The NNT | Quick Summaries of Evidence-Based Medicine.
I think I blogged this before, but didn’t describe it much. Allow me to rectify that mistake.
theNNT.com is an ever expanding site which boils down high quality reviews of medications and interventions, and presents its recommendations in a very much more approachable grren/yellow/red/Warning triangle format rather than some ratio.
While I won’t use this as a single source to change my practice I’m going to have to do some more research on some ofht eh shibboleths of our age ( Octreotide for variceal bleeding, PPI infusions for Upper GI bleeding, etc) are just two of the studies that fly in the face of current practice.
An aside: while inhaled corticosteroids for asthma aren’t beneficial in the review, what it doesn’ tell you is that the Feds think it does, and will grade your asthma care on how many of your asthma patients get a prescription for them. So, be aware.
Graham is behind this, and good for him.
Thanks Alan! The site is there to try to educate and challenge some of those long-held medical teachings/beliefs. We certainly aren’t trying to dictate practice, but are at least trying to challenge some of the guidelines and notions about certain medications and their (in)effectiveness.
At least I can agree with Graham that this site should not dictate practice. I blogged somewhat critically about NNT a while back, here:
http://doctorrw.blogspot.com/2010/10/nnt.html
So in the section about anticoagulation for VTE they say evidence shows no patients helped and a few harmed. I would ask Alan and Graham: If it’s your mother who presents with acute DVT and has no contraindications in terms of bleeding risk, do you want her treated? What do you do in your own ED when such a patient presents?
The site is very interesting largely as an academic exercise (something to make you think) but the casual uncritical reader may not appreciate that. A conspicuous disclaimer might help.
I did find an inconsistency I was curious about. The section on octreotide says no patients helped, none harmed, and gives it a red light. The section on anticoagulation for VTE says none helped, some harmed, yet gives it a yellow light. What am I missing there?
One more thing concerning Alan’s final point. This whole exercise points up the lunacy of the idea that a panel of government health care wonks should dictate for the rest of us what’s evidence based and what’s not. (If only EBM were so simple). Here you have the Feds saying one thing and Graham and his panel saying another. Intelligent people striving to be evidence based can disagree.
On asthma: In the studies examined the longest period of ICS use was 24 days after the ER visit. No benefit shown in terms of keeping people from returning to the ER, but that isn’t the only reason to give the stuff. A large number of patients who present with asthma attacks are already on ICS, but not taking them because they’re feeling ok. I think the benefit of prescribing ICS at discharge is more about trying to keep people on their preventative medications to hopefully prevent return visits several months later. Same as reminding them to quit smoking-probably not going to make a big difference in the first few weeks, but still reasonable to consider as part of standard care.