UBC Wiki - User contributions [en]

Evidence Appraisal Integrated Activities

2026-09-24T15:15:44Z

JamesMcCormack:

'''OBJECTIVE'''

To critically appraise studies, develop a brief synopsis of the trial results, succinctly present the results and then put the results into a proper clinical context

'''INITIAL PRE-READING'''

'''How To Critically Appraise an RCT In 10 minutes'''
*[https://itunes.apple.com/ca/book/how-to-critically-appraise/id524600667?mt=11 iBook/iPad version]
*[https://therapeuticseducation.org/sites/therapeuticseducation.org/files/Ten_Minute_Critical_Appraisal.pdf PDF version]
Watch this video
[http://youtu.be/QUW0Q8tXVUc Viva La Evidence]

'''Study Results at Your Fingertips'''
*[https://mystudies.org MyStudies] - Free access

'''INTEGRATION ACTIVITY FORMAT'''
# Students placed in groups of ~ 5-7
# Each group is given one of the studies below to review
# Students then work in pairs and develop a one-slide critical appraisal and results synopsis
# One student in each group will be chosen at random to present their group findings to the class
# A discussion about the appraisal and the appropriate clinical context for the results is had with the entire class for each study

'''MODULE'''
[[File:Screen Shot 2022-01-09 at 10.00.16 AM.jpg|thumb|'''TRIAL PRESENTATION FORMAT'''|none]]

Studies chosen include landmark studies and/or studies that address important therapeutic issues for the particular module

'''ACADEMIC YEAR 1 - FIRST TERM'''

1) FOUNDATION STUDIES (Groups)
*[https://pubmed.ncbi.nlm.nih.gov/37952131 SELECT] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/12466506 AFFIRM] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/22085343 AIM-HIGH] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/10639539 HOPE] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/18378519 HYVET] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/15007110 PROVE-IT] Groups 6,18,30
*[http://www.ncbi.nlm.nih.gov/pubmed/15755765 TNT] Groups 7,19,31
*[https://pubmed.ncbi.nlm.nih.gov/26378978 EMPAREG] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/17984165 ILLUMINATE] Groups 9,21,33
*[https://pubmed.ncbi.nlm.nih.gov/26551272/ SPRINT] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/15325833 CARDS] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/12117397 WHI] Groups 12,24,36

'''ACADEMIC YEAR 1 - SECOND TERM'''

2) INTRO TO INFECTIOUS DISEASE STUDIES

[https://wiki.ubc.ca/images/8/8b/Antibiotic_Sensitivity_Chart_2024.pdf The "Best" Antibiotic Sensitivity Chart Ever]
*[http://www.ncbi.nlm.nih.gov/pubmed/17567657 IV vs PO antibiotics] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/24603565 Delayed antibiotics for respiratory tract infections] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/11159657 Delayed antibiotics for otitis media] Groups 3,15,27
*[https://pubmed.ncbi.nlm.nih.gov/27455166/ Duration of treatment for community acquired pneumonia] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/22726802 Duration of treatment for pyelonephritis] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/25830421 Choice of antibiotic for community acquired pneumonia-1] Groups 6,18,30
*[http://www.ncbi.nlm.nih.gov/pubmed/25286173 Choice of antibiotic for community acquired pneumonia-2] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/20647284 HPV vaccine study] Groups 8,20,32
*[https://pubmed.ncbi.nlm.nih.gov/40888720/ High-Dose Influenza Vaccine - hospitalization] Groups 9,21,33
*[https://pubmed.ncbi.nlm.nih.gov/40884442 High-Dose Influenza Vaccine - cardiovascular outcomes] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/27626517 Herpes zoster vaccine study 1] Groups 11,23,35
*[https://www.ncbi.nlm.nih.gov/pubmed/25916341 Herpes zoster vaccine study 2] Groups 12,24,36

3) MUSCULOSKELETAL STUDIES

*[http://www.ncbi.nlm.nih.gov/pubmed/28199814 Baricitinib versus Placebo or Adalimumab in Rheumatoid Arthritis] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/0010979111 CLASS – celecoxib vs NSAIDs] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/26501533 Naproxen with cyclobenzaprine, oxycodone/acetaminophen, or placebo for low back pain] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/24395557 Glucosamine and chondroitin for OA] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/12546607 Acetaminophen vs diclofenac for OA] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/23964752 Diclofenac gel for acute neck pain] Groups 6,18,30
*[https://pubmed.ncbi.nlm.nih.gov/15468367/ Topical diclofenac vs oral diclofenac] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/25064594 Acetaminophen for low back pain] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/7611589 Misoprostol and NSAID induced ulcers] Groups 9,21,33
*[http://www.ncbi.nlm.nih.gov/pubmed/20131255 Low dose vs high dose colchicine for gout] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/22508468 TEAR - oral triple therapy versus etanercept plus methotrexate in early aggressive rheumatoid arthritis] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/25589511 MOVES - Glucosamine and chondroitin for OA for moderate to severe pain] Groups 12,24,36

4) DERMATOLOGY STUDIES

*[https://www.ncbi.nlm.nih.gov/pubmed/9598014 Glycolic acid 5% Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/21896132 Glycolic acid 10% Acne]
*[https://www.ncbi.nlm.nih.gov/pubmed/14531866 Petrolatum vs Ceramide/skin related lipids Hand Dermatitis]
*[https://www.ncbi.nlm.nih.gov/pubmed/11896774 Vitamin C Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/17515510 Retinol (VitaminA) Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/21896129 Hyaluronic acid Atopic Dermatitis]

5) EENT STUDIES

[http://www.amstar.ca/docs/AMSTARguideline.pdf AMSTAR meta-analysis checklist]

'''Scenario 1 - Otitis Media''' - GROUPS 1, 7, 18, 19, 25, 36

Anthony Martin arrives at your pharmacy somewhat frustrated since his family physician declined to write an antibiotic prescription for his two and half year old son, Oscar. His symptoms started yesterday afternoon - Oscar complains of right ear pain but there is no discharge. Rectal temperature taken today was 38.5 degrees. His wife is sure Oscar has an ear infection since the last time he had these same symptoms, that was ultimately the diagnosis. Mr. Martin asks if you think buying acetaminophen is really “enough”?

[https://pubmed.ncbi.nlm.nih.gov/26099233/ Antibiotics for acute otitis media in children]

'''Scenario 2 - Allergic Rhinitis''' - GROUPS 2, 8, 17, 20, 26, 35

Ruby Parmar is a firefighter. She is plagued by sinus congestion (preventing her from sleeping) and a runny nose associated with seasonal allergies. Her prescription for intranasal triamcinolone is typically effective, but she would like to know if a non-sedating anti-allergy pill would work just as well since it’s inconvenient carrying around the “nose spray”.

[https://www.ncbi.nlm.nih.gov/pubmed/28234147 Intranasal steroids vs antihistamines for allergic rhinitis]

'''Scenario 3 - Acute Sinusitis''' - GROUPS 3, 9, 16, 21, 27, 34

You are seeing a patient in clinic before her appointment with the primary care physician. She was feeling unwell with a “flu” last week. While most of her symptoms have resolved (cough, fever), the nasal congestion and discharge persists and so she has made an appointment (she is an otherwise healthy 32 year old with treated thyroid disease). She would like your advice for what treatment she should ask the doctor to prescribe.

[http://www.ncbi.nlm.nih.gov/pubmed/24293353 Intranasal steroids for acute sinusitis]

'''Scenario 4 - Glaucoma''' - GROUPS 4, 10, 15, 22, 28, 33

Mrs. Ada Waters is a 63 year-old woman you. Her ophthalmologist prescribed timolol and xalatan eye drops for treatment of open angle glaucoma. She has never really felt much different on treatment since she recovered from her first episode (of acute angle closure glaucoma requiring ER visit) and surgery. She asks you if the treatment is really making a difference.

[https://www.ncbi.nlm.nih.gov/pubmed/17943780 Interventions for open angle glaucoma]

'''Scenario 5 - Sore Throat''' - GROUPS 5, 11, 14, 23, 29, 32

You have a good friend who is applying for pharmacy. Her invitation for the multiple-mini interview (MMI) is coming up soon, but she is starting to experience a sore throat. While she is worried about not being able to speak through all of those stations, she knows she often gets a terrible headache along with her sore throat. She has an unused prescription for amoxicillin (unexpired) and wonders if you recommend for her to take it.

[https://pubmed.ncbi.nlm.nih.gov/34881426/ Antibiotics for sore throat]

'''Scenario 6 - Conjunctivitis''' - GROUPS 6, 12, 13, 24, 30, 31

A man comes to your pharmacy (he appears in his early twenties) complaining of “pink eye”. He has had a pink discolouration and discharge from his left eye for two days. He asks if the OTC antibiotic eye drops (he’s holding a product with polymixin B) are any better than “waiting it out”.

[https://www.ncbi.nlm.nih.gov/pubmed/22972049 Antibiotics for acute conjunctivitis]

6) HEMATOLOGY STUDIES

None so far

'''ACADEMIC YEAR 2 - FIRST TERM'''

7) RESPIROLOGY STUDIES
[[File:IA Pulm.pdf|thumb]]
*[http://www.ncbi.nlm.nih.gov/pubmed/2062329 First inhaled steroid study] Groups 1,13,25
*[https://pubmed.ncbi.nlm.nih.gov/40388330/ As-Needed Albuterol-Budesonide in Mild Asthma] Groups 2,14,26
*[https://pubmed.ncbi.nlm.nih.gov/35569035/ Albuterol-Budesonide Fixed-Dose Combination Rescue Inhaler for Asthma] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/29768149 Combined Budesonide–Formoterol as Needed in Mild Asthma] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/15223858 Doubling dose of inhaled corticosteroid] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/29768147 As-Needed Budesonide–Formoterol versus Maintenance Budesonide in Mild Asthma] Groups 6,18,30
*[https://pubmed.ncbi.nlm.nih.gov/32579807/ Triple Inhaled Therapy at Two Glucocorticoid Doses in Moderate-to-Very-Severe COPD] Groups 7,19,31
*[https://pubmed.ncbi.nlm.nih.gov/29605624/ Tiotropium and olodaterol in the prevention of COPD] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/23695200 Short VS long steroids for COPD exacerbation] Groups 9,21,33
*[http://www.ncbi.nlm.nih.gov/pubmed/25196117 Stopping inhaled steroids in COPD] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/29668352 Once-Daily Single-Inhaler Triple versus Dual Therapy in Patients with COPD] Groups 11,23,35
*[https://pubmed.ncbi.nlm.nih.gov/33979488/ Tezepelumab in Adults and Adolescents with Severe, Uncontrolled Asthma] Groups 12,24,36

8) CARDIOVASCULAR STUDIES

SESSION 1

*[https://www.ncbi.nlm.nih.gov/pubmed/4862069 VA1] (Group 1, 13, 25)
*[https://www.ncbi.nlm.nih.gov/pubmed/4914579 VA 2] (Group 2, 14, 26)
*[https://pubmed.ncbi.nlm.nih.gov/33186492 Polycap Study 3] (Group 3, 15, 27)
*[http://www.ncbi.nlm.nih.gov/pubmed/20228401 ACCORD-BP] (Group 4, 16, 28)
*[https://www.ncbi.nlm.nih.gov/pubmed/26551272 SPRINT] (Group 5, 17, 29)
*[http://www.ncbi.nlm.nih.gov/pubmed/2883575 CONSENSUS] (Group 6,18,30)
*[https://pubmed.ncbi.nlm.nih.gov/31535829/ DAPA-HF] (Group 7, 19, 31)
*[https://pubmed.ncbi.nlm.nih.gov/25176939/ CONFIRM-HF] (Group 8, 20, 32)
*[http://www.ncbi.nlm.nih.gov/pubmed/12457784 PROSPER] (Group 9, 21, 33)
*[http://www.ncbi.nlm.nih.gov/pubmed/27040132 HOPE-3] (Group 10, 22, 34)
*[http://www.ncbi.nlm.nih.gov/pubmed/12114036 Heart Protection Study (HPS)] (Group 11, 23, 35)
*[http://www.ncbi.nlm.nih.gov/pubmed/30415628 REDUCE-IT] (Group 12, 24, 36)

[[File:CV Case.pdf|thumb|CV case|left]]

SESSION 2

'''The Guideline Case'''

A 63 y/o patient with CHOOSE ONE (⬆︎HTN/⬆︎Chol/⬆︎glucose/HF/A fib) and using the guideline determine:
# their 5yr/10yr risks of mortality/CVD events
# the potential benefit
# the potential side effects (with magnitude)
# words/sentiment patient values and preferences/SDM

Atrial fibrillation - Groups 1,13,25,2,14,26
*[https://www.onlinecjc.ca/article/S0828-282X(18)31062-6/pdf 2018 Atrial fibrillation guidelines]
Diabetes - Groups 3,15,27,4,16,28
*[http://guidelines.diabetes.ca/docs/CPG-2018-full-EN.pdf 2018 Diabetes guidelines]
Lipid Simplified - Groups 5,17,29,6,18,30
*[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4607330/pdf/0610857.pdf 2015 Simplified lipid guidelines]
Lipid - Groups 7,19,31,8,20,32
*[http://www.onlinecjc.ca/article/S0828-282X(16)30732-2/pdf 2016 Lipid guidelines]
Heart failure - Groups 9,21,33,10,22,34
*[http://www.onlinecjc.ca/article/S0828-282X(17)30973-X/pdf 2017 Heart failure guidelines]
Hypertension - Groups 11,23,35,12,24,36
*[https://www.onlinecjc.ca/article/S0828-282X(18)30183-1/pdf 2018 Hypertension guidelines]

OPTIONAL SESSION
*[http://www.ncbi.nlm.nih.gov/pubmed/16899775 SPARCL]
*[http://www.ncbi.nlm.nih.gov/pubmed/10471456 RALES]
*[http://www.ncbi.nlm.nih.gov/pubmed/11386263 Carvedilol in heart failure]
*[http://www.ncbi.nlm.nih.gov/pubmed/18460663 WAFACS]
*[http://www.ncbi.nlm.nih.gov/pubmed/10376614 MERIT-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/25176015 PARADIGM-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/24490264 High-dose multivitamins after MI]
*[http://www.ncbi.nlm.nih.gov/pubmed/7911176 Mediterranean Diet after MI]
*[http://www.ncbi.nlm.nih.gov/pubmed/15337732 A TO Z]
*[http://www.ncbi.nlm.nih.gov/pubmed/21073363 EMPHASIS-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/12853193 COMET]
*[http://www.ncbi.nlm.nih.gov/pubmed/24716680 TOPCAT]
*[http://www.ncbi.nlm.nih.gov/pubmed/26039521 IMPROVE-IT]

'''ACADEMIC YEAR 2 - SECOND TERM'''

9) NEPHROLOGY STUDIES

None so far

10) ENDOCRINOLOGY

[[File:IA ENDO LAYOUT.pdf|thumb|IA ENDO LAYOUT TEMPLATE|none]] [[File:Osteoporosis Evidence SUPP.pdf|none|thumb]]

'''RISK ASSESSMENT CASES FOR DIABETES AND OSTEOPOROSIS'''

'''1) DIABETES CASE'''

66 y/o white male who was diagnosed with diabetes 8 years ago

* His blood pressure over the last year has been roughly 145/80 mmHg - at present untreated
* A1c = 8%, no diabetes meds, non-smoker, BMI ~30
* '''When calculating without diabetes for PREVENT use an A1c of 5.5%'''
* Total cholesterol is 6 mmol/L, his HDL is 2 mmol/L, non-HDL = 6 minus 2, not on a statin
* No retinopathy, urine albumin-to-creatinine ratio (UACR) = 15ug/mg (7mg/mmol),
* Serum creatinine = 70 micromol/L, waist circumference 100 cm
* GFR 75 mL/min/1.73m2
* In normal sinus rhythm
* Age at end of highest education = 19
* Mother alive, father died of a heart attack at age 80

'''Calculate Risks'''

'''CVD RISK ESTIMATES''' - list the endpoints described by the specific calculator

Framingham - xx% - 10-year risk - also if no diabetes xx%

ASCVD - xx% - 10-year risk - also if no diabetes xx%

'''The Calculator'''
*CVD CALCULATOR
https://decisionaid.ca/cvd/

'''DIABETES COMPLICATIONS RISK ESTIMATES''' - list the endpoints described by the specific calculator

xx% - also 10-year risk if A1c 9, 8, 7 and 6

also get risk of kidney failure, vision loss, pressure sensation loss – also if A1c 9, 8,7,6

'''The Calculator'''
*DIABETES DECISION AID
http://decisionaid.ca/diabetes/

'''BENEFITS AND HARMS'''

Use the [https://guidelines.diabetes.ca/cpg/chapter-13-2020-update 2024 diabetes guidelines] and/or Diabetes Decision Aid to get estimates of benefits and harms and also use the MyStudies synopsis listed below

'''COSTS'''

Try using [https://pricingdoc.acfp.ca Pricing Doc] to get costs

'''Groups 1,13,25'''

* Metformin - UKPDS 34 [https://mystudies.org/studies.php#studies/28929e89-d01e-4b11-8e67-4d7086f9e4aa/outcome MyStudies Data]

'''Groups 2,14,26'''

* Sulfonlyureas - UKPDS 33 [https://mystudies.org/studies.php#studies/5eadb5dd-d403-4c13-b03e-d4f8d28c96ba/outcome MyStudies Data]

'''Groups 3,15,27'''

* Insulin - ORIGIN [https://mystudies.org/studies.php#studies/f611818f-2e69-4952-b55e-661116bd84b6/outcome MyStudies Data]

'''Groups 4,16,28'''

* SGLT2 - EMPA-REG OUTCOME [https://mystudies.org/studies.php#studies/32e9cf1a-f33e-480b-91ca-6f28a4dcf862/outcome MyStudies Data]

'''Groups 5,17,29'''

* GLP - LEADER [https://mystudies.org/studies.php#studies/1adbc9a1-7603-40f1-ac15-b813ce1f0ad6/outcome MyStudies Data]

'''Groups 6,18,30'''

* DPP4 - TECOS [https://mystudies.org/studies.php#studies/8659968a-cefb-4f99-b4ae-8b9b659acbd5/outcome MyStudies Data]

'''Groups 7,19,31'''

* Intensive treatment – small scale - STENO [https://mystudies.org/studies.php#studies/39d423e3-af57-40c8-ab7a-cbc7f389bdb6/paper MyStudies Data]

'''Groups 8,20,32'''

* Intensive treatment – large scale - ADDITION-Europe - [https://mystudies.org/studies.php#studies/5e07d86d-aa92-4db9-a283-76080db4b6fd/outcome MyStudies Data]

'''2) OSTEOPOROSIS CASE'''

60 y/o Canadian female

* 72 kg, 1.69m, BMI = 25.2
* t-score of -2.5
* Worried about falling and getting a hip fracture
* A friend recently had an atraumatic fracture from simply tripping and falling over in the snow
* No other risk factors

'''Calculate Risks'''

'''FRACTURE RISK ESTIMATES''' - list the endpoints described by the specific calculator

Major osteoporotic fracture - xx% - 10-year risk – if no BMD (just BMI), and then if they had a BMD t-Score of -2.0, -2.5, and -3.0

Hip fracture - - xx% - 10-year risk – if no BMD (just BMI) and if you have a BMD xx% - 10-year risk – if no BMD, and then if they had a BMD T-Score of -2.0, -2.5, and -3.0

'''The Calculator'''

* FRACTURE CALCULATOR

[https://frax.shef.ac.uk/frax/tool.aspx?country=19 Frax Tool - Canada]

'''BENEFITS AND HARMS'''

Use the [https://www.cmaj.ca/content/195/39/E1333 2023 Osteoporosis Guideline] and/or your osteoporosis lecture notes to get the benefits and apply these to your patient, and also get the harms

'''COSTS'''

Try using [https://pricingdoc.acfp.ca Pricing Doc] to get costs

'''Groups 9,21,33'''

* Activity

'''Groups 10,22,34'''

* Calcium/Vitamin D

'''Groups 11,23,35'''

* Bisphosphonates

'''Groups 12,24,36'''

* Denosumab

11) NEUROLOGY STUDIES

*[http://www.ncbi.nlm.nih.gov/pubmed/16717269 Opioids for chronic non-cancer pain] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/29509867 Effect of Opioid vs Nonopioid Medications on Pain-Related Function in Patients With Chronic Back Pain] Groups 2,14,26
*[https://www.ncbi.nlm.nih.gov/pubmed/31291515 Galcanezumab for prevention of cluster headaches] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/27150433 Immediate or delayed treatment of a first seizure] Groups 4,16,28
*[https://www.ncbi.nlm.nih.gov/pubmed/31291516 Rimegepant for episodic migraine] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/26212846 Sleep restriction for insomnia] Groups 6,18,30
*[https://www.ncbi.nlm.nih.gov/pubmed/25957224 CHANCE] Groups 7,19,31
*[https://www.ncbi.nlm.nih.gov/pubmed/16899775 SPARCL] Groups 8,20,32
*[https://www.ncbi.nlm.nih.gov/pubmed/29171821 Erenumab for episodic migraine] Groups 9,21,33
*[https://www.ncbi.nlm.nih.gov/pubmed/24733354 Reduction of benzodiazepines through education] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/26035341 Patient controlled opioid analgesia versus non-patient controlled opioid analgesia for postoperative pain] Groups 11,23,35
*[https://www.ncbi.nlm.nih.gov/pubmed/11589932 PROGRESS] Groups 12,24,36

'''ACADEMIC YEAR 3'''

12) PSYCHIATRY STUDIES

[[:File:2021 Psych Evidence Appraisal - Intro Slides.pdf|Psychiatry Rating Scales Introduction]]

* Study 1: [http://www.ncbi.nlm.nih.gov/pubmed/16554525 STAR*D (Level 2)] Bupropion-SR, sertraline, or venlafaxine-XR after failure of SSRIs for depression
* Study 2: [http://www.ncbi.nlm.nih.gov/pubmed/29477251 Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder]
* Study 3: [https://pubmed.ncbi.nlm.nih.gov/33862018/ Long-acting injectable versus oral antipsychotics for the maintenance treatment of schizophrenia]
* Study 4: [https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2725088 Association of Antipsychotic Polypharmacy vs Monotherapy With Psychiatric Rehospitalization Among Adults With Schizophrenia]
* Study 5: [https://www.ncbi.nlm.nih.gov/pubmed/29490359 Real-world Effectiveness of Pharmacologic Treatments for the Prevention of Bipolar Disorder]
* Study 6: [http://www.ncbi.nlm.nih.gov/pubmed/20092882 BALANCE] Combination lithium and valproate therapy versus monotherapy for relapse prevention in bipolar I disorder
13) GASTROENTEROLOGY STUDIES - LINKS ON CANVAS[[File:Screenshot 2025-11-17 at 7.50.27 AM.png|thumb]][[File:GI ChatGPT Instructions.jpg|thumb|GPT Instructions]]
*Short-term treatment for gastro-oesophageal reflux disease-like symptoms and endoscopy negative reflux disease (Review)
*Oral budesonide for induction of remission in ulcerative colitis (Review)
*Probiotics for the prevention of Clostridium difficile-associated diarrhea in adults and children (Review)
*Deprescribing versus continuation of chronic proton pump inhibitor use in adults (Review)
*Prevention of NSAID-induced gastroduodenal ulcers (Review)
*Methotrexate for maintenance of remission in Crohn's disease (Review)

14) OB/GYN STUDIES
*[http://www.ncbi.nlm.nih.gov/pubmed/25601350 Comparative contraceptive effectiveness of levonorgestrel-releasing and copper IUD Devices]
*[http://www.ncbi.nlm.nih.gov/pubmed/29211679 Hormonal contraception and the risk of breast cancer]
*[http://www.ncbi.nlm.nih.gov/pubmed/30322986 Sexual behaviours in adolescent girls before and after introduction of the HPV]
*[http://www.ncbi.nlm.nih.gov/pubmed/30181338 Intramuscular vs intravenous oxytocin to prevent postpartum haemorrhage at vaginal delivery]
*[http://www.ncbi.nlm.nih.gov/pubmed/27682034 Azithromycin Prophylaxis for Cesarean Delivery]
*[http://www.ncbi.nlm.nih.gov/pubmed/28461374 Antibiotics during pregnancy and risk of spontaneous abortion]

File:IA Pulm.pdf

2026-09-24T15:14:56Z

JamesMcCormack: Uploaded own work with UploadWizard

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Evidence Appraisal Integrated Activities

2026-09-21T19:28:33Z

JamesMcCormack:

'''OBJECTIVE'''

To critically appraise studies, develop a brief synopsis of the trial results, succinctly present the results and then put the results into a proper clinical context

'''INITIAL PRE-READING'''

'''How To Critically Appraise an RCT In 10 minutes'''
*[https://itunes.apple.com/ca/book/how-to-critically-appraise/id524600667?mt=11 iBook/iPad version]
*[https://therapeuticseducation.org/sites/therapeuticseducation.org/files/Ten_Minute_Critical_Appraisal.pdf PDF version]
Watch this video
[http://youtu.be/QUW0Q8tXVUc Viva La Evidence]

'''Study Results at Your Fingertips'''
*[https://mystudies.org MyStudies] - Free access

'''INTEGRATION ACTIVITY FORMAT'''
# Students placed in groups of ~ 5-7
# Each group is given one of the studies below to review
# Students then work in pairs and develop a one-slide critical appraisal and results synopsis
# One student in each group will be chosen at random to present their group findings to the class
# A discussion about the appraisal and the appropriate clinical context for the results is had with the entire class for each study

'''MODULE'''
[[File:Screen Shot 2022-01-09 at 10.00.16 AM.jpg|thumb|'''TRIAL PRESENTATION FORMAT'''|none]]

Studies chosen include landmark studies and/or studies that address important therapeutic issues for the particular module

'''ACADEMIC YEAR 1 - FIRST TERM'''

1) FOUNDATION STUDIES (Groups)
*[https://pubmed.ncbi.nlm.nih.gov/37952131 SELECT] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/12466506 AFFIRM] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/22085343 AIM-HIGH] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/10639539 HOPE] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/18378519 HYVET] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/15007110 PROVE-IT] Groups 6,18,30
*[http://www.ncbi.nlm.nih.gov/pubmed/15755765 TNT] Groups 7,19,31
*[https://pubmed.ncbi.nlm.nih.gov/26378978 EMPAREG] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/17984165 ILLUMINATE] Groups 9,21,33
*[https://pubmed.ncbi.nlm.nih.gov/26551272/ SPRINT] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/15325833 CARDS] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/12117397 WHI] Groups 12,24,36

'''ACADEMIC YEAR 1 - SECOND TERM'''

2) INTRO TO INFECTIOUS DISEASE STUDIES

[https://wiki.ubc.ca/images/8/8b/Antibiotic_Sensitivity_Chart_2024.pdf The "Best" Antibiotic Sensitivity Chart Ever]
*[http://www.ncbi.nlm.nih.gov/pubmed/17567657 IV vs PO antibiotics] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/24603565 Delayed antibiotics for respiratory tract infections] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/11159657 Delayed antibiotics for otitis media] Groups 3,15,27
*[https://pubmed.ncbi.nlm.nih.gov/27455166/ Duration of treatment for community acquired pneumonia] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/22726802 Duration of treatment for pyelonephritis] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/25830421 Choice of antibiotic for community acquired pneumonia-1] Groups 6,18,30
*[http://www.ncbi.nlm.nih.gov/pubmed/25286173 Choice of antibiotic for community acquired pneumonia-2] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/20647284 HPV vaccine study] Groups 8,20,32
*[https://pubmed.ncbi.nlm.nih.gov/40888720/ High-Dose Influenza Vaccine - hospitalization] Groups 9,21,33
*[https://pubmed.ncbi.nlm.nih.gov/40884442 High-Dose Influenza Vaccine - cardiovascular outcomes] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/27626517 Herpes zoster vaccine study 1] Groups 11,23,35
*[https://www.ncbi.nlm.nih.gov/pubmed/25916341 Herpes zoster vaccine study 2] Groups 12,24,36

3) MUSCULOSKELETAL STUDIES

*[http://www.ncbi.nlm.nih.gov/pubmed/28199814 Baricitinib versus Placebo or Adalimumab in Rheumatoid Arthritis] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/0010979111 CLASS – celecoxib vs NSAIDs] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/26501533 Naproxen with cyclobenzaprine, oxycodone/acetaminophen, or placebo for low back pain] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/24395557 Glucosamine and chondroitin for OA] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/12546607 Acetaminophen vs diclofenac for OA] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/23964752 Diclofenac gel for acute neck pain] Groups 6,18,30
*[https://pubmed.ncbi.nlm.nih.gov/15468367/ Topical diclofenac vs oral diclofenac] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/25064594 Acetaminophen for low back pain] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/7611589 Misoprostol and NSAID induced ulcers] Groups 9,21,33
*[http://www.ncbi.nlm.nih.gov/pubmed/20131255 Low dose vs high dose colchicine for gout] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/22508468 TEAR - oral triple therapy versus etanercept plus methotrexate in early aggressive rheumatoid arthritis] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/25589511 MOVES - Glucosamine and chondroitin for OA for moderate to severe pain] Groups 12,24,36

4) DERMATOLOGY STUDIES

*[https://www.ncbi.nlm.nih.gov/pubmed/9598014 Glycolic acid 5% Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/21896132 Glycolic acid 10% Acne]
*[https://www.ncbi.nlm.nih.gov/pubmed/14531866 Petrolatum vs Ceramide/skin related lipids Hand Dermatitis]
*[https://www.ncbi.nlm.nih.gov/pubmed/11896774 Vitamin C Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/17515510 Retinol (VitaminA) Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/21896129 Hyaluronic acid Atopic Dermatitis]

5) EENT STUDIES

[http://www.amstar.ca/docs/AMSTARguideline.pdf AMSTAR meta-analysis checklist]

'''Scenario 1 - Otitis Media''' - GROUPS 1, 7, 18, 19, 25, 36

Anthony Martin arrives at your pharmacy somewhat frustrated since his family physician declined to write an antibiotic prescription for his two and half year old son, Oscar. His symptoms started yesterday afternoon - Oscar complains of right ear pain but there is no discharge. Rectal temperature taken today was 38.5 degrees. His wife is sure Oscar has an ear infection since the last time he had these same symptoms, that was ultimately the diagnosis. Mr. Martin asks if you think buying acetaminophen is really “enough”?

[https://pubmed.ncbi.nlm.nih.gov/26099233/ Antibiotics for acute otitis media in children]

'''Scenario 2 - Allergic Rhinitis''' - GROUPS 2, 8, 17, 20, 26, 35

Ruby Parmar is a firefighter. She is plagued by sinus congestion (preventing her from sleeping) and a runny nose associated with seasonal allergies. Her prescription for intranasal triamcinolone is typically effective, but she would like to know if a non-sedating anti-allergy pill would work just as well since it’s inconvenient carrying around the “nose spray”.

[https://www.ncbi.nlm.nih.gov/pubmed/28234147 Intranasal steroids vs antihistamines for allergic rhinitis]

'''Scenario 3 - Acute Sinusitis''' - GROUPS 3, 9, 16, 21, 27, 34

You are seeing a patient in clinic before her appointment with the primary care physician. She was feeling unwell with a “flu” last week. While most of her symptoms have resolved (cough, fever), the nasal congestion and discharge persists and so she has made an appointment (she is an otherwise healthy 32 year old with treated thyroid disease). She would like your advice for what treatment she should ask the doctor to prescribe.

[http://www.ncbi.nlm.nih.gov/pubmed/24293353 Intranasal steroids for acute sinusitis]

'''Scenario 4 - Glaucoma''' - GROUPS 4, 10, 15, 22, 28, 33

Mrs. Ada Waters is a 63 year-old woman you. Her ophthalmologist prescribed timolol and xalatan eye drops for treatment of open angle glaucoma. She has never really felt much different on treatment since she recovered from her first episode (of acute angle closure glaucoma requiring ER visit) and surgery. She asks you if the treatment is really making a difference.

[https://www.ncbi.nlm.nih.gov/pubmed/17943780 Interventions for open angle glaucoma]

'''Scenario 5 - Sore Throat''' - GROUPS 5, 11, 14, 23, 29, 32

You have a good friend who is applying for pharmacy. Her invitation for the multiple-mini interview (MMI) is coming up soon, but she is starting to experience a sore throat. While she is worried about not being able to speak through all of those stations, she knows she often gets a terrible headache along with her sore throat. She has an unused prescription for amoxicillin (unexpired) and wonders if you recommend for her to take it.

[https://pubmed.ncbi.nlm.nih.gov/34881426/ Antibiotics for sore throat]

'''Scenario 6 - Conjunctivitis''' - GROUPS 6, 12, 13, 24, 30, 31

A man comes to your pharmacy (he appears in his early twenties) complaining of “pink eye”. He has had a pink discolouration and discharge from his left eye for two days. He asks if the OTC antibiotic eye drops (he’s holding a product with polymixin B) are any better than “waiting it out”.

[https://www.ncbi.nlm.nih.gov/pubmed/22972049 Antibiotics for acute conjunctivitis]

6) HEMATOLOGY STUDIES

None so far

'''ACADEMIC YEAR 2 - FIRST TERM'''

7) RESPIROLOGY STUDIES
[[File:IA COPD info.pdf|thumb]]

*[http://www.ncbi.nlm.nih.gov/pubmed/2062329 First inhaled steroid study] Groups 1,13,25
*[https://pubmed.ncbi.nlm.nih.gov/40388330/ As-Needed Albuterol-Budesonide in Mild Asthma] Groups 2,14,26
*[https://pubmed.ncbi.nlm.nih.gov/35569035/ Albuterol-Budesonide Fixed-Dose Combination Rescue Inhaler for Asthma] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/29768149 Combined Budesonide–Formoterol as Needed in Mild Asthma] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/15223858 Doubling dose of inhaled corticosteroid] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/29768147 As-Needed Budesonide–Formoterol versus Maintenance Budesonide in Mild Asthma] Groups 6,18,30
*[https://pubmed.ncbi.nlm.nih.gov/32579807/ Triple Inhaled Therapy at Two Glucocorticoid Doses in Moderate-to-Very-Severe COPD] Groups 7,19,31
*[https://pubmed.ncbi.nlm.nih.gov/29605624/ Tiotropium and olodaterol in the prevention of COPD] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/23695200 Short VS long steroids for COPD exacerbation] Groups 9,21,33
*[http://www.ncbi.nlm.nih.gov/pubmed/25196117 Stopping inhaled steroids in COPD] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/29668352 Once-Daily Single-Inhaler Triple versus Dual Therapy in Patients with COPD] Groups 11,23,35
*[https://pubmed.ncbi.nlm.nih.gov/33979488/ Tezepelumab in Adults and Adolescents with Severe, Uncontrolled Asthma] Groups 12,24,36

8) CARDIOVASCULAR STUDIES

SESSION 1

*[https://www.ncbi.nlm.nih.gov/pubmed/4862069 VA1] (Group 1, 13, 25)
*[https://www.ncbi.nlm.nih.gov/pubmed/4914579 VA 2] (Group 2, 14, 26)
*[https://pubmed.ncbi.nlm.nih.gov/33186492 Polycap Study 3] (Group 3, 15, 27)
*[http://www.ncbi.nlm.nih.gov/pubmed/20228401 ACCORD-BP] (Group 4, 16, 28)
*[https://www.ncbi.nlm.nih.gov/pubmed/26551272 SPRINT] (Group 5, 17, 29)
*[http://www.ncbi.nlm.nih.gov/pubmed/2883575 CONSENSUS] (Group 6,18,30)
*[https://pubmed.ncbi.nlm.nih.gov/31535829/ DAPA-HF] (Group 7, 19, 31)
*[https://pubmed.ncbi.nlm.nih.gov/25176939/ CONFIRM-HF] (Group 8, 20, 32)
*[http://www.ncbi.nlm.nih.gov/pubmed/12457784 PROSPER] (Group 9, 21, 33)
*[http://www.ncbi.nlm.nih.gov/pubmed/27040132 HOPE-3] (Group 10, 22, 34)
*[http://www.ncbi.nlm.nih.gov/pubmed/12114036 Heart Protection Study (HPS)] (Group 11, 23, 35)
*[http://www.ncbi.nlm.nih.gov/pubmed/30415628 REDUCE-IT] (Group 12, 24, 36)

[[File:CV Case.pdf|thumb|CV case|left]]

SESSION 2

'''The Guideline Case'''

A 63 y/o patient with CHOOSE ONE (⬆︎HTN/⬆︎Chol/⬆︎glucose/HF/A fib) and using the guideline determine:
# their 5yr/10yr risks of mortality/CVD events
# the potential benefit
# the potential side effects (with magnitude)
# words/sentiment patient values and preferences/SDM

Atrial fibrillation - Groups 1,13,25,2,14,26
*[https://www.onlinecjc.ca/article/S0828-282X(18)31062-6/pdf 2018 Atrial fibrillation guidelines]
Diabetes - Groups 3,15,27,4,16,28
*[http://guidelines.diabetes.ca/docs/CPG-2018-full-EN.pdf 2018 Diabetes guidelines]
Lipid Simplified - Groups 5,17,29,6,18,30
*[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4607330/pdf/0610857.pdf 2015 Simplified lipid guidelines]
Lipid - Groups 7,19,31,8,20,32
*[http://www.onlinecjc.ca/article/S0828-282X(16)30732-2/pdf 2016 Lipid guidelines]
Heart failure - Groups 9,21,33,10,22,34
*[http://www.onlinecjc.ca/article/S0828-282X(17)30973-X/pdf 2017 Heart failure guidelines]
Hypertension - Groups 11,23,35,12,24,36
*[https://www.onlinecjc.ca/article/S0828-282X(18)30183-1/pdf 2018 Hypertension guidelines]

OPTIONAL SESSION
*[http://www.ncbi.nlm.nih.gov/pubmed/16899775 SPARCL]
*[http://www.ncbi.nlm.nih.gov/pubmed/10471456 RALES]
*[http://www.ncbi.nlm.nih.gov/pubmed/11386263 Carvedilol in heart failure]
*[http://www.ncbi.nlm.nih.gov/pubmed/18460663 WAFACS]
*[http://www.ncbi.nlm.nih.gov/pubmed/10376614 MERIT-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/25176015 PARADIGM-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/24490264 High-dose multivitamins after MI]
*[http://www.ncbi.nlm.nih.gov/pubmed/7911176 Mediterranean Diet after MI]
*[http://www.ncbi.nlm.nih.gov/pubmed/15337732 A TO Z]
*[http://www.ncbi.nlm.nih.gov/pubmed/21073363 EMPHASIS-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/12853193 COMET]
*[http://www.ncbi.nlm.nih.gov/pubmed/24716680 TOPCAT]
*[http://www.ncbi.nlm.nih.gov/pubmed/26039521 IMPROVE-IT]

'''ACADEMIC YEAR 2 - SECOND TERM'''

9) NEPHROLOGY STUDIES

None so far

10) ENDOCRINOLOGY

[[File:IA ENDO LAYOUT.pdf|thumb|IA ENDO LAYOUT TEMPLATE|none]] [[File:Osteoporosis Evidence SUPP.pdf|none|thumb]]

'''RISK ASSESSMENT CASES FOR DIABETES AND OSTEOPOROSIS'''

'''1) DIABETES CASE'''

66 y/o white male who was diagnosed with diabetes 8 years ago

* His blood pressure over the last year has been roughly 145/80 mmHg - at present untreated
* A1c = 8%, no diabetes meds, non-smoker, BMI ~30
* '''When calculating without diabetes for PREVENT use an A1c of 5.5%'''
* Total cholesterol is 6 mmol/L, his HDL is 2 mmol/L, non-HDL = 6 minus 2, not on a statin
* No retinopathy, urine albumin-to-creatinine ratio (UACR) = 15ug/mg (7mg/mmol),
* Serum creatinine = 70 micromol/L, waist circumference 100 cm
* GFR 75 mL/min/1.73m2
* In normal sinus rhythm
* Age at end of highest education = 19
* Mother alive, father died of a heart attack at age 80

'''Calculate Risks'''

'''CVD RISK ESTIMATES''' - list the endpoints described by the specific calculator

Framingham - xx% - 10-year risk - also if no diabetes xx%

ASCVD - xx% - 10-year risk - also if no diabetes xx%

'''The Calculator'''
*CVD CALCULATOR
https://decisionaid.ca/cvd/

'''DIABETES COMPLICATIONS RISK ESTIMATES''' - list the endpoints described by the specific calculator

xx% - also 10-year risk if A1c 9, 8, 7 and 6

also get risk of kidney failure, vision loss, pressure sensation loss – also if A1c 9, 8,7,6

'''The Calculator'''
*DIABETES DECISION AID
http://decisionaid.ca/diabetes/

'''BENEFITS AND HARMS'''

Use the [https://guidelines.diabetes.ca/cpg/chapter-13-2020-update 2024 diabetes guidelines] and/or Diabetes Decision Aid to get estimates of benefits and harms and also use the MyStudies synopsis listed below

'''COSTS'''

Try using [https://pricingdoc.acfp.ca Pricing Doc] to get costs

'''Groups 1,13,25'''

* Metformin - UKPDS 34 [https://mystudies.org/studies.php#studies/28929e89-d01e-4b11-8e67-4d7086f9e4aa/outcome MyStudies Data]

'''Groups 2,14,26'''

* Sulfonlyureas - UKPDS 33 [https://mystudies.org/studies.php#studies/5eadb5dd-d403-4c13-b03e-d4f8d28c96ba/outcome MyStudies Data]

'''Groups 3,15,27'''

* Insulin - ORIGIN [https://mystudies.org/studies.php#studies/f611818f-2e69-4952-b55e-661116bd84b6/outcome MyStudies Data]

'''Groups 4,16,28'''

* SGLT2 - EMPA-REG OUTCOME [https://mystudies.org/studies.php#studies/32e9cf1a-f33e-480b-91ca-6f28a4dcf862/outcome MyStudies Data]

'''Groups 5,17,29'''

* GLP - LEADER [https://mystudies.org/studies.php#studies/1adbc9a1-7603-40f1-ac15-b813ce1f0ad6/outcome MyStudies Data]

'''Groups 6,18,30'''

* DPP4 - TECOS [https://mystudies.org/studies.php#studies/8659968a-cefb-4f99-b4ae-8b9b659acbd5/outcome MyStudies Data]

'''Groups 7,19,31'''

* Intensive treatment – small scale - STENO [https://mystudies.org/studies.php#studies/39d423e3-af57-40c8-ab7a-cbc7f389bdb6/paper MyStudies Data]

'''Groups 8,20,32'''

* Intensive treatment – large scale - ADDITION-Europe - [https://mystudies.org/studies.php#studies/5e07d86d-aa92-4db9-a283-76080db4b6fd/outcome MyStudies Data]

'''2) OSTEOPOROSIS CASE'''

60 y/o Canadian female

* 72 kg, 1.69m, BMI = 25.2
* t-score of -2.5
* Worried about falling and getting a hip fracture
* A friend recently had an atraumatic fracture from simply tripping and falling over in the snow
* No other risk factors

'''Calculate Risks'''

'''FRACTURE RISK ESTIMATES''' - list the endpoints described by the specific calculator

Major osteoporotic fracture - xx% - 10-year risk – if no BMD (just BMI), and then if they had a BMD t-Score of -2.0, -2.5, and -3.0

Hip fracture - - xx% - 10-year risk – if no BMD (just BMI) and if you have a BMD xx% - 10-year risk – if no BMD, and then if they had a BMD T-Score of -2.0, -2.5, and -3.0

'''The Calculator'''

* FRACTURE CALCULATOR

[https://frax.shef.ac.uk/frax/tool.aspx?country=19 Frax Tool - Canada]

'''BENEFITS AND HARMS'''

Use the [https://www.cmaj.ca/content/195/39/E1333 2023 Osteoporosis Guideline] and/or your osteoporosis lecture notes to get the benefits and apply these to your patient, and also get the harms

'''COSTS'''

Try using [https://pricingdoc.acfp.ca Pricing Doc] to get costs

'''Groups 9,21,33'''

* Activity

'''Groups 10,22,34'''

* Calcium/Vitamin D

'''Groups 11,23,35'''

* Bisphosphonates

'''Groups 12,24,36'''

* Denosumab

11) NEUROLOGY STUDIES

*[http://www.ncbi.nlm.nih.gov/pubmed/16717269 Opioids for chronic non-cancer pain] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/29509867 Effect of Opioid vs Nonopioid Medications on Pain-Related Function in Patients With Chronic Back Pain] Groups 2,14,26
*[https://www.ncbi.nlm.nih.gov/pubmed/31291515 Galcanezumab for prevention of cluster headaches] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/27150433 Immediate or delayed treatment of a first seizure] Groups 4,16,28
*[https://www.ncbi.nlm.nih.gov/pubmed/31291516 Rimegepant for episodic migraine] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/26212846 Sleep restriction for insomnia] Groups 6,18,30
*[https://www.ncbi.nlm.nih.gov/pubmed/25957224 CHANCE] Groups 7,19,31
*[https://www.ncbi.nlm.nih.gov/pubmed/16899775 SPARCL] Groups 8,20,32
*[https://www.ncbi.nlm.nih.gov/pubmed/29171821 Erenumab for episodic migraine] Groups 9,21,33
*[https://www.ncbi.nlm.nih.gov/pubmed/24733354 Reduction of benzodiazepines through education] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/26035341 Patient controlled opioid analgesia versus non-patient controlled opioid analgesia for postoperative pain] Groups 11,23,35
*[https://www.ncbi.nlm.nih.gov/pubmed/11589932 PROGRESS] Groups 12,24,36

'''ACADEMIC YEAR 3'''

12) PSYCHIATRY STUDIES

[[:File:2021 Psych Evidence Appraisal - Intro Slides.pdf|Psychiatry Rating Scales Introduction]]

* Study 1: [http://www.ncbi.nlm.nih.gov/pubmed/16554525 STAR*D (Level 2)] Bupropion-SR, sertraline, or venlafaxine-XR after failure of SSRIs for depression
* Study 2: [http://www.ncbi.nlm.nih.gov/pubmed/29477251 Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder]
* Study 3: [https://pubmed.ncbi.nlm.nih.gov/33862018/ Long-acting injectable versus oral antipsychotics for the maintenance treatment of schizophrenia]
* Study 4: [https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2725088 Association of Antipsychotic Polypharmacy vs Monotherapy With Psychiatric Rehospitalization Among Adults With Schizophrenia]
* Study 5: [https://www.ncbi.nlm.nih.gov/pubmed/29490359 Real-world Effectiveness of Pharmacologic Treatments for the Prevention of Bipolar Disorder]
* Study 6: [http://www.ncbi.nlm.nih.gov/pubmed/20092882 BALANCE] Combination lithium and valproate therapy versus monotherapy for relapse prevention in bipolar I disorder
13) GASTROENTEROLOGY STUDIES - LINKS ON CANVAS[[File:Screenshot 2025-11-17 at 7.50.27 AM.png|thumb]][[File:GI ChatGPT Instructions.jpg|thumb|GPT Instructions]]
*Short-term treatment for gastro-oesophageal reflux disease-like symptoms and endoscopy negative reflux disease (Review)
*Oral budesonide for induction of remission in ulcerative colitis (Review)
*Probiotics for the prevention of Clostridium difficile-associated diarrhea in adults and children (Review)
*Deprescribing versus continuation of chronic proton pump inhibitor use in adults (Review)
*Prevention of NSAID-induced gastroduodenal ulcers (Review)
*Methotrexate for maintenance of remission in Crohn's disease (Review)

14) OB/GYN STUDIES
*[http://www.ncbi.nlm.nih.gov/pubmed/25601350 Comparative contraceptive effectiveness of levonorgestrel-releasing and copper IUD Devices]
*[http://www.ncbi.nlm.nih.gov/pubmed/29211679 Hormonal contraception and the risk of breast cancer]
*[http://www.ncbi.nlm.nih.gov/pubmed/30322986 Sexual behaviours in adolescent girls before and after introduction of the HPV]
*[http://www.ncbi.nlm.nih.gov/pubmed/30181338 Intramuscular vs intravenous oxytocin to prevent postpartum haemorrhage at vaginal delivery]
*[http://www.ncbi.nlm.nih.gov/pubmed/27682034 Azithromycin Prophylaxis for Cesarean Delivery]
*[http://www.ncbi.nlm.nih.gov/pubmed/28461374 Antibiotics during pregnancy and risk of spontaneous abortion]

Evidence Appraisal Integrated Activities

2026-09-21T19:21:14Z

JamesMcCormack:

'''OBJECTIVE'''

To critically appraise studies, develop a brief synopsis of the trial results, succinctly present the results and then put the results into a proper clinical context

'''INITIAL PRE-READING'''

'''How To Critically Appraise an RCT In 10 minutes'''
*[https://itunes.apple.com/ca/book/how-to-critically-appraise/id524600667?mt=11 iBook/iPad version]
*[https://therapeuticseducation.org/sites/therapeuticseducation.org/files/Ten_Minute_Critical_Appraisal.pdf PDF version]
Watch this video
[http://youtu.be/QUW0Q8tXVUc Viva La Evidence]

'''Study Results at Your Fingertips'''
*[https://mystudies.org MyStudies] - Free access

'''INTEGRATION ACTIVITY FORMAT'''
# Students placed in groups of ~ 5-7
# Each group is given one of the studies below to review
# Students then work in pairs and develop a one-slide critical appraisal and results synopsis
# One student in each group will be chosen at random to present their group findings to the class
# A discussion about the appraisal and the appropriate clinical context for the results is had with the entire class for each study

'''MODULE'''
[[File:Screen Shot 2022-01-09 at 10.00.16 AM.jpg|thumb|'''TRIAL PRESENTATION FORMAT'''|none]]

Studies chosen include landmark studies and/or studies that address important therapeutic issues for the particular module

'''ACADEMIC YEAR 1 - FIRST TERM'''

1) FOUNDATION STUDIES (Groups)
*[https://pubmed.ncbi.nlm.nih.gov/37952131 SELECT] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/12466506 AFFIRM] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/22085343 AIM-HIGH] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/10639539 HOPE] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/18378519 HYVET] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/15007110 PROVE-IT] Groups 6,18,30
*[http://www.ncbi.nlm.nih.gov/pubmed/15755765 TNT] Groups 7,19,31
*[https://pubmed.ncbi.nlm.nih.gov/26378978 EMPAREG] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/17984165 ILLUMINATE] Groups 9,21,33
*[https://pubmed.ncbi.nlm.nih.gov/26551272/ SPRINT] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/15325833 CARDS] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/12117397 WHI] Groups 12,24,36

'''ACADEMIC YEAR 1 - SECOND TERM'''

2) INTRO TO INFECTIOUS DISEASE STUDIES

[https://wiki.ubc.ca/images/8/8b/Antibiotic_Sensitivity_Chart_2024.pdf The "Best" Antibiotic Sensitivity Chart Ever]
*[http://www.ncbi.nlm.nih.gov/pubmed/17567657 IV vs PO antibiotics] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/24603565 Delayed antibiotics for respiratory tract infections] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/11159657 Delayed antibiotics for otitis media] Groups 3,15,27
*[https://pubmed.ncbi.nlm.nih.gov/27455166/ Duration of treatment for community acquired pneumonia] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/22726802 Duration of treatment for pyelonephritis] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/25830421 Choice of antibiotic for community acquired pneumonia-1] Groups 6,18,30
*[http://www.ncbi.nlm.nih.gov/pubmed/25286173 Choice of antibiotic for community acquired pneumonia-2] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/20647284 HPV vaccine study] Groups 8,20,32
*[https://pubmed.ncbi.nlm.nih.gov/40888720/ High-Dose Influenza Vaccine - hospitalization] Groups 9,21,33
*[https://pubmed.ncbi.nlm.nih.gov/40884442 High-Dose Influenza Vaccine - cardiovascular outcomes] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/27626517 Herpes zoster vaccine study 1] Groups 11,23,35
*[https://www.ncbi.nlm.nih.gov/pubmed/25916341 Herpes zoster vaccine study 2] Groups 12,24,36

3) MUSCULOSKELETAL STUDIES

*[http://www.ncbi.nlm.nih.gov/pubmed/28199814 Baricitinib versus Placebo or Adalimumab in Rheumatoid Arthritis] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/0010979111 CLASS – celecoxib vs NSAIDs] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/26501533 Naproxen with cyclobenzaprine, oxycodone/acetaminophen, or placebo for low back pain] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/24395557 Glucosamine and chondroitin for OA] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/12546607 Acetaminophen vs diclofenac for OA] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/23964752 Diclofenac gel for acute neck pain] Groups 6,18,30
*[https://pubmed.ncbi.nlm.nih.gov/15468367/ Topical diclofenac vs oral diclofenac] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/25064594 Acetaminophen for low back pain] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/7611589 Misoprostol and NSAID induced ulcers] Groups 9,21,33
*[http://www.ncbi.nlm.nih.gov/pubmed/20131255 Low dose vs high dose colchicine for gout] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/22508468 TEAR - oral triple therapy versus etanercept plus methotrexate in early aggressive rheumatoid arthritis] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/25589511 MOVES - Glucosamine and chondroitin for OA for moderate to severe pain] Groups 12,24,36

4) DERMATOLOGY STUDIES

*[https://www.ncbi.nlm.nih.gov/pubmed/9598014 Glycolic acid 5% Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/21896132 Glycolic acid 10% Acne]
*[https://www.ncbi.nlm.nih.gov/pubmed/14531866 Petrolatum vs Ceramide/skin related lipids Hand Dermatitis]
*[https://www.ncbi.nlm.nih.gov/pubmed/11896774 Vitamin C Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/17515510 Retinol (VitaminA) Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/21896129 Hyaluronic acid Atopic Dermatitis]

5) EENT STUDIES

[http://www.amstar.ca/docs/AMSTARguideline.pdf AMSTAR meta-analysis checklist]

'''Scenario 1 - Otitis Media''' - GROUPS 1, 7, 18, 19, 25, 36

Anthony Martin arrives at your pharmacy somewhat frustrated since his family physician declined to write an antibiotic prescription for his two and half year old son, Oscar. His symptoms started yesterday afternoon - Oscar complains of right ear pain but there is no discharge. Rectal temperature taken today was 38.5 degrees. His wife is sure Oscar has an ear infection since the last time he had these same symptoms, that was ultimately the diagnosis. Mr. Martin asks if you think buying acetaminophen is really “enough”?

[https://pubmed.ncbi.nlm.nih.gov/26099233/ Antibiotics for acute otitis media in children]

'''Scenario 2 - Allergic Rhinitis''' - GROUPS 2, 8, 17, 20, 26, 35

Ruby Parmar is a firefighter. She is plagued by sinus congestion (preventing her from sleeping) and a runny nose associated with seasonal allergies. Her prescription for intranasal triamcinolone is typically effective, but she would like to know if a non-sedating anti-allergy pill would work just as well since it’s inconvenient carrying around the “nose spray”.

[https://www.ncbi.nlm.nih.gov/pubmed/28234147 Intranasal steroids vs antihistamines for allergic rhinitis]

'''Scenario 3 - Acute Sinusitis''' - GROUPS 3, 9, 16, 21, 27, 34

You are seeing a patient in clinic before her appointment with the primary care physician. She was feeling unwell with a “flu” last week. While most of her symptoms have resolved (cough, fever), the nasal congestion and discharge persists and so she has made an appointment (she is an otherwise healthy 32 year old with treated thyroid disease). She would like your advice for what treatment she should ask the doctor to prescribe.

[http://www.ncbi.nlm.nih.gov/pubmed/24293353 Intranasal steroids for acute sinusitis]

'''Scenario 4 - Glaucoma''' - GROUPS 4, 10, 15, 22, 28, 33

Mrs. Ada Waters is a 63 year-old woman you. Her ophthalmologist prescribed timolol and xalatan eye drops for treatment of open angle glaucoma. She has never really felt much different on treatment since she recovered from her first episode (of acute angle closure glaucoma requiring ER visit) and surgery. She asks you if the treatment is really making a difference.

[https://www.ncbi.nlm.nih.gov/pubmed/17943780 Interventions for open angle glaucoma]

'''Scenario 5 - Sore Throat''' - GROUPS 5, 11, 14, 23, 29, 32

You have a good friend who is applying for pharmacy. Her invitation for the multiple-mini interview (MMI) is coming up soon, but she is starting to experience a sore throat. While she is worried about not being able to speak through all of those stations, she knows she often gets a terrible headache along with her sore throat. She has an unused prescription for amoxicillin (unexpired) and wonders if you recommend for her to take it.

[https://pubmed.ncbi.nlm.nih.gov/34881426/ Antibiotics for sore throat]

'''Scenario 6 - Conjunctivitis''' - GROUPS 6, 12, 13, 24, 30, 31

A man comes to your pharmacy (he appears in his early twenties) complaining of “pink eye”. He has had a pink discolouration and discharge from his left eye for two days. He asks if the OTC antibiotic eye drops (he’s holding a product with polymixin B) are any better than “waiting it out”.

[https://www.ncbi.nlm.nih.gov/pubmed/22972049 Antibiotics for acute conjunctivitis]

6) HEMATOLOGY STUDIES

None so far

'''ACADEMIC YEAR 2 - FIRST TERM'''

7) RESPIROLOGY STUDIES
[[File:IA COPD info.pdf|thumb]]

*[http://www.ncbi.nlm.nih.gov/pubmed/2062329 First inhaled steroid study] Groups 1,13,25
*[https://pubmed.ncbi.nlm.nih.gov/40388330/ As-Needed Albuterol-Budesonide in Mild Asthma] Groups 2,14,26
*[https://pubmed.ncbi.nlm.nih.gov/35569035/ Albuterol-Budesonide Fixed-Dose Combination Rescue Inhaler for Asthma] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/29768149 Combined Budesonide–Formoterol as Needed in Mild Asthma] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/15223858 Doubling dose of inhaled corticosteroid] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/29768147 As-Needed Budesonide–Formoterol versus Maintenance Budesonide in Mild Asthma] Groups 6,18,30
*[https://pubmed.ncbi.nlm.nih.gov/32579807/ Triple Inhaled Therapy at Two Glucocorticoid Doses in Moderate-to-Very-Severe COPD] Groups 7,19,31
*[https://pubmed.ncbi.nlm.nih.gov/29605624/ Tiotropium and olodaterol in the prevention of COPD] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/23695200 Short VS long steroids for COPD exacerbation] Groups 9,21,33
*[http://www.ncbi.nlm.nih.gov/pubmed/25196117 Stopping inhaled steroids in COPD] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/29668352 Once-Daily Single-Inhaler Triple versus Dual Therapy in Patients with COPD] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/28877011 Tezepelumab in Adults with Uncontrolled Asthma] Groups 12,24,36

8) CARDIOVASCULAR STUDIES

SESSION 1

*[https://www.ncbi.nlm.nih.gov/pubmed/4862069 VA1] (Group 1, 13, 25)
*[https://www.ncbi.nlm.nih.gov/pubmed/4914579 VA 2] (Group 2, 14, 26)
*[https://pubmed.ncbi.nlm.nih.gov/33186492 Polycap Study 3] (Group 3, 15, 27)
*[http://www.ncbi.nlm.nih.gov/pubmed/20228401 ACCORD-BP] (Group 4, 16, 28)
*[https://www.ncbi.nlm.nih.gov/pubmed/26551272 SPRINT] (Group 5, 17, 29)
*[http://www.ncbi.nlm.nih.gov/pubmed/2883575 CONSENSUS] (Group 6,18,30)
*[https://pubmed.ncbi.nlm.nih.gov/31535829/ DAPA-HF] (Group 7, 19, 31)
*[https://pubmed.ncbi.nlm.nih.gov/25176939/ CONFIRM-HF] (Group 8, 20, 32)
*[http://www.ncbi.nlm.nih.gov/pubmed/12457784 PROSPER] (Group 9, 21, 33)
*[http://www.ncbi.nlm.nih.gov/pubmed/27040132 HOPE-3] (Group 10, 22, 34)
*[http://www.ncbi.nlm.nih.gov/pubmed/12114036 Heart Protection Study (HPS)] (Group 11, 23, 35)
*[http://www.ncbi.nlm.nih.gov/pubmed/30415628 REDUCE-IT] (Group 12, 24, 36)

[[File:CV Case.pdf|thumb|CV case|left]]

SESSION 2

'''The Guideline Case'''

A 63 y/o patient with CHOOSE ONE (⬆︎HTN/⬆︎Chol/⬆︎glucose/HF/A fib) and using the guideline determine:
# their 5yr/10yr risks of mortality/CVD events
# the potential benefit
# the potential side effects (with magnitude)
# words/sentiment patient values and preferences/SDM

Atrial fibrillation - Groups 1,13,25,2,14,26
*[https://www.onlinecjc.ca/article/S0828-282X(18)31062-6/pdf 2018 Atrial fibrillation guidelines]
Diabetes - Groups 3,15,27,4,16,28
*[http://guidelines.diabetes.ca/docs/CPG-2018-full-EN.pdf 2018 Diabetes guidelines]
Lipid Simplified - Groups 5,17,29,6,18,30
*[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4607330/pdf/0610857.pdf 2015 Simplified lipid guidelines]
Lipid - Groups 7,19,31,8,20,32
*[http://www.onlinecjc.ca/article/S0828-282X(16)30732-2/pdf 2016 Lipid guidelines]
Heart failure - Groups 9,21,33,10,22,34
*[http://www.onlinecjc.ca/article/S0828-282X(17)30973-X/pdf 2017 Heart failure guidelines]
Hypertension - Groups 11,23,35,12,24,36
*[https://www.onlinecjc.ca/article/S0828-282X(18)30183-1/pdf 2018 Hypertension guidelines]

OPTIONAL SESSION
*[http://www.ncbi.nlm.nih.gov/pubmed/16899775 SPARCL]
*[http://www.ncbi.nlm.nih.gov/pubmed/10471456 RALES]
*[http://www.ncbi.nlm.nih.gov/pubmed/11386263 Carvedilol in heart failure]
*[http://www.ncbi.nlm.nih.gov/pubmed/18460663 WAFACS]
*[http://www.ncbi.nlm.nih.gov/pubmed/10376614 MERIT-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/25176015 PARADIGM-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/24490264 High-dose multivitamins after MI]
*[http://www.ncbi.nlm.nih.gov/pubmed/7911176 Mediterranean Diet after MI]
*[http://www.ncbi.nlm.nih.gov/pubmed/15337732 A TO Z]
*[http://www.ncbi.nlm.nih.gov/pubmed/21073363 EMPHASIS-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/12853193 COMET]
*[http://www.ncbi.nlm.nih.gov/pubmed/24716680 TOPCAT]
*[http://www.ncbi.nlm.nih.gov/pubmed/26039521 IMPROVE-IT]

'''ACADEMIC YEAR 2 - SECOND TERM'''

9) NEPHROLOGY STUDIES

None so far

10) ENDOCRINOLOGY

[[File:IA ENDO LAYOUT.pdf|thumb|IA ENDO LAYOUT TEMPLATE|none]] [[File:Osteoporosis Evidence SUPP.pdf|none|thumb]]

'''RISK ASSESSMENT CASES FOR DIABETES AND OSTEOPOROSIS'''

'''1) DIABETES CASE'''

66 y/o white male who was diagnosed with diabetes 8 years ago

* His blood pressure over the last year has been roughly 145/80 mmHg - at present untreated
* A1c = 8%, no diabetes meds, non-smoker, BMI ~30
* '''When calculating without diabetes for PREVENT use an A1c of 5.5%'''
* Total cholesterol is 6 mmol/L, his HDL is 2 mmol/L, non-HDL = 6 minus 2, not on a statin
* No retinopathy, urine albumin-to-creatinine ratio (UACR) = 15ug/mg (7mg/mmol),
* Serum creatinine = 70 micromol/L, waist circumference 100 cm
* GFR 75 mL/min/1.73m2
* In normal sinus rhythm
* Age at end of highest education = 19
* Mother alive, father died of a heart attack at age 80

'''Calculate Risks'''

'''CVD RISK ESTIMATES''' - list the endpoints described by the specific calculator

Framingham - xx% - 10-year risk - also if no diabetes xx%

ASCVD - xx% - 10-year risk - also if no diabetes xx%

'''The Calculator'''
*CVD CALCULATOR
https://decisionaid.ca/cvd/

'''DIABETES COMPLICATIONS RISK ESTIMATES''' - list the endpoints described by the specific calculator

xx% - also 10-year risk if A1c 9, 8, 7 and 6

also get risk of kidney failure, vision loss, pressure sensation loss – also if A1c 9, 8,7,6

'''The Calculator'''
*DIABETES DECISION AID
http://decisionaid.ca/diabetes/

'''BENEFITS AND HARMS'''

Use the [https://guidelines.diabetes.ca/cpg/chapter-13-2020-update 2024 diabetes guidelines] and/or Diabetes Decision Aid to get estimates of benefits and harms and also use the MyStudies synopsis listed below

'''COSTS'''

Try using [https://pricingdoc.acfp.ca Pricing Doc] to get costs

'''Groups 1,13,25'''

* Metformin - UKPDS 34 [https://mystudies.org/studies.php#studies/28929e89-d01e-4b11-8e67-4d7086f9e4aa/outcome MyStudies Data]

'''Groups 2,14,26'''

* Sulfonlyureas - UKPDS 33 [https://mystudies.org/studies.php#studies/5eadb5dd-d403-4c13-b03e-d4f8d28c96ba/outcome MyStudies Data]

'''Groups 3,15,27'''

* Insulin - ORIGIN [https://mystudies.org/studies.php#studies/f611818f-2e69-4952-b55e-661116bd84b6/outcome MyStudies Data]

'''Groups 4,16,28'''

* SGLT2 - EMPA-REG OUTCOME [https://mystudies.org/studies.php#studies/32e9cf1a-f33e-480b-91ca-6f28a4dcf862/outcome MyStudies Data]

'''Groups 5,17,29'''

* GLP - LEADER [https://mystudies.org/studies.php#studies/1adbc9a1-7603-40f1-ac15-b813ce1f0ad6/outcome MyStudies Data]

'''Groups 6,18,30'''

* DPP4 - TECOS [https://mystudies.org/studies.php#studies/8659968a-cefb-4f99-b4ae-8b9b659acbd5/outcome MyStudies Data]

'''Groups 7,19,31'''

* Intensive treatment – small scale - STENO [https://mystudies.org/studies.php#studies/39d423e3-af57-40c8-ab7a-cbc7f389bdb6/paper MyStudies Data]

'''Groups 8,20,32'''

* Intensive treatment – large scale - ADDITION-Europe - [https://mystudies.org/studies.php#studies/5e07d86d-aa92-4db9-a283-76080db4b6fd/outcome MyStudies Data]

'''2) OSTEOPOROSIS CASE'''

60 y/o Canadian female

* 72 kg, 1.69m, BMI = 25.2
* t-score of -2.5
* Worried about falling and getting a hip fracture
* A friend recently had an atraumatic fracture from simply tripping and falling over in the snow
* No other risk factors

'''Calculate Risks'''

'''FRACTURE RISK ESTIMATES''' - list the endpoints described by the specific calculator

Major osteoporotic fracture - xx% - 10-year risk – if no BMD (just BMI), and then if they had a BMD t-Score of -2.0, -2.5, and -3.0

Hip fracture - - xx% - 10-year risk – if no BMD (just BMI) and if you have a BMD xx% - 10-year risk – if no BMD, and then if they had a BMD T-Score of -2.0, -2.5, and -3.0

'''The Calculator'''

* FRACTURE CALCULATOR

[https://frax.shef.ac.uk/frax/tool.aspx?country=19 Frax Tool - Canada]

'''BENEFITS AND HARMS'''

Use the [https://www.cmaj.ca/content/195/39/E1333 2023 Osteoporosis Guideline] and/or your osteoporosis lecture notes to get the benefits and apply these to your patient, and also get the harms

'''COSTS'''

Try using [https://pricingdoc.acfp.ca Pricing Doc] to get costs

'''Groups 9,21,33'''

* Activity

'''Groups 10,22,34'''

* Calcium/Vitamin D

'''Groups 11,23,35'''

* Bisphosphonates

'''Groups 12,24,36'''

* Denosumab

11) NEUROLOGY STUDIES

*[http://www.ncbi.nlm.nih.gov/pubmed/16717269 Opioids for chronic non-cancer pain] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/29509867 Effect of Opioid vs Nonopioid Medications on Pain-Related Function in Patients With Chronic Back Pain] Groups 2,14,26
*[https://www.ncbi.nlm.nih.gov/pubmed/31291515 Galcanezumab for prevention of cluster headaches] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/27150433 Immediate or delayed treatment of a first seizure] Groups 4,16,28
*[https://www.ncbi.nlm.nih.gov/pubmed/31291516 Rimegepant for episodic migraine] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/26212846 Sleep restriction for insomnia] Groups 6,18,30
*[https://www.ncbi.nlm.nih.gov/pubmed/25957224 CHANCE] Groups 7,19,31
*[https://www.ncbi.nlm.nih.gov/pubmed/16899775 SPARCL] Groups 8,20,32
*[https://www.ncbi.nlm.nih.gov/pubmed/29171821 Erenumab for episodic migraine] Groups 9,21,33
*[https://www.ncbi.nlm.nih.gov/pubmed/24733354 Reduction of benzodiazepines through education] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/26035341 Patient controlled opioid analgesia versus non-patient controlled opioid analgesia for postoperative pain] Groups 11,23,35
*[https://www.ncbi.nlm.nih.gov/pubmed/11589932 PROGRESS] Groups 12,24,36

'''ACADEMIC YEAR 3'''

12) PSYCHIATRY STUDIES

[[:File:2021 Psych Evidence Appraisal - Intro Slides.pdf|Psychiatry Rating Scales Introduction]]

* Study 1: [http://www.ncbi.nlm.nih.gov/pubmed/16554525 STAR*D (Level 2)] Bupropion-SR, sertraline, or venlafaxine-XR after failure of SSRIs for depression
* Study 2: [http://www.ncbi.nlm.nih.gov/pubmed/29477251 Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder]
* Study 3: [https://pubmed.ncbi.nlm.nih.gov/33862018/ Long-acting injectable versus oral antipsychotics for the maintenance treatment of schizophrenia]
* Study 4: [https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2725088 Association of Antipsychotic Polypharmacy vs Monotherapy With Psychiatric Rehospitalization Among Adults With Schizophrenia]
* Study 5: [https://www.ncbi.nlm.nih.gov/pubmed/29490359 Real-world Effectiveness of Pharmacologic Treatments for the Prevention of Bipolar Disorder]
* Study 6: [http://www.ncbi.nlm.nih.gov/pubmed/20092882 BALANCE] Combination lithium and valproate therapy versus monotherapy for relapse prevention in bipolar I disorder
13) GASTROENTEROLOGY STUDIES - LINKS ON CANVAS[[File:Screenshot 2025-11-17 at 7.50.27 AM.png|thumb]][[File:GI ChatGPT Instructions.jpg|thumb|GPT Instructions]]
*Short-term treatment for gastro-oesophageal reflux disease-like symptoms and endoscopy negative reflux disease (Review)
*Oral budesonide for induction of remission in ulcerative colitis (Review)
*Probiotics for the prevention of Clostridium difficile-associated diarrhea in adults and children (Review)
*Deprescribing versus continuation of chronic proton pump inhibitor use in adults (Review)
*Prevention of NSAID-induced gastroduodenal ulcers (Review)
*Methotrexate for maintenance of remission in Crohn's disease (Review)

14) OB/GYN STUDIES
*[http://www.ncbi.nlm.nih.gov/pubmed/25601350 Comparative contraceptive effectiveness of levonorgestrel-releasing and copper IUD Devices]
*[http://www.ncbi.nlm.nih.gov/pubmed/29211679 Hormonal contraception and the risk of breast cancer]
*[http://www.ncbi.nlm.nih.gov/pubmed/30322986 Sexual behaviours in adolescent girls before and after introduction of the HPV]
*[http://www.ncbi.nlm.nih.gov/pubmed/30181338 Intramuscular vs intravenous oxytocin to prevent postpartum haemorrhage at vaginal delivery]
*[http://www.ncbi.nlm.nih.gov/pubmed/27682034 Azithromycin Prophylaxis for Cesarean Delivery]
*[http://www.ncbi.nlm.nih.gov/pubmed/28461374 Antibiotics during pregnancy and risk of spontaneous abortion]

Evidence Appraisal Integrated Activities

2026-09-21T18:12:00Z

JamesMcCormack:

'''OBJECTIVE'''

To critically appraise studies, develop a brief synopsis of the trial results, succinctly present the results and then put the results into a proper clinical context

'''INITIAL PRE-READING'''

'''How To Critically Appraise an RCT In 10 minutes'''
*[https://itunes.apple.com/ca/book/how-to-critically-appraise/id524600667?mt=11 iBook/iPad version]
*[https://therapeuticseducation.org/sites/therapeuticseducation.org/files/Ten_Minute_Critical_Appraisal.pdf PDF version]
Watch this video
[http://youtu.be/QUW0Q8tXVUc Viva La Evidence]

'''Study Results at Your Fingertips'''
*[https://mystudies.org MyStudies] - Free access

'''INTEGRATION ACTIVITY FORMAT'''
# Students placed in groups of ~ 5-7
# Each group is given one of the studies below to review
# Students then work in pairs and develop a one-slide critical appraisal and results synopsis
# One student in each group will be chosen at random to present their group findings to the class
# A discussion about the appraisal and the appropriate clinical context for the results is had with the entire class for each study

'''MODULE'''
[[File:Screen Shot 2022-01-09 at 10.00.16 AM.jpg|thumb|'''TRIAL PRESENTATION FORMAT'''|none]]

Studies chosen include landmark studies and/or studies that address important therapeutic issues for the particular module

'''ACADEMIC YEAR 1 - FIRST TERM'''

1) FOUNDATION STUDIES (Groups)
*[https://pubmed.ncbi.nlm.nih.gov/37952131 SELECT] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/12466506 AFFIRM] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/22085343 AIM-HIGH] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/10639539 HOPE] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/18378519 HYVET] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/15007110 PROVE-IT] Groups 6,18,30
*[http://www.ncbi.nlm.nih.gov/pubmed/15755765 TNT] Groups 7,19,31
*[https://pubmed.ncbi.nlm.nih.gov/26378978 EMPAREG] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/17984165 ILLUMINATE] Groups 9,21,33
*[https://pubmed.ncbi.nlm.nih.gov/26551272/ SPRINT] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/15325833 CARDS] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/12117397 WHI] Groups 12,24,36

'''ACADEMIC YEAR 1 - SECOND TERM'''

2) INTRO TO INFECTIOUS DISEASE STUDIES

[https://wiki.ubc.ca/images/8/8b/Antibiotic_Sensitivity_Chart_2024.pdf The "Best" Antibiotic Sensitivity Chart Ever]
*[http://www.ncbi.nlm.nih.gov/pubmed/17567657 IV vs PO antibiotics] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/24603565 Delayed antibiotics for respiratory tract infections] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/11159657 Delayed antibiotics for otitis media] Groups 3,15,27
*[https://pubmed.ncbi.nlm.nih.gov/27455166/ Duration of treatment for community acquired pneumonia] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/22726802 Duration of treatment for pyelonephritis] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/25830421 Choice of antibiotic for community acquired pneumonia-1] Groups 6,18,30
*[http://www.ncbi.nlm.nih.gov/pubmed/25286173 Choice of antibiotic for community acquired pneumonia-2] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/20647284 HPV vaccine study] Groups 8,20,32
*[https://pubmed.ncbi.nlm.nih.gov/40888720/ High-Dose Influenza Vaccine - hospitalization] Groups 9,21,33
*[https://pubmed.ncbi.nlm.nih.gov/40884442 High-Dose Influenza Vaccine - cardiovascular outcomes] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/27626517 Herpes zoster vaccine study 1] Groups 11,23,35
*[https://www.ncbi.nlm.nih.gov/pubmed/25916341 Herpes zoster vaccine study 2] Groups 12,24,36

3) MUSCULOSKELETAL STUDIES

*[http://www.ncbi.nlm.nih.gov/pubmed/28199814 Baricitinib versus Placebo or Adalimumab in Rheumatoid Arthritis] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/0010979111 CLASS – celecoxib vs NSAIDs] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/26501533 Naproxen with cyclobenzaprine, oxycodone/acetaminophen, or placebo for low back pain] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/24395557 Glucosamine and chondroitin for OA] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/12546607 Acetaminophen vs diclofenac for OA] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/23964752 Diclofenac gel for acute neck pain] Groups 6,18,30
*[https://pubmed.ncbi.nlm.nih.gov/15468367/ Topical diclofenac vs oral diclofenac] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/25064594 Acetaminophen for low back pain] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/7611589 Misoprostol and NSAID induced ulcers] Groups 9,21,33
*[http://www.ncbi.nlm.nih.gov/pubmed/20131255 Low dose vs high dose colchicine for gout] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/22508468 TEAR - oral triple therapy versus etanercept plus methotrexate in early aggressive rheumatoid arthritis] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/25589511 MOVES - Glucosamine and chondroitin for OA for moderate to severe pain] Groups 12,24,36

4) DERMATOLOGY STUDIES

*[https://www.ncbi.nlm.nih.gov/pubmed/9598014 Glycolic acid 5% Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/21896132 Glycolic acid 10% Acne]
*[https://www.ncbi.nlm.nih.gov/pubmed/14531866 Petrolatum vs Ceramide/skin related lipids Hand Dermatitis]
*[https://www.ncbi.nlm.nih.gov/pubmed/11896774 Vitamin C Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/17515510 Retinol (VitaminA) Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/21896129 Hyaluronic acid Atopic Dermatitis]

5) EENT STUDIES

[http://www.amstar.ca/docs/AMSTARguideline.pdf AMSTAR meta-analysis checklist]

'''Scenario 1 - Otitis Media''' - GROUPS 1, 7, 18, 19, 25, 36

Anthony Martin arrives at your pharmacy somewhat frustrated since his family physician declined to write an antibiotic prescription for his two and half year old son, Oscar. His symptoms started yesterday afternoon - Oscar complains of right ear pain but there is no discharge. Rectal temperature taken today was 38.5 degrees. His wife is sure Oscar has an ear infection since the last time he had these same symptoms, that was ultimately the diagnosis. Mr. Martin asks if you think buying acetaminophen is really “enough”?

[https://pubmed.ncbi.nlm.nih.gov/26099233/ Antibiotics for acute otitis media in children]

'''Scenario 2 - Allergic Rhinitis''' - GROUPS 2, 8, 17, 20, 26, 35

Ruby Parmar is a firefighter. She is plagued by sinus congestion (preventing her from sleeping) and a runny nose associated with seasonal allergies. Her prescription for intranasal triamcinolone is typically effective, but she would like to know if a non-sedating anti-allergy pill would work just as well since it’s inconvenient carrying around the “nose spray”.

[https://www.ncbi.nlm.nih.gov/pubmed/28234147 Intranasal steroids vs antihistamines for allergic rhinitis]

'''Scenario 3 - Acute Sinusitis''' - GROUPS 3, 9, 16, 21, 27, 34

You are seeing a patient in clinic before her appointment with the primary care physician. She was feeling unwell with a “flu” last week. While most of her symptoms have resolved (cough, fever), the nasal congestion and discharge persists and so she has made an appointment (she is an otherwise healthy 32 year old with treated thyroid disease). She would like your advice for what treatment she should ask the doctor to prescribe.

[http://www.ncbi.nlm.nih.gov/pubmed/24293353 Intranasal steroids for acute sinusitis]

'''Scenario 4 - Glaucoma''' - GROUPS 4, 10, 15, 22, 28, 33

Mrs. Ada Waters is a 63 year-old woman you. Her ophthalmologist prescribed timolol and xalatan eye drops for treatment of open angle glaucoma. She has never really felt much different on treatment since she recovered from her first episode (of acute angle closure glaucoma requiring ER visit) and surgery. She asks you if the treatment is really making a difference.

[https://www.ncbi.nlm.nih.gov/pubmed/17943780 Interventions for open angle glaucoma]

'''Scenario 5 - Sore Throat''' - GROUPS 5, 11, 14, 23, 29, 32

You have a good friend who is applying for pharmacy. Her invitation for the multiple-mini interview (MMI) is coming up soon, but she is starting to experience a sore throat. While she is worried about not being able to speak through all of those stations, she knows she often gets a terrible headache along with her sore throat. She has an unused prescription for amoxicillin (unexpired) and wonders if you recommend for her to take it.

[https://pubmed.ncbi.nlm.nih.gov/34881426/ Antibiotics for sore throat]

'''Scenario 6 - Conjunctivitis''' - GROUPS 6, 12, 13, 24, 30, 31

A man comes to your pharmacy (he appears in his early twenties) complaining of “pink eye”. He has had a pink discolouration and discharge from his left eye for two days. He asks if the OTC antibiotic eye drops (he’s holding a product with polymixin B) are any better than “waiting it out”.

[https://www.ncbi.nlm.nih.gov/pubmed/22972049 Antibiotics for acute conjunctivitis]

6) HEMATOLOGY STUDIES

None so far

'''ACADEMIC YEAR 2 - FIRST TERM'''

7) RESPIROLOGY STUDIES
[[File:IA COPD info.pdf|thumb]]

*[http://www.ncbi.nlm.nih.gov/pubmed/2062329 First inhaled steroid study] Groups 1,13,25
*[https://pubmed.ncbi.nlm.nih.gov/40388330/ As-Needed Albuterol-Budesonide in Mild Asthma] Groups 2,14,26
*[https://pubmed.ncbi.nlm.nih.gov/35569035/ Albuterol-Budesonide Fixed-Dose Combination Rescue Inhaler for Asthma] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/29768149 Combined Budesonide–Formoterol as Needed in Mild Asthma] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/15223858 Doubling dose of inhaled corticosteroid] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/29768147 As-Needed Budesonide–Formoterol versus Maintenance Budesonide in Mild Asthma] Groups 6,18,30
*[https://pubmed.ncbi.nlm.nih.gov/32579807/ Triple Inhaled Therapy at Two Glucocorticoid Doses in Moderate-to-Very-Severe COPD] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/21428765 Tiotropium VS salmeterol in COPD] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/23695200 Short VS long steroids for COPD exacerbation] Groups 9,21,33
*[http://www.ncbi.nlm.nih.gov/pubmed/25196117 Stopping inhaled steroids in COPD] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/29668352 Once-Daily Single-Inhaler Triple versus Dual Therapy in Patients with COPD] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/28877011 Tezepelumab in Adults with Uncontrolled Asthma] Groups 12,24,36

8) CARDIOVASCULAR STUDIES

SESSION 1

*[https://www.ncbi.nlm.nih.gov/pubmed/4862069 VA1] (Group 1, 13, 25)
*[https://www.ncbi.nlm.nih.gov/pubmed/4914579 VA 2] (Group 2, 14, 26)
*[https://pubmed.ncbi.nlm.nih.gov/33186492 Polycap Study 3] (Group 3, 15, 27)
*[http://www.ncbi.nlm.nih.gov/pubmed/20228401 ACCORD-BP] (Group 4, 16, 28)
*[https://www.ncbi.nlm.nih.gov/pubmed/26551272 SPRINT] (Group 5, 17, 29)
*[http://www.ncbi.nlm.nih.gov/pubmed/2883575 CONSENSUS] (Group 6,18,30)
*[https://pubmed.ncbi.nlm.nih.gov/31535829/ DAPA-HF] (Group 7, 19, 31)
*[https://pubmed.ncbi.nlm.nih.gov/25176939/ CONFIRM-HF] (Group 8, 20, 32)
*[http://www.ncbi.nlm.nih.gov/pubmed/12457784 PROSPER] (Group 9, 21, 33)
*[http://www.ncbi.nlm.nih.gov/pubmed/27040132 HOPE-3] (Group 10, 22, 34)
*[http://www.ncbi.nlm.nih.gov/pubmed/12114036 Heart Protection Study (HPS)] (Group 11, 23, 35)
*[http://www.ncbi.nlm.nih.gov/pubmed/30415628 REDUCE-IT] (Group 12, 24, 36)

[[File:CV Case.pdf|thumb|CV case|left]]

SESSION 2

'''The Guideline Case'''

A 63 y/o patient with CHOOSE ONE (⬆︎HTN/⬆︎Chol/⬆︎glucose/HF/A fib) and using the guideline determine:
# their 5yr/10yr risks of mortality/CVD events
# the potential benefit
# the potential side effects (with magnitude)
# words/sentiment patient values and preferences/SDM

Atrial fibrillation - Groups 1,13,25,2,14,26
*[https://www.onlinecjc.ca/article/S0828-282X(18)31062-6/pdf 2018 Atrial fibrillation guidelines]
Diabetes - Groups 3,15,27,4,16,28
*[http://guidelines.diabetes.ca/docs/CPG-2018-full-EN.pdf 2018 Diabetes guidelines]
Lipid Simplified - Groups 5,17,29,6,18,30
*[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4607330/pdf/0610857.pdf 2015 Simplified lipid guidelines]
Lipid - Groups 7,19,31,8,20,32
*[http://www.onlinecjc.ca/article/S0828-282X(16)30732-2/pdf 2016 Lipid guidelines]
Heart failure - Groups 9,21,33,10,22,34
*[http://www.onlinecjc.ca/article/S0828-282X(17)30973-X/pdf 2017 Heart failure guidelines]
Hypertension - Groups 11,23,35,12,24,36
*[https://www.onlinecjc.ca/article/S0828-282X(18)30183-1/pdf 2018 Hypertension guidelines]

OPTIONAL SESSION
*[http://www.ncbi.nlm.nih.gov/pubmed/16899775 SPARCL]
*[http://www.ncbi.nlm.nih.gov/pubmed/10471456 RALES]
*[http://www.ncbi.nlm.nih.gov/pubmed/11386263 Carvedilol in heart failure]
*[http://www.ncbi.nlm.nih.gov/pubmed/18460663 WAFACS]
*[http://www.ncbi.nlm.nih.gov/pubmed/10376614 MERIT-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/25176015 PARADIGM-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/24490264 High-dose multivitamins after MI]
*[http://www.ncbi.nlm.nih.gov/pubmed/7911176 Mediterranean Diet after MI]
*[http://www.ncbi.nlm.nih.gov/pubmed/15337732 A TO Z]
*[http://www.ncbi.nlm.nih.gov/pubmed/21073363 EMPHASIS-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/12853193 COMET]
*[http://www.ncbi.nlm.nih.gov/pubmed/24716680 TOPCAT]
*[http://www.ncbi.nlm.nih.gov/pubmed/26039521 IMPROVE-IT]

'''ACADEMIC YEAR 2 - SECOND TERM'''

9) NEPHROLOGY STUDIES

None so far

10) ENDOCRINOLOGY

[[File:IA ENDO LAYOUT.pdf|thumb|IA ENDO LAYOUT TEMPLATE|none]] [[File:Osteoporosis Evidence SUPP.pdf|none|thumb]]

'''RISK ASSESSMENT CASES FOR DIABETES AND OSTEOPOROSIS'''

'''1) DIABETES CASE'''

66 y/o white male who was diagnosed with diabetes 8 years ago

* His blood pressure over the last year has been roughly 145/80 mmHg - at present untreated
* A1c = 8%, no diabetes meds, non-smoker, BMI ~30
* '''When calculating without diabetes for PREVENT use an A1c of 5.5%'''
* Total cholesterol is 6 mmol/L, his HDL is 2 mmol/L, non-HDL = 6 minus 2, not on a statin
* No retinopathy, urine albumin-to-creatinine ratio (UACR) = 15ug/mg (7mg/mmol),
* Serum creatinine = 70 micromol/L, waist circumference 100 cm
* GFR 75 mL/min/1.73m2
* In normal sinus rhythm
* Age at end of highest education = 19
* Mother alive, father died of a heart attack at age 80

'''Calculate Risks'''

'''CVD RISK ESTIMATES''' - list the endpoints described by the specific calculator

Framingham - xx% - 10-year risk - also if no diabetes xx%

ASCVD - xx% - 10-year risk - also if no diabetes xx%

'''The Calculator'''
*CVD CALCULATOR
https://decisionaid.ca/cvd/

'''DIABETES COMPLICATIONS RISK ESTIMATES''' - list the endpoints described by the specific calculator

xx% - also 10-year risk if A1c 9, 8, 7 and 6

also get risk of kidney failure, vision loss, pressure sensation loss – also if A1c 9, 8,7,6

'''The Calculator'''
*DIABETES DECISION AID
http://decisionaid.ca/diabetes/

'''BENEFITS AND HARMS'''

Use the [https://guidelines.diabetes.ca/cpg/chapter-13-2020-update 2024 diabetes guidelines] and/or Diabetes Decision Aid to get estimates of benefits and harms and also use the MyStudies synopsis listed below

'''COSTS'''

Try using [https://pricingdoc.acfp.ca Pricing Doc] to get costs

'''Groups 1,13,25'''

* Metformin - UKPDS 34 [https://mystudies.org/studies.php#studies/28929e89-d01e-4b11-8e67-4d7086f9e4aa/outcome MyStudies Data]

'''Groups 2,14,26'''

* Sulfonlyureas - UKPDS 33 [https://mystudies.org/studies.php#studies/5eadb5dd-d403-4c13-b03e-d4f8d28c96ba/outcome MyStudies Data]

'''Groups 3,15,27'''

* Insulin - ORIGIN [https://mystudies.org/studies.php#studies/f611818f-2e69-4952-b55e-661116bd84b6/outcome MyStudies Data]

'''Groups 4,16,28'''

* SGLT2 - EMPA-REG OUTCOME [https://mystudies.org/studies.php#studies/32e9cf1a-f33e-480b-91ca-6f28a4dcf862/outcome MyStudies Data]

'''Groups 5,17,29'''

* GLP - LEADER [https://mystudies.org/studies.php#studies/1adbc9a1-7603-40f1-ac15-b813ce1f0ad6/outcome MyStudies Data]

'''Groups 6,18,30'''

* DPP4 - TECOS [https://mystudies.org/studies.php#studies/8659968a-cefb-4f99-b4ae-8b9b659acbd5/outcome MyStudies Data]

'''Groups 7,19,31'''

* Intensive treatment – small scale - STENO [https://mystudies.org/studies.php#studies/39d423e3-af57-40c8-ab7a-cbc7f389bdb6/paper MyStudies Data]

'''Groups 8,20,32'''

* Intensive treatment – large scale - ADDITION-Europe - [https://mystudies.org/studies.php#studies/5e07d86d-aa92-4db9-a283-76080db4b6fd/outcome MyStudies Data]

'''2) OSTEOPOROSIS CASE'''

60 y/o Canadian female

* 72 kg, 1.69m, BMI = 25.2
* t-score of -2.5
* Worried about falling and getting a hip fracture
* A friend recently had an atraumatic fracture from simply tripping and falling over in the snow
* No other risk factors

'''Calculate Risks'''

'''FRACTURE RISK ESTIMATES''' - list the endpoints described by the specific calculator

Major osteoporotic fracture - xx% - 10-year risk – if no BMD (just BMI), and then if they had a BMD t-Score of -2.0, -2.5, and -3.0

Hip fracture - - xx% - 10-year risk – if no BMD (just BMI) and if you have a BMD xx% - 10-year risk – if no BMD, and then if they had a BMD T-Score of -2.0, -2.5, and -3.0

'''The Calculator'''

* FRACTURE CALCULATOR

[https://frax.shef.ac.uk/frax/tool.aspx?country=19 Frax Tool - Canada]

'''BENEFITS AND HARMS'''

Use the [https://www.cmaj.ca/content/195/39/E1333 2023 Osteoporosis Guideline] and/or your osteoporosis lecture notes to get the benefits and apply these to your patient, and also get the harms

'''COSTS'''

Try using [https://pricingdoc.acfp.ca Pricing Doc] to get costs

'''Groups 9,21,33'''

* Activity

'''Groups 10,22,34'''

* Calcium/Vitamin D

'''Groups 11,23,35'''

* Bisphosphonates

'''Groups 12,24,36'''

* Denosumab

11) NEUROLOGY STUDIES

*[http://www.ncbi.nlm.nih.gov/pubmed/16717269 Opioids for chronic non-cancer pain] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/29509867 Effect of Opioid vs Nonopioid Medications on Pain-Related Function in Patients With Chronic Back Pain] Groups 2,14,26
*[https://www.ncbi.nlm.nih.gov/pubmed/31291515 Galcanezumab for prevention of cluster headaches] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/27150433 Immediate or delayed treatment of a first seizure] Groups 4,16,28
*[https://www.ncbi.nlm.nih.gov/pubmed/31291516 Rimegepant for episodic migraine] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/26212846 Sleep restriction for insomnia] Groups 6,18,30
*[https://www.ncbi.nlm.nih.gov/pubmed/25957224 CHANCE] Groups 7,19,31
*[https://www.ncbi.nlm.nih.gov/pubmed/16899775 SPARCL] Groups 8,20,32
*[https://www.ncbi.nlm.nih.gov/pubmed/29171821 Erenumab for episodic migraine] Groups 9,21,33
*[https://www.ncbi.nlm.nih.gov/pubmed/24733354 Reduction of benzodiazepines through education] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/26035341 Patient controlled opioid analgesia versus non-patient controlled opioid analgesia for postoperative pain] Groups 11,23,35
*[https://www.ncbi.nlm.nih.gov/pubmed/11589932 PROGRESS] Groups 12,24,36

'''ACADEMIC YEAR 3'''

12) PSYCHIATRY STUDIES

[[:File:2021 Psych Evidence Appraisal - Intro Slides.pdf|Psychiatry Rating Scales Introduction]]

* Study 1: [http://www.ncbi.nlm.nih.gov/pubmed/16554525 STAR*D (Level 2)] Bupropion-SR, sertraline, or venlafaxine-XR after failure of SSRIs for depression
* Study 2: [http://www.ncbi.nlm.nih.gov/pubmed/29477251 Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder]
* Study 3: [https://pubmed.ncbi.nlm.nih.gov/33862018/ Long-acting injectable versus oral antipsychotics for the maintenance treatment of schizophrenia]
* Study 4: [https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2725088 Association of Antipsychotic Polypharmacy vs Monotherapy With Psychiatric Rehospitalization Among Adults With Schizophrenia]
* Study 5: [https://www.ncbi.nlm.nih.gov/pubmed/29490359 Real-world Effectiveness of Pharmacologic Treatments for the Prevention of Bipolar Disorder]
* Study 6: [http://www.ncbi.nlm.nih.gov/pubmed/20092882 BALANCE] Combination lithium and valproate therapy versus monotherapy for relapse prevention in bipolar I disorder
13) GASTROENTEROLOGY STUDIES - LINKS ON CANVAS[[File:Screenshot 2025-11-17 at 7.50.27 AM.png|thumb]][[File:GI ChatGPT Instructions.jpg|thumb|GPT Instructions]]
*Short-term treatment for gastro-oesophageal reflux disease-like symptoms and endoscopy negative reflux disease (Review)
*Oral budesonide for induction of remission in ulcerative colitis (Review)
*Probiotics for the prevention of Clostridium difficile-associated diarrhea in adults and children (Review)
*Deprescribing versus continuation of chronic proton pump inhibitor use in adults (Review)
*Prevention of NSAID-induced gastroduodenal ulcers (Review)
*Methotrexate for maintenance of remission in Crohn's disease (Review)

14) OB/GYN STUDIES
*[http://www.ncbi.nlm.nih.gov/pubmed/25601350 Comparative contraceptive effectiveness of levonorgestrel-releasing and copper IUD Devices]
*[http://www.ncbi.nlm.nih.gov/pubmed/29211679 Hormonal contraception and the risk of breast cancer]
*[http://www.ncbi.nlm.nih.gov/pubmed/30322986 Sexual behaviours in adolescent girls before and after introduction of the HPV]
*[http://www.ncbi.nlm.nih.gov/pubmed/30181338 Intramuscular vs intravenous oxytocin to prevent postpartum haemorrhage at vaginal delivery]
*[http://www.ncbi.nlm.nih.gov/pubmed/27682034 Azithromycin Prophylaxis for Cesarean Delivery]
*[http://www.ncbi.nlm.nih.gov/pubmed/28461374 Antibiotics during pregnancy and risk of spontaneous abortion]

Evidence Appraisal Integrated Activities

2026-09-21T18:06:29Z

JamesMcCormack:

'''OBJECTIVE'''

To critically appraise studies, develop a brief synopsis of the trial results, succinctly present the results and then put the results into a proper clinical context

'''INITIAL PRE-READING'''

'''How To Critically Appraise an RCT In 10 minutes'''
*[https://itunes.apple.com/ca/book/how-to-critically-appraise/id524600667?mt=11 iBook/iPad version]
*[https://therapeuticseducation.org/sites/therapeuticseducation.org/files/Ten_Minute_Critical_Appraisal.pdf PDF version]
Watch this video
[http://youtu.be/QUW0Q8tXVUc Viva La Evidence]

'''Study Results at Your Fingertips'''
*[https://mystudies.org MyStudies] - Free access

'''INTEGRATION ACTIVITY FORMAT'''
# Students placed in groups of ~ 5-7
# Each group is given one of the studies below to review
# Students then work in pairs and develop a one-slide critical appraisal and results synopsis
# One student in each group will be chosen at random to present their group findings to the class
# A discussion about the appraisal and the appropriate clinical context for the results is had with the entire class for each study

'''MODULE'''
[[File:Screen Shot 2022-01-09 at 10.00.16 AM.jpg|thumb|'''TRIAL PRESENTATION FORMAT'''|none]]

Studies chosen include landmark studies and/or studies that address important therapeutic issues for the particular module

'''ACADEMIC YEAR 1 - FIRST TERM'''

1) FOUNDATION STUDIES (Groups)
*[https://pubmed.ncbi.nlm.nih.gov/37952131 SELECT] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/12466506 AFFIRM] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/22085343 AIM-HIGH] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/10639539 HOPE] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/18378519 HYVET] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/15007110 PROVE-IT] Groups 6,18,30
*[http://www.ncbi.nlm.nih.gov/pubmed/15755765 TNT] Groups 7,19,31
*[https://pubmed.ncbi.nlm.nih.gov/26378978 EMPAREG] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/17984165 ILLUMINATE] Groups 9,21,33
*[https://pubmed.ncbi.nlm.nih.gov/26551272/ SPRINT] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/15325833 CARDS] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/12117397 WHI] Groups 12,24,36

'''ACADEMIC YEAR 1 - SECOND TERM'''

2) INTRO TO INFECTIOUS DISEASE STUDIES

[https://wiki.ubc.ca/images/8/8b/Antibiotic_Sensitivity_Chart_2024.pdf The "Best" Antibiotic Sensitivity Chart Ever]
*[http://www.ncbi.nlm.nih.gov/pubmed/17567657 IV vs PO antibiotics] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/24603565 Delayed antibiotics for respiratory tract infections] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/11159657 Delayed antibiotics for otitis media] Groups 3,15,27
*[https://pubmed.ncbi.nlm.nih.gov/27455166/ Duration of treatment for community acquired pneumonia] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/22726802 Duration of treatment for pyelonephritis] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/25830421 Choice of antibiotic for community acquired pneumonia-1] Groups 6,18,30
*[http://www.ncbi.nlm.nih.gov/pubmed/25286173 Choice of antibiotic for community acquired pneumonia-2] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/20647284 HPV vaccine study] Groups 8,20,32
*[https://pubmed.ncbi.nlm.nih.gov/40888720/ High-Dose Influenza Vaccine - hospitalization] Groups 9,21,33
*[https://pubmed.ncbi.nlm.nih.gov/40884442 High-Dose Influenza Vaccine - cardiovascular outcomes] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/27626517 Herpes zoster vaccine study 1] Groups 11,23,35
*[https://www.ncbi.nlm.nih.gov/pubmed/25916341 Herpes zoster vaccine study 2] Groups 12,24,36

3) MUSCULOSKELETAL STUDIES

*[http://www.ncbi.nlm.nih.gov/pubmed/28199814 Baricitinib versus Placebo or Adalimumab in Rheumatoid Arthritis] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/0010979111 CLASS – celecoxib vs NSAIDs] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/26501533 Naproxen with cyclobenzaprine, oxycodone/acetaminophen, or placebo for low back pain] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/24395557 Glucosamine and chondroitin for OA] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/12546607 Acetaminophen vs diclofenac for OA] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/23964752 Diclofenac gel for acute neck pain] Groups 6,18,30
*[https://pubmed.ncbi.nlm.nih.gov/15468367/ Topical diclofenac vs oral diclofenac] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/25064594 Acetaminophen for low back pain] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/7611589 Misoprostol and NSAID induced ulcers] Groups 9,21,33
*[http://www.ncbi.nlm.nih.gov/pubmed/20131255 Low dose vs high dose colchicine for gout] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/22508468 TEAR - oral triple therapy versus etanercept plus methotrexate in early aggressive rheumatoid arthritis] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/25589511 MOVES - Glucosamine and chondroitin for OA for moderate to severe pain] Groups 12,24,36

4) DERMATOLOGY STUDIES

*[https://www.ncbi.nlm.nih.gov/pubmed/9598014 Glycolic acid 5% Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/21896132 Glycolic acid 10% Acne]
*[https://www.ncbi.nlm.nih.gov/pubmed/14531866 Petrolatum vs Ceramide/skin related lipids Hand Dermatitis]
*[https://www.ncbi.nlm.nih.gov/pubmed/11896774 Vitamin C Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/17515510 Retinol (VitaminA) Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/21896129 Hyaluronic acid Atopic Dermatitis]

5) EENT STUDIES

[http://www.amstar.ca/docs/AMSTARguideline.pdf AMSTAR meta-analysis checklist]

'''Scenario 1 - Otitis Media''' - GROUPS 1, 7, 18, 19, 25, 36

Anthony Martin arrives at your pharmacy somewhat frustrated since his family physician declined to write an antibiotic prescription for his two and half year old son, Oscar. His symptoms started yesterday afternoon - Oscar complains of right ear pain but there is no discharge. Rectal temperature taken today was 38.5 degrees. His wife is sure Oscar has an ear infection since the last time he had these same symptoms, that was ultimately the diagnosis. Mr. Martin asks if you think buying acetaminophen is really “enough”?

[https://pubmed.ncbi.nlm.nih.gov/26099233/ Antibiotics for acute otitis media in children]

'''Scenario 2 - Allergic Rhinitis''' - GROUPS 2, 8, 17, 20, 26, 35

Ruby Parmar is a firefighter. She is plagued by sinus congestion (preventing her from sleeping) and a runny nose associated with seasonal allergies. Her prescription for intranasal triamcinolone is typically effective, but she would like to know if a non-sedating anti-allergy pill would work just as well since it’s inconvenient carrying around the “nose spray”.

[https://www.ncbi.nlm.nih.gov/pubmed/28234147 Intranasal steroids vs antihistamines for allergic rhinitis]

'''Scenario 3 - Acute Sinusitis''' - GROUPS 3, 9, 16, 21, 27, 34

You are seeing a patient in clinic before her appointment with the primary care physician. She was feeling unwell with a “flu” last week. While most of her symptoms have resolved (cough, fever), the nasal congestion and discharge persists and so she has made an appointment (she is an otherwise healthy 32 year old with treated thyroid disease). She would like your advice for what treatment she should ask the doctor to prescribe.

[http://www.ncbi.nlm.nih.gov/pubmed/24293353 Intranasal steroids for acute sinusitis]

'''Scenario 4 - Glaucoma''' - GROUPS 4, 10, 15, 22, 28, 33

Mrs. Ada Waters is a 63 year-old woman you. Her ophthalmologist prescribed timolol and xalatan eye drops for treatment of open angle glaucoma. She has never really felt much different on treatment since she recovered from her first episode (of acute angle closure glaucoma requiring ER visit) and surgery. She asks you if the treatment is really making a difference.

[https://www.ncbi.nlm.nih.gov/pubmed/17943780 Interventions for open angle glaucoma]

'''Scenario 5 - Sore Throat''' - GROUPS 5, 11, 14, 23, 29, 32

You have a good friend who is applying for pharmacy. Her invitation for the multiple-mini interview (MMI) is coming up soon, but she is starting to experience a sore throat. While she is worried about not being able to speak through all of those stations, she knows she often gets a terrible headache along with her sore throat. She has an unused prescription for amoxicillin (unexpired) and wonders if you recommend for her to take it.

[https://pubmed.ncbi.nlm.nih.gov/34881426/ Antibiotics for sore throat]

'''Scenario 6 - Conjunctivitis''' - GROUPS 6, 12, 13, 24, 30, 31

A man comes to your pharmacy (he appears in his early twenties) complaining of “pink eye”. He has had a pink discolouration and discharge from his left eye for two days. He asks if the OTC antibiotic eye drops (he’s holding a product with polymixin B) are any better than “waiting it out”.

[https://www.ncbi.nlm.nih.gov/pubmed/22972049 Antibiotics for acute conjunctivitis]

6) HEMATOLOGY STUDIES

None so far

'''ACADEMIC YEAR 2 - FIRST TERM'''

7) RESPIROLOGY STUDIES
[[File:IA COPD info.pdf|thumb]]

*[http://www.ncbi.nlm.nih.gov/pubmed/2062329 First inhaled steroid study] Groups 1,13,25
*[https://pubmed.ncbi.nlm.nih.gov/40388330/ As-Needed Albuterol-Budesonide in Mild Asthma] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/21324520 Inhaled steroid in children] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/29768149 Combined Budesonide–Formoterol as Needed in Mild Asthma] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/15223858 Doubling dose of inhaled corticosteroid] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/29768147 As-Needed Budesonide–Formoterol versus Maintenance Budesonide in Mild Asthma] Groups 6,18,30
*[https://pubmed.ncbi.nlm.nih.gov/32579807/ Triple Inhaled Therapy at Two Glucocorticoid Doses in Moderate-to-Very-Severe COPD] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/21428765 Tiotropium VS salmeterol in COPD] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/23695200 Short VS long steroids for COPD exacerbation] Groups 9,21,33
*[http://www.ncbi.nlm.nih.gov/pubmed/25196117 Stopping inhaled steroids in COPD] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/29668352 Once-Daily Single-Inhaler Triple versus Dual Therapy in Patients with COPD] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/28877011 Tezepelumab in Adults with Uncontrolled Asthma] Groups 12,24,36

8) CARDIOVASCULAR STUDIES

SESSION 1

*[https://www.ncbi.nlm.nih.gov/pubmed/4862069 VA1] (Group 1, 13, 25)
*[https://www.ncbi.nlm.nih.gov/pubmed/4914579 VA 2] (Group 2, 14, 26)
*[https://pubmed.ncbi.nlm.nih.gov/33186492 Polycap Study 3] (Group 3, 15, 27)
*[http://www.ncbi.nlm.nih.gov/pubmed/20228401 ACCORD-BP] (Group 4, 16, 28)
*[https://www.ncbi.nlm.nih.gov/pubmed/26551272 SPRINT] (Group 5, 17, 29)
*[http://www.ncbi.nlm.nih.gov/pubmed/2883575 CONSENSUS] (Group 6,18,30)
*[https://pubmed.ncbi.nlm.nih.gov/31535829/ DAPA-HF] (Group 7, 19, 31)
*[https://pubmed.ncbi.nlm.nih.gov/25176939/ CONFIRM-HF] (Group 8, 20, 32)
*[http://www.ncbi.nlm.nih.gov/pubmed/12457784 PROSPER] (Group 9, 21, 33)
*[http://www.ncbi.nlm.nih.gov/pubmed/27040132 HOPE-3] (Group 10, 22, 34)
*[http://www.ncbi.nlm.nih.gov/pubmed/12114036 Heart Protection Study (HPS)] (Group 11, 23, 35)
*[http://www.ncbi.nlm.nih.gov/pubmed/30415628 REDUCE-IT] (Group 12, 24, 36)

[[File:CV Case.pdf|thumb|CV case|left]]

SESSION 2

'''The Guideline Case'''

A 63 y/o patient with CHOOSE ONE (⬆︎HTN/⬆︎Chol/⬆︎glucose/HF/A fib) and using the guideline determine:
# their 5yr/10yr risks of mortality/CVD events
# the potential benefit
# the potential side effects (with magnitude)
# words/sentiment patient values and preferences/SDM

Atrial fibrillation - Groups 1,13,25,2,14,26
*[https://www.onlinecjc.ca/article/S0828-282X(18)31062-6/pdf 2018 Atrial fibrillation guidelines]
Diabetes - Groups 3,15,27,4,16,28
*[http://guidelines.diabetes.ca/docs/CPG-2018-full-EN.pdf 2018 Diabetes guidelines]
Lipid Simplified - Groups 5,17,29,6,18,30
*[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4607330/pdf/0610857.pdf 2015 Simplified lipid guidelines]
Lipid - Groups 7,19,31,8,20,32
*[http://www.onlinecjc.ca/article/S0828-282X(16)30732-2/pdf 2016 Lipid guidelines]
Heart failure - Groups 9,21,33,10,22,34
*[http://www.onlinecjc.ca/article/S0828-282X(17)30973-X/pdf 2017 Heart failure guidelines]
Hypertension - Groups 11,23,35,12,24,36
*[https://www.onlinecjc.ca/article/S0828-282X(18)30183-1/pdf 2018 Hypertension guidelines]

OPTIONAL SESSION
*[http://www.ncbi.nlm.nih.gov/pubmed/16899775 SPARCL]
*[http://www.ncbi.nlm.nih.gov/pubmed/10471456 RALES]
*[http://www.ncbi.nlm.nih.gov/pubmed/11386263 Carvedilol in heart failure]
*[http://www.ncbi.nlm.nih.gov/pubmed/18460663 WAFACS]
*[http://www.ncbi.nlm.nih.gov/pubmed/10376614 MERIT-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/25176015 PARADIGM-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/24490264 High-dose multivitamins after MI]
*[http://www.ncbi.nlm.nih.gov/pubmed/7911176 Mediterranean Diet after MI]
*[http://www.ncbi.nlm.nih.gov/pubmed/15337732 A TO Z]
*[http://www.ncbi.nlm.nih.gov/pubmed/21073363 EMPHASIS-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/12853193 COMET]
*[http://www.ncbi.nlm.nih.gov/pubmed/24716680 TOPCAT]
*[http://www.ncbi.nlm.nih.gov/pubmed/26039521 IMPROVE-IT]

'''ACADEMIC YEAR 2 - SECOND TERM'''

9) NEPHROLOGY STUDIES

None so far

10) ENDOCRINOLOGY

[[File:IA ENDO LAYOUT.pdf|thumb|IA ENDO LAYOUT TEMPLATE|none]] [[File:Osteoporosis Evidence SUPP.pdf|none|thumb]]

'''RISK ASSESSMENT CASES FOR DIABETES AND OSTEOPOROSIS'''

'''1) DIABETES CASE'''

66 y/o white male who was diagnosed with diabetes 8 years ago

* His blood pressure over the last year has been roughly 145/80 mmHg - at present untreated
* A1c = 8%, no diabetes meds, non-smoker, BMI ~30
* '''When calculating without diabetes for PREVENT use an A1c of 5.5%'''
* Total cholesterol is 6 mmol/L, his HDL is 2 mmol/L, non-HDL = 6 minus 2, not on a statin
* No retinopathy, urine albumin-to-creatinine ratio (UACR) = 15ug/mg (7mg/mmol),
* Serum creatinine = 70 micromol/L, waist circumference 100 cm
* GFR 75 mL/min/1.73m2
* In normal sinus rhythm
* Age at end of highest education = 19
* Mother alive, father died of a heart attack at age 80

'''Calculate Risks'''

'''CVD RISK ESTIMATES''' - list the endpoints described by the specific calculator

Framingham - xx% - 10-year risk - also if no diabetes xx%

ASCVD - xx% - 10-year risk - also if no diabetes xx%

'''The Calculator'''
*CVD CALCULATOR
https://decisionaid.ca/cvd/

'''DIABETES COMPLICATIONS RISK ESTIMATES''' - list the endpoints described by the specific calculator

xx% - also 10-year risk if A1c 9, 8, 7 and 6

also get risk of kidney failure, vision loss, pressure sensation loss – also if A1c 9, 8,7,6

'''The Calculator'''
*DIABETES DECISION AID
http://decisionaid.ca/diabetes/

'''BENEFITS AND HARMS'''

Use the [https://guidelines.diabetes.ca/cpg/chapter-13-2020-update 2024 diabetes guidelines] and/or Diabetes Decision Aid to get estimates of benefits and harms and also use the MyStudies synopsis listed below

'''COSTS'''

Try using [https://pricingdoc.acfp.ca Pricing Doc] to get costs

'''Groups 1,13,25'''

* Metformin - UKPDS 34 [https://mystudies.org/studies.php#studies/28929e89-d01e-4b11-8e67-4d7086f9e4aa/outcome MyStudies Data]

'''Groups 2,14,26'''

* Sulfonlyureas - UKPDS 33 [https://mystudies.org/studies.php#studies/5eadb5dd-d403-4c13-b03e-d4f8d28c96ba/outcome MyStudies Data]

'''Groups 3,15,27'''

* Insulin - ORIGIN [https://mystudies.org/studies.php#studies/f611818f-2e69-4952-b55e-661116bd84b6/outcome MyStudies Data]

'''Groups 4,16,28'''

* SGLT2 - EMPA-REG OUTCOME [https://mystudies.org/studies.php#studies/32e9cf1a-f33e-480b-91ca-6f28a4dcf862/outcome MyStudies Data]

'''Groups 5,17,29'''

* GLP - LEADER [https://mystudies.org/studies.php#studies/1adbc9a1-7603-40f1-ac15-b813ce1f0ad6/outcome MyStudies Data]

'''Groups 6,18,30'''

* DPP4 - TECOS [https://mystudies.org/studies.php#studies/8659968a-cefb-4f99-b4ae-8b9b659acbd5/outcome MyStudies Data]

'''Groups 7,19,31'''

* Intensive treatment – small scale - STENO [https://mystudies.org/studies.php#studies/39d423e3-af57-40c8-ab7a-cbc7f389bdb6/paper MyStudies Data]

'''Groups 8,20,32'''

* Intensive treatment – large scale - ADDITION-Europe - [https://mystudies.org/studies.php#studies/5e07d86d-aa92-4db9-a283-76080db4b6fd/outcome MyStudies Data]

'''2) OSTEOPOROSIS CASE'''

60 y/o Canadian female

* 72 kg, 1.69m, BMI = 25.2
* t-score of -2.5
* Worried about falling and getting a hip fracture
* A friend recently had an atraumatic fracture from simply tripping and falling over in the snow
* No other risk factors

'''Calculate Risks'''

'''FRACTURE RISK ESTIMATES''' - list the endpoints described by the specific calculator

Major osteoporotic fracture - xx% - 10-year risk – if no BMD (just BMI), and then if they had a BMD t-Score of -2.0, -2.5, and -3.0

Hip fracture - - xx% - 10-year risk – if no BMD (just BMI) and if you have a BMD xx% - 10-year risk – if no BMD, and then if they had a BMD T-Score of -2.0, -2.5, and -3.0

'''The Calculator'''

* FRACTURE CALCULATOR

[https://frax.shef.ac.uk/frax/tool.aspx?country=19 Frax Tool - Canada]

'''BENEFITS AND HARMS'''

Use the [https://www.cmaj.ca/content/195/39/E1333 2023 Osteoporosis Guideline] and/or your osteoporosis lecture notes to get the benefits and apply these to your patient, and also get the harms

'''COSTS'''

Try using [https://pricingdoc.acfp.ca Pricing Doc] to get costs

'''Groups 9,21,33'''

* Activity

'''Groups 10,22,34'''

* Calcium/Vitamin D

'''Groups 11,23,35'''

* Bisphosphonates

'''Groups 12,24,36'''

* Denosumab

11) NEUROLOGY STUDIES

*[http://www.ncbi.nlm.nih.gov/pubmed/16717269 Opioids for chronic non-cancer pain] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/29509867 Effect of Opioid vs Nonopioid Medications on Pain-Related Function in Patients With Chronic Back Pain] Groups 2,14,26
*[https://www.ncbi.nlm.nih.gov/pubmed/31291515 Galcanezumab for prevention of cluster headaches] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/27150433 Immediate or delayed treatment of a first seizure] Groups 4,16,28
*[https://www.ncbi.nlm.nih.gov/pubmed/31291516 Rimegepant for episodic migraine] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/26212846 Sleep restriction for insomnia] Groups 6,18,30
*[https://www.ncbi.nlm.nih.gov/pubmed/25957224 CHANCE] Groups 7,19,31
*[https://www.ncbi.nlm.nih.gov/pubmed/16899775 SPARCL] Groups 8,20,32
*[https://www.ncbi.nlm.nih.gov/pubmed/29171821 Erenumab for episodic migraine] Groups 9,21,33
*[https://www.ncbi.nlm.nih.gov/pubmed/24733354 Reduction of benzodiazepines through education] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/26035341 Patient controlled opioid analgesia versus non-patient controlled opioid analgesia for postoperative pain] Groups 11,23,35
*[https://www.ncbi.nlm.nih.gov/pubmed/11589932 PROGRESS] Groups 12,24,36

'''ACADEMIC YEAR 3'''

12) PSYCHIATRY STUDIES

[[:File:2021 Psych Evidence Appraisal - Intro Slides.pdf|Psychiatry Rating Scales Introduction]]

* Study 1: [http://www.ncbi.nlm.nih.gov/pubmed/16554525 STAR*D (Level 2)] Bupropion-SR, sertraline, or venlafaxine-XR after failure of SSRIs for depression
* Study 2: [http://www.ncbi.nlm.nih.gov/pubmed/29477251 Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder]
* Study 3: [https://pubmed.ncbi.nlm.nih.gov/33862018/ Long-acting injectable versus oral antipsychotics for the maintenance treatment of schizophrenia]
* Study 4: [https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2725088 Association of Antipsychotic Polypharmacy vs Monotherapy With Psychiatric Rehospitalization Among Adults With Schizophrenia]
* Study 5: [https://www.ncbi.nlm.nih.gov/pubmed/29490359 Real-world Effectiveness of Pharmacologic Treatments for the Prevention of Bipolar Disorder]
* Study 6: [http://www.ncbi.nlm.nih.gov/pubmed/20092882 BALANCE] Combination lithium and valproate therapy versus monotherapy for relapse prevention in bipolar I disorder
13) GASTROENTEROLOGY STUDIES - LINKS ON CANVAS[[File:Screenshot 2025-11-17 at 7.50.27 AM.png|thumb]][[File:GI ChatGPT Instructions.jpg|thumb|GPT Instructions]]
*Short-term treatment for gastro-oesophageal reflux disease-like symptoms and endoscopy negative reflux disease (Review)
*Oral budesonide for induction of remission in ulcerative colitis (Review)
*Probiotics for the prevention of Clostridium difficile-associated diarrhea in adults and children (Review)
*Deprescribing versus continuation of chronic proton pump inhibitor use in adults (Review)
*Prevention of NSAID-induced gastroduodenal ulcers (Review)
*Methotrexate for maintenance of remission in Crohn's disease (Review)

14) OB/GYN STUDIES
*[http://www.ncbi.nlm.nih.gov/pubmed/25601350 Comparative contraceptive effectiveness of levonorgestrel-releasing and copper IUD Devices]
*[http://www.ncbi.nlm.nih.gov/pubmed/29211679 Hormonal contraception and the risk of breast cancer]
*[http://www.ncbi.nlm.nih.gov/pubmed/30322986 Sexual behaviours in adolescent girls before and after introduction of the HPV]
*[http://www.ncbi.nlm.nih.gov/pubmed/30181338 Intramuscular vs intravenous oxytocin to prevent postpartum haemorrhage at vaginal delivery]
*[http://www.ncbi.nlm.nih.gov/pubmed/27682034 Azithromycin Prophylaxis for Cesarean Delivery]
*[http://www.ncbi.nlm.nih.gov/pubmed/28461374 Antibiotics during pregnancy and risk of spontaneous abortion]

Evidence Appraisal Integrated Activities

2026-02-05T20:23:27Z

JamesMcCormack:

'''OBJECTIVE'''

To critically appraise studies, develop a brief synopsis of the trial results, succinctly present the results and then put the results into a proper clinical context

'''INITIAL PRE-READING'''

'''How To Critically Appraise an RCT In 10 minutes'''
*[https://itunes.apple.com/ca/book/how-to-critically-appraise/id524600667?mt=11 iBook/iPad version]
*[https://therapeuticseducation.org/sites/therapeuticseducation.org/files/Ten_Minute_Critical_Appraisal.pdf PDF version]
Watch this video
[http://youtu.be/QUW0Q8tXVUc Viva La Evidence]

'''Study Results at Your Fingertips'''
*[https://mystudies.org MyStudies] - Free access

'''INTEGRATION ACTIVITY FORMAT'''
# Students placed in groups of ~ 5-7
# Each group is given one of the studies below to review
# Students then work in pairs and develop a one-slide critical appraisal and results synopsis
# One student in each group will be chosen at random to present their group findings to the class
# A discussion about the appraisal and the appropriate clinical context for the results is had with the entire class for each study

'''MODULE'''
[[File:Screen Shot 2022-01-09 at 10.00.16 AM.jpg|thumb|'''TRIAL PRESENTATION FORMAT'''|none]]

Studies chosen include landmark studies and/or studies that address important therapeutic issues for the particular module

'''ACADEMIC YEAR 1 - FIRST TERM'''

1) FOUNDATION STUDIES (Groups)
*[https://pubmed.ncbi.nlm.nih.gov/37952131 SELECT] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/12466506 AFFIRM] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/22085343 AIM-HIGH] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/10639539 HOPE] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/18378519 HYVET] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/15007110 PROVE-IT] Groups 6,18,30
*[http://www.ncbi.nlm.nih.gov/pubmed/15755765 TNT] Groups 7,19,31
*[https://pubmed.ncbi.nlm.nih.gov/26378978 EMPAREG] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/17984165 ILLUMINATE] Groups 9,21,33
*[https://pubmed.ncbi.nlm.nih.gov/26551272/ SPRINT] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/15325833 CARDS] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/12117397 WHI] Groups 12,24,36

'''ACADEMIC YEAR 1 - SECOND TERM'''

2) INTRO TO INFECTIOUS DISEASE STUDIES

[https://wiki.ubc.ca/images/8/8b/Antibiotic_Sensitivity_Chart_2024.pdf The "Best" Antibiotic Sensitivity Chart Ever]
*[http://www.ncbi.nlm.nih.gov/pubmed/17567657 IV vs PO antibiotics] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/24603565 Delayed antibiotics for respiratory tract infections] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/11159657 Delayed antibiotics for otitis media] Groups 3,15,27
*[https://pubmed.ncbi.nlm.nih.gov/27455166/ Duration of treatment for community acquired pneumonia] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/22726802 Duration of treatment for pyelonephritis] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/25830421 Choice of antibiotic for community acquired pneumonia-1] Groups 6,18,30
*[http://www.ncbi.nlm.nih.gov/pubmed/25286173 Choice of antibiotic for community acquired pneumonia-2] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/20647284 HPV vaccine study] Groups 8,20,32
*[https://pubmed.ncbi.nlm.nih.gov/40888720/ High-Dose Influenza Vaccine - hospitalization] Groups 9,21,33
*[https://pubmed.ncbi.nlm.nih.gov/40884442 High-Dose Influenza Vaccine - cardiovascular outcomes] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/27626517 Herpes zoster vaccine study 1] Groups 11,23,35
*[https://www.ncbi.nlm.nih.gov/pubmed/25916341 Herpes zoster vaccine study 2] Groups 12,24,36

3) MUSCULOSKELETAL STUDIES

*[http://www.ncbi.nlm.nih.gov/pubmed/28199814 Baricitinib versus Placebo or Adalimumab in Rheumatoid Arthritis] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/0010979111 CLASS – celecoxib vs NSAIDs] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/26501533 Naproxen with cyclobenzaprine, oxycodone/acetaminophen, or placebo for low back pain] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/24395557 Glucosamine and chondroitin for OA] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/12546607 Acetaminophen vs diclofenac for OA] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/23964752 Diclofenac gel for acute neck pain] Groups 6,18,30
*[https://pubmed.ncbi.nlm.nih.gov/15468367/ Topical diclofenac vs oral diclofenac] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/25064594 Acetaminophen for low back pain] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/7611589 Misoprostol and NSAID induced ulcers] Groups 9,21,33
*[http://www.ncbi.nlm.nih.gov/pubmed/20131255 Low dose vs high dose colchicine for gout] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/22508468 TEAR - oral triple therapy versus etanercept plus methotrexate in early aggressive rheumatoid arthritis] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/25589511 MOVES - Glucosamine and chondroitin for OA for moderate to severe pain] Groups 12,24,36

4) DERMATOLOGY STUDIES

*[https://www.ncbi.nlm.nih.gov/pubmed/9598014 Glycolic acid 5% Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/21896132 Glycolic acid 10% Acne]
*[https://www.ncbi.nlm.nih.gov/pubmed/14531866 Petrolatum vs Ceramide/skin related lipids Hand Dermatitis]
*[https://www.ncbi.nlm.nih.gov/pubmed/11896774 Vitamin C Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/17515510 Retinol (VitaminA) Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/21896129 Hyaluronic acid Atopic Dermatitis]

5) EENT STUDIES

[http://www.amstar.ca/docs/AMSTARguideline.pdf AMSTAR meta-analysis checklist]

'''Scenario 1 - Otitis Media''' - GROUPS 1, 7, 18, 19, 25, 36

Anthony Martin arrives at your pharmacy somewhat frustrated since his family physician declined to write an antibiotic prescription for his two and half year old son, Oscar. His symptoms started yesterday afternoon - Oscar complains of right ear pain but there is no discharge. Rectal temperature taken today was 38.5 degrees. His wife is sure Oscar has an ear infection since the last time he had these same symptoms, that was ultimately the diagnosis. Mr. Martin asks if you think buying acetaminophen is really “enough”?

