Jenny Doust Copyright (c) 2013 All rights reserved. http://works.bepress.com/jenny_doust Recent documents in Jenny Doust en-us Thu, 31 Jan 2013 17:23:06 PST 3600 Antibiotics for bronchiolitis in children http://works.bepress.com/jenny_doust/35 http://works.bepress.com/jenny_doust/35 Sun, 21 Oct 2012 21:17:00 PDT Background: Bronchiolitis is a serious, potentially life-threatening respiratory illness commonly affecting babies. It is often caused by respiratory syncytial virus (RSV). Antibiotics are not recommended for bronchiolitis unless there is concern about complications such as secondary bacterial pneumonia or respiratory failure. Nevertheless, they are used at rates of 34% to 99% in uncomplicated cases.

Objectives: To evaluate the effectiveness of antibiotics for bronchiolitis.

Search strategy: We searched the Cochrane Central Register of Controlled Trials (CENTRAL 2010, issue 4), which includes the Cochrane Acute Respiratory Infection Group’s Specialised Register, and the Database of Abstracts of Reviews of Effects, MEDLINE (January 1966 to November 2010), EMBASE (1990 to December 2010) and Current Contents (2001 to December 2010).

Selection criteria: Randomised controlled trials (RCTs) comparing antibiotics to placebo in children under two years diagnosed with bronchiolitis, using clinical criteria (including respiratory distress preceded by coryzal symptoms with or without fever). Primary clinical outcomes included time to resolution of signs or symptoms (pulmonary markers included respiratory distress, wheeze, crepitations, oxygen saturation and fever). Secondary outcomes included hospital admissions, length of hospital stay, re-admissions, complications or adverse events and radiological findings.

Data collection and analysis: Two review authors independently analysed the search results.

Main results: Five studies (543 participants) met our inclusion criteria. One study randomised 52 children to either ampicillin or placebo and found no significant difference between the two groups for length of illness. A small study (21 children) with higher risk of potential bias randomised children with proven RSV infection to clarithromycin or placebo and found clarithromycin may reduce hospital readmission (8% antibiotics versus 44% placebo; Fishers exact; P = 0.081). The two studies (267 children) providing adequate data for length of hospital stay showed no difference between antibiotics and control (pooled mean difference 0.34; 95% CI -0.71 to 1.38). Two studies randomised children to intravenous ampicillin, oral erythromycin and control and found no difference for most symptom measures. None of the trials reported deaths.

Authors’ conclusions: This review found minimal evidence to support the use of antibiotics for bronchiolitis. Research to identify a possible small subgroup of patients who have complications from bronchiolitis such as respiratory failure and who may benefit from antibiotics is justified.

]]> Geoffrey Spurling et al. Predicting influenza A and 2009 H1N1 influenza in patients admitted to hospital with acute respiratory illness http://works.bepress.com/jenny_doust/34 http://works.bepress.com/jenny_doust/34 Tue, 09 Oct 2012 22:30:35 PDT Objective: To create a clinical decision tool for suspected influenza A (including 2009 H1N1) to facilitate treatment and isolation decisions for patients admitted to hospital with an acute respiratory illness from the emergency department (ED) during a 2009 H1N1 pandemic.

Methods: Cross-sectional study conducted in two hospitals in Queensland, Australia. All patients admitted to hospital from the ED between 24 May and 16 August 2009 with an acute respiratory illness were included. All had nasal and throat swabs taken. Data were collected from clinical chart review regarding clinical symptoms, co-morbidities, examination findings, pathology and radiology results. Influenza A status was detected by reverse transcription - PCR assay. Univariate and multivariate regression analyses were performed to identify independent predictors of influenza A status.

