Norfloxacin

By E. Goran. Northwestern Michigan College.

It was also the only one that administered BUD+FM in separate inhalers and used a two-fold greater dose of BUD than the other trials norfloxacin 400mg. The only other included outcomes that were statistically significantly different between 98 purchase norfloxacin visa, 99 treatments were from a 6-month trial order norfloxacin from india. Specifically, the authors reported greater improvement in the number of rescue puffs used per day for those treated with FP/SM (mean difference, 95% CI: 0. The total number of hospitalizations or emergency visits was not analyzed for statistical significance, but there were fewer such events in the BUD/FM arm compared with the FP/SM arm (72 and 106, respectively). A post-hoc analysis of the original study that was limited to participants ages 16 and above yielded similar results. Of note, the total daily dose of BUD delivered by DPI in this study is considered medium and the total daily dose of FP delivered by pMDI is considered high. There were additional numerical trends for some outcomes that favored one intervention 95 over the other but for which statistical tests were not performed. One study reported 101 numerically fewer hospitalizations/ER visits in patients treated with BUD/FM; another reported the same number of ER contacts in both arms but more inpatient days and outpatient hospital visits in the BUD/FM arm than in the FP/SM arm. It is unclear in the latter study how many hospital visits contributed to the total number of inpatient days. Median percentage of patients with symptom-free days was slightly higher in the FP/SM arm than in the BUD/FM arm 97 98, 99 (between-group difference = 3%) in another study. In the aforementioned 6-month trial, fewer severe exacerbations were reported in the BUD/FM arm, compared with the FP/SM arm (173 and 208, respectively), but this difference was not reported to be statistically significant. Controller medications for asthma 64 of 369 Final Update 1 Report Drug Effectiveness Review Project We conducted meta-analyses for exacerbations requiring oral steroid treatment for ≥ 3 days and for exacerbations requiring emergency department visits and/or hospital admissions (Appendix I). The results of our meta-analyses show no statistically significant difference between those treated with BUD/FM and those treated with FP/SM in exacerbations requiring oral steroids or exacerbations requiring emergency visits or hospital admissions. Controller medications for asthma 65 of 369 Final Update 1 Report Drug Effectiveness Review Project Table 12. Characteristics of head-to-head studies comparing ICS+LABA with ICS+LABA Study design Country Comparison Equipotent N Population (total daily ex-mouthpiece dose in steroid Quality Study Duration Setting mcg) component rating Budesonide/formoterol (BUD/FM) compared with fluticasone/salmeterol (FP/SM) Lasserson et al. Multinational BUD/FM (320-640/9-18) DPI, pMDI Variable Good 94 SR 2008 vs. EXCEL trial 1397 Age > 18 years with asthma for a minimum FP/SM (500/100) DPI of 6 months, not controlled on 1000-2000 24 weeks BDP or equivalent, moderate to severe, excluded smokers with ≥ 10 pack-year history Multicenter 98 Kuna et al. AND Multicenter, outpatients FP/SM (500/100) pMDI 100b Kuna 2010 Controller medications for asthma 66 of 369 Final Update 1 Report Drug Effectiveness Review Project Table 12. Characteristics of head-to-head studies comparing ICS+LABA with ICS+LABA Study design Country Comparison Equipotent N Population (total daily ex-mouthpiece dose in steroid Quality Study Duration Setting mcg) component rating 101 Ringdal et al. Controller medications for asthma 67 of 369 Final Update 1 Report Drug Effectiveness Review Project 2. ICS/LABA for both maintenance and as-needed relief (ICS/LABA MART) vs. ICS/LABA for maintenance with a Short-Acting Beta-Agonist (SABA) for relief Summary of findings We found four fair or good quality RCTs (making five relevant comparisons) meeting our 98-100, 103-106 inclusion/exclusion criteria (Table 13). All compared the combination of budesonide (BUD) plus formoterol (FM) in a single inhaler for maintenance and as-needed relief with a fixed dose ICS/LABA combination plus a Short-Acting Beta-Agonist (SABA) for as-needed relief. BUD/FM is not approved for use as a relief medication in the United States, but it has been approved for maintenance and reliever therapy in Canada when administered via a DPI. Delivery of BUD/FM via pMDI is not indicated for MART. Two trials compared BUD/FM for 98-100, 103, 105 maintenance and relief to BUD/FM for maintenance with a SABA for relief; three trials compared BUD/FM for maintenance and relief to the combination of fluticasone and 98, 100, 104, 106 salmeterol (FP/SM) for maintenance with a SABA for relief. Several of the trials included in this section significantly reduced the total ICS doses for many of the subjects upon randomization (some studies averaged a 75% dose reduction). Overall, results from large trials up to twelve months in duration found statistically significantly lower odds of exacerbations requiring medical intervention for those treated with BUD/FM for maintenance and relief than for those treated with ICS/LABA for maintenance and a SABA for relief (moderate strength of evidence, Appendix H, Table H-6). A separate meta-analysis of exacerbations resulting in emergency department visits or hospital admissions revealed similar findings; the odds ratio for MART was 0. MART was also associated with fewer nocturnal awakenings, compared with 2 ICS/LABA + SABA (SMD = -0. I values for each of those meta-analyses were < 25%, indicating low heterogeneity, and sensitivity analysis results did not change our conclusions in either case. None of the individual trials found a significant difference in symptoms. Our meta-analyses found no statistically significant differences in symptom-free days (SMD = 0. Sensitivity analyses for each of these comparisons did not reveal anything that would change our conclusions. Detailed Assessment Description of Studies Of the four RCTs we included (Table 13), two compared BUD/FM MART to BUD/FM for 98-100, 103, 105 maintenance and SABA for relief, and three compared BUD/FM MART to FP/SM for maintenance and SABA for relief.

