{\rtf1\ansi\ansicpg1252\uc1 \deff0\deflang1033\deflangfe1033{\fonttbl{\f0\froman\fcharset0\fprq2{\*\panose 02020603050405020304}Times New Roman;}{\f28\fswiss\fcharset0\fprq2{\*\panose 020f0502020204030204}Calibri;} {\f29\froman\fcharset238\fprq2 Times New Roman CE;}{\f30\froman\fcharset204\fprq2 Times New Roman Cyr;}{\f32\froman\fcharset161\fprq2 Times New Roman Greek;}{\f33\froman\fcharset162\fprq2 Times New Roman Tur;} {\f34\froman\fcharset177\fprq2 Times New Roman (Hebrew);}{\f35\froman\fcharset178\fprq2 Times New Roman (Arabic);}{\f36\froman\fcharset186\fprq2 Times New Roman Baltic;}{\f253\fswiss\fcharset238\fprq2 Calibri CE;} {\f254\fswiss\fcharset204\fprq2 Calibri Cyr;}{\f256\fswiss\fcharset161\fprq2 Calibri Greek;}{\f257\fswiss\fcharset162\fprq2 Calibri Tur;}{\f260\fswiss\fcharset186\fprq2 Calibri Baltic;}}{\colortbl;\red0\green0\blue0;\red0\green0\blue255; \red0\green255\blue255;\red0\green255\blue0;\red255\green0\blue255;\red255\green0\blue0;\red255\green255\blue0;\red255\green255\blue255;\red0\green0\blue128;\red0\green128\blue128;\red0\green128\blue0;\red128\green0\blue128;\red128\green0\blue0; \red128\green128\blue0;\red128\green128\blue128;\red192\green192\blue192;}{\stylesheet{\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \fs24\lang2057\langfe1033\loch\f0\hich\af0\dbch\af28\cgrid\langnp2057\langfenp1033 \snext0 Normal;}{\s1\ql \li0\ri0\sa200\sl276\slmult1\keepn\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \b\fs24\lang2057\langfe1033\loch\f0\hich\af0\dbch\af28\cgrid\langnp2057\langfenp1033 \sbasedon0 \snext0 heading 1;}{\s2\ql \li0\ri0\sa200\sl276\slmult1\keepn\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \fs32\lang2057\langfe1033\loch\f0\hich\af0\dbch\af28\cgrid\langnp2057\langfenp1033 \sbasedon0 \snext0 heading 2;}{\s3\ql \li0\ri0\sa200\sl276\slmult1\keepn\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \fs36\lang2057\langfe1033\loch\f0\hich\af0\dbch\af28\cgrid\langnp2057\langfenp1033 \sbasedon0 \snext0 heading 3;}{\*\cs10 \additive Default Paragraph Font;}{\s15\ql \li0\ri0\sa200\sl276\slmult1\widctlpar \tqc\tx4153\tqr\tx8306\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \fs24\lang2057\langfe1033\loch\f0\hich\af0\dbch\af28\cgrid\langnp2057\langfenp1033 \sbasedon0 \snext15 footer;}{\*\cs16 \additive \sbasedon10 page number;}}{\info{\title ISOLDE} {\author }{\operator Chris}{\creatim\yr2009\mo3\dy12\hr22\min27}{\revtim\yr2009\mo3\dy12\hr22\min27}{\printim\yr2009\mo3\dy6\hr12\min53}{\version2}{\edmins2}{\nofpages16}{\nofwords1291}{\nofchars7362}{\*\company }{\nofcharsws9041}{\vern8283}} \paperw11906\paperh16838\margl1440\margr1440 \widowctrl\ftnbj\aenddoc\noxlattoyen\expshrtn\noultrlspc\dntblnsbdb\nospaceforul\formshade\horzdoc\dgmargin\dghspace180\dgvspace180\dghorigin1440\dgvorigin1440\dghshow1\dgvshow1 \jexpand\viewkind1\viewscale100\pgbrdrhead\pgbrdrfoot\splytwnine\ftnlytwnine\htmautsp\nolnhtadjtbl\useltbaln\alntblind\lytcalctblwd\lyttblrtgr\lnbrkrule \fet0\sectd \linex0\headery708\footery708\colsx708\endnhere\sectlinegrid360\sectdefaultcl {\footer \pard\plain \s15\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\tqc\tx4153\tqr\tx8306\pvpara\phmrg\posxr\posy0\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \fs24\lang2057\langfe1033\loch\af0\hich\af0\dbch\af28\cgrid\langnp2057\langfenp1033 {\field{\*\fldinst {\cs16 \hich\af0\dbch\af28\loch\f0 PAGE }}{\fldrslt {\cs16\lang1024\langfe1024\noproof \hich\af0\dbch\af28\loch\f0 11}}}{\cs16 \par }\pard \s15\ql \li0\ri360\sa200\sl276\slmult1\widctlpar\tqc\tx4153\tqr\tx8306\aspalpha\aspnum\faauto\adjustright\rin360\lin0\itap0 { \par }}{\*\pnseclvl1\pnucrm\pnstart1\pnindent720\pnhang{\pntxta .}}{\*\pnseclvl2\pnucltr\pnstart1\pnindent720\pnhang{\pntxta .