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Centre for Evidence-
Based Medicine

Therapy: Clinical Scenario

As a clinical manager of a geriatric unit in a large hospital, you are interested to know whether any benefit can be gained from drugs purporting to improve quality of life for people with Alzheimer's disease, particularly as new drugs are expensive and may have serious adverse effects. A patient's wife alerts you to the existence of a new drug she heard about on the Internet called rivastigmine, and you promise her that you will look into it. With interested colleagues, you formulate the question: "Is rivastigmine likely to reduce the effects of Alzheimer's in people with mild to moderate disease?"

You start up Best Evidence, enter "rivastigmine" and "Alzheimer's", and find nothing (yet). You then search PubMed (the Internet version of MEDLINE that is most up to date) for "rivastigmine alzheimer* controlled trial". (Note there is no need to use connectors such as AND, OR, NOT when doing a quick search on Pub Med). You see that indeed, there is a new trial. Happily it is published in the British Medical Journal - freely available in full text on the Web. BMJ 1999;318:633-40.

Read the article and decide:

  1. Is the evidence from this randomised trial valid?
  2. If valid, does the evidence address an important issue?
  3. If valid and important, can you apply this evidence in caring for your patients and population?

Continue to completed worksheet