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Società 
Italiana di 
Medicina 
Generale

Workshop 
Decisioni Cliniche e Prove di Efficacia
Dai grandi trial al paziente individuale: 
un percorso tra preconcetti, errori salutari e volute dimenticanze

Riccione, 5-6 aprile 2002

GIMBE^â

Con il patrocinio di 
Associazione Medicina e Persona 
Ordine dei Medici Chirurghi ed Odontoiatri della Provincia di Rimini
Azienda USL di Rimini

Vecchi FANS e nuovi Coxib: il naufragar ci è dolce in questo mare.  
Discussant: Angelo Corvetta, Giovanni Pomponio

• Caso clinico. Silvio Guidi

• Evidence

• Linee guida

  • National Institute for Clinical Excellence (NICE)  - Cox II inhibitors for osteoarthritis and rheumatoid arthritis   

    • Full guidance on Cox II selective inhibitors 

• Revisioni non sistematiche

  • Bollettino d'Informazione sui Farmaci

    • Celecoxib e rofecoxib. Bollettino d'Informazione sui Farmaci 2001;n°4-5:171:5

    • Celecoxib e rofecoxib: quali evidenze da due nuovi studi? Bollettino d'Informazione sui Farmaci 2001;n°2:74-77

    • Una nuova classe di farmaci: gli inibitori selettivi della COX-2 o coxib. Bollettino d'Informazione sui Farmaci 2000;n°4:12-27

  • Altre review

    • Bombardier C.An evidence-based evaluation of the gastrointestinal safety of coxibs. Am J Cardiol. 2002 Mar 21;89(6 Suppl 1):3-9. [abstract]

    • Hawkey CJ. Gastrointestinal safety of COX-2 specific inhibitors. Gastroenterol Clin North Am 2001;30:921-36. [abstract]

    • Schoenfeld P. An evidence-based approach to the gastrointestinal safety profile of COX-2-selective anti-inflammatories. Gastroenterol Clin North Am 2001;30:1027-44 [abstract]

    • Fitzgerald GA, Patrono C. The coxibs, selective inhibitors of cyclooxygenase-2. N Engl J Med. 2001;345:433-42

    • Watson DJ, Harper SE, Zhao PL, et al. Gastrointestinal tolerability of the selective cyclooxygenase-2 (COX-2) inhibitor rofecoxib compared with nonselective COX-1 and COX-2 inhibitors in osteoarthritis. Arch Intern Med 2000;160:2998-3003

    • Langman MJ, Jensen DM, Watson DJ, et al. Adverse upper gastrointestinal effects of rofecoxib compared with NSAIDs. JAMA 1999;282:1929-33.

    • Cox-2 round up. Bandolier, March 2000

    • Selective COX-2 inhibitors: Are they safer NSAIDs ? Therapeutics Letter 39, January / February 2001

• Ricerca primaria (RCTs ed altri studi)

  • Geba GP, Weaver AL, Polis AB, et al. Efficacy of rofecoxib, celecoxib, and acetaminophen in osteoarthritis of the knee: a randomized trial. JAMA 2002;287:64-71

• Hot topics

  • Competizione tra gastroprotezione e cardioprotezione

    • Ray WA, Stein CM, Hall K, et al. Non-steroidal anti-inflammatory drugs and risk of serious coronary heart disease: an observational cohort study. Lancet 2002;359:118-23

    • Cleland JG. No reduction in cardiovascular risk with NSAIDs-including aspirin? Lancet 2002;359:92-3.

    • Catella-Lawson F, Reilly MP, Kapoor SC, et al. Cyclooxygenase inhibitors and the antiplatelet effects of aspirin. N Engl J Med. 2001;345:1809-17

    • Crofford LJ. Rational use of analgesic and antiinflammatory drugs. N Engl J Med 2001;345:1844-6

    • Konstam MA, Weir MR, Reicin A, et al. Cardiovascular thrombotic events in controlled, clinical trials of rofecoxib. Circulation 2001;104:2280-8

    • Mukherjee D, Nissen SE, Topol EJ. Risk of Cardiovascular Events Associated With Selective COX-2 Inhibitors. JAMA 2001;286:954-959

      • Lettere correlate

      • Revisione ACP Journal Club

    • Boers M. NSAIDS and selective COX-2 inhibitors: competition between gastroprotection and cardioprotection. Lancet 2001;357:1222-3

  • Parziale pubblicazione dei risultati dello studio CLASS

    • Celecoxib e rofecoxib. Bollettino d'Informazione sui Farmaci 2001;n°4-5:171:5

    • COX-2 inhibitors update: Do journal publications tell the full story? Therapeutics Letter, issue 43

    • Wright JM, Perry TL, Bassett KL, Chambers GK. Reporting of 6-month vs 12-month data in a clinical trial of celecoxib. JAMA 2001;286:2398-2400.