}}{\*\pnseclvl3\pndec\pnstart1\pnindent720\pnhang{\pntxta .}}{\*\pnseclvl4\pnlcltr\pnstart1\pnindent720\pnhang{\pntxta )}} {\*\pnseclvl5\pndec\pnstart1\pnindent720\pnhang{\pntxtb (}{\pntxta )}}{\*\pnseclvl6\pnlcltr\pnstart1\pnindent720\pnhang{\pntxtb (}{\pntxta )}}{\*\pnseclvl7\pnlcrm\pnstart1\pnindent720\pnhang{\pntxtb (}{\pntxta )}}{\*\pnseclvl8 \pnlcltr\pnstart1\pnindent720\pnhang{\pntxtb (}{\pntxta )}}{\*\pnseclvl9\pnlcrm\pnstart1\pnindent720\pnhang{\pntxtb (}{\pntxta )}}\pard\plain \s2\ql \li0\ri0\sa200\sl276\slmult1 \keepn\widctlpar\aspalpha\aspnum\faauto\outlinelevel1\adjustright\rin0\lin0\itap0 \fs32\lang2057\langfe1033\loch\af0\hich\af0\dbch\af28\cgrid\langnp2057\langfenp1033 {\hich\af0\dbch\af28\loch\f0 ISOLDE \par }\pard\plain \ql \li0\ri0\sa200\sl276\slmult1\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \fs24\lang2057\langfe1033\loch\af0\hich\af0\dbch\af28\cgrid\langnp2057\langfenp1033 {\hich\af0\dbch\af28\loch\f0 Randomised, double blind, placebo controlled study of fluticasone propionate in patients with moderate to severe COPD; the ISOLDE Trial. BMJ 2000; 320:1297-3003 \par \hich\af0\dbch\af28\loch\f0 In patients with moderate to severe chronic obstructive disease does inhaled fluticasone\hich\af0\dbch\af28\loch\f0 , at a dose of 500 mcg BD, when compared with placebo, reduce the rate of decline of post bronchodilator FEV1, the rate of decline of health status, the frequency of exacerbations and the rate of respiratory withdrawals. \par \hich\af0\dbch\af28\loch\f0 For exacerbations over 3 years \par \hich\af0\dbch\af28\loch\f0 CER \hich\af0\dbch\af28\loch\f0 is 570% \par \hich\af0\dbch\af28\loch\f0 EER is 429% \par \hich\af0\dbch\af28\loch\f0 RR is 0.75 \par \hich\af0\dbch\af28\loch\f0 RR is 25% \par \hich\af0\dbch\af28\loch\f0 ARR is 141% \par \hich\af0\dbch\af28\loch\f0 NNT is 2 \par \par \par \par \par \par \par \par \par \par \page \par }\pard\plain \s2\ql \li0\ri0\sa200\sl276\slmult1\keepn\widctlpar\aspalpha\aspnum\faauto\outlinelevel1\adjustright\rin0\lin0\itap0 \fs32\lang2057\langfe1033\loch\af0\hich\af0\dbch\af28\cgrid\langnp2057\langfenp1033 {\hich\af0\dbch\af28\loch\f0 ISOLDE \hich\f0 \endash \loch\f0 your task \par }\pard\plain \ql \li0\ri0\sa200\sl276\slmult1\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \fs24\lang2057\langfe1033\loch\af0\hich\af0\dbch\af28\cgrid\langnp2057\langfenp1033 {\hich\af0\dbch\af28\loch\f0 Write in PICO form the clinical question addressed by this study. In the clinical question include as many of the stated trial outcomes as you can (found in abstra\hich\af0\dbch\af28\loch\f0 ct page 1297). \par \hich\af0\dbch\af28\loch\f0 For the outcome }{\b \hich\af0\dbch\af28\loch\f0 exacerbations}{\hich\af0\dbch\af28\loch\f0 calculate \par \tab \hich\af0\dbch\af28\loch\f0 CER \par \tab \hich\af0\dbch\af28\loch\f0 EER \par }\pard \ql \li720\ri0\sa200\sl276\slmult1\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0 {\hich\af0\dbch\af28\loch\f0 RR \par \hich\af0\dbch\af28\loch\f0 RRR \par \hich\af0\dbch\af28\loch\f0 ARR \par \hich\af0\dbch\af28\loch\f0 NNT for the study period \par \hich\af0\dbch\af28\loch\f0 NNT for one year. \par }\pard\plain \s3\ql \li0\ri0\sa200\sl276\slmult1\keepn\widctlpar\aspalpha\aspnum\faauto\outlinelevel2\adjustright\rin0\lin0\itap0 \fs36\lang2057\langfe1033\loch\af0\hich\af0\dbch\af28\cgrid\langnp2057\langfenp1033 {\hich\af0\dbch\af28\loch\f0 Help \par }\pard\plain \ql \li0\ri0\sa200\sl276\slmult1\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \fs24\lang2057\langfe1033\loch\af0\hich\af0\dbch\af28\cgrid\langnp2057\langfenp1033 {\hich\af0\dbch\af28\loch\f0 Raw data is hard to find in this paper \par \hich\af0\dbch\af28\loch\f0 In the placebo arm 370 patients had a total of 2109 exacerbations