Results: 346 consecutive patients were identified, of which 106 were positive for 2009 H1N1 influenza; an additional 11 patients were positive for other influenza A viruses. Independent clinical predictors (with points allocated using weighted scoring) for all types of influenza A in patients admitted with acute respiratory illness were: age 18-64 years (2 points); history of fever (2); cough (1); normal level of consciousness (2); C-reactive protein >5 and ≤100 mg/l (2) and normal leucocyte count (1). A clinical score of 5 (presence of two or three predictors) gave a sensitivity of 93% (95% CI 87% to 96%), specificity of 36% (95% CI 30% to 42%), resulting in a negative-predictive value of 91% (95% CI 83% to 95%).

Conclusion: A clinical prediction tool was developed that may be able to assist in making appropriate isolation decisions during future 2009 H1N1 outbreaks.

]]> Gerben B. Keijzers et al. Cardiovascular risk scores do not account for the effect of treatment: A review http://works.bepress.com/jenny_doust/32 http://works.bepress.com/jenny_doust/32 Sun, 08 May 2011 18:10:29 PDT Objective - To compare the strengths and limitations of cardiovascular risk scores available for clinicians in assessing the global (absolute) risk of cardiovascular disease.

Design - Review of cardiovascular risk scores.

Data sources - Medline (1966 to May 2009) using a mixture of MeSH terms and free text for the keywords ‘cardiovascular’, ‘risk prediction’ and ‘cohort studies’.

Eligibility - criteria for selecting studies A study was eligible if it fulfilled the following criteria: (1) it was a cohort study of adults in the general population with no prior history of cardiovascular disease and not restricted by a disease condition; (2) the primary objective was the development of a cardiovascular risk score/equation that predicted an individual's absolute cardiovascular risk in 5–10 years; (3) the score could be used by a clinician to calculate the risk for an individual patient.

Results - 21 risk scores from 18 papers were identified from 3536 papers. Cohort size ranged from 4372 participants (SHS) to 1591209 records (QRISK2). More than half of the cardiovascular risk scores (11) were from studies with recruitment starting after 1980. Definitions and methods for measuring risk predictors and outcomes varied widely between scores. Fourteen cardiovascular risk scores reported data on prior treatment, but this was mainly limited to antihypertensive treatment. Only two studies reported prior use of lipid-lowering agents. None reported on prior use of platelet inhibitors or data on treatment drop-ins.

Conclusions - The use of risk-factor-modifying drugs—for example, statins—and disease-modifying medication—for example, platelet inhibitors—was not accounted for. In addition, none of the risk scores addressed the effect of treatment drop-ins—that is, treatment started during the study period. Ideally, a risk score should be derived from a population free from treatment. The lack of accounting for treatment effect and the wide variation in study characteristics, predictors and outcomes causes difficulties in the use of cardiovascular risk scores for clinical treatment decision.

]]> Su May Liew et al. What is Cochrane all about? http://works.bepress.com/jenny_doust/31 http://works.bepress.com/jenny_doust/31 Sun, 08 May 2011 16:25:51 PDT Recently the Australian Minister for Health, the Hon Kay Patterson, announced that Australia is purchasing the Cochrane Library for all Australians. Australians will now have access to the library free of charge through the web.

]]> Chris Del Mar et al. General Practice Diagnosing patients with tiredness in general practice http://works.bepress.com/jenny_doust/30 http://works.bepress.com/jenny_doust/30 Sun, 08 May 2011 16:21:33 PDT Trying to sort out which patients have a relatively simple problem that will resolve spontaneously from those that require medical treatment and those that require urgent attention is one of the aspects of general practice that makes it interesting and challenging. Patients who present with tiredness in general practice can have any of a long list of diagnoses ranging from the trivial to the life threatening, and knowing how to determine who has which is an essential skill for competent practice.