[https://pubmed.ncbi.nlm.nih.gov/26099233/ Antibiotics for acute otitis media in children]

'''Scenario 2 - Allergic Rhinitis''' - GROUPS 2, 8, 17, 20, 26, 35

Ruby Parmar is a firefighter. She is plagued by sinus congestion (preventing her from sleeping) and a runny nose associated with seasonal allergies. Her prescription for intranasal triamcinolone is typically effective, but she would like to know if a non-sedating anti-allergy pill would work just as well since it’s inconvenient carrying around the “nose spray”.

[https://www.ncbi.nlm.nih.gov/pubmed/28234147 Intranasal steroids vs antihistamines for allergic rhinitis]

'''Scenario 3 - Acute Sinusitis''' - GROUPS 3, 9, 16, 21, 27, 34

You are seeing a patient in clinic before her appointment with the primary care physician. She was feeling unwell with a “flu” last week. While most of her symptoms have resolved (cough, fever), the nasal congestion and discharge persists and so she has made an appointment (she is an otherwise healthy 32 year old with treated thyroid disease). She would like your advice for what treatment she should ask the doctor to prescribe.

[http://www.ncbi.nlm.nih.gov/pubmed/24293353 Intranasal steroids for acute sinusitis]

'''Scenario 4 - Glaucoma''' - GROUPS 4, 10, 15, 22, 28, 33

Mrs. Ada Waters is a 63 year-old woman you. Her ophthalmologist prescribed timolol and xalatan eye drops for treatment of open angle glaucoma. She has never really felt much different on treatment since she recovered from her first episode (of acute angle closure glaucoma requiring ER visit) and surgery. She asks you if the treatment is really making a difference.

[https://www.ncbi.nlm.nih.gov/pubmed/17943780 Interventions for open angle glaucoma]

'''Scenario 5 - Sore Throat''' - GROUPS 5, 11, 14, 23, 29, 32

You have a good friend who is applying for pharmacy. Her invitation for the multiple-mini interview (MMI) is coming up soon, but she is starting to experience a sore throat. While she is worried about not being able to speak through all of those stations, she knows she often gets a terrible headache along with her sore throat. She has an unused prescription for amoxicillin (unexpired) and wonders if you recommend for her to take it.

[https://pubmed.ncbi.nlm.nih.gov/34881426/ Antibiotics for sore throat]

'''Scenario 6 - Conjunctivitis''' - GROUPS 6, 12, 13, 24, 30, 31

A man comes to your pharmacy (he appears in his early twenties) complaining of “pink eye”. He has had a pink discolouration and discharge from his left eye for two days. He asks if the OTC antibiotic eye drops (he’s holding a product with polymixin B) are any better than “waiting it out”.

[https://www.ncbi.nlm.nih.gov/pubmed/22972049 Antibiotics for acute conjunctivitis]

6) HEMATOLOGY STUDIES

None so far

'''ACADEMIC YEAR 2 - FIRST TERM'''

7) RESPIROLOGY STUDIES
[[File:IA COPD info.pdf|thumb]]

*[http://www.ncbi.nlm.nih.gov/pubmed/2062329 First inhaled steroid study] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/22938706 Tiotropium in asthma] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/21324520 Inhaled steroid in children] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/29768149 Combined Budesonide–Formoterol as Needed in Mild Asthma] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/15223858 Doubling dose of inhaled corticosteroid] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/29768147 As-Needed Budesonide–Formoterol versus Maintenance Budesonide in Mild Asthma] Groups 6,18,30
*[https://pubmed.ncbi.nlm.nih.gov/32579807/ Triple Inhaled Therapy at Two Glucocorticoid Doses in Moderate-to-Very-Severe COPD] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/21428765 Tiotropium VS salmeterol in COPD] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/23695200 Short VS long steroids for COPD exacerbation] Groups 9,21,33
*[http://www.ncbi.nlm.nih.gov/pubmed/25196117 Stopping inhaled steroids in COPD] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/29668352 Once-Daily Single-Inhaler Triple versus Dual Therapy in Patients with COPD] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/28877011 Tezepelumab in Adults with Uncontrolled Asthma] Groups 12,24,36

8) CARDIOVASCULAR STUDIES

SESSION 1

*[https://www.ncbi.nlm.nih.gov/pubmed/4862069 VA1] (Group 1, 13, 25)
*[https://www.ncbi.nlm.nih.gov/pubmed/4914579 VA 2] (Group 2, 14, 26)
*[https://pubmed.ncbi.nlm.nih.gov/33186492 Polycap Study 3] (Group 3, 15, 27)
*[http://www.ncbi.nlm.nih.gov/pubmed/20228401 ACCORD-BP] (Group 4, 16, 28)
*[https://www.ncbi.nlm.nih.gov/pubmed/26551272 SPRINT] (Group 5, 17, 29)
*[http://www.ncbi.nlm.nih.gov/pubmed/2883575 CONSENSUS] (Group 6,18,30)
*[https://pubmed.ncbi.nlm.nih.gov/31535829/ DAPA-HF] (Group 7, 19, 31)
*[https://pubmed.ncbi.nlm.nih.gov/25176939/ CONFIRM-HF] (Group 8, 20, 32)
*[http://www.ncbi.nlm.nih.gov/pubmed/12457784 PROSPER] (Group 9, 21, 33)
*[http://www.ncbi.nlm.nih.gov/pubmed/27040132 HOPE-3] (Group 10, 22, 34)
*[http://www.ncbi.nlm.nih.gov/pubmed/12114036 Heart Protection Study (HPS)] (Group 11, 23, 35)
*[http://www.ncbi.nlm.nih.gov/pubmed/30415628 REDUCE-IT] (Group 12, 24, 36)

[[File:CV Case.pdf|thumb|CV case|left]]

SESSION 2

'''The Guideline Case'''

A 63 y/o patient with CHOOSE ONE (⬆︎HTN/⬆︎Chol/⬆︎glucose/HF/A fib) and using the guideline determine:
# their 5yr/10yr risks of mortality/CVD events
# the potential benefit
# the potential side effects (with magnitude)
# words/sentiment patient values and preferences/SDM

Atrial fibrillation - Groups 1,13,25,2,14,26
*[https://www.onlinecjc.ca/article/S0828-282X(18)31062-6/pdf 2018 Atrial fibrillation guidelines]
Diabetes - Groups 3,15,27,4,16,28
*[http://guidelines.diabetes.ca/docs/CPG-2018-full-EN.pdf 2018 Diabetes guidelines]
Lipid Simplified - Groups 5,17,29,6,18,30
*[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4607330/pdf/0610857.pdf 2015 Simplified lipid guidelines]
Lipid - Groups 7,19,31,8,20,32
*[http://www.onlinecjc.ca/article/S0828-282X(16)30732-2/pdf 2016 Lipid guidelines]
Heart failure - Groups 9,21,33,10,22,34
*[http://www.onlinecjc.ca/article/S0828-282X(17)30973-X/pdf 2017 Heart failure guidelines]
Hypertension - Groups 11,23,35,12,24,36
*[https://www.onlinecjc.ca/article/S0828-282X(18)30183-1/pdf 2018 Hypertension guidelines]

OPTIONAL SESSION
*[http://www.ncbi.nlm.nih.gov/pubmed/16899775 SPARCL]
*[http://www.ncbi.nlm.nih.gov/pubmed/10471456 RALES]
*[http://www.ncbi.nlm.nih.gov/pubmed/11386263 Carvedilol in heart failure]
*[http://www.ncbi.nlm.nih.gov/pubmed/18460663 WAFACS]
*[http://www.ncbi.nlm.nih.gov/pubmed/10376614 MERIT-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/25176015 PARADIGM-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/24490264 High-dose multivitamins after MI]
*[http://www.ncbi.nlm.nih.gov/pubmed/7911176 Mediterranean Diet after MI]
*[http://www.ncbi.nlm.nih.gov/pubmed/15337732 A TO Z]
*[http://www.ncbi.nlm.nih.gov/pubmed/21073363 EMPHASIS-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/12853193 COMET]
*[http://www.ncbi.nlm.nih.gov/pubmed/24716680 TOPCAT]
*[http://www.ncbi.nlm.nih.gov/pubmed/26039521 IMPROVE-IT]

'''ACADEMIC YEAR 2 - SECOND TERM'''

9) NEPHROLOGY STUDIES

None so far

10) ENDOCRINOLOGY

[[File:IA ENDO LAYOUT.pdf|thumb|IA ENDO LAYOUT TEMPLATE|none]] [[File:Osteoporosis Evidence SUPP.pdf|none|thumb]]

'''RISK ASSESSMENT CASES FOR DIABETES AND OSTEOPOROSIS'''

'''1) DIABETES CASE'''

66 y/o white male who was diagnosed with diabetes 8 years ago

* His blood pressure over the last year has been roughly 145/80 mmHg - at present untreated
* A1c = 8%, no diabetes meds, non-smoker, BMI ~30
* '''When calculating without diabetes for PREVENT use an A1c of 5.5%'''
* Total cholesterol is 6 mmol/L, his HDL is 2 mmol/L, non-HDL = 6 minus 2, not on a statin
* No retinopathy, urine albumin-to-creatinine ratio (UACR) = 15ug/mg (7mg/mmol),
* Serum creatinine = 70 micromol/L, waist circumference 100 cm
* GFR 75 mL/min/1.73m2
* In normal sinus rhythm
* Age at end of highest education = 19
* Mother alive, father died of a heart attack at age 80

'''Calculate Risks'''

'''CVD RISK ESTIMATES''' - list the endpoints described by the specific calculator

Framingham - xx% - 10-year risk - also if no diabetes xx%

ASCVD - xx% - 10-year risk - also if no diabetes xx%

'''The Calculator'''
*CVD CALCULATOR
https://decisionaid.ca/cvd/

'''DIABETES COMPLICATIONS RISK ESTIMATES''' - list the endpoints described by the specific calculator

xx% - also 10-year risk if A1c 9, 8, 7 and 6

also get risk of kidney failure, vision loss, pressure sensation loss – also if A1c 9, 8,7,6

'''The Calculator'''
*DIABETES DECISION AID
http://decisionaid.ca/diabetes/

'''BENEFITS AND HARMS'''

Use the [https://guidelines.diabetes.ca/cpg/chapter-13-2020-update 2024 diabetes guidelines] and/or Diabetes Decision Aid to get estimates of benefits and harms and also use the MyStudies synopsis listed below

'''COSTS'''

Try using [https://pricingdoc.acfp.ca Pricing Doc] to get costs

'''Groups 1,13,25'''

* Metformin - UKPDS 34 [https://mystudies.org/studies.php#studies/28929e89-d01e-4b11-8e67-4d7086f9e4aa/outcome MyStudies Data]

'''Groups 2,14,26'''

* Sulfonlyureas - UKPDS 33 [https://mystudies.org/studies.php#studies/5eadb5dd-d403-4c13-b03e-d4f8d28c96ba/outcome MyStudies Data]

'''Groups 3,15,27'''

* Insulin - ORIGIN [https://mystudies.org/studies.php#studies/f611818f-2e69-4952-b55e-661116bd84b6/outcome MyStudies Data]

'''Groups 4,16,28'''

* SGLT2 - EMPA-REG OUTCOME [https://mystudies.org/studies.php#studies/32e9cf1a-f33e-480b-91ca-6f28a4dcf862/outcome MyStudies Data]

'''Groups 5,17,29'''

* GLP - LEADER [https://mystudies.org/studies.php#studies/1adbc9a1-7603-40f1-ac15-b813ce1f0ad6/outcome MyStudies Data]

'''Groups 6,18,30'''

* DPP4 - TECOS [https://mystudies.org/studies.php#studies/8659968a-cefb-4f99-b4ae-8b9b659acbd5/outcome MyStudies Data]

'''Groups 7,19,31'''

* Intensive treatment – small scale - STENO [https://mystudies.org/studies.php#studies/39d423e3-af57-40c8-ab7a-cbc7f389bdb6/paper MyStudies Data]

'''Groups 8,20,32'''

* Intensive treatment – large scale - ADDITION-Europe - [https://mystudies.org/studies.php#studies/5e07d86d-aa92-4db9-a283-76080db4b6fd/outcome MyStudies Data]

'''2) OSTEOPOROSIS CASE'''

60 y/o Canadian female

* 72 kg, 1.69m, BMI = 25.2
* t-score of -2.5
* Worried about falling and getting a hip fracture
* A friend recently had an atraumatic fracture from simply tripping and falling over in the snow
* No other risk factors

'''Calculate Risks'''

'''FRACTURE RISK ESTIMATES''' - list the endpoints described by the specific calculator

Major osteoporotic fracture - xx% - 10-year risk – if no BMD (just BMI), and then if they had a BMD t-Score of -2.0, -2.5, and -3.0

Hip fracture - - xx% - 10-year risk – if no BMD (just BMI) and if you have a BMD xx% - 10-year risk – if no BMD, and then if they had a BMD T-Score of -2.0, -2.5, and -3.0

'''The Calculator'''

* FRACTURE CALCULATOR

[https://frax.shef.ac.uk/frax/tool.aspx?country=19 Frax Tool - Canada]

'''BENEFITS AND HARMS'''

Use the [https://www.cmaj.ca/content/195/39/E1333 2023 Osteoporosis Guideline] and/or your osteoporosis lecture notes to get the benefits and apply these to your patient, and also get the harms

'''COSTS'''

Try using [https://pricingdoc.acfp.ca Pricing Doc] to get costs

'''Groups 9,21,33'''

* Activity

'''Groups 10,22,34'''

* Calcium/Vitamin D

'''Groups 11,23,35'''

* Bisphosphonates

'''Groups 12,24,36'''

* Denosumab

11) NEUROLOGY STUDIES

*[http://www.ncbi.nlm.nih.gov/pubmed/16717269 Opioids for chronic non-cancer pain] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/29509867 Effect of Opioid vs Nonopioid Medications on Pain-Related Function in Patients With Chronic Back Pain] Groups 2,14,26
*[https://www.ncbi.nlm.nih.gov/pubmed/31291515 Galcanezumab for prevention of cluster headaches] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/27150433 Immediate or delayed treatment of a first seizure] Groups 4,16,28
*[https://www.ncbi.nlm.nih.gov/pubmed/31291516 Rimegepant for episodic migraine] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/26212846 Sleep restriction for insomnia] Groups 6,18,30
*[https://www.ncbi.nlm.nih.gov/pubmed/25957224 CHANCE] Groups 7,19,31
*[https://www.ncbi.nlm.nih.gov/pubmed/16899775 SPARCL] Groups 8,20,32
*[https://www.ncbi.nlm.nih.gov/pubmed/29171821 Erenumab for episodic migraine] Groups 9,21,33
*[https://www.ncbi.nlm.nih.gov/pubmed/24733354 Reduction of benzodiazepines through education] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/26035341 Patient controlled opioid analgesia versus non-patient controlled opioid analgesia for postoperative pain] Groups 11,23,35
*[https://www.ncbi.nlm.nih.gov/pubmed/11589932 PROGRESS] Groups 12,24,36

'''ACADEMIC YEAR 3'''

12) PSYCHIATRY STUDIES

[[:File:2021 Psych Evidence Appraisal - Intro Slides.pdf|Psychiatry Rating Scales Introduction]]

* Study 1: [http://www.ncbi.nlm.nih.gov/pubmed/16554525 STAR*D (Level 2)] Bupropion-SR, sertraline, or venlafaxine-XR after failure of SSRIs for depression
* Study 2: [http://www.ncbi.nlm.nih.gov/pubmed/29477251 Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder]
* Study 3: [https://pubmed.ncbi.nlm.nih.gov/33862018/ Long-acting injectable versus oral antipsychotics for the maintenance treatment of schizophrenia]
* Study 4: [https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2725088 Association of Antipsychotic Polypharmacy vs Monotherapy With Psychiatric Rehospitalization Among Adults With Schizophrenia]
* Study 5: [https://www.ncbi.nlm.nih.gov/pubmed/29490359 Real-world Effectiveness of Pharmacologic Treatments for the Prevention of Bipolar Disorder]
* Study 6: [http://www.ncbi.nlm.nih.gov/pubmed/20092882 BALANCE] Combination lithium and valproate therapy versus monotherapy for relapse prevention in bipolar I disorder
13) GASTROENTEROLOGY STUDIES - LINKS ON CANVAS[[File:Screenshot 2025-11-17 at 7.50.27 AM.png|thumb]][[File:GI ChatGPT Instructions.jpg|thumb|GPT Instructions]]
*Short-term treatment for gastro-oesophageal reflux disease-like symptoms and endoscopy negative reflux disease (Review)
*Oral budesonide for induction of remission in ulcerative colitis (Review)
*Probiotics for the prevention of Clostridium difficile-associated diarrhea in adults and children (Review)
*Deprescribing versus continuation of chronic proton pump inhibitor use in adults (Review)
*Prevention of NSAID-induced gastroduodenal ulcers (Review)
*Methotrexate for maintenance of remission in Crohn's disease (Review)

14) OB/GYN STUDIES
*[http://www.ncbi.nlm.nih.gov/pubmed/25601350 Comparative contraceptive effectiveness of levonorgestrel-releasing and copper IUD Devices]
*[http://www.ncbi.nlm.nih.gov/pubmed/29211679 Hormonal contraception and the risk of breast cancer]
*[http://www.ncbi.nlm.nih.gov/pubmed/30322986 Sexual behaviours in adolescent girls before and after introduction of the HPV]
*[http://www.ncbi.nlm.nih.gov/pubmed/30181338 Intramuscular vs intravenous oxytocin to prevent postpartum haemorrhage at vaginal delivery]
*[http://www.ncbi.nlm.nih.gov/pubmed/27682034 Azithromycin Prophylaxis for Cesarean Delivery]
*[http://www.ncbi.nlm.nih.gov/pubmed/28461374 Antibiotics during pregnancy and risk of spontaneous abortion]

Evidence Appraisal Integrated Activities

2026-02-05T20:19:26Z

JamesMcCormack:

'''OBJECTIVE'''

To critically appraise studies, develop a brief synopsis of the trial results, succinctly present the results and then put the results into a proper clinical context

'''INITIAL PRE-READING'''

'''How To Critically Appraise an RCT In 10 minutes'''
*[https://itunes.apple.com/ca/book/how-to-critically-appraise/id524600667?mt=11 iBook/iPad version]
*[https://therapeuticseducation.org/sites/therapeuticseducation.org/files/Ten_Minute_Critical_Appraisal.pdf PDF version]
Watch this video
[http://youtu.be/QUW0Q8tXVUc Viva La Evidence]

'''Study Results at Your Fingertips'''
*[https://mystudies.org MyStudies] - Free access

'''INTEGRATION ACTIVITY FORMAT'''
# Students placed in groups of ~ 5-7
# Each group is given one of the studies below to review
# Students then work in pairs and develop a one-slide critical appraisal and results synopsis
# One student in each group will be chosen at random to present their group findings to the class
# A discussion about the appraisal and the appropriate clinical context for the results is had with the entire class for each study

'''MODULE'''
[[File:Screen Shot 2022-01-09 at 10.00.16 AM.jpg|thumb|'''TRIAL PRESENTATION FORMAT'''|none]]

Studies chosen include landmark studies and/or studies that address important therapeutic issues for the particular module

'''ACADEMIC YEAR 1 - FIRST TERM'''

1) FOUNDATION STUDIES (Groups)
*[https://pubmed.ncbi.nlm.nih.gov/37952131 SELECT] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/12466506 AFFIRM] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/22085343 AIM-HIGH] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/10639539 HOPE] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/18378519 HYVET] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/15007110 PROVE-IT] Groups 6,18,30
*[http://www.ncbi.nlm.nih.gov/pubmed/15755765 TNT] Groups 7,19,31
*[https://pubmed.ncbi.nlm.nih.gov/26378978 EMPAREG] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/17984165 ILLUMINATE] Groups 9,21,33
*[https://pubmed.ncbi.nlm.nih.gov/26551272/ SPRINT] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/15325833 CARDS] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/12117397 WHI] Groups 12,24,36

'''ACADEMIC YEAR 1 - SECOND TERM'''

2) INTRO TO INFECTIOUS DISEASE STUDIES

[https://wiki.ubc.ca/images/8/8b/Antibiotic_Sensitivity_Chart_2024.pdf The "Best" Antibiotic Sensitivity Chart Ever]
*[http://www.ncbi.nlm.nih.gov/pubmed/17567657 IV vs PO antibiotics] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/24603565 Delayed antibiotics for respiratory tract infections] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/11159657 Delayed antibiotics for otitis media] Groups 3,15,27
*[https://pubmed.ncbi.nlm.nih.gov/27455166/ Duration of treatment for community acquired pneumonia] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/22726802 Duration of treatment for pyelonephritis] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/25830421 Choice of antibiotic for community acquired pneumonia-1] Groups 6,18,30
*[http://www.ncbi.nlm.nih.gov/pubmed/25286173 Choice of antibiotic for community acquired pneumonia-2] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/20647284 HPV vaccine study] Groups 8,20,32
*[https://pubmed.ncbi.nlm.nih.gov/40888720/ High-Dose Influenza Vaccine - hospitalization] Groups 9,21,33
*[https://pubmed.ncbi.nlm.nih.gov/40884442 High-Dose Influenza Vaccine - cardiovascular outcomes] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/27626517 Herpes zoster vaccine study 1] Groups 11,23,35
*[https://www.ncbi.nlm.nih.gov/pubmed/25916341 Herpes zoster vaccine study 2] Groups 12,24,36

3) MUSCULOSKELETAL STUDIES

*[http://www.ncbi.nlm.nih.gov/pubmed/28199814 Baricitinib versus Placebo or Adalimumab in Rheumatoid Arthritis] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/0010979111 CLASS – celecoxib vs NSAIDs] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/26501533 Naproxen with cyclobenzaprine, oxycodone/acetaminophen, or placebo for low back pain] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/24395557 Glucosamine and chondroitin for OA] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/12546607 Acetaminophen vs diclofenac for OA] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/23964752 Diclofenac gel for acute neck pain] Groups 6,18,30
*[https://pubmed.ncbi.nlm.nih.gov/15468367/ Topical diclofenac vs oral diclofenac] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/25064594 Acetaminophen for low back pain] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/7611589 Misoprostol and NSAID induced ulcers] Groups 9,21,33
*[http://www.ncbi.nlm.nih.gov/pubmed/20131255 Low dose vs high dose colchicine for gout] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/22508468 TEAR - oral triple therapy versus etanercept plus methotrexate in early aggressive rheumatoid arthritis] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/25589511 MOVES - Glucosamine and chondroitin for OA for moderate to severe pain] Groups 12,24,36

4) DERMATOLOGY STUDIES

*[https://www.ncbi.nlm.nih.gov/pubmed/9598014 Glycolic acid 5% Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/21896132 Glycolic acid 10% Acne]
*[https://www.ncbi.nlm.nih.gov/pubmed/14531866 Petrolatum vs Ceramide/skin related lipids Hand Dermatitis]
*[https://www.ncbi.nlm.nih.gov/pubmed/11896774 Vitamin C Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/17515510 Retinol (VitaminA) Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/21896129 Hyaluronic acid Atopic Dermatitis]

5) EENT STUDIES

[http://www.amstar.ca/docs/AMSTARguideline.pdf AMSTAR meta-analysis checklist]

'''Scenario 1 - Otitis Media''' - GROUPS 1, 7, 18, 19, 25, 36

Anthony Martin arrives at your pharmacy somewhat frustrated since his family physician declined to write an antibiotic prescription for his two and half year old son, Oscar. His symptoms started yesterday afternoon - Oscar complains of right ear pain but there is no discharge. Rectal temperature taken today was 38.5 degrees. His wife is sure Oscar has an ear infection since the last time he had these same symptoms, that was ultimately the diagnosis. Mr. Martin asks if you think buying acetaminophen is really “enough”?

[https://pubmed.ncbi.nlm.nih.gov/26099233/ Antibiotics for acute otitis media in children]

'''Scenario 2 - Allergic Rhinitis''' - GROUPS 2, 8, 17, 20, 26, 35

Ruby Parmar is a firefighter. She is plagued by sinus congestion (preventing her from sleeping) and a runny nose associated with seasonal allergies. Her prescription for intranasal triamcinolone is typically effective, but she would like to know if a non-sedating anti-allergy pill would work just as well since it’s inconvenient carrying around the “nose spray”.

[https://www.ncbi.nlm.nih.gov/pubmed/28234147 Intranasal steroids vs antihistamines for allergic rhinitis]

'''Scenario 3 - Acute Sinusitis''' - GROUPS 3, 9, 16, 21, 27, 34

You are seeing a patient in clinic before her appointment with the primary care physician. She was feeling unwell with a “flu” last week. While most of her symptoms have resolved (cough, fever), the nasal congestion and discharge persists and so she has made an appointment (she is an otherwise healthy 32 year old with treated thyroid disease). She would like your advice for what treatment she should ask the doctor to prescribe.

[http://www.ncbi.nlm.nih.gov/pubmed/24293353 Intranasal steroids for acute sinusitis]

'''Scenario 4 - Glaucoma''' - GROUPS 4, 10, 15, 22, 28, 33

Mrs. Ada Waters is a 63 year-old woman you. Her ophthalmologist prescribed timolol and xalatan eye drops for treatment of open angle glaucoma. She has never really felt much different on treatment since she recovered from her first episode (of acute angle closure glaucoma requiring ER visit) and surgery. She asks you if the treatment is really making a difference.

[https://www.ncbi.nlm.nih.gov/pubmed/17943780 Interventions for open angle glaucoma]

'''Scenario 5 - Sore Throat''' - GROUPS 5, 11, 14, 23, 29, 32

You have a good friend who is applying for pharmacy. Her invitation for the multiple-mini interview (MMI) is coming up soon, but she is starting to experience a sore throat. While she is worried about not being able to speak through all of those stations, she knows she often gets a terrible headache along with her sore throat. She has an unused prescription for amoxicillin (unexpired) and wonders if you recommend for her to take it.

[https://pubmed.ncbi.nlm.nih.gov/34881426/ Antibiotics for sore throat]

'''Scenario 6 - Conjunctivitis''' - GROUPS 6, 12, 13, 24, 30, 31

A man comes to your pharmacy (he appears in his early twenties) complaining of “pink eye”. He has had a pink discolouration and discharge from his left eye for two days. He asks if the OTC antibiotic eye drops (he’s holding a product with polymixin B) are any better than “waiting it out”.

[https://www.ncbi.nlm.nih.gov/pubmed/22972049 Antibiotics for acute conjunctivitis]

6) HEMATOLOGY STUDIES

None so far

'''ACADEMIC YEAR 2 - FIRST TERM'''

7) RESPIROLOGY STUDIES
[[File:IA COPD info.pdf|thumb]]

*[http://www.ncbi.nlm.nih.gov/pubmed/2062329 First inhaled steroid study] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/22938706 Tiotropium in asthma] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/21324520 Inhaled steroid in children] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/29768149 Combined Budesonide–Formoterol as Needed in Mild Asthma] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/15223858 Doubling dose of inhaled corticosteroid] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/29768147 As-Needed Budesonide–Formoterol versus Maintenance Budesonide in Mild Asthma] Groups 6,18,30
*[https://pubmed.ncbi.nlm.nih.gov/32579807/ Triple Inhaled Therapy at Two Glucocorticoid Doses in Moderate-to-Very-Severe COPD] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/21428765 Tiotropium VS salmeterol in COPD] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/23695200 Short VS long steroids for COPD exacerbation] Groups 9,21,33
*[http://www.ncbi.nlm.nih.gov/pubmed/25196117 Stopping inhaled steroids in COPD] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/29668352 Once-Daily Single-Inhaler Triple versus Dual Therapy in Patients with COPD] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/28877011 Tezepelumab in Adults with Uncontrolled Asthma] Groups 12,24,36

8) CARDIOVASCULAR STUDIES

SESSION 1

*[https://www.ncbi.nlm.nih.gov/pubmed/4862069 VA1] (Group 1, 13, 25)
*[https://www.ncbi.nlm.nih.gov/pubmed/4914579 VA 2] (Group 2, 14, 26)
*[https://pubmed.ncbi.nlm.nih.gov/33186492 Polycap Study 3] (Group 3, 15, 27)
*[http://www.ncbi.nlm.nih.gov/pubmed/20228401 ACCORD-BP] (Group 4, 16, 28)
*[https://www.ncbi.nlm.nih.gov/pubmed/26551272 SPRINT] (Group 5, 17, 29)
*[http://www.ncbi.nlm.nih.gov/pubmed/2883575 CONSENSUS] (Group 6,18,30)
*[https://pubmed.ncbi.nlm.nih.gov/31535829/ DAPA-HF] (Group 7, 19, 31)
*[https://pubmed.ncbi.nlm.nih.gov/25176939/ CONFIRM-HF] (Group 8, 20, 32)
*[http://www.ncbi.nlm.nih.gov/pubmed/12457784 PROSPER] (Group 9, 21, 33)
*[http://www.ncbi.nlm.nih.gov/pubmed/27040132 HOPE-3] (Group 10, 22, 34)
*[http://www.ncbi.nlm.nih.gov/pubmed/12114036 Heart Protection Study (HPS)] (Group 11, 23, 35)
*[http://www.ncbi.nlm.nih.gov/pubmed/30415628 REDUCE-IT] (Group 12, 24, 36)

[[File:CV Case.pdf|thumb|CV case|left]]

SESSION 2

'''The Guideline Case'''

A 63 y/o patient with CHOOSE ONE (⬆︎HTN/⬆︎Chol/⬆︎glucose/HF/A fib) and using the guideline determine:
# their 5yr/10yr risks of mortality/CVD events
# the potential benefit
# the potential side effects (with magnitude)
# words/sentiment patient values and preferences/SDM

Atrial fibrillation - Groups 1,13,25,2,14,26
*[https://www.onlinecjc.ca/article/S0828-282X(18)31062-6/pdf 2018 Atrial fibrillation guidelines]
Diabetes - Groups 3,15,27,4,16,28
*[http://guidelines.diabetes.ca/docs/CPG-2018-full-EN.pdf 2018 Diabetes guidelines]
Lipid Simplified - Groups 5,17,29,6,18,30
*[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4607330/pdf/0610857.pdf 2015 Simplified lipid guidelines]
Lipid - Groups 7,19,31,8,20,32
*[http://www.onlinecjc.ca/article/S0828-282X(16)30732-2/pdf 2016 Lipid guidelines]
Heart failure - Groups 9,21,33,10,22,34
*[http://www.onlinecjc.ca/article/S0828-282X(17)30973-X/pdf 2017 Heart failure guidelines]
Hypertension - Groups 11,23,35,12,24,36
*[https://www.onlinecjc.ca/article/S0828-282X(18)30183-1/pdf 2018 Hypertension guidelines]

OPTIONAL SESSION
*[http://www.ncbi.nlm.nih.gov/pubmed/16899775 SPARCL]
*[http://www.ncbi.nlm.nih.gov/pubmed/10471456 RALES]
*[http://www.ncbi.nlm.nih.gov/pubmed/11386263 Carvedilol in heart failure]
*[http://www.ncbi.nlm.nih.gov/pubmed/18460663 WAFACS]
*[http://www.ncbi.nlm.nih.gov/pubmed/10376614 MERIT-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/25176015 PARADIGM-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/24490264 High-dose multivitamins after MI]
*[http://www.ncbi.nlm.nih.gov/pubmed/7911176 Mediterranean Diet after MI]
*[http://www.ncbi.nlm.nih.gov/pubmed/15337732 A TO Z]
*[http://www.ncbi.nlm.nih.gov/pubmed/21073363 EMPHASIS-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/12853193 COMET]
*[http://www.ncbi.nlm.nih.gov/pubmed/24716680 TOPCAT]
*[http://www.ncbi.nlm.nih.gov/pubmed/26039521 IMPROVE-IT]

'''ACADEMIC YEAR 2 - SECOND TERM'''

9) NEPHROLOGY STUDIES

None so far

10) ENDOCRINOLOGY

[[File:IA ENDO LAYOUT.pdf|thumb|IA ENDO LAYOUT TEMPLATE|none]][[File:Osteoporosis Evidence SUPP.pdf|none|thumb]]

'''RISK ASSESSMENT CASES FOR DIABETES AND OSTEOPOROSIS'''

'''1) DIABETES CASE'''

66 y/o white male who was diagnosed with diabetes 8 years ago

* His blood pressure over the last year has been roughly 145/80 mmHg - at present untreated
* A1c = 8%, no diabetes meds, non-smoker, BMI ~30
* '''When calculating without diabetes for PREVENT use an A1c of 5.5%'''
* Total cholesterol is 6 mmol/L, his HDL is 2 mmol/L, non-HDL = 6 minus 2, not on a statin
* No retinopathy, urine albumin-to-creatinine ratio (UACR) = 15ug/mg (7mg/mmol),
* Serum creatinine = 70 micromol/L, waist circumference 100 cm
* GFR 75 mL/min/1.73m2
* In normal sinus rhythm
* Age at end of highest education = 19
* Mother alive, father died of a heart attack at age 80

'''Calculate Risks'''

'''CVD RISK ESTIMATES''' - list the endpoints described by the specific calculator

Framingham - xx% - 10-year risk - also if no diabetes xx%

ASCVD - xx% - 10-year risk - also if no diabetes xx%

'''The Calculator'''
*CVD CALCULATOR
https://decisionaid.ca/cvd/

'''DIABETES COMPLICATIONS RISK ESTIMATES''' - list the endpoints described by the specific calculator

xx% - also 10-year risk if A1c 9, 8, 7 and 6

also get risk of kidney failure, vision loss, pressure sensation loss – also if A1c 9, 8,7,6

'''The Calculator'''
*DIABETES DECISION AID
http://decisionaid.ca/diabetes/

'''BENEFITS AND HARMS'''

Use the [https://guidelines.diabetes.ca/cpg/chapter-13-2020-update 2024 diabetes guidelines] and/or Diabetes Decision Aid to get estimates of benefits and harms and also use the MyStudies synopsis listed below

'''COSTS'''

Try using [https://pricingdoc.acfp.ca Pricing Doc] to get costs

'''Groups 1,13,25'''

* Metformin - UKPDS 34 [https://mystudies.org/studies.php#studies/28929e89-d01e-4b11-8e67-4d7086f9e4aa/outcome MyStudies Data]

'''Groups 2,14,26'''

* Sulfonlyureas - UKPDS 33 [https://mystudies.org/studies.php#studies/5eadb5dd-d403-4c13-b03e-d4f8d28c96ba/outcome MyStudies Data]

'''Groups 3,15,27'''

* Insulin - ORIGIN [https://mystudies.org/studies.php#studies/f611818f-2e69-4952-b55e-661116bd84b6/outcome MyStudies Data]

'''Groups 4,16,28'''

* SGLT2 - EMPA-REG OUTCOME [https://mystudies.org/studies.php#studies/32e9cf1a-f33e-480b-91ca-6f28a4dcf862/outcome MyStudies Data]

'''Groups 5,17,29'''

* GLP - LEADER [https://mystudies.org/studies.php#studies/1adbc9a1-7603-40f1-ac15-b813ce1f0ad6/outcome MyStudies Data]

'''Groups 6,18,30'''

* DPP4 - TECOS [https://mystudies.org/studies.php#studies/8659968a-cefb-4f99-b4ae-8b9b659acbd5/outcome MyStudies Data]

'''Groups 7,19,31'''

* Intensive treatment – small scale - STENO [https://mystudies.org/studies.php#studies/39d423e3-af57-40c8-ab7a-cbc7f389bdb6/paper MyStudies Data]

'''Groups 8,20,32'''

* Intensive treatment – large scale - ADDITION-Europe - [https://mystudies.org/studies.php#studies/5e07d86d-aa92-4db9-a283-76080db4b6fd/outcome MyStudies Data]

'''2) OSTEOPOROSIS CASE'''

60 y/o Canadian female

* 72 kg, 1.69m, BMI = 25.2
* t-score of -2.5
* Worried about falling and getting a hip fracture
* A friend recently had an atraumatic fracture from simply tripping and falling over in the snow
* No other risk factors

'''Calculate Risks'''

'''FRACTURE RISK ESTIMATES''' - list the endpoints described by the specific calculator

Major osteoporotic fracture - xx% - 10-year risk – if no BMD (just BMI), and then if they had a BMD t-Score of -2.0, -2.5, and -3.0

Hip fracture - - xx% - 10-year risk – if no BMD (just BMI) and if you have a BMD xx% - 10-year risk – if no BMD, and then if they had a BMD T-Score of -2.0, -2.5, and -3.0

'''The Calculator'''

* FRACTURE CALCULATOR

[https://frax.shef.ac.uk/frax/tool.aspx?country=19 Frax Tool - Canada]

'''BENEFITS AND HARMS'''

Use the [https://www.cmaj.ca/content/195/39/E1333 2023 Osteoporosis Guideline] and/or your osteoporosis lecture notes to get the benefits and apply these to your patient, and also get the harms

'''COSTS'''

Try using [https://pricingdoc.acfp.ca Pricing Doc] to get costs

'''Groups 9,21,33'''

* Activity

'''Groups 10,22,34'''

* Calcium/Vitamin D

'''Groups 11,23,35'''

* Bisphosphonates

'''Groups 12,24,36'''

* Denosumab

11) NEUROLOGY STUDIES

*[http://www.ncbi.nlm.nih.gov/pubmed/16717269 Opioids for chronic non-cancer pain] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/29509867 Effect of Opioid vs Nonopioid Medications on Pain-Related Function in Patients With Chronic Back Pain] Groups 2,14,26
*[https://www.ncbi.nlm.nih.gov/pubmed/31291515 Galcanezumab for prevention of cluster headaches] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/27150433 Immediate or delayed treatment of a first seizure] Groups 4,16,28
*[https://www.ncbi.nlm.nih.gov/pubmed/31291516 Rimegepant for episodic migraine] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/26212846 Sleep restriction for insomnia] Groups 6,18,30
*[https://www.ncbi.nlm.nih.gov/pubmed/25957224 CHANCE] Groups 7,19,31
*[https://www.ncbi.nlm.nih.gov/pubmed/16899775 SPARCL] Groups 8,20,32
*[https://www.ncbi.nlm.nih.gov/pubmed/29171821 Erenumab for episodic migraine] Groups 9,21,33
*[https://www.ncbi.nlm.nih.gov/pubmed/24733354 Reduction of benzodiazepines through education] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/26035341 Patient controlled opioid analgesia versus non-patient controlled opioid analgesia for postoperative pain] Groups 11,23,35
*[https://www.ncbi.nlm.nih.gov/pubmed/11589932 PROGRESS] Groups 12,24,36

'''ACADEMIC YEAR 3'''

12) PSYCHIATRY STUDIES

[[:File:2021 Psych Evidence Appraisal - Intro Slides.pdf|Psychiatry Rating Scales Introduction]]

* Study 1: [http://www.ncbi.nlm.nih.gov/pubmed/16554525 STAR*D (Level 2)] Bupropion-SR, sertraline, or venlafaxine-XR after failure of SSRIs for depression
* Study 2: [http://www.ncbi.nlm.nih.gov/pubmed/29477251 Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder]
* Study 3: [https://pubmed.ncbi.nlm.nih.gov/33862018/ Long-acting injectable versus oral antipsychotics for the maintenance treatment of schizophrenia]
* Study 4: [https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2725088 Association of Antipsychotic Polypharmacy vs Monotherapy With Psychiatric Rehospitalization Among Adults With Schizophrenia]
* Study 5: [https://www.ncbi.nlm.nih.gov/pubmed/29490359 Real-world Effectiveness of Pharmacologic Treatments for the Prevention of Bipolar Disorder]
* Study 6: [http://www.ncbi.nlm.nih.gov/pubmed/20092882 BALANCE] Combination lithium and valproate therapy versus monotherapy for relapse prevention in bipolar I disorder
13) GASTROENTEROLOGY STUDIES - LINKS ON CANVAS[[File:Screenshot 2025-11-17 at 7.50.27 AM.png|thumb]][[File:GI ChatGPT Instructions.jpg|thumb|GPT Instructions]]
*Short-term treatment for gastro-oesophageal reflux disease-like symptoms and endoscopy negative reflux disease (Review)
*Oral budesonide for induction of remission in ulcerative colitis (Review)
*Probiotics for the prevention of Clostridium difficile-associated diarrhea in adults and children (Review)
*Deprescribing versus continuation of chronic proton pump inhibitor use in adults (Review)
*Prevention of NSAID-induced gastroduodenal ulcers (Review)
*Methotrexate for maintenance of remission in Crohn's disease (Review)

14) OB/GYN STUDIES
*[http://www.ncbi.nlm.nih.gov/pubmed/25601350 Comparative contraceptive effectiveness of levonorgestrel-releasing and copper IUD Devices]
*[http://www.ncbi.nlm.nih.gov/pubmed/29211679 Hormonal contraception and the risk of breast cancer]
*[http://www.ncbi.nlm.nih.gov/pubmed/30322986 Sexual behaviours in adolescent girls before and after introduction of the HPV]
*[http://www.ncbi.nlm.nih.gov/pubmed/30181338 Intramuscular vs intravenous oxytocin to prevent postpartum haemorrhage at vaginal delivery]
*[http://www.ncbi.nlm.nih.gov/pubmed/27682034 Azithromycin Prophylaxis for Cesarean Delivery]
*[http://www.ncbi.nlm.nih.gov/pubmed/28461374 Antibiotics during pregnancy and risk of spontaneous abortion]

Evidence Appraisal Integrated Activities

2026-02-05T20:18:34Z

JamesMcCormack:

'''OBJECTIVE'''

To critically appraise studies, develop a brief synopsis of the trial results, succinctly present the results and then put the results into a proper clinical context

'''INITIAL PRE-READING'''

'''How To Critically Appraise an RCT In 10 minutes'''
*[https://itunes.apple.com/ca/book/how-to-critically-appraise/id524600667?mt=11 iBook/iPad version]
*[https://therapeuticseducation.org/sites/therapeuticseducation.org/files/Ten_Minute_Critical_Appraisal.pdf PDF version]
Watch this video
[http://youtu.be/QUW0Q8tXVUc Viva La Evidence]

'''Study Results at Your Fingertips'''
*[https://mystudies.org MyStudies] - Free access

'''INTEGRATION ACTIVITY FORMAT'''
# Students placed in groups of ~ 5-7
# Each group is given one of the studies below to review
# Students then work in pairs and develop a one-slide critical appraisal and results synopsis
# One student in each group will be chosen at random to present their group findings to the class
# A discussion about the appraisal and the appropriate clinical context for the results is had with the entire class for each study

'''MODULE'''
[[File:Screen Shot 2022-01-09 at 10.00.16 AM.jpg|thumb|'''TRIAL PRESENTATION FORMAT'''|none]]

Studies chosen include landmark studies and/or studies that address important therapeutic issues for the particular module

'''ACADEMIC YEAR 1 - FIRST TERM'''

1) FOUNDATION STUDIES (Groups)
*[https://pubmed.ncbi.nlm.nih.gov/37952131 SELECT] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/12466506 AFFIRM] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/22085343 AIM-HIGH] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/10639539 HOPE] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/18378519 HYVET] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/15007110 PROVE-IT] Groups 6,18,30
*[http://www.ncbi.nlm.nih.gov/pubmed/15755765 TNT] Groups 7,19,31
*[https://pubmed.ncbi.nlm.nih.gov/26378978 EMPAREG] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/17984165 ILLUMINATE] Groups 9,21,33
*[https://pubmed.ncbi.nlm.nih.gov/26551272/ SPRINT] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/15325833 CARDS] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/12117397 WHI] Groups 12,24,36

'''ACADEMIC YEAR 1 - SECOND TERM'''

2) INTRO TO INFECTIOUS DISEASE STUDIES

[https://wiki.ubc.ca/images/8/8b/Antibiotic_Sensitivity_Chart_2024.pdf The "Best" Antibiotic Sensitivity Chart Ever]
*[http://www.ncbi.nlm.nih.gov/pubmed/17567657 IV vs PO antibiotics] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/24603565 Delayed antibiotics for respiratory tract infections] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/11159657 Delayed antibiotics for otitis media] Groups 3,15,27
*[https://pubmed.ncbi.nlm.nih.gov/27455166/ Duration of treatment for community acquired pneumonia] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/22726802 Duration of treatment for pyelonephritis] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/25830421 Choice of antibiotic for community acquired pneumonia-1] Groups 6,18,30
*[http://www.ncbi.nlm.nih.gov/pubmed/25286173 Choice of antibiotic for community acquired pneumonia-2] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/20647284 HPV vaccine study] Groups 8,20,32
*[https://pubmed.ncbi.nlm.nih.gov/40888720/ High-Dose Influenza Vaccine - hospitalization] Groups 9,21,33
*[https://pubmed.ncbi.nlm.nih.gov/40884442 High-Dose Influenza Vaccine - cardiovascular outcomes] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/27626517 Herpes zoster vaccine study 1] Groups 11,23,35
*[https://www.ncbi.nlm.nih.gov/pubmed/25916341 Herpes zoster vaccine study 2] Groups 12,24,36

3) MUSCULOSKELETAL STUDIES

*[http://www.ncbi.nlm.nih.gov/pubmed/28199814 Baricitinib versus Placebo or Adalimumab in Rheumatoid Arthritis] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/0010979111 CLASS – celecoxib vs NSAIDs] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/26501533 Naproxen with cyclobenzaprine, oxycodone/acetaminophen, or placebo for low back pain] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/24395557 Glucosamine and chondroitin for OA] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/12546607 Acetaminophen vs diclofenac for OA] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/23964752 Diclofenac gel for acute neck pain] Groups 6,18,30
*[https://pubmed.ncbi.nlm.nih.gov/15468367/ Topical diclofenac vs oral diclofenac] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/25064594 Acetaminophen for low back pain] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/7611589 Misoprostol and NSAID induced ulcers] Groups 9,21,33
*[http://www.ncbi.nlm.nih.gov/pubmed/20131255 Low dose vs high dose colchicine for gout] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/22508468 TEAR - oral triple therapy versus etanercept plus methotrexate in early aggressive rheumatoid arthritis] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/25589511 MOVES - Glucosamine and chondroitin for OA for moderate to severe pain] Groups 12,24,36

4) DERMATOLOGY STUDIES

*[https://www.ncbi.nlm.nih.gov/pubmed/9598014 Glycolic acid 5% Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/21896132 Glycolic acid 10% Acne]
*[https://www.ncbi.nlm.nih.gov/pubmed/14531866 Petrolatum vs Ceramide/skin related lipids Hand Dermatitis]
*[https://www.ncbi.nlm.nih.gov/pubmed/11896774 Vitamin C Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/17515510 Retinol (VitaminA) Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/21896129 Hyaluronic acid Atopic Dermatitis]

5) EENT STUDIES

[http://www.amstar.ca/docs/AMSTARguideline.pdf AMSTAR meta-analysis checklist]

'''Scenario 1 - Otitis Media''' - GROUPS 1, 7, 18, 19, 25, 36

Anthony Martin arrives at your pharmacy somewhat frustrated since his family physician declined to write an antibiotic prescription for his two and half year old son, Oscar. His symptoms started yesterday afternoon - Oscar complains of right ear pain but there is no discharge. Rectal temperature taken today was 38.5 degrees. His wife is sure Oscar has an ear infection since the last time he had these same symptoms, that was ultimately the diagnosis. Mr. Martin asks if you think buying acetaminophen is really “enough”?

[https://pubmed.ncbi.nlm.nih.gov/26099233/ Antibiotics for acute otitis media in children]

'''Scenario 2 - Allergic Rhinitis''' - GROUPS 2, 8, 17, 20, 26, 35

Ruby Parmar is a firefighter. She is plagued by sinus congestion (preventing her from sleeping) and a runny nose associated with seasonal allergies. Her prescription for intranasal triamcinolone is typically effective, but she would like to know if a non-sedating anti-allergy pill would work just as well since it’s inconvenient carrying around the “nose spray”.

[https://www.ncbi.nlm.nih.gov/pubmed/28234147 Intranasal steroids vs antihistamines for allergic rhinitis]

'''Scenario 3 - Acute Sinusitis''' - GROUPS 3, 9, 16, 21, 27, 34

You are seeing a patient in clinic before her appointment with the primary care physician. She was feeling unwell with a “flu” last week. While most of her symptoms have resolved (cough, fever), the nasal congestion and discharge persists and so she has made an appointment (she is an otherwise healthy 32 year old with treated thyroid disease). She would like your advice for what treatment she should ask the doctor to prescribe.

[http://www.ncbi.nlm.nih.gov/pubmed/24293353 Intranasal steroids for acute sinusitis]

'''Scenario 4 - Glaucoma''' - GROUPS 4, 10, 15, 22, 28, 33

Mrs. Ada Waters is a 63 year-old woman you. Her ophthalmologist prescribed timolol and xalatan eye drops for treatment of open angle glaucoma. She has never really felt much different on treatment since she recovered from her first episode (of acute angle closure glaucoma requiring ER visit) and surgery. She asks you if the treatment is really making a difference.

[https://www.ncbi.nlm.nih.gov/pubmed/17943780 Interventions for open angle glaucoma]

'''Scenario 5 - Sore Throat''' - GROUPS 5, 11, 14, 23, 29, 32

You have a good friend who is applying for pharmacy. Her invitation for the multiple-mini interview (MMI) is coming up soon, but she is starting to experience a sore throat. While she is worried about not being able to speak through all of those stations, she knows she often gets a terrible headache along with her sore throat. She has an unused prescription for amoxicillin (unexpired) and wonders if you recommend for her to take it.

[https://pubmed.ncbi.nlm.nih.gov/34881426/ Antibiotics for sore throat]

'''Scenario 6 - Conjunctivitis''' - GROUPS 6, 12, 13, 24, 30, 31

A man comes to your pharmacy (he appears in his early twenties) complaining of “pink eye”. He has had a pink discolouration and discharge from his left eye for two days. He asks if the OTC antibiotic eye drops (he’s holding a product with polymixin B) are any better than “waiting it out”.

[https://www.ncbi.nlm.nih.gov/pubmed/22972049 Antibiotics for acute conjunctivitis]

6) HEMATOLOGY STUDIES

None so far

'''ACADEMIC YEAR 2 - FIRST TERM'''

7) RESPIROLOGY STUDIES
[[File:IA COPD info.pdf|thumb]]

*[http://www.ncbi.nlm.nih.gov/pubmed/2062329 First inhaled steroid study] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/22938706 Tiotropium in asthma] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/21324520 Inhaled steroid in children] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/29768149 Combined Budesonide–Formoterol as Needed in Mild Asthma] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/15223858 Doubling dose of inhaled corticosteroid] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/29768147 As-Needed Budesonide–Formoterol versus Maintenance Budesonide in Mild Asthma] Groups 6,18,30
*[https://pubmed.ncbi.nlm.nih.gov/32579807/ Triple Inhaled Therapy at Two Glucocorticoid Doses in Moderate-to-Very-Severe COPD] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/21428765 Tiotropium VS salmeterol in COPD] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/23695200 Short VS long steroids for COPD exacerbation] Groups 9,21,33
*[http://www.ncbi.nlm.nih.gov/pubmed/25196117 Stopping inhaled steroids in COPD] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/29668352 Once-Daily Single-Inhaler Triple versus Dual Therapy in Patients with COPD] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/28877011 Tezepelumab in Adults with Uncontrolled Asthma] Groups 12,24,36

8) CARDIOVASCULAR STUDIES

SESSION 1

*[https://www.ncbi.nlm.nih.gov/pubmed/4862069 VA1] (Group 1, 13, 25)
*[https://www.ncbi.nlm.nih.gov/pubmed/4914579 VA 2] (Group 2, 14, 26)
*[https://pubmed.ncbi.nlm.nih.gov/33186492 Polycap Study 3] (Group 3, 15, 27)
*[http://www.ncbi.nlm.nih.gov/pubmed/20228401 ACCORD-BP] (Group 4, 16, 28)
*[https://www.ncbi.nlm.nih.gov/pubmed/26551272 SPRINT] (Group 5, 17, 29)
*[http://www.ncbi.nlm.nih.gov/pubmed/2883575 CONSENSUS] (Group 6,18,30)
*[https://pubmed.ncbi.nlm.nih.gov/31535829/ DAPA-HF] (Group 7, 19, 31)
*[https://pubmed.ncbi.nlm.nih.gov/25176939/ CONFIRM-HF] (Group 8, 20, 32)
*[http://www.ncbi.nlm.nih.gov/pubmed/12457784 PROSPER] (Group 9, 21, 33)
*[http://www.ncbi.nlm.nih.gov/pubmed/27040132 HOPE-3] (Group 10, 22, 34)
*[http://www.ncbi.nlm.nih.gov/pubmed/12114036 Heart Protection Study (HPS)] (Group 11, 23, 35)
*[http://www.ncbi.nlm.nih.gov/pubmed/30415628 REDUCE-IT] (Group 12, 24, 36)

[[File:CV Case.pdf|thumb|CV case|left]]

SESSION 2

'''The Guideline Case'''

A 63 y/o patient with CHOOSE ONE (⬆︎HTN/⬆︎Chol/⬆︎glucose/HF/A fib) and using the guideline determine:
# their 5yr/10yr risks of mortality/CVD events
# the potential benefit
# the potential side effects (with magnitude)
# words/sentiment patient values and preferences/SDM

Atrial fibrillation - Groups 1,13,25,2,14,26
*[https://www.onlinecjc.ca/article/S0828-282X(18)31062-6/pdf 2018 Atrial fibrillation guidelines]
Diabetes - Groups 3,15,27,4,16,28
*[http://guidelines.diabetes.ca/docs/CPG-2018-full-EN.pdf 2018 Diabetes guidelines]
Lipid Simplified - Groups 5,17,29,6,18,30
*[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4607330/pdf/0610857.pdf 2015 Simplified lipid guidelines]
Lipid - Groups 7,19,31,8,20,32
*[http://www.onlinecjc.ca/article/S0828-282X(16)30732-2/pdf 2016 Lipid guidelines]
Heart failure - Groups 9,21,33,10,22,34
*[http://www.onlinecjc.ca/article/S0828-282X(17)30973-X/pdf 2017 Heart failure guidelines]
Hypertension - Groups 11,23,35,12,24,36
*[https://www.onlinecjc.ca/article/S0828-282X(18)30183-1/pdf 2018 Hypertension guidelines]

OPTIONAL SESSION
*[http://www.ncbi.nlm.nih.gov/pubmed/16899775 SPARCL]
*[http://www.ncbi.nlm.nih.gov/pubmed/10471456 RALES]
*[http://www.ncbi.nlm.nih.gov/pubmed/11386263 Carvedilol in heart failure]
*[http://www.ncbi.nlm.nih.gov/pubmed/18460663 WAFACS]
*[http://www.ncbi.nlm.nih.gov/pubmed/10376614 MERIT-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/25176015 PARADIGM-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/24490264 High-dose multivitamins after MI]
*[http://www.ncbi.nlm.nih.gov/pubmed/7911176 Mediterranean Diet after MI]
*[http://www.ncbi.nlm.nih.gov/pubmed/15337732 A TO Z]
*[http://www.ncbi.nlm.nih.gov/pubmed/21073363 EMPHASIS-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/12853193 COMET]
*[http://www.ncbi.nlm.nih.gov/pubmed/24716680 TOPCAT]
*[http://www.ncbi.nlm.nih.gov/pubmed/26039521 IMPROVE-IT]

'''ACADEMIC YEAR 2 - SECOND TERM'''

9) NEPHROLOGY STUDIES

None so far

10) ENDOCRINOLOGY

[[File:IA ENDO LAYOUT.pdf|thumb|IA ENDO LAYOUT TEMPLATE|none]]2[[File:Osteoporosis Evidence SUPP.pdf|none|thumb]]

'''RISK ASSESSMENT CASES FOR DIABETES AND OSTEOPOROSIS'''

'''1) DIABETES CASE'''

66 y/o white male who was diagnosed with diabetes 8 years ago

* His blood pressure over the last year has been roughly 145/80 mmHg - at present untreated
* A1c = 8%, no diabetes meds, non-smoker, BMI ~30
* '''When calculating without diabetes for PREVENT use an A1c of 5.5%'''
* Total cholesterol is 6 mmol/L, his HDL is 2 mmol/L, non-HDL = 6 minus 2, not on a statin
* No retinopathy, urine albumin-to-creatinine ratio (UACR) = 15ug/mg (7mg/mmol),
* Serum creatinine = 70 micromol/L, waist circumference 100 cm
* GFR 75 mL/min/1.73m2
* In normal sinus rhythm
* Age at end of highest education = 19
* Mother alive, father died of a heart attack at age 80

'''Calculate Risks'''

'''CVD RISK ESTIMATES''' - list the endpoints described by the specific calculator

Framingham - xx% - 10-year risk - also if no diabetes xx%

ASCVD - xx% - 10-year risk - also if no diabetes xx%

'''The Calculator'''
*CVD CALCULATOR
https://decisionaid.ca/cvd/

'''DIABETES COMPLICATIONS RISK ESTIMATES''' - list the endpoints described by the specific calculator

xx% - also 10-year risk if A1c 9, 8, 7 and 6

also get risk of kidney failure, vision loss, pressure sensation loss – also if A1c 9, 8,7,6

'''The Calculator'''
*DIABETES DECISION AID
http://decisionaid.ca/diabetes/

'''BENEFITS AND HARMS'''

Use the [https://guidelines.diabetes.ca/cpg/chapter-13-2020-update 2024 diabetes guidelines] and/or Diabetes Decision Aid to get estimates of benefits and harms and also use the MyStudies synopsis listed below

'''COSTS'''

Try using [https://pricingdoc.acfp.ca Pricing Doc] to get costs

'''Groups 1,13,25'''

* Metformin - UKPDS 34 [https://mystudies.org/studies.php#studies/28929e89-d01e-4b11-8e67-4d7086f9e4aa/outcome MyStudies Data]

'''Groups 2,14,26'''

* Sulfonlyureas - UKPDS 33 [https://mystudies.org/studies.php#studies/5eadb5dd-d403-4c13-b03e-d4f8d28c96ba/outcome MyStudies Data]

'''Groups 3,15,27'''

* Insulin - ORIGIN [https://mystudies.org/studies.php#studies/f611818f-2e69-4952-b55e-661116bd84b6/outcome MyStudies Data]

'''Groups 4,16,28'''

* SGLT2 - EMPA-REG OUTCOME [https://mystudies.org/studies.php#studies/32e9cf1a-f33e-480b-91ca-6f28a4dcf862/outcome MyStudies Data]

'''Groups 5,17,29'''

* GLP - LEADER [https://mystudies.org/studies.php#studies/1adbc9a1-7603-40f1-ac15-b813ce1f0ad6/outcome MyStudies Data]

'''Groups 6,18,30'''

* DPP4 - TECOS [https://mystudies.org/studies.php#studies/8659968a-cefb-4f99-b4ae-8b9b659acbd5/outcome MyStudies Data]

'''Groups 7,19,31'''

* Intensive treatment – small scale - STENO [https://mystudies.org/studies.php#studies/39d423e3-af57-40c8-ab7a-cbc7f389bdb6/paper MyStudies Data]

'''Groups 8,20,32'''

* Intensive treatment – large scale - ADDITION-Europe - [https://mystudies.org/studies.php#studies/5e07d86d-aa92-4db9-a283-76080db4b6fd/outcome MyStudies Data]

'''2) OSTEOPOROSIS CASE'''

60 y/o Canadian female

* 72 kg, 1.69m, BMI = 25.2
* t-score of -2.5
* Worried about falling and getting a hip fracture
* A friend recently had an atraumatic fracture from simply tripping and falling over in the snow
* No other risk factors

'''Calculate Risks'''

'''FRACTURE RISK ESTIMATES''' - list the endpoints described by the specific calculator

Major osteoporotic fracture - xx% - 10-year risk – if no BMD (just BMI), and then if they had a BMD t-Score of -2.0, -2.5, and -3.0

Hip fracture - - xx% - 10-year risk – if no BMD (just BMI) and if you have a BMD xx% - 10-year risk – if no BMD, and then if they had a BMD T-Score of -2.0, -2.5, and -3.0

'''The Calculator'''

* FRACTURE CALCULATOR

[https://frax.shef.ac.uk/frax/tool.aspx?country=19 Frax Tool - Canada]

'''BENEFITS AND HARMS'''

Use the [https://www.cmaj.ca/content/195/39/E1333 2023 Osteoporosis Guideline] and/or your osteoporosis lecture notes to get the benefits and apply these to your patient, and also get the harms

'''COSTS'''

Try using [https://pricingdoc.acfp.ca Pricing Doc] to get costs

'''Groups 9,21,33'''

* Activity

'''Groups 10,22,34'''

* Calcium/Vitamin D

'''Groups 11,23,35'''

* Bisphosphonates

'''Groups 12,24,36'''

* Denosumab

11) NEUROLOGY STUDIES

*[http://www.ncbi.nlm.nih.gov/pubmed/16717269 Opioids for chronic non-cancer pain] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/29509867 Effect of Opioid vs Nonopioid Medications on Pain-Related Function in Patients With Chronic Back Pain] Groups 2,14,26
*[https://www.ncbi.nlm.nih.gov/pubmed/31291515 Galcanezumab for prevention of cluster headaches] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/27150433 Immediate or delayed treatment of a first seizure] Groups 4,16,28
*[https://www.ncbi.nlm.nih.gov/pubmed/31291516 Rimegepant for episodic migraine] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/26212846 Sleep restriction for insomnia] Groups 6,18,30
*[https://www.ncbi.nlm.nih.gov/pubmed/25957224 CHANCE] Groups 7,19,31
*[https://www.ncbi.nlm.nih.gov/pubmed/16899775 SPARCL] Groups 8,20,32
*[https://www.ncbi.nlm.nih.gov/pubmed/29171821 Erenumab for episodic migraine] Groups 9,21,33
*[https://www.ncbi.nlm.nih.gov/pubmed/24733354 Reduction of benzodiazepines through education] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/26035341 Patient controlled opioid analgesia versus non-patient controlled opioid analgesia for postoperative pain] Groups 11,23,35
*[https://www.ncbi.nlm.nih.gov/pubmed/11589932 PROGRESS] Groups 12,24,36

'''ACADEMIC YEAR 3'''

12) PSYCHIATRY STUDIES

[[:File:2021 Psych Evidence Appraisal - Intro Slides.pdf|Psychiatry Rating Scales Introduction]]

* Study 1: [http://www.ncbi.nlm.nih.gov/pubmed/16554525 STAR*D (Level 2)] Bupropion-SR, sertraline, or venlafaxine-XR after failure of SSRIs for depression
* Study 2: [http://www.ncbi.nlm.nih.gov/pubmed/29477251 Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder]
* Study 3: [https://pubmed.ncbi.nlm.nih.gov/33862018/ Long-acting injectable versus oral antipsychotics for the maintenance treatment of schizophrenia]
* Study 4: [https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2725088 Association of Antipsychotic Polypharmacy vs Monotherapy With Psychiatric Rehospitalization Among Adults With Schizophrenia]
* Study 5: [https://www.ncbi.nlm.nih.gov/pubmed/29490359 Real-world Effectiveness of Pharmacologic Treatments for the Prevention of Bipolar Disorder]
* Study 6: [http://www.ncbi.nlm.nih.gov/pubmed/20092882 BALANCE] Combination lithium and valproate therapy versus monotherapy for relapse prevention in bipolar I disorder
13) GASTROENTEROLOGY STUDIES - LINKS ON CANVAS[[File:Screenshot 2025-11-17 at 7.50.27 AM.png|thumb]][[File:GI ChatGPT Instructions.jpg|thumb|GPT Instructions]]
*Short-term treatment for gastro-oesophageal reflux disease-like symptoms and endoscopy negative reflux disease (Review)
*Oral budesonide for induction of remission in ulcerative colitis (Review)
*Probiotics for the prevention of Clostridium difficile-associated diarrhea in adults and children (Review)
*Deprescribing versus continuation of chronic proton pump inhibitor use in adults (Review)
*Prevention of NSAID-induced gastroduodenal ulcers (Review)
*Methotrexate for maintenance of remission in Crohn's disease (Review)

14) OB/GYN STUDIES
*[http://www.ncbi.nlm.nih.gov/pubmed/25601350 Comparative contraceptive effectiveness of levonorgestrel-releasing and copper IUD Devices]
*[http://www.ncbi.nlm.nih.gov/pubmed/29211679 Hormonal contraception and the risk of breast cancer]
*[http://www.ncbi.nlm.nih.gov/pubmed/30322986 Sexual behaviours in adolescent girls before and after introduction of the HPV]
*[http://www.ncbi.nlm.nih.gov/pubmed/30181338 Intramuscular vs intravenous oxytocin to prevent postpartum haemorrhage at vaginal delivery]
*[http://www.ncbi.nlm.nih.gov/pubmed/27682034 Azithromycin Prophylaxis for Cesarean Delivery]
*[http://www.ncbi.nlm.nih.gov/pubmed/28461374 Antibiotics during pregnancy and risk of spontaneous abortion]

Evidence Appraisal Integrated Activities

2026-02-05T16:07:27Z

JamesMcCormack:

'''OBJECTIVE'''

To critically appraise studies, develop a brief synopsis of the trial results, succinctly present the results and then put the results into a proper clinical context

'''INITIAL PRE-READING'''

'''How To Critically Appraise an RCT In 10 minutes'''
*[https://itunes.apple.com/ca/book/how-to-critically-appraise/id524600667?mt=11 iBook/iPad version]
*[https://therapeuticseducation.org/sites/therapeuticseducation.org/files/Ten_Minute_Critical_Appraisal.pdf PDF version]
Watch this video
[http://youtu.be/QUW0Q8tXVUc Viva La Evidence]

'''Study Results at Your Fingertips'''
*[https://mystudies.org MyStudies] - Free access

'''INTEGRATION ACTIVITY FORMAT'''
# Students placed in groups of ~ 5-7
# Each group is given one of the studies below to review
# Students then work in pairs and develop a one-slide critical appraisal and results synopsis
# One student in each group will be chosen at random to present their group findings to the class
# A discussion about the appraisal and the appropriate clinical context for the results is had with the entire class for each study

'''MODULE'''
[[File:Screen Shot 2022-01-09 at 10.00.16 AM.jpg|thumb|'''TRIAL PRESENTATION FORMAT'''|none]]

Studies chosen include landmark studies and/or studies that address important therapeutic issues for the particular module

'''ACADEMIC YEAR 1 - FIRST TERM'''

1) FOUNDATION STUDIES (Groups)
*[https://pubmed.ncbi.nlm.nih.gov/37952131 SELECT] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/12466506 AFFIRM] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/22085343 AIM-HIGH] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/10639539 HOPE] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/18378519 HYVET] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/15007110 PROVE-IT] Groups 6,18,30
*[http://www.ncbi.nlm.nih.gov/pubmed/15755765 TNT] Groups 7,19,31
*[https://pubmed.ncbi.nlm.nih.gov/26378978 EMPAREG] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/17984165 ILLUMINATE] Groups 9,21,33
*[https://pubmed.ncbi.nlm.nih.gov/26551272/ SPRINT] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/15325833 CARDS] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/12117397 WHI] Groups 12,24,36

'''ACADEMIC YEAR 1 - SECOND TERM'''

2) INTRO TO INFECTIOUS DISEASE STUDIES

[https://wiki.ubc.ca/images/8/8b/Antibiotic_Sensitivity_Chart_2024.pdf The "Best" Antibiotic Sensitivity Chart Ever]
*[http://www.ncbi.nlm.nih.gov/pubmed/17567657 IV vs PO antibiotics] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/24603565 Delayed antibiotics for respiratory tract infections] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/11159657 Delayed antibiotics for otitis media] Groups 3,15,27
*[https://pubmed.ncbi.nlm.nih.gov/27455166/ Duration of treatment for community acquired pneumonia] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/22726802 Duration of treatment for pyelonephritis] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/25830421 Choice of antibiotic for community acquired pneumonia-1] Groups 6,18,30
*[http://www.ncbi.nlm.nih.gov/pubmed/25286173 Choice of antibiotic for community acquired pneumonia-2] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/20647284 HPV vaccine study] Groups 8,20,32
*[https://pubmed.ncbi.nlm.nih.gov/40888720/ High-Dose Influenza Vaccine - hospitalization] Groups 9,21,33
*[https://pubmed.ncbi.nlm.nih.gov/40884442 High-Dose Influenza Vaccine - cardiovascular outcomes] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/27626517 Herpes zoster vaccine study 1] Groups 11,23,35
*[https://www.ncbi.nlm.nih.gov/pubmed/25916341 Herpes zoster vaccine study 2] Groups 12,24,36

3) MUSCULOSKELETAL STUDIES

*[http://www.ncbi.nlm.nih.gov/pubmed/28199814 Baricitinib versus Placebo or Adalimumab in Rheumatoid Arthritis] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/0010979111 CLASS – celecoxib vs NSAIDs] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/26501533 Naproxen with cyclobenzaprine, oxycodone/acetaminophen, or placebo for low back pain] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/24395557 Glucosamine and chondroitin for OA] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/12546607 Acetaminophen vs diclofenac for OA] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/23964752 Diclofenac gel for acute neck pain] Groups 6,18,30
*[https://pubmed.ncbi.nlm.nih.gov/15468367/ Topical diclofenac vs oral diclofenac] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/25064594 Acetaminophen for low back pain] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/7611589 Misoprostol and NSAID induced ulcers] Groups 9,21,33
*[http://www.ncbi.nlm.nih.gov/pubmed/20131255 Low dose vs high dose colchicine for gout] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/22508468 TEAR - oral triple therapy versus etanercept plus methotrexate in early aggressive rheumatoid arthritis] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/25589511 MOVES - Glucosamine and chondroitin for OA for moderate to severe pain] Groups 12,24,36

4) DERMATOLOGY STUDIES

*[https://www.ncbi.nlm.nih.gov/pubmed/9598014 Glycolic acid 5% Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/21896132 Glycolic acid 10% Acne]
*[https://www.ncbi.nlm.nih.gov/pubmed/14531866 Petrolatum vs Ceramide/skin related lipids Hand Dermatitis]
*[https://www.ncbi.nlm.nih.gov/pubmed/11896774 Vitamin C Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/17515510 Retinol (VitaminA) Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/21896129 Hyaluronic acid Atopic Dermatitis]

5) EENT STUDIES

[http://www.amstar.ca/docs/AMSTARguideline.pdf AMSTAR meta-analysis checklist]

'''Scenario 1 - Otitis Media''' - GROUPS 1, 7, 18, 19, 25, 36

Anthony Martin arrives at your pharmacy somewhat frustrated since his family physician declined to write an antibiotic prescription for his two and half year old son, Oscar. His symptoms started yesterday afternoon - Oscar complains of right ear pain but there is no discharge. Rectal temperature taken today was 38.5 degrees. His wife is sure Oscar has an ear infection since the last time he had these same symptoms, that was ultimately the diagnosis. Mr. Martin asks if you think buying acetaminophen is really “enough”?

[https://pubmed.ncbi.nlm.nih.gov/26099233/ Antibiotics for acute otitis media in children]

'''Scenario 2 - Allergic Rhinitis''' - GROUPS 2, 8, 17, 20, 26, 35

Ruby Parmar is a firefighter. She is plagued by sinus congestion (preventing her from sleeping) and a runny nose associated with seasonal allergies. Her prescription for intranasal triamcinolone is typically effective, but she would like to know if a non-sedating anti-allergy pill would work just as well since it’s inconvenient carrying around the “nose spray”.

[https://www.ncbi.nlm.nih.gov/pubmed/28234147 Intranasal steroids vs antihistamines for allergic rhinitis]

'''Scenario 3 - Acute Sinusitis''' - GROUPS 3, 9, 16, 21, 27, 34

You are seeing a patient in clinic before her appointment with the primary care physician. She was feeling unwell with a “flu” last week. While most of her symptoms have resolved (cough, fever), the nasal congestion and discharge persists and so she has made an appointment (she is an otherwise healthy 32 year old with treated thyroid disease). She would like your advice for what treatment she should ask the doctor to prescribe.

[http://www.ncbi.nlm.nih.gov/pubmed/24293353 Intranasal steroids for acute sinusitis]

'''Scenario 4 - Glaucoma''' - GROUPS 4, 10, 15, 22, 28, 33

Mrs. Ada Waters is a 63 year-old woman you. Her ophthalmologist prescribed timolol and xalatan eye drops for treatment of open angle glaucoma. She has never really felt much different on treatment since she recovered from her first episode (of acute angle closure glaucoma requiring ER visit) and surgery. She asks you if the treatment is really making a difference.

[https://www.ncbi.nlm.nih.gov/pubmed/17943780 Interventions for open angle glaucoma]

'''Scenario 5 - Sore Throat''' - GROUPS 5, 11, 14, 23, 29, 32

You have a good friend who is applying for pharmacy. Her invitation for the multiple-mini interview (MMI) is coming up soon, but she is starting to experience a sore throat. While she is worried about not being able to speak through all of those stations, she knows she often gets a terrible headache along with her sore throat. She has an unused prescription for amoxicillin (unexpired) and wonders if you recommend for her to take it.

[https://pubmed.ncbi.nlm.nih.gov/34881426/ Antibiotics for sore throat]

'''Scenario 6 - Conjunctivitis''' - GROUPS 6, 12, 13, 24, 30, 31

A man comes to your pharmacy (he appears in his early twenties) complaining of “pink eye”. He has had a pink discolouration and discharge from his left eye for two days. He asks if the OTC antibiotic eye drops (he’s holding a product with polymixin B) are any better than “waiting it out”.

[https://www.ncbi.nlm.nih.gov/pubmed/22972049 Antibiotics for acute conjunctivitis]

6) HEMATOLOGY STUDIES

None so far

'''ACADEMIC YEAR 2 - FIRST TERM'''

7) RESPIROLOGY STUDIES
[[File:IA COPD info.pdf|thumb]]

*[http://www.ncbi.nlm.nih.gov/pubmed/2062329 First inhaled steroid study] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/22938706 Tiotropium in asthma] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/21324520 Inhaled steroid in children] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/29768149 Combined Budesonide–Formoterol as Needed in Mild Asthma] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/15223858 Doubling dose of inhaled corticosteroid] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/29768147 As-Needed Budesonide–Formoterol versus Maintenance Budesonide in Mild Asthma] Groups 6,18,30
*[https://pubmed.ncbi.nlm.nih.gov/32579807/ Triple Inhaled Therapy at Two Glucocorticoid Doses in Moderate-to-Very-Severe COPD] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/21428765 Tiotropium VS salmeterol in COPD] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/23695200 Short VS long steroids for COPD exacerbation] Groups 9,21,33
*[http://www.ncbi.nlm.nih.gov/pubmed/25196117 Stopping inhaled steroids in COPD] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/29668352 Once-Daily Single-Inhaler Triple versus Dual Therapy in Patients with COPD] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/28877011 Tezepelumab in Adults with Uncontrolled Asthma] Groups 12,24,36

8) CARDIOVASCULAR STUDIES

SESSION 1

*[https://www.ncbi.nlm.nih.gov/pubmed/4862069 VA1] (Group 1, 13, 25)
*[https://www.ncbi.nlm.nih.gov/pubmed/4914579 VA 2] (Group 2, 14, 26)
*[https://pubmed.ncbi.nlm.nih.gov/33186492 Polycap Study 3] (Group 3, 15, 27)
*[http://www.ncbi.nlm.nih.gov/pubmed/20228401 ACCORD-BP] (Group 4, 16, 28)
*[https://www.ncbi.nlm.nih.gov/pubmed/26551272 SPRINT] (Group 5, 17, 29)
*[http://www.ncbi.nlm.nih.gov/pubmed/2883575 CONSENSUS] (Group 6,18,30)
*[https://pubmed.ncbi.nlm.nih.gov/31535829/ DAPA-HF] (Group 7, 19, 31)
*[https://pubmed.ncbi.nlm.nih.gov/25176939/ CONFIRM-HF] (Group 8, 20, 32)
*[http://www.ncbi.nlm.nih.gov/pubmed/12457784 PROSPER] (Group 9, 21, 33)
*[http://www.ncbi.nlm.nih.gov/pubmed/27040132 HOPE-3] (Group 10, 22, 34)
*[http://www.ncbi.nlm.nih.gov/pubmed/12114036 Heart Protection Study (HPS)] (Group 11, 23, 35)
*[http://www.ncbi.nlm.nih.gov/pubmed/30415628 REDUCE-IT] (Group 12, 24, 36)

[[File:CV Case.pdf|thumb|CV case|left]]

SESSION 2

'''The Guideline Case'''

A 63 y/o patient with CHOOSE ONE (⬆︎HTN/⬆︎Chol/⬆︎glucose/HF/A fib) and using the guideline determine:
# their 5yr/10yr risks of mortality/CVD events
# the potential benefit
# the potential side effects (with magnitude)
# words/sentiment patient values and preferences/SDM

Atrial fibrillation - Groups 1,13,25,2,14,26
*[https://www.onlinecjc.ca/article/S0828-282X(18)31062-6/pdf 2018 Atrial fibrillation guidelines]
Diabetes - Groups 3,15,27,4,16,28
*[http://guidelines.diabetes.ca/docs/CPG-2018-full-EN.pdf 2018 Diabetes guidelines]
Lipid Simplified - Groups 5,17,29,6,18,30
*[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4607330/pdf/0610857.pdf 2015 Simplified lipid guidelines]
Lipid - Groups 7,19,31,8,20,32
*[http://www.onlinecjc.ca/article/S0828-282X(16)30732-2/pdf 2016 Lipid guidelines]
Heart failure - Groups 9,21,33,10,22,34
*[http://www.onlinecjc.ca/article/S0828-282X(17)30973-X/pdf 2017 Heart failure guidelines]
Hypertension - Groups 11,23,35,12,24,36
*[https://www.onlinecjc.ca/article/S0828-282X(18)30183-1/pdf 2018 Hypertension guidelines]

OPTIONAL SESSION
*[http://www.ncbi.nlm.nih.gov/pubmed/16899775 SPARCL]
*[http://www.ncbi.nlm.nih.gov/pubmed/10471456 RALES]
*[http://www.ncbi.nlm.nih.gov/pubmed/11386263 Carvedilol in heart failure]
*[http://www.ncbi.nlm.nih.gov/pubmed/18460663 WAFACS]
*[http://www.ncbi.nlm.nih.gov/pubmed/10376614 MERIT-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/25176015 PARADIGM-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/24490264 High-dose multivitamins after MI]
*[http://www.ncbi.nlm.nih.gov/pubmed/7911176 Mediterranean Diet after MI]
*[http://www.ncbi.nlm.nih.gov/pubmed/15337732 A TO Z]
*[http://www.ncbi.nlm.nih.gov/pubmed/21073363 EMPHASIS-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/12853193 COMET]
*[http://www.ncbi.nlm.nih.gov/pubmed/24716680 TOPCAT]
*[http://www.ncbi.nlm.nih.gov/pubmed/26039521 IMPROVE-IT]

'''ACADEMIC YEAR 2 - SECOND TERM'''

9) NEPHROLOGY STUDIES

None so far

10) ENDOCRINOLOGY

[[File:IA ENDO LAYOUT.pdf|thumb|IA ENDO LAYOUT TEMPLATE|none]]
[[File:Osteoporosis Evidence SUPP.pdf|none|thumb]]

'''RISK ASSESSMENT CASES FOR DIABETES AND OSTEOPOROSIS'''

'''1) DIABETES CASE'''

66 y/o white male who was diagnosed with diabetes 8 years ago

* His blood pressure over the last year has been roughly 145/80 mmHg - at present untreated
* A1c = 8%, no diabetes meds, non-smoker, BMI ~30
* '''When calculating without diabetes for PREVENT use an A1c of 5.5%'''
* Total cholesterol is 6 mmol/L, his HDL is 2 mmol/L, non-HDL = 6 minus 2, not on a statin
* No retinopathy, urine albumin-to-creatinine ratio (UACR) = 15ug/mg (7mg/mmol),
* Serum creatinine = 70 micromol/L, waist circumference 100 cm
* GFR 75 mL/min/1.73m2
* In normal sinus rhythm
* Age at end of highest education = 19
* Mother alive, father died of a heart attack at age 80

'''Calculate Risks'''

'''CVD RISK ESTIMATES''' - list the endpoints described by the specific calculator

Framingham - xx% - 10-year risk - also if no diabetes xx%

ASCVD - xx% - 10-year risk - also if no diabetes xx%

'''The Calculator'''
*CVD CALCULATOR
https://decisionaid.ca/cvd/

'''DIABETES COMPLICATIONS RISK ESTIMATES''' - list the endpoints described by the specific calculator

xx% - also 10-year risk if A1c 9, 8, 7 and 6

also get risk of kidney failure, vision loss, pressure sensation loss – also if A1c 9, 8,7,6

'''The Calculator'''
*DIABETES DECISION AID
http://decisionaid.ca/diabetes/

'''BENEFITS AND HARMS'''

Use the [https://guidelines.diabetes.ca/cpg/chapter-13-2020-update 2024 diabetes guidelines] and/or Diabetes Decision Aid to get estimates of benefits and harms and also use the MyStudies synopsis listed below

'''COSTS'''

Try using [https://pricingdoc.acfp.ca Pricing Doc] to get costs

'''Groups 1,13,25'''

* Metformin - UKPDS 34 [https://mystudies.org/studies.php#studies/28929e89-d01e-4b11-8e67-4d7086f9e4aa/outcome MyStudies Data]

'''Groups 2,14,26'''

* Sulfonlyureas - UKPDS 33 [https://mystudies.org/studies.php#studies/5eadb5dd-d403-4c13-b03e-d4f8d28c96ba/outcome MyStudies Data]

'''Groups 3,15,27'''

* Insulin - ORIGIN [https://mystudies.org/studies.php#studies/f611818f-2e69-4952-b55e-661116bd84b6/outcome MyStudies Data]

'''Groups 4,16,28'''

* SGLT2 - EMPA-REG OUTCOME [https://mystudies.org/studies.php#studies/32e9cf1a-f33e-480b-91ca-6f28a4dcf862/outcome MyStudies Data]

'''Groups 5,17,29'''

* GLP - LEADER [https://mystudies.org/studies.php#studies/1adbc9a1-7603-40f1-ac15-b813ce1f0ad6/outcome MyStudies Data]

'''Groups 6,18,30'''

* DPP4 - TECOS [https://mystudies.org/studies.php#studies/8659968a-cefb-4f99-b4ae-8b9b659acbd5/outcome MyStudies Data]

'''Groups 7,19,31'''

* Intensive treatment – small scale - STENO [https://mystudies.org/studies.php#studies/39d423e3-af57-40c8-ab7a-cbc7f389bdb6/paper MyStudies Data]

'''Groups 8,20,32'''

* Intensive treatment – large scale - ADDITION-Europe - [https://mystudies.org/studies.php#studies/5e07d86d-aa92-4db9-a283-76080db4b6fd/outcome MyStudies Data]

'''2) OSTEOPOROSIS CASE'''

60 y/o Canadian female

* 72 kg, 1.69m, BMI = 25.2
* t-score of -2.5
* Worried about falling and getting a hip fracture
* A friend recently had an atraumatic fracture from simply tripping and falling over in the snow
* No other risk factors

'''Calculate Risks'''

'''FRACTURE RISK ESTIMATES''' - list the endpoints described by the specific calculator

Major osteoporotic fracture - xx% - 10-year risk – if no BMD (just BMI), and then if they had a BMD t-Score of -2.0, -2.5, and -3.0

Hip fracture - - xx% - 10-year risk – if no BMD (just BMI) and if you have a BMD xx% - 10-year risk – if no BMD, and then if they had a BMD T-Score of -2.0, -2.5, and -3.0

'''The Calculator'''

* FRACTURE CALCULATOR

[https://frax.shef.ac.uk/frax/tool.aspx?country=19 Frax Tool - Canada]

'''BENEFITS AND HARMS'''

Use the [https://www.cmaj.ca/content/195/39/E1333 2023 Osteoporosis Guideline] and/or your osteoporosis lecture notes to get the benefits and apply these to your patient, and also get the harms

'''COSTS'''

Try using [https://pricingdoc.acfp.ca Pricing Doc] to get costs

'''Groups 9,21,33'''

* Activity

'''Groups 10,22,34'''

* Calcium/Vitamin D

'''Groups 11,23,35'''

* Bisphosphonates

'''Groups 12,24,36'''

* Denosumab

11) NEUROLOGY STUDIES

*[http://www.ncbi.nlm.nih.gov/pubmed/16717269 Opioids for chronic non-cancer pain] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/29509867 Effect of Opioid vs Nonopioid Medications on Pain-Related Function in Patients With Chronic Back Pain] Groups 2,14,26
*[https://www.ncbi.nlm.nih.gov/pubmed/31291515 Galcanezumab for prevention of cluster headaches] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/27150433 Immediate or delayed treatment of a first seizure] Groups 4,16,28
*[https://www.ncbi.nlm.nih.gov/pubmed/31291516 Rimegepant for episodic migraine] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/26212846 Sleep restriction for insomnia] Groups 6,18,30
*[https://www.ncbi.nlm.nih.gov/pubmed/25957224 CHANCE] Groups 7,19,31
*[https://www.ncbi.nlm.nih.gov/pubmed/16899775 SPARCL] Groups 8,20,32
*[https://www.ncbi.nlm.nih.gov/pubmed/29171821 Erenumab for episodic migraine] Groups 9,21,33
*[https://www.ncbi.nlm.nih.gov/pubmed/24733354 Reduction of benzodiazepines through education] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/26035341 Patient controlled opioid analgesia versus non-patient controlled opioid analgesia for postoperative pain] Groups 11,23,35
*[https://www.ncbi.nlm.nih.gov/pubmed/11589932 PROGRESS] Groups 12,24,36

'''ACADEMIC YEAR 3'''

12) PSYCHIATRY STUDIES

[[:File:2021 Psych Evidence Appraisal - Intro Slides.pdf|Psychiatry Rating Scales Introduction]]

* Study 1: [http://www.ncbi.nlm.nih.gov/pubmed/16554525 STAR*D (Level 2)] Bupropion-SR, sertraline, or venlafaxine-XR after failure of SSRIs for depression
* Study 2: [http://www.ncbi.nlm.nih.gov/pubmed/29477251 Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder]
* Study 3: [https://pubmed.ncbi.nlm.nih.gov/33862018/ Long-acting injectable versus oral antipsychotics for the maintenance treatment of schizophrenia]
* Study 4: [https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2725088 Association of Antipsychotic Polypharmacy vs Monotherapy With Psychiatric Rehospitalization Among Adults With Schizophrenia]
* Study 5: [https://www.ncbi.nlm.nih.gov/pubmed/29490359 Real-world Effectiveness of Pharmacologic Treatments for the Prevention of Bipolar Disorder]
* Study 6: [http://www.ncbi.nlm.nih.gov/pubmed/20092882 BALANCE] Combination lithium and valproate therapy versus monotherapy for relapse prevention in bipolar I disorder
13) GASTROENTEROLOGY STUDIES - LINKS ON CANVAS[[File:Screenshot 2025-11-17 at 7.50.27 AM.png|thumb]][[File:GI ChatGPT Instructions.jpg|thumb|GPT Instructions]]
*Short-term treatment for gastro-oesophageal reflux disease-like symptoms and endoscopy negative reflux disease (Review)
*Oral budesonide for induction of remission in ulcerative colitis (Review)
*Probiotics for the prevention of Clostridium difficile-associated diarrhea in adults and children (Review)
*Deprescribing versus continuation of chronic proton pump inhibitor use in adults (Review)
*Prevention of NSAID-induced gastroduodenal ulcers (Review)
*Methotrexate for maintenance of remission in Crohn's disease (Review)

14) OB/GYN STUDIES
*[http://www.ncbi.nlm.nih.gov/pubmed/25601350 Comparative contraceptive effectiveness of levonorgestrel-releasing and copper IUD Devices]
*[http://www.ncbi.nlm.nih.gov/pubmed/29211679 Hormonal contraception and the risk of breast cancer]
*[http://www.ncbi.nlm.nih.gov/pubmed/30322986 Sexual behaviours in adolescent girls before and after introduction of the HPV]
*[http://www.ncbi.nlm.nih.gov/pubmed/30181338 Intramuscular vs intravenous oxytocin to prevent postpartum haemorrhage at vaginal delivery]
*[http://www.ncbi.nlm.nih.gov/pubmed/27682034 Azithromycin Prophylaxis for Cesarean Delivery]
*[http://www.ncbi.nlm.nih.gov/pubmed/28461374 Antibiotics during pregnancy and risk of spontaneous abortion]

Evidence Appraisal Integrated Activities

2026-01-07T02:34:34Z

JamesMcCormack:

'''OBJECTIVE'''

To critically appraise studies, develop a brief synopsis of the trial results, succinctly present the results and then put the results into a proper clinical context

'''INITIAL PRE-READING'''

'''How To Critically Appraise an RCT In 10 minutes'''
*[https://itunes.apple.com/ca/book/how-to-critically-appraise/id524600667?mt=11 iBook/iPad version]
*[https://therapeuticseducation.org/sites/therapeuticseducation.org/files/Ten_Minute_Critical_Appraisal.pdf PDF version]
Watch this video
[http://youtu.be/QUW0Q8tXVUc Viva La Evidence]

'''Study Results at Your Fingertips'''
*[https://mystudies.org MyStudies] - Free access

'''INTEGRATION ACTIVITY FORMAT'''
# Students placed in groups of ~ 5-7
# Each group is given one of the studies below to review
# Students then work in pairs and develop a one-slide critical appraisal and results synopsis
# One student in each group will be chosen at random to present their group findings to the class
# A discussion about the appraisal and the appropriate clinical context for the results is had with the entire class for each study

'''MODULE'''
[[File:Screen Shot 2022-01-09 at 10.00.16 AM.jpg|thumb|'''TRIAL PRESENTATION FORMAT'''|none]]

Studies chosen include landmark studies and/or studies that address important therapeutic issues for the particular module

'''ACADEMIC YEAR 1 - FIRST TERM'''

1) FOUNDATION STUDIES (Groups)
*[https://pubmed.ncbi.nlm.nih.gov/37952131 SELECT] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/12466506 AFFIRM] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/22085343 AIM-HIGH] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/10639539 HOPE] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/18378519 HYVET] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/15007110 PROVE-IT] Groups 6,18,30
*[http://www.ncbi.nlm.nih.gov/pubmed/15755765 TNT] Groups 7,19,31
*[https://pubmed.ncbi.nlm.nih.gov/26378978 EMPAREG] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/17984165 ILLUMINATE] Groups 9,21,33
*[https://pubmed.ncbi.nlm.nih.gov/26551272/ SPRINT] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/15325833 CARDS] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/12117397 WHI] Groups 12,24,36

'''ACADEMIC YEAR 1 - SECOND TERM'''

2) INTRO TO INFECTIOUS DISEASE STUDIES

[https://wiki.ubc.ca/images/8/8b/Antibiotic_Sensitivity_Chart_2024.pdf The "Best" Antibiotic Sensitivity Chart Ever]
*[http://www.ncbi.nlm.nih.gov/pubmed/17567657 IV vs PO antibiotics] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/24603565 Delayed antibiotics for respiratory tract infections] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/11159657 Delayed antibiotics for otitis media] Groups 3,15,27
*[https://pubmed.ncbi.nlm.nih.gov/27455166/ Duration of treatment for community acquired pneumonia] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/22726802 Duration of treatment for pyelonephritis] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/25830421 Choice of antibiotic for community acquired pneumonia-1] Groups 6,18,30
*[http://www.ncbi.nlm.nih.gov/pubmed/25286173 Choice of antibiotic for community acquired pneumonia-2] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/20647284 HPV vaccine study] Groups 8,20,32
*[https://pubmed.ncbi.nlm.nih.gov/40888720/ High-Dose Influenza Vaccine - hospitalization] Groups 9,21,33
*[https://pubmed.ncbi.nlm.nih.gov/40884442 High-Dose Influenza Vaccine - cardiovascular outcomes] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/27626517 Herpes zoster vaccine study 1] Groups 11,23,35
*[https://www.ncbi.nlm.nih.gov/pubmed/25916341 Herpes zoster vaccine study 2] Groups 12,24,36

3) MUSCULOSKELETAL STUDIES

*[http://www.ncbi.nlm.nih.gov/pubmed/28199814 Baricitinib versus Placebo or Adalimumab in Rheumatoid Arthritis] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/0010979111 CLASS – celecoxib vs NSAIDs] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/26501533 Naproxen with cyclobenzaprine, oxycodone/acetaminophen, or placebo for low back pain] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/24395557 Glucosamine and chondroitin for OA] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/12546607 Acetaminophen vs diclofenac for OA] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/23964752 Diclofenac gel for acute neck pain] Groups 6,18,30
*[https://pubmed.ncbi.nlm.nih.gov/15468367/ Topical diclofenac vs oral diclofenac] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/25064594 Acetaminophen for low back pain] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/7611589 Misoprostol and NSAID induced ulcers] Groups 9,21,33
*[http://www.ncbi.nlm.nih.gov/pubmed/20131255 Low dose vs high dose colchicine for gout] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/22508468 TEAR - oral triple therapy versus etanercept plus methotrexate in early aggressive rheumatoid arthritis] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/25589511 MOVES - Glucosamine and chondroitin for OA for moderate to severe pain] Groups 12,24,36

4) DERMATOLOGY STUDIES

*[https://www.ncbi.nlm.nih.gov/pubmed/9598014 Glycolic acid 5% Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/21896132 Glycolic acid 10% Acne]
*[https://www.ncbi.nlm.nih.gov/pubmed/14531866 Petrolatum vs Ceramide/skin related lipids Hand Dermatitis]
*[https://www.ncbi.nlm.nih.gov/pubmed/11896774 Vitamin C Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/17515510 Retinol (VitaminA) Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/21896129 Hyaluronic acid Atopic Dermatitis]

5) EENT STUDIES

[http://www.amstar.ca/docs/AMSTARguideline.pdf AMSTAR meta-analysis checklist]

'''Scenario 1 - Otitis Media''' - GROUPS 1, 7, 18, 19, 25, 36

Anthony Martin arrives at your pharmacy somewhat frustrated since his family physician declined to write an antibiotic prescription for his two and half year old son, Oscar. His symptoms started yesterday afternoon - Oscar complains of right ear pain but there is no discharge. Rectal temperature taken today was 38.5 degrees. His wife is sure Oscar has an ear infection since the last time he had these same symptoms, that was ultimately the diagnosis. Mr. Martin asks if you think buying acetaminophen is really “enough”?

[https://pubmed.ncbi.nlm.nih.gov/26099233/ Antibiotics for acute otitis media in children]

'''Scenario 2 - Allergic Rhinitis''' - GROUPS 2, 8, 17, 20, 26, 35

Ruby Parmar is a firefighter. She is plagued by sinus congestion (preventing her from sleeping) and a runny nose associated with seasonal allergies. Her prescription for intranasal triamcinolone is typically effective, but she would like to know if a non-sedating anti-allergy pill would work just as well since it’s inconvenient carrying around the “nose spray”.

[https://www.ncbi.nlm.nih.gov/pubmed/28234147 Intranasal steroids vs antihistamines for allergic rhinitis]

'''Scenario 3 - Acute Sinusitis''' - GROUPS 3, 9, 16, 21, 27, 34

You are seeing a patient in clinic before her appointment with the primary care physician. She was feeling unwell with a “flu” last week. While most of her symptoms have resolved (cough, fever), the nasal congestion and discharge persists and so she has made an appointment (she is an otherwise healthy 32 year old with treated thyroid disease). She would like your advice for what treatment she should ask the doctor to prescribe.

[http://www.ncbi.nlm.nih.gov/pubmed/24293353 Intranasal steroids for acute sinusitis]

'''Scenario 4 - Glaucoma''' - GROUPS 4, 10, 15, 22, 28, 33

Mrs. Ada Waters is a 63 year-old woman you. Her ophthalmologist prescribed timolol and xalatan eye drops for treatment of open angle glaucoma. She has never really felt much different on treatment since she recovered from her first episode (of acute angle closure glaucoma requiring ER visit) and surgery. She asks you if the treatment is really making a difference.

[https://www.ncbi.nlm.nih.gov/pubmed/17943780 Interventions for open angle glaucoma]

'''Scenario 5 - Sore Throat''' - GROUPS 5, 11, 14, 23, 29, 32

You have a good friend who is applying for pharmacy. Her invitation for the multiple-mini interview (MMI) is coming up soon, but she is starting to experience a sore throat. While she is worried about not being able to speak through all of those stations, she knows she often gets a terrible headache along with her sore throat. She has an unused prescription for amoxicillin (unexpired) and wonders if you recommend for her to take it.

[https://pubmed.ncbi.nlm.nih.gov/34881426/ Antibiotics for sore throat]

'''Scenario 6 - Conjunctivitis''' - GROUPS 6, 12, 13, 24, 30, 31

A man comes to your pharmacy (he appears in his early twenties) complaining of “pink eye”. He has had a pink discolouration and discharge from his left eye for two days. He asks if the OTC antibiotic eye drops (he’s holding a product with polymixin B) are any better than “waiting it out”.

[https://www.ncbi.nlm.nih.gov/pubmed/22972049 Antibiotics for acute conjunctivitis]

6) HEMATOLOGY STUDIES

None so far

'''ACADEMIC YEAR 2 - FIRST TERM'''

7) RESPIROLOGY STUDIES
[[File:IA COPD info.pdf|thumb]]

*[http://www.ncbi.nlm.nih.gov/pubmed/2062329 First inhaled steroid study] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/22938706 Tiotropium in asthma] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/21324520 Inhaled steroid in children] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/29768149 Combined Budesonide–Formoterol as Needed in Mild Asthma] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/15223858 Doubling dose of inhaled corticosteroid] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/29768147 As-Needed Budesonide–Formoterol versus Maintenance Budesonide in Mild Asthma] Groups 6,18,30
*[https://pubmed.ncbi.nlm.nih.gov/32579807/ Triple Inhaled Therapy at Two Glucocorticoid Doses in Moderate-to-Very-Severe COPD] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/21428765 Tiotropium VS salmeterol in COPD] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/23695200 Short VS long steroids for COPD exacerbation] Groups 9,21,33
*[http://www.ncbi.nlm.nih.gov/pubmed/25196117 Stopping inhaled steroids in COPD] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/29668352 Once-Daily Single-Inhaler Triple versus Dual Therapy in Patients with COPD] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/28877011 Tezepelumab in Adults with Uncontrolled Asthma] Groups 12,24,36

8) CARDIOVASCULAR STUDIES

SESSION 1

*[https://www.ncbi.nlm.nih.gov/pubmed/4862069 VA1] (Group 1, 13, 25)
*[https://www.ncbi.nlm.nih.gov/pubmed/4914579 VA 2] (Group 2, 14, 26)
*[https://pubmed.ncbi.nlm.nih.gov/33186492 Polycap Study 3] (Group 3, 15, 27)
*[http://www.ncbi.nlm.nih.gov/pubmed/20228401 ACCORD-BP] (Group 4, 16, 28)
*[https://www.ncbi.nlm.nih.gov/pubmed/26551272 SPRINT] (Group 5, 17, 29)
*[http://www.ncbi.nlm.nih.gov/pubmed/2883575 CONSENSUS] (Group 6,18,30)
*[https://pubmed.ncbi.nlm.nih.gov/31535829/ DAPA-HF] (Group 7, 19, 31)
*[https://pubmed.ncbi.nlm.nih.gov/25176939/ CONFIRM-HF] (Group 8, 20, 32)
*[http://www.ncbi.nlm.nih.gov/pubmed/12457784 PROSPER] (Group 9, 21, 33)
*[http://www.ncbi.nlm.nih.gov/pubmed/27040132 HOPE-3] (Group 10, 22, 34)
*[http://www.ncbi.nlm.nih.gov/pubmed/12114036 Heart Protection Study (HPS)] (Group 11, 23, 35)
*[http://www.ncbi.nlm.nih.gov/pubmed/30415628 REDUCE-IT] (Group 12, 24, 36)

[[File:CV Case.pdf|thumb|CV case|left]]

SESSION 2

'''The Guideline Case'''

A 63 y/o patient with CHOOSE ONE (⬆︎HTN/⬆︎Chol/⬆︎glucose/HF/A fib) and using the guideline determine:
# their 5yr/10yr risks of mortality/CVD events
# the potential benefit
# the potential side effects (with magnitude)
# words/sentiment patient values and preferences/SDM

Atrial fibrillation - Groups 1,13,25,2,14,26
*[https://www.onlinecjc.ca/article/S0828-282X(18)31062-6/pdf 2018 Atrial fibrillation guidelines]
Diabetes - Groups 3,15,27,4,16,28
*[http://guidelines.diabetes.ca/docs/CPG-2018-full-EN.pdf 2018 Diabetes guidelines]
Lipid Simplified - Groups 5,17,29,6,18,30
*[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4607330/pdf/0610857.pdf 2015 Simplified lipid guidelines]
Lipid - Groups 7,19,31,8,20,32
*[http://www.onlinecjc.ca/article/S0828-282X(16)30732-2/pdf 2016 Lipid guidelines]
Heart failure - Groups 9,21,33,10,22,34
*[http://www.onlinecjc.ca/article/S0828-282X(17)30973-X/pdf 2017 Heart failure guidelines]
Hypertension - Groups 11,23,35,12,24,36
*[https://www.onlinecjc.ca/article/S0828-282X(18)30183-1/pdf 2018 Hypertension guidelines]

OPTIONAL SESSION
*[http://www.ncbi.nlm.nih.gov/pubmed/16899775 SPARCL]
*[http://www.ncbi.nlm.nih.gov/pubmed/10471456 RALES]
*[http://www.ncbi.nlm.nih.gov/pubmed/11386263 Carvedilol in heart failure]
*[http://www.ncbi.nlm.nih.gov/pubmed/18460663 WAFACS]
*[http://www.ncbi.nlm.nih.gov/pubmed/10376614 MERIT-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/25176015 PARADIGM-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/24490264 High-dose multivitamins after MI]
*[http://www.ncbi.nlm.nih.gov/pubmed/7911176 Mediterranean Diet after MI]
*[http://www.ncbi.nlm.nih.gov/pubmed/15337732 A TO Z]
*[http://www.ncbi.nlm.nih.gov/pubmed/21073363 EMPHASIS-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/12853193 COMET]
*[http://www.ncbi.nlm.nih.gov/pubmed/24716680 TOPCAT]
*[http://www.ncbi.nlm.nih.gov/pubmed/26039521 IMPROVE-IT]

'''ACADEMIC YEAR 2 - SECOND TERM'''

9) NEPHROLOGY STUDIES

None so far

10) ENDOCRINOLOGY

[[File:IA ENDO LAYOUT.pdf|thumb|IA ENDO LAYOUT TEMPLATE|none]]
[[File:Osteoporosis Evidence SUPP.pdf|none|thumb]]

'''RISK ASSESSMENT CASES FOR DIABETES AND OSTEOPOROSIS'''

'''1) DIABETES CASE'''

66 y/o white male who was diagnosed with diabetes 8 years ago

* His blood pressure over the last year has been roughly 145/80 mmHg - at present untreated
* A1c = 8%, no diabetes meds, non-smoker, BMI ~30
* '''When calculating without diabetes for PREVENT use an A1c of 5.5%'''
* Total cholesterol is 6 mmol/L, his HDL is 2 mmol/L, non-HDL = 6 minus 2, not on a statin
* No retinopathy, urine albumin-to-creatinine ratio (UACR) = 15ug/mg (7mg/mmol),
* Serum creatinine = 70 micromol/L, waist circumference 100 cm
* GFR 75 mL/min/1.73m2
* In normal sinus rhythm
* Age at end of highest education = 19
* Mother alive, father died of a heart attack at age 80

'''Calculate Risks'''

'''CVD RISK ESTIMATES''' - list the endpoints described by the specific calculator

Framingham - xx% - 10-year risk - also if no diabetes xx%

ASCVD - xx% - 10-year risk - also if no diabetes xx%

'''The Calculator'''
*CVD CALCULATOR
https://decisionaid.ca/cvd/

'''DIABETES COMPLICATIONS RISK ESTIMATES''' - list the endpoints described by the specific calculator

xx% - also 10-year risk if A1c 9, 8, 7 and 6

also get risk of kidney failure, vision loss, pressure sensation loss – also if A1c 9, 8,7,6

'''The Calculator'''
*DIABETES DECISION AID
http://decisionaid.ca/diabetes/

'''BENEFITS AND HARMS'''

Use the [https://guidelines.diabetes.ca/cpg/chapter-13-2020-update 2024 diabetes guidelines] and/or Diabetes Decision Aid to get estimates of benefits and harms and also use the MyStudies synopsis listed below

'''COSTS'''

Try using [https://pricingdoc.acfp.ca Pricing Doc] to get costs

'''Groups 1,13,25'''

* Metformin - UKPDS 34 [https://mystudies.org/studies.php#studies/28929e89-d01e-4b11-8e67-4d7086f9e4aa/outcome MyStudies Data]

'''Groups 2,14,26'''

* Sulfonlyureas - UKPDS 33 [https://mystudies.org/studies.php#studies/5eadb5dd-d403-4c13-b03e-d4f8d28c96ba/outcome MyStudies Data]

'''Groups 3,15,27'''

* Insulin - ORIGIN [https://mystudies.org/studies.php#studies/f611818f-2e69-4952-b55e-661116bd84b6/outcome MyStudies Data]

'''Groups 4,16,28'''

* SGLT2 - EMPA-REG OUTCOME [https://mystudies.org/studies.php#studies/32e9cf1a-f33e-480b-91ca-6f28a4dcf862/outcome MyStudies Data]

'''Groups 5,17,29'''

* GLP - LEADER [https://mystudies.org/studies.php#studies/1adbc9a1-7603-40f1-ac15-b813ce1f0ad6/outcome MyStudies Data]

'''Groups 6,18,30'''

* DPP4 - TECOS [https://mystudies.org/studies.php#studies/8659968a-cefb-4f99-b4ae-8b9b659acbd5/outcome MyStudies Data]

'''Groups 7,19,31'''

* Intensive treatment – small scale - STENO [https://mystudies.org/studies.php#studies/39d423e3-af57-40c8-ab7a-cbc7f389bdb6/paper MyStudies Data]

'''Groups 8,20,32'''

* Intensive treatment – large scale - ADDITION-Europe - [https://mystudies.org/studies.php#studies/5e07d86d-aa92-4db9-a283-76080db4b6fd/outcome MyStudies Data]

'''2) OSTEOPOROSIS CASE'''

60 y/o female

* 72 kg, 1.69m, BMI = 25.2
* t-score of -2.5
* Worried about falling and getting a hip fracture
* A friend recently had an atraumatic fracture from simply tripping and falling over in the snow
* No other risk factors

'''Calculate Risks'''

'''FRACTURE RISK ESTIMATES''' - list the endpoints described by the specific calculator

Major osteoporotic fracture - xx% - 10-year risk – if no BMD (just BMI), and then if they had a BMD t-Score of -2.0, -2.5, and -3.0

Hip fracture - - xx% - 10-year risk – if no BMD (just BMI) and if you have a BMD xx% - 10-year risk – if no BMD, and then if they had a BMD T-Score of -2.0, -2.5, and -3.0

'''The Calculator'''

* FRACTURE CALCULATOR

[https://frax.shef.ac.uk/frax/tool.aspx?country=19 Frax Tool - Canada]

'''BENEFITS AND HARMS'''

Use the [https://www.cmaj.ca/content/195/39/E1333 2023 Osteoporosis Guideline] and/or your osteoporosis lecture notes to get the benefits and apply these to your patient, and also get the harms

'''COSTS'''

Try using [https://pricingdoc.acfp.ca Pricing Doc] to get costs

'''Groups 9,21,33'''

* Activity

'''Groups 10,22,34'''

* Calcium/Vitamin D

'''Groups 11,23,35'''

* Bisphosphonates

'''Groups 12,24,36'''

* Denosumab

11) NEUROLOGY STUDIES

*[http://www.ncbi.nlm.nih.gov/pubmed/16717269 Opioids for chronic non-cancer pain] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/29509867 Effect of Opioid vs Nonopioid Medications on Pain-Related Function in Patients With Chronic Back Pain] Groups 2,14,26
*[https://www.ncbi.nlm.nih.gov/pubmed/31291515 Galcanezumab for prevention of cluster headaches] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/27150433 Immediate or delayed treatment of a first seizure] Groups 4,16,28
*[https://www.ncbi.nlm.nih.gov/pubmed/31291516 Rimegepant for episodic migraine] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/26212846 Sleep restriction for insomnia] Groups 6,18,30
*[https://www.ncbi.nlm.nih.gov/pubmed/25957224 CHANCE] Groups 7,19,31
*[https://www.ncbi.nlm.nih.gov/pubmed/16899775 SPARCL] Groups 8,20,32
*[https://www.ncbi.nlm.nih.gov/pubmed/29171821 Erenumab for episodic migraine] Groups 9,21,33
*[https://www.ncbi.nlm.nih.gov/pubmed/24733354 Reduction of benzodiazepines through education] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/26035341 Patient controlled opioid analgesia versus non-patient controlled opioid analgesia for postoperative pain] Groups 11,23,35
*[https://www.ncbi.nlm.nih.gov/pubmed/11589932 PROGRESS] Groups 12,24,36

'''ACADEMIC YEAR 3'''

12) PSYCHIATRY STUDIES

[[:File:2021 Psych Evidence Appraisal - Intro Slides.pdf|Psychiatry Rating Scales Introduction]]

* Study 1: [http://www.ncbi.nlm.nih.gov/pubmed/16554525 STAR*D (Level 2)] Bupropion-SR, sertraline, or venlafaxine-XR after failure of SSRIs for depression
* Study 2: [http://www.ncbi.nlm.nih.gov/pubmed/29477251 Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder]
* Study 3: [https://pubmed.ncbi.nlm.nih.gov/33862018/ Long-acting injectable versus oral antipsychotics for the maintenance treatment of schizophrenia]
* Study 4: [https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2725088 Association of Antipsychotic Polypharmacy vs Monotherapy With Psychiatric Rehospitalization Among Adults With Schizophrenia]
* Study 5: [https://www.ncbi.nlm.nih.gov/pubmed/29490359 Real-world Effectiveness of Pharmacologic Treatments for the Prevention of Bipolar Disorder]
* Study 6: [http://www.ncbi.nlm.nih.gov/pubmed/20092882 BALANCE] Combination lithium and valproate therapy versus monotherapy for relapse prevention in bipolar I disorder
13) GASTROENTEROLOGY STUDIES - LINKS ON CANVAS[[File:Screenshot 2025-11-17 at 7.50.27 AM.png|thumb]][[File:GI ChatGPT Instructions.jpg|thumb|GPT Instructions]]
*Short-term treatment for gastro-oesophageal reflux disease-like symptoms and endoscopy negative reflux disease (Review)
*Oral budesonide for induction of remission in ulcerative colitis (Review)
*Probiotics for the prevention of Clostridium difficile-associated diarrhea in adults and children (Review)
*Deprescribing versus continuation of chronic proton pump inhibitor use in adults (Review)
*Prevention of NSAID-induced gastroduodenal ulcers (Review)
*Methotrexate for maintenance of remission in Crohn's disease (Review)

14) OB/GYN STUDIES
*[http://www.ncbi.nlm.nih.gov/pubmed/25601350 Comparative contraceptive effectiveness of levonorgestrel-releasing and copper IUD Devices]
*[http://www.ncbi.nlm.nih.gov/pubmed/29211679 Hormonal contraception and the risk of breast cancer]
*[http://www.ncbi.nlm.nih.gov/pubmed/30322986 Sexual behaviours in adolescent girls before and after introduction of the HPV]
*[http://www.ncbi.nlm.nih.gov/pubmed/30181338 Intramuscular vs intravenous oxytocin to prevent postpartum haemorrhage at vaginal delivery]
*[http://www.ncbi.nlm.nih.gov/pubmed/27682034 Azithromycin Prophylaxis for Cesarean Delivery]
*[http://www.ncbi.nlm.nih.gov/pubmed/28461374 Antibiotics during pregnancy and risk of spontaneous abortion]

Evidence Appraisal Integrated Activities

2026-01-05T17:57:13Z

JamesMcCormack:

'''OBJECTIVE'''

To critically appraise studies, develop a brief synopsis of the trial results, succinctly present the results and then put the results into a proper clinical context

'''INITIAL PRE-READING'''

'''How To Critically Appraise an RCT In 10 minutes'''
*[https://itunes.apple.com/ca/book/how-to-critically-appraise/id524600667?mt=11 iBook/iPad version]
*[https://therapeuticseducation.org/sites/therapeuticseducation.org/files/Ten_Minute_Critical_Appraisal.pdf PDF version]
Watch this video
[http://youtu.be/QUW0Q8tXVUc Viva La Evidence]

'''Study Results at Your Fingertips'''
*[https://mystudies.org MyStudies] - Free access

'''INTEGRATION ACTIVITY FORMAT'''
# Students placed in groups of ~ 5-7
# Each group is given one of the studies below to review
# Students then work in pairs and develop a one-slide critical appraisal and results synopsis
# One student in each group will be chosen at random to present their group findings to the class
# A discussion about the appraisal and the appropriate clinical context for the results is had with the entire class for each study

'''MODULE'''
[[File:Screen Shot 2022-01-09 at 10.00.16 AM.jpg|thumb|'''TRIAL PRESENTATION FORMAT'''|none]]

Studies chosen include landmark studies and/or studies that address important therapeutic issues for the particular module

'''ACADEMIC YEAR 1 - FIRST TERM'''

1) FOUNDATION STUDIES (Groups)
*[https://pubmed.ncbi.nlm.nih.gov/37952131 SELECT] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/12466506 AFFIRM] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/22085343 AIM-HIGH] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/10639539 HOPE] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/18378519 HYVET] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/15007110 PROVE-IT] Groups 6,18,30
*[http://www.ncbi.nlm.nih.gov/pubmed/15755765 TNT] Groups 7,19,31
*[https://pubmed.ncbi.nlm.nih.gov/26378978 EMPAREG] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/17984165 ILLUMINATE] Groups 9,21,33
*[https://pubmed.ncbi.nlm.nih.gov/26551272/ SPRINT] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/15325833 CARDS] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/12117397 WHI] Groups 12,24,36

'''ACADEMIC YEAR 1 - SECOND TERM'''

2) INTRO TO INFECTIOUS DISEASE STUDIES

[https://wiki.ubc.ca/images/8/8b/Antibiotic_Sensitivity_Chart_2024.pdf The "Best" Antibiotic Sensitivity Chart Ever]
*[http://www.ncbi.nlm.nih.gov/pubmed/17567657 IV vs PO antibiotics] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/24603565 Delayed antibiotics for respiratory tract infections] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/11159657 Delayed antibiotics for otitis media] Groups 3,15,27
*[https://pubmed.ncbi.nlm.nih.gov/27455166/ Duration of treatment for community acquired pneumonia] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/22726802 Duration of treatment for pyelonephritis] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/25830421 Choice of antibiotic for community acquired pneumonia-1] Groups 6,18,30
*[http://www.ncbi.nlm.nih.gov/pubmed/25286173 Choice of antibiotic for community acquired pneumonia-2] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/20647284 HPV vaccine study] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/7966893 High-Dose Influenza Vaccine - hospitalization] Groups 9,21,33
*[https://pubmed.ncbi.nlm.nih.gov/40884442 High-Dose Influenza Vaccine - cardiovascular outcomes] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/27626517 Herpes zoster vaccine study 1] Groups 11,23,35
*[https://www.ncbi.nlm.nih.gov/pubmed/25916341 Herpes zoster vaccine study 2] Groups 12,24,36

3) MUSCULOSKELETAL STUDIES

*[http://www.ncbi.nlm.nih.gov/pubmed/28199814 Baricitinib versus Placebo or Adalimumab in Rheumatoid Arthritis] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/0010979111 CLASS – celecoxib vs NSAIDs] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/26501533 Naproxen with cyclobenzaprine, oxycodone/acetaminophen, or placebo for low back pain] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/24395557 Glucosamine and chondroitin for OA] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/12546607 Acetaminophen vs diclofenac for OA] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/23964752 Diclofenac gel for acute neck pain] Groups 6,18,30
*[https://pubmed.ncbi.nlm.nih.gov/15468367/ Topical diclofenac vs oral diclofenac] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/25064594 Acetaminophen for low back pain] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/7611589 Misoprostol and NSAID induced ulcers] Groups 9,21,33
*[http://www.ncbi.nlm.nih.gov/pubmed/20131255 Low dose vs high dose colchicine for gout] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/22508468 TEAR - oral triple therapy versus etanercept plus methotrexate in early aggressive rheumatoid arthritis] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/25589511 MOVES - Glucosamine and chondroitin for OA for moderate to severe pain] Groups 12,24,36

4) DERMATOLOGY STUDIES

*[https://www.ncbi.nlm.nih.gov/pubmed/9598014 Glycolic acid 5% Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/21896132 Glycolic acid 10% Acne]
*[https://www.ncbi.nlm.nih.gov/pubmed/14531866 Petrolatum vs Ceramide/skin related lipids Hand Dermatitis]
*[https://www.ncbi.nlm.nih.gov/pubmed/11896774 Vitamin C Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/17515510 Retinol (VitaminA) Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/21896129 Hyaluronic acid Atopic Dermatitis]

5) EENT STUDIES

[http://www.amstar.ca/docs/AMSTARguideline.pdf AMSTAR meta-analysis checklist]

'''Scenario 1 - Otitis Media''' - GROUPS 1, 7, 18, 19, 25, 36

Anthony Martin arrives at your pharmacy somewhat frustrated since his family physician declined to write an antibiotic prescription for his two and half year old son, Oscar. His symptoms started yesterday afternoon - Oscar complains of right ear pain but there is no discharge. Rectal temperature taken today was 38.5 degrees. His wife is sure Oscar has an ear infection since the last time he had these same symptoms, that was ultimately the diagnosis. Mr. Martin asks if you think buying acetaminophen is really “enough”?