in 3 years (annual rate was\hich\af0\dbch\af28\loch\f0 1.9 exacerbations per patient per year Table 2 page 1300. \par \hich\af0\dbch\af28\loch\f0 In the treatment arm SFC 372 patients had a total of 1596 exacerbations in 3 years (annual rate of 1.43 exacerbations per patient per year) \par \hich\af0\dbch\af28\loch\f0 Using this data it should be possible to calculate the ab\hich\af0\dbch\af28\loch\f0 ove\page \par }\pard\plain \s2\ql \li0\ri0\sa200\sl276\slmult1\keepn\widctlpar\aspalpha\aspnum\faauto\outlinelevel1\adjustright\rin0\lin0\itap0 \fs32\lang2057\langfe1033\loch\af0\hich\af0\dbch\af28\cgrid\langnp2057\langfenp1033 {\hich\af0\dbch\af28\loch\f0 Uplift Study \par }\pard\plain \ql \li0\ri0\sa200\sl276\slmult1\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \fs24\lang2057\langfe1033\loch\af0\hich\af0\dbch\af28\cgrid\langnp2057\langfenp1033 {\hich\af0\dbch\af28\loch\f0 A 4 Year Trial of Tiotropium in COPD Tashkin et al NEJM 2008;359: 1543 - 54 \par \hich\af0\dbch\af28\loch\f0 In patients with COPD, does inhaled Tiotropium, when compared to placebo, reduce the rate of decline of pre and post bronchodilator FEV1, the rate of decline of S\hich\af0\dbch\af28\loch\f0 GRQ score, the exacerbation rate, and mortality, \par \hich\af0\dbch\af28\loch\f0 For the outcome of exacerbations \par \hich\af0\dbch\af28\loch\f0 CER = 291% \par \hich\af0\dbch\af28\loch\f0 EER = 339% \par \hich\af0\dbch\af28\loch\f0 RR = 0.85 \par \hich\af0\dbch\af28\loch\f0 RRR = 14.7% \par \hich\af0\dbch\af28\loch\f0 ARR = 50% \par \hich\af0\dbch\af28\loch\f0 NNT = 2 for 4 years \par \hich\af0\dbch\af28\loch\f0 NNT for one year is 8 \par \page \par }\pard\plain \s2\ql \li0\ri0\sa200\sl276\slmult1\keepn\widctlpar\aspalpha\aspnum\faauto\outlinelevel1\adjustright\rin0\lin0\itap0 \fs32\lang2057\langfe1033\loch\af0\hich\af0\dbch\af28\cgrid\langnp2057\langfenp1033 {\hich\af0\dbch\af28\loch\f0 UPLIFT \hich\f0 \endash \loch\f0 your task \par }\pard\plain \ql \li0\ri0\sa200\sl276\slmult1\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \fs24\lang2057\langfe1033\loch\af0\hich\af0\dbch\af28\cgrid\langnp2057\langfenp1033 {\hich\af0\dbch\af28\loch\f0 Write in PICO form the clinical question addressed by t\hich\af0\dbch\af28\loch\f0 his study. In the clinical question include as many of the stated trial outcomes as you can (found in abstract page 1543). \par \hich\af0\dbch\af28\loch\f0 For the outcome }{\b \hich\af0\dbch\af28\loch\f0 exacerbations}{\hich\af0\dbch\af28\loch\f0 calculate \par \tab \hich\af0\dbch\af28\loch\f0 CER \par }\pard \ql \fi720\li0\ri0\sa200\sl276\slmult1\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\hich\af0\dbch\af28\loch\f0 EER \par }\pard \ql \li720\ri0\sa200\sl276\slmult1\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0 {\hich\af0\dbch\af28\loch\f0 RR \par \hich\af0\dbch\af28\loch\f0 RRR \par \hich\af0\dbch\af28\loch\f0 ARR \par \hich\af0\dbch\af28\loch\f0 NNT for 4 years \par \hich\af0\dbch\af28\loch\f0 NNT for one year. \par }\pard\plain \s3\ql \li0\ri0\sa200\sl276\slmult1\keepn\widctlpar\aspalpha\aspnum\faauto\outlinelevel2\adjustright\rin0\lin0\itap0 \fs36\lang2057\langfe1033\loch\af0\hich\af0\dbch\af28\cgrid\langnp2057\langfenp1033 {\hich\af0\dbch\af28\loch\f0 Help \par }\pard\plain \ql \li0\ri0\sa200\sl276\slmult1\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \fs24\lang2057\langfe1033\loch\af0\hich\af0\dbch\af28\cgrid\langnp2057\langfenp1033 {\hich\af0\dbch\af28\loch\f0 Raw data is difficult to find in t \hich\af0\dbch\af28\loch\f0 his paper \par \hich\af0\dbch\af28\loch\f0 In the tiotropium arm 2986 patients had 8719 exacerbations over 4 years (exacerbation rate of 0.73 per patient per year) \par \hich\af0\dbch\af28\loch\f0 In the placebo arm 3006 