CAMP-Therapeutic

Therapeutic Study (2) – Case Scenario and Article

Your 54-year old Uncle Tom called you up one morning and asked you about a conversation he had with you Uncle Bob regarding multivitamins. Uncle Bob has been taking multivitamins since news broke out October of last year linking multivitamins to cancer prevention. Now Uncle Bob is insisting that Uncle Tom should take multivitamins. While Uncle Bob did not think it was necessary to consult you. Uncle Tom felt that he needs more information before he purchases a bottle as it is rather expensive.
Uncle Tom then went on to remind you that your grandfather died of cancer and that this would be of benefit to him in the long run. But other than a parental history of cancer, Uncle Tom lived a very healthy lifestyle. He bikes regularly, plays badminton 3x a week, enjoys ballroom dancing once in a while and eats balanced meals. He only binges on ice cream at times.
You tell your uncle that you will look into the evidence and discuss this with him later in the day. Having just attended a workshop on EBM, you did your search and found the study the October 2012 news report was referring to:

Gaziano JM et al. Multivitamins in the Prevention of Cancer in Men. The Physicians’ Health Study II Randomized Controlled Trial. JAMA 2012; 308(18)

A. Read the article and …

  1. Decide if it provides a direct answer to the clinical question you ask
  2. Appraise validity using the validity guides
  3. Appraise the results of the study
  4. Assess its applicability to your specific patient, and
  5. Calculate your uncle’s patient-specific results.

B. How will you discuss the results with your Uncle Tom?

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Therapeutic Study (1) – Case Scenario and Article

Madam Tan comes to your clinic for a second opinion. She is a 78-year old lady and claims that she has always had clean bill of health … all thanks to a vegetarian diet and a lifetime without vices. One month age, Madam Tan’s children insisted that she undergo a “health check”. Narrates that the “crazy doctor” who saw her previously had said that she has hypertension and needs to be taking daily medications to control her blood pressure and prevent a heart attack. “Doctor, my blood pressure stays below 140/80 without any medicines. That’s very good for someone my age. Why do I have to take these medications?”

As you look through her blood pressure diary (130 mm Hg on most days, an occasional spike of 140 mm Hg), her amazingly normal lipid profile and blood sugars, and the unused packet of antihypertensive medications, you start to wonder whether there really is a need for her to start taking these medications. You rack your brains, trying to remember the latest practice guidelines and the studies they were based on. Still not sure, and wanting to avoid being labeled the “second crazy doctors”, you search PubMed and come across this article”:

The SPRINT Research Group. “A Randomized Trial of Intensive versus Standard Blood-Pressure Control.” New England Journal of Medicine 373, no.22 (November 26, 2015): 2103-16. doi:10.1056/NEJMoa15511939.

A. Read the article and …

  1. Decide if it provides a direct answer to the clinical question you ask
  2. Appraise validity using the validity guides,
  3. Appraise the results of the study,
  4. Assess its applicability to your specific patient, and
  5. Calculate your uncle’s patient-specific results.

B. How will you discuss the results with your patient?

Download related articles from here …