Copyright (c) 2009 Bond University All rights reserved. http://epublications.bond.edu.au/chris_del_mar Recent documents in Christopher Del Mar en-us Wed, 18 Feb 2009 16:23:48 PST 3600 http://epublications.bond.edu.au/hsm_pubs/62 http://epublications.bond.edu.au/hsm_pubs/62 Tue, 12 Aug 2008 17:44:24 PDT Extract These essays from the pricker of British medical establishment conscience are thought-provoking and controversial. Chris Del Mar http://epublications.bond.edu.au/hsm_pubs/61 http://epublications.bond.edu.au/hsm_pubs/61 Sun, 18 May 2008 21:38:13 PDT Extract: This is an updated version of an original check unit on evidence based medicine (EBM) written by Chris Del Mar, Paul Glasziou and Chris Silagy in 1999. Our aim for this unit is to present a practical strategy in learning to use EBM in our every day practice. To practise EBM means to make clinical decisions based on the best evidence currently available. It sounds simple, however, the 'devil' is in the detail! Exactly how do we go about it? On completion of this unit we hope that participants will: appreciate the role that EBM can play in improving the quality of patient care and in involving patients in the decision making process display increased confidence in the steps involved in EBM: formulating questions, finding evidence, critically appraising evidence and applying evidence with the patient understand which information sources are most appropriate for different types of questions, eg. therapeutic or diagnostic questions, and understand the basic principles to apply when appraising evidence, and confidently use the cochrane and Pubmed databases to undertake basic searches. Chris Del Mar http://epublications.bond.edu.au/hsm_pubs/53 http://epublications.bond.edu.au/hsm_pubs/53 Thu, 13 Sep 2007 19:01:09 PDT Extract: Antibiotic resistance will probably eventually appear by natural selection for every new antibiotic developed by the drug industry, and the race to produce new drugs ahead of resistance is run ever closer. Antibiotics should be thought of like oil, a non-renewable resource to be carefully husbanded. What we use now cannot be used some time in the future. Chris Del Mar http://epublications.bond.edu.au/hsm_pubs/51 http://epublications.bond.edu.au/hsm_pubs/51 Tue, 19 Jun 2007 18:35:13 PDT Background Acute otitis media (AOM) is a spontaneously remitting disease for which pain is the most distressing symptom. Antibiotics are now known to have less benefit than previously assumed.Objectives To assess the effectiveness of topical analgesia for AOM.Search strategy We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2, 2006), MEDLINE (1966 to May Week 3 2006), EMBASE (1990 to December 2005) and LILACS (1982 to September 2005) without language restriction, and the reference lists of articles. We also contacted manufacturers and authors.Selection criteria Double-blind randomised or quasi-randomised controlled trials comparing an otic preparation with an analgesic effect (excluding antibiotics) versus placebo or an otic preparation with an analgesic effect (excluding antibiotics) versus any other otic preparation with an analgesic effect, in adults or children presenting at primary care settings with AOM without perforation.Data collection and analysis Potential studies were screened independently and trial quality was assessed by three authors, and differences were resolved by discussion. Data was then independently extracted from the trials selected by two authors. We contacted the authors of three trials to acquire additional information not available in published articles.Main results Our searches yielded 356 records; four trials met our criteria. One trial with 54 participants compared treatment with anaesthetic ear drops versus an olive oil placebo immediately at diagnosis. All patients were also given paracetamol. There was a statistically significant pain reduction of 25% in those receiving anaesthetic drops 30 minutes after instillation. Three trials (with one common co-author) compared anaesthetic ear drops with naturopathic herbal ear drops in 274 patients. One of these trials also used antibiotics in both groups. There were statistically significant differences at instillation of drops, or 15 or 30 minutes after the instillation (or both) on one to three days after diagnosis, always favouring the naturopathic group in each trial.Authors' conclusions The evidence from these four randomised controlled trials, only one of which addresses the most relevant question of primary effectiveness, is insufficient to know whether ear drops are effective or not.Copyright© 1999-2007 John Wiley & Sons, Inc. All rights reserved. Ruth Foxlee http://epublications.bond.edu.au/hsm_pubs/50 http://epublications.bond.edu.au/hsm_pubs/50 Tue, 19 Jun 2007 18:12:27 PDT Background Clinical trials have shown that exercise in adults with overweight or obesity can reduce bodyweight. There has been no quantitative systematic review of this in The Cochrane Library.Objectives To assess exercise as a means of achieving weight loss in people with overweight or obesity, using randomised controlled clinical trials.Search strategy Studies were obtained from computerised searches of multiple electronic bibliographic databases. The last search was conducted in January 2006.Selection criteria Studies were included if they were randomised controlled trials that examined body weight change using one or more physical activity intervention in adults with overweight or obesity at baseline and loss to follow-up of participants of less than 15%.Data collection and analysis Two authors independently assessed trial quality and extracted data.Main results The 43 studies included 3476 participants. Although significant heterogeneity in some of the main effects' analyses limited ability to pool effect sizes across some studies, a number of pooled effect sizes were calculated. When compared with no treatment, exercise resulted in small weight losses across studies. Exercise combined with diet resulted in a greater weight reduction than diet alone (WMD - 1.1 kg; 95% confidence interval (CI) -1.5 to -0.6). Increasing exercise intensity increased the magnitude of weight loss (WMD - 1.5 kg; 95% CI -2.3 to -0.7). There were significant differences in other outcome measures such as serum lipids, blood pressure and fasting plasma glucose. Exercise as a sole weight loss intervention resulted in significant reductions in diastolic blood pressure (WMD - 2 mmHg; 95% CI -4 