patients had 10,200 exacerbations over 4 years (exacerbation rate of 0.85 per patient per year) \par \hich\af0\dbch\af28\loch\f0 (Deri\hich\af0\dbch\af28\loch\f0 ved from Figure 1 p 1547 and table 3 p 1552)\page \par }\pard\plain \s2\ql \li0\ri0\sa200\sl276\slmult1\keepn\widctlpar\aspalpha\aspnum\faauto\outlinelevel1\adjustright\rin0\lin0\itap0 \fs32\lang2057\langfe1033\loch\af0\hich\af0\dbch\af28\cgrid\langnp2057\langfenp1033 {\hich\af0\dbch\af28\loch\f0 The Torch Study \par }\pard\plain \ql \li0\ri0\sa200\sl276\slmult1\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \fs24\lang2057\langfe1033\loch\af0\hich\af0\dbch\af28\cgrid\langnp2057\langfenp1033 {\hich\af0\dbch\af28\loch\f0 Salmeterol and Fluticasone Propionate and Survival in COPD. NEJM 2007;356:775-89 \par \hich\af0\dbch\af28\loch\f0 In patients with COPD (FEV1 < 60%) does use of SFC in a single inhaler when compared with placebo, or salmeterol \hich\af0\dbch\af28\loch\f0 alone, or fluticasone alone, reduce all cause mortality, the frequency of exacerbations, the rate of decline in health status, or the rate of decline of spirometry values. \par \hich\af0\dbch\af28\loch\f0 For moderate or severe exacerbations comparing Combination Therapy and placebo \par \hich\af0\dbch\af28\loch\f0 CER\tab 3\hich\af0\dbch\af28\loch\f0 39% \par \hich\af0\dbch\af28\loch\f0 EER\tab 255% \par \hich\af0\dbch\af28\loch\f0 RR \tab 0.75 \par \hich\af0\dbch\af28\loch\f0 RRR \tab 25% \par \hich\af0\dbch\af28\loch\f0 ARR\tab 84% \par \hich\af0\dbch\af28\loch\f0 NNT\tab 1.2 \par \hich\af0\dbch\af28\loch\f0 NNT for one year is 3.6 \par \par \par \par \page \par }\pard\plain \s2\ql \li0\ri0\sa200\sl276\slmult1\keepn\widctlpar\aspalpha\aspnum\faauto\outlinelevel1\adjustright\rin0\lin0\itap0 \fs32\lang2057\langfe1033\loch\af0\hich\af0\dbch\af28\cgrid\langnp2057\langfenp1033 {\hich\af0\dbch\af28\loch\f0 TORCH \hich\f0 \endash \loch\f0 your task \par }\pard\plain \ql \li0\ri0\sa200\sl276\slmult1\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \fs24\lang2057\langfe1033\loch\af0\hich\af0\dbch\af28\cgrid\langnp2057\langfenp1033 {\hich\af0\dbch\af28\loch\f0 Write in PICO form the clinical question addressed by this study. In the clinical question include as many of the stated trial outcomes as you can (found in abstr\hich\af0\dbch\af28\loch\f0 act page 775). \par \hich\af0\dbch\af28\loch\f0 For the outcome }{\b \hich\af0\dbch\af28\loch\f0 exacerbations}{\hich\af0\dbch\af28\loch\f0 calculate when comparing SFC with placebo \par \tab \hich\af0\dbch\af28\loch\f0 CER \par \tab \hich\af0\dbch\af28\loch\f0 EER \par }\pard \ql \li720\ri0\sa200\sl276\slmult1\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0 {\hich\af0\dbch\af28\loch\f0 RR \par \hich\af0\dbch\af28\loch\f0 RRR \par \hich\af0\dbch\af28\loch\f0 ARR \par \hich\af0\dbch\af28\loch\f0 NNT for study duration \par \hich\af0\dbch\af28\loch\f0 NNT for one year. \par }\pard\plain \s3\ql \li0\ri0\sa200\sl276\slmult1\keepn\widctlpar\aspalpha\aspnum\faauto\outlinelevel2\adjustright\rin0\lin0\itap0 \fs36\lang2057\langfe1033\loch\af0\hich\af0\dbch\af28\cgrid\langnp2057\langfenp1033 {\hich\af0\dbch\af28\loch\f0 Help \par }\pard\plain \ql \li0\ri0\sa200\sl276\slmult1\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \fs24\lang2057\langfe1033\loch\af0\hich\af0\dbch\af28\cgrid\langnp2057\langfenp1033 {\hich\af0\dbch\af28\loch\f0 Raw data is not easy to come by in this paper \par \hich\af0\dbch\af28\loch\f0 1524 patients allocated to placebo had 5166 exacerbatio\hich\af0\dbch\af28\loch\f0 ns in the 3 year study period annual exacerbation rate was 1.13 exacerbations per patient per year \par \hich\af0\dbch\af28\loch\f0 1534 patients allocated to combined SFC had 3909 exacerbations in the 3 