Ch aracteristics ofh ead-to-h ead trials ofnewerinsomniadrugs A uth or order norfloxacin from india,year InclusionCriteria ExclusionCriteria Demograph ics N umberScreened N umberW ith drawn Study Interventions (Q uality) Eligible L ostto followup Duration Enrolled A nalyzed A llain safe 400mg norfloxacin,2003 (F air) A ge between40 and65 years; Currentepisode h avinglasted M eanage (SD):52 N R/ 0/ 1 days Z olpidem; with aclinicalexaminationjudged more th anth ree weeks;any (7); compatible with difficultiesfalling secondaryinsomniaresultingfrom asleep norfloxacin 400 mg overnight delivery,with previoush istoryof medicalorpsych iatriccauses; recurrentepisodesofinsomnia patientswh ofolloweda andjustifyingth e prescriptionof continuoustreatmentwith th e h ypnotictreatmentatth e time of same h ypnoticformore th ansix inclusion. Th ish istorymusth ave scalesadministeredduring includedausualsleeplatencyof screeningwere >=50. Patients 30 minutesormore andeith er3 or were alsoexcludedifth eyh ad more awakeningspernigh ton sleepapneaorrestlesslegs average orausualtotalsleeptime syndrome,ifth eirsleepcomplaint of<= 6. Ch aracteristics ofh ead-to-h ead trials ofnewerinsomniadrugs A uth or,year InclusionCriteria ExclusionCriteria Demograph ics N umberScreened N umberW ith drawn Study Interventions (Q uality) Eligible L ostto followup Duration Enrolled A nalyzed Elie,1999 (F air) M etcriteriaforprimaryinsomniaorTransientinsomnia,situational M eanage (SD):42. A lsoexcludedwere wh owere usingamedically patientswith ah istoryorcurrent acceptable meth odof manifestationsofsleepapnea, contraception,orpostmenopausal restlesslegssyndrome,oramajor women. Duringth e month psych iatricdisorderandpatients precedingstudyenrollment, wh ose raw score oneith erth e patientsmusth ave experienced Z ungSelf-RatingA nxietyScale or th e followingsymptoms:atypical th e Z ungSelf-RatingDepression sleeplatencyof30 minutesor Scale was>49. Race/eth nicity:99% 615 574 Z aleplon20 mg; wh ite <1% black <1% A sian Z olpidem 10 mg; Baseline Z aleplon5 mg; Z aleplon10 mg; Z aleplon20 mg; Z olpidem 10 mg; Placebo Z aleplon5 mg; Z aleplon10 mg; Z aleplon20 mg; Z olpidem 10 mg; placebo Z aleplon5mg; Z aleplon10mg; Z aleplon20mg; Z olpidem 10mg; Insomnia 4 of 309 Final Report Update 2 Drug Effectiveness Review Project Evidence Table 1. Ch aracteristics ofh ead-to-h ead trials ofnewerinsomniadrugs A uth or,year InclusionCriteria ExclusionCriteria Demograph ics N umberScreened N umberW ith drawn Study Interventions (Q uality) Eligible L ostto followup Duration Enrolled A nalyzed F ry,2000 (F air) M enornon-pregnantwomen,18- Patientsexcludedifth ey M eanage (SD):42 N R/ 9/ 4 weeks Z aleplon5 mg; 65 yearswh ometth e criteriafor experiencedtransientinsomnia, (12); primaryinsomniaorinsomnia situationalinsomnia,orinsomnia associatedwith mildnon-psych otic associatedwith sleep-wake psych iatricdisordersbasedonth e sch edules(e. A lso capable ofbecomingpregnanth ad excludedwere patientswith a touse amedicallyacceptable h istoryorcurrentmanifestations meth odofcontraception. A tinitial ofsleepapnea,restlesslegs screening,patientsh adtoreport