[https://pubmed.ncbi.nlm.nih.gov/26099233/ Antibiotics for acute otitis media in children]

'''Scenario 2 - Allergic Rhinitis''' - GROUPS 2, 8, 17, 20, 26, 35

Ruby Parmar is a firefighter. She is plagued by sinus congestion (preventing her from sleeping) and a runny nose associated with seasonal allergies. Her prescription for intranasal triamcinolone is typically effective, but she would like to know if a non-sedating anti-allergy pill would work just as well since it’s inconvenient carrying around the “nose spray”.

[https://www.ncbi.nlm.nih.gov/pubmed/28234147 Intranasal steroids vs antihistamines for allergic rhinitis]

'''Scenario 3 - Acute Sinusitis''' - GROUPS 3, 9, 16, 21, 27, 34

You are seeing a patient in clinic before her appointment with the primary care physician. She was feeling unwell with a “flu” last week. While most of her symptoms have resolved (cough, fever), the nasal congestion and discharge persists and so she has made an appointment (she is an otherwise healthy 32 year old with treated thyroid disease). She would like your advice for what treatment she should ask the doctor to prescribe.

[http://www.ncbi.nlm.nih.gov/pubmed/24293353 Intranasal steroids for acute sinusitis]

'''Scenario 4 - Glaucoma''' - GROUPS 4, 10, 15, 22, 28, 33

Mrs. Ada Waters is a 63 year-old woman you. Her ophthalmologist prescribed timolol and xalatan eye drops for treatment of open angle glaucoma. She has never really felt much different on treatment since she recovered from her first episode (of acute angle closure glaucoma requiring ER visit) and surgery. She asks you if the treatment is really making a difference.

[https://www.ncbi.nlm.nih.gov/pubmed/17943780 Interventions for open angle glaucoma]

'''Scenario 5 - Sore Throat''' - GROUPS 5, 11, 14, 23, 29, 32

You have a good friend who is applying for pharmacy. Her invitation for the multiple-mini interview (MMI) is coming up soon, but she is starting to experience a sore throat. While she is worried about not being able to speak through all of those stations, she knows she often gets a terrible headache along with her sore throat. She has an unused prescription for amoxicillin (unexpired) and wonders if you recommend for her to take it.

[https://pubmed.ncbi.nlm.nih.gov/34881426/ Antibiotics for sore throat]

'''Scenario 6 - Conjunctivitis''' - GROUPS 6, 12, 13, 24, 30, 31

A man comes to your pharmacy (he appears in his early twenties) complaining of “pink eye”. He has had a pink discolouration and discharge from his left eye for two days. He asks if the OTC antibiotic eye drops (he’s holding a product with polymixin B) are any better than “waiting it out”.

[https://www.ncbi.nlm.nih.gov/pubmed/22972049 Antibiotics for acute conjunctivitis]

6) HEMATOLOGY STUDIES

None so far

'''ACADEMIC YEAR 2 - FIRST TERM'''

7) RESPIROLOGY STUDIES
[[File:IA COPD info.pdf|thumb]]

*[http://www.ncbi.nlm.nih.gov/pubmed/2062329 First inhaled steroid study] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/22938706 Tiotropium in asthma] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/21324520 Inhaled steroid in children] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/29768149 Combined Budesonide–Formoterol as Needed in Mild Asthma] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/15223858 Doubling dose of inhaled corticosteroid] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/29768147 As-Needed Budesonide–Formoterol versus Maintenance Budesonide in Mild Asthma] Groups 6,18,30
*[https://pubmed.ncbi.nlm.nih.gov/32579807/ Triple Inhaled Therapy at Two Glucocorticoid Doses in Moderate-to-Very-Severe COPD] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/21428765 Tiotropium VS salmeterol in COPD] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/23695200 Short VS long steroids for COPD exacerbation] Groups 9,21,33
*[http://www.ncbi.nlm.nih.gov/pubmed/25196117 Stopping inhaled steroids in COPD] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/29668352 Once-Daily Single-Inhaler Triple versus Dual Therapy in Patients with COPD] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/28877011 Tezepelumab in Adults with Uncontrolled Asthma] Groups 12,24,36

8) CARDIOVASCULAR STUDIES

SESSION 1

*[https://www.ncbi.nlm.nih.gov/pubmed/4862069 VA1] (Group 1, 13, 25)
*[https://www.ncbi.nlm.nih.gov/pubmed/4914579 VA 2] (Group 2, 14, 26)
*[https://pubmed.ncbi.nlm.nih.gov/33186492 Polycap Study 3] (Group 3, 15, 27)
*[http://www.ncbi.nlm.nih.gov/pubmed/20228401 ACCORD-BP] (Group 4, 16, 28)
*[https://www.ncbi.nlm.nih.gov/pubmed/26551272 SPRINT] (Group 5, 17, 29)
*[http://www.ncbi.nlm.nih.gov/pubmed/2883575 CONSENSUS] (Group 6,18,30)
*[https://pubmed.ncbi.nlm.nih.gov/31535829/ DAPA-HF] (Group 7, 19, 31)
*[https://pubmed.ncbi.nlm.nih.gov/25176939/ CONFIRM-HF] (Group 8, 20, 32)
*[http://www.ncbi.nlm.nih.gov/pubmed/12457784 PROSPER] (Group 9, 21, 33)
*[http://www.ncbi.nlm.nih.gov/pubmed/27040132 HOPE-3] (Group 10, 22, 34)
*[http://www.ncbi.nlm.nih.gov/pubmed/12114036 Heart Protection Study (HPS)] (Group 11, 23, 35)
*[http://www.ncbi.nlm.nih.gov/pubmed/30415628 REDUCE-IT] (Group 12, 24, 36)

[[File:CV Case.pdf|thumb|CV case|left]]

SESSION 2

'''The Guideline Case'''

A 63 y/o patient with CHOOSE ONE (⬆︎HTN/⬆︎Chol/⬆︎glucose/HF/A fib) and using the guideline determine:
# their 5yr/10yr risks of mortality/CVD events
# the potential benefit
# the potential side effects (with magnitude)
# words/sentiment patient values and preferences/SDM

Atrial fibrillation - Groups 1,13,25,2,14,26
*[https://www.onlinecjc.ca/article/S0828-282X(18)31062-6/pdf 2018 Atrial fibrillation guidelines]
Diabetes - Groups 3,15,27,4,16,28
*[http://guidelines.diabetes.ca/docs/CPG-2018-full-EN.pdf 2018 Diabetes guidelines]
Lipid Simplified - Groups 5,17,29,6,18,30
*[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4607330/pdf/0610857.pdf 2015 Simplified lipid guidelines]
Lipid - Groups 7,19,31,8,20,32
*[http://www.onlinecjc.ca/article/S0828-282X(16)30732-2/pdf 2016 Lipid guidelines]
Heart failure - Groups 9,21,33,10,22,34
*[http://www.onlinecjc.ca/article/S0828-282X(17)30973-X/pdf 2017 Heart failure guidelines]
Hypertension - Groups 11,23,35,12,24,36
*[https://www.onlinecjc.ca/article/S0828-282X(18)30183-1/pdf 2018 Hypertension guidelines]

OPTIONAL SESSION
*[http://www.ncbi.nlm.nih.gov/pubmed/16899775 SPARCL]
*[http://www.ncbi.nlm.nih.gov/pubmed/10471456 RALES]
*[http://www.ncbi.nlm.nih.gov/pubmed/11386263 Carvedilol in heart failure]
*[http://www.ncbi.nlm.nih.gov/pubmed/18460663 WAFACS]
*[http://www.ncbi.nlm.nih.gov/pubmed/10376614 MERIT-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/25176015 PARADIGM-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/24490264 High-dose multivitamins after MI]
*[http://www.ncbi.nlm.nih.gov/pubmed/7911176 Mediterranean Diet after MI]
*[http://www.ncbi.nlm.nih.gov/pubmed/15337732 A TO Z]
*[http://www.ncbi.nlm.nih.gov/pubmed/21073363 EMPHASIS-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/12853193 COMET]
*[http://www.ncbi.nlm.nih.gov/pubmed/24716680 TOPCAT]
*[http://www.ncbi.nlm.nih.gov/pubmed/26039521 IMPROVE-IT]

'''ACADEMIC YEAR 2 - SECOND TERM'''

9) NEPHROLOGY STUDIES

None so far

10) ENDOCRINOLOGY

[[File:IA ENDO LAYOUT.pdf|thumb|IA ENDO LAYOUT TEMPLATE|none]]
[[File:Osteoporosis Evidence SUPP.pdf|none|thumb]]

'''RISK ASSESSMENT CASES FOR DIABETES AND OSTEOPOROSIS'''

'''1) DIABETES CASE'''

66 y/o white male who was diagnosed with diabetes 8 years ago

* His blood pressure over the last year has been roughly 145/80 mmHg - at present untreated
* A1c = 8%, no diabetes meds, non-smoker, BMI ~30
* '''When calculating without diabetes for PREVENT use an A1c of 5.5%'''
* Total cholesterol is 6 mmol/L, his HDL is 2 mmol/L, non-HDL = 6 minus 2, not on a statin
* No retinopathy, urine albumin-to-creatinine ratio (UACR) = 15ug/mg (7mg/mmol),
* Serum creatinine = 70 micromol/L, waist circumference 100 cm
* GFR 75 mL/min/1.73m2
* In normal sinus rhythm
* Age at end of highest education = 19
* Mother alive, father died of a heart attack at age 80

'''Calculate Risks'''

'''CVD RISK ESTIMATES''' - list the endpoints described by the specific calculator

Framingham - xx% - 10-year risk - also if no diabetes xx%

ASCVD - xx% - 10-year risk - also if no diabetes xx%

'''The Calculator'''
*CVD CALCULATOR
https://decisionaid.ca/cvd/

'''DIABETES COMPLICATIONS RISK ESTIMATES''' - list the endpoints described by the specific calculator

xx% - also 10-year risk if A1c 9, 8, 7 and 6

also get risk of kidney failure, vision loss, pressure sensation loss – also if A1c 9, 8,7,6

'''The Calculator'''
*DIABETES DECISION AID
http://decisionaid.ca/diabetes/

'''BENEFITS AND HARMS'''

Use the [https://guidelines.diabetes.ca/cpg/chapter-13-2020-update 2024 diabetes guidelines] and/or Diabetes Decision Aid to get estimates of benefits and harms and also use the MyStudies synopsis listed below

'''COSTS'''

Try using [https://pricingdoc.acfp.ca Pricing Doc] to get costs

'''Groups 1,13,25'''

* Metformin - UKPDS 34 [https://mystudies.org/studies.php#studies/28929e89-d01e-4b11-8e67-4d7086f9e4aa/outcome MyStudies Data]

'''Groups 2,14,26'''

* Sulfonlyureas - UKPDS 33 [https://mystudies.org/studies.php#studies/5eadb5dd-d403-4c13-b03e-d4f8d28c96ba/outcome MyStudies Data]

'''Groups 3,15,27'''

* Insulin - ORIGIN [https://mystudies.org/studies.php#studies/f611818f-2e69-4952-b55e-661116bd84b6/outcome MyStudies Data]

'''Groups 4,16,28'''

* SGLT2 - EMPA-REG OUTCOME [https://mystudies.org/studies.php#studies/32e9cf1a-f33e-480b-91ca-6f28a4dcf862/outcome MyStudies Data]

'''Groups 5,17,29'''

* GLP - LEADER [https://mystudies.org/studies.php#studies/1adbc9a1-7603-40f1-ac15-b813ce1f0ad6/outcome MyStudies Data]

'''Groups 6,18,30'''

* DPP4 - TECOS [https://mystudies.org/studies.php#studies/8659968a-cefb-4f99-b4ae-8b9b659acbd5/outcome MyStudies Data]

'''Groups 7,19,31'''

* Intensive treatment – small scale - STENO [https://mystudies.org/studies.php#studies/39d423e3-af57-40c8-ab7a-cbc7f389bdb6/paper MyStudies Data]

'''Groups 8,20,32'''

* Intensive treatment – large scale - ADDITION-Europe - [https://mystudies.org/studies.php#studies/5e07d86d-aa92-4db9-a283-76080db4b6fd/outcome MyStudies Data]

'''2) OSTEOPOROSIS CASE'''

60 y/o female

* 72 kg, 1.69m, BMI = 25.2
* t-score of -2.5
* Worried about falling and getting a hip fracture
* A friend recently had an atraumatic fracture from simply tripping and falling over in the snow
* No other risk factors

'''Calculate Risks'''

'''FRACTURE RISK ESTIMATES''' - list the endpoints described by the specific calculator

Major osteoporotic fracture - xx% - 10-year risk – if no BMD (just BMI), and then if they had a BMD t-Score of -2.0, -2.5, and -3.0

Hip fracture - - xx% - 10-year risk – if no BMD (just BMI) and if you have a BMD xx% - 10-year risk – if no BMD, and then if they had a BMD T-Score of -2.0, -2.5, and -3.0

'''The Calculator'''

* FRACTURE CALCULATOR

[https://frax.shef.ac.uk/frax/tool.aspx?country=19 Frax Tool - Canada]

'''BENEFITS AND HARMS'''

Use the [https://www.cmaj.ca/content/195/39/E1333 2023 Osteoporosis Guideline] and/or your osteoporosis lecture notes to get the benefits and apply these to your patient, and also get the harms

'''COSTS'''

Try using [https://pricingdoc.acfp.ca Pricing Doc] to get costs

'''Groups 9,21,33'''

* Activity

'''Groups 10,22,34'''

* Calcium/Vitamin D

'''Groups 11,23,35'''

* Bisphosphonates

'''Groups 12,24,36'''

* Denosumab

11) NEUROLOGY STUDIES

*[http://www.ncbi.nlm.nih.gov/pubmed/16717269 Opioids for chronic non-cancer pain] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/29509867 Effect of Opioid vs Nonopioid Medications on Pain-Related Function in Patients With Chronic Back Pain] Groups 2,14,26
*[https://www.ncbi.nlm.nih.gov/pubmed/31291515 Galcanezumab for prevention of cluster headaches] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/27150433 Immediate or delayed treatment of a first seizure] Groups 4,16,28
*[https://www.ncbi.nlm.nih.gov/pubmed/31291516 Rimegepant for episodic migraine] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/26212846 Sleep restriction for insomnia] Groups 6,18,30
*[https://www.ncbi.nlm.nih.gov/pubmed/25957224 CHANCE] Groups 7,19,31
*[https://www.ncbi.nlm.nih.gov/pubmed/16899775 SPARCL] Groups 8,20,32
*[https://www.ncbi.nlm.nih.gov/pubmed/29171821 Erenumab for episodic migraine] Groups 9,21,33
*[https://www.ncbi.nlm.nih.gov/pubmed/24733354 Reduction of benzodiazepines through education] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/26035341 Patient controlled opioid analgesia versus non-patient controlled opioid analgesia for postoperative pain] Groups 11,23,35
*[https://www.ncbi.nlm.nih.gov/pubmed/11589932 PROGRESS] Groups 12,24,36

'''ACADEMIC YEAR 3'''

12) PSYCHIATRY STUDIES

[[:File:2021 Psych Evidence Appraisal - Intro Slides.pdf|Psychiatry Rating Scales Introduction]]

* Study 1: [http://www.ncbi.nlm.nih.gov/pubmed/16554525 STAR*D (Level 2)] Bupropion-SR, sertraline, or venlafaxine-XR after failure of SSRIs for depression
* Study 2: [http://www.ncbi.nlm.nih.gov/pubmed/29477251 Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder]
* Study 3: [https://pubmed.ncbi.nlm.nih.gov/33862018/ Long-acting injectable versus oral antipsychotics for the maintenance treatment of schizophrenia]
* Study 4: [https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2725088 Association of Antipsychotic Polypharmacy vs Monotherapy With Psychiatric Rehospitalization Among Adults With Schizophrenia]
* Study 5: [https://www.ncbi.nlm.nih.gov/pubmed/29490359 Real-world Effectiveness of Pharmacologic Treatments for the Prevention of Bipolar Disorder]
* Study 6: [http://www.ncbi.nlm.nih.gov/pubmed/20092882 BALANCE] Combination lithium and valproate therapy versus monotherapy for relapse prevention in bipolar I disorder
13) GASTROENTEROLOGY STUDIES - LINKS ON CANVAS[[File:Screenshot 2025-11-17 at 7.50.27 AM.png|thumb]][[File:GI ChatGPT Instructions.jpg|thumb|GPT Instructions]]
*Short-term treatment for gastro-oesophageal reflux disease-like symptoms and endoscopy negative reflux disease (Review)
*Oral budesonide for induction of remission in ulcerative colitis (Review)
*Probiotics for the prevention of Clostridium difficile-associated diarrhea in adults and children (Review)
*Deprescribing versus continuation of chronic proton pump inhibitor use in adults (Review)
*Prevention of NSAID-induced gastroduodenal ulcers (Review)
*Methotrexate for maintenance of remission in Crohn's disease (Review)

14) OB/GYN STUDIES
*[http://www.ncbi.nlm.nih.gov/pubmed/25601350 Comparative contraceptive effectiveness of levonorgestrel-releasing and copper IUD Devices]
*[http://www.ncbi.nlm.nih.gov/pubmed/29211679 Hormonal contraception and the risk of breast cancer]
*[http://www.ncbi.nlm.nih.gov/pubmed/30322986 Sexual behaviours in adolescent girls before and after introduction of the HPV]
*[http://www.ncbi.nlm.nih.gov/pubmed/30181338 Intramuscular vs intravenous oxytocin to prevent postpartum haemorrhage at vaginal delivery]
*[http://www.ncbi.nlm.nih.gov/pubmed/27682034 Azithromycin Prophylaxis for Cesarean Delivery]
*[http://www.ncbi.nlm.nih.gov/pubmed/28461374 Antibiotics during pregnancy and risk of spontaneous abortion]

Evidence Appraisal Integrated Activities

2025-11-17T15:57:59Z

JamesMcCormack:

'''OBJECTIVE'''

To critically appraise studies, develop a brief synopsis of the trial results, succinctly present the results and then put the results into a proper clinical context

'''INITIAL PRE-READING'''

'''How To Critically Appraise an RCT In 10 minutes'''
*[https://itunes.apple.com/ca/book/how-to-critically-appraise/id524600667?mt=11 iBook/iPad version]
*[https://therapeuticseducation.org/sites/therapeuticseducation.org/files/Ten_Minute_Critical_Appraisal.pdf PDF version]
Watch this video
[http://youtu.be/QUW0Q8tXVUc Viva La Evidence]

'''Study Results at Your Fingertips'''
*[https://mystudies.org MyStudies] - Free access

'''INTEGRATION ACTIVITY FORMAT'''
# Students placed in groups of ~ 5-7
# Each group is given one of the studies below to review
# Students then work in pairs and develop a one-slide critical appraisal and results synopsis
# One student in each group will be chosen at random to present their group findings to the class
# A discussion about the appraisal and the appropriate clinical context for the results is had with the entire class for each study

'''MODULE'''
[[File:Screen Shot 2022-01-09 at 10.00.16 AM.jpg|thumb|'''TRIAL PRESENTATION FORMAT'''|none]]

Studies chosen include landmark studies and/or studies that address important therapeutic issues for the particular module

'''ACADEMIC YEAR 1 - FIRST TERM'''

1) FOUNDATION STUDIES (Groups)
*[https://pubmed.ncbi.nlm.nih.gov/37952131 SELECT] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/12466506 AFFIRM] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/22085343 AIM-HIGH] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/10639539 HOPE] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/18378519 HYVET] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/15007110 PROVE-IT] Groups 6,18,30
*[http://www.ncbi.nlm.nih.gov/pubmed/15755765 TNT] Groups 7,19,31
*[https://pubmed.ncbi.nlm.nih.gov/26378978 EMPAREG] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/17984165 ILLUMINATE] Groups 9,21,33
*[https://pubmed.ncbi.nlm.nih.gov/26551272/ SPRINT] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/15325833 CARDS] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/12117397 WHI] Groups 12,24,36

'''ACADEMIC YEAR 1 - SECOND TERM'''

2) INTRO TO INFECTIOUS DISEASE STUDIES

[https://wiki.ubc.ca/images/8/8b/Antibiotic_Sensitivity_Chart_2024.pdf The "Best" Antibiotic Sensitivity Chart Ever]
*[http://www.ncbi.nlm.nih.gov/pubmed/17567657 IV vs PO antibiotics] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/24603565 Delayed antibiotics for respiratory tract infections] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/11159657 Delayed antibiotics for otitis media] Groups 3,15,27
*[https://pubmed.ncbi.nlm.nih.gov/27455166/ Duration of treatment for community acquired pneumonia] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/22726802 Duration of treatment for pyelonephritis] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/25830421 Choice of antibiotic for community acquired pneumonia-1] Groups 6,18,30
*[http://www.ncbi.nlm.nih.gov/pubmed/25286173 Choice of antibiotic for community acquired pneumonia-2] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/20647284 HPV vaccine study] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/7966893 Influenza vaccine study] Groups 9,21,33
*[https://pubmed.ncbi.nlm.nih.gov/33301246/ COVID vaccine Pfizer] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/27626517 Herpes zoster vaccine study 1] Groups 11,23,35
*[https://www.ncbi.nlm.nih.gov/pubmed/25916341 Herpes zoster vaccine study 2] Groups 12,24,36

3) MUSCULOSKELETAL STUDIES

*[http://www.ncbi.nlm.nih.gov/pubmed/28199814 Baricitinib versus Placebo or Adalimumab in Rheumatoid Arthritis] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/0010979111 CLASS – celecoxib vs NSAIDs] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/26501533 Naproxen with cyclobenzaprine, oxycodone/acetaminophen, or placebo for low back pain] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/24395557 Glucosamine and chondroitin for OA] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/12546607 Acetaminophen vs diclofenac for OA] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/23964752 Diclofenac gel for acute neck pain] Groups 6,18,30
*[https://pubmed.ncbi.nlm.nih.gov/15468367/ Topical diclofenac vs oral diclofenac] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/25064594 Acetaminophen for low back pain] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/7611589 Misoprostol and NSAID induced ulcers] Groups 9,21,33
*[http://www.ncbi.nlm.nih.gov/pubmed/20131255 Low dose vs high dose colchicine for gout] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/22508468 TEAR - oral triple therapy versus etanercept plus methotrexate in early aggressive rheumatoid arthritis] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/25589511 MOVES - Glucosamine and chondroitin for OA for moderate to severe pain] Groups 12,24,36

4) DERMATOLOGY STUDIES

*[https://www.ncbi.nlm.nih.gov/pubmed/9598014 Glycolic acid 5% Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/21896132 Glycolic acid 10% Acne]
*[https://www.ncbi.nlm.nih.gov/pubmed/14531866 Petrolatum vs Ceramide/skin related lipids Hand Dermatitis]
*[https://www.ncbi.nlm.nih.gov/pubmed/11896774 Vitamin C Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/17515510 Retinol (VitaminA) Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/21896129 Hyaluronic acid Atopic Dermatitis]

5) EENT STUDIES

[http://www.amstar.ca/docs/AMSTARguideline.pdf AMSTAR meta-analysis checklist]

'''Scenario 1 - Otitis Media''' - GROUPS 1, 7, 18, 19, 25, 36

Anthony Martin arrives at your pharmacy somewhat frustrated since his family physician declined to write an antibiotic prescription for his two and half year old son, Oscar. His symptoms started yesterday afternoon - Oscar complains of right ear pain but there is no discharge. Rectal temperature taken today was 38.5 degrees. His wife is sure Oscar has an ear infection since the last time he had these same symptoms, that was ultimately the diagnosis. Mr. Martin asks if you think buying acetaminophen is really “enough”?

[https://pubmed.ncbi.nlm.nih.gov/26099233/ Antibiotics for acute otitis media in children]

'''Scenario 2 - Allergic Rhinitis''' - GROUPS 2, 8, 17, 20, 26, 35

Ruby Parmar is a firefighter. She is plagued by sinus congestion (preventing her from sleeping) and a runny nose associated with seasonal allergies. Her prescription for intranasal triamcinolone is typically effective, but she would like to know if a non-sedating anti-allergy pill would work just as well since it’s inconvenient carrying around the “nose spray”.

[https://www.ncbi.nlm.nih.gov/pubmed/28234147 Intranasal steroids vs antihistamines for allergic rhinitis]

'''Scenario 3 - Acute Sinusitis''' - GROUPS 3, 9, 16, 21, 27, 34

You are seeing a patient in clinic before her appointment with the primary care physician. She was feeling unwell with a “flu” last week. While most of her symptoms have resolved (cough, fever), the nasal congestion and discharge persists and so she has made an appointment (she is an otherwise healthy 32 year old with treated thyroid disease). She would like your advice for what treatment she should ask the doctor to prescribe.

[http://www.ncbi.nlm.nih.gov/pubmed/24293353 Intranasal steroids for acute sinusitis]

'''Scenario 4 - Glaucoma''' - GROUPS 4, 10, 15, 22, 28, 33

Mrs. Ada Waters is a 63 year-old woman you. Her ophthalmologist prescribed timolol and xalatan eye drops for treatment of open angle glaucoma. She has never really felt much different on treatment since she recovered from her first episode (of acute angle closure glaucoma requiring ER visit) and surgery. She asks you if the treatment is really making a difference.

[https://www.ncbi.nlm.nih.gov/pubmed/17943780 Interventions for open angle glaucoma]

'''Scenario 5 - Sore Throat''' - GROUPS 5, 11, 14, 23, 29, 32

You have a good friend who is applying for pharmacy. Her invitation for the multiple-mini interview (MMI) is coming up soon, but she is starting to experience a sore throat. While she is worried about not being able to speak through all of those stations, she knows she often gets a terrible headache along with her sore throat. She has an unused prescription for amoxicillin (unexpired) and wonders if you recommend for her to take it.

[https://pubmed.ncbi.nlm.nih.gov/34881426/ Antibiotics for sore throat]

'''Scenario 6 - Conjunctivitis''' - GROUPS 6, 12, 13, 24, 30, 31

A man comes to your pharmacy (he appears in his early twenties) complaining of “pink eye”. He has had a pink discolouration and discharge from his left eye for two days. He asks if the OTC antibiotic eye drops (he’s holding a product with polymixin B) are any better than “waiting it out”.

[https://www.ncbi.nlm.nih.gov/pubmed/22972049 Antibiotics for acute conjunctivitis]

6) HEMATOLOGY STUDIES

None so far

'''ACADEMIC YEAR 2 - FIRST TERM'''

7) RESPIROLOGY STUDIES
[[File:IA COPD info.pdf|thumb]]

*[http://www.ncbi.nlm.nih.gov/pubmed/2062329 First inhaled steroid study] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/22938706 Tiotropium in asthma] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/21324520 Inhaled steroid in children] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/29768149 Combined Budesonide–Formoterol as Needed in Mild Asthma] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/15223858 Doubling dose of inhaled corticosteroid] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/29768147 As-Needed Budesonide–Formoterol versus Maintenance Budesonide in Mild Asthma] Groups 6,18,30
*[https://pubmed.ncbi.nlm.nih.gov/32579807/ Triple Inhaled Therapy at Two Glucocorticoid Doses in Moderate-to-Very-Severe COPD] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/21428765 Tiotropium VS salmeterol in COPD] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/23695200 Short VS long steroids for COPD exacerbation] Groups 9,21,33
*[http://www.ncbi.nlm.nih.gov/pubmed/25196117 Stopping inhaled steroids in COPD] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/29668352 Once-Daily Single-Inhaler Triple versus Dual Therapy in Patients with COPD] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/28877011 Tezepelumab in Adults with Uncontrolled Asthma] Groups 12,24,36

8) CARDIOVASCULAR STUDIES

SESSION 1

*[https://www.ncbi.nlm.nih.gov/pubmed/4862069 VA1] (Group 1, 13, 25)
*[https://www.ncbi.nlm.nih.gov/pubmed/4914579 VA 2] (Group 2, 14, 26)
*[https://pubmed.ncbi.nlm.nih.gov/33186492 Polycap Study 3] (Group 3, 15, 27)
*[http://www.ncbi.nlm.nih.gov/pubmed/20228401 ACCORD-BP] (Group 4, 16, 28)
*[https://www.ncbi.nlm.nih.gov/pubmed/26551272 SPRINT] (Group 5, 17, 29)
*[http://www.ncbi.nlm.nih.gov/pubmed/2883575 CONSENSUS] (Group 6,18,30)
*[https://pubmed.ncbi.nlm.nih.gov/31535829/ DAPA-HF] (Group 7, 19, 31)
*[https://pubmed.ncbi.nlm.nih.gov/25176939/ CONFIRM-HF] (Group 8, 20, 32)
*[http://www.ncbi.nlm.nih.gov/pubmed/12457784 PROSPER] (Group 9, 21, 33)
*[http://www.ncbi.nlm.nih.gov/pubmed/27040132 HOPE-3] (Group 10, 22, 34)
*[http://www.ncbi.nlm.nih.gov/pubmed/12114036 Heart Protection Study (HPS)] (Group 11, 23, 35)
*[http://www.ncbi.nlm.nih.gov/pubmed/30415628 REDUCE-IT] (Group 12, 24, 36)

[[File:CV Case.pdf|thumb|CV case|left]]

SESSION 2

'''The Guideline Case'''

A 63 y/o patient with CHOOSE ONE (⬆︎HTN/⬆︎Chol/⬆︎glucose/HF/A fib) and using the guideline determine:
# their 5yr/10yr risks of mortality/CVD events
# the potential benefit
# the potential side effects (with magnitude)
# words/sentiment patient values and preferences/SDM

Atrial fibrillation - Groups 1,13,25,2,14,26
*[https://www.onlinecjc.ca/article/S0828-282X(18)31062-6/pdf 2018 Atrial fibrillation guidelines]
Diabetes - Groups 3,15,27,4,16,28
*[http://guidelines.diabetes.ca/docs/CPG-2018-full-EN.pdf 2018 Diabetes guidelines]
Lipid Simplified - Groups 5,17,29,6,18,30
*[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4607330/pdf/0610857.pdf 2015 Simplified lipid guidelines]
Lipid - Groups 7,19,31,8,20,32
*[http://www.onlinecjc.ca/article/S0828-282X(16)30732-2/pdf 2016 Lipid guidelines]
Heart failure - Groups 9,21,33,10,22,34
*[http://www.onlinecjc.ca/article/S0828-282X(17)30973-X/pdf 2017 Heart failure guidelines]
Hypertension - Groups 11,23,35,12,24,36
*[https://www.onlinecjc.ca/article/S0828-282X(18)30183-1/pdf 2018 Hypertension guidelines]

OPTIONAL SESSION
*[http://www.ncbi.nlm.nih.gov/pubmed/16899775 SPARCL]
*[http://www.ncbi.nlm.nih.gov/pubmed/10471456 RALES]
*[http://www.ncbi.nlm.nih.gov/pubmed/11386263 Carvedilol in heart failure]
*[http://www.ncbi.nlm.nih.gov/pubmed/18460663 WAFACS]
*[http://www.ncbi.nlm.nih.gov/pubmed/10376614 MERIT-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/25176015 PARADIGM-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/24490264 High-dose multivitamins after MI]
*[http://www.ncbi.nlm.nih.gov/pubmed/7911176 Mediterranean Diet after MI]
*[http://www.ncbi.nlm.nih.gov/pubmed/15337732 A TO Z]
*[http://www.ncbi.nlm.nih.gov/pubmed/21073363 EMPHASIS-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/12853193 COMET]
*[http://www.ncbi.nlm.nih.gov/pubmed/24716680 TOPCAT]
*[http://www.ncbi.nlm.nih.gov/pubmed/26039521 IMPROVE-IT]

'''ACADEMIC YEAR 2 - SECOND TERM'''

9) NEPHROLOGY STUDIES

None so far

10) ENDOCRINOLOGY

[[File:IA ENDO LAYOUT.pdf|thumb|IA ENDO LAYOUT TEMPLATE|none]]
[[File:Osteoporosis Evidence SUPP.pdf|none|thumb]]

'''RISK ASSESSMENT CASES FOR DIABETES AND OSTEOPOROSIS'''

'''1) DIABETES CASE'''

66 y/o white male who was diagnosed with diabetes 8 years ago

* His blood pressure over the last year has been roughly 145/80 mmHg - at present untreated
* A1c = 8%, no diabetes meds, non-smoker, BMI ~30
* '''When calculating without diabetes for PREVENT use an A1c of 5.5%'''
* Total cholesterol is 6 mmol/L, his HDL is 2 mmol/L, non-HDL = 6 minus 2, not on a statin
* No retinopathy, urine albumin-to-creatinine ratio (UACR) = 15ug/mg (7mg/mmol),
* Serum creatinine = 70 micromol/L, waist circumference 100 cm
* GFR 75 mL/min/1.73m2
* In normal sinus rhythm
* Age at end of highest education = 19
* Mother alive, father died of a heart attack at age 80

'''Calculate Risks'''

'''CVD RISK ESTIMATES''' - list the endpoints described by the specific calculator

Framingham - xx% - 10-year risk - also if no diabetes xx%

ASCVD - xx% - 10-year risk - also if no diabetes xx%

'''The Calculator'''
*CVD CALCULATOR
https://decisionaid.ca/cvd/

'''DIABETES COMPLICATIONS RISK ESTIMATES''' - list the endpoints described by the specific calculator

xx% - also 10-year risk if A1c 9, 8, 7 and 6

also get risk of kidney failure, vision loss, pressure sensation loss – also if A1c 9, 8,7,6

'''The Calculator'''
*DIABETES DECISION AID
http://decisionaid.ca/diabetes/

'''BENEFITS AND HARMS'''

Use the [https://guidelines.diabetes.ca/cpg/chapter-13-2020-update 2024 diabetes guidelines] and/or Diabetes Decision Aid to get estimates of benefits and harms and also use the MyStudies synopsis listed below

'''COSTS'''

Try using [https://pricingdoc.acfp.ca Pricing Doc] to get costs

'''Groups 1,13,25'''

* Metformin - UKPDS 34 [https://mystudies.org/studies.php#studies/28929e89-d01e-4b11-8e67-4d7086f9e4aa/outcome MyStudies Data]

'''Groups 2,14,26'''

* Sulfonlyureas - UKPDS 33 [https://mystudies.org/studies.php#studies/5eadb5dd-d403-4c13-b03e-d4f8d28c96ba/outcome MyStudies Data]

'''Groups 3,15,27'''

* Insulin - ORIGIN [https://mystudies.org/studies.php#studies/f611818f-2e69-4952-b55e-661116bd84b6/outcome MyStudies Data]

'''Groups 4,16,28'''

* SGLT2 - EMPA-REG OUTCOME [https://mystudies.org/studies.php#studies/32e9cf1a-f33e-480b-91ca-6f28a4dcf862/outcome MyStudies Data]

'''Groups 5,17,29'''

* GLP - LEADER [https://mystudies.org/studies.php#studies/1adbc9a1-7603-40f1-ac15-b813ce1f0ad6/outcome MyStudies Data]

'''Groups 6,18,30'''

* DPP4 - TECOS [https://mystudies.org/studies.php#studies/8659968a-cefb-4f99-b4ae-8b9b659acbd5/outcome MyStudies Data]

'''Groups 7,19,31'''

* Intensive treatment – small scale - STENO [https://mystudies.org/studies.php#studies/39d423e3-af57-40c8-ab7a-cbc7f389bdb6/paper MyStudies Data]

'''Groups 8,20,32'''

* Intensive treatment – large scale - ADDITION-Europe - [https://mystudies.org/studies.php#studies/5e07d86d-aa92-4db9-a283-76080db4b6fd/outcome MyStudies Data]

'''2) OSTEOPOROSIS CASE'''

60 y/o female

* 72 kg, 1.69m, BMI = 25.2
* t-score of -2.5
* Worried about falling and getting a hip fracture
* A friend recently had an atraumatic fracture from simply tripping and falling over in the snow
* No other risk factors

'''Calculate Risks'''

'''FRACTURE RISK ESTIMATES''' - list the endpoints described by the specific calculator

Major osteoporotic fracture - xx% - 10-year risk – if no BMD (just BMI), and then if they had a BMD t-Score of -2.0, -2.5, and -3.0

Hip fracture - - xx% - 10-year risk – if no BMD (just BMI) and if you have a BMD xx% - 10-year risk – if no BMD, and then if they had a BMD T-Score of -2.0, -2.5, and -3.0

'''The Calculator'''

* FRACTURE CALCULATOR

[https://frax.shef.ac.uk/frax/tool.aspx?country=19 Frax Tool - Canada]

'''BENEFITS AND HARMS'''

Use the [https://www.cmaj.ca/content/195/39/E1333 2023 Osteoporosis Guideline] and/or your osteoporosis lecture notes to get the benefits and apply these to your patient, and also get the harms

'''COSTS'''

Try using [https://pricingdoc.acfp.ca Pricing Doc] to get costs

'''Groups 9,21,33'''

* Activity

'''Groups 10,22,34'''

* Calcium/Vitamin D

'''Groups 11,23,35'''

* Bisphosphonates

'''Groups 12,24,36'''

* Denosumab

11) NEUROLOGY STUDIES

*[http://www.ncbi.nlm.nih.gov/pubmed/16717269 Opioids for chronic non-cancer pain] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/29509867 Effect of Opioid vs Nonopioid Medications on Pain-Related Function in Patients With Chronic Back Pain] Groups 2,14,26
*[https://www.ncbi.nlm.nih.gov/pubmed/31291515 Galcanezumab for prevention of cluster headaches] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/27150433 Immediate or delayed treatment of a first seizure] Groups 4,16,28
*[https://www.ncbi.nlm.nih.gov/pubmed/31291516 Rimegepant for episodic migraine] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/26212846 Sleep restriction for insomnia] Groups 6,18,30
*[https://www.ncbi.nlm.nih.gov/pubmed/25957224 CHANCE] Groups 7,19,31
*[https://www.ncbi.nlm.nih.gov/pubmed/16899775 SPARCL] Groups 8,20,32
*[https://www.ncbi.nlm.nih.gov/pubmed/29171821 Erenumab for episodic migraine] Groups 9,21,33
*[https://www.ncbi.nlm.nih.gov/pubmed/24733354 Reduction of benzodiazepines through education] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/26035341 Patient controlled opioid analgesia versus non-patient controlled opioid analgesia for postoperative pain] Groups 11,23,35
*[https://www.ncbi.nlm.nih.gov/pubmed/11589932 PROGRESS] Groups 12,24,36

'''ACADEMIC YEAR 3'''

12) PSYCHIATRY STUDIES

[[:File:2021 Psych Evidence Appraisal - Intro Slides.pdf|Psychiatry Rating Scales Introduction]]

* Study 1: [http://www.ncbi.nlm.nih.gov/pubmed/16554525 STAR*D (Level 2)] Bupropion-SR, sertraline, or venlafaxine-XR after failure of SSRIs for depression
* Study 2: [http://www.ncbi.nlm.nih.gov/pubmed/29477251 Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder]
* Study 3: [https://pubmed.ncbi.nlm.nih.gov/33862018/ Long-acting injectable versus oral antipsychotics for the maintenance treatment of schizophrenia]
* Study 4: [https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2725088 Association of Antipsychotic Polypharmacy vs Monotherapy With Psychiatric Rehospitalization Among Adults With Schizophrenia]
* Study 5: [https://www.ncbi.nlm.nih.gov/pubmed/29490359 Real-world Effectiveness of Pharmacologic Treatments for the Prevention of Bipolar Disorder]
* Study 6: [http://www.ncbi.nlm.nih.gov/pubmed/20092882 BALANCE] Combination lithium and valproate therapy versus monotherapy for relapse prevention in bipolar I disorder
13) GASTROENTEROLOGY STUDIES - LINKS ON CANVAS[[File:Screenshot 2025-11-17 at 7.50.27 AM.png|thumb]][[File:GI ChatGPT Instructions.jpg|thumb|GPT Instructions]]
*Short-term treatment for gastro-oesophageal reflux disease-like symptoms and endoscopy negative reflux disease (Review)
*Oral budesonide for induction of remission in ulcerative colitis (Review)
*Probiotics for the prevention of Clostridium difficile-associated diarrhea in adults and children (Review)
*Deprescribing versus continuation of chronic proton pump inhibitor use in adults (Review)
*Prevention of NSAID-induced gastroduodenal ulcers (Review)
*Methotrexate for maintenance of remission in Crohn's disease (Review)

14) OB/GYN STUDIES
*[http://www.ncbi.nlm.nih.gov/pubmed/25601350 Comparative contraceptive effectiveness of levonorgestrel-releasing and copper IUD Devices]
*[http://www.ncbi.nlm.nih.gov/pubmed/29211679 Hormonal contraception and the risk of breast cancer]
*[http://www.ncbi.nlm.nih.gov/pubmed/30322986 Sexual behaviours in adolescent girls before and after introduction of the HPV]
*[http://www.ncbi.nlm.nih.gov/pubmed/30181338 Intramuscular vs intravenous oxytocin to prevent postpartum haemorrhage at vaginal delivery]
*[http://www.ncbi.nlm.nih.gov/pubmed/27682034 Azithromycin Prophylaxis for Cesarean Delivery]
*[http://www.ncbi.nlm.nih.gov/pubmed/28461374 Antibiotics during pregnancy and risk of spontaneous abortion]

Evidence Appraisal Integrated Activities

2025-11-17T15:57:31Z

JamesMcCormack:

'''OBJECTIVE'''

To critically appraise studies, develop a brief synopsis of the trial results, succinctly present the results and then put the results into a proper clinical context

'''INITIAL PRE-READING'''

'''How To Critically Appraise an RCT In 10 minutes'''
*[https://itunes.apple.com/ca/book/how-to-critically-appraise/id524600667?mt=11 iBook/iPad version]
*[https://therapeuticseducation.org/sites/therapeuticseducation.org/files/Ten_Minute_Critical_Appraisal.pdf PDF version]
Watch this video
[http://youtu.be/QUW0Q8tXVUc Viva La Evidence]

'''Study Results at Your Fingertips'''
*[https://mystudies.org MyStudies] - Free access

'''INTEGRATION ACTIVITY FORMAT'''
# Students placed in groups of ~ 5-7
# Each group is given one of the studies below to review
# Students then work in pairs and develop a one-slide critical appraisal and results synopsis
# One student in each group will be chosen at random to present their group findings to the class
# A discussion about the appraisal and the appropriate clinical context for the results is had with the entire class for each study

'''MODULE'''
[[File:Screen Shot 2022-01-09 at 10.00.16 AM.jpg|thumb|'''TRIAL PRESENTATION FORMAT'''|none]]

Studies chosen include landmark studies and/or studies that address important therapeutic issues for the particular module

'''ACADEMIC YEAR 1 - FIRST TERM'''

1) FOUNDATION STUDIES (Groups)
*[https://pubmed.ncbi.nlm.nih.gov/37952131 SELECT] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/12466506 AFFIRM] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/22085343 AIM-HIGH] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/10639539 HOPE] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/18378519 HYVET] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/15007110 PROVE-IT] Groups 6,18,30
*[http://www.ncbi.nlm.nih.gov/pubmed/15755765 TNT] Groups 7,19,31
*[https://pubmed.ncbi.nlm.nih.gov/26378978 EMPAREG] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/17984165 ILLUMINATE] Groups 9,21,33
*[https://pubmed.ncbi.nlm.nih.gov/26551272/ SPRINT] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/15325833 CARDS] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/12117397 WHI] Groups 12,24,36

'''ACADEMIC YEAR 1 - SECOND TERM'''

2) INTRO TO INFECTIOUS DISEASE STUDIES

[https://wiki.ubc.ca/images/8/8b/Antibiotic_Sensitivity_Chart_2024.pdf The "Best" Antibiotic Sensitivity Chart Ever]
*[http://www.ncbi.nlm.nih.gov/pubmed/17567657 IV vs PO antibiotics] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/24603565 Delayed antibiotics for respiratory tract infections] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/11159657 Delayed antibiotics for otitis media] Groups 3,15,27
*[https://pubmed.ncbi.nlm.nih.gov/27455166/ Duration of treatment for community acquired pneumonia] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/22726802 Duration of treatment for pyelonephritis] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/25830421 Choice of antibiotic for community acquired pneumonia-1] Groups 6,18,30
*[http://www.ncbi.nlm.nih.gov/pubmed/25286173 Choice of antibiotic for community acquired pneumonia-2] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/20647284 HPV vaccine study] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/7966893 Influenza vaccine study] Groups 9,21,33
*[https://pubmed.ncbi.nlm.nih.gov/33301246/ COVID vaccine Pfizer] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/27626517 Herpes zoster vaccine study 1] Groups 11,23,35
*[https://www.ncbi.nlm.nih.gov/pubmed/25916341 Herpes zoster vaccine study 2] Groups 12,24,36

3) MUSCULOSKELETAL STUDIES

*[http://www.ncbi.nlm.nih.gov/pubmed/28199814 Baricitinib versus Placebo or Adalimumab in Rheumatoid Arthritis] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/0010979111 CLASS – celecoxib vs NSAIDs] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/26501533 Naproxen with cyclobenzaprine, oxycodone/acetaminophen, or placebo for low back pain] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/24395557 Glucosamine and chondroitin for OA] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/12546607 Acetaminophen vs diclofenac for OA] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/23964752 Diclofenac gel for acute neck pain] Groups 6,18,30
*[https://pubmed.ncbi.nlm.nih.gov/15468367/ Topical diclofenac vs oral diclofenac] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/25064594 Acetaminophen for low back pain] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/7611589 Misoprostol and NSAID induced ulcers] Groups 9,21,33
*[http://www.ncbi.nlm.nih.gov/pubmed/20131255 Low dose vs high dose colchicine for gout] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/22508468 TEAR - oral triple therapy versus etanercept plus methotrexate in early aggressive rheumatoid arthritis] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/25589511 MOVES - Glucosamine and chondroitin for OA for moderate to severe pain] Groups 12,24,36

4) DERMATOLOGY STUDIES

*[https://www.ncbi.nlm.nih.gov/pubmed/9598014 Glycolic acid 5% Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/21896132 Glycolic acid 10% Acne]
*[https://www.ncbi.nlm.nih.gov/pubmed/14531866 Petrolatum vs Ceramide/skin related lipids Hand Dermatitis]
*[https://www.ncbi.nlm.nih.gov/pubmed/11896774 Vitamin C Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/17515510 Retinol (VitaminA) Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/21896129 Hyaluronic acid Atopic Dermatitis]

5) EENT STUDIES

[http://www.amstar.ca/docs/AMSTARguideline.pdf AMSTAR meta-analysis checklist]

'''Scenario 1 - Otitis Media''' - GROUPS 1, 7, 18, 19, 25, 36

Anthony Martin arrives at your pharmacy somewhat frustrated since his family physician declined to write an antibiotic prescription for his two and half year old son, Oscar. His symptoms started yesterday afternoon - Oscar complains of right ear pain but there is no discharge. Rectal temperature taken today was 38.5 degrees. His wife is sure Oscar has an ear infection since the last time he had these same symptoms, that was ultimately the diagnosis. Mr. Martin asks if you think buying acetaminophen is really “enough”?

[https://pubmed.ncbi.nlm.nih.gov/26099233/ Antibiotics for acute otitis media in children]

'''Scenario 2 - Allergic Rhinitis''' - GROUPS 2, 8, 17, 20, 26, 35

Ruby Parmar is a firefighter. She is plagued by sinus congestion (preventing her from sleeping) and a runny nose associated with seasonal allergies. Her prescription for intranasal triamcinolone is typically effective, but she would like to know if a non-sedating anti-allergy pill would work just as well since it’s inconvenient carrying around the “nose spray”.

[https://www.ncbi.nlm.nih.gov/pubmed/28234147 Intranasal steroids vs antihistamines for allergic rhinitis]

'''Scenario 3 - Acute Sinusitis''' - GROUPS 3, 9, 16, 21, 27, 34

You are seeing a patient in clinic before her appointment with the primary care physician. She was feeling unwell with a “flu” last week. While most of her symptoms have resolved (cough, fever), the nasal congestion and discharge persists and so she has made an appointment (she is an otherwise healthy 32 year old with treated thyroid disease). She would like your advice for what treatment she should ask the doctor to prescribe.

[http://www.ncbi.nlm.nih.gov/pubmed/24293353 Intranasal steroids for acute sinusitis]

'''Scenario 4 - Glaucoma''' - GROUPS 4, 10, 15, 22, 28, 33

Mrs. Ada Waters is a 63 year-old woman you. Her ophthalmologist prescribed timolol and xalatan eye drops for treatment of open angle glaucoma. She has never really felt much different on treatment since she recovered from her first episode (of acute angle closure glaucoma requiring ER visit) and surgery. She asks you if the treatment is really making a difference.

[https://www.ncbi.nlm.nih.gov/pubmed/17943780 Interventions for open angle glaucoma]

'''Scenario 5 - Sore Throat''' - GROUPS 5, 11, 14, 23, 29, 32

You have a good friend who is applying for pharmacy. Her invitation for the multiple-mini interview (MMI) is coming up soon, but she is starting to experience a sore throat. While she is worried about not being able to speak through all of those stations, she knows she often gets a terrible headache along with her sore throat. She has an unused prescription for amoxicillin (unexpired) and wonders if you recommend for her to take it.

[https://pubmed.ncbi.nlm.nih.gov/34881426/ Antibiotics for sore throat]

'''Scenario 6 - Conjunctivitis''' - GROUPS 6, 12, 13, 24, 30, 31

A man comes to your pharmacy (he appears in his early twenties) complaining of “pink eye”. He has had a pink discolouration and discharge from his left eye for two days. He asks if the OTC antibiotic eye drops (he’s holding a product with polymixin B) are any better than “waiting it out”.

[https://www.ncbi.nlm.nih.gov/pubmed/22972049 Antibiotics for acute conjunctivitis]

6) HEMATOLOGY STUDIES

None so far

'''ACADEMIC YEAR 2 - FIRST TERM'''

7) RESPIROLOGY STUDIES
[[File:IA COPD info.pdf|thumb]]

*[http://www.ncbi.nlm.nih.gov/pubmed/2062329 First inhaled steroid study] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/22938706 Tiotropium in asthma] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/21324520 Inhaled steroid in children] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/29768149 Combined Budesonide–Formoterol as Needed in Mild Asthma] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/15223858 Doubling dose of inhaled corticosteroid] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/29768147 As-Needed Budesonide–Formoterol versus Maintenance Budesonide in Mild Asthma] Groups 6,18,30
*[https://pubmed.ncbi.nlm.nih.gov/32579807/ Triple Inhaled Therapy at Two Glucocorticoid Doses in Moderate-to-Very-Severe COPD] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/21428765 Tiotropium VS salmeterol in COPD] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/23695200 Short VS long steroids for COPD exacerbation] Groups 9,21,33
*[http://www.ncbi.nlm.nih.gov/pubmed/25196117 Stopping inhaled steroids in COPD] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/29668352 Once-Daily Single-Inhaler Triple versus Dual Therapy in Patients with COPD] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/28877011 Tezepelumab in Adults with Uncontrolled Asthma] Groups 12,24,36

8) CARDIOVASCULAR STUDIES

SESSION 1

*[https://www.ncbi.nlm.nih.gov/pubmed/4862069 VA1] (Group 1, 13, 25)
*[https://www.ncbi.nlm.nih.gov/pubmed/4914579 VA 2] (Group 2, 14, 26)
*[https://pubmed.ncbi.nlm.nih.gov/33186492 Polycap Study 3] (Group 3, 15, 27)
*[http://www.ncbi.nlm.nih.gov/pubmed/20228401 ACCORD-BP] (Group 4, 16, 28)
*[https://www.ncbi.nlm.nih.gov/pubmed/26551272 SPRINT] (Group 5, 17, 29)
*[http://www.ncbi.nlm.nih.gov/pubmed/2883575 CONSENSUS] (Group 6,18,30)
*[https://pubmed.ncbi.nlm.nih.gov/31535829/ DAPA-HF] (Group 7, 19, 31)
*[https://pubmed.ncbi.nlm.nih.gov/25176939/ CONFIRM-HF] (Group 8, 20, 32)
*[http://www.ncbi.nlm.nih.gov/pubmed/12457784 PROSPER] (Group 9, 21, 33)
*[http://www.ncbi.nlm.nih.gov/pubmed/27040132 HOPE-3] (Group 10, 22, 34)
*[http://www.ncbi.nlm.nih.gov/pubmed/12114036 Heart Protection Study (HPS)] (Group 11, 23, 35)
*[http://www.ncbi.nlm.nih.gov/pubmed/30415628 REDUCE-IT] (Group 12, 24, 36)

[[File:CV Case.pdf|thumb|CV case|left]]

SESSION 2

'''The Guideline Case'''

A 63 y/o patient with CHOOSE ONE (⬆︎HTN/⬆︎Chol/⬆︎glucose/HF/A fib) and using the guideline determine:
# their 5yr/10yr risks of mortality/CVD events
# the potential benefit
# the potential side effects (with magnitude)
# words/sentiment patient values and preferences/SDM

Atrial fibrillation - Groups 1,13,25,2,14,26
*[https://www.onlinecjc.ca/article/S0828-282X(18)31062-6/pdf 2018 Atrial fibrillation guidelines]
Diabetes - Groups 3,15,27,4,16,28
*[http://guidelines.diabetes.ca/docs/CPG-2018-full-EN.pdf 2018 Diabetes guidelines]
Lipid Simplified - Groups 5,17,29,6,18,30
*[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4607330/pdf/0610857.pdf 2015 Simplified lipid guidelines]
Lipid - Groups 7,19,31,8,20,32
*[http://www.onlinecjc.ca/article/S0828-282X(16)30732-2/pdf 2016 Lipid guidelines]
Heart failure - Groups 9,21,33,10,22,34
*[http://www.onlinecjc.ca/article/S0828-282X(17)30973-X/pdf 2017 Heart failure guidelines]
Hypertension - Groups 11,23,35,12,24,36
*[https://www.onlinecjc.ca/article/S0828-282X(18)30183-1/pdf 2018 Hypertension guidelines]

OPTIONAL SESSION
*[http://www.ncbi.nlm.nih.gov/pubmed/16899775 SPARCL]
*[http://www.ncbi.nlm.nih.gov/pubmed/10471456 RALES]
*[http://www.ncbi.nlm.nih.gov/pubmed/11386263 Carvedilol in heart failure]
*[http://www.ncbi.nlm.nih.gov/pubmed/18460663 WAFACS]
*[http://www.ncbi.nlm.nih.gov/pubmed/10376614 MERIT-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/25176015 PARADIGM-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/24490264 High-dose multivitamins after MI]
*[http://www.ncbi.nlm.nih.gov/pubmed/7911176 Mediterranean Diet after MI]
*[http://www.ncbi.nlm.nih.gov/pubmed/15337732 A TO Z]
*[http://www.ncbi.nlm.nih.gov/pubmed/21073363 EMPHASIS-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/12853193 COMET]
*[http://www.ncbi.nlm.nih.gov/pubmed/24716680 TOPCAT]
*[http://www.ncbi.nlm.nih.gov/pubmed/26039521 IMPROVE-IT]

'''ACADEMIC YEAR 2 - SECOND TERM'''

9) NEPHROLOGY STUDIES

None so far

10) ENDOCRINOLOGY

[[File:IA ENDO LAYOUT.pdf|thumb|IA ENDO LAYOUT TEMPLATE|none]]
[[File:Osteoporosis Evidence SUPP.pdf|none|thumb]]

'''RISK ASSESSMENT CASES FOR DIABETES AND OSTEOPOROSIS'''

'''1) DIABETES CASE'''

66 y/o white male who was diagnosed with diabetes 8 years ago

* His blood pressure over the last year has been roughly 145/80 mmHg - at present untreated
* A1c = 8%, no diabetes meds, non-smoker, BMI ~30
* '''When calculating without diabetes for PREVENT use an A1c of 5.5%'''
* Total cholesterol is 6 mmol/L, his HDL is 2 mmol/L, non-HDL = 6 minus 2, not on a statin
* No retinopathy, urine albumin-to-creatinine ratio (UACR) = 15ug/mg (7mg/mmol),
* Serum creatinine = 70 micromol/L, waist circumference 100 cm
* GFR 75 mL/min/1.73m2
* In normal sinus rhythm
* Age at end of highest education = 19
* Mother alive, father died of a heart attack at age 80

'''Calculate Risks'''

'''CVD RISK ESTIMATES''' - list the endpoints described by the specific calculator

Framingham - xx% - 10-year risk - also if no diabetes xx%

ASCVD - xx% - 10-year risk - also if no diabetes xx%

'''The Calculator'''
*CVD CALCULATOR
https://decisionaid.ca/cvd/

'''DIABETES COMPLICATIONS RISK ESTIMATES''' - list the endpoints described by the specific calculator

xx% - also 10-year risk if A1c 9, 8, 7 and 6

also get risk of kidney failure, vision loss, pressure sensation loss – also if A1c 9, 8,7,6

'''The Calculator'''
*DIABETES DECISION AID
http://decisionaid.ca/diabetes/

'''BENEFITS AND HARMS'''

Use the [https://guidelines.diabetes.ca/cpg/chapter-13-2020-update 2024 diabetes guidelines] and/or Diabetes Decision Aid to get estimates of benefits and harms and also use the MyStudies synopsis listed below

'''COSTS'''

Try using [https://pricingdoc.acfp.ca Pricing Doc] to get costs

'''Groups 1,13,25'''

* Metformin - UKPDS 34 [https://mystudies.org/studies.php#studies/28929e89-d01e-4b11-8e67-4d7086f9e4aa/outcome MyStudies Data]

'''Groups 2,14,26'''

* Sulfonlyureas - UKPDS 33 [https://mystudies.org/studies.php#studies/5eadb5dd-d403-4c13-b03e-d4f8d28c96ba/outcome MyStudies Data]

'''Groups 3,15,27'''

* Insulin - ORIGIN [https://mystudies.org/studies.php#studies/f611818f-2e69-4952-b55e-661116bd84b6/outcome MyStudies Data]

'''Groups 4,16,28'''

* SGLT2 - EMPA-REG OUTCOME [https://mystudies.org/studies.php#studies/32e9cf1a-f33e-480b-91ca-6f28a4dcf862/outcome MyStudies Data]

'''Groups 5,17,29'''

* GLP - LEADER [https://mystudies.org/studies.php#studies/1adbc9a1-7603-40f1-ac15-b813ce1f0ad6/outcome MyStudies Data]

'''Groups 6,18,30'''

* DPP4 - TECOS [https://mystudies.org/studies.php#studies/8659968a-cefb-4f99-b4ae-8b9b659acbd5/outcome MyStudies Data]

'''Groups 7,19,31'''

* Intensive treatment – small scale - STENO [https://mystudies.org/studies.php#studies/39d423e3-af57-40c8-ab7a-cbc7f389bdb6/paper MyStudies Data]

'''Groups 8,20,32'''

* Intensive treatment – large scale - ADDITION-Europe - [https://mystudies.org/studies.php#studies/5e07d86d-aa92-4db9-a283-76080db4b6fd/outcome MyStudies Data]

'''2) OSTEOPOROSIS CASE'''

60 y/o female

* 72 kg, 1.69m, BMI = 25.2
* t-score of -2.5
* Worried about falling and getting a hip fracture
* A friend recently had an atraumatic fracture from simply tripping and falling over in the snow
* No other risk factors

'''Calculate Risks'''

'''FRACTURE RISK ESTIMATES''' - list the endpoints described by the specific calculator

Major osteoporotic fracture - xx% - 10-year risk – if no BMD (just BMI), and then if they had a BMD t-Score of -2.0, -2.5, and -3.0

Hip fracture - - xx% - 10-year risk – if no BMD (just BMI) and if you have a BMD xx% - 10-year risk – if no BMD, and then if they had a BMD T-Score of -2.0, -2.5, and -3.0

'''The Calculator'''

* FRACTURE CALCULATOR

[https://frax.shef.ac.uk/frax/tool.aspx?country=19 Frax Tool - Canada]

'''BENEFITS AND HARMS'''

Use the [https://www.cmaj.ca/content/195/39/E1333 2023 Osteoporosis Guideline] and/or your osteoporosis lecture notes to get the benefits and apply these to your patient, and also get the harms

'''COSTS'''

Try using [https://pricingdoc.acfp.ca Pricing Doc] to get costs

'''Groups 9,21,33'''

* Activity

'''Groups 10,22,34'''

* Calcium/Vitamin D

'''Groups 11,23,35'''

* Bisphosphonates

'''Groups 12,24,36'''

* Denosumab

11) NEUROLOGY STUDIES

*[http://www.ncbi.nlm.nih.gov/pubmed/16717269 Opioids for chronic non-cancer pain] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/29509867 Effect of Opioid vs Nonopioid Medications on Pain-Related Function in Patients With Chronic Back Pain] Groups 2,14,26
*[https://www.ncbi.nlm.nih.gov/pubmed/31291515 Galcanezumab for prevention of cluster headaches] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/27150433 Immediate or delayed treatment of a first seizure] Groups 4,16,28
*[https://www.ncbi.nlm.nih.gov/pubmed/31291516 Rimegepant for episodic migraine] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/26212846 Sleep restriction for insomnia] Groups 6,18,30
*[https://www.ncbi.nlm.nih.gov/pubmed/25957224 CHANCE] Groups 7,19,31
*[https://www.ncbi.nlm.nih.gov/pubmed/16899775 SPARCL] Groups 8,20,32
*[https://www.ncbi.nlm.nih.gov/pubmed/29171821 Erenumab for episodic migraine] Groups 9,21,33
*[https://www.ncbi.nlm.nih.gov/pubmed/24733354 Reduction of benzodiazepines through education] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/26035341 Patient controlled opioid analgesia versus non-patient controlled opioid analgesia for postoperative pain] Groups 11,23,35
*[https://www.ncbi.nlm.nih.gov/pubmed/11589932 PROGRESS] Groups 12,24,36

'''ACADEMIC YEAR 3'''

12) PSYCHIATRY STUDIES

[[:File:2021 Psych Evidence Appraisal - Intro Slides.pdf|Psychiatry Rating Scales Introduction]]

* Study 1: [http://www.ncbi.nlm.nih.gov/pubmed/16554525 STAR*D (Level 2)] Bupropion-SR, sertraline, or venlafaxine-XR after failure of SSRIs for depression
* Study 2: [http://www.ncbi.nlm.nih.gov/pubmed/29477251 Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder]
* Study 3: [https://pubmed.ncbi.nlm.nih.gov/33862018/ Long-acting injectable versus oral antipsychotics for the maintenance treatment of schizophrenia]
* Study 4: [https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2725088 Association of Antipsychotic Polypharmacy vs Monotherapy With Psychiatric Rehospitalization Among Adults With Schizophrenia]
* Study 5: [https://www.ncbi.nlm.nih.gov/pubmed/29490359 Real-world Effectiveness of Pharmacologic Treatments for the Prevention of Bipolar Disorder]
* Study 6: [http://www.ncbi.nlm.nih.gov/pubmed/20092882 BALANCE] Combination lithium and valproate therapy versus monotherapy for relapse prevention in bipolar I disorder
13) GASTROENTEROLOGY STUDIES - LINKS ON CANVAS[[File:Screenshot 2025-11-17 at 7.50.27 AM.png|thumb]][[File:GI ChatGPT Instructions.jpg|thumb|GPT Instructions]]
*Short-term treatment for gastro-oesophageal reflux disease-like symptoms and endoscopy negative reflux disease (Review)
*Oral budesonide for induction of remission in ulcerative colitis (Review)
*Probiotics for the prevention of Clostridium difficile-associated diarrhea in adults and children (Review)
*Deprescribing versus continuation of chronic proton pump inhibitor use in adults (Review)
*Prevention of NSAID-induced gastroduodenal ulcers (Review)
*Methotrexate for maintenance of remission in Crohn's disease (Review)

14) OB/GYN STUDIES
*[http://www.ncbi.nlm.nih.gov/pubmed/25601350 Comparative contraceptive effectiveness of levonorgestrel-releasing and copper IUD Devices]
*[http://www.ncbi.nlm.nih.gov/pubmed/29211679 Hormonal contraception and the risk of breast cancer]
*[http://www.ncbi.nlm.nih.gov/pubmed/30322986 Sexual behaviours in adolescent girls before and after introduction of the HPV]
*[http://www.ncbi.nlm.nih.gov/pubmed/30181338 Intramuscular vs intravenous oxytocin to prevent postpartum haemorrhage at vaginal delivery]
*[http://www.ncbi.nlm.nih.gov/pubmed/27682034 Azithromycin Prophylaxis for Cesarean Delivery]
*[http://www.ncbi.nlm.nih.gov/pubmed/28461374 Antibiotics during pregnancy and risk of spontaneous abortion]

Evidence Appraisal Integrated Activities

2025-11-17T15:56:56Z

JamesMcCormack:

'''OBJECTIVE'''

To critically appraise studies, develop a brief synopsis of the trial results, succinctly present the results and then put the results into a proper clinical context

'''INITIAL PRE-READING'''

'''How To Critically Appraise an RCT In 10 minutes'''
*[https://itunes.apple.com/ca/book/how-to-critically-appraise/id524600667?mt=11 iBook/iPad version]
*[https://therapeuticseducation.org/sites/therapeuticseducation.org/files/Ten_Minute_Critical_Appraisal.pdf PDF version]
Watch this video
[http://youtu.be/QUW0Q8tXVUc Viva La Evidence]

'''Study Results at Your Fingertips'''
*[https://mystudies.org MyStudies] - Free access

'''INTEGRATION ACTIVITY FORMAT'''
# Students placed in groups of ~ 5-7
# Each group is given one of the studies below to review
# Students then work in pairs and develop a one-slide critical appraisal and results synopsis
# One student in each group will be chosen at random to present their group findings to the class
# A discussion about the appraisal and the appropriate clinical context for the results is had with the entire class for each study

'''MODULE'''
[[File:Screen Shot 2022-01-09 at 10.00.16 AM.jpg|thumb|'''TRIAL PRESENTATION FORMAT'''|none]]

Studies chosen include landmark studies and/or studies that address important therapeutic issues for the particular module

'''ACADEMIC YEAR 1 - FIRST TERM'''

1) FOUNDATION STUDIES (Groups)
*[https://pubmed.ncbi.nlm.nih.gov/37952131 SELECT] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/12466506 AFFIRM] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/22085343 AIM-HIGH] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/10639539 HOPE] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/18378519 HYVET] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/15007110 PROVE-IT] Groups 6,18,30
*[http://www.ncbi.nlm.nih.gov/pubmed/15755765 TNT] Groups 7,19,31
*[https://pubmed.ncbi.nlm.nih.gov/26378978 EMPAREG] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/17984165 ILLUMINATE] Groups 9,21,33
*[https://pubmed.ncbi.nlm.nih.gov/26551272/ SPRINT] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/15325833 CARDS] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/12117397 WHI] Groups 12,24,36

'''ACADEMIC YEAR 1 - SECOND TERM'''

2) INTRO TO INFECTIOUS DISEASE STUDIES

[https://wiki.ubc.ca/images/8/8b/Antibiotic_Sensitivity_Chart_2024.pdf The "Best" Antibiotic Sensitivity Chart Ever]
*[http://www.ncbi.nlm.nih.gov/pubmed/17567657 IV vs PO antibiotics] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/24603565 Delayed antibiotics for respiratory tract infections] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/11159657 Delayed antibiotics for otitis media] Groups 3,15,27
*[https://pubmed.ncbi.nlm.nih.gov/27455166/ Duration of treatment for community acquired pneumonia] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/22726802 Duration of treatment for pyelonephritis] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/25830421 Choice of antibiotic for community acquired pneumonia-1] Groups 6,18,30
*[http://www.ncbi.nlm.nih.gov/pubmed/25286173 Choice of antibiotic for community acquired pneumonia-2] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/20647284 HPV vaccine study] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/7966893 Influenza vaccine study] Groups 9,21,33
*[https://pubmed.ncbi.nlm.nih.gov/33301246/ COVID vaccine Pfizer] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/27626517 Herpes zoster vaccine study 1] Groups 11,23,35
*[https://www.ncbi.nlm.nih.gov/pubmed/25916341 Herpes zoster vaccine study 2] Groups 12,24,36

3) MUSCULOSKELETAL STUDIES

*[http://www.ncbi.nlm.nih.gov/pubmed/28199814 Baricitinib versus Placebo or Adalimumab in Rheumatoid Arthritis] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/0010979111 CLASS – celecoxib vs NSAIDs] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/26501533 Naproxen with cyclobenzaprine, oxycodone/acetaminophen, or placebo for low back pain] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/24395557 Glucosamine and chondroitin for OA] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/12546607 Acetaminophen vs diclofenac for OA] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/23964752 Diclofenac gel for acute neck pain] Groups 6,18,30
*[https://pubmed.ncbi.nlm.nih.gov/15468367/ Topical diclofenac vs oral diclofenac] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/25064594 Acetaminophen for low back pain] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/7611589 Misoprostol and NSAID induced ulcers] Groups 9,21,33
*[http://www.ncbi.nlm.nih.gov/pubmed/20131255 Low dose vs high dose colchicine for gout] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/22508468 TEAR - oral triple therapy versus etanercept plus methotrexate in early aggressive rheumatoid arthritis] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/25589511 MOVES - Glucosamine and chondroitin for OA for moderate to severe pain] Groups 12,24,36

4) DERMATOLOGY STUDIES

*[https://www.ncbi.nlm.nih.gov/pubmed/9598014 Glycolic acid 5% Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/21896132 Glycolic acid 10% Acne]
*[https://www.ncbi.nlm.nih.gov/pubmed/14531866 Petrolatum vs Ceramide/skin related lipids Hand Dermatitis]
*[https://www.ncbi.nlm.nih.gov/pubmed/11896774 Vitamin C Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/17515510 Retinol (VitaminA) Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/21896129 Hyaluronic acid Atopic Dermatitis]

5) EENT STUDIES

[http://www.amstar.ca/docs/AMSTARguideline.pdf AMSTAR meta-analysis checklist]

'''Scenario 1 - Otitis Media''' - GROUPS 1, 7, 18, 19, 25, 36

Anthony Martin arrives at your pharmacy somewhat frustrated since his family physician declined to write an antibiotic prescription for his two and half year old son, Oscar. His symptoms started yesterday afternoon - Oscar complains of right ear pain but there is no discharge. Rectal temperature taken today was 38.5 degrees. His wife is sure Oscar has an ear infection since the last time he had these same symptoms, that was ultimately the diagnosis. Mr. Martin asks if you think buying acetaminophen is really “enough”?

[https://pubmed.ncbi.nlm.nih.gov/26099233/ Antibiotics for acute otitis media in children]

'''Scenario 2 - Allergic Rhinitis''' - GROUPS 2, 8, 17, 20, 26, 35

Ruby Parmar is a firefighter. She is plagued by sinus congestion (preventing her from sleeping) and a runny nose associated with seasonal allergies. Her prescription for intranasal triamcinolone is typically effective, but she would like to know if a non-sedating anti-allergy pill would work just as well since it’s inconvenient carrying around the “nose spray”.

[https://www.ncbi.nlm.nih.gov/pubmed/28234147 Intranasal steroids vs antihistamines for allergic rhinitis]

'''Scenario 3 - Acute Sinusitis''' - GROUPS 3, 9, 16, 21, 27, 34

You are seeing a patient in clinic before her appointment with the primary care physician. She was feeling unwell with a “flu” last week. While most of her symptoms have resolved (cough, fever), the nasal congestion and discharge persists and so she has made an appointment (she is an otherwise healthy 32 year old with treated thyroid disease). She would like your advice for what treatment she should ask the doctor to prescribe.

[http://www.ncbi.nlm.nih.gov/pubmed/24293353 Intranasal steroids for acute sinusitis]

'''Scenario 4 - Glaucoma''' - GROUPS 4, 10, 15, 22, 28, 33

Mrs. Ada Waters is a 63 year-old woman you. Her ophthalmologist prescribed timolol and xalatan eye drops for treatment of open angle glaucoma. She has never really felt much different on treatment since she recovered from her first episode (of acute angle closure glaucoma requiring ER visit) and surgery. She asks you if the treatment is really making a difference.

[https://www.ncbi.nlm.nih.gov/pubmed/17943780 Interventions for open angle glaucoma]

'''Scenario 5 - Sore Throat''' - GROUPS 5, 11, 14, 23, 29, 32

You have a good friend who is applying for pharmacy. Her invitation for the multiple-mini interview (MMI) is coming up soon, but she is starting to experience a sore throat. While she is worried about not being able to speak through all of those stations, she knows she often gets a terrible headache along with her sore throat. She has an unused prescription for amoxicillin (unexpired) and wonders if you recommend for her to take it.

[https://pubmed.ncbi.nlm.nih.gov/34881426/ Antibiotics for sore throat]

'''Scenario 6 - Conjunctivitis''' - GROUPS 6, 12, 13, 24, 30, 31

A man comes to your pharmacy (he appears in his early twenties) complaining of “pink eye”. He has had a pink discolouration and discharge from his left eye for two days. He asks if the OTC antibiotic eye drops (he’s holding a product with polymixin B) are any better than “waiting it out”.

[https://www.ncbi.nlm.nih.gov/pubmed/22972049 Antibiotics for acute conjunctivitis]

6) HEMATOLOGY STUDIES

None so far

'''ACADEMIC YEAR 2 - FIRST TERM'''

7) RESPIROLOGY STUDIES
[[File:IA COPD info.pdf|thumb]]

*[http://www.ncbi.nlm.nih.gov/pubmed/2062329 First inhaled steroid study] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/22938706 Tiotropium in asthma] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/21324520 Inhaled steroid in children] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/29768149 Combined Budesonide–Formoterol as Needed in Mild Asthma] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/15223858 Doubling dose of inhaled corticosteroid] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/29768147 As-Needed Budesonide–Formoterol versus Maintenance Budesonide in Mild Asthma] Groups 6,18,30
*[https://pubmed.ncbi.nlm.nih.gov/32579807/ Triple Inhaled Therapy at Two Glucocorticoid Doses in Moderate-to-Very-Severe COPD] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/21428765 Tiotropium VS salmeterol in COPD] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/23695200 Short VS long steroids for COPD exacerbation] Groups 9,21,33
*[http://www.ncbi.nlm.nih.gov/pubmed/25196117 Stopping inhaled steroids in COPD] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/29668352 Once-Daily Single-Inhaler Triple versus Dual Therapy in Patients with COPD] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/28877011 Tezepelumab in Adults with Uncontrolled Asthma] Groups 12,24,36

8) CARDIOVASCULAR STUDIES

SESSION 1

*[https://www.ncbi.nlm.nih.gov/pubmed/4862069 VA1] (Group 1, 13, 25)
*[https://www.ncbi.nlm.nih.gov/pubmed/4914579 VA 2] (Group 2, 14, 26)
*[https://pubmed.ncbi.nlm.nih.gov/33186492 Polycap Study 3] (Group 3, 15, 27)
*[http://www.ncbi.nlm.nih.gov/pubmed/20228401 ACCORD-BP] (Group 4, 16, 28)
*[https://www.ncbi.nlm.nih.gov/pubmed/26551272 SPRINT] (Group 5, 17, 29)
*[http://www.ncbi.nlm.nih.gov/pubmed/2883575 CONSENSUS] (Group 6,18,30)
*[https://pubmed.ncbi.nlm.nih.gov/31535829/ DAPA-HF] (Group 7, 19, 31)
*[https://pubmed.ncbi.nlm.nih.gov/25176939/ CONFIRM-HF] (Group 8, 20, 32)
*[http://www.ncbi.nlm.nih.gov/pubmed/12457784 PROSPER] (Group 9, 21, 33)
*[http://www.ncbi.nlm.nih.gov/pubmed/27040132 HOPE-3] (Group 10, 22, 34)
*[http://www.ncbi.nlm.nih.gov/pubmed/12114036 Heart Protection Study (HPS)] (Group 11, 23, 35)
*[http://www.ncbi.nlm.nih.gov/pubmed/30415628 REDUCE-IT] (Group 12, 24, 36)

[[File:CV Case.pdf|thumb|CV case|left]]

SESSION 2

'''The Guideline Case'''

A 63 y/o patient with CHOOSE ONE (⬆︎HTN/⬆︎Chol/⬆︎glucose/HF/A fib) and using the guideline determine:
# their 5yr/10yr risks of mortality/CVD events
# the potential benefit
# the potential side effects (with magnitude)
# words/sentiment patient values and preferences/SDM

Atrial fibrillation - Groups 1,13,25,2,14,26
*[https://www.onlinecjc.ca/article/S0828-282X(18)31062-6/pdf 2018 Atrial fibrillation guidelines]
Diabetes - Groups 3,15,27,4,16,28
*[http://guidelines.diabetes.ca/docs/CPG-2018-full-EN.pdf 2018 Diabetes guidelines]
Lipid Simplified - Groups 5,17,29,6,18,30
*[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4607330/pdf/0610857.pdf 2015 Simplified lipid guidelines]
Lipid - Groups 7,19,31,8,20,32
*[http://www.onlinecjc.ca/article/S0828-282X(16)30732-2/pdf 2016 Lipid guidelines]
Heart failure - Groups 9,21,33,10,22,34
*[http://www.onlinecjc.ca/article/S0828-282X(17)30973-X/pdf 2017 Heart failure guidelines]
Hypertension - Groups 11,23,35,12,24,36
*[https://www.onlinecjc.ca/article/S0828-282X(18)30183-1/pdf 2018 Hypertension guidelines]

OPTIONAL SESSION
*[http://www.ncbi.nlm.nih.gov/pubmed/16899775 SPARCL]
*[http://www.ncbi.nlm.nih.gov/pubmed/10471456 RALES]
*[http://www.ncbi.nlm.nih.gov/pubmed/11386263 Carvedilol in heart failure]
*[http://www.ncbi.nlm.nih.gov/pubmed/18460663 WAFACS]
*[http://www.ncbi.nlm.nih.gov/pubmed/10376614 MERIT-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/25176015 PARADIGM-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/24490264 High-dose multivitamins after MI]
*[http://www.ncbi.nlm.nih.gov/pubmed/7911176 Mediterranean Diet after MI]
*[http://www.ncbi.nlm.nih.gov/pubmed/15337732 A TO Z]
*[http://www.ncbi.nlm.nih.gov/pubmed/21073363 EMPHASIS-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/12853193 COMET]
*[http://www.ncbi.nlm.nih.gov/pubmed/24716680 TOPCAT]
*[http://www.ncbi.nlm.nih.gov/pubmed/26039521 IMPROVE-IT]

'''ACADEMIC YEAR 2 - SECOND TERM'''

9) NEPHROLOGY STUDIES

None so far

10) ENDOCRINOLOGY

[[File:IA ENDO LAYOUT.pdf|thumb|IA ENDO LAYOUT TEMPLATE|none]]
[[File:Osteoporosis Evidence SUPP.pdf|none|thumb]]

'''RISK ASSESSMENT CASES FOR DIABETES AND OSTEOPOROSIS'''

'''1) DIABETES CASE'''

66 y/o white male who was diagnosed with diabetes 8 years ago

* His blood pressure over the last year has been roughly 145/80 mmHg - at present untreated
* A1c = 8%, no diabetes meds, non-smoker, BMI ~30
* '''When calculating without diabetes for PREVENT use an A1c of 5.5%'''
* Total cholesterol is 6 mmol/L, his HDL is 2 mmol/L, non-HDL = 6 minus 2, not on a statin
* No retinopathy, urine albumin-to-creatinine ratio (UACR) = 15ug/mg (7mg/mmol),
* Serum creatinine = 70 micromol/L, waist circumference 100 cm
* GFR 75 mL/min/1.73m2
* In normal sinus rhythm
* Age at end of highest education = 19
* Mother alive, father died of a heart attack at age 80

'''Calculate Risks'''

'''CVD RISK ESTIMATES''' - list the endpoints described by the specific calculator

Framingham - xx% - 10-year risk - also if no diabetes xx%

ASCVD - xx% - 10-year risk - also if no diabetes xx%

'''The Calculator'''
*CVD CALCULATOR
https://decisionaid.ca/cvd/

'''DIABETES COMPLICATIONS RISK ESTIMATES''' - list the endpoints described by the specific calculator

xx% - also 10-year risk if A1c 9, 8, 7 and 6

also get risk of kidney failure, vision loss, pressure sensation loss – also if A1c 9, 8,7,6

'''The Calculator'''
*DIABETES DECISION AID
http://decisionaid.ca/diabetes/

'''BENEFITS AND HARMS'''

Use the [https://guidelines.diabetes.ca/cpg/chapter-13-2020-update 2024 diabetes guidelines] and/or Diabetes Decision Aid to get estimates of benefits and harms and also use the MyStudies synopsis listed below

'''COSTS'''

Try using [https://pricingdoc.acfp.ca Pricing Doc] to get costs

'''Groups 1,13,25'''

* Metformin - UKPDS 34 [https://mystudies.org/studies.php#studies/28929e89-d01e-4b11-8e67-4d7086f9e4aa/outcome MyStudies Data]

'''Groups 2,14,26'''

* Sulfonlyureas - UKPDS 33 [https://mystudies.org/studies.php#studies/5eadb5dd-d403-4c13-b03e-d4f8d28c96ba/outcome MyStudies Data]

'''Groups 3,15,27'''

* Insulin - ORIGIN [https://mystudies.org/studies.php#studies/f611818f-2e69-4952-b55e-661116bd84b6/outcome MyStudies Data]

'''Groups 4,16,28'''

* SGLT2 - EMPA-REG OUTCOME [https://mystudies.org/studies.php#studies/32e9cf1a-f33e-480b-91ca-6f28a4dcf862/outcome MyStudies Data]

'''Groups 5,17,29'''

* GLP - LEADER [https://mystudies.org/studies.php#studies/1adbc9a1-7603-40f1-ac15-b813ce1f0ad6/outcome MyStudies Data]

'''Groups 6,18,30'''

* DPP4 - TECOS [https://mystudies.org/studies.php#studies/8659968a-cefb-4f99-b4ae-8b9b659acbd5/outcome MyStudies Data]

'''Groups 7,19,31'''

* Intensive treatment – small scale - STENO [https://mystudies.org/studies.php#studies/39d423e3-af57-40c8-ab7a-cbc7f389bdb6/paper MyStudies Data]

'''Groups 8,20,32'''

* Intensive treatment – large scale - ADDITION-Europe - [https://mystudies.org/studies.php#studies/5e07d86d-aa92-4db9-a283-76080db4b6fd/outcome MyStudies Data]

'''2) OSTEOPOROSIS CASE'''

60 y/o female

* 72 kg, 1.69m, BMI = 25.2
* t-score of -2.5
* Worried about falling and getting a hip fracture
* A friend recently had an atraumatic fracture from simply tripping and falling over in the snow
* No other risk factors

'''Calculate Risks'''

'''FRACTURE RISK ESTIMATES''' - list the endpoints described by the specific calculator

Major osteoporotic fracture - xx% - 10-year risk – if no BMD (just BMI), and then if they had a BMD t-Score of -2.0, -2.5, and -3.0

Hip fracture - - xx% - 10-year risk – if no BMD (just BMI) and if you have a BMD xx% - 10-year risk – if no BMD, and then if they had a BMD T-Score of -2.0, -2.5, and -3.0

'''The Calculator'''

* FRACTURE CALCULATOR

[https://frax.shef.ac.uk/frax/tool.aspx?country=19 Frax Tool - Canada]

'''BENEFITS AND HARMS'''

Use the [https://www.cmaj.ca/content/195/39/E1333 2023 Osteoporosis Guideline] and/or your osteoporosis lecture notes to get the benefits and apply these to your patient, and also get the harms

'''COSTS'''

Try using [https://pricingdoc.acfp.ca Pricing Doc] to get costs

'''Groups 9,21,33'''

* Activity

'''Groups 10,22,34'''

* Calcium/Vitamin D

'''Groups 11,23,35'''

* Bisphosphonates

'''Groups 12,24,36'''

* Denosumab

11) NEUROLOGY STUDIES

*[http://www.ncbi.nlm.nih.gov/pubmed/16717269 Opioids for chronic non-cancer pain] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/29509867 Effect of Opioid vs Nonopioid Medications on Pain-Related Function in Patients With Chronic Back Pain] Groups 2,14,26
*[https://www.ncbi.nlm.nih.gov/pubmed/31291515 Galcanezumab for prevention of cluster headaches] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/27150433 Immediate or delayed treatment of a first seizure] Groups 4,16,28
*[https://www.ncbi.nlm.nih.gov/pubmed/31291516 Rimegepant for episodic migraine] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/26212846 Sleep restriction for insomnia] Groups 6,18,30
*[https://www.ncbi.nlm.nih.gov/pubmed/25957224 CHANCE] Groups 7,19,31
*[https://www.ncbi.nlm.nih.gov/pubmed/16899775 SPARCL] Groups 8,20,32
*[https://www.ncbi.nlm.nih.gov/pubmed/29171821 Erenumab for episodic migraine] Groups 9,21,33
*[https://www.ncbi.nlm.nih.gov/pubmed/24733354 Reduction of benzodiazepines through education] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/26035341 Patient controlled opioid analgesia versus non-patient controlled opioid analgesia for postoperative pain] Groups 11,23,35
*[https://www.ncbi.nlm.nih.gov/pubmed/11589932 PROGRESS] Groups 12,24,36

'''ACADEMIC YEAR 3'''

12) PSYCHIATRY STUDIES

[[:File:2021 Psych Evidence Appraisal - Intro Slides.pdf|Psychiatry Rating Scales Introduction]]

* Study 1: [http://www.ncbi.nlm.nih.gov/pubmed/16554525 STAR*D (Level 2)] Bupropion-SR, sertraline, or venlafaxine-XR after failure of SSRIs for depression
* Study 2: [http://www.ncbi.nlm.nih.gov/pubmed/29477251 Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder]
* Study 3: [https://pubmed.ncbi.nlm.nih.gov/33862018/ Long-acting injectable versus oral antipsychotics for the maintenance treatment of schizophrenia]
* Study 4: [https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2725088 Association of Antipsychotic Polypharmacy vs Monotherapy With Psychiatric Rehospitalization Among Adults With Schizophrenia]
* Study 5: [https://www.ncbi.nlm.nih.gov/pubmed/29490359 Real-world Effectiveness of Pharmacologic Treatments for the Prevention of Bipolar Disorder]
* Study 6: [http://www.ncbi.nlm.nih.gov/pubmed/20092882 BALANCE] Combination lithium and valproate therapy versus monotherapy for relapse prevention in bipolar I disorder
13) GASTROENTEROLOGY STUDIES - LINKS ON CANVAS
[[File:GI ChatGPT Instructions.jpg|thumb|GPT Instructions]]
*[[File:Screenshot 2025-11-17 at 7.50.27 AM.png|thumb]]Short-term treatment for gastro-oesophageal reflux disease-like symptoms and endoscopy negative reflux disease (Review)
*Oral budesonide for induction of remission in ulcerative colitis (Review)
*Probiotics for the prevention of Clostridium difficile-associated diarrhea in adults and children (Review)
*Deprescribing versus continuation of chronic proton pump inhibitor use in adults (Review)
*Prevention of NSAID-induced gastroduodenal ulcers (Review)
*Methotrexate for maintenance of remission in Crohn's disease (Review)

14) OB/GYN STUDIES
*[http://www.ncbi.nlm.nih.gov/pubmed/25601350 Comparative contraceptive effectiveness of levonorgestrel-releasing and copper IUD Devices]
*[http://www.ncbi.nlm.nih.gov/pubmed/29211679 Hormonal contraception and the risk of breast cancer]
*[http://www.ncbi.nlm.nih.gov/pubmed/30322986 Sexual behaviours in adolescent girls before and after introduction of the HPV]
*[http://www.ncbi.nlm.nih.gov/pubmed/30181338 Intramuscular vs intravenous oxytocin to prevent postpartum haemorrhage at vaginal delivery]
*[http://www.ncbi.nlm.nih.gov/pubmed/27682034 Azithromycin Prophylaxis for Cesarean Delivery]
*[http://www.ncbi.nlm.nih.gov/pubmed/28461374 Antibiotics during pregnancy and risk of spontaneous abortion]

File:Screenshot 2025-11-17 at 7.50.27 AM.png

2025-11-17T15:52:32Z

JamesMcCormack: Uploaded own work with UploadWizard

=={{int:filedesc}}==
{{Information
|description={{en|1=Review Guide}}
|date=2025-11-17
|source={{own}}
|author=[[User:JamesMcCormack|JamesMcCormack]]
|permission=
|other versions=
}}

=={{int:license-header}}==
{{self|cc-by-sa-4.0}}

Evidence Appraisal Integrated Activities

2025-11-13T18:16:52Z

JamesMcCormack:

'''OBJECTIVE'''

To critically appraise studies, develop a brief synopsis of the trial results, succinctly present the results and then put the results into a proper clinical context

'''INITIAL PRE-READING'''

'''How To Critically Appraise an RCT In 10 minutes'''
*[https://itunes.apple.com/ca/book/how-to-critically-appraise/id524600667?mt=11 iBook/iPad version]
*[https://therapeuticseducation.org/sites/therapeuticseducation.org/files/Ten_Minute_Critical_Appraisal.pdf PDF version]
Watch this video
[http://youtu.be/QUW0Q8tXVUc Viva La Evidence]

'''Study Results at Your Fingertips'''
*[https://mystudies.org MyStudies] - Free access

'''INTEGRATION ACTIVITY FORMAT'''
# Students placed in groups of ~ 5-7
# Each group is given one of the studies below to review
# Students then work in pairs and develop a one-slide critical appraisal and results synopsis
# One student in each group will be chosen at random to present their group findings to the class
# A discussion about the appraisal and the appropriate clinical context for the results is had with the entire class for each study

'''MODULE'''
[[File:Screen Shot 2022-01-09 at 10.00.16 AM.jpg|thumb|'''TRIAL PRESENTATION FORMAT'''|none]]

Studies chosen include landmark studies and/or studies that address important therapeutic issues for the particular module

'''ACADEMIC YEAR 1 - FIRST TERM'''

1) FOUNDATION STUDIES (Groups)
*[https://pubmed.ncbi.nlm.nih.gov/37952131 SELECT] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/12466506 AFFIRM] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/22085343 AIM-HIGH] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/10639539 HOPE] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/18378519 HYVET] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/15007110 PROVE-IT] Groups 6,18,30
*[http://www.ncbi.nlm.nih.gov/pubmed/15755765 TNT] Groups 7,19,31
*[https://pubmed.ncbi.nlm.nih.gov/26378978 EMPAREG] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/17984165 ILLUMINATE] Groups 9,21,33
*[https://pubmed.ncbi.nlm.nih.gov/26551272/ SPRINT] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/15325833 CARDS] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/12117397 WHI] Groups 12,24,36

'''ACADEMIC YEAR 1 - SECOND TERM'''

2) INTRO TO INFECTIOUS DISEASE STUDIES

[https://wiki.ubc.ca/images/8/8b/Antibiotic_Sensitivity_Chart_2024.pdf The "Best" Antibiotic Sensitivity Chart Ever]
*[http://www.ncbi.nlm.nih.gov/pubmed/17567657 IV vs PO antibiotics] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/24603565 Delayed antibiotics for respiratory tract infections] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/11159657 Delayed antibiotics for otitis media] Groups 3,15,27
*[https://pubmed.ncbi.nlm.nih.gov/27455166/ Duration of treatment for community acquired pneumonia] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/22726802 Duration of treatment for pyelonephritis] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/25830421 Choice of antibiotic for community acquired pneumonia-1] Groups 6,18,30
*[http://www.ncbi.nlm.nih.gov/pubmed/25286173 Choice of antibiotic for community acquired pneumonia-2] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/20647284 HPV vaccine study] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/7966893 Influenza vaccine study] Groups 9,21,33
*[https://pubmed.ncbi.nlm.nih.gov/33301246/ COVID vaccine Pfizer] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/27626517 Herpes zoster vaccine study 1] Groups 11,23,35
*[https://www.ncbi.nlm.nih.gov/pubmed/25916341 Herpes zoster vaccine study 2] Groups 12,24,36

3) MUSCULOSKELETAL STUDIES

*[http://www.ncbi.nlm.nih.gov/pubmed/28199814 Baricitinib versus Placebo or Adalimumab in Rheumatoid Arthritis] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/0010979111 CLASS – celecoxib vs NSAIDs] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/26501533 Naproxen with cyclobenzaprine, oxycodone/acetaminophen, or placebo for low back pain] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/24395557 Glucosamine and chondroitin for OA] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/12546607 Acetaminophen vs diclofenac for OA] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/23964752 Diclofenac gel for acute neck pain] Groups 6,18,30
*[https://pubmed.ncbi.nlm.nih.gov/15468367/ Topical diclofenac vs oral diclofenac] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/25064594 Acetaminophen for low back pain] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/7611589 Misoprostol and NSAID induced ulcers] Groups 9,21,33
*[http://www.ncbi.nlm.nih.gov/pubmed/20131255 Low dose vs high dose colchicine for gout] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/22508468 TEAR - oral triple therapy versus etanercept plus methotrexate in early aggressive rheumatoid arthritis] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/25589511 MOVES - Glucosamine and chondroitin for OA for moderate to severe pain] Groups 12,24,36

4) DERMATOLOGY STUDIES

*[https://www.ncbi.nlm.nih.gov/pubmed/9598014 Glycolic acid 5% Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/21896132 Glycolic acid 10% Acne]
*[https://www.ncbi.nlm.nih.gov/pubmed/14531866 Petrolatum vs Ceramide/skin related lipids Hand Dermatitis]
*[https://www.ncbi.nlm.nih.gov/pubmed/11896774 Vitamin C Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/17515510 Retinol (VitaminA) Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/21896129 Hyaluronic acid Atopic Dermatitis]

5) EENT STUDIES

[http://www.amstar.ca/docs/AMSTARguideline.pdf AMSTAR meta-analysis checklist]

'''Scenario 1 - Otitis Media''' - GROUPS 1, 7, 18, 19, 25, 36

Anthony Martin arrives at your pharmacy somewhat frustrated since his family physician declined to write an antibiotic prescription for his two and half year old son, Oscar. His symptoms started yesterday afternoon - Oscar complains of right ear pain but there is no discharge. Rectal temperature taken today was 38.5 degrees. His wife is sure Oscar has an ear infection since the last time he had these same symptoms, that was ultimately the diagnosis. Mr. Martin asks if you think buying acetaminophen is really “enough”?

[https://pubmed.ncbi.nlm.nih.gov/26099233/ Antibiotics for acute otitis media in children]

'''Scenario 2 - Allergic Rhinitis''' - GROUPS 2, 8, 17, 20, 26, 35

Ruby Parmar is a firefighter. She is plagued by sinus congestion (preventing her from sleeping) and a runny nose associated with seasonal allergies. Her prescription for intranasal triamcinolone is typically effective, but she would like to know if a non-sedating anti-allergy pill would work just as well since it’s inconvenient carrying around the “nose spray”.

[https://www.ncbi.nlm.nih.gov/pubmed/28234147 Intranasal steroids vs antihistamines for allergic rhinitis]

'''Scenario 3 - Acute Sinusitis''' - GROUPS 3, 9, 16, 21, 27, 34

You are seeing a patient in clinic before her appointment with the primary care physician. She was feeling unwell with a “flu” last week. While most of her symptoms have resolved (cough, fever), the nasal congestion and discharge persists and so she has made an appointment (she is an otherwise healthy 32 year old with treated thyroid disease). She would like your advice for what treatment she should ask the doctor to prescribe.

[http://www.ncbi.nlm.nih.gov/pubmed/24293353 Intranasal steroids for acute sinusitis]

'''Scenario 4 - Glaucoma''' - GROUPS 4, 10, 15, 22, 28, 33

Mrs. Ada Waters is a 63 year-old woman you. Her ophthalmologist prescribed timolol and xalatan eye drops for treatment of open angle glaucoma. She has never really felt much different on treatment since she recovered from her first episode (of acute angle closure glaucoma requiring ER visit) and surgery. She asks you if the treatment is really making a difference.

[https://www.ncbi.nlm.nih.gov/pubmed/17943780 Interventions for open angle glaucoma]

'''Scenario 5 - Sore Throat''' - GROUPS 5, 11, 14, 23, 29, 32

You have a good friend who is applying for pharmacy. Her invitation for the multiple-mini interview (MMI) is coming up soon, but she is starting to experience a sore throat. While she is worried about not being able to speak through all of those stations, she knows she often gets a terrible headache along with her sore throat. She has an unused prescription for amoxicillin (unexpired) and wonders if you recommend for her to take it.

[https://pubmed.ncbi.nlm.nih.gov/34881426/ Antibiotics for sore throat]

'''Scenario 6 - Conjunctivitis''' - GROUPS 6, 12, 13, 24, 30, 31

A man comes to your pharmacy (he appears in his early twenties) complaining of “pink eye”. He has had a pink discolouration and discharge from his left eye for two days. He asks if the OTC antibiotic eye drops (he’s holding a product with polymixin B) are any better than “waiting it out”.

[https://www.ncbi.nlm.nih.gov/pubmed/22972049 Antibiotics for acute conjunctivitis]

6) HEMATOLOGY STUDIES

None so far

'''ACADEMIC YEAR 2 - FIRST TERM'''

7) RESPIROLOGY STUDIES
[[File:IA COPD info.pdf|thumb]]

*[http://www.ncbi.nlm.nih.gov/pubmed/2062329 First inhaled steroid study] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/22938706 Tiotropium in asthma] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/21324520 Inhaled steroid in children] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/29768149 Combined Budesonide–Formoterol as Needed in Mild Asthma] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/15223858 Doubling dose of inhaled corticosteroid] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/29768147 As-Needed Budesonide–Formoterol versus Maintenance Budesonide in Mild Asthma] Groups 6,18,30
*[https://pubmed.ncbi.nlm.nih.gov/32579807/ Triple Inhaled Therapy at Two Glucocorticoid Doses in Moderate-to-Very-Severe COPD] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/21428765 Tiotropium VS salmeterol in COPD] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/23695200 Short VS long steroids for COPD exacerbation] Groups 9,21,33
*[http://www.ncbi.nlm.nih.gov/pubmed/25196117 Stopping inhaled steroids in COPD] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/29668352 Once-Daily Single-Inhaler Triple versus Dual Therapy in Patients with COPD] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/28877011 Tezepelumab in Adults with Uncontrolled Asthma] Groups 12,24,36

8) CARDIOVASCULAR STUDIES

SESSION 1

*[https://www.ncbi.nlm.nih.gov/pubmed/4862069 VA1] (Group 1, 13, 25)
*[https://www.ncbi.nlm.nih.gov/pubmed/4914579 VA 2] (Group 2, 14, 26)
*[https://pubmed.ncbi.nlm.nih.gov/33186492 Polycap Study 3] (Group 3, 15, 27)
*[http://www.ncbi.nlm.nih.gov/pubmed/20228401 ACCORD-BP] (Group 4, 16, 28)
*[https://www.ncbi.nlm.nih.gov/pubmed/26551272 SPRINT] (Group 5, 17, 29)
*[http://www.ncbi.nlm.nih.gov/pubmed/2883575 CONSENSUS] (Group 6,18,30)
*[https://pubmed.ncbi.nlm.nih.gov/31535829/ DAPA-HF] (Group 7, 19, 31)
*[https://pubmed.ncbi.nlm.nih.gov/25176939/ CONFIRM-HF] (Group 8, 20, 32)
*[http://www.ncbi.nlm.nih.gov/pubmed/12457784 PROSPER] (Group 9, 21, 33)
*[http://www.ncbi.nlm.nih.gov/pubmed/27040132 HOPE-3] (Group 10, 22, 34)
*[http://www.ncbi.nlm.nih.gov/pubmed/12114036 Heart Protection Study (HPS)] (Group 11, 23, 35)
*[http://www.ncbi.nlm.nih.gov/pubmed/30415628 REDUCE-IT] (Group 12, 24, 36)

[[File:CV Case.pdf|thumb|CV case|left]]

SESSION 2

'''The Guideline Case'''

A 63 y/o patient with CHOOSE ONE (⬆︎HTN/⬆︎Chol/⬆︎glucose/HF/A fib) and using the guideline determine:
# their 5yr/10yr risks of mortality/CVD events
# the potential benefit
# the potential side effects (with magnitude)
# words/sentiment patient values and preferences/SDM

Atrial fibrillation - Groups 1,13,25,2,14,26
*[https://www.onlinecjc.ca/article/S0828-282X(18)31062-6/pdf 2018 Atrial fibrillation guidelines]
Diabetes - Groups 3,15,27,4,16,28
*[http://guidelines.diabetes.ca/docs/CPG-2018-full-EN.pdf 2018 Diabetes guidelines]
Lipid Simplified - Groups 5,17,29,6,18,30
*[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4607330/pdf/0610857.pdf 2015 Simplified lipid guidelines]
Lipid - Groups 7,19,31,8,20,32
*[http://www.onlinecjc.ca/article/S0828-282X(16)30732-2/pdf 2016 Lipid guidelines]
Heart failure - Groups 9,21,33,10,22,34
*[http://www.onlinecjc.ca/article/S0828-282X(17)30973-X/pdf 2017 Heart failure guidelines]
Hypertension - Groups 11,23,35,12,24,36
*[https://www.onlinecjc.ca/article/S0828-282X(18)30183-1/pdf 2018 Hypertension guidelines]

OPTIONAL SESSION
*[http://www.ncbi.nlm.nih.gov/pubmed/16899775 SPARCL]
*[http://www.ncbi.nlm.nih.gov/pubmed/10471456 RALES]
*[http://www.ncbi.nlm.nih.gov/pubmed/11386263 Carvedilol in heart failure]
*[http://www.ncbi.nlm.nih.gov/pubmed/18460663 WAFACS]
*[http://www.ncbi.nlm.nih.gov/pubmed/10376614 MERIT-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/25176015 PARADIGM-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/24490264 High-dose multivitamins after MI]
*[http://www.ncbi.nlm.nih.gov/pubmed/7911176 Mediterranean Diet after MI]
*[http://www.ncbi.nlm.nih.gov/pubmed/15337732 A TO Z]
*[http://www.ncbi.nlm.nih.gov/pubmed/21073363 EMPHASIS-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/12853193 COMET]
*[http://www.ncbi.nlm.nih.gov/pubmed/24716680 TOPCAT]
*[http://www.ncbi.nlm.nih.gov/pubmed/26039521 IMPROVE-IT]

'''ACADEMIC YEAR 2 - SECOND TERM'''

9) NEPHROLOGY STUDIES

None so far

10) ENDOCRINOLOGY

[[File:IA ENDO LAYOUT.pdf|thumb|IA ENDO LAYOUT TEMPLATE|none]]
[[File:Osteoporosis Evidence SUPP.pdf|none|thumb]]

'''RISK ASSESSMENT CASES FOR DIABETES AND OSTEOPOROSIS'''

'''1) DIABETES CASE'''

66 y/o white male who was diagnosed with diabetes 8 years ago

* His blood pressure over the last year has been roughly 145/80 mmHg - at present untreated
* A1c = 8%, no diabetes meds, non-smoker, BMI ~30
* '''When calculating without diabetes for PREVENT use an A1c of 5.5%'''
* Total cholesterol is 6 mmol/L, his HDL is 2 mmol/L, non-HDL = 6 minus 2, not on a statin
* No retinopathy, urine albumin-to-creatinine ratio (UACR) = 15ug/mg (7mg/mmol),
* Serum creatinine = 70 micromol/L, waist circumference 100 cm
* GFR 75 mL/min/1.73m2
* In normal sinus rhythm
* Age at end of highest education = 19
* Mother alive, father died of a heart attack at age 80

'''Calculate Risks'''

'''CVD RISK ESTIMATES''' - list the endpoints described by the specific calculator

Framingham - xx% - 10-year risk - also if no diabetes xx%

ASCVD - xx% - 10-year risk - also if no diabetes xx%

'''The Calculator'''
*CVD CALCULATOR
https://decisionaid.ca/cvd/

'''DIABETES COMPLICATIONS RISK ESTIMATES''' - list the endpoints described by the specific calculator

xx% - also 10-year risk if A1c 9, 8, 7 and 6

also get risk of kidney failure, vision loss, pressure sensation loss – also if A1c 9, 8,7,6

'''The Calculator'''
*DIABETES DECISION AID
http://decisionaid.ca/diabetes/

'''BENEFITS AND HARMS'''

Use the [https://guidelines.diabetes.ca/cpg/chapter-13-2020-update 2024 diabetes guidelines] and/or Diabetes Decision Aid to get estimates of benefits and harms and also use the MyStudies synopsis listed below

'''COSTS'''

Try using [https://pricingdoc.acfp.ca Pricing Doc] to get costs

'''Groups 1,13,25'''

* Metformin - UKPDS 34 [https://mystudies.org/studies.php#studies/28929e89-d01e-4b11-8e67-4d7086f9e4aa/outcome MyStudies Data]

'''Groups 2,14,26'''

* Sulfonlyureas - UKPDS 33 [https://mystudies.org/studies.php#studies/5eadb5dd-d403-4c13-b03e-d4f8d28c96ba/outcome MyStudies Data]

'''Groups 3,15,27'''

* Insulin - ORIGIN [https://mystudies.org/studies.php#studies/f611818f-2e69-4952-b55e-661116bd84b6/outcome MyStudies Data]

'''Groups 4,16,28'''

* SGLT2 - EMPA-REG OUTCOME [https://mystudies.org/studies.php#studies/32e9cf1a-f33e-480b-91ca-6f28a4dcf862/outcome MyStudies Data]

'''Groups 5,17,29'''

* GLP - LEADER [https://mystudies.org/studies.php#studies/1adbc9a1-7603-40f1-ac15-b813ce1f0ad6/outcome MyStudies Data]

'''Groups 6,18,30'''

* DPP4 - TECOS [https://mystudies.org/studies.php#studies/8659968a-cefb-4f99-b4ae-8b9b659acbd5/outcome MyStudies Data]

'''Groups 7,19,31'''

* Intensive treatment – small scale - STENO [https://mystudies.org/studies.php#studies/39d423e3-af57-40c8-ab7a-cbc7f389bdb6/paper MyStudies Data]

'''Groups 8,20,32'''

* Intensive treatment – large scale - ADDITION-Europe - [https://mystudies.org/studies.php#studies/5e07d86d-aa92-4db9-a283-76080db4b6fd/outcome MyStudies Data]

'''2) OSTEOPOROSIS CASE'''

60 y/o female

* 72 kg, 1.69m, BMI = 25.2
* t-score of -2.5
* Worried about falling and getting a hip fracture
* A friend recently had an atraumatic fracture from simply tripping and falling over in the snow
* No other risk factors

'''Calculate Risks'''

'''FRACTURE RISK ESTIMATES''' - list the endpoints described by the specific calculator

Major osteoporotic fracture - xx% - 10-year risk – if no BMD (just BMI), and then if they had a BMD t-Score of -2.0, -2.5, and -3.0

Hip fracture - - xx% - 10-year risk – if no BMD (just BMI) and if you have a BMD xx% - 10-year risk – if no BMD, and then if they had a BMD T-Score of -2.0, -2.5, and -3.0

'''The Calculator'''

* FRACTURE CALCULATOR

[https://frax.shef.ac.uk/frax/tool.aspx?country=19 Frax Tool - Canada]

'''BENEFITS AND HARMS'''

Use the [https://www.cmaj.ca/content/195/39/E1333 2023 Osteoporosis Guideline] and/or your osteoporosis lecture notes to get the benefits and apply these to your patient, and also get the harms

'''COSTS'''

Try using [https://pricingdoc.acfp.ca Pricing Doc] to get costs

'''Groups 9,21,33'''

* Activity

'''Groups 10,22,34'''

* Calcium/Vitamin D

'''Groups 11,23,35'''

* Bisphosphonates

'''Groups 12,24,36'''

* Denosumab

11) NEUROLOGY STUDIES

*[http://www.ncbi.nlm.nih.gov/pubmed/16717269 Opioids for chronic non-cancer pain] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/29509867 Effect of Opioid vs Nonopioid Medications on Pain-Related Function in Patients With Chronic Back Pain] Groups 2,14,26
*[https://www.ncbi.nlm.nih.gov/pubmed/31291515 Galcanezumab for prevention of cluster headaches] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/27150433 Immediate or delayed treatment of a first seizure] Groups 4,16,28
*[https://www.ncbi.nlm.nih.gov/pubmed/31291516 Rimegepant for episodic migraine] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/26212846 Sleep restriction for insomnia] Groups 6,18,30
*[https://www.ncbi.nlm.nih.gov/pubmed/25957224 CHANCE] Groups 7,19,31
*[https://www.ncbi.nlm.nih.gov/pubmed/16899775 SPARCL] Groups 8,20,32
*[https://www.ncbi.nlm.nih.gov/pubmed/29171821 Erenumab for episodic migraine] Groups 9,21,33
*[https://www.ncbi.nlm.nih.gov/pubmed/24733354 Reduction of benzodiazepines through education] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/26035341 Patient controlled opioid analgesia versus non-patient controlled opioid analgesia for postoperative pain] Groups 11,23,35
*[https://www.ncbi.nlm.nih.gov/pubmed/11589932 PROGRESS] Groups 12,24,36

'''ACADEMIC YEAR 3'''

12) PSYCHIATRY STUDIES

[[:File:2021 Psych Evidence Appraisal - Intro Slides.pdf|Psychiatry Rating Scales Introduction]]

* Study 1: [http://www.ncbi.nlm.nih.gov/pubmed/16554525 STAR*D (Level 2)] Bupropion-SR, sertraline, or venlafaxine-XR after failure of SSRIs for depression
* Study 2: [http://www.ncbi.nlm.nih.gov/pubmed/29477251 Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder]
* Study 3: [https://pubmed.ncbi.nlm.nih.gov/33862018/ Long-acting injectable versus oral antipsychotics for the maintenance treatment of schizophrenia]
* Study 4: [https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2725088 Association of Antipsychotic Polypharmacy vs Monotherapy With Psychiatric Rehospitalization Among Adults With Schizophrenia]
* Study 5: [https://www.ncbi.nlm.nih.gov/pubmed/29490359 Real-world Effectiveness of Pharmacologic Treatments for the Prevention of Bipolar Disorder]
* Study 6: [http://www.ncbi.nlm.nih.gov/pubmed/20092882 BALANCE] Combination lithium and valproate therapy versus monotherapy for relapse prevention in bipolar I disorder
13) GASTROENTEROLOGY STUDIES - LINKS ON CANVAS
[[File:GI ChatGPT Instructions.jpg|thumb|GPT Instructions]]
*Short-term treatment for gastro-oesophageal reflux disease-like symptoms and endoscopy negative reflux disease (Review)
*Oral budesonide for induction of remission in ulcerative colitis (Review)
*Probiotics for the prevention of Clostridium difficile-associated diarrhea in adults and children (Review)
*Deprescribing versus continuation of chronic proton pump inhibitor use in adults (Review)
*Prevention of NSAID-induced gastroduodenal ulcers (Review)
*Methotrexate for maintenance of remission in Crohn's disease (Review)

14) OB/GYN STUDIES
*[http://www.ncbi.nlm.nih.gov/pubmed/25601350 Comparative contraceptive effectiveness of levonorgestrel-releasing and copper IUD Devices]
*[http://www.ncbi.nlm.nih.gov/pubmed/29211679 Hormonal contraception and the risk of breast cancer]
*[http://www.ncbi.nlm.nih.gov/pubmed/30322986 Sexual behaviours in adolescent girls before and after introduction of the HPV]
*[http://www.ncbi.nlm.nih.gov/pubmed/30181338 Intramuscular vs intravenous oxytocin to prevent postpartum haemorrhage at vaginal delivery]
*[http://www.ncbi.nlm.nih.gov/pubmed/27682034 Azithromycin Prophylaxis for Cesarean Delivery]
*[http://www.ncbi.nlm.nih.gov/pubmed/28461374 Antibiotics during pregnancy and risk of spontaneous abortion]

Evidence Appraisal Integrated Activities

2025-11-13T18:16:21Z

JamesMcCormack:

'''OBJECTIVE'''

To critically appraise studies, develop a brief synopsis of the trial results, succinctly present the results and then put the results into a proper clinical context

'''INITIAL PRE-READING'''

'''How To Critically Appraise an RCT In 10 minutes'''
*[https://itunes.apple.com/ca/book/how-to-critically-appraise/id524600667?mt=11 iBook/iPad version]
*[https://therapeuticseducation.org/sites/therapeuticseducation.org/files/Ten_Minute_Critical_Appraisal.pdf PDF version]
Watch this video
[http://youtu.be/QUW0Q8tXVUc Viva La Evidence]

'''Study Results at Your Fingertips'''
*[https://mystudies.org MyStudies] - Free access

'''INTEGRATION ACTIVITY FORMAT'''
# Students placed in groups of ~ 5-7
# Each group is given one of the studies below to review
# Students then work in pairs and develop a one-slide critical appraisal and results synopsis
# One student in each group will be chosen at random to present their group findings to the class
# A discussion about the appraisal and the appropriate clinical context for the results is had with the entire class for each study

'''MODULE'''
[[File:Screen Shot 2022-01-09 at 10.00.16 AM.jpg|thumb|'''TRIAL PRESENTATION FORMAT'''|none]]

Studies chosen include landmark studies and/or studies that address important therapeutic issues for the particular module

'''ACADEMIC YEAR 1 - FIRST TERM'''

1) FOUNDATION STUDIES (Groups)
*[https://pubmed.ncbi.nlm.nih.gov/37952131 SELECT] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/12466506 AFFIRM] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/22085343 AIM-HIGH] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/10639539 HOPE] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/18378519 HYVET] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/15007110 PROVE-IT] Groups 6,18,30
*[http://www.ncbi.nlm.nih.gov/pubmed/15755765 TNT] Groups 7,19,31
*[https://pubmed.ncbi.nlm.nih.gov/26378978 EMPAREG] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/17984165 ILLUMINATE] Groups 9,21,33
*[https://pubmed.ncbi.nlm.nih.gov/26551272/ SPRINT] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/15325833 CARDS] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/12117397 WHI] Groups 12,24,36

'''ACADEMIC YEAR 1 - SECOND TERM'''

2) INTRO TO INFECTIOUS DISEASE STUDIES

[https://wiki.ubc.ca/images/8/8b/Antibiotic_Sensitivity_Chart_2024.pdf The "Best" Antibiotic Sensitivity Chart Ever]
*[http://www.ncbi.nlm.nih.gov/pubmed/17567657 IV vs PO antibiotics] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/24603565 Delayed antibiotics for respiratory tract infections] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/11159657 Delayed antibiotics for otitis media] Groups 3,15,27
*[https://pubmed.ncbi.nlm.nih.gov/27455166/ Duration of treatment for community acquired pneumonia] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/22726802 Duration of treatment for pyelonephritis] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/25830421 Choice of antibiotic for community acquired pneumonia-1] Groups 6,18,30
*[http://www.ncbi.nlm.nih.gov/pubmed/25286173 Choice of antibiotic for community acquired pneumonia-2] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/20647284 HPV vaccine study] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/7966893 Influenza vaccine study] Groups 9,21,33
*[https://pubmed.ncbi.nlm.nih.gov/33301246/ COVID vaccine Pfizer] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/27626517 Herpes zoster vaccine study 1] Groups 11,23,35
*[https://www.ncbi.nlm.nih.gov/pubmed/25916341 Herpes zoster vaccine study 2] Groups 12,24,36

3) MUSCULOSKELETAL STUDIES

*[http://www.ncbi.nlm.nih.gov/pubmed/28199814 Baricitinib versus Placebo or Adalimumab in Rheumatoid Arthritis] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/0010979111 CLASS – celecoxib vs NSAIDs] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/26501533 Naproxen with cyclobenzaprine, oxycodone/acetaminophen, or placebo for low back pain] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/24395557 Glucosamine and chondroitin for OA] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/12546607 Acetaminophen vs diclofenac for OA] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/23964752 Diclofenac gel for acute neck pain] Groups 6,18,30
*[https://pubmed.ncbi.nlm.nih.gov/15468367/ Topical diclofenac vs oral diclofenac] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/25064594 Acetaminophen for low back pain] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/7611589 Misoprostol and NSAID induced ulcers] Groups 9,21,33
*[http://www.ncbi.nlm.nih.gov/pubmed/20131255 Low dose vs high dose colchicine for gout] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/22508468 TEAR - oral triple therapy versus etanercept plus methotrexate in early aggressive rheumatoid arthritis] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/25589511 MOVES - Glucosamine and chondroitin for OA for moderate to severe pain] Groups 12,24,36

4) DERMATOLOGY STUDIES

*[https://www.ncbi.nlm.nih.gov/pubmed/9598014 Glycolic acid 5% Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/21896132 Glycolic acid 10% Acne]
*[https://www.ncbi.nlm.nih.gov/pubmed/14531866 Petrolatum vs Ceramide/skin related lipids Hand Dermatitis]
*[https://www.ncbi.nlm.nih.gov/pubmed/11896774 Vitamin C Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/17515510 Retinol (VitaminA) Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/21896129 Hyaluronic acid Atopic Dermatitis]

5) EENT STUDIES

[http://www.amstar.ca/docs/AMSTARguideline.pdf AMSTAR meta-analysis checklist]

'''Scenario 1 - Otitis Media''' - GROUPS 1, 7, 18, 19, 25, 36

Anthony Martin arrives at your pharmacy somewhat frustrated since his family physician declined to write an antibiotic prescription for his two and half year old son, Oscar. His symptoms started yesterday afternoon - Oscar complains of right ear pain but there is no discharge. Rectal temperature taken today was 38.5 degrees. His wife is sure Oscar has an ear infection since the last time he had these same symptoms, that was ultimately the diagnosis. Mr. Martin asks if you think buying acetaminophen is really “enough”?