]]> Jenny Doust General Practice Diagnosis of heart failure in primary care http://works.bepress.com/jenny_doust/29 http://works.bepress.com/jenny_doust/29 Wed, 04 May 2011 19:24:23 PDT Extract:

Heart failure is a syndrome resulting from a structural or functional cardiac disorder. For a diagnosis of heart failure to be made, there should be symptoms or signs, such as breathlessness, effort intolerance or fluid retention, together with objective evidence of cardiac dysfunction.
Heart failure is an increasingly important chronic disease syndrome, associated with poor prognosis, poor quality of life for patients, and high healthcare costs. In the general population, where all grades of heart failure are represented, 5 year mortality is around 42%; however, where the diagnosis is established during a hospital admission, 5 year mortality is between 50–75%, although the prognosis has improved in the past 10 years.

]]> F. D. R. Hobbs et al. Teaching evidence based laboratory medicine http://works.bepress.com/jenny_doust/28 http://works.bepress.com/jenny_doust/28 Tue, 08 Mar 2011 15:03:34 PST Jenny Doust et al. Antibiotics for bronchiolitis in children http://works.bepress.com/jenny_doust/27 http://works.bepress.com/jenny_doust/27 Sun, 27 Feb 2011 22:49:42 PST Background
Bronchiolitis is a serious, potentially life-threatening respiratory illness commonly affecting young babies. It is most often caused by Respiratory Syncytial Virus (RSV). Diagnosis is usually made on clinical grounds (especially tachypnoea and wheezing in a child less than two years of age). Antibiotics are not recommended for bronchiolitis unless there is concern about complications such as secondary bacterial pneumonia. Nevertheless, they are used at rates of 34 to 99% in uncomplicated cases.

Objectives
To evaluate the use of antibiotics for bronchiolitis.

Search strategy
We searched the Cochrane Central Register of Controlled Trials (CENTRAL) which includes the Acute Respiratory Infection Groups' specialized register, the Database of Abstracts of Reviews of Effects (DARE) (The Cochrane Library 2006, issue 3); MEDLINE (January 1966 to August Week 2, 2006); EMBASE (1990 to March 2006); and Current Contents (2001 to September 2006).

Selection criteria
Types of studies: single or double blind randomised controlled trials comparing antibiotics to placebo in the treatment of bronchiolitis.
Types of participants: children under the age of two years diagnosed with bronchiolitis using clinical criteria (including respiratory distress preceded by coryzal symptoms with or without fever). Types of interventions: oral, intravenous, intramuscular or inhaled antibiotics versus placebo. Types of outcome measures: primary clinical outcomes: time for the resolution of symptoms/signs (pulmonary markers: respiratory distress; wheeze; crepitations; oxygen saturation; and fever). Secondary outcomes: hospital admissions; time to discharge from hospital; re-admissions; complications/adverse events developed; and radiological findings.

Data collection and analysis
Data were analysed using Review Manager software, version 4.2.7.

Main results
One study met our inclusion criteria. It randomised children presenting clinically with bronchiolitis to either ampicillin or placebo. The main outcome measure was duration of illness and death. There was no significant difference between the two groups for length of illness and there were no deaths in either group.

Authors' conclusions
This review found no evidence to support the use of antibiotics for bronchiolitis. This results needs to be treated with caution given only one RCT justified inclusion. It is unlikely that simple RCTs of antibiotics against placebo for bronchiolitis will be undertaken in future. Research to identify a possible small subgroup of patients presenting with bronchiolitis-like symptoms who may benefit from antibiotics may be justified. Otherwise, research may be better focused on determining the reasons for clinicians to use antibiotics so readily for bronchiolitis, and ways of reducing their anxiety, and therefore their use of antibiotics for bronchiolitis.

]]> Geoffrey KP Spurling et al. Early invasive versus conservative strategies for unstable angina & non-ST-elevation myocardial infarction in the stent era http://works.bepress.com/jenny_doust/26 http://works.bepress.com/jenny_doust/26 Sun, 27 Feb 2011 22:49:40 PST Background
In patients with unstable angina and non-ST-elevation myocardial infarction (UA/NSTEMI) two strategies are possible: a routine invasive strategy where all patients undergo coronary angiography shortly after admission and, if indicated, coronary revascularization; or a conservative strategy where medical therapy alone is used initially with selection of patients for angiography based on clinical symptoms or investigational evidence of persistent myocardial ischemia.


