Untitled. Clinicians and patients need to interpret a multitude of medical measurements.
These are often central to monitoring health and informed decision making. Has the serum cholesterol concentration come down since starting a statin? Trick of the Trade: Combine Adenosine with the Flush. “6 mg IV as a rapid IV push followed by a 20 mL saline flush; repeat if required as 12 mg IV push” This recommendation remained in the 2015 iteration.
While most drugs are metabolized in the liver, adenosine doesn’t even make it that far, being metabolized in the erythrocytes and vascular endothelial cells. With this extremely short half-life (10 seconds), it is important to help it reach the heart before it’s metabolized and excreted without being effective. Effect of anticoagulants and NSAIDs on accuracy of faecal immunochemical tests (FITs) in colorectal cancer screening: a systematic review and meta-... - PubMed - NCBI. Drinking More Water for Prevention of Recurrent Cystitis. For decades, it has been said that increasing fluid intake could help prevent or cure urinary tract infections.
In this issue of JAMA Internal Medicine, a randomized clinical trial confirms that folk wisdom. Hooton and colleagues1 randomized women with 3 or more episodes of cystitis in the prior year to consume 1.5 L of water per day (three 0.5-L bottles) in addition to their usual intake, or to consume no additional water. The women who consumed additional water had an approximately 50% reduction in number of cystitis episodes in the year after randomization and were prescribed fewer antibiotics. We realize that this trial was not blinded, the primary outcome was self-reported, and it was sponsored by Danone Research, which sells the bottled water used in this study. However, the research question is important and the intervention was safe, easy, and effective (and it would be impossible to blind a trial in which drinking water is the intervention). Managing osteoarthritis: evidence gives new insights on two common treatments. In this blog for our Evidence for Everyday Health Choices series, Sarah Chapman looks at new Cochrane evidence on two treatments for hip and knee osteoarthritis: paracetamol and exercise.
This week two things have prompted me to blog about osteoarthritis, a very common condition in the UK, where almost one in five people aged 50 and older have disabling knee or hip pain. The first is a newly updated Cochrane Review on the effects of paracetamol for people with osteoarthritis of the hip or knee. Might there be new evidence to move forward the debate about whether it is actually helpful or safe? Taking a fresh look at paracetamol If you go to your doctor with osteoarthritis pain, it is likely that the first thing they will suggest you try is paracetamol. Respiratory Tract Infections in Children in the Community: Prospective Online Inception Cohort Study. - PubMed - NCBI. Reduced Salt Intake for Heart Failure: A Systematic Review. - PubMed - NCBI. Is Sunscreen the New Margarine? Association Between Calcium or Vitamin D Supplementation and Fracture Incidence in Community-Dwelling Older Adults.
Switch over from intravenous to oral therapy: A concise overview. Effect of Increased Daily Water Intake in Premenopausal Women With Recurrent Urinary Tract Infections: A Randomized Clinical Trial. - PubMed - NCBI. Opioids no more effective for treating chronic pain than over-the-counter options, study finds. Opioids are no better at treating chronic pain than over-the-counter pain relievers such as ibuprofen and naproxen, according to a study that raises questions about how often the drugs are prescribed, considering the risks they pose.
The study, published Tuesday in the Journal of the American Medical Association, was an analysis of nearly 100 studies on the effectiveness of opioids at treating chronic non-cancer pain. The studies compared opioids to a placebo as well as other pain-relieving drugs. The researchers concluded that opioids are slightly better than a placebo at treating pain and provide similar benefits as non-steroidal anti-inflammatory drugs such as ibuprofen and naproxen. The findings also suggest opioids are no better than antidepressants for treating pain, but that they may provide better pain relief than anticonvulsant drugs such as gabapentin and pregabalin. “[Opioids] won’t work for most patients.
Dr. Effects of vitamin D supplementation on musculoskeletal health: a systematic review, meta-analysis, and trial sequential analysis - The Lancet Diabetes & Endocrinology. Gout BMJ - The role of diet in serum urate concentration. Core IM: Mind the Gap on UTI’s and Delirium – Clinical Correlations. Obesity alone does not increase risk of death: New study could change the way we think about obesity and health. Bed rest: a potentially harmful treatment needing more careful evaluation. - PubMed - NCBI. Isopropyl Alcohol Nasal Inhalation for Nausea in the Emergency Department: A Randomized Controlled Trial. - PubMed - NCBI. Z-drugs and risk for falls and fractures in older adults-a systematic review and meta-analysis. - PubMed - NCBI.
A robust association between some classes of anticholinergic drugs and future dementia incidence was observed. This could be caused by a class specific effect, or by drugs being used for very early symptoms of dementia. Are Fasting Lipids Necessary? By Anthony MartePeer Reviewed It is a common sequence of dialogue in clinic: “I’d like to draw some blood for cholesterol,” says the doctor.