"Vecchi" e "nuovi" chinolonici: vantaggi per chi?
Discussant: Giampaolo Cordioli, Gabriele Cortellini

• Caso clinico. Roberto Nardi

• Evidence

• Linee guida

  • British Thoracic Society, 2001

  • American Thoracic Society, 2001

  • Infectious Diseases Society of America, 2000

  • European Respiratory Society, 1998

• Technology assessment report

  • Metge CJ, Vercaigne L, Carrie A, Zhanel GG. The new fluoroquinolones in community-acquired pneumonia: clinical and economic perspectives. Ottawa: Canadian Coordinating Office for Health Technology Assessment; 2001. Technology Overview no 5.

• Evidence-report

  • Marrie T. Community-acquired pneumonia. In: Clinical Evidence, issue 6. March 2002

• Evidence-based Case Report. 

  • Cartabellotta A, Potena A. La polmonite dell'ingegnere ed i problemi del medico generalista. Ricerca e Sanità 2000;1:119-23

• Revisioni sistematiche

  • Verheij T, Kochen M, Hoepelman IM, Lammers JW, Macfarlane J, Woodhead M. Antibiotics for community acquired pneumonia in adult outpatients (Protocol for a Cochrane Review). In: The Cochrane Library, Issue 1, 2002. Oxford: Update Software

  • Metlay J P, Kapoor W N, Fine M J. Does this patient have community-acquired pneumonia? Diagnosing pneumonia by history and physical examination. JAMA 1997;278:1440-5 [abstract]

• Revisioni non sistematiche

  • Pomilla PV, Brown RB. Outpatient treatment of community-acquired pneumonia in adults. Arch Intern Med 1994;154:1793-802 [abstract]

• Ricerca primaria (RCTs ed altri studi)

  • Marrie TJ, Lau CY, Wheeler SL, et al. A controlled trial of a critical pathway for treatment of community-acquired pneumonia. JAMA 2000;283:749–755 

  • Fine MJ, Auble TE, et al. A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med 1997;336:243-50

    • Clinical Prediction Rule 

Bronchite cronica, asma, BPCO. Pratica clinica ed eccesso di linee guida?
Discussant: Giampaolo Cordioli, Gabriele Cortellini

• Caso clinico. Modesto Fantini

• Evidence

• Linee guida

  • GOLD - Global Initiative for Chronic Obstructive Lung Disease, World Health Organization, National Heart, Lung, and Blood Institute. April 2001

  • Lacasse Y, Ferreira I, Brooks D, Newman T, Goldstein RS. Critical appraisal of clinical practice guidelines targeting chronic obstructive pulmonary disease. Arch Intern Med 2001;161:69-74

• Evidence-report

  • Chronic obstructive pulmonary disease. In: Clinical Evidence, issue 6. March 2002

  • Management of Acute Exacerbations of Chronic Obstructive Pulmonary Disease. Summary, Evidence Report/Technology Assessment: Number 19. AHRQ Publication No. 00-E020, September 2000. Agency for Healthcare Research and Quality, Rockville, MD

    • American College of Chest Physicians, American College of Physicians, American Society of Internal Medicine. Evidence Base for Management of Acute Exacerbations of Chronic Obstructive Pulmonary Disease.Ann Intern Med 2001;134.595-99

    • Management of Acute Exacerbations of Chronic Obstructive Pulmonary Disease: A Summary and Appraisal of Published Evidence

Le statine: il diavolo o l'acquasanta?  
Discussant: Ezio Degli Esposti,  Giancarlo Piovaccari 

• Caso clinico. Marco Grassi

• Evidence

• Linee guida

  • Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol  in Adults (Adult Treatment Panel III). JAMA 2001;285:2486-97

  • Programma Nazionale Linee Guida. L'uso delle carte di rischio per identificare gli individui a rischio coronarico aumentato

  • Carte del Rischio Cardiovascolare

  • Nota CUF 13

• Ricerca primaria (RCTs ed altri studi)

  • Diamond GA, Forrester JS. Analysis of probability as an aid in the clinical diagnosis of coronary artery disease. N Engl J Med. 1979;300:1350-8.

  • Applying clinical trial results. Guidelines for determining whether a drug is exerting (more than) a class effect. JAMA 1999;282:1371-77

    • Versione italiana