Objectives
To determine the benefits of an invasive compared to a conservative strategy for treating UA/NSTEMI in the stent era.


Search strategy
The Cochrane Central Register of Controlled Trials (Issue 3 2005), MEDLINE and EMBASE were searched from 1996 to September 2005 with no language restrictions.


Selection criteria
Included studies were prospective trials comparing invasive with conservative strategies in UA/NSTEMI.


Data collection and analysis
We identified 5 studies (7818 participants). Using intention-to-treat analysis with random effects models, summary estimates of relative risk (95% confidence interval [CI]) were determined for primary end-points of all-cause death, fatal and non-fatal myocardial infarction; all-cause death or non-fatal myocardial infarction; and refractory angina. Further analysis of included studies was undertaken based on whether glycoprotein IIb/IIIa receptor antagonists were used routinely. Heterogeneity was assessed using chi-square and variance (I2) methods.


Main results
In the all-study analysis, mortality during initial hospitalization showed a trend to hazard with an invasive strategy; relative risk 1.59 (95% CI 0.96 to 2.64). Mortality and myocardial infarction assessed at 2-5 years in two trials were significantly decreased by an invasive strategy with relative risk of 0.75 (95% CI 0.62 to 0.92) and 0.75 (95% CI 0.61 to 0.91) respectively. The composite end-point of death or non-fatal myocardial infarction was significantly decreased by an invasive strategy at several time points after initial hospitalization. The incidence of early (<4>months) and intermediate (6-12 months) refractory angina were both significantly decreased by an invasive strategy; relative risk 0.47 (95% CI 0.32 to 0.68) and 0.67 (95% CI 0.55 to 0.83) respectively, as were early and intermediate rehospitalization rates with relative risk 0.60 (95% CI 0.41 to 0.88) and 0.67 (95% CI 0.61 to 0.74) respectively. The invasive strategy was associated with a two-fold increase in the relative risk of peri-procedural myocardial infarction (as variably defined) and a 1.7-fold increase in the relative risk of bleeding.


Authors' conclusions
An early invasive strategy is preferable to a conservative strategy in the treatment of UA/NSTEMI.

]]> Michel R. Hoenig et al. A systematic review of brachytherapy. Is it an effective and safe treatment for localised prostate cancer? http://works.bepress.com/jenny_doust/25 http://works.bepress.com/jenny_doust/25 Sun, 27 Feb 2011 15:24:56 PST BACKGROUND Brachytherapy is a promising treatment for prostate cancer as it may have reduced rates of impotence and incontinence.

OBJECTIVE General practitioners can influence the treatment patients receive by their referral patterns, so it is important they understand the effectiveness and safety of treatment. We reviewed the primary literature on brachytherapy as sole therapy for localised prostate cancer.

DISCUSSION Although there have been many studies on the safety and effectiveness of brachytherapy, there have been no trials of brachytherapy versus other treatments that would control for factors such as tumour stage, grade, or initial prostate specific antigen levels. Brachytherapy for localised prostate cancer appears to have equivalent survival rates to surgery and lower rates of impotence and urinary incontinence.

]]> Jenny Doust et al. Promoting better use of the PSA test in general practice: Randomized controlled trial of educational strategies based on outreach visits and mailout http://works.bepress.com/jenny_doust/24 http://works.bepress.com/jenny_doust/24 Sun, 27 Feb 2011 15:13:40 PST Background. Prostate-specific antigen (PSA) testing for prostate cancer is controversial. Demand for PSA testing is likely to rise in the UK, Australia and other western countries. Primary care needs to develop appropriate strategies to respond to this demand.

Objectives. Our aim was to compare the effectiveness of educational outreach visits (EOVs) and mailout strategies targeting PSA testing in Australian primary care.

