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Meta-Analysis

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Www.bmj
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16

Risk of neuropsychiatric adverse events associated with varenicline: systematic review and meta-analysis

Objective To determine the risk of neuropsychiatric adverse events associated with use of varenicline compared with placebo in randomised controlled trials.  
bmj.com
over 5 years ago
Www.bmj
1
13

Methotrexate use and risk of lung disease in psoriasis, psoriatic arthritis, and inflammatory bowel disease: systematic literature review and meta-analysis of randomised controlled trials

Objective To evaluate the relative risk of pulmonary disease among patients with psoriasis, psoriatic arthritis, and inflammatory bowel disease treated with methotrexate.  
bmj.com
over 5 years ago
Www.bmj
1
11

Methotrexate use and risk of lung disease in psoriasis, psoriatic arthritis, and inflammatory bowel disease: systematic literature review and meta-analysis of randomised controlled trials

Objective To evaluate the relative risk of pulmonary disease among patients with psoriasis, psoriatic arthritis, and inflammatory bowel disease treated with methotrexate.  
bmj.com
over 5 years ago
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1025

Problem based learning - Friend or Foe?

What is Problem Based Learning? During my time at medical school, I enjoyed (at times) a curriculum delivered through the traditional model. As the name suggests, this is an approach experienced by the majority of doctors to date. The traditional model was first implemented by the American Medical College Association and American Academy of Medicine in 1894 (Barr, 2010) and has been used by the majority of medical schools. It traditionally consists of didactic lectures in the initial years covering the basic sciences followed by clinical years, where students learn clinical medicine while attending hospital placements. Is It Better? A few years after my graduation I found myself teaching at a university which had fully adopted the use of problem based learning (PBL) in the delivery of their curriculum. PBL is a philosophy of teaching that has increasingly been used in medical education over the past 40 years. It has rapidly been replaced or supplemented in medical education as opposed to the traditional model. PBL seeks to promote a more integrated and active approach to learning right from the first year with less reliance on didactic lectures. Having been involved in these two different approaches to medical education, I was interested to explore what the evidence was for and against each. For the purposes of this blog, I have looked at four specific areas. These include student attitudes, academic achievement, the academic process of learning and clinical functioning and skills. Student Attitudes Student attitudes to PBL have been highly featured in studies and many show that there is a clear favourability towards this philosophy of teaching. Blumberg and Eckenfel (1988) found that students in a problem based preclinical curriculum rated this three times higher than those in the a traditional group in terms of what they expect to experience, what they would like, and what they actually experienced. Heale et al (1988) found physicians in the problem-solving sessions rated a Continuing Medical Education short course higher compared to others who attended traditional lectures and large-group sessions. Vernon and Black (1993) performed a Meta analysis on 12 studies that looked at attitudes and towards PBL and found PBL was favored in some way by all studies. PBL appears to be preferred by the majority of students at a range of academic levels. However, Trappler (2006) found that converting a conventional curriculum to a problem based learning model for part of a psychopathology course did not show complete favourability. Students preferred the conventional lectures given by experts, rather than PBL groups run by mentors and not experts. They did however show preference towards PBL small group sessions run by experts Academic Achievement Academic achievement is an important factor to assess. Vernon and Blake (1993) compared a number of studies and found that those, which could be compared, showed a significant trend favouring traditional teaching methods. However, it was felt this might not be reliable. When looking at the heterogeneity of the studies there was significant variation that could not be accounted for by chance alone. Interestingly, they found that there was significant geographical variation across the United States such that New Mexico showed consistently negative effects and Michigan State showed consistently positive. Other studies have shown that the traditional method may show a slightly better outcome when assessing academic achievement. Schmidt et al (1987) looked at the same progress test taken among students in six different Universities in the Netherlands and found that those taught by a traditional approach showed slightly better outcomes. Baca et al (1990) compared performances of medical students in two separate tracks, one PBL the other a traditional model. Baca et al found that PBL students scored slightly lower in the National Board of Medical Examiners (NBME) examinations. Dochy et al (2003) conducted a meta analysis comparing 43 studies and found that when considering the effect of PBL on the knowledge of students the combined effect size is slightly negative. The academic process of learning It is important in medical education to enable people to continue life long learning, to overcome problems and fill in knowledge gaps. Coles (1990) and