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Workshop
Evidence based Medicine
Le opportunità di un linguaggio comune

Como, 9-11 maggio 2003

in collaborazione con

Società
Nazionale di
Aggiornamento
Medico
InterDisciplinare

Sezione di Como

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EBM-ECM: metodologie e prove di efficacia dell'Educazione Continua in Medicina

• Slides

BPCO: perché un eccesso di evidenze non modifica i comportamenti?
Conduttore: Antonino Cartabellotta.
Discussant: Daniela Canini, Gian Paolo Bonini, Alfredo Potena

• Slides

• Evidence appraised

  • 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

Distorsioni e piccoli traumi agli arti inferiori: dobbiamo prescrivere eparine proprio a tutti?
Conduttore: Antonino Cartabellotta.
Discussant: Fabio Alberghina, Alessandro Di Pasquale, Domenico Prestamburgo

• Slides

• Evidence appraised

  • Linee guida

    • SIGN - Scottish Intercollegiate Guidelines Network. Prophylaxis of venous thromboembolism. October 2002

    • American College of Chest Physicians

      • Heparin and Low-Molecular-Weight Heparin Mechanisms of Action, Pharmacokinetics, Dosing, Monitoring, Efficacy, and Safety. Chest 2001;119: 64S-94S

      • Prevention of Venous Thromboembolism. Chest 2001;119:132S-175S

    • College of American Pathologist.Platelet count monitoring and laboratory testing for heparin-induced thrombocytopenia. Arch Pathol Lab Med 2002;126:1415-23

  • Revisioni non sistematiche

    • O'Shea SI, Ortel TL. Issues in the utilization of low molecular weight heparins. Semin Hematol 2002;39:172-8

    • Boneu B, de Moerloose P. How and when to monitor a patient treated with low molecular weight heparin. Semin Thromb Hemost 2001;27:519-22 [abstract]

    • Duplaga BA, Rivers CW, Nutescu E. Dosing and monitoring of low-molecular-weight heparins in special populations. Pharmacotherapy 2001;21:218-34 

  • Ricerca primaria (RCTs ed altri studi)

    • Lassen MR, Borris LC, Nakov RL. Use of the low-molecular-weight heparin reviparin to prevent deep-vein thrombosis after leg injury requiring immobilization. N Engl J Med 2002;347:726-30

    • Jorgensen PS, Warming T, Hansen K, et al. Low molecular weight heparin (Innohep) as thromboprophylaxis in outpatients with a plaster cast: a venografic controlled study. Thromb Res 2002;105:477-80 

    • Warkentin TE, Kelton JG. Temporal aspects of heparin-induced thrombocytopenia. N Engl J Med 2001;344:1286-92

    • Kock HJ, Schmit-Neuerburg KP, Hanke J, Rudofsky G, Hirche H.Thromboprophylaxis with low-molecular-weight heparin in outpatients with plaster-cast immobilisation of the leg. Lancet 1995;346:459-61 [abstract]

    • Spannagel U, Kujath P. Low molecular weight heparin for the prevention of thromboembolism in outpatients immobilized by plaster cast. Semin Thromb Hemost 1993;19 Suppl 1:131-41 [abstract]

Evidence-based screening: quali prove di efficacia in oncologia?
Conduttore: Antonino Cartabellotta.
Discussant: Nereo Segnan

FANS più gastroprotezione versus coxib. Ai posteri (?) l'ardua sentenza!

Conduttore: Antonino Cartabellotta
Discussant: Marco Fini, Matteo Longhi, Omero Triossi

• Slides

• Evidence appraised

  • Linee guida

    • The Australian COX-2-Specific Inhibitor Prescribing Group

      • Considerations for the safe prescribing and use of COX-2-specific inhibitors. April, 2002

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

      • Full guidance on Cox II selective inhibitors

  • Revisioni sistematiche

    • Cochrane

      • Garner S, Fidan D, Frankish R, et al. Rofecoxib for rheumatoid arthritis. In: The Cochrane Library, Issue 2, 2003. Oxford: Update Software.