[https://pubmed.ncbi.nlm.nih.gov/26099233/ Antibiotics for acute otitis media in children]

'''Scenario 2 - Allergic Rhinitis''' - GROUPS 2, 8, 17, 20, 26, 35

Ruby Parmar is a firefighter. She is plagued by sinus congestion (preventing her from sleeping) and a runny nose associated with seasonal allergies. Her prescription for intranasal triamcinolone is typically effective, but she would like to know if a non-sedating anti-allergy pill would work just as well since it’s inconvenient carrying around the “nose spray”.

[https://www.ncbi.nlm.nih.gov/pubmed/28234147 Intranasal steroids vs antihistamines for allergic rhinitis]

'''Scenario 3 - Acute Sinusitis''' - GROUPS 3, 9, 16, 21, 27, 34

You are seeing a patient in clinic before her appointment with the primary care physician. She was feeling unwell with a “flu” last week. While most of her symptoms have resolved (cough, fever), the nasal congestion and discharge persists and so she has made an appointment (she is an otherwise healthy 32 year old with treated thyroid disease). She would like your advice for what treatment she should ask the doctor to prescribe.

[http://www.ncbi.nlm.nih.gov/pubmed/24293353 Intranasal steroids for acute sinusitis]

'''Scenario 4 - Glaucoma''' - GROUPS 4, 10, 15, 22, 28, 33

Mrs. Ada Waters is a 63 year-old woman you. Her ophthalmologist prescribed timolol and xalatan eye drops for treatment of open angle glaucoma. She has never really felt much different on treatment since she recovered from her first episode (of acute angle closure glaucoma requiring ER visit) and surgery. She asks you if the treatment is really making a difference.

[https://www.ncbi.nlm.nih.gov/pubmed/17943780 Interventions for open angle glaucoma]

'''Scenario 5 - Sore Throat''' - GROUPS 5, 11, 14, 23, 29, 32

You have a good friend who is applying for pharmacy. Her invitation for the multiple-mini interview (MMI) is coming up soon, but she is starting to experience a sore throat. While she is worried about not being able to speak through all of those stations, she knows she often gets a terrible headache along with her sore throat. She has an unused prescription for amoxicillin (unexpired) and wonders if you recommend for her to take it.

[https://pubmed.ncbi.nlm.nih.gov/34881426/ Antibiotics for sore throat]

'''Scenario 6 - Conjunctivitis''' - GROUPS 6, 12, 13, 24, 30, 31

A man comes to your pharmacy (he appears in his early twenties) complaining of “pink eye”. He has had a pink discolouration and discharge from his left eye for two days. He asks if the OTC antibiotic eye drops (he’s holding a product with polymixin B) are any better than “waiting it out”.

[https://www.ncbi.nlm.nih.gov/pubmed/22972049 Antibiotics for acute conjunctivitis]

6) HEMATOLOGY STUDIES

None so far

'''ACADEMIC YEAR 2 - FIRST TERM'''

7) RESPIROLOGY STUDIES
[[File:IA COPD info.pdf|thumb]]

*[http://www.ncbi.nlm.nih.gov/pubmed/2062329 First inhaled steroid study] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/22938706 Tiotropium in asthma] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/21324520 Inhaled steroid in children] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/29768149 Combined Budesonide–Formoterol as Needed in Mild Asthma] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/15223858 Doubling dose of inhaled corticosteroid] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/29768147 As-Needed Budesonide–Formoterol versus Maintenance Budesonide in Mild Asthma] Groups 6,18,30
*[https://pubmed.ncbi.nlm.nih.gov/32579807/ Triple Inhaled Therapy at Two Glucocorticoid Doses in Moderate-to-Very-Severe COPD] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/21428765 Tiotropium VS salmeterol in COPD] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/23695200 Short VS long steroids for COPD exacerbation] Groups 9,21,33
*[http://www.ncbi.nlm.nih.gov/pubmed/25196117 Stopping inhaled steroids in COPD] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/29668352 Once-Daily Single-Inhaler Triple versus Dual Therapy in Patients with COPD] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/28877011 Tezepelumab in Adults with Uncontrolled Asthma] Groups 12,24,36

8) CARDIOVASCULAR STUDIES

SESSION 1

*[https://www.ncbi.nlm.nih.gov/pubmed/4862069 VA1] (Group 1, 13, 25)
*[https://www.ncbi.nlm.nih.gov/pubmed/4914579 VA 2] (Group 2, 14, 26)
*[https://pubmed.ncbi.nlm.nih.gov/33186492 Polycap Study 3] (Group 3, 15, 27)
*[http://www.ncbi.nlm.nih.gov/pubmed/20228401 ACCORD-BP] (Group 4, 16, 28)
*[https://www.ncbi.nlm.nih.gov/pubmed/26551272 SPRINT] (Group 5, 17, 29)
*[http://www.ncbi.nlm.nih.gov/pubmed/2883575 CONSENSUS] (Group 6,18,30)
*[https://pubmed.ncbi.nlm.nih.gov/31535829/ DAPA-HF] (Group 7, 19, 31)
*[https://pubmed.ncbi.nlm.nih.gov/25176939/ CONFIRM-HF] (Group 8, 20, 32)
*[http://www.ncbi.nlm.nih.gov/pubmed/12457784 PROSPER] (Group 9, 21, 33)
*[http://www.ncbi.nlm.nih.gov/pubmed/27040132 HOPE-3] (Group 10, 22, 34)
*[http://www.ncbi.nlm.nih.gov/pubmed/12114036 Heart Protection Study (HPS)] (Group 11, 23, 35)
*[http://www.ncbi.nlm.nih.gov/pubmed/30415628 REDUCE-IT] (Group 12, 24, 36)

[[File:CV Case.pdf|thumb|CV case|left]]

SESSION 2

'''The Guideline Case'''

A 63 y/o patient with CHOOSE ONE (⬆︎HTN/⬆︎Chol/⬆︎glucose/HF/A fib) and using the guideline determine:
# their 5yr/10yr risks of mortality/CVD events
# the potential benefit
# the potential side effects (with magnitude)
# words/sentiment patient values and preferences/SDM

Atrial fibrillation - Groups 1,13,25,2,14,26
*[https://www.onlinecjc.ca/article/S0828-282X(18)31062-6/pdf 2018 Atrial fibrillation guidelines]
Diabetes - Groups 3,15,27,4,16,28
*[http://guidelines.diabetes.ca/docs/CPG-2018-full-EN.pdf 2018 Diabetes guidelines]
Lipid Simplified - Groups 5,17,29,6,18,30
*[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4607330/pdf/0610857.pdf 2015 Simplified lipid guidelines]
Lipid - Groups 7,19,31,8,20,32
*[http://www.onlinecjc.ca/article/S0828-282X(16)30732-2/pdf 2016 Lipid guidelines]
Heart failure - Groups 9,21,33,10,22,34
*[http://www.onlinecjc.ca/article/S0828-282X(17)30973-X/pdf 2017 Heart failure guidelines]
Hypertension - Groups 11,23,35,12,24,36
*[https://www.onlinecjc.ca/article/S0828-282X(18)30183-1/pdf 2018 Hypertension guidelines]

OPTIONAL SESSION
*[http://www.ncbi.nlm.nih.gov/pubmed/16899775 SPARCL]
*[http://www.ncbi.nlm.nih.gov/pubmed/10471456 RALES]
*[http://www.ncbi.nlm.nih.gov/pubmed/11386263 Carvedilol in heart failure]
*[http://www.ncbi.nlm.nih.gov/pubmed/18460663 WAFACS]
*[http://www.ncbi.nlm.nih.gov/pubmed/10376614 MERIT-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/25176015 PARADIGM-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/24490264 High-dose multivitamins after MI]
*[http://www.ncbi.nlm.nih.gov/pubmed/7911176 Mediterranean Diet after MI]
*[http://www.ncbi.nlm.nih.gov/pubmed/15337732 A TO Z]
*[http://www.ncbi.nlm.nih.gov/pubmed/21073363 EMPHASIS-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/12853193 COMET]
*[http://www.ncbi.nlm.nih.gov/pubmed/24716680 TOPCAT]
*[http://www.ncbi.nlm.nih.gov/pubmed/26039521 IMPROVE-IT]

'''ACADEMIC YEAR 2 - SECOND TERM'''

9) NEPHROLOGY STUDIES

None so far

10) ENDOCRINOLOGY

[[File:IA ENDO LAYOUT.pdf|thumb|IA ENDO LAYOUT TEMPLATE|none]]
[[File:Osteoporosis Evidence SUPP.pdf|none|thumb]]

'''RISK ASSESSMENT CASES FOR DIABETES AND OSTEOPOROSIS'''

'''1) DIABETES CASE'''

66 y/o white male who was diagnosed with diabetes 8 years ago

* His blood pressure over the last year has been roughly 145/80 mmHg - at present untreated
* A1c = 8%, no diabetes meds, non-smoker, BMI ~30
* '''When calculating without diabetes for PREVENT use an A1c of 5.5%'''
* Total cholesterol is 6 mmol/L, his HDL is 2 mmol/L, non-HDL = 6 minus 2, not on a statin
* No retinopathy, urine albumin-to-creatinine ratio (UACR) = 15ug/mg (7mg/mmol),
* Serum creatinine = 70 micromol/L, waist circumference 100 cm
* GFR 75 mL/min/1.73m2
* In normal sinus rhythm
* Age at end of highest education = 19
* Mother alive, father died of a heart attack at age 80

'''Calculate Risks'''

'''CVD RISK ESTIMATES''' - list the endpoints described by the specific calculator

Framingham - xx% - 10-year risk - also if no diabetes xx%

ASCVD - xx% - 10-year risk - also if no diabetes xx%

'''The Calculator'''
*CVD CALCULATOR
https://decisionaid.ca/cvd/

'''DIABETES COMPLICATIONS RISK ESTIMATES''' - list the endpoints described by the specific calculator

xx% - also 10-year risk if A1c 9, 8, 7 and 6

also get risk of kidney failure, vision loss, pressure sensation loss – also if A1c 9, 8,7,6

'''The Calculator'''
*DIABETES DECISION AID
http://decisionaid.ca/diabetes/

'''BENEFITS AND HARMS'''

Use the [https://guidelines.diabetes.ca/cpg/chapter-13-2020-update 2024 diabetes guidelines] and/or Diabetes Decision Aid to get estimates of benefits and harms and also use the MyStudies synopsis listed below

'''COSTS'''

Try using [https://pricingdoc.acfp.ca Pricing Doc] to get costs

'''Groups 1,13,25'''

* Metformin - UKPDS 34 [https://mystudies.org/studies.php#studies/28929e89-d01e-4b11-8e67-4d7086f9e4aa/outcome MyStudies Data]

'''Groups 2,14,26'''

* Sulfonlyureas - UKPDS 33 [https://mystudies.org/studies.php#studies/5eadb5dd-d403-4c13-b03e-d4f8d28c96ba/outcome MyStudies Data]

'''Groups 3,15,27'''

* Insulin - ORIGIN [https://mystudies.org/studies.php#studies/f611818f-2e69-4952-b55e-661116bd84b6/outcome MyStudies Data]

'''Groups 4,16,28'''

* SGLT2 - EMPA-REG OUTCOME [https://mystudies.org/studies.php#studies/32e9cf1a-f33e-480b-91ca-6f28a4dcf862/outcome MyStudies Data]

'''Groups 5,17,29'''

* GLP - LEADER [https://mystudies.org/studies.php#studies/1adbc9a1-7603-40f1-ac15-b813ce1f0ad6/outcome MyStudies Data]

'''Groups 6,18,30'''

* DPP4 - TECOS [https://mystudies.org/studies.php#studies/8659968a-cefb-4f99-b4ae-8b9b659acbd5/outcome MyStudies Data]

'''Groups 7,19,31'''

* Intensive treatment – small scale - STENO [https://mystudies.org/studies.php#studies/39d423e3-af57-40c8-ab7a-cbc7f389bdb6/paper MyStudies Data]

'''Groups 8,20,32'''

* Intensive treatment – large scale - ADDITION-Europe - [https://mystudies.org/studies.php#studies/5e07d86d-aa92-4db9-a283-76080db4b6fd/outcome MyStudies Data]

'''2) OSTEOPOROSIS CASE'''

60 y/o female

* 72 kg, 1.69m, BMI = 25.2
* t-score of -2.5
* Worried about falling and getting a hip fracture
* A friend recently had an atraumatic fracture from simply tripping and falling over in the snow
* No other risk factors

'''Calculate Risks'''

'''FRACTURE RISK ESTIMATES''' - list the endpoints described by the specific calculator

Major osteoporotic fracture - xx% - 10-year risk – if no BMD (just BMI), and then if they had a BMD t-Score of -2.0, -2.5, and -3.0

Hip fracture - - xx% - 10-year risk – if no BMD (just BMI) and if you have a BMD xx% - 10-year risk – if no BMD, and then if they had a BMD T-Score of -2.0, -2.5, and -3.0

'''The Calculator'''

* FRACTURE CALCULATOR

[https://frax.shef.ac.uk/frax/tool.aspx?country=19 Frax Tool - Canada]

'''BENEFITS AND HARMS'''

Use the [https://www.cmaj.ca/content/195/39/E1333 2023 Osteoporosis Guideline] and/or your osteoporosis lecture notes to get the benefits and apply these to your patient, and also get the harms

'''COSTS'''

Try using [https://pricingdoc.acfp.ca Pricing Doc] to get costs

'''Groups 9,21,33'''

* Activity

'''Groups 10,22,34'''

* Calcium/Vitamin D

'''Groups 11,23,35'''

* Bisphosphonates

'''Groups 12,24,36'''

* Denosumab

11) NEUROLOGY STUDIES

*[http://www.ncbi.nlm.nih.gov/pubmed/16717269 Opioids for chronic non-cancer pain] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/29509867 Effect of Opioid vs Nonopioid Medications on Pain-Related Function in Patients With Chronic Back Pain] Groups 2,14,26
*[https://www.ncbi.nlm.nih.gov/pubmed/31291515 Galcanezumab for prevention of cluster headaches] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/27150433 Immediate or delayed treatment of a first seizure] Groups 4,16,28
*[https://www.ncbi.nlm.nih.gov/pubmed/31291516 Rimegepant for episodic migraine] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/26212846 Sleep restriction for insomnia] Groups 6,18,30
*[https://www.ncbi.nlm.nih.gov/pubmed/25957224 CHANCE] Groups 7,19,31
*[https://www.ncbi.nlm.nih.gov/pubmed/16899775 SPARCL] Groups 8,20,32
*[https://www.ncbi.nlm.nih.gov/pubmed/29171821 Erenumab for episodic migraine] Groups 9,21,33
*[https://www.ncbi.nlm.nih.gov/pubmed/24733354 Reduction of benzodiazepines through education] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/26035341 Patient controlled opioid analgesia versus non-patient controlled opioid analgesia for postoperative pain] Groups 11,23,35
*[https://www.ncbi.nlm.nih.gov/pubmed/11589932 PROGRESS] Groups 12,24,36

'''ACADEMIC YEAR 3'''

12) PSYCHIATRY STUDIES

[[:File:2021 Psych Evidence Appraisal - Intro Slides.pdf|Psychiatry Rating Scales Introduction]]

* Study 1: [http://www.ncbi.nlm.nih.gov/pubmed/16554525 STAR*D (Level 2)] Bupropion-SR, sertraline, or venlafaxine-XR after failure of SSRIs for depression
* Study 2: [http://www.ncbi.nlm.nih.gov/pubmed/29477251 Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder]
* Study 3: [https://pubmed.ncbi.nlm.nih.gov/33862018/ Long-acting injectable versus oral antipsychotics for the maintenance treatment of schizophrenia]
* Study 4: [https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2725088 Association of Antipsychotic Polypharmacy vs Monotherapy With Psychiatric Rehospitalization Among Adults With Schizophrenia]
* Study 5: [https://www.ncbi.nlm.nih.gov/pubmed/29490359 Real-world Effectiveness of Pharmacologic Treatments for the Prevention of Bipolar Disorder]
* Study 6: [http://www.ncbi.nlm.nih.gov/pubmed/20092882 BALANCE] Combination lithium and valproate therapy versus monotherapy for relapse prevention in bipolar I disorder
[[File:GI GPT slide.pdf|frame]]
13) GASTROENTEROLOGY STUDIES - LINKS ON CANVAS
[[File:GI ChatGPT Instructions.jpg|thumb|GPT Instructions]]
*Short-term treatment for gastro-oesophageal reflux disease-like symptoms and endoscopy negative reflux disease (Review)
*Oral budesonide for induction of remission in ulcerative colitis (Review)
*Probiotics for the prevention of Clostridium difficile-associated diarrhea in adults and children (Review)
*Deprescribing versus continuation of chronic proton pump inhibitor use in adults (Review)
*Prevention of NSAID-induced gastroduodenal ulcers (Review)
*Methotrexate for maintenance of remission in Crohn's disease (Review)

14) OB/GYN STUDIES
*[http://www.ncbi.nlm.nih.gov/pubmed/25601350 Comparative contraceptive effectiveness of levonorgestrel-releasing and copper IUD Devices]
*[http://www.ncbi.nlm.nih.gov/pubmed/29211679 Hormonal contraception and the risk of breast cancer]
*[http://www.ncbi.nlm.nih.gov/pubmed/30322986 Sexual behaviours in adolescent girls before and after introduction of the HPV]
*[http://www.ncbi.nlm.nih.gov/pubmed/30181338 Intramuscular vs intravenous oxytocin to prevent postpartum haemorrhage at vaginal delivery]
*[http://www.ncbi.nlm.nih.gov/pubmed/27682034 Azithromycin Prophylaxis for Cesarean Delivery]
*[http://www.ncbi.nlm.nih.gov/pubmed/28461374 Antibiotics during pregnancy and risk of spontaneous abortion]

File:GI ChatGPT Instructions.jpg

2025-11-13T18:14:00Z

JamesMcCormack: Uploaded own work with UploadWizard

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File:GI GPT slide.pdf

2025-11-13T18:09:43Z

JamesMcCormack: Uploaded own work with UploadWizard

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Evidence Appraisal Integrated Activities

2025-09-16T14:11:03Z

JamesMcCormack:

'''OBJECTIVE'''

To critically appraise studies, develop a brief synopsis of the trial results, succinctly present the results and then put the results into a proper clinical context

'''INITIAL PRE-READING'''

'''How To Critically Appraise an RCT In 10 minutes'''
*[https://itunes.apple.com/ca/book/how-to-critically-appraise/id524600667?mt=11 iBook/iPad version]
*[https://therapeuticseducation.org/sites/therapeuticseducation.org/files/Ten_Minute_Critical_Appraisal.pdf PDF version]
Watch this video
[http://youtu.be/QUW0Q8tXVUc Viva La Evidence]

'''Study Results at Your Fingertips'''
*[https://mystudies.org MyStudies] - Free access

'''INTEGRATION ACTIVITY FORMAT'''
# Students placed in groups of ~ 5-7
# Each group is given one of the studies below to review
# Students then work in pairs and develop a one-slide critical appraisal and results synopsis
# One student in each group will be chosen at random to present their group findings to the class
# A discussion about the appraisal and the appropriate clinical context for the results is had with the entire class for each study

'''MODULE'''
[[File:Screen Shot 2022-01-09 at 10.00.16 AM.jpg|thumb|'''TRIAL PRESENTATION FORMAT'''|none]]

Studies chosen include landmark studies and/or studies that address important therapeutic issues for the particular module

'''ACADEMIC YEAR 1 - FIRST TERM'''

1) FOUNDATION STUDIES (Groups)
*[https://pubmed.ncbi.nlm.nih.gov/37952131 SELECT] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/12466506 AFFIRM] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/22085343 AIM-HIGH] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/10639539 HOPE] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/18378519 HYVET] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/15007110 PROVE-IT] Groups 6,18,30
*[http://www.ncbi.nlm.nih.gov/pubmed/15755765 TNT] Groups 7,19,31
*[https://pubmed.ncbi.nlm.nih.gov/26378978 EMPAREG] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/17984165 ILLUMINATE] Groups 9,21,33
*[https://pubmed.ncbi.nlm.nih.gov/26551272/ SPRINT] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/15325833 CARDS] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/12117397 WHI] Groups 12,24,36

'''ACADEMIC YEAR 1 - SECOND TERM'''

2) INTRO TO INFECTIOUS DISEASE STUDIES

[https://wiki.ubc.ca/images/8/8b/Antibiotic_Sensitivity_Chart_2024.pdf The "Best" Antibiotic Sensitivity Chart Ever]
*[http://www.ncbi.nlm.nih.gov/pubmed/17567657 IV vs PO antibiotics] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/24603565 Delayed antibiotics for respiratory tract infections] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/11159657 Delayed antibiotics for otitis media] Groups 3,15,27
*[https://pubmed.ncbi.nlm.nih.gov/27455166/ Duration of treatment for community acquired pneumonia] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/22726802 Duration of treatment for pyelonephritis] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/25830421 Choice of antibiotic for community acquired pneumonia-1] Groups 6,18,30
*[http://www.ncbi.nlm.nih.gov/pubmed/25286173 Choice of antibiotic for community acquired pneumonia-2] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/20647284 HPV vaccine study] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/7966893 Influenza vaccine study] Groups 9,21,33
*[https://pubmed.ncbi.nlm.nih.gov/33301246/ COVID vaccine Pfizer] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/27626517 Herpes zoster vaccine study 1] Groups 11,23,35
*[https://www.ncbi.nlm.nih.gov/pubmed/25916341 Herpes zoster vaccine study 2] Groups 12,24,36

3) MUSCULOSKELETAL STUDIES

*[http://www.ncbi.nlm.nih.gov/pubmed/28199814 Baricitinib versus Placebo or Adalimumab in Rheumatoid Arthritis] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/0010979111 CLASS – celecoxib vs NSAIDs] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/26501533 Naproxen with cyclobenzaprine, oxycodone/acetaminophen, or placebo for low back pain] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/24395557 Glucosamine and chondroitin for OA] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/12546607 Acetaminophen vs diclofenac for OA] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/23964752 Diclofenac gel for acute neck pain] Groups 6,18,30
*[https://pubmed.ncbi.nlm.nih.gov/15468367/ Topical diclofenac vs oral diclofenac] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/25064594 Acetaminophen for low back pain] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/7611589 Misoprostol and NSAID induced ulcers] Groups 9,21,33
*[http://www.ncbi.nlm.nih.gov/pubmed/20131255 Low dose vs high dose colchicine for gout] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/22508468 TEAR - oral triple therapy versus etanercept plus methotrexate in early aggressive rheumatoid arthritis] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/25589511 MOVES - Glucosamine and chondroitin for OA for moderate to severe pain] Groups 12,24,36

4) DERMATOLOGY STUDIES

*[https://www.ncbi.nlm.nih.gov/pubmed/9598014 Glycolic acid 5% Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/21896132 Glycolic acid 10% Acne]
*[https://www.ncbi.nlm.nih.gov/pubmed/14531866 Petrolatum vs Ceramide/skin related lipids Hand Dermatitis]
*[https://www.ncbi.nlm.nih.gov/pubmed/11896774 Vitamin C Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/17515510 Retinol (VitaminA) Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/21896129 Hyaluronic acid Atopic Dermatitis]

5) EENT STUDIES

[http://www.amstar.ca/docs/AMSTARguideline.pdf AMSTAR meta-analysis checklist]

'''Scenario 1 - Otitis Media''' - GROUPS 1, 7, 18, 19, 25, 36

Anthony Martin arrives at your pharmacy somewhat frustrated since his family physician declined to write an antibiotic prescription for his two and half year old son, Oscar. His symptoms started yesterday afternoon - Oscar complains of right ear pain but there is no discharge. Rectal temperature taken today was 38.5 degrees. His wife is sure Oscar has an ear infection since the last time he had these same symptoms, that was ultimately the diagnosis. Mr. Martin asks if you think buying acetaminophen is really “enough”?

[https://pubmed.ncbi.nlm.nih.gov/26099233/ Antibiotics for acute otitis media in children]

'''Scenario 2 - Allergic Rhinitis''' - GROUPS 2, 8, 17, 20, 26, 35

Ruby Parmar is a firefighter. She is plagued by sinus congestion (preventing her from sleeping) and a runny nose associated with seasonal allergies. Her prescription for intranasal triamcinolone is typically effective, but she would like to know if a non-sedating anti-allergy pill would work just as well since it’s inconvenient carrying around the “nose spray”.

[https://www.ncbi.nlm.nih.gov/pubmed/28234147 Intranasal steroids vs antihistamines for allergic rhinitis]

'''Scenario 3 - Acute Sinusitis''' - GROUPS 3, 9, 16, 21, 27, 34

You are seeing a patient in clinic before her appointment with the primary care physician. She was feeling unwell with a “flu” last week. While most of her symptoms have resolved (cough, fever), the nasal congestion and discharge persists and so she has made an appointment (she is an otherwise healthy 32 year old with treated thyroid disease). She would like your advice for what treatment she should ask the doctor to prescribe.

[http://www.ncbi.nlm.nih.gov/pubmed/24293353 Intranasal steroids for acute sinusitis]

'''Scenario 4 - Glaucoma''' - GROUPS 4, 10, 15, 22, 28, 33

Mrs. Ada Waters is a 63 year-old woman you. Her ophthalmologist prescribed timolol and xalatan eye drops for treatment of open angle glaucoma. She has never really felt much different on treatment since she recovered from her first episode (of acute angle closure glaucoma requiring ER visit) and surgery. She asks you if the treatment is really making a difference.

[https://www.ncbi.nlm.nih.gov/pubmed/17943780 Interventions for open angle glaucoma]

'''Scenario 5 - Sore Throat''' - GROUPS 5, 11, 14, 23, 29, 32

You have a good friend who is applying for pharmacy. Her invitation for the multiple-mini interview (MMI) is coming up soon, but she is starting to experience a sore throat. While she is worried about not being able to speak through all of those stations, she knows she often gets a terrible headache along with her sore throat. She has an unused prescription for amoxicillin (unexpired) and wonders if you recommend for her to take it.

[https://pubmed.ncbi.nlm.nih.gov/34881426/ Antibiotics for sore throat]

'''Scenario 6 - Conjunctivitis''' - GROUPS 6, 12, 13, 24, 30, 31

A man comes to your pharmacy (he appears in his early twenties) complaining of “pink eye”. He has had a pink discolouration and discharge from his left eye for two days. He asks if the OTC antibiotic eye drops (he’s holding a product with polymixin B) are any better than “waiting it out”.

[https://www.ncbi.nlm.nih.gov/pubmed/22972049 Antibiotics for acute conjunctivitis]

6) HEMATOLOGY STUDIES

None so far

'''ACADEMIC YEAR 2 - FIRST TERM'''

7) RESPIROLOGY STUDIES
[[File:IA COPD info.pdf|thumb]]

*[http://www.ncbi.nlm.nih.gov/pubmed/2062329 First inhaled steroid study] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/22938706 Tiotropium in asthma] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/21324520 Inhaled steroid in children] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/29768149 Combined Budesonide–Formoterol as Needed in Mild Asthma] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/15223858 Doubling dose of inhaled corticosteroid] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/29768147 As-Needed Budesonide–Formoterol versus Maintenance Budesonide in Mild Asthma] Groups 6,18,30
*[https://pubmed.ncbi.nlm.nih.gov/32579807/ Triple Inhaled Therapy at Two Glucocorticoid Doses in Moderate-to-Very-Severe COPD] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/21428765 Tiotropium VS salmeterol in COPD] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/23695200 Short VS long steroids for COPD exacerbation] Groups 9,21,33
*[http://www.ncbi.nlm.nih.gov/pubmed/25196117 Stopping inhaled steroids in COPD] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/29668352 Once-Daily Single-Inhaler Triple versus Dual Therapy in Patients with COPD] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/28877011 Tezepelumab in Adults with Uncontrolled Asthma] Groups 12,24,36

8) CARDIOVASCULAR STUDIES

SESSION 1

*[https://www.ncbi.nlm.nih.gov/pubmed/4862069 VA1] (Group 1, 13, 25)
*[https://www.ncbi.nlm.nih.gov/pubmed/4914579 VA 2] (Group 2, 14, 26)
*[https://pubmed.ncbi.nlm.nih.gov/33186492 Polycap Study 3] (Group 3, 15, 27)
*[http://www.ncbi.nlm.nih.gov/pubmed/20228401 ACCORD-BP] (Group 4, 16, 28)
*[https://www.ncbi.nlm.nih.gov/pubmed/26551272 SPRINT] (Group 5, 17, 29)
*[http://www.ncbi.nlm.nih.gov/pubmed/2883575 CONSENSUS] (Group 6,18,30)
*[https://pubmed.ncbi.nlm.nih.gov/31535829/ DAPA-HF] (Group 7, 19, 31)
*[https://pubmed.ncbi.nlm.nih.gov/25176939/ CONFIRM-HF] (Group 8, 20, 32)
*[http://www.ncbi.nlm.nih.gov/pubmed/12457784 PROSPER] (Group 9, 21, 33)
*[http://www.ncbi.nlm.nih.gov/pubmed/27040132 HOPE-3] (Group 10, 22, 34)
*[http://www.ncbi.nlm.nih.gov/pubmed/12114036 Heart Protection Study (HPS)] (Group 11, 23, 35)
*[http://www.ncbi.nlm.nih.gov/pubmed/30415628 REDUCE-IT] (Group 12, 24, 36)

[[File:CV Case.pdf|thumb|CV case|left]]

SESSION 2

'''The Guideline Case'''

A 63 y/o patient with CHOOSE ONE (⬆︎HTN/⬆︎Chol/⬆︎glucose/HF/A fib) and using the guideline determine:
# their 5yr/10yr risks of mortality/CVD events
# the potential benefit
# the potential side effects (with magnitude)
# words/sentiment patient values and preferences/SDM

Atrial fibrillation - Groups 1,13,25,2,14,26
*[https://www.onlinecjc.ca/article/S0828-282X(18)31062-6/pdf 2018 Atrial fibrillation guidelines]
Diabetes - Groups 3,15,27,4,16,28
*[http://guidelines.diabetes.ca/docs/CPG-2018-full-EN.pdf 2018 Diabetes guidelines]
Lipid Simplified - Groups 5,17,29,6,18,30
*[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4607330/pdf/0610857.pdf 2015 Simplified lipid guidelines]
Lipid - Groups 7,19,31,8,20,32
*[http://www.onlinecjc.ca/article/S0828-282X(16)30732-2/pdf 2016 Lipid guidelines]
Heart failure - Groups 9,21,33,10,22,34
*[http://www.onlinecjc.ca/article/S0828-282X(17)30973-X/pdf 2017 Heart failure guidelines]
Hypertension - Groups 11,23,35,12,24,36
*[https://www.onlinecjc.ca/article/S0828-282X(18)30183-1/pdf 2018 Hypertension guidelines]

OPTIONAL SESSION
*[http://www.ncbi.nlm.nih.gov/pubmed/16899775 SPARCL]
*[http://www.ncbi.nlm.nih.gov/pubmed/10471456 RALES]
*[http://www.ncbi.nlm.nih.gov/pubmed/11386263 Carvedilol in heart failure]
*[http://www.ncbi.nlm.nih.gov/pubmed/18460663 WAFACS]
*[http://www.ncbi.nlm.nih.gov/pubmed/10376614 MERIT-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/25176015 PARADIGM-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/24490264 High-dose multivitamins after MI]
*[http://www.ncbi.nlm.nih.gov/pubmed/7911176 Mediterranean Diet after MI]
*[http://www.ncbi.nlm.nih.gov/pubmed/15337732 A TO Z]
*[http://www.ncbi.nlm.nih.gov/pubmed/21073363 EMPHASIS-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/12853193 COMET]
*[http://www.ncbi.nlm.nih.gov/pubmed/24716680 TOPCAT]
*[http://www.ncbi.nlm.nih.gov/pubmed/26039521 IMPROVE-IT]

'''ACADEMIC YEAR 2 - SECOND TERM'''

9) NEPHROLOGY STUDIES

None so far

10) ENDOCRINOLOGY

[[File:IA ENDO LAYOUT.pdf|thumb|IA ENDO LAYOUT TEMPLATE|none]]
[[File:Osteoporosis Evidence SUPP.pdf|none|thumb]]

'''RISK ASSESSMENT CASES FOR DIABETES AND OSTEOPOROSIS'''

'''1) DIABETES CASE'''

66 y/o white male who was diagnosed with diabetes 8 years ago

* His blood pressure over the last year has been roughly 145/80 mmHg - at present untreated
* A1c = 8%, no diabetes meds, non-smoker, BMI ~30
* '''When calculating without diabetes for PREVENT use an A1c of 5.5%'''
* Total cholesterol is 6 mmol/L, his HDL is 2 mmol/L, non-HDL = 6 minus 2, not on a statin
* No retinopathy, urine albumin-to-creatinine ratio (UACR) = 15ug/mg (7mg/mmol),
* Serum creatinine = 70 micromol/L, waist circumference 100 cm
* GFR 75 mL/min/1.73m2
* In normal sinus rhythm
* Age at end of highest education = 19
* Mother alive, father died of a heart attack at age 80

'''Calculate Risks'''

'''CVD RISK ESTIMATES''' - list the endpoints described by the specific calculator

Framingham - xx% - 10-year risk - also if no diabetes xx%

ASCVD - xx% - 10-year risk - also if no diabetes xx%

'''The Calculator'''
*CVD CALCULATOR
https://decisionaid.ca/cvd/

'''DIABETES COMPLICATIONS RISK ESTIMATES''' - list the endpoints described by the specific calculator

xx% - also 10-year risk if A1c 9, 8, 7 and 6

also get risk of kidney failure, vision loss, pressure sensation loss – also if A1c 9, 8,7,6

'''The Calculator'''
*DIABETES DECISION AID
http://decisionaid.ca/diabetes/

'''BENEFITS AND HARMS'''

Use the [https://guidelines.diabetes.ca/cpg/chapter-13-2020-update 2024 diabetes guidelines] and/or Diabetes Decision Aid to get estimates of benefits and harms and also use the MyStudies synopsis listed below

'''COSTS'''

Try using [https://pricingdoc.acfp.ca Pricing Doc] to get costs

'''Groups 1,13,25'''

* Metformin - UKPDS 34 [https://mystudies.org/studies.php#studies/28929e89-d01e-4b11-8e67-4d7086f9e4aa/outcome MyStudies Data]

'''Groups 2,14,26'''

* Sulfonlyureas - UKPDS 33 [https://mystudies.org/studies.php#studies/5eadb5dd-d403-4c13-b03e-d4f8d28c96ba/outcome MyStudies Data]

'''Groups 3,15,27'''

* Insulin - ORIGIN [https://mystudies.org/studies.php#studies/f611818f-2e69-4952-b55e-661116bd84b6/outcome MyStudies Data]

'''Groups 4,16,28'''

* SGLT2 - EMPA-REG OUTCOME [https://mystudies.org/studies.php#studies/32e9cf1a-f33e-480b-91ca-6f28a4dcf862/outcome MyStudies Data]

'''Groups 5,17,29'''

* GLP - LEADER [https://mystudies.org/studies.php#studies/1adbc9a1-7603-40f1-ac15-b813ce1f0ad6/outcome MyStudies Data]

'''Groups 6,18,30'''

* DPP4 - TECOS [https://mystudies.org/studies.php#studies/8659968a-cefb-4f99-b4ae-8b9b659acbd5/outcome MyStudies Data]

'''Groups 7,19,31'''

* Intensive treatment – small scale - STENO [https://mystudies.org/studies.php#studies/39d423e3-af57-40c8-ab7a-cbc7f389bdb6/paper MyStudies Data]

'''Groups 8,20,32'''

* Intensive treatment – large scale - ADDITION-Europe - [https://mystudies.org/studies.php#studies/5e07d86d-aa92-4db9-a283-76080db4b6fd/outcome MyStudies Data]

'''2) OSTEOPOROSIS CASE'''

60 y/o female

* 72 kg, 1.69m, BMI = 25.2
* t-score of -2.5
* Worried about falling and getting a hip fracture
* A friend recently had an atraumatic fracture from simply tripping and falling over in the snow
* No other risk factors

'''Calculate Risks'''

'''FRACTURE RISK ESTIMATES''' - list the endpoints described by the specific calculator

Major osteoporotic fracture - xx% - 10-year risk – if no BMD (just BMI), and then if they had a BMD t-Score of -2.0, -2.5, and -3.0

Hip fracture - - xx% - 10-year risk – if no BMD (just BMI) and if you have a BMD xx% - 10-year risk – if no BMD, and then if they had a BMD T-Score of -2.0, -2.5, and -3.0

'''The Calculator'''

* FRACTURE CALCULATOR

[https://frax.shef.ac.uk/frax/tool.aspx?country=19 Frax Tool - Canada]

'''BENEFITS AND HARMS'''

Use the [https://www.cmaj.ca/content/195/39/E1333 2023 Osteoporosis Guideline] and/or your osteoporosis lecture notes to get the benefits and apply these to your patient, and also get the harms

'''COSTS'''

Try using [https://pricingdoc.acfp.ca Pricing Doc] to get costs

'''Groups 9,21,33'''

* Activity

'''Groups 10,22,34'''

* Calcium/Vitamin D

'''Groups 11,23,35'''

* Bisphosphonates

'''Groups 12,24,36'''

* Denosumab

11) NEUROLOGY STUDIES

*[http://www.ncbi.nlm.nih.gov/pubmed/16717269 Opioids for chronic non-cancer pain] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/29509867 Effect of Opioid vs Nonopioid Medications on Pain-Related Function in Patients With Chronic Back Pain] Groups 2,14,26
*[https://www.ncbi.nlm.nih.gov/pubmed/31291515 Galcanezumab for prevention of cluster headaches] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/27150433 Immediate or delayed treatment of a first seizure] Groups 4,16,28
*[https://www.ncbi.nlm.nih.gov/pubmed/31291516 Rimegepant for episodic migraine] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/26212846 Sleep restriction for insomnia] Groups 6,18,30
*[https://www.ncbi.nlm.nih.gov/pubmed/25957224 CHANCE] Groups 7,19,31
*[https://www.ncbi.nlm.nih.gov/pubmed/16899775 SPARCL] Groups 8,20,32
*[https://www.ncbi.nlm.nih.gov/pubmed/29171821 Erenumab for episodic migraine] Groups 9,21,33
*[https://www.ncbi.nlm.nih.gov/pubmed/24733354 Reduction of benzodiazepines through education] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/26035341 Patient controlled opioid analgesia versus non-patient controlled opioid analgesia for postoperative pain] Groups 11,23,35
*[https://www.ncbi.nlm.nih.gov/pubmed/11589932 PROGRESS] Groups 12,24,36

'''ACADEMIC YEAR 3'''

12) PSYCHIATRY STUDIES

[[:File:2021 Psych Evidence Appraisal - Intro Slides.pdf|Psychiatry Rating Scales Introduction]]

* Study 1: [http://www.ncbi.nlm.nih.gov/pubmed/16554525 STAR*D (Level 2)] Bupropion-SR, sertraline, or venlafaxine-XR after failure of SSRIs for depression
* Study 2: [http://www.ncbi.nlm.nih.gov/pubmed/29477251 Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder]
* Study 3: [https://pubmed.ncbi.nlm.nih.gov/33862018/ Long-acting injectable versus oral antipsychotics for the maintenance treatment of schizophrenia]
* Study 4: [https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2725088 Association of Antipsychotic Polypharmacy vs Monotherapy With Psychiatric Rehospitalization Among Adults With Schizophrenia]
* Study 5: [https://www.ncbi.nlm.nih.gov/pubmed/29490359 Real-world Effectiveness of Pharmacologic Treatments for the Prevention of Bipolar Disorder]
* Study 6: [http://www.ncbi.nlm.nih.gov/pubmed/20092882 BALANCE] Combination lithium and valproate therapy versus monotherapy for relapse prevention in bipolar I disorder
[[File:ChatGPT directions.jpg|thumb|ChatGPT Directions]]
13) GASTROENTEROLOGY STUDIES - LINKS ON CANVAS

*Short-term treatment for gastro-oesophageal reflux disease-like symptoms and endoscopy negative reflux disease (Review)
*Oral budesonide for induction of remission in ulcerative colitis (Review)
*Probiotics for the prevention of Clostridium difficile-associated diarrhea in adults and children (Review)
*Deprescribing versus continuation of chronic proton pump inhibitor use in adults (Review)
*Prevention of NSAID-induced gastroduodenal ulcers (Review)
*Methotrexate for maintenance of remission in Crohn's disease (Review)

14) OB/GYN STUDIES
*[http://www.ncbi.nlm.nih.gov/pubmed/25601350 Comparative contraceptive effectiveness of levonorgestrel-releasing and copper IUD Devices]
*[http://www.ncbi.nlm.nih.gov/pubmed/29211679 Hormonal contraception and the risk of breast cancer]
*[http://www.ncbi.nlm.nih.gov/pubmed/30322986 Sexual behaviours in adolescent girls before and after introduction of the HPV]
*[http://www.ncbi.nlm.nih.gov/pubmed/30181338 Intramuscular vs intravenous oxytocin to prevent postpartum haemorrhage at vaginal delivery]
*[http://www.ncbi.nlm.nih.gov/pubmed/27682034 Azithromycin Prophylaxis for Cesarean Delivery]
*[http://www.ncbi.nlm.nih.gov/pubmed/28461374 Antibiotics during pregnancy and risk of spontaneous abortion]

Evidence Appraisal Integrated Activities

2025-02-04T19:26:44Z

JamesMcCormack:

'''OBJECTIVE'''

To critically appraise studies, develop a brief synopsis of the trial results, succinctly present the results and then put the results into a proper clinical context

'''INITIAL PRE-READING'''

'''How To Critically Appraise an RCT In 10 minutes'''
*[https://itunes.apple.com/ca/book/how-to-critically-appraise/id524600667?mt=11 iBook/iPad version]
*[https://therapeuticseducation.org/sites/therapeuticseducation.org/files/Ten_Minute_Critical_Appraisal.pdf PDF version]
Watch this video
[http://youtu.be/QUW0Q8tXVUc Viva La Evidence]

'''Study Results at Your Fingertips'''
*[https://mystudies.org MyStudies] - Free access

'''INTEGRATION ACTIVITY FORMAT'''
# Students placed in groups of ~ 5-7
# Each group is given one of the studies below to review
# Students then work in pairs and develop a one-slide critical appraisal and results synopsis
# One student in each group will be chosen at random to present their group findings to the class
# A discussion about the appraisal and the appropriate clinical context for the results is had with the entire class for each study

'''MODULE'''
[[File:Screen Shot 2022-01-09 at 10.00.16 AM.jpg|thumb|'''TRIAL PRESENTATION FORMAT'''|none]]

Studies chosen include landmark studies and/or studies that address important therapeutic issues for the particular module

'''ACADEMIC YEAR 1 - FIRST TERM'''

1) FOUNDATION STUDIES (Groups)
*[https://pubmed.ncbi.nlm.nih.gov/37952131 SELECT] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/12466506 AFFIRM] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/22085343 AIM-HIGH] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/10639539 HOPE] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/18378519 HYVET] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/15007110 PROVE-IT] Groups 6,18,30
*[http://www.ncbi.nlm.nih.gov/pubmed/15755765 TNT] Groups 7,19,31
*[https://pubmed.ncbi.nlm.nih.gov/26378978 EMPAREG] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/17984165 ILLUMINATE] Groups 9,21,33
*[https://pubmed.ncbi.nlm.nih.gov/26551272/ SPRINT] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/15325833 CARDS] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/12117397 WHI] Groups 12,24,36

'''ACADEMIC YEAR 1 - SECOND TERM'''

2) INTRO TO INFECTIOUS DISEASE STUDIES

[https://wiki.ubc.ca/images/8/8b/Antibiotic_Sensitivity_Chart_2024.pdf The "Best" Antibiotic Sensitivity Chart Ever]
*[http://www.ncbi.nlm.nih.gov/pubmed/17567657 IV vs PO antibiotics] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/24603565 Delayed antibiotics for respiratory tract infections] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/11159657 Delayed antibiotics for otitis media] Groups 3,15,27
*[https://pubmed.ncbi.nlm.nih.gov/27455166/ Duration of treatment for community acquired pneumonia] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/22726802 Duration of treatment for pyelonephritis] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/25830421 Choice of antibiotic for community acquired pneumonia-1] Groups 6,18,30
*[http://www.ncbi.nlm.nih.gov/pubmed/25286173 Choice of antibiotic for community acquired pneumonia-2] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/20647284 HPV vaccine study] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/7966893 Influenza vaccine study] Groups 9,21,33
*[https://pubmed.ncbi.nlm.nih.gov/33301246/ COVID vaccine Pfizer] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/27626517 Herpes zoster vaccine study 1] Groups 11,23,35
*[https://www.ncbi.nlm.nih.gov/pubmed/25916341 Herpes zoster vaccine study 2] Groups 12,24,36

3) MUSCULOSKELETAL STUDIES

*[http://www.ncbi.nlm.nih.gov/pubmed/28199814 Baricitinib versus Placebo or Adalimumab in Rheumatoid Arthritis] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/0010979111 CLASS – celecoxib vs NSAIDs] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/26501533 Naproxen with cyclobenzaprine, oxycodone/acetaminophen, or placebo for low back pain] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/24395557 Glucosamine and chondroitin for OA] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/12546607 Acetaminophen vs diclofenac for OA] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/23964752 Diclofenac gel for acute neck pain] Groups 6,18,30
*[https://pubmed.ncbi.nlm.nih.gov/15468367/ Topical diclofenac vs oral diclofenac] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/25064594 Acetaminophen for low back pain] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/7611589 Misoprostol and NSAID induced ulcers] Groups 9,21,33
*[http://www.ncbi.nlm.nih.gov/pubmed/20131255 Low dose vs high dose colchicine for gout] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/22508468 TEAR - oral triple therapy versus etanercept plus methotrexate in early aggressive rheumatoid arthritis] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/25589511 MOVES - Glucosamine and chondroitin for OA for moderate to severe pain] Groups 12,24,36

4) DERMATOLOGY STUDIES

*[https://www.ncbi.nlm.nih.gov/pubmed/9598014 Glycolic acid 5% Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/21896132 Glycolic acid 10% Acne]
*[https://www.ncbi.nlm.nih.gov/pubmed/14531866 Petrolatum vs Ceramide/skin related lipids Hand Dermatitis]
*[https://www.ncbi.nlm.nih.gov/pubmed/11896774 Vitamin C Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/17515510 Retinol (VitaminA) Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/21896129 Hyaluronic acid Atopic Dermatitis]

5) EENT STUDIES

[http://www.amstar.ca/docs/AMSTARguideline.pdf AMSTAR meta-analysis checklist]

'''Scenario 1 - Otitis Media''' - GROUPS 1, 7, 18, 19, 25, 36

Anthony Martin arrives at your pharmacy somewhat frustrated since his family physician declined to write an antibiotic prescription for his two and half year old son, Oscar. His symptoms started yesterday afternoon - Oscar complains of right ear pain but there is no discharge. Rectal temperature taken today was 38.5 degrees. His wife is sure Oscar has an ear infection since the last time he had these same symptoms, that was ultimately the diagnosis. Mr. Martin asks if you think buying acetaminophen is really “enough”?

[https://pubmed.ncbi.nlm.nih.gov/26099233/ Antibiotics for acute otitis media in children]

'''Scenario 2 - Allergic Rhinitis''' - GROUPS 2, 8, 17, 20, 26, 35

Ruby Parmar is a firefighter. She is plagued by sinus congestion (preventing her from sleeping) and a runny nose associated with seasonal allergies. Her prescription for intranasal triamcinolone is typically effective, but she would like to know if a non-sedating anti-allergy pill would work just as well since it’s inconvenient carrying around the “nose spray”.

[https://www.ncbi.nlm.nih.gov/pubmed/28234147 Intranasal steroids vs antihistamines for allergic rhinitis]

'''Scenario 3 - Acute Sinusitis''' - GROUPS 3, 9, 16, 21, 27, 34

You are seeing a patient in clinic before her appointment with the primary care physician. She was feeling unwell with a “flu” last week. While most of her symptoms have resolved (cough, fever), the nasal congestion and discharge persists and so she has made an appointment (she is an otherwise healthy 32 year old with treated thyroid disease). She would like your advice for what treatment she should ask the doctor to prescribe.

[http://www.ncbi.nlm.nih.gov/pubmed/24293353 Intranasal steroids for acute sinusitis]

'''Scenario 4 - Glaucoma''' - GROUPS 4, 10, 15, 22, 28, 33

Mrs. Ada Waters is a 63 year-old woman you. Her ophthalmologist prescribed timolol and xalatan eye drops for treatment of open angle glaucoma. She has never really felt much different on treatment since she recovered from her first episode (of acute angle closure glaucoma requiring ER visit) and surgery. She asks you if the treatment is really making a difference.

[https://www.ncbi.nlm.nih.gov/pubmed/17943780 Interventions for open angle glaucoma]

'''Scenario 5 - Sore Throat''' - GROUPS 5, 11, 14, 23, 29, 32

You have a good friend who is applying for pharmacy. Her invitation for the multiple-mini interview (MMI) is coming up soon, but she is starting to experience a sore throat. While she is worried about not being able to speak through all of those stations, she knows she often gets a terrible headache along with her sore throat. She has an unused prescription for amoxicillin (unexpired) and wonders if you recommend for her to take it.

[https://pubmed.ncbi.nlm.nih.gov/34881426/ Antibiotics for sore throat]

'''Scenario 6 - Conjunctivitis''' - GROUPS 6, 12, 13, 24, 30, 31

A man comes to your pharmacy (he appears in his early twenties) complaining of “pink eye”. He has had a pink discolouration and discharge from his left eye for two days. He asks if the OTC antibiotic eye drops (he’s holding a product with polymixin B) are any better than “waiting it out”.

[https://www.ncbi.nlm.nih.gov/pubmed/22972049 Antibiotics for acute conjunctivitis]

6) HEMATOLOGY STUDIES

None so far

'''ACADEMIC YEAR 2 - FIRST TERM'''

7) RESPIROLOGY STUDIES
[[File:IA COPD info.pdf|thumb]]

*[http://www.ncbi.nlm.nih.gov/pubmed/2062329 First inhaled steroid study] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/22938706 Tiotropium in asthma] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/21324520 Inhaled steroid in children] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/29768149 Combined Budesonide–Formoterol as Needed in Mild Asthma] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/15223858 Doubling dose of inhaled corticosteroid] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/29768147 As-Needed Budesonide–Formoterol versus Maintenance Budesonide in Mild Asthma] Groups 6,18,30
*[http://www.ncbi.nlm.nih.gov/pubmed/27181606 Indacaterol-glycopyrronium VS salmeterol/fluticasone in COPD] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/21428765 Tiotropium VS salmeterol in COPD] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/23695200 Short VS long steroids for COPD exacerbation] Groups 9,21,33
*[http://www.ncbi.nlm.nih.gov/pubmed/25196117 Stopping inhaled steroids in COPD] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/29668352 Once-Daily Single-Inhaler Triple versus Dual Therapy in Patients with COPD] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/28877011 Tezepelumab in Adults with Uncontrolled Asthma] Groups 12,24,36

8) CARDIOVASCULAR STUDIES

SESSION 1

*[https://www.ncbi.nlm.nih.gov/pubmed/4862069 VA1] (Group 1, 13, 25)
*[https://www.ncbi.nlm.nih.gov/pubmed/4914579 VA 2] (Group 2, 14, 26)
*[https://pubmed.ncbi.nlm.nih.gov/33186492 Polycap Study 3] (Group 3, 15, 27)
*[http://www.ncbi.nlm.nih.gov/pubmed/20228401 ACCORD-BP] (Group 4, 16, 28)
*[https://www.ncbi.nlm.nih.gov/pubmed/26551272 SPRINT] (Group 5, 17, 29)
*[http://www.ncbi.nlm.nih.gov/pubmed/2883575 CONSENSUS] (Group 6,18,30)
*[https://pubmed.ncbi.nlm.nih.gov/31535829/ DAPA-HF] (Group 7, 19, 31)
*[https://pubmed.ncbi.nlm.nih.gov/25176939/ CONFIRM-HF] (Group 8, 20, 32)
*[http://www.ncbi.nlm.nih.gov/pubmed/12457784 PROSPER] (Group 9, 21, 33)
*[http://www.ncbi.nlm.nih.gov/pubmed/27040132 HOPE-3] (Group 10, 22, 34)
*[http://www.ncbi.nlm.nih.gov/pubmed/12114036 Heart Protection Study (HPS)] (Group 11, 23, 35)
*[http://www.ncbi.nlm.nih.gov/pubmed/30415628 REDUCE-IT] (Group 12, 24, 36)

[[File:CV Case.pdf|thumb|CV case|left]]

SESSION 2

'''The Guideline Case'''

A 63 y/o patient with CHOOSE ONE (⬆︎HTN/⬆︎Chol/⬆︎glucose/HF/A fib) and using the guideline determine:
# their 5yr/10yr risks of mortality/CVD events
# the potential benefit
# the potential side effects (with magnitude)
# words/sentiment patient values and preferences/SDM

Atrial fibrillation - Groups 1,13,25,2,14,26
*[https://www.onlinecjc.ca/article/S0828-282X(18)31062-6/pdf 2018 Atrial fibrillation guidelines]
Diabetes - Groups 3,15,27,4,16,28
*[http://guidelines.diabetes.ca/docs/CPG-2018-full-EN.pdf 2018 Diabetes guidelines]
Lipid Simplified - Groups 5,17,29,6,18,30
*[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4607330/pdf/0610857.pdf 2015 Simplified lipid guidelines]
Lipid - Groups 7,19,31,8,20,32
*[http://www.onlinecjc.ca/article/S0828-282X(16)30732-2/pdf 2016 Lipid guidelines]
Heart failure - Groups 9,21,33,10,22,34
*[http://www.onlinecjc.ca/article/S0828-282X(17)30973-X/pdf 2017 Heart failure guidelines]
Hypertension - Groups 11,23,35,12,24,36
*[https://www.onlinecjc.ca/article/S0828-282X(18)30183-1/pdf 2018 Hypertension guidelines]

OPTIONAL SESSION
*[http://www.ncbi.nlm.nih.gov/pubmed/16899775 SPARCL]
*[http://www.ncbi.nlm.nih.gov/pubmed/10471456 RALES]
*[http://www.ncbi.nlm.nih.gov/pubmed/11386263 Carvedilol in heart failure]
*[http://www.ncbi.nlm.nih.gov/pubmed/18460663 WAFACS]
*[http://www.ncbi.nlm.nih.gov/pubmed/10376614 MERIT-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/25176015 PARADIGM-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/24490264 High-dose multivitamins after MI]
*[http://www.ncbi.nlm.nih.gov/pubmed/7911176 Mediterranean Diet after MI]
*[http://www.ncbi.nlm.nih.gov/pubmed/15337732 A TO Z]
*[http://www.ncbi.nlm.nih.gov/pubmed/21073363 EMPHASIS-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/12853193 COMET]
*[http://www.ncbi.nlm.nih.gov/pubmed/24716680 TOPCAT]
*[http://www.ncbi.nlm.nih.gov/pubmed/26039521 IMPROVE-IT]

'''ACADEMIC YEAR 2 - SECOND TERM'''

9) NEPHROLOGY STUDIES

None so far

10) ENDOCRINOLOGY

[[File:IA ENDO LAYOUT.pdf|thumb|IA ENDO LAYOUT TEMPLATE|none]]
[[File:Osteoporosis Evidence SUPP.pdf|none|thumb]]

'''RISK ASSESSMENT CASES FOR DIABETES AND OSTEOPOROSIS'''

'''1) DIABETES CASE'''

66 y/o white male who was diagnosed with diabetes 8 years ago

* His blood pressure over the last year has been roughly 145/80 mmHg - at present untreated
* A1c = 8%, no diabetes meds, non-smoker, BMI ~30
* '''When calculating without diabetes for PREVENT use an A1c of 5.5%'''
* Total cholesterol is 6 mmol/L, his HDL is 2 mmol/L, non-HDL = 6 minus 2, not on a statin
* No retinopathy, urine albumin-to-creatinine ratio (UACR) = 15ug/mg (7mg/mmol),
* Serum creatinine = 70 micromol/L, waist circumference 100 cm
* GFR 75 mL/min/1.73m2
* In normal sinus rhythm
* Age at end of highest education = 19
* Mother alive, father died of a heart attack at age 80

'''Calculate Risks'''

'''CVD RISK ESTIMATES''' - list the endpoints described by the specific calculator

Framingham - xx% - 10-year risk - also if no diabetes xx%

ASCVD - xx% - 10-year risk - also if no diabetes xx%

'''The Calculator'''
*CVD CALCULATOR
https://decisionaid.ca/cvd/

'''DIABETES COMPLICATIONS RISK ESTIMATES''' - list the endpoints described by the specific calculator

xx% - also 10-year risk if A1c 9, 8, 7 and 6

also get risk of kidney failure, vision loss, pressure sensation loss – also if A1c 9, 8,7,6

'''The Calculator'''
*DIABETES DECISION AID
http://decisionaid.ca/diabetes/

'''BENEFITS AND HARMS'''

Use the [https://guidelines.diabetes.ca/cpg/chapter-13-2020-update 2024 diabetes guidelines] and/or Diabetes Decision Aid to get estimates of benefits and harms and also use the MyStudies synopsis listed below

'''COSTS'''

Try using [https://pricingdoc.acfp.ca Pricing Doc] to get costs

'''Groups 1,13,25'''

* Metformin - UKPDS 34 [https://mystudies.org/studies.php#studies/28929e89-d01e-4b11-8e67-4d7086f9e4aa/outcome MyStudies Data]

'''Groups 2,14,26'''

* Sulfonlyureas - UKPDS 33 [https://mystudies.org/studies.php#studies/5eadb5dd-d403-4c13-b03e-d4f8d28c96ba/outcome MyStudies Data]

'''Groups 3,15,27'''

* Insulin - ORIGIN [https://mystudies.org/studies.php#studies/f611818f-2e69-4952-b55e-661116bd84b6/outcome MyStudies Data]

'''Groups 4,16,28'''

* SGLT2 - EMPA-REG OUTCOME [https://mystudies.org/studies.php#studies/32e9cf1a-f33e-480b-91ca-6f28a4dcf862/outcome MyStudies Data]

'''Groups 5,17,29'''

* GLP - LEADER [https://mystudies.org/studies.php#studies/1adbc9a1-7603-40f1-ac15-b813ce1f0ad6/outcome MyStudies Data]

'''Groups 6,18,30'''

* DPP4 - TECOS [https://mystudies.org/studies.php#studies/8659968a-cefb-4f99-b4ae-8b9b659acbd5/outcome MyStudies Data]

'''Groups 7,19,31'''

* Intensive treatment – small scale - STENO [https://mystudies.org/studies.php#studies/39d423e3-af57-40c8-ab7a-cbc7f389bdb6/paper MyStudies Data]

'''Groups 8,20,32'''

* Intensive treatment – large scale - ADDITION-Europe - [https://mystudies.org/studies.php#studies/5e07d86d-aa92-4db9-a283-76080db4b6fd/outcome MyStudies Data]

'''2) OSTEOPOROSIS CASE'''

60 y/o female

* 72 kg, 1.69m, BMI = 25.2
* t-score of -2.5
* Worried about falling and getting a hip fracture
* A friend recently had an atraumatic fracture from simply tripping and falling over in the snow
* No other risk factors

'''Calculate Risks'''

'''FRACTURE RISK ESTIMATES''' - list the endpoints described by the specific calculator

Major osteoporotic fracture - xx% - 10-year risk – if no BMD (just BMI), and then if they had a BMD t-Score of -2.0, -2.5, and -3.0

Hip fracture - - xx% - 10-year risk – if no BMD (just BMI) and if you have a BMD xx% - 10-year risk – if no BMD, and then if they had a BMD T-Score of -2.0, -2.5, and -3.0

'''The Calculator'''

* FRACTURE CALCULATOR

[https://frax.shef.ac.uk/frax/tool.aspx?country=19 Frax Tool - Canada]

'''BENEFITS AND HARMS'''

Use the [https://www.cmaj.ca/content/195/39/E1333 2023 Osteoporosis Guideline] and/or your osteoporosis lecture notes to get the benefits and apply these to your patient, and also get the harms

'''COSTS'''

Try using [https://pricingdoc.acfp.ca Pricing Doc] to get costs

'''Groups 9,21,33'''

* Activity

'''Groups 10,22,34'''

* Calcium/Vitamin D

'''Groups 11,23,35'''

* Bisphosphonates

'''Groups 12,24,36'''

* Denosumab

11) NEUROLOGY STUDIES

*[http://www.ncbi.nlm.nih.gov/pubmed/16717269 Opioids for chronic non-cancer pain] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/29509867 Effect of Opioid vs Nonopioid Medications on Pain-Related Function in Patients With Chronic Back Pain] Groups 2,14,26
*[https://www.ncbi.nlm.nih.gov/pubmed/31291515 Galcanezumab for prevention of cluster headaches] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/27150433 Immediate or delayed treatment of a first seizure] Groups 4,16,28
*[https://www.ncbi.nlm.nih.gov/pubmed/31291516 Rimegepant for episodic migraine] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/26212846 Sleep restriction for insomnia] Groups 6,18,30
*[https://www.ncbi.nlm.nih.gov/pubmed/25957224 CHANCE] Groups 7,19,31
*[https://www.ncbi.nlm.nih.gov/pubmed/16899775 SPARCL] Groups 8,20,32
*[https://www.ncbi.nlm.nih.gov/pubmed/29171821 Erenumab for episodic migraine] Groups 9,21,33
*[https://www.ncbi.nlm.nih.gov/pubmed/24733354 Reduction of benzodiazepines through education] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/26035341 Patient controlled opioid analgesia versus non-patient controlled opioid analgesia for postoperative pain] Groups 11,23,35
*[https://www.ncbi.nlm.nih.gov/pubmed/11589932 PROGRESS] Groups 12,24,36

'''ACADEMIC YEAR 3'''

12) PSYCHIATRY STUDIES

[[:File:2021 Psych Evidence Appraisal - Intro Slides.pdf|Psychiatry Rating Scales Introduction]]

* Study 1: [http://www.ncbi.nlm.nih.gov/pubmed/16554525 STAR*D (Level 2)] Bupropion-SR, sertraline, or venlafaxine-XR after failure of SSRIs for depression
* Study 2: [http://www.ncbi.nlm.nih.gov/pubmed/29477251 Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder]
* Study 3: [https://pubmed.ncbi.nlm.nih.gov/33862018/ Long-acting injectable versus oral antipsychotics for the maintenance treatment of schizophrenia]
* Study 4: [https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2725088 Association of Antipsychotic Polypharmacy vs Monotherapy With Psychiatric Rehospitalization Among Adults With Schizophrenia]
* Study 5: [https://www.ncbi.nlm.nih.gov/pubmed/29490359 Real-world Effectiveness of Pharmacologic Treatments for the Prevention of Bipolar Disorder]
* Study 6: [http://www.ncbi.nlm.nih.gov/pubmed/20092882 BALANCE] Combination lithium and valproate therapy versus monotherapy for relapse prevention in bipolar I disorder
[[File:ChatGPT directions.jpg|thumb|ChatGPT Directions]]
13) GASTROENTEROLOGY STUDIES - LINKS ON CANVAS

*Short-term treatment for gastro-oesophageal reflux disease-like symptoms and endoscopy negative reflux disease (Review)
*Oral budesonide for induction of remission in ulcerative colitis (Review)
*Probiotics for the prevention of Clostridium difficile-associated diarrhea in adults and children (Review)
*Deprescribing versus continuation of chronic proton pump inhibitor use in adults (Review)
*Prevention of NSAID-induced gastroduodenal ulcers (Review)
*Methotrexate for maintenance of remission in Crohn's disease (Review)

14) OB/GYN STUDIES
*[http://www.ncbi.nlm.nih.gov/pubmed/25601350 Comparative contraceptive effectiveness of levonorgestrel-releasing and copper IUD Devices]
*[http://www.ncbi.nlm.nih.gov/pubmed/29211679 Hormonal contraception and the risk of breast cancer]
*[http://www.ncbi.nlm.nih.gov/pubmed/30322986 Sexual behaviours in adolescent girls before and after introduction of the HPV]
*[http://www.ncbi.nlm.nih.gov/pubmed/30181338 Intramuscular vs intravenous oxytocin to prevent postpartum haemorrhage at vaginal delivery]
*[http://www.ncbi.nlm.nih.gov/pubmed/27682034 Azithromycin Prophylaxis for Cesarean Delivery]
*[http://www.ncbi.nlm.nih.gov/pubmed/28461374 Antibiotics during pregnancy and risk of spontaneous abortion]

Evidence Appraisal Integrated Activities

2025-02-04T19:26:20Z

JamesMcCormack:

'''OBJECTIVE'''

To critically appraise studies, develop a brief synopsis of the trial results, succinctly present the results and then put the results into a proper clinical context

'''INITIAL PRE-READING'''

'''How To Critically Appraise an RCT In 10 minutes'''
*[https://itunes.apple.com/ca/book/how-to-critically-appraise/id524600667?mt=11 iBook/iPad version]
*[https://therapeuticseducation.org/sites/therapeuticseducation.org/files/Ten_Minute_Critical_Appraisal.pdf PDF version]
Watch this video
[http://youtu.be/QUW0Q8tXVUc Viva La Evidence]

'''Study Results at Your Fingertips'''
*[https://mystudies.org MyStudies] - Free access

'''INTEGRATION ACTIVITY FORMAT'''
# Students placed in groups of ~ 5-7
# Each group is given one of the studies below to review
# Students then work in pairs and develop a one-slide critical appraisal and results synopsis
# One student in each group will be chosen at random to present their group findings to the class
# A discussion about the appraisal and the appropriate clinical context for the results is had with the entire class for each study

'''MODULE'''
[[File:Screen Shot 2022-01-09 at 10.00.16 AM.jpg|thumb|'''TRIAL PRESENTATION FORMAT'''|none]]

Studies chosen include landmark studies and/or studies that address important therapeutic issues for the particular module

'''ACADEMIC YEAR 1 - FIRST TERM'''

1) FOUNDATION STUDIES (Groups)
*[https://pubmed.ncbi.nlm.nih.gov/37952131 SELECT] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/12466506 AFFIRM] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/22085343 AIM-HIGH] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/10639539 HOPE] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/18378519 HYVET] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/15007110 PROVE-IT] Groups 6,18,30
*[http://www.ncbi.nlm.nih.gov/pubmed/15755765 TNT] Groups 7,19,31
*[https://pubmed.ncbi.nlm.nih.gov/26378978 EMPAREG] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/17984165 ILLUMINATE] Groups 9,21,33
*[https://pubmed.ncbi.nlm.nih.gov/26551272/ SPRINT] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/15325833 CARDS] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/12117397 WHI] Groups 12,24,36

'''ACADEMIC YEAR 1 - SECOND TERM'''

2) INTRO TO INFECTIOUS DISEASE STUDIES

[https://wiki.ubc.ca/images/8/8b/Antibiotic_Sensitivity_Chart_2024.pdf The "Best" Antibiotic Sensitivity Chart Ever]
*[http://www.ncbi.nlm.nih.gov/pubmed/17567657 IV vs PO antibiotics] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/24603565 Delayed antibiotics for respiratory tract infections] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/11159657 Delayed antibiotics for otitis media] Groups 3,15,27
*[https://pubmed.ncbi.nlm.nih.gov/27455166/ Duration of treatment for community acquired pneumonia] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/22726802 Duration of treatment for pyelonephritis] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/25830421 Choice of antibiotic for community acquired pneumonia-1] Groups 6,18,30
*[http://www.ncbi.nlm.nih.gov/pubmed/25286173 Choice of antibiotic for community acquired pneumonia-2] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/20647284 HPV vaccine study] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/7966893 Influenza vaccine study] Groups 9,21,33
*[https://pubmed.ncbi.nlm.nih.gov/33301246/ COVID vaccine Pfizer] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/27626517 Herpes zoster vaccine study 1] Groups 11,23,35
*[https://www.ncbi.nlm.nih.gov/pubmed/25916341 Herpes zoster vaccine study 2] Groups 12,24,36

3) MUSCULOSKELETAL STUDIES

*[http://www.ncbi.nlm.nih.gov/pubmed/28199814 Baricitinib versus Placebo or Adalimumab in Rheumatoid Arthritis] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/0010979111 CLASS – celecoxib vs NSAIDs] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/26501533 Naproxen with cyclobenzaprine, oxycodone/acetaminophen, or placebo for low back pain] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/24395557 Glucosamine and chondroitin for OA] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/12546607 Acetaminophen vs diclofenac for OA] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/23964752 Diclofenac gel for acute neck pain] Groups 6,18,30
*[https://pubmed.ncbi.nlm.nih.gov/15468367/ Topical diclofenac vs oral diclofenac] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/25064594 Acetaminophen for low back pain] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/7611589 Misoprostol and NSAID induced ulcers] Groups 9,21,33
*[http://www.ncbi.nlm.nih.gov/pubmed/20131255 Low dose vs high dose colchicine for gout] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/22508468 TEAR - oral triple therapy versus etanercept plus methotrexate in early aggressive rheumatoid arthritis] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/25589511 MOVES - Glucosamine and chondroitin for OA for moderate to severe pain] Groups 12,24,36

4) DERMATOLOGY STUDIES

*[https://www.ncbi.nlm.nih.gov/pubmed/9598014 Glycolic acid 5% Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/21896132 Glycolic acid 10% Acne]
*[https://www.ncbi.nlm.nih.gov/pubmed/14531866 Petrolatum vs Ceramide/skin related lipids Hand Dermatitis]
*[https://www.ncbi.nlm.nih.gov/pubmed/11896774 Vitamin C Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/17515510 Retinol (VitaminA) Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/21896129 Hyaluronic acid Atopic Dermatitis]

5) EENT STUDIES

[http://www.amstar.ca/docs/AMSTARguideline.pdf AMSTAR meta-analysis checklist]

'''Scenario 1 - Otitis Media''' - GROUPS 1, 7, 18, 19, 25, 36

Anthony Martin arrives at your pharmacy somewhat frustrated since his family physician declined to write an antibiotic prescription for his two and half year old son, Oscar. His symptoms started yesterday afternoon - Oscar complains of right ear pain but there is no discharge. Rectal temperature taken today was 38.5 degrees. His wife is sure Oscar has an ear infection since the last time he had these same symptoms, that was ultimately the diagnosis. Mr. Martin asks if you think buying acetaminophen is really “enough”?

[https://pubmed.ncbi.nlm.nih.gov/26099233/ Antibiotics for acute otitis media in children]

'''Scenario 2 - Allergic Rhinitis''' - GROUPS 2, 8, 17, 20, 26, 35

Ruby Parmar is a firefighter. She is plagued by sinus congestion (preventing her from sleeping) and a runny nose associated with seasonal allergies. Her prescription for intranasal triamcinolone is typically effective, but she would like to know if a non-sedating anti-allergy pill would work just as well since it’s inconvenient carrying around the “nose spray”.

[https://www.ncbi.nlm.nih.gov/pubmed/28234147 Intranasal steroids vs antihistamines for allergic rhinitis]

'''Scenario 3 - Acute Sinusitis''' - GROUPS 3, 9, 16, 21, 27, 34

You are seeing a patient in clinic before her appointment with the primary care physician. She was feeling unwell with a “flu” last week. While most of her symptoms have resolved (cough, fever), the nasal congestion and discharge persists and so she has made an appointment (she is an otherwise healthy 32 year old with treated thyroid disease). She would like your advice for what treatment she should ask the doctor to prescribe.

[http://www.ncbi.nlm.nih.gov/pubmed/24293353 Intranasal steroids for acute sinusitis]

'''Scenario 4 - Glaucoma''' - GROUPS 4, 10, 15, 22, 28, 33

Mrs. Ada Waters is a 63 year-old woman you. Her ophthalmologist prescribed timolol and xalatan eye drops for treatment of open angle glaucoma. She has never really felt much different on treatment since she recovered from her first episode (of acute angle closure glaucoma requiring ER visit) and surgery. She asks you if the treatment is really making a difference.

[https://www.ncbi.nlm.nih.gov/pubmed/17943780 Interventions for open angle glaucoma]

'''Scenario 5 - Sore Throat''' - GROUPS 5, 11, 14, 23, 29, 32

You have a good friend who is applying for pharmacy. Her invitation for the multiple-mini interview (MMI) is coming up soon, but she is starting to experience a sore throat. While she is worried about not being able to speak through all of those stations, she knows she often gets a terrible headache along with her sore throat. She has an unused prescription for amoxicillin (unexpired) and wonders if you recommend for her to take it.

[https://pubmed.ncbi.nlm.nih.gov/34881426/ Antibiotics for sore throat]

'''Scenario 6 - Conjunctivitis''' - GROUPS 6, 12, 13, 24, 30, 31

A man comes to your pharmacy (he appears in his early twenties) complaining of “pink eye”. He has had a pink discolouration and discharge from his left eye for two days. He asks if the OTC antibiotic eye drops (he’s holding a product with polymixin B) are any better than “waiting it out”.

[https://www.ncbi.nlm.nih.gov/pubmed/22972049 Antibiotics for acute conjunctivitis]

6) HEMATOLOGY STUDIES

None so far

'''ACADEMIC YEAR 2 - FIRST TERM'''

7) RESPIROLOGY STUDIES
[[File:IA COPD info.pdf|thumb]]

*[http://www.ncbi.nlm.nih.gov/pubmed/2062329 First inhaled steroid study] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/22938706 Tiotropium in asthma] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/21324520 Inhaled steroid in children] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/29768149 Combined Budesonide–Formoterol as Needed in Mild Asthma] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/15223858 Doubling dose of inhaled corticosteroid] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/29768147 As-Needed Budesonide–Formoterol versus Maintenance Budesonide in Mild Asthma] Groups 6,18,30
*[http://www.ncbi.nlm.nih.gov/pubmed/27181606 Indacaterol-glycopyrronium VS salmeterol/fluticasone in COPD] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/21428765 Tiotropium VS salmeterol in COPD] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/23695200 Short VS long steroids for COPD exacerbation] Groups 9,21,33
*[http://www.ncbi.nlm.nih.gov/pubmed/25196117 Stopping inhaled steroids in COPD] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/29668352 Once-Daily Single-Inhaler Triple versus Dual Therapy in Patients with COPD] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/28877011 Tezepelumab in Adults with Uncontrolled Asthma] Groups 12,24,36

8) CARDIOVASCULAR STUDIES

SESSION 1

*[https://www.ncbi.nlm.nih.gov/pubmed/4862069 VA1] (Group 1, 13, 25)
*[https://www.ncbi.nlm.nih.gov/pubmed/4914579 VA 2] (Group 2, 14, 26)
*[https://pubmed.ncbi.nlm.nih.gov/33186492 Polycap Study 3] (Group 3, 15, 27)
*[http://www.ncbi.nlm.nih.gov/pubmed/20228401 ACCORD-BP] (Group 4, 16, 28)
*[https://www.ncbi.nlm.nih.gov/pubmed/26551272 SPRINT] (Group 5, 17, 29)
*[http://www.ncbi.nlm.nih.gov/pubmed/2883575 CONSENSUS] (Group 6,18,30)
*[https://pubmed.ncbi.nlm.nih.gov/31535829/ DAPA-HF] (Group 7, 19, 31)
*[https://pubmed.ncbi.nlm.nih.gov/25176939/ CONFIRM-HF] (Group 8, 20, 32)
*[http://www.ncbi.nlm.nih.gov/pubmed/12457784 PROSPER] (Group 9, 21, 33)
*[http://www.ncbi.nlm.nih.gov/pubmed/27040132 HOPE-3] (Group 10, 22, 34)
*[http://www.ncbi.nlm.nih.gov/pubmed/12114036 Heart Protection Study (HPS)] (Group 11, 23, 35)
*[http://www.ncbi.nlm.nih.gov/pubmed/30415628 REDUCE-IT] (Group 12, 24, 36)

[[File:CV Case.pdf|thumb|CV case|left]]

SESSION 2

'''The Guideline Case'''

A 63 y/o patient with CHOOSE ONE (⬆︎HTN/⬆︎Chol/⬆︎glucose/HF/A fib) and using the guideline determine:
# their 5yr/10yr risks of mortality/CVD events
# the potential benefit
# the potential side effects (with magnitude)
# words/sentiment patient values and preferences/SDM

Atrial fibrillation - Groups 1,13,25,2,14,26
*[https://www.onlinecjc.ca/article/S0828-282X(18)31062-6/pdf 2018 Atrial fibrillation guidelines]
Diabetes - Groups 3,15,27,4,16,28
*[http://guidelines.diabetes.ca/docs/CPG-2018-full-EN.pdf 2018 Diabetes guidelines]
Lipid Simplified - Groups 5,17,29,6,18,30
*[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4607330/pdf/0610857.pdf 2015 Simplified lipid guidelines]
Lipid - Groups 7,19,31,8,20,32
*[http://www.onlinecjc.ca/article/S0828-282X(16)30732-2/pdf 2016 Lipid guidelines]
Heart failure - Groups 9,21,33,10,22,34
*[http://www.onlinecjc.ca/article/S0828-282X(17)30973-X/pdf 2017 Heart failure guidelines]
Hypertension - Groups 11,23,35,12,24,36
*[https://www.onlinecjc.ca/article/S0828-282X(18)30183-1/pdf 2018 Hypertension guidelines]

OPTIONAL SESSION
*[http://www.ncbi.nlm.nih.gov/pubmed/16899775 SPARCL]
*[http://www.ncbi.nlm.nih.gov/pubmed/10471456 RALES]
*[http://www.ncbi.nlm.nih.gov/pubmed/11386263 Carvedilol in heart failure]
*[http://www.ncbi.nlm.nih.gov/pubmed/18460663 WAFACS]
*[http://www.ncbi.nlm.nih.gov/pubmed/10376614 MERIT-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/25176015 PARADIGM-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/24490264 High-dose multivitamins after MI]
*[http://www.ncbi.nlm.nih.gov/pubmed/7911176 Mediterranean Diet after MI]
*[http://www.ncbi.nlm.nih.gov/pubmed/15337732 A TO Z]
*[http://www.ncbi.nlm.nih.gov/pubmed/21073363 EMPHASIS-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/12853193 COMET]
*[http://www.ncbi.nlm.nih.gov/pubmed/24716680 TOPCAT]
*[http://www.ncbi.nlm.nih.gov/pubmed/26039521 IMPROVE-IT]

'''ACADEMIC YEAR 2 - SECOND TERM'''

9) NEPHROLOGY STUDIES

None so far

10) ENDOCRINOLOGY

[[File:IA ENDO LAYOUT.pdf|thumb|IA ENDO LAYOUT TEMPLATE|none]]
[[File:Osteoporosis Evidence SUPP.pdf|none|thumb]]

'''RISK ASSESSMENT CASES FOR DIABETES AND OSTEOPOROSIS'''

'''1) DIABETES CASE'''

66 y/o white male who was diagnosed with diabetes 8 years ago

* His blood pressure over the last year has been roughly 145/80 mmHg - at present untreated
* A1c = 8%, no diabetes meds, non-smoker, BMI ~30
* '''When calculating without diabetes for PREVENT use an A1c of 5.5%'''
* Total cholesterol is 6 mmol/L, his HDL is 2 mmol/L, non-HDL = 6 minus 2, not on a statin
* No retinopathy, urine albumin-to-creatinine ratio (UACR) = 15ug/mg (7mg/mmol),
* Serum creatinine = 70 micromol/L, waist circumference 100 cm
* GFR 75 mL/min/1.73m2
* In normal sinus rhythm
* Age at end of highest education = 19
* Mother alive, father died of a heart attack at age 80

'''Calculate Risks'''

'''CVD RISK ESTIMATES''' - list the endpoints described by the specific calculator

Framingham - xx% - 10-year risk - also if no diabetes xx%

ASCVD - xx% - 10-year risk - also if no diabetes xx%

'''The Calculator'''
*CVD CALCULATOR
https://decisionaid.ca/cvd/

'''DIABETES COMPLICATIONS RISK ESTIMATES''' - list the endpoints described by the specific calculator

xx% - also 10-year risk if A1c 9, 8, 7 and 6

also get risk of kidney failure, vision loss, pressure sensation loss – also if A1c 9, 8,7,6

'''The Calculator'''
*DIABETES DECISION AID
http://decisionaid.ca/diabetes/

'''BENEFITS AND HARMS'''

Use the [https://guidelines.diabetes.ca/cpg/chapter-13-2020-update 2024 diabetes guidelines] and/or Diabetes Decision Aid to get estimates of benefits and harms and also use the MyStudies synopsis listed below

'''COSTS'''

Try using [https://pricingdoc.acfp.ca Pricing Doc] to get costs

'''Groups 1,13,25'''

* Metformin - UKPDS 34 [https://mystudies.org/studies.php#studies/28929e89-d01e-4b11-8e67-4d7086f9e4aa/outcome MyStudies Data]

'''Groups 2,14,26'''

* Sulfonlyureas - UKPDS 33 [https://mystudies.org/studies.php#studies/5eadb5dd-d403-4c13-b03e-d4f8d28c96ba/outcome MyStudies Data]

'''Groups 3,15,27'''

* Insulin - ORIGIN [https://mystudies.org/studies.php#studies/f611818f-2e69-4952-b55e-661116bd84b6/outcome MyStudies Data]

'''Groups 4,16,28'''

* SGLT2 - EMPA-REG OUTCOME [https://mystudies.org/studies.php#studies/32e9cf1a-f33e-480b-91ca-6f28a4dcf862/outcome MyStudies Data]

'''Groups 5,17,29'''

* GLP - LEADER [https://mystudies.org/studies.php#studies/1adbc9a1-7603-40f1-ac15-b813ce1f0ad6/outcome MyStudies Data]

'''Groups 6,18,30'''

* DPP4 - TECOS [https://mystudies.org/studies.php#studies/8659968a-cefb-4f99-b4ae-8b9b659acbd5/outcome MyStudies Data]

'''Groups 7,19,31'''

* Intensive treatment – small scale - STENO [https://mystudies.org/studies.php#studies/39d423e3-af57-40c8-ab7a-cbc7f389bdb6/paper MyStudies Data]

'''Groups 8,20,32'''

* Intensive treatment – large scale - ADDITION-Europe - [https://mystudies.org/studies.php#studies/5e07d86d-aa92-4db9-a283-76080db4b6fd/outcome MyStudies Data]

'''2) OSTEOPOROSIS CASE'''

60 y/o female

* 72 kg, 1.69m, BMI = 25.2
* t-score of -2.5
* Worried about falling and getting a hip fracture
* A friend recently had an atraumatic fracture from simply tripping and falling over in the snow
* No other risk factors

'''Calculate Risks'''

'''FRACTURE RISK ESTIMATES''' - list the endpoints described by the specific calculator

Major osteoporotic fracture - xx% - 10-year risk – if no BMD (just BMI), and then if they had a BMD t-Score of -2.0, -2.5, and -3.0

Hip fracture - - xx% - 10-year risk – if no BMD (just BMI) and if you have a BMD xx% - 10-year risk – if no BMD, and then if they had a BMD T-Score of -2.0, -2.5, and -3.0

'''The Calculator'''

* FRACTURE CALCULATOR

[https://frax.shef.ac.uk/frax/tool.aspx?country=19 Frax Tool - Canada]

'''BENEFITS AND HARMS'''

Use the [https://www.cmaj.ca/content/195/39/E1333 2023 Osteoporosis Guideline] and/or your osteoporosis lecture notes to get the benefits and apply these to your patient, and also get the harms

'''COSTS'''

Try using [https://pricingdoc.acfp.ca Pricing Doc] to get costs

'''Groups 9,21,33'''

* Activity

'''Groups 10,22,34'''

* Calcium/Vitamin D

'''Groups 11,23,35'''

* Bisphosphonates

'''Groups 12,24,36'''

* Denosumab

11) NEUROLOGY STUDIES

*[http://www.ncbi.nlm.nih.gov/pubmed/16717269 Opioids for chronic non-cancer pain] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/29509867 Effect of Opioid vs Nonopioid Medications on Pain-Related Function in Patients With Chronic Back Pain] Groups 2,14,26
*[https://www.ncbi.nlm.nih.gov/pubmed/31291515 Galcanezumab for prevention of cluster headaches] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/27150433 Immediate or delayed treatment of a first seizure] Groups 4,16,28
*[https://www.ncbi.nlm.nih.gov/pubmed/31291516 Rimegepant for episodic migraine] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/26212846 Sleep restriction for insomnia] Groups 6,18,30
*[https://www.ncbi.nlm.nih.gov/pubmed/25957224 CHANCE] Groups 7,19,31
*[https://www.ncbi.nlm.nih.gov/pubmed/16899775 SPARCL] Groups 8,20,32
*[https://www.ncbi.nlm.nih.gov/pubmed/29171821 Erenumab for episodic migraine] Groups 9,21,33
*[https://www.ncbi.nlm.nih.gov/pubmed/24733354 Reduction of benzodiazepines through education] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/26035341 Patient controlled opioid analgesia versus non-patient controlled opioid analgesia for postoperative pain] Groups 11,23,35
*[https://www.ncbi.nlm.nih.gov/pubmed/11589932 PROGRESS] Groups 12,24,36

'''ACADEMIC YEAR 3'''

12) PSYCHIATRY STUDIES

[[:File:2021 Psych Evidence Appraisal - Intro Slides.pdf|Psychiatry Rating Scales Introduction]]

* Study 1: [http://www.ncbi.nlm.nih.gov/pubmed/16554525 STAR*D (Level 2)] Bupropion-SR, sertraline, or venlafaxine-XR after failure of SSRIs for depression
* Study 2: [http://www.ncbi.nlm.nih.gov/pubmed/29477251 Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder]
* Study 3: [https://pubmed.ncbi.nlm.nih.gov/33862018/ Long-acting injectable versus oral antipsychotics for the maintenance treatment of schizophrenia]
* Study 4: [https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2725088 Association of Antipsychotic Polypharmacy vs Monotherapy With Psychiatric Rehospitalization Among Adults With Schizophrenia]
* Study 5: [https://www.ncbi.nlm.nih.gov/pubmed/29490359 Real-world Effectiveness of Pharmacologic Treatments for the Prevention of Bipolar Disorder]
* Study 6: [http://www.ncbi.nlm.nih.gov/pubmed/20092882 BALANCE] Combination lithium and valproate therapy versus monotherapy for relapse prevention in bipolar I disorder
[[File:ChatGPT directions.jpg|thumb|ChatGPT Directions]]
13) GASTROENTEROLOGY STUDIES - LINKS ON CANVAS

*Short-term treatment for gastro-oesophageal reflux disease-like symptoms and endoscopy negative reflux disease (Review)
*Oral budesonide for induction of remission in ulcerative colitis (Review)
*Probiotics for the prevention of Clostridium difficile-associated diarrhea in adults and children (Review)
*Deprescribing versus continuation of chronic proton pump inhibitor use in adults (Review)
*Prevention of NSAID-induced gastroduodenal ulcers (Review)
*Methotrexate for maintenance of remission in Crohn's disease (Review)

14) OB/GYN STUDIES
*[http://www.ncbi.nlm.nih.gov/pubmed/25601350 Comparative contraceptive effectiveness of levonorgestrel-releasing and copper IUD Devices]
*[http://www.ncbi.nlm.nih.gov/pubmed/29211679 Hormonal contraception and the risk of breast cancer]
*[http://www.ncbi.nlm.nih.gov/pubmed/30322986 Sexual behaviours in adolescent girls before and after introduction of the HPV]
*[http://www.ncbi.nlm.nih.gov/pubmed/30181338 Intramuscular vs intravenous oxytocin to prevent postpartum haemorrhage at vaginal delivery]
*[http://www.ncbi.nlm.nih.gov/pubmed/27682034 Azithromycin Prophylaxis for Cesarean Delivery]
*[http://www.ncbi.nlm.nih.gov/pubmed/28461374 Antibiotics during pregnancy and risk of spontaneous abortion]

Evidence Appraisal Integrated Activities

2025-02-04T19:25:57Z

JamesMcCormack:

'''OBJECTIVE'''

To critically appraise studies, develop a brief synopsis of the trial results, succinctly present the results and then put the results into a proper clinical context

'''INITIAL PRE-READING'''

'''How To Critically Appraise an RCT In 10 minutes'''
*[https://itunes.apple.com/ca/book/how-to-critically-appraise/id524600667?mt=11 iBook/iPad version]
*[https://therapeuticseducation.org/sites/therapeuticseducation.org/files/Ten_Minute_Critical_Appraisal.pdf PDF version]
Watch this video
[http://youtu.be/QUW0Q8tXVUc Viva La Evidence]

'''Study Results at Your Fingertips'''
*[https://mystudies.org MyStudies] - Free access

'''INTEGRATION ACTIVITY FORMAT'''
# Students placed in groups of ~ 5-7
# Each group is given one of the studies below to review
# Students then work in pairs and develop a one-slide critical appraisal and results synopsis
# One student in each group will be chosen at random to present their group findings to the class
# A discussion about the appraisal and the appropriate clinical context for the results is had with the entire class for each study

'''MODULE'''
[[File:Screen Shot 2022-01-09 at 10.00.16 AM.jpg|thumb|'''TRIAL PRESENTATION FORMAT'''|none]]

Studies chosen include landmark studies and/or studies that address important therapeutic issues for the particular module

'''ACADEMIC YEAR 1 - FIRST TERM'''

1) FOUNDATION STUDIES (Groups)
*[https://pubmed.ncbi.nlm.nih.gov/37952131 SELECT] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/12466506 AFFIRM] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/22085343 AIM-HIGH] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/10639539 HOPE] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/18378519 HYVET] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/15007110 PROVE-IT] Groups 6,18,30
*[http://www.ncbi.nlm.nih.gov/pubmed/15755765 TNT] Groups 7,19,31
*[https://pubmed.ncbi.nlm.nih.gov/26378978 EMPAREG] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/17984165 ILLUMINATE] Groups 9,21,33
*[https://pubmed.ncbi.nlm.nih.gov/26551272/ SPRINT] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/15325833 CARDS] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/12117397 WHI] Groups 12,24,36

'''ACADEMIC YEAR 1 - SECOND TERM'''

2) INTRO TO INFECTIOUS DISEASE STUDIES

[https://wiki.ubc.ca/images/8/8b/Antibiotic_Sensitivity_Chart_2024.pdf The "Best" Antibiotic Sensitivity Chart Ever]
*[http://www.ncbi.nlm.nih.gov/pubmed/17567657 IV vs PO antibiotics] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/24603565 Delayed antibiotics for respiratory tract infections] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/11159657 Delayed antibiotics for otitis media] Groups 3,15,27
*[https://pubmed.ncbi.nlm.nih.gov/27455166/ Duration of treatment for community acquired pneumonia] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/22726802 Duration of treatment for pyelonephritis] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/25830421 Choice of antibiotic for community acquired pneumonia-1] Groups 6,18,30
*[http://www.ncbi.nlm.nih.gov/pubmed/25286173 Choice of antibiotic for community acquired pneumonia-2] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/20647284 HPV vaccine study] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/7966893 Influenza vaccine study] Groups 9,21,33
*[https://pubmed.ncbi.nlm.nih.gov/33301246/ COVID vaccine Pfizer] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/27626517 Herpes zoster vaccine study 1] Groups 11,23,35
*[https://www.ncbi.nlm.nih.gov/pubmed/25916341 Herpes zoster vaccine study 2] Groups 12,24,36

3) MUSCULOSKELETAL STUDIES

*[http://www.ncbi.nlm.nih.gov/pubmed/28199814 Baricitinib versus Placebo or Adalimumab in Rheumatoid Arthritis] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/0010979111 CLASS – celecoxib vs NSAIDs] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/26501533 Naproxen with cyclobenzaprine, oxycodone/acetaminophen, or placebo for low back pain] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/24395557 Glucosamine and chondroitin for OA] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/12546607 Acetaminophen vs diclofenac for OA] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/23964752 Diclofenac gel for acute neck pain] Groups 6,18,30
*[https://pubmed.ncbi.nlm.nih.gov/15468367/ Topical diclofenac vs oral diclofenac] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/25064594 Acetaminophen for low back pain] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/7611589 Misoprostol and NSAID induced ulcers] Groups 9,21,33
*[http://www.ncbi.nlm.nih.gov/pubmed/20131255 Low dose vs high dose colchicine for gout] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/22508468 TEAR - oral triple therapy versus etanercept plus methotrexate in early aggressive rheumatoid arthritis] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/25589511 MOVES - Glucosamine and chondroitin for OA for moderate to severe pain] Groups 12,24,36

4) DERMATOLOGY STUDIES

*[https://www.ncbi.nlm.nih.gov/pubmed/9598014 Glycolic acid 5% Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/21896132 Glycolic acid 10% Acne]
*[https://www.ncbi.nlm.nih.gov/pubmed/14531866 Petrolatum vs Ceramide/skin related lipids Hand Dermatitis]
*[https://www.ncbi.nlm.nih.gov/pubmed/11896774 Vitamin C Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/17515510 Retinol (VitaminA) Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/21896129 Hyaluronic acid Atopic Dermatitis]

5) EENT STUDIES

[http://www.amstar.ca/docs/AMSTARguideline.pdf AMSTAR meta-analysis checklist]

'''Scenario 1 - Otitis Media''' - GROUPS 1, 7, 18, 19, 25, 36

Anthony Martin arrives at your pharmacy somewhat frustrated since his family physician declined to write an antibiotic prescription for his two and half year old son, Oscar. His symptoms started yesterday afternoon - Oscar complains of right ear pain but there is no discharge. Rectal temperature taken today was 38.5 degrees. His wife is sure Oscar has an ear infection since the last time he had these same symptoms, that was ultimately the diagnosis. Mr. Martin asks if you think buying acetaminophen is really “enough”?

[https://pubmed.ncbi.nlm.nih.gov/26099233/ Antibiotics for acute otitis media in children]

'''Scenario 2 - Allergic Rhinitis''' - GROUPS 2, 8, 17, 20, 26, 35

Ruby Parmar is a firefighter. She is plagued by sinus congestion (preventing her from sleeping) and a runny nose associated with seasonal allergies. Her prescription for intranasal triamcinolone is typically effective, but she would like to know if a non-sedating anti-allergy pill would work just as well since it’s inconvenient carrying around the “nose spray”.

[https://www.ncbi.nlm.nih.gov/pubmed/28234147 Intranasal steroids vs antihistamines for allergic rhinitis]

'''Scenario 3 - Acute Sinusitis''' - GROUPS 3, 9, 16, 21, 27, 34

You are seeing a patient in clinic before her appointment with the primary care physician. She was feeling unwell with a “flu” last week. While most of her symptoms have resolved (cough, fever), the nasal congestion and discharge persists and so she has made an appointment (she is an otherwise healthy 32 year old with treated thyroid disease). She would like your advice for what treatment she should ask the doctor to prescribe.

[http://www.ncbi.nlm.nih.gov/pubmed/24293353 Intranasal steroids for acute sinusitis]

'''Scenario 4 - Glaucoma''' - GROUPS 4, 10, 15, 22, 28, 33

Mrs. Ada Waters is a 63 year-old woman you. Her ophthalmologist prescribed timolol and xalatan eye drops for treatment of open angle glaucoma. She has never really felt much different on treatment since she recovered from her first episode (of acute angle closure glaucoma requiring ER visit) and surgery. She asks you if the treatment is really making a difference.

[https://www.ncbi.nlm.nih.gov/pubmed/17943780 Interventions for open angle glaucoma]

'''Scenario 5 - Sore Throat''' - GROUPS 5, 11, 14, 23, 29, 32

You have a good friend who is applying for pharmacy. Her invitation for the multiple-mini interview (MMI) is coming up soon, but she is starting to experience a sore throat. While she is worried about not being able to speak through all of those stations, she knows she often gets a terrible headache along with her sore throat. She has an unused prescription for amoxicillin (unexpired) and wonders if you recommend for her to take it.

[https://pubmed.ncbi.nlm.nih.gov/34881426/ Antibiotics for sore throat]

'''Scenario 6 - Conjunctivitis''' - GROUPS 6, 12, 13, 24, 30, 31

A man comes to your pharmacy (he appears in his early twenties) complaining of “pink eye”. He has had a pink discolouration and discharge from his left eye for two days. He asks if the OTC antibiotic eye drops (he’s holding a product with polymixin B) are any better than “waiting it out”.

[https://www.ncbi.nlm.nih.gov/pubmed/22972049 Antibiotics for acute conjunctivitis]

6) HEMATOLOGY STUDIES

None so far

'''ACADEMIC YEAR 2 - FIRST TERM'''

7) RESPIROLOGY STUDIES
[[File:IA COPD info.pdf|thumb]]

*[http://www.ncbi.nlm.nih.gov/pubmed/2062329 First inhaled steroid study] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/22938706 Tiotropium in asthma] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/21324520 Inhaled steroid in children] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/29768149 Combined Budesonide–Formoterol as Needed in Mild Asthma] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/15223858 Doubling dose of inhaled corticosteroid] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/29768147 As-Needed Budesonide–Formoterol versus Maintenance Budesonide in Mild Asthma] Groups 6,18,30
*[http://www.ncbi.nlm.nih.gov/pubmed/27181606 Indacaterol-glycopyrronium VS salmeterol/fluticasone in COPD] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/21428765 Tiotropium VS salmeterol in COPD] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/23695200 Short VS long steroids for COPD exacerbation] Groups 9,21,33
*[http://www.ncbi.nlm.nih.gov/pubmed/25196117 Stopping inhaled steroids in COPD] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/29668352 Once-Daily Single-Inhaler Triple versus Dual Therapy in Patients with COPD] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/28877011 Tezepelumab in Adults with Uncontrolled Asthma] Groups 12,24,36

8) CARDIOVASCULAR STUDIES

SESSION 1

*[https://www.ncbi.nlm.nih.gov/pubmed/4862069 VA1] (Group 1, 13, 25)
*[https://www.ncbi.nlm.nih.gov/pubmed/4914579 VA 2] (Group 2, 14, 26)
*[https://pubmed.ncbi.nlm.nih.gov/33186492 Polycap Study 3] (Group 3, 15, 27)
*[http://www.ncbi.nlm.nih.gov/pubmed/20228401 ACCORD-BP] (Group 4, 16, 28)
*[https://www.ncbi.nlm.nih.gov/pubmed/26551272 SPRINT] (Group 5, 17, 29)
*[http://www.ncbi.nlm.nih.gov/pubmed/2883575 CONSENSUS] (Group 6,18,30)
*[https://pubmed.ncbi.nlm.nih.gov/31535829/ DAPA-HF] (Group 7, 19, 31)
*[https://pubmed.ncbi.nlm.nih.gov/25176939/ CONFIRM-HF] (Group 8, 20, 32)
*[http://www.ncbi.nlm.nih.gov/pubmed/12457784 PROSPER] (Group 9, 21, 33)
*[http://www.ncbi.nlm.nih.gov/pubmed/27040132 HOPE-3] (Group 10, 22, 34)
*[http://www.ncbi.nlm.nih.gov/pubmed/12114036 Heart Protection Study (HPS)] (Group 11, 23, 35)
*[http://www.ncbi.nlm.nih.gov/pubmed/30415628 REDUCE-IT] (Group 12, 24, 36)

[[File:CV Case.pdf|thumb|CV case|left]]

SESSION 2

'''The Guideline Case'''

A 63 y/o patient with CHOOSE ONE (⬆︎HTN/⬆︎Chol/⬆︎glucose/HF/A fib) and using the guideline determine:
# their 5yr/10yr risks of mortality/CVD events
# the potential benefit
# the potential side effects (with magnitude)
# words/sentiment patient values and preferences/SDM

Atrial fibrillation - Groups 1,13,25,2,14,26
*[https://www.onlinecjc.ca/article/S0828-282X(18)31062-6/pdf 2018 Atrial fibrillation guidelines]
Diabetes - Groups 3,15,27,4,16,28
*[http://guidelines.diabetes.ca/docs/CPG-2018-full-EN.pdf 2018 Diabetes guidelines]
Lipid Simplified - Groups 5,17,29,6,18,30
*[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4607330/pdf/0610857.pdf 2015 Simplified lipid guidelines]
Lipid - Groups 7,19,31,8,20,32
*[http://www.onlinecjc.ca/article/S0828-282X(16)30732-2/pdf 2016 Lipid guidelines]
Heart failure - Groups 9,21,33,10,22,34
*[http://www.onlinecjc.ca/article/S0828-282X(17)30973-X/pdf 2017 Heart failure guidelines]
Hypertension - Groups 11,23,35,12,24,36
*[https://www.onlinecjc.ca/article/S0828-282X(18)30183-1/pdf 2018 Hypertension guidelines]

OPTIONAL SESSION
*[http://www.ncbi.nlm.nih.gov/pubmed/16899775 SPARCL]
*[http://www.ncbi.nlm.nih.gov/pubmed/10471456 RALES]
*[http://www.ncbi.nlm.nih.gov/pubmed/11386263 Carvedilol in heart failure]
*[http://www.ncbi.nlm.nih.gov/pubmed/18460663 WAFACS]
*[http://www.ncbi.nlm.nih.gov/pubmed/10376614 MERIT-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/25176015 PARADIGM-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/24490264 High-dose multivitamins after MI]
*[http://www.ncbi.nlm.nih.gov/pubmed/7911176 Mediterranean Diet after MI]
*[http://www.ncbi.nlm.nih.gov/pubmed/15337732 A TO Z]
*[http://www.ncbi.nlm.nih.gov/pubmed/21073363 EMPHASIS-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/12853193 COMET]
*[http://www.ncbi.nlm.nih.gov/pubmed/24716680 TOPCAT]
*[http://www.ncbi.nlm.nih.gov/pubmed/26039521 IMPROVE-IT]

'''ACADEMIC YEAR 2 - SECOND TERM'''

9) NEPHROLOGY STUDIES

None so far

10) ENDOCRINOLOGY

[[File:IA ENDO LAYOUT.pdf|thumb|IA ENDO LAYOUT TEMPLATE|none]]
[[File:Osteoporosis Evidence SUPP.pdf|none|thumb]]

'''RISK ASSESSMENT CASES FOR DIABETES AND OSTEOPOROSIS'''

'''1) DIABETES CASE'''

66 y/o white male who was diagnosed with diabetes 8 years ago

* His blood pressure over the last year has been roughly 145/80 mmHg - at present untreated
* A1c = 8%, no diabetes meds, non-smoker, BMI ~30
* '''When calculating without diabetes for PREVENT use an A1c of 5.5%'''
* Total cholesterol is 6 mmol/L, his HDL is 2 mmol/L, non-HDL = 6 minus 2, not on a statin
* No retinopathy, urine albumin-to-creatinine ratio (UACR) = 15ug/mg (7mg/mmol),
* Serum creatinine = 70 micromol/L, waist circumference 100 cm
* GFR 75 mL/min/1.73m2
* In normal sinus rhythm
* Age at end of highest education = 19
* Mother alive, father died of a heart attack at age 80

'''Calculate Risks'''

'''CVD RISK ESTIMATES''' - list the endpoints described by the specific calculator

Framingham - xx% - 10-year risk - also if no diabetes xx%

ASCVD - xx% - 10-year risk - also if no diabetes xx%

'''The Calculator'''
*CVD CALCULATOR
https://decisionaid.ca/cvd/

'''DIABETES COMPLICATIONS RISK ESTIMATES''' - list the endpoints described by the specific calculator

xx% - also 10-year risk if A1c 9, 8, 7 and 6

also get risk of kidney failure, vision loss, pressure sensation loss – also if A1c 9, 8,7,6

'''The Calculator'''
*DIABETES DECISION AID
http://decisionaid.ca/diabetes/

'''BENEFITS AND HARMS'''

Use the [https://guidelines.diabetes.ca/cpg/chapter-13-2020-update 2024 diabetes guidelines] and/or Diabetes Decision Aid to get estimates of benefits and harms and also use the MyStudies synopsis listed below

'''COSTS'''

Try using [https://pricingdoc.acfp.ca Pricing Doc] to get costs

'''Groups 1,13,25'''

* Metformin - UKPDS 34 [https://mystudies.org/studies.php#studies/28929e89-d01e-4b11-8e67-4d7086f9e4aa/outcome MyStudies Data]

'''Groups 2,14,26'''

* Sulfonlyureas - UKPDS 33 [https://mystudies.org/studies.php#studies/5eadb5dd-d403-4c13-b03e-d4f8d28c96ba/outcome MyStudies Data]

'''Groups 3,15,27'''

* Insulin - ORIGIN [https://mystudies.org/studies.php#studies/f611818f-2e69-4952-b55e-661116bd84b6/outcome MyStudies Data]

'''Groups 4,16,28'''

* SGLT2 - EMPA-REG OUTCOME [https://mystudies.org/studies.php#studies/32e9cf1a-f33e-480b-91ca-6f28a4dcf862/outcome MyStudies Data]

'''Groups 5,17,29'''

* GLP - LEADER [https://mystudies.org/studies.php#studies/1adbc9a1-7603-40f1-ac15-b813ce1f0ad6/outcome MyStudies Data]

'''Groups 6,18,30'''

* DPP4 - TECOS [https://mystudies.org/studies.php#studies/8659968a-cefb-4f99-b4ae-8b9b659acbd5/outcome MyStudies Data]

'''Groups 7,19,31'''

* Intensive treatment – small scale - STENO [https://mystudies.org/studies.php#studies/39d423e3-af57-40c8-ab7a-cbc7f389bdb6/paper MyStudies Data]

'''Groups 8,20,32'''

* Intensive treatment – large scale - ADDITION-Europe - [https://mystudies.org/studies.php#studies/5e07d86d-aa92-4db9-a283-76080db4b6fd/outcome MyStudies Data]

'''2) OSTEOPOROSIS CASE'''

60 y/o female

* 72 kg, 1.69m, BMI = 25.2
* t-score of -2.5
* Worried about falling and getting a hip fracture
* A friend recently had an atraumatic fracture from simply tripping and falling over in the snow
* No other risk factors

'''Calculate Risks'''

'''FRACTURE RISK ESTIMATES''' - list the endpoints described by the specific calculator

Major osteoporotic fracture - xx% - 10-year risk – if no BMD (just BMI), and then if they had a BMD t-Score of -2.0, -2.5, and -3.0

Hip fracture - - xx% - 10-year risk – if no BMD (just BMI) and if you have a BMD xx% - 10-year risk – if no BMD, and then if they had a BMD T-Score of -2.0, -2.5, and -3.0

'''The Calculator'''

* FRACTURE CALCULATOR

[https://frax.shef.ac.uk/frax/tool.aspx?country=19 Frax Tool - Canada]

'''BENEFITS AND HARMS'''

Use the [https://www.cmaj.ca/content/195/39/E1333 2023 Osteoporosis Guideline] and/or your osteoporosis lecture notes to get the benefits and apply these to your patient, and also get the harms

'''COSTS'''

Try using [https://pricingdoc.acfp.ca Pricing Doc] to get costs

'''Groups 9,21,33'''

* Activity

'''Groups 10,22,34'''

* Calcium/Vitamin D

'''Groups 11,23,35'''

* Bisphosphonates

'''Groups 12,24,36'''

* Denosumab

11) NEUROLOGY STUDIES

*[http://www.ncbi.nlm.nih.gov/pubmed/16717269 Opioids for chronic non-cancer pain] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/29509867 Effect of Opioid vs Nonopioid Medications on Pain-Related Function in Patients With Chronic Back Pain] Groups 2,14,26
*[https://www.ncbi.nlm.nih.gov/pubmed/31291515 Galcanezumab for prevention of cluster headaches] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/27150433 Immediate or delayed treatment of a first seizure] Groups 4,16,28
*[https://www.ncbi.nlm.nih.gov/pubmed/31291516 Rimegepant for episodic migraine] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/26212846 Sleep restriction for insomnia] Groups 6,18,30
*[https://www.ncbi.nlm.nih.gov/pubmed/25957224 CHANCE] Groups 7,19,31
*[https://www.ncbi.nlm.nih.gov/pubmed/16899775 SPARCL] Groups 8,20,32
*[https://www.ncbi.nlm.nih.gov/pubmed/29171821 Erenumab for episodic migraine] Groups 9,21,33
*[https://www.ncbi.nlm.nih.gov/pubmed/24733354 Reduction of benzodiazepines through education] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/26035341 Patient controlled opioid analgesia versus non-patient controlled opioid analgesia for postoperative pain] Groups 11,23,35
*[https://www.ncbi.nlm.nih.gov/pubmed/11589932 PROGRESS] Groups 12,24,36

'''ACADEMIC YEAR 3'''

12) PSYCHIATRY STUDIES

[[:File:2021 Psych Evidence Appraisal - Intro Slides.pdf|Psychiatry Rating Scales Introduction]]

* Study 1: [http://www.ncbi.nlm.nih.gov/pubmed/16554525 STAR*D (Level 2)] Bupropion-SR, sertraline, or venlafaxine-XR after failure of SSRIs for depression
* Study 2: [http://www.ncbi.nlm.nih.gov/pubmed/29477251 Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder]
* Study 3: [https://pubmed.ncbi.nlm.nih.gov/33862018/ Long-acting injectable versus oral antipsychotics for the maintenance treatment of schizophrenia]
* Study 4: [https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2725088 Association of Antipsychotic Polypharmacy vs Monotherapy With Psychiatric Rehospitalization Among Adults With Schizophrenia]
* Study 5: [https://www.ncbi.nlm.nih.gov/pubmed/29490359 Real-world Effectiveness of Pharmacologic Treatments for the Prevention of Bipolar Disorder]
* Study 6: [http://www.ncbi.nlm.nih.gov/pubmed/20092882 BALANCE] Combination lithium and valproate therapy versus monotherapy for relapse prevention in bipolar I disorder
[[File:ChatGPT directions.jpg|thumb|ChatGPT Directions]]
13) GASTROENTEROLOGY STUDIES - LINKS ON CANVAS

*Short-term treatment for gastro-oesophageal reflux disease-like symptoms and endoscopy negative reflux disease (Review)
*Oral budesonide for induction of remission in ulcerative colitis (Review)
*Probiotics for the prevention of Clostridium difficile-associated diarrhea in adults and children (Review)
*Deprescribing versus continuation of chronic proton pump inhibitor use in adults (Review)
*Prevention of NSAID-induced gastroduodenal ulcers (Review)
*Methotrexate for maintenance of remission in Crohn's disease (Review)

14) OB/GYN STUDIES
*[http://www.ncbi.nlm.nih.gov/pubmed/25601350 Comparative contraceptive effectiveness of levonorgestrel-releasing and copper IUD Devices]
*[http://www.ncbi.nlm.nih.gov/pubmed/29211679 Hormonal contraception and the risk of breast cancer]
*[http://www.ncbi.nlm.nih.gov/pubmed/30322986 Sexual behaviours in adolescent girls before and after introduction of the HPV]
*[http://www.ncbi.nlm.nih.gov/pubmed/30181338 Intramuscular vs intravenous oxytocin to prevent postpartum haemorrhage at vaginal delivery]
*[http://www.ncbi.nlm.nih.gov/pubmed/27682034 Azithromycin Prophylaxis for Cesarean Delivery]
*[http://www.ncbi.nlm.nih.gov/pubmed/28461374 Antibiotics during pregnancy and risk of spontaneous abortion]

Evidence Appraisal Integrated Activities

2025-02-04T19:25:31Z

JamesMcCormack:

'''OBJECTIVE'''

To critically appraise studies, develop a brief synopsis of the trial results, succinctly present the results and then put the results into a proper clinical context

'''INITIAL PRE-READING'''

'''How To Critically Appraise an RCT In 10 minutes'''
*[https://itunes.apple.com/ca/book/how-to-critically-appraise/id524600667?mt=11 iBook/iPad version]
*[https://therapeuticseducation.org/sites/therapeuticseducation.org/files/Ten_Minute_Critical_Appraisal.pdf PDF version]
Watch this video
[http://youtu.be/QUW0Q8tXVUc Viva La Evidence]

'''Study Results at Your Fingertips'''
*[https://mystudies.org MyStudies] - Free access

'''INTEGRATION ACTIVITY FORMAT'''
# Students placed in groups of ~ 5-7
# Each group is given one of the studies below to review
# Students then work in pairs and develop a one-slide critical appraisal and results synopsis
# One student in each group will be chosen at random to present their group findings to the class
# A discussion about the appraisal and the appropriate clinical context for the results is had with the entire class for each study

'''MODULE'''
[[File:Screen Shot 2022-01-09 at 10.00.16 AM.jpg|thumb|'''TRIAL PRESENTATION FORMAT'''|none]]

Studies chosen include landmark studies and/or studies that address important therapeutic issues for the particular module

'''ACADEMIC YEAR 1 - FIRST TERM'''

1) FOUNDATION STUDIES (Groups)
*[https://pubmed.ncbi.nlm.nih.gov/37952131 SELECT] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/12466506 AFFIRM] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/22085343 AIM-HIGH] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/10639539 HOPE] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/18378519 HYVET] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/15007110 PROVE-IT] Groups 6,18,30
*[http://www.ncbi.nlm.nih.gov/pubmed/15755765 TNT] Groups 7,19,31
*[https://pubmed.ncbi.nlm.nih.gov/26378978 EMPAREG] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/17984165 ILLUMINATE] Groups 9,21,33
*[https://pubmed.ncbi.nlm.nih.gov/26551272/ SPRINT] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/15325833 CARDS] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/12117397 WHI] Groups 12,24,36

'''ACADEMIC YEAR 1 - SECOND TERM'''

2) INTRO TO INFECTIOUS DISEASE STUDIES

[https://wiki.ubc.ca/images/8/8b/Antibiotic_Sensitivity_Chart_2024.pdf The "Best" Antibiotic Sensitivity Chart Ever]
*[http://www.ncbi.nlm.nih.gov/pubmed/17567657 IV vs PO antibiotics] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/24603565 Delayed antibiotics for respiratory tract infections] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/11159657 Delayed antibiotics for otitis media] Groups 3,15,27
*[https://pubmed.ncbi.nlm.nih.gov/27455166/ Duration of treatment for community acquired pneumonia] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/22726802 Duration of treatment for pyelonephritis] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/25830421 Choice of antibiotic for community acquired pneumonia-1] Groups 6,18,30
*[http://www.ncbi.nlm.nih.gov/pubmed/25286173 Choice of antibiotic for community acquired pneumonia-2] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/20647284 HPV vaccine study] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/7966893 Influenza vaccine study] Groups 9,21,33
*[https://pubmed.ncbi.nlm.nih.gov/33301246/ COVID vaccine Pfizer] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/27626517 Herpes zoster vaccine study 1] Groups 11,23,35
*[https://www.ncbi.nlm.nih.gov/pubmed/25916341 Herpes zoster vaccine study 2] Groups 12,24,36

3) MUSCULOSKELETAL STUDIES

*[http://www.ncbi.nlm.nih.gov/pubmed/28199814 Baricitinib versus Placebo or Adalimumab in Rheumatoid Arthritis] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/0010979111 CLASS – celecoxib vs NSAIDs] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/26501533 Naproxen with cyclobenzaprine, oxycodone/acetaminophen, or placebo for low back pain] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/24395557 Glucosamine and chondroitin for OA] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/12546607 Acetaminophen vs diclofenac for OA] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/23964752 Diclofenac gel for acute neck pain] Groups 6,18,30
*[https://pubmed.ncbi.nlm.nih.gov/15468367/ Topical diclofenac vs oral diclofenac] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/25064594 Acetaminophen for low back pain] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/7611589 Misoprostol and NSAID induced ulcers] Groups 9,21,33
*[http://www.ncbi.nlm.nih.gov/pubmed/20131255 Low dose vs high dose colchicine for gout] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/22508468 TEAR - oral triple therapy versus etanercept plus methotrexate in early aggressive rheumatoid arthritis] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/25589511 MOVES - Glucosamine and chondroitin for OA for moderate to severe pain] Groups 12,24,36

4) DERMATOLOGY STUDIES

*[https://www.ncbi.nlm.nih.gov/pubmed/9598014 Glycolic acid 5% Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/21896132 Glycolic acid 10% Acne]
*[https://www.ncbi.nlm.nih.gov/pubmed/14531866 Petrolatum vs Ceramide/skin related lipids Hand Dermatitis]
*[https://www.ncbi.nlm.nih.gov/pubmed/11896774 Vitamin C Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/17515510 Retinol (VitaminA) Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/21896129 Hyaluronic acid Atopic Dermatitis]

5) EENT STUDIES

[http://www.amstar.ca/docs/AMSTARguideline.pdf AMSTAR meta-analysis checklist]

'''Scenario 1 - Otitis Media''' - GROUPS 1, 7, 18, 19, 25, 36

Anthony Martin arrives at your pharmacy somewhat frustrated since his family physician declined to write an antibiotic prescription for his two and half year old son, Oscar. His symptoms started yesterday afternoon - Oscar complains of right ear pain but there is no discharge. Rectal temperature taken today was 38.5 degrees. His wife is sure Oscar has an ear infection since the last time he had these same symptoms, that was ultimately the diagnosis. Mr. Martin asks if you think buying acetaminophen is really “enough”?

