Most Recent Tools for Practice
Tools for Practice #291 – Early dual antiplatelet therapy after minor stroke: Does it take two to tango?
In acute non-cardioembolic minor ischemic stroke or transient ischemic attack (TIA), does adding a second antiplatelet (like clopidogrel or ticagrelor) to ASA reduce recurrent stroke?
BOTTOM LINE: Compared to ASA alone, clopidogrel plus ASA reduced the risk of stroke from 8.2% to 5.5% but increased the risk of major bleeds from 0.6% to 1.2% at 21 days. Continuing clopidogrel beyond 21 days increased major bleeds without reducing strokes. There is no evidence that ticagrelor is more efficacious in reducing stroke than clopidogrel. Read More
Tools for Practice #290 – Needle in a Pain-Stack: Acupuncture for Chronic Low Back Pain
Does acupuncture improve pain for patients with chronic low back pain?
BOTTOM LINE: The benefit of acupuncture for chronic low back pain is unclear. At best, one in 6 patients will get meaningful pain relief (>=30% reduction in pain) over control. The benefit is reduced to one in 20 when compared to sham acupuncture and disappears when studies of higher quality or longer duration are considered. Read More
Tools for Practice #289 – Keeping it Simple for Emergency Room Dyspepsia
Should lidocaine or anti-spasmodics be added to antacids when treating emergency room patients with dyspepsia?
BOTTOM LINE: Best evidence suggests adding lidocaine and/or anti-spasmodics to antacids is unlikely to add meaningful pain relief compared to antacids alone. Evidence is inconsistent with one study finding antacids alone better, another no added benefit and a third (unblinded, older) showing lidocaine provided additional benefit. Patients (especially females) who present to emergency with new onset dyspepsia should have cardiac diagnosis ruled out. Read More
Tools for Practice #288 – Clearing up the evidence for topical acne combination products
How effective are topical combination products for moderate facial acne?
BOTTOM LINE: For patients using combination products, including benzoyl peroxide/adapalene and benzoyl peroxide/clindamycin, about 40- 50% will perceive complete or near complete improvement in their acne, compared to 30-40% using individual products, and 20-30% using vehicle. No direct head-to-head trials with patient reported outcomes exist between combination products. Cost may influence product choice. Read More
Tools for Practice #287 – How to Slow the Flow: NSAIDs for Heavy Menstrual Bleeding
In premenopausal heavy menstrual bleeding without pathological cause, do nonsteroidal anti-inflammatory drugs (NSAIDs) improve patient outcomes?
Bottom Line: Based on low-quality evidence, NSAIDs reduce relative mean menstrual blood loss by ~30%, and ~20-50% fewer sanitary products used than placebo. Effects on bleeding duration are inconsistent. Read More
When creating primary care education and programs, the PEER team focuses on minimizing bias, patient orientated outcomes, shared decision making, collaboration and most importantly simplicity.
Who is PEER?
Patients, Experience, Evidence and Research (PEER) was formed between a group of primary care providers who shared a common belief that evidence should be made accessible to all primary care providers.