      • Garner S, Fidan D, Frankish R, et al. Celecoxib for rheumatoid arthritis. In: The Cochrane Library, Issue 2, 2003. Oxford: Update Software

      • Rostom A, Dube C, Wells G, et al.  Prevention of NSAID-induced gastroduodenal ulcers. In: The Cochrane Library, Issue 2 2003. Oxford: Update Software

    • Non-Cochrane

      • Gomez Cerezo J, Lubomirov Hristov R, Carcas Sansuan AJ, Vazquez Rodriguez JJ. Outcome trials of COX-2 selective inhibitors: global safety evaluation does not promise benefits. Eur J Clin Pharmacol 2003 [abstract]

      • Deeks JJ, Smith LA, Bradley MD.  Efficacy, tolerability, and upper gastrointestinal safety of celecoxib for treatment of osteoarthritis and rheumatoid arthritis: systematic review of randomised controlled trials. BMJ 2002;325:619

        • Editoriale

        • Lettere all'Editore  

      • Henry D, et al. Variability in risk of gastrointestinal complications with individual non-steroidal anti-inflammatory drugs: results of a collaborative meta-analysis. BMJ 1996;312:1563-6

  • Revisioni non sistematiche

    • Bollettino d'Informazione sui Farmaci

      • Farmaci antinfiammatori non steroidei e tossicità gastroinstestinale. Bollettino di’Informazione sui Farmaci Gennaio-Aprile 2002, pag 21-22

      • 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

    • Bandolier

      • COXIBs and NSAIDs (aprile 2003)

        • COXIBs in the real world

        • COXIBs and GI ulcers: real world risk reduction

        • Risk stratification with NSAID and COXIB

        • Underuse of GPAs with NSAIDs

        • COXIB, NSAID, paracetamol and gastric protection

      • NSAIDs and adverse effects (monography)

      • Low dose aspirin - harm and benefits. Bandolier, April 2001

      • More on NSAID adverse effects. Bandolier, September 2000

      • Better prescribing of NSAIDs. Bandolier, August 2000

      • Cox-2 round up. Bandolier, March 2000

      • More on NSAIDs. Bandolier, July 1998

      • NSAID Focus. Bandolier, June 1998

      • NSAID-induced GI Injury. Bandolier, May 1997

      • GI complications and NSAIDs (2). Bandolier, May 1996

      • GI complications and NSAIDs (1). Bandolier, March 1996

  • Altre review

    • DeBisschop M. What are the risks of long-term NSAIDs and COX-2 inhibitors? J Fam Pract 2003;52:199-200

    • Juni P, Rutjes AW, Dieppe PA. Are selective COX 2 inhibitors superior to traditional non steroidal anti-inflammatory drugs? BMJ 2002;324:1287-8

    • Skelly MM, Hawkey CJ. Potential alternatives to COX 2 inhibitors. BMJ 2002;324:1289-90

    • Wright JM. The double-edged sword of COX-2 selective NSAIDs. CMAJ 2002;167:1131-1137

    • Bombardier C.An evidence-based evaluation of the gastrointestinal safety of coxibs. Am J Cardiol. 2002;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]

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

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

    • Cox-2 round up. Bandolier, March 2000

    • 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.

  • Ricerca primaria (RCTs ed altri studi)

    • Chan FK, Hung LC, Suen BY, et al. Celecoxib versus diclofenac and omeprazole in reducing the risk of recurrent ulcer bleeding in patients with arthritis. N Engl J Med 2002;347:2104-10

      • Editoriale

    • Graham DY, Agrawal NM, Campbell DR, et al. Prevention in Long-term Users of Nonsteroidal Anti-inflammatory Drugs: Results of a Double-blind, Randomized, Multicenter, Active-and Placebo-Controlled Study of Misoprostol vs Lansoprazole. Arch Intern Med 2002;162:169-175.

    • Mamdani M, Rochon PA, Juurlink DN, et al. Observational study of upper gastrointestinal haemorrhage in elderly patients given selective cyclo-oxygenase-2 inhibitors or conventional non-steroidal anti-inflammatory drugs. BMJ 2002;325:624

  • Hot topics

    • Competizione tra gastroprotezione e cardioprotezione

      • Mamdani M, Rochon P, Juurlink DN, et al. Effect of selective cyclooxygenase 2 inhibitors and naproxen on short-term risk of acute myocardial infarction in the elderly. Arch Intern Med 2003;163:481-6.