Entwistle (1983) found that PBL students would place more emphasis on understanding and meaning compared to just rote learning, seen more in those taught by a traditional approach. Students on a PBL course also place more focus on using resources such as the library and online sources rather than those taught in a traditional approach (Rankin, 1992). Students taught by a traditional model place more emphasis on the resources supplied by the faculty itself. It has also been shown that students who learn through a process of problem solving, are more likely to use this spontaneously to solve new problems in the future compared with those taught in a traditional way (Bransford et al, 1989). Clinical functioning and skills Clinical competence is an important aspect in medical education and has been measured in studies comparing PBL and traditional methods. The traditional model focuses acquisition of clinical competence in the final years of a program with hospital placements. In a PBL course it may be more integrated early on. There are however, only a few studies that look at clinical competence gained in undergraduate PBL courses. Vernon and Blake (1993) compared some of these studies and found that students obtained better clinical functioning in a PBL setting compared to a traditional approach. This was statistically significant, however there was still significant heterogeneity amongst studies and for conclusive results to be made 110 studies would have to be compared, rather that the 16 samples they were able to use. They also found that in contrast to the NBME I giving better results in the traditional model, PBL students score slightly higher in NBME II and federation licensing examination which related more on clinical functioning than basic sciences. On reflection, this evidence has indicated to me that PBL is a very valuable approach and it has a number of benefits. The traditional model in which I was taught has provided a good level of academic education. However, it may not have supported me as well as a PBL course in other areas of medical education such as academic process, clinical functioning and satisfaction. On reflection and current recommendations are for a hybridisation of the PBL and traditional approach to be used (Albanese, 2010) and I would support this view in light of the evidence. References Baca, E., Mennin, S. P., Kaufman, A., and Moore-West, M. A Comparison between a Problem-Based, Community Orientated track and Traditional track Within One Medical school. In Innovation in Medical Education; An Evaluation of Its Present Status. New York: Springer publishing Barr D. (2010) Revolution or evolution? Putting the Flexner Report in context. Medical Education; 45: 17–22 Blumberg P, Eckenfels E. (1988) A comparison of student satisfaction with their preclinical environment in a traditional and a problem based curriculum. Research in Medical Education: Proceedings of the Twenty-Seventh Annual Conference, pp. 60- 65 Bransford, J. D., Franks, J. J., Vye, N. J., & Sherwood, R. D. (1989). New Approaches to Instruction: Because Wisdom Can't Be Told. In S. Vosiadou & A. Ortony (Eds.), Similarity and Analogical Reasoning (pp. 470 297). New York: Cambridge University Press. Coles CR. (1990) Evaluating the effects curricula have on student learning: toward a more competent theory for medical education. In: Innovation in medical education: an evaluation of its present status. New York: Springer publishing; 1990;76-93. Dochy F., Segersb M., Van den Bosscheb P., Gijbelsb D., (2003) Effects of problem-based learning: a meta-analysis. Learning and Instruction. 13:5, 533-568 Entwistle NJ, Ramsden P. Understanding student learning. London: Croom Helm; 1983 Heale J, Davis D, Norman G, Woodward C, Neufeld V, Dodd P. (1988) A randomized controlled trial assessing the impact of problem-based versus didactic teaching methods in CME. Research in Medical Education.;27:72-7. Trappler B., (2006) Integrated problem-based learning in the neuroscience curriculum - the SUNY Downstate experience. BMC Medical Education 6: 47. Rankin JA. Problem-based medical education: effect on library use. Bull Med Libr Assoc 1992;80:36-43. Schmidt, H G; Dauphinee, W D; Patel, V L (1987) Comparing the effects of problem-based and conventional curricula in an international sample Journal of Medical Education. 62(4): 305-15 Vernon D. T., Blake R. L., (1993) Does Problem-based learning work? A meta-analysis of evaluated research. Academic Medicine.  
Dr Alastair Buick
almost 8 years ago
Www.bmj
0
13

Impact of smoking and smoking cessation on cardiovascular events and mortality among older adults: meta-analysis of individual participant data from prospective cohort studies of the CHANCES consortium

Objective To investigate the impact of smoking and smoking cessation on cardiovascular mortality, acute coronary events, and stroke events in people aged 60 and older, and to calculate and report risk advancement periods for cardiovascular mortality in addition to traditional epidemiological relative risk measures.  
feeds.bmj.com
over 5 years ago
Www.bmj
0
11

Optimal duration of dual antiplatelet therapy after percutaneous coronary intervention with drug eluting stents: meta-analysis of randomised controlled trials

Objective To assess the benefits and risks of short term (<12 months) or extended (>12 months) dual antiplatelet therapy (DAPT) versus standard 12 month therapy, following percutaneous coronary intervention with drug eluting stents.  
feeds.bmj.com
over 5 years ago
Www.bmj
0
15

Optimal duration of dual antiplatelet therapy after percutaneous coronary intervention with drug eluting stents: meta-analysis of randomised controlled trials