syndrome,oramajorpsych iatric h avingexperiencedth e following disorder,andpatientswh ose raw symptomsfrequently(atleast3 score oneith erth e Z unganxiety timesperweek,accordingtoDSM -ordepressionself-ratingscales III-R)duringth e month preceding was50 orgreater. Patientswere alsoexcluded ifth eyh adbeentakingany psych otropicdrug(with th e exceptionofz opiclone or z olpidem)with inth e previoustwo weeks. Race/eth nicity: 394 390 ; Insomnia 5 of 309 Final Report Update 2 Drug Effectiveness Review Project Evidence Table 1. Ch aracteristics ofh ead-to-h ead trials ofnewerinsomniadrugs A uth or,year InclusionCriteria ExclusionCriteria Demograph ics N umberScreened N umberW ith drawn Study Interventions (Q uality) Eligible L ostto followup Duration Enrolled A nalyzed ; SepracorStudy Patientsaged21 to64 yearswith A nyclinicallysignificantand/or M eanage (SD):40. Z olpidem Insomnia 6 of 309 Final Report Update 2 Drug Effectiveness Review Project Evidence Table 1. Ch aracteristics ofh ead-to-h ead trials ofnewerinsomniadrugs A uth or,year InclusionCriteria ExclusionCriteria Demograph ics N umberScreened N umberW ith drawn Study Interventions (Q uality) Eligible L ostto followup Duration Enrolled A nalyzed Tsutsui,2001 Patientswith ch ronicprimary Sch iz oph renia,depression,manic M eanage (SD):42. Race/eth nicity:N R 479 428 ; ; Insomnia 7 of 309 Final Report Update 2 Drug Effectiveness Review Project Evidence Table 2. R esults ofh ead-to-h ead trials ofnewerinsom niadrugs A uth or,year O utcom e M easure R esults (Q uality) A llain,2003 (F air)A nxiety meanscore Z olpidem:29. R esults ofh ead-to-h ead trials ofnewerinsom niadrugs A uth or,year O utcom e M easure R esults (Q uality) P-value=0. R esults ofh ead-to-h ead trials ofnewerinsom niadrugs A uth or,year O utcom e M easure R esults (Q uality) :; P-value=<0. R esults ofh ead-to-h ead trials ofnewerinsom niadrugs A uth or,year O utcom e M easure R esults (Q uality) Placebo:326; :; P-value= N umberofawakenings atweek 1 Z aleplon5 mg:1. R esults ofh ead-to-h ead trials ofnewerinsom niadrugs A uth or,year O utcom e M easure R esults (Q uality) Z aleplon20 mg:2; Z olpidem 10 mg:2; Baseline:2; P-value= M ediannumberofawakenings atweek 1 Z aleplon5 mg:2; Z aleplon10 mg:2; Z aleplon20 mg:2; Z olpidem 10 mg:2; Baseline:2; P-value= M ediannumberofawakenings atweek 2 Z aleplon5 mg:2; Z aleplon10 mg:2; Z aleplon20 mg:2; Z olpidem 10 mg:2; Baseline:2; P-value= M ediannumberofawakenings atweek 3 Z aleplon5 mg:2; Z aleplon10 mg:2; Z aleplon20 mg:1; Z olpidem 10 mg:2; Baseline:2; P-value= M ediannumberofawakenings atweek 4 Z aleplon5 mg:2; Z aleplon10 mg:2; Z aleplon20 mg:1; Z olpidem 10 mg:2; Baseline:2; P-value= M ediansleepdurationatbaseline (minutes) Z aleplon5 mg:313; Z aleplon10 mg:331; Z aleplon20 mg:328; Z olpidem 10 mg:330; Placebo:334; P-value= M ediansleepdurationatweek 1 (minutes) Z aleplon5 mg:351; Insomnia 12 of 309 Final Report Update 2 Drug Effectiveness Review Project Evidence Table 2. R esults ofh ead-to-h ead trials ofnewerinsom niadrugs A uth or,year O utcom e M easure R esults (Q uality) Z aleplon10 mg:370; Z aleplon20 mg:370; Z