Article Title Resident Name, MD SVCH6/13/2016 Journal Club

Clinical Vignette 54 yo AAM w PMH of comes to SVCH w CC: MedsHosp.course

Objectives of the Journal Club

What is already known on this topic

Where was it published? In which one of the “Big Five”?

Article Title Author names Affilitiated institutions…

Objectives of the Article

Design RCT or cohort studies or meta-analysis

Outcome measures Proportional reduction in CAD events and stroke Life years gained Prevalence of adverse effects

Methods Effect of changing the 4 risk factors calculated by multiplying the relative risks associated with each factor

Methods - Statistics

Results Reduces CAD events by 88% (95% confidence interval, 84% to 91%) CVA by 80% (71% to 87%)

Study Conclusion This strategy could largely prevent heart attacks and stroke if taken by everyone aged 55 and older and everyone with existing CVS disease

EBM assessment of the study Are the results of the study valid? What are the results? Will the results help me in caring for my patients?

Are the results of the study valid? Did the overview address a focused clinical question? Yes….

Are the results of the study valid? Was the assignment of patients to treatment randomized? Were all patients who entered the trial properly accounted for and attributed at its conclusion? Was follow-up complete?

Are the results of the study valid? Were patients, their clinicians, and study personnel 'blind' to treatment? Were the groups similar at the start of the trial? Baseline prognostic factors (demographics, co- morditity, disease severity, other known confounders) balanced? Aside from the experimental intervention, were the groups treated equally?

What are the Results How large was the treatment effect? Absolute risk reduction? Relative risk reduction?

How precise were the results? How precise was the estimate of the treatment effect? Confidence intervals? Not ideal Risk reduction was calculated as relative risk reduction No absolute risk reduction was measured and consequently no NNT could be derived

Will the results help me in caring for my patients? Patients similar for demographics, severity, co-morbidity and other prognostic factors? Compelling reason why the results should not be applied? Were all clinically important outcomes considered? Were all clinically important outcomes considered?

Are the benefits worth the harms and costs? NNT for different outcomes? Yes, if efficacy and side effects incidence are confirmed by randomized controlled trials

Take home message

Any questions ?

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