Therapy

Instructor: Ken Schmader, MD
Email: schma001@mc.duke.edu

Read: Chapter 7: Therapy

Learning goals:

  • Describe the basic design of a randomized controlled trial and its advantages and disadvantages for examining the effectiveness of a given therapy.
  • Explain the rationale of each of the validity criteria set forth in the Critical Appraisal Worksheet.
  • Understand the magnitude and precision of results and be able to describe them to patients with respect to both benefits and risks.
  • Logically apply evidence for therapy in clinical practice.

Case:

A 78 year old woman come to see you in the office for a scheduled office visit to follow-up on her main problems of hypertension, atrial fibrillation, congestive heart failure, hypothyroidism, osteoarthritis, osteoporosis, and GERD. Her current medications include Metoprolol XL 100 mg/d, Lisinopril 20 mg/d, Warfarin 2 mg/d, Levothyroxine 0.05 mg/d, Acetaminophen 1 gm tid, Calcium/Vitamin D bid, Alendronate 70 mg/wk, Pantoprazole 40 mg/d. She has done well in the interim with no new complaints or physical exam findings. Towards the end of the appointment she asks you about getting the new shingles vaccine. Her mother had shingles “real bad” and she doesn’t want to get it.

You wonder if the zoster vaccine effectively and safely prevents herpes zoster and postherpetic neuralgia in older people.

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