olpidem 10 mg:379; Placebo:351; P-value= M ediansleepdurationatweek 2 (minutes) Z aleplon5 mg:359; Z aleplon10 mg:368; Z aleplon20 mg:369; Z olpidem 10 mg:387; Placebo:359; P-value= M ediansleepdurationatweek 3 (minutes) Z aleplon5 mg:384; Z aleplon10 mg:371; Z aleplon20 mg:374; Z olpidem 10 mg:385; Placebo:365; P-value= M ediansleepdurationatweek 4 (minutes) Z aleplon5 mg:372; Z aleplon10 mg:384; Z aleplon20 mg:385; Z olpidem 10 mg:400; Placebo:377; P-value= M ediantime to sleeponsetatweek 2 Z aleplon5 mg:35; (median,minutes) Z aleplon10 mg:32; Z aleplon20 mg:31; Z olpidem 10 mg:37; placebo:47; P-value= M ediantime to sleeponsetatweek 3 Z aleplon5 mg:31; (median,minutes) Z aleplon10 mg:30; Z aleplon20 mg:28; Z olpidem 10 mg:34; placebo:41; P-value= Insomnia 13 of 309 Final Report Update 2 Drug Effectiveness Review Project Evidence Table 2. R esults ofh ead-to-h ead trials ofnewerinsom niadrugs A uth or,year O utcom e M easure R esults (Q uality) M ediantime to sleeponsetatweek 4 Z aleplon5 mg:31; (median,minutes) Z aleplon10 mg:28; Z aleplon20 mg:27; Z olpidem 10 mg:36; placebo:36; P-value= R ebound:N umberofawakenings onnigh t Z aleplon5mg:2. R esults ofh ead-to-h ead trials ofnewerinsom niadrugs A uth or,year O utcom e M easure R esults (Q uality) P-value= Sleepquality meanscore atweek 2 Z aleplon5 mg:4. R esults ofh ead-to-h ead trials ofnewerinsom niadrugs A uth or,year O utcom e M easure R esults (Q uality) placebo:2. R esults ofh ead-to-h ead trials ofnewerinsom niadrugs A uth or,year O utcom e M easure R esults (Q uality) Z olpidem 10 mg:3. R esults ofh ead-to-h ead trials ofnewerinsom niadrugs A uth or,year O utcom e M easure R esults (Q uality) Z aleplon20 mg:368. R esults ofh ead-to-h ead trials ofnewerinsom niadrugs A uth or,year O utcom e M easure R esults (Q uality) #190-045 (F air) Esz opiclone 2mg:59. R esults ofh ead-to-h ead trials ofnewerinsom niadrugs A uth or,year O utcom e M easure R esults (Q uality) Esz opiclone 1mg:43. R esults ofh ead-to-h ead trials ofnewerinsom niadrugs A uth or,year O utcom e M easure R esults (Q uality) P-value= sleeplatency (min) Esz opiclone 1mg:16. R esults ofh ead-to-h ead trials ofnewerinsom niadrugs A uth or,year O utcom e M easure R esults (Q uality) Z olpidem:24. R esults ofh ead-to-h ead trials ofnewerinsom niadrugs A uth or,year O utcom e M easure R esults (Q uality) Placebo:0. R esults ofh ead-to-h ead trials ofnewerinsom niadrugs A uth or,year O utcom e M easure R esults (Q uality) :; :; :; P-value=N S Patients ratingth e treatmentas "ineffective" Z olpidem:5. C h aracteristics ofPlacebo-controlled trials ofnewerinsom niadrugs A uth or,year InclusionC riteria ExclusionC riteria Dem ograph ics N um ber N um ber Study Interventions (Q uality) Screened W ith drawn Duration Eligible L ostto followup Enrolled A nalyz ed A llain,1998 Th e subjects were suffering Patients were notincluded ifany of M eanage (SD): N R / 18/ 21 days Z olpidem; (F air) from ch ronicinsomnia,being th e followingexclusioncriteria 51. R ace/eth nicity:N R 37 37 ; ; Insomnia 25 of 309 Final Report Update 2 Drug Effectiveness Review Project Evidence Table 3.

