Anticoagulation for the initial treatment of venous thromboembolism in patients with cancer: a systematic review.

Background: The authors compared the relative efficacy and safety of low-molecular-weight heparin (LMWH) and unfractionated heparin (UFH) for the initial treatment of venous thromboembolism (VTE) between patients with and without cancer.

Methods: By using Cochrane methodology for systematic reviews, separate meta-analyses were conducted for subgroups of patients with and without cancer, and relative risks (RRs) were compared for statistical significance. The methodologic quality for each outcome was assessed by using the Grading of Recommendations Assessment, Development, and Evaluation approach.

Low-molecular-weight heparins are superior to vitamin K antagonists for the long term treatment of venous thromboembolism in patients with cancer: a cochrane systematic review.

Background: Cancer and its therapies increase the risk of venous thromboembolism. Compared to patients without cancer, patients with cancer anticoagulated for venous thromboembolism are more likely to develop recurrent thrombotic events and major bleeding. Addressing all important outcomes including harm is of great importance to make evidence based health care decisions.

Specific HRQL instruments and symptom scores were more responsive than preference-based generic instruments in patients with GERD.

Objective: To determine relative responsiveness of disease-specific and generic preference-based health-related quality of life instruments in gastroesophageal reflux disease (GERD).

Study Design And Setting: We compared standardized response means (SRM) of disease-specific and preference-based instruments in 217 outpatients with GERD.

Results: Quality of Life in Reflux and Dyspepsia and symptom scores were responsive across all domains, whereas global rating of change and Work Productivity and Activity Impairment-GERD only in single domains.

Parenteral anticoagulation may prolong the survival of patients with limited small cell lung cancer: a Cochrane systematic review.

Background: To determine the efficacy and safety of heparin (unfractionated heparin (UFH) or low-molecular-weight-heparin (LMWH)) and fondaparinux in improving the survival of patients with cancer.

Methods: We conducted in January 2007 a comprehensive search for relevant randomized clinical trials (RCTs). We used a standardized form to extract in duplicate data on methodological quality, participants, interventions and outcomes of interest including all cause mortality, thromboembolic events, and bleeding events.

Anticoagulation in patients with cancer: an overview of reviews.

Introduction: Relative benefits and harms of anticoagulants are required for judgments regarding appropriate anticoagulation in patients with cancer.

Objectives: To review the benefits and harms of anticoagulants for prophylactic, therapeutic, and survival improvement indications in patients with cancer.

Patients And Methods: Overview of 6 systematic reviews of anticoagulation in cancer following the Cochrane Collaboration and Grading of Recommendations Assessment, Development and Evaluation methodology.

Low-molecular-weight heparin vs unfractionated heparin for perioperative thromboprophylaxis in patients with cancer: a systematic review and meta-analysis.

Background: The relative benefits and harms of low-molecular-weight heparin (LMWH) and unfractionated heparin (UFH) are required for judgments regarding the appropriate perioperative thromboprophylaxis in patients with cancer. We systematically reviewed the literature to quantify these effects.

Methods: The comprehensive searches included (1) an electronic search of MEDLINE, EMBASE, ISI the Web of Science, and CENTRAL (The Cochrane Central Register of Controlled Trials); (2) a hand search of relevant conference proceedings; (3) a reference check of included trials; and (4) use of the PubMed "Related Articles" feature.

Post-graduation migration intentions of students of Lebanese medical schools: a survey study.

Background: The international migration of physicians is a global public health problem. Lebanon is a source country with the highest emigration factor in the Middle East and North Africa and the 7th highest in the World. Given that residency training abroad is a critical step in the migration of physicians, the objective of this study was to survey students of Lebanese medical schools about their intentions to train abroad and their post training plans.

Blinding of outcomes in trials of orthopaedic trauma: an opportunity to enhance the validity of clinical trials.

Background: Blinding personnel in randomized controlled trials is an important strategy to minimize bias and increase the validity of the results. Trials of surgical interventions present blinding challenges not seen in drug trials. How often orthopaedic trauma investigators undertake blinding, and the frequency with which they could potentially utilize blinding, remains uncertain.

Thromboprophylaxis for patients with cancer and central venous catheters: a systematic review and a meta-analysis.

Background: Central venous catheter (CVC) placement increases the risk of thrombosis and subsequent death in patients with cancer. The objective of this systematic review was to determine the efficacy and safety of anticoagulation in reducing mortality and thromboembolic events in cancer patients with a CVC.

Methods: The authors searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, and ISI the Web of Science databases.

The use of expertise-based randomized controlled trials to assess spinal manipulation and acupuncture for low back pain: a systematic review.

Study Design: Systematic review.

Objective: To assess current use of expertise-based randomization in trials of acupuncture or spinal manipulation for low back pain.

Summary Of Background Data: The randomized clinical trial is often referred to as the gold standard for providing evidence to guide therapeutic decisions.

Symbols were superior to numbers for presenting strength of recommendations to health care consumers: a randomized trial.

Objective: To compare health care consumers' understanding, evaluations, and preferences for symbols vs. numbers and letters for the representation of strength of recommendations (SOR) and quality of evidence (QOE).

Study Design And Setting: Questionnaire study in a randomized controlled design in the setting of a community health education program.

