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Biomedical subjects

James J Stevermer

Publications and source records attributed to James J Stevermer.

16 recordsLinked to original sources
PubMed2003

Early invasive strategy for acute cardiac ischemia is cost effective.

In patients with unstable angina and non-ST segment myocardial infarction treated with aspirin, heparin, and tirofiban, an early invasive strategy with routine angiography and appropriate revascularization has better clinical outcomes, at a relatively minimal increase in cost.

Comment↗
PubMed2003

Does C-reactive protein predict cardiovascular events in women better than LDL?

C-reactive protein (CRP) is an independent predictor of a first cardiovascular event in women and appears to be a stronger predictor than low-density lipoprotein (LDL) cholesterol levels. Unfortunately, this information does not lead directly to a therapeutic intervention. As an accompanying editorial stated, low carotenoid levels also predict cardiovascular events, but supplementation with beta carotene does not reduce an individual's risk. This study does not clarify whether CRP is a causative agent, a marker, or a result of cardiovascular disease. Our focus should remain on identifying and treating conventional risk factors until we better understand the exact role CRP has in therapeutic decisions regarding cardiovascular disease.

C-Reactive Protein↗
PubMed2003

Low-dose doxycycline moderately effective for acne.

The authors propose that moderate acne may be treated with doxycycline in subantimicrobial doses (20-mg tablets taken twice daily). This regimen was well-tolerated, moderately effective in reducing skin lesions, and did not have a detectable effect on the antibiotic resistance of skin flora. The cost of Periostat (the only form of doxycycline 20 mg available in the US) is about 55 US dollars per month, while generic doxycycline 100 mg is about 10 US dollars. This study has some significant flaws, but a trial of low-dose doxycycline in an adult with acne severe enough to warrant antibiotics would still seem a reasonable, albeit expensive, option

Comment↗
PubMed2003

Nebulized epinephrine does not help bronchiolitis.

Nebulized epinephrine does not improve clinical status or reduce the length of the hospital stay in infants aged <1 year with acute bronchiolitis. It also does not reduce clinical scores during or shortly after medication administration. In this study, infants requiring oxygen and intravenous fluids-presumably the sickest infants in the study-required longer hospital stays if they received epinephrine. A wheezing infant may be presenting with a first episode of asthma, so a trial of bronchodilators would seem reasonable; however, it appears that the primary intervention for bronchiolitis is supportive treatment, with supplemental oxygen, intravenous fluids, and ventilatory support when needed.

Comment↗
PubMed2002

Obstacles to answering doctors' questions about patient care with evidence: qualitative study.

OBJECTIVE: To describe the obstacles encountered when attempting to answer doctors' questions with evidence. DESIGN: Qualitative study. SETTING: General practices in Iowa. PARTICIPANTS: 9 academic generalist doctors, 14 family doctors, and 2 medical librarians. MAIN OUTCOME MEASURE: A taxonomy of obstacles encountered while searching for evidence based answers to doctors' questions. RESULTS: 59 obstacles were encountered and organised according to the five steps in asking and answering questions: recognise a gap in knowledge, formulate a question, search for relevant information, formulate an answer, and use the answer to direct patient care. Six obstacles were considered particularly salient by the investigators and practising doctors: the excessive time required to find information; difficulty modifying the original question, which was often vague and open to interpretation; difficulty selecting an optimal strategy to search for information; failure of a seemingly appropriate resource to cover the topic; uncertainty about how to know when all the relevant evidence has been found so that the search can stop; and inadequate synthesis of multiple bits of evidence into a clinically useful statement. CONCLUSIONS: Many obstacles are encountered when asking and answering questions about how to care for patients. Addressing these obstacles could lead to better patient care by improving clinically oriented information resources.

Clinical Competence↗
PubMed2002

Intention-to-treat analysis: who is in? Who is out?

To assess whether the term "intention to treat" (ITT) predicts inclusion of all randomized subjects in the analysis, we reviewed 100 randomly selected reports of randomized trials that mentioned analysis by ITT. Only 42 of 100 reports included all randomized subjects in the ITT analysis. We could not determine which categories of participants were excluded from the ITT analysis in 13 trials. The most common categories of excluded subjects were patients who, after randomization, received no follow-up (16/100), received no treatment (14/100), or were found not to meet study entry criteria (12/100). We could determine the number of participants in the ITT analysis for 92 studies. Nineteen of the 92 studies excluded more than 5% of randomized participants, and 10 excluded more than 10%. There is considerable variation in how researchers define and apply the principle of intention to treat.

Data Interpretation, Statistical↗