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Similarly discount 400mg norfloxacin with mastercard, fewer patients on atomoxetine relapsed than on placebo (22% compared with 38%; P<0 order norfloxacin 400mg on-line. As a continuation of that study discount norfloxacin online amex, subjects initially randomized to atomoxetine were rerandomized to an additional 6 months of either atomoxetine (n=81) or placebo (n=82), with mean time to relapse being 160 days for atomoxetine and 130. A few noncomparative observational studies evaluated 146, 147 duration of effectiveness for atomoxetine. In 1 study, 229 children who had a ≥40% reduction in ADHD rating scale total score after a 7- to 9-week trial of atomoxetine (51% of original sample) were randomly assigned to continue treatment for 8 months at the same or lower 146 dosages. In the other study, stability of treatment response over time was examined in 312 children who had completed 24 months of open treatment with atomoxetine (34% of original 147 sample). Both studies were consistent in finding that improvements in ADHD symptoms and in aspects of health-related quality of life were maintained during longer-term treatment periods, even with reduced dosages of atomoxetine. Although encouraging, findings from these studies must be interpreted with caution, mainly due to the extremely high attrition rates. Attention deficit hyperactivity disorder 60 of 200 Final Update 4 Report Drug Effectiveness Review Project In a pooled analysis of data from 714 children who received atomoxetine for at least 3 years in open-label studies, 1. Clonidine Immediate-release clonidine compared with methylphenidate. Four parallel group randomized controlled trials of immediate-release clonidine compared with immediate-release 149-152 methylphenidate were found. Two small randomized controlled trials of immediate-release clonidine compared with immediate-release methylphenidate measured outcomes using scales or tests that have either been shown to have low validity (e. The remaining small trials (N = 122 and 132) reported no statistically significant differences in Conners’ Abbreviated Symptom Questionnaire Teacher scale from baseline to endpoint (16 weeks) between immediate-release methylphenidate and clonidine. However, this comparison was not the primary aim of either study, and the studies have conflicting findings outside of this comparison. While the studies had similar 2 x 2 factorial designs, 1 enrolled children with both ADHD and Tourette’s disorder and evaluated the effect of drugs on tics, while the other enrolled children without Tourette’s disorder. The study of children with Tourette’s disorder and ADHD enrolled 136 children (mean age 10. All analyses made comparisons of each drug group to placebo, although it is stated that there was no difference between the immediate-release methylphenidate and immediate-release clonidine groups on the primary outcome measure of the Conners’ Abbreviated Symptom Questionnaire Teacher scale (Table 8). Immediate-release clonidine was significantly better than placebo on more Tourette’s outcome measures than immediate-release methylphenidate, and immediate-release methylphenidate was significantly better than placebo on more ADHD outcome measures than clonidine. Summary of differences in results of ADHD/Tourette’s disorder study Immediate-release clonidine vs. Based on the primary outcome measure of mean change in the Conners’ Abbreviated Symptom Questionnaire Teacher scale no difference was found between groups receiving clonidine and those receiving methylphenidate although the change was greater with methylphenidate (‒3. Similar results were found with secondary outcome measures for the direct comparison of the drugs. The difference in results of these 2 studies is shown in Table 9 below. Using the 2x 2 factorial designs, the analysis of treatment effect in groups receiving methylphenidate (alone or with clonidine) was statistically significant compared with groups not receiving methylphenidate (clonidine or placebo groups) in both studies. However, the treatment effect of clonidine (alone or with methylphenidate) was statistically significant only in the Tourette’s syndrome study, and not in the Palumbo 2008 trial. The parent ratings in the Palumbo trial conflict with the results based on teacher ratings – showing methylphenidate to have no effect and clonidine to have an effect. In the Tourette’s syndrome study, the parent and teacher ratings results were similar, finding both drugs beneficial. The reasons for the differences were not clear, but may have been related to differential attrition rates across groups in the Palumbo study, and while the both studies allowed psychological interventions, important variation across the studies may have occurred. Taken together, and considering all efficacy outcomes, we were not able to currently identify a difference in effect between immediate-release clonidine and immediate-release methylphenidate, but it may be that clonidine has a lesser effect. Change in Conners’ Abbreviated Symptom Questionnaire Teacher scale Immediate-release clonidine vs. Two placebo-controlled trials were not helpful in examining the comparative effectiveness of immediate-release clonidine. A small randomized placebo- 153, 154 155 controlled crossover trial was rated poor quality. The other did not report clear eligibility criteria but it appears that the children had to have a diagnosis of ADHD and Tourette’s disorder based on DSM-IIIR. Outcomes were assessed using primarily Child Behavior Checklists for parents and teachers, and linear analogue scales of parent assessments of hyperactivity and tics, as compared with any time in the past. Based on the linear analogue assessments, clonidine was not significantly different to placebo. The assessment of tics, based on 4 scales, did not show a difference between placebo and clonidine. Multiple subgroup analyses of the checklists resulted in clonidine being superior to placebo on some subscale items.