to -1), triglycerides (WMD - 0.2 mmol/L; 95% CI -0.3 to -0.1) and fasting glucose (WMD - 0.2 mmol/L; 95% CI -0.3 to -0.1). Higher intensity exercise resulted in greater reduction in fasting serum glucose than lower intensity exercise (WMD - 0.3 mmol/L; 95% CI -0.5 to -0.2). No data were identified on adverse events, quality of life, morbidity, costs or on mortality.Authors' conclusions The results of this review support the use of exercise as a weight loss intervention, particularly when combined with dietary change. Exercise is associated with improved cardiovascular disease risk factors even if no weight is lost.Copyright © 2007 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd K. Shaw http://epublications.bond.edu.au/hsm_pubs/49 http://epublications.bond.edu.au/hsm_pubs/49 Tue, 19 Jun 2007 17:50:09 PDT Objective. To assess the use of n-of-1 trials for short-term choice of drugs for osteoarthritis, with particular reference to comparing the efficacy of sustained-release [SR] paracetamol with celecoxib in individual patients. Methods. Evaluation of community-based patients undergoing n-of-1 trials which consisted of double-blind, crossover comparisons of celecoxib 200 or 400 mg/day with sustained-release paracetamol 1330 mg three times a day in three pairs of 2 week treatment periods per drug with random order of the drugs within pairs. Outcomes evaluated were pain and stiffness in sites nominated by the patient, functional limitation scores, preferred medication, side effects and changes in drug use after an n-of-1 trial. Participants were 59 patients with osteoarthritis in multiple sites (hip 6, knee 24, hand 6, shoulder/neck 8, back 14, foot 5), with pain for 1 month severe enough to warrant consideration of long-term use of celecoxib but for whom there was doubt about its efficacy. Forty-one n-of-1 trials were completed. Results. Although on average, celecoxib showed better scores than SR paracetamol [0.2 (0.1) for pain, 0.3 (0.1) for stiffness and 0.3 (0.1) for functional limitation], 33 of the 41 individual patients (80%) failed to identify the differences between SR paracetamol and celecoxib in terms of overall symptom relief. Of the eight patients who were able to identify the differences, seven had better relief with celecoxib and one with SR paracetamol. In 25 out of 41 [61%] patients, subsequent management was consistent with their trial results. Conclusions. N-of-1 trials may provide a rational and effective method to best choose drugs for individuals with osteoarthritis. SR paracetamol is more useful than celecoxib for most patients of whom management is uncertain. Michael J. Yelland http://epublications.bond.edu.au/hsm_pubs/37 http://epublications.bond.edu.au/hsm_pubs/37 Thu, 07 Jun 2007 18:22:53 PDT Practical General Practice is an interactive manual that is specifically designed for use during the consultation process. Containing over 1000 conditions, the unique underlying structure of the book allows the GP to see immediately what treatment is recommended and why. All recommendations are highly specific - giving a firm guide to the GP during the consultation process rather than a list of possibilities that the GP might wish to consider. This particular chapter deals with skin problems. Geoffrey Mitchell http://epublications.bond.edu.au/hsm_pubs/36 http://epublications.bond.edu.au/hsm_pubs/36 Thu, 07 Jun 2007 18:07:10 PDT Clinicians are taught masses of facts, but not how to use them in the messy reality of patient care. This book provides a missing link between evidence and the clinical coalface. Though there are plenty of guides to evidence-based medicine, few explain how to build the information into patient oriented decision-making. Clinical Thinking allows you to think both logically and laterally about daily clinical issues and look at problems from different angles. Copyright © Blackwell Publishing 2006. Chris Del Mar http://epublications.bond.edu.au/hsm_pubs/34 http://epublications.bond.edu.au/hsm_pubs/34 Wed, 23 May 2007 22:06:47 PDT BACKGROUND Research papers submitted to Australian Family Physician (AFP) are accepted or rejected on the judgment of the research editor with advice from expert reviewers. Rejection can be outright (eg. when research is 'fatally flawed') or, more often, conditional (when authors are invited to respond to criticisms). Sometimes authors fail to resubmit. The fate of both groups of papers is unknown, as are the reasons for failing to resubmit.METHOD We sent an explanatory email to all authors who submitted a paper to the AFP research section between 2002 and 2004, with a simple eight question survey (plus 1-2 additional questions for authors of rejected/withdrawn articles).RESULTS Of 123 requests sent, 50 were returned (41% response rate). These were supplemented by an extra 19 papers identified by literature searching. Authors of accepted papers were more likely to participate than those whose papers were rejected or withdrawn. Most papers (28/47, 60%) submitted to AFP were written specifically for the journal. Those that were published underwent major change from the original submitted. Three out of 11 papers rejected by AFP were published in another journal. Authors who failed to resubmit (or withdrew) their paper usually cited being too busy. The editorial and peer review process was considered valuable by 74% of respondents. Most accepted papers (20/37, 54%) underwent one revision: rejected articles were usually rejected outright (9/11, 82%).DISCUSSION That authors often lose interest in getting their paper published after preparing it for submission is curious. Most authors consider peer and editorial review to be valuable. Rachel Green http://epublications.bond.edu.au/hsm_pubs/33 http://epublications.bond.edu.au/hsm_pubs/33 Wed, 23 May 2007 21:34:30 PDT The health workforce crisis needs radical treatment; simply educating more health workers will be insufficient, and role substitution among existing health workers is untenable. We propose a new class of health worker who would take on single disease or single procedure responsibilities, working mostly to protocols; and be embedded within current structures. We also propose modular health education which has fewer entry points into the health system, allows transfer between different disciplines, and is based on modules that can be accumulated to allow progress through the system to gain more clinical responsibility. © Australasian Medical Publishing Company Chris Del Mar