[https://pubmed.ncbi.nlm.nih.gov/26099233/ Antibiotics for acute otitis media in children]

'''Scenario 2 - Allergic Rhinitis''' - GROUPS 2, 8, 17, 20, 26, 35

Ruby Parmar is a firefighter. She is plagued by sinus congestion (preventing her from sleeping) and a runny nose associated with seasonal allergies. Her prescription for intranasal triamcinolone is typically effective, but she would like to know if a non-sedating anti-allergy pill would work just as well since it’s inconvenient carrying around the “nose spray”.

[https://www.ncbi.nlm.nih.gov/pubmed/28234147 Intranasal steroids vs antihistamines for allergic rhinitis]

'''Scenario 3 - Acute Sinusitis''' - GROUPS 3, 9, 16, 21, 27, 34

You are seeing a patient in clinic before her appointment with the primary care physician. She was feeling unwell with a “flu” last week. While most of her symptoms have resolved (cough, fever), the nasal congestion and discharge persists and so she has made an appointment (she is an otherwise healthy 32 year old with treated thyroid disease). She would like your advice for what treatment she should ask the doctor to prescribe.

[http://www.ncbi.nlm.nih.gov/pubmed/24293353 Intranasal steroids for acute sinusitis]

'''Scenario 4 - Glaucoma''' - GROUPS 4, 10, 15, 22, 28, 33

Mrs. Ada Waters is a 63 year-old woman you. Her ophthalmologist prescribed timolol and xalatan eye drops for treatment of open angle glaucoma. She has never really felt much different on treatment since she recovered from her first episode (of acute angle closure glaucoma requiring ER visit) and surgery. She asks you if the treatment is really making a difference.

[https://www.ncbi.nlm.nih.gov/pubmed/17943780 Interventions for open angle glaucoma]

'''Scenario 5 - Sore Throat''' - GROUPS 5, 11, 14, 23, 29, 32

You have a good friend who is applying for pharmacy. Her invitation for the multiple-mini interview (MMI) is coming up soon, but she is starting to experience a sore throat. While she is worried about not being able to speak through all of those stations, she knows she often gets a terrible headache along with her sore throat. She has an unused prescription for amoxicillin (unexpired) and wonders if you recommend for her to take it.

[https://pubmed.ncbi.nlm.nih.gov/34881426/ Antibiotics for sore throat]

'''Scenario 6 - Conjunctivitis''' - GROUPS 6, 12, 13, 24, 30, 31

A man comes to your pharmacy (he appears in his early twenties) complaining of “pink eye”. He has had a pink discolouration and discharge from his left eye for two days. He asks if the OTC antibiotic eye drops (he’s holding a product with polymixin B) are any better than “waiting it out”.

[https://www.ncbi.nlm.nih.gov/pubmed/22972049 Antibiotics for acute conjunctivitis]

6) HEMATOLOGY STUDIES

None so far

'''ACADEMIC YEAR 2 - FIRST TERM'''

7) RESPIROLOGY STUDIES
[[File:IA COPD info.pdf|thumb]]

*[http://www.ncbi.nlm.nih.gov/pubmed/2062329 First inhaled steroid study] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/22938706 Tiotropium in asthma] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/21324520 Inhaled steroid in children] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/29768149 Combined Budesonide–Formoterol as Needed in Mild Asthma] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/15223858 Doubling dose of inhaled corticosteroid] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/29768147 As-Needed Budesonide–Formoterol versus Maintenance Budesonide in Mild Asthma] Groups 6,18,30
*[http://www.ncbi.nlm.nih.gov/pubmed/27181606 Indacaterol-glycopyrronium VS salmeterol/fluticasone in COPD] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/21428765 Tiotropium VS salmeterol in COPD] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/23695200 Short VS long steroids for COPD exacerbation] Groups 9,21,33
*[http://www.ncbi.nlm.nih.gov/pubmed/25196117 Stopping inhaled steroids in COPD] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/29668352 Once-Daily Single-Inhaler Triple versus Dual Therapy in Patients with COPD] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/28877011 Tezepelumab in Adults with Uncontrolled Asthma] Groups 12,24,36

8) CARDIOVASCULAR STUDIES

SESSION 1

*[https://www.ncbi.nlm.nih.gov/pubmed/4862069 VA1] (Group 1, 13, 25)
*[https://www.ncbi.nlm.nih.gov/pubmed/4914579 VA 2] (Group 2, 14, 26)
*[https://pubmed.ncbi.nlm.nih.gov/33186492 Polycap Study 3] (Group 3, 15, 27)
*[http://www.ncbi.nlm.nih.gov/pubmed/20228401 ACCORD-BP] (Group 4, 16, 28)
*[https://www.ncbi.nlm.nih.gov/pubmed/26551272 SPRINT] (Group 5, 17, 29)
*[http://www.ncbi.nlm.nih.gov/pubmed/2883575 CONSENSUS] (Group 6,18,30)
*[https://pubmed.ncbi.nlm.nih.gov/31535829/ DAPA-HF] (Group 7, 19, 31)
*[https://pubmed.ncbi.nlm.nih.gov/25176939/ CONFIRM-HF] (Group 8, 20, 32)
*[http://www.ncbi.nlm.nih.gov/pubmed/12457784 PROSPER] (Group 9, 21, 33)
*[http://www.ncbi.nlm.nih.gov/pubmed/27040132 HOPE-3] (Group 10, 22, 34)
*[http://www.ncbi.nlm.nih.gov/pubmed/12114036 Heart Protection Study (HPS)] (Group 11, 23, 35)
*[http://www.ncbi.nlm.nih.gov/pubmed/30415628 REDUCE-IT] (Group 12, 24, 36)

[[File:CV Case.pdf|thumb|CV case|left]]

SESSION 2

'''The Guideline Case'''

A 63 y/o patient with CHOOSE ONE (⬆︎HTN/⬆︎Chol/⬆︎glucose/HF/A fib) and using the guideline determine:
# their 5yr/10yr risks of mortality/CVD events
# the potential benefit
# the potential side effects (with magnitude)
# words/sentiment patient values and preferences/SDM

Atrial fibrillation - Groups 1,13,25,2,14,26
*[https://www.onlinecjc.ca/article/S0828-282X(18)31062-6/pdf 2018 Atrial fibrillation guidelines]
Diabetes - Groups 3,15,27,4,16,28
*[http://guidelines.diabetes.ca/docs/CPG-2018-full-EN.pdf 2018 Diabetes guidelines]
Lipid Simplified - Groups 5,17,29,6,18,30
*[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4607330/pdf/0610857.pdf 2015 Simplified lipid guidelines]
Lipid - Groups 7,19,31,8,20,32
*[http://www.onlinecjc.ca/article/S0828-282X(16)30732-2/pdf 2016 Lipid guidelines]
Heart failure - Groups 9,21,33,10,22,34
*[http://www.onlinecjc.ca/article/S0828-282X(17)30973-X/pdf 2017 Heart failure guidelines]
Hypertension - Groups 11,23,35,12,24,36
*[https://www.onlinecjc.ca/article/S0828-282X(18)30183-1/pdf 2018 Hypertension guidelines]

OPTIONAL SESSION
*[http://www.ncbi.nlm.nih.gov/pubmed/16899775 SPARCL]
*[http://www.ncbi.nlm.nih.gov/pubmed/10471456 RALES]
*[http://www.ncbi.nlm.nih.gov/pubmed/11386263 Carvedilol in heart failure]
*[http://www.ncbi.nlm.nih.gov/pubmed/18460663 WAFACS]
*[http://www.ncbi.nlm.nih.gov/pubmed/10376614 MERIT-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/25176015 PARADIGM-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/24490264 High-dose multivitamins after MI]
*[http://www.ncbi.nlm.nih.gov/pubmed/7911176 Mediterranean Diet after MI]
*[http://www.ncbi.nlm.nih.gov/pubmed/15337732 A TO Z]
*[http://www.ncbi.nlm.nih.gov/pubmed/21073363 EMPHASIS-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/12853193 COMET]
*[http://www.ncbi.nlm.nih.gov/pubmed/24716680 TOPCAT]
*[http://www.ncbi.nlm.nih.gov/pubmed/26039521 IMPROVE-IT]

'''ACADEMIC YEAR 2 - SECOND TERM'''

9) NEPHROLOGY STUDIES

None so far

10) ENDOCRINOLOGY

[[File:IA ENDO LAYOUT.pdf|thumb|IA ENDO LAYOUT TEMPLATE|none]]
[[File:Osteoporosis Evidence SUPP.pdf|none|thumb]]
'''RISK ASSESSMENT CASES FOR DIABETES AND OSTEOPOROSIS'''

'''1) DIABETES CASE'''

66 y/o white male who was diagnosed with diabetes 8 years ago

* His blood pressure over the last year has been roughly 145/80 mmHg - at present untreated
* A1c = 8%, no diabetes meds, non-smoker, BMI ~30
* '''When calculating without diabetes for PREVENT use an A1c of 5.5%'''
* Total cholesterol is 6 mmol/L, his HDL is 2 mmol/L, non-HDL = 6 minus 2, not on a statin
* No retinopathy, urine albumin-to-creatinine ratio (UACR) = 15ug/mg (7mg/mmol),
* Serum creatinine = 70 micromol/L, waist circumference 100 cm
* GFR 75 mL/min/1.73m2
* In normal sinus rhythm
* Age at end of highest education = 19
* Mother alive, father died of a heart attack at age 80

'''Calculate Risks'''

'''CVD RISK ESTIMATES''' - list the endpoints described by the specific calculator

Framingham - xx% - 10-year risk - also if no diabetes xx%

ASCVD - xx% - 10-year risk - also if no diabetes xx%

'''The Calculator'''
*CVD CALCULATOR
https://decisionaid.ca/cvd/

'''DIABETES COMPLICATIONS RISK ESTIMATES''' - list the endpoints described by the specific calculator

xx% - also 10-year risk if A1c 9, 8, 7 and 6

also get risk of kidney failure, vision loss, pressure sensation loss – also if A1c 9, 8,7,6

'''The Calculator'''
*DIABETES DECISION AID
http://decisionaid.ca/diabetes/

'''BENEFITS AND HARMS'''

Use the [https://guidelines.diabetes.ca/cpg/chapter-13-2020-update 2024 diabetes guidelines] and/or Diabetes Decision Aid to get estimates of benefits and harms and also use the MyStudies synopsis listed below

'''COSTS'''

Try using [https://pricingdoc.acfp.ca Pricing Doc] to get costs

'''Groups 1,13,25'''

* Metformin - UKPDS 34 [https://mystudies.org/studies.php#studies/28929e89-d01e-4b11-8e67-4d7086f9e4aa/outcome MyStudies Data]

'''Groups 2,14,26'''

* Sulfonlyureas - UKPDS 33 [https://mystudies.org/studies.php#studies/5eadb5dd-d403-4c13-b03e-d4f8d28c96ba/outcome MyStudies Data]

'''Groups 3,15,27'''

* Insulin - ORIGIN [https://mystudies.org/studies.php#studies/f611818f-2e69-4952-b55e-661116bd84b6/outcome MyStudies Data]

'''Groups 4,16,28'''

* SGLT2 - EMPA-REG OUTCOME [https://mystudies.org/studies.php#studies/32e9cf1a-f33e-480b-91ca-6f28a4dcf862/outcome MyStudies Data]

'''Groups 5,17,29'''

* GLP - LEADER [https://mystudies.org/studies.php#studies/1adbc9a1-7603-40f1-ac15-b813ce1f0ad6/outcome MyStudies Data]

'''Groups 6,18,30'''

* DPP4 - TECOS [https://mystudies.org/studies.php#studies/8659968a-cefb-4f99-b4ae-8b9b659acbd5/outcome MyStudies Data]

'''Groups 7,19,31'''

* Intensive treatment – small scale - STENO [https://mystudies.org/studies.php#studies/39d423e3-af57-40c8-ab7a-cbc7f389bdb6/paper MyStudies Data]

'''Groups 8,20,32'''

* Intensive treatment – large scale - ADDITION-Europe - [https://mystudies.org/studies.php#studies/5e07d86d-aa92-4db9-a283-76080db4b6fd/outcome MyStudies Data]

'''2) OSTEOPOROSIS CASE'''

60 y/o female

* 72 kg, 1.69m, BMI = 25.2
* t-score of -2.5
* Worried about falling and getting a hip fracture
* A friend recently had an atraumatic fracture from simply tripping and falling over in the snow
* No other risk factors

'''Calculate Risks'''

'''FRACTURE RISK ESTIMATES''' - list the endpoints described by the specific calculator

Major osteoporotic fracture - xx% - 10-year risk – if no BMD (just BMI), and then if they had a BMD t-Score of -2.0, -2.5, and -3.0

Hip fracture - - xx% - 10-year risk – if no BMD (just BMI) and if you have a BMD xx% - 10-year risk – if no BMD, and then if they had a BMD T-Score of -2.0, -2.5, and -3.0

'''The Calculator'''

* FRACTURE CALCULATOR

[https://frax.shef.ac.uk/frax/tool.aspx?country=19 Frax Tool - Canada]

'''BENEFITS AND HARMS'''

Use the [https://www.cmaj.ca/content/195/39/E1333 2023 Osteoporosis Guideline] and/or your osteoporosis lecture notes to get the benefits and apply these to your patient, and also get the harms

'''COSTS'''

Try using [https://pricingdoc.acfp.ca Pricing Doc] to get costs

'''Groups 9,21,33'''

* Activity

'''Groups 10,22,34'''

* Calcium/Vitamin D

'''Groups 11,23,35'''

* Bisphosphonates

'''Groups 12,24,36'''

* Denosumab

11) NEUROLOGY STUDIES

*[http://www.ncbi.nlm.nih.gov/pubmed/16717269 Opioids for chronic non-cancer pain] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/29509867 Effect of Opioid vs Nonopioid Medications on Pain-Related Function in Patients With Chronic Back Pain] Groups 2,14,26
*[https://www.ncbi.nlm.nih.gov/pubmed/31291515 Galcanezumab for prevention of cluster headaches] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/27150433 Immediate or delayed treatment of a first seizure] Groups 4,16,28
*[https://www.ncbi.nlm.nih.gov/pubmed/31291516 Rimegepant for episodic migraine] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/26212846 Sleep restriction for insomnia] Groups 6,18,30
*[https://www.ncbi.nlm.nih.gov/pubmed/25957224 CHANCE] Groups 7,19,31
*[https://www.ncbi.nlm.nih.gov/pubmed/16899775 SPARCL] Groups 8,20,32
*[https://www.ncbi.nlm.nih.gov/pubmed/29171821 Erenumab for episodic migraine] Groups 9,21,33
*[https://www.ncbi.nlm.nih.gov/pubmed/24733354 Reduction of benzodiazepines through education] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/26035341 Patient controlled opioid analgesia versus non-patient controlled opioid analgesia for postoperative pain] Groups 11,23,35
*[https://www.ncbi.nlm.nih.gov/pubmed/11589932 PROGRESS] Groups 12,24,36

'''ACADEMIC YEAR 3'''

12) PSYCHIATRY STUDIES

[[:File:2021 Psych Evidence Appraisal - Intro Slides.pdf|Psychiatry Rating Scales Introduction]]

* Study 1: [http://www.ncbi.nlm.nih.gov/pubmed/16554525 STAR*D (Level 2)] Bupropion-SR, sertraline, or venlafaxine-XR after failure of SSRIs for depression
* Study 2: [http://www.ncbi.nlm.nih.gov/pubmed/29477251 Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder]
* Study 3: [https://pubmed.ncbi.nlm.nih.gov/33862018/ Long-acting injectable versus oral antipsychotics for the maintenance treatment of schizophrenia]
* Study 4: [https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2725088 Association of Antipsychotic Polypharmacy vs Monotherapy With Psychiatric Rehospitalization Among Adults With Schizophrenia]
* Study 5: [https://www.ncbi.nlm.nih.gov/pubmed/29490359 Real-world Effectiveness of Pharmacologic Treatments for the Prevention of Bipolar Disorder]
* Study 6: [http://www.ncbi.nlm.nih.gov/pubmed/20092882 BALANCE] Combination lithium and valproate therapy versus monotherapy for relapse prevention in bipolar I disorder
[[File:ChatGPT directions.jpg|thumb|ChatGPT Directions]]
13) GASTROENTEROLOGY STUDIES - LINKS ON CANVAS

*Short-term treatment for gastro-oesophageal reflux disease-like symptoms and endoscopy negative reflux disease (Review)
*Oral budesonide for induction of remission in ulcerative colitis (Review)
*Probiotics for the prevention of Clostridium difficile-associated diarrhea in adults and children (Review)
*Deprescribing versus continuation of chronic proton pump inhibitor use in adults (Review)
*Prevention of NSAID-induced gastroduodenal ulcers (Review)
*Methotrexate for maintenance of remission in Crohn's disease (Review)

14) OB/GYN STUDIES
*[http://www.ncbi.nlm.nih.gov/pubmed/25601350 Comparative contraceptive effectiveness of levonorgestrel-releasing and copper IUD Devices]
*[http://www.ncbi.nlm.nih.gov/pubmed/29211679 Hormonal contraception and the risk of breast cancer]
*[http://www.ncbi.nlm.nih.gov/pubmed/30322986 Sexual behaviours in adolescent girls before and after introduction of the HPV]
*[http://www.ncbi.nlm.nih.gov/pubmed/30181338 Intramuscular vs intravenous oxytocin to prevent postpartum haemorrhage at vaginal delivery]
*[http://www.ncbi.nlm.nih.gov/pubmed/27682034 Azithromycin Prophylaxis for Cesarean Delivery]
*[http://www.ncbi.nlm.nih.gov/pubmed/28461374 Antibiotics during pregnancy and risk of spontaneous abortion]

File:Osteoporosis Evidence SUPP.pdf

2025-02-04T19:23:41Z

JamesMcCormack: Uploaded own work with UploadWizard

=={{int:filedesc}}==
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|description={{en|1=Osteoporosis Evidence SUPP}}
|date=2025-02-04
|source={{own}}
|author=[[User:JamesMcCormack|JamesMcCormack]]
|permission=
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=={{int:license-header}}==
{{self|cc-by-sa-4.0}}

Evidence Appraisal Integrated Activities

2025-02-04T19:18:46Z

JamesMcCormack:

'''OBJECTIVE'''

To critically appraise studies, develop a brief synopsis of the trial results, succinctly present the results and then put the results into a proper clinical context

'''INITIAL PRE-READING'''

'''How To Critically Appraise an RCT In 10 minutes'''
*[https://itunes.apple.com/ca/book/how-to-critically-appraise/id524600667?mt=11 iBook/iPad version]
*[https://therapeuticseducation.org/sites/therapeuticseducation.org/files/Ten_Minute_Critical_Appraisal.pdf PDF version]
Watch this video
[http://youtu.be/QUW0Q8tXVUc Viva La Evidence]

'''Study Results at Your Fingertips'''
*[https://mystudies.org MyStudies] - Free access

'''INTEGRATION ACTIVITY FORMAT'''
# Students placed in groups of ~ 5-7
# Each group is given one of the studies below to review
# Students then work in pairs and develop a one-slide critical appraisal and results synopsis
# One student in each group will be chosen at random to present their group findings to the class
# A discussion about the appraisal and the appropriate clinical context for the results is had with the entire class for each study

'''MODULE'''
[[File:Screen Shot 2022-01-09 at 10.00.16 AM.jpg|thumb|'''TRIAL PRESENTATION FORMAT'''|none]]

Studies chosen include landmark studies and/or studies that address important therapeutic issues for the particular module

'''ACADEMIC YEAR 1 - FIRST TERM'''

1) FOUNDATION STUDIES (Groups)
*[https://pubmed.ncbi.nlm.nih.gov/37952131 SELECT] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/12466506 AFFIRM] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/22085343 AIM-HIGH] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/10639539 HOPE] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/18378519 HYVET] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/15007110 PROVE-IT] Groups 6,18,30
*[http://www.ncbi.nlm.nih.gov/pubmed/15755765 TNT] Groups 7,19,31
*[https://pubmed.ncbi.nlm.nih.gov/26378978 EMPAREG] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/17984165 ILLUMINATE] Groups 9,21,33
*[https://pubmed.ncbi.nlm.nih.gov/26551272/ SPRINT] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/15325833 CARDS] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/12117397 WHI] Groups 12,24,36

'''ACADEMIC YEAR 1 - SECOND TERM'''

2) INTRO TO INFECTIOUS DISEASE STUDIES

[https://wiki.ubc.ca/images/8/8b/Antibiotic_Sensitivity_Chart_2024.pdf The "Best" Antibiotic Sensitivity Chart Ever]
*[http://www.ncbi.nlm.nih.gov/pubmed/17567657 IV vs PO antibiotics] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/24603565 Delayed antibiotics for respiratory tract infections] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/11159657 Delayed antibiotics for otitis media] Groups 3,15,27
*[https://pubmed.ncbi.nlm.nih.gov/27455166/ Duration of treatment for community acquired pneumonia] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/22726802 Duration of treatment for pyelonephritis] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/25830421 Choice of antibiotic for community acquired pneumonia-1] Groups 6,18,30
*[http://www.ncbi.nlm.nih.gov/pubmed/25286173 Choice of antibiotic for community acquired pneumonia-2] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/20647284 HPV vaccine study] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/7966893 Influenza vaccine study] Groups 9,21,33
*[https://pubmed.ncbi.nlm.nih.gov/33301246/ COVID vaccine Pfizer] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/27626517 Herpes zoster vaccine study 1] Groups 11,23,35
*[https://www.ncbi.nlm.nih.gov/pubmed/25916341 Herpes zoster vaccine study 2] Groups 12,24,36

3) MUSCULOSKELETAL STUDIES

*[http://www.ncbi.nlm.nih.gov/pubmed/28199814 Baricitinib versus Placebo or Adalimumab in Rheumatoid Arthritis] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/0010979111 CLASS – celecoxib vs NSAIDs] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/26501533 Naproxen with cyclobenzaprine, oxycodone/acetaminophen, or placebo for low back pain] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/24395557 Glucosamine and chondroitin for OA] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/12546607 Acetaminophen vs diclofenac for OA] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/23964752 Diclofenac gel for acute neck pain] Groups 6,18,30
*[https://pubmed.ncbi.nlm.nih.gov/15468367/ Topical diclofenac vs oral diclofenac] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/25064594 Acetaminophen for low back pain] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/7611589 Misoprostol and NSAID induced ulcers] Groups 9,21,33
*[http://www.ncbi.nlm.nih.gov/pubmed/20131255 Low dose vs high dose colchicine for gout] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/22508468 TEAR - oral triple therapy versus etanercept plus methotrexate in early aggressive rheumatoid arthritis] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/25589511 MOVES - Glucosamine and chondroitin for OA for moderate to severe pain] Groups 12,24,36

4) DERMATOLOGY STUDIES

*[https://www.ncbi.nlm.nih.gov/pubmed/9598014 Glycolic acid 5% Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/21896132 Glycolic acid 10% Acne]
*[https://www.ncbi.nlm.nih.gov/pubmed/14531866 Petrolatum vs Ceramide/skin related lipids Hand Dermatitis]
*[https://www.ncbi.nlm.nih.gov/pubmed/11896774 Vitamin C Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/17515510 Retinol (VitaminA) Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/21896129 Hyaluronic acid Atopic Dermatitis]

5) EENT STUDIES

[http://www.amstar.ca/docs/AMSTARguideline.pdf AMSTAR meta-analysis checklist]

'''Scenario 1 - Otitis Media''' - GROUPS 1, 7, 18, 19, 25, 36

Anthony Martin arrives at your pharmacy somewhat frustrated since his family physician declined to write an antibiotic prescription for his two and half year old son, Oscar. His symptoms started yesterday afternoon - Oscar complains of right ear pain but there is no discharge. Rectal temperature taken today was 38.5 degrees. His wife is sure Oscar has an ear infection since the last time he had these same symptoms, that was ultimately the diagnosis. Mr. Martin asks if you think buying acetaminophen is really “enough”?

[https://pubmed.ncbi.nlm.nih.gov/26099233/ Antibiotics for acute otitis media in children]

'''Scenario 2 - Allergic Rhinitis''' - GROUPS 2, 8, 17, 20, 26, 35

Ruby Parmar is a firefighter. She is plagued by sinus congestion (preventing her from sleeping) and a runny nose associated with seasonal allergies. Her prescription for intranasal triamcinolone is typically effective, but she would like to know if a non-sedating anti-allergy pill would work just as well since it’s inconvenient carrying around the “nose spray”.

[https://www.ncbi.nlm.nih.gov/pubmed/28234147 Intranasal steroids vs antihistamines for allergic rhinitis]

'''Scenario 3 - Acute Sinusitis''' - GROUPS 3, 9, 16, 21, 27, 34

You are seeing a patient in clinic before her appointment with the primary care physician. She was feeling unwell with a “flu” last week. While most of her symptoms have resolved (cough, fever), the nasal congestion and discharge persists and so she has made an appointment (she is an otherwise healthy 32 year old with treated thyroid disease). She would like your advice for what treatment she should ask the doctor to prescribe.

[http://www.ncbi.nlm.nih.gov/pubmed/24293353 Intranasal steroids for acute sinusitis]

'''Scenario 4 - Glaucoma''' - GROUPS 4, 10, 15, 22, 28, 33

Mrs. Ada Waters is a 63 year-old woman you. Her ophthalmologist prescribed timolol and xalatan eye drops for treatment of open angle glaucoma. She has never really felt much different on treatment since she recovered from her first episode (of acute angle closure glaucoma requiring ER visit) and surgery. She asks you if the treatment is really making a difference.

[https://www.ncbi.nlm.nih.gov/pubmed/17943780 Interventions for open angle glaucoma]

'''Scenario 5 - Sore Throat''' - GROUPS 5, 11, 14, 23, 29, 32

You have a good friend who is applying for pharmacy. Her invitation for the multiple-mini interview (MMI) is coming up soon, but she is starting to experience a sore throat. While she is worried about not being able to speak through all of those stations, she knows she often gets a terrible headache along with her sore throat. She has an unused prescription for amoxicillin (unexpired) and wonders if you recommend for her to take it.

[https://pubmed.ncbi.nlm.nih.gov/34881426/ Antibiotics for sore throat]

'''Scenario 6 - Conjunctivitis''' - GROUPS 6, 12, 13, 24, 30, 31

A man comes to your pharmacy (he appears in his early twenties) complaining of “pink eye”. He has had a pink discolouration and discharge from his left eye for two days. He asks if the OTC antibiotic eye drops (he’s holding a product with polymixin B) are any better than “waiting it out”.

[https://www.ncbi.nlm.nih.gov/pubmed/22972049 Antibiotics for acute conjunctivitis]

6) HEMATOLOGY STUDIES

None so far

'''ACADEMIC YEAR 2 - FIRST TERM'''

7) RESPIROLOGY STUDIES
[[File:IA COPD info.pdf|thumb]]

*[http://www.ncbi.nlm.nih.gov/pubmed/2062329 First inhaled steroid study] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/22938706 Tiotropium in asthma] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/21324520 Inhaled steroid in children] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/29768149 Combined Budesonide–Formoterol as Needed in Mild Asthma] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/15223858 Doubling dose of inhaled corticosteroid] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/29768147 As-Needed Budesonide–Formoterol versus Maintenance Budesonide in Mild Asthma] Groups 6,18,30
*[http://www.ncbi.nlm.nih.gov/pubmed/27181606 Indacaterol-glycopyrronium VS salmeterol/fluticasone in COPD] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/21428765 Tiotropium VS salmeterol in COPD] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/23695200 Short VS long steroids for COPD exacerbation] Groups 9,21,33
*[http://www.ncbi.nlm.nih.gov/pubmed/25196117 Stopping inhaled steroids in COPD] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/29668352 Once-Daily Single-Inhaler Triple versus Dual Therapy in Patients with COPD] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/28877011 Tezepelumab in Adults with Uncontrolled Asthma] Groups 12,24,36

8) CARDIOVASCULAR STUDIES

SESSION 1

*[https://www.ncbi.nlm.nih.gov/pubmed/4862069 VA1] (Group 1, 13, 25)
*[https://www.ncbi.nlm.nih.gov/pubmed/4914579 VA 2] (Group 2, 14, 26)
*[https://pubmed.ncbi.nlm.nih.gov/33186492 Polycap Study 3] (Group 3, 15, 27)
*[http://www.ncbi.nlm.nih.gov/pubmed/20228401 ACCORD-BP] (Group 4, 16, 28)
*[https://www.ncbi.nlm.nih.gov/pubmed/26551272 SPRINT] (Group 5, 17, 29)
*[http://www.ncbi.nlm.nih.gov/pubmed/2883575 CONSENSUS] (Group 6,18,30)
*[https://pubmed.ncbi.nlm.nih.gov/31535829/ DAPA-HF] (Group 7, 19, 31)
*[https://pubmed.ncbi.nlm.nih.gov/25176939/ CONFIRM-HF] (Group 8, 20, 32)
*[http://www.ncbi.nlm.nih.gov/pubmed/12457784 PROSPER] (Group 9, 21, 33)
*[http://www.ncbi.nlm.nih.gov/pubmed/27040132 HOPE-3] (Group 10, 22, 34)
*[http://www.ncbi.nlm.nih.gov/pubmed/12114036 Heart Protection Study (HPS)] (Group 11, 23, 35)
*[http://www.ncbi.nlm.nih.gov/pubmed/30415628 REDUCE-IT] (Group 12, 24, 36)

[[File:CV Case.pdf|thumb|CV case|left]]

SESSION 2

'''The Guideline Case'''

A 63 y/o patient with CHOOSE ONE (⬆︎HTN/⬆︎Chol/⬆︎glucose/HF/A fib) and using the guideline determine:
# their 5yr/10yr risks of mortality/CVD events
# the potential benefit
# the potential side effects (with magnitude)
# words/sentiment patient values and preferences/SDM

Atrial fibrillation - Groups 1,13,25,2,14,26
*[https://www.onlinecjc.ca/article/S0828-282X(18)31062-6/pdf 2018 Atrial fibrillation guidelines]
Diabetes - Groups 3,15,27,4,16,28
*[http://guidelines.diabetes.ca/docs/CPG-2018-full-EN.pdf 2018 Diabetes guidelines]
Lipid Simplified - Groups 5,17,29,6,18,30
*[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4607330/pdf/0610857.pdf 2015 Simplified lipid guidelines]
Lipid - Groups 7,19,31,8,20,32
*[http://www.onlinecjc.ca/article/S0828-282X(16)30732-2/pdf 2016 Lipid guidelines]
Heart failure - Groups 9,21,33,10,22,34
*[http://www.onlinecjc.ca/article/S0828-282X(17)30973-X/pdf 2017 Heart failure guidelines]
Hypertension - Groups 11,23,35,12,24,36
*[https://www.onlinecjc.ca/article/S0828-282X(18)30183-1/pdf 2018 Hypertension guidelines]

OPTIONAL SESSION
*[http://www.ncbi.nlm.nih.gov/pubmed/16899775 SPARCL]
*[http://www.ncbi.nlm.nih.gov/pubmed/10471456 RALES]
*[http://www.ncbi.nlm.nih.gov/pubmed/11386263 Carvedilol in heart failure]
*[http://www.ncbi.nlm.nih.gov/pubmed/18460663 WAFACS]
*[http://www.ncbi.nlm.nih.gov/pubmed/10376614 MERIT-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/25176015 PARADIGM-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/24490264 High-dose multivitamins after MI]
*[http://www.ncbi.nlm.nih.gov/pubmed/7911176 Mediterranean Diet after MI]
*[http://www.ncbi.nlm.nih.gov/pubmed/15337732 A TO Z]
*[http://www.ncbi.nlm.nih.gov/pubmed/21073363 EMPHASIS-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/12853193 COMET]
*[http://www.ncbi.nlm.nih.gov/pubmed/24716680 TOPCAT]
*[http://www.ncbi.nlm.nih.gov/pubmed/26039521 IMPROVE-IT]

'''ACADEMIC YEAR 2 - SECOND TERM'''

9) NEPHROLOGY STUDIES

None so far

10) ENDOCRINOLOGY

[[File:IA ENDO LAYOUT.pdf|thumb|IA ENDO LAYOUT TEMPLATE|none]]

'''RISK ASSESSMENT CASES FOR DIABETES AND OSTEOPOROSIS'''

'''1) DIABETES CASE'''

66 y/o white male who was diagnosed with diabetes 8 years ago

* His blood pressure over the last year has been roughly 145/80 mmHg - at present untreated
* A1c = 8%, no diabetes meds, non-smoker, BMI ~30
* '''When calculating without diabetes for PREVENT use an A1c of 5.5%'''
* Total cholesterol is 6 mmol/L, his HDL is 2 mmol/L, non-HDL = 6 minus 2, not on a statin
* No retinopathy, urine albumin-to-creatinine ratio (UACR) = 15ug/mg (7mg/mmol),
* Serum creatinine = 70 micromol/L, waist circumference 100 cm
* GFR 75 mL/min/1.73m2
* In normal sinus rhythm
* Age at end of highest education = 19
* Mother alive, father died of a heart attack at age 80

'''Calculate Risks'''

'''CVD RISK ESTIMATES''' - list the endpoints described by the specific calculator

Framingham - xx% - 10-year risk - also if no diabetes xx%

ASCVD - xx% - 10-year risk - also if no diabetes xx%

'''The Calculator'''
*CVD CALCULATOR
https://decisionaid.ca/cvd/

'''DIABETES COMPLICATIONS RISK ESTIMATES''' - list the endpoints described by the specific calculator

xx% - also 10-year risk if A1c 9, 8, 7 and 6

also get risk of kidney failure, vision loss, pressure sensation loss – also if A1c 9, 8,7,6

'''The Calculator'''
*DIABETES DECISION AID
http://decisionaid.ca/diabetes/

'''BENEFITS AND HARMS'''

Use the [https://guidelines.diabetes.ca/cpg/chapter-13-2020-update 2024 diabetes guidelines] and/or Diabetes Decision Aid to get estimates of benefits and harms and also use the MyStudies synopsis listed below

'''COSTS'''

Try using [https://pricingdoc.acfp.ca Pricing Doc] to get costs

'''Groups 1,13,25'''

* Metformin - UKPDS 34 [https://mystudies.org/studies.php#studies/28929e89-d01e-4b11-8e67-4d7086f9e4aa/outcome MyStudies Data]

'''Groups 2,14,26'''

* Sulfonlyureas - UKPDS 33 [https://mystudies.org/studies.php#studies/5eadb5dd-d403-4c13-b03e-d4f8d28c96ba/outcome MyStudies Data]

'''Groups 3,15,27'''

* Insulin - ORIGIN [https://mystudies.org/studies.php#studies/f611818f-2e69-4952-b55e-661116bd84b6/outcome MyStudies Data]

'''Groups 4,16,28'''

* SGLT2 - EMPA-REG OUTCOME [https://mystudies.org/studies.php#studies/32e9cf1a-f33e-480b-91ca-6f28a4dcf862/outcome MyStudies Data]

'''Groups 5,17,29'''

* GLP - LEADER [https://mystudies.org/studies.php#studies/1adbc9a1-7603-40f1-ac15-b813ce1f0ad6/outcome MyStudies Data]

'''Groups 6,18,30'''

* DPP4 - TECOS [https://mystudies.org/studies.php#studies/8659968a-cefb-4f99-b4ae-8b9b659acbd5/outcome MyStudies Data]

'''Groups 7,19,31'''

* Intensive treatment – small scale - STENO [https://mystudies.org/studies.php#studies/39d423e3-af57-40c8-ab7a-cbc7f389bdb6/paper MyStudies Data]

'''Groups 8,20,32'''

* Intensive treatment – large scale - ADDITION-Europe - [https://mystudies.org/studies.php#studies/5e07d86d-aa92-4db9-a283-76080db4b6fd/outcome MyStudies Data]

'''2) OSTEOPOROSIS CASE'''

60 y/o female

* 72 kg, 1.69m, BMI = 25.2
* t-score of -2.5
* Worried about falling and getting a hip fracture
* A friend recently had an atraumatic fracture from simply tripping and falling over in the snow
* No other risk factors

'''Calculate Risks'''

'''FRACTURE RISK ESTIMATES''' - list the endpoints described by the specific calculator

Major osteoporotic fracture - xx% - 10-year risk – if no BMD (just BMI), and then if they had a BMD t-Score of -2.0, -2.5, and -3.0

Hip fracture - - xx% - 10-year risk – if no BMD (just BMI) and if you have a BMD xx% - 10-year risk – if no BMD, and then if they had a BMD T-Score of -2.0, -2.5, and -3.0

'''The Calculator'''

* FRACTURE CALCULATOR

[https://frax.shef.ac.uk/frax/tool.aspx?country=19 Frax Tool - Canada]

'''BENEFITS AND HARMS'''

Use the [https://www.cmaj.ca/content/195/39/E1333 2023 Osteoporosis Guideline] and/or your osteoporosis lecture notes to get the benefits and apply these to your patient, and also get the harms

'''COSTS'''

Try using [https://pricingdoc.acfp.ca Pricing Doc] to get costs

'''Groups 9,21,33'''

* Activity

'''Groups 10,22,34'''

* Calcium/Vitamin D

'''Groups 11,23,35'''

* Bisphosphonates

'''Groups 12,24,36'''

* Denosumab

11) NEUROLOGY STUDIES

*[http://www.ncbi.nlm.nih.gov/pubmed/16717269 Opioids for chronic non-cancer pain] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/29509867 Effect of Opioid vs Nonopioid Medications on Pain-Related Function in Patients With Chronic Back Pain] Groups 2,14,26
*[https://www.ncbi.nlm.nih.gov/pubmed/31291515 Galcanezumab for prevention of cluster headaches] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/27150433 Immediate or delayed treatment of a first seizure] Groups 4,16,28
*[https://www.ncbi.nlm.nih.gov/pubmed/31291516 Rimegepant for episodic migraine] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/26212846 Sleep restriction for insomnia] Groups 6,18,30
*[https://www.ncbi.nlm.nih.gov/pubmed/25957224 CHANCE] Groups 7,19,31
*[https://www.ncbi.nlm.nih.gov/pubmed/16899775 SPARCL] Groups 8,20,32
*[https://www.ncbi.nlm.nih.gov/pubmed/29171821 Erenumab for episodic migraine] Groups 9,21,33
*[https://www.ncbi.nlm.nih.gov/pubmed/24733354 Reduction of benzodiazepines through education] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/26035341 Patient controlled opioid analgesia versus non-patient controlled opioid analgesia for postoperative pain] Groups 11,23,35
*[https://www.ncbi.nlm.nih.gov/pubmed/11589932 PROGRESS] Groups 12,24,36

'''ACADEMIC YEAR 3'''

12) PSYCHIATRY STUDIES

[[:File:2021 Psych Evidence Appraisal - Intro Slides.pdf|Psychiatry Rating Scales Introduction]]

* Study 1: [http://www.ncbi.nlm.nih.gov/pubmed/16554525 STAR*D (Level 2)] Bupropion-SR, sertraline, or venlafaxine-XR after failure of SSRIs for depression
* Study 2: [http://www.ncbi.nlm.nih.gov/pubmed/29477251 Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder]
* Study 3: [https://pubmed.ncbi.nlm.nih.gov/33862018/ Long-acting injectable versus oral antipsychotics for the maintenance treatment of schizophrenia]
* Study 4: [https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2725088 Association of Antipsychotic Polypharmacy vs Monotherapy With Psychiatric Rehospitalization Among Adults With Schizophrenia]
* Study 5: [https://www.ncbi.nlm.nih.gov/pubmed/29490359 Real-world Effectiveness of Pharmacologic Treatments for the Prevention of Bipolar Disorder]
* Study 6: [http://www.ncbi.nlm.nih.gov/pubmed/20092882 BALANCE] Combination lithium and valproate therapy versus monotherapy for relapse prevention in bipolar I disorder
[[File:ChatGPT directions.jpg|thumb|ChatGPT Directions]]
13) GASTROENTEROLOGY STUDIES - LINKS ON CANVAS

*Short-term treatment for gastro-oesophageal reflux disease-like symptoms and endoscopy negative reflux disease (Review)
*Oral budesonide for induction of remission in ulcerative colitis (Review)
*Probiotics for the prevention of Clostridium difficile-associated diarrhea in adults and children (Review)
*Deprescribing versus continuation of chronic proton pump inhibitor use in adults (Review)
*Prevention of NSAID-induced gastroduodenal ulcers (Review)
*Methotrexate for maintenance of remission in Crohn's disease (Review)

14) OB/GYN STUDIES
*[http://www.ncbi.nlm.nih.gov/pubmed/25601350 Comparative contraceptive effectiveness of levonorgestrel-releasing and copper IUD Devices]
*[http://www.ncbi.nlm.nih.gov/pubmed/29211679 Hormonal contraception and the risk of breast cancer]
*[http://www.ncbi.nlm.nih.gov/pubmed/30322986 Sexual behaviours in adolescent girls before and after introduction of the HPV]
*[http://www.ncbi.nlm.nih.gov/pubmed/30181338 Intramuscular vs intravenous oxytocin to prevent postpartum haemorrhage at vaginal delivery]
*[http://www.ncbi.nlm.nih.gov/pubmed/27682034 Azithromycin Prophylaxis for Cesarean Delivery]
*[http://www.ncbi.nlm.nih.gov/pubmed/28461374 Antibiotics during pregnancy and risk of spontaneous abortion]

Evidence Appraisal Integrated Activities

2025-02-04T19:18:01Z

JamesMcCormack:

'''OBJECTIVE'''

To critically appraise studies, develop a brief synopsis of the trial results, succinctly present the results and then put the results into a proper clinical context

'''INITIAL PRE-READING'''

'''How To Critically Appraise an RCT In 10 minutes'''
*[https://itunes.apple.com/ca/book/how-to-critically-appraise/id524600667?mt=11 iBook/iPad version]
*[https://therapeuticseducation.org/sites/therapeuticseducation.org/files/Ten_Minute_Critical_Appraisal.pdf PDF version]
Watch this video
[http://youtu.be/QUW0Q8tXVUc Viva La Evidence]

'''Study Results at Your Fingertips'''
*[https://mystudies.org MyStudies] - Free access

'''INTEGRATION ACTIVITY FORMAT'''
# Students placed in groups of ~ 5-7
# Each group is given one of the studies below to review
# Students then work in pairs and develop a one-slide critical appraisal and results synopsis
# One student in each group will be chosen at random to present their group findings to the class
# A discussion about the appraisal and the appropriate clinical context for the results is had with the entire class for each study

'''MODULE'''
[[File:Screen Shot 2022-01-09 at 10.00.16 AM.jpg|thumb|'''TRIAL PRESENTATION FORMAT'''|none]]

Studies chosen include landmark studies and/or studies that address important therapeutic issues for the particular module

'''ACADEMIC YEAR 1 - FIRST TERM'''

1) FOUNDATION STUDIES (Groups)
*[https://pubmed.ncbi.nlm.nih.gov/37952131 SELECT] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/12466506 AFFIRM] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/22085343 AIM-HIGH] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/10639539 HOPE] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/18378519 HYVET] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/15007110 PROVE-IT] Groups 6,18,30
*[http://www.ncbi.nlm.nih.gov/pubmed/15755765 TNT] Groups 7,19,31
*[https://pubmed.ncbi.nlm.nih.gov/26378978 EMPAREG] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/17984165 ILLUMINATE] Groups 9,21,33
*[https://pubmed.ncbi.nlm.nih.gov/26551272/ SPRINT] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/15325833 CARDS] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/12117397 WHI] Groups 12,24,36

'''ACADEMIC YEAR 1 - SECOND TERM'''

2) INTRO TO INFECTIOUS DISEASE STUDIES

[https://wiki.ubc.ca/images/8/8b/Antibiotic_Sensitivity_Chart_2024.pdf The "Best" Antibiotic Sensitivity Chart Ever]
*[http://www.ncbi.nlm.nih.gov/pubmed/17567657 IV vs PO antibiotics] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/24603565 Delayed antibiotics for respiratory tract infections] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/11159657 Delayed antibiotics for otitis media] Groups 3,15,27
*[https://pubmed.ncbi.nlm.nih.gov/27455166/ Duration of treatment for community acquired pneumonia] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/22726802 Duration of treatment for pyelonephritis] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/25830421 Choice of antibiotic for community acquired pneumonia-1] Groups 6,18,30
*[http://www.ncbi.nlm.nih.gov/pubmed/25286173 Choice of antibiotic for community acquired pneumonia-2] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/20647284 HPV vaccine study] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/7966893 Influenza vaccine study] Groups 9,21,33
*[https://pubmed.ncbi.nlm.nih.gov/33301246/ COVID vaccine Pfizer] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/27626517 Herpes zoster vaccine study 1] Groups 11,23,35
*[https://www.ncbi.nlm.nih.gov/pubmed/25916341 Herpes zoster vaccine study 2] Groups 12,24,36

3) MUSCULOSKELETAL STUDIES

*[http://www.ncbi.nlm.nih.gov/pubmed/28199814 Baricitinib versus Placebo or Adalimumab in Rheumatoid Arthritis] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/0010979111 CLASS – celecoxib vs NSAIDs] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/26501533 Naproxen with cyclobenzaprine, oxycodone/acetaminophen, or placebo for low back pain] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/24395557 Glucosamine and chondroitin for OA] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/12546607 Acetaminophen vs diclofenac for OA] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/23964752 Diclofenac gel for acute neck pain] Groups 6,18,30
*[https://pubmed.ncbi.nlm.nih.gov/15468367/ Topical diclofenac vs oral diclofenac] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/25064594 Acetaminophen for low back pain] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/7611589 Misoprostol and NSAID induced ulcers] Groups 9,21,33
*[http://www.ncbi.nlm.nih.gov/pubmed/20131255 Low dose vs high dose colchicine for gout] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/22508468 TEAR - oral triple therapy versus etanercept plus methotrexate in early aggressive rheumatoid arthritis] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/25589511 MOVES - Glucosamine and chondroitin for OA for moderate to severe pain] Groups 12,24,36

4) DERMATOLOGY STUDIES

*[https://www.ncbi.nlm.nih.gov/pubmed/9598014 Glycolic acid 5% Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/21896132 Glycolic acid 10% Acne]
*[https://www.ncbi.nlm.nih.gov/pubmed/14531866 Petrolatum vs Ceramide/skin related lipids Hand Dermatitis]
*[https://www.ncbi.nlm.nih.gov/pubmed/11896774 Vitamin C Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/17515510 Retinol (VitaminA) Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/21896129 Hyaluronic acid Atopic Dermatitis]

5) EENT STUDIES

[http://www.amstar.ca/docs/AMSTARguideline.pdf AMSTAR meta-analysis checklist]

'''Scenario 1 - Otitis Media''' - GROUPS 1, 7, 18, 19, 25, 36

Anthony Martin arrives at your pharmacy somewhat frustrated since his family physician declined to write an antibiotic prescription for his two and half year old son, Oscar. His symptoms started yesterday afternoon - Oscar complains of right ear pain but there is no discharge. Rectal temperature taken today was 38.5 degrees. His wife is sure Oscar has an ear infection since the last time he had these same symptoms, that was ultimately the diagnosis. Mr. Martin asks if you think buying acetaminophen is really “enough”?

[https://pubmed.ncbi.nlm.nih.gov/26099233/ Antibiotics for acute otitis media in children]

'''Scenario 2 - Allergic Rhinitis''' - GROUPS 2, 8, 17, 20, 26, 35

Ruby Parmar is a firefighter. She is plagued by sinus congestion (preventing her from sleeping) and a runny nose associated with seasonal allergies. Her prescription for intranasal triamcinolone is typically effective, but she would like to know if a non-sedating anti-allergy pill would work just as well since it’s inconvenient carrying around the “nose spray”.

[https://www.ncbi.nlm.nih.gov/pubmed/28234147 Intranasal steroids vs antihistamines for allergic rhinitis]

'''Scenario 3 - Acute Sinusitis''' - GROUPS 3, 9, 16, 21, 27, 34

You are seeing a patient in clinic before her appointment with the primary care physician. She was feeling unwell with a “flu” last week. While most of her symptoms have resolved (cough, fever), the nasal congestion and discharge persists and so she has made an appointment (she is an otherwise healthy 32 year old with treated thyroid disease). She would like your advice for what treatment she should ask the doctor to prescribe.

[http://www.ncbi.nlm.nih.gov/pubmed/24293353 Intranasal steroids for acute sinusitis]

'''Scenario 4 - Glaucoma''' - GROUPS 4, 10, 15, 22, 28, 33

Mrs. Ada Waters is a 63 year-old woman you. Her ophthalmologist prescribed timolol and xalatan eye drops for treatment of open angle glaucoma. She has never really felt much different on treatment since she recovered from her first episode (of acute angle closure glaucoma requiring ER visit) and surgery. She asks you if the treatment is really making a difference.

[https://www.ncbi.nlm.nih.gov/pubmed/17943780 Interventions for open angle glaucoma]

'''Scenario 5 - Sore Throat''' - GROUPS 5, 11, 14, 23, 29, 32

You have a good friend who is applying for pharmacy. Her invitation for the multiple-mini interview (MMI) is coming up soon, but she is starting to experience a sore throat. While she is worried about not being able to speak through all of those stations, she knows she often gets a terrible headache along with her sore throat. She has an unused prescription for amoxicillin (unexpired) and wonders if you recommend for her to take it.

[https://pubmed.ncbi.nlm.nih.gov/34881426/ Antibiotics for sore throat]

'''Scenario 6 - Conjunctivitis''' - GROUPS 6, 12, 13, 24, 30, 31

A man comes to your pharmacy (he appears in his early twenties) complaining of “pink eye”. He has had a pink discolouration and discharge from his left eye for two days. He asks if the OTC antibiotic eye drops (he’s holding a product with polymixin B) are any better than “waiting it out”.

[https://www.ncbi.nlm.nih.gov/pubmed/22972049 Antibiotics for acute conjunctivitis]

6) HEMATOLOGY STUDIES

None so far

'''ACADEMIC YEAR 2 - FIRST TERM'''

7) RESPIROLOGY STUDIES
[[File:IA COPD info.pdf|thumb]]

*[http://www.ncbi.nlm.nih.gov/pubmed/2062329 First inhaled steroid study] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/22938706 Tiotropium in asthma] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/21324520 Inhaled steroid in children] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/29768149 Combined Budesonide–Formoterol as Needed in Mild Asthma] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/15223858 Doubling dose of inhaled corticosteroid] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/29768147 As-Needed Budesonide–Formoterol versus Maintenance Budesonide in Mild Asthma] Groups 6,18,30
*[http://www.ncbi.nlm.nih.gov/pubmed/27181606 Indacaterol-glycopyrronium VS salmeterol/fluticasone in COPD] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/21428765 Tiotropium VS salmeterol in COPD] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/23695200 Short VS long steroids for COPD exacerbation] Groups 9,21,33
*[http://www.ncbi.nlm.nih.gov/pubmed/25196117 Stopping inhaled steroids in COPD] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/29668352 Once-Daily Single-Inhaler Triple versus Dual Therapy in Patients with COPD] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/28877011 Tezepelumab in Adults with Uncontrolled Asthma] Groups 12,24,36

8) CARDIOVASCULAR STUDIES

SESSION 1

*[https://www.ncbi.nlm.nih.gov/pubmed/4862069 VA1] (Group 1, 13, 25)
*[https://www.ncbi.nlm.nih.gov/pubmed/4914579 VA 2] (Group 2, 14, 26)
*[https://pubmed.ncbi.nlm.nih.gov/33186492 Polycap Study 3] (Group 3, 15, 27)
*[http://www.ncbi.nlm.nih.gov/pubmed/20228401 ACCORD-BP] (Group 4, 16, 28)
*[https://www.ncbi.nlm.nih.gov/pubmed/26551272 SPRINT] (Group 5, 17, 29)
*[http://www.ncbi.nlm.nih.gov/pubmed/2883575 CONSENSUS] (Group 6,18,30)
*[https://pubmed.ncbi.nlm.nih.gov/31535829/ DAPA-HF] (Group 7, 19, 31)
*[https://pubmed.ncbi.nlm.nih.gov/25176939/ CONFIRM-HF] (Group 8, 20, 32)
*[http://www.ncbi.nlm.nih.gov/pubmed/12457784 PROSPER] (Group 9, 21, 33)
*[http://www.ncbi.nlm.nih.gov/pubmed/27040132 HOPE-3] (Group 10, 22, 34)
*[http://www.ncbi.nlm.nih.gov/pubmed/12114036 Heart Protection Study (HPS)] (Group 11, 23, 35)
*[http://www.ncbi.nlm.nih.gov/pubmed/30415628 REDUCE-IT] (Group 12, 24, 36)

[[File:CV Case.pdf|thumb|CV case|left]]

SESSION 2

'''The Guideline Case'''

A 63 y/o patient with CHOOSE ONE (⬆︎HTN/⬆︎Chol/⬆︎glucose/HF/A fib) and using the guideline determine:
# their 5yr/10yr risks of mortality/CVD events
# the potential benefit
# the potential side effects (with magnitude)
# words/sentiment patient values and preferences/SDM

Atrial fibrillation - Groups 1,13,25,2,14,26
*[https://www.onlinecjc.ca/article/S0828-282X(18)31062-6/pdf 2018 Atrial fibrillation guidelines]
Diabetes - Groups 3,15,27,4,16,28
*[http://guidelines.diabetes.ca/docs/CPG-2018-full-EN.pdf 2018 Diabetes guidelines]
Lipid Simplified - Groups 5,17,29,6,18,30
*[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4607330/pdf/0610857.pdf 2015 Simplified lipid guidelines]
Lipid - Groups 7,19,31,8,20,32
*[http://www.onlinecjc.ca/article/S0828-282X(16)30732-2/pdf 2016 Lipid guidelines]
Heart failure - Groups 9,21,33,10,22,34
*[http://www.onlinecjc.ca/article/S0828-282X(17)30973-X/pdf 2017 Heart failure guidelines]
Hypertension - Groups 11,23,35,12,24,36
*[https://www.onlinecjc.ca/article/S0828-282X(18)30183-1/pdf 2018 Hypertension guidelines]

OPTIONAL SESSION
*[http://www.ncbi.nlm.nih.gov/pubmed/16899775 SPARCL]
*[http://www.ncbi.nlm.nih.gov/pubmed/10471456 RALES]
*[http://www.ncbi.nlm.nih.gov/pubmed/11386263 Carvedilol in heart failure]
*[http://www.ncbi.nlm.nih.gov/pubmed/18460663 WAFACS]
*[http://www.ncbi.nlm.nih.gov/pubmed/10376614 MERIT-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/25176015 PARADIGM-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/24490264 High-dose multivitamins after MI]
*[http://www.ncbi.nlm.nih.gov/pubmed/7911176 Mediterranean Diet after MI]
*[http://www.ncbi.nlm.nih.gov/pubmed/15337732 A TO Z]
*[http://www.ncbi.nlm.nih.gov/pubmed/21073363 EMPHASIS-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/12853193 COMET]
*[http://www.ncbi.nlm.nih.gov/pubmed/24716680 TOPCAT]
*[http://www.ncbi.nlm.nih.gov/pubmed/26039521 IMPROVE-IT]

'''ACADEMIC YEAR 2 - SECOND TERM'''

9) NEPHROLOGY STUDIES

None so far

10) ENDOCRINOLOGY

[[File:IA ENDO LAYOUT.pdf|thumb|IA ENDO LAYOUT TEMPLATE|none]]

'''RISK ASSESSMENT CASES FOR DIABETES AND OSTEOPOROSIS'''

'''1) DIABETES CASE'''

66 y/o white male who was diagnosed with diabetes 8 years ago

* His blood pressure over the last year has been roughly 145/80 mmHg - at present untreated
* A1c = 8%, no diabetes meds, non-smoker, BMI ~30
* '''When calculating without diabetes for PREVENT use an A1c of 5.5%'''
* Total cholesterol is 6 mmol/L, his HDL is 2 mmol/L, non-HDL = 6 minus 2, not on a statin
* No retinopathy, urine albumin-to-creatinine ratio (UACR) = 15ug/mg (7mg/mmol),
* Serum creatinine = 70 micromol/L, waist circumference 100 cm
* GFR 75 mL/min/1.73m2
* In normal sinus rhythm
* Age at end of highest education = 19
* Mother alive, father died of a heart attack at age 80

'''Calculate Risks'''

'''CVD RISK ESTIMATES''' - list the endpoints described by the specific calculator

Framingham - xx% - 10-year risk - also if no diabetes xx%

ASCVD - xx% - 10-year risk - also if no diabetes xx%

'''The Calculator'''
*CVD CALCULATOR
https://decisionaid.ca/cvd/

'''DIABETES COMPLICATIONS RISK ESTIMATES''' - list the endpoints described by the specific calculator

xx% - also 10-year risk if A1c 9, 8, 7 and 6

also get risk of kidney failure, vision loss, pressure sensation loss – also if A1c 9, 8,7,6

'''The Calculator'''
*DIABETES DECISION AID
http://decisionaid.ca/diabetes/

'''BENEFITS AND HARMS'''

Use the [https://guidelines.diabetes.ca/cpg/chapter-13-2020-update 2024 diabetes guidelines] and/or Diabetes Decision Aid to get estimates of benefits and harms and also use the MyStudies synopsis listed below

'''COSTS'''

Try using [https://pricingdoc.acfp.ca Pricing Doc] to get costs

'''Groups 1,13,25'''

* Metformin - UKPDS 34 [https://mystudies.org/studies.php#studies/28929e89-d01e-4b11-8e67-4d7086f9e4aa/outcome MyStudies Data]

'''Groups 2,14,26'''

* Sulfonlyureas - UKPDS 33 [https://mystudies.org/studies.php#studies/5eadb5dd-d403-4c13-b03e-d4f8d28c96ba/outcome MyStudies Data]

'''Groups 3,15,27'''

* Insulin - ORIGIN [https://mystudies.org/studies.php#studies/f611818f-2e69-4952-b55e-661116bd84b6/outcome MyStudies Data]

'''Groups 4,16,28'''

* SGLT2 - EMPA-REG OUTCOME [https://mystudies.org/studies.php#studies/32e9cf1a-f33e-480b-91ca-6f28a4dcf862/outcome MyStudies Data]

'''Groups 5,17,29'''

* GLP - LEADER [https://mystudies.org/studies.php#studies/1adbc9a1-7603-40f1-ac15-b813ce1f0ad6/outcome MyStudies Data]

'''Groups 6,18,30'''

* DPP4 - TECOS [https://mystudies.org/studies.php#studies/8659968a-cefb-4f99-b4ae-8b9b659acbd5/outcome MyStudies Data]

'''Groups 7,19,31'''

* Intensive treatment – small scale - STENO [https://mystudies.org/studies.php#studies/39d423e3-af57-40c8-ab7a-cbc7f389bdb6/paper MyStudies Data]

'''Groups 8,20,32'''

* Intensive treatment – large scale - ADDITION-Europe - [https://mystudies.org/studies.php#studies/5e07d86d-aa92-4db9-a283-76080db4b6fd/outcome MyStudies Data]

'''2) OSTEOPOROSIS CASE'''

60 y/o female

* 72 kg, 1.69m, BMI = 25.2
* t-score of -2.5
* Worried about falling and getting a hip fracture
* A friend recently had an atraumatic fracture from simply tripping and falling over in the snow
* No other risk factors

'''Calculate Risks'''

'''FRACTURE RISK ESTIMATES''' - list the endpoints described by the specific calculator

Major osteoporotic fracture - xx% - 10-year risk – if no BMD (just BMI), and then if they had a BMD t-Score of -2.0, -2.5, and -3.0

Hip fracture - - xx% - 10-year risk – if no BMD (just BMI) and if you have a BMD xx% - 10-year risk – if no BMD, and then if they had a BMD T-Score of -2.0, -2.5, and -3.0

'''The Calculator'''

* FRACTURE CALCULATOR

[https://frax.shef.ac.uk/frax/tool.aspx?country=19 Frax Tool - Canada]

'''BENEFITS AND HARMS'''

Use the [https://www.cmaj.ca/content/195/39/E1333 2023 Osteoporosis Guideline] and/or your osteoporosis lecture notes to get the benefits and apply these to your patient, and also get the harms

'''COSTS'''

Try using [https://pricingdoc.acfp.ca Pricing Doc] to get costs

'''Groups 9,21,33'''

* Activity

'''Groups 10,22,34'''

* Calcium/Vitamin D

'''Groups 11,23,35'''

* Bisphosphonates

'''Groups 12,24,36'''

* Denosumab

11) NEUROLOGY STUDIES

*[http://www.ncbi.nlm.nih.gov/pubmed/16717269 Opioids for chronic non-cancer pain] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/29509867 Effect of Opioid vs Nonopioid Medications on Pain-Related Function in Patients With Chronic Back Pain] Groups 2,14,26
*[https://www.ncbi.nlm.nih.gov/pubmed/31291515 Galcanezumab for prevention of cluster headaches] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/27150433 Immediate or delayed treatment of a first seizure] Groups 4,16,28
*[https://www.ncbi.nlm.nih.gov/pubmed/31291516 Rimegepant for episodic migraine] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/26212846 Sleep restriction for insomnia] Groups 6,18,30
*[https://www.ncbi.nlm.nih.gov/pubmed/25957224 CHANCE] Groups 7,19,31
*[https://www.ncbi.nlm.nih.gov/pubmed/16899775 SPARCL] Groups 8,20,32
*[https://www.ncbi.nlm.nih.gov/pubmed/29171821 Erenumab for episodic migraine] Groups 9,21,33
*[https://www.ncbi.nlm.nih.gov/pubmed/24733354 Reduction of benzodiazepines through education] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/26035341 Patient controlled opioid analgesia versus non-patient controlled opioid analgesia for postoperative pain] Groups 11,23,35
*[https://www.ncbi.nlm.nih.gov/pubmed/11589932 PROGRESS] Groups 12,24,36

'''ACADEMIC YEAR 3'''

12) PSYCHIATRY STUDIES

[[:File:2021 Psych Evidence Appraisal - Intro Slides.pdf|Psychiatry Rating Scales Introduction]]

* Study 1: [http://www.ncbi.nlm.nih.gov/pubmed/16554525 STAR*D (Level 2)] Bupropion-SR, sertraline, or venlafaxine-XR after failure of SSRIs for depression
* Study 2: [http://www.ncbi.nlm.nih.gov/pubmed/29477251 Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder]
* Study 3: [https://pubmed.ncbi.nlm.nih.gov/33862018/ Long-acting injectable versus oral antipsychotics for the maintenance treatment of schizophrenia]
* Study 4: [https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2725088 Association of Antipsychotic Polypharmacy vs Monotherapy With Psychiatric Rehospitalization Among Adults With Schizophrenia]
* Study 5: [https://www.ncbi.nlm.nih.gov/pubmed/29490359 Real-world Effectiveness of Pharmacologic Treatments for the Prevention of Bipolar Disorder]
* Study 6: [http://www.ncbi.nlm.nih.gov/pubmed/20092882 BALANCE] Combination lithium and valproate therapy versus monotherapy for relapse prevention in bipolar I disorder
[[File:ChatGPT directions.jpg|thumb|ChatGPT Directions]]
13) GASTROENTEROLOGY STUDIES - LINKS ON CANVAS

*Short-term treatment for gastro-oesophageal reflux disease-like symptoms and endoscopy negative reflux disease (Review)
*Oral budesonide for induction of remission in ulcerative colitis (Review)
*Probiotics for the prevention of Clostridium difficile-associated diarrhea in adults and children (Review)
*Deprescribing versus continuation of chronic proton pump inhibitor use in adults (Review)
*Prevention of NSAID-induced gastroduodenal ulcers (Review)
*Methotrexate for maintenance of remission in Crohn's disease (Review)

14) OB/GYN STUDIES
*[http://www.ncbi.nlm.nih.gov/pubmed/25601350 Comparative contraceptive effectiveness of levonorgestrel-releasing and copper IUD Devices]
*[http://www.ncbi.nlm.nih.gov/pubmed/29211679 Hormonal contraception and the risk of breast cancer]
*[http://www.ncbi.nlm.nih.gov/pubmed/30322986 Sexual behaviours in adolescent girls before and after introduction of the HPV]
*[http://www.ncbi.nlm.nih.gov/pubmed/30181338 Intramuscular vs intravenous oxytocin to prevent postpartum haemorrhage at vaginal delivery]
*[http://www.ncbi.nlm.nih.gov/pubmed/27682034 Azithromycin Prophylaxis for Cesarean Delivery]
*[http://www.ncbi.nlm.nih.gov/pubmed/28461374 Antibiotics during pregnancy and risk of spontaneous abortion]

Evidence Appraisal Integrated Activities

2025-02-04T19:16:16Z

JamesMcCormack:

'''OBJECTIVE'''

To critically appraise studies, develop a brief synopsis of the trial results, succinctly present the results and then put the results into a proper clinical context

'''INITIAL PRE-READING'''

'''How To Critically Appraise an RCT In 10 minutes'''
*[https://itunes.apple.com/ca/book/how-to-critically-appraise/id524600667?mt=11 iBook/iPad version]
*[https://therapeuticseducation.org/sites/therapeuticseducation.org/files/Ten_Minute_Critical_Appraisal.pdf PDF version]
Watch this video
[http://youtu.be/QUW0Q8tXVUc Viva La Evidence]

'''Study Results at Your Fingertips'''
*[https://mystudies.org MyStudies] - Free access

'''INTEGRATION ACTIVITY FORMAT'''
# Students placed in groups of ~ 5-7
# Each group is given one of the studies below to review
# Students then work in pairs and develop a one-slide critical appraisal and results synopsis
# One student in each group will be chosen at random to present their group findings to the class
# A discussion about the appraisal and the appropriate clinical context for the results is had with the entire class for each study

'''MODULE'''
[[File:Screen Shot 2022-01-09 at 10.00.16 AM.jpg|thumb|'''TRIAL PRESENTATION FORMAT'''|none]]

Studies chosen include landmark studies and/or studies that address important therapeutic issues for the particular module

'''ACADEMIC YEAR 1 - FIRST TERM'''

1) FOUNDATION STUDIES (Groups)
*[https://pubmed.ncbi.nlm.nih.gov/37952131 SELECT] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/12466506 AFFIRM] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/22085343 AIM-HIGH] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/10639539 HOPE] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/18378519 HYVET] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/15007110 PROVE-IT] Groups 6,18,30
*[http://www.ncbi.nlm.nih.gov/pubmed/15755765 TNT] Groups 7,19,31
*[https://pubmed.ncbi.nlm.nih.gov/26378978 EMPAREG] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/17984165 ILLUMINATE] Groups 9,21,33
*[https://pubmed.ncbi.nlm.nih.gov/26551272/ SPRINT] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/15325833 CARDS] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/12117397 WHI] Groups 12,24,36

'''ACADEMIC YEAR 1 - SECOND TERM'''

2) INTRO TO INFECTIOUS DISEASE STUDIES

[https://wiki.ubc.ca/images/8/8b/Antibiotic_Sensitivity_Chart_2024.pdf The "Best" Antibiotic Sensitivity Chart Ever]
*[http://www.ncbi.nlm.nih.gov/pubmed/17567657 IV vs PO antibiotics] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/24603565 Delayed antibiotics for respiratory tract infections] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/11159657 Delayed antibiotics for otitis media] Groups 3,15,27
*[https://pubmed.ncbi.nlm.nih.gov/27455166/ Duration of treatment for community acquired pneumonia] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/22726802 Duration of treatment for pyelonephritis] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/25830421 Choice of antibiotic for community acquired pneumonia-1] Groups 6,18,30
*[http://www.ncbi.nlm.nih.gov/pubmed/25286173 Choice of antibiotic for community acquired pneumonia-2] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/20647284 HPV vaccine study] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/7966893 Influenza vaccine study] Groups 9,21,33
*[https://pubmed.ncbi.nlm.nih.gov/33301246/ COVID vaccine Pfizer] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/27626517 Herpes zoster vaccine study 1] Groups 11,23,35
*[https://www.ncbi.nlm.nih.gov/pubmed/25916341 Herpes zoster vaccine study 2] Groups 12,24,36

3) MUSCULOSKELETAL STUDIES

*[http://www.ncbi.nlm.nih.gov/pubmed/28199814 Baricitinib versus Placebo or Adalimumab in Rheumatoid Arthritis] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/0010979111 CLASS – celecoxib vs NSAIDs] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/26501533 Naproxen with cyclobenzaprine, oxycodone/acetaminophen, or placebo for low back pain] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/24395557 Glucosamine and chondroitin for OA] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/12546607 Acetaminophen vs diclofenac for OA] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/23964752 Diclofenac gel for acute neck pain] Groups 6,18,30
*[https://pubmed.ncbi.nlm.nih.gov/15468367/ Topical diclofenac vs oral diclofenac] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/25064594 Acetaminophen for low back pain] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/7611589 Misoprostol and NSAID induced ulcers] Groups 9,21,33
*[http://www.ncbi.nlm.nih.gov/pubmed/20131255 Low dose vs high dose colchicine for gout] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/22508468 TEAR - oral triple therapy versus etanercept plus methotrexate in early aggressive rheumatoid arthritis] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/25589511 MOVES - Glucosamine and chondroitin for OA for moderate to severe pain] Groups 12,24,36

4) DERMATOLOGY STUDIES

*[https://www.ncbi.nlm.nih.gov/pubmed/9598014 Glycolic acid 5% Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/21896132 Glycolic acid 10% Acne]
*[https://www.ncbi.nlm.nih.gov/pubmed/14531866 Petrolatum vs Ceramide/skin related lipids Hand Dermatitis]
*[https://www.ncbi.nlm.nih.gov/pubmed/11896774 Vitamin C Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/17515510 Retinol (VitaminA) Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/21896129 Hyaluronic acid Atopic Dermatitis]

5) EENT STUDIES

[http://www.amstar.ca/docs/AMSTARguideline.pdf AMSTAR meta-analysis checklist]

'''Scenario 1 - Otitis Media''' - GROUPS 1, 7, 18, 19, 25, 36

Anthony Martin arrives at your pharmacy somewhat frustrated since his family physician declined to write an antibiotic prescription for his two and half year old son, Oscar. His symptoms started yesterday afternoon - Oscar complains of right ear pain but there is no discharge. Rectal temperature taken today was 38.5 degrees. His wife is sure Oscar has an ear infection since the last time he had these same symptoms, that was ultimately the diagnosis. Mr. Martin asks if you think buying acetaminophen is really “enough”?

[https://pubmed.ncbi.nlm.nih.gov/26099233/ Antibiotics for acute otitis media in children]

'''Scenario 2 - Allergic Rhinitis''' - GROUPS 2, 8, 17, 20, 26, 35

Ruby Parmar is a firefighter. She is plagued by sinus congestion (preventing her from sleeping) and a runny nose associated with seasonal allergies. Her prescription for intranasal triamcinolone is typically effective, but she would like to know if a non-sedating anti-allergy pill would work just as well since it’s inconvenient carrying around the “nose spray”.

[https://www.ncbi.nlm.nih.gov/pubmed/28234147 Intranasal steroids vs antihistamines for allergic rhinitis]

'''Scenario 3 - Acute Sinusitis''' - GROUPS 3, 9, 16, 21, 27, 34

You are seeing a patient in clinic before her appointment with the primary care physician. She was feeling unwell with a “flu” last week. While most of her symptoms have resolved (cough, fever), the nasal congestion and discharge persists and so she has made an appointment (she is an otherwise healthy 32 year old with treated thyroid disease). She would like your advice for what treatment she should ask the doctor to prescribe.

[http://www.ncbi.nlm.nih.gov/pubmed/24293353 Intranasal steroids for acute sinusitis]

'''Scenario 4 - Glaucoma''' - GROUPS 4, 10, 15, 22, 28, 33

Mrs. Ada Waters is a 63 year-old woman you. Her ophthalmologist prescribed timolol and xalatan eye drops for treatment of open angle glaucoma. She has never really felt much different on treatment since she recovered from her first episode (of acute angle closure glaucoma requiring ER visit) and surgery. She asks you if the treatment is really making a difference.

[https://www.ncbi.nlm.nih.gov/pubmed/17943780 Interventions for open angle glaucoma]

'''Scenario 5 - Sore Throat''' - GROUPS 5, 11, 14, 23, 29, 32

You have a good friend who is applying for pharmacy. Her invitation for the multiple-mini interview (MMI) is coming up soon, but she is starting to experience a sore throat. While she is worried about not being able to speak through all of those stations, she knows she often gets a terrible headache along with her sore throat. She has an unused prescription for amoxicillin (unexpired) and wonders if you recommend for her to take it.

[https://pubmed.ncbi.nlm.nih.gov/34881426/ Antibiotics for sore throat]

'''Scenario 6 - Conjunctivitis''' - GROUPS 6, 12, 13, 24, 30, 31

A man comes to your pharmacy (he appears in his early twenties) complaining of “pink eye”. He has had a pink discolouration and discharge from his left eye for two days. He asks if the OTC antibiotic eye drops (he’s holding a product with polymixin B) are any better than “waiting it out”.

[https://www.ncbi.nlm.nih.gov/pubmed/22972049 Antibiotics for acute conjunctivitis]

6) HEMATOLOGY STUDIES

None so far

'''ACADEMIC YEAR 2 - FIRST TERM'''

7) RESPIROLOGY STUDIES
[[File:IA COPD info.pdf|thumb]]

*[http://www.ncbi.nlm.nih.gov/pubmed/2062329 First inhaled steroid study] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/22938706 Tiotropium in asthma] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/21324520 Inhaled steroid in children] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/29768149 Combined Budesonide–Formoterol as Needed in Mild Asthma] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/15223858 Doubling dose of inhaled corticosteroid] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/29768147 As-Needed Budesonide–Formoterol versus Maintenance Budesonide in Mild Asthma] Groups 6,18,30
*[http://www.ncbi.nlm.nih.gov/pubmed/27181606 Indacaterol-glycopyrronium VS salmeterol/fluticasone in COPD] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/21428765 Tiotropium VS salmeterol in COPD] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/23695200 Short VS long steroids for COPD exacerbation] Groups 9,21,33
*[http://www.ncbi.nlm.nih.gov/pubmed/25196117 Stopping inhaled steroids in COPD] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/29668352 Once-Daily Single-Inhaler Triple versus Dual Therapy in Patients with COPD] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/28877011 Tezepelumab in Adults with Uncontrolled Asthma] Groups 12,24,36

8) CARDIOVASCULAR STUDIES

SESSION 1

*[https://www.ncbi.nlm.nih.gov/pubmed/4862069 VA1] (Group 1, 13, 25)
*[https://www.ncbi.nlm.nih.gov/pubmed/4914579 VA 2] (Group 2, 14, 26)
*[https://pubmed.ncbi.nlm.nih.gov/33186492 Polycap Study 3] (Group 3, 15, 27)
*[http://www.ncbi.nlm.nih.gov/pubmed/20228401 ACCORD-BP] (Group 4, 16, 28)
*[https://www.ncbi.nlm.nih.gov/pubmed/26551272 SPRINT] (Group 5, 17, 29)
*[http://www.ncbi.nlm.nih.gov/pubmed/2883575 CONSENSUS] (Group 6,18,30)
*[https://pubmed.ncbi.nlm.nih.gov/31535829/ DAPA-HF] (Group 7, 19, 31)
*[https://pubmed.ncbi.nlm.nih.gov/25176939/ CONFIRM-HF] (Group 8, 20, 32)
*[http://www.ncbi.nlm.nih.gov/pubmed/12457784 PROSPER] (Group 9, 21, 33)
*[http://www.ncbi.nlm.nih.gov/pubmed/27040132 HOPE-3] (Group 10, 22, 34)
*[http://www.ncbi.nlm.nih.gov/pubmed/12114036 Heart Protection Study (HPS)] (Group 11, 23, 35)
*[http://www.ncbi.nlm.nih.gov/pubmed/30415628 REDUCE-IT] (Group 12, 24, 36)

[[File:CV Case.pdf|thumb|CV case|left]]

SESSION 2

'''The Guideline Case'''

A 63 y/o patient with CHOOSE ONE (⬆︎HTN/⬆︎Chol/⬆︎glucose/HF/A fib) and using the guideline determine:
# their 5yr/10yr risks of mortality/CVD events
# the potential benefit
# the potential side effects (with magnitude)
# words/sentiment patient values and preferences/SDM

Atrial fibrillation - Groups 1,13,25,2,14,26
*[https://www.onlinecjc.ca/article/S0828-282X(18)31062-6/pdf 2018 Atrial fibrillation guidelines]
Diabetes - Groups 3,15,27,4,16,28
*[http://guidelines.diabetes.ca/docs/CPG-2018-full-EN.pdf 2018 Diabetes guidelines]
Lipid Simplified - Groups 5,17,29,6,18,30
*[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4607330/pdf/0610857.pdf 2015 Simplified lipid guidelines]
Lipid - Groups 7,19,31,8,20,32
*[http://www.onlinecjc.ca/article/S0828-282X(16)30732-2/pdf 2016 Lipid guidelines]
Heart failure - Groups 9,21,33,10,22,34
*[http://www.onlinecjc.ca/article/S0828-282X(17)30973-X/pdf 2017 Heart failure guidelines]
Hypertension - Groups 11,23,35,12,24,36
*[https://www.onlinecjc.ca/article/S0828-282X(18)30183-1/pdf 2018 Hypertension guidelines]

OPTIONAL SESSION
*[http://www.ncbi.nlm.nih.gov/pubmed/16899775 SPARCL]
*[http://www.ncbi.nlm.nih.gov/pubmed/10471456 RALES]
*[http://www.ncbi.nlm.nih.gov/pubmed/11386263 Carvedilol in heart failure]
*[http://www.ncbi.nlm.nih.gov/pubmed/18460663 WAFACS]
*[http://www.ncbi.nlm.nih.gov/pubmed/10376614 MERIT-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/25176015 PARADIGM-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/24490264 High-dose multivitamins after MI]
*[http://www.ncbi.nlm.nih.gov/pubmed/7911176 Mediterranean Diet after MI]
*[http://www.ncbi.nlm.nih.gov/pubmed/15337732 A TO Z]
*[http://www.ncbi.nlm.nih.gov/pubmed/21073363 EMPHASIS-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/12853193 COMET]
*[http://www.ncbi.nlm.nih.gov/pubmed/24716680 TOPCAT]
*[http://www.ncbi.nlm.nih.gov/pubmed/26039521 IMPROVE-IT]

'''ACADEMIC YEAR 2 - SECOND TERM'''

9) NEPHROLOGY STUDIES

None so far

10) ENDOCRINOLOGY

[[File:IA ENDO LAYOUT.pdf|thumb|IA ENDO LAYOUT TEMPLATE]]

'''RISK ASSESSMENT CASES FOR DIABETES AND OSTEOPOROSIS'''

'''1) DIABETES CASE'''

66 y/o white male who was diagnosed with diabetes 8 years ago

* His blood pressure over the last year has been roughly 145/80 mmHg - at present untreated
* A1c = 8%, no diabetes meds, non-smoker, BMI ~30
* '''When calculating without diabetes for PREVENT use an A1c of 5.5%'''
* Total cholesterol is 6 mmol/L, his HDL is 2 mmol/L, non-HDL = 6 minus 2, not on a statin
* No retinopathy, urine albumin-to-creatinine ratio (UACR) = 15ug/mg (7mg/mmol),
* Serum creatinine = 70 micromol/L, waist circumference 100 cm
* GFR 75 mL/min/1.73m2
* In normal sinus rhythm
* Age at end of highest education = 19
* Mother alive, father died of a heart attack at age 80

'''Calculate Risks'''

'''CVD RISK ESTIMATES''' - list the endpoints described by the specific calculator

Framingham - xx% - 10-year risk - also if no diabetes xx%

ASCVD - xx% - 10-year risk - also if no diabetes xx%

'''The Calculator'''
*CVD CALCULATOR
https://decisionaid.ca/cvd/

'''DIABETES COMPLICATIONS RISK ESTIMATES''' - list the endpoints described by the specific calculator

xx% - also 10-year risk if A1c 9, 8, 7 and 6

also get risk of kidney failure, vision loss, pressure sensation loss – also if A1c 9, 8,7,6

'''The Calculator'''
*DIABETES DECISION AID
http://decisionaid.ca/diabetes/

'''BENEFITS AND HARMS'''

Use the [https://guidelines.diabetes.ca/cpg/chapter-13-2020-update 2024 diabetes guidelines] and/or Diabetes Decision Aid to get estimates of benefits and harms and also use the MyStudies synopsis listed below

'''COSTS'''

Try using [https://pricingdoc.acfp.ca Pricing Doc] to get costs

'''Groups 1,13,25'''

* Metformin - UKPDS 34 [https://mystudies.org/studies.php#studies/28929e89-d01e-4b11-8e67-4d7086f9e4aa/outcome MyStudies Data]

'''Groups 2,14,26'''

* Sulfonlyureas - UKPDS 33 [https://mystudies.org/studies.php#studies/5eadb5dd-d403-4c13-b03e-d4f8d28c96ba/outcome MyStudies Data]

'''Groups 3,15,27'''

* Insulin - ORIGIN [https://mystudies.org/studies.php#studies/f611818f-2e69-4952-b55e-661116bd84b6/outcome MyStudies Data]

'''Groups 4,16,28'''

* SGLT2 - EMPA-REG OUTCOME [https://mystudies.org/studies.php#studies/32e9cf1a-f33e-480b-91ca-6f28a4dcf862/outcome MyStudies Data]

'''Groups 5,17,29'''

* GLP - LEADER [https://mystudies.org/studies.php#studies/1adbc9a1-7603-40f1-ac15-b813ce1f0ad6/outcome MyStudies Data]

'''Groups 6,18,30'''

* DPP4 - TECOS [https://mystudies.org/studies.php#studies/8659968a-cefb-4f99-b4ae-8b9b659acbd5/outcome MyStudies Data]

'''Groups 7,19,31'''

* Intensive treatment – small scale - STENO [https://mystudies.org/studies.php#studies/39d423e3-af57-40c8-ab7a-cbc7f389bdb6/paper MyStudies Data]

'''Groups 8,20,32'''

* Intensive treatment – large scale - ADDITION-Europe - [https://mystudies.org/studies.php#studies/5e07d86d-aa92-4db9-a283-76080db4b6fd/outcome MyStudies Data]

'''2) OSTEOPOROSIS CASE'''

60 y/o female

* 72 kg, 1.69m, BMI = 25.2
* t-score of -2.5
* Worried about falling and getting a hip fracture
* A friend recently had an atraumatic fracture from simply tripping and falling over in the snow
* No other risk factors

'''Calculate Risks'''

'''FRACTURE RISK ESTIMATES''' - list the endpoints described by the specific calculator

Major osteoporotic fracture - xx% - 10-year risk – if no BMD (just BMI), and then if they had a BMD t-Score of -2.0, -2.5, and -3.0

Hip fracture - - xx% - 10-year risk – if no BMD (just BMI) and if you have a BMD xx% - 10-year risk – if no BMD, and then if they had a BMD T-Score of -2.0, -2.5, and -3.0

'''The Calculator'''

* FRACTURE CALCULATOR

[https://frax.shef.ac.uk/frax/tool.aspx?country=19 Frax Tool - Canada]

'''BENEFITS AND HARMS'''

Use the [https://www.cmaj.ca/content/195/39/E1333 2023 Osteoporosis Guideline] and/or your osteoporosis lecture notes to get the benefits and apply these to your patient, and also get the harms

'''COSTS'''

Try using [https://pricingdoc.acfp.ca Pricing Doc] to get costs

'''Groups 9,21,33'''

* Activity

'''Groups 10,22,34'''

* Calcium/Vitamin D

'''Groups 11,23,35'''

* Bisphosphonates

'''Groups 12,24,36'''

* Denosumab

11) NEUROLOGY STUDIES

*[http://www.ncbi.nlm.nih.gov/pubmed/16717269 Opioids for chronic non-cancer pain] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/29509867 Effect of Opioid vs Nonopioid Medications on Pain-Related Function in Patients With Chronic Back Pain] Groups 2,14,26
*[https://www.ncbi.nlm.nih.gov/pubmed/31291515 Galcanezumab for prevention of cluster headaches] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/27150433 Immediate or delayed treatment of a first seizure] Groups 4,16,28
*[https://www.ncbi.nlm.nih.gov/pubmed/31291516 Rimegepant for episodic migraine] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/26212846 Sleep restriction for insomnia] Groups 6,18,30
*[https://www.ncbi.nlm.nih.gov/pubmed/25957224 CHANCE] Groups 7,19,31
*[https://www.ncbi.nlm.nih.gov/pubmed/16899775 SPARCL] Groups 8,20,32
*[https://www.ncbi.nlm.nih.gov/pubmed/29171821 Erenumab for episodic migraine] Groups 9,21,33
*[https://www.ncbi.nlm.nih.gov/pubmed/24733354 Reduction of benzodiazepines through education] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/26035341 Patient controlled opioid analgesia versus non-patient controlled opioid analgesia for postoperative pain] Groups 11,23,35
*[https://www.ncbi.nlm.nih.gov/pubmed/11589932 PROGRESS] Groups 12,24,36

'''ACADEMIC YEAR 3'''

12) PSYCHIATRY STUDIES

[[:File:2021 Psych Evidence Appraisal - Intro Slides.pdf|Psychiatry Rating Scales Introduction]]

* Study 1: [http://www.ncbi.nlm.nih.gov/pubmed/16554525 STAR*D (Level 2)] Bupropion-SR, sertraline, or venlafaxine-XR after failure of SSRIs for depression
* Study 2: [http://www.ncbi.nlm.nih.gov/pubmed/29477251 Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder]
* Study 3: [https://pubmed.ncbi.nlm.nih.gov/33862018/ Long-acting injectable versus oral antipsychotics for the maintenance treatment of schizophrenia]
* Study 4: [https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2725088 Association of Antipsychotic Polypharmacy vs Monotherapy With Psychiatric Rehospitalization Among Adults With Schizophrenia]
* Study 5: [https://www.ncbi.nlm.nih.gov/pubmed/29490359 Real-world Effectiveness of Pharmacologic Treatments for the Prevention of Bipolar Disorder]
* Study 6: [http://www.ncbi.nlm.nih.gov/pubmed/20092882 BALANCE] Combination lithium and valproate therapy versus monotherapy for relapse prevention in bipolar I disorder
[[File:ChatGPT directions.jpg|thumb|ChatGPT Directions]]
13) GASTROENTEROLOGY STUDIES - LINKS ON CANVAS

*Short-term treatment for gastro-oesophageal reflux disease-like symptoms and endoscopy negative reflux disease (Review)
*Oral budesonide for induction of remission in ulcerative colitis (Review)
*Probiotics for the prevention of Clostridium difficile-associated diarrhea in adults and children (Review)
*Deprescribing versus continuation of chronic proton pump inhibitor use in adults (Review)
*Prevention of NSAID-induced gastroduodenal ulcers (Review)
*Methotrexate for maintenance of remission in Crohn's disease (Review)

14) OB/GYN STUDIES
*[http://www.ncbi.nlm.nih.gov/pubmed/25601350 Comparative contraceptive effectiveness of levonorgestrel-releasing and copper IUD Devices]
*[http://www.ncbi.nlm.nih.gov/pubmed/29211679 Hormonal contraception and the risk of breast cancer]
*[http://www.ncbi.nlm.nih.gov/pubmed/30322986 Sexual behaviours in adolescent girls before and after introduction of the HPV]
*[http://www.ncbi.nlm.nih.gov/pubmed/30181338 Intramuscular vs intravenous oxytocin to prevent postpartum haemorrhage at vaginal delivery]
*[http://www.ncbi.nlm.nih.gov/pubmed/27682034 Azithromycin Prophylaxis for Cesarean Delivery]
*[http://www.ncbi.nlm.nih.gov/pubmed/28461374 Antibiotics during pregnancy and risk of spontaneous abortion]

Evidence Appraisal Integrated Activities

2025-02-04T19:15:27Z

JamesMcCormack:

'''OBJECTIVE'''

To critically appraise studies, develop a brief synopsis of the trial results, succinctly present the results and then put the results into a proper clinical context

'''INITIAL PRE-READING'''

'''How To Critically Appraise an RCT In 10 minutes'''
*[https://itunes.apple.com/ca/book/how-to-critically-appraise/id524600667?mt=11 iBook/iPad version]
*[https://therapeuticseducation.org/sites/therapeuticseducation.org/files/Ten_Minute_Critical_Appraisal.pdf PDF version]
Watch this video
[http://youtu.be/QUW0Q8tXVUc Viva La Evidence]

'''Study Results at Your Fingertips'''
*[https://mystudies.org MyStudies] - Free access

'''INTEGRATION ACTIVITY FORMAT'''
# Students placed in groups of ~ 5-7
# Each group is given one of the studies below to review
# Students then work in pairs and develop a one-slide critical appraisal and results synopsis
# One student in each group will be chosen at random to present their group findings to the class
# A discussion about the appraisal and the appropriate clinical context for the results is had with the entire class for each study

'''MODULE'''
[[File:Screen Shot 2022-01-09 at 10.00.16 AM.jpg|thumb|'''TRIAL PRESENTATION FORMAT'''|none]]

Studies chosen include landmark studies and/or studies that address important therapeutic issues for the particular module

'''ACADEMIC YEAR 1 - FIRST TERM'''

1) FOUNDATION STUDIES (Groups)
*[https://pubmed.ncbi.nlm.nih.gov/37952131 SELECT] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/12466506 AFFIRM] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/22085343 AIM-HIGH] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/10639539 HOPE] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/18378519 HYVET] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/15007110 PROVE-IT] Groups 6,18,30
*[http://www.ncbi.nlm.nih.gov/pubmed/15755765 TNT] Groups 7,19,31
*[https://pubmed.ncbi.nlm.nih.gov/26378978 EMPAREG] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/17984165 ILLUMINATE] Groups 9,21,33
*[https://pubmed.ncbi.nlm.nih.gov/26551272/ SPRINT] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/15325833 CARDS] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/12117397 WHI] Groups 12,24,36

'''ACADEMIC YEAR 1 - SECOND TERM'''

2) INTRO TO INFECTIOUS DISEASE STUDIES

[https://wiki.ubc.ca/images/8/8b/Antibiotic_Sensitivity_Chart_2024.pdf The "Best" Antibiotic Sensitivity Chart Ever]
*[http://www.ncbi.nlm.nih.gov/pubmed/17567657 IV vs PO antibiotics] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/24603565 Delayed antibiotics for respiratory tract infections] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/11159657 Delayed antibiotics for otitis media] Groups 3,15,27
*[https://pubmed.ncbi.nlm.nih.gov/27455166/ Duration of treatment for community acquired pneumonia] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/22726802 Duration of treatment for pyelonephritis] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/25830421 Choice of antibiotic for community acquired pneumonia-1] Groups 6,18,30
*[http://www.ncbi.nlm.nih.gov/pubmed/25286173 Choice of antibiotic for community acquired pneumonia-2] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/20647284 HPV vaccine study] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/7966893 Influenza vaccine study] Groups 9,21,33
*[https://pubmed.ncbi.nlm.nih.gov/33301246/ COVID vaccine Pfizer] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/27626517 Herpes zoster vaccine study 1] Groups 11,23,35
*[https://www.ncbi.nlm.nih.gov/pubmed/25916341 Herpes zoster vaccine study 2] Groups 12,24,36

3) MUSCULOSKELETAL STUDIES

*[http://www.ncbi.nlm.nih.gov/pubmed/28199814 Baricitinib versus Placebo or Adalimumab in Rheumatoid Arthritis] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/0010979111 CLASS – celecoxib vs NSAIDs] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/26501533 Naproxen with cyclobenzaprine, oxycodone/acetaminophen, or placebo for low back pain] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/24395557 Glucosamine and chondroitin for OA] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/12546607 Acetaminophen vs diclofenac for OA] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/23964752 Diclofenac gel for acute neck pain] Groups 6,18,30
*[https://pubmed.ncbi.nlm.nih.gov/15468367/ Topical diclofenac vs oral diclofenac] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/25064594 Acetaminophen for low back pain] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/7611589 Misoprostol and NSAID induced ulcers] Groups 9,21,33
*[http://www.ncbi.nlm.nih.gov/pubmed/20131255 Low dose vs high dose colchicine for gout] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/22508468 TEAR - oral triple therapy versus etanercept plus methotrexate in early aggressive rheumatoid arthritis] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/25589511 MOVES - Glucosamine and chondroitin for OA for moderate to severe pain] Groups 12,24,36

4) DERMATOLOGY STUDIES

*[https://www.ncbi.nlm.nih.gov/pubmed/9598014 Glycolic acid 5% Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/21896132 Glycolic acid 10% Acne]
*[https://www.ncbi.nlm.nih.gov/pubmed/14531866 Petrolatum vs Ceramide/skin related lipids Hand Dermatitis]
*[https://www.ncbi.nlm.nih.gov/pubmed/11896774 Vitamin C Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/17515510 Retinol (VitaminA) Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/21896129 Hyaluronic acid Atopic Dermatitis]

5) EENT STUDIES

[http://www.amstar.ca/docs/AMSTARguideline.pdf AMSTAR meta-analysis checklist]

'''Scenario 1 - Otitis Media''' - GROUPS 1, 7, 18, 19, 25, 36

Anthony Martin arrives at your pharmacy somewhat frustrated since his family physician declined to write an antibiotic prescription for his two and half year old son, Oscar. His symptoms started yesterday afternoon - Oscar complains of right ear pain but there is no discharge. Rectal temperature taken today was 38.5 degrees. His wife is sure Oscar has an ear infection since the last time he had these same symptoms, that was ultimately the diagnosis. Mr. Martin asks if you think buying acetaminophen is really “enough”?

[https://pubmed.ncbi.nlm.nih.gov/26099233/ Antibiotics for acute otitis media in children]

'''Scenario 2 - Allergic Rhinitis''' - GROUPS 2, 8, 17, 20, 26, 35

Ruby Parmar is a firefighter. She is plagued by sinus congestion (preventing her from sleeping) and a runny nose associated with seasonal allergies. Her prescription for intranasal triamcinolone is typically effective, but she would like to know if a non-sedating anti-allergy pill would work just as well since it’s inconvenient carrying around the “nose spray”.

[https://www.ncbi.nlm.nih.gov/pubmed/28234147 Intranasal steroids vs antihistamines for allergic rhinitis]

'''Scenario 3 - Acute Sinusitis''' - GROUPS 3, 9, 16, 21, 27, 34

You are seeing a patient in clinic before her appointment with the primary care physician. She was feeling unwell with a “flu” last week. While most of her symptoms have resolved (cough, fever), the nasal congestion and discharge persists and so she has made an appointment (she is an otherwise healthy 32 year old with treated thyroid disease). She would like your advice for what treatment she should ask the doctor to prescribe.

[http://www.ncbi.nlm.nih.gov/pubmed/24293353 Intranasal steroids for acute sinusitis]

'''Scenario 4 - Glaucoma''' - GROUPS 4, 10, 15, 22, 28, 33

Mrs. Ada Waters is a 63 year-old woman you. Her ophthalmologist prescribed timolol and xalatan eye drops for treatment of open angle glaucoma. She has never really felt much different on treatment since she recovered from her first episode (of acute angle closure glaucoma requiring ER visit) and surgery. She asks you if the treatment is really making a difference.

[https://www.ncbi.nlm.nih.gov/pubmed/17943780 Interventions for open angle glaucoma]

'''Scenario 5 - Sore Throat''' - GROUPS 5, 11, 14, 23, 29, 32

You have a good friend who is applying for pharmacy. Her invitation for the multiple-mini interview (MMI) is coming up soon, but she is starting to experience a sore throat. While she is worried about not being able to speak through all of those stations, she knows she often gets a terrible headache along with her sore throat. She has an unused prescription for amoxicillin (unexpired) and wonders if you recommend for her to take it.

[https://pubmed.ncbi.nlm.nih.gov/34881426/ Antibiotics for sore throat]

'''Scenario 6 - Conjunctivitis''' - GROUPS 6, 12, 13, 24, 30, 31

A man comes to your pharmacy (he appears in his early twenties) complaining of “pink eye”. He has had a pink discolouration and discharge from his left eye for two days. He asks if the OTC antibiotic eye drops (he’s holding a product with polymixin B) are any better than “waiting it out”.

[https://www.ncbi.nlm.nih.gov/pubmed/22972049 Antibiotics for acute conjunctivitis]

6) HEMATOLOGY STUDIES

None so far

'''ACADEMIC YEAR 2 - FIRST TERM'''

7) RESPIROLOGY STUDIES
[[File:IA COPD info.pdf|thumb]]

*[http://www.ncbi.nlm.nih.gov/pubmed/2062329 First inhaled steroid study] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/22938706 Tiotropium in asthma] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/21324520 Inhaled steroid in children] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/29768149 Combined Budesonide–Formoterol as Needed in Mild Asthma] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/15223858 Doubling dose of inhaled corticosteroid] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/29768147 As-Needed Budesonide–Formoterol versus Maintenance Budesonide in Mild Asthma] Groups 6,18,30
*[http://www.ncbi.nlm.nih.gov/pubmed/27181606 Indacaterol-glycopyrronium VS salmeterol/fluticasone in COPD] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/21428765 Tiotropium VS salmeterol in COPD] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/23695200 Short VS long steroids for COPD exacerbation] Groups 9,21,33
*[http://www.ncbi.nlm.nih.gov/pubmed/25196117 Stopping inhaled steroids in COPD] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/29668352 Once-Daily Single-Inhaler Triple versus Dual Therapy in Patients with COPD] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/28877011 Tezepelumab in Adults with Uncontrolled Asthma] Groups 12,24,36

8) CARDIOVASCULAR STUDIES

SESSION 1

*[https://www.ncbi.nlm.nih.gov/pubmed/4862069 VA1] (Group 1, 13, 25)
*[https://www.ncbi.nlm.nih.gov/pubmed/4914579 VA 2] (Group 2, 14, 26)
*[https://pubmed.ncbi.nlm.nih.gov/33186492 Polycap Study 3] (Group 3, 15, 27)
*[http://www.ncbi.nlm.nih.gov/pubmed/20228401 ACCORD-BP] (Group 4, 16, 28)
*[https://www.ncbi.nlm.nih.gov/pubmed/26551272 SPRINT] (Group 5, 17, 29)
*[http://www.ncbi.nlm.nih.gov/pubmed/2883575 CONSENSUS] (Group 6,18,30)
*[https://pubmed.ncbi.nlm.nih.gov/31535829/ DAPA-HF] (Group 7, 19, 31)
*[https://pubmed.ncbi.nlm.nih.gov/25176939/ CONFIRM-HF] (Group 8, 20, 32)
*[http://www.ncbi.nlm.nih.gov/pubmed/12457784 PROSPER] (Group 9, 21, 33)
*[http://www.ncbi.nlm.nih.gov/pubmed/27040132 HOPE-3] (Group 10, 22, 34)
*[http://www.ncbi.nlm.nih.gov/pubmed/12114036 Heart Protection Study (HPS)] (Group 11, 23, 35)
*[http://www.ncbi.nlm.nih.gov/pubmed/30415628 REDUCE-IT] (Group 12, 24, 36)

[[File:CV Case.pdf|thumb|CV case|left]]

SESSION 2

'''The Guideline Case'''

A 63 y/o patient with CHOOSE ONE (⬆︎HTN/⬆︎Chol/⬆︎glucose/HF/A fib) and using the guideline determine:
# their 5yr/10yr risks of mortality/CVD events
# the potential benefit
# the potential side effects (with magnitude)
# words/sentiment patient values and preferences/SDM

Atrial fibrillation - Groups 1,13,25,2,14,26
*[https://www.onlinecjc.ca/article/S0828-282X(18)31062-6/pdf 2018 Atrial fibrillation guidelines]
Diabetes - Groups 3,15,27,4,16,28
*[http://guidelines.diabetes.ca/docs/CPG-2018-full-EN.pdf 2018 Diabetes guidelines]
Lipid Simplified - Groups 5,17,29,6,18,30
*[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4607330/pdf/0610857.pdf 2015 Simplified lipid guidelines]
Lipid - Groups 7,19,31,8,20,32
*[http://www.onlinecjc.ca/article/S0828-282X(16)30732-2/pdf 2016 Lipid guidelines]
Heart failure - Groups 9,21,33,10,22,34
*[http://www.onlinecjc.ca/article/S0828-282X(17)30973-X/pdf 2017 Heart failure guidelines]
Hypertension - Groups 11,23,35,12,24,36
*[https://www.onlinecjc.ca/article/S0828-282X(18)30183-1/pdf 2018 Hypertension guidelines]

OPTIONAL SESSION
*[http://www.ncbi.nlm.nih.gov/pubmed/16899775 SPARCL]
*[http://www.ncbi.nlm.nih.gov/pubmed/10471456 RALES]
*[http://www.ncbi.nlm.nih.gov/pubmed/11386263 Carvedilol in heart failure]
*[http://www.ncbi.nlm.nih.gov/pubmed/18460663 WAFACS]
*[http://www.ncbi.nlm.nih.gov/pubmed/10376614 MERIT-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/25176015 PARADIGM-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/24490264 High-dose multivitamins after MI]
*[http://www.ncbi.nlm.nih.gov/pubmed/7911176 Mediterranean Diet after MI]
*[http://www.ncbi.nlm.nih.gov/pubmed/15337732 A TO Z]
*[http://www.ncbi.nlm.nih.gov/pubmed/21073363 EMPHASIS-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/12853193 COMET]
*[http://www.ncbi.nlm.nih.gov/pubmed/24716680 TOPCAT]
*[http://www.ncbi.nlm.nih.gov/pubmed/26039521 IMPROVE-IT]

'''ACADEMIC YEAR 2 - SECOND TERM'''

9) NEPHROLOGY STUDIES

None so far

10) ENDOCRINOLOGY

[[File:IA ENDO LAYOUT.pdf|thumb|IA ENDO LAYOUT TEMPLATE]]

'''RISK ASSESSMENT CASES FOR DIABETES AND OSTEOPOROSIS'''

'''1) DIABETES CASE'''

66 y/o white male who was diagnosed with diabetes 8 years ago

* His blood pressure over the last year has been roughly 145/80 mmHg - at present untreated
* A1c = 8%, no diabetes meds, non-smoker, BMI ~30
* '''When calculating without diabetes for PREVENT use an A1c of 5.5%'''
* Total cholesterol is 6 mmol/L, his HDL is 2 mmol/L, non-HDL = 6 minus 2, not on a statin
* No retinopathy, urine albumin-to-creatinine ratio (UACR) = 15ug/mg (7mg/mmol),
* Serum creatinine = 70 micromol/L, waist circumference 100 cm
* GFR 75 mL/min/1.73m2
* In normal sinus rhythm
* Age at end of highest education = 19
* Mother alive, father died of a heart attack at age 80

'''Calculate Risks'''

'''CVD RISK ESTIMATES''' - list the endpoints described by the specific calculator

Framingham - xx% - 10-year risk - also if no diabetes xx%

ASCVD - xx% - 10-year risk - also if no diabetes xx%

'''The Calculator'''
*CVD CALCULATOR
https://decisionaid.ca/cvd/

'''DIABETES COMPLICATIONS RISK ESTIMATES''' - list the endpoints described by the specific calculator

xx% - also 10-year risk if A1c 9, 8, 7 and 6

also get risk of kidney failure, vision loss, pressure sensation loss – also if A1c 9, 8,7,6

'''The Calculator'''
*DIABETES DECISION AID
http://decisionaid.ca/diabetes/

'''BENEFITS AND HARMS'''

Use the [https://guidelines.diabetes.ca/cpg/chapter-13-2020-update 2024 diabetes guidelines] and/or Diabetes Decision Aid to get estimates of benefits and harms and also use the MyStudies synopsis listed below

'''COSTS'''

Try using [https://pricingdoc.acfp.ca Pricing Doc] to get costs

'''Groups 1,13,25'''

* Metformin - UKPDS 34 [https://mystudies.org/studies.php#studies/28929e89-d01e-4b11-8e67-4d7086f9e4aa/outcome MyStudies Data]

'''Groups 2,14,26'''

* Sulfonlyureas - UKPDS 33 [https://mystudies.org/studies.php#studies/5eadb5dd-d403-4c13-b03e-d4f8d28c96ba/outcome MyStudies Data]

'''Groups 3,15,27'''

* Insulin - ORIGIN [https://mystudies.org/studies.php#studies/f611818f-2e69-4952-b55e-661116bd84b6/outcome MyStudies Data]

'''Groups 4,16,28'''

* SGLT2 - EMPA-REG OUTCOME [https://mystudies.org/studies.php#studies/32e9cf1a-f33e-480b-91ca-6f28a4dcf862/outcome MyStudies Data]

'''Groups 5,17,29'''

* GLP - LEADER [https://mystudies.org/studies.php#studies/1adbc9a1-7603-40f1-ac15-b813ce1f0ad6/outcome MyStudies Data]

'''Groups 6,18,30'''

* DPP4 - TECOS [https://mystudies.org/studies.php#studies/8659968a-cefb-4f99-b4ae-8b9b659acbd5/outcome MyStudies Data]

'''Groups 7,19,31'''

* Intensive treatment – small scale - STENO [https://mystudies.org/studies.php#studies/39d423e3-af57-40c8-ab7a-cbc7f389bdb6/paper MyStudies Data]

'''Groups 8,20,32'''

* Intensive treatment – large scale - ADDITION-Europe - [https://mystudies.org/studies.php#studies/5e07d86d-aa92-4db9-a283-76080db4b6fd/outcome MyStudies Data]

'''2) OSTEOPOROSIS CASE'''

60 y/o female

* 72 kg, 1.69m, BMI = 25.2
* t-score of -2.5
* Worried about falling and getting a hip fracture
* A friend recently had an atraumatic fracture from simply tripping and falling over in the snow
* No other risk factors

'''Calculate Risks'''

'''FRACTURE RISK ESTIMATES''' - list the endpoints described by the specific calculator

Major osteoporotic fracture - xx% - 10-year risk – if no BMD (just BMI), and then if they had a BMD t-Score of -2.0, -2.5, and -3.0

Hip fracture - - xx% - 10-year risk – if no BMD (just BMI) and if you have a BMD xx% - 10-year risk – if no BMD, and then if they had a BMD T-Score of -2.0, -2.5, and -3.0

'''The Calculator'''

* FRACTURE CALCULATOR

[https://frax.shef.ac.uk/frax/tool.aspx?country=19 Frax Tool - Canada]

'''BENEFITS AND HARMS'''

Use the [https://www.cmaj.ca/content/195/39/E1333 2023 Osteoporosis Guideline] and/or your osteoporosis lecture notes to get the benefits and apply these to your patient, and also get the harms

'''COSTS'''

Try using [https://pricingdoc.acfp.ca Pricing Doc] to get costs

'''Groups 9,21,33'''

* Activity

'''Groups 10,22,34'''

* Calcium/Vitamin D

'''Groups 11,23,35'''

* Bisphosphonates

'''Groups 12,24,36'''

* Denosumab

11) NEUROLOGY STUDIES

*[http://www.ncbi.nlm.nih.gov/pubmed/16717269 Opioids for chronic non-cancer pain] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/29509867 Effect of Opioid vs Nonopioid Medications on Pain-Related Function in Patients With Chronic Back Pain] Groups 2,14,26
*[https://www.ncbi.nlm.nih.gov/pubmed/31291515 Galcanezumab for prevention of cluster headaches] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/27150433 Immediate or delayed treatment of a first seizure] Groups 4,16,28
*[https://www.ncbi.nlm.nih.gov/pubmed/31291516 Rimegepant for episodic migraine] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/26212846 Sleep restriction for insomnia] Groups 6,18,30
*[https://www.ncbi.nlm.nih.gov/pubmed/25957224 CHANCE] Groups 7,19,31
*[https://www.ncbi.nlm.nih.gov/pubmed/16899775 SPARCL] Groups 8,20,32
*[https://www.ncbi.nlm.nih.gov/pubmed/29171821 Erenumab for episodic migraine] Groups 9,21,33
*[https://www.ncbi.nlm.nih.gov/pubmed/24733354 Reduction of benzodiazepines through education] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/26035341 Patient controlled opioid analgesia versus non-patient controlled opioid analgesia for postoperative pain] Groups 11,23,35
*[https://www.ncbi.nlm.nih.gov/pubmed/11589932 PROGRESS] Groups 12,24,36

'''ACADEMIC YEAR 3'''

12) PSYCHIATRY STUDIES

[[:File:2021 Psych Evidence Appraisal - Intro Slides.pdf|Psychiatry Rating Scales Introduction]]

* Study 1: [http://www.ncbi.nlm.nih.gov/pubmed/16554525 STAR*D (Level 2)] Bupropion-SR, sertraline, or venlafaxine-XR after failure of SSRIs for depression
* Study 2: [http://www.ncbi.nlm.nih.gov/pubmed/29477251 Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder]
* Study 3: [https://pubmed.ncbi.nlm.nih.gov/33862018/ Long-acting injectable versus oral antipsychotics for the maintenance treatment of schizophrenia]
* Study 4: [https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2725088 Association of Antipsychotic Polypharmacy vs Monotherapy With Psychiatric Rehospitalization Among Adults With Schizophrenia]
* Study 5: [https://www.ncbi.nlm.nih.gov/pubmed/29490359 Real-world Effectiveness of Pharmacologic Treatments for the Prevention of Bipolar Disorder]
* Study 6: [http://www.ncbi.nlm.nih.gov/pubmed/20092882 BALANCE] Combination lithium and valproate therapy versus monotherapy for relapse prevention in bipolar I disorder
[[File:ChatGPT directions.jpg|thumb|ChatGPT Directions]]
13) GASTROENTEROLOGY STUDIES - LINKS ON CANVAS

*Short-term treatment for gastro-oesophageal reflux disease-like symptoms and endoscopy negative reflux disease (Review)
*Oral budesonide for induction of remission in ulcerative colitis (Review)
*Probiotics for the prevention of Clostridium difficile-associated diarrhea in adults and children (Review)
*Deprescribing versus continuation of chronic proton pump inhibitor use in adults (Review)
*Prevention of NSAID-induced gastroduodenal ulcers (Review)
*Methotrexate for maintenance of remission in Crohn's disease (Review)

14) OB/GYN STUDIES
*[http://www.ncbi.nlm.nih.gov/pubmed/25601350 Comparative contraceptive effectiveness of levonorgestrel-releasing and copper IUD Devices]
*[http://www.ncbi.nlm.nih.gov/pubmed/29211679 Hormonal contraception and the risk of breast cancer]
*[http://www.ncbi.nlm.nih.gov/pubmed/30322986 Sexual behaviours in adolescent girls before and after introduction of the HPV]
*[http://www.ncbi.nlm.nih.gov/pubmed/30181338 Intramuscular vs intravenous oxytocin to prevent postpartum haemorrhage at vaginal delivery]
*[http://www.ncbi.nlm.nih.gov/pubmed/27682034 Azithromycin Prophylaxis for Cesarean Delivery]
*[http://www.ncbi.nlm.nih.gov/pubmed/28461374 Antibiotics during pregnancy and risk of spontaneous abortion]

Evidence Appraisal Integrated Activities

2025-02-04T19:14:42Z

JamesMcCormack:

'''OBJECTIVE'''

To critically appraise studies, develop a brief synopsis of the trial results, succinctly present the results and then put the results into a proper clinical context

'''INITIAL PRE-READING'''

'''How To Critically Appraise an RCT In 10 minutes'''
*[https://itunes.apple.com/ca/book/how-to-critically-appraise/id524600667?mt=11 iBook/iPad version]
*[https://therapeuticseducation.org/sites/therapeuticseducation.org/files/Ten_Minute_Critical_Appraisal.pdf PDF version]
Watch this video
[http://youtu.be/QUW0Q8tXVUc Viva La Evidence]

'''Study Results at Your Fingertips'''
*[https://mystudies.org MyStudies] - Free access

'''INTEGRATION ACTIVITY FORMAT'''
# Students placed in groups of ~ 5-7
# Each group is given one of the studies below to review
# Students then work in pairs and develop a one-slide critical appraisal and results synopsis
# One student in each group will be chosen at random to present their group findings to the class
# A discussion about the appraisal and the appropriate clinical context for the results is had with the entire class for each study

'''MODULE'''
[[File:Screen Shot 2022-01-09 at 10.00.16 AM.jpg|thumb|'''TRIAL PRESENTATION FORMAT'''|none]]

Studies chosen include landmark studies and/or studies that address important therapeutic issues for the particular module

'''ACADEMIC YEAR 1 - FIRST TERM'''

1) FOUNDATION STUDIES (Groups)
*[https://pubmed.ncbi.nlm.nih.gov/37952131 SELECT] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/12466506 AFFIRM] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/22085343 AIM-HIGH] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/10639539 HOPE] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/18378519 HYVET] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/15007110 PROVE-IT] Groups 6,18,30
*[http://www.ncbi.nlm.nih.gov/pubmed/15755765 TNT] Groups 7,19,31
*[https://pubmed.ncbi.nlm.nih.gov/26378978 EMPAREG] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/17984165 ILLUMINATE] Groups 9,21,33
*[https://pubmed.ncbi.nlm.nih.gov/26551272/ SPRINT] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/15325833 CARDS] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/12117397 WHI] Groups 12,24,36

'''ACADEMIC YEAR 1 - SECOND TERM'''

2) INTRO TO INFECTIOUS DISEASE STUDIES

[https://wiki.ubc.ca/images/8/8b/Antibiotic_Sensitivity_Chart_2024.pdf The "Best" Antibiotic Sensitivity Chart Ever]
*[http://www.ncbi.nlm.nih.gov/pubmed/17567657 IV vs PO antibiotics] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/24603565 Delayed antibiotics for respiratory tract infections] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/11159657 Delayed antibiotics for otitis media] Groups 3,15,27
*[https://pubmed.ncbi.nlm.nih.gov/27455166/ Duration of treatment for community acquired pneumonia] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/22726802 Duration of treatment for pyelonephritis] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/25830421 Choice of antibiotic for community acquired pneumonia-1] Groups 6,18,30
*[http://www.ncbi.nlm.nih.gov/pubmed/25286173 Choice of antibiotic for community acquired pneumonia-2] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/20647284 HPV vaccine study] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/7966893 Influenza vaccine study] Groups 9,21,33
*[https://pubmed.ncbi.nlm.nih.gov/33301246/ COVID vaccine Pfizer] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/27626517 Herpes zoster vaccine study 1] Groups 11,23,35
*[https://www.ncbi.nlm.nih.gov/pubmed/25916341 Herpes zoster vaccine study 2] Groups 12,24,36

3) MUSCULOSKELETAL STUDIES

*[http://www.ncbi.nlm.nih.gov/pubmed/28199814 Baricitinib versus Placebo or Adalimumab in Rheumatoid Arthritis] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/0010979111 CLASS – celecoxib vs NSAIDs] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/26501533 Naproxen with cyclobenzaprine, oxycodone/acetaminophen, or placebo for low back pain] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/24395557 Glucosamine and chondroitin for OA] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/12546607 Acetaminophen vs diclofenac for OA] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/23964752 Diclofenac gel for acute neck pain] Groups 6,18,30
*[https://pubmed.ncbi.nlm.nih.gov/15468367/ Topical diclofenac vs oral diclofenac] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/25064594 Acetaminophen for low back pain] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/7611589 Misoprostol and NSAID induced ulcers] Groups 9,21,33
*[http://www.ncbi.nlm.nih.gov/pubmed/20131255 Low dose vs high dose colchicine for gout] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/22508468 TEAR - oral triple therapy versus etanercept plus methotrexate in early aggressive rheumatoid arthritis] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/25589511 MOVES - Glucosamine and chondroitin for OA for moderate to severe pain] Groups 12,24,36

4) DERMATOLOGY STUDIES

*[https://www.ncbi.nlm.nih.gov/pubmed/9598014 Glycolic acid 5% Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/21896132 Glycolic acid 10% Acne]
*[https://www.ncbi.nlm.nih.gov/pubmed/14531866 Petrolatum vs Ceramide/skin related lipids Hand Dermatitis]
*[https://www.ncbi.nlm.nih.gov/pubmed/11896774 Vitamin C Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/17515510 Retinol (VitaminA) Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/21896129 Hyaluronic acid Atopic Dermatitis]

5) EENT STUDIES

[http://www.amstar.ca/docs/AMSTARguideline.pdf AMSTAR meta-analysis checklist]

'''Scenario 1 - Otitis Media''' - GROUPS 1, 7, 18, 19, 25, 36

Anthony Martin arrives at your pharmacy somewhat frustrated since his family physician declined to write an antibiotic prescription for his two and half year old son, Oscar. His symptoms started yesterday afternoon - Oscar complains of right ear pain but there is no discharge. Rectal temperature taken today was 38.5 degrees. His wife is sure Oscar has an ear infection since the last time he had these same symptoms, that was ultimately the diagnosis. Mr. Martin asks if you think buying acetaminophen is really “enough”?