Objective To assess the benefits and risks of short term (<12 months) or extended (>12 months) dual antiplatelet therapy (DAPT) versus standard 12 month therapy, following percutaneous coronary intervention with drug eluting stents.  
feeds.bmj.com
over 5 years ago
Www.bmj
0
26

Short term exposure to air pollution and stroke: systematic review and meta-analysis

Data sources Medline, Embase, Global Health, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Web of Science searched to January 2014 with no language restrictions.  
feeds.bmj.com
over 5 years ago
Static.www.bmj
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14

Time to benefit for colorectal cancer screening: survival meta-analysis of flexible sigmoidoscopy trials

Eligibility criteria Randomized controlled trials comparing screening flexible sigmoidoscopy with no screening. Trials with fewer than 100 flexible sigmoidoscopy screenings were excluded.  
feeds.bmj.com
over 5 years ago
Www.bmj
0
16

Methotrexate use and risk of lung disease in psoriasis, psoriatic arthritis, and inflammatory bowel disease: systematic literature review and meta-analysis of randomised controlled trials

Objective To evaluate the relative risk of pulmonary disease among patients with psoriasis, psoriatic arthritis, and inflammatory bowel disease treated with methotrexate.  
feeds.bmj.com
over 5 years ago
Www.bmj
0
11

Risk of neuropsychiatric adverse events associated with varenicline: systematic review and meta-analysis

Objective To determine the risk of neuropsychiatric adverse events associated with use of varenicline compared with placebo in randomised controlled trials.  
feeds.bmj.com
over 5 years ago
Www.bmj
0
10

Optimal duration of dual antiplatelet therapy after percutaneous coronary intervention with drug eluting stents: meta-analysis of randomised controlled trials

Objective To assess the benefits and risks of short term (<12 months) or extended (>12 months) dual antiplatelet therapy (DAPT) versus standard 12 month therapy, following percutaneous coronary intervention with drug eluting stents.  
feeds.bmj.com
over 5 years ago
Static.www.bmj
0
10

Time to benefit for colorectal cancer screening: survival meta-analysis of flexible sigmoidoscopy trials

Eligibility criteria Randomized controlled trials comparing screening flexible sigmoidoscopy with no screening. Trials with fewer than 100 flexible sigmoidoscopy screenings were excluded.  
feeds.bmj.com
over 5 years ago
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4

'Increased risk of venous thromboembolism among NSAID users'

Venous thromboembolism - the condition that includes both deep vein thrombosis and pulmonary embolism - has been linked to NSAID use in a new systematic review and meta-analysis.  
medicalnewstoday.com
over 5 years ago
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0
1

High dose zinc acetate lozenges may help shorten symptoms associated with the common cold

According to a meta-analysis published in BMC Family Practice, high dose zinc acetate lozenges shortened the duration of common-cold associated nasal discharge by 34%, nasal congestion...  
medicalnewstoday.com
over 5 years ago
Preview
0
2

New Tamiflu study suggests drug does reduce flu impact considerably

The new study comes after a previous meta-analysis described Tamiflu as having “small, non-specific effects on reducing the time to alleviation of influenza symptoms in adults.”  
medicalnewstoday.com
over 5 years ago
Preview
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12

Episode 2: Urologic Emergencies

Episode 2 - Urologic Emergencies (iTunes)  The Free Open Access Medical Education (FOAM) - The Skeptics Guide to Emergency Medicine (SGEM) Episode 71 The podcast reviews: Tamsulosin for ureteral stones: a systematic review and meta-analysis of a randomized controlled trial. Paper's Conclusion:  ‘Tamsulosin is a safe and effective medical expulsive therapy choice for ureteral stones. It…  
foamcast.org
over 5 years ago
Screen shot 2014 06 08 at 9 39 12 pm
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Episode 4 – Transfusions and Ingested Foreign Bodies

Episode 4 – Transfusion Emergencies (iTunes or Listen Here)  The Free Open Access Medical Education (FOAM) –from Dr. Ryan Radecki's erudite blog, Emergency Medicine Literature of Note.. "Infections & Transfusions" - a JAMA meta-analysis found that higher hemoglobin targets were associated with an increased incidence of infection with a number needed to harm of 20-38.  The  group with a target level…  
foamcast.org
over 5 years ago
Preview
0
1

Stroke Rounds: Sleep Apnea Tx May Cut Afib Recurrence

Meta-analysis establishes continuous positive airway pressure as an important treatment option.  
medpagetoday.com
over 5 years ago
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Low-Normal Thyroid Function Not Linked to Coronary Risk

Patient-level meta-analysis suggests no coronary event or mortality risk.  
medpagetoday.com
over 5 years ago