year study period annual exacerbation rate was 0.85 exacerbations per patient per yea\hich\af0\dbch\af28\loch\f0 r \par \hich\af0\dbch\af28\loch\f0 This information is on p 782 and 783 table 2. \par \hich\af0\dbch\af28\loch\f0 Using this data it is possible to calculate the above. \par }\pard\plain \s15\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \fs24\lang2057\langfe1033\loch\af0\hich\af0\dbch\af28\cgrid\langnp2057\langfenp1033 {\page }{\fs32 \par }\pard\plain \ql \li0\ri0\sa200\sl276\slmult1\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \fs24\lang2057\langfe1033\loch\af0\hich\af0\dbch\af28\cgrid\langnp2057\langfenp1033 {\fs32 \hich\af0\dbch\af28\loch\f0 4S \par }{\hich\af0\dbch\af28\loch\f0 Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study. Lancet 1994;344:\hich\af0\dbch\af28\loch\f0 1383- 89}{\fs32 \par }{\hich\af0\dbch\af28\loch\f0 In patients with coronary heart disease, does treatment with simvastatin, when compared to placebo, reduce total mortality. \par \hich\af0\dbch\af28\loch\f0 For definite acute MI \par \hich\af0\dbch\af28\loch\f0 CER\tab 12.1 % \par \hich\af0\dbch\af28\loch\f0 EER\tab 7.4 % \par \hich\af0\dbch\af28\loch\f0 RR \tab 0.61 \par \hich\af0\dbch\af28\loch\f0 RRR\tab 39% \par \hich\af0\dbch\af28\loch\f0 ARR\tab 4.7% \par \hich\af0\dbch\af28\loch\f0 NNT for period of study 21 \par \hich\af0\dbch\af28\loch\f0 NNT for one year 115 \par \page }{\fs32 \hich\af0\dbch\af28\loch\f0 4S \hich\f0 \endash \loch\f0 \hich\af0\dbch\af28\loch\f0 your task \par }{\hich\af0\dbch\af28\loch\f0 Write in PICO form the clinical question addressed by this study. In the clinical question include the primary outcome only. Try and identify as many secondary and tertiary outcomes as you can but do not attempt to write a PICO for each of these \hich\af0\dbch\af28\loch\f0 or one PICO with all outcomes included! \par \hich\af0\dbch\af28\loch\f0 For the outcome }{\b \hich\af0\dbch\af28\loch\f0 definite acute MI compared with placebo}{\hich\af0\dbch\af28\loch\f0 calculate \par \tab \hich\af0\dbch\af28\loch\f0 CER \par \tab \hich\af0\dbch\af28\loch\f0 EER \par }\pard \ql \li720\ri0\sa200\sl276\slmult1\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0 {\hich\af0\dbch\af28\loch\f0 RR \par \hich\af0\dbch\af28\loch\f0 RRR \par \hich\af0\dbch\af28\loch\f0 ARR \par \hich\af0\dbch\af28\loch\f0 NNT for the duration of the study \par \hich\af0\dbch\af28\loch\f0 NNT for one year. (= above x 5.4?) \par }\pard\plain \s2\ql \li0\ri0\sa200\sl276\slmult1\keepn\widctlpar\aspalpha\aspnum\faauto\outlinelevel1\adjustright\rin0\lin0\itap0 \fs32\lang2057\langfe1033\loch\af0\hich\af0\dbch\af28\cgrid\langnp2057\langfenp1033 {\hich\af0\dbch\af28\loch\f0 HELP \par }\pard\plain \ql \li0\ri0\sa200\sl276\slmult1\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \fs24\lang2057\langfe1033\loch\af0\hich\af0\dbch\af28\cgrid\langnp2057\langfenp1033 {\hich\af0\dbch\af28\loch\f0 Data for definite acute MI in control and statin group\hich\af0\dbch\af28\loch\f0 s are given on page 1386 marked with a black arrow! \par \page }{\fs32 \hich\af0\dbch\af28\loch\f0 Woscops \par }{\hich\af0\dbch\af28\loch\f0 Preventions of coronary heart disease with pravastatin in men with hypercholesterolaemia. NEJM 1995. 