[https://pubmed.ncbi.nlm.nih.gov/26099233/ Antibiotics for acute otitis media in children]

'''Scenario 2 - Allergic Rhinitis''' - GROUPS 2, 8, 17, 20, 26, 35

Ruby Parmar is a firefighter. She is plagued by sinus congestion (preventing her from sleeping) and a runny nose associated with seasonal allergies. Her prescription for intranasal triamcinolone is typically effective, but she would like to know if a non-sedating anti-allergy pill would work just as well since it’s inconvenient carrying around the “nose spray”.

[https://www.ncbi.nlm.nih.gov/pubmed/28234147 Intranasal steroids vs antihistamines for allergic rhinitis]

'''Scenario 3 - Acute Sinusitis''' - GROUPS 3, 9, 16, 21, 27, 34

You are seeing a patient in clinic before her appointment with the primary care physician. She was feeling unwell with a “flu” last week. While most of her symptoms have resolved (cough, fever), the nasal congestion and discharge persists and so she has made an appointment (she is an otherwise healthy 32 year old with treated thyroid disease). She would like your advice for what treatment she should ask the doctor to prescribe.

[http://www.ncbi.nlm.nih.gov/pubmed/24293353 Intranasal steroids for acute sinusitis]

'''Scenario 4 - Glaucoma''' - GROUPS 4, 10, 15, 22, 28, 33

Mrs. Ada Waters is a 63 year-old woman you. Her ophthalmologist prescribed timolol and xalatan eye drops for treatment of open angle glaucoma. She has never really felt much different on treatment since she recovered from her first episode (of acute angle closure glaucoma requiring ER visit) and surgery. She asks you if the treatment is really making a difference.

[https://www.ncbi.nlm.nih.gov/pubmed/17943780 Interventions for open angle glaucoma]

'''Scenario 5 - Sore Throat''' - GROUPS 5, 11, 14, 23, 29, 32

You have a good friend who is applying for pharmacy. Her invitation for the multiple-mini interview (MMI) is coming up soon, but she is starting to experience a sore throat. While she is worried about not being able to speak through all of those stations, she knows she often gets a terrible headache along with her sore throat. She has an unused prescription for amoxicillin (unexpired) and wonders if you recommend for her to take it.

[https://pubmed.ncbi.nlm.nih.gov/34881426/ Antibiotics for sore throat]

'''Scenario 6 - Conjunctivitis''' - GROUPS 6, 12, 13, 24, 30, 31

A man comes to your pharmacy (he appears in his early twenties) complaining of “pink eye”. He has had a pink discolouration and discharge from his left eye for two days. He asks if the OTC antibiotic eye drops (he’s holding a product with polymixin B) are any better than “waiting it out”.

[https://www.ncbi.nlm.nih.gov/pubmed/22972049 Antibiotics for acute conjunctivitis]

6) HEMATOLOGY STUDIES

None so far

'''ACADEMIC YEAR 2 - FIRST TERM'''

7) RESPIROLOGY STUDIES
[[File:IA COPD info.pdf|thumb]]

*[http://www.ncbi.nlm.nih.gov/pubmed/2062329 First inhaled steroid study] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/22938706 Tiotropium in asthma] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/21324520 Inhaled steroid in children] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/29768149 Combined Budesonide–Formoterol as Needed in Mild Asthma] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/15223858 Doubling dose of inhaled corticosteroid] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/29768147 As-Needed Budesonide–Formoterol versus Maintenance Budesonide in Mild Asthma] Groups 6,18,30
*[http://www.ncbi.nlm.nih.gov/pubmed/27181606 Indacaterol-glycopyrronium VS salmeterol/fluticasone in COPD] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/21428765 Tiotropium VS salmeterol in COPD] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/23695200 Short VS long steroids for COPD exacerbation] Groups 9,21,33
*[http://www.ncbi.nlm.nih.gov/pubmed/25196117 Stopping inhaled steroids in COPD] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/29668352 Once-Daily Single-Inhaler Triple versus Dual Therapy in Patients with COPD] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/28877011 Tezepelumab in Adults with Uncontrolled Asthma] Groups 12,24,36

8) CARDIOVASCULAR STUDIES

SESSION 1

*[https://www.ncbi.nlm.nih.gov/pubmed/4862069 VA1] (Group 1, 13, 25)
*[https://www.ncbi.nlm.nih.gov/pubmed/4914579 VA 2] (Group 2, 14, 26)
*[https://pubmed.ncbi.nlm.nih.gov/33186492 Polycap Study 3] (Group 3, 15, 27)
*[http://www.ncbi.nlm.nih.gov/pubmed/20228401 ACCORD-BP] (Group 4, 16, 28)
*[https://www.ncbi.nlm.nih.gov/pubmed/26551272 SPRINT] (Group 5, 17, 29)
*[http://www.ncbi.nlm.nih.gov/pubmed/2883575 CONSENSUS] (Group 6,18,30)
*[https://pubmed.ncbi.nlm.nih.gov/31535829/ DAPA-HF] (Group 7, 19, 31)
*[https://pubmed.ncbi.nlm.nih.gov/25176939/ CONFIRM-HF] (Group 8, 20, 32)
*[http://www.ncbi.nlm.nih.gov/pubmed/12457784 PROSPER] (Group 9, 21, 33)
*[http://www.ncbi.nlm.nih.gov/pubmed/27040132 HOPE-3] (Group 10, 22, 34)
*[http://www.ncbi.nlm.nih.gov/pubmed/12114036 Heart Protection Study (HPS)] (Group 11, 23, 35)
*[http://www.ncbi.nlm.nih.gov/pubmed/30415628 REDUCE-IT] (Group 12, 24, 36)

[[File:CV Case.pdf|thumb|CV case|left]]

SESSION 2

'''The Guideline Case'''

A 63 y/o patient with CHOOSE ONE (⬆︎HTN/⬆︎Chol/⬆︎glucose/HF/A fib) and using the guideline determine:
# their 5yr/10yr risks of mortality/CVD events
# the potential benefit
# the potential side effects (with magnitude)
# words/sentiment patient values and preferences/SDM

Atrial fibrillation - Groups 1,13,25,2,14,26
*[https://www.onlinecjc.ca/article/S0828-282X(18)31062-6/pdf 2018 Atrial fibrillation guidelines]
Diabetes - Groups 3,15,27,4,16,28
*[http://guidelines.diabetes.ca/docs/CPG-2018-full-EN.pdf 2018 Diabetes guidelines]
Lipid Simplified - Groups 5,17,29,6,18,30
*[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4607330/pdf/0610857.pdf 2015 Simplified lipid guidelines]
Lipid - Groups 7,19,31,8,20,32
*[http://www.onlinecjc.ca/article/S0828-282X(16)30732-2/pdf 2016 Lipid guidelines]
Heart failure - Groups 9,21,33,10,22,34
*[http://www.onlinecjc.ca/article/S0828-282X(17)30973-X/pdf 2017 Heart failure guidelines]
Hypertension - Groups 11,23,35,12,24,36
*[https://www.onlinecjc.ca/article/S0828-282X(18)30183-1/pdf 2018 Hypertension guidelines]

OPTIONAL SESSION
*[http://www.ncbi.nlm.nih.gov/pubmed/16899775 SPARCL]
*[http://www.ncbi.nlm.nih.gov/pubmed/10471456 RALES]
*[http://www.ncbi.nlm.nih.gov/pubmed/11386263 Carvedilol in heart failure]
*[http://www.ncbi.nlm.nih.gov/pubmed/18460663 WAFACS]
*[http://www.ncbi.nlm.nih.gov/pubmed/10376614 MERIT-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/25176015 PARADIGM-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/24490264 High-dose multivitamins after MI]
*[http://www.ncbi.nlm.nih.gov/pubmed/7911176 Mediterranean Diet after MI]
*[http://www.ncbi.nlm.nih.gov/pubmed/15337732 A TO Z]
*[http://www.ncbi.nlm.nih.gov/pubmed/21073363 EMPHASIS-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/12853193 COMET]
*[http://www.ncbi.nlm.nih.gov/pubmed/24716680 TOPCAT]
*[http://www.ncbi.nlm.nih.gov/pubmed/26039521 IMPROVE-IT]

'''ACADEMIC YEAR 2 - SECOND TERM'''

9) NEPHROLOGY STUDIES

None so far

10) ENDOCRINOLOGY

[[File:IA ENDO LAYOUT.pdf|thumb|IA ENDO LAYOUT TEMPLATE]]
'''RISK ASSESSMENT CASES FOR DIABETES AND OSTEOPOROSIS'''

'''1) DIABETES CASE'''

66 y/o white male who was diagnosed with diabetes 8 years ago

* His blood pressure over the last year has been roughly 145/80 mmHg - at present untreated
* A1c = 8%, no diabetes meds, non-smoker, BMI ~30
* '''When calculating without diabetes for PREVENT use an A1c of 5.5%'''
* Total cholesterol is 6 mmol/L, his HDL is 2 mmol/L, non-HDL = 6 minus 2, not on a statin
* No retinopathy, urine albumin-to-creatinine ratio (UACR) = 15ug/mg (7mg/mmol),
* Serum creatinine = 70 micromol/L, waist circumference 100 cm
* GFR 75 mL/min/1.73m2
* In normal sinus rhythm
* Age at end of highest education = 19
* Mother alive, father died of a heart attack at age 80

'''Calculate Risks'''

'''CVD RISK ESTIMATES''' - list the endpoints described by the specific calculator

Framingham - xx% - 10-year risk - also if no diabetes xx%

ASCVD - xx% - 10-year risk - also if no diabetes xx%

'''The Calculator'''
*CVD CALCULATOR
https://decisionaid.ca/cvd/

'''DIABETES COMPLICATIONS RISK ESTIMATES''' - list the endpoints described by the specific calculator

xx% - also 10-year risk if A1c 9, 8, 7 and 6

also get risk of kidney failure, vision loss, pressure sensation loss – also if A1c 9, 8,7,6

'''The Calculator'''
*DIABETES DECISION AID
http://decisionaid.ca/diabetes/

'''BENEFITS AND HARMS'''

Use the [https://guidelines.diabetes.ca/cpg/chapter-13-2020-update 2024 diabetes guidelines] and/or Diabetes Decision Aid to get estimates of benefits and harms and also use the MyStudies synopsis listed below

'''COSTS'''

Try using [https://pricingdoc.acfp.ca Pricing Doc] to get costs

'''Groups 1,13,25'''

* Metformin - UKPDS 34 [https://mystudies.org/studies.php#studies/28929e89-d01e-4b11-8e67-4d7086f9e4aa/outcome MyStudies Data]

'''Groups 2,14,26'''

* Sulfonlyureas - UKPDS 33 [https://mystudies.org/studies.php#studies/5eadb5dd-d403-4c13-b03e-d4f8d28c96ba/outcome MyStudies Data]

'''Groups 3,15,27'''

* Insulin - ORIGIN [https://mystudies.org/studies.php#studies/f611818f-2e69-4952-b55e-661116bd84b6/outcome MyStudies Data]

'''Groups 4,16,28'''

* SGLT2 - EMPA-REG OUTCOME [https://mystudies.org/studies.php#studies/32e9cf1a-f33e-480b-91ca-6f28a4dcf862/outcome MyStudies Data]

'''Groups 5,17,29'''

* GLP - LEADER [https://mystudies.org/studies.php#studies/1adbc9a1-7603-40f1-ac15-b813ce1f0ad6/outcome MyStudies Data]

'''Groups 6,18,30'''

* DPP4 - TECOS [https://mystudies.org/studies.php#studies/8659968a-cefb-4f99-b4ae-8b9b659acbd5/outcome MyStudies Data]

'''Groups 7,19,31'''

* Intensive treatment – small scale - STENO [https://mystudies.org/studies.php#studies/39d423e3-af57-40c8-ab7a-cbc7f389bdb6/paper MyStudies Data]

'''Groups 8,20,32'''

* Intensive treatment – large scale - ADDITION-Europe - [https://mystudies.org/studies.php#studies/5e07d86d-aa92-4db9-a283-76080db4b6fd/outcome MyStudies Data]

'''2) OSTEOPOROSIS CASE'''

60 y/o female

* 72 kg, 1.69m, BMI = 25.2
* t-score of -2.5
* Worried about falling and getting a hip fracture
* A friend recently had an atraumatic fracture from simply tripping and falling over in the snow
* No other risk factors

'''Calculate Risks'''

'''FRACTURE RISK ESTIMATES''' - list the endpoints described by the specific calculator

Major osteoporotic fracture - xx% - 10-year risk – if no BMD (just BMI), and then if they had a BMD t-Score of -2.0, -2.5, and -3.0

Hip fracture - - xx% - 10-year risk – if no BMD (just BMI) and if you have a BMD xx% - 10-year risk – if no BMD, and then if they had a BMD T-Score of -2.0, -2.5, and -3.0

'''The Calculator'''

* FRACTURE CALCULATOR

[https://frax.shef.ac.uk/frax/tool.aspx?country=19 Frax Tool - Canada]

'''BENEFITS AND HARMS'''

Use the [https://www.cmaj.ca/content/195/39/E1333 2023 Osteoporosis Guideline] and/or your osteoporosis lecture notes to get the benefits and apply these to your patient, and also get the harms

'''COSTS'''

Try using [https://pricingdoc.acfp.ca Pricing Doc] to get costs

'''Groups 9,21,33'''

* Activity

'''Groups 10,22,34'''

* Calcium/Vitamin D

'''Groups 11,23,35'''

* Bisphosphonates

'''Groups 12,24,36'''

* Denosumab

11) NEUROLOGY STUDIES

*[http://www.ncbi.nlm.nih.gov/pubmed/16717269 Opioids for chronic non-cancer pain] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/29509867 Effect of Opioid vs Nonopioid Medications on Pain-Related Function in Patients With Chronic Back Pain] Groups 2,14,26
*[https://www.ncbi.nlm.nih.gov/pubmed/31291515 Galcanezumab for prevention of cluster headaches] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/27150433 Immediate or delayed treatment of a first seizure] Groups 4,16,28
*[https://www.ncbi.nlm.nih.gov/pubmed/31291516 Rimegepant for episodic migraine] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/26212846 Sleep restriction for insomnia] Groups 6,18,30
*[https://www.ncbi.nlm.nih.gov/pubmed/25957224 CHANCE] Groups 7,19,31
*[https://www.ncbi.nlm.nih.gov/pubmed/16899775 SPARCL] Groups 8,20,32
*[https://www.ncbi.nlm.nih.gov/pubmed/29171821 Erenumab for episodic migraine] Groups 9,21,33
*[https://www.ncbi.nlm.nih.gov/pubmed/24733354 Reduction of benzodiazepines through education] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/26035341 Patient controlled opioid analgesia versus non-patient controlled opioid analgesia for postoperative pain] Groups 11,23,35
*[https://www.ncbi.nlm.nih.gov/pubmed/11589932 PROGRESS] Groups 12,24,36

'''ACADEMIC YEAR 3'''

12) PSYCHIATRY STUDIES

[[:File:2021 Psych Evidence Appraisal - Intro Slides.pdf|Psychiatry Rating Scales Introduction]]

* Study 1: [http://www.ncbi.nlm.nih.gov/pubmed/16554525 STAR*D (Level 2)] Bupropion-SR, sertraline, or venlafaxine-XR after failure of SSRIs for depression
* Study 2: [http://www.ncbi.nlm.nih.gov/pubmed/29477251 Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder]
* Study 3: [https://pubmed.ncbi.nlm.nih.gov/33862018/ Long-acting injectable versus oral antipsychotics for the maintenance treatment of schizophrenia]
* Study 4: [https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2725088 Association of Antipsychotic Polypharmacy vs Monotherapy With Psychiatric Rehospitalization Among Adults With Schizophrenia]
* Study 5: [https://www.ncbi.nlm.nih.gov/pubmed/29490359 Real-world Effectiveness of Pharmacologic Treatments for the Prevention of Bipolar Disorder]
* Study 6: [http://www.ncbi.nlm.nih.gov/pubmed/20092882 BALANCE] Combination lithium and valproate therapy versus monotherapy for relapse prevention in bipolar I disorder
[[File:ChatGPT directions.jpg|thumb|ChatGPT Directions]]
13) GASTROENTEROLOGY STUDIES - LINKS ON CANVAS

*Short-term treatment for gastro-oesophageal reflux disease-like symptoms and endoscopy negative reflux disease (Review)
*Oral budesonide for induction of remission in ulcerative colitis (Review)
*Probiotics for the prevention of Clostridium difficile-associated diarrhea in adults and children (Review)
*Deprescribing versus continuation of chronic proton pump inhibitor use in adults (Review)
*Prevention of NSAID-induced gastroduodenal ulcers (Review)
*Methotrexate for maintenance of remission in Crohn's disease (Review)

14) OB/GYN STUDIES
*[http://www.ncbi.nlm.nih.gov/pubmed/25601350 Comparative contraceptive effectiveness of levonorgestrel-releasing and copper IUD Devices]
*[http://www.ncbi.nlm.nih.gov/pubmed/29211679 Hormonal contraception and the risk of breast cancer]
*[http://www.ncbi.nlm.nih.gov/pubmed/30322986 Sexual behaviours in adolescent girls before and after introduction of the HPV]
*[http://www.ncbi.nlm.nih.gov/pubmed/30181338 Intramuscular vs intravenous oxytocin to prevent postpartum haemorrhage at vaginal delivery]
*[http://www.ncbi.nlm.nih.gov/pubmed/27682034 Azithromycin Prophylaxis for Cesarean Delivery]
*[http://www.ncbi.nlm.nih.gov/pubmed/28461374 Antibiotics during pregnancy and risk of spontaneous abortion]

Evidence Appraisal Integrated Activities

2025-02-04T19:14:12Z

JamesMcCormack:

'''OBJECTIVE'''

To critically appraise studies, develop a brief synopsis of the trial results, succinctly present the results and then put the results into a proper clinical context

'''INITIAL PRE-READING'''

'''How To Critically Appraise an RCT In 10 minutes'''
*[https://itunes.apple.com/ca/book/how-to-critically-appraise/id524600667?mt=11 iBook/iPad version]
*[https://therapeuticseducation.org/sites/therapeuticseducation.org/files/Ten_Minute_Critical_Appraisal.pdf PDF version]
Watch this video
[http://youtu.be/QUW0Q8tXVUc Viva La Evidence]

'''Study Results at Your Fingertips'''
*[https://mystudies.org MyStudies] - Free access

'''INTEGRATION ACTIVITY FORMAT'''
# Students placed in groups of ~ 5-7
# Each group is given one of the studies below to review
# Students then work in pairs and develop a one-slide critical appraisal and results synopsis
# One student in each group will be chosen at random to present their group findings to the class
# A discussion about the appraisal and the appropriate clinical context for the results is had with the entire class for each study

'''MODULE'''
[[File:Screen Shot 2022-01-09 at 10.00.16 AM.jpg|thumb|'''TRIAL PRESENTATION FORMAT'''|none]]

Studies chosen include landmark studies and/or studies that address important therapeutic issues for the particular module

'''ACADEMIC YEAR 1 - FIRST TERM'''

1) FOUNDATION STUDIES (Groups)
*[https://pubmed.ncbi.nlm.nih.gov/37952131 SELECT] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/12466506 AFFIRM] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/22085343 AIM-HIGH] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/10639539 HOPE] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/18378519 HYVET] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/15007110 PROVE-IT] Groups 6,18,30
*[http://www.ncbi.nlm.nih.gov/pubmed/15755765 TNT] Groups 7,19,31
*[https://pubmed.ncbi.nlm.nih.gov/26378978 EMPAREG] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/17984165 ILLUMINATE] Groups 9,21,33
*[https://pubmed.ncbi.nlm.nih.gov/26551272/ SPRINT] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/15325833 CARDS] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/12117397 WHI] Groups 12,24,36

'''ACADEMIC YEAR 1 - SECOND TERM'''

2) INTRO TO INFECTIOUS DISEASE STUDIES

[https://wiki.ubc.ca/images/8/8b/Antibiotic_Sensitivity_Chart_2024.pdf The "Best" Antibiotic Sensitivity Chart Ever]
*[http://www.ncbi.nlm.nih.gov/pubmed/17567657 IV vs PO antibiotics] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/24603565 Delayed antibiotics for respiratory tract infections] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/11159657 Delayed antibiotics for otitis media] Groups 3,15,27
*[https://pubmed.ncbi.nlm.nih.gov/27455166/ Duration of treatment for community acquired pneumonia] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/22726802 Duration of treatment for pyelonephritis] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/25830421 Choice of antibiotic for community acquired pneumonia-1] Groups 6,18,30
*[http://www.ncbi.nlm.nih.gov/pubmed/25286173 Choice of antibiotic for community acquired pneumonia-2] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/20647284 HPV vaccine study] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/7966893 Influenza vaccine study] Groups 9,21,33
*[https://pubmed.ncbi.nlm.nih.gov/33301246/ COVID vaccine Pfizer] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/27626517 Herpes zoster vaccine study 1] Groups 11,23,35
*[https://www.ncbi.nlm.nih.gov/pubmed/25916341 Herpes zoster vaccine study 2] Groups 12,24,36

3) MUSCULOSKELETAL STUDIES

*[http://www.ncbi.nlm.nih.gov/pubmed/28199814 Baricitinib versus Placebo or Adalimumab in Rheumatoid Arthritis] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/0010979111 CLASS – celecoxib vs NSAIDs] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/26501533 Naproxen with cyclobenzaprine, oxycodone/acetaminophen, or placebo for low back pain] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/24395557 Glucosamine and chondroitin for OA] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/12546607 Acetaminophen vs diclofenac for OA] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/23964752 Diclofenac gel for acute neck pain] Groups 6,18,30
*[https://pubmed.ncbi.nlm.nih.gov/15468367/ Topical diclofenac vs oral diclofenac] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/25064594 Acetaminophen for low back pain] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/7611589 Misoprostol and NSAID induced ulcers] Groups 9,21,33
*[http://www.ncbi.nlm.nih.gov/pubmed/20131255 Low dose vs high dose colchicine for gout] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/22508468 TEAR - oral triple therapy versus etanercept plus methotrexate in early aggressive rheumatoid arthritis] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/25589511 MOVES - Glucosamine and chondroitin for OA for moderate to severe pain] Groups 12,24,36

4) DERMATOLOGY STUDIES

*[https://www.ncbi.nlm.nih.gov/pubmed/9598014 Glycolic acid 5% Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/21896132 Glycolic acid 10% Acne]
*[https://www.ncbi.nlm.nih.gov/pubmed/14531866 Petrolatum vs Ceramide/skin related lipids Hand Dermatitis]
*[https://www.ncbi.nlm.nih.gov/pubmed/11896774 Vitamin C Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/17515510 Retinol (VitaminA) Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/21896129 Hyaluronic acid Atopic Dermatitis]

5) EENT STUDIES

[http://www.amstar.ca/docs/AMSTARguideline.pdf AMSTAR meta-analysis checklist]

'''Scenario 1 - Otitis Media''' - GROUPS 1, 7, 18, 19, 25, 36

Anthony Martin arrives at your pharmacy somewhat frustrated since his family physician declined to write an antibiotic prescription for his two and half year old son, Oscar. His symptoms started yesterday afternoon - Oscar complains of right ear pain but there is no discharge. Rectal temperature taken today was 38.5 degrees. His wife is sure Oscar has an ear infection since the last time he had these same symptoms, that was ultimately the diagnosis. Mr. Martin asks if you think buying acetaminophen is really “enough”?

[https://pubmed.ncbi.nlm.nih.gov/26099233/ Antibiotics for acute otitis media in children]

'''Scenario 2 - Allergic Rhinitis''' - GROUPS 2, 8, 17, 20, 26, 35

Ruby Parmar is a firefighter. She is plagued by sinus congestion (preventing her from sleeping) and a runny nose associated with seasonal allergies. Her prescription for intranasal triamcinolone is typically effective, but she would like to know if a non-sedating anti-allergy pill would work just as well since it’s inconvenient carrying around the “nose spray”.

[https://www.ncbi.nlm.nih.gov/pubmed/28234147 Intranasal steroids vs antihistamines for allergic rhinitis]

'''Scenario 3 - Acute Sinusitis''' - GROUPS 3, 9, 16, 21, 27, 34

You are seeing a patient in clinic before her appointment with the primary care physician. She was feeling unwell with a “flu” last week. While most of her symptoms have resolved (cough, fever), the nasal congestion and discharge persists and so she has made an appointment (she is an otherwise healthy 32 year old with treated thyroid disease). She would like your advice for what treatment she should ask the doctor to prescribe.

[http://www.ncbi.nlm.nih.gov/pubmed/24293353 Intranasal steroids for acute sinusitis]

'''Scenario 4 - Glaucoma''' - GROUPS 4, 10, 15, 22, 28, 33

Mrs. Ada Waters is a 63 year-old woman you. Her ophthalmologist prescribed timolol and xalatan eye drops for treatment of open angle glaucoma. She has never really felt much different on treatment since she recovered from her first episode (of acute angle closure glaucoma requiring ER visit) and surgery. She asks you if the treatment is really making a difference.

[https://www.ncbi.nlm.nih.gov/pubmed/17943780 Interventions for open angle glaucoma]

'''Scenario 5 - Sore Throat''' - GROUPS 5, 11, 14, 23, 29, 32

You have a good friend who is applying for pharmacy. Her invitation for the multiple-mini interview (MMI) is coming up soon, but she is starting to experience a sore throat. While she is worried about not being able to speak through all of those stations, she knows she often gets a terrible headache along with her sore throat. She has an unused prescription for amoxicillin (unexpired) and wonders if you recommend for her to take it.

[https://pubmed.ncbi.nlm.nih.gov/34881426/ Antibiotics for sore throat]

'''Scenario 6 - Conjunctivitis''' - GROUPS 6, 12, 13, 24, 30, 31

A man comes to your pharmacy (he appears in his early twenties) complaining of “pink eye”. He has had a pink discolouration and discharge from his left eye for two days. He asks if the OTC antibiotic eye drops (he’s holding a product with polymixin B) are any better than “waiting it out”.

[https://www.ncbi.nlm.nih.gov/pubmed/22972049 Antibiotics for acute conjunctivitis]

6) HEMATOLOGY STUDIES

None so far

'''ACADEMIC YEAR 2 - FIRST TERM'''

7) RESPIROLOGY STUDIES
[[File:IA COPD info.pdf|thumb]]

*[http://www.ncbi.nlm.nih.gov/pubmed/2062329 First inhaled steroid study] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/22938706 Tiotropium in asthma] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/21324520 Inhaled steroid in children] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/29768149 Combined Budesonide–Formoterol as Needed in Mild Asthma] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/15223858 Doubling dose of inhaled corticosteroid] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/29768147 As-Needed Budesonide–Formoterol versus Maintenance Budesonide in Mild Asthma] Groups 6,18,30
*[http://www.ncbi.nlm.nih.gov/pubmed/27181606 Indacaterol-glycopyrronium VS salmeterol/fluticasone in COPD] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/21428765 Tiotropium VS salmeterol in COPD] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/23695200 Short VS long steroids for COPD exacerbation] Groups 9,21,33
*[http://www.ncbi.nlm.nih.gov/pubmed/25196117 Stopping inhaled steroids in COPD] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/29668352 Once-Daily Single-Inhaler Triple versus Dual Therapy in Patients with COPD] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/28877011 Tezepelumab in Adults with Uncontrolled Asthma] Groups 12,24,36

8) CARDIOVASCULAR STUDIES

SESSION 1

*[https://www.ncbi.nlm.nih.gov/pubmed/4862069 VA1] (Group 1, 13, 25)
*[https://www.ncbi.nlm.nih.gov/pubmed/4914579 VA 2] (Group 2, 14, 26)
*[https://pubmed.ncbi.nlm.nih.gov/33186492 Polycap Study 3] (Group 3, 15, 27)
*[http://www.ncbi.nlm.nih.gov/pubmed/20228401 ACCORD-BP] (Group 4, 16, 28)
*[https://www.ncbi.nlm.nih.gov/pubmed/26551272 SPRINT] (Group 5, 17, 29)
*[http://www.ncbi.nlm.nih.gov/pubmed/2883575 CONSENSUS] (Group 6,18,30)
*[https://pubmed.ncbi.nlm.nih.gov/31535829/ DAPA-HF] (Group 7, 19, 31)
*[https://pubmed.ncbi.nlm.nih.gov/25176939/ CONFIRM-HF] (Group 8, 20, 32)
*[http://www.ncbi.nlm.nih.gov/pubmed/12457784 PROSPER] (Group 9, 21, 33)
*[http://www.ncbi.nlm.nih.gov/pubmed/27040132 HOPE-3] (Group 10, 22, 34)
*[http://www.ncbi.nlm.nih.gov/pubmed/12114036 Heart Protection Study (HPS)] (Group 11, 23, 35)
*[http://www.ncbi.nlm.nih.gov/pubmed/30415628 REDUCE-IT] (Group 12, 24, 36)

[[File:CV Case.pdf|thumb|CV case|left]]

SESSION 2

'''The Guideline Case'''

A 63 y/o patient with CHOOSE ONE (⬆︎HTN/⬆︎Chol/⬆︎glucose/HF/A fib) and using the guideline determine:
# their 5yr/10yr risks of mortality/CVD events
# the potential benefit
# the potential side effects (with magnitude)
# words/sentiment patient values and preferences/SDM

Atrial fibrillation - Groups 1,13,25,2,14,26
*[https://www.onlinecjc.ca/article/S0828-282X(18)31062-6/pdf 2018 Atrial fibrillation guidelines]
Diabetes - Groups 3,15,27,4,16,28
*[http://guidelines.diabetes.ca/docs/CPG-2018-full-EN.pdf 2018 Diabetes guidelines]
Lipid Simplified - Groups 5,17,29,6,18,30
*[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4607330/pdf/0610857.pdf 2015 Simplified lipid guidelines]
Lipid - Groups 7,19,31,8,20,32
*[http://www.onlinecjc.ca/article/S0828-282X(16)30732-2/pdf 2016 Lipid guidelines]
Heart failure - Groups 9,21,33,10,22,34
*[http://www.onlinecjc.ca/article/S0828-282X(17)30973-X/pdf 2017 Heart failure guidelines]
Hypertension - Groups 11,23,35,12,24,36
*[https://www.onlinecjc.ca/article/S0828-282X(18)30183-1/pdf 2018 Hypertension guidelines]

OPTIONAL SESSION
*[http://www.ncbi.nlm.nih.gov/pubmed/16899775 SPARCL]
*[http://www.ncbi.nlm.nih.gov/pubmed/10471456 RALES]
*[http://www.ncbi.nlm.nih.gov/pubmed/11386263 Carvedilol in heart failure]
*[http://www.ncbi.nlm.nih.gov/pubmed/18460663 WAFACS]
*[http://www.ncbi.nlm.nih.gov/pubmed/10376614 MERIT-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/25176015 PARADIGM-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/24490264 High-dose multivitamins after MI]
*[http://www.ncbi.nlm.nih.gov/pubmed/7911176 Mediterranean Diet after MI]
*[http://www.ncbi.nlm.nih.gov/pubmed/15337732 A TO Z]
*[http://www.ncbi.nlm.nih.gov/pubmed/21073363 EMPHASIS-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/12853193 COMET]
*[http://www.ncbi.nlm.nih.gov/pubmed/24716680 TOPCAT]
*[http://www.ncbi.nlm.nih.gov/pubmed/26039521 IMPROVE-IT]

'''ACADEMIC YEAR 2 - SECOND TERM'''

9) NEPHROLOGY STUDIES

None so far

10) ENDOCRINOLOGY
[[File:IA ENDO LAYOUT.pdf|thumb|IA ENDO LAYOUT TEMPLATE]]
'''RISK ASSESSMENT CASES FOR DIABETES AND OSTEOPOROSIS'''

'''1) DIABETES CASE'''

66 y/o white male who was diagnosed with diabetes 8 years ago

* His blood pressure over the last year has been roughly 145/80 mmHg - at present untreated
* A1c = 8%, no diabetes meds, non-smoker, BMI ~30
* '''When calculating without diabetes for PREVENT use an A1c of 5.5%'''
* Total cholesterol is 6 mmol/L, his HDL is 2 mmol/L, non-HDL = 6 minus 2, not on a statin
* No retinopathy, urine albumin-to-creatinine ratio (UACR) = 15ug/mg (7mg/mmol),
* Serum creatinine = 70 micromol/L, waist circumference 100 cm
* GFR 75 mL/min/1.73m2
* In normal sinus rhythm
* Age at end of highest education = 19
* Mother alive, father died of a heart attack at age 80

'''Calculate Risks'''

'''CVD RISK ESTIMATES''' - list the endpoints described by the specific calculator

Framingham - xx% - 10-year risk - also if no diabetes xx%

ASCVD - xx% - 10-year risk - also if no diabetes xx%

'''The Calculator'''
*CVD CALCULATOR
https://decisionaid.ca/cvd/

'''DIABETES COMPLICATIONS RISK ESTIMATES''' - list the endpoints described by the specific calculator

xx% - also 10-year risk if A1c 9, 8, 7 and 6

also get risk of kidney failure, vision loss, pressure sensation loss – also if A1c 9, 8,7,6

'''The Calculator'''
*DIABETES DECISION AID
http://decisionaid.ca/diabetes/

'''BENEFITS AND HARMS'''

Use the [https://guidelines.diabetes.ca/cpg/chapter-13-2020-update 2024 diabetes guidelines] and/or Diabetes Decision Aid to get estimates of benefits and harms and also use the MyStudies synopsis listed below

'''COSTS'''

Try using [https://pricingdoc.acfp.ca Pricing Doc] to get costs

'''Groups 1,13,25'''

* Metformin - UKPDS 34 [https://mystudies.org/studies.php#studies/28929e89-d01e-4b11-8e67-4d7086f9e4aa/outcome MyStudies Data]

'''Groups 2,14,26'''

* Sulfonlyureas - UKPDS 33 [https://mystudies.org/studies.php#studies/5eadb5dd-d403-4c13-b03e-d4f8d28c96ba/outcome MyStudies Data]

'''Groups 3,15,27'''

* Insulin - ORIGIN [https://mystudies.org/studies.php#studies/f611818f-2e69-4952-b55e-661116bd84b6/outcome MyStudies Data]

'''Groups 4,16,28'''

* SGLT2 - EMPA-REG OUTCOME [https://mystudies.org/studies.php#studies/32e9cf1a-f33e-480b-91ca-6f28a4dcf862/outcome MyStudies Data]

'''Groups 5,17,29'''

* GLP - LEADER [https://mystudies.org/studies.php#studies/1adbc9a1-7603-40f1-ac15-b813ce1f0ad6/outcome MyStudies Data]

'''Groups 6,18,30'''

* DPP4 - TECOS [https://mystudies.org/studies.php#studies/8659968a-cefb-4f99-b4ae-8b9b659acbd5/outcome MyStudies Data]

'''Groups 7,19,31'''

* Intensive treatment – small scale - STENO [https://mystudies.org/studies.php#studies/39d423e3-af57-40c8-ab7a-cbc7f389bdb6/paper MyStudies Data]

'''Groups 8,20,32'''

* Intensive treatment – large scale - ADDITION-Europe - [https://mystudies.org/studies.php#studies/5e07d86d-aa92-4db9-a283-76080db4b6fd/outcome MyStudies Data]

'''2) OSTEOPOROSIS CASE'''

60 y/o female

* 72 kg, 1.69m, BMI = 25.2
* t-score of -2.5
* Worried about falling and getting a hip fracture
* A friend recently had an atraumatic fracture from simply tripping and falling over in the snow
* No other risk factors

'''Calculate Risks'''

'''FRACTURE RISK ESTIMATES''' - list the endpoints described by the specific calculator

Major osteoporotic fracture - xx% - 10-year risk – if no BMD (just BMI), and then if they had a BMD t-Score of -2.0, -2.5, and -3.0

Hip fracture - - xx% - 10-year risk – if no BMD (just BMI) and if you have a BMD xx% - 10-year risk – if no BMD, and then if they had a BMD T-Score of -2.0, -2.5, and -3.0

'''The Calculator'''

* FRACTURE CALCULATOR

[https://frax.shef.ac.uk/frax/tool.aspx?country=19 Frax Tool - Canada]

'''BENEFITS AND HARMS'''

Use the [https://www.cmaj.ca/content/195/39/E1333 2023 Osteoporosis Guideline] and/or your osteoporosis lecture notes to get the benefits and apply these to your patient, and also get the harms

'''COSTS'''

Try using [https://pricingdoc.acfp.ca Pricing Doc] to get costs

'''Groups 9,21,33'''

* Activity

'''Groups 10,22,34'''

* Calcium/Vitamin D

'''Groups 11,23,35'''

* Bisphosphonates

'''Groups 12,24,36'''

* Denosumab

11) NEUROLOGY STUDIES

*[http://www.ncbi.nlm.nih.gov/pubmed/16717269 Opioids for chronic non-cancer pain] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/29509867 Effect of Opioid vs Nonopioid Medications on Pain-Related Function in Patients With Chronic Back Pain] Groups 2,14,26
*[https://www.ncbi.nlm.nih.gov/pubmed/31291515 Galcanezumab for prevention of cluster headaches] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/27150433 Immediate or delayed treatment of a first seizure] Groups 4,16,28
*[https://www.ncbi.nlm.nih.gov/pubmed/31291516 Rimegepant for episodic migraine] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/26212846 Sleep restriction for insomnia] Groups 6,18,30
*[https://www.ncbi.nlm.nih.gov/pubmed/25957224 CHANCE] Groups 7,19,31
*[https://www.ncbi.nlm.nih.gov/pubmed/16899775 SPARCL] Groups 8,20,32
*[https://www.ncbi.nlm.nih.gov/pubmed/29171821 Erenumab for episodic migraine] Groups 9,21,33
*[https://www.ncbi.nlm.nih.gov/pubmed/24733354 Reduction of benzodiazepines through education] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/26035341 Patient controlled opioid analgesia versus non-patient controlled opioid analgesia for postoperative pain] Groups 11,23,35
*[https://www.ncbi.nlm.nih.gov/pubmed/11589932 PROGRESS] Groups 12,24,36

'''ACADEMIC YEAR 3'''

12) PSYCHIATRY STUDIES

[[:File:2021 Psych Evidence Appraisal - Intro Slides.pdf|Psychiatry Rating Scales Introduction]]

* Study 1: [http://www.ncbi.nlm.nih.gov/pubmed/16554525 STAR*D (Level 2)] Bupropion-SR, sertraline, or venlafaxine-XR after failure of SSRIs for depression
* Study 2: [http://www.ncbi.nlm.nih.gov/pubmed/29477251 Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder]
* Study 3: [https://pubmed.ncbi.nlm.nih.gov/33862018/ Long-acting injectable versus oral antipsychotics for the maintenance treatment of schizophrenia]
* Study 4: [https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2725088 Association of Antipsychotic Polypharmacy vs Monotherapy With Psychiatric Rehospitalization Among Adults With Schizophrenia]
* Study 5: [https://www.ncbi.nlm.nih.gov/pubmed/29490359 Real-world Effectiveness of Pharmacologic Treatments for the Prevention of Bipolar Disorder]
* Study 6: [http://www.ncbi.nlm.nih.gov/pubmed/20092882 BALANCE] Combination lithium and valproate therapy versus monotherapy for relapse prevention in bipolar I disorder
[[File:ChatGPT directions.jpg|thumb|ChatGPT Directions]]
13) GASTROENTEROLOGY STUDIES - LINKS ON CANVAS

*Short-term treatment for gastro-oesophageal reflux disease-like symptoms and endoscopy negative reflux disease (Review)
*Oral budesonide for induction of remission in ulcerative colitis (Review)
*Probiotics for the prevention of Clostridium difficile-associated diarrhea in adults and children (Review)
*Deprescribing versus continuation of chronic proton pump inhibitor use in adults (Review)
*Prevention of NSAID-induced gastroduodenal ulcers (Review)
*Methotrexate for maintenance of remission in Crohn's disease (Review)

14) OB/GYN STUDIES
*[http://www.ncbi.nlm.nih.gov/pubmed/25601350 Comparative contraceptive effectiveness of levonorgestrel-releasing and copper IUD Devices]
*[http://www.ncbi.nlm.nih.gov/pubmed/29211679 Hormonal contraception and the risk of breast cancer]
*[http://www.ncbi.nlm.nih.gov/pubmed/30322986 Sexual behaviours in adolescent girls before and after introduction of the HPV]
*[http://www.ncbi.nlm.nih.gov/pubmed/30181338 Intramuscular vs intravenous oxytocin to prevent postpartum haemorrhage at vaginal delivery]
*[http://www.ncbi.nlm.nih.gov/pubmed/27682034 Azithromycin Prophylaxis for Cesarean Delivery]
*[http://www.ncbi.nlm.nih.gov/pubmed/28461374 Antibiotics during pregnancy and risk of spontaneous abortion]

File:IA ENDO LAYOUT.pdf

2025-02-04T19:11:18Z

JamesMcCormack: Uploaded own work with UploadWizard

=={{int:filedesc}}==
{{Information
|description={{en|1=IA ENDO LAYOUT}}
|date=2025-02-04
|source={{own}}
|author=[[User:JamesMcCormack|JamesMcCormack]]
|permission=
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=={{int:license-header}}==
{{self|cc-by-sa-4.0}}

Evidence Appraisal Integrated Activities

2025-01-14T16:11:19Z

JamesMcCormack:

'''OBJECTIVE'''

To critically appraise studies, develop a brief synopsis of the trial results, succinctly present the results and then put the results into a proper clinical context

'''INITIAL PRE-READING'''

'''How To Critically Appraise an RCT In 10 minutes'''
*[https://itunes.apple.com/ca/book/how-to-critically-appraise/id524600667?mt=11 iBook/iPad version]
*[https://therapeuticseducation.org/sites/therapeuticseducation.org/files/Ten_Minute_Critical_Appraisal.pdf PDF version]
Watch this video
[http://youtu.be/QUW0Q8tXVUc Viva La Evidence]

'''Study Results at Your Fingertips'''
*[https://mystudies.org MyStudies] - Free access

'''INTEGRATION ACTIVITY FORMAT'''
# Students placed in groups of ~ 5-7
# Each group is given one of the studies below to review
# Students then work in pairs and develop a one-slide critical appraisal and results synopsis
# One student in each group will be chosen at random to present their group findings to the class
# A discussion about the appraisal and the appropriate clinical context for the results is had with the entire class for each study

'''MODULE'''
[[File:Screen Shot 2022-01-09 at 10.00.16 AM.jpg|thumb|'''TRIAL PRESENTATION FORMAT'''|none]]

Studies chosen include landmark studies and/or studies that address important therapeutic issues for the particular module

'''ACADEMIC YEAR 1 - FIRST TERM'''

1) FOUNDATION STUDIES (Groups)
*[https://pubmed.ncbi.nlm.nih.gov/37952131 SELECT] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/12466506 AFFIRM] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/22085343 AIM-HIGH] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/10639539 HOPE] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/18378519 HYVET] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/15007110 PROVE-IT] Groups 6,18,30
*[http://www.ncbi.nlm.nih.gov/pubmed/15755765 TNT] Groups 7,19,31
*[https://pubmed.ncbi.nlm.nih.gov/26378978 EMPAREG] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/17984165 ILLUMINATE] Groups 9,21,33
*[https://pubmed.ncbi.nlm.nih.gov/26551272/ SPRINT] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/15325833 CARDS] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/12117397 WHI] Groups 12,24,36

'''ACADEMIC YEAR 1 - SECOND TERM'''

2) INTRO TO INFECTIOUS DISEASE STUDIES

[https://wiki.ubc.ca/images/8/8b/Antibiotic_Sensitivity_Chart_2024.pdf The "Best" Antibiotic Sensitivity Chart Ever]
*[http://www.ncbi.nlm.nih.gov/pubmed/17567657 IV vs PO antibiotics] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/24603565 Delayed antibiotics for respiratory tract infections] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/11159657 Delayed antibiotics for otitis media] Groups 3,15,27
*[https://pubmed.ncbi.nlm.nih.gov/27455166/ Duration of treatment for community acquired pneumonia] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/22726802 Duration of treatment for pyelonephritis] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/25830421 Choice of antibiotic for community acquired pneumonia-1] Groups 6,18,30
*[http://www.ncbi.nlm.nih.gov/pubmed/25286173 Choice of antibiotic for community acquired pneumonia-2] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/20647284 HPV vaccine study] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/7966893 Influenza vaccine study] Groups 9,21,33
*[https://pubmed.ncbi.nlm.nih.gov/33301246/ COVID vaccine Pfizer] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/27626517 Herpes zoster vaccine study 1] Groups 11,23,35
*[https://www.ncbi.nlm.nih.gov/pubmed/25916341 Herpes zoster vaccine study 2] Groups 12,24,36

3) MUSCULOSKELETAL STUDIES

*[http://www.ncbi.nlm.nih.gov/pubmed/28199814 Baricitinib versus Placebo or Adalimumab in Rheumatoid Arthritis] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/0010979111 CLASS – celecoxib vs NSAIDs] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/26501533 Naproxen with cyclobenzaprine, oxycodone/acetaminophen, or placebo for low back pain] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/24395557 Glucosamine and chondroitin for OA] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/12546607 Acetaminophen vs diclofenac for OA] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/23964752 Diclofenac gel for acute neck pain] Groups 6,18,30
*[https://pubmed.ncbi.nlm.nih.gov/15468367/ Topical diclofenac vs oral diclofenac] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/25064594 Acetaminophen for low back pain] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/7611589 Misoprostol and NSAID induced ulcers] Groups 9,21,33
*[http://www.ncbi.nlm.nih.gov/pubmed/20131255 Low dose vs high dose colchicine for gout] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/22508468 TEAR - oral triple therapy versus etanercept plus methotrexate in early aggressive rheumatoid arthritis] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/25589511 MOVES - Glucosamine and chondroitin for OA for moderate to severe pain] Groups 12,24,36

4) DERMATOLOGY STUDIES

*[https://www.ncbi.nlm.nih.gov/pubmed/9598014 Glycolic acid 5% Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/21896132 Glycolic acid 10% Acne]
*[https://www.ncbi.nlm.nih.gov/pubmed/14531866 Petrolatum vs Ceramide/skin related lipids Hand Dermatitis]
*[https://www.ncbi.nlm.nih.gov/pubmed/11896774 Vitamin C Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/17515510 Retinol (VitaminA) Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/21896129 Hyaluronic acid Atopic Dermatitis]

5) EENT STUDIES

[http://www.amstar.ca/docs/AMSTARguideline.pdf AMSTAR meta-analysis checklist]

'''Scenario 1 - Otitis Media''' - GROUPS 1, 7, 18, 19, 25, 36

Anthony Martin arrives at your pharmacy somewhat frustrated since his family physician declined to write an antibiotic prescription for his two and half year old son, Oscar. His symptoms started yesterday afternoon - Oscar complains of right ear pain but there is no discharge. Rectal temperature taken today was 38.5 degrees. His wife is sure Oscar has an ear infection since the last time he had these same symptoms, that was ultimately the diagnosis. Mr. Martin asks if you think buying acetaminophen is really “enough”?

[https://pubmed.ncbi.nlm.nih.gov/26099233/ Antibiotics for acute otitis media in children]

'''Scenario 2 - Allergic Rhinitis''' - GROUPS 2, 8, 17, 20, 26, 35

Ruby Parmar is a firefighter. She is plagued by sinus congestion (preventing her from sleeping) and a runny nose associated with seasonal allergies. Her prescription for intranasal triamcinolone is typically effective, but she would like to know if a non-sedating anti-allergy pill would work just as well since it’s inconvenient carrying around the “nose spray”.

[https://www.ncbi.nlm.nih.gov/pubmed/28234147 Intranasal steroids vs antihistamines for allergic rhinitis]

'''Scenario 3 - Acute Sinusitis''' - GROUPS 3, 9, 16, 21, 27, 34

You are seeing a patient in clinic before her appointment with the primary care physician. She was feeling unwell with a “flu” last week. While most of her symptoms have resolved (cough, fever), the nasal congestion and discharge persists and so she has made an appointment (she is an otherwise healthy 32 year old with treated thyroid disease). She would like your advice for what treatment she should ask the doctor to prescribe.

[http://www.ncbi.nlm.nih.gov/pubmed/24293353 Intranasal steroids for acute sinusitis]

'''Scenario 4 - Glaucoma''' - GROUPS 4, 10, 15, 22, 28, 33

Mrs. Ada Waters is a 63 year-old woman you. Her ophthalmologist prescribed timolol and xalatan eye drops for treatment of open angle glaucoma. She has never really felt much different on treatment since she recovered from her first episode (of acute angle closure glaucoma requiring ER visit) and surgery. She asks you if the treatment is really making a difference.

[https://www.ncbi.nlm.nih.gov/pubmed/17943780 Interventions for open angle glaucoma]

'''Scenario 5 - Sore Throat''' - GROUPS 5, 11, 14, 23, 29, 32

You have a good friend who is applying for pharmacy. Her invitation for the multiple-mini interview (MMI) is coming up soon, but she is starting to experience a sore throat. While she is worried about not being able to speak through all of those stations, she knows she often gets a terrible headache along with her sore throat. She has an unused prescription for amoxicillin (unexpired) and wonders if you recommend for her to take it.

[https://pubmed.ncbi.nlm.nih.gov/34881426/ Antibiotics for sore throat]

'''Scenario 6 - Conjunctivitis''' - GROUPS 6, 12, 13, 24, 30, 31

A man comes to your pharmacy (he appears in his early twenties) complaining of “pink eye”. He has had a pink discolouration and discharge from his left eye for two days. He asks if the OTC antibiotic eye drops (he’s holding a product with polymixin B) are any better than “waiting it out”.

[https://www.ncbi.nlm.nih.gov/pubmed/22972049 Antibiotics for acute conjunctivitis]

6) HEMATOLOGY STUDIES

None so far

'''ACADEMIC YEAR 2 - FIRST TERM'''

7) RESPIROLOGY STUDIES
[[File:IA COPD info.pdf|thumb]]

*[http://www.ncbi.nlm.nih.gov/pubmed/2062329 First inhaled steroid study] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/22938706 Tiotropium in asthma] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/21324520 Inhaled steroid in children] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/29768149 Combined Budesonide–Formoterol as Needed in Mild Asthma] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/15223858 Doubling dose of inhaled corticosteroid] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/29768147 As-Needed Budesonide–Formoterol versus Maintenance Budesonide in Mild Asthma] Groups 6,18,30
*[http://www.ncbi.nlm.nih.gov/pubmed/27181606 Indacaterol-glycopyrronium VS salmeterol/fluticasone in COPD] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/21428765 Tiotropium VS salmeterol in COPD] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/23695200 Short VS long steroids for COPD exacerbation] Groups 9,21,33
*[http://www.ncbi.nlm.nih.gov/pubmed/25196117 Stopping inhaled steroids in COPD] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/29668352 Once-Daily Single-Inhaler Triple versus Dual Therapy in Patients with COPD] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/28877011 Tezepelumab in Adults with Uncontrolled Asthma] Groups 12,24,36

8) CARDIOVASCULAR STUDIES

SESSION 1

*[https://www.ncbi.nlm.nih.gov/pubmed/4862069 VA1] (Group 1, 13, 25)
*[https://www.ncbi.nlm.nih.gov/pubmed/4914579 VA 2] (Group 2, 14, 26)
*[https://pubmed.ncbi.nlm.nih.gov/33186492 Polycap Study 3] (Group 3, 15, 27)
*[http://www.ncbi.nlm.nih.gov/pubmed/20228401 ACCORD-BP] (Group 4, 16, 28)
*[https://www.ncbi.nlm.nih.gov/pubmed/26551272 SPRINT] (Group 5, 17, 29)
*[http://www.ncbi.nlm.nih.gov/pubmed/2883575 CONSENSUS] (Group 6,18,30)
*[https://pubmed.ncbi.nlm.nih.gov/31535829/ DAPA-HF] (Group 7, 19, 31)
*[https://pubmed.ncbi.nlm.nih.gov/25176939/ CONFIRM-HF] (Group 8, 20, 32)
*[http://www.ncbi.nlm.nih.gov/pubmed/12457784 PROSPER] (Group 9, 21, 33)
*[http://www.ncbi.nlm.nih.gov/pubmed/27040132 HOPE-3] (Group 10, 22, 34)
*[http://www.ncbi.nlm.nih.gov/pubmed/12114036 Heart Protection Study (HPS)] (Group 11, 23, 35)
*[http://www.ncbi.nlm.nih.gov/pubmed/30415628 REDUCE-IT] (Group 12, 24, 36)

[[File:CV Case.pdf|thumb|CV case|left]]

SESSION 2

'''The Guideline Case'''

A 63 y/o patient with CHOOSE ONE (⬆︎HTN/⬆︎Chol/⬆︎glucose/HF/A fib) and using the guideline determine:
# their 5yr/10yr risks of mortality/CVD events
# the potential benefit
# the potential side effects (with magnitude)
# words/sentiment patient values and preferences/SDM

Atrial fibrillation - Groups 1,13,25,2,14,26
*[https://www.onlinecjc.ca/article/S0828-282X(18)31062-6/pdf 2018 Atrial fibrillation guidelines]
Diabetes - Groups 3,15,27,4,16,28
*[http://guidelines.diabetes.ca/docs/CPG-2018-full-EN.pdf 2018 Diabetes guidelines]
Lipid Simplified - Groups 5,17,29,6,18,30
*[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4607330/pdf/0610857.pdf 2015 Simplified lipid guidelines]
Lipid - Groups 7,19,31,8,20,32
*[http://www.onlinecjc.ca/article/S0828-282X(16)30732-2/pdf 2016 Lipid guidelines]
Heart failure - Groups 9,21,33,10,22,34
*[http://www.onlinecjc.ca/article/S0828-282X(17)30973-X/pdf 2017 Heart failure guidelines]
Hypertension - Groups 11,23,35,12,24,36
*[https://www.onlinecjc.ca/article/S0828-282X(18)30183-1/pdf 2018 Hypertension guidelines]

OPTIONAL SESSION
*[http://www.ncbi.nlm.nih.gov/pubmed/16899775 SPARCL]
*[http://www.ncbi.nlm.nih.gov/pubmed/10471456 RALES]
*[http://www.ncbi.nlm.nih.gov/pubmed/11386263 Carvedilol in heart failure]
*[http://www.ncbi.nlm.nih.gov/pubmed/18460663 WAFACS]
*[http://www.ncbi.nlm.nih.gov/pubmed/10376614 MERIT-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/25176015 PARADIGM-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/24490264 High-dose multivitamins after MI]
*[http://www.ncbi.nlm.nih.gov/pubmed/7911176 Mediterranean Diet after MI]
*[http://www.ncbi.nlm.nih.gov/pubmed/15337732 A TO Z]
*[http://www.ncbi.nlm.nih.gov/pubmed/21073363 EMPHASIS-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/12853193 COMET]
*[http://www.ncbi.nlm.nih.gov/pubmed/24716680 TOPCAT]
*[http://www.ncbi.nlm.nih.gov/pubmed/26039521 IMPROVE-IT]

'''ACADEMIC YEAR 2 - SECOND TERM'''

9) NEPHROLOGY STUDIES

None so far

10) ENDOCRINOLOGY[[File:IA ENDO LAYOUT 1.pdf|left|thumb|IA ENDO LAYOUT]]

'''RISK ASSESSMENT CASES FOR DIABETES AND OSTEOPOROSIS'''

'''1) DIABETES CASE'''

66 y/o white male who was diagnosed with diabetes 8 years ago

* His blood pressure over the last year has been roughly 145/80 mmHg - at present untreated
* A1c = 8%, no diabetes meds, non-smoker, BMI ~30
* Total cholesterol is 6 mmol/L, his HDL is 2 mmol/L, non-HDL = 6 minus 2, not on a statin
* No retinopathy, urine albumin-to-creatinine ratio (UACR) = 15ug/mg (7mg/mmol),
* Serum creatinine = 70 micromol/L, waist circumference 100 cm
* GFR 75 mL/min/1.73m2
* In normal sinus rhythm
* Age at end of highest education = 19
* Mother alive, father died of a heart attack at age 80

'''Calculate Risks'''

'''CVD RISK ESTIMATES''' - list the endpoints described by the specific calculator

Framingham - xx% - 10-year risk - also if no diabetes xx%

ASCVD - xx% - 10-year risk - also if no diabetes xx%

'''The Calculator'''
*CVD CALCULATOR
https://decisionaid.ca/cvd/

'''DIABETES COMPLICATIONS RISK ESTIMATES''' - list the endpoints described by the specific calculator

xx% - also 10-year risk if A1c 9, 8, 7 and 6

also get risk of kidney failure, vision loss, pressure sensation loss – also if A1c 9, 8,7,6

'''The Calculator'''
*DIABETES DECISION AID
http://decisionaid.ca/diabetes/

'''BENEFITS AND HARMS'''

Use the [https://guidelines.diabetes.ca/cpg/chapter-13-2020-update 2024 diabetes guidelines] and/or Diabetes Decision Aid to get estimates of benefits and harms and also use the MyStudies synopsis listed below

'''COSTS'''

Try using [https://pricingdoc.acfp.ca Pricing Doc] to get costs

'''Groups 1,13,25'''

* Metformin - UKPDS 34 [https://mystudies.org/studies.php#studies/28929e89-d01e-4b11-8e67-4d7086f9e4aa/outcome MyStudies Data]

'''Groups 2,14,26'''

* Sulfonlyureas - UKPDS 33 [https://mystudies.org/studies.php#studies/5eadb5dd-d403-4c13-b03e-d4f8d28c96ba/outcome MyStudies Data]

'''Groups 3,15,27'''

* Insulin - ORIGIN [https://mystudies.org/studies.php#studies/f611818f-2e69-4952-b55e-661116bd84b6/outcome MyStudies Data]

'''Groups 4,16,28'''

* SGLT2 - EMPA-REG OUTCOME [https://mystudies.org/studies.php#studies/32e9cf1a-f33e-480b-91ca-6f28a4dcf862/outcome MyStudies Data]

'''Groups 5,17,29'''

* GLP - LEADER [https://mystudies.org/studies.php#studies/1adbc9a1-7603-40f1-ac15-b813ce1f0ad6/outcome MyStudies Data]

'''Groups 6,18,30'''

* DPP4 - TECOS [https://mystudies.org/studies.php#studies/8659968a-cefb-4f99-b4ae-8b9b659acbd5/outcome MyStudies Data]

'''Groups 7,19,31'''

* Intensive treatment – small scale - STENO [https://mystudies.org/studies.php#studies/39d423e3-af57-40c8-ab7a-cbc7f389bdb6/paper MyStudies Data]

'''Groups 8,20,32'''

* Intensive treatment – large scale - ADDITION-Europe - [https://mystudies.org/studies.php#studies/5e07d86d-aa92-4db9-a283-76080db4b6fd/outcome MyStudies Data]

'''2) OSTEOPOROSIS CASE'''

60 y/o female

* 72 kg, 1.69m, BMI = 25.2
* t-score of -2.5
* Worried about falling and getting a hip fracture
* A friend recently had an atraumatic fracture from simply tripping and falling over in the snow
* No other risk factors

'''Calculate Risks'''

'''FRACTURE RISK ESTIMATES''' - list the endpoints described by the specific calculator

Major osteoporotic fracture - xx% - 10-year risk – if no BMD (just BMI), and then if they had a BMD t-Score of -2.0, -2.5, and -3.0

Hip fracture - - xx% - 10-year risk – if no BMD (just BMI) and if you have a BMD xx% - 10-year risk – if no BMD, and then if they had a BMD T-Score of -2.0, -2.5, and -3.0

'''The Calculator'''

* FRACTURE CALCULATOR

[https://frax.shef.ac.uk/frax/tool.aspx?country=19 Frax Tool - Canada]

'''BENEFITS AND HARMS'''

Use the [https://www.cmaj.ca/content/195/39/E1333 2023 Osteoporosis Guideline] and/or your osteoporosis lecture notes to get the benefits and apply these to your patient, and also get the harms

'''COSTS'''

Try using [https://pricingdoc.acfp.ca Pricing Doc] to get costs

'''Groups 9,21,33'''

* Activity

'''Groups 10,22,34'''

* Calcium/Vitamin D

'''Groups 11,23,35'''

* Bisphosphonates

'''Groups 12,24,36'''

* Denosumab

11) NEUROLOGY STUDIES

*[http://www.ncbi.nlm.nih.gov/pubmed/16717269 Opioids for chronic non-cancer pain] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/29509867 Effect of Opioid vs Nonopioid Medications on Pain-Related Function in Patients With Chronic Back Pain] Groups 2,14,26
*[https://www.ncbi.nlm.nih.gov/pubmed/31291515 Galcanezumab for prevention of cluster headaches] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/27150433 Immediate or delayed treatment of a first seizure] Groups 4,16,28
*[https://www.ncbi.nlm.nih.gov/pubmed/31291516 Rimegepant for episodic migraine] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/26212846 Sleep restriction for insomnia] Groups 6,18,30
*[https://www.ncbi.nlm.nih.gov/pubmed/25957224 CHANCE] Groups 7,19,31
*[https://www.ncbi.nlm.nih.gov/pubmed/16899775 SPARCL] Groups 8,20,32
*[https://www.ncbi.nlm.nih.gov/pubmed/29171821 Erenumab for episodic migraine] Groups 9,21,33
*[https://www.ncbi.nlm.nih.gov/pubmed/24733354 Reduction of benzodiazepines through education] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/26035341 Patient controlled opioid analgesia versus non-patient controlled opioid analgesia for postoperative pain] Groups 11,23,35
*[https://www.ncbi.nlm.nih.gov/pubmed/11589932 PROGRESS] Groups 12,24,36

'''ACADEMIC YEAR 3'''

12) PSYCHIATRY STUDIES

[[:File:2021 Psych Evidence Appraisal - Intro Slides.pdf|Psychiatry Rating Scales Introduction]]

* Study 1: [http://www.ncbi.nlm.nih.gov/pubmed/16554525 STAR*D (Level 2)] Bupropion-SR, sertraline, or venlafaxine-XR after failure of SSRIs for depression
* Study 2: [http://www.ncbi.nlm.nih.gov/pubmed/29477251 Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder]
* Study 3: [https://pubmed.ncbi.nlm.nih.gov/33862018/ Long-acting injectable versus oral antipsychotics for the maintenance treatment of schizophrenia]
* Study 4: [https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2725088 Association of Antipsychotic Polypharmacy vs Monotherapy With Psychiatric Rehospitalization Among Adults With Schizophrenia]
* Study 5: [https://www.ncbi.nlm.nih.gov/pubmed/29490359 Real-world Effectiveness of Pharmacologic Treatments for the Prevention of Bipolar Disorder]
* Study 6: [http://www.ncbi.nlm.nih.gov/pubmed/20092882 BALANCE] Combination lithium and valproate therapy versus monotherapy for relapse prevention in bipolar I disorder
[[File:ChatGPT directions.jpg|thumb|ChatGPT Directions]]
13) GASTROENTEROLOGY STUDIES - LINKS ON CANVAS

*Short-term treatment for gastro-oesophageal reflux disease-like symptoms and endoscopy negative reflux disease (Review)
*Oral budesonide for induction of remission in ulcerative colitis (Review)
*Probiotics for the prevention of Clostridium difficile-associated diarrhea in adults and children (Review)
*Deprescribing versus continuation of chronic proton pump inhibitor use in adults (Review)
*Prevention of NSAID-induced gastroduodenal ulcers (Review)
*Methotrexate for maintenance of remission in Crohn's disease (Review)

14) OB/GYN STUDIES
*[http://www.ncbi.nlm.nih.gov/pubmed/25601350 Comparative contraceptive effectiveness of levonorgestrel-releasing and copper IUD Devices]
*[http://www.ncbi.nlm.nih.gov/pubmed/29211679 Hormonal contraception and the risk of breast cancer]
*[http://www.ncbi.nlm.nih.gov/pubmed/30322986 Sexual behaviours in adolescent girls before and after introduction of the HPV]
*[http://www.ncbi.nlm.nih.gov/pubmed/30181338 Intramuscular vs intravenous oxytocin to prevent postpartum haemorrhage at vaginal delivery]
*[http://www.ncbi.nlm.nih.gov/pubmed/27682034 Azithromycin Prophylaxis for Cesarean Delivery]
*[http://www.ncbi.nlm.nih.gov/pubmed/28461374 Antibiotics during pregnancy and risk of spontaneous abortion]

Evidence Appraisal Integrated Activities

2024-12-30T06:46:57Z

JamesMcCormack:

'''OBJECTIVE'''

To critically appraise studies, develop a brief synopsis of the trial results, succinctly present the results and then put the results into a proper clinical context

'''INITIAL PRE-READING'''

'''How To Critically Appraise an RCT In 10 minutes'''
*[https://itunes.apple.com/ca/book/how-to-critically-appraise/id524600667?mt=11 iBook/iPad version]
*[https://therapeuticseducation.org/sites/therapeuticseducation.org/files/Ten_Minute_Critical_Appraisal.pdf PDF version]
Watch this video
[http://youtu.be/QUW0Q8tXVUc Viva La Evidence]

'''Study Results at Your Fingertips'''
*[https://mystudies.org MyStudies] - Free access

'''INTEGRATION ACTIVITY FORMAT'''
# Students placed in groups of ~ 5-7
# Each group is given one of the studies below to review
# Students then work in pairs and develop a one-slide critical appraisal and results synopsis
# One student in each group will be chosen at random to present their group findings to the class
# A discussion about the appraisal and the appropriate clinical context for the results is had with the entire class for each study

'''MODULE'''
[[File:Screen Shot 2022-01-09 at 10.00.16 AM.jpg|thumb|'''TRIAL PRESENTATION FORMAT'''|none]]

Studies chosen include landmark studies and/or studies that address important therapeutic issues for the particular module

'''ACADEMIC YEAR 1 - FIRST TERM'''

1) FOUNDATION STUDIES (Groups)
*[https://pubmed.ncbi.nlm.nih.gov/37952131 SELECT] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/12466506 AFFIRM] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/22085343 AIM-HIGH] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/10639539 HOPE] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/18378519 HYVET] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/15007110 PROVE-IT] Groups 6,18,30
*[http://www.ncbi.nlm.nih.gov/pubmed/15755765 TNT] Groups 7,19,31
*[https://pubmed.ncbi.nlm.nih.gov/26378978 EMPAREG] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/17984165 ILLUMINATE] Groups 9,21,33
*[https://pubmed.ncbi.nlm.nih.gov/26551272/ SPRINT] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/15325833 CARDS] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/12117397 WHI] Groups 12,24,36

'''ACADEMIC YEAR 1 - SECOND TERM'''

2) INTRO TO INFECTIOUS DISEASE STUDIES

[https://wiki.ubc.ca/images/8/8b/Antibiotic_Sensitivity_Chart_2024.pdf The "Best" Antibiotic Sensitivity Chart Ever]
*[http://www.ncbi.nlm.nih.gov/pubmed/17567657 IV vs PO antibiotics] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/24603565 Delayed antibiotics for respiratory tract infections] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/11159657 Delayed antibiotics for otitis media] Groups 3,15,27
*[https://pubmed.ncbi.nlm.nih.gov/27455166/ Duration of treatment for community acquired pneumonia] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/22726802 Duration of treatment for pyelonephritis] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/25830421 Choice of antibiotic for community acquired pneumonia-1] Groups 6,18,30
*[http://www.ncbi.nlm.nih.gov/pubmed/25286173 Choice of antibiotic for community acquired pneumonia-2] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/20647284 HPV vaccine study] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/7966893 Influenza vaccine study] Groups 9,21,33
*[https://pubmed.ncbi.nlm.nih.gov/33301246/ COVID vaccine Pfizer] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/27626517 Herpes zoster vaccine study 1] Groups 11,23,35
*[https://www.ncbi.nlm.nih.gov/pubmed/25916341 Herpes zoster vaccine study 3] Groups 12,24,36

3) MUSCULOSKELETAL STUDIES

*[http://www.ncbi.nlm.nih.gov/pubmed/28199814 Baricitinib versus Placebo or Adalimumab in Rheumatoid Arthritis] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/0010979111 CLASS – celecoxib vs NSAIDs] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/26501533 Naproxen with cyclobenzaprine, oxycodone/acetaminophen, or placebo for low back pain] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/24395557 Glucosamine and chondroitin for OA] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/12546607 Acetaminophen vs diclofenac for OA] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/23964752 Diclofenac gel for acute neck pain] Groups 6,18,30
*[https://pubmed.ncbi.nlm.nih.gov/15468367/ Topical diclofenac vs oral diclofenac] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/25064594 Acetaminophen for low back pain] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/7611589 Misoprostol and NSAID induced ulcers] Groups 9,21,33
*[http://www.ncbi.nlm.nih.gov/pubmed/20131255 Low dose vs high dose colchicine for gout] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/22508468 TEAR - oral triple therapy versus etanercept plus methotrexate in early aggressive rheumatoid arthritis] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/25589511 MOVES - Glucosamine and chondroitin for OA for moderate to severe pain] Groups 12,24,36

4) DERMATOLOGY STUDIES

*[https://www.ncbi.nlm.nih.gov/pubmed/9598014 Glycolic acid 5% Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/21896132 Glycolic acid 10% Acne]
*[https://www.ncbi.nlm.nih.gov/pubmed/14531866 Petrolatum vs Ceramide/skin related lipids Hand Dermatitis]
*[https://www.ncbi.nlm.nih.gov/pubmed/11896774 Vitamin C Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/17515510 Retinol (VitaminA) Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/21896129 Hyaluronic acid Atopic Dermatitis]

5) EENT STUDIES

[http://www.amstar.ca/docs/AMSTARguideline.pdf AMSTAR meta-analysis checklist]

'''Scenario 1 - Otitis Media''' - GROUPS 1, 7, 18, 19, 25, 36

Anthony Martin arrives at your pharmacy somewhat frustrated since his family physician declined to write an antibiotic prescription for his two and half year old son, Oscar. His symptoms started yesterday afternoon - Oscar complains of right ear pain but there is no discharge. Rectal temperature taken today was 38.5 degrees. His wife is sure Oscar has an ear infection since the last time he had these same symptoms, that was ultimately the diagnosis. Mr. Martin asks if you think buying acetaminophen is really “enough”?

[https://pubmed.ncbi.nlm.nih.gov/26099233/ Antibiotics for acute otitis media in children]

'''Scenario 2 - Allergic Rhinitis''' - GROUPS 2, 8, 17, 20, 26, 35

Ruby Parmar is a firefighter. She is plagued by sinus congestion (preventing her from sleeping) and a runny nose associated with seasonal allergies. Her prescription for intranasal triamcinolone is typically effective, but she would like to know if a non-sedating anti-allergy pill would work just as well since it’s inconvenient carrying around the “nose spray”.

[https://www.ncbi.nlm.nih.gov/pubmed/28234147 Intranasal steroids vs antihistamines for allergic rhinitis]

'''Scenario 3 - Acute Sinusitis''' - GROUPS 3, 9, 16, 21, 27, 34

You are seeing a patient in clinic before her appointment with the primary care physician. She was feeling unwell with a “flu” last week. While most of her symptoms have resolved (cough, fever), the nasal congestion and discharge persists and so she has made an appointment (she is an otherwise healthy 32 year old with treated thyroid disease). She would like your advice for what treatment she should ask the doctor to prescribe.

[http://www.ncbi.nlm.nih.gov/pubmed/24293353 Intranasal steroids for acute sinusitis]

'''Scenario 4 - Glaucoma''' - GROUPS 4, 10, 15, 22, 28, 33

Mrs. Ada Waters is a 63 year-old woman you. Her ophthalmologist prescribed timolol and xalatan eye drops for treatment of open angle glaucoma. She has never really felt much different on treatment since she recovered from her first episode (of acute angle closure glaucoma requiring ER visit) and surgery. She asks you if the treatment is really making a difference.

[https://www.ncbi.nlm.nih.gov/pubmed/17943780 Interventions for open angle glaucoma]

'''Scenario 5 - Sore Throat''' - GROUPS 5, 11, 14, 23, 29, 32

You have a good friend who is applying for pharmacy. Her invitation for the multiple-mini interview (MMI) is coming up soon, but she is starting to experience a sore throat. While she is worried about not being able to speak through all of those stations, she knows she often gets a terrible headache along with her sore throat. She has an unused prescription for amoxicillin (unexpired) and wonders if you recommend for her to take it.

[https://pubmed.ncbi.nlm.nih.gov/34881426/ Antibiotics for sore throat]

'''Scenario 6 - Conjunctivitis''' - GROUPS 6, 12, 13, 24, 30, 31

A man comes to your pharmacy (he appears in his early twenties) complaining of “pink eye”. He has had a pink discolouration and discharge from his left eye for two days. He asks if the OTC antibiotic eye drops (he’s holding a product with polymixin B) are any better than “waiting it out”.

[https://www.ncbi.nlm.nih.gov/pubmed/22972049 Antibiotics for acute conjunctivitis]

6) HEMATOLOGY STUDIES

None so far

'''ACADEMIC YEAR 2 - FIRST TERM'''

7) RESPIROLOGY STUDIES
[[File:IA COPD info.pdf|thumb]]

*[http://www.ncbi.nlm.nih.gov/pubmed/2062329 First inhaled steroid study] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/22938706 Tiotropium in asthma] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/21324520 Inhaled steroid in children] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/29768149 Combined Budesonide–Formoterol as Needed in Mild Asthma] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/15223858 Doubling dose of inhaled corticosteroid] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/29768147 As-Needed Budesonide–Formoterol versus Maintenance Budesonide in Mild Asthma] Groups 6,18,30
*[http://www.ncbi.nlm.nih.gov/pubmed/27181606 Indacaterol-glycopyrronium VS salmeterol/fluticasone in COPD] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/21428765 Tiotropium VS salmeterol in COPD] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/23695200 Short VS long steroids for COPD exacerbation] Groups 9,21,33
*[http://www.ncbi.nlm.nih.gov/pubmed/25196117 Stopping inhaled steroids in COPD] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/29668352 Once-Daily Single-Inhaler Triple versus Dual Therapy in Patients with COPD] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/28877011 Tezepelumab in Adults with Uncontrolled Asthma] Groups 12,24,36

8) CARDIOVASCULAR STUDIES

SESSION 1

*[https://www.ncbi.nlm.nih.gov/pubmed/4862069 VA1] (Group 1, 13, 25)
*[https://www.ncbi.nlm.nih.gov/pubmed/4914579 VA 2] (Group 2, 14, 26)
*[https://pubmed.ncbi.nlm.nih.gov/33186492 Polycap Study 3] (Group 3, 15, 27)
*[http://www.ncbi.nlm.nih.gov/pubmed/20228401 ACCORD-BP] (Group 4, 16, 28)
*[https://www.ncbi.nlm.nih.gov/pubmed/26551272 SPRINT] (Group 5, 17, 29)
*[http://www.ncbi.nlm.nih.gov/pubmed/2883575 CONSENSUS] (Group 6,18,30)
*[https://pubmed.ncbi.nlm.nih.gov/31535829/ DAPA-HF] (Group 7, 19, 31)
*[https://pubmed.ncbi.nlm.nih.gov/25176939/ CONFIRM-HF] (Group 8, 20, 32)
*[http://www.ncbi.nlm.nih.gov/pubmed/12457784 PROSPER] (Group 9, 21, 33)
*[http://www.ncbi.nlm.nih.gov/pubmed/27040132 HOPE-3] (Group 10, 22, 34)
*[http://www.ncbi.nlm.nih.gov/pubmed/12114036 Heart Protection Study (HPS)] (Group 11, 23, 35)
*[http://www.ncbi.nlm.nih.gov/pubmed/30415628 REDUCE-IT] (Group 12, 24, 36)

[[File:CV Case.pdf|thumb|CV case|left]]

SESSION 2

'''The Guideline Case'''

A 63 y/o patient with CHOOSE ONE (⬆︎HTN/⬆︎Chol/⬆︎glucose/HF/A fib) and using the guideline determine:
# their 5yr/10yr risks of mortality/CVD events
# the potential benefit
# the potential side effects (with magnitude)
# words/sentiment patient values and preferences/SDM

Atrial fibrillation - Groups 1,13,25,2,14,26
*[https://www.onlinecjc.ca/article/S0828-282X(18)31062-6/pdf 2018 Atrial fibrillation guidelines]
Diabetes - Groups 3,15,27,4,16,28
*[http://guidelines.diabetes.ca/docs/CPG-2018-full-EN.pdf 2018 Diabetes guidelines]
Lipid Simplified - Groups 5,17,29,6,18,30
*[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4607330/pdf/0610857.pdf 2015 Simplified lipid guidelines]
Lipid - Groups 7,19,31,8,20,32
*[http://www.onlinecjc.ca/article/S0828-282X(16)30732-2/pdf 2016 Lipid guidelines]
Heart failure - Groups 9,21,33,10,22,34
*[http://www.onlinecjc.ca/article/S0828-282X(17)30973-X/pdf 2017 Heart failure guidelines]
Hypertension - Groups 11,23,35,12,24,36
*[https://www.onlinecjc.ca/article/S0828-282X(18)30183-1/pdf 2018 Hypertension guidelines]

OPTIONAL SESSION
*[http://www.ncbi.nlm.nih.gov/pubmed/16899775 SPARCL]
*[http://www.ncbi.nlm.nih.gov/pubmed/10471456 RALES]
*[http://www.ncbi.nlm.nih.gov/pubmed/11386263 Carvedilol in heart failure]
*[http://www.ncbi.nlm.nih.gov/pubmed/18460663 WAFACS]
*[http://www.ncbi.nlm.nih.gov/pubmed/10376614 MERIT-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/25176015 PARADIGM-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/24490264 High-dose multivitamins after MI]
*[http://www.ncbi.nlm.nih.gov/pubmed/7911176 Mediterranean Diet after MI]
*[http://www.ncbi.nlm.nih.gov/pubmed/15337732 A TO Z]
*[http://www.ncbi.nlm.nih.gov/pubmed/21073363 EMPHASIS-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/12853193 COMET]
*[http://www.ncbi.nlm.nih.gov/pubmed/24716680 TOPCAT]
*[http://www.ncbi.nlm.nih.gov/pubmed/26039521 IMPROVE-IT]

'''ACADEMIC YEAR 2 - SECOND TERM'''

9) NEPHROLOGY STUDIES

None so far

10) ENDOCRINOLOGY[[File:IA ENDO LAYOUT 1.pdf|left|thumb|IA ENDO LAYOUT]]

'''RISK ASSESSMENT CASES FOR DIABETES AND OSTEOPOROSIS'''

'''1) DIABETES CASE'''

66 y/o white male who was diagnosed with diabetes 8 years ago

* His blood pressure over the last year has been roughly 145/80 mmHg - at present untreated
* A1c = 8%, no diabetes meds, non-smoker, BMI ~30
* Total cholesterol is 6 mmol/L, his HDL is 2 mmol/L, non-HDL = 6 minus 2, not on a statin
* No retinopathy, urine albumin-to-creatinine ratio (UACR) = 15ug/mg (7mg/mmol),
* Serum creatinine = 70 micromol/L, waist circumference 100 cm
* GFR 75 mL/min/1.73m2
* In normal sinus rhythm
* Age at end of highest education = 19
* Mother alive, father died of a heart attack at age 80

'''Calculate Risks'''

'''CVD RISK ESTIMATES''' - list the endpoints described by the specific calculator

Framingham - xx% - 10-year risk - also if no diabetes xx%

ASCVD - xx% - 10-year risk - also if no diabetes xx%

'''The Calculator'''
*CVD CALCULATOR
https://decisionaid.ca/cvd/

'''DIABETES COMPLICATIONS RISK ESTIMATES''' - list the endpoints described by the specific calculator

xx% - also 10-year risk if A1c 9, 8, 7 and 6

also get risk of kidney failure, vision loss, pressure sensation loss – also if A1c 9, 8,7,6

'''The Calculator'''
*DIABETES DECISION AID
http://decisionaid.ca/diabetes/

'''BENEFITS AND HARMS'''

Use the [https://guidelines.diabetes.ca/cpg/chapter-13-2020-update 2024 diabetes guidelines] and/or Diabetes Decision Aid to get estimates of benefits and harms and also use the MyStudies synopsis listed below

'''COSTS'''

Try using [https://pricingdoc.acfp.ca Pricing Doc] to get costs

'''Groups 1,13,25'''

* Metformin - UKPDS 34 [https://mystudies.org/studies.php#studies/28929e89-d01e-4b11-8e67-4d7086f9e4aa/outcome MyStudies Data]

'''Groups 2,14,26'''

* Sulfonlyureas - UKPDS 33 [https://mystudies.org/studies.php#studies/5eadb5dd-d403-4c13-b03e-d4f8d28c96ba/outcome MyStudies Data]

'''Groups 3,15,27'''

* Insulin - ORIGIN [https://mystudies.org/studies.php#studies/f611818f-2e69-4952-b55e-661116bd84b6/outcome MyStudies Data]

'''Groups 4,16,28'''

* SGLT2 - EMPA-REG OUTCOME [https://mystudies.org/studies.php#studies/32e9cf1a-f33e-480b-91ca-6f28a4dcf862/outcome MyStudies Data]

'''Groups 5,17,29'''

* GLP - LEADER [https://mystudies.org/studies.php#studies/1adbc9a1-7603-40f1-ac15-b813ce1f0ad6/outcome MyStudies Data]

'''Groups 6,18,30'''

* DPP4 - TECOS [https://mystudies.org/studies.php#studies/8659968a-cefb-4f99-b4ae-8b9b659acbd5/outcome MyStudies Data]

'''Groups 7,19,31'''

* Intensive treatment – small scale - STENO [https://mystudies.org/studies.php#studies/39d423e3-af57-40c8-ab7a-cbc7f389bdb6/paper MyStudies Data]

'''Groups 8,20,32'''

* Intensive treatment – large scale - ADDITION-Europe - [https://mystudies.org/studies.php#studies/5e07d86d-aa92-4db9-a283-76080db4b6fd/outcome MyStudies Data]

'''2) OSTEOPOROSIS CASE'''

60 y/o female

* 72 kg, 1.69m, BMI = 25.2
* t-score of -2.5
* Worried about falling and getting a hip fracture
* A friend recently had an atraumatic fracture from simply tripping and falling over in the snow
* No other risk factors

'''Calculate Risks'''

'''FRACTURE RISK ESTIMATES''' - list the endpoints described by the specific calculator

Major osteoporotic fracture - xx% - 10-year risk – if no BMD (just BMI), and then if they had a BMD t-Score of -2.0, -2.5, and -3.0

Hip fracture - - xx% - 10-year risk – if no BMD (just BMI) and if you have a BMD xx% - 10-year risk – if no BMD, and then if they had a BMD T-Score of -2.0, -2.5, and -3.0

'''The Calculator'''

* FRACTURE CALCULATOR

[https://frax.shef.ac.uk/frax/tool.aspx?country=19 Frax Tool - Canada]

'''BENEFITS AND HARMS'''

Use the [https://www.cmaj.ca/content/195/39/E1333 2023 Osteoporosis Guideline] and/or your osteoporosis lecture notes to get the benefits and apply these to your patient, and also get the harms

'''COSTS'''

Try using [https://pricingdoc.acfp.ca Pricing Doc] to get costs

'''Groups 9,21,33'''

* Activity

'''Groups 10,22,34'''

* Calcium/Vitamin D

'''Groups 11,23,35'''

* Bisphosphonates

'''Groups 12,24,36'''

* Denosumab

11) NEUROLOGY STUDIES

*[http://www.ncbi.nlm.nih.gov/pubmed/16717269 Opioids for chronic non-cancer pain] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/29509867 Effect of Opioid vs Nonopioid Medications on Pain-Related Function in Patients With Chronic Back Pain] Groups 2,14,26
*[https://www.ncbi.nlm.nih.gov/pubmed/31291515 Galcanezumab for prevention of cluster headaches] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/27150433 Immediate or delayed treatment of a first seizure] Groups 4,16,28
*[https://www.ncbi.nlm.nih.gov/pubmed/31291516 Rimegepant for episodic migraine] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/26212846 Sleep restriction for insomnia] Groups 6,18,30
*[https://www.ncbi.nlm.nih.gov/pubmed/25957224 CHANCE] Groups 7,19,31
*[https://www.ncbi.nlm.nih.gov/pubmed/16899775 SPARCL] Groups 8,20,32
*[https://www.ncbi.nlm.nih.gov/pubmed/29171821 Erenumab for episodic migraine] Groups 9,21,33
*[https://www.ncbi.nlm.nih.gov/pubmed/24733354 Reduction of benzodiazepines through education] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/26035341 Patient controlled opioid analgesia versus non-patient controlled opioid analgesia for postoperative pain] Groups 11,23,35
*[https://www.ncbi.nlm.nih.gov/pubmed/11589932 PROGRESS] Groups 12,24,36

'''ACADEMIC YEAR 3'''

12) PSYCHIATRY STUDIES

[[:File:2021 Psych Evidence Appraisal - Intro Slides.pdf|Psychiatry Rating Scales Introduction]]

* Study 1: [http://www.ncbi.nlm.nih.gov/pubmed/16554525 STAR*D (Level 2)] Bupropion-SR, sertraline, or venlafaxine-XR after failure of SSRIs for depression
* Study 2: [http://www.ncbi.nlm.nih.gov/pubmed/29477251 Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder]
* Study 3: [https://pubmed.ncbi.nlm.nih.gov/33862018/ Long-acting injectable versus oral antipsychotics for the maintenance treatment of schizophrenia]
* Study 4: [https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2725088 Association of Antipsychotic Polypharmacy vs Monotherapy With Psychiatric Rehospitalization Among Adults With Schizophrenia]
* Study 5: [https://www.ncbi.nlm.nih.gov/pubmed/29490359 Real-world Effectiveness of Pharmacologic Treatments for the Prevention of Bipolar Disorder]
* Study 6: [http://www.ncbi.nlm.nih.gov/pubmed/20092882 BALANCE] Combination lithium and valproate therapy versus monotherapy for relapse prevention in bipolar I disorder
[[File:ChatGPT directions.jpg|thumb|ChatGPT Directions]]
13) GASTROENTEROLOGY STUDIES - LINKS ON CANVAS

*Short-term treatment for gastro-oesophageal reflux disease-like symptoms and endoscopy negative reflux disease (Review)
*Oral budesonide for induction of remission in ulcerative colitis (Review)
*Probiotics for the prevention of Clostridium difficile-associated diarrhea in adults and children (Review)
*Deprescribing versus continuation of chronic proton pump inhibitor use in adults (Review)
*Prevention of NSAID-induced gastroduodenal ulcers (Review)
*Methotrexate for maintenance of remission in Crohn's disease (Review)

14) OB/GYN STUDIES
*[http://www.ncbi.nlm.nih.gov/pubmed/25601350 Comparative contraceptive effectiveness of levonorgestrel-releasing and copper IUD Devices]
*[http://www.ncbi.nlm.nih.gov/pubmed/29211679 Hormonal contraception and the risk of breast cancer]
*[http://www.ncbi.nlm.nih.gov/pubmed/30322986 Sexual behaviours in adolescent girls before and after introduction of the HPV]
*[http://www.ncbi.nlm.nih.gov/pubmed/30181338 Intramuscular vs intravenous oxytocin to prevent postpartum haemorrhage at vaginal delivery]
*[http://www.ncbi.nlm.nih.gov/pubmed/27682034 Azithromycin Prophylaxis for Cesarean Delivery]
*[http://www.ncbi.nlm.nih.gov/pubmed/28461374 Antibiotics during pregnancy and risk of spontaneous abortion]

Evidence Appraisal Integrated Activities

2024-12-18T16:34:26Z

JamesMcCormack:

'''OBJECTIVE'''

To critically appraise studies, develop a brief synopsis of the trial results, succinctly present the results and then put the results into a proper clinical context

'''INITIAL PRE-READING'''

'''How To Critically Appraise an RCT In 10 minutes'''
*[https://itunes.apple.com/ca/book/how-to-critically-appraise/id524600667?mt=11 iBook/iPad version]
*[https://therapeuticseducation.org/sites/therapeuticseducation.org/files/Ten_Minute_Critical_Appraisal.pdf PDF version]
Watch this video
[http://youtu.be/QUW0Q8tXVUc Viva La Evidence]

'''Study Results at Your Fingertips'''
*[https://mystudies.org MyStudies] - Free access

'''INTEGRATION ACTIVITY FORMAT'''
# Students placed in groups of ~ 5-7
# Each group is given one of the studies below to review
# Students then work in pairs and develop a one-slide critical appraisal and results synopsis
# One student in each group will be chosen at random to present their group findings to the class
# A discussion about the appraisal and the appropriate clinical context for the results is had with the entire class for each study

'''MODULE'''
[[File:Screen Shot 2022-01-09 at 10.00.16 AM.jpg|thumb|'''TRIAL PRESENTATION FORMAT'''|none]]

Studies chosen include landmark studies and/or studies that address important therapeutic issues for the particular module

'''ACADEMIC YEAR 1 - FIRST TERM'''

1) FOUNDATION STUDIES (Groups)
*[https://pubmed.ncbi.nlm.nih.gov/37952131 SELECT] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/12466506 AFFIRM] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/22085343 AIM-HIGH] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/10639539 HOPE] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/18378519 HYVET] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/15007110 PROVE-IT] Groups 6,18,30
*[http://www.ncbi.nlm.nih.gov/pubmed/15755765 TNT] Groups 7,19,31
*[https://pubmed.ncbi.nlm.nih.gov/26378978 EMPAREG] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/17984165 ILLUMINATE] Groups 9,21,33
*[https://pubmed.ncbi.nlm.nih.gov/26551272/ SPRINT] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/15325833 CARDS] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/12117397 WHI] Groups 12,24,36

'''ACADEMIC YEAR 1 - SECOND TERM'''

2) INTRO TO INFECTIOUS DISEASE STUDIES

[https://wiki.ubc.ca/images/8/8b/Antibiotic_Sensitivity_Chart_2024.pdf The "Best" Antibiotic Sensitivity Chart Ever]
*[http://www.ncbi.nlm.nih.gov/pubmed/17567657 IV vs PO antibiotics] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/24603565 Delayed antibiotics for respiratory tract infections] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/11159657 Delayed antibiotics for otitis media] Groups 3,15,27
*[https://pubmed.ncbi.nlm.nih.gov/27455166/ Duration of treatment for community acquired pneumonia] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/22726802 Duration of treatment for pyelonephritis] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/25830421 Choice of antibiotic for community acquired pneumonia-1] Groups 6,18,30
*[http://www.ncbi.nlm.nih.gov/pubmed/25286173 Choice of antibiotic for community acquired pneumonia-2] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/20647284 HPV vaccine study] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/7966893 Influenza vaccine study] Groups 9,21,33
*[https://pubmed.ncbi.nlm.nih.gov/33301246/ COVID vaccine Pfizer] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/27626517 Herpes zoster vaccine study 1] Groups 11,23,35
*[https://www.ncbi.nlm.nih.gov/pubmed/25916341 Herpes zoster vaccine study 3] Groups 12,24,36

3) MUSCULOSKELETAL STUDIES

*[http://www.ncbi.nlm.nih.gov/pubmed/28199814 Baricitinib versus Placebo or Adalimumab in Rheumatoid Arthritis] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/0010979111 CLASS – celecoxib vs NSAIDs] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/26501533 Naproxen with cyclobenzaprine, oxycodone/acetaminophen, or placebo for low back pain] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/24395557 Glucosamine and chondroitin for OA] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/12546607 Acetaminophen vs diclofenac for OA] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/23964752 Diclofenac gel for acute neck pain] Groups 6,18,30
*[https://pubmed.ncbi.nlm.nih.gov/15468367/ Topical diclofenac vs oral diclofenac] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/25064594 Acetaminophen for low back pain] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/7611589 Misoprostol and NSAID induced ulcers] Groups 9,21,33
*[http://www.ncbi.nlm.nih.gov/pubmed/20131255 Low dose vs high dose colchicine for gout] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/22508468 TEAR - oral triple therapy versus etanercept plus methotrexate in early aggressive rheumatoid arthritis] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/25589511 MOVES - Glucosamine and chondroitin for OA for moderate to severe pain] Groups 12,24,36

4) DERMATOLOGY STUDIES

*[https://www.ncbi.nlm.nih.gov/pubmed/9598014 Glycolic acid 5% Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/21896132 Glycolic acid 10% Acne]
*[https://www.ncbi.nlm.nih.gov/pubmed/14531866 Petrolatum vs Ceramide/skin related lipids Hand Dermatitis]
*[https://www.ncbi.nlm.nih.gov/pubmed/11896774 Vitamin C Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/17515510 Retinol (VitaminA) Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/21896129 Hyaluronic acid Atopic Dermatitis]

5) EENT STUDIES

[http://www.amstar.ca/docs/AMSTARguideline.pdf AMSTAR meta-analysis checklist]

'''Scenario 1 - Otitis Media''' - GROUPS 1, 7, 18, 19, 25, 36

Anthony Martin arrives at your pharmacy somewhat frustrated since his family physician declined to write an antibiotic prescription for his two and half year old son, Oscar. His symptoms started yesterday afternoon - Oscar complains of right ear pain but there is no discharge. Rectal temperature taken today was 38.5 degrees. His wife is sure Oscar has an ear infection since the last time he had these same symptoms, that was ultimately the diagnosis. Mr. Martin asks if you think buying acetaminophen is really “enough”?

[https://pubmed.ncbi.nlm.nih.gov/26099233/ Antibiotics for acute otitis media in children]

'''Scenario 2 - Allergic Rhinitis''' - GROUPS 2, 8, 17, 20, 26, 35

Ruby Parmar is a firefighter. She is plagued by sinus congestion (preventing her from sleeping) and a runny nose associated with seasonal allergies. Her prescription for intranasal triamcinolone is typically effective, but she would like to know if a non-sedating anti-allergy pill would work just as well since it’s inconvenient carrying around the “nose spray”.

[https://www.ncbi.nlm.nih.gov/pubmed/28234147 Intranasal steroids vs antihistamines for allergic rhinitis]

'''Scenario 3 - Acute Sinusitis''' - GROUPS 3, 9, 16, 21, 27, 34

You are seeing a patient in clinic before her appointment with the primary care physician. She was feeling unwell with a “flu” last week. While most of her symptoms have resolved (cough, fever), the nasal congestion and discharge persists and so she has made an appointment (she is an otherwise healthy 32 year old with treated thyroid disease). She would like your advice for what treatment she should ask the doctor to prescribe.

[http://www.ncbi.nlm.nih.gov/pubmed/24293353 Intranasal steroids for acute sinusitis]

'''Scenario 4 - Glaucoma''' - GROUPS 4, 10, 15, 22, 28, 33

Mrs. Ada Waters is a 63 year-old woman you. Her ophthalmologist prescribed timolol and xalatan eye drops for treatment of open angle glaucoma. She has never really felt much different on treatment since she recovered from her first episode (of acute angle closure glaucoma requiring ER visit) and surgery. She asks you if the treatment is really making a difference.

[https://www.ncbi.nlm.nih.gov/pubmed/17943780 Interventions for open angle glaucoma]

'''Scenario 5 - Sore Throat''' - GROUPS 5, 11, 14, 23, 29, 32

You have a good friend who is applying for pharmacy. Her invitation for the multiple-mini interview (MMI) is coming up soon, but she is starting to experience a sore throat. While she is worried about not being able to speak through all of those stations, she knows she often gets a terrible headache along with her sore throat. She has an unused prescription for amoxicillin (unexpired) and wonders if you recommend for her to take it.

[https://pubmed.ncbi.nlm.nih.gov/34881426/ Antibiotics for sore throat]

'''Scenario 6 - Conjunctivitis''' - GROUPS 6, 12, 13, 24, 30, 31

A man comes to your pharmacy (he appears in his early twenties) complaining of “pink eye”. He has had a pink discolouration and discharge from his left eye for two days. He asks if the OTC antibiotic eye drops (he’s holding a product with polymixin B) are any better than “waiting it out”.

[https://www.ncbi.nlm.nih.gov/pubmed/22972049 Antibiotics for acute conjunctivitis]

6) HEMATOLOGY STUDIES

None so far

'''ACADEMIC YEAR 2 - FIRST TERM'''

7) RESPIROLOGY STUDIES
[[File:IA COPD info.pdf|thumb]]

*[http://www.ncbi.nlm.nih.gov/pubmed/2062329 First inhaled steroid study] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/22938706 Tiotropium in asthma] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/21324520 Inhaled steroid in children] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/29768149 Combined Budesonide–Formoterol as Needed in Mild Asthma] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/15223858 Doubling dose of inhaled corticosteroid] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/29768147 As-Needed Budesonide–Formoterol versus Maintenance Budesonide in Mild Asthma] Groups 6,18,30
*[http://www.ncbi.nlm.nih.gov/pubmed/27181606 Indacaterol-glycopyrronium VS salmeterol/fluticasone in COPD] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/21428765 Tiotropium VS salmeterol in COPD] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/23695200 Short VS long steroids for COPD exacerbation] Groups 9,21,33
*[http://www.ncbi.nlm.nih.gov/pubmed/25196117 Stopping inhaled steroids in COPD] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/29668352 Once-Daily Single-Inhaler Triple versus Dual Therapy in Patients with COPD] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/28877011 Tezepelumab in Adults with Uncontrolled Asthma] Groups 12,24,36

8) CARDIOVASCULAR STUDIES

SESSION 1

*[https://www.ncbi.nlm.nih.gov/pubmed/4862069 VA1] (Group 1, 13, 25)
*[https://www.ncbi.nlm.nih.gov/pubmed/4914579 VA 2] (Group 2, 14, 26)
*[https://pubmed.ncbi.nlm.nih.gov/33186492 Polycap Study 3] (Group 3, 15, 27)
*[http://www.ncbi.nlm.nih.gov/pubmed/20228401 ACCORD-BP] (Group 4, 16, 28)
*[https://www.ncbi.nlm.nih.gov/pubmed/26551272 SPRINT] (Group 5, 17, 29)
*[http://www.ncbi.nlm.nih.gov/pubmed/2883575 CONSENSUS] (Group 6,18,30)
*[https://pubmed.ncbi.nlm.nih.gov/31535829/ DAPA-HF] (Group 7, 19, 31)
*[https://pubmed.ncbi.nlm.nih.gov/25176939/ CONFIRM-HF] (Group 8, 20, 32)
*[http://www.ncbi.nlm.nih.gov/pubmed/12457784 PROSPER] (Group 9, 21, 33)
*[http://www.ncbi.nlm.nih.gov/pubmed/27040132 HOPE-3] (Group 10, 22, 34)
*[http://www.ncbi.nlm.nih.gov/pubmed/12114036 Heart Protection Study (HPS)] (Group 11, 23, 35)
*[http://www.ncbi.nlm.nih.gov/pubmed/30415628 REDUCE-IT] (Group 12, 24, 36)

[[File:CV Case.pdf|thumb|CV case|left]]

SESSION 2

'''The Guideline Case'''

A 63 y/o patient with CHOOSE ONE (⬆︎HTN/⬆︎Chol/⬆︎glucose/HF/A fib) and using the guideline determine:
# their 5yr/10yr risks of mortality/CVD events
# the potential benefit
# the potential side effects (with magnitude)
# words/sentiment patient values and preferences/SDM

Atrial fibrillation - Groups 1,13,25,2,14,26
*[https://www.onlinecjc.ca/article/S0828-282X(18)31062-6/pdf 2018 Atrial fibrillation guidelines]
Diabetes - Groups 3,15,27,4,16,28
*[http://guidelines.diabetes.ca/docs/CPG-2018-full-EN.pdf 2018 Diabetes guidelines]
Lipid Simplified - Groups 5,17,29,6,18,30
*[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4607330/pdf/0610857.pdf 2015 Simplified lipid guidelines]
Lipid - Groups 7,19,31,8,20,32
*[http://www.onlinecjc.ca/article/S0828-282X(16)30732-2/pdf 2016 Lipid guidelines]
Heart failure - Groups 9,21,33,10,22,34
*[http://www.onlinecjc.ca/article/S0828-282X(17)30973-X/pdf 2017 Heart failure guidelines]
Hypertension - Groups 11,23,35,12,24,36
*[https://www.onlinecjc.ca/article/S0828-282X(18)30183-1/pdf 2018 Hypertension guidelines]

OPTIONAL SESSION
*[http://www.ncbi.nlm.nih.gov/pubmed/16899775 SPARCL]
*[http://www.ncbi.nlm.nih.gov/pubmed/10471456 RALES]
*[http://www.ncbi.nlm.nih.gov/pubmed/11386263 Carvedilol in heart failure]
*[http://www.ncbi.nlm.nih.gov/pubmed/18460663 WAFACS]
*[http://www.ncbi.nlm.nih.gov/pubmed/10376614 MERIT-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/25176015 PARADIGM-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/24490264 High-dose multivitamins after MI]
*[http://www.ncbi.nlm.nih.gov/pubmed/7911176 Mediterranean Diet after MI]
*[http://www.ncbi.nlm.nih.gov/pubmed/15337732 A TO Z]
*[http://www.ncbi.nlm.nih.gov/pubmed/21073363 EMPHASIS-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/12853193 COMET]
*[http://www.ncbi.nlm.nih.gov/pubmed/24716680 TOPCAT]
*[http://www.ncbi.nlm.nih.gov/pubmed/26039521 IMPROVE-IT]

'''ACADEMIC YEAR 2 - SECOND TERM'''

9) NEPHROLOGY STUDIES

None so far

10) ENDOCRINOLOGY[[File:IA ENDO LAYOUT 1.pdf|left|thumb|IA ENDO LAYOUT]]

'''RISK ASSESSMENT CASES FOR DIABETES AND OSTEOPOROSIS'''

'''1) DIABETES CASE'''

66 y/o white male who was diagnosed with diabetes 8 years ago

* His blood pressure over the last year has been roughly 145/80 mmHg - at present untreated
* A1c = 8%, no diabetes meds, non-smoker, BMI ~30
* Total cholesterol is 6 mmol/L, his HDL is 2 mmol/L, non-HDL = 6 minus 2, not on a statin
* No retinopathy, urine albumin-to-creatinine ratio (UACR) = 15ug/mg (7mg/mmol),
* Serum creatinine = 70 micromol/L, waist circumference 100 cm
* GFR 75 mL/min/1.73m2
* In normal sinus rhythm
* Age at end of highest education = 19
* Mother alive, father died of a heart attack at age 80

'''Calculate Risks'''

'''CVD RISK ESTIMATES''' - list the endpoints described by the specific calculator

Framingham - xx% - 10-year risk - also if no diabetes xx%

ASCVD - xx% - 10-year risk - also if no diabetes xx%

'''The Calculator'''
*CVD CALCULATOR
https://decisionaid.ca/cvd/

'''DIABETES COMPLICATIONS RISK ESTIMATES''' - list the endpoints described by the specific calculator

xx% - also 10-year risk if A1c 9, 8, 7 and 6

also get risk of kidney failure, vision loss, pressure sensation loss – also if A1c 9, 8,7,6

'''The Calculator'''
*DIABETES DECISION AID
http://decisionaid.ca/diabetes/

'''BENEFITS AND HARMS'''

Use the [https://guidelines.diabetes.ca/cpg/chapter-13-2020-update 2020 diabetes guidelines] and/or Diabetes Decision Aid to get estimates of benefits and harms and also use the MyStudies synopsis listed below

'''COSTS'''

Try using [https://pricingdoc.acfp.ca Pricing Doc] to get costs

'''Groups 1,13,25'''

* Metformin - UKPDS 34 [https://mystudies.org/studies.php#studies/28929e89-d01e-4b11-8e67-4d7086f9e4aa/outcome MyStudies Data]

'''Groups 2,14,26'''

* Sulfonlyureas - UKPDS 33 [https://mystudies.org/studies.php#studies/5eadb5dd-d403-4c13-b03e-d4f8d28c96ba/outcome MyStudies Data]

'''Groups 3,15,27'''

* Insulin - ORIGIN [https://mystudies.org/studies.php#studies/f611818f-2e69-4952-b55e-661116bd84b6/outcome MyStudies Data]

'''Groups 4,16,28'''

* SGLT2 - EMPA-REG OUTCOME [https://mystudies.org/studies.php#studies/32e9cf1a-f33e-480b-91ca-6f28a4dcf862/outcome MyStudies Data]

'''Groups 5,17,29'''

* GLP - LEADER [https://mystudies.org/studies.php#studies/1adbc9a1-7603-40f1-ac15-b813ce1f0ad6/outcome MyStudies Data]

'''Groups 6,18,30'''

* DPP4 - TECOS [https://mystudies.org/studies.php#studies/8659968a-cefb-4f99-b4ae-8b9b659acbd5/outcome MyStudies Data]

'''Groups 7,19,31'''

* Intensive treatment – small scale - STENO [https://mystudies.org/studies.php#studies/39d423e3-af57-40c8-ab7a-cbc7f389bdb6/paper MyStudies Data]

'''Groups 8,20,32'''

* Intensive treatment – large scale - ADDITION-Europe - [https://mystudies.org/studies.php#studies/5e07d86d-aa92-4db9-a283-76080db4b6fd/outcome MyStudies Data]

'''2) OSTEOPOROSIS CASE'''

60 y/o female

* 72 kg, 1.69m, BMI = 25.2
* t-score of -2.5
* Worried about falling and getting a hip fracture
* A friend recently had an atraumatic fracture from simply tripping and falling over in the snow
* No other risk factors

'''Calculate Risks'''

'''FRACTURE RISK ESTIMATES''' - list the endpoints described by the specific calculator

Major osteoporotic fracture - xx% - 10-year risk – if no BMD (just BMI), and then if they had a BMD t-Score of -2.0, -2.5, and -3.0

Hip fracture - - xx% - 10-year risk – if no BMD (just BMI) and if you have a BMD xx% - 10-year risk – if no BMD, and then if they had a BMD T-Score of -2.0, -2.5, and -3.0

'''The Calculator'''

* FRACTURE CALCULATOR

[https://frax.shef.ac.uk/frax/tool.aspx?country=19 Frax Tool - Canada]

'''BENEFITS AND HARMS'''

Use the [https://www.cmaj.ca/content/195/39/E1333 2023 Osteoporosis Guideline] and/or your osteoporosis lecture notes to get the benefits and apply these to your patient, and also get the harms

'''COSTS'''

Try using [https://pricingdoc.acfp.ca Pricing Doc] to get costs

'''Groups 9,21,33'''

* Activity

'''Groups 10,22,34'''

* Calcium/Vitamin D

'''Groups 11,23,35'''

* Bisphosphonates

'''Groups 12,24,36'''

* Denosumab

11) NEUROLOGY STUDIES

*[http://www.ncbi.nlm.nih.gov/pubmed/16717269 Opioids for chronic non-cancer pain] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/29509867 Effect of Opioid vs Nonopioid Medications on Pain-Related Function in Patients With Chronic Back Pain] Groups 2,14,26
*[https://www.ncbi.nlm.nih.gov/pubmed/31291515 Galcanezumab for prevention of cluster headaches] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/27150433 Immediate or delayed treatment of a first seizure] Groups 4,16,28
*[https://www.ncbi.nlm.nih.gov/pubmed/31291516 Rimegepant for episodic migraine] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/26212846 Sleep restriction for insomnia] Groups 6,18,30
*[https://www.ncbi.nlm.nih.gov/pubmed/25957224 CHANCE] Groups 7,19,31
*[https://www.ncbi.nlm.nih.gov/pubmed/16899775 SPARCL] Groups 8,20,32
*[https://www.ncbi.nlm.nih.gov/pubmed/29171821 Erenumab for episodic migraine] Groups 9,21,33
*[https://www.ncbi.nlm.nih.gov/pubmed/24733354 Reduction of benzodiazepines through education] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/26035341 Patient controlled opioid analgesia versus non-patient controlled opioid analgesia for postoperative pain] Groups 11,23,35
*[https://www.ncbi.nlm.nih.gov/pubmed/11589932 PROGRESS] Groups 12,24,36

'''ACADEMIC YEAR 3'''

12) PSYCHIATRY STUDIES

[[:File:2021 Psych Evidence Appraisal - Intro Slides.pdf|Psychiatry Rating Scales Introduction]]

* Study 1: [http://www.ncbi.nlm.nih.gov/pubmed/16554525 STAR*D (Level 2)] Bupropion-SR, sertraline, or venlafaxine-XR after failure of SSRIs for depression
* Study 2: [http://www.ncbi.nlm.nih.gov/pubmed/29477251 Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder]
* Study 3: [https://pubmed.ncbi.nlm.nih.gov/33862018/ Long-acting injectable versus oral antipsychotics for the maintenance treatment of schizophrenia]
* Study 4: [https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2725088 Association of Antipsychotic Polypharmacy vs Monotherapy With Psychiatric Rehospitalization Among Adults With Schizophrenia]
* Study 5: [https://www.ncbi.nlm.nih.gov/pubmed/29490359 Real-world Effectiveness of Pharmacologic Treatments for the Prevention of Bipolar Disorder]
* Study 6: [http://www.ncbi.nlm.nih.gov/pubmed/20092882 BALANCE] Combination lithium and valproate therapy versus monotherapy for relapse prevention in bipolar I disorder
[[File:ChatGPT directions.jpg|thumb|ChatGPT Directions]]
13) GASTROENTEROLOGY STUDIES - LINKS ON CANVAS

*Short-term treatment for gastro-oesophageal reflux disease-like symptoms and endoscopy negative reflux disease (Review)
*Oral budesonide for induction of remission in ulcerative colitis (Review)
*Probiotics for the prevention of Clostridium difficile-associated diarrhea in adults and children (Review)
*Deprescribing versus continuation of chronic proton pump inhibitor use in adults (Review)
*Prevention of NSAID-induced gastroduodenal ulcers (Review)
*Methotrexate for maintenance of remission in Crohn's disease (Review)

14) OB/GYN STUDIES
*[http://www.ncbi.nlm.nih.gov/pubmed/25601350 Comparative contraceptive effectiveness of levonorgestrel-releasing and copper IUD Devices]
*[http://www.ncbi.nlm.nih.gov/pubmed/29211679 Hormonal contraception and the risk of breast cancer]
*[http://www.ncbi.nlm.nih.gov/pubmed/30322986 Sexual behaviours in adolescent girls before and after introduction of the HPV]
*[http://www.ncbi.nlm.nih.gov/pubmed/30181338 Intramuscular vs intravenous oxytocin to prevent postpartum haemorrhage at vaginal delivery]
*[http://www.ncbi.nlm.nih.gov/pubmed/27682034 Azithromycin Prophylaxis for Cesarean Delivery]
*[http://www.ncbi.nlm.nih.gov/pubmed/28461374 Antibiotics during pregnancy and risk of spontaneous abortion]

Evidence Appraisal Integrated Activities

2024-12-18T16:24:24Z

JamesMcCormack:

'''OBJECTIVE'''

To critically appraise studies, develop a brief synopsis of the trial results, succinctly present the results and then put the results into a proper clinical context

'''INITIAL PRE-READING'''

'''How To Critically Appraise an RCT In 10 minutes'''
*[https://itunes.apple.com/ca/book/how-to-critically-appraise/id524600667?mt=11 iBook/iPad version]
*[https://therapeuticseducation.org/sites/therapeuticseducation.org/files/Ten_Minute_Critical_Appraisal.pdf PDF version]
Watch this video
[http://youtu.be/QUW0Q8tXVUc Viva La Evidence]

'''Study Results at Your Fingertips'''
*[https://mystudies.org MyStudies] - Free access

'''INTEGRATION ACTIVITY FORMAT'''
# Students placed in groups of ~ 5-7
# Each group chooses one of the studies below to review
# Students then work in pairs and develop a one-slide critical appraisal and results synopsis
# One to two students in each group will be chosen at random to present their findings to the class
# A discussion about the appraisal and the appropriate clinical context for the results is had with the entire class for each study

'''MODULE'''
[[File:Screen Shot 2022-01-09 at 10.00.16 AM.jpg|thumb|'''TRIAL PRESENTATION FORMAT'''|none]]

Studies chosen include landmark studies and/or studies that address important therapeutic issues for the particular module

'''ACADEMIC YEAR 1 - FIRST TERM'''

1) FOUNDATION STUDIES (Groups)
*[https://pubmed.ncbi.nlm.nih.gov/37952131 SELECT] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/12466506 AFFIRM] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/22085343 AIM-HIGH] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/10639539 HOPE] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/18378519 HYVET] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/15007110 PROVE-IT] Groups 6,18,30
*[http://www.ncbi.nlm.nih.gov/pubmed/15755765 TNT] Groups 7,19,31
*[https://pubmed.ncbi.nlm.nih.gov/26378978 EMPAREG] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/17984165 ILLUMINATE] Groups 9,21,33
*[https://pubmed.ncbi.nlm.nih.gov/26551272/ SPRINT] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/15325833 CARDS] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/12117397 WHI] Groups 12,24,36

'''ACADEMIC YEAR 1 - SECOND TERM'''

2) INTRO TO INFECTIOUS DISEASE STUDIES

[https://wiki.ubc.ca/images/8/8b/Antibiotic_Sensitivity_Chart_2024.pdf The "Best" Antibiotic Sensitivity Chart Ever]
*[http://www.ncbi.nlm.nih.gov/pubmed/17567657 IV vs PO antibiotics] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/24603565 Delayed antibiotics for respiratory tract infections] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/11159657 Delayed antibiotics for otitis media] Groups 3,15,27
*[https://pubmed.ncbi.nlm.nih.gov/27455166/ Duration of treatment for community acquired pneumonia] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/22726802 Duration of treatment for pyelonephritis] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/25830421 Choice of antibiotic for community acquired pneumonia-1] Groups 6,18,30
*[http://www.ncbi.nlm.nih.gov/pubmed/25286173 Choice of antibiotic for community acquired pneumonia-2] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/20647284 HPV vaccine study] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/7966893 Influenza vaccine study] Groups 9,21,33
*[https://pubmed.ncbi.nlm.nih.gov/33301246/ COVID vaccine Pfizer] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/27626517 Herpes zoster vaccine study 1] Groups 11,23,35
*[https://www.ncbi.nlm.nih.gov/pubmed/25916341 Herpes zoster vaccine study 3] Groups 12,24,36

3) MUSCULOSKELETAL STUDIES

*[http://www.ncbi.nlm.nih.gov/pubmed/28199814 Baricitinib versus Placebo or Adalimumab in Rheumatoid Arthritis] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/0010979111 CLASS – celecoxib vs NSAIDs] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/26501533 Naproxen with cyclobenzaprine, oxycodone/acetaminophen, or placebo for low back pain] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/24395557 Glucosamine and chondroitin for OA] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/12546607 Acetaminophen vs diclofenac for OA] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/23964752 Diclofenac gel for acute neck pain] Groups 6,18,30
*[https://pubmed.ncbi.nlm.nih.gov/15468367/ Topical diclofenac vs oral diclofenac] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/25064594 Acetaminophen for low back pain] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/7611589 Misoprostol and NSAID induced ulcers] Groups 9,21,33
*[http://www.ncbi.nlm.nih.gov/pubmed/20131255 Low dose vs high dose colchicine for gout] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/22508468 TEAR - oral triple therapy versus etanercept plus methotrexate in early aggressive rheumatoid arthritis] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/25589511 MOVES - Glucosamine and chondroitin for OA for moderate to severe pain] Groups 12,24,36

4) DERMATOLOGY STUDIES

*[https://www.ncbi.nlm.nih.gov/pubmed/9598014 Glycolic acid 5% Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/21896132 Glycolic acid 10% Acne]
*[https://www.ncbi.nlm.nih.gov/pubmed/14531866 Petrolatum vs Ceramide/skin related lipids Hand Dermatitis]
*[https://www.ncbi.nlm.nih.gov/pubmed/11896774 Vitamin C Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/17515510 Retinol (VitaminA) Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/21896129 Hyaluronic acid Atopic Dermatitis]

5) EENT STUDIES

[http://www.amstar.ca/docs/AMSTARguideline.pdf AMSTAR meta-analysis checklist]

'''Scenario 1 - Otitis Media''' - GROUPS 1, 7, 18, 19, 25, 36

Anthony Martin arrives at your pharmacy somewhat frustrated since his family physician declined to write an antibiotic prescription for his two and half year old son, Oscar. His symptoms started yesterday afternoon - Oscar complains of right ear pain but there is no discharge. Rectal temperature taken today was 38.5 degrees. His wife is sure Oscar has an ear infection since the last time he had these same symptoms, that was ultimately the diagnosis. Mr. Martin asks if you think buying acetaminophen is really “enough”?