“Have you eaten today?” With downcast eyes, the patient replies, “Yes, I had a snack. I just got so hungry.” The well-intentioned physician concedes, “That’s okay. Patients requiring lipid panels frequently report to their clinic appointments in the non-fasting state. The preference for fasting lipids in primary hyperlipidemia screening is decades old. LDL cholesterol= total cholesterol – HDL cholesterol – [triglycerides/5] Former guidelines, including the Adult Treatment Panel III of 2001, emphasized specific LDL cholesterol goals based on cardiovascular risk in primary prevention patients.3 Recent food intake significantly raises triglycerides and has very little effect on the other components of the lipid panel. The lipid panel has clinical implications beyond just primary prevention, however. Dr. The Skeptics Guide to Emergency Medicine.
As you know, the BEEM Team of Drs.
Crocco, Milne and Upadhye was in Sweden last month for SweetBEEM. This was one of the best BEEM trips ever for a variety of reasons. Members of BEEM were asked to speak at their National Emergency Medicine conference while in Stockholm. I was invited to debate the evidence for thrombolysis in acute CVA with Dr. Kjell Asplund. Want to predict a child's future health? First measure their stress, says researcher.
We've all been told that stress is harmful to our health.
But new evidence suggests that children who suffer stressful or traumatic events could suffer life-long consequences. The events are known as adverse childhood experiences (ACEs), which range from parental separation to sexual abuse. Researchers have discovered that they're clear indictors of a child's future health outcomes. The culprit is the stress hormone cortisol, which is toxic to a child, said Jennifer Mervyn, a psychologist and ACE consultant. "The impact on the brain is significant," Mervyn said during an interview on CBC's The Early Edition. The study could have broader implications in B.C., which is grappling with an opioid overdose crisis. Sequential application of non-pharmacological interventions reduces the severity of labour pain, delays use of pharmacological analgesia, and impro... - PubMed - NCBI. Morning sickness drug Diclectin doesn't work, confidential industry documents reviewed by doctor show - Health.
Confidential industry data reveals a morning sickness pill taken by hundreds of thousands of Canadian women did not meet the company's own targets for efficacy.
The drug is called Diclectin, a combination of vitamin B6 and a common antihistamine, and is recommended as a treatment for women suffering from nausea and vomiting during pregnancy. Canadian doctors write 300,000 prescriptions for Diclectin every year. 'I don't think it should be prescribed. I don't think patients should take it.' - Dr. Nav Persaud, family doctor and researcher at St. Yet when Toronto family doctor Nav Persaud reanalyzed the original data from a 2009 manufacturer-funded clinical trial, he could find no evidence the pill was effective.
Acute Kidney Injury After Computed Tomography: A Meta-analysis. - PubMed - NCBI. Effectiveness of Light Therapy in Cognitively Impaired Persons: A Metaanalysis of Randomized Controlled Trials. - PubMed - NCBI. Mother-Infant Room-Sharing and Sleep Outcomes in the INSIGHT Study. Long-Term Oral Bisphosphonate Therapy and Fractures in Older Women: The Women's Health Initiative. - PubMed - NCBI. A guide to more efficient medical screenings whether you're 35 or 75.
In 1976, the government formed the Canadian Task Force on the Periodic Health Examination.
The task force was given a daunting task: come up with a comprehensive plan for protecting the health of Canadians. After 3 years of deliberation they concluded, "…that the annual check-up, as practiced almost ritualistically for several decades in North America, be abandoned. " Yet forty years later, we're still doing it. The main issue with the routine, annual check-up is that it's an inefficient way to screen for disease and casts too wide a net. Effect of Intra-articular Triamcinolone vs Saline on Knee Cartilage Volume and Pain in Patients With Knee Osteoarthritis: A Randomized Clinical Trial. Effect of Intra-articular Triamcinolone vs Saline on Knee Cartilage Volume and Pain in Patients With Knee Osteoarthritis: A Randomized Clinical Trial.
 Is cyclobenzaprine useful for pain? Cyclobenzaprine is a tricyclic molecule discovered in 1956 that is structurally related to amitriptyline and imipramine. Levocetirizine and Prednisone Are Not Superior to Levocetirizine Alone for the Treatment of Acute Urticaria: A Randomized Double-Blind Clinical Trial. Faster clean catch urine collection (Quick-Wee method) from infants: randomised controlled trial. MMS: Error. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Myths in Emergency Medicine: Still Prescribing Oseltamivir? : Emergency Medicine News.
