# data[].attributes.body
P- patient with heart failure

I-SGLT-2

C-Improved cardiovascular outcomes compared to ACEI

O- reduction in hospitalization due to heart failure

Clinical Question

-              In patient with heart failure, does SGLT-2 reduce the rate of hospitalisation secondary to decompensation compared to ACEI?

Dapagliflozin in Patients with Heart Failure and Reduced Ejection Fraction | New England Journal of Medicine

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Question: In a case of erectile dysfunction in diabetic men, is lifestyle changes and glycaemic control preferred over pharmacological intervention?

P: Men with type 2 diabetes presented with symptoms of erectile dysfunction

I: lifestyle changes and glycaemic control

C: pharmacological intervention (eg. PDE5 inhibitor)

O: symptoms improve

https://pubmed.ncbi.nlm.nih.gov/15599697/

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Impact of diabetes mellitus on the severity of erectile dysfunction and response to treatment: analysis of data from tadalafil clinical trials - PubMed

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Despite more severe baseline erectile dysfunction in men with diabetes, tadalafil was efficacious and well tolerated in this population. As reported for other phosphodiesterase 5 inhibitors, the response to tadalafil was slightly lower in men with diabetes than in men without diabetes.

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Cognitive Therapy vs Medications in the Treatment of Moderate to Severe Depression

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Background There is substantial evidence that antidepressant medications treat moderate to severe depression effectively, but there is less data on cognitive therapy’s effects in this population.Objective To compare the efficacy in moderate to severe depression of antidepressant…

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Clinical question - why is low glycemic index diet preferred over standard balanced diet

Randomized control trial:

https://pubmed.ncbi.nlm.nih.gov/26224300/

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Comparison of low- and high-carbohydrate diets for type 2 diabetes management: a randomized trial - PubMed

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Both diets achieved substantial weight loss and reduced HbA1c and fasting glucose. The LC diet, which was high in unsaturated fat and low in saturated fat, achieved greater improvements in the lipid profile, blood glucose stability, and reductions in diabetes medication requirements, suggesting an e …

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In a patient with Moderate to Severe Depressive Episode without psychosis, is Cognitive Behavioral Therapy (CBT) alone more effective than pharmacological treatment in reducing depressive symptoms?

P - adult with moderate to severe depression

I - CBT

C - pharmacological intervention

O - reduction in depressive symptoms assessed by BDI

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Question: does physiotherapy alone improve symptoms in adults with severe osteoarthritis more compared with the use of NSAIDs only

P: adult patient with severe osteoarthritis

I: physiotherapy

C: pain relief with NSAIDs

O: reduced pain score, improved quality of life

https://pmc.ncbi.nlm.nih.gov/articles/PMC10423468/

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Comparative efficacy of exercise therapy and oral non-steroidal anti-inflammatory drugs and paracetamol for knee or hip osteoarthritis: a network meta-analysis of randomised controlled trials

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Clinical guidelines recommend exercise as a core treatment for knee or hip osteoarthritis (OA). However, how its analgesic effect compares to analgesics, for example, oral non-steroidal anti-inflammatory drugs (NSAIDs) and paracetamol—the most…

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Clinical question:- why is low glycemic index diet preferred over standard balanced diet?

Patient - 58yo Female with type 2 diabetes with uncontrolled glucose (HbA1C - 8.5%)

Intervention - low glycemic index diet

Comparison - standard balance diet

Outcome - improved glycemic control

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In an adolescent newly diagnosed with asthma, does early initiation of inhaled steroids from diagnosis reduce frequency of annual exacerbations compared to initiation after 6 months

Patient - adolescents newly diagnosed with asthma

Intervention - steroids

Comparison - Delayed initiation of inhaled steroid on diagnosis

Outcome - Frequency of annual exacerbations

https://pubmed.ncbi.nlm.nih.gov/10195073/

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Abstract

Background: Early treatment with inhaled corticosteroids appears to improve clinical symptoms in asthma. Whether a first treatment initiated in the year following the recognition of asthma can prevent major outcomes such as admission to hospital has yet to be studied.

