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Adjunctive Mechanical Thrombectomy Devices Versus PCI Alone in Patients With STEMI: All Outcomes and Adverse Events

Definition of an Analytic Framework. What is an analytic framework? A. A way to identify and measure bias. B. A visual way of linking and defining clinical concepts, evidence, and populations as they relate to outcomes. C. A way to check for logical flaws in the systematic review. D. Both B and C. E. None of the above.

Definition of an Analytic Framework

This slide presents a table describing how the comparator or outcomes assessed can affect applicability of the study.  The table consists of two columns of six rows.  Column one is titled ,“Conditions that limit applicability” and column two is titled, “Features that should be extracted into evidence tables.” The data rows are organized under subheader rows. The first row below the column header is a subheader row is designated Comparator.  This is followed by two data rows. Each data row contains conditions described in column one and associated features to be extracted in column two. In the first row, conditions that limit applicability: regimen not reflective of current practice.  In the second column, features that should be extracted into evidence tables: medication dose, schedule and duration, followed in parentheses by the words if applicable. In the second row, conditions that limit applicability: use of substandard alternative therapy. In the second column, features that should be extracted into evidence tables: comparator chosen vs. others available, followed in parentheses by the words if applicable. The next row is the subheader row entitled, “Outcomes.” This is followed by one data row. In the column, conditions that limit applicability: surrogate endpoints, brief follow-up periods, improper definitions for outcomes, composite endpoints . In the second column, features that should be extracted into evidence tables: outcomes (benefits and harms) and  how they were defined.

Comparator, Outcomes, and Applicability

Key Messages (I): Definition of Quality Assessment. Quality assessment: Is synonymous with internal validity. Refers to individual studies. Contributes to, but is separate from, the evaluation of the risk of systematic bias for the body of evidence.

Key Messages (I): Definition of Quality Assessment

Two-Dimensional Radiation Therapy and Three-Dimensional Conformal Radiation Therapy

This slide summarizes the most pertinent results from the Comparative Effectiveness Review (CER) on the benefits and harms of adding an angiotensin-converting enzyme inhibitor (ACEI) or an angiotensin II receptor blocker (ARB) to standard medical therapy for stable ischemic heart disease with preserved left ventricular systolic function as compared to standard medical therapy alone or with a placebo. The next several slides will discuss these data in greater detail. When considered together, the benefits and harms of adding an ACEI or an ARB to standard medical therapy indicate that there may be a clinical benefit from such therapy for some patients with stable ischemic heart disease and preserved left ventricular systolic function (LVSF). However, the potential risks of cough, syncope, or hyperkalemia should be considered for each individual patient before adding an ACEI or an ARB to his or her treatment regimen. Very few of the trials evaluated for the CER compared the addition of an ACEI or an ARB or both to an active control. Only two trials compared the addition of an ACEI or a calcium channel blocker to standard medical therapy (Nissen et al., 2004; Yiu et al., 2004). In both trials, the clinical benefits were similar between the two treatment arms, and there was some limited evidence that ACEIs may increase the risk for hypotension and cough. Additional trials are required to make any definitive clinical recommendations with regard to the addition of calcium channel blockers over ACEIs to standard medical therapy. Cardiovascular events are the leading cause of death in patients treated with hemodialysis for chronic kidney disease. Among these patients, left ventricular hypertrophy is considered to be an ischemic heart disease equivalent, as defined by the National Kidney Foundation. In a clinical trial conducted by Zannad et al. (2006), however, there was no impact on cardiovascular mortality after fosinopril, an ACEI, was added to standard therapy for patients with end-stage renal disease and left ventricular hypertrophy.
Additional Issues
Three small comparative studies assessed augmentation, such as grafts or patches, in the repair of a rotator cuff tear. However, evidence was too limited to permit conclusions. Although older age, increasing tear size, and extent of preoperative symptoms were associated with recurrent tears in several studies, evidence regarding the relationship of patient or disease characteristics to prognosis was too limited to permit definitive conclusions.
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