[https://pubmed.ncbi.nlm.nih.gov/26099233/ Antibiotics for acute otitis media in children]

'''Scenario 2 - Allergic Rhinitis''' - GROUPS 2, 8, 17, 20, 26, 35

Ruby Parmar is a firefighter. She is plagued by sinus congestion (preventing her from sleeping) and a runny nose associated with seasonal allergies. Her prescription for intranasal triamcinolone is typically effective, but she would like to know if a non-sedating anti-allergy pill would work just as well since it’s inconvenient carrying around the “nose spray”.

[https://www.ncbi.nlm.nih.gov/pubmed/28234147 Intranasal steroids vs antihistamines for allergic rhinitis]

'''Scenario 3 - Acute Sinusitis''' - GROUPS 3, 9, 16, 21, 27, 34

You are seeing a patient in clinic before her appointment with the primary care physician. She was feeling unwell with a “flu” last week. While most of her symptoms have resolved (cough, fever), the nasal congestion and discharge persists and so she has made an appointment (she is an otherwise healthy 32 year old with treated thyroid disease). She would like your advice for what treatment she should ask the doctor to prescribe.

[http://www.ncbi.nlm.nih.gov/pubmed/24293353 Intranasal steroids for acute sinusitis]

'''Scenario 4 - Glaucoma''' - GROUPS 4, 10, 15, 22, 28, 33

Mrs. Ada Waters is a 63 year-old woman you. Her ophthalmologist prescribed timolol and xalatan eye drops for treatment of open angle glaucoma. She has never really felt much different on treatment since she recovered from her first episode (of acute angle closure glaucoma requiring ER visit) and surgery. She asks you if the treatment is really making a difference.

[https://www.ncbi.nlm.nih.gov/pubmed/17943780 Interventions for open angle glaucoma]

'''Scenario 5 - Sore Throat''' - GROUPS 5, 11, 14, 23, 29, 32

You have a good friend who is applying for pharmacy. Her invitation for the multiple-mini interview (MMI) is coming up soon, but she is starting to experience a sore throat. While she is worried about not being able to speak through all of those stations, she knows she often gets a terrible headache along with her sore throat. She has an unused prescription for amoxicillin (unexpired) and wonders if you recommend for her to take it.

[https://pubmed.ncbi.nlm.nih.gov/34881426/ Antibiotics for sore throat]

'''Scenario 6 - Conjunctivitis''' - GROUPS 6, 12, 13, 24, 30, 31

A man comes to your pharmacy (he appears in his early twenties) complaining of “pink eye”. He has had a pink discolouration and discharge from his left eye for two days. He asks if the OTC antibiotic eye drops (he’s holding a product with polymixin B) are any better than “waiting it out”.

[https://www.ncbi.nlm.nih.gov/pubmed/22972049 Antibiotics for acute conjunctivitis]

6) HEMATOLOGY STUDIES

None so far

'''ACADEMIC YEAR 2 - FIRST TERM'''

7) RESPIROLOGY STUDIES
[[File:IA COPD info.pdf|thumb]]

*[http://www.ncbi.nlm.nih.gov/pubmed/2062329 First inhaled steroid study] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/22938706 Tiotropium in asthma] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/21324520 Inhaled steroid in children] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/29768149 Combined Budesonide–Formoterol as Needed in Mild Asthma] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/15223858 Doubling dose of inhaled corticosteroid] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/29768147 As-Needed Budesonide–Formoterol versus Maintenance Budesonide in Mild Asthma] Groups 6,18,30
*[http://www.ncbi.nlm.nih.gov/pubmed/27181606 Indacaterol-glycopyrronium VS salmeterol/fluticasone in COPD] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/21428765 Tiotropium VS salmeterol in COPD] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/23695200 Short VS long steroids for COPD exacerbation] Groups 9,21,33
*[http://www.ncbi.nlm.nih.gov/pubmed/25196117 Stopping inhaled steroids in COPD] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/29668352 Once-Daily Single-Inhaler Triple versus Dual Therapy in Patients with COPD] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/28877011 Tezepelumab in Adults with Uncontrolled Asthma] Groups 12,24,36

8) CARDIOVASCULAR STUDIES

SESSION 1

*[https://www.ncbi.nlm.nih.gov/pubmed/4862069 VA1] (Group 1, 13, 25)
*[https://www.ncbi.nlm.nih.gov/pubmed/4914579 VA 2] (Group 2, 14, 26)
*[https://pubmed.ncbi.nlm.nih.gov/33186492 Polycap Study 3] (Group 3, 15, 27)
*[http://www.ncbi.nlm.nih.gov/pubmed/20228401 ACCORD-BP] (Group 4, 16, 28)
*[https://www.ncbi.nlm.nih.gov/pubmed/26551272 SPRINT] (Group 5, 17, 29)
*[http://www.ncbi.nlm.nih.gov/pubmed/2883575 CONSENSUS] (Group 6,18,30)
*[https://pubmed.ncbi.nlm.nih.gov/31535829/ DAPA-HF] (Group 7, 19, 31)
*[https://pubmed.ncbi.nlm.nih.gov/25176939/ CONFIRM-HF] (Group 8, 20, 32)
*[http://www.ncbi.nlm.nih.gov/pubmed/12457784 PROSPER] (Group 9, 21, 33)
*[http://www.ncbi.nlm.nih.gov/pubmed/27040132 HOPE-3] (Group 10, 22, 34)
*[http://www.ncbi.nlm.nih.gov/pubmed/12114036 Heart Protection Study (HPS)] (Group 11, 23, 35)
*[http://www.ncbi.nlm.nih.gov/pubmed/30415628 REDUCE-IT] (Group 12, 24, 36)

[[File:CV Case.pdf|thumb|CV case|left]]

SESSION 2

'''The Guideline Case'''

A 63 y/o patient with CHOOSE ONE (⬆︎HTN/⬆︎Chol/⬆︎glucose/HF/A fib) and using the guideline determine:
# their 5yr/10yr risks of mortality/CVD events
# the potential benefit
# the potential side effects (with magnitude)
# words/sentiment patient values and preferences/SDM

Atrial fibrillation - Groups 1,13,25,2,14,26
*[https://www.onlinecjc.ca/article/S0828-282X(18)31062-6/pdf 2018 Atrial fibrillation guidelines]
Diabetes - Groups 3,15,27,4,16,28
*[http://guidelines.diabetes.ca/docs/CPG-2018-full-EN.pdf 2018 Diabetes guidelines]
Lipid Simplified - Groups 5,17,29,6,18,30
*[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4607330/pdf/0610857.pdf 2015 Simplified lipid guidelines]
Lipid - Groups 7,19,31,8,20,32
*[http://www.onlinecjc.ca/article/S0828-282X(16)30732-2/pdf 2016 Lipid guidelines]
Heart failure - Groups 9,21,33,10,22,34
*[http://www.onlinecjc.ca/article/S0828-282X(17)30973-X/pdf 2017 Heart failure guidelines]
Hypertension - Groups 11,23,35,12,24,36
*[https://www.onlinecjc.ca/article/S0828-282X(18)30183-1/pdf 2018 Hypertension guidelines]

OPTIONAL SESSION
*[http://www.ncbi.nlm.nih.gov/pubmed/16899775 SPARCL]
*[http://www.ncbi.nlm.nih.gov/pubmed/10471456 RALES]
*[http://www.ncbi.nlm.nih.gov/pubmed/11386263 Carvedilol in heart failure]
*[http://www.ncbi.nlm.nih.gov/pubmed/18460663 WAFACS]
*[http://www.ncbi.nlm.nih.gov/pubmed/10376614 MERIT-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/25176015 PARADIGM-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/24490264 High-dose multivitamins after MI]
*[http://www.ncbi.nlm.nih.gov/pubmed/7911176 Mediterranean Diet after MI]
*[http://www.ncbi.nlm.nih.gov/pubmed/15337732 A TO Z]
*[http://www.ncbi.nlm.nih.gov/pubmed/21073363 EMPHASIS-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/12853193 COMET]
*[http://www.ncbi.nlm.nih.gov/pubmed/24716680 TOPCAT]
*[http://www.ncbi.nlm.nih.gov/pubmed/26039521 IMPROVE-IT]

'''ACADEMIC YEAR 2 - SECOND TERM'''

9) NEPHROLOGY STUDIES

None so far

10) ENDOCRINOLOGY[[File:IA ENDO LAYOUT 1.pdf|left|thumb|IA ENDO LAYOUT]]

'''RISK ASSESSMENT CASES FOR DIABETES AND OSTEOPOROSIS'''

'''1) DIABETES CASE'''

66 y/o white male who was diagnosed with diabetes 8 years ago

* His blood pressure over the last year has been roughly 145/80 mmHg - at present untreated
* A1c = 8%, no diabetes meds, non-smoker, BMI ~30
* Total cholesterol is 6 mmol/L, his HDL is 2 mmol/L, non-HDL = 6 minus 2, not on a statin
* No retinopathy, urine albumin-to-creatinine ratio (UACR) = 15ug/mg (7mg/mmol),
* Serum creatinine = 70 micromol/L, waist circumference 100 cm
* GFR 75 mL/min/1.73m2
* In normal sinus rhythm
* Age at end of highest education = 19
* Mother alive, father died of a heart attack at age 80

'''Calculate Risks'''

'''CVD RISK ESTIMATES''' - list the endpoints described by the specific calculator

Framingham - xx% - 10-year risk - also if no diabetes xx%

ASCVD - xx% - 10-year risk - also if no diabetes xx%

'''The Calculator'''
*CVD CALCULATOR
https://decisionaid.ca/cvd/

'''DIABETES COMPLICATIONS RISK ESTIMATES''' - list the endpoints described by the specific calculator

xx% - also 10-year risk if A1c 9, 8, 7 and 6

also get risk of kidney failure, vision loss, pressure sensation loss – also if A1c 9, 8,7,6

'''The Calculator'''
*DIABETES DECISION AID
http://decisionaid.ca/diabetes/

'''BENEFITS AND HARMS'''

Use the [https://guidelines.diabetes.ca/cpg/chapter-13-2020-update 2020 diabetes guidelines] and/or Diabetes Decision Aid to get estimates of benefits and harms and also use the MyStudies synopsis listed below

'''COSTS'''

Try using [https://pricingdoc.acfp.ca Pricing Doc] to get costs

'''Groups 1,13,25'''

* Metformin - UKPDS 34 [https://mystudies.org/studies.php#studies/28929e89-d01e-4b11-8e67-4d7086f9e4aa/outcome MyStudies Data]

'''Groups 2,14,26'''

* Sulfonlyureas - UKPDS 33 [https://mystudies.org/studies.php#studies/5eadb5dd-d403-4c13-b03e-d4f8d28c96ba/outcome MyStudies Data]

'''Groups 3,15,27'''

* Insulin - ORIGIN [https://mystudies.org/studies.php#studies/f611818f-2e69-4952-b55e-661116bd84b6/outcome MyStudies Data]

'''Groups 4,16,28'''

* SGLT2 - EMPA-REG OUTCOME [https://mystudies.org/studies.php#studies/32e9cf1a-f33e-480b-91ca-6f28a4dcf862/outcome MyStudies Data]

'''Groups 5,17,29'''

* GLP - LEADER [https://mystudies.org/studies.php#studies/1adbc9a1-7603-40f1-ac15-b813ce1f0ad6/outcome MyStudies Data]

'''Groups 6,18,30'''

* DPP4 - TECOS [https://mystudies.org/studies.php#studies/8659968a-cefb-4f99-b4ae-8b9b659acbd5/outcome MyStudies Data]

'''Groups 7,19,31'''

* Intensive treatment – small scale - STENO [https://mystudies.org/studies.php#studies/39d423e3-af57-40c8-ab7a-cbc7f389bdb6/paper MyStudies Data]

'''Groups 8,20,32'''

* Intensive treatment – large scale - ADDITION-Europe - [https://mystudies.org/studies.php#studies/5e07d86d-aa92-4db9-a283-76080db4b6fd/outcome MyStudies Data]

'''2) OSTEOPOROSIS CASE'''

60 y/o female

* 72 kg, 1.69m, BMI = 25.2
* t-score of -2.5
* Worried about falling and getting a hip fracture
* A friend recently had an atraumatic fracture from simply tripping and falling over in the snow
* No other risk factors

'''Calculate Risks'''

'''FRACTURE RISK ESTIMATES''' - list the endpoints described by the specific calculator

Major osteoporotic fracture - xx% - 10-year risk – if no BMD (just BMI), and then if they had a BMD t-Score of -2.0, -2.5, and -3.0

Hip fracture - - xx% - 10-year risk – if no BMD (just BMI) and if you have a BMD xx% - 10-year risk – if no BMD, and then if they had a BMD T-Score of -2.0, -2.5, and -3.0

'''The Calculator'''

* FRACTURE CALCULATOR

[https://frax.shef.ac.uk/frax/tool.aspx?country=19 Frax Tool - Canada]

'''BENEFITS AND HARMS'''

Use the [https://www.cmaj.ca/content/195/39/E1333 2023 Osteoporosis Guideline] and/or your osteoporosis lecture notes to get the benefits and apply these to your patient, and also get the harms

'''COSTS'''

Try using [https://pricingdoc.acfp.ca Pricing Doc] to get costs

'''Groups 9,21,33'''

* Activity

'''Groups 10,22,34'''

* Calcium/Vitamin D

'''Groups 11,23,35'''

* Bisphosphonates

'''Groups 12,24,36'''

* Denosumab

11) NEUROLOGY STUDIES

*[http://www.ncbi.nlm.nih.gov/pubmed/16717269 Opioids for chronic non-cancer pain] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/29509867 Effect of Opioid vs Nonopioid Medications on Pain-Related Function in Patients With Chronic Back Pain] Groups 2,14,26
*[https://www.ncbi.nlm.nih.gov/pubmed/31291515 Galcanezumab for prevention of cluster headaches] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/27150433 Immediate or delayed treatment of a first seizure] Groups 4,16,28
*[https://www.ncbi.nlm.nih.gov/pubmed/31291516 Rimegepant for episodic migraine] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/26212846 Sleep restriction for insomnia] Groups 6,18,30
*[https://www.ncbi.nlm.nih.gov/pubmed/25957224 CHANCE] Groups 7,19,31
*[https://www.ncbi.nlm.nih.gov/pubmed/16899775 SPARCL] Groups 8,20,32
*[https://www.ncbi.nlm.nih.gov/pubmed/29171821 Erenumab for episodic migraine] Groups 9,21,33
*[https://www.ncbi.nlm.nih.gov/pubmed/24733354 Reduction of benzodiazepines through education] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/26035341 Patient controlled opioid analgesia versus non-patient controlled opioid analgesia for postoperative pain] Groups 11,23,35
*[https://www.ncbi.nlm.nih.gov/pubmed/11589932 PROGRESS] Groups 12,24,36

'''ACADEMIC YEAR 3'''

12) PSYCHIATRY STUDIES

[[:File:2021 Psych Evidence Appraisal - Intro Slides.pdf|Psychiatry Rating Scales Introduction]]

* Study 1: [http://www.ncbi.nlm.nih.gov/pubmed/16554525 STAR*D (Level 2)] Bupropion-SR, sertraline, or venlafaxine-XR after failure of SSRIs for depression
* Study 2: [http://www.ncbi.nlm.nih.gov/pubmed/29477251 Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder]
* Study 3: [https://pubmed.ncbi.nlm.nih.gov/33862018/ Long-acting injectable versus oral antipsychotics for the maintenance treatment of schizophrenia]
* Study 4: [https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2725088 Association of Antipsychotic Polypharmacy vs Monotherapy With Psychiatric Rehospitalization Among Adults With Schizophrenia]
* Study 5: [https://www.ncbi.nlm.nih.gov/pubmed/29490359 Real-world Effectiveness of Pharmacologic Treatments for the Prevention of Bipolar Disorder]
* Study 6: [http://www.ncbi.nlm.nih.gov/pubmed/20092882 BALANCE] Combination lithium and valproate therapy versus monotherapy for relapse prevention in bipolar I disorder
[[File:ChatGPT directions.jpg|thumb|ChatGPT Directions]]
13) GASTROENTEROLOGY STUDIES - LINKS ON CANVAS

*Short-term treatment for gastro-oesophageal reflux disease-like symptoms and endoscopy negative reflux disease (Review)
*Oral budesonide for induction of remission in ulcerative colitis (Review)
*Probiotics for the prevention of Clostridium difficile-associated diarrhea in adults and children (Review)
*Deprescribing versus continuation of chronic proton pump inhibitor use in adults (Review)
*Prevention of NSAID-induced gastroduodenal ulcers (Review)
*Methotrexate for maintenance of remission in Crohn's disease (Review)

14) OB/GYN STUDIES
*[http://www.ncbi.nlm.nih.gov/pubmed/25601350 Comparative contraceptive effectiveness of levonorgestrel-releasing and copper IUD Devices]
*[http://www.ncbi.nlm.nih.gov/pubmed/29211679 Hormonal contraception and the risk of breast cancer]
*[http://www.ncbi.nlm.nih.gov/pubmed/30322986 Sexual behaviours in adolescent girls before and after introduction of the HPV]
*[http://www.ncbi.nlm.nih.gov/pubmed/30181338 Intramuscular vs intravenous oxytocin to prevent postpartum haemorrhage at vaginal delivery]
*[http://www.ncbi.nlm.nih.gov/pubmed/27682034 Azithromycin Prophylaxis for Cesarean Delivery]
*[http://www.ncbi.nlm.nih.gov/pubmed/28461374 Antibiotics during pregnancy and risk of spontaneous abortion]

File:Antibiotic Sensitivity Chart 2024.pdf

2024-12-18T16:19:44Z

JamesMcCormack: Uploaded a work by James McCormack, Fawziah Lalji, Tim Lau, Cesilia Nishi, Solomon Chow from The people below created it with UploadWizard

=={{int:filedesc}}==
{{Information
|description={{en|1=Antibiotic Chart}}
|date=2024-12-18
|source=The people below created it
|author= James McCormack, Fawziah Lalji, Tim Lau, Cesilia Nishi, Solomon Chow
|permission=
|other versions=
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=={{int:license-header}}==
{{cc-by-sa-4.0}}

Evidence Appraisal Integrated Activities

2024-11-17T23:56:47Z

JamesMcCormack:

'''OBJECTIVE'''

To critically appraise studies, develop a brief synopsis of the trial results, succinctly present the results and then put the results into a proper clinical context

'''INITIAL PRE-READING'''

'''How To Critically Appraise an RCT In 10 minutes'''
*[https://itunes.apple.com/ca/book/how-to-critically-appraise/id524600667?mt=11 iBook/iPad version]
*[https://therapeuticseducation.org/sites/therapeuticseducation.org/files/Ten_Minute_Critical_Appraisal.pdf PDF version]
Watch this video
[http://youtu.be/QUW0Q8tXVUc Viva La Evidence]

'''Study Results at Your Fingertips'''
*[https://mystudies.org MyStudies] - Free access

'''INTEGRATION ACTIVITY FORMAT'''
# Students placed in groups of ~ 5-7
# Each group chooses one of the studies below to review
# Students then work in pairs and develop a one-slide critical appraisal and results synopsis
# One to two students in each group will be chosen at random to present their findings to the class
# A discussion about the appraisal and the appropriate clinical context for the results is had with the entire class for each study

'''MODULE'''
[[File:Screen Shot 2022-01-09 at 10.00.16 AM.jpg|thumb|'''TRIAL PRESENTATION FORMAT'''|none]]

Studies chosen include landmark studies and/or studies that address important therapeutic issues for the particular module

'''ACADEMIC YEAR 1 - FIRST TERM'''

1) FOUNDATION STUDIES (Groups)
*[https://pubmed.ncbi.nlm.nih.gov/37952131 SELECT] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/12466506 AFFIRM] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/22085343 AIM-HIGH] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/10639539 HOPE] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/18378519 HYVET] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/15007110 PROVE-IT] Groups 6,18,30
*[http://www.ncbi.nlm.nih.gov/pubmed/15755765 TNT] Groups 7,19,31
*[https://pubmed.ncbi.nlm.nih.gov/26378978 EMPAREG] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/17984165 ILLUMINATE] Groups 9,21,33
*[https://pubmed.ncbi.nlm.nih.gov/26551272/ SPRINT] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/15325833 CARDS] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/12117397 WHI] Groups 12,24,36

'''ACADEMIC YEAR 1 - SECOND TERM'''

2) INTRO TO INFECTIOUS DISEASE STUDIES

[https://therapeuticseducation.org/sites/therapeuticseducation.org/files/Antibiotic_Sensitivity_FINAL_Nov_2019.pdf The "Best" Antibiotic Sensitivity Chart Ever]
*[http://www.ncbi.nlm.nih.gov/pubmed/17567657 IV vs PO antibiotics] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/24603565 Delayed antibiotics for respiratory tract infections] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/11159657 Delayed antibiotics for otitis media] Groups 3,15,27
*[https://pubmed.ncbi.nlm.nih.gov/27455166/ Duration of treatment for community acquired pneumonia] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/22726802 Duration of treatment for pyelonephritis] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/25830421 Choice of antibiotic for community acquired pneumonia-1] Groups 6,18,30
*[http://www.ncbi.nlm.nih.gov/pubmed/25286173 Choice of antibiotic for community acquired pneumonia-2] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/20647284 HPV vaccine study] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/7966893 Influenza vaccine study] Groups 9,21,33
*[https://pubmed.ncbi.nlm.nih.gov/33301246/ COVID vaccine Pfizer] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/27626517 Herpes zoster vaccine study 1] Groups 11,23,35
*[https://www.ncbi.nlm.nih.gov/pubmed/25916341 Herpes zoster vaccine study 3] Groups 12,24,36

3) MUSCULOSKELETAL STUDIES

*[http://www.ncbi.nlm.nih.gov/pubmed/28199814 Baricitinib versus Placebo or Adalimumab in Rheumatoid Arthritis] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/0010979111 CLASS – celecoxib vs NSAIDs] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/26501533 Naproxen with cyclobenzaprine, oxycodone/acetaminophen, or placebo for low back pain] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/24395557 Glucosamine and chondroitin for OA] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/12546607 Acetaminophen vs diclofenac for OA] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/23964752 Diclofenac gel for acute neck pain] Groups 6,18,30
*[https://pubmed.ncbi.nlm.nih.gov/15468367/ Topical diclofenac vs oral diclofenac] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/25064594 Acetaminophen for low back pain] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/7611589 Misoprostol and NSAID induced ulcers] Groups 9,21,33
*[http://www.ncbi.nlm.nih.gov/pubmed/20131255 Low dose vs high dose colchicine for gout] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/22508468 TEAR - oral triple therapy versus etanercept plus methotrexate in early aggressive rheumatoid arthritis] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/25589511 MOVES - Glucosamine and chondroitin for OA for moderate to severe pain] Groups 12,24,36

4) DERMATOLOGY STUDIES

*[https://www.ncbi.nlm.nih.gov/pubmed/9598014 Glycolic acid 5% Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/21896132 Glycolic acid 10% Acne]
*[https://www.ncbi.nlm.nih.gov/pubmed/14531866 Petrolatum vs Ceramide/skin related lipids Hand Dermatitis]
*[https://www.ncbi.nlm.nih.gov/pubmed/11896774 Vitamin C Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/17515510 Retinol (VitaminA) Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/21896129 Hyaluronic acid Atopic Dermatitis]

5) EENT STUDIES

[http://www.amstar.ca/docs/AMSTARguideline.pdf AMSTAR meta-analysis checklist]

'''Scenario 1 - Otitis Media''' - GROUPS 1, 7, 18, 19, 25, 36

Anthony Martin arrives at your pharmacy somewhat frustrated since his family physician declined to write an antibiotic prescription for his two and half year old son, Oscar. His symptoms started yesterday afternoon - Oscar complains of right ear pain but there is no discharge. Rectal temperature taken today was 38.5 degrees. His wife is sure Oscar has an ear infection since the last time he had these same symptoms, that was ultimately the diagnosis. Mr. Martin asks if you think buying acetaminophen is really “enough”?

[https://pubmed.ncbi.nlm.nih.gov/26099233/ Antibiotics for acute otitis media in children]

'''Scenario 2 - Allergic Rhinitis''' - GROUPS 2, 8, 17, 20, 26, 35

Ruby Parmar is a firefighter. She is plagued by sinus congestion (preventing her from sleeping) and a runny nose associated with seasonal allergies. Her prescription for intranasal triamcinolone is typically effective, but she would like to know if a non-sedating anti-allergy pill would work just as well since it’s inconvenient carrying around the “nose spray”.

[https://www.ncbi.nlm.nih.gov/pubmed/28234147 Intranasal steroids vs antihistamines for allergic rhinitis]

'''Scenario 3 - Acute Sinusitis''' - GROUPS 3, 9, 16, 21, 27, 34

You are seeing a patient in clinic before her appointment with the primary care physician. She was feeling unwell with a “flu” last week. While most of her symptoms have resolved (cough, fever), the nasal congestion and discharge persists and so she has made an appointment (she is an otherwise healthy 32 year old with treated thyroid disease). She would like your advice for what treatment she should ask the doctor to prescribe.

[http://www.ncbi.nlm.nih.gov/pubmed/24293353 Intranasal steroids for acute sinusitis]

'''Scenario 4 - Glaucoma''' - GROUPS 4, 10, 15, 22, 28, 33

Mrs. Ada Waters is a 63 year-old woman you. Her ophthalmologist prescribed timolol and xalatan eye drops for treatment of open angle glaucoma. She has never really felt much different on treatment since she recovered from her first episode (of acute angle closure glaucoma requiring ER visit) and surgery. She asks you if the treatment is really making a difference.

[https://www.ncbi.nlm.nih.gov/pubmed/17943780 Interventions for open angle glaucoma]

'''Scenario 5 - Sore Throat''' - GROUPS 5, 11, 14, 23, 29, 32

You have a good friend who is applying for pharmacy. Her invitation for the multiple-mini interview (MMI) is coming up soon, but she is starting to experience a sore throat. While she is worried about not being able to speak through all of those stations, she knows she often gets a terrible headache along with her sore throat. She has an unused prescription for amoxicillin (unexpired) and wonders if you recommend for her to take it.

[https://pubmed.ncbi.nlm.nih.gov/34881426/ Antibiotics for sore throat]

'''Scenario 6 - Conjunctivitis''' - GROUPS 6, 12, 13, 24, 30, 31

A man comes to your pharmacy (he appears in his early twenties) complaining of “pink eye”. He has had a pink discolouration and discharge from his left eye for two days. He asks if the OTC antibiotic eye drops (he’s holding a product with polymixin B) are any better than “waiting it out”.

[https://www.ncbi.nlm.nih.gov/pubmed/22972049 Antibiotics for acute conjunctivitis]

6) HEMATOLOGY STUDIES

None so far

'''ACADEMIC YEAR 2 - FIRST TERM'''

7) RESPIROLOGY STUDIES
[[File:IA COPD info.pdf|thumb]]

*[http://www.ncbi.nlm.nih.gov/pubmed/2062329 First inhaled steroid study] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/22938706 Tiotropium in asthma] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/21324520 Inhaled steroid in children] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/29768149 Combined Budesonide–Formoterol as Needed in Mild Asthma] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/15223858 Doubling dose of inhaled corticosteroid] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/29768147 As-Needed Budesonide–Formoterol versus Maintenance Budesonide in Mild Asthma] Groups 6,18,30
*[http://www.ncbi.nlm.nih.gov/pubmed/27181606 Indacaterol-glycopyrronium VS salmeterol/fluticasone in COPD] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/21428765 Tiotropium VS salmeterol in COPD] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/23695200 Short VS long steroids for COPD exacerbation] Groups 9,21,33
*[http://www.ncbi.nlm.nih.gov/pubmed/25196117 Stopping inhaled steroids in COPD] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/29668352 Once-Daily Single-Inhaler Triple versus Dual Therapy in Patients with COPD] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/28877011 Tezepelumab in Adults with Uncontrolled Asthma] Groups 12,24,36

8) CARDIOVASCULAR STUDIES

SESSION 1

*[https://www.ncbi.nlm.nih.gov/pubmed/4862069 VA1] (Group 1, 13, 25)
*[https://www.ncbi.nlm.nih.gov/pubmed/4914579 VA 2] (Group 2, 14, 26)
*[https://pubmed.ncbi.nlm.nih.gov/33186492 Polycap Study 3] (Group 3, 15, 27)
*[http://www.ncbi.nlm.nih.gov/pubmed/20228401 ACCORD-BP] (Group 4, 16, 28)
*[https://www.ncbi.nlm.nih.gov/pubmed/26551272 SPRINT] (Group 5, 17, 29)
*[http://www.ncbi.nlm.nih.gov/pubmed/2883575 CONSENSUS] (Group 6,18,30)
*[https://pubmed.ncbi.nlm.nih.gov/31535829/ DAPA-HF] (Group 7, 19, 31)
*[https://pubmed.ncbi.nlm.nih.gov/25176939/ CONFIRM-HF] (Group 8, 20, 32)
*[http://www.ncbi.nlm.nih.gov/pubmed/12457784 PROSPER] (Group 9, 21, 33)
*[http://www.ncbi.nlm.nih.gov/pubmed/27040132 HOPE-3] (Group 10, 22, 34)
*[http://www.ncbi.nlm.nih.gov/pubmed/12114036 Heart Protection Study (HPS)] (Group 11, 23, 35)
*[http://www.ncbi.nlm.nih.gov/pubmed/30415628 REDUCE-IT] (Group 12, 24, 36)

[[File:CV Case.pdf|thumb|CV case|left]]

SESSION 2

'''The Guideline Case'''

A 63 y/o patient with CHOOSE ONE (⬆︎HTN/⬆︎Chol/⬆︎glucose/HF/A fib) and using the guideline determine:
# their 5yr/10yr risks of mortality/CVD events
# the potential benefit
# the potential side effects (with magnitude)
# words/sentiment patient values and preferences/SDM

Atrial fibrillation - Groups 1,13,25,2,14,26
*[https://www.onlinecjc.ca/article/S0828-282X(18)31062-6/pdf 2018 Atrial fibrillation guidelines]
Diabetes - Groups 3,15,27,4,16,28
*[http://guidelines.diabetes.ca/docs/CPG-2018-full-EN.pdf 2018 Diabetes guidelines]
Lipid Simplified - Groups 5,17,29,6,18,30
*[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4607330/pdf/0610857.pdf 2015 Simplified lipid guidelines]
Lipid - Groups 7,19,31,8,20,32
*[http://www.onlinecjc.ca/article/S0828-282X(16)30732-2/pdf 2016 Lipid guidelines]
Heart failure - Groups 9,21,33,10,22,34
*[http://www.onlinecjc.ca/article/S0828-282X(17)30973-X/pdf 2017 Heart failure guidelines]
Hypertension - Groups 11,23,35,12,24,36
*[https://www.onlinecjc.ca/article/S0828-282X(18)30183-1/pdf 2018 Hypertension guidelines]

OPTIONAL SESSION
*[http://www.ncbi.nlm.nih.gov/pubmed/16899775 SPARCL]
*[http://www.ncbi.nlm.nih.gov/pubmed/10471456 RALES]
*[http://www.ncbi.nlm.nih.gov/pubmed/11386263 Carvedilol in heart failure]
*[http://www.ncbi.nlm.nih.gov/pubmed/18460663 WAFACS]
*[http://www.ncbi.nlm.nih.gov/pubmed/10376614 MERIT-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/25176015 PARADIGM-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/24490264 High-dose multivitamins after MI]
*[http://www.ncbi.nlm.nih.gov/pubmed/7911176 Mediterranean Diet after MI]
*[http://www.ncbi.nlm.nih.gov/pubmed/15337732 A TO Z]
*[http://www.ncbi.nlm.nih.gov/pubmed/21073363 EMPHASIS-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/12853193 COMET]
*[http://www.ncbi.nlm.nih.gov/pubmed/24716680 TOPCAT]
*[http://www.ncbi.nlm.nih.gov/pubmed/26039521 IMPROVE-IT]

'''ACADEMIC YEAR 2 - SECOND TERM'''

9) NEPHROLOGY STUDIES

None so far

10) ENDOCRINOLOGY[[File:IA ENDO LAYOUT 1.pdf|left|thumb|IA ENDO LAYOUT]]

'''RISK ASSESSMENT CASES FOR DIABETES AND OSTEOPOROSIS'''

'''1) DIABETES CASE'''

66 y/o white male who was diagnosed with diabetes 8 years ago

* His blood pressure over the last year has been roughly 145/80 mmHg - at present untreated
* A1c = 8%, no diabetes meds, non-smoker, BMI ~30
* Total cholesterol is 6 mmol/L, his HDL is 2 mmol/L, non-HDL = 6 minus 2, not on a statin
* No retinopathy, urine albumin-to-creatinine ratio (UACR) = 15ug/mg (7mg/mmol),
* Serum creatinine = 70 micromol/L, waist circumference 100 cm
* GFR 75 mL/min/1.73m2
* In normal sinus rhythm
* Age at end of highest education = 19
* Mother alive, father died of a heart attack at age 80

'''Calculate Risks'''

'''CVD RISK ESTIMATES''' - list the endpoints described by the specific calculator

Framingham - xx% - 10-year risk - also if no diabetes xx%

ASCVD - xx% - 10-year risk - also if no diabetes xx%

'''The Calculator'''
*CVD CALCULATOR
https://decisionaid.ca/cvd/

'''DIABETES COMPLICATIONS RISK ESTIMATES''' - list the endpoints described by the specific calculator

xx% - also 10-year risk if A1c 9, 8, 7 and 6

also get risk of kidney failure, vision loss, pressure sensation loss – also if A1c 9, 8,7,6

'''The Calculator'''
*DIABETES DECISION AID
http://decisionaid.ca/diabetes/

'''BENEFITS AND HARMS'''

Use the [https://guidelines.diabetes.ca/cpg/chapter-13-2020-update 2020 diabetes guidelines] and/or Diabetes Decision Aid to get estimates of benefits and harms and also use the MyStudies synopsis listed below

'''COSTS'''

Try using [https://pricingdoc.acfp.ca Pricing Doc] to get costs

'''Groups 1,13,25'''

* Metformin - UKPDS 34 [https://mystudies.org/studies.php#studies/28929e89-d01e-4b11-8e67-4d7086f9e4aa/outcome MyStudies Data]

'''Groups 2,14,26'''

* Sulfonlyureas - UKPDS 33 [https://mystudies.org/studies.php#studies/5eadb5dd-d403-4c13-b03e-d4f8d28c96ba/outcome MyStudies Data]

'''Groups 3,15,27'''

* Insulin - ORIGIN [https://mystudies.org/studies.php#studies/f611818f-2e69-4952-b55e-661116bd84b6/outcome MyStudies Data]

'''Groups 4,16,28'''

* SGLT2 - EMPA-REG OUTCOME [https://mystudies.org/studies.php#studies/32e9cf1a-f33e-480b-91ca-6f28a4dcf862/outcome MyStudies Data]

'''Groups 5,17,29'''

* GLP - LEADER [https://mystudies.org/studies.php#studies/1adbc9a1-7603-40f1-ac15-b813ce1f0ad6/outcome MyStudies Data]

'''Groups 6,18,30'''

* DPP4 - TECOS [https://mystudies.org/studies.php#studies/8659968a-cefb-4f99-b4ae-8b9b659acbd5/outcome MyStudies Data]

'''Groups 7,19,31'''

* Intensive treatment – small scale - STENO [https://mystudies.org/studies.php#studies/39d423e3-af57-40c8-ab7a-cbc7f389bdb6/paper MyStudies Data]

'''Groups 8,20,32'''

* Intensive treatment – large scale - ADDITION-Europe - [https://mystudies.org/studies.php#studies/5e07d86d-aa92-4db9-a283-76080db4b6fd/outcome MyStudies Data]

'''2) OSTEOPOROSIS CASE'''

60 y/o female

* 72 kg, 1.69m, BMI = 25.2
* t-score of -2.5
* Worried about falling and getting a hip fracture
* A friend recently had an atraumatic fracture from simply tripping and falling over in the snow
* No other risk factors

'''Calculate Risks'''

'''FRACTURE RISK ESTIMATES''' - list the endpoints described by the specific calculator

Major osteoporotic fracture - xx% - 10-year risk – if no BMD (just BMI), and then if they had a BMD t-Score of -2.0, -2.5, and -3.0

Hip fracture - - xx% - 10-year risk – if no BMD (just BMI) and if you have a BMD xx% - 10-year risk – if no BMD, and then if they had a BMD T-Score of -2.0, -2.5, and -3.0

'''The Calculator'''

* FRACTURE CALCULATOR

[https://frax.shef.ac.uk/frax/tool.aspx?country=19 Frax Tool - Canada]

'''BENEFITS AND HARMS'''

Use the [https://www.cmaj.ca/content/195/39/E1333 2023 Osteoporosis Guideline] and/or your osteoporosis lecture notes to get the benefits and apply these to your patient, and also get the harms

'''COSTS'''

Try using [https://pricingdoc.acfp.ca Pricing Doc] to get costs

'''Groups 9,21,33'''

* Activity

'''Groups 10,22,34'''

* Calcium/Vitamin D

'''Groups 11,23,35'''

* Bisphosphonates

'''Groups 12,24,36'''

* Denosumab

11) NEUROLOGY STUDIES

*[http://www.ncbi.nlm.nih.gov/pubmed/16717269 Opioids for chronic non-cancer pain] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/29509867 Effect of Opioid vs Nonopioid Medications on Pain-Related Function in Patients With Chronic Back Pain] Groups 2,14,26
*[https://www.ncbi.nlm.nih.gov/pubmed/31291515 Galcanezumab for prevention of cluster headaches] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/27150433 Immediate or delayed treatment of a first seizure] Groups 4,16,28
*[https://www.ncbi.nlm.nih.gov/pubmed/31291516 Rimegepant for episodic migraine] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/26212846 Sleep restriction for insomnia] Groups 6,18,30
*[https://www.ncbi.nlm.nih.gov/pubmed/25957224 CHANCE] Groups 7,19,31
*[https://www.ncbi.nlm.nih.gov/pubmed/16899775 SPARCL] Groups 8,20,32
*[https://www.ncbi.nlm.nih.gov/pubmed/29171821 Erenumab for episodic migraine] Groups 9,21,33
*[https://www.ncbi.nlm.nih.gov/pubmed/24733354 Reduction of benzodiazepines through education] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/26035341 Patient controlled opioid analgesia versus non-patient controlled opioid analgesia for postoperative pain] Groups 11,23,35
*[https://www.ncbi.nlm.nih.gov/pubmed/11589932 PROGRESS] Groups 12,24,36

'''ACADEMIC YEAR 3'''

12) PSYCHIATRY STUDIES

[[:File:2021 Psych Evidence Appraisal - Intro Slides.pdf|Psychiatry Rating Scales Introduction]]

* Study 1: [http://www.ncbi.nlm.nih.gov/pubmed/16554525 STAR*D (Level 2)] Bupropion-SR, sertraline, or venlafaxine-XR after failure of SSRIs for depression
* Study 2: [http://www.ncbi.nlm.nih.gov/pubmed/29477251 Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder]
* Study 3: [https://pubmed.ncbi.nlm.nih.gov/33862018/ Long-acting injectable versus oral antipsychotics for the maintenance treatment of schizophrenia]
* Study 4: [https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2725088 Association of Antipsychotic Polypharmacy vs Monotherapy With Psychiatric Rehospitalization Among Adults With Schizophrenia]
* Study 5: [https://www.ncbi.nlm.nih.gov/pubmed/29490359 Real-world Effectiveness of Pharmacologic Treatments for the Prevention of Bipolar Disorder]
* Study 6: [http://www.ncbi.nlm.nih.gov/pubmed/20092882 BALANCE] Combination lithium and valproate therapy versus monotherapy for relapse prevention in bipolar I disorder
[[File:ChatGPT directions.jpg|thumb|ChatGPT Directions]]
13) GASTROENTEROLOGY STUDIES - LINKS ON CANVAS

*Short-term treatment for gastro-oesophageal reflux disease-like symptoms and endoscopy negative reflux disease (Review)
*Oral budesonide for induction of remission in ulcerative colitis (Review)
*Probiotics for the prevention of Clostridium difficile-associated diarrhea in adults and children (Review)
*Deprescribing versus continuation of chronic proton pump inhibitor use in adults (Review)
*Prevention of NSAID-induced gastroduodenal ulcers (Review)
*Methotrexate for maintenance of remission in Crohn's disease (Review)

14) OB/GYN STUDIES
*[http://www.ncbi.nlm.nih.gov/pubmed/25601350 Comparative contraceptive effectiveness of levonorgestrel-releasing and copper IUD Devices]
*[http://www.ncbi.nlm.nih.gov/pubmed/29211679 Hormonal contraception and the risk of breast cancer]
*[http://www.ncbi.nlm.nih.gov/pubmed/30322986 Sexual behaviours in adolescent girls before and after introduction of the HPV]
*[http://www.ncbi.nlm.nih.gov/pubmed/30181338 Intramuscular vs intravenous oxytocin to prevent postpartum haemorrhage at vaginal delivery]
*[http://www.ncbi.nlm.nih.gov/pubmed/27682034 Azithromycin Prophylaxis for Cesarean Delivery]
*[http://www.ncbi.nlm.nih.gov/pubmed/28461374 Antibiotics during pregnancy and risk of spontaneous abortion]

Evidence Appraisal Integrated Activities

2024-11-17T23:54:37Z

JamesMcCormack:

'''OBJECTIVE'''

To critically appraise studies, develop a brief synopsis of the trial results, succinctly present the results and then put the results into a proper clinical context

'''INITIAL PRE-READING'''

'''How To Critically Appraise an RCT In 10 minutes'''
*[https://itunes.apple.com/ca/book/how-to-critically-appraise/id524600667?mt=11 iBook/iPad version]
*[https://therapeuticseducation.org/sites/therapeuticseducation.org/files/Ten_Minute_Critical_Appraisal.pdf PDF version]
Watch this video
[http://youtu.be/QUW0Q8tXVUc Viva La Evidence]

'''Study Results at Your Fingertips'''
*[https://mystudies.org MyStudies] - Free access

'''INTEGRATION ACTIVITY FORMAT'''
# Students placed in groups of ~ 5-7
# Each group chooses one of the studies below to review
# Students then work in pairs and develop a one-slide critical appraisal and results synopsis
# One to two students in each group will be chosen at random to present their findings to the class
# A discussion about the appraisal and the appropriate clinical context for the results is had with the entire class for each study

'''MODULE'''
[[File:Screen Shot 2022-01-09 at 10.00.16 AM.jpg|thumb|'''TRIAL PRESENTATION FORMAT'''|none]]

Studies chosen include landmark studies and/or studies that address important therapeutic issues for the particular module

'''ACADEMIC YEAR 1 - FIRST TERM'''

1) FOUNDATION STUDIES (Groups)
*[https://pubmed.ncbi.nlm.nih.gov/37952131 SELECT] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/12466506 AFFIRM] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/22085343 AIM-HIGH] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/10639539 HOPE] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/18378519 HYVET] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/15007110 PROVE-IT] Groups 6,18,30
*[http://www.ncbi.nlm.nih.gov/pubmed/15755765 TNT] Groups 7,19,31
*[https://pubmed.ncbi.nlm.nih.gov/26378978 EMPAREG] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/17984165 ILLUMINATE] Groups 9,21,33
*[https://pubmed.ncbi.nlm.nih.gov/26551272/ SPRINT] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/15325833 CARDS] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/12117397 WHI] Groups 12,24,36

'''ACADEMIC YEAR 1 - SECOND TERM'''

2) INTRO TO INFECTIOUS DISEASE STUDIES

[https://therapeuticseducation.org/sites/therapeuticseducation.org/files/Antibiotic_Sensitivity_FINAL_Nov_2019.pdf The "Best" Antibiotic Sensitivity Chart Ever]
*[http://www.ncbi.nlm.nih.gov/pubmed/17567657 IV vs PO antibiotics] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/24603565 Delayed antibiotics for respiratory tract infections] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/11159657 Delayed antibiotics for otitis media] Groups 3,15,27
*[https://pubmed.ncbi.nlm.nih.gov/27455166/ Duration of treatment for community acquired pneumonia] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/22726802 Duration of treatment for pyelonephritis] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/25830421 Choice of antibiotic for community acquired pneumonia-1] Groups 6,18,30
*[http://www.ncbi.nlm.nih.gov/pubmed/25286173 Choice of antibiotic for community acquired pneumonia-2] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/20647284 HPV vaccine study] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/7966893 Influenza vaccine study] Groups 9,21,33
*[https://pubmed.ncbi.nlm.nih.gov/33301246/ COVID vaccine Pfizer] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/27626517 Herpes zoster vaccine study 1] Groups 11,23,35
*[https://www.ncbi.nlm.nih.gov/pubmed/25916341 Herpes zoster vaccine study 3] Groups 12,24,36

3) MUSCULOSKELETAL STUDIES

*[http://www.ncbi.nlm.nih.gov/pubmed/28199814 Baricitinib versus Placebo or Adalimumab in Rheumatoid Arthritis] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/0010979111 CLASS – celecoxib vs NSAIDs] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/26501533 Naproxen with cyclobenzaprine, oxycodone/acetaminophen, or placebo for low back pain] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/24395557 Glucosamine and chondroitin for OA] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/12546607 Acetaminophen vs diclofenac for OA] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/23964752 Diclofenac gel for acute neck pain] Groups 6,18,30
*[https://pubmed.ncbi.nlm.nih.gov/15468367/ Topical diclofenac vs oral diclofenac] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/25064594 Acetaminophen for low back pain] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/7611589 Misoprostol and NSAID induced ulcers] Groups 9,21,33
*[http://www.ncbi.nlm.nih.gov/pubmed/20131255 Low dose vs high dose colchicine for gout] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/22508468 TEAR - oral triple therapy versus etanercept plus methotrexate in early aggressive rheumatoid arthritis] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/25589511 MOVES - Glucosamine and chondroitin for OA for moderate to severe pain] Groups 12,24,36

4) DERMATOLOGY STUDIES

*[https://www.ncbi.nlm.nih.gov/pubmed/9598014 Glycolic acid 5% Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/21896132 Glycolic acid 10% Acne]
*[https://www.ncbi.nlm.nih.gov/pubmed/14531866 Petrolatum vs Ceramide/skin related lipids Hand Dermatitis]
*[https://www.ncbi.nlm.nih.gov/pubmed/11896774 Vitamin C Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/17515510 Retinol (VitaminA) Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/21896129 Hyaluronic acid Atopic Dermatitis]

5) EENT STUDIES

[http://www.amstar.ca/docs/AMSTARguideline.pdf AMSTAR meta-analysis checklist]

'''Scenario 1 - Otitis Media''' - GROUPS 1, 7, 18, 19, 25, 36

Anthony Martin arrives at your pharmacy somewhat frustrated since his family physician declined to write an antibiotic prescription for his two and half year old son, Oscar. His symptoms started yesterday afternoon - Oscar complains of right ear pain but there is no discharge. Rectal temperature taken today was 38.5 degrees. His wife is sure Oscar has an ear infection since the last time he had these same symptoms, that was ultimately the diagnosis. Mr. Martin asks if you think buying acetaminophen is really “enough”?

[https://pubmed.ncbi.nlm.nih.gov/26099233/ Antibiotics for acute otitis media in children]

'''Scenario 2 - Allergic Rhinitis''' - GROUPS 2, 8, 17, 20, 26, 35

Ruby Parmar is a firefighter. She is plagued by sinus congestion (preventing her from sleeping) and a runny nose associated with seasonal allergies. Her prescription for intranasal triamcinolone is typically effective, but she would like to know if a non-sedating anti-allergy pill would work just as well since it’s inconvenient carrying around the “nose spray”.

[https://www.ncbi.nlm.nih.gov/pubmed/28234147 Intranasal steroids vs antihistamines for allergic rhinitis]

'''Scenario 3 - Acute Sinusitis''' - GROUPS 3, 9, 16, 21, 27, 34

You are seeing a patient in clinic before her appointment with the primary care physician. She was feeling unwell with a “flu” last week. While most of her symptoms have resolved (cough, fever), the nasal congestion and discharge persists and so she has made an appointment (she is an otherwise healthy 32 year old with treated thyroid disease). She would like your advice for what treatment she should ask the doctor to prescribe.

[http://www.ncbi.nlm.nih.gov/pubmed/24293353 Intranasal steroids for acute sinusitis]

'''Scenario 4 - Glaucoma''' - GROUPS 4, 10, 15, 22, 28, 33

Mrs. Ada Waters is a 63 year-old woman you. Her ophthalmologist prescribed timolol and xalatan eye drops for treatment of open angle glaucoma. She has never really felt much different on treatment since she recovered from her first episode (of acute angle closure glaucoma requiring ER visit) and surgery. She asks you if the treatment is really making a difference.

[https://www.ncbi.nlm.nih.gov/pubmed/17943780 Interventions for open angle glaucoma]

'''Scenario 5 - Sore Throat''' - GROUPS 5, 11, 14, 23, 29, 32

You have a good friend who is applying for pharmacy. Her invitation for the multiple-mini interview (MMI) is coming up soon, but she is starting to experience a sore throat. While she is worried about not being able to speak through all of those stations, she knows she often gets a terrible headache along with her sore throat. She has an unused prescription for amoxicillin (unexpired) and wonders if you recommend for her to take it.

[https://pubmed.ncbi.nlm.nih.gov/34881426/ Antibiotics for sore throat]

'''Scenario 6 - Conjunctivitis''' - GROUPS 6, 12, 13, 24, 30, 31

A man comes to your pharmacy (he appears in his early twenties) complaining of “pink eye”. He has had a pink discolouration and discharge from his left eye for two days. He asks if the OTC antibiotic eye drops (he’s holding a product with polymixin B) are any better than “waiting it out”.

[https://www.ncbi.nlm.nih.gov/pubmed/22972049 Antibiotics for acute conjunctivitis]

6) HEMATOLOGY STUDIES

None so far

'''ACADEMIC YEAR 2 - FIRST TERM'''

7) RESPIROLOGY STUDIES
[[File:IA COPD info.pdf|thumb]]

*[http://www.ncbi.nlm.nih.gov/pubmed/2062329 First inhaled steroid study] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/22938706 Tiotropium in asthma] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/21324520 Inhaled steroid in children] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/29768149 Combined Budesonide–Formoterol as Needed in Mild Asthma] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/15223858 Doubling dose of inhaled corticosteroid] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/29768147 As-Needed Budesonide–Formoterol versus Maintenance Budesonide in Mild Asthma] Groups 6,18,30
*[http://www.ncbi.nlm.nih.gov/pubmed/27181606 Indacaterol-glycopyrronium VS salmeterol/fluticasone in COPD] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/21428765 Tiotropium VS salmeterol in COPD] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/23695200 Short VS long steroids for COPD exacerbation] Groups 9,21,33
*[http://www.ncbi.nlm.nih.gov/pubmed/25196117 Stopping inhaled steroids in COPD] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/29668352 Once-Daily Single-Inhaler Triple versus Dual Therapy in Patients with COPD] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/28877011 Tezepelumab in Adults with Uncontrolled Asthma] Groups 12,24,36

8) CARDIOVASCULAR STUDIES

SESSION 1

*[https://www.ncbi.nlm.nih.gov/pubmed/4862069 VA1] (Group 1, 13, 25)
*[https://www.ncbi.nlm.nih.gov/pubmed/4914579 VA 2] (Group 2, 14, 26)
*[https://pubmed.ncbi.nlm.nih.gov/33186492 Polycap Study 3] (Group 3, 15, 27)
*[http://www.ncbi.nlm.nih.gov/pubmed/20228401 ACCORD-BP] (Group 4, 16, 28)
*[https://www.ncbi.nlm.nih.gov/pubmed/26551272 SPRINT] (Group 5, 17, 29)
*[http://www.ncbi.nlm.nih.gov/pubmed/2883575 CONSENSUS] (Group 6,18,30)
*[https://pubmed.ncbi.nlm.nih.gov/31535829/ DAPA-HF] (Group 7, 19, 31)
*[https://pubmed.ncbi.nlm.nih.gov/25176939/ CONFIRM-HF] (Group 8, 20, 32)
*[http://www.ncbi.nlm.nih.gov/pubmed/12457784 PROSPER] (Group 9, 21, 33)
*[http://www.ncbi.nlm.nih.gov/pubmed/27040132 HOPE-3] (Group 10, 22, 34)
*[http://www.ncbi.nlm.nih.gov/pubmed/12114036 Heart Protection Study (HPS)] (Group 11, 23, 35)
*[http://www.ncbi.nlm.nih.gov/pubmed/30415628 REDUCE-IT] (Group 12, 24, 36)

[[File:CV Case.pdf|thumb|CV case|left]]

SESSION 2

'''The Guideline Case'''

A 63 y/o patient with CHOOSE ONE (⬆︎HTN/⬆︎Chol/⬆︎glucose/HF/A fib) and using the guideline determine:
# their 5yr/10yr risks of mortality/CVD events
# the potential benefit
# the potential side effects (with magnitude)
# words/sentiment patient values and preferences/SDM

Atrial fibrillation - Groups 1,13,25,2,14,26
*[https://www.onlinecjc.ca/article/S0828-282X(18)31062-6/pdf 2018 Atrial fibrillation guidelines]
Diabetes - Groups 3,15,27,4,16,28
*[http://guidelines.diabetes.ca/docs/CPG-2018-full-EN.pdf 2018 Diabetes guidelines]
Lipid Simplified - Groups 5,17,29,6,18,30
*[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4607330/pdf/0610857.pdf 2015 Simplified lipid guidelines]
Lipid - Groups 7,19,31,8,20,32
*[http://www.onlinecjc.ca/article/S0828-282X(16)30732-2/pdf 2016 Lipid guidelines]
Heart failure - Groups 9,21,33,10,22,34
*[http://www.onlinecjc.ca/article/S0828-282X(17)30973-X/pdf 2017 Heart failure guidelines]
Hypertension - Groups 11,23,35,12,24,36
*[https://www.onlinecjc.ca/article/S0828-282X(18)30183-1/pdf 2018 Hypertension guidelines]

OPTIONAL SESSION
*[http://www.ncbi.nlm.nih.gov/pubmed/16899775 SPARCL]
*[http://www.ncbi.nlm.nih.gov/pubmed/10471456 RALES]
*[http://www.ncbi.nlm.nih.gov/pubmed/11386263 Carvedilol in heart failure]
*[http://www.ncbi.nlm.nih.gov/pubmed/18460663 WAFACS]
*[http://www.ncbi.nlm.nih.gov/pubmed/10376614 MERIT-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/25176015 PARADIGM-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/24490264 High-dose multivitamins after MI]
*[http://www.ncbi.nlm.nih.gov/pubmed/7911176 Mediterranean Diet after MI]
*[http://www.ncbi.nlm.nih.gov/pubmed/15337732 A TO Z]
*[http://www.ncbi.nlm.nih.gov/pubmed/21073363 EMPHASIS-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/12853193 COMET]
*[http://www.ncbi.nlm.nih.gov/pubmed/24716680 TOPCAT]
*[http://www.ncbi.nlm.nih.gov/pubmed/26039521 IMPROVE-IT]

'''ACADEMIC YEAR 2 - SECOND TERM'''

9) NEPHROLOGY STUDIES

None so far

10) ENDOCRINOLOGY[[File:IA ENDO LAYOUT 1.pdf|left|thumb|IA ENDO LAYOUT]]

'''RISK ASSESSMENT CASES FOR DIABETES AND OSTEOPOROSIS'''

'''1) DIABETES CASE'''

66 y/o white male who was diagnosed with diabetes 8 years ago

* His blood pressure over the last year has been roughly 145/80 mmHg - at present untreated
* A1c = 8%, no diabetes meds, non-smoker, BMI ~30
* Total cholesterol is 6 mmol/L, his HDL is 2 mmol/L, non-HDL = 6 minus 2, not on a statin
* No retinopathy, urine albumin-to-creatinine ratio (UACR) = 15ug/mg (7mg/mmol),
* Serum creatinine = 70 micromol/L, waist circumference 100 cm
* GFR 75 mL/min/1.73m2
* In normal sinus rhythm
* Age at end of highest education = 19
* Mother alive, father died of a heart attack at age 80

'''Calculate Risks'''

'''CVD RISK ESTIMATES''' - list the endpoints described by the specific calculator

Framingham - xx% - 10-year risk - also if no diabetes xx%

ASCVD - xx% - 10-year risk - also if no diabetes xx%

'''The Calculator'''
*CVD CALCULATOR
https://decisionaid.ca/cvd/

'''DIABETES COMPLICATIONS RISK ESTIMATES''' - list the endpoints described by the specific calculator

xx% - also 10-year risk if A1c 9, 8, 7 and 6

also get risk of kidney failure, vision loss, pressure sensation loss – also if A1c 9, 8,7,6

'''The Calculator'''
*DIABETES DECISION AID
http://decisionaid.ca/diabetes/

'''BENEFITS AND HARMS'''

Use the [https://guidelines.diabetes.ca/cpg/chapter-13-2020-update 2020 diabetes guidelines] and/or Diabetes Decision Aid to get estimates of benefits and harms and also use the MyStudies synopsis listed below

'''COSTS'''

Try using [https://pricingdoc.acfp.ca Pricing Doc] to get costs

'''Groups 1,13,25'''

* Metformin - UKPDS 34 [https://mystudies.org/studies.php#studies/28929e89-d01e-4b11-8e67-4d7086f9e4aa/outcome MyStudies Data]

'''Groups 2,14,26'''

* Sulfonlyureas - UKPDS 33 [https://mystudies.org/studies.php#studies/5eadb5dd-d403-4c13-b03e-d4f8d28c96ba/outcome MyStudies Data]

'''Groups 3,15,27'''

* Insulin - ORIGIN [https://mystudies.org/studies.php#studies/f611818f-2e69-4952-b55e-661116bd84b6/outcome MyStudies Data]

'''Groups 4,16,28'''

* SGLT2 - EMPA-REG OUTCOME [https://mystudies.org/studies.php#studies/32e9cf1a-f33e-480b-91ca-6f28a4dcf862/outcome MyStudies Data]

'''Groups 5,17,29'''

* GLP - LEADER [https://mystudies.org/studies.php#studies/1adbc9a1-7603-40f1-ac15-b813ce1f0ad6/outcome MyStudies Data]

'''Groups 6,18,30'''

* DPP4 - TECOS [https://mystudies.org/studies.php#studies/8659968a-cefb-4f99-b4ae-8b9b659acbd5/outcome MyStudies Data]

'''Groups 7,19,31'''

* Intensive treatment – small scale - STENO [https://mystudies.org/studies.php#studies/39d423e3-af57-40c8-ab7a-cbc7f389bdb6/paper MyStudies Data]

'''Groups 8,20,32'''

* Intensive treatment – large scale - ADDITION-Europe - [https://mystudies.org/studies.php#studies/5e07d86d-aa92-4db9-a283-76080db4b6fd/outcome MyStudies Data]

'''2) OSTEOPOROSIS CASE'''

60 y/o female

* 72 kg, 1.69m, BMI = 25.2
* t-score of -2.5
* Worried about falling and getting a hip fracture
* A friend recently had an atraumatic fracture from simply tripping and falling over in the snow
* No other risk factors

'''Calculate Risks'''

'''FRACTURE RISK ESTIMATES''' - list the endpoints described by the specific calculator

Major osteoporotic fracture - xx% - 10-year risk – if no BMD (just BMI), and then if they had a BMD t-Score of -2.0, -2.5, and -3.0

Hip fracture - - xx% - 10-year risk – if no BMD (just BMI) and if you have a BMD xx% - 10-year risk – if no BMD, and then if they had a BMD T-Score of -2.0, -2.5, and -3.0

'''The Calculator'''

* FRACTURE CALCULATOR

[https://frax.shef.ac.uk/frax/tool.aspx?country=19 Frax Tool - Canada]

'''BENEFITS AND HARMS'''

Use the [https://www.cmaj.ca/content/195/39/E1333 2023 Osteoporosis Guideline] and/or your osteoporosis lecture notes to get the benefits and apply these to your patient, and also get the harms

'''COSTS'''

Try using [https://pricingdoc.acfp.ca Pricing Doc] to get costs

'''Groups 9,21,33'''

* Activity

'''Groups 10,22,34'''

* Calcium/Vitamin D

'''Groups 11,23,35'''

* Bisphosphonates

'''Groups 12,24,36'''

* Denosumab

11) NEUROLOGY STUDIES

*[http://www.ncbi.nlm.nih.gov/pubmed/16717269 Opioids for chronic non-cancer pain] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/29509867 Effect of Opioid vs Nonopioid Medications on Pain-Related Function in Patients With Chronic Back Pain] Groups 2,14,26
*[https://www.ncbi.nlm.nih.gov/pubmed/31291515 Galcanezumab for prevention of cluster headaches] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/27150433 Immediate or delayed treatment of a first seizure] Groups 4,16,28
*[https://www.ncbi.nlm.nih.gov/pubmed/31291516 Rimegepant for episodic migraine] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/26212846 Sleep restriction for insomnia] Groups 6,18,30
*[https://www.ncbi.nlm.nih.gov/pubmed/25957224 CHANCE] Groups 7,19,31
*[https://www.ncbi.nlm.nih.gov/pubmed/16899775 SPARCL] Groups 8,20,32
*[https://www.ncbi.nlm.nih.gov/pubmed/29171821 Erenumab for episodic migraine] Groups 9,21,33
*[https://www.ncbi.nlm.nih.gov/pubmed/24733354 Reduction of benzodiazepines through education] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/26035341 Patient controlled opioid analgesia versus non-patient controlled opioid analgesia for postoperative pain] Groups 11,23,35
*[https://www.ncbi.nlm.nih.gov/pubmed/11589932 PROGRESS] Groups 12,24,36

'''ACADEMIC YEAR 3'''

12) PSYCHIATRY STUDIES

[[:File:2021 Psych Evidence Appraisal - Intro Slides.pdf|Psychiatry Rating Scales Introduction]]

* Study 1: [http://www.ncbi.nlm.nih.gov/pubmed/16554525 STAR*D (Level 2)] Bupropion-SR, sertraline, or venlafaxine-XR after failure of SSRIs for depression
* Study 2: [http://www.ncbi.nlm.nih.gov/pubmed/29477251 Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder]
* Study 3: [https://pubmed.ncbi.nlm.nih.gov/33862018/ Long-acting injectable versus oral antipsychotics for the maintenance treatment of schizophrenia]
* Study 4: [https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2725088 Association of Antipsychotic Polypharmacy vs Monotherapy With Psychiatric Rehospitalization Among Adults With Schizophrenia]
* Study 5: [https://www.ncbi.nlm.nih.gov/pubmed/29490359 Real-world Effectiveness of Pharmacologic Treatments for the Prevention of Bipolar Disorder]
* Study 6: [http://www.ncbi.nlm.nih.gov/pubmed/20092882 BALANCE] Combination lithium and valproate therapy versus monotherapy for relapse prevention in bipolar I disorder
[[File:ChatGPT directions.jpg|thumb|ChatGPT Directions]]
13) GASTROENTEROLOGY STUDIES - LINKS ON CANVAS

*Short-term treatment for gastro-oesophageal reflux disease-like symptoms and endoscopy negative reflux disease (Review)
*Oral budesonide for induction of remission in ulcerative colitis (Review)
*Probiotics for the prevention of Clostridium difficile-associated diarrhea in adults and children (Review)
*Deprescribing versus continuation of chronic proton pump inhibitor use in adults (Review)
*Prevention of NSAID-induced gastroduodenal ulcers (Review)
*Methotrexate for maintenance of remission in Crohn's disease (Review). *

14) OB/GYN STUDIES
*[http://www.ncbi.nlm.nih.gov/pubmed/25601350 Comparative contraceptive effectiveness of levonorgestrel-releasing and copper IUD Devices]
*[http://www.ncbi.nlm.nih.gov/pubmed/29211679 Hormonal contraception and the risk of breast cancer]
*[http://www.ncbi.nlm.nih.gov/pubmed/30322986 Sexual behaviours in adolescent girls before and after introduction of the HPV]
*[http://www.ncbi.nlm.nih.gov/pubmed/30181338 Intramuscular vs intravenous oxytocin to prevent postpartum haemorrhage at vaginal delivery]
*[http://www.ncbi.nlm.nih.gov/pubmed/27682034 Azithromycin Prophylaxis for Cesarean Delivery]
*[http://www.ncbi.nlm.nih.gov/pubmed/28461374 Antibiotics during pregnancy and risk of spontaneous abortion]

File:ChatGPT directions.jpg

2024-11-17T23:52:45Z

JamesMcCormack: Uploaded own work with UploadWizard

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File:ChatGPT directions.pdf

2024-11-17T23:49:13Z

JamesMcCormack: Uploaded own work with UploadWizard

Evidence Appraisal Integrated Activities

2024-09-19T14:59:59Z

JamesMcCormack:

'''OBJECTIVE'''

To critically appraise studies, develop a brief synopsis of the trial results, succinctly present the results and then put the results into a proper clinical context

'''INITIAL PRE-READING'''

'''How To Critically Appraise an RCT In 10 minutes'''
*[https://itunes.apple.com/ca/book/how-to-critically-appraise/id524600667?mt=11 iBook/iPad version]
*[https://therapeuticseducation.org/sites/therapeuticseducation.org/files/Ten_Minute_Critical_Appraisal.pdf PDF version]
Watch this video
[http://youtu.be/QUW0Q8tXVUc Viva La Evidence]

'''Study Results at Your Fingertips'''
*[https://mystudies.org MyStudies] - Free access

'''INTEGRATION ACTIVITY FORMAT'''
# Students placed in groups of ~ 5-7
# Each group chooses one of the studies below to review
# Students then work in pairs and develop a one-slide critical appraisal and results synopsis
# One to two students in each group will be chosen at random to present their findings to the class
# A discussion about the appraisal and the appropriate clinical context for the results is had with the entire class for each study

'''MODULE'''
[[File:Screen Shot 2022-01-09 at 10.00.16 AM.jpg|thumb|'''TRIAL PRESENTATION FORMAT'''|none]]

Studies chosen include landmark studies and/or studies that address important therapeutic issues for the particular module

'''ACADEMIC YEAR 1 - FIRST TERM'''

1) FOUNDATION STUDIES (Groups)
*[https://pubmed.ncbi.nlm.nih.gov/37952131 SELECT] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/12466506 AFFIRM] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/22085343 AIM-HIGH] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/10639539 HOPE] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/18378519 HYVET] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/15007110 PROVE-IT] Groups 6,18,30
*[http://www.ncbi.nlm.nih.gov/pubmed/15755765 TNT] Groups 7,19,31
*[https://pubmed.ncbi.nlm.nih.gov/26378978 EMPAREG] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/17984165 ILLUMINATE] Groups 9,21,33
*[https://pubmed.ncbi.nlm.nih.gov/26551272/ SPRINT] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/15325833 CARDS] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/12117397 WHI] Groups 12,24,36

'''ACADEMIC YEAR 1 - SECOND TERM'''

2) INTRO TO INFECTIOUS DISEASE STUDIES

[https://therapeuticseducation.org/sites/therapeuticseducation.org/files/Antibiotic_Sensitivity_FINAL_Nov_2019.pdf The "Best" Antibiotic Sensitivity Chart Ever]
*[http://www.ncbi.nlm.nih.gov/pubmed/17567657 IV vs PO antibiotics] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/24603565 Delayed antibiotics for respiratory tract infections] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/11159657 Delayed antibiotics for otitis media] Groups 3,15,27
*[https://pubmed.ncbi.nlm.nih.gov/27455166/ Duration of treatment for community acquired pneumonia] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/22726802 Duration of treatment for pyelonephritis] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/25830421 Choice of antibiotic for community acquired pneumonia-1] Groups 6,18,30
*[http://www.ncbi.nlm.nih.gov/pubmed/25286173 Choice of antibiotic for community acquired pneumonia-2] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/20647284 HPV vaccine study] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/7966893 Influenza vaccine study] Groups 9,21,33
*[https://pubmed.ncbi.nlm.nih.gov/33301246/ COVID vaccine Pfizer] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/27626517 Herpes zoster vaccine study 1] Groups 11,23,35
*[https://www.ncbi.nlm.nih.gov/pubmed/25916341 Herpes zoster vaccine study 3] Groups 12,24,36

3) MUSCULOSKELETAL STUDIES

*[http://www.ncbi.nlm.nih.gov/pubmed/28199814 Baricitinib versus Placebo or Adalimumab in Rheumatoid Arthritis] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/0010979111 CLASS – celecoxib vs NSAIDs] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/26501533 Naproxen with cyclobenzaprine, oxycodone/acetaminophen, or placebo for low back pain] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/24395557 Glucosamine and chondroitin for OA] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/12546607 Acetaminophen vs diclofenac for OA] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/23964752 Diclofenac gel for acute neck pain] Groups 6,18,30
*[https://pubmed.ncbi.nlm.nih.gov/15468367/ Topical diclofenac vs oral diclofenac] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/25064594 Acetaminophen for low back pain] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/7611589 Misoprostol and NSAID induced ulcers] Groups 9,21,33
*[http://www.ncbi.nlm.nih.gov/pubmed/20131255 Low dose vs high dose colchicine for gout] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/22508468 TEAR - oral triple therapy versus etanercept plus methotrexate in early aggressive rheumatoid arthritis] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/25589511 MOVES - Glucosamine and chondroitin for OA for moderate to severe pain] Groups 12,24,36

4) DERMATOLOGY STUDIES

*[https://www.ncbi.nlm.nih.gov/pubmed/9598014 Glycolic acid 5% Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/21896132 Glycolic acid 10% Acne]
*[https://www.ncbi.nlm.nih.gov/pubmed/14531866 Petrolatum vs Ceramide/skin related lipids Hand Dermatitis]
*[https://www.ncbi.nlm.nih.gov/pubmed/11896774 Vitamin C Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/17515510 Retinol (VitaminA) Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/21896129 Hyaluronic acid Atopic Dermatitis]

5) EENT STUDIES

[http://www.amstar.ca/docs/AMSTARguideline.pdf AMSTAR meta-analysis checklist]

'''Scenario 1 - Otitis Media''' - GROUPS 1, 7, 18, 19, 25, 36

Anthony Martin arrives at your pharmacy somewhat frustrated since his family physician declined to write an antibiotic prescription for his two and half year old son, Oscar. His symptoms started yesterday afternoon - Oscar complains of right ear pain but there is no discharge. Rectal temperature taken today was 38.5 degrees. His wife is sure Oscar has an ear infection since the last time he had these same symptoms, that was ultimately the diagnosis. Mr. Martin asks if you think buying acetaminophen is really “enough”?

[https://pubmed.ncbi.nlm.nih.gov/26099233/ Antibiotics for acute otitis media in children]

'''Scenario 2 - Allergic Rhinitis''' - GROUPS 2, 8, 17, 20, 26, 35

Ruby Parmar is a firefighter. She is plagued by sinus congestion (preventing her from sleeping) and a runny nose associated with seasonal allergies. Her prescription for intranasal triamcinolone is typically effective, but she would like to know if a non-sedating anti-allergy pill would work just as well since it’s inconvenient carrying around the “nose spray”.

[https://www.ncbi.nlm.nih.gov/pubmed/28234147 Intranasal steroids vs antihistamines for allergic rhinitis]

'''Scenario 3 - Acute Sinusitis''' - GROUPS 3, 9, 16, 21, 27, 34

You are seeing a patient in clinic before her appointment with the primary care physician. She was feeling unwell with a “flu” last week. While most of her symptoms have resolved (cough, fever), the nasal congestion and discharge persists and so she has made an appointment (she is an otherwise healthy 32 year old with treated thyroid disease). She would like your advice for what treatment she should ask the doctor to prescribe.

[http://www.ncbi.nlm.nih.gov/pubmed/24293353 Intranasal steroids for acute sinusitis]

'''Scenario 4 - Glaucoma''' - GROUPS 4, 10, 15, 22, 28, 33

Mrs. Ada Waters is a 63 year-old woman you. Her ophthalmologist prescribed timolol and xalatan eye drops for treatment of open angle glaucoma. She has never really felt much different on treatment since she recovered from her first episode (of acute angle closure glaucoma requiring ER visit) and surgery. She asks you if the treatment is really making a difference.

[https://www.ncbi.nlm.nih.gov/pubmed/17943780 Interventions for open angle glaucoma]

'''Scenario 5 - Sore Throat''' - GROUPS 5, 11, 14, 23, 29, 32

You have a good friend who is applying for pharmacy. Her invitation for the multiple-mini interview (MMI) is coming up soon, but she is starting to experience a sore throat. While she is worried about not being able to speak through all of those stations, she knows she often gets a terrible headache along with her sore throat. She has an unused prescription for amoxicillin (unexpired) and wonders if you recommend for her to take it.

[https://pubmed.ncbi.nlm.nih.gov/34881426/ Antibiotics for sore throat]

'''Scenario 6 - Conjunctivitis''' - GROUPS 6, 12, 13, 24, 30, 31

A man comes to your pharmacy (he appears in his early twenties) complaining of “pink eye”. He has had a pink discolouration and discharge from his left eye for two days. He asks if the OTC antibiotic eye drops (he’s holding a product with polymixin B) are any better than “waiting it out”.

[https://www.ncbi.nlm.nih.gov/pubmed/22972049 Antibiotics for acute conjunctivitis]

6) HEMATOLOGY STUDIES

None so far

'''ACADEMIC YEAR 2 - FIRST TERM'''

7) RESPIROLOGY STUDIES
[[File:IA COPD info.pdf|thumb]]

*[http://www.ncbi.nlm.nih.gov/pubmed/2062329 First inhaled steroid study] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/22938706 Tiotropium in asthma] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/21324520 Inhaled steroid in children] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/29768149 Combined Budesonide–Formoterol as Needed in Mild Asthma] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/15223858 Doubling dose of inhaled corticosteroid] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/29768147 As-Needed Budesonide–Formoterol versus Maintenance Budesonide in Mild Asthma] Groups 6,18,30
*[http://www.ncbi.nlm.nih.gov/pubmed/27181606 Indacaterol-glycopyrronium VS salmeterol/fluticasone in COPD] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/21428765 Tiotropium VS salmeterol in COPD] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/23695200 Short VS long steroids for COPD exacerbation] Groups 9,21,33
*[http://www.ncbi.nlm.nih.gov/pubmed/25196117 Stopping inhaled steroids in COPD] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/29668352 Once-Daily Single-Inhaler Triple versus Dual Therapy in Patients with COPD] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/28877011 Tezepelumab in Adults with Uncontrolled Asthma] Groups 12,24,36

8) CARDIOVASCULAR STUDIES

SESSION 1

*[https://www.ncbi.nlm.nih.gov/pubmed/4862069 VA1] (Group 1, 13, 25)
*[https://www.ncbi.nlm.nih.gov/pubmed/4914579 VA 2] (Group 2, 14, 26)
*[https://pubmed.ncbi.nlm.nih.gov/33186492 Polycap Study 3] (Group 3, 15, 27)
*[http://www.ncbi.nlm.nih.gov/pubmed/20228401 ACCORD-BP] (Group 4, 16, 28)
*[https://www.ncbi.nlm.nih.gov/pubmed/26551272 SPRINT] (Group 5, 17, 29)
*[http://www.ncbi.nlm.nih.gov/pubmed/2883575 CONSENSUS] (Group 6,18,30)
*[https://pubmed.ncbi.nlm.nih.gov/31535829/ DAPA-HF] (Group 7, 19, 31)
*[https://pubmed.ncbi.nlm.nih.gov/25176939/ CONFIRM-HF] (Group 8, 20, 32)
*[http://www.ncbi.nlm.nih.gov/pubmed/12457784 PROSPER] (Group 9, 21, 33)
*[http://www.ncbi.nlm.nih.gov/pubmed/27040132 HOPE-3] (Group 10, 22, 34)
*[http://www.ncbi.nlm.nih.gov/pubmed/12114036 Heart Protection Study (HPS)] (Group 11, 23, 35)
*[http://www.ncbi.nlm.nih.gov/pubmed/30415628 REDUCE-IT] (Group 12, 24, 36)

[[File:CV Case.pdf|thumb|CV case|left]]

SESSION 2

'''The Guideline Case'''

A 63 y/o patient with CHOOSE ONE (⬆︎HTN/⬆︎Chol/⬆︎glucose/HF/A fib) and using the guideline determine:
# their 5yr/10yr risks of mortality/CVD events
# the potential benefit
# the potential side effects (with magnitude)
# words/sentiment patient values and preferences/SDM

Atrial fibrillation - Groups 1,13,25,2,14,26
*[https://www.onlinecjc.ca/article/S0828-282X(18)31062-6/pdf 2018 Atrial fibrillation guidelines]
Diabetes - Groups 3,15,27,4,16,28
*[http://guidelines.diabetes.ca/docs/CPG-2018-full-EN.pdf 2018 Diabetes guidelines]
Lipid Simplified - Groups 5,17,29,6,18,30
*[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4607330/pdf/0610857.pdf 2015 Simplified lipid guidelines]
Lipid - Groups 7,19,31,8,20,32
*[http://www.onlinecjc.ca/article/S0828-282X(16)30732-2/pdf 2016 Lipid guidelines]
Heart failure - Groups 9,21,33,10,22,34
*[http://www.onlinecjc.ca/article/S0828-282X(17)30973-X/pdf 2017 Heart failure guidelines]
Hypertension - Groups 11,23,35,12,24,36
*[https://www.onlinecjc.ca/article/S0828-282X(18)30183-1/pdf 2018 Hypertension guidelines]

OPTIONAL SESSION
*[http://www.ncbi.nlm.nih.gov/pubmed/16899775 SPARCL]
*[http://www.ncbi.nlm.nih.gov/pubmed/10471456 RALES]
*[http://www.ncbi.nlm.nih.gov/pubmed/11386263 Carvedilol in heart failure]
*[http://www.ncbi.nlm.nih.gov/pubmed/18460663 WAFACS]
*[http://www.ncbi.nlm.nih.gov/pubmed/10376614 MERIT-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/25176015 PARADIGM-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/24490264 High-dose multivitamins after MI]
*[http://www.ncbi.nlm.nih.gov/pubmed/7911176 Mediterranean Diet after MI]
*[http://www.ncbi.nlm.nih.gov/pubmed/15337732 A TO Z]
*[http://www.ncbi.nlm.nih.gov/pubmed/21073363 EMPHASIS-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/12853193 COMET]
*[http://www.ncbi.nlm.nih.gov/pubmed/24716680 TOPCAT]
*[http://www.ncbi.nlm.nih.gov/pubmed/26039521 IMPROVE-IT]

'''ACADEMIC YEAR 2 - SECOND TERM'''

9) NEPHROLOGY STUDIES

None so far

10) ENDOCRINOLOGY[[File:IA ENDO LAYOUT 1.pdf|left|thumb|IA ENDO LAYOUT]]

'''RISK ASSESSMENT CASES FOR DIABETES AND OSTEOPOROSIS'''

'''1) DIABETES CASE'''

66 y/o white male who was diagnosed with diabetes 8 years ago

* His blood pressure over the last year has been roughly 145/80 mmHg - at present untreated
* A1c = 8%, no diabetes meds, non-smoker, BMI ~30
* Total cholesterol is 6 mmol/L, his HDL is 2 mmol/L, non-HDL = 6 minus 2, not on a statin
* No retinopathy, urine albumin-to-creatinine ratio (UACR) = 15ug/mg (7mg/mmol),
* Serum creatinine = 70 micromol/L, waist circumference 100 cm
* GFR 75 mL/min/1.73m2
* In normal sinus rhythm
* Age at end of highest education = 19
* Mother alive, father died of a heart attack at age 80

'''Calculate Risks'''

'''CVD RISK ESTIMATES''' - list the endpoints described by the specific calculator

Framingham - xx% - 10-year risk - also if no diabetes xx%

ASCVD - xx% - 10-year risk - also if no diabetes xx%

'''The Calculator'''
*CVD CALCULATOR
https://decisionaid.ca/cvd/

'''DIABETES COMPLICATIONS RISK ESTIMATES''' - list the endpoints described by the specific calculator

xx% - also 10-year risk if A1c 9, 8, 7 and 6

also get risk of kidney failure, vision loss, pressure sensation loss – also if A1c 9, 8,7,6

'''The Calculator'''
*DIABETES DECISION AID
http://decisionaid.ca/diabetes/

'''BENEFITS AND HARMS'''

Use the [https://guidelines.diabetes.ca/cpg/chapter-13-2020-update 2020 diabetes guidelines] and/or Diabetes Decision Aid to get estimates of benefits and harms and also use the MyStudies synopsis listed below

'''COSTS'''

Try using [https://pricingdoc.acfp.ca Pricing Doc] to get costs

'''Groups 1,13,25'''

* Metformin - UKPDS 34 [https://mystudies.org/studies.php#studies/28929e89-d01e-4b11-8e67-4d7086f9e4aa/outcome MyStudies Data]

'''Groups 2,14,26'''

* Sulfonlyureas - UKPDS 33 [https://mystudies.org/studies.php#studies/5eadb5dd-d403-4c13-b03e-d4f8d28c96ba/outcome MyStudies Data]

'''Groups 3,15,27'''

* Insulin - ORIGIN [https://mystudies.org/studies.php#studies/f611818f-2e69-4952-b55e-661116bd84b6/outcome MyStudies Data]

'''Groups 4,16,28'''

* SGLT2 - EMPA-REG OUTCOME [https://mystudies.org/studies.php#studies/32e9cf1a-f33e-480b-91ca-6f28a4dcf862/outcome MyStudies Data]

'''Groups 5,17,29'''

* GLP - LEADER [https://mystudies.org/studies.php#studies/1adbc9a1-7603-40f1-ac15-b813ce1f0ad6/outcome MyStudies Data]

'''Groups 6,18,30'''

* DPP4 - TECOS [https://mystudies.org/studies.php#studies/8659968a-cefb-4f99-b4ae-8b9b659acbd5/outcome MyStudies Data]

'''Groups 7,19,31'''

* Intensive treatment – small scale - STENO [https://mystudies.org/studies.php#studies/39d423e3-af57-40c8-ab7a-cbc7f389bdb6/paper MyStudies Data]

'''Groups 8,20,32'''

* Intensive treatment – large scale - ADDITION-Europe - [https://mystudies.org/studies.php#studies/5e07d86d-aa92-4db9-a283-76080db4b6fd/outcome MyStudies Data]

'''2) OSTEOPOROSIS CASE'''

60 y/o female

* 72 kg, 1.69m, BMI = 25.2
* t-score of -2.5
* Worried about falling and getting a hip fracture
* A friend recently had an atraumatic fracture from simply tripping and falling over in the snow
* No other risk factors

'''Calculate Risks'''

'''FRACTURE RISK ESTIMATES''' - list the endpoints described by the specific calculator

Major osteoporotic fracture - xx% - 10-year risk – if no BMD (just BMI), and then if they had a BMD t-Score of -2.0, -2.5, and -3.0

Hip fracture - - xx% - 10-year risk – if no BMD (just BMI) and if you have a BMD xx% - 10-year risk – if no BMD, and then if they had a BMD T-Score of -2.0, -2.5, and -3.0

'''The Calculator'''

* FRACTURE CALCULATOR

[https://frax.shef.ac.uk/frax/tool.aspx?country=19 Frax Tool - Canada]

'''BENEFITS AND HARMS'''

Use the [https://www.cmaj.ca/content/195/39/E1333 2023 Osteoporosis Guideline] and/or your osteoporosis lecture notes to get the benefits and apply these to your patient, and also get the harms

'''COSTS'''

Try using [https://pricingdoc.acfp.ca Pricing Doc] to get costs

'''Groups 9,21,33'''

* Activity

'''Groups 10,22,34'''

* Calcium/Vitamin D

'''Groups 11,23,35'''

* Bisphosphonates

'''Groups 12,24,36'''

* Denosumab

11) NEUROLOGY STUDIES

*[http://www.ncbi.nlm.nih.gov/pubmed/16717269 Opioids for chronic non-cancer pain] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/29509867 Effect of Opioid vs Nonopioid Medications on Pain-Related Function in Patients With Chronic Back Pain] Groups 2,14,26
*[https://www.ncbi.nlm.nih.gov/pubmed/31291515 Galcanezumab for prevention of cluster headaches] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/27150433 Immediate or delayed treatment of a first seizure] Groups 4,16,28
*[https://www.ncbi.nlm.nih.gov/pubmed/31291516 Rimegepant for episodic migraine] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/26212846 Sleep restriction for insomnia] Groups 6,18,30
*[https://www.ncbi.nlm.nih.gov/pubmed/25957224 CHANCE] Groups 7,19,31
*[https://www.ncbi.nlm.nih.gov/pubmed/16899775 SPARCL] Groups 8,20,32
*[https://www.ncbi.nlm.nih.gov/pubmed/29171821 Erenumab for episodic migraine] Groups 9,21,33
*[https://www.ncbi.nlm.nih.gov/pubmed/24733354 Reduction of benzodiazepines through education] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/26035341 Patient controlled opioid analgesia versus non-patient controlled opioid analgesia for postoperative pain] Groups 11,23,35
*[https://www.ncbi.nlm.nih.gov/pubmed/11589932 PROGRESS] Groups 12,24,36

'''ACADEMIC YEAR 3'''

12) PSYCHIATRY STUDIES

[[:File:2021 Psych Evidence Appraisal - Intro Slides.pdf|Psychiatry Rating Scales Introduction]]

* Study 1: [http://www.ncbi.nlm.nih.gov/pubmed/16554525 STAR*D (Level 2)] Bupropion-SR, sertraline, or venlafaxine-XR after failure of SSRIs for depression
* Study 2: [http://www.ncbi.nlm.nih.gov/pubmed/29477251 Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder]
* Study 3: [https://pubmed.ncbi.nlm.nih.gov/33862018/ Long-acting injectable versus oral antipsychotics for the maintenance treatment of schizophrenia]
* Study 4: [https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2725088 Association of Antipsychotic Polypharmacy vs Monotherapy With Psychiatric Rehospitalization Among Adults With Schizophrenia]
* Study 5: [https://www.ncbi.nlm.nih.gov/pubmed/29490359 Real-world Effectiveness of Pharmacologic Treatments for the Prevention of Bipolar Disorder]
* Study 6: [http://www.ncbi.nlm.nih.gov/pubmed/20092882 BALANCE] Combination lithium and valproate therapy versus monotherapy for relapse prevention in bipolar I disorder
13) GASTROENTEROLOGY STUDIES

*[http://www.ncbi.nlm.nih.gov/pubmed/27366179 Fidaxomicin versus vancomycin for Clostridium difficile infection] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/19501587 Prophylaxis of hepatic encephalopathy: Lactulose vs placebo] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/27759621 Antibiotics vs surgical therapy for uncomplicated appendicitis: Systematic review and meta-analysis] Groups 3,15,27
*[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1914504 Use of probiotic Lactobacillus preparation to prevent diarrhoea associated with antibiotics] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/17442905 Omeprazole before endoscopy in patients with gastrointestinal bleeding] Groups 5,17,29
*[http://go.galegroup.com/ps/retrieve.do?tabID=T002&resultListType=RESULT_LIST&searchResultsType=SingleTab&searchType=AdvancedSearchForm&currentPosition=3&docId=GALE%7CA489080729&docType=Report&sort=Relevance&contentSegment=&prodId=HRCA&contentSet=GALE%7CA489080729&searchId=R1&userGroupName=ubcolumbia&inPS=true Sequential-therapy treatment regimens vs standard triple therapy for the eradication of H. pylori infection] Groups 6,18,30
*[http://www.ncbi.nlm.nih.gov/pubmed/27614124 Adding licorice to the standard treatment regimen of Helicobacter pylori] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/15602019 Palifermin for oral mucositis after intensive therapy for hematologic cancers] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/9178669 Speed of healing and symptom relief in grade II to IV gastroesophageal reflux disease: a meta-analysis] Groups 9,21,33
*[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3108684 Prevention of NSAID-induced gastroduodenal ulcers: a meta-analysis] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/8985266 Beta-Adrenergic Antagonists in the Prevention of Gastrointestinal Rebleeding in Patients With Cirrhosis: A Meta-Analysis] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/27512927 Rifaximin versus norfloxacin for secondary prophylaxis of spontaneous bacterial peritonitis] Groups 12,24,36

14) OB/GYN STUDIES
*[http://www.ncbi.nlm.nih.gov/pubmed/25601350 Comparative contraceptive effectiveness of levonorgestrel-releasing and copper IUD Devices]
*[http://www.ncbi.nlm.nih.gov/pubmed/29211679 Hormonal contraception and the risk of breast cancer]
*[http://www.ncbi.nlm.nih.gov/pubmed/30322986 Sexual behaviours in adolescent girls before and after introduction of the HPV]
*[http://www.ncbi.nlm.nih.gov/pubmed/30181338 Intramuscular vs intravenous oxytocin to prevent postpartum haemorrhage at vaginal delivery]
*[http://www.ncbi.nlm.nih.gov/pubmed/27682034 Azithromycin Prophylaxis for Cesarean Delivery]
*[http://www.ncbi.nlm.nih.gov/pubmed/28461374 Antibiotics during pregnancy and risk of spontaneous abortion]

File:IA COPD info.pdf

2024-09-19T14:56:19Z

JamesMcCormack: Uploaded own work with UploadWizard

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{{Information
|description={{en|1=COPD background}}
|date=2024-09-19
|source={{own}}
|author=[[User:JamesMcCormack|JamesMcCormack]]
|permission=
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=={{int:license-header}}==
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Evidence Appraisal Integrated Activities

2024-09-02T13:14:07Z

JamesMcCormack:

'''OBJECTIVE'''

To critically appraise studies, develop a brief synopsis of the trial results, succinctly present the results and then put the results into a proper clinical context

'''INITIAL PRE-READING'''

'''How To Critically Appraise an RCT In 10 minutes'''
*[https://itunes.apple.com/ca/book/how-to-critically-appraise/id524600667?mt=11 iBook/iPad version]
*[https://therapeuticseducation.org/sites/therapeuticseducation.org/files/Ten_Minute_Critical_Appraisal.pdf PDF version]
Watch this video
[http://youtu.be/QUW0Q8tXVUc Viva La Evidence]

'''Study Results at Your Fingertips'''
*[https://mystudies.org MyStudies] - Free access

'''INTEGRATION ACTIVITY FORMAT'''
# Students placed in groups of ~ 5-7
# Each group chooses one of the studies below to review
# Students then work in pairs and develop a one-slide critical appraisal and results synopsis
# One to two students in each group will be chosen at random to present their findings to the class
# A discussion about the appraisal and the appropriate clinical context for the results is had with the entire class for each study

'''MODULE'''
[[File:Screen Shot 2022-01-09 at 10.00.16 AM.jpg|thumb|'''TRIAL PRESENTATION FORMAT'''|none]]

Studies chosen include landmark studies and/or studies that address important therapeutic issues for the particular module

'''ACADEMIC YEAR 1 - FIRST TERM'''

1) FOUNDATION STUDIES (Groups)
*[https://pubmed.ncbi.nlm.nih.gov/37952131 SELECT] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/12466506 AFFIRM] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/22085343 AIM-HIGH] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/10639539 HOPE] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/18378519 HYVET] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/15007110 PROVE-IT] Groups 6,18,30
*[http://www.ncbi.nlm.nih.gov/pubmed/15755765 TNT] Groups 7,19,31
*[https://pubmed.ncbi.nlm.nih.gov/26378978 EMPAREG] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/17984165 ILLUMINATE] Groups 9,21,33
*[https://pubmed.ncbi.nlm.nih.gov/26551272/ SPRINT] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/15325833 CARDS] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/12117397 WHI] Groups 12,24,36

'''ACADEMIC YEAR 1 - SECOND TERM'''

2) INTRO TO INFECTIOUS DISEASE STUDIES

[https://therapeuticseducation.org/sites/therapeuticseducation.org/files/Antibiotic_Sensitivity_FINAL_Nov_2019.pdf The "Best" Antibiotic Sensitivity Chart Ever]
*[http://www.ncbi.nlm.nih.gov/pubmed/17567657 IV vs PO antibiotics] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/24603565 Delayed antibiotics for respiratory tract infections] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/11159657 Delayed antibiotics for otitis media] Groups 3,15,27
*[https://pubmed.ncbi.nlm.nih.gov/27455166/ Duration of treatment for community acquired pneumonia] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/22726802 Duration of treatment for pyelonephritis] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/25830421 Choice of antibiotic for community acquired pneumonia-1] Groups 6,18,30
*[http://www.ncbi.nlm.nih.gov/pubmed/25286173 Choice of antibiotic for community acquired pneumonia-2] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/20647284 HPV vaccine study] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/7966893 Influenza vaccine study] Groups 9,21,33
*[https://pubmed.ncbi.nlm.nih.gov/33301246/ COVID vaccine Pfizer] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/27626517 Herpes zoster vaccine study 1] Groups 11,23,35
*[https://www.ncbi.nlm.nih.gov/pubmed/25916341 Herpes zoster vaccine study 3] Groups 12,24,36

3) MUSCULOSKELETAL STUDIES

*[http://www.ncbi.nlm.nih.gov/pubmed/28199814 Baricitinib versus Placebo or Adalimumab in Rheumatoid Arthritis] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/0010979111 CLASS – celecoxib vs NSAIDs] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/26501533 Naproxen with cyclobenzaprine, oxycodone/acetaminophen, or placebo for low back pain] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/24395557 Glucosamine and chondroitin for OA] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/12546607 Acetaminophen vs diclofenac for OA] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/23964752 Diclofenac gel for acute neck pain] Groups 6,18,30
*[https://pubmed.ncbi.nlm.nih.gov/15468367/ Topical diclofenac vs oral diclofenac] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/25064594 Acetaminophen for low back pain] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/7611589 Misoprostol and NSAID induced ulcers] Groups 9,21,33
*[http://www.ncbi.nlm.nih.gov/pubmed/20131255 Low dose vs high dose colchicine for gout] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/22508468 TEAR - oral triple therapy versus etanercept plus methotrexate in early aggressive rheumatoid arthritis] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/25589511 MOVES - Glucosamine and chondroitin for OA for moderate to severe pain] Groups 12,24,36

4) DERMATOLOGY STUDIES

*[https://www.ncbi.nlm.nih.gov/pubmed/9598014 Glycolic acid 5% Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/21896132 Glycolic acid 10% Acne]
*[https://www.ncbi.nlm.nih.gov/pubmed/14531866 Petrolatum vs Ceramide/skin related lipids Hand Dermatitis]
*[https://www.ncbi.nlm.nih.gov/pubmed/11896774 Vitamin C Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/17515510 Retinol (VitaminA) Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/21896129 Hyaluronic acid Atopic Dermatitis]

5) EENT STUDIES

[http://www.amstar.ca/docs/AMSTARguideline.pdf AMSTAR meta-analysis checklist]

'''Scenario 1 - Otitis Media''' - GROUPS 1, 7, 18, 19, 25, 36

Anthony Martin arrives at your pharmacy somewhat frustrated since his family physician declined to write an antibiotic prescription for his two and half year old son, Oscar. His symptoms started yesterday afternoon - Oscar complains of right ear pain but there is no discharge. Rectal temperature taken today was 38.5 degrees. His wife is sure Oscar has an ear infection since the last time he had these same symptoms, that was ultimately the diagnosis. Mr. Martin asks if you think buying acetaminophen is really “enough”?

[https://pubmed.ncbi.nlm.nih.gov/26099233/ Antibiotics for acute otitis media in children]

'''Scenario 2 - Allergic Rhinitis''' - GROUPS 2, 8, 17, 20, 26, 35

Ruby Parmar is a firefighter. She is plagued by sinus congestion (preventing her from sleeping) and a runny nose associated with seasonal allergies. Her prescription for intranasal triamcinolone is typically effective, but she would like to know if a non-sedating anti-allergy pill would work just as well since it’s inconvenient carrying around the “nose spray”.

[https://www.ncbi.nlm.nih.gov/pubmed/28234147 Intranasal steroids vs antihistamines for allergic rhinitis]

'''Scenario 3 - Acute Sinusitis''' - GROUPS 3, 9, 16, 21, 27, 34

You are seeing a patient in clinic before her appointment with the primary care physician. She was feeling unwell with a “flu” last week. While most of her symptoms have resolved (cough, fever), the nasal congestion and discharge persists and so she has made an appointment (she is an otherwise healthy 32 year old with treated thyroid disease). She would like your advice for what treatment she should ask the doctor to prescribe.

[http://www.ncbi.nlm.nih.gov/pubmed/24293353 Intranasal steroids for acute sinusitis]

'''Scenario 4 - Glaucoma''' - GROUPS 4, 10, 15, 22, 28, 33

Mrs. Ada Waters is a 63 year-old woman you. Her ophthalmologist prescribed timolol and xalatan eye drops for treatment of open angle glaucoma. She has never really felt much different on treatment since she recovered from her first episode (of acute angle closure glaucoma requiring ER visit) and surgery. She asks you if the treatment is really making a difference.

[https://www.ncbi.nlm.nih.gov/pubmed/17943780 Interventions for open angle glaucoma]

'''Scenario 5 - Sore Throat''' - GROUPS 5, 11, 14, 23, 29, 32

You have a good friend who is applying for pharmacy. Her invitation for the multiple-mini interview (MMI) is coming up soon, but she is starting to experience a sore throat. While she is worried about not being able to speak through all of those stations, she knows she often gets a terrible headache along with her sore throat. She has an unused prescription for amoxicillin (unexpired) and wonders if you recommend for her to take it.

[https://pubmed.ncbi.nlm.nih.gov/34881426/ Antibiotics for sore throat]

'''Scenario 6 - Conjunctivitis''' - GROUPS 6, 12, 13, 24, 30, 31

A man comes to your pharmacy (he appears in his early twenties) complaining of “pink eye”. He has had a pink discolouration and discharge from his left eye for two days. He asks if the OTC antibiotic eye drops (he’s holding a product with polymixin B) are any better than “waiting it out”.

[https://www.ncbi.nlm.nih.gov/pubmed/22972049 Antibiotics for acute conjunctivitis]

6) HEMATOLOGY STUDIES

None so far

'''ACADEMIC YEAR 2 - FIRST TERM'''

7) RESPIROLOGY STUDIES

*[http://www.ncbi.nlm.nih.gov/pubmed/2062329 First inhaled steroid study] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/22938706 Tiotropium in asthma] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/21324520 Inhaled steroid in children] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/29768149 Combined Budesonide–Formoterol as Needed in Mild Asthma] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/15223858 Doubling dose of inhaled corticosteroid] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/29768147 As-Needed Budesonide–Formoterol versus Maintenance Budesonide in Mild Asthma] Groups 6,18,30
*[http://www.ncbi.nlm.nih.gov/pubmed/27181606 Indacaterol-glycopyrronium VS salmeterol/fluticasone in COPD] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/21428765 Tiotropium VS salmeterol in COPD] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/23695200 Short VS long steroids for COPD exacerbation] Groups 9,21,33
*[http://www.ncbi.nlm.nih.gov/pubmed/25196117 Stopping inhaled steroids in COPD] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/29668352 Once-Daily Single-Inhaler Triple versus Dual Therapy in Patients with COPD] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/28877011 Tezepelumab in Adults with Uncontrolled Asthma] Groups 12,24,36

8) CARDIOVASCULAR STUDIES

SESSION 1

*[https://www.ncbi.nlm.nih.gov/pubmed/4862069 VA1] (Group 1, 13, 25)
*[https://www.ncbi.nlm.nih.gov/pubmed/4914579 VA 2] (Group 2, 14, 26)
*[https://pubmed.ncbi.nlm.nih.gov/33186492 Polycap Study 3] (Group 3, 15, 27)
*[http://www.ncbi.nlm.nih.gov/pubmed/20228401 ACCORD-BP] (Group 4, 16, 28)
*[https://www.ncbi.nlm.nih.gov/pubmed/26551272 SPRINT] (Group 5, 17, 29)
*[http://www.ncbi.nlm.nih.gov/pubmed/2883575 CONSENSUS] (Group 6,18,30)
*[https://pubmed.ncbi.nlm.nih.gov/31535829/ DAPA-HF] (Group 7, 19, 31)
*[https://pubmed.ncbi.nlm.nih.gov/25176939/ CONFIRM-HF] (Group 8, 20, 32)
*[http://www.ncbi.nlm.nih.gov/pubmed/12457784 PROSPER] (Group 9, 21, 33)
*[http://www.ncbi.nlm.nih.gov/pubmed/27040132 HOPE-3] (Group 10, 22, 34)
*[http://www.ncbi.nlm.nih.gov/pubmed/12114036 Heart Protection Study (HPS)] (Group 11, 23, 35)
*[http://www.ncbi.nlm.nih.gov/pubmed/30415628 REDUCE-IT] (Group 12, 24, 36)

[[File:CV Case.pdf|thumb|CV case|left]]

SESSION 2

'''The Guideline Case'''

A 63 y/o patient with CHOOSE ONE (⬆︎HTN/⬆︎Chol/⬆︎glucose/HF/A fib) and using the guideline determine:
# their 5yr/10yr risks of mortality/CVD events
# the potential benefit
# the potential side effects (with magnitude)
# words/sentiment patient values and preferences/SDM

Atrial fibrillation - Groups 1,13,25,2,14,26
*[https://www.onlinecjc.ca/article/S0828-282X(18)31062-6/pdf 2018 Atrial fibrillation guidelines]
Diabetes - Groups 3,15,27,4,16,28
*[http://guidelines.diabetes.ca/docs/CPG-2018-full-EN.pdf 2018 Diabetes guidelines]
Lipid Simplified - Groups 5,17,29,6,18,30
*[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4607330/pdf/0610857.pdf 2015 Simplified lipid guidelines]
Lipid - Groups 7,19,31,8,20,32
*[http://www.onlinecjc.ca/article/S0828-282X(16)30732-2/pdf 2016 Lipid guidelines]
Heart failure - Groups 9,21,33,10,22,34
*[http://www.onlinecjc.ca/article/S0828-282X(17)30973-X/pdf 2017 Heart failure guidelines]
Hypertension - Groups 11,23,35,12,24,36
*[https://www.onlinecjc.ca/article/S0828-282X(18)30183-1/pdf 2018 Hypertension guidelines]

OPTIONAL SESSION
*[http://www.ncbi.nlm.nih.gov/pubmed/16899775 SPARCL]
*[http://www.ncbi.nlm.nih.gov/pubmed/10471456 RALES]
*[http://www.ncbi.nlm.nih.gov/pubmed/11386263 Carvedilol in heart failure]
*[http://www.ncbi.nlm.nih.gov/pubmed/18460663 WAFACS]
*[http://www.ncbi.nlm.nih.gov/pubmed/10376614 MERIT-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/25176015 PARADIGM-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/24490264 High-dose multivitamins after MI]
*[http://www.ncbi.nlm.nih.gov/pubmed/7911176 Mediterranean Diet after MI]
*[http://www.ncbi.nlm.nih.gov/pubmed/15337732 A TO Z]
*[http://www.ncbi.nlm.nih.gov/pubmed/21073363 EMPHASIS-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/12853193 COMET]
*[http://www.ncbi.nlm.nih.gov/pubmed/24716680 TOPCAT]
*[http://www.ncbi.nlm.nih.gov/pubmed/26039521 IMPROVE-IT]

'''ACADEMIC YEAR 2 - SECOND TERM'''

9) NEPHROLOGY STUDIES

None so far

10) ENDOCRINOLOGY[[File:IA ENDO LAYOUT 1.pdf|left|thumb|IA ENDO LAYOUT]]

'''RISK ASSESSMENT CASES FOR DIABETES AND OSTEOPOROSIS'''

'''1) DIABETES CASE'''

66 y/o white male who was diagnosed with diabetes 8 years ago

* His blood pressure over the last year has been roughly 145/80 mmHg - at present untreated
* A1c = 8%, no diabetes meds, non-smoker, BMI ~30
* Total cholesterol is 6 mmol/L, his HDL is 2 mmol/L, non-HDL = 6 minus 2, not on a statin
* No retinopathy, urine albumin-to-creatinine ratio (UACR) = 15ug/mg (7mg/mmol),
* Serum creatinine = 70 micromol/L, waist circumference 100 cm
* GFR 75 mL/min/1.73m2
* In normal sinus rhythm
* Age at end of highest education = 19
* Mother alive, father died of a heart attack at age 80

'''Calculate Risks'''

'''CVD RISK ESTIMATES''' - list the endpoints described by the specific calculator

Framingham - xx% - 10-year risk - also if no diabetes xx%

ASCVD - xx% - 10-year risk - also if no diabetes xx%

'''The Calculator'''
*CVD CALCULATOR
https://decisionaid.ca/cvd/

'''DIABETES COMPLICATIONS RISK ESTIMATES''' - list the endpoints described by the specific calculator

xx% - also 10-year risk if A1c 9, 8, 7 and 6

also get risk of kidney failure, vision loss, pressure sensation loss – also if A1c 9, 8,7,6

'''The Calculator'''
*DIABETES DECISION AID
http://decisionaid.ca/diabetes/

'''BENEFITS AND HARMS'''

Use the [https://guidelines.diabetes.ca/cpg/chapter-13-2020-update 2020 diabetes guidelines] and/or Diabetes Decision Aid to get estimates of benefits and harms and also use the MyStudies synopsis listed below

'''COSTS'''

Try using [https://pricingdoc.acfp.ca Pricing Doc] to get costs

'''Groups 1,13,25'''

* Metformin - UKPDS 34 [https://mystudies.org/studies.php#studies/28929e89-d01e-4b11-8e67-4d7086f9e4aa/outcome MyStudies Data]

'''Groups 2,14,26'''

* Sulfonlyureas - UKPDS 33 [https://mystudies.org/studies.php#studies/5eadb5dd-d403-4c13-b03e-d4f8d28c96ba/outcome MyStudies Data]

'''Groups 3,15,27'''

* Insulin - ORIGIN [https://mystudies.org/studies.php#studies/f611818f-2e69-4952-b55e-661116bd84b6/outcome MyStudies Data]

'''Groups 4,16,28'''

* SGLT2 - EMPA-REG OUTCOME [https://mystudies.org/studies.php#studies/32e9cf1a-f33e-480b-91ca-6f28a4dcf862/outcome MyStudies Data]

'''Groups 5,17,29'''

* GLP - LEADER [https://mystudies.org/studies.php#studies/1adbc9a1-7603-40f1-ac15-b813ce1f0ad6/outcome MyStudies Data]

'''Groups 6,18,30'''

* DPP4 - TECOS [https://mystudies.org/studies.php#studies/8659968a-cefb-4f99-b4ae-8b9b659acbd5/outcome MyStudies Data]

'''Groups 7,19,31'''

* Intensive treatment – small scale - STENO [https://mystudies.org/studies.php#studies/39d423e3-af57-40c8-ab7a-cbc7f389bdb6/paper MyStudies Data]

'''Groups 8,20,32'''

* Intensive treatment – large scale - ADDITION-Europe - [https://mystudies.org/studies.php#studies/5e07d86d-aa92-4db9-a283-76080db4b6fd/outcome MyStudies Data]

'''2) OSTEOPOROSIS CASE'''

60 y/o female

* 72 kg, 1.69m, BMI = 25.2
* t-score of -2.5
* Worried about falling and getting a hip fracture
* A friend recently had an atraumatic fracture from simply tripping and falling over in the snow
* No other risk factors

'''Calculate Risks'''

'''FRACTURE RISK ESTIMATES''' - list the endpoints described by the specific calculator

Major osteoporotic fracture - xx% - 10-year risk – if no BMD (just BMI), and then if they had a BMD t-Score of -2.0, -2.5, and -3.0

Hip fracture - - xx% - 10-year risk – if no BMD (just BMI) and if you have a BMD xx% - 10-year risk – if no BMD, and then if they had a BMD T-Score of -2.0, -2.5, and -3.0

'''The Calculator'''

* FRACTURE CALCULATOR

[https://frax.shef.ac.uk/frax/tool.aspx?country=19 Frax Tool - Canada]

'''BENEFITS AND HARMS'''

Use the [https://www.cmaj.ca/content/195/39/E1333 2023 Osteoporosis Guideline] and/or your osteoporosis lecture notes to get the benefits and apply these to your patient, and also get the harms

'''COSTS'''

Try using [https://pricingdoc.acfp.ca Pricing Doc] to get costs

'''Groups 9,21,33'''

* Activity

'''Groups 10,22,34'''

* Calcium/Vitamin D

'''Groups 11,23,35'''

* Bisphosphonates

'''Groups 12,24,36'''

* Denosumab

11) NEUROLOGY STUDIES

*[http://www.ncbi.nlm.nih.gov/pubmed/16717269 Opioids for chronic non-cancer pain] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/29509867 Effect of Opioid vs Nonopioid Medications on Pain-Related Function in Patients With Chronic Back Pain] Groups 2,14,26
*[https://www.ncbi.nlm.nih.gov/pubmed/31291515 Galcanezumab for prevention of cluster headaches] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/27150433 Immediate or delayed treatment of a first seizure] Groups 4,16,28
*[https://www.ncbi.nlm.nih.gov/pubmed/31291516 Rimegepant for episodic migraine] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/26212846 Sleep restriction for insomnia] Groups 6,18,30
*[https://www.ncbi.nlm.nih.gov/pubmed/25957224 CHANCE] Groups 7,19,31
*[https://www.ncbi.nlm.nih.gov/pubmed/16899775 SPARCL] Groups 8,20,32
*[https://www.ncbi.nlm.nih.gov/pubmed/29171821 Erenumab for episodic migraine] Groups 9,21,33
*[https://www.ncbi.nlm.nih.gov/pubmed/24733354 Reduction of benzodiazepines through education] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/26035341 Patient controlled opioid analgesia versus non-patient controlled opioid analgesia for postoperative pain] Groups 11,23,35
*[https://www.ncbi.nlm.nih.gov/pubmed/11589932 PROGRESS] Groups 12,24,36

'''ACADEMIC YEAR 3'''

12) PSYCHIATRY STUDIES

[[:File:2021 Psych Evidence Appraisal - Intro Slides.pdf|Psychiatry Rating Scales Introduction]]

* Study 1: [http://www.ncbi.nlm.nih.gov/pubmed/16554525 STAR*D (Level 2)] Bupropion-SR, sertraline, or venlafaxine-XR after failure of SSRIs for depression
* Study 2: [http://www.ncbi.nlm.nih.gov/pubmed/29477251 Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder]
* Study 3: [https://pubmed.ncbi.nlm.nih.gov/33862018/ Long-acting injectable versus oral antipsychotics for the maintenance treatment of schizophrenia]
* Study 4: [https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2725088 Association of Antipsychotic Polypharmacy vs Monotherapy With Psychiatric Rehospitalization Among Adults With Schizophrenia]
* Study 5: [https://www.ncbi.nlm.nih.gov/pubmed/29490359 Real-world Effectiveness of Pharmacologic Treatments for the Prevention of Bipolar Disorder]
* Study 6: [http://www.ncbi.nlm.nih.gov/pubmed/20092882 BALANCE] Combination lithium and valproate therapy versus monotherapy for relapse prevention in bipolar I disorder
13) GASTROENTEROLOGY STUDIES

*[http://www.ncbi.nlm.nih.gov/pubmed/27366179 Fidaxomicin versus vancomycin for Clostridium difficile infection] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/19501587 Prophylaxis of hepatic encephalopathy: Lactulose vs placebo] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/27759621 Antibiotics vs surgical therapy for uncomplicated appendicitis: Systematic review and meta-analysis] Groups 3,15,27
*[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1914504 Use of probiotic Lactobacillus preparation to prevent diarrhoea associated with antibiotics] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/17442905 Omeprazole before endoscopy in patients with gastrointestinal bleeding] Groups 5,17,29
*[http://go.galegroup.com/ps/retrieve.do?tabID=T002&resultListType=RESULT_LIST&searchResultsType=SingleTab&searchType=AdvancedSearchForm&currentPosition=3&docId=GALE%7CA489080729&docType=Report&sort=Relevance&contentSegment=&prodId=HRCA&contentSet=GALE%7CA489080729&searchId=R1&userGroupName=ubcolumbia&inPS=true Sequential-therapy treatment regimens vs standard triple therapy for the eradication of H. pylori infection] Groups 6,18,30
*[http://www.ncbi.nlm.nih.gov/pubmed/27614124 Adding licorice to the standard treatment regimen of Helicobacter pylori] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/15602019 Palifermin for oral mucositis after intensive therapy for hematologic cancers] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/9178669 Speed of healing and symptom relief in grade II to IV gastroesophageal reflux disease: a meta-analysis] Groups 9,21,33
*[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3108684 Prevention of NSAID-induced gastroduodenal ulcers: a meta-analysis] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/8985266 Beta-Adrenergic Antagonists in the Prevention of Gastrointestinal Rebleeding in Patients With Cirrhosis: A Meta-Analysis] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/27512927 Rifaximin versus norfloxacin for secondary prophylaxis of spontaneous bacterial peritonitis] Groups 12,24,36

14) OB/GYN STUDIES
*[http://www.ncbi.nlm.nih.gov/pubmed/25601350 Comparative contraceptive effectiveness of levonorgestrel-releasing and copper IUD Devices]
*[http://www.ncbi.nlm.nih.gov/pubmed/29211679 Hormonal contraception and the risk of breast cancer]
*[http://www.ncbi.nlm.nih.gov/pubmed/30322986 Sexual behaviours in adolescent girls before and after introduction of the HPV]
*[http://www.ncbi.nlm.nih.gov/pubmed/30181338 Intramuscular vs intravenous oxytocin to prevent postpartum haemorrhage at vaginal delivery]
*[http://www.ncbi.nlm.nih.gov/pubmed/27682034 Azithromycin Prophylaxis for Cesarean Delivery]
*[http://www.ncbi.nlm.nih.gov/pubmed/28461374 Antibiotics during pregnancy and risk of spontaneous abortion]

Evidence Appraisal Integrated Activities

2024-02-26T08:29:24Z

JamesMcCormack:

'''OBJECTIVE'''

To critically appraise studies, develop a brief synopsis of the trial results, succinctly present the results and then put the results into a proper clinical context

'''INITIAL PRE-READING'''

'''How To Critically Appraise an RCT In 10 minutes'''
*[https://itunes.apple.com/ca/book/how-to-critically-appraise/id524600667?mt=11 iBook/iPad version]
*[https://therapeuticseducation.org/sites/therapeuticseducation.org/files/Ten_Minute_Critical_Appraisal.pdf PDF version]
Watch this video
[http://youtu.be/QUW0Q8tXVUc Viva La Evidence]

'''Study Results at Your Fingertips'''
*[https://mystudies.org MyStudies] - Free access

'''INTEGRATION ACTIVITY FORMAT'''
# Students placed in groups of ~ 5-7
# Each group chooses one of the studies below to review
# Students then work in pairs and develop a one-slide critical appraisal and results synopsis
# One to two students in each group will be chosen at random to present their findings to the class
# A discussion about the appraisal and the appropriate clinical context for the results is had with the entire class for each study

'''MODULE'''
[[File:Screen Shot 2022-01-09 at 10.00.16 AM.jpg|thumb|'''TRIAL PRESENTATION FORMAT'''|none]]

Studies chosen include landmark studies and/or studies that address important therapeutic issues for the particular module

'''ACADEMIC YEAR 1 - FIRST TERM'''

1) FOUNDATION STUDIES (Groups)
*[http://www.ncbi.nlm.nih.gov/pubmed/20228404 ACCORD FIBRATES] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/12466506 AFFIRM] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/22085343 AIM-HIGH] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/10639539 HOPE] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/18378519 HYVET] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/15007110 PROVE-IT] Groups 6,18,30
*[http://www.ncbi.nlm.nih.gov/pubmed/15755765 TNT] Groups 7,19,31
*[https://pubmed.ncbi.nlm.nih.gov/26378978 EMPAREG] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/17984165 ILLUMINATE] Groups 9,21,33
*[https://pubmed.ncbi.nlm.nih.gov/26551272/ SPRINT] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/15325833 CARDS] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/12117397 WHI] Groups 12,24,36

'''ACADEMIC YEAR 1 - SECOND TERM'''

2) INTRO TO INFECTIOUS DISEASE STUDIES

[https://therapeuticseducation.org/sites/therapeuticseducation.org/files/Antibiotic_Sensitivity_FINAL_Nov_2019.pdf The "Best" Antibiotic Sensitivity Chart Ever]
*[http://www.ncbi.nlm.nih.gov/pubmed/17567657 IV vs PO antibiotics] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/24603565 Delayed antibiotics for respiratory tract infections] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/11159657 Delayed antibiotics for otitis media] Groups 3,15,27
*[https://pubmed.ncbi.nlm.nih.gov/27455166/ Duration of treatment for community acquired pneumonia] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/22726802 Duration of treatment for pyelonephritis] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/25830421 Choice of antibiotic for community acquired pneumonia-1] Groups 6,18,30
*[http://www.ncbi.nlm.nih.gov/pubmed/25286173 Choice of antibiotic for community acquired pneumonia-2] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/20647284 HPV vaccine study] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/7966893 Influenza vaccine study] Groups 9,21,33
*[https://pubmed.ncbi.nlm.nih.gov/33301246/ COVID vaccine Pfizer] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/27626517 Herpes zoster vaccine study 1] Groups 11,23,35
*[https://www.ncbi.nlm.nih.gov/pubmed/25916341 Herpes zoster vaccine study 3] Groups 12,24,36

3) MUSCULOSKELETAL STUDIES

*[http://www.ncbi.nlm.nih.gov/pubmed/28199814 Baricitinib versus Placebo or Adalimumab in Rheumatoid Arthritis] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/0010979111 CLASS – celecoxib vs NSAIDs] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/26501533 Naproxen with cyclobenzaprine, oxycodone/acetaminophen, or placebo for low back pain] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/24395557 Glucosamine and chondroitin for OA] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/12546607 Acetaminophen vs diclofenac for OA] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/23964752 Diclofenac gel for acute neck pain] Groups 6,18,30
*[https://pubmed.ncbi.nlm.nih.gov/15468367/ Topical diclofenac vs oral diclofenac] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/25064594 Acetaminophen for low back pain] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/7611589 Misoprostol and NSAID induced ulcers] Groups 9,21,33
*[http://www.ncbi.nlm.nih.gov/pubmed/20131255 Low dose vs high dose colchicine for gout] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/22508468 TEAR - oral triple therapy versus etanercept plus methotrexate in early aggressive rheumatoid arthritis] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/25589511 MOVES - Glucosamine and chondroitin for OA for moderate to severe pain] Groups 12,24,36

4) DERMATOLOGY STUDIES

*[https://www.ncbi.nlm.nih.gov/pubmed/9598014 Glycolic acid 5% Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/21896132 Glycolic acid 10% Acne]
*[https://www.ncbi.nlm.nih.gov/pubmed/14531866 Petrolatum vs Ceramide/skin related lipids Hand Dermatitis]
*[https://www.ncbi.nlm.nih.gov/pubmed/11896774 Vitamin C Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/17515510 Retinol (VitaminA) Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/21896129 Hyaluronic acid Atopic Dermatitis]

5) EENT STUDIES

[http://www.amstar.ca/docs/AMSTARguideline.pdf AMSTAR meta-analysis checklist]

'''Scenario 1 - Otitis Media''' - GROUPS 1, 7, 18, 19, 25, 36

Anthony Martin arrives at your pharmacy somewhat frustrated since his family physician declined to write an antibiotic prescription for his two and half year old son, Oscar. His symptoms started yesterday afternoon - Oscar complains of right ear pain but there is no discharge. Rectal temperature taken today was 38.5 degrees. His wife is sure Oscar has an ear infection since the last time he had these same symptoms, that was ultimately the diagnosis. Mr. Martin asks if you think buying acetaminophen is really “enough”?