Methods: A case-control study nested within a cohort of 13,563 newly treated asthmatic subjects selected from the databases of Saskatchewan Health (1977-1993) was undertaken to investigate the effectiveness of a first treatment with inhaled corticosteroids in preventing admissions to hospital for asthma. Study subjects were aged between five and 44 years at cohort entry. First time users of inhaled corticosteroids were compared with first time users of theophylline for a maximum of 12 months of treatment. The two treatments under study were further classified into initial and subsequent therapy to minimize selection bias and confounding by indication. Odds ratios associated with hospital admissions for asthma were estimated using conditional logistic regression. Markers of asthma severity, as well as age and sex, were considered as potential confounders.

Results: Three hundred and three patients admitted to hospital with asthma were identified and 2636 matched controls were selected. subjects initially treated with regular inhaled corticosteroids were 40% less likely to be admitted to hospital for asthma than regular users of theophylline (odds ratio 0.6; 95% CI 0.4 to 1.0). The odds ratio decreased to 0.2 (95% CI 0.1 to 0.5) when inhaled corticosteroids and theophylline were given subsequently.

Conclusion: The first regular treatment with inhaled corticosteroids initiated in the year following the recognition of asthma can reduce the risk of admission to hospital for asthma by up to 80% compared with regular treatment with theophylline. This is probably due, at least in part, to reducing the likelihood of a worsening in the severity of asthma.

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anti-inflammatory agents / administration & dosage*

# data[].attributes.attachment_link.keywords[]
bronchodilator agents / administration & dosage*

# data[].attributes.attachment_link.keywords[]
national center for biotechnology information

# data[].attributes.attachment_link.title
First treatment with inhaled corticosteroids and the prevention of admissions to hospital for asthma - PubMed

# data[].attributes.attachment_link.description
The first regular treatment with inhaled corticosteroids initiated in the year following the recognition of asthma can reduce the risk of admission to hospital for asthma by up to 80% compared with regular treatment with theophylline. This is probably due, at least in part, to reducing the likelihoo ...

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60 year old woman who has chronic knee osteoarthritis. She’s already on OTC ibuprofen.

Would physiotherapy be a better initial management over medication?

Patient/problem: 60 year old woman with chronic knee arthritis

Intervention: physical therapy, including strengthening and flexibility exercises

Comparison : Medical management (NSAIDS and Steroids)

Outcome: Improvement in pain reduction and joint mobility

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• Randomized allocation.

• Stratification clearly described.

• patient characteristics mentioned… confounders not statistically significant

• no blinding

• analysis does not include participants who dropped out.. no longer intention to treat analysis.. per-protocol analysis.

• data collection — home BP measurements, lack of standardization… 2 monthly follow up as oppose to recommended biweekly follow up, introduces variability — we don’t know about compliance, diet, other lifestyle factors, but they assessed other med usage. Subjective.

• initially 58, 58 -> 57, 56 — 80% power assumption (reasonable)

• Eastern India — ethnically limited, restricted generalizability

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✉
Tariladei S. Peresuodei tariperezyahoo.com ✉Corresponding author.

# data[].attributes.attachment_link.title
A Comparative Study of the Safety and Efficacy Between Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers on the Management of Hypertension: A Systematic Review - PMC

# data[].attributes.attachment_link.description
Renin-angiotensin-aldosterone system (RAAS) inhibitors, including angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs), are commonly used in the management of hypertension. High blood pressure is a vital risk…

# data[].attributes.body
https://pubmed.ncbi.nlm.nih.gov/33467972/

# data[].attributes.attachment_link.title
Multicenter randomized controlled trial of the effects of individual reminiscence therapy on cognition, depression and quality of life: Analysis of a sample of older adults with Alzheimer’s disease and vascular dementia - PubMed

# data[].attributes.attachment_link.description
Objective: To determine the effectiveness of a 13-week individual reminiscence therapy (RT) intervention on cognition, memory, executive function, mood, and quality of life of people with Alzheimer’s disease and vascular dementia. Method: Non-protocolized analysis using data from a lar …

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https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2819450

# data[].attributes.body
https://pmc.ncbi.nlm.nih.gov/articles/PMC10311037/

# data[].attributes.attachment_link.title
Diagnostic reliability of pediatric appendicitis score, ultrasound and low-dose computed tomography scan in children with suspected acute appendicitis - PMC

# data[].attributes.attachment_link.description
Diagnosis of appendicitis in children is clinically challenging. Computed tomography (CT) is the gold standard for diagnosis; however, radiation exposure early in life is a concern with this technique. Therefore, in this study, we aimed to evaluate…

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In adult male patients with a diagnosis of epilepsy, does the benefits of prescribing sodium valproate first line outweigh its risks compared to lamotrigine ?