Methods. A randomized controlled trial was conducted in general practices in southern Adelaide. The main outcome measures at baseline, 6 months and 12 months post-intervention were PSA testing rates and GP knowledge in key areas relating to prostate cancer and PSA testing.

Results. The interventions were able to demonstrate a change in clinical practice. In the 6 months post-intervention, median PSA testing rate in the EOV group was significantly lower than in the postal group, which in turn was significantly lower than the control group (P 0.001). Statistically significant differences were not, however, maintained in the 6 to 12 month postintervention period. The EOV group, at 6 months follow-up, had a significantly greater proportion of ‘correct’ responses than the control group to questions about prostate cancer treatment effectiveness (P = 0.004) and endorsement of PSA screening by professional bodies (P = 0.041).

Conclusions. Primary care has a central role in PSA testing for prostate cancer. Clinical practice in this area is receptive to evidence-based interventions.

]]> D Weller et al. Identifying health centers in Honduras infested with Rhodnius prolixus using the seroprevalence of Chagas disease in children younger than 13 years http://works.bepress.com/jenny_doust/23 http://works.bepress.com/jenny_doust/23 Wed, 23 Feb 2011 18:40:54 PST The objective of this study is to determine if a Chagas disease protocol starting with a serological survey is as reliable at identifying insect-infested areas as one using the gold standard entomological survey. The study found that health center areas infested with Rhodnius prolixus were identified using a threshold seroprevalence of 0.1%. The serological survey took half the time and was 30% less expensive than the entomological survey. Developing countries with limited resources may find this strategy useful in combating Chagas disease. This strategy also identifies seropositive children, which facilitates their treatment.

]]> Geoffrey Spurling et al. How well does B-type natriuretic peptide predict death and cardiac events in patients with heart failure: Systematic review http://works.bepress.com/jenny_doust/22 http://works.bepress.com/jenny_doust/22 Wed, 23 Feb 2011 18:30:06 PST Objective To assess how well B-type natriuretic peptide (BNP) predicts prognosis in patients with heart failure.

Design Systematic review of studies assessing BNP for prognosis in patients with heart failure or asymptomatic patients.

Data sources Electronic searches of Medline and Embase from January 1994 to March 2004 and reference lists of included studies.

Study selection and data extraction We included all studies that estimated the relation between BNP measurement and the risk of death, cardiac death, sudden death, or cardiovascular event in patients with heart failure or asymptomatic patients, including initial values and changes in values in response to treatment. Multivariable models that included both BNP and left ventricular ejection fraction as predictors were used to compare the prognostic value of each variable. Two reviewers independently selected studies and extracted data.

Data synthesis 19 studies used BNP to estimate the relative risk of death or cardiovascular events in heart failure patients and five studies in asymptomatic patients. In heart failure patients, each 100 pg/ml increase was associated with a 35% increase in the relative risk of death. BNP was used in 35 multivariable models of prognosis. In nine of the models, it was the only variable to reach significance—that is, other variables contained no prognostic information beyond that of BNP. Even allowing for the scale of the variables, it seems to be a strong indicator of risk.

Conclusion Although systematic reviews of prognostic studies have inherent difficulties, including the possibility of publication bias, the results of the studies in this review show that BNP is a strong prognostic indicator for both asymptomatic patients and for patients with heart failure at all stages of disease.

