Problem #4More NNT calculations – use theNNT.com website to find the information needed to answer this question. Statins 1. What is the number needed to treat (NNT) for statins in a patient with no known heart disease? 2. What is the Number needed to harm? 3. What is the cost to prevent 1 cardiovascular episode (assume pravastatin ($33.70/mo for generic) and a time period of 5 years). Aspirin 1. What is the number needed to treat (NNT) for aspirin to prevent a first heart attack or stroke? 2. What is the Number needed to harm? 3. What is the cost to prevent 1 cardiovascular episode (assume generic 81mg tablets (cost $0.97/100 tablets) every day for a period of 5 years)? Problem #5: Clinical Practice Guidelines Try using google to search for "Clinical practice guidelines type 2 diabetes treatment" and see if you can find the current recommendations for diabetes treatment put out by the American Diabetes Association (ADA). Revisit Access Medicine and find the guidelines for type 2 diabetes. Do both of these sources agree? If not, which one is the most reliable (based on evidence)? What is the evidence you used to determine this? Which one has been updated most recently? After looking at the CPG sites answer these questions: 1. How should CPGs be available for busy docs in the exam room? 2. What can be done to make it easier to access the appropriate information during a patient encounter? 3. What features do you think need to be included in a clinical guideline? Problem #6 Web-based Calculators Look at two web-based calculators that are related to CPGs: FRAX (Links to an external site.) calculates the 10 year risk of a fracture in men and women based on bone mineral density (BMD). Select Calculation tool, US and pick a race (try all 4 choices with the following information to see effect of race on fracture risk). IU has a large bone density research group and has generated much of the bone density data for Caucasian subjects. Example: woman, aged 65, weighs 110kg, height 163cm, previous fracture, a smoker and drinker. The machine used was Hologic and her bone mineral density result was 0.5 gm/cm2. 1. Calculate the 10 year fracture risk for the example patient. Cardiovascular Risk Calculator (Links to an external site.) online calculator determines the 10 year risk of heart attacks and death. 1. Calculate the risk for an African American male patient aged 65 years with a blood pressure of 150/86, total cholesterol of 280 and HDL 25 who does not have diabetes, but smokes and is on blood pressure medicines. ▪ What is the 10 year risk for heart disease or stroke? 2. Try it again for a Caucasian female aged 60 with a blood pressure of 116/68, total cholesterol of 230 and HDL of 60 who has diabetes, doesn't smoke and is not on blood pressure medicines. ▪ What is the 10 year risk for heart disease or stroke? Follow-up questions on Web-based calculators: 1. Could calculators like the two demonstrated be part of an EHR and calculate real time risk assessments? 2. Should they be available on smartphones or other mobile technology like iPads? 3. Would patients be receptive to this type of information? 4. Can you see how a large organization might use EBM, a risk calculator and drug costs to decide on the best therapy? How would this be useful to providers when they are deciding on therapy?