[https://pubmed.ncbi.nlm.nih.gov/26099233/ Antibiotics for acute otitis media in children]

'''Scenario 2 - Allergic Rhinitis''' - GROUPS 2, 8, 17, 20, 26, 35

Ruby Parmar is a firefighter. She is plagued by sinus congestion (preventing her from sleeping) and a runny nose associated with seasonal allergies. Her prescription for intranasal triamcinolone is typically effective, but she would like to know if a non-sedating anti-allergy pill would work just as well since it’s inconvenient carrying around the “nose spray”.

[https://www.ncbi.nlm.nih.gov/pubmed/28234147 Intranasal steroids vs antihistamines for allergic rhinitis]

'''Scenario 3 - Acute Sinusitis''' - GROUPS 3, 9, 16, 21, 27, 34

You are seeing a patient in clinic before her appointment with the primary care physician. She was feeling unwell with a “flu” last week. While most of her symptoms have resolved (cough, fever), the nasal congestion and discharge persists and so she has made an appointment (she is an otherwise healthy 32 year old with treated thyroid disease). She would like your advice for what treatment she should ask the doctor to prescribe.

[http://www.ncbi.nlm.nih.gov/pubmed/24293353 Intranasal steroids for acute sinusitis]

'''Scenario 4 - Glaucoma''' - GROUPS 4, 10, 15, 22, 28, 33

Mrs. Ada Waters is a 63 year-old woman you. Her ophthalmologist prescribed timolol and xalatan eye drops for treatment of open angle glaucoma. She has never really felt much different on treatment since she recovered from her first episode (of acute angle closure glaucoma requiring ER visit) and surgery. She asks you if the treatment is really making a difference.

[https://www.ncbi.nlm.nih.gov/pubmed/17943780 Interventions for open angle glaucoma]

'''Scenario 5 - Sore Throat''' - GROUPS 5, 11, 14, 23, 29, 32

You have a good friend who is applying for pharmacy. Her invitation for the multiple-mini interview (MMI) is coming up soon, but she is starting to experience a sore throat. While she is worried about not being able to speak through all of those stations, she knows she often gets a terrible headache along with her sore throat. She has an unused prescription for amoxicillin (unexpired) and wonders if you recommend for her to take it.

[https://pubmed.ncbi.nlm.nih.gov/34881426/ Antibiotics for sore throat]

'''Scenario 6 - Conjunctivitis''' - GROUPS 6, 12, 13, 24, 30, 31

A man comes to your pharmacy (he appears in his early twenties) complaining of “pink eye”. He has had a pink discolouration and discharge from his left eye for two days. He asks if the OTC antibiotic eye drops (he’s holding a product with polymixin B) are any better than “waiting it out”.

[https://www.ncbi.nlm.nih.gov/pubmed/22972049 Antibiotics for acute conjunctivitis]

6) HEMATOLOGY STUDIES

None so far

'''ACADEMIC YEAR 2 - FIRST TERM'''

7) RESPIROLOGY STUDIES

*[http://www.ncbi.nlm.nih.gov/pubmed/2062329 First inhaled steroid study] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/22938706 Tiotropium in asthma] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/21324520 Inhaled steroid in children] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/29768149 Combined Budesonide–Formoterol as Needed in Mild Asthma] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/15223858 Doubling dose of inhaled corticosteroid] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/29768147 As-Needed Budesonide–Formoterol versus Maintenance Budesonide in Mild Asthma] Groups 6,18,30
*[http://www.ncbi.nlm.nih.gov/pubmed/27181606 Indacaterol-glycopyrronium VS salmeterol/fluticasone in COPD] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/21428765 Tiotropium VS salmeterol in COPD] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/23695200 Short VS long steroids for COPD exacerbation] Groups 9,21,33
*[http://www.ncbi.nlm.nih.gov/pubmed/25196117 Stopping inhaled steroids in COPD] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/29668352 Once-Daily Single-Inhaler Triple versus Dual Therapy in Patients with COPD] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/28877011 Tezepelumab in Adults with Uncontrolled Asthma] Groups 12,24,36

8) CARDIOVASCULAR STUDIES

SESSION 1

*[https://www.ncbi.nlm.nih.gov/pubmed/4862069 VA1] (Group 1, 13, 25)
*[https://www.ncbi.nlm.nih.gov/pubmed/4914579 VA 2] (Group 2, 14, 26)
*[https://pubmed.ncbi.nlm.nih.gov/33186492 Polycap Study 3] (Group 3, 15, 27)
*[http://www.ncbi.nlm.nih.gov/pubmed/20228401 ACCORD-BP] (Group 4, 16, 28)
*[https://www.ncbi.nlm.nih.gov/pubmed/26551272 SPRINT] (Group 5, 17, 29)
*[http://www.ncbi.nlm.nih.gov/pubmed/2883575 CONSENSUS] (Group 6,18,30)
*[https://pubmed.ncbi.nlm.nih.gov/31535829/ DAPA-HF] (Group 7, 19, 31)
*[https://pubmed.ncbi.nlm.nih.gov/25176939/ CONFIRM-HF] (Group 8, 20, 32)
*[http://www.ncbi.nlm.nih.gov/pubmed/12457784 PROSPER] (Group 9, 21, 33)
*[http://www.ncbi.nlm.nih.gov/pubmed/27040132 HOPE-3] (Group 10, 22, 34)
*[http://www.ncbi.nlm.nih.gov/pubmed/12114036 Heart Protection Study (HPS)] (Group 11, 23, 35)
*[http://www.ncbi.nlm.nih.gov/pubmed/30415628 REDUCE-IT] (Group 12, 24, 36)

[[File:CV Case.pdf|thumb|CV case|left]]

SESSION 2

'''The Guideline Case'''

A 63 y/o patient with CHOOSE ONE (⬆︎HTN/⬆︎Chol/⬆︎glucose/HF/A fib) and using the guideline determine:
# their 5yr/10yr risks of mortality/CVD events
# the potential benefit
# the potential side effects (with magnitude)
# words/sentiment patient values and preferences/SDM

Atrial fibrillation - Groups 1,13,25,2,14,26
*[https://www.onlinecjc.ca/article/S0828-282X(18)31062-6/pdf 2018 Atrial fibrillation guidelines]
Diabetes - Groups 3,15,27,4,16,28
*[http://guidelines.diabetes.ca/docs/CPG-2018-full-EN.pdf 2018 Diabetes guidelines]
Lipid Simplified - Groups 5,17,29,6,18,30
*[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4607330/pdf/0610857.pdf 2015 Simplified lipid guidelines]
Lipid - Groups 7,19,31,8,20,32
*[http://www.onlinecjc.ca/article/S0828-282X(16)30732-2/pdf 2016 Lipid guidelines]
Heart failure - Groups 9,21,33,10,22,34
*[http://www.onlinecjc.ca/article/S0828-282X(17)30973-X/pdf 2017 Heart failure guidelines]
Hypertension - Groups 11,23,35,12,24,36
*[https://www.onlinecjc.ca/article/S0828-282X(18)30183-1/pdf 2018 Hypertension guidelines]

OPTIONAL SESSION
*[http://www.ncbi.nlm.nih.gov/pubmed/16899775 SPARCL]
*[http://www.ncbi.nlm.nih.gov/pubmed/10471456 RALES]
*[http://www.ncbi.nlm.nih.gov/pubmed/11386263 Carvedilol in heart failure]
*[http://www.ncbi.nlm.nih.gov/pubmed/18460663 WAFACS]
*[http://www.ncbi.nlm.nih.gov/pubmed/10376614 MERIT-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/25176015 PARADIGM-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/24490264 High-dose multivitamins after MI]
*[http://www.ncbi.nlm.nih.gov/pubmed/7911176 Mediterranean Diet after MI]
*[http://www.ncbi.nlm.nih.gov/pubmed/15337732 A TO Z]
*[http://www.ncbi.nlm.nih.gov/pubmed/21073363 EMPHASIS-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/12853193 COMET]
*[http://www.ncbi.nlm.nih.gov/pubmed/24716680 TOPCAT]
*[http://www.ncbi.nlm.nih.gov/pubmed/26039521 IMPROVE-IT]

'''ACADEMIC YEAR 2 - SECOND TERM'''

9) NEPHROLOGY STUDIES

None so far

10) ENDOCRINOLOGY[[File:IA ENDO LAYOUT 1.pdf|left|thumb|IA ENDO LAYOUT]]

'''RISK ASSESSMENT CASES FOR DIABETES AND OSTEOPOROSIS'''

'''1) DIABETES CASE'''

66 y/o white male who was diagnosed with diabetes 8 years ago

* His blood pressure over the last year has been roughly 145/80 mmHg - at present untreated
* A1c = 8%, no diabetes meds, non-smoker, BMI ~30
* Total cholesterol is 6 mmol/L, his HDL is 2 mmol/L, non-HDL = 6 minus 2, not on a statin
* No retinopathy, urine albumin-to-creatinine ratio (UACR) = 15ug/mg (7mg/mmol),
* Serum creatinine = 70 micromol/L, waist circumference 100 cm
* GFR 75 mL/min/1.73m2
* In normal sinus rhythm
* Age at end of highest education = 19
* Mother alive, father died of a heart attack at age 80

'''Calculate Risks'''

'''CVD RISK ESTIMATES''' - list the endpoints described by the specific calculator

Framingham - xx% - 10-year risk - also if no diabetes xx%

ASCVD - xx% - 10-year risk - also if no diabetes xx%

'''The Calculator'''
*CVD CALCULATOR
https://decisionaid.ca/cvd/

'''DIABETES COMPLICATIONS RISK ESTIMATES''' - list the endpoints described by the specific calculator

xx% - also 10-year risk if A1c 9, 8, 7 and 6

also get risk of kidney failure, vision loss, pressure sensation loss – also if A1c 9, 8,7,6

'''The Calculator'''
*DIABETES DECISION AID
http://decisionaid.ca/diabetes/

'''BENEFITS AND HARMS'''

Use the [https://guidelines.diabetes.ca/cpg/chapter-13-2020-update 2020 diabetes guidelines] and/or Diabetes Decision Aid to get estimates of benefits and harms and also use the MyStudies synopsis listed below

'''COSTS'''

Try using [https://pricingdoc.acfp.ca Pricing Doc] to get costs

'''Groups 1,13,25'''

* Metformin - UKPDS 34 [https://mystudies.org/studies.php#studies/28929e89-d01e-4b11-8e67-4d7086f9e4aa/outcome MyStudies Data]

'''Groups 2,14,26'''

* Sulfonlyureas - UKPDS 33 [https://mystudies.org/studies.php#studies/5eadb5dd-d403-4c13-b03e-d4f8d28c96ba/outcome MyStudies Data]

'''Groups 3,15,27'''

* Insulin - ORIGIN [https://mystudies.org/studies.php#studies/f611818f-2e69-4952-b55e-661116bd84b6/outcome MyStudies Data]

'''Groups 4,16,28'''

* SGLT2 - EMPA-REG OUTCOME [https://mystudies.org/studies.php#studies/32e9cf1a-f33e-480b-91ca-6f28a4dcf862/outcome MyStudies Data]

'''Groups 5,17,29'''

* GLP - LEADER [https://mystudies.org/studies.php#studies/1adbc9a1-7603-40f1-ac15-b813ce1f0ad6/outcome MyStudies Data]

'''Groups 6,18,30'''

* DPP4 - TECOS [https://mystudies.org/studies.php#studies/8659968a-cefb-4f99-b4ae-8b9b659acbd5/outcome MyStudies Data]

'''Groups 7,19,31'''

* Intensive treatment – small scale - STENO [https://mystudies.org/studies.php#studies/39d423e3-af57-40c8-ab7a-cbc7f389bdb6/paper MyStudies Data]

'''Groups 8,20,32'''

* Intensive treatment – large scale - ADDITION-Europe - [https://mystudies.org/studies.php#studies/5e07d86d-aa92-4db9-a283-76080db4b6fd/outcome MyStudies Data]

'''2) OSTEOPOROSIS CASE'''

60 y/o female

* 72 kg, 1.69m, BMI = 25.2
* t-score of -2.5
* Worried about falling and getting a hip fracture
* A friend recently had an atraumatic fracture from simply tripping and falling over in the snow
* No other risk factors

'''Calculate Risks'''

'''FRACTURE RISK ESTIMATES''' - list the endpoints described by the specific calculator

Major osteoporotic fracture - xx% - 10-year risk – if no BMD (just BMI), and then if they had a BMD t-Score of -2.0, -2.5, and -3.0

Hip fracture - - xx% - 10-year risk – if no BMD (just BMI) and if you have a BMD xx% - 10-year risk – if no BMD, and then if they had a BMD T-Score of -2.0, -2.5, and -3.0

'''The Calculator'''

* FRACTURE CALCULATOR

[https://frax.shef.ac.uk/frax/tool.aspx?country=19 Frax Tool - Canada]

'''BENEFITS AND HARMS'''

Use the [https://www.cmaj.ca/content/195/39/E1333 2023 Osteoporosis Guideline] and/or your osteoporosis lecture notes to get the benefits and apply these to your patient, and also get the harms

'''COSTS'''

Try using [https://pricingdoc.acfp.ca Pricing Doc] to get costs

'''Groups 9,21,33'''

* Activity

'''Groups 10,22,34'''

* Calcium/Vitamin D

'''Groups 11,23,35'''

* Bisphosphonates

'''Groups 12,24,36'''

* Denosumab

11) NEUROLOGY STUDIES

*[http://www.ncbi.nlm.nih.gov/pubmed/16717269 Opioids for chronic non-cancer pain] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/29509867 Effect of Opioid vs Nonopioid Medications on Pain-Related Function in Patients With Chronic Back Pain] Groups 2,14,26
*[https://www.ncbi.nlm.nih.gov/pubmed/31291515 Galcanezumab for prevention of cluster headaches] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/27150433 Immediate or delayed treatment of a first seizure] Groups 4,16,28
*[https://www.ncbi.nlm.nih.gov/pubmed/31291516 Rimegepant for episodic migraine] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/26212846 Sleep restriction for insomnia] Groups 6,18,30
*[https://www.ncbi.nlm.nih.gov/pubmed/25957224 CHANCE] Groups 7,19,31
*[https://www.ncbi.nlm.nih.gov/pubmed/16899775 SPARCL] Groups 8,20,32
*[https://www.ncbi.nlm.nih.gov/pubmed/29171821 Erenumab for episodic migraine] Groups 9,21,33
*[https://www.ncbi.nlm.nih.gov/pubmed/24733354 Reduction of benzodiazepines through education] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/26035341 Patient controlled opioid analgesia versus non-patient controlled opioid analgesia for postoperative pain] Groups 11,23,35
*[https://www.ncbi.nlm.nih.gov/pubmed/11589932 PROGRESS] Groups 12,24,36

'''ACADEMIC YEAR 3'''

12) PSYCHIATRY STUDIES

[[:File:2021 Psych Evidence Appraisal - Intro Slides.pdf|Psychiatry Rating Scales Introduction]]

* Study 1: [http://www.ncbi.nlm.nih.gov/pubmed/16554525 STAR*D (Level 2)] Bupropion-SR, sertraline, or venlafaxine-XR after failure of SSRIs for depression
* Study 2: [http://www.ncbi.nlm.nih.gov/pubmed/29477251 Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder]
* Study 3: [https://pubmed.ncbi.nlm.nih.gov/33862018/ Long-acting injectable versus oral antipsychotics for the maintenance treatment of schizophrenia]
* Study 4: [https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2725088 Association of Antipsychotic Polypharmacy vs Monotherapy With Psychiatric Rehospitalization Among Adults With Schizophrenia]
* Study 5: [https://www.ncbi.nlm.nih.gov/pubmed/29490359 Real-world Effectiveness of Pharmacologic Treatments for the Prevention of Bipolar Disorder]
* Study 6: [http://www.ncbi.nlm.nih.gov/pubmed/20092882 BALANCE] Combination lithium and valproate therapy versus monotherapy for relapse prevention in bipolar I disorder
13) GASTROENTEROLOGY STUDIES

*[http://www.ncbi.nlm.nih.gov/pubmed/27366179 Fidaxomicin versus vancomycin for Clostridium difficile infection] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/19501587 Prophylaxis of hepatic encephalopathy: Lactulose vs placebo] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/27759621 Antibiotics vs surgical therapy for uncomplicated appendicitis: Systematic review and meta-analysis] Groups 3,15,27
*[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1914504 Use of probiotic Lactobacillus preparation to prevent diarrhoea associated with antibiotics] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/17442905 Omeprazole before endoscopy in patients with gastrointestinal bleeding] Groups 5,17,29
*[http://go.galegroup.com/ps/retrieve.do?tabID=T002&resultListType=RESULT_LIST&searchResultsType=SingleTab&searchType=AdvancedSearchForm&currentPosition=3&docId=GALE%7CA489080729&docType=Report&sort=Relevance&contentSegment=&prodId=HRCA&contentSet=GALE%7CA489080729&searchId=R1&userGroupName=ubcolumbia&inPS=true Sequential-therapy treatment regimens vs standard triple therapy for the eradication of H. pylori infection] Groups 6,18,30
*[http://www.ncbi.nlm.nih.gov/pubmed/27614124 Adding licorice to the standard treatment regimen of Helicobacter pylori] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/15602019 Palifermin for oral mucositis after intensive therapy for hematologic cancers] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/9178669 Speed of healing and symptom relief in grade II to IV gastroesophageal reflux disease: a meta-analysis] Groups 9,21,33
*[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3108684 Prevention of NSAID-induced gastroduodenal ulcers: a meta-analysis] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/8985266 Beta-Adrenergic Antagonists in the Prevention of Gastrointestinal Rebleeding in Patients With Cirrhosis: A Meta-Analysis] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/27512927 Rifaximin versus norfloxacin for secondary prophylaxis of spontaneous bacterial peritonitis] Groups 12,24,36

14) OB/GYN STUDIES
*[http://www.ncbi.nlm.nih.gov/pubmed/25601350 Comparative contraceptive effectiveness of levonorgestrel-releasing and copper IUD Devices]
*[http://www.ncbi.nlm.nih.gov/pubmed/29211679 Hormonal contraception and the risk of breast cancer]
*[http://www.ncbi.nlm.nih.gov/pubmed/30322986 Sexual behaviours in adolescent girls before and after introduction of the HPV]
*[http://www.ncbi.nlm.nih.gov/pubmed/30181338 Intramuscular vs intravenous oxytocin to prevent postpartum haemorrhage at vaginal delivery]
*[http://www.ncbi.nlm.nih.gov/pubmed/27682034 Azithromycin Prophylaxis for Cesarean Delivery]
*[http://www.ncbi.nlm.nih.gov/pubmed/28461374 Antibiotics during pregnancy and risk of spontaneous abortion]

Evidence Appraisal Integrated Activities

2024-02-26T08:28:38Z

JamesMcCormack:

'''OBJECTIVE'''

To critically appraise studies, develop a brief synopsis of the trial results, succinctly present the results and then put the results into a proper clinical context

'''INITIAL PRE-READING'''

'''How To Critically Appraise an RCT In 10 minutes'''
*[https://itunes.apple.com/ca/book/how-to-critically-appraise/id524600667?mt=11 iBook/iPad version]
*[https://therapeuticseducation.org/sites/therapeuticseducation.org/files/Ten_Minute_Critical_Appraisal.pdf PDF version]
Watch this video
[http://youtu.be/QUW0Q8tXVUc Viva La Evidence]

'''Study Results at Your Fingertips'''
*[https://mystudies.org MyStudies] - Free access

'''INTEGRATION ACTIVITY FORMAT'''
# Students placed in groups of ~ 5-7
# Each group chooses one of the studies below to review
# Students then work in pairs and develop a one-slide critical appraisal and results synopsis
# One to two students in each group will be chosen at random to present their findings to the class
# A discussion about the appraisal and the appropriate clinical context for the results is had with the entire class for each study

'''MODULE'''
[[File:Screen Shot 2022-01-09 at 10.00.16 AM.jpg|left|thumb|'''TRIAL PRESENTATION FORMAT''']]

Studies chosen include landmark studies and/or studies that address important therapeutic issues for the particular module

'''ACADEMIC YEAR 1 - FIRST TERM'''

1) FOUNDATION STUDIES (Groups)
*[http://www.ncbi.nlm.nih.gov/pubmed/20228404 ACCORD FIBRATES] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/12466506 AFFIRM] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/22085343 AIM-HIGH] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/10639539 HOPE] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/18378519 HYVET] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/15007110 PROVE-IT] Groups 6,18,30
*[http://www.ncbi.nlm.nih.gov/pubmed/15755765 TNT] Groups 7,19,31
*[https://pubmed.ncbi.nlm.nih.gov/26378978 EMPAREG] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/17984165 ILLUMINATE] Groups 9,21,33
*[https://pubmed.ncbi.nlm.nih.gov/26551272/ SPRINT] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/15325833 CARDS] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/12117397 WHI] Groups 12,24,36

'''ACADEMIC YEAR 1 - SECOND TERM'''

2) INTRO TO INFECTIOUS DISEASE STUDIES

[https://therapeuticseducation.org/sites/therapeuticseducation.org/files/Antibiotic_Sensitivity_FINAL_Nov_2019.pdf The "Best" Antibiotic Sensitivity Chart Ever]
*[http://www.ncbi.nlm.nih.gov/pubmed/17567657 IV vs PO antibiotics] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/24603565 Delayed antibiotics for respiratory tract infections] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/11159657 Delayed antibiotics for otitis media] Groups 3,15,27
*[https://pubmed.ncbi.nlm.nih.gov/27455166/ Duration of treatment for community acquired pneumonia] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/22726802 Duration of treatment for pyelonephritis] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/25830421 Choice of antibiotic for community acquired pneumonia-1] Groups 6,18,30
*[http://www.ncbi.nlm.nih.gov/pubmed/25286173 Choice of antibiotic for community acquired pneumonia-2] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/20647284 HPV vaccine study] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/7966893 Influenza vaccine study] Groups 9,21,33
*[https://pubmed.ncbi.nlm.nih.gov/33301246/ COVID vaccine Pfizer] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/27626517 Herpes zoster vaccine study 1] Groups 11,23,35
*[https://www.ncbi.nlm.nih.gov/pubmed/25916341 Herpes zoster vaccine study 3] Groups 12,24,36

3) MUSCULOSKELETAL STUDIES

*[http://www.ncbi.nlm.nih.gov/pubmed/28199814 Baricitinib versus Placebo or Adalimumab in Rheumatoid Arthritis] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/0010979111 CLASS – celecoxib vs NSAIDs] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/26501533 Naproxen with cyclobenzaprine, oxycodone/acetaminophen, or placebo for low back pain] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/24395557 Glucosamine and chondroitin for OA] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/12546607 Acetaminophen vs diclofenac for OA] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/23964752 Diclofenac gel for acute neck pain] Groups 6,18,30
*[https://pubmed.ncbi.nlm.nih.gov/15468367/ Topical diclofenac vs oral diclofenac] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/25064594 Acetaminophen for low back pain] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/7611589 Misoprostol and NSAID induced ulcers] Groups 9,21,33
*[http://www.ncbi.nlm.nih.gov/pubmed/20131255 Low dose vs high dose colchicine for gout] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/22508468 TEAR - oral triple therapy versus etanercept plus methotrexate in early aggressive rheumatoid arthritis] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/25589511 MOVES - Glucosamine and chondroitin for OA for moderate to severe pain] Groups 12,24,36

4) DERMATOLOGY STUDIES

*[https://www.ncbi.nlm.nih.gov/pubmed/9598014 Glycolic acid 5% Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/21896132 Glycolic acid 10% Acne]
*[https://www.ncbi.nlm.nih.gov/pubmed/14531866 Petrolatum vs Ceramide/skin related lipids Hand Dermatitis]
*[https://www.ncbi.nlm.nih.gov/pubmed/11896774 Vitamin C Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/17515510 Retinol (VitaminA) Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/21896129 Hyaluronic acid Atopic Dermatitis]

5) EENT STUDIES

[http://www.amstar.ca/docs/AMSTARguideline.pdf AMSTAR meta-analysis checklist]

'''Scenario 1 - Otitis Media''' - GROUPS 1, 7, 18, 19, 25, 36

Anthony Martin arrives at your pharmacy somewhat frustrated since his family physician declined to write an antibiotic prescription for his two and half year old son, Oscar. His symptoms started yesterday afternoon - Oscar complains of right ear pain but there is no discharge. Rectal temperature taken today was 38.5 degrees. His wife is sure Oscar has an ear infection since the last time he had these same symptoms, that was ultimately the diagnosis. Mr. Martin asks if you think buying acetaminophen is really “enough”?

[https://pubmed.ncbi.nlm.nih.gov/26099233/ Antibiotics for acute otitis media in children]

'''Scenario 2 - Allergic Rhinitis''' - GROUPS 2, 8, 17, 20, 26, 35

Ruby Parmar is a firefighter. She is plagued by sinus congestion (preventing her from sleeping) and a runny nose associated with seasonal allergies. Her prescription for intranasal triamcinolone is typically effective, but she would like to know if a non-sedating anti-allergy pill would work just as well since it’s inconvenient carrying around the “nose spray”.

[https://www.ncbi.nlm.nih.gov/pubmed/28234147 Intranasal steroids vs antihistamines for allergic rhinitis]

'''Scenario 3 - Acute Sinusitis''' - GROUPS 3, 9, 16, 21, 27, 34

You are seeing a patient in clinic before her appointment with the primary care physician. She was feeling unwell with a “flu” last week. While most of her symptoms have resolved (cough, fever), the nasal congestion and discharge persists and so she has made an appointment (she is an otherwise healthy 32 year old with treated thyroid disease). She would like your advice for what treatment she should ask the doctor to prescribe.

[http://www.ncbi.nlm.nih.gov/pubmed/24293353 Intranasal steroids for acute sinusitis]

'''Scenario 4 - Glaucoma''' - GROUPS 4, 10, 15, 22, 28, 33

Mrs. Ada Waters is a 63 year-old woman you. Her ophthalmologist prescribed timolol and xalatan eye drops for treatment of open angle glaucoma. She has never really felt much different on treatment since she recovered from her first episode (of acute angle closure glaucoma requiring ER visit) and surgery. She asks you if the treatment is really making a difference.

[https://www.ncbi.nlm.nih.gov/pubmed/17943780 Interventions for open angle glaucoma]

'''Scenario 5 - Sore Throat''' - GROUPS 5, 11, 14, 23, 29, 32

You have a good friend who is applying for pharmacy. Her invitation for the multiple-mini interview (MMI) is coming up soon, but she is starting to experience a sore throat. While she is worried about not being able to speak through all of those stations, she knows she often gets a terrible headache along with her sore throat. She has an unused prescription for amoxicillin (unexpired) and wonders if you recommend for her to take it.

[https://pubmed.ncbi.nlm.nih.gov/34881426/ Antibiotics for sore throat]

'''Scenario 6 - Conjunctivitis''' - GROUPS 6, 12, 13, 24, 30, 31

A man comes to your pharmacy (he appears in his early twenties) complaining of “pink eye”. He has had a pink discolouration and discharge from his left eye for two days. He asks if the OTC antibiotic eye drops (he’s holding a product with polymixin B) are any better than “waiting it out”.

[https://www.ncbi.nlm.nih.gov/pubmed/22972049 Antibiotics for acute conjunctivitis]

6) HEMATOLOGY STUDIES

None so far

'''ACADEMIC YEAR 2 - FIRST TERM'''

7) RESPIROLOGY STUDIES

*[http://www.ncbi.nlm.nih.gov/pubmed/2062329 First inhaled steroid study] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/22938706 Tiotropium in asthma] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/21324520 Inhaled steroid in children] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/29768149 Combined Budesonide–Formoterol as Needed in Mild Asthma] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/15223858 Doubling dose of inhaled corticosteroid] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/29768147 As-Needed Budesonide–Formoterol versus Maintenance Budesonide in Mild Asthma] Groups 6,18,30
*[http://www.ncbi.nlm.nih.gov/pubmed/27181606 Indacaterol-glycopyrronium VS salmeterol/fluticasone in COPD] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/21428765 Tiotropium VS salmeterol in COPD] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/23695200 Short VS long steroids for COPD exacerbation] Groups 9,21,33
*[http://www.ncbi.nlm.nih.gov/pubmed/25196117 Stopping inhaled steroids in COPD] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/29668352 Once-Daily Single-Inhaler Triple versus Dual Therapy in Patients with COPD] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/28877011 Tezepelumab in Adults with Uncontrolled Asthma] Groups 12,24,36

8) CARDIOVASCULAR STUDIES

SESSION 1

*[https://www.ncbi.nlm.nih.gov/pubmed/4862069 VA1] (Group 1, 13, 25)
*[https://www.ncbi.nlm.nih.gov/pubmed/4914579 VA 2] (Group 2, 14, 26)
*[https://pubmed.ncbi.nlm.nih.gov/33186492 Polycap Study 3] (Group 3, 15, 27)
*[http://www.ncbi.nlm.nih.gov/pubmed/20228401 ACCORD-BP] (Group 4, 16, 28)
*[https://www.ncbi.nlm.nih.gov/pubmed/26551272 SPRINT] (Group 5, 17, 29)
*[http://www.ncbi.nlm.nih.gov/pubmed/2883575 CONSENSUS] (Group 6,18,30)
*[https://pubmed.ncbi.nlm.nih.gov/31535829/ DAPA-HF] (Group 7, 19, 31)
*[https://pubmed.ncbi.nlm.nih.gov/25176939/ CONFIRM-HF] (Group 8, 20, 32)
*[http://www.ncbi.nlm.nih.gov/pubmed/12457784 PROSPER] (Group 9, 21, 33)
*[http://www.ncbi.nlm.nih.gov/pubmed/27040132 HOPE-3] (Group 10, 22, 34)
*[http://www.ncbi.nlm.nih.gov/pubmed/12114036 Heart Protection Study (HPS)] (Group 11, 23, 35)
*[http://www.ncbi.nlm.nih.gov/pubmed/30415628 REDUCE-IT] (Group 12, 24, 36)

[[File:CV Case.pdf|thumb|CV case|left]]

SESSION 2

'''The Guideline Case'''

A 63 y/o patient with CHOOSE ONE (⬆︎HTN/⬆︎Chol/⬆︎glucose/HF/A fib) and using the guideline determine:
# their 5yr/10yr risks of mortality/CVD events
# the potential benefit
# the potential side effects (with magnitude)
# words/sentiment patient values and preferences/SDM

Atrial fibrillation - Groups 1,13,25,2,14,26
*[https://www.onlinecjc.ca/article/S0828-282X(18)31062-6/pdf 2018 Atrial fibrillation guidelines]
Diabetes - Groups 3,15,27,4,16,28
*[http://guidelines.diabetes.ca/docs/CPG-2018-full-EN.pdf 2018 Diabetes guidelines]
Lipid Simplified - Groups 5,17,29,6,18,30
*[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4607330/pdf/0610857.pdf 2015 Simplified lipid guidelines]
Lipid - Groups 7,19,31,8,20,32
*[http://www.onlinecjc.ca/article/S0828-282X(16)30732-2/pdf 2016 Lipid guidelines]
Heart failure - Groups 9,21,33,10,22,34
*[http://www.onlinecjc.ca/article/S0828-282X(17)30973-X/pdf 2017 Heart failure guidelines]
Hypertension - Groups 11,23,35,12,24,36
*[https://www.onlinecjc.ca/article/S0828-282X(18)30183-1/pdf 2018 Hypertension guidelines]

OPTIONAL SESSION
*[http://www.ncbi.nlm.nih.gov/pubmed/16899775 SPARCL]
*[http://www.ncbi.nlm.nih.gov/pubmed/10471456 RALES]
*[http://www.ncbi.nlm.nih.gov/pubmed/11386263 Carvedilol in heart failure]
*[http://www.ncbi.nlm.nih.gov/pubmed/18460663 WAFACS]
*[http://www.ncbi.nlm.nih.gov/pubmed/10376614 MERIT-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/25176015 PARADIGM-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/24490264 High-dose multivitamins after MI]
*[http://www.ncbi.nlm.nih.gov/pubmed/7911176 Mediterranean Diet after MI]
*[http://www.ncbi.nlm.nih.gov/pubmed/15337732 A TO Z]
*[http://www.ncbi.nlm.nih.gov/pubmed/21073363 EMPHASIS-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/12853193 COMET]
*[http://www.ncbi.nlm.nih.gov/pubmed/24716680 TOPCAT]
*[http://www.ncbi.nlm.nih.gov/pubmed/26039521 IMPROVE-IT]

'''ACADEMIC YEAR 2 - SECOND TERM'''

9) NEPHROLOGY STUDIES

None so far

10) ENDOCRINOLOGY[[File:IA ENDO LAYOUT 1.pdf|left|thumb|IA ENDO LAYOUT]]

'''RISK ASSESSMENT CASES FOR DIABETES AND OSTEOPOROSIS'''

'''1) DIABETES CASE'''

66 y/o white male who was diagnosed with diabetes 8 years ago

* His blood pressure over the last year has been roughly 145/80 mmHg - at present untreated
* A1c = 8%, no diabetes meds, non-smoker, BMI ~30
* Total cholesterol is 6 mmol/L, his HDL is 2 mmol/L, non-HDL = 6 minus 2, not on a statin
* No retinopathy, urine albumin-to-creatinine ratio (UACR) = 15ug/mg (7mg/mmol),
* Serum creatinine = 70 micromol/L, waist circumference 100 cm
* GFR 75 mL/min/1.73m2
* In normal sinus rhythm
* Age at end of highest education = 19
* Mother alive, father died of a heart attack at age 80

'''Calculate Risks'''

'''CVD RISK ESTIMATES''' - list the endpoints described by the specific calculator

Framingham - xx% - 10-year risk - also if no diabetes xx%

ASCVD - xx% - 10-year risk - also if no diabetes xx%

'''The Calculator'''
*CVD CALCULATOR
https://decisionaid.ca/cvd/

'''DIABETES COMPLICATIONS RISK ESTIMATES''' - list the endpoints described by the specific calculator

xx% - also 10-year risk if A1c 9, 8, 7 and 6

also get risk of kidney failure, vision loss, pressure sensation loss – also if A1c 9, 8,7,6

'''The Calculator'''
*DIABETES DECISION AID
http://decisionaid.ca/diabetes/

'''BENEFITS AND HARMS'''

Use the [https://guidelines.diabetes.ca/cpg/chapter-13-2020-update 2020 diabetes guidelines] and/or Diabetes Decision Aid to get estimates of benefits and harms and also use the MyStudies synopsis listed below

'''COSTS'''

Try using [https://pricingdoc.acfp.ca Pricing Doc] to get costs

'''Groups 1,13,25'''

* Metformin - UKPDS 34 [https://mystudies.org/studies.php#studies/28929e89-d01e-4b11-8e67-4d7086f9e4aa/outcome MyStudies Data]

'''Groups 2,14,26'''

* Sulfonlyureas - UKPDS 33 [https://mystudies.org/studies.php#studies/5eadb5dd-d403-4c13-b03e-d4f8d28c96ba/outcome MyStudies Data]

'''Groups 3,15,27'''

* Insulin - ORIGIN [https://mystudies.org/studies.php#studies/f611818f-2e69-4952-b55e-661116bd84b6/outcome MyStudies Data]

'''Groups 4,16,28'''

* SGLT2 - EMPA-REG OUTCOME [https://mystudies.org/studies.php#studies/32e9cf1a-f33e-480b-91ca-6f28a4dcf862/outcome MyStudies Data]

'''Groups 5,17,29'''

* GLP - LEADER [https://mystudies.org/studies.php#studies/1adbc9a1-7603-40f1-ac15-b813ce1f0ad6/outcome MyStudies Data]

'''Groups 6,18,30'''

* DPP4 - TECOS [https://mystudies.org/studies.php#studies/8659968a-cefb-4f99-b4ae-8b9b659acbd5/outcome MyStudies Data]

'''Groups 7,19,31'''

* Intensive treatment – small scale - STENO [https://mystudies.org/studies.php#studies/39d423e3-af57-40c8-ab7a-cbc7f389bdb6/paper MyStudies Data]

'''Groups 8,20,32'''

* Intensive treatment – large scale - ADDITION-Europe - [https://mystudies.org/studies.php#studies/5e07d86d-aa92-4db9-a283-76080db4b6fd/outcome MyStudies Data]

'''2) OSTEOPOROSIS CASE'''

60 y/o female

* 72 kg, 1.69m, BMI = 25.2
* t-score of -2.5
* Worried about falling and getting a hip fracture
* A friend recently had an atraumatic fracture from simply tripping and falling over in the snow
* No other risk factors

'''Calculate Risks'''

'''FRACTURE RISK ESTIMATES''' - list the endpoints described by the specific calculator

Major osteoporotic fracture - xx% - 10-year risk – if no BMD (just BMI), and then if they had a BMD t-Score of -2.0, -2.5, and -3.0

Hip fracture - - xx% - 10-year risk – if no BMD (just BMI) and if you have a BMD xx% - 10-year risk – if no BMD, and then if they had a BMD T-Score of -2.0, -2.5, and -3.0

'''The Calculator'''

* FRACTURE CALCULATOR

[https://frax.shef.ac.uk/frax/tool.aspx?country=19 Frax Tool - Canada]

'''BENEFITS AND HARMS'''

Use the [https://www.cmaj.ca/content/195/39/E1333 2023 Osteoporosis Guideline] and/or your osteoporosis lecture notes to get the benefits and apply these to your patient, and also get the harms

'''COSTS'''

Try using [https://pricingdoc.acfp.ca Pricing Doc] to get costs

'''Groups 9,21,33'''

* Activity

'''Groups 10,22,34'''

* Calcium/Vitamin D

'''Groups 11,23,35'''

* Bisphosphonates

'''Groups 12,24,36'''

* Denosumab

11) NEUROLOGY STUDIES

*[http://www.ncbi.nlm.nih.gov/pubmed/16717269 Opioids for chronic non-cancer pain] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/29509867 Effect of Opioid vs Nonopioid Medications on Pain-Related Function in Patients With Chronic Back Pain] Groups 2,14,26
*[https://www.ncbi.nlm.nih.gov/pubmed/31291515 Galcanezumab for prevention of cluster headaches] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/27150433 Immediate or delayed treatment of a first seizure] Groups 4,16,28
*[https://www.ncbi.nlm.nih.gov/pubmed/31291516 Rimegepant for episodic migraine] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/26212846 Sleep restriction for insomnia] Groups 6,18,30
*[https://www.ncbi.nlm.nih.gov/pubmed/25957224 CHANCE] Groups 7,19,31
*[https://www.ncbi.nlm.nih.gov/pubmed/16899775 SPARCL] Groups 8,20,32
*[https://www.ncbi.nlm.nih.gov/pubmed/29171821 Erenumab for episodic migraine] Groups 9,21,33
*[https://www.ncbi.nlm.nih.gov/pubmed/24733354 Reduction of benzodiazepines through education] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/26035341 Patient controlled opioid analgesia versus non-patient controlled opioid analgesia for postoperative pain] Groups 11,23,35
*[https://www.ncbi.nlm.nih.gov/pubmed/11589932 PROGRESS] Groups 12,24,36

'''ACADEMIC YEAR 3'''

12) PSYCHIATRY STUDIES

[[:File:2021 Psych Evidence Appraisal - Intro Slides.pdf|Psychiatry Rating Scales Introduction]]

* Study 1: [http://www.ncbi.nlm.nih.gov/pubmed/16554525 STAR*D (Level 2)] Bupropion-SR, sertraline, or venlafaxine-XR after failure of SSRIs for depression
* Study 2: [http://www.ncbi.nlm.nih.gov/pubmed/29477251 Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder]
* Study 3: [https://pubmed.ncbi.nlm.nih.gov/33862018/ Long-acting injectable versus oral antipsychotics for the maintenance treatment of schizophrenia]
* Study 4: [https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2725088 Association of Antipsychotic Polypharmacy vs Monotherapy With Psychiatric Rehospitalization Among Adults With Schizophrenia]
* Study 5: [https://www.ncbi.nlm.nih.gov/pubmed/29490359 Real-world Effectiveness of Pharmacologic Treatments for the Prevention of Bipolar Disorder]
* Study 6: [http://www.ncbi.nlm.nih.gov/pubmed/20092882 BALANCE] Combination lithium and valproate therapy versus monotherapy for relapse prevention in bipolar I disorder
13) GASTROENTEROLOGY STUDIES

*[http://www.ncbi.nlm.nih.gov/pubmed/27366179 Fidaxomicin versus vancomycin for Clostridium difficile infection] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/19501587 Prophylaxis of hepatic encephalopathy: Lactulose vs placebo] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/27759621 Antibiotics vs surgical therapy for uncomplicated appendicitis: Systematic review and meta-analysis] Groups 3,15,27
*[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1914504 Use of probiotic Lactobacillus preparation to prevent diarrhoea associated with antibiotics] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/17442905 Omeprazole before endoscopy in patients with gastrointestinal bleeding] Groups 5,17,29
*[http://go.galegroup.com/ps/retrieve.do?tabID=T002&resultListType=RESULT_LIST&searchResultsType=SingleTab&searchType=AdvancedSearchForm&currentPosition=3&docId=GALE%7CA489080729&docType=Report&sort=Relevance&contentSegment=&prodId=HRCA&contentSet=GALE%7CA489080729&searchId=R1&userGroupName=ubcolumbia&inPS=true Sequential-therapy treatment regimens vs standard triple therapy for the eradication of H. pylori infection] Groups 6,18,30
*[http://www.ncbi.nlm.nih.gov/pubmed/27614124 Adding licorice to the standard treatment regimen of Helicobacter pylori] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/15602019 Palifermin for oral mucositis after intensive therapy for hematologic cancers] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/9178669 Speed of healing and symptom relief in grade II to IV gastroesophageal reflux disease: a meta-analysis] Groups 9,21,33
*[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3108684 Prevention of NSAID-induced gastroduodenal ulcers: a meta-analysis] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/8985266 Beta-Adrenergic Antagonists in the Prevention of Gastrointestinal Rebleeding in Patients With Cirrhosis: A Meta-Analysis] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/27512927 Rifaximin versus norfloxacin for secondary prophylaxis of spontaneous bacterial peritonitis] Groups 12,24,36

14) OB/GYN STUDIES
*[http://www.ncbi.nlm.nih.gov/pubmed/25601350 Comparative contraceptive effectiveness of levonorgestrel-releasing and copper IUD Devices]
*[http://www.ncbi.nlm.nih.gov/pubmed/29211679 Hormonal contraception and the risk of breast cancer]
*[http://www.ncbi.nlm.nih.gov/pubmed/30322986 Sexual behaviours in adolescent girls before and after introduction of the HPV]
*[http://www.ncbi.nlm.nih.gov/pubmed/30181338 Intramuscular vs intravenous oxytocin to prevent postpartum haemorrhage at vaginal delivery]
*[http://www.ncbi.nlm.nih.gov/pubmed/27682034 Azithromycin Prophylaxis for Cesarean Delivery]
*[http://www.ncbi.nlm.nih.gov/pubmed/28461374 Antibiotics during pregnancy and risk of spontaneous abortion]

Evidence Appraisal Integrated Activities

2024-02-08T21:57:28Z

JamesMcCormack:

'''OBJECTIVE'''

To critically appraise studies, develop a brief synopsis of the trial results, succinctly present the results and then put the results into a proper clinical context

'''INITIAL PRE-READING'''

'''How To Critically Appraise an RCT In 10 minutes'''
*[https://itunes.apple.com/ca/book/how-to-critically-appraise/id524600667?mt=11 iBook/iPad version]
*[https://therapeuticseducation.org/sites/therapeuticseducation.org/files/Ten_Minute_Critical_Appraisal.pdf PDF version]
Watch this video
[http://youtu.be/QUW0Q8tXVUc Viva La Evidence]

'''Study Results at Your Fingertips'''
*[https://mystudies.org MyStudies] - Free access

'''INTEGRATION ACTIVITY FORMAT'''
# Students placed in groups of ~ 5-7
# Each group chooses one of the studies below to review
# Students then work in pairs and develop a one-slide critical appraisal and results synopsis
# One to two students in each group will be chosen at random to present their findings to the class
# A discussion about the appraisal and the appropriate clinical context for the results is had with the entire class for each study

'''MODULE'''
[[File:Screen Shot 2022-01-09 at 10.00.16 AM.jpg|left|thumb|'''TRIAL PRESENTATION FORMAT''']]

Studies chosen include landmark studies and/or studies that address important therapeutic issues for the particular module

'''ACADEMIC YEAR 1 - FIRST TERM'''

1) FOUNDATION STUDIES (Groups)
*[http://www.ncbi.nlm.nih.gov/pubmed/20228404 ACCORD FIBRATES] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/12466506 AFFIRM] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/22085343 AIM-HIGH] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/10639539 HOPE] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/18378519 HYVET] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/15007110 PROVE-IT] Groups 6,18,30
*[http://www.ncbi.nlm.nih.gov/pubmed/15755765 TNT] Groups 7,19,31
*[https://pubmed.ncbi.nlm.nih.gov/26378978 EMPAREG] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/17984165 ILLUMINATE] Groups 9,21,33
*[https://pubmed.ncbi.nlm.nih.gov/26551272/ SPRINT] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/15325833 CARDS] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/12117397 WHI] Groups 12,24,36

'''ACADEMIC YEAR 1 - SECOND TERM'''

2) INTRO TO INFECTIOUS DISEASE STUDIES

[https://therapeuticseducation.org/sites/therapeuticseducation.org/files/Antibiotic_Sensitivity_FINAL_Nov_2019.pdf The "Best" Antibiotic Sensitivity Chart Ever]
*[http://www.ncbi.nlm.nih.gov/pubmed/17567657 IV vs PO antibiotics] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/24603565 Delayed antibiotics for respiratory tract infections] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/11159657 Delayed antibiotics for otitis media] Groups 3,15,27
*[https://pubmed.ncbi.nlm.nih.gov/27455166/ Duration of treatment for community acquired pneumonia] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/22726802 Duration of treatment for pyelonephritis] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/25830421 Choice of antibiotic for community acquired pneumonia-1] Groups 6,18,30
*[http://www.ncbi.nlm.nih.gov/pubmed/25286173 Choice of antibiotic for community acquired pneumonia-2] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/20647284 HPV vaccine study] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/7966893 Influenza vaccine study] Groups 9,21,33
*[https://pubmed.ncbi.nlm.nih.gov/33301246/ COVID vaccine Pfizer] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/27626517 Herpes zoster vaccine study 1] Groups 11,23,35
*[https://www.ncbi.nlm.nih.gov/pubmed/25916341 Herpes zoster vaccine study 3] Groups 12,24,36

3) MUSCULOSKELETAL STUDIES

*[http://www.ncbi.nlm.nih.gov/pubmed/28199814 Baricitinib versus Placebo or Adalimumab in Rheumatoid Arthritis] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/0010979111 CLASS – celecoxib vs NSAIDs] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/26501533 Naproxen with cyclobenzaprine, oxycodone/acetaminophen, or placebo for low back pain] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/24395557 Glucosamine and chondroitin for OA] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/12546607 Acetaminophen vs diclofenac for OA] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/23964752 Diclofenac gel for acute neck pain] Groups 6,18,30
*[https://pubmed.ncbi.nlm.nih.gov/15468367/ Topical diclofenac vs oral diclofenac] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/25064594 Acetaminophen for low back pain] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/7611589 Misoprostol and NSAID induced ulcers] Groups 9,21,33
*[http://www.ncbi.nlm.nih.gov/pubmed/20131255 Low dose vs high dose colchicine for gout] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/22508468 TEAR - oral triple therapy versus etanercept plus methotrexate in early aggressive rheumatoid arthritis] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/25589511 MOVES - Glucosamine and chondroitin for OA for moderate to severe pain] Groups 12,24,36

4) DERMATOLOGY STUDIES

*[https://www.ncbi.nlm.nih.gov/pubmed/9598014 Glycolic acid 5% Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/21896132 Glycolic acid 10% Acne]
*[https://www.ncbi.nlm.nih.gov/pubmed/14531866 Petrolatum vs Ceramide/skin related lipids Hand Dermatitis]
*[https://www.ncbi.nlm.nih.gov/pubmed/11896774 Vitamin C Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/17515510 Retinol (VitaminA) Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/21896129 Hyaluronic acid Atopic Dermatitis]

5) EENT STUDIES

[http://www.amstar.ca/docs/AMSTARguideline.pdf AMSTAR meta-analysis checklist]

'''Scenario 1 - Otitis Media''' - GROUPS 1, 7, 18, 19, 25, 36

Anthony Martin arrives at your pharmacy somewhat frustrated since his family physician declined to write an antibiotic prescription for his two and half year old son, Oscar. His symptoms started yesterday afternoon - Oscar complains of right ear pain but there is no discharge. Rectal temperature taken today was 38.5 degrees. His wife is sure Oscar has an ear infection since the last time he had these same symptoms, that was ultimately the diagnosis. Mr. Martin asks if you think buying acetaminophen is really “enough”?

[https://pubmed.ncbi.nlm.nih.gov/26099233/ Antibiotics for acute otitis media in children]

'''Scenario 2 - Allergic Rhinitis''' - GROUPS 2, 8, 17, 20, 26, 35

Ruby Parmar is a firefighter. She is plagued by sinus congestion (preventing her from sleeping) and a runny nose associated with seasonal allergies. Her prescription for intranasal triamcinolone is typically effective, but she would like to know if a non-sedating anti-allergy pill would work just as well since it’s inconvenient carrying around the “nose spray”.

[https://www.ncbi.nlm.nih.gov/pubmed/28234147 Intranasal steroids vs antihistamines for allergic rhinitis]

'''Scenario 3 - Acute Sinusitis''' - GROUPS 3, 9, 16, 21, 27, 34

You are seeing a patient in clinic before her appointment with the primary care physician. She was feeling unwell with a “flu” last week. While most of her symptoms have resolved (cough, fever), the nasal congestion and discharge persists and so she has made an appointment (she is an otherwise healthy 32 year old with treated thyroid disease). She would like your advice for what treatment she should ask the doctor to prescribe.

[http://www.ncbi.nlm.nih.gov/pubmed/24293353 Intranasal steroids for acute sinusitis]

'''Scenario 4 - Glaucoma''' - GROUPS 4, 10, 15, 22, 28, 33

Mrs. Ada Waters is a 63 year-old woman you. Her ophthalmologist prescribed timolol and xalatan eye drops for treatment of open angle glaucoma. She has never really felt much different on treatment since she recovered from her first episode (of acute angle closure glaucoma requiring ER visit) and surgery. She asks you if the treatment is really making a difference.

[https://www.ncbi.nlm.nih.gov/pubmed/17943780 Interventions for open angle glaucoma]

'''Scenario 5 - Sore Throat''' - GROUPS 5, 11, 14, 23, 29, 32

You have a good friend who is applying for pharmacy. Her invitation for the multiple-mini interview (MMI) is coming up soon, but she is starting to experience a sore throat. While she is worried about not being able to speak through all of those stations, she knows she often gets a terrible headache along with her sore throat. She has an unused prescription for amoxicillin (unexpired) and wonders if you recommend for her to take it.

[https://pubmed.ncbi.nlm.nih.gov/34881426/ Antibiotics for sore throat]

'''Scenario 6 - Conjunctivitis''' - GROUPS 6, 12, 13, 24, 30, 31

A man comes to your pharmacy (he appears in his early twenties) complaining of “pink eye”. He has had a pink discolouration and discharge from his left eye for two days. He asks if the OTC antibiotic eye drops (he’s holding a product with polymixin B) are any better than “waiting it out”.

[https://www.ncbi.nlm.nih.gov/pubmed/22972049 Antibiotics for acute conjunctivitis]

6) HEMATOLOGY STUDIES

None so far

'''ACADEMIC YEAR 2 - FIRST TERM'''

7) RESPIROLOGY STUDIES

*[http://www.ncbi.nlm.nih.gov/pubmed/2062329 First inhaled steroid study] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/22938706 Tiotropium in asthma] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/21324520 Inhaled steroid in children] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/29768149 Combined Budesonide–Formoterol as Needed in Mild Asthma] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/15223858 Doubling dose of inhaled corticosteroid] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/29768147 As-Needed Budesonide–Formoterol versus Maintenance Budesonide in Mild Asthma] Groups 6,18,30
*[http://www.ncbi.nlm.nih.gov/pubmed/27181606 Indacaterol-glycopyrronium VS salmeterol/fluticasone in COPD] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/21428765 Tiotropium VS salmeterol in COPD] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/23695200 Short VS long steroids for COPD exacerbation] Groups 9,21,33
*[http://www.ncbi.nlm.nih.gov/pubmed/25196117 Stopping inhaled steroids in COPD] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/29668352 Once-Daily Single-Inhaler Triple versus Dual Therapy in Patients with COPD] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/28877011 Tezepelumab in Adults with Uncontrolled Asthma] Groups 12,24,36

8) CARDIOVASCULAR STUDIES

SESSION 1

*[https://www.ncbi.nlm.nih.gov/pubmed/4862069 VA1] (Group 1, 13, 25)
*[https://www.ncbi.nlm.nih.gov/pubmed/4914579 VA 2] (Group 2, 14, 26)
*[https://pubmed.ncbi.nlm.nih.gov/33186492 Polycap Study 3] (Group 3, 15, 27)
*[http://www.ncbi.nlm.nih.gov/pubmed/20228401 ACCORD-BP] (Group 4, 16, 28)
*[https://www.ncbi.nlm.nih.gov/pubmed/26551272 SPRINT] (Group 5, 17, 29)
*[http://www.ncbi.nlm.nih.gov/pubmed/2883575 CONSENSUS] (Group 6,18,30)
*[https://pubmed.ncbi.nlm.nih.gov/31535829/ DAPA-HF] (Group 7, 19, 31)
*[https://pubmed.ncbi.nlm.nih.gov/25176939/ CONFIRM-HF] (Group 8, 20, 32)
*[http://www.ncbi.nlm.nih.gov/pubmed/12457784 PROSPER] (Group 9, 21, 33)
*[http://www.ncbi.nlm.nih.gov/pubmed/27040132 HOPE-3] (Group 10, 22, 34)
*[http://www.ncbi.nlm.nih.gov/pubmed/12114036 Heart Protection Study (HPS)] (Group 11, 23, 35)
*[http://www.ncbi.nlm.nih.gov/pubmed/30415628 REDUCE-IT] (Group 12, 24, 36)

[[File:CV Case.pdf|thumb|CV case|left]]

SESSION 2

'''The Guideline Case'''

A 63 y/o patient with CHOOSE ONE (⬆︎HTN/⬆︎Chol/⬆︎glucose/HF/A fib) and using the guideline determine:
# their 5yr/10yr risks of mortality/CVD events
# the potential benefit
# the potential side effects (with magnitude)
# words/sentiment patient values and preferences/SDM

Atrial fibrillation - Groups 1,13,25,2,14,26
*[https://www.onlinecjc.ca/article/S0828-282X(18)31062-6/pdf 2018 Atrial fibrillation guidelines]
Diabetes - Groups 3,15,27,4,16,28
*[http://guidelines.diabetes.ca/docs/CPG-2018-full-EN.pdf 2018 Diabetes guidelines]
Lipid Simplified - Groups 5,17,29,6,18,30
*[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4607330/pdf/0610857.pdf 2015 Simplified lipid guidelines]
Lipid - Groups 7,19,31,8,20,32
*[http://www.onlinecjc.ca/article/S0828-282X(16)30732-2/pdf 2016 Lipid guidelines]
Heart failure - Groups 9,21,33,10,22,34
*[http://www.onlinecjc.ca/article/S0828-282X(17)30973-X/pdf 2017 Heart failure guidelines]
Hypertension - Groups 11,23,35,12,24,36
*[https://www.onlinecjc.ca/article/S0828-282X(18)30183-1/pdf 2018 Hypertension guidelines]

OPTIONAL SESSION
*[http://www.ncbi.nlm.nih.gov/pubmed/16899775 SPARCL]
*[http://www.ncbi.nlm.nih.gov/pubmed/10471456 RALES]
*[http://www.ncbi.nlm.nih.gov/pubmed/11386263 Carvedilol in heart failure]
*[http://www.ncbi.nlm.nih.gov/pubmed/18460663 WAFACS]
*[http://www.ncbi.nlm.nih.gov/pubmed/10376614 MERIT-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/25176015 PARADIGM-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/24490264 High-dose multivitamins after MI]
*[http://www.ncbi.nlm.nih.gov/pubmed/7911176 Mediterranean Diet after MI]
*[http://www.ncbi.nlm.nih.gov/pubmed/15337732 A TO Z]
*[http://www.ncbi.nlm.nih.gov/pubmed/21073363 EMPHASIS-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/12853193 COMET]
*[http://www.ncbi.nlm.nih.gov/pubmed/24716680 TOPCAT]
*[http://www.ncbi.nlm.nih.gov/pubmed/26039521 IMPROVE-IT]

'''ACADEMIC YEAR 2 - SECOND TERM'''

9) NEPHROLOGY STUDIES

None so far

10) ENDOCRINOLOGY[[File:IA ENDO LAYOUT 1.pdf|left|thumb|IA ENDO LAYOUT]]

'''RISK ASSESSMENT CASES FOR DIABETES AND OSTEOPOROSIS'''

'''1) DIABETES CASE'''

66 y/o white male who was diagnosed with diabetes 8 years ago

* His blood pressure over the last year has been roughly 145/80 mmHg - at present untreated
* A1c = 8%, no diabetes meds, non-smoker, BMI ~30
* Total cholesterol is 6 mmol/L, his HDL is 2 mmol/L, non-HDL = 6 minus 2, not on a statin
* No retinopathy, urine albumin-to-creatinine ratio (UACR) = 15ug/mg (7mg/mmol),
* Serum creatinine = 70 micromol/L, waist circumference 100 cm
* GFR 75 mL/min/1.73m2
* In normal sinus rhythm
* Age at end of highest education = 19
* Mother alive, father died of a heart attack at age 80

'''Calculate Risks'''

'''CVD RISK ESTIMATES''' - list the endpoints described by the specific calculator

Framingham - xx% - 10-year risk - also if no diabetes xx%

ASCVD - xx% - 10-year risk - also if no diabetes xx%

'''The Calculator'''
*CVD CALCULATOR
https://decisionaid.ca/cvd/

'''DIABETES COMPLICATIONS RISK ESTIMATES''' - list the endpoints described by the specific calculator

xx% - also 10-year risk if A1c 9, 8, 7 and 6

also get risk of kidney failure, vision loss, pressure sensation loss – also if A1c 9, 8,7,6

'''The Calculator'''
*DIABETES DECISION AID
http://decisionaid.ca/diabetes/

'''BENEFITS AND HARMS'''

Use the [https://guidelines.diabetes.ca/cpg/chapter-13-2020-update 2020 diabetes guidelines] and/or Diabetes Decision Aid to get estimates of benefits and harms and also use the MyStudies synopsis listed below

'''COSTS'''

Try using [https://pricingdoc.acfp.ca Pricing Doc] to get costs

'''Groups 1,13,25'''

* Metformin - UKPDS 34 [https://mystudies.org/studies.php#studies/28929e89-d01e-4b11-8e67-4d7086f9e4aa/outcome MyStudies Data]

'''Groups 2,14,26'''

* Sulfonlyureas - UKPDS 33 [https://mystudies.org/studies.php#studies/5eadb5dd-d403-4c13-b03e-d4f8d28c96ba/outcome MyStudies Data]

'''Groups 3,15,27'''

* Insulin - ORIGIN [https://mystudies.org/studies.php#studies/f611818f-2e69-4952-b55e-661116bd84b6/outcome MyStudies Data]

'''Groups 4,16,28'''

* SGLT2 - EMPA-REG OUTCOME [https://mystudies.org/studies.php#studies/32e9cf1a-f33e-480b-91ca-6f28a4dcf862/outcome MyStudies Data]

'''Groups 5,17,29'''

* GLP - LEADER [https://mystudies.org/studies.php#studies/1adbc9a1-7603-40f1-ac15-b813ce1f0ad6/outcome MyStudies Data]

'''Groups 6,18,30'''

* DPP4 - TECOS [https://mystudies.org/studies.php#studies/8659968a-cefb-4f99-b4ae-8b9b659acbd5/outcome MyStudies Data]

'''Groups 7,19,31'''

* Intensive treatment – small scale - STENO [https://mystudies.org/studies.php#studies/39d423e3-af57-40c8-ab7a-cbc7f389bdb6/paper MyStudies Data]

'''Groups 8,20,32'''

* Intensive treatment – large scale - ADDITION-Europe - [https://mystudies.org/studies.php#studies/5e07d86d-aa92-4db9-a283-76080db4b6fd/outcome MyStudies Data]

'''2) OSTEOPOROSIS CASE'''

60 y/o female

* 72 kg, 1.69m, BMI = 25.2
* t-score of -2.5
* Worried about falling and getting a hip fracture
* A friend recently had an atraumatic fracture from simply tripping and falling over in the snow
* No other risk factors

'''Calculate Risks'''

'''FRACTURE RISK ESTIMATES''' - list the endpoints described by the specific calculator

Major osteoporotic fracture - xx% - 10-year risk – if no BMD (just BMI), and then if they had a BMD t-Score of -2.0, -2.5, and -3.0

Hip fracture - - xx% - 10-year risk – if no BMD (just BMI) and if you have a BMD xx% - 10-year risk – if no BMD, and then if they had a BMD T-Score of -2.0, -2.5, and -3.0

'''The Calculator'''

* FRACTURE CALCULATOR

[https://frax.shef.ac.uk/frax/tool.aspx?country=19 Frax Tool - Canada]

'''BENEFITS AND HARMS'''

Use the [https://www.cmaj.ca/content/195/39/E1333 2023 Osteoporosis Guideline] and/or your osteoporosis lecture notes to get the benefits and apply these to your patient, and also get the harms

'''COSTS'''

Try using [https://pricingdoc.acfp.ca Pricing Doc] to get costs

'''Groups 9,21,33'''

* Activity

'''Groups 10,22,34'''

* Calcium/Vitamin D

'''Groups 11,23,35'''

* Bisphosphonates

'''Groups 12,24,36'''

* Denosumab

11) NEUROLOGY STUDIES

*[http://www.ncbi.nlm.nih.gov/pubmed/16717269 Opioids for chronic non-cancer pain] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/29509867 Effect of Opioid vs Nonopioid Medications on Pain-Related Function in Patients With Chronic Back Pain] Groups 2,14,26
*[https://www.ncbi.nlm.nih.gov/pubmed/31291515 Galcanezumab for prevention of cluster headaches] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/27150433 Immediate or delayed treatment of a first seizure] Groups 4,16,28
*[https://www.ncbi.nlm.nih.gov/pubmed/31291516 Rimegepant for episodic migraine] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/26212846 Sleep restriction for insomnia] Groups 6,18,30
*[https://www.ncbi.nlm.nih.gov/pubmed/25957224 CHANCE] Groups 7,19,31
*[https://www.ncbi.nlm.nih.gov/pubmed/16899775 SPARCL] Groups 8,20,32
*[https://www.ncbi.nlm.nih.gov/pubmed/29171821 Erenumab for episodic migraine] Groups 9,21,33
*[https://www.ncbi.nlm.nih.gov/pubmed/24733354 Reduction of benzodiazepines through education] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/26035341 Patient controlled opioid analgesia versus non-patient controlled opioid analgesia for postoperative pain] Groups 11,23,35
*[https://www.ncbi.nlm.nih.gov/pubmed/11589932 PROGRESS] Groups 12,24,36

'''ACADEMIC YEAR 3'''

12) PSYCHIATRY STUDIES

[[:File:2021 Psych Evidence Appraisal - Intro Slides.pdf|Psychiatry Rating Scales Introduction]]

* Study 1: [http://www.ncbi.nlm.nih.gov/pubmed/16554525 STAR*D (Level 2)] Bupropion-SR, sertraline, or venlafaxine-XR after failure of SSRIs for depression
* Study 2: [http://www.ncbi.nlm.nih.gov/pubmed/29477251 Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder]
* Study 3: [https://pubmed.ncbi.nlm.nih.gov/33862018/ Long-acting injectable versus oral antipsychotics for the maintenance treatment of schizophrenia]
* Study 4: [https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2725088 Association of Antipsychotic Polypharmacy vs Monotherapy With Psychiatric Rehospitalization Among Adults With Schizophrenia]
* Study 5: [https://www.ncbi.nlm.nih.gov/pubmed/29490359 Real-world Effectiveness of Pharmacologic Treatments for the Prevention of Bipolar Disorder]
* Study 6: [http://www.ncbi.nlm.nih.gov/pubmed/20092882 BALANCE] Combination lithium and valproate therapy versus monotherapy for relapse prevention in bipolar I disorder
13) GASTROENTEROLOGY STUDIES

*[http://www.ncbi.nlm.nih.gov/pubmed/27366179 Fidaxomicin versus vancomycin for Clostridium difficile infection] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/19501587 Prophylaxis of hepatic encephalopathy: Lactulose vs placebo] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/27759621 Antibiotics vs surgical therapy for uncomplicated appendicitis: Systematic review and meta-analysis] Groups 3,15,27
*[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1914504 Use of probiotic Lactobacillus preparation to prevent diarrhoea associated with antibiotics] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/17442905 Omeprazole before endoscopy in patients with gastrointestinal bleeding] Groups 5,17,29
*[http://go.galegroup.com/ps/retrieve.do?tabID=T002&resultListType=RESULT_LIST&searchResultsType=SingleTab&searchType=AdvancedSearchForm&currentPosition=3&docId=GALE%7CA489080729&docType=Report&sort=Relevance&contentSegment=&prodId=HRCA&contentSet=GALE%7CA489080729&searchId=R1&userGroupName=ubcolumbia&inPS=true Sequential-therapy treatment regimens vs standard triple therapy for the eradication of H. pylori infection] Groups 6,18,30
*[http://www.ncbi.nlm.nih.gov/pubmed/27614124 Adding licorice to the standard treatment regimen of Helicobacter pylori] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/15602019 Palifermin for oral mucositis after intensive therapy for hematologic cancers] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/9178669 Speed of healing and symptom relief in grade II to IV gastroesophageal reflux disease: a meta-analysis] Groups 9,21,33
*[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3108684 Prevention of NSAID-induced gastroduodenal ulcers: a meta-analysis] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/8985266 Beta-Adrenergic Antagonists in the Prevention of Gastrointestinal Rebleeding in Patients With Cirrhosis: A Meta-Analysis] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/27512927 Rifaximin versus norfloxacin for secondary prophylaxis of spontaneous bacterial peritonitis] Groups 12,24,36

14) OB/GYN STUDIES
*[http://www.ncbi.nlm.nih.gov/pubmed/25601350 Comparative contraceptive effectiveness of levonorgestrel-releasing and copper IUD Devices]
*[http://www.ncbi.nlm.nih.gov/pubmed/29211679 Hormonal contraception and the risk of breast cancer]
*[http://www.ncbi.nlm.nih.gov/pubmed/30322986 Sexual behaviours in adolescent girls before and after introduction of the HPV]
*[http://www.ncbi.nlm.nih.gov/pubmed/30181338 Intramuscular vs intravenous oxytocin to prevent postpartum haemorrhage at vaginal delivery]
*[http://www.ncbi.nlm.nih.gov/pubmed/27682034 Azithromycin Prophylaxis for Cesarean Delivery]
*[http://www.ncbi.nlm.nih.gov/pubmed/28461374 Antibiotics during pregnancy and risk of spontaneous abortion]

Evidence Appraisal Integrated Activities

2024-02-08T20:56:19Z

JamesMcCormack:

'''OBJECTIVE'''

To critically appraise studies, develop a brief synopsis of the trial results, succinctly present the results and then put the results into a proper clinical context

'''INITIAL PRE-READING'''

'''How To Critically Appraise an RCT In 10 minutes'''
*[https://itunes.apple.com/ca/book/how-to-critically-appraise/id524600667?mt=11 iBook/iPad version]
*[https://therapeuticseducation.org/sites/therapeuticseducation.org/files/Ten_Minute_Critical_Appraisal.pdf PDF version]
Watch this video
[http://youtu.be/QUW0Q8tXVUc Viva La Evidence]

'''Study Results at Your Fingertips'''
*[https://mystudies.org MyStudies] - Free access

'''INTEGRATION ACTIVITY FORMAT'''
# Students placed in groups of ~ 5-7
# Each group chooses one of the studies below to review
# Students then work in pairs and develop a one-slide critical appraisal and results synopsis
# One to two students in each group will be chosen at random to present their findings to the class
# A discussion about the appraisal and the appropriate clinical context for the results is had with the entire class for each study

'''MODULE'''
[[File:Screen Shot 2022-01-09 at 10.00.16 AM.jpg|left|thumb|'''TRIAL PRESENTATION FORMAT''']]

Studies chosen include landmark studies and/or studies that address important therapeutic issues for the particular module

'''ACADEMIC YEAR 1 - FIRST TERM'''

1) FOUNDATION STUDIES (Groups)
*[http://www.ncbi.nlm.nih.gov/pubmed/20228404 ACCORD FIBRATES] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/12466506 AFFIRM] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/22085343 AIM-HIGH] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/10639539 HOPE] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/18378519 HYVET] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/15007110 PROVE-IT] Groups 6,18,30
*[http://www.ncbi.nlm.nih.gov/pubmed/15755765 TNT] Groups 7,19,31
*[https://pubmed.ncbi.nlm.nih.gov/26378978 EMPAREG] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/17984165 ILLUMINATE] Groups 9,21,33
*[https://pubmed.ncbi.nlm.nih.gov/26551272/ SPRINT] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/15325833 CARDS] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/12117397 WHI] Groups 12,24,36

'''ACADEMIC YEAR 1 - SECOND TERM'''

2) INTRO TO INFECTIOUS DISEASE STUDIES

[https://therapeuticseducation.org/sites/therapeuticseducation.org/files/Antibiotic_Sensitivity_FINAL_Nov_2019.pdf The "Best" Antibiotic Sensitivity Chart Ever]
*[http://www.ncbi.nlm.nih.gov/pubmed/17567657 IV vs PO antibiotics] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/24603565 Delayed antibiotics for respiratory tract infections] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/11159657 Delayed antibiotics for otitis media] Groups 3,15,27
*[https://pubmed.ncbi.nlm.nih.gov/27455166/ Duration of treatment for community acquired pneumonia] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/22726802 Duration of treatment for pyelonephritis] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/25830421 Choice of antibiotic for community acquired pneumonia-1] Groups 6,18,30
*[http://www.ncbi.nlm.nih.gov/pubmed/25286173 Choice of antibiotic for community acquired pneumonia-2] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/20647284 HPV vaccine study] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/7966893 Influenza vaccine study] Groups 9,21,33
*[https://pubmed.ncbi.nlm.nih.gov/33301246/ COVID vaccine Pfizer] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/27626517 Herpes zoster vaccine study 1] Groups 11,23,35
*[https://www.ncbi.nlm.nih.gov/pubmed/25916341 Herpes zoster vaccine study 3] Groups 12,24,36

3) MUSCULOSKELETAL STUDIES

*[http://www.ncbi.nlm.nih.gov/pubmed/28199814 Baricitinib versus Placebo or Adalimumab in Rheumatoid Arthritis] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/0010979111 CLASS – celecoxib vs NSAIDs] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/26501533 Naproxen with cyclobenzaprine, oxycodone/acetaminophen, or placebo for low back pain] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/24395557 Glucosamine and chondroitin for OA] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/12546607 Acetaminophen vs diclofenac for OA] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/23964752 Diclofenac gel for acute neck pain] Groups 6,18,30
*[https://pubmed.ncbi.nlm.nih.gov/15468367/ Topical diclofenac vs oral diclofenac] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/25064594 Acetaminophen for low back pain] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/7611589 Misoprostol and NSAID induced ulcers] Groups 9,21,33
*[http://www.ncbi.nlm.nih.gov/pubmed/20131255 Low dose vs high dose colchicine for gout] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/22508468 TEAR - oral triple therapy versus etanercept plus methotrexate in early aggressive rheumatoid arthritis] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/25589511 MOVES - Glucosamine and chondroitin for OA for moderate to severe pain] Groups 12,24,36

4) DERMATOLOGY STUDIES

*[https://www.ncbi.nlm.nih.gov/pubmed/9598014 Glycolic acid 5% Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/21896132 Glycolic acid 10% Acne]
*[https://www.ncbi.nlm.nih.gov/pubmed/14531866 Petrolatum vs Ceramide/skin related lipids Hand Dermatitis]
*[https://www.ncbi.nlm.nih.gov/pubmed/11896774 Vitamin C Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/17515510 Retinol (VitaminA) Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/21896129 Hyaluronic acid Atopic Dermatitis]

5) EENT STUDIES

[http://www.amstar.ca/docs/AMSTARguideline.pdf AMSTAR meta-analysis checklist]

'''Scenario 1 - Otitis Media''' - GROUPS 1, 7, 18, 19, 25, 36

Anthony Martin arrives at your pharmacy somewhat frustrated since his family physician declined to write an antibiotic prescription for his two and half year old son, Oscar. His symptoms started yesterday afternoon - Oscar complains of right ear pain but there is no discharge. Rectal temperature taken today was 38.5 degrees. His wife is sure Oscar has an ear infection since the last time he had these same symptoms, that was ultimately the diagnosis. Mr. Martin asks if you think buying acetaminophen is really “enough”?

[https://pubmed.ncbi.nlm.nih.gov/26099233/ Antibiotics for acute otitis media in children]

'''Scenario 2 - Allergic Rhinitis''' - GROUPS 2, 8, 17, 20, 26, 35

Ruby Parmar is a firefighter. She is plagued by sinus congestion (preventing her from sleeping) and a runny nose associated with seasonal allergies. Her prescription for intranasal triamcinolone is typically effective, but she would like to know if a non-sedating anti-allergy pill would work just as well since it’s inconvenient carrying around the “nose spray”.

[https://www.ncbi.nlm.nih.gov/pubmed/28234147 Intranasal steroids vs antihistamines for allergic rhinitis]

'''Scenario 3 - Acute Sinusitis''' - GROUPS 3, 9, 16, 21, 27, 34

You are seeing a patient in clinic before her appointment with the primary care physician. She was feeling unwell with a “flu” last week. While most of her symptoms have resolved (cough, fever), the nasal congestion and discharge persists and so she has made an appointment (she is an otherwise healthy 32 year old with treated thyroid disease). She would like your advice for what treatment she should ask the doctor to prescribe.

[http://www.ncbi.nlm.nih.gov/pubmed/24293353 Intranasal steroids for acute sinusitis]

'''Scenario 4 - Glaucoma''' - GROUPS 4, 10, 15, 22, 28, 33

Mrs. Ada Waters is a 63 year-old woman you. Her ophthalmologist prescribed timolol and xalatan eye drops for treatment of open angle glaucoma. She has never really felt much different on treatment since she recovered from her first episode (of acute angle closure glaucoma requiring ER visit) and surgery. She asks you if the treatment is really making a difference.

[https://www.ncbi.nlm.nih.gov/pubmed/17943780 Interventions for open angle glaucoma]

'''Scenario 5 - Sore Throat''' - GROUPS 5, 11, 14, 23, 29, 32

You have a good friend who is applying for pharmacy. Her invitation for the multiple-mini interview (MMI) is coming up soon, but she is starting to experience a sore throat. While she is worried about not being able to speak through all of those stations, she knows she often gets a terrible headache along with her sore throat. She has an unused prescription for amoxicillin (unexpired) and wonders if you recommend for her to take it.

[https://pubmed.ncbi.nlm.nih.gov/34881426/ Antibiotics for sore throat]

'''Scenario 6 - Conjunctivitis''' - GROUPS 6, 12, 13, 24, 30, 31

A man comes to your pharmacy (he appears in his early twenties) complaining of “pink eye”. He has had a pink discolouration and discharge from his left eye for two days. He asks if the OTC antibiotic eye drops (he’s holding a product with polymixin B) are any better than “waiting it out”.

[https://www.ncbi.nlm.nih.gov/pubmed/22972049 Antibiotics for acute conjunctivitis]

6) HEMATOLOGY STUDIES

None so far

'''ACADEMIC YEAR 2 - FIRST TERM'''

7) RESPIROLOGY STUDIES

*[http://www.ncbi.nlm.nih.gov/pubmed/2062329 First inhaled steroid study] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/22938706 Tiotropium in asthma] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/21324520 Inhaled steroid in children] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/29768149 Combined Budesonide–Formoterol as Needed in Mild Asthma] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/15223858 Doubling dose of inhaled corticosteroid] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/29768147 As-Needed Budesonide–Formoterol versus Maintenance Budesonide in Mild Asthma] Groups 6,18,30
*[http://www.ncbi.nlm.nih.gov/pubmed/27181606 Indacaterol-glycopyrronium VS salmeterol/fluticasone in COPD] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/21428765 Tiotropium VS salmeterol in COPD] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/23695200 Short VS long steroids for COPD exacerbation] Groups 9,21,33
*[http://www.ncbi.nlm.nih.gov/pubmed/25196117 Stopping inhaled steroids in COPD] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/29668352 Once-Daily Single-Inhaler Triple versus Dual Therapy in Patients with COPD] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/28877011 Tezepelumab in Adults with Uncontrolled Asthma] Groups 12,24,36

8) CARDIOVASCULAR STUDIES

SESSION 1

*[https://www.ncbi.nlm.nih.gov/pubmed/4862069 VA1] (Group 1, 13, 25)
*[https://www.ncbi.nlm.nih.gov/pubmed/4914579 VA 2] (Group 2, 14, 26)
*[https://pubmed.ncbi.nlm.nih.gov/33186492 Polycap Study 3] (Group 3, 15, 27)
*[http://www.ncbi.nlm.nih.gov/pubmed/20228401 ACCORD-BP] (Group 4, 16, 28)
*[https://www.ncbi.nlm.nih.gov/pubmed/26551272 SPRINT] (Group 5, 17, 29)
*[http://www.ncbi.nlm.nih.gov/pubmed/2883575 CONSENSUS] (Group 6,18,30)
*[https://pubmed.ncbi.nlm.nih.gov/31535829/ DAPA-HF] (Group 7, 19, 31)
*[https://pubmed.ncbi.nlm.nih.gov/25176939/ CONFIRM-HF] (Group 8, 20, 32)
*[http://www.ncbi.nlm.nih.gov/pubmed/12457784 PROSPER] (Group 9, 21, 33)
*[http://www.ncbi.nlm.nih.gov/pubmed/27040132 HOPE-3] (Group 10, 22, 34)
*[http://www.ncbi.nlm.nih.gov/pubmed/12114036 Heart Protection Study (HPS)] (Group 11, 23, 35)
*[http://www.ncbi.nlm.nih.gov/pubmed/30415628 REDUCE-IT] (Group 12, 24, 36)

[[File:CV Case.pdf|thumb|CV case|left]]

SESSION 2

'''The Guideline Case'''

A 63 y/o patient with CHOOSE ONE (⬆︎HTN/⬆︎Chol/⬆︎glucose/HF/A fib) and using the guideline determine:
# their 5yr/10yr risks of mortality/CVD events
# the potential benefit
# the potential side effects (with magnitude)
# words/sentiment patient values and preferences/SDM

Atrial fibrillation - Groups 1,13,25,2,14,26
*[https://www.onlinecjc.ca/article/S0828-282X(18)31062-6/pdf 2018 Atrial fibrillation guidelines]
Diabetes - Groups 3,15,27,4,16,28
*[http://guidelines.diabetes.ca/docs/CPG-2018-full-EN.pdf 2018 Diabetes guidelines]
Lipid Simplified - Groups 5,17,29,6,18,30
*[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4607330/pdf/0610857.pdf 2015 Simplified lipid guidelines]
Lipid - Groups 7,19,31,8,20,32
*[http://www.onlinecjc.ca/article/S0828-282X(16)30732-2/pdf 2016 Lipid guidelines]
Heart failure - Groups 9,21,33,10,22,34
*[http://www.onlinecjc.ca/article/S0828-282X(17)30973-X/pdf 2017 Heart failure guidelines]
Hypertension - Groups 11,23,35,12,24,36
*[https://www.onlinecjc.ca/article/S0828-282X(18)30183-1/pdf 2018 Hypertension guidelines]

OPTIONAL SESSION
*[http://www.ncbi.nlm.nih.gov/pubmed/16899775 SPARCL]
*[http://www.ncbi.nlm.nih.gov/pubmed/10471456 RALES]
*[http://www.ncbi.nlm.nih.gov/pubmed/11386263 Carvedilol in heart failure]
*[http://www.ncbi.nlm.nih.gov/pubmed/18460663 WAFACS]
*[http://www.ncbi.nlm.nih.gov/pubmed/10376614 MERIT-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/25176015 PARADIGM-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/24490264 High-dose multivitamins after MI]
*[http://www.ncbi.nlm.nih.gov/pubmed/7911176 Mediterranean Diet after MI]
*[http://www.ncbi.nlm.nih.gov/pubmed/15337732 A TO Z]
*[http://www.ncbi.nlm.nih.gov/pubmed/21073363 EMPHASIS-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/12853193 COMET]
*[http://www.ncbi.nlm.nih.gov/pubmed/24716680 TOPCAT]
*[http://www.ncbi.nlm.nih.gov/pubmed/26039521 IMPROVE-IT]

'''ACADEMIC YEAR 2 - SECOND TERM'''

9) NEPHROLOGY STUDIES

None so far

10) ENDOCRINOLOGY[[File:IA ENDO LAYOUT 1.pdf|left|thumb|IA ENDO LAYOUT]]

'''RISK ASSESSMENT CASES FOR DIABETES AND OSTEOPOROSIS'''

'''1) DIABETES CASE'''

66 y/o white male who was diagnosed with diabetes 8 years ago

* His blood pressure over the last year has been roughly 145/80 mmHg - at present untreated
* A1c = 8%, no diabetes meds, non-smoker, BMI ~30
* Total cholesterol is 6 mmol/L, his HDL is 2 mmol/L, non-HDL = 6 minus 2, not on a statin
* No retinopathy, urine albumin-to-creatinine ratio (UACR) = 15ug/mg (7mg/mmol),
* Serum creatinine = 70 micromol/L, waist circumference 100 cm
* GFR 75 mL/min/1.73m2
* In normal sinus rhythm
* Age at end of highest education = 19
* Mother alive, father died of a heart attack at age 80

'''Calculate Risks'''

'''CVD RISK ESTIMATES''' - list the endpoints described by the specific calculator

Framingham - xx% - 10-year risk - also if no diabetes xx%

ASCVD - xx% - 10-year risk - also if no diabetes xx%

'''The Calculator'''
*CVD CALCULATOR
https://decisionaid.ca/cvd/

'''DIABETES COMPLICATIONS RISK ESTIMATES''' - list the endpoints described by the specific calculator

xx% - also 10-year risk if A1c 9, 8, 7 and 6

also get risk of kidney failure, vision loss, pressure sensation loss – also if A1c 9, 8,7,6

'''The Calculator'''
*DIABETES DECISION AID
http://decisionaid.ca/diabetes/

'''BENEFITS AND HARMS'''

Use the [https://guidelines.diabetes.ca/cpg/chapter-13-2020-update 2020 diabetes guidelines] and/or Diabetes Decision Aid to get estimates of benefits and harms and also use the MyStudies synopsis listed below

'''COSTS'''

Try using [https://pricingdoc.acfp.ca Pricing Doc] to get costs

'''Groups 1,13,25'''

* Metformin - UKPDS 34 [https://mystudies.org/studies.php#studies/28929e89-d01e-4b11-8e67-4d7086f9e4aa/outcome MyStudies Data]

'''Groups 2,14,26'''

* Sulfonlyureas - UKPDS 33 [https://mystudies.org/studies.php#studies/5eadb5dd-d403-4c13-b03e-d4f8d28c96ba/outcome MyStudies Data]

'''Groups 3,15,27'''

* Insulin - ORIGIN [https://mystudies.org/studies.php#studies/f611818f-2e69-4952-b55e-661116bd84b6/outcome MyStudies Data]

'''Groups 4,16,28'''

* SGLT2 - EMPA-REG OUTCOME [https://mystudies.org/studies.php#studies/32e9cf1a-f33e-480b-91ca-6f28a4dcf862/outcome MyStudies Data]

'''Groups 5,17,29'''

* GLP - LEADER [https://mystudies.org/studies.php#studies/1adbc9a1-7603-40f1-ac15-b813ce1f0ad6/outcome MyStudies Data]

'''Groups 6,18,30'''

* DPP4 - TECOS [https://mystudies.org/studies.php#studies/8659968a-cefb-4f99-b4ae-8b9b659acbd5/outcome MyStudies Data]

'''Groups 7,19,31'''

* Intensive treatment – small scale - STENO [https://mystudies.org/studies.php#studies/39d423e3-af57-40c8-ab7a-cbc7f389bdb6/paper MyStudies Data]

'''Groups 8,20,32'''

* Intensive treatment – large scale - ADDITION-Europe - [https://mystudies.org/studies.php#studies/5e07d86d-aa92-4db9-a283-76080db4b6fd/outcome MyStudies Data] Groups

'''2) OSTEOPOROSIS CASE'''

60 y/o female

* 72 kg, 1.69m, BMI = 25.2
* t-score of -2.5
* Worried about falling and getting a hip fracture
* A friend recently had an atraumatic fracture from simply tripping and falling over in the snow
* No other risk factors

'''Calculate Risks'''

'''FRACTURE RISK ESTIMATES''' - list the endpoints described by the specific calculator

Major osteoporotic fracture - xx% - 10-year risk – if no BMD (just BMI), and then if they had a BMD t-Score of -2.0, -2.5, and -3.0

Hip fracture - - xx% - 10-year risk – if no BMD (just BMI) and if you have a BMD xx% - 10-year risk – if no BMD, and then if they had a BMD T-Score of -2.0, -2.5, and -3.0

'''The Calculator'''

* FRACTURE CALCULATOR

[https://frax.shef.ac.uk/frax/tool.aspx?country=19 Frax Tool - Canada]

'''BENEFITS AND HARMS'''

Use the [https://www.cmaj.ca/content/195/39/E1333 2023 Osteoporosis Guideline] and/or your osteoporosis lecture notes to get the benefits and apply these to your patient, and also get the harms

'''COSTS'''

Try using [https://pricingdoc.acfp.ca Pricing Doc] to get costs

'''Groups 9,21,33'''

* Activity

'''Groups 10,22,34'''

* Calcium/Vitamin D

'''Groups 11,23,35'''

* Bisphosphonates

'''Groups 12,24,36'''

* Denosumab

11) NEUROLOGY STUDIES

*[http://www.ncbi.nlm.nih.gov/pubmed/16717269 Opioids for chronic non-cancer pain] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/29509867 Effect of Opioid vs Nonopioid Medications on Pain-Related Function in Patients With Chronic Back Pain] Groups 2,14,26
*[https://www.ncbi.nlm.nih.gov/pubmed/31291515 Galcanezumab for prevention of cluster headaches] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/27150433 Immediate or delayed treatment of a first seizure] Groups 4,16,28
*[https://www.ncbi.nlm.nih.gov/pubmed/31291516 Rimegepant for episodic migraine] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/26212846 Sleep restriction for insomnia] Groups 6,18,30
*[https://www.ncbi.nlm.nih.gov/pubmed/25957224 CHANCE] Groups 7,19,31
*[https://www.ncbi.nlm.nih.gov/pubmed/16899775 SPARCL] Groups 8,20,32
*[https://www.ncbi.nlm.nih.gov/pubmed/29171821 Erenumab for episodic migraine] Groups 9,21,33
*[https://www.ncbi.nlm.nih.gov/pubmed/24733354 Reduction of benzodiazepines through education] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/26035341 Patient controlled opioid analgesia versus non-patient controlled opioid analgesia for postoperative pain] Groups 11,23,35
*[https://www.ncbi.nlm.nih.gov/pubmed/11589932 PROGRESS] Groups 12,24,36

'''ACADEMIC YEAR 3'''

12) PSYCHIATRY STUDIES

[[:File:2021 Psych Evidence Appraisal - Intro Slides.pdf|Psychiatry Rating Scales Introduction]]

* Study 1: [http://www.ncbi.nlm.nih.gov/pubmed/16554525 STAR*D (Level 2)] Bupropion-SR, sertraline, or venlafaxine-XR after failure of SSRIs for depression
* Study 2: [http://www.ncbi.nlm.nih.gov/pubmed/29477251 Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder]
* Study 3: [https://pubmed.ncbi.nlm.nih.gov/33862018/ Long-acting injectable versus oral antipsychotics for the maintenance treatment of schizophrenia]
* Study 4: [https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2725088 Association of Antipsychotic Polypharmacy vs Monotherapy With Psychiatric Rehospitalization Among Adults With Schizophrenia]
* Study 5: [https://www.ncbi.nlm.nih.gov/pubmed/29490359 Real-world Effectiveness of Pharmacologic Treatments for the Prevention of Bipolar Disorder]
* Study 6: [http://www.ncbi.nlm.nih.gov/pubmed/20092882 BALANCE] Combination lithium and valproate therapy versus monotherapy for relapse prevention in bipolar I disorder
13) GASTROENTEROLOGY STUDIES

*[http://www.ncbi.nlm.nih.gov/pubmed/27366179 Fidaxomicin versus vancomycin for Clostridium difficile infection] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/19501587 Prophylaxis of hepatic encephalopathy: Lactulose vs placebo] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/27759621 Antibiotics vs surgical therapy for uncomplicated appendicitis: Systematic review and meta-analysis] Groups 3,15,27
*[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1914504 Use of probiotic Lactobacillus preparation to prevent diarrhoea associated with antibiotics] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/17442905 Omeprazole before endoscopy in patients with gastrointestinal bleeding] Groups 5,17,29
*[http://go.galegroup.com/ps/retrieve.do?tabID=T002&resultListType=RESULT_LIST&searchResultsType=SingleTab&searchType=AdvancedSearchForm&currentPosition=3&docId=GALE%7CA489080729&docType=Report&sort=Relevance&contentSegment=&prodId=HRCA&contentSet=GALE%7CA489080729&searchId=R1&userGroupName=ubcolumbia&inPS=true Sequential-therapy treatment regimens vs standard triple therapy for the eradication of H. pylori infection] Groups 6,18,30
*[http://www.ncbi.nlm.nih.gov/pubmed/27614124 Adding licorice to the standard treatment regimen of Helicobacter pylori] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/15602019 Palifermin for oral mucositis after intensive therapy for hematologic cancers] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/9178669 Speed of healing and symptom relief in grade II to IV gastroesophageal reflux disease: a meta-analysis] Groups 9,21,33
*[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3108684 Prevention of NSAID-induced gastroduodenal ulcers: a meta-analysis] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/8985266 Beta-Adrenergic Antagonists in the Prevention of Gastrointestinal Rebleeding in Patients With Cirrhosis: A Meta-Analysis] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/27512927 Rifaximin versus norfloxacin for secondary prophylaxis of spontaneous bacterial peritonitis] Groups 12,24,36

14) OB/GYN STUDIES
*[http://www.ncbi.nlm.nih.gov/pubmed/25601350 Comparative contraceptive effectiveness of levonorgestrel-releasing and copper IUD Devices]
*[http://www.ncbi.nlm.nih.gov/pubmed/29211679 Hormonal contraception and the risk of breast cancer]
*[http://www.ncbi.nlm.nih.gov/pubmed/30322986 Sexual behaviours in adolescent girls before and after introduction of the HPV]
*[http://www.ncbi.nlm.nih.gov/pubmed/30181338 Intramuscular vs intravenous oxytocin to prevent postpartum haemorrhage at vaginal delivery]
*[http://www.ncbi.nlm.nih.gov/pubmed/27682034 Azithromycin Prophylaxis for Cesarean Delivery]
*[http://www.ncbi.nlm.nih.gov/pubmed/28461374 Antibiotics during pregnancy and risk of spontaneous abortion]

Evidence Appraisal Integrated Activities

2024-02-08T16:21:13Z

JamesMcCormack:

'''OBJECTIVE'''

To critically appraise studies, develop a brief synopsis of the trial results, succinctly present the results and then put the results into a proper clinical context

'''INITIAL PRE-READING'''

'''How To Critically Appraise an RCT In 10 minutes'''
*[https://itunes.apple.com/ca/book/how-to-critically-appraise/id524600667?mt=11 iBook/iPad version]
*[https://therapeuticseducation.org/sites/therapeuticseducation.org/files/Ten_Minute_Critical_Appraisal.pdf PDF version]
Watch this video
[http://youtu.be/QUW0Q8tXVUc Viva La Evidence]

'''Study Results at Your Fingertips'''
*[https://mystudies.org MyStudies] - Free access

'''INTEGRATION ACTIVITY FORMAT'''
# Students placed in groups of ~ 5-7
# Each group chooses one of the studies below to review
# Students then work in pairs and develop a one-slide critical appraisal and results synopsis
# One to two students in each group will be chosen at random to present their findings to the class
# A discussion about the appraisal and the appropriate clinical context for the results is had with the entire class for each study

'''MODULE'''
[[File:Screen Shot 2022-01-09 at 10.00.16 AM.jpg|left|thumb|'''TRIAL PRESENTATION FORMAT''']]

Studies chosen include landmark studies and/or studies that address important therapeutic issues for the particular module

'''ACADEMIC YEAR 1 - FIRST TERM'''

1) FOUNDATION STUDIES (Groups)
*[http://www.ncbi.nlm.nih.gov/pubmed/20228404 ACCORD FIBRATES] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/12466506 AFFIRM] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/22085343 AIM-HIGH] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/10639539 HOPE] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/18378519 HYVET] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/15007110 PROVE-IT] Groups 6,18,30
*[http://www.ncbi.nlm.nih.gov/pubmed/15755765 TNT] Groups 7,19,31
*[https://pubmed.ncbi.nlm.nih.gov/26378978 EMPAREG] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/17984165 ILLUMINATE] Groups 9,21,33
*[https://pubmed.ncbi.nlm.nih.gov/26551272/ SPRINT] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/15325833 CARDS] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/12117397 WHI] Groups 12,24,36

'''ACADEMIC YEAR 1 - SECOND TERM'''

2) INTRO TO INFECTIOUS DISEASE STUDIES

[https://therapeuticseducation.org/sites/therapeuticseducation.org/files/Antibiotic_Sensitivity_FINAL_Nov_2019.pdf The "Best" Antibiotic Sensitivity Chart Ever]
*[http://www.ncbi.nlm.nih.gov/pubmed/17567657 IV vs PO antibiotics] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/24603565 Delayed antibiotics for respiratory tract infections] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/11159657 Delayed antibiotics for otitis media] Groups 3,15,27
*[https://pubmed.ncbi.nlm.nih.gov/27455166/ Duration of treatment for community acquired pneumonia] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/22726802 Duration of treatment for pyelonephritis] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/25830421 Choice of antibiotic for community acquired pneumonia-1] Groups 6,18,30
*[http://www.ncbi.nlm.nih.gov/pubmed/25286173 Choice of antibiotic for community acquired pneumonia-2] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/20647284 HPV vaccine study] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/7966893 Influenza vaccine study] Groups 9,21,33
*[https://pubmed.ncbi.nlm.nih.gov/33301246/ COVID vaccine Pfizer] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/27626517 Herpes zoster vaccine study 1] Groups 11,23,35
*[https://www.ncbi.nlm.nih.gov/pubmed/25916341 Herpes zoster vaccine study 3] Groups 12,24,36

3) MUSCULOSKELETAL STUDIES

*[http://www.ncbi.nlm.nih.gov/pubmed/28199814 Baricitinib versus Placebo or Adalimumab in Rheumatoid Arthritis] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/0010979111 CLASS – celecoxib vs NSAIDs] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/26501533 Naproxen with cyclobenzaprine, oxycodone/acetaminophen, or placebo for low back pain] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/24395557 Glucosamine and chondroitin for OA] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/12546607 Acetaminophen vs diclofenac for OA] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/23964752 Diclofenac gel for acute neck pain] Groups 6,18,30
*[https://pubmed.ncbi.nlm.nih.gov/15468367/ Topical diclofenac vs oral diclofenac] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/25064594 Acetaminophen for low back pain] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/7611589 Misoprostol and NSAID induced ulcers] Groups 9,21,33
*[http://www.ncbi.nlm.nih.gov/pubmed/20131255 Low dose vs high dose colchicine for gout] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/22508468 TEAR - oral triple therapy versus etanercept plus methotrexate in early aggressive rheumatoid arthritis] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/25589511 MOVES - Glucosamine and chondroitin for OA for moderate to severe pain] Groups 12,24,36

4) DERMATOLOGY STUDIES

*[https://www.ncbi.nlm.nih.gov/pubmed/9598014 Glycolic acid 5% Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/21896132 Glycolic acid 10% Acne]
*[https://www.ncbi.nlm.nih.gov/pubmed/14531866 Petrolatum vs Ceramide/skin related lipids Hand Dermatitis]
*[https://www.ncbi.nlm.nih.gov/pubmed/11896774 Vitamin C Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/17515510 Retinol (VitaminA) Photo-aging]
*[https://www.ncbi.nlm.nih.gov/pubmed/21896129 Hyaluronic acid Atopic Dermatitis]

5) EENT STUDIES

[http://www.amstar.ca/docs/AMSTARguideline.pdf AMSTAR meta-analysis checklist]

'''Scenario 1 - Otitis Media''' - GROUPS 1, 7, 18, 19, 25, 36

Anthony Martin arrives at your pharmacy somewhat frustrated since his family physician declined to write an antibiotic prescription for his two and half year old son, Oscar. His symptoms started yesterday afternoon - Oscar complains of right ear pain but there is no discharge. Rectal temperature taken today was 38.5 degrees. His wife is sure Oscar has an ear infection since the last time he had these same symptoms, that was ultimately the diagnosis. Mr. Martin asks if you think buying acetaminophen is really “enough”?

[https://pubmed.ncbi.nlm.nih.gov/26099233/ Antibiotics for acute otitis media in children]

'''Scenario 2 - Allergic Rhinitis''' - GROUPS 2, 8, 17, 20, 26, 35

Ruby Parmar is a firefighter. She is plagued by sinus congestion (preventing her from sleeping) and a runny nose associated with seasonal allergies. Her prescription for intranasal triamcinolone is typically effective, but she would like to know if a non-sedating anti-allergy pill would work just as well since it’s inconvenient carrying around the “nose spray”.

[https://www.ncbi.nlm.nih.gov/pubmed/28234147 Intranasal steroids vs antihistamines for allergic rhinitis]

'''Scenario 3 - Acute Sinusitis''' - GROUPS 3, 9, 16, 21, 27, 34

You are seeing a patient in clinic before her appointment with the primary care physician. She was feeling unwell with a “flu” last week. While most of her symptoms have resolved (cough, fever), the nasal congestion and discharge persists and so she has made an appointment (she is an otherwise healthy 32 year old with treated thyroid disease). She would like your advice for what treatment she should ask the doctor to prescribe.

[http://www.ncbi.nlm.nih.gov/pubmed/24293353 Intranasal steroids for acute sinusitis]

'''Scenario 4 - Glaucoma''' - GROUPS 4, 10, 15, 22, 28, 33

Mrs. Ada Waters is a 63 year-old woman you. Her ophthalmologist prescribed timolol and xalatan eye drops for treatment of open angle glaucoma. She has never really felt much different on treatment since she recovered from her first episode (of acute angle closure glaucoma requiring ER visit) and surgery. She asks you if the treatment is really making a difference.

[https://www.ncbi.nlm.nih.gov/pubmed/17943780 Interventions for open angle glaucoma]

'''Scenario 5 - Sore Throat''' - GROUPS 5, 11, 14, 23, 29, 32

You have a good friend who is applying for pharmacy. Her invitation for the multiple-mini interview (MMI) is coming up soon, but she is starting to experience a sore throat. While she is worried about not being able to speak through all of those stations, she knows she often gets a terrible headache along with her sore throat. She has an unused prescription for amoxicillin (unexpired) and wonders if you recommend for her to take it.

[https://pubmed.ncbi.nlm.nih.gov/34881426/ Antibiotics for sore throat]

'''Scenario 6 - Conjunctivitis''' - GROUPS 6, 12, 13, 24, 30, 31

A man comes to your pharmacy (he appears in his early twenties) complaining of “pink eye”. He has had a pink discolouration and discharge from his left eye for two days. He asks if the OTC antibiotic eye drops (he’s holding a product with polymixin B) are any better than “waiting it out”.

[https://www.ncbi.nlm.nih.gov/pubmed/22972049 Antibiotics for acute conjunctivitis]

6) HEMATOLOGY STUDIES

None so far

'''ACADEMIC YEAR 2 - FIRST TERM'''

7) RESPIROLOGY STUDIES

*[http://www.ncbi.nlm.nih.gov/pubmed/2062329 First inhaled steroid study] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/22938706 Tiotropium in asthma] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/21324520 Inhaled steroid in children] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/29768149 Combined Budesonide–Formoterol as Needed in Mild Asthma] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/15223858 Doubling dose of inhaled corticosteroid] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/29768147 As-Needed Budesonide–Formoterol versus Maintenance Budesonide in Mild Asthma] Groups 6,18,30
*[http://www.ncbi.nlm.nih.gov/pubmed/27181606 Indacaterol-glycopyrronium VS salmeterol/fluticasone in COPD] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/21428765 Tiotropium VS salmeterol in COPD] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/23695200 Short VS long steroids for COPD exacerbation] Groups 9,21,33
*[http://www.ncbi.nlm.nih.gov/pubmed/25196117 Stopping inhaled steroids in COPD] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/29668352 Once-Daily Single-Inhaler Triple versus Dual Therapy in Patients with COPD] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/28877011 Tezepelumab in Adults with Uncontrolled Asthma] Groups 12,24,36

8) CARDIOVASCULAR STUDIES

SESSION 1

*[https://www.ncbi.nlm.nih.gov/pubmed/4862069 VA1] (Group 1, 13, 25)
*[https://www.ncbi.nlm.nih.gov/pubmed/4914579 VA 2] (Group 2, 14, 26)
*[https://pubmed.ncbi.nlm.nih.gov/33186492 Polycap Study 3] (Group 3, 15, 27)
*[http://www.ncbi.nlm.nih.gov/pubmed/20228401 ACCORD-BP] (Group 4, 16, 28)
*[https://www.ncbi.nlm.nih.gov/pubmed/26551272 SPRINT] (Group 5, 17, 29)
*[http://www.ncbi.nlm.nih.gov/pubmed/2883575 CONSENSUS] (Group 6,18,30)
*[https://pubmed.ncbi.nlm.nih.gov/31535829/ DAPA-HF] (Group 7, 19, 31)
*[https://pubmed.ncbi.nlm.nih.gov/25176939/ CONFIRM-HF] (Group 8, 20, 32)
*[http://www.ncbi.nlm.nih.gov/pubmed/12457784 PROSPER] (Group 9, 21, 33)
*[http://www.ncbi.nlm.nih.gov/pubmed/27040132 HOPE-3] (Group 10, 22, 34)
*[http://www.ncbi.nlm.nih.gov/pubmed/12114036 Heart Protection Study (HPS)] (Group 11, 23, 35)
*[http://www.ncbi.nlm.nih.gov/pubmed/30415628 REDUCE-IT] (Group 12, 24, 36)

[[File:CV Case.pdf|thumb|CV case|left]]

SESSION 2

'''The Guideline Case'''

A 63 y/o patient with CHOOSE ONE (⬆︎HTN/⬆︎Chol/⬆︎glucose/HF/A fib) and using the guideline determine:
# their 5yr/10yr risks of mortality/CVD events
# the potential benefit
# the potential side effects (with magnitude)
# words/sentiment patient values and preferences/SDM

Atrial fibrillation - Groups 1,13,25,2,14,26
*[https://www.onlinecjc.ca/article/S0828-282X(18)31062-6/pdf 2018 Atrial fibrillation guidelines]
Diabetes - Groups 3,15,27,4,16,28
*[http://guidelines.diabetes.ca/docs/CPG-2018-full-EN.pdf 2018 Diabetes guidelines]
Lipid Simplified - Groups 5,17,29,6,18,30
*[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4607330/pdf/0610857.pdf 2015 Simplified lipid guidelines]
Lipid - Groups 7,19,31,8,20,32
*[http://www.onlinecjc.ca/article/S0828-282X(16)30732-2/pdf 2016 Lipid guidelines]
Heart failure - Groups 9,21,33,10,22,34
*[http://www.onlinecjc.ca/article/S0828-282X(17)30973-X/pdf 2017 Heart failure guidelines]
Hypertension - Groups 11,23,35,12,24,36
*[https://www.onlinecjc.ca/article/S0828-282X(18)30183-1/pdf 2018 Hypertension guidelines]

OPTIONAL SESSION
*[http://www.ncbi.nlm.nih.gov/pubmed/16899775 SPARCL]
*[http://www.ncbi.nlm.nih.gov/pubmed/10471456 RALES]
*[http://www.ncbi.nlm.nih.gov/pubmed/11386263 Carvedilol in heart failure]
*[http://www.ncbi.nlm.nih.gov/pubmed/18460663 WAFACS]
*[http://www.ncbi.nlm.nih.gov/pubmed/10376614 MERIT-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/25176015 PARADIGM-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/24490264 High-dose multivitamins after MI]
*[http://www.ncbi.nlm.nih.gov/pubmed/7911176 Mediterranean Diet after MI]
*[http://www.ncbi.nlm.nih.gov/pubmed/15337732 A TO Z]
*[http://www.ncbi.nlm.nih.gov/pubmed/21073363 EMPHASIS-HF]
*[http://www.ncbi.nlm.nih.gov/pubmed/12853193 COMET]
*[http://www.ncbi.nlm.nih.gov/pubmed/24716680 TOPCAT]
*[http://www.ncbi.nlm.nih.gov/pubmed/26039521 IMPROVE-IT]

'''ACADEMIC YEAR 2 - SECOND TERM'''

9) NEPHROLOGY STUDIES

None so far

10) ENDOCRINOLOGY[[File:IA ENDO LAYOUT 1.pdf|left|thumb|IA ENDO LAYOUT]]

'''RISK ASSESSMENT CASES FOR DIABETES AND OSTEOPOROSIS'''

'''1) DIABETES CASE'''

66 y/o white male who was diagnosed with diabetes 8 years ago

* His blood pressure over the last year has been roughly 145/80 mmHg - at present untreated
* A1c = 8%, no diabetes meds, non-smoker, BMI ~30
* Total cholesterol is 6 mmol/L, his HDL is 2 mmol/L, non-HDL = 6 minus 2, not on a statin
* No retinopathy, urine albumin-to-creatinine ratio (UACR) = 15ug/mg (7mg/mmol),
* Serum creatinine = 70 micromol/L, waist circumference 100 cm
* GFR 75 mL/min/1.73m2
* In normal sinus rhythm
* Age at end of highest education = 19
* Mother alive, father died of a heart attack at age 80

'''Calculate Risks'''

'''CVD RISK ESTIMATES''' - list the endpoints described by the specific calculator

Framingham - xx% - 10-year risk - also if no diabetes xx%

ASCVD - xx% - 10-year risk - also if no diabetes xx%

'''The Calculator'''
*CVD CALCULATOR
https://decisionaid.ca/cvd/

'''DIABETES COMPLICATIONS RISK ESTIMATES''' - list the endpoints described by the specific calculator

xx% - also 10-year risk if A1c 9, 8, 7 and 6

also get risk of kidney failure, vision loss, pressure sensation loss – also if A1c 9, 8,7,6

'''The Calculator'''
*DIABETES DECISION AID
http://decisionaid.ca/diabetes/

'''BENEFITS AND HARMS'''

Use the [https://guidelines.diabetes.ca/cpg/chapter-13-2020-update 2020 diabetes guidelines] and/or Diabetes Decision Aid to get estimates of benefits and harms and also use the MyStudies synopsis listed below

'''COSTS'''

Try using [https://pricingdoc.acfp.ca Pricing Doc] to get costs

'''Groups 1,13,25'''

* Metformin - UKPDS 34 [https://mystudies.org/studies.php#studies/28929e89-d01e-4b11-8e67-4d7086f9e4aa/outcome MyStudies Data]

'''Groups 2,14,26'''

* Sulfonlyureas - UKPDS 33 [https://mystudies.org/studies.php#studies/5eadb5dd-d403-4c13-b03e-d4f8d28c96ba/outcome MyStudies Data]

'''Groups 3,15,27'''

* Insulin - ORIGIN [https://mystudies.org/studies.php#studies/f611818f-2e69-4952-b55e-661116bd84b6/outcome MyStudies Data]

'''Groups 4,16,28'''

* SGLT2 - EMPA-REG OUTCOME [https://mystudies.org/studies.php#studies/32e9cf1a-f33e-480b-91ca-6f28a4dcf862/outcome MyStudies Data]

'''Groups 5,17,29'''

* GLP - LEADER [https://mystudies.org/studies.php#studies/1adbc9a1-7603-40f1-ac15-b813ce1f0ad6/outcome MyStudies Data]

'''Groups 6,18,30'''

* DPP4 - TECOS [https://mystudies.org/studies.php#studies/8659968a-cefb-4f99-b4ae-8b9b659acbd5/outcome MyStudies Data]

'''Groups 7,19,31'''

* Intensive treatment – small scale - ADVANCE [https://mystudies.org/studies.php#studies/d28c62d1-2ac8-4e81-b374-69963f001657/outcome MyStudies Data]

'''Groups 8,20,32'''

* Intensive treatment – large scale - ADDITION-Europe - [https://mystudies.org/studies.php#studies/5e07d86d-aa92-4db9-a283-76080db4b6fd/outcome MyStudies Data] Groups

'''2) OSTEOPOROSIS CASE'''

60 y/o female

* 72 kg, 1.69m, BMI = 25.2
* t-score of -2.5
* Worried about falling and getting a hip fracture
* A friend recently had an atraumatic fracture from simply tripping and falling over in the snow
* No other risk factors

'''Calculate Risks'''

'''FRACTURE RISK ESTIMATES''' - list the endpoints described by the specific calculator

Major osteoporotic fracture - xx% - 10-year risk – if no BMD (just BMI), and then if they had a BMD t-Score of -2.0, -2.5, and -3.0

Hip fracture - - xx% - 10-year risk – if no BMD (just BMI) and if you have a BMD xx% - 10-year risk – if no BMD, and then if they had a BMD T-Score of -2.0, -2.5, and -3.0

'''The Calculator'''

* FRACTURE CALCULATOR

[https://frax.shef.ac.uk/frax/tool.aspx?country=19 Frax Tool - Canada]

'''BENEFITS AND HARMS'''

Use the [https://www.cmaj.ca/content/195/39/E1333 2023 Osteoporosis Guideline] and/or your osteoporosis lecture notes to get the benefits and apply these to your patient, and also get the harms

'''COSTS'''

Try using [https://pricingdoc.acfp.ca Pricing Doc] to get costs

'''Groups 9,21,33'''

* Activity

'''Groups 10,22,34'''

* Calcium/Vitamin D

'''Groups 11,23,35'''

* Bisphosphonates

'''Groups 12,24,36'''

* Denosumab

11) NEUROLOGY STUDIES

*[http://www.ncbi.nlm.nih.gov/pubmed/16717269 Opioids for chronic non-cancer pain] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/29509867 Effect of Opioid vs Nonopioid Medications on Pain-Related Function in Patients With Chronic Back Pain] Groups 2,14,26
*[https://www.ncbi.nlm.nih.gov/pubmed/31291515 Galcanezumab for prevention of cluster headaches] Groups 3,15,27
*[http://www.ncbi.nlm.nih.gov/pubmed/27150433 Immediate or delayed treatment of a first seizure] Groups 4,16,28
*[https://www.ncbi.nlm.nih.gov/pubmed/31291516 Rimegepant for episodic migraine] Groups 5,17,29
*[http://www.ncbi.nlm.nih.gov/pubmed/26212846 Sleep restriction for insomnia] Groups 6,18,30
*[https://www.ncbi.nlm.nih.gov/pubmed/25957224 CHANCE] Groups 7,19,31
*[https://www.ncbi.nlm.nih.gov/pubmed/16899775 SPARCL] Groups 8,20,32
*[https://www.ncbi.nlm.nih.gov/pubmed/29171821 Erenumab for episodic migraine] Groups 9,21,33
*[https://www.ncbi.nlm.nih.gov/pubmed/24733354 Reduction of benzodiazepines through education] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/26035341 Patient controlled opioid analgesia versus non-patient controlled opioid analgesia for postoperative pain] Groups 11,23,35
*[https://www.ncbi.nlm.nih.gov/pubmed/11589932 PROGRESS] Groups 12,24,36

'''ACADEMIC YEAR 3'''

12) PSYCHIATRY STUDIES

[[:File:2021 Psych Evidence Appraisal - Intro Slides.pdf|Psychiatry Rating Scales Introduction]]

* Study 1: [http://www.ncbi.nlm.nih.gov/pubmed/16554525 STAR*D (Level 2)] Bupropion-SR, sertraline, or venlafaxine-XR after failure of SSRIs for depression
* Study 2: [http://www.ncbi.nlm.nih.gov/pubmed/29477251 Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder]
* Study 3: [https://pubmed.ncbi.nlm.nih.gov/33862018/ Long-acting injectable versus oral antipsychotics for the maintenance treatment of schizophrenia]
* Study 4: [https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2725088 Association of Antipsychotic Polypharmacy vs Monotherapy With Psychiatric Rehospitalization Among Adults With Schizophrenia]
* Study 5: [https://www.ncbi.nlm.nih.gov/pubmed/29490359 Real-world Effectiveness of Pharmacologic Treatments for the Prevention of Bipolar Disorder]
* Study 6: [http://www.ncbi.nlm.nih.gov/pubmed/20092882 BALANCE] Combination lithium and valproate therapy versus monotherapy for relapse prevention in bipolar I disorder
13) GASTROENTEROLOGY STUDIES

*[http://www.ncbi.nlm.nih.gov/pubmed/27366179 Fidaxomicin versus vancomycin for Clostridium difficile infection] Groups 1,13,25
*[http://www.ncbi.nlm.nih.gov/pubmed/19501587 Prophylaxis of hepatic encephalopathy: Lactulose vs placebo] Groups 2,14,26
*[http://www.ncbi.nlm.nih.gov/pubmed/27759621 Antibiotics vs surgical therapy for uncomplicated appendicitis: Systematic review and meta-analysis] Groups 3,15,27
*[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1914504 Use of probiotic Lactobacillus preparation to prevent diarrhoea associated with antibiotics] Groups 4,16,28
*[http://www.ncbi.nlm.nih.gov/pubmed/17442905 Omeprazole before endoscopy in patients with gastrointestinal bleeding] Groups 5,17,29
*[http://go.galegroup.com/ps/retrieve.do?tabID=T002&resultListType=RESULT_LIST&searchResultsType=SingleTab&searchType=AdvancedSearchForm&currentPosition=3&docId=GALE%7CA489080729&docType=Report&sort=Relevance&contentSegment=&prodId=HRCA&contentSet=GALE%7CA489080729&searchId=R1&userGroupName=ubcolumbia&inPS=true Sequential-therapy treatment regimens vs standard triple therapy for the eradication of H. pylori infection] Groups 6,18,30
*[http://www.ncbi.nlm.nih.gov/pubmed/27614124 Adding licorice to the standard treatment regimen of Helicobacter pylori] Groups 7,19,31
*[http://www.ncbi.nlm.nih.gov/pubmed/15602019 Palifermin for oral mucositis after intensive therapy for hematologic cancers] Groups 8,20,32
*[http://www.ncbi.nlm.nih.gov/pubmed/9178669 Speed of healing and symptom relief in grade II to IV gastroesophageal reflux disease: a meta-analysis] Groups 9,21,33
*[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3108684 Prevention of NSAID-induced gastroduodenal ulcers: a meta-analysis] Groups 10,22,34
*[http://www.ncbi.nlm.nih.gov/pubmed/8985266 Beta-Adrenergic Antagonists in the Prevention of Gastrointestinal Rebleeding in Patients With Cirrhosis: A Meta-Analysis] Groups 11,23,35
*[http://www.ncbi.nlm.nih.gov/pubmed/27512927 Rifaximin versus norfloxacin for secondary prophylaxis of spontaneous bacterial peritonitis] Groups 12,24,36

14) OB/GYN STUDIES
*[http://www.ncbi.nlm.nih.gov/pubmed/25601350 Comparative contraceptive effectiveness of levonorgestrel-releasing and copper IUD Devices]
*[http://www.ncbi.nlm.nih.gov/pubmed/29211679 Hormonal contraception and the risk of breast cancer]
*[http://www.ncbi.nlm.nih.gov/pubmed/30322986 Sexual behaviours in adolescent girls before and after introduction of the HPV]
*[http://www.ncbi.nlm.nih.gov/pubmed/30181338 Intramuscular vs intravenous oxytocin to prevent postpartum haemorrhage at vaginal delivery]
*[http://www.ncbi.nlm.nih.gov/pubmed/27682034 Azithromycin Prophylaxis for Cesarean Delivery]
*[http://www.ncbi.nlm.nih.gov/pubmed/28461374 Antibiotics during pregnancy and risk of spontaneous abortion]