      • Dalen JE. Selective COX-2 Inhibitors, NSAIDs, aspirin, and myocardial infarction. Arch Intern Med 2002;162:1091-2

      • 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

"Dottore voglio dimagrire!". La difficile gestione del paziente obeso in medicina generale
Conduttore: Antonino Cartabellotta.
Discussant: Arturo Brenna, Daniele Luraschi, Alfredo Vanotti, Michele Zini

• Slides

• Evidence appraised

• Linee Guida

  • American Gastroenterological Association 

    • Medical position statement on obesity. Gastroenterology 2002;123:879-81

    • Technical review on obesity. Gastroenterology 2002;123:882-932

  • National Heart, Lung, and Blood Institute, North American Association for the Study of Obesity.  The practical guide: identification, evaluation, and treatment of overweight and obesity in adults. Bethesda, Md, 2000

  • American Association of Clinical Endocrinologists/American College of Endocrinology. AACE/ACE position statement on the prevention, diagnosis and treatment of obesity. 1997 (revised 1998)

  • Prodigy (UK). Obesity

  • American Society for Bariatric Surgery. Society of American Gastrointestinal Endoscopic Surgeons. Guidelines for laparoscopic and open surgical treatment of morbid obesity. Obes Surg 2000;10:378-9

• Technology assessment reports

• UK Health Technology Assessment Programme

  • The clinical effectiveness and cost-effectiveness of surgery for people with morbid obesity: a systematic review and economic evaluation. Health Technology Assessment 2002; Vol. 6: No. 12

  • The clinical effectiveness and cost-effectiveness of sibutramine in the management of obesity: a technology assessment. Health Technology Assessment 2002; Vol. 6: No. 6

  • A rapid and systematic review of the clinical effectiveness and cost-effectiveness of orlistat in the management of obesity. Health Technol Assess 2001 Vol 5 No 18

• National Institute for Clinical Excellence. Obesity (morbid) – surgery

• SBU. Obesity – Problems and Interventions

• ASERNIP - Australian Safety and Efficacy Register of New Interventional Procedures. Surgical Laparoscopic adjustable gastric banding. June 2000

• Alberta Heritage Foundation for Medical Research. Laparoscopic adjustable gastric banding for clinically severe (morbid) obesity. December 2000

• Wessex Institute for Health Research & Development, University of Southampton. Allgood P. Surgical interventions for morbid obesity. December 2001

• Revisioni sistematiche

• Cochrane

  • Advice on low-fat diets for obesity

  • Improving health professionals' management and the organisation of care for overweight and obese people

• Non-Cochrane

  • Haddock CK, Poston WS, Dill PL, et al. Pharmacotherapy for obesity: a quantitative analysis of four decades of published randomized clinical trials. Int J Obes Relat Metab Disord 2002;26:262-73 [abstract]

  • Gentileschi P, Kini S, Catarci M, Gagner M. Evidence-based medicine: open and laparoscopic bariatric surgery. Surg Endosc 2002;16:736-44 [abstract]

  • Anderson JW, Konz EC, Frederich RC, et ak. Long-term weight-loss maintenance: a meta-analysis of US studies. Am J Clin Nutr 2001;74:579-84 [abstract].

• Revisioni narrative

  • Cottam DR, Mattar SG, Schauer PR. Laparoscopic Era of Operations for Morbid Obesity  Arch Surg. 2003;138:367-375 

  • Shepherd TM. Effective management of obesity. J Fam Pract 2003;52:34-42

  • Polly Hitchcock NoÎl,  Pugh JA. Management of overweight and obese adults. BMJ 2002;325:757–61

  • Yanovski SZ, Yanovski J. A. Drug Therapy: Obesity. N Engl J Med 2002;346:591-602

  • Glazer G. Long-term pharmacotherapy of obesity 2000: a review of efficacy and safety. Arch Intern Med 2001;161:1814-24

"Dottore mi prescriva il doppler!". Potenzialità e limiti di un'indagine che non si nega a nessuno
Conduttore: Antonino Cartabellotta.
Discussant: Caronno Roberto, De Carolis Piero

• Slides

• Evidence appraised

• Linee guida
  • CeVEAS. Ecodoppler vascolare, 2003
  • Piano Nazionale Linee Guida. Sinossi di linee guida nazionali ed internazionali