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In general 400mg norfloxacin mastercard, for questions about the relative benefits of a drug purchase norfloxacin cheap, the results of well-done best 400mg norfloxacin, randomized controlled trials are regarded as better evidence than results of cohort, case-control, or cross- sectional studies. In turn, these studies are considered better evidence than uncontrolled trials or case series. For questions about tolerability and harms, controlled trials typically provide limited information. For these questions, observational study designs may provide important information that is not available from trials. Within this hierarchy, cohort designs are preferred when well conducted and assessing a relatively common outcome. Case control studies are preferred only when the outcome measure is rare, and the study is well conducted. An evidence report pays particular attention to the generalizability of efficacy studies performed in controlled or academic settings. Efficacy studies provide the best information about how a drug performs in a controlled setting that allows for better control over potential confounding factors and bias. However, the results of efficacy studies are not always applicable to many, or to most patients seen in everyday practice. This is because most efficacy studies use strict eligibility criteria that may exclude patients based on their age, sex, medication compliance, or severity of illness. For many drug classes, including antipsychotics, unstable or severely impaired patients are often excluded from trials. Often, efficacy studies also exclude patients who have comorbid diseases, meaning diseases other than the one under study. Efficacy studies may also use dosing regimens and follow-up protocols that may be impractical in other practice settings. They often restrict options, such as combining therapies or switching drugs that Controller medications for asthma 18 of 369 Final Update 1 Report Drug Effectiveness Review Project are of value in actual practice. They often examine the short-term effects of drugs that in practice are used for much longer periods of time. Finally, efficacy studies tend to use objective measures of effects that do not capture all of the benefits and harms of a drug or do not reflect the outcomes that are most important to patients and their families. An evidence report also highlights studies that reflect actual clinical effectiveness in unselected patients and community practice settings. Effectiveness studies conducted in primary care or office-based settings use less stringent eligibility criteria, assess health outcomes, and have longer follow-up periods than most efficacy studies. The results of effectiveness studies are more applicable to the “average” patient than results from highly selected populations in efficacy studies. Examples of effectiveness outcomes include quality of life, hospitalizations, and the ability to work or function in social activities. These outcomes are more important to patients, family, and care providers than surrogate or intermediate measures such as scores based on psychometric scales. For example, a study might use very narrow inclusion criteria like an efficacy study, but, like an effectiveness study, might examine flexible dosing regimens, have a long follow-up period, and measure quality of life and functional outcomes. For this report we sought evidence about outcomes that are important to patients and would normally be considered appropriate for an effectiveness study. However, many of the studies that reported these outcomes were short-term and used strict inclusion criteria to select eligible patients. For these reasons, it is neither possible nor desirable to exclude evidence based on these characteristics. Labeling each study as an efficacy or effectiveness study, while convenient, is of limited value; it is more useful to consider whether the patient population, interventions, time frame, and outcomes are relevant to one’s practice, or, in the clinical setting, how relevant they are to a particular patient. Studies across the continuum from efficacy to effectiveness can be useful in comparing the clinical value of different drugs. Effectiveness studies are more applicable to practice, but efficacy studies are a useful scientific standard to determine whether the characteristics of different drugs are related to their effects on disease. An evidence report reviews the efficacy data thoroughly to ensure that decision-makers can assess the scope, quality, and relevance of the available data. This thoroughness is not intended to obscure the fact that efficacy data, no matter how much there is of it, may have limited applicability to practice. Clinicians can judge the relevance of the study results to their practice and should note where there are gaps in the available scientific information. Unfortunately, for many drugs, there are few or no effectiveness studies and many efficacy studies. As a result, clinicians must make decisions about treatment for many patients who would not have been included in controlled trials and for whom the effectiveness and tolerability of the different drugs are uncertain. An evidence report indicates whether or not there is evidence that drugs differ in their effects in various subgroups of patients, but it does not attempt to set a standard for how results of controlled trials should be applied to patients who would not have been eligible for them. With or without an evidence report, these are decisions that must be informed by clinical judgment.