PICO framework

P (patient) - male patients with epilepsy

I (intervention) - sodium valproate

C (comparison) - lamotrigine

O (outcome) - does the benefits outweigh the risks?

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Clinical question:

Is there any preference in choosing ACEi or ARB in treating hypertension

P: Patient above 18 y/o diagnosed with primary hypertension

I: ACEi

C: ARB

O: Target BP : 140/90

https://pmc.ncbi.nlm.nih.gov/articles/PMC10944326/

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Question: In older patients with Alzheimer’s, does reminiscence therapy compare with just pharmacological treatment improve quality of life?

PICO framework:

P: older patients with Alzheimer’s

I: reminiscence therapy with pharmacological treatment

C: pharmacological treatment only

O: improved quality of life

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In pregnant women with a previous history of pre-eclampsia, how much more effective is 150 mg of aspirin in preventing pre-eclampsia in the current pregnancy compared to 75 mg of aspirin.

P:

• Pregnant women

• Previous history of pre-eclampsia

• Currently before 12 weeks

I:

• 150 mg aspirin PO OD from 12 weeks until birth

C:

• 75 mg aspirin PO OD from 12 weeks until birth

O:

• Prevention of pre-eclampsia measured as the relative risk reduction in incidence (risk ratio)

Study Design:

• Randomized Controlled Trial

• Prospective Cohort Study

• Retrospective Cohort Study

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Use of CT vs USG in diagnosing appendicitis in paediatric population?

P - pediatric (0-16yo) population with suspected appendicitis

I - USG

C - CT

O - diagnostic accuracy

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Clinical Question:

“Is a breathing exercise intervention effective in reducing chronic pain among breast cancer survivors compared to standard care?”

PICO Framework:

• Problem (P): Breast cancer survivors with chronic pain

• Intervention (I): Evidence-based breathing exercise intervention

• Control (C): Standard care or no intervention

• Outcome (O): Reduction in chronic pain

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https://link.springer.com/content/pdf/10.1007/s00330-021-08161-9.pdf

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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9672973/#:~:text=In%20this%20randomized%20clinical%20trial,a%20significant%20but%20clinically%20modest

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Effect of Medication Optimization vs Cognitive Behavioral Therapy Among US Veterans With Chronic Low Back Pain Receiving Long-term Opioid Therapy: A Randomized Clinical Trial

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What are the most effective pain treatments for patients prescribed opioids?In this randomized clinical trial of 261 veterans with chronic low back pain prescribed opioids, pain improvement on the Brief Pain Inventory was greater with medication optimization…

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https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/647555

# data[].attributes.attachment_link.title
Effects of Reduced Sodium Intake on Hypertension Control in Older Individuals

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Background Few trials have evaluated the effects of reduced sodium intake in older individuals, and no trial has examined the effects in relevant subgroups such as African Americans.Patients and Methods The effects of sodium reduction on blood pressure (BP) and hypertension control were…

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Do antibiotics affect the rate of recovery in patients presenting with acute infective exacerbation of COPD?

P: Patient with COPD exacerbation

I: Antibiotics

C: With or without Antibiotics

O: Rate of Recovery

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Redearch question: In pregnant women suspected of having a pulmonary embolism, is CTPA (compared to a V/Q scan or no imaging) more effective in diagnosing PE while minimising risks to the mother and foetus?

P: Pregnant women suspected of having a PE

I: CTPA

C: V/Q scan or no imaging

O: Accurate diagnosis of PE, minimising maternal and fetal risks (e.g. radiation exposure)

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In adults with chronic low back pain (P), does cognitive behavioral therapy (I) compared to medication (C) improve pain outcomes (O)?

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Research Question:

In elderly patients with hypertension, does the use of a low sodium diet compared to standard dietary advice lead to better blood pressure control?

﻿﻿P: Elderly patients with hypertension

﻿﻿I: low sodium diet

﻿﻿C: Standard dietary advice

﻿﻿O: Blood pressure control

# data[].attributes.body
Which are the best and most effective for management in preventing eczema flares in children between calcineurin inhibitors with emoillent vs steroid with emoillent

P :children under 12

I : topical treatment regime with calcineurin inhibitors and emoillent

C: treatment with steroid and emoillent

O: reduction in frequency and severity in eczema flares in a month