Users' Guides to the Medical Literature
Guyatt G, Rennie D, Meade MO, Cook DJ
Part B Therapy
Chapter 11.1. Applying Results to Individual Patients
Antonio L. Dans, Leonila F. Dans, Gordon Guyatt
Using the Guide—Part 3
Topics Discussed:
adherence, aspirin, blood pressure, clinical decision making, clinician behavior, comorbidity, influenza virus vaccine, medication adherence, meta-analyses, myocardial infarction, nonadherent, patient compliance, proton pump inhibitors, provider adherence, streptokinase, treatment effect
Excerpt:
"Clinicians looking at RCTs to guide medical decisions
must decide how to apply results to individual patients. Chapter 6, Therapy, suggested 2 criteria for
deciding on applicability: (1) Can you apply the results of the
study to the patient before you? (2) Are the benefits worth the risks and
costs? In this chapter, we discuss these guides in greater detail.Table 11.1-2 lists 5 biologic factors
that sometimes lead us to reject the idea of applying results to
a particular patient. "SCRAP" is a mnemonic to remember
these 5 factors, which include a patient's sex, presence
of comorbidity, race or ethnicity, age, and pathology of
the disease. The following examples illustrate how these factors
may modify treatment effects in individual patients.Cardiovascular disease prevention provides
a setting in which treatment responses have differed between men
and women.5 For example, a meta-analysis of
the use of aspirin in primary prevention detected
significant differences in the treatment effect between
men and women.4 As Figure 11.1-1 shows,
administration of aspirin to healthy women did not decrease the
incidence of MI as it did in men. In contrast, aspirin reduced the incidence of
stroke in women while seeming to increase it in men. Contrary to expectations,
these findings suggest that, overall, women derive more benefit
from treatment.Streptokinase is administered intravenously as a single dose.
Thus, in our scenario, if the patient can afford the drug, patient adherence will not
be a problem. ..."
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