MedWorm.com provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest items from the 'Evidence-Based Medicine' source. Thu, 09 Feb 2012 09:15:08 +0100 http://www.medworm.com/index.php?rid=5623604&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F17%2F1%2F36%3Frss%3D1 Hooper L. Meta-analysis of RCTs finds that increasing consumption of polyunsaturated fat as a replacement for saturated fat reduces the risk of coronary heart disease. Evid Based Med 2010;15:108–109. doi:10.1136/ebm1093. In the August 2010 issue, this article was published with the incorrect DOI number. The correct DOI is 10.1136/ebmed1093. (Source: Evidence-Based Medicine) Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=5623604 Mon, 23 Jan 2012 05:00:00 +0100 5623604 http://www.medworm.com/index.php?rid=5623603&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F17%2F1%2F35%3Frss%3D1 This study was conducted with male army personnel in... (Source: Evidence-Based Medicine) Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=5623603 Mon, 23 Jan 2012 05:00:00 +0100 5623603 http://www.medworm.com/index.php?rid=5623602&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F17%2F1%2F33%3Frss%3D1 Context Proton pump inhibitors (PPIs) block the final step in gastric acid production, increasing intragastric pH from about 1 to above 4, depending on the agent and dose used.1 This increase may influence the fate of drugs in the stomach. In the case of acetylsalicylic acid (ASA), neutralisation of gastric contents significantly decreases the absorption of both ASA and salicylic acid,2 but the clinical significance of this is uncertain. While lansoprazole does not influence the effect of low-dose enteric-coated ASA on platelet aggregation,3 patients with coronary disease receiving PPIs appear to have an impaired platelet response to aspirin.4 Methods To explore the consequences of the potential drug interaction between PPIs and ASA, Charlot et al conducted a cohort study of 19 925 patient... Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=5623602 Mon, 23 Jan 2012 05:00:00 +0100 5623602 http://www.medworm.com/index.php?rid=5623601&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F17%2F1%2F32%3Frss%3D1 Context Obesity is the most important risk factor for obstructive sleep apnoea (OSA). The lack of well-designed studies on the effects of weight reduction on OSA has led to conclusions that although weight loss may reduce the severity of OSA, the beneficial effects may not be sustained and it is not curative. However, recent reports in patients with mild OSA and in OSA patients with type 2 diabetes raise questions about these conclusions.1 2 We also need well-controlled trials on the effects of weight reduction programs among patients with more severe OSA. The aim of the study was to determine whether initial improvements in OSA after a very low calorie diet (VLCD) proven efficacious in a randomised trial followed by a weight loss maintenance program were maintained after 1 year in patient... Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=5623601 Mon, 23 Jan 2012 05:00:00 +0100 5623601 http://www.medworm.com/index.php?rid=5623600&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F17%2F1%2F31%3Frss%3D1 Context Chronic obstructive pulmonary disease (COPD) is currently recognised as an inflammatory disease associated with significant extrapulmonary effects and important comorbidities, including ischaemic heart disease and heart failure.1 Despite ample evidence of the benefits of β-blockers in hypertension, ischaemic heart disease and congestive heart failure, use of β-blockers is >50% lower in heart failure patients with than without COPD,2 probably because of concern regarding the possibility of bronchospasm provoked by β-blockers in patients with underlying obstructive lung disease, despite evidence to the contrary.3 In view of the compelling evidence demonstrating beneficial effects of β-blockers in cardiovascular disease (CVD), including improved survival, failur... Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=5623600 Mon, 23 Jan 2012 05:00:00 +0100 5623600 http://www.medworm.com/index.php?rid=5623599&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F17%2F1%2F30%3Frss%3D1 This study was done to determine the short-term adverse effects of medical abortion in younger and older women. Methods This was a population-based retrospective cohort study using the Finnish abortion register from 2000 to 2006. The only exclusions were abortions over 20 weeks, and only the first-induced abortion was analysed for each woman. The main outcome measures were the incidence of adverse events (haemorrhage, infection, incomplete abortion, surgical evacuation, psychiatric morbidity, injury, thromboembolic disease and death) among adolescent (<18 years) and older (≥18 years) women through record linkage of Finnish registries. The data from the abortion were linked to data from inpatient and outpatient visits for 42 days postprocedure. Diagnoses of adverse events were based o... Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=5623599 Mon, 23 Jan 2012 05:00:00 +0100 5623599 http://www.medworm.com/index.php?rid=5623598&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F17%2F1%2F28%3Frss%3D1 Context CT is currently the primary modality for investigating possible intracranial injury. The benefit of CT scanning for head injury in certain circumstances was recognised more than 30 years ago,1 but only recently have restrictive protocols based on specialist authorisation given way to a liberal approach with unrestricted access to CT scans in most high income countries. Recently, the long-term effects of radiation have been re-emphasised along with the cost of indiscriminate CT scanning, highlighting the need to determine the optimal use of CT scans for minor head injury. Methods In this systematic review, Pandor et al aimed to determine the most appropriate diagnostic imaging strategy for adults and children with minor Glasgow Coma Scale (GCS) 13–15 head injury through a syst... Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=5623598 Mon, 23 Jan 2012 05:00:00 +0100 5623598 http://www.medworm.com/index.php?rid=5623597&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F17%2F1%2F27%3Frss%3D1 Context A complaint of acute onset headache mandates that subarachnoid haemorrhage (SAH) be excluded as the cause. Because of the less than perfect sensitivity of unenhanced head CT, standard practice is to follow a negative CT with lumbar puncture (LP) to exclude subarachnoid haemorrhage. Improvements in CT technology have raised the question of whether modern third-generation CT scanners are sensitive enough to adequately exclude subarachnoid haemorrhage. Methods This was a prospective multicentre cohort study conducted at 11 university affiliated tertiary care teaching hospitals in Canada between November 2000 and December 2009. Consecutive patients aged 15 or older who presented with acute non-traumatic headache or with syncope associated with a headache were eligible for the study. CT... Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=5623597 Mon, 23 Jan 2012 05:00:00 +0100 5623597 http://www.medworm.com/index.php?rid=5623596&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F17%2F1%2F25%3Frss%3D1 Context Screening for prostate cancer (PC) is one of the most controversial subjects in uro-oncology. PC is the second most common male cancer worldwide. Although PC is not rare, it has a variable natural history, ranging from indolent to strikingly aggressive with a long preclinical phase. Although we await a breakthrough in the treatment of advanced disease, earlier diagnosis of clinically significant disease could provide an opportunity to ‘stem the tide’. Methods The Norrkoping PC screening trial reported on mortality 20 years after the start of the study. The study provided data on 9026 men from the Swedish city of Norrkoping who were between the ages of 50 and 69 years in 1987. Of these men, 1494 were randomly selected for screening; they were initially screened for PC wi... Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=5623596 Mon, 23 Jan 2012 05:00:00 +0100 5623596 http://www.medworm.com/index.php?rid=5623595&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F17%2F1%2F23%3Frss%3D1 Context Asthma is common and flare-ups associated with exposure to a variety of triggers may result in emergency department (ED) visits, school and work absenteeism, hospitalisations and significant healthcare costs. The majority of adult patients presenting with acute asthma are discharged home following management in the ED. Many national and international guidelines have been developed on this topic.1 In the outpatient setting, care is focused on the use of systemic (SC) and inhaled corticosteroid (ICS) agents to regain asthma control. While prednisone is the most common SC used, there has been an interest in reducing the duration of treatment using agents with longer half life such as dexamethasone. Due to compliance and palatability concerns, this question has been most frequently add... Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=5623595 Mon, 23 Jan 2012 05:00:00 +0100 5623595 http://www.medworm.com/index.php?rid=5623594&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F17%2F1%2F22%3Frss%3D1 Context Primary prevention strategies to curtail the development of allergic disorders have become paramount as allergy prevalence rises to epidemic proportions, specifically in regions undergoing western transition. While many factors have been implicated, decreased dietary intake of -3 polyunsaturated fatty acids (n-3 PUFA) and increased n-6 PUFA intake may affect allergy predisposition due to differential inflammatory potential and immunomodulatory effects of n-6 and n-3 PUFA. For decades, this has attracted interest in fish oil supplementation as a means of increasing n-3 PUFA intake and restoring fatty acid balance to treat and prevent allergic diseases. While treatment of established symptoms has proven overall ineffective, fish oil has shown more promise during early development, wh... Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=5623594 Mon, 23 Jan 2012 05:00:00 +0100 5623594 http://www.medworm.com/index.php?rid=5623593&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F17%2F1%2F21%3Frss%3D1 Context Wassen and colleagues have published an article on a topic of great practical importance: Does epidural analgesia (EA) given early in labour (≤3 cm cervical dilatation) increase the risk of instrumental delivery, compared with EA administered later in labour? This is important because EA is the most effective labour analgesia, and, if the timing of its administration is not associated with any adverse consequences, then it should not be denied to women in early labour. Women who have EA during their labour, compared with women who have other forms of analgesia, are at increased risk of instrumental delivery (RR 1.38, 95% CI 1.24 to 1.53).1 Instrumental deliveries are associated with increased risks to women of vaginal/perineal trauma and anal sphincter damage, which may in turn ... Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=5623593 Mon, 23 Jan 2012 05:00:00 +0100 5623593 http://www.medworm.com/index.php?rid=5623592&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F17%2F1%2F19%3Frss%3D1 Context The absence of digital manipulation of tissue and thereby the loss of informing input for the surgeon is a consequence of laparoscopic colorectal surgery. Presentation and care of the pathologic organ and surroundings could be compromised when metallic instruments replace the fingers. However, numerous reports have shown equal outcome results of laparoscopic versus open colorectal surgery. But if intraoperative organ injury is more common in laparoscopic colorectal procedures, attention would need to be directed towards its prevention. Methods This was a meta-analysis of available randomised controlled clinical trials (RCTs) evaluating laparoscopic versus open surgery for any colonic or rectal indication. Hand-assisted laparoscopic surgery was excluded. The literature search was ba... Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=5623592 Mon, 23 Jan 2012 05:00:00 +0100 5623592 http://www.medworm.com/index.php?rid=5623591&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F17%2F1%2F18%3Frss%3D1 Context Hypoglycaemia is the primary limiting factor in the glycaemic management of diabetes.1 This is especially true of individuals with long-standing type 1 diabetes, who are at highest risk of severe hypoglycaemia due to the loss of counter-regulatory hormone responses and hypoglycaemic symptom awareness. Continuous glucose monitoring (CGM), using a subcutaneous sensor to frequently measure interstitial glucose, was developed as a tool for improving glycaemic control and reducing hypoglycaemia in diabetes. Recent studies have shown that real-time CGM can improve haemoglobin A1c (HbA1c)3 and reduce the duration of hyperglycaemia or hypoglycaemia over short periods in selected individuals.4 However, inherent problems have limited its effective use, including lower accuracy than intermitt... Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=5623591 Mon, 23 Jan 2012 05:00:00 +0100 5623591 http://www.medworm.com/index.php?rid=5623590&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F17%2F1%2F17%3Frss%3D1 Context Gastro-oesophageal reflux disease (GERD) is a chronic, relapsing condition – manifesting mostly with heartburn and acid regurgitation – that negatively affects daily quality of life. The two main treatments for GERD are medical – proton pump inhibitors (PPIs) and laparoscopic antireflux surgery (LARS). Both treatments have advantages and side effects that continue to be debated. On one hand, medical therapy may be associated with residual regurgitation and the potential long-term side effects of PPI (eg, osteoporotic fractures, drug–drug interaction). On the other hand, LARS may be associated with technical failures, dysphagia and bloating. Methods Under the acronym LOTUS, this 5-year randomised study compared efficacy and safety of LARS with ‘optimise... Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=5623590 Mon, 23 Jan 2012 05:00:00 +0100 5623590 http://www.medworm.com/index.php?rid=5623589&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F17%2F1%2F16%3Frss%3D1 Context Calcium supplementation is widely used for osteoporosis (OP) prevention and treatment. Many women buy calcium supplements, ±vitamin D. The authors' earlier randomised controlled trial (RCT) and meta-analysis suggests that calcium supplementation increases cardiovascular-event risks provoked controversy, as has this report.1–3 Methods The ‘Women’s Health Initiative Calcium/vitamin D Supplementation Study' (WHICaD) limited access data set of 36 282 community-dwelling postmenopausal women comparing calcium plus vitamin D with placebo over 7 years was re-examined for effects of personal (preprotocol) calcium usage, adjusted for other cardiovascular disease (CVD) risk factors, followed by meta-analysis of the data on non-personal calcium users and from eight sim... Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=5623589 Mon, 23 Jan 2012 05:00:00 +0100 5623589 http://www.medworm.com/index.php?rid=5623588&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F17%2F1%2F14%3Frss%3D1 Context Obesity is a growing epidemic with multiple associated comorbidities including type 2 diabetes, hypertension and hyperlipidaemia. Multiple studies have shown that weight loss can improve these obesity RR factors. But weight loss is difficult. There is an urgent need for new and more efficacious pharmacological treatments to help curtail this growing epidemic. There have been previous studies looking at the use of phentermine and topiramate as single agents for weight loss. In the CONQUER trial, Gadde and colleagues have asked whether a combination of these two agents could provide a more effective treatment option for obesity with fewer side effects. Methods The CONQUER trial is a randomised controlled trial to assess the effects of two different doses of the combination of control... Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=5623588 Mon, 23 Jan 2012 05:00:00 +0100 5623588 http://www.medworm.com/index.php?rid=5623587&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F17%2F1%2F13%3Frss%3D1 Context In the current era, periprocedural myocardial infarction (MI) can still occur in a significant proportion of percutaneous coronary interventions (PCIs).1 Large periprocedural ischaemic events are associated with harm; however, even small increases in cardiac enzymes have been associated with increased long-term mortality.2 Attempts to enhance the safety of PCI have typically occurred through the use of potent antiplatelet agents (eg, aspirin, ADP receptor blockers (clopidogrel and prasugrel) and glycoprotein inhibitors (abciximab and eptifibatide)), as well as antithrombin agents (eg, unfractionated heparin, low-molecular weight heparin and bivalirudin). Although antiplatelet and antithrombin agents are effective at reducing ischaemic events, a cost from their use is sometimes paid... Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=5623587 Mon, 23 Jan 2012 05:00:00 +0100 5623587 http://www.medworm.com/index.php?rid=5623586&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F17%2F1%2F12%3Frss%3D1 This study analysed the available literature (regardless of language) on acute bronchiolitis therapy, including randomised controlled trials involving children below 24 months of age with bronchiolitis. Papers evaluated the effect of salbutamol, terbutaline, epinephrine, ipratropium and/or steroids for their effect on hospital admission rates, hospital length of stay, clinical scores, oxygen saturations, respiratory... (Source: Evidence-Based Medicine) Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=5623586 Mon, 23 Jan 2012 05:00:00 +0100 5623586 http://www.medworm.com/index.php?rid=5623585&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F17%2F1%2F11%3Frss%3D1 Context The need for interventions to manage the global epidemic of childhood overweight is well recognised,1 and, increasingly, the role of parents in this process is acknowledged for early school-aged children.2 However, the evidence to guide such interventions is limited. Many studies have methodological limitations and short follow-up periods.1 Most interventions in adult and child populations show positive outcomes at the end of the intervention period, but it is the sustainability of these that is of paramount interest. The study by Collins and colleagues addresses many of the limitations of previous studies, reports sustainability of the intervention 2 years from baseline and provides further evidence of the key role of parents. Methods The Hunter Illawarra Kids Challenge Using Pare... Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=5623585 Mon, 23 Jan 2012 05:00:00 +0100 5623585 http://www.medworm.com/index.php?rid=5623584&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F17%2F1%2F9%3Frss%3D1 Context Prostate cancer is the most common cancer among men, with a lifetime risk of one in six. Urinary incontinence (UI) is reported to affect 2–57% of men after radical prostatectomy.1 Patients report much higher rates of UI than doctors. The wide variation in rates may relate to different definitions of incontinence, different surgical techniques and different time points for measurement. Rates of UI are possibly higher and take longer time to resolve with advancing age. Adjuvant radiotherapy does not seem to affect long-term UI. The prevalence tends to decrease with time, probably with a peak 1–2 years after surgery.1 There are few studies that have followed men beyond 2 years. Incontinence affects quality of life and return to normal activities. It is common to offer beha... Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=5623584 Mon, 23 Jan 2012 05:00:00 +0100 5623584 http://www.medworm.com/index.php?rid=5623583&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F17%2F1%2F8%3Frss%3D1 Context Hyperglycaemia occurs in about 38% of hospitalised patients and is associated with increased morbidity, mortality and excessive cost.1–3 Earlier randomised controlled trials (RCTs), which reported improved outcome in critically ill patients treated with intensive insulin therapy (IIT),4 5 raised enthusiasm in intensive protocols aimed at correcting hyperglycaemia to normoglycaemic levels. However, recent studies have not replicated the encouraging observations of earlier RCTs6 or have indicated increased mortality7 and increased risk of severe hypoglycaemia.6–9 These studies differed with respect to study population, glycaemic targets and sampling, insulin protocols and nutritional support which could have affected their comparison with each other. A meta-analysis of 26... Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=5623583 Mon, 23 Jan 2012 05:00:00 +0100 5623583 http://www.medworm.com/index.php?rid=5623582&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F17%2F1%2F3%3Frss%3D1 Conclusion Studies of anti-TNF agents that report surrogate outcomes are of lesser methodological quality. As such, inclusion of such studies in evidence syntheses may bias results. (Source: Evidence-Based Medicine) Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=5623582 Mon, 23 Jan 2012 05:00:00 +0100 5623582 http://www.medworm.com/index.php?rid=5623581&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F17%2F1%2Fe1%3Frss%3D1 The general purpose of Evidence-Based Medicine is to select from the health-related literature* those articles reporting important advances in internal medicine, general and family practice, surgery, psychiatry, paediatrics, and obstetrics and gynaecology, and whose results are most likely to be both true and useful. These articles are described, critiqued and commented on by clinical experts. The specific purposes of Evidence-Based Medicine are: to identify, using predefined criteria, the best original and review articles on the cause, course, diagnosis, prevention, treatment, quality of care, or economics of disorders in the foregoing fields to provide a description and expert commentary on the context of each article, its methods, and the clinical applications that its findings warrant... Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=5623581 Mon, 23 Jan 2012 05:00:00 +0100 5623581 http://www.medworm.com/index.php?rid=5623580&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F17%2F1%2F1%3Frss%3D1 What are the benefits of random allocation in clinical studies? John Worrall, a philosopher of science, recently questioned whether evidence-based medicine's advice to base therapeutic decisions on the results of randomised controlled trials (RCTs) could be justified.1 2 Here we provide a response to Worrall and others who challenge the epistemological value of RCTs. Worrall's primary target is the view that RCTs are the only reliable source of evidence for medicine. But in arguing against this strong view, he posits a similarly strong counterposition. Worrall argues that randomisation offers no advantage over balanced systematic designs in which experimental and control groups are carefully matched according to known confounders.The best we can do (as ever) is test our theories against ri... Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=5623580 Mon, 23 Jan 2012 05:00:00 +0100 5623580 http://www.medworm.com/index.php?rid=5435941&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F16%2F6%2F192-b%3Frss%3D1 I agree with Dr Tomedi's assertion that one might question the credibility of a commentary written by someone who has received pharmaceutical industry support or for a number of other reasons.1 It is for this reason that BMJ Group policies ask authors to acknowledge and openly state any competing interests2, and, as a result of this policy, Dr Tomedi could become aware of them and consider them in reading the commentary. An alternative policy could be to prohibit any person who has received pharmaceutical company funding from writing a commentary. However, in some fields, many experts have received some such funding. In the specific case of this commentary3, the commentator has raised a number of cautions about the results of the study he critically appraised. In addition, the competing in... Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=5435941 Sun, 20 Nov 2011 05:00:00 +0100 5435941 http://www.medworm.com/index.php?rid=5435940&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F16%2F6%2F192-a%3Frss%3D1 The important influence of pharmaceutical manufacturers on the medical literature, and the positive ‘spin’ placed on results and conclusions, has been well documented. Given this pervasive problem, readers may question the credibility of the commentary1 of an EBM reviewer who has received consulting fees from MSD, Schering, Novartis and GSK and received honoraria from Altana, Astra Zeneca, Boehringer Inglehiem, GSK, MSD, Merck Respiratory, Schering-Plough and Teva. Competing interestsNone. (Source: Evidence-Based Medicine) Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=5435940 Sun, 20 Nov 2011 05:00:00 +0100 5435940 http://www.medworm.com/index.php?rid=5435939&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F16%2F6%2F190%3Frss%3D1 Context Investigations in triggering of acute cardiac disorders have elucidated that physical and sexual activity markedly and briefly increase the risk of such events. These common activities activate the sympathetic nervous system and may be considered typical ‘sympathetic’ triggers.1 Heavy physical activity precedes around 6% while sexual activity precedes 1% of all acute myocardial infarctions.2 Considering the strength and exposure, it seems that air pollution is the most public health relevant trigger of myocardial infarction, immediately followed by heavy exertion, whereas sexual activity has lower relevance. Nawrot and colleagues estimate that 6.2% of all infarction cases could be avoided if the patients were not engaged in heavy exertion and 2.2% if there was no sexual... Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=5435939 Sun, 20 Nov 2011 05:00:00 +0100 5435939 http://www.medworm.com/index.php?rid=5435938&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F16%2F6%2F189%3Frss%3D1 Context Spiriva or tiotropium bromide (long-acting muscarinic receptor antagonist) is licensed for maintenance bronchodilator treatment in the management of chronic obstructive pulmonary disease (COPD) in 55 countries. Singh and colleagues conducted a systematic review of high-quality randomised controlled trials (RCTs) and assessed all-cause mortality in COPD patients using the Spiriva Respimat Soft Mist Inhaler (RSMI) compared with placebo. Methods The authors conducted a systematic review of high-quality RCTs with 6522 patients. All included trials were of parallel design with study duration varying from 12 to 52 weeks. The authors conducted various sensitivity analyses to test the robustness of their findings which included using random effects models, limiting the analysis to three tr... Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=5435938 Sun, 20 Nov 2011 05:00:00 +0100 5435938 http://www.medworm.com/index.php?rid=5435937&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F16%2F6%2F187%3Frss%3D1 Context Atrial fibrillation (AF) is a common dysrhythmia associated with reduced quality of life, higher risk of developing heart failure, cognitive impairment and increased mortality.1–3 Patients with AF have a five-fold increased risk of stroke, and up to 25% of all strokes in the elderly are a consequence of AF.4 Vitamin K antagonists (VKAs) reduce the risk of stroke in patients with AF by 64% compared with placebo.5 Unfortunately, many patients at risk for AF-related stroke do not take VKA for a variety of reasons.6–8 Aspirin is an alternative antithrombotic strategy which is less effective than VKA but probably more effective than placebo.5 Methods The goal of the AVERROES trial was to compare apixaban, a new oral factor Xa inhibitor, with aspirin for stroke prevention in ... Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=5435937 Sun, 20 Nov 2011 05:00:00 +0100 5435937 http://www.medworm.com/index.php?rid=5435936&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F16%2F6%2F186%3Frss%3D1 Context The Action to Control Cardiovascular Risk in Diabetes (ACCORD)trial attempted to address the uncertainty that exists over whether intensively lowering blood glucose can reduce the significant excess of cardiovascular risk in people with type 2 diabetes. The trial was stopped after 3.5 years, because of an excess of deaths in the intensive glycaemia arm.1 The ACCORD investigators have now reported outcomes from an extended follow-up. Methods The ACCORD trial recruited 10 251 patients with inadequately controlled type 2 diabetes (haemoglobin A1c (HbA1c)>7.5%) in the USA and Canada. Participants were aged 40–79 with either prior cardiovascular disease (CVD) or with CVD risk factors, had a mean diabetes duration of 10 years, and were randomised to either intensive blood glucos... Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=5435936 Sun, 20 Nov 2011 05:00:00 +0100 5435936 http://www.medworm.com/index.php?rid=5435935&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F16%2F6%2F185%3Frss%3D1 Context The prevalence of childhood obesity continues to rise, especially among ethnic minorities and low-income subgroups.1 Overweight children more often suffer physical health consequences, have lower self-esteem, higher rates of anxiety disorders and more depression than normal-weight counterparts.2–5 Though less well understood, evidence suggests an association between improvements in weight measures and better academic performance.6 Recommendations for assessment/treatment of childhood obesity call for clinicians to be at the centre of obesity efforts.7 8 Methods Savoye et al conducted a clinician-led, weight-management intervention whereby ethnic, obese children (body mass index (BMI) >95th percentile) aged 8–16 years were randomised to either a 12-month family-based ... Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=5435935 Sun, 20 Nov 2011 05:00:00 +0100 5435935 http://www.medworm.com/index.php?rid=5435934&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F16%2F6%2F183%3Frss%3D1 Context Many studies have shown that regular use of inhaled corticosteroids improves asthma control in children with asthma. However, intermittent therapy with inhaled corticosteroids is common practice in the community1 as many physicians and families are reluctant to administer inhaled corticosteroids long term. Several previous studies have examined this approach and have generally not found it to be convincingly effective. The investigators wished to evaluate the efficacy of this approach in children potentially ready to be ‘weaned off’ inhaled corticosteroids. Their findings add to the body of literature evaluating the efficacy of intermittent therapy with inhaled corticosteroids in children with mild, persistent asthma. Methods This was a large, multicentre, randomised, d... Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=5435934 Sun, 20 Nov 2011 05:00:00 +0100 5435934 http://www.medworm.com/index.php?rid=5435933&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F16%2F6%2F182%3Frss%3D1 Context Historically, women have been supported and attended by other women during the births of their children. In many countries today, labouring women are, however, not permitted to bring a companion. One-to-one support by hospital staff or lay support persons is also rare because of work load and policies at the birth clinics. Support in labour may reduce anxiety and stress, which has a negative effect on the childbirth experience and also on course of labour. It can also buffer stressful effects of harsh conditions in the birth environment. Methods This is an updated systematic review in The Cochrane Library summarising results of 21 controlled trials, including 15 061 women randomly allocated to continuous labour support or usual care. The review incorporates trials from all continen... Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=5435933 Sun, 20 Nov 2011 05:00:00 +0100 5435933 http://www.medworm.com/index.php?rid=5435932&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F16%2F6%2F181%3Frss%3D1 Context Acute otitis media (AOM) is a common infection of childhood often immediately treated with antibiotics in the USA,1 while delayed prescribing is common in the UK.2 It is unclear how recent conjugate vaccines have affected microbial epidemiology and whether antibiotic efficacy in AOM has changed over the past decade. Methods Coker and colleagues systematically searched the PubMed, Cochrane and Web of Science databases for manuscripts published from 1999 through 2010 for studies of children with AOM (aged 4 months to 18 years) that reported diagnostic accuracy, treatment outcomes or the effect of heptavalent pneumococcal conjugate vaccine (PCV-7) upon microbial epidemiology. This search supplemented to authors published systematic review of the literature from 1966 through 1999.3 Two... Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=5435932 Sun, 20 Nov 2011 05:00:00 +0100 5435932 http://www.medworm.com/index.php?rid=5435931&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F16%2F6%2F180%3Frss%3D1 Context Death from postpartum haemorrhage (PPH) is frequently unpredictable and rapid. The global burden of these deaths disproportionately affects women giving birth in remote environments, without skilled birth attendance. Recent efforts to provide access to elements of the ‘active management of the third stage of labour’ in these settings have focused on misoprostol, a uterotonic agent that requires neither refrigeration nor parenteral administration. Methods Mobeen and colleagues conducted a randomised, double blind, placebo-controlled trial in Chitral, Khyber Pakhtunkhwa Province, Pakistan. Traditional birth attendants at home births were trained to administer oral misoprostol 600 µg or placebo after birth of the baby, to collect blood loss for subsequent measurement... Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=5435931 Sun, 20 Nov 2011 05:00:00 +0100 5435931 http://www.medworm.com/index.php?rid=5435930&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F16%2F6%2F178%3Frss%3D1 Context Continuation of antiepileptic drug (AED) treatment during pregnancy is a necessity for the majority of women with epilepsy. Adverse physical outcomes following in utero exposure to AEDs have been widely documented with the greatest risk being associated with in utero exposure to sodium valproate (VPA).1 Substantially less research has been undertaken into the effects of in utero exposure to AEDs on the developing brain and the resulting cognitive consequences for the child. Most research completed to date reports that VPA carries the largest risk to cognitive abilities, but in the majority has involved younger children.2 3 The investigation of cognitive abilities in older children is important due to the increase in the complexity of abilities over time. Methods Children were recru... Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=5435930 Sun, 20 Nov 2011 05:00:00 +0100 5435930 http://www.medworm.com/index.php?rid=5435929&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F16%2F6%2F177%3Frss%3D1 Context Obesity is all around us. Wherever we live or travel, it is one of our major health problems. There is some evidence in the more developed countries that obesity prevalence in children might have stabilised.1 But even if this is so, it has stabilised at a level far too high for optimum public health. Several major reviews have analysed the available cohort studies and supported an association between breastfeeding and the later development of obesity2 although the one large cluster randomised controlled trial (RCT) of a health promotion intervention in Belarus did not find an association.3 The introduction of solid foods earlier than 4 months has also been associated with increased body weight and later obesity, and the effect may be present if solids are introduced before 6 months... Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=5435929 Sun, 20 Nov 2011 05:00:00 +0100 5435929 http://www.medworm.com/index.php?rid=5435928&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F16%2F6%2F176%3Frss%3D1 Context Recent estimates suggest that approximately two-thirds of Americans are overweight and one-third are obese.1 The current study evaluated patients' perceptions of overweight and obesity in a nationally representative sample of adults in the USA and examined whether reports of physician acknowledgement of patients' weight status are associated with a difference in their perceptions and behaviours. Methods The participants included in this study are participants in the 2005–2008 National Health and Nutrition Examination Survey study, aged between 20 and 64 years with measured body mass index (BMI), who were asked whether they had been told by their physician or another health professional that they were overweight. There were 7790 participants, of whom 5474 had a BMI of 25.0 or ... Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=5435928 Sun, 20 Nov 2011 05:00:00 +0100 5435928 http://www.medworm.com/index.php?rid=5435927&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F16%2F6%2F174%3Frss%3D1 Context In 2009, there were more than 9 million new cases of tuberculosis, but only 63% were diagnosed. The situation for multidrug-resistant tuberculosis (MDR-TB) was even more dismal, with less than 12% of the estimated 250 000 cases diagnosed.1 The most important cause for the diagnostic gap was the absence of a rapid and sensitive test. Smear microscopy, the most widespread first-line diagnostic, is cheap and simple but has poor sensitivity and cannot detect resistance. Culture is highly sensitive and can identify drug resistance, but it requires a sophisticated laboratory infrastructure and is slow. Following a large evaluation study,2 the WHO recommended Xpert MTB/RIF (Xpert), a highly automated real-time PCR assay, as the initial diagnostic test for people suspected of HIV-associate... Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=5435927 Sun, 20 Nov 2011 05:00:00 +0100 5435927 http://www.medworm.com/index.php?rid=5435926&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F16%2F6%2F173%3Frss%3D1 Context Tuberculosis (TB) persists as a major cause of human morbidity and mortality, affecting almost 9.4 million people and causing 1.8 million deaths yearly worldwide.1 Examining Mycobacterium tuberculosis bacilli, using light microscopy with Ziehl–Neelsen stain, is still considered the most specific, cost-effective, quick and reliable test for the diagnosis of pulmonary TB.2 In recent years, new diagnostics such as ‘Xpert MTB/RIF’ (97.6% sensitivity and 99.2% specificity) have emerged and are being endorsed by the WHO. The ‘Gene Xpert’ has been recommended by WHO to use as a first-line test for multidrug-resistant TB or HIV-associated TB.3 Collecting and processing quality sputum specimens for microscopy is a manageable process but requires trained and ded... Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=5435926 Sun, 20 Nov 2011 05:00:00 +0100 5435926 http://www.medworm.com/index.php?rid=5435925&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F16%2F6%2F172%3Frss%3D1 Context Despite the use of gold standard equipment such as mercury sphygmomanometers in primary care for the measurement of blood pressure, accuracy remains a problem. This is due to a combination of system (eg, lack of calibration of instruments), physician (eg, observer error) and patient (eg, sympathetic drive) factors. Programmable automatic and semiautomatic oscillometric devices are likely to replace such devices because of occupational health concerns with the use of mercury. Methods This is a cluster randomised controlled study of an automated oscillometric blood pressure device method of determining blood pressure (intervention) versus usual manual measurement (control) in primary care. Both arms ambulatory blood pressure (ABP) measurements were also taken. The study included 555 ... Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=5435925 Sun, 20 Nov 2011 05:00:00 +0100 5435925 http://www.medworm.com/index.php?rid=5435924&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F16%2F6%2F170%3Frss%3D1 Context An association between in utero exposure to ionising radiation and childhood cancer, in particular leukaemia, was first identified in 1956.1 Subsequent studies have reported similar findings.2 3 To date, all have retrospectively interviewed mothers regarding exposure to diagnostic radiation and are therefore susceptible to recall bias. Little is known about the effects of neonatal exposure to diagnostic radiation. The purpose of this study was to determine whether exposure to diagnostic radiation and ultrasound in utero and during the first 100 days of life is associated with childhood cancer. Methods A case-control study was chosen as childhood cancer is relatively rare in the UK, affecting 138.6 per million children under 14 years.4 Cases were identified from the UK Childhood Can... Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=5435924 Sun, 20 Nov 2011 05:00:00 +0100 5435924 http://www.medworm.com/index.php?rid=5435923&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F16%2F6%2F169%3Frss%3D1 Context Treatment of latent tuberculosis infection (LTBI) is an important tuberculosis prevention and control strategy, especially in high-resource countries. The effectiveness of LTBI treatment, which usually consists of isoniazid (also known as isonicotinylhydrazine (INH)) for 6–9 months, is limited by poor patient adherence because of long treatment duration and adverse effects. The most common serious adverse effect of INH is hepatotoxicity, which increases with age and can be fatal.1 A meta-analysis of six studies found that the pooled rate of INH-associated hepatotoxicity was 0.6%.2 Methods Smith and colleagues conducted a population-based evaluation of serious adverse events of LTBI treatment in Quebec, Canada. Data were abstracted from administrative databases of the governme... Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=5435923 Sun, 20 Nov 2011 05:00:00 +0100 5435923 http://www.medworm.com/index.php?rid=5435922&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F16%2F6%2F168%3Frss%3D1 Context It is now recognised that fractures of the subtrochanteric femur or femoral shaft (ST/FS fractures) can be divided radiologically into (1) typical fractures and (2) atypical fractures. The latter appear to be rare in patients untreated by bisphosphonates. In this new study, Park-Wyllie et al used Ontario claims data to investigate the association between the amount of bisphosphonates taken and the risk of ST/FS fractures. Methods The study was a nested 5:1 case-control study, linking prescriptions with hospitalisations, physician service claims and death certificates. Women aged 68 years or older who filled prescriptions for bisphosphonates at least once over a 6-year period were included. Those with malignant disease in the past 10 years, specific bone diseases or secondary causes... Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=5435922 Sun, 20 Nov 2011 05:00:00 +0100 5435922 http://www.medworm.com/index.php?rid=5435921&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F16%2F6%2F163%3Frss%3D1 While decisions made according to Bayes' theorem are the academic normative standard, the theorem is rarely used explicitly in clinical practice. Yet the principles can be followed without intimidating mathematics. To do so, one can first categorise the prior-probability of the disease being tested for as very unlikely (less likely than 10%), unlikely (10–33%), uncertain (34–66%), likely (67–90%) or very likely (more likely than 90%). Usually, for disorders that are very unlikely or very likely, no further testing is needed. If the prior probability is unlikely, uncertain or likely, a test and a Bayesian-inspired update process incorporating the result can help. A positive result of a good test increases the probability of the disorder by one likelihood category (eg, from... Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=5435921 Sun, 20 Nov 2011 05:00:00 +0100 5435921 http://www.medworm.com/index.php?rid=5435920&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F16%2F6%2F161%3Frss%3D1 Time pressures often require highly efficient, intuitive approaches to decision making. On the fly, we depend upon short cuts, or heuristics, to make rapid, efficient decisions. Heuristics are indispensable cognitive processes for quickly solving problems without the formal use of logic and research evidence. Encountering unfamiliar situations, for example, we act based on outcomes of recent similar, memorable or noteworthy experiences (the availability heuristic).1 In light of the flood of data encountered in daily life, such short cuts are unavoidable, but they can also lead to error, such as overestimating the likelihood of a rare event. Physicians, like everybody else, are psychologically predisposed to similar errors in their medical practices.2 Evidence-based practice and teaching re... Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=5435920 Sun, 20 Nov 2011 05:00:00 +0100 5435920 http://www.medworm.com/index.php?rid=5435919&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F16%2F6%2Fe3%3Frss%3D1 The general purpose of Evidence-Based Medicine is to select from the health-related literature* those articles reporting important advances in internal medicine, general and family practice, surgery, psychiatry, paediatrics, and obstetrics and gynaecology, and whose results are most likely to be both true and useful. These articles are described, critiqued and commented on by clinical experts. The specific purposes of Evidence-Based Medicine are: to identify, using predefined criteria, the best original and review articles on the cause, course, diagnosis, prevention, treatment, quality of care, or economics of disorders in the foregoing fields to provide a description and expert commentary on the context of each article, its methods, and the clinical applications that its findings warrant... Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=5435919 Sun, 20 Nov 2011 05:00:00 +0100 5435919 http://www.medworm.com/index.php?rid=5244548&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F16%2F5%2F159%3Frss%3D1 Context Vasomotor symptoms (VMS – hot flashes, night sweats) are considered the hallmark of the menopausal transition and early postmenopausal years; these symptoms affect 60–90% of women during this time period and quite often result in significant discomfort and impaired quality of life (QOL). Mechanistically, the occurrence of VMS is attributed to a malfunction or disruption within complex temperature circuits in charge of thermoregulation. Existing evidence suggests that these circuits are at least in part modulated by oestrogen and monoamine systems – that is, serotonin, norepinephrine. In the aftermath of the Women's Health Initiative Study, physicians and patients became more reluctant to pursue or remain adherent to hormone-based therapies, and a growing interest ... Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=5244548 Fri, 16 Sep 2011 04:00:00 +0100 5244548 http://www.medworm.com/index.php?rid=5244547&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F16%2F5%2F157%3Frss%3D1 Context Awareness is growing that in developed countries around a quarter of human papillomavirus (HPV) related cancers occur in men and that the incidence of some of those cancers, particularly anal cancers1 and certain oropharyngeal cancers,2 is growing. As well as providing direct protection for males, a population-based programme of male HPV vaccination could provide protection for females where the levels of population coverage of female vaccination programmes are limited. There has been no formal evaluation of the efficacy of the HPV vaccination against HPV-related disease in males. Methods This rigorous randomised, placebo-controlled, double-blind study enrolled 4065 boys and men aged 16–26 years through 71 sites in 18 countries. None was permitted to have had more than five s... Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=5244547 Fri, 16 Sep 2011 04:00:00 +0100 5244547 http://www.medworm.com/index.php?rid=5244546&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F16%2F5%2F156%3Frss%3D1 Context Although some studies indicate that small intestinal bacterial overgrowth (SIBO) is prevalent in irritable bowel syndrome (IBS), it remains unclear whether SIBO causes IBS. The poorly absorbed, gut-specific antibiotic, rifaximin, may be well suited to treat SIBO in IBS. Methods The TARGET study combines data from a pair of large, well-designed, phase III registration trials in 1260 IBS patients with mild-to-moderate, non-constipating symptoms. Patients were randomised to receive either rifaximin, 550 mg three times daily for 2 weeks, or placebo. There was no effort to test for SIBO before treatment, which was initiated empirically. The main outcome measure was improvement in global IBS symptoms as determined using a binary assessment. Secondary outcomes included improvement in indi... Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=5244546 Fri, 16 Sep 2011 04:00:00 +0100 5244546 http://www.medworm.com/index.php?rid=5244545&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F16%2F5%2F154%3Frss%3D1 Context Neonatal death accounts for 25% of under-5 mortality in Africa. Many African countries will not achieve Millennium Development Goal 4 (a 2/3 reduction in under-5 mortality from the 1990 level by 2015) without reducing newborn deaths. Efforts to promote skilled birth attendance in Africa have largely assumed no role for trained traditional birth attendants (TBAs), despite families' continued use of TBAs where facility delivery and skilled birth attendance remain out of reach. Gill and colleagues considered the effect of training TBAs on newborn death in Lufwanyama District in rural Zambia. Methods This was a prospective, cluster randomised and controlled effectiveness study of trained TBAs (60 intervention and 67 control) and the newborns they delivered (1962 intervention and 1536 c... Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=5244545 Fri, 16 Sep 2011 04:00:00 +0100 5244545 http://www.medworm.com/index.php?rid=5244544&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F16%2F5%2F153%3Frss%3D1 Context Low bone mineral density has been identified as a risk factor for osteoporotic fracture1 and fracture in childhood.2 Vitamin D supplementation in childhood may be a clinical strategy to maximise peak bone mass in children and, in turn, improve bone mineral density and reduce fracture risk in adulthood. However, the effectiveness of vitamin D supplementation for improving bone density in children is unclear. Therefore, Winzenberg and colleagues performed a systematic review and meta-analysis to evaluate the efficacy of vitamin D supplementation for improving paediatric bone mineral density, including how supplement dose and baseline vitamin D status may impact the outcome. Methods This is a systematic review and meta-analysis of studies with the following inclusion criteria: (1) ran... Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=5244544 Fri, 16 Sep 2011 04:00:00 +0100 5244544 http://www.medworm.com/index.php?rid=5244543&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F16%2F5%2F152%3Frss%3D1 Context The incidence of type 2 diabetes is increasing and has been associated with the Westernisation of dietary habits. The Mediterranean dietary pattern (Med diet) may be a way to reduce the incidence of type 2 diabetes. In a trial, it was shown to reduce the need for antidiabetic drugs in diabetic patients,1 and an epidemiological study suggested a lower incidence of diabetes with increasing adherence to the Med diet.2 However, its role in the prevention of diabetes has not been investigated so far in a randomised trial. Methods The Prevención con Dieta Mediterránea (PREDIMED) study is a three-arm randomised trial to assess the effects of two Med diets (supplemented with either olive oil or mixed nuts) versus a low-fat control diet on cardiovascular and other chronic dise... Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=5244543 Fri, 16 Sep 2011 04:00:00 +0100 5244543 http://www.medworm.com/index.php?rid=5244542&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F16%2F5%2F150%3Frss%3D1 Context The debate about whether to treat acute otitis media (AOM) with antibiotics affects nearly all practicing paediatricians. In 2004, the American Academy of Pediatrics (AAP) recommended watchful waiting, long practiced in European countries, as an option in children 6–23 months old with ‘non-severe’ illness and an ‘uncertain’ diagnosis.1 This recommendation was based on clinical trials showing high rates of spontaneous resolution of symptoms, so that an estimated 7–17 children would need to be treated with antibiotics to improve one child's clinical outcomes. However, limitations of previous trials, including variability in diagnostic criteria, participants' ages and antimicrobial and supportive treatments used, have kept the debate alive.2–4... Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=5244542 Fri, 16 Sep 2011 04:00:00 +0100 5244542 http://www.medworm.com/index.php?rid=5244541&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F16%2F5%2F148%3Frss%3D1 Context Several hypertension drug trials have suggested that the intensity of initial treatment may be important in determining blood pressure (BP) responses to incrementally more intense antihypertensive drug therapy over the longer term.1 2 In these studies, diminished early BP response portended less subsequent blood BP lowering despite the addition of extra antihypertensive agents. It has long been the traditional wisdom that attainment and maintenance of BP control over the long term, not the short term, was the most important determinant of risk for pressure-related complications (eg, stroke, retinopathy, heart failure). Accordingly, this assumption was not questioned until the results of the Valsartan Antihypertensive Long-term Use Evaluation (VALUE) trial were reported, which clear... Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=5244541 Fri, 16 Sep 2011 04:00:00 +0100 5244541 http://www.medworm.com/index.php?rid=5244540&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F16%2F5%2F147%3Frss%3D1 Context Type A behaviour pattern, characterised by anger, impatience, competitiveness and time-urgency, was recognised in the 1970s as an important risk factor for coronary heart disease.1 In 1986, a randomised controlled trial, the Recurrent Coronary Prevention Project, found that group therapy to reduce Type A behaviour led to reduced recurrent coronary events in post-myocardial infarction (MI) patients.2 However, difficulty in standardising measurement of Type A behaviour, changes in the medical management of coronary heart disease and an increasing interest in depression as a cardiac risk factor combined to remove Type A behaviour from the foreground of research on psychosocial risk factors in heart disease.3 Still, some studies on anger/hostility and time urgency continued to support ... Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=5244540 Fri, 16 Sep 2011 04:00:00 +0100 5244540 http://www.medworm.com/index.php?rid=5244539&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F16%2F5%2F146%3Frss%3D1 Context Additional interventions to combat the HIV/AIDS epidemic are needed urgently. Prevention interventions using antiretroviral agents to prevent sexually acquired HIV are being studied in humans. Current evidence suggests that, by reducing viral load to undetectable level, combination antiretroviral therapy used to treat and extend the life of HIV-infected individuals may also reduce their infectivity thereby reducing the risk of transmission to their uninfected partners.1 In 2010, a topical antiretroviral-based vaginal microbicide, Tenofovir 1% gel, was shown to reduce HIV acquisition among South African women.2 The iPrEX study is the first multicentre double-blinded randomised trial evaluating the efficacy and safety of antiretroviral drugs used as oral pre-exposure prophylaxis (PrE... Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=5244539 Fri, 16 Sep 2011 04:00:00 +0100 5244539 http://www.medworm.com/index.php?rid=5244538&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F16%2F5%2F144%3Frss%3D1 Context Antiplatelet therapy represents the mainstay of treatment for patients undergoing percutaneous coronary intervention.1 However, an increased risk for gastrointestinal bleeding is associated with use of aspirin and clopidogrel. To reduce the bleeding risk, proton pump inhibitors (PPIs) are prescribed in combination with platelet inhibitors, a strategy that is recommended by existing consensus guidelines2 though no randomised trial has proved this. Recently, a pharmacodynamic drug–drug interaction has been shown for clopidogrel and omeprazole but not for pantoprazole.3 4 Whether this interaction has an impact on patient outcomes has not been investigated in a randomised trial. Methods Clopidogrel and the Optimization of Gastrointestinal Events (COGENT) was a randomised, double-... Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=5244538 Fri, 16 Sep 2011 04:00:00 +0100 5244538 http://www.medworm.com/index.php?rid=5244537&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F16%2F5%2F143%3Frss%3D1 Context Prostatitis represents the most frequent urological diagnosis in men below 50 years of age and the third most common diagnosis among individuals beyond that age.1 Chronic prostatitis (CP) syndromes are traditionally classified as bacterial or abacterial. CP/chronic pelvic pain syndrome (CPPS) (National Institutes of Health (NIH) category III) is diagnosed when patients show signs and symptoms of prostatitis and pelvic pain without evidence of prostatic bacterial infection. Years of clinical research failed to discover a single aetiological factor for CP/CPPS. Therefore, therapy for CP/CPPS is essentially symptomatic and involves the use of antibacterial agents, α-blockers, anti-inflammatory drugs, phytotherapy and so on – alone or in combination. Methods MEDLINE and EMB... Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=5244537 Fri, 16 Sep 2011 04:00:00 +0100 5244537 http://www.medworm.com/index.php?rid=5244536&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F16%2F5%2F142%3Frss%3D1 Context Non-steroidal anti-inflammatory drugs (NSAIDs) are a cornerstone of the treatment of mild to moderate pain and are frequently used on a long-term basis for patients with arthritis. In 2004, rofecoxib, a cyclooxygenase-2 (COX-2) inhibitor, was removed from the market because of an increased risk of cardiovascular events associated with the drug.1 Subsequently, concern has grown about the cardiovascular safety of COX-2 inhibitors and traditional non-selective NSAIDs.2 Multiple studies with varying outcomes have not yet answered which, if any, NSAIDs are safe from a cardiovascular standpoint. Methods This was a network meta-analysis that involved large-scale randomised controlled trials comparing any NSAID with other NSAIDs or placebo. Selected studies had at least two arms with at le... Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=5244536 Fri, 16 Sep 2011 04:00:00 +0100 5244536 http://www.medworm.com/index.php?rid=5244535&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F16%2F5%2F141%3Frss%3D1 Context Recurrent abdominal pain (RAP) is among the most frequent functional disorders in children, consuming immense healthcare resources. Therapeutic approaches are difficult and often unsatisfying. Probiotics are live microorganisms that are perceived to benefit the host beyond their inherent basic nutrition. They have been shown to have beneficial effects on various aspects of human health, and their success in treating childhood diarrhoea and certain chronic inflammatory bowel diseases has led to increased interest in their use in patients with RAP. The rationale is based on trials suggesting a role for intestinal infection, inflammation and food allergies in the pathogenesis of the disorder and observed beneficial effects of probiotics on these pathomechanisms.1 Despite growing inter... Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=5244535 Fri, 16 Sep 2011 04:00:00 +0100 5244535 http://www.medworm.com/index.php?rid=5244534&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F16%2F5%2F139%3Frss%3D1 This article reports the results of two rivaroxaban trials: treatment of acute deep vein thrombosis (DVT) and long-term treatment of DVT or pulmonary embolism (PE) after initial therapy. Methods The acute DVT study is a randomised, open label non-inferiority trial comparing rivaroxaban with standard therapy for acute, symptomatic, proximal DVT. Participants received rivaroxaban 15 mg twice daily for 3 weeks, then 20 mg daily for 3, 6 or 12 months; alternatively, they received enoxaparin 1.0 mg/kg twice daily bridging to... (Source: Evidence-Based Medicine) Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=5244534 Fri, 16 Sep 2011 04:00:00 +0100 5244534 http://www.medworm.com/index.php?rid=5244533&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F16%2F5%2F138%3Frss%3D1 Context Heart failure (HF) is common and associated with considerable mortality and morbidity and decline in quality of life. Since the beginning of this century, cardiac resynchronisation therapy (CRT) has emerged as a new modality to treat patients with HF already on optimal pharmacological treatment. A systematic review of major clinical trials found that CRT, when added to medical treatment, reduces morbidity and mortality in HF patients who have a left ventricular ejection fraction (LVEF) less than 35%, sinus rhythm, QRS>120 ms and advanced HF symptoms.1 Until recently, the efficacy of CRT in less symptomatic HF patients remained the major unanswered question in this field; the Resynchronization/Defibrillation for Ambulatory Heart Failure Trial (RAFT) addressed this specific questi... Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=5244533 Fri, 16 Sep 2011 04:00:00 +0100 5244533 http://www.medworm.com/index.php?rid=5244532&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F16%2F5%2F136%3Frss%3D1 Context Incidence of acute stroke in older people is continuously growing. However, treatment with intravenous tissue plasminogen activator (tPA) in this group of patients is still scarce.1 The majority of clinical trials using thrombolytic treatment have excluded very older people, and although the last European Stroke Organization (ESO) Guidelines support intravenous tPA treatment without age-limit (class III, level C), the terms of tPA-labelled indications do not include patients ≥80 years.2 The study by Mishra and colleagues aimed to evaluate the safety and efficacy of intravenous tPA according to age, especially in very older people, controlled by patients with similar stroke severity without tPA treatment. Methods This is a large retrospective comparison of two different registers... Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=5244532 Fri, 16 Sep 2011 04:00:00 +0100 5244532 http://www.medworm.com/index.php?rid=5244531&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F16%2F5%2F131%3Frss%3D1 Conclusions The impact of bibliographic assistance on clinically important outcomes could not be proven by this study. However, results suggest that some interventions, such as delivering information by hand, might be beneficial in a subgroup of inpatients. (Source: Evidence-Based Medicine) Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=5244531 Fri, 16 Sep 2011 04:00:00 +0100 5244531 http://www.medworm.com/index.php?rid=5244530&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F16%2F5%2F129%3Frss%3D1 Critics of evidence-based medicine (EBM) often ask for randomised trial proof that ‘EBM’ works. The trial1 by Izcovich and colleagues is a laudable attempt to address this gap, but, to interpret it, we need to examine two things: the EBM processes used and the statistical power of the study. EBM is an approach to clinical care and continuing medical education; it is not a single standard process. Different specialties and different individuals have adapted and adopted the principles of EBM to different degrees and in vastly different ways (to learn about some examples of this diversity of processes listen to the podcasts on http://www.cebm.net/index.aspx?o=4648). The EBM process of Izcovich and colleagues focused on a posthospital rounds literature search – an idea that e... Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=5244530 Fri, 16 Sep 2011 04:00:00 +0100 5244530 http://www.medworm.com/index.php?rid=5244529&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F16%2F5%2Fe2%3Frss%3D1 The general purpose of Evidence-Based Medicine is to select from the health-related literature* those articles reporting important advances in internal medicine, general and family practice, surgery, psychiatry, paediatrics, and obstetrics and gynaecology, and whose results are most likely to be both true and useful. These articles are described, critiqued and commented on by clinical experts. The specific purposes of Evidence-Based Medicine are: to identify, using predefined criteria, the best original and review articles on the cause, course, diagnosis, prevention, treatment, quality of care, or economics of disorders in the foregoing fields to provide a description and expert commentary on the context of each article, its methods, and the clinical applications that its findings warrant... Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=5244529 Fri, 16 Sep 2011 04:00:00 +0100 5244529 http://www.medworm.com/index.php?rid=5046395&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F16%2F4%2F127%3Frss%3D1 Context Cervical screening is a highly effective way to reduce the rate of cervical cancer, which is one of the leading causes of death in young women.1 The 2001 Bethesda System divides premalignant glandular lesions into atypical glandular cells (AGC), AGC favour neoplasia and adenocarcinoma in situ. Screening guidelines have typically assigned higher priority to these lesions because of their association with increased rates of gynaecologic malignancy.2 The Taiwanese annual cervical screening programme was launched in 1995, and investigators have analysed this database in order to better categorise the risks associated with AGC. Methods This is a large retrospective cohort trial of Taiwanese women age >30 years from 1994 through 2006. Results of women with AGC were retrieved from the ... Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=5046395 Mon, 18 Jul 2011 23:00:00 +0100 5046395 http://www.medworm.com/index.php?rid=5046394&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F16%2F4%2F125%3Frss%3D1 Context Overweight and obesity are increasing worldwide and present a significant health risk during pregnancy and childbirth. Research efforts have focused on limiting gestational weight gain (GWG). The study by Beyerlein and colleagues evaluated the effect of gestational weight loss (GWL) on pregnancy outcomes. Methods Beyerlein and colleagues describe a population-based retrospective cohort study, involving maternal and infant data from 819 905 singleton pregnancies. After excluding women with missing data (81 371), with unknown date of booking (28 959) and where GWG was considered excessive according to Institute of Medicine (IOM) recommendations (264 252), a final sample of 445 323 was available for analysis. Women were categorised according to body mass index (BMI) at their booking v... Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=5046394 Mon, 18 Jul 2011 23:00:00 +0100 5046394 http://www.medworm.com/index.php?rid=5046393&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F16%2F4%2F124%3Frss%3D1 Context The antiplatelet effect of clopidogrel varies among users as measured by ex vivo platelet function studies and clinical outcomes. Studies have identified common reduced-function variants in the cytochrome P450 enzyme gene, CYP2C19, that are associated with clopidogrel responsiveness. The fully functional form of the gene, designated CYP2C19*1, metabolises clopidogrel from its native prodrug state to its active antiplatelet metabolite more efficiently than CYP2C19*2, found commonly in Caucasians, African Americans and Asians, and CYP2C9*3, common only in Asians. Individuals carrying one of these reduced-function alleles are intermediate metabolisers, whereas those carrying two reduced-function alleles are poor metabolisers. In patients on clopidogrel, these variants have been associ... Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=5046393 Mon, 18 Jul 2011 23:00:00 +0100 5046393 http://www.medworm.com/index.php?rid=5046392&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F16%2F4%2F122%3Frss%3D1 Context Impaired glucose tolerance, which represents an intermediate stage before the onset of diabetes, is associated with an increased risk of cardiovascular diseases. Moreover, the concomitant presence of confirmed cardiovascular disease or cardiovascular risk factors in glucose-intolerant patients significantly augments their risk of cardiovascular events. Among the different treatment strategies used in high-risk patients, blockade of the renin-angiotensin system (RAS) has been shown to decrease the onset of new diabetes as well as the incidence of cardiovascular events. Therefore, the NAVIGATOR study was designed to evaluate the efficacy of blocking the RAS on the incidence of predetermined cardiovascular events such as myocardial infarction and stroke and on the prevalence of new di... Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=5046392 Mon, 18 Jul 2011 23:00:00 +0100 5046392 http://www.medworm.com/index.php?rid=5046391&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F16%2F4%2F121%3Frss%3D1 Context Mineralocorticoid receptor antagonists (MRAs) have been shown to decrease all-cause mortality and cardiovascular (CV) hospitalisation in patients with moderate-to-severe heart failure (HF) (ie, New York Heart Association (NYHA) class III and IV symptoms) with a reduced ejection fraction (EF)1 and in patients with acute myocardial infarction complicated by HF with systolic dysfunction.2 The aim of EMPHASIS-HF was to investigate the effects of eplerenone, in addition to evidence-based background therapy, on clinical outcomes in patients with mild HF (ie, NYHA class II symptoms) with a reduced EF. Methods Patients ≥55 years of age with NYHA functional class II symptoms, an EF ≤30%, treated with an ACE inhibitor/angiotensin receptor blocker and a β-blocker, and a history of ... Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=5046391 Mon, 18 Jul 2011 23:00:00 +0100 5046391 http://www.medworm.com/index.php?rid=5046390&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F16%2F4%2F120%3Frss%3D1 Context Infant apnoea is defined as a cessation of breathing that lasts for more than 20 s, or lasts less than 20 s and is associated with cyanosis, marked pallor, hypotonia or bradycardia.1 Recurrent apnoeas occur frequently in preterm infants, and incidence and severity are inversely related to gestational age.2 It has been previously demonstrated that methylxanthines, such as caffeine and theophylline, can reduce the frequency of apnoeas in preterm infants. However, some short-term adverse effects, such as tachycardia and feeding intolerance, have been reported, and only few trials have investigated potential long-term effects on growth and neurodevelopmental outcome.3 Methods The review aims to determine the effect of methylxanthines on the incidence of apnoea and the need for intermit... Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=5046390 Mon, 18 Jul 2011 23:00:00 +0100 5046390 http://www.medworm.com/index.php?rid=5046389&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F16%2F4%2F118%3Frss%3D1 Context People with epilepsy (PWE) have identified driving as an important factor influencing quality of life and employment. Most countries, provinces and states have laws or guidelines regulating driving privileges following single or recurrent seizures. Driving restrictions for PWE are typically defined by the seizure-free interval (SFI), which varies by jurisdiction. The purpose of such regulations is presumed to be public safety followed by safety of the PWE. Balancing public safety with personal freedom to drive and its potential affect on quality of life may be in conflict. The efficacy of such regulations has been minimally studied. Methods Bonnett and colleagues reanalysed data from the Multicentre study of early Epilepsy and Single Seizures (MESS) study which was originally desig... Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=5046389 Mon, 18 Jul 2011 23:00:00 +0100 5046389 http://www.medworm.com/index.php?rid=5046388&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F16%2F4%2F117%3Frss%3D1 Context Several large randomised controlled trials designed to examine the effect of homocysteine lowering with folic acid and B-vitamin supplementation on cardiovascular disease, cancer and overall mortality were conducted in the past decade and have reported results. However, many of those were designed to detect large reductions in risk and may have been underpowered to detect smaller but still important effects. Therefore, a collaboration between trial investigators was established to pool individual-level results. Methods This is a meta-analysis of individual-level data from trials of folic acid and B-vitamin supplements for the prevention of vascular disease. Trials were considered eligible if they were randomised, double-blinded and placebo controlled; if treatment arms differed onl... Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=5046388 Mon, 18 Jul 2011 23:00:00 +0100 5046388 http://www.medworm.com/index.php?rid=5046387&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F16%2F4%2F116%3Frss%3D1 Context Cortisone injections have been an accepted and recommended treatment for chronic tendinopathies for many years, including tennis elbow (lateral epicondylitis), Achilles tendinopathy and rotator cuff tendinopathy. Most of the recommendations to use cortisone injections are based on case series or controlled studies with short-term follow-up. However, theoretical objections have been raised against the use of cortisone, particularly that tendinopathy is not generally an inflammatory disorder. There have been reported associations of tendon weakening and rupture after cortisone injections. Tendinopathy experts have argued for years that, since inflammation is not a major part of the pathology, anti-inflammatory treatment such as cortisone injections may not be ideal management.1&ndash... Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=5046387 Mon, 18 Jul 2011 23:00:00 +0100 5046387 http://www.medworm.com/index.php?rid=5046386&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F16%2F4%2F114%3Frss%3D1 Context Migraine is an extraordinarily common primary headache disorder, and the majority of sufferers rely solely on non-prescription analgesics such as paracetamol for relief. In a survey of 165 000 individuals in the USA, 68% of people with migraine reported using paracetamol for acute attacks at least monthly, and 35% of those with chronic migraine used paracetamol an average of 19 days monthly.1 Antiemetics like metoclopramide are often prescribed in combination therapy with analgesics like paracetamol. Methods Massey and colleagues systematically evaluated randomised, double-blind, placebo- or active comparator-controlled studies in which paracetamol with or without an antiemetic was used to treat acute migraine attacks. The authors identified studies by searching Cochrane CENTRAL, M... Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=5046386 Mon, 18 Jul 2011 23:00:00 +0100 5046386 http://www.medworm.com/index.php?rid=5046385&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F16%2F4%2F113%3Frss%3D1 Context Cigarette smoking is the leading cause of preventable premature death in the world, with an estimated 5 million smoking-related deaths worldwide. Quitting substantially reduces the health risk associated with smoking. Treatments available for smoking cessation include nicotine replacement therapies (NRTs), bupropion and the most recently marketed, varenicline. Varenicline, an analogue of cytisine, is a partial agonist for the α4β2 subtype of nicotinic cholinergic receptors, which are associated with the addictive effects of nicotine. Varenicline may help smokers quit smoking by reducing the rewarding effects of nicotine as well as attenuating the withdrawal symptoms.1 This meta-analysis evaluated the efficacy and safety of partial nicotine agonists, varenicline or cytisi... Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=5046385 Mon, 18 Jul 2011 23:00:00 +0100 5046385 http://www.medworm.com/index.php?rid=5046384&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F16%2F4%2F112%3Frss%3D1 Context Long-term weight maintenance is difficult, and there is very limited and variable evidence about the value of altering macronutrient composition in order to improve weight maintenance for periods of 6 months or longer. A higher protein diet has been shown to be useful in some longer studies,1–3 but there are no data to support a low-glycaemic index (GI) diet. Methods A total of 1209 overweight and obese adults (body mass index between 27 and 45) were recruited from eight European countries. Eligible participants were aged between 18 and 65 and had at least one healthy child. They were invited to take part in an 8-week low-calorie diet (3.3–4.2 MJ), and those who achieved at least an 8% weight loss were eligible to participate in a 6-month weight-loss maintenance trial. ... Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=5046384 Mon, 18 Jul 2011 23:00:00 +0100 5046384 http://www.medworm.com/index.php?rid=5046383&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F16%2F4%2F110%3Frss%3D1 Context Although traditional non-steroidal anti-inflammatory drugs (tNSAIDs) have been recognised to have adverse effects throughout the gastrointestinal (GI) tract, emphasis has historically centred on reducing their upper GI ulcerogenic effects.1 Randomised trials and systematic reviews have shown that misoprostol and proton pump inhibitors (PPIs) are effective at reducing the risk of tNSAID-related upper GI toxicity. The tNSAID+PPI strategy emerged as the preferred strategy for several reasons including a favourable side effect profile. Over the last 10 years, the focus has shifted towards using cyclooxygenase-2 (COX-2) inhibitors alone as another effective strategy to reduce upper GI toxicity. COX-2 inhibitors, however, have been associated with other adverse effects, and many have bee... Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=5046383 Mon, 18 Jul 2011 23:00:00 +0100 5046383 http://www.medworm.com/index.php?rid=5046382&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F16%2F4%2F109%3Frss%3D1 Context The kidney plays an essential role in the regulation of blood pressure through sodium, volume, renin modulation and renal-sympathetic neuronal interactions. Over many years, the contribution of the renal nerves has been investigated by renal denervation in experimental animal models and by mainly indirect techniques in humans.1 2 Depending on the setting, the contribution to hypertension may be mediated mainly by activation of the efferent or afferent sympathetic renal nerves which lie within and immediately adjacent to the wall of the renal arteries. As the causative factors of hypertension change over time, denervation of efferent and afferent nerves should result in long-term attenuation of hypertension. The importance of the renal nerves in patients with resistant essential hyp... Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=5046382 Mon, 18 Jul 2011 23:00:00 +0100 5046382 http://www.medworm.com/index.php?rid=5046381&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F16%2F4%2F108%3Frss%3D1 Context Ulcerative colitis (UC) is a chronic inflammatory disorder affecting the large bowel. Currently recognised therapies act in controlling the inflammation associated with this disease. However, the intestinal microbiome seems to play a major role in the pathogenesis of the disease. Therefore, the modulation of the gut flora using probiotics has been suggested as a way to maintain balance as well as integrity of the intestinal flora. However, the available evidence is limited in regard to the use of probiotics to induce remission as adjunctive therapy in mild-to-moderate UC – mostly as large, randomised, placebo-controlled trials have yet to be performed. The goal of this study was to assess whether adding VSL#3 to standard maintenance treatment of patients with relapsing mild-t... Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=5046381 Mon, 18 Jul 2011 23:00:00 +0100 5046381 http://www.medworm.com/index.php?rid=5046380&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F16%2F4%2F107%3Frss%3D1 Context Cardiac surgery is associated with a high rate of allogeneic blood transfusion (BT), varying from 40% to 90% in most centres. However, BT may be both beneficial and harmful. Severe anaemia is an independent risk factor for cardiac surgery morbidity and mortality, but BT substantially increases costs and is associated with adverse outcomes, including increased rates of infections, neurologic complications, renal failure and decreased in-hospital and long-term survival after cardiac operations. The decision for transfusion is often based on haemoglobin or haematocrit levels, but there are no evidence-based guidelines on transfusion triggers after cardiac surgery.1 Methods A prospective, randomised, non-inferiority controlled trial was conducted at the Heart Institute of the Universit... Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=5046380 Mon, 18 Jul 2011 23:00:00 +0100 5046380 http://www.medworm.com/index.php?rid=5046379&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F16%2F4%2F105%3Frss%3D1 Context Low back pain disability is the second most common reason for work absence in the UK. Societal costs, all costs attributed to the condition not just medical costs, were £12 billion in the UK in 1998, with the greatest proportion (£11 billion) due to work absence.1 Similar patterns of high societal cost, largely due to work absence, exist throughout the developed world within different healthcare and welfare systems. Despite high societal costs, most back pain trials report clinical outcomes, and the small number of economic evaluations are usually from a healthcare provider's perspective, comparing clinical effectiveness with healthcare cost. A multidisciplinary outpatient programme previously demonstrated to be clinically effective was evaluated for cost-effectiveness,... Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=5046379 Mon, 18 Jul 2011 23:00:00 +0100 5046379 http://www.medworm.com/index.php?rid=5046378&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F16%2F4%2F100%3Frss%3D1 Introduction Critically appraised evidence summaries and practice guidelines can help provide clinicians with answers to clinical questions. Resources that provide such summaries, however, may be limited by the small number of conditions covered.1 Consequently, to answer many clinical questions, physicians may need to access original research reports and critically appraise the design, conduct, analysis and results of each study. Critical appraisal of original research may be a challenge for many physicians as more complicated statistical methods are being reported in the medical literature.2 3 Practicing physicians have a minimal understanding of common statistical tests and limited ability to interpret study results.4–6 A recent study of internal medicine residents showed similarly... Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=5046378 Mon, 18 Jul 2011 23:00:00 +0100 5046378 http://www.medworm.com/index.php?rid=5046377&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F16%2F4%2F97%3Frss%3D1 "The good news is that evidence can matter. The bad news is that it often does not."1 If imitation is the sincerest form of flattery, the clinicians and clinical epidemiologists who promoted evidence-based medicine in the early 1990s should feel flattered. Evidence-based medicine now has many imitators: from evidence-based nursing,2 dentistry3 and public health4 through to evidence-based social work and social interventions.5 6 To this growing list, we can now add evidence-based global health policy, a ‘movement’ that is gaining increasing prominence.7 8 We are firm supporters of this movement. Indeed, we lead a project called the Evidence to Policy initiative (E2Pi), which aims to help narrow the gap between evidence synthesis and practical policymaking in global health. Resea... Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=5046377 Mon, 18 Jul 2011 23:00:00 +0100 5046377 http://www.medworm.com/index.php?rid=5046376&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F16%2F4%2Fe1%3Frss%3D1 The general purpose of Evidence-Based Medicine is to select from the health-related literature* those articles reporting important advances in internal medicine, general and family practice, surgery, psychiatry, paediatrics, and obstetrics and gynaecology, and whose results are most likely to be both true and useful. These articles are described, critiqued and commented on by clinical experts. The specific purposes of Evidence-Based Medicine are: to identify, using predefined criteria, the best original and review articles on the cause, course, diagnosis, prevention, treatment, quality of care, or economics of disorders in the foregoing fields to provide a description and expert commentary on the context of each article, its methods, and the clinical applications that its findings warrant... Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=5046376 Mon, 18 Jul 2011 23:00:00 +0100 5046376 http://www.medworm.com/index.php?rid=4838020&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F16%2F3%2F95%3Frss%3D1 Context Defibrillation is the only effective treatment of cardiac arrest with a shockable rhythm (ventricular fibrillation or pulseless ventricular tachycardia). Defibrillation success declines by approximately 10% for each minute that defibrillation is delayed when there are no chest compressions.1 Cardiopulmonary resuscitation with high-quality chest compressions with minimal interruption are also important. Automated external defibrillators (AEDs) are easy to use, identify the cardiac arrest rhythm and advise a defibrillatory shock, if appropriate. They can be used by individuals without medical training to shorten the time to defibrillation and improve survival for out-of-hospital cardiac arrest.2 AEDs are also widely deployed in hospitals as most staff do not have the rhythm recogniti... Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=4838020 Tue, 17 May 2011 23:00:00 +0100 4838020 http://www.medworm.com/index.php?rid=4838019&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F16%2F3%2F94%3Frss%3D1 In this study, adult patients prescribed with methadone or buprenorphine between 1990 and 2005 in the UK General Practice settings made up a cohort of 5577 persons followed for mortality assessments up to 1 year after their final prescription. Persons included were those... (Source: Evidence-Based Medicine) Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=4838019 Tue, 17 May 2011 23:00:00 +0100 4838019 http://www.medworm.com/index.php?rid=4838018&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F16%2F3%2F93%3Frss%3D1 Context Most women with congenital heart disease can now expect to reach childbearing age. Collectively, congenital malformations are the most common form of heart disease in pregnant women and the leading cardiac cause of maternal morbidity and mortality.1 Over the past two decades, several studies have characterised pregnancy-related changes, assessed maternal and fetal complications and identified related high-risk features. However, risk-stratification attempts have largely focused on acute pregnancy-related complications. Little is known about cardiac outcomes beyond the immediate peripartum setting. It is in this context that Balint and colleagues systematically assessed the frequency and determinants of adverse maternal cardiac events late after pregnancy in women with a broad spect... Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=4838018 Tue, 17 May 2011 23:00:00 +0100 4838018 http://www.medworm.com/index.php?rid=4838017&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F16%2F3%2F91%3Frss%3D1 Context Each year in the USA, approximately 110 000–120 000 children are treated for acute appendicitis. However, the number of children referred for imaging evaluation for suspected appendicitis is much higher. The clinical diagnosis can be challenging, especially in a young child or adolescent girl. Over the last decade, the role of imaging in the evaluation of suspected appendicitis has become well established in adults and children. What remains unclear is which modality should be used under which circumstance. The ideal imaging test would be readily available, fast, inexpensive, reproducible and safe and would accurately distinguish children with appendicitis from those without the disease. Ultrasound fulfils many of these ideal characteristics. However, its biggest limitation i... Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=4838017 Tue, 17 May 2011 23:00:00 +0100 4838017 http://www.medworm.com/index.php?rid=4838016&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F16%2F3%2F90%3Frss%3D1 Context Magnetic resonance angiography (MRA) has been increasingly used to assess peripheral arterial disease over the past decade as an alternative to conventional catheter angiography (digital subtraction angiography (DSA)), which has been the gold standard. Method This meta-analysis by Menke and Larsen selected 32 studies which compared MRA with DSA. The studies were published between 2004 and 2009 and are all prospective. The data are from 1032 adults and an assessment of 18 345 imaged arterial segments. This is a rigorous study. All the articles assessed are high quality with a QUADAS score of >11 and a median score of 13. One factor reducing the scores has been the absence of clinical data, but we agree with the authors that this may not be appropriate in what should be a solely t... Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=4838016 Tue, 17 May 2011 23:00:00 +0100 4838016 http://www.medworm.com/index.php?rid=4838015&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F16%2F3%2F89%3Frss%3D1 Context Despite large-scale, vaccine-based preventive efforts, bacterial meningitis remains an important cause of paediatric morbidity and mortality worldwide.1 2 Definitive diagnosis of meningitis requires a lumbar puncture (LP), which is invasive and technically challenging, particularly in children. Further, the means to analyse the resulting cerebrospinal fluid sample are not universally available. Clinicians frequently confront a child with symptoms or signs concerning for meningitis. Providers rely on the medical history and physical examination to determine whether additional diagnostic and treatment measures are indicated. The utility of symptoms and signs for identifying a subgroup of children at elevated risk for bacterial meningitis, however, is unclear. Methods The authors cond... Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=4838015 Tue, 17 May 2011 23:00:00 +0100 4838015 http://www.medworm.com/index.php?rid=4838014&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F16%2F3%2F87%3Frss%3D1 Context Colonoscopy is a valuable diagnostic and therapeutic tool in colon cancer screening and prevention. Earlier studies have reported higher failure rates and lower adenoma detection rates among patients undergoing colonoscopy in the afternoon,1 2 and poor bowel preparation is considered to be the main cause for these results.2 3 Inadequate bowel preparation can result in longer procedure time, missed lesions and reduced screening intervals, thereby increasing cost and complications. Though there are several factors implicated in successful completion of a colonoscopy, quality of bowel preparation and timing of colonoscopy are considered two modifiable factors4 5 to improve successful completion. Therefore investigators in this study performed a randomised endoscopist-blinded study to ... Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=4838014 Tue, 17 May 2011 23:00:00 +0100 4838014 http://www.medworm.com/index.php?rid=4838013&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F16%2F3%2F85%3Frss%3D1 Context Carotid artery stenosis causes up to 10% of all ischaemic strokes. Carotid endarterectomy (CEA) was introduced in the early 1950s and is an effective surgical treatment to prevent stroke. Carotid stenting (CAS) was introduced as a treatment to prevent stroke in 1994. Since then, both methods have been compared in a considerable number of studies. Three randomised controlled trials aiming to compare the outcome after CAS with CEA have been published in the last 4 years.1–3 Two of the three studies suggested a higher procedural risk in CAS. However, these studies were statistically underpowered to answer the question of whether stenting might be a safe alternative to endarterectomy in specific patient subgroups.4 The present study pooled the data from these three trials and per... Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=4838013 Tue, 17 May 2011 23:00:00 +0100 4838013 http://www.medworm.com/index.php?rid=4838012&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F16%2F3%2F84%3Frss%3D1 Context The aim of the Stanford Girls' health Enrichment Multisite Study (Stanford GEMS) was to reduce weight gain in low-income African American preadolescent girls. The importance of this targeted research is highlighted by recent evidence that severe obesity has increased among Black and American Indian girls while staying the same or decreasing for others.1 Methods Stanford GEMS is a 2-year randomised controlled trial of culturally tailored dance and reducing screen time in after-school community and home settings. Recruitment occurred predominately in African American neighbourhood schools, community centres and churches in Oakland, California, USA. Eligibility criteria included African American or Black child between 8 and 10 years old, a body mass index (BMI) at or higher than the 2... Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=4838012 Tue, 17 May 2011 23:00:00 +0100 4838012 http://www.medworm.com/index.php?rid=4838011&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F16%2F3%2F83%3Frss%3D1 Context In developing countries, a significant proportion of children die following prolonged episodes of diarrhoea. The reasons for this poor outcome include undernutrition, micronutrient deficiencies, stunting and cognitive impairment.1 Currently proposed treatment strategies include fluid replacement and zinc treatment, promotion of early and exclusive breast feeding and vitamin A supplementation, promotion of hand washing using soap, improved water supply and safe storage and community wide sanitation.2 Despite all measures, approximately 3 million disability-adjusted life years lost annually has been associated to persistent diarrhoea.3 Taking into account very high incidence and poor outcome of persistent diarrhoea in developing countries and lack of effective treatment, the authors ... Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=4838011 Tue, 17 May 2011 23:00:00 +0100 4838011 http://www.medworm.com/index.php?rid=4838010&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F16%2F3%2F82%3Frss%3D1 This study evaluated the clinical utility of the therapy in a short stay unit and attempted to... (Source: Evidence-Based Medicine) Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=4838010 Tue, 17 May 2011 23:00:00 +0100 4838010 http://www.medworm.com/index.php?rid=4838009&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F16%2F3%2F80%3Frss%3D1 Context Dual antiplatelet therapy with aspirin and clopidogrel has evolved to form the basis for early treatment of acute coronary syndromes (ACSs). Although initiating aspirin and clopidogrel effectively decreases adverse cardiovascular (CV) events, it also increases the risk of major bleeding. As ischaemic and bleeding complications are strongly related to mortality, it is of paramount importance to maximise efficacy (inhibit thrombotic events) and minimise toxicity (bleeding events). Most patients presenting with ACS undergo percutaneous coronary intervention (PCI) and therefore require antiplatelet regimens with rapid onset and of sufficient intensity. Since clopidogrel has a slow onset of action and wide variability, it has been suggested that a higher loading and maintenance dose is ... Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=4838009 Tue, 17 May 2011 23:00:00 +0100 4838009 http://www.medworm.com/index.php?rid=4838008&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F16%2F3%2F79%3Frss%3D1 Context Shoulder pain can have several causes. The problem is common and often difficult to treat. Acupuncture has long been advocated for the management of various pain syndromes, including shoulder pain. Anecdotal evidence supports its use for this purpose, but clinical trials have yielded mixed findings. Methods In this multicentre patient-blinded study, the German researchers randomised 424 outpatients suffering from shoulder pain for at least 6 weeks who had a pain score of at least 50 mm into three groups: (1) group A received 15 sessions of acupuncture according to the principles of traditional Chinese medicine; (2) group B received 15 sessions of sham acupuncture which consisted of needling at non-acupoints and (3) group C received standard treatment with drugs and physiotherapy. T... Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=4838008 Tue, 17 May 2011 23:00:00 +0100 4838008 http://www.medworm.com/index.php?rid=4838007&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F16%2F3%2F78%3Frss%3D1 Context Randomised trials have shown that screening reduces bowel cancer incidence and mortality, and many countries and health plans have established national or regional screening programmes. Bowel cancer screening has also been incorporated into metrics of primary care quality. High population uptake of bowel screening would maximise societal benefit, but physicians are concurrently interested in assuring that patients are well informed when deciding whether to complete screening. This trial assesses a decision aid designed to enhance informed decision making regarding faecal occult blood test (FOBT) screening. Methods The authors used telephone outreach to recruit subjects residing in socioeconomically deprived areas of New South Wales, Australia, who were eligible for bowel cancer scr... Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=4838007 Tue, 17 May 2011 23:00:00 +0100 4838007 http://www.medworm.com/index.php?rid=4838006&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F16%2F3%2F77%3Frss%3D1 Context Migraine is a common and temporarily disabling neurologic disorder affecting about 11% of the general population in western countries, including the UK and the USA.1 Optimal migraine treatment involves both behavioural interventions and pharmacotherapy.2 Methods Holroyd and colleagues present a four-arm randomised placebo controlled trial in two study centres comparing the separate and joint effects of preventive pharmacotherapy and behavioural intervention in migraine sufferers, following optimisation of acute treatment. Eligible patients were 18 to 65 years of age who met the criteria of the International Classification of Headache Disorders for migraine without aura or migraine with aura. Patients were recruited by both physician referral and advertisements and had to have at le... Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=4838006 Tue, 17 May 2011 23:00:00 +0100 4838006 http://www.medworm.com/index.php?rid=4838005&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F16%2F3%2F75%3Frss%3D1 Context Of the primary headache disorders, tension-type headache (TTH) and migraine account for the majority, with prevalence estimates for migraine between 8.4% and 18% and TTH between 16% and 30% of the population. The socioeconomic burden of headache is huge, with an estimated annual societal cost in the USA of $16.6 billion. A previous smaller meta-analysis1 suggested a beneficial effect of tricyclic antidepressants over placebo for both TTH and migraine. This larger systemic review and meta-analysis aimed to extend previous findings across a larger number of studies, including comparison of tricyclics against selective serotonin reuptake inhibitors (SSRIs). Methods A meta-analysis using the PRISMA method of reporting was undertaken by searching multiple databases up to early 2010. Inc... Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=4838005 Tue, 17 May 2011 23:00:00 +0100 4838005 http://www.medworm.com/index.php?rid=4838004&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F16%2F3%2F74%3Frss%3D1 Context Aortic stenosis is a common condition occurring in 2–4% of adults over the age of 65 years. This prevalence increases with age and it is estimated that up to 2.9% of adults between the ages of 75 and 86 years have severe aortic stenosis.1 Although the annual mortality for patients with asymptomatic stenosis is low (1%),2 once symptoms develop, the prognosis is poor. The mean survival after the onset of heart failure is 11 months, after syncope 27 months and after angina 45 months.3 Current guidelines recommend surgery for patients with severe aortic stenosis who have symptoms or in asymptomatic patients with a left ventricular ejection fraction <50%.4 However, up to 30% of patients with symptoms have numerous concurrent comorbidities and are considered to be too high risk ... Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=4838004 Tue, 17 May 2011 23:00:00 +0100 4838004 http://www.medworm.com/index.php?rid=4838003&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F16%2F3%2F72%3Frss%3D1 Context In the treatment of non-ST-segment elevation acute coronary syndromes (NSTEACS), antithrombotic therapies are indispensible, and a large percentage of these patients undergo diagnostic coronary angiography and percutaneous coronary intervention (PCI). The traditional cornerstone of the antithrombotic regimen in patients with NSTEACS is unfractionated heparin (UFH). Unfortunately, achieving optimal anticoagulation with UFH is difficult, and up to 10% of patients treated with UFH who undergo PCI experience bleeding.1 In an effort to increase the safety of the medical and interventional treatment of NSTEACS, there has been great interest in the use of alternative anticoagulant agents.2 Fondaparinux is an indirect Factor Xa inhibitor that was initially studied for this application in t... Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=4838003 Tue, 17 May 2011 23:00:00 +0100 4838003 http://www.medworm.com/index.php?rid=4838002&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F16%2F3%2F71%3Frss%3D1 Context Ulcerative colitis (UC) is a non-transmural inflammatory disease (inflammatory bowel disease (IBD)) with episodic progression that is restricted to the colon. It results from an inappropriate immune response, in genetically susceptible individuals, to microbial antigens of indigenous flora of the gut. This inappropriate response is promoted by certain environmental factors. There is no cure for UC. Many currently available pharmacological treatments are associated with important adverse effects.1 Low-molecular weight heparin (LMWH) and unfractionated heparin (UFH) best known for their antithrombotic properties were recently discovered to also have anti-inflammatory properties. One potential mechanism was accidently discovered in dialysis patients who were found to have lower tumour... Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=4838002 Tue, 17 May 2011 23:00:00 +0100 4838002 http://www.medworm.com/index.php?rid=4838001&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F16%2F3%2F70%3Frss%3D1 Context Life style including dietary habits and physical activity is an important determinate for health of individuals and populations. Healthcare systems concerned about improving health should thus consider measures to change the present situation. But resources are scarce and such measures will compete with other potential activities for prevention and treatments that also improve health. Cost-utility analysis is a method that can be used to compare different interventions in terms of costs and outcome. This method, usually included in a comprehensive Health Technology Assessment (HTA), is standard in many countries to inform decisions to allocate resources for drugs and other medical technologies. Promoters of patented and chargeable technologies have incentives and resources to suppl... Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=4838001 Tue, 17 May 2011 23:00:00 +0100 4838001 http://www.medworm.com/index.php?rid=4838000&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F16%2F3%2F65%3Frss%3D1 Introduction Improving healthcare through evidence-based practice and policy hinges on decision-making informed by summarised research findings. Deciphering the salience of findings is not straightforward particularly when there are many competing interventions whose effects are evaluated on several outcomes ranging from critical to unimportant and when the strength of the evidence may vary for each. For generating recommendations, the quality of the evidence is assessed to determine the extent to which the estimates of observed effects are likely to be correct for clinically important outcomes. Evidence quality assessments increasingly employ Grading of Recommendations Assessment, Development and Evaluation (GRADE),1 an approach that takes into account several domains including the import... Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=4838000 Tue, 17 May 2011 23:00:00 +0100 4838000 http://www.medworm.com/index.php?rid=4837999&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F16%2F3%2Fe1%3Frss%3D1 The general purpose of Evidence-Based Medicine is to select from the health-related literature* those articles reporting important advances in internal medicine, general and family practice, surgery, psychiatry, paediatrics, and obstetrics and gynaecology, and whose results are most likely to be both true and useful. These articles are described, critiqued and commented on by clinical experts. The specific purposes of Evidence-Based Medicine are: to identify, using predefined criteria, the best original and review articles on the cause, course, diagnosis, prevention, treatment, quality of care, or economics of disorders in the foregoing fields to provide a description and expert commentary on the context of each article, its methods, and the clinical applications that its findings warrant... Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=4837999 Tue, 17 May 2011 23:00:00 +0100 4837999 http://www.medworm.com/index.php?rid=4620463&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F16%2F2%2F63%3Frss%3D1 (Source: Evidence-Based Medicine) Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=4620463 Mon, 21 Mar 2011 00:00:00 +0100 4620463 http://www.medworm.com/index.php?rid=4620462&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F16%2F2%2F60%3Frss%3D1 (Source: Evidence-Based Medicine) Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=4620462 Mon, 21 Mar 2011 00:00:00 +0100 4620462 http://www.medworm.com/index.php?rid=4620461&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F16%2F2%2F59%3Frss%3D1 (Source: Evidence-Based Medicine) Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=4620461 Mon, 21 Mar 2011 00:00:00 +0100 4620461 http://www.medworm.com/index.php?rid=4620460&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F16%2F2%2F57%3Frss%3D1 (Source: Evidence-Based Medicine) Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=4620460 Mon, 21 Mar 2011 00:00:00 +0100 4620460 http://www.medworm.com/index.php?rid=4620459&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F16%2F2%2F55%3Frss%3D1 (Source: Evidence-Based Medicine) Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=4620459 Mon, 21 Mar 2011 00:00:00 +0100 4620459 http://www.medworm.com/index.php?rid=4620458&cid=s_28855_49_f&fid=28855&url=http%3A%2F%2Febm.bmj.com%2Fcgi%2Fcontent%2Fshort%2F16%2F2%2F53%3Frss%3D1 (Source: Evidence-Based Medicine) Evidence-Based Medicine journals http://www.medworm.com/rss/comments.php?id=4620458 Mon, 21 Mar 2011 00:00:00 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