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'''Welcome to ''Clinfowiki''!'''
 
We hope you will contribute much and well.
 
You will probably want to read the [[Help:Contents|help pages]].
 
Again, welcome and have fun! [[User:Vmohan|Vmohan]] ([[User talk:Vmohan|talk]]) 14:01, 1 May 2015 (PDT)
 
  
== TheNNT.com ==
 
 
TheNNT.com is a website that provides evidence based summaries for clinicians making decisions regarding testing and treatment.  Reviews are based on the simple statistical concept of the “Number Needed to Treat” or “NNT.”
 
 
 
== Statistical Basis ==
 
 
The Number Needed to Treat (NNT) is the number of patients you need to treat to prevent one additional bad outcome (death, stroke, etc.).  For example, if a drug has an NNT of 5, it means you have to treat 5 people with the drug to prevent one additional bad outcome.  It is calculated using the absolute risk reduction (ARR) and represents the inverse of the ARR (1/ARR).  The ARR = control event rate (CER) – experimental event rate (EER).  The NNT is always rounded up to the nearest whole number. (1)
 
 
 
== History ==
 
 
The site was created in 2010 by Dr. David H. Newman and colleagues. (2)
 
 
The authors (as the NNT Group) have created an Application Program Interface (API), currently in use at Mt. Sinai, that presents evidence within the EMR and delivered at the point of care with the goal of changing physician treatment behavior.
 
 
 
== Philosophy and Methods ==
 
 
As described on the web site, the authors start with a patient-oriented question about a medical intervention.  An author is then selected and a literature search conducted.  Systematic reviews are preferred, but randomized controlled trials are sometimes accepted.  Cochrane Collaboration reviews are preferred.  Meta-analyses are generally not accepted.  NNTs are generally derived from binary data.  The authors note their general suspicion regarding industry sponsored data.  They do not accept any outside funding or advertising.
 
 
The authors utilize a simple, color coded system to summarize their ratings.
 
 
'''Green''' – clear evidence of patient-important benefits that outweigh associated harms
 
 
'''Yellow''' – requires more study
 
 
'''Red''' – benefits and harms may be equal or equivocal
 
 
'''Black''' – very clear associated harms without any recognizable benefit
 
 
The goal is to provide a tool to help communicate patient oriented risks and benefits in an easy-to-understand fashion.
 
 
The authors acknowledge that the approach is not as useful in evaluating outcomes that involve a scale as opposed to binary or dichotomous outcome measures.
 
 
 
== Organization ==
 
 
Content is divided into three sections
 
 
Therapy (NNT) reviews (40 distinct reviews) – organized by specialty, system, alphabetically, and rating
 
 
Diagnosis (LR) reviews (15 distinct reviews) – organized by specialty, system, and alphabetically
 
 
Risk Assessments (6 distinct reviews) – organized alphabetically
 
 
== Examples ==
 
 
'''Thrombolytics for Stroke (www.thennt.com/nnt/thrombolytics-for-stroke)'''
 
 
Red – no benefit found
 
 
Benefits in NNT – none were helped (stroke symptoms improved)
 
 
Harms in NNH – 1 in 20 were harmed (symptomatic intracranial hemorrhage)
 
 
Reviews 12 high-quality trials with significant discussion regarding methods and flaws
 
 
'''Deep Venous Thrombosis (DVT) (www.thennt.com/lr/deep-venous-thrombosis-dvt)'''
 
 
Likelihood ratios reported based on pre-test probability and high sensitivity d-dimer assay
 
 
Based on a single paper
 
 
'''Syncope in the Emergency Department (www.thennt.com/risk/syncope-in-the-emergency-department)'''
 
 
Evaluates  San Francisco Syncope Rule (SFSR)
 
 
Defines risk of an adverse outcome based on this clinical decision rule
 
 
10% will have a 7 day serious outcome
 
 
0.4% will die in 7 days
 
 
1.4% of SFSR negative patients will have a 7 day serious outcome
 
 
== Team ==
 
 
The editor in chief is Dr. David H. Newman, Associate Professor and Director of Clinical Research in the Department of Emergency Medicine at Mt. Sinai School of Medicine.
 
 
Other members include
 
 
Gary Green, MD – Medical Education Fellow and Clinical Instructor at the University of California, San Francisco
 
 
Koustav Mukherjee, MD – Emergency Physician at Bronx-Lebanon Hospital in NYC
 
 
Joshua Quaas, MD – Associate Director of the Mt. Sinai-St. Luke’s Emergency Department
 
 
Daniel Runde, MD – Assistant Program Director for the Emergency Medicine Residency Program at the University of Iowa Hospitals and Clinics
 
 
Ashley Shreves, MD – Emergency Physician at Mt. Sinai Hospital
 
 
Graham Walker, MD – Emergency Physician at Kaiser San Francisco
 
 
Shahriar Zehtabchi, MD – Professor of Emergency Medicine and Vice Chair of Scientific Affairs at SUNY Downstate Medical Center and Kings County Hospital in Brooklyn
 
 
== Media ==
 
 
Wall Street Journal Health Blog.  “Doctors Launch ‘TheNNT.com’ to Give Treatment Info.” October 5, 2010.
 
 
Wired Magazine.  “This Man’s Simple System Could Transform American Medicine.” October 2014.
 
 
PBS NewsHour.  “How One Doctor is Prescribing Data to Improve Health Care.”  December 31, 2014.
 
 
== Related websites ==
 
 
www.smartem.org
 
 
www.cebm.net
 
 
www.nntonline.net
 
 
www.mdcalc.com (created and developed by Dr. Graham Walker)
 
 
plus.mcmaster.ca/evidenceupdates (BMJ evidence updates)
 
 
== Sources ==
 
 
www.thennt.com
 
 
== References ==
 
 
1 – www.cebm.net/number-needed-to-treat-nnt
 
 
2 - Wall Street Journal Health Blog.  “Doctors Launch ‘TheNNT.com’ to Give Treatment Info.” October 5, 2010.
 
 
== Related Topics ==
 
 
EBM (evidence based medicine)
 

Latest revision as of 22:31, 1 May 2015