, Tyroler HA., Analysis and interpretation of treatment effects in subgroups of patients in randomized clinical trials. JAMA 1991; 266: 93–8.
- Davey Smith G, Egger M., Who benefits from medical interventions? Treating low risk patients can be a high risk strategy. BMJ 1994; 308: 72–4.
- Sharp SJ, Thompson SG, Altman DG., The relation between treatment benefit and underlying risk in meta-analysis. BMJ 1996; 313: 735–8.
- Stewart LA, Clarke MJ., Practical methodology of meta-analyses (overviews) using updated individual patient data. Stat Med 1995; 14: 2057–79.
- Rothwell PM., Can overall results of clinical trials be applied to all patients? Lancet 1995; 345: 1616–19.
- Glasziou PP, Irwig LM., An evidence based approach to individualising treatment. BMJ 1995; 311: 1356–9.
- Rothwell PM, Warlow CP on behalf of the European Carotid Surgery Trialists? Collaborative Group. Prediction of benefit from carotid endarterectomy in individual patients: a risk-modelling study. Lancet 1999; 353: 2105–10.
- Laupacis A, Wells G, Richardson WS, Tugwell P, for the Evidence-Based Medicine Working Group. User's guides to the medical literature. V. How to use an article about prognosis. JAMA 1994; 272: 234–7.
- Cook RJ, Sackett DL., The number needed to treat: a clinically useful measure of treatment effect. BMJ 1995; 310: 452–4.
- Grover SA, Lowensteyn I, Esrey KL, Steinert Y, Joseph L, Abrahamowicz M., Do doctors accurately assess coronary risk in their patients? Preliminary results of the coronary health assessment study. BMJ 1995; 310: 975–8.
- Szabo E, Moody H, Hamilton T, Ang C, Kovithavongs C, Kjellstrand C., Choice of treatment improves quality of life: a study of patients undergoing dialysis. Arch Intern Med 1997; 157: 1352–6.
- Greenfield S, Kaplan SH, Ware JE Jr, Yano EM, Frank HJL., Patients' participation in medical care: effects on blood sugar control and quality of life in diabetes. J Gen Intern Med 1988; 3: 448–57.
- Kaplan SH, Greenfield S, Ware JE Jr., Assessing the effects of physician-patient interactions on the outcomes of chronic disease. Med Care 1989; 27 (suppl 3): S110–127.
- Schulman BA., Active patient orientation and outcomes in hypertension treatment. Application of a socio-organizational perspective. Med Care 1979; 17: 267–80.
- Stewart MA., Effective physician-patient communication and health outcomes: a review. Can Med Assoc J 1995; 152: 1423–33.
- Vickery DM, Golaszewski TJ, Wright EC, Kalmer H., The effect of self-care inter-ventions on the use of medical service within a Medicare population. Med Care 1988; 26: 580–8.
- Gage BF, Cardinalli AB, Owens DK., Cost-effectiveness of preference-based antithrom-botic therapy for patients with nonvalvular atrial fibrillation. Stroke 1998; 29: 1083–91.
- O'Connor AM., Consumer/patient decision support in the new millenium: where should our research take us? Can J Nurs Res 1997; 29: 7–12.
- Straus SE, Sackett DL., The likelihood of being helped versus harmed – a new method of presenting information to patients about the risks and benefits of therapy. 3rd Cochrane Colloquium, Amsterdam, October 1997.
- Ross JM., Commentary on applying the results of trials and systematic reviews to individual patients [EBM Note]. Evidence-Based Med 1998; 3: 167.
