Most Recent Tools for Practice
Tools for Practice #277 – Somethin’ Fishy: Prescription variants of Omega-3 to prevent cardiovascular disease
Do prescription variants of omega-3’s, like icosapent, reduce the risk of cardiovascular events when added to statins?
Bottom Line: In high risk patients, icosapent reduced cardiovascular events to 17% from 22% on placebo after 5 years. In lower risk patients, Eicosapentaenoic Acid (EPA) ethyl ester reduced major cardiovascular events to 2.8% from 3.5% with control after 5 years. Whether these products differ from each other or traditional omega-3 fatty acids (that don’t show cardiovascular benefit) is unknown. Cost will likely limit use. Read More
Tools for Practice #276 – Glucosamine & Chondroitin: Natural remedies for osteoarthritis?
Does glucosamine and/or chondroitin improve pain for patients with osteoarthritis?
Bottom Line: Glucosamine and chondroitin do not appear to be effective in higher-quality, larger and/or publicly funded studies. If studies at high risk of bias are included, at best ~10% more people will have meaningful reduction in pain with either treatment over 35-45% of people with placebo. There is reason to doubt the effectiveness of either treatments. Read More
Tools for Practice #275 – A good sleep would be dop(aminergic) doc! Pramipexole in restless legs syndrome
Is pramipexole effective for the treatment of restless legs syndrome (RLS)?
Bottom Line: Systematic review of twelve randomized controlled trials demonstrates 63% of patients using pramipexole report feeling much or very much better compared to 41% on placebo over 3-26 weeks. Lower doses (example 0.25/0.5mg) may have equivalent efficacy to higher doses with less risk of augmentation (paradoxical worsening of symptoms with treatment), although up to ~40% of patients may experience augmentation after 1 year. Read More
Tools for Practice #274 – Making your head spin: Betahistine for benign paroxysmal positional vertigo
Is betahistine effective for adults with benign paroxysmal positional vertigo (BPPV)?
Bottom Line: When used alone without repositioning maneuvers (i.e. Epley maneuver), limited data suggest more patients have “improved” dizziness with betahistine compared to placebo (75% versus 52% placebo at 3 months). However, betahistine is less effective than Epley. Whether betahistine is effective for residual dizziness post-Epley is uncertain. At best, 44% of patients compared to 21% on placebo will “improve”. Read More
Tools for Practice #273 – Virtual visits versus face-to-face: Diagnostic accuracy in primary care
What is the diagnostic accuracy of primary care physicians performing virtual visits compared to in-person visits for undifferentiated presentations?
Bottom Line: Based on limited, lower-level evidence, diagnostic accuracy of virtual visits was between 71-91%, measured using standardized patients or case review at 3 months. Diagnostic accuracy/agreement of virtual care seems similar to in-person visits. These studies do not address continuity of care or patient outcomes. 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.
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