Bear work-sheet

BEAR Work-Sheet (Title): Urine collection technique for Chlamydia infection

Name of Resident:
Date: Sept. 28, 2011

Question: _Are midstream urine and 1st void urine samples comparable in their accuracy
for diagnosis of Chlamydia infections? _________________________________
Search: (Check all that apply)
Pubmed/Ovid/Medline:  Filtered Resources: 
Other:  ( Describe: _primary research paper_ )
Number of Resources Reviewed: _3__
Resources (Top 3)
#1 Resource: Abstract  Paper 
Review/Meta-Analysis  College/Society/Guideline Paper  Other Research  (found through Dynamed and Pubmed samples…at home, BMJ 1996. Nov 9, 313 (7066) 1986) - Abbreviated Citation: _Diagnosis of…Chlamydia in women…_________ - Strengths:_Used nucleic acid amplification, 8 tests/patient, RCT________ - Weaknesses:_narrow age range, one study, small sample______________ Take-Home Message:_midstream were better than 1st void urine for detecting Chlamydia
#2 Resource: Abstract  Paper 
Review/Meta-Analysis  College/Society/Guideline Paper  Other Research  - Abbreviated Citation: CMA: -Laboratory Diagnosis of sexually Strengths:_description of proper collection of samples with references___ - Weaknesses: _no analysis of evidence, no comparison of techniques____ Take-Home Message: _Use 1st void urine, not necessarily at certain time post-
menstruation_____________________________________________________________
#3 Resource: Abstract  Paper 
Review/Meta-Analysis  College/Society/Guideline Paper  Other Research  Abbreviated Citation: _The laboratory diagnosis of Chlamydia… Can.J.Infec.Med Microbiol. 2005 Jan-Feb 16(1)_____________________ - Strengths:_good review article for general diagnosis__________________ - Weaknesses:_expert opinion, not analytical, not comment on specific evidence____________________________________________________ Take-Home Message: _Use 1st void specimens tested using nucleic acid amplification__
Bottom-line: _Limited evidence to show differences in accuracy of detecting Chlamydia
infection between midstream and 1st void urine. Guidelines seem to be adamant about
using 1st void, presumably based on theory or previous studies (not found) based on older
diagnostic tests._
Practice (These findings had a):
Large Change 
 I do not want my BEAR (name removed) on the Dept EBM Website
BEAR Work-Sheet (Title): _Medication for BPPV_________________

Name of Resident:
Date: Sept. 21, 2011

Question: _Does medication work for BPPV?__________________________________
_______________________________________________________________________
Search: (Check all that apply)
Pubmed/Ovid/Medline:  Filtered Resources: 
Other:  ( Describe: ___________________ )
Number of Resources Reviewed: _3__
Resources (Top 3)
#1 Resource: Abstract  Paper 
Review/Meta-Analysis  College/Society/Guideline Paper  Other Research  - Abbreviated Citation: _searched Dynamed for BPPV________________ - Strengths:_indexed summary with direct links to supporting evidence ___ - Weaknesses:_takes a minute to log in_____________________________ Take-Home Message:_no evidence of benefit, potential adverse effects. Medication not
recommended for BPPV____________________________________________________
#2 Resource: Abstract  Paper 
Review/Meta-Analysis  College/Society/Guideline Paper  Other Research  - Abbreviated Citation: Am Academy of Neurology Guidelines (thru TRIP) - Strengths:_indexed guidelines and provides level of evidence_________ - Weaknesses: _no link to supporting primary research________________ Take-Home Message: _Same as Dynamed essentially.___________________________
#3 Resource: Abstract  Paper 
Review/Meta-Analysis  College/Society/Guideline Paper  Other Research  Abbreviated Citation: _www.fpnotebook.com BPPV article____________ Strengths:_very brief, easy to access and read quickly_________________ - Weaknesses: _minimal references to outdated sources, doesn’t appear to be very thorough or rigorous site_________________________________ Take-Home Message: _Lists potential therapies, but no mention of efficacy or evidence._
Bottom-line: _There doesn’t appear to be any conclusive evidence of benefit for anti-
vertigo medication (meclizine, scopolamine, betahistine, etc.) in the treatment of BPPV.
There is good evidence for Epley’s maneuver done by clinicians and even for patients to
do at home.__________________________________________________________
Practice (These findings had a):
Large Change 
 I do not want my BEAR (name removed) on the Dept EBM Website
BEAR Work-Sheet (Title): _Cymbalta (SNRI) and chronic pain______