333:1301 - 1307 \par \hich\af0\dbch\af28\loch\f0 In Men with hypercholesterolaemia and no history of myocardial infarction, d\hich\af0\dbch\af28\loch\f0 oes treatment with pravastatin when compared to placebo reduce the combined incidence of non fatal MI and death from Coronary Heart Disease. \par }\pard\plain \s1\ql \li0\ri0\sa200\sl276\slmult1\keepn\widctlpar\aspalpha\aspnum\faauto\outlinelevel0\adjustright\rin0\lin0\itap0 \b\fs24\lang2057\langfe1033\loch\af0\hich\af0\dbch\af28\cgrid\langnp2057\langfenp1033 {\hich\af0\dbch\af28\loch\f0 For Non Fatal MI or death from CHD \par }\pard\plain \ql \li0\ri0\sa200\sl276\slmult1\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \fs24\lang2057\langfe1033\loch\af0\hich\af0\dbch\af28\cgrid\langnp2057\langfenp1033 {\hich\af0\dbch\af28\loch\f0 CER\tab 7.5 % \par \hich\af0\dbch\af28\loch\f0 EER\tab 5.3 % \par \hich\af0\dbch\af28\loch\f0 RR \tab 0.7 \par \hich\af0\dbch\af28\loch\f0 RRR\tab 29% \par \hich\af0\dbch\af28\loch\f0 ARR\tab 2.2% \par \hich\af0\dbch\af28\loch\f0 NNT for period of study 45 (4.9 yea\hich\af0\dbch\af28\loch\f0 rs) \par \hich\af0\dbch\af28\loch\f0 NNT for one year 220 \par \par \par \page }{\fs32 \hich\af0\dbch\af28\loch\f0 WOSCOPS your task \par }{\hich\af0\dbch\af28\loch\f0 Write in PICO form the clinical question addressed by this study. In the clinical question include the primary outcome only. \par \hich\af0\dbch\af28\loch\f0 For the outcome }{\b \hich\af0\dbch\af28\loch\f0 non fatal MI or Death from CHD}{\hich\af0\dbch\af28\loch\f0 calculate \par \tab \hich\af0\dbch\af28\loch\f0 CER \par \tab \hich\af0\dbch\af28\loch\f0 EER \par }\pard \ql \li720\ri0\sa200\sl276\slmult1\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0 {\hich\af0\dbch\af28\loch\f0 RR \par \hich\af0\dbch\af28\loch\f0 RRR \par \hich\af0\dbch\af28\loch\f0 ARR \par \hich\af0\dbch\af28\loch\f0 NNT f\hich\af0\dbch\af28\loch\f0 or the duration of the study \par \hich\af0\dbch\af28\loch\f0 NNT for one year. (= above x 4.9) \par }\pard\plain \s2\ql \li0\ri0\sa200\sl276\slmult1\keepn\widctlpar\aspalpha\aspnum\faauto\outlinelevel1\adjustright\rin0\lin0\itap0 \fs32\lang2057\langfe1033\loch\af0\hich\af0\dbch\af28\cgrid\langnp2057\langfenp1033 {\hich\af0\dbch\af28\loch\f0 Clue \par }\pard\plain \ql \li0\ri0\sa200\sl276\slmult1\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \fs24\lang2057\langfe1033\loch\af0\hich\af0\dbch\af28\cgrid\langnp2057\langfenp1033 {\hich\af0\dbch\af28\loch\f0 Data for }{\b \hich\af0\dbch\af28\loch\f0 non fatal MI or Death from CHD}{\hich\af0\dbch\af28\loch\f0 in control and statin groups are given on page 1303 marked with a black arrow! \par \par \par \par \par \par \par \par \par \par \par \par \par \par \page }{\fs32 \hich\af0\dbch\af28\loch\f0 Heart Protection Study \par }{\hich\af0\dbch\af28\loch\f0 MRC/BHF Heart Protection Study o\hich\af0\dbch\af28\loch\f0 f cholesterol lowering with Simvastatin in 20536 high risk individuals: a randomised placebo controlled trial. The Lancet 2002 Vol 360 7 - 22 \par \hich\af0\dbch\af28\loch\f0 In patients with occlusive cardiovascular disease or diabetes does treatment with Simvastatin when compared to pla\hich\af0\dbch\af28\loch\f0 cebo reduce rates of mortality, and fatal or non -fatal vascular events? \par \hich\af0\dbch\af28\loch\f0 For non fatal MI, non fatal stroke and vascular death \par }\pard \ql \li720\ri0\sa200\sl276\slmult1\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0 {\hich\af0\dbch\af28\loch\f0 CER = 17.5% \par \hich\af0\dbch\af28\loch\f0 EER = 13% \par \hich\af0\dbch\af28\loch\f0 RR = 0.74 \par \hich\af0\dbch\af28\loch\f0 ARR = 4.5% \par \hich\af0\dbch\af28\loch\f0 RRR = 26% \par \hich\af0\dbch\af28\loch\f0 NNT for duration of study (5 years = 22) \par \hich\af0\dbch\af28\loch\f0 NNT for one year 110 \par }\pard \ql \li0\ri0\sa200\sl276\slmult1\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\page }{\fs32 \hich\af0\dbch\af28\loch\f0 Heart Protect\hich\af0\dbch\af28\loch\f0 ion Study \par }{\hich\af0\dbch\af28\loch\f0 Write in PICO form the clinical question addressed by this study. In the clinical question include the primary outcomes only. \par \hich\af0\dbch\af28\loch\f0 For the composite outcome of }{\b \hich\af0\dbch\af28\loch\f0 