Transcript Critical reading 12.03

CRITICAL READING
Stephen Newell.
December 2003
Reading a paper – R-E-A-D-ER
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Relevant?
Educational? Does it add anything?
Applicable? Primary-care based?
Discrimination - does it answer the
questions it set out to? Any patients
excluded? Appropriate design / statistics?
Concepts understood – risk, NNT, etc?
 Evaluation (oveRall)
“RCT of the READER method of critical
appraisal in general practice”.
MacAuley et al, BMJ 1997; 316:134
(11/4/97).
Paper for discussion
“Systematic review of randomised
controlled trials of over the counter
cough medicines for acute cough
in adults”.
Schroeder, K and Fahey, T. BMJ
2002; 324:329-31 (9/2/02).
Tasks
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Read the paper
Write the abstract using the
following headings:
Objectives
Design
Data sources
Included studies
Results
Conclusion
BMJ abstract
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Objectives: To determine whether OTC cough medicines
are effective in adults.
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Design: Systematic review of RCTs.
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Data sources: Search of the Cochrane Acute Respiratory
Infections Group specialised register, Cochrane Controlled
Trials Register, Medline, Embase, and the UK Department
of Health National research Register in all languages.
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Included studies: All RCTs that compared OTC cough
preparations with placebo in adults with acute cough due
to URTI in ambulatory settings and that had cough as an
outcome.
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Results: 15 trials involving 2166 participants met
all the inclusion criteria. Antihistamines seemed to
be no better than placebo. There was conflicting
evidence on the effectiveness of antitussives,
expectorants. Antihistamine-decongestant
combinations, and other drug combinations
compared with placebo
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Conclusion: OTC cough medicines for acute
cough cannot be recommended because there is
no good evidence for their effectiveness. Even
when trials had significant results, the effect sizes
were small and of doubtful clinical relevance.
Because of the small number of trials in each
category the results have to interpreted cautiously.
Subsequent BMJ correspondence
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3 letters in edition of 11/5/02
First – “If current advice on cough
medicines is changed to appease
the EBM purists, patients with
uncomplicated URTI are likely to
consult their doctor. Not only is this
an unnecessary use of a scare
resource but it is also likely to
increase the number of
inappropriate prescriptions for
antibiotics”.
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Second – “Absence of evidence is not
evidence of absence... Annually over
£100 million is spent in the UK on OTC
cough medicines”.
Third – “... We give them things to do
while they wait for the viral illness to get
better on its own… Don’t let us confuse
pharmacological efficacy with the real
world of managing human emotions
alongside physical illness”.
R-E-A-D-ER
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Relevant?
Educational? Does it add anything?
Applicable? Primary-care based?
Discrimination. Does it answer the
questions it set out to?
 Evaluation (oveRall)
So, what is the overall
opinion about this paper?