]]> Jenny A. Doust et al. Evidence based answers - Is salmeterol safe in asthma? http://works.bepress.com/jenny_doust/21 http://works.bepress.com/jenny_doust/21 Wed, 23 Feb 2011 18:17:09 PST Case history
SW, 21 years of age, presented for a prescription for her salbutamol puffer. She had a long history of chronic persistent asthma usually exacerbated by upper respiratory tract infections (URTIs). These exacerbations had occasionally landed her in hospital but never in intensive care. After a friend died of an asthma attack, SW adhered rigorously to her asthma plan and always used a spacer for her preventer, fluticasone. It therefore surprised me when I noticed that she had had no URTIs yet had been prescribed salbutamol by another general practitioner in the practice only 2 weeks previously. In response to my concern, she admitted that despite using the correct puffer technique, the salbutamol was only lasting a few hours before she became breathless. She found she needed the salbutamol a number of times a day. We decided to add a long acting beta agonist (LABA), salmeterol, to her regimen to help control her symptoms. SW agreed but asked: ‘It will help won’t it, I don’t want to end up like my friend.’ Obviously SW was worried with her recent increase in symptoms. I assured her that with her current regimen and a good action plan, there should be no cause for concern. She left with her salmeterol prescription feeling reassured. However, a thought nagged me for the rest of the session. Wasn’t fenoterol, a LABA, found to cause asthma deaths?

]]> Geoffrey Spurling et al. The role of BNP testing in heart failure http://works.bepress.com/jenny_doust/20 http://works.bepress.com/jenny_doust/20 Wed, 23 Feb 2011 16:10:34 PST Brain natriuretic peptide (BNP) levels are simple and objective measures of cardiac function. These measurements can be used to diagnose heart failure, including diastolic dysfunction, and using them has been shown to save money in the emergency department setting. The high negative predictive value of BNP tests is particularly helpful for ruling out heart failure. Treatment with angiotensin-converting enzyme inhibitors, angiotensin-II receptor blockers, spironolactone, and diuretics reduces BNP levels, suggesting that BNP testing may have a role in monitoring patients with heart failure. However, patients with treated chronic stable heart failure may have levels in the normal range (i.e., BNP less than 100 pg per mL and N-terminal proBNP less than 125 pg per mL in patients younger than 75 years). Increases in BNP levels may be caused by intrinsic cardiac dysfunction or may be secondary to other causes such as pulmonary or renal diseases (e.g., chronic hypoxia). BNP tests are correlated with other measures of cardiac status such as New York Heart Association classification. BNP level is a strong predictor of risk of death and cardiovascular events in patients previously diagnosed with heart failure or cardiac dysfunction.

]]> Jenny Doust et al. Is pulse palpation helpful in detecting atrial fibrillation? A systematic review http://works.bepress.com/jenny_doust/19 http://works.bepress.com/jenny_doust/19 Wed, 23 Feb 2011 15:56:37 PST Background: Atrial fibrillation in the elderly is common and potentially life threatening. The classical sign of atrial fibrillation is an irregularly irregular pulse.

Objective: The objective of this research was to determine the accuracy of pulse palpation to detect atrial fibrillation.

Methods: We searched Medline, EMBASE, and the reference lists of review articles for studies that compared pulse palpation with the electrocardiogram (ECG) diagnosis of atrial fibrillation. Two reviewers independently assessed the search results to determine the eligibility of studies, extracted data, and assessed the quality of the studies.

Results: We identified 3 studies (2385 patients) that compared pulse palpation with ECG. The estimated sensitivity of pulse palpation ranged from 91% to 100%, while specificity ranged from 70% to 77%. Pooled sensitivity was 94% (95% confidence interval [CI], 84%–97%) and pooled specificity was 72% (95% CI, 69%–75%). The pooled positive likelihood ratio was 3.39, while the pooled negative likelihood ratio was 0.10.

Conclusions: Pulse palpation has a high sensitivity but relatively low specificity for atrial fibrillation. It is therefore useful for ruling out atrial fibrillation. It may also be a useful screen to apply opportunistically for previously undetected atrial fibrillation. Assuming a prevalence of 3% for undetected atrial fibrillation in patients older than 65 years, and given the test’s sensitivity and specificity, opportunistic pulse palpation in this age group would detect an irregular pulse in 30% of screened patients, requiring further testing with ECG. Among screened patients, 0.2% would have atrial fibrillation undetected with pulse palpation.