NorthStar, a support tool for the design and evaluation of quality improvement interventions in healthcare.

Background: The Research-Based Education and Quality Improvement (ReBEQI) European partnership aims to establish a framework and provide practical tools for the selection, implementation, and evaluation of quality improvement (QI) interventions. We describe the development and preliminary evaluation of the software tool NorthStar, a major product of the ReBEQI project.

Methods: We focused the content of NorthStar on the design and evaluation of QI interventions.

A decision aid for COPD patients considering inhaled steroid therapy: development and before and after pilot testing.

Background: Decision aids (DA) are tools designed to help patients make specific and deliberative choices among disease management options. DAs can improve the quality of decision-making and reduce decisional conflict. An area not covered by a DA is the decision of a patient with chronic obstructive pulmonary disease (COPD) to use inhaled steroids which requires balancing the benefits and downsides of therapy.

Graduates of Lebanese medical schools in the United States: an observational study of international migration of physicians.

Background: As healthcare systems around the world are facing increasing physician shortages, more physicians are migrating from low to high income countries. As an illustrative case of international migration of physicians, we evaluated the current number and historical trends of Lebanese medical graduates (LMG) in the US, and compared their characteristics to those of US medical graduates (USMG) and other international medical graduates (IMG).

Methods: We evaluated the number of LMG using the 2004 the American Medical Association Physicians' Professional Data (AMA-PPD) and then compared it to the number of graduates of other countries.

Problems with use of composite end points in cardiovascular trials: systematic review of randomised controlled trials.

Objective: To explore the extent to which components of composite end points in randomised controlled trials vary in importance to patients, the frequency of events in the more and less important components, and the extent of variability in the relative risk reductions across components.

Design: Systematic review of randomised controlled trials.

Data Sources: Cardiovascular randomised controlled trials published in the Lancet, Annals of Internal Medicine, Circulation, European Heart Journal, JAMA, and New England Journal of Medicine, from 1 January 2002 to 30 June 2003.

The United States physician workforce and international medical graduates: trends and characteristics.

Background: International medical graduates (IMGs) have been a valuable resource for the United States physician workforce, and their contribution to the United States workforce is likely to increase.

Objective: To describe the historical trends and compare the characteristics of IMGs to United States medical graduates (USMGs) in the United States.

Design: Longitudinal analysis of the American Medical Association Physicians' Professional Data (AMA-PPD) database using the 1978-2004 files and a comparative analysis of the characteristics of a random sample of 1,000 IMGs and a random sample of 1,000 USMGs using the 2004 file.

Why are you draining your brain? Factors underlying decisions of graduating Lebanese medical students to migrate.

In the context of a worldwide physician brain drain phenomenon, Lebanon has the highest emigration factor in the Middle East and North Africa. In this manuscript we aim to identify and develop a conceptual framework for the factors underlying the decisions of graduating Lebanese medical students to train abroad. We conducted two focus groups and seven semi-structured individual interviews with 23 students.

Interpreting the results of patient reported outcome measures in clinical trials: the clinician's perspective.

This article deals with the problem of interpreting health-related quality of life (HRQL) outcomes in clinical trials. First, we will briefly describe how dichotomization and item response theory can facilitate interpretation. Based on examples from the medical literature for the interpretation of HRQL scores we will show that dichotomies may help clinicians understand information provided by HRQL instruments in RCTs.

EBM user and practitioner models for graduate medical education: what do residents prefer?

The objective of the study reported in this article was to assess and explain medical residents' preferences for the evidence based medicine (EBM) practitioner versus the EBM user models. A self-administered survey and focus group of residents attending a core curriculum EBM master session were undertaken. Most residents, particularly those earlier in their training, preferred the practitioner model.

Brief report: Internal medicine residents', attendings', and nurses' perceptions of the night float system.

Background: Residency training programs use the night float system increasingly to meet the new resident work hour regulations.

Objective: To assess and compare residents', attendings', and nurses' perceptions of the night float system.

Design: A survey study.

Can contraindications compromise evidence-based, patient-centered clinical practice?

Background: Despite their often weak evidence base, contraindications convey the unequivocally adverse risk-benefit profile of an intervention in a specific clinical context. However, some patients in that context may nonetheless prefer the contraindicated intervention (with its potential benefits and risks) to the available alternatives. The impact of contraindications on treatment decisions remains unexplored.

Electronic mail was not better than postal mail for surveying residents and faculty.

Objective: To compare response rate, time to response, and data quality of electronic and postal surveys in the setting of postgraduate medical education.

Study Design And Setting: A randomized controlled trial in a university-based internal medicine residency program. We randomized 119 residents and 83 faculty to an electronic versus a postal survey with up to two reminders and measured response rate, time to response, and data quality.

Validity of composite end points in clinical trials.

Use of composite end points as the main outcome in randomised trials can hide wide differences in the individual measures. How should you apply the results to clinical practice?

A survey of internal medicine residents and faculty about the duration of attendings' inpatient rotations.

Objective: Some training programs are shortening the duration of attendings' rotations from 4 weeks to 2 weeks. Our objective was to determine the effect of 2-week inpatient rotation on self-reported impact on medical education, patient care practices, and faculty performance by internal medicine residents and teaching faculty.

Design: Cross-sectional study using an anonymous mailed and emailed survey.