Background-Use of cardiovascular disease risk calculators is often recommended by guidelines, but research on consistency in risk assessment among calculators is limited. Method and Results-A search of PubMed and Google was performed. Five clinicians selected 25 calculators by independent review. Hypothetical patients were created with the use of 7 risk factors (age, sex, smoking, blood pressure, high-density lipoprotein, total cholesterol, and diabetes mellitus) dichotomized to high and low, generating 2 7 patients (128 total). These patients were assessed by each calculator by 2 clinicians. Risk estimates (and assigned risk categories) were compared among calculators. Selected calculators were from 8 countries, used 5-or 10-year predictions, and estimated either cardiovascular disease or coronary heart disease. With the use of 3 risk categories (low, medium, and high), the 25 calculators categorized each patient into a mean of 2.2 different categories, and 41% of unique patients were assigned across all 3 risk categories. Risk category agreement between pairs of calculators was 67%. This did not improve when analysis was limited to just the 10-year cardiovascular disease calculators. In nondiabetics, the highest calculated risk estimate from a calculator averaged 4.9 times higher (range, 1.9-13.3) than the lowest calculated risk estimate for the same patient. This did not change meaningfully for diabetics or when the analysis was limited to 10-year cardiovascular disease calculators. Conclusions-The decision as to which calculator to use for risk estimation has an important impact on both risk categorization and absolute risk estimates. This has broad implications for guidelines recommending therapies based on specific calculators.

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Objective To determine the quality of health recommendations and claims made on popular medical talk shows.Design Prospective observational study. Setting Mainstream television media. SourcesInternationally syndicated medical television talk shows that air daily (The Dr Oz Show and The Doctors). Interventions Investigators randomly selected 40 episodes of each ofThe Dr Oz Show and The Doctors from early 2013 and identified and evaluated all recommendations made on each program. A group of experienced evidence reviewers independently searched for, and evaluated as a team, evidence to support 80 randomly selected recommendations from each show. Main outcomes measuresPercentage of recommendations that are supported by evidence as determined by a team of experienced evidence reviewers. Secondary outcomes included topics discussed, the number of recommendations made on the shows, and the types and details of recommendations that were made. ResultsWe could find at least a case study or better evidence to support 54% (95% confidence interval 47% to 62%) of the 160 recommendations (80 from each show). For recommendations in The Dr Oz Show, evidence supported 46%, contradicted 15%, and was not found for 39%. For recommendations in The Doctors, evidence supported 63%, contradicted 14%, and was not found for 24%. Believable or somewhat believable evidence supported 33% of the recommendations on The Dr Oz Show and 53% on The Doctors. On average, The Dr Oz Show had 12 recommendations per episode and The Doctors 11. The most common recommendation category on The Dr Oz Show was dietary advice (39%) and on The Doctors was to consult a healthcare provider (18%). A specific benefit was described for 43% and 41% of the recommendations made on the shows respectively. The magnitude of benefit was described for 17% of the recommendations on The Dr Oz Show and 11% on The Doctors. Disclosure of potential conflicts of interest accompanied 0.4% of recommendations. ConclusionsRecommendations made on medical talk shows often lack adequate information on specific benefits or the magnitude of the effects of these benefits. Approximately half of the recommendations have either no evidence or are contradicted by the best available evidence. Potential conflicts of interest are rarely addressed. The public should be skeptical about recommendations made on medical talk shows.Additional details of methods used and changes made to study protocol

Routine pharmacokinetic drug monitoring has become an inherent component of aminoglycoside therapy over the last 10-15 years. The intent of this monitoring is to improve the outcome of treatment and to decrease the incidence of toxicity through the attainment and maintenance of serum aminoglycoside concentrations within a normal therapeutic range. The primary objective of this review was to critically analyze the scientific support for the following premises: (1) there is a causal relation between peak serum aminoglycoside concentrations in serum and the outcome of treatment; (2) there is a causal relation between trough serum aminoglycoside concentrations in serum and the outcome of treatment; (3) outcome is improved by monitoring and maintenance of serum aminoglycoside concentrations in the normal therapeutic range; (4) there is a causal relation between serum aminoglycoside concentrations and toxicity; and (5) monitoring and maintenance of serum aminoglycoside concentrations within a normal therapeutic range decrease the risk of toxicity. After a critical review of the literature, it was concluded that the evidence was insufficient to support the presently accepted normal therapeutic range. Recommendations for the monitoring of aminoglycoside therapy were drawn up.