Most Recent Tools for Practice
Tools for Practice #264 – From theory to reality: ACEi, ARB, and COVID-19
Do angiotensin converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARB) increase the risk of catching, or severity of infection with, COVID-19?
Bottom Line: Despite initial theoretical suggestions that ACEi and ARB are harmful, four observational studies have since found no association between COVID-19 infection or severity of disease and ACEi/ARB. One cohort study with the smallest number of COVID-19 patients found an association between ACEi, ARB and hospitalization but not mechanical ventilation. All studies have limitations associated with observational studies including potential confounders and bias which require imperfect statistical adjustments. Read More
Tools for Practice #263 – Finding COVID – How Good is the Test to Detect it?
What is the chance of obtaining an incorrect result with the polymerase chain reaction (PCR) test for COVID-19?
Bottom Line: If the PCR COVID-19 test is positive you have COVID-19 (specificity ~100%). Small Canadian studies suggest the test will detect COVID-19 ~80-90% of the time (sensitivity), although estimates range from ~50%-90%. Collection technique, anatomical sample and timing of collection influence these numbers. The chance of a false negative depends on sensitivity and the pre-test probability the person has COVID-19. Example: someone with abnormal chest x-rays and close COVID-19 positive contacts has a higher risk of false negatives than someone who is asymptomatic. Read More
Tools for Practice #262 – Who let the Gout Out? Targeting Uric Acid Levels in Treating Gout
To prevent gout recurrence, should we dose urate lowering therapies (like allopurinol) to target uric acid levels?
Bottom Line: Best evidence finds that increasing doses of allopurinol to achieve a specific serum urate target (example <360 μmol/L) does not reduce gout flares, pain, or function, compared to standard allopurinol dosing. Febuxostat increases cardiovascular and overall mortality and should not be used in most patients with gout. Read More
Tools for Practice #261 – Antivirals for COVID-19
Do treatments such as remdesivir or other anti-virals change patient outcomes in COVID-19 patients?
Bottom Line: To date, published RCTs have not demonstrated benefit of treating COVID-19 patients with remdesivir, lopinavir-ritonavir or oseltamivir. There are signals of potential benefits from one interim analysis of remdesivir and non-statistically different results, but more research is needed. Full publication of studies and ongoing trials will help to answer this question. Read More
Tools for Practice #260 – Are there tools to help assess dyspnea virtually?
Are there any techniques (like the Roth Score) to augment a typical history when assessing dyspnea/pneumonia over the phone or by video?
Bottom Line: Unfortunately, no specific technique, including the Roth Score, is reliable in assuring dyspneic patients are not at risk and safe to stay home. Furthermore, no studies have evaluated dyspnea assessment in COVID-19 patients. Clinicians are encouraged to use available tools (https://www.bmj.com/content/368/bmj.m1182/infographic) and have patients assessed in-person if there are any concerns. 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.