Name of Resident:
Date: October 19, 2011

Question: _Is Cymbala (duloxetine) effective for chronic low back pain?_____________
_______________________________________________________________________
Search: (Check all that apply)
Pubmed/Ovid/Medline:  Filtered Resources: 
Other:  ( Describe: ___________________ )
Number of Resources Reviewed: _5_
TRIP, EBM, UpToDate, ACP Pier, Cochran Library
Resources (Top 3)
#1 Resource: Abstract  Paper Filtered Article  Summary UpToDate
Review/Meta-Analysis  College/Society/Guideline Paper  Other Research 
- Abbreviated Citation: _Chronic pain management___________________ - Strengths:_randomized trial____________________________________ - Weaknesses:_sponsored by the drug manufacturer, the difference that was found was small (<1 point on the Brief Pain Inventory and <2 points on the Roland Morris Disability Questionnaire)________________________ _Pts were more likely to discontinue use of duloxetine compared to placebo due to adverse effects ___________________________________ Take-Home Message:_Insufficient evidence to suggest this is a viable option in CLBP__
#2 Resource: Abstract  Paper 
Review/Meta-Analysis  College/Society/Guideline Paper  Other Research  - Abbreviated Citation: _a dbl blind, randomized trial of duloxetine vs. placebo in the management of chronic low back pain_ - 13 wk, dbl blind study looking at 20, 60, and 120 mg of duloxetine vs. placebo. Their primary measure was 60 mg of duloxetine vs. placebo on weekly mean 24 hr average pain. Secondary measures included BPI and RMDQ, PGI-I (pt’s global impressions of improvement), safety and tolerability. Entrance eligibility included pts with >6 months of pain in LB or LB with proximal radiation and pain rating >4._______________ - 404 enrolled, 267 completed___________________________________ - Strengths:_dbl-blind, vs. placebo________________________________ - Weaknesses: _study design, funding and drugs supplied by the company, Eli Lilly, and authors may be minor shareholders____________________ Take-Home Message: _no difference in dosage for 24 hr avg weekly pain scale, more stopped the 120 mg dose d/t s/e. A significant difference was noted from wks 3-11 in relieving pain, but not at 12-13 wks. Duloxetine would not be in the first few lines of treatment options.________________________________________________________  I do not want my BEAR (name removed) on the Dept EBM Website

#3 Resource: Abstract  Paper 
Review/Meta-Analysis  College/Society/Guideline Paper  Other Research  Abbreviated Citation: _Escitalopram vs. duloxetine in CLBP, RCT, not blinded____________________________________________________ Escitalopram has never been shown to be useful in the tx of CLBP. The aim of this study was to see any efficacy in its use in CLBP___________ - Strengths:_did a 13 wk study comparing 20 mg escitalopram to 60 mg duloxetine. The primary outcome measure was 24 hr avg weekly pain. Secondary measures included Clinical Global Impressions of severity and Short Form Health Survey. 80 pts participated. No significant difference was found to exist b/w these 2 drugs. Avg pain improvement was by 2.35 points on a pain scale. Both drugs improved the global impressions and short form health survey. Clinically depressed pts were excluded from the trial, and despite, a path analysis was done to see if mood improvement contributed to the overall outcome and found the majority of the effect was due to the analgesic effect.________________________________ - Weaknesses:_not blinded, no placebo, despite improvement, small margin of improvement_____________________________________________ Take-Home Message: _Uncertain whether these medications have shown improvement
based on their efficacy or on confounding variables since not blinded. Other
antidepressant use was d/c’d prior to trial, and no placebo comparison.______________
Bottom-line: _The evidence provided shows and improvement in pain index, but the
change is small and not likely to warrant being used within any of the top treatment
options for chronic low back pain.___________________________________________
Practice (These findings had a):
Large Change 
 I do not want my BEAR (name removed) on the Dept EBM Website

Source: http://www.familymed.med.ualberta.ca/Library/Documents/RecentBEARsamples2011.pdf