]]> Georga Cooke et al. Scrub typhus serologic testing with the indirect immunofluorescence method as a diagnostic gold standard: A lack of consensus leads to a lot of confusion http://works.bepress.com/jenny_doust/18 http://works.bepress.com/jenny_doust/18 Tue, 22 Feb 2011 18:47:48 PST A review was performed to determine the evidence base for scrub typhus indirect immunofluorescence assay (IFA) methodologies and the criteria for positive results. This review included a total of 109 publications, which comprised 123 eligible studies for analysis (14 publications included 2 substudies). There was considerable underreporting of the IFA methodology and seropositivity criteria used, with most studies using a defined cutoff titer rather than an increase in the titer in paired samples. The choice of positivity cutoff titer varied by country and purpose of the IFA test. This variation limits the comparability of seroprevalence rates between studies and, more seriously, raises questions about the appropriateness of the cutoffs for positive IFA results chosen for diagnosis of acute scrub typhus infection. We suggest that the diagnosis of scrub typhus using IFA should be based on a 4-fold increase in the titer in paired serum samples and should only be based on a single sample titer when there is an adequate local evidence base.

]]> Stuart D. Blacksell et al. Seriously working together: Integrated governance models to achieve sustainable partnerships between health care organisations http://works.bepress.com/jenny_doust/17 http://works.bepress.com/jenny_doust/17 Tue, 22 Feb 2011 18:22:32 PST Objective: To identify sustainable governance arrangements for health care organisations undertaking integrated health service delivery based on best available evidence.

Method: Systematic review of the literature (1990–2006), supported by key informant interviews as an integrative process.

Results: 16 studies met our selection criteria. All described enablers of and barriers to delivering integrated health services. We identified three models for integrated health care governance with a demonstrated ability to be sustained in the medium term. Common themes that emerged as the logical starting point for more ambitious integrated governance arrangements regionally were: the need for a clear separation between governance and operational management; and the need for local communities with the vision, leadership and commitment to extend health service integration. These themes were reinforced by interviews with key informants. Careful measurement of the process, impact and outcomes of such activities was often overlooked.

Conclusion: State governments are increasingly attempting to work with non-government organisations and the private sector to maximise scarce resources in the face of increasing health care demand. Ambitious integration agendas must be underpinned by effective governance mechanisms that are appropriate to the undertaking, the stakeholders involved and the scale of delivery.

]]> Claire L. Jackson et al. Qualification versus validation of biomarkers http://works.bepress.com/jenny_doust/16 http://works.bepress.com/jenny_doust/16 Tue, 22 Feb 2011 18:19:14 PST The phases of research used to evaluate new drugs provide a useful reference point for determining the studies that need to be conducted to evaluate new biomarkers. However, biomarkers do not have a single pathway for changing health outcomes and may be used for a variety of purposes, such as improving diagnostic criteria, improving prognosis, improving the monitoring of disease or as a measurement of health outcomes. The impact on health outcomes is also less direct and is dependent on the sequence of actions taken as a consequence of the test results. The different purposes of biomarkers and the less direct effect on health outcomes require different study designs to those used for the evaluation of pharmaceutical products and a more careful interpretation of results. Greater collaboration between researchers designing laboratory-based qualification studies and researchers designing clinical validation studies could achieve a process of evaluation for biomarkers that is both reliable and efficient.

]]> Jenny Doust EBM journal clubs in general practice http://works.bepress.com/jenny_doust/15 http://works.bepress.com/jenny_doust/15 Tue, 22 Feb 2011 18:19:13 PST Evidence based medicine (EBM) changes the way medicine is practised by integrating individual clinical expertise with the best available external clinical evidence and patient values. In hospitals, clinicians can incorporate evidence into clinical decision making during ward rounds and team consultations. In general practice however, this can be more challenging; consultations are shorter (often with patients backed up waiting to be seen), clinical decision making is more solitary, and there is less access to library services. Searching for and using evidence during the consultation process is only rarely feasible. One solution is the establishment of EBM journal clubs.

]]> Jenny Doust et al.