non fatal MI or non fatal stroke or Death from CVD}{\hich\af0\dbch\af28\loch\f0 calculate \par \tab \hich\af0\dbch\af28\loch\f0 CER \par \tab \hich\af0\dbch\af28\loch\f0 EER \par }\pard \ql \li720\ri0\sa200\sl276\slmult1\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0 {\hich\af0\dbch\af28\loch\f0 RR \par \hich\af0\dbch\af28\loch\f0 RRR \par \hich\af0\dbch\af28\loch\f0 ARR \par \hich\af0\dbch\af28\loch\f0 NNT for\hich\af0\dbch\af28\loch\f0 the duration of the study \par \hich\af0\dbch\af28\loch\f0 NNT for one year. \par }\pard\plain \s2\ql \li0\ri0\sa200\sl276\slmult1\keepn\widctlpar\aspalpha\aspnum\faauto\outlinelevel1\adjustright\rin0\lin0\itap0 \fs32\lang2057\langfe1033\loch\af0\hich\af0\dbch\af28\cgrid\langnp2057\langfenp1033 {\hich\af0\dbch\af28\loch\f0 Clue \par }\pard\plain \ql \li0\ri0\sa200\sl276\slmult1\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \fs24\lang2057\langfe1033\loch\af0\hich\af0\dbch\af28\cgrid\langnp2057\langfenp1033 {\hich\af0\dbch\af28\loch\f0 Data for }{\b \hich\af0\dbch\af28\loch\f0 non fatal MI or non fatal stroke or Death from CVD}{\hich\af0\dbch\af28\loch\f0 in control and statin groups are given on page 13 top of figure 4 marked with a black arrow! \par \page \hich\af0\dbch\af28\loch\f0 MRC Trial of Hypertension \par \hich\af0\dbch\af28\loch\f0 MRC Trial or Treatment of\hich\af0\dbch\af28\loch\f0 Mild Hypertension BMJ 1985 Vol 291 97-104 \par \hich\af0\dbch\af28\loch\f0 In men and women aged 35 to 64 with mild hypertension does treatment with bendrofluazide or propranolol, when compared to placebo, reduce the rate of stroke, of coronary events, and of death due to hypertension. \par \hich\af0\dbch\af28\loch\f0 F\hich\af0\dbch\af28\loch\f0 or Stroke \par \hich\af0\dbch\af28\loch\f0 CER 109/10654 = 1.0% \par \hich\af0\dbch\af28\loch\f0 EER 60/9700 = 0.6% \par \hich\af0\dbch\af28\loch\f0 RR 0.6 \par \hich\af0\dbch\af28\loch\f0 ARR 0.4% \par \hich\af0\dbch\af28\loch\f0 RRR 40% \par \hich\af0\dbch\af28\loch\f0 NNT = 250 \par \hich\af0\dbch\af28\loch\f0 Average duration of treatment is 4.4 years \par \hich\af0\dbch\af28\loch\f0 For one year 1100 \par \par \page \hich\af0\dbch\af28\loch\f0 MRC trial of mild hypertension - your task \par \hich\af0\dbch\af28\loch\f0 Write in PICO form the clinical question addressed by this study. \hich\af0\dbch\af28\loch\f0 In the clinical question include the three primary outcomes only. \par \hich\af0\dbch\af28\loch\f0 For the outcome }{\b \hich\af0\dbch\af28\loch\f0 Stroke}{\hich\af0\dbch\af28\loch\f0 calculate \par \tab \hich\af0\dbch\af28\loch\f0 CER \par \tab \hich\af0\dbch\af28\loch\f0 EER \par }\pard \ql \li720\ri0\sa200\sl276\slmult1\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0 {\hich\af0\dbch\af28\loch\f0 RR \par \hich\af0\dbch\af28\loch\f0 RRR \par \hich\af0\dbch\af28\loch\f0 ARR \par \hich\af0\dbch\af28\loch\f0 NNT for the duration of the study \par \hich\af0\dbch\af28\loch\f0 NNT for one year. (= above x 4.4) \par }\pard\plain \s1\ql \li0\ri0\sa200\sl276\slmult1\keepn\widctlpar\aspalpha\aspnum\faauto\outlinelevel0\adjustright\rin0\lin0\itap0 \b\fs24\lang2057\langfe1033\loch\af0\hich\af0\dbch\af28\cgrid\langnp2057\langfenp1033 {\hich\af0\dbch\af28\loch\f0 Clues \par }\pard\plain \ql \li0\ri0\sa200\sl276\slmult1\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \fs24\lang2057\langfe1033\loch\af0\hich\af0\dbch\af28\cgrid\langnp2057\langfenp1033 {\hich\af0\dbch\af28\loch\f0 You will need either a magnifying glass or very good eyesig\hich\af0\dbch\af28\loch\f0 ht to extract the data from this paper! \par \hich\af0\dbch\af28\loch\f0 Fortunately I have a magnifying glass and can help as follows \par \hich\af0\dbch\af28\loch\f0 No of patients randomised to treatment (i.e. male + female on bendrofluazide or propranolol is }{\b \hich\af0\dbch\af28\loch\f0 9700 }{\hich\af0\dbch\af28\loch\f0 (page 100 table 1 m) \par \hich\af0\dbch\af28\loch\f0 Strokes in treatment group is }{\b \hich\af0\dbch\af28\loch\f0 60}{\hich\af0\dbch\af28\loch\f0 \hich\af0\dbch\af28\loch\f0 (p 101 table 6) \par \hich\af0\dbch\af28\loch\f0 No of patients randomised to placebo was }{\b \hich\af0\dbch\af28\loch\f0 10654}{\hich\af0\dbch\af28\loch\f0 . (page100 table 1m) \par \hich\af0\dbch\af28\loch\f0 Strokes in placebo group is }{\b \hich\af0\dbch\af28\loch\f0 109}{\hich\af0\dbch\af28\loch\f0 (p101 table 6) \par \par \hich\af0\dbch\af28\loch\f0 And \par \par \hich\af0\dbch\af28\loch\f0 Total Number of patients treated is 9700 \par \hich\af0\dbch\af28\loch\f0 Total Number of patient treatment years 42,911 (page 100 table 1m) \par \hich\af0\dbch\af28\loch\f0 So Average t\hich\af0\dbch\af28\loch\f0 reatment duration 4.4 years. (You need this to calculate the NNT for one year) \par \page }{\fs32 \hich\af0\dbch\af28\loch\f0 SHEP \par }{\hich\af0\dbch\af28\loch\f0 Prevention of stroke by Antihypertensive Drug Treatment in Older Persons with Isolated Systolic Hypertension JAMA 1991 vol 265 No 24 P 3255 - 3263 \par \hich\af0\dbch\af28\loch\f0 In patients over aged 60\hich\af0\dbch\af28\loch\f0 with isolated systolic hypertension does treatment with anti hypertensive drugs (chlorthalidone or atenolol), when compared to placebo, reduce the risk of fatal and non-fatal stroke. \par \hich\af0\dbch\af28\loch\f0 For non fatal stroke \par \hich\af0\dbch\af28\loch\f0 CER \tab 6.2 % \par \hich\af0\dbch\af28\loch\f0 EER \tab 4% \par \hich\af0\dbch\af28\loch\f0 RR\tab 0.63\tab \par \hich\af0\dbch\af28\loch\f0 ARR\tab 2.2% \par \hich\af0\dbch\af28\loch\f0 RRR\tab 35% \par \hich\af0\dbch\af28\loch\f0 NNT\tab 4\hich\af0\dbch\af28\loch\f0 5 \par \hich\af0\dbch\af28\loch\f0 NNT for one year 204 \par \page }{\b \hich\af0\dbch\af28\loch\f0 SHEP trial - your task \par }{\hich\af0\dbch\af28\loch\f0 Write in PICO form the clinical question addressed by this study. In the clinical question include the primary outcomes only. \par \hich\af0\dbch\af28\loch\f0 For the outcome }{\b \hich\af0\dbch\af28\loch\f0 non fatal}{\hich\af0\dbch\af28\loch\f0 }{\b \hich\af0\dbch\af28\loch\f0 Stroke}{\hich\af0\dbch\af28\loch\f0 calculate \par \tab \hich\af0\dbch\af28\loch\f0 CER \par \tab \hich\af0\dbch\af28\loch\f0 EER \par }\pard \ql \li720\ri0\sa200\sl276\slmult1\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0 {\hich\af0\dbch\af28\loch\f0 RR \par \hich\af0\dbch\af28\loch\f0 RRR \par \hich\af0\dbch\af28\loch\f0 ARR \par \hich\af0\dbch\af28\loch\f0 NNT for the durat\hich\af0\dbch\af28\loch\f0 ion of the study \par }\pard \ql \fi720\li0\ri0\sa200\sl276\slmult1\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\hich\af0\dbch\af28\loch\f0 NNT for one year. (= Above x 4.5) \par }\pard \ql \li0\ri0\sa200\sl276\slmult1\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 { \par }\pard\plain \s2\ql \li0\ri0\sa200\sl276\slmult1\keepn\widctlpar\aspalpha\aspnum\faauto\outlinelevel1\adjustright\rin0\lin0\itap0 \fs32\lang2057\langfe1033\loch\af0\hich\af0\dbch\af28\cgrid\langnp2057\langfenp1033 {\hich\af0\dbch\af28\loch\f0 Clues \par }\pard\plain \ql \li0\ri0\sa200\sl276\slmult1\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \fs24\lang2057\langfe1033\loch\af0\hich\af0\dbch\af28\cgrid\langnp2057\langfenp1033 {\hich\af0\dbch\af28\loch\f0 Table 6 on P3260 gives the numbers of patients randomised to placebo and active treatment \par \hich\af0\dbch\af28\loch\f0 The first row gives the numbers of }{\b \hich\af0\dbch\af28\loch\f0 non-fatal strokes}{\hich\af0\dbch\af28\loch\f0 in each of these groups \par }}