Let's start this one at the end: Oseltamivir, better known as Tamiflu to everyone else on the planet, is a dud of a drug. There is plenty more to discuss on the subject, but these are the highlights, courtesy of a truly remarkable and headline-making Cochrane review by Tom Jefferson, MD, and colleagues: * It does not decrease hospitalizations in patients with influenza. * It does not decrease complications of influenza. * It makes patients vomit. (NNTH=22 in adults, 19 in kids.) * It messes with the mind. . * It hurts the head. . * It can kick the kidneys. Rethinking cellulitis. From the February ACP Hospitalist, copyright © 2017 by the American College of Physicians By Amy Karon Busy hospitalists and emergency department physicians frequently diagnose their patients with cellulitis.
But they are often mistaken, research shows. Update on Preventative Health Checklist. Abstract Objective To describe updates to the Preventive Care Checklist Form© to help family physicians stay up to date with current preventive health care recommendations. Quality of evidence The Ovid MEDLINE database was searched using specified key words and other terms relevant to the periodic health examination. Secondary sources, such as the Canadian Task Force on Preventive Health Care, the Public Health Agency of Canada, the Trip database, and the Canadian Medical Association Infobase, were also searched. Cardiac Monitoring Is Unnecessary for Most Patients with Chest Pain in the Emergency Department.
Physiotherapy of No Benefit for Ankle Sprain. Physiotherapy after a simple acute ankle sprain does not hasten functional recovery when compared with basic self-management, according to a large Canadian randomized controlled trial. But while the 2 groups showed little clinical difference, fewer than half of all study participants reported excellent recovery 3 months after injury, suggesting the need for more effective interventions, according to the authors. The study included 503 adults with ankle sprains that were grade 1 (mechanically stable) or grade 2 (some joint laxity) who came to either of 2 hospitals’ emergency departments. Statin Use and the Risk of Parkinson's Disease: An Updated Meta-Analysis. Comparison of Sterile vs Nonsterile Gloves in Cutaneous Surgery and Common Outpatient Dental Procedures: A Systematic Review and Meta-analysis.
Ondansetron, metoclorpomide, placebo for nausea in ER. Figure 1 CONSORT diagram of patient flow. Figure 2. TB screening prior to long term care admission: time to choose wisely. I recently had a patient who was accepted for admission into long-term care, and I completed the usual paperwork detailing their active problem list, past history, medications, vaccinations, and last chest x-ray (for TB screening purposes). A few days later, I received a call from the long-term care home. The patient’s chest x-ray was not done recently enough.
Naproxen With Cyclobenzaprine, Oxycodone/Acetaminophen, or Placebo for Treating Acute Low Back Pain. Importance Low back pain (LBP) is responsible for more than 2.5 million visits to US emergency departments (EDs) annually. These patients are usually treated with nonsteroidal anti-inflammatory drugs, acetaminophen, opioids, or skeletal muscle relaxants, often in combination. Spontaneous Subarachnoid Hemorrhage: A Systematic Review and Meta-analysis Describing the Diagnostic Accuracy of History, Physical Examination, Ima... Vitamin D deficiency is widely overestimated, U.S. doctors warn - Health. Vitamin D pill use grew from 5 per cent of Americans in 1999 to 19 per cent in 2012. (Lawrence Looi/EPA) Doctors are warning about vitamin D again, and it's not the "we need more" news you might expect. Instead, they say there's too much needless testing and too many people taking too many pills for a problem that few people truly have.
The nutrient is crucial for strong bones and may play a role in other health conditions, though that is far less certain. Misunderstandings about the recommended amount of vitamin D have led to misinterpretation of blood tests and many people thinking they need more than they really do, some experts who helped set the levels write in Thursday's New England Journal of Medicine. Correctly interpreted, less than 6 per cent of Americans ages 1 to 70 are deficient and only 13 per cent are in danger of not getting enough. That's concerning, "but these levels of deficiency do not constitute a pandemic," the authors write. Choosing Wisely®: Things we do for no reason - Feldman - 2015 - Journal of Hospital Medicine.
Efficacy, Tolerability, and Dose-Dependent Effects of Opioid Analgesics for Low Back Pain: A Systematic Review and Meta-analysis. Suicide risk and absconding in psychiatric hospitals with and without open door policies: a 15 year, observational study. To view the full text, please login as a subscribed user or purchase a subscription. Click here to view the full text on ScienceDirect. Summary Background. Characteristics and Outcomes of Patients Presenting With Hypertensive Urgency in the Office Setting. Effectiveness of N95 respirators versus surgical masks in protecting health care workers from acute respiratory infection: a systematic review and. Efficacy and safety of paracetamol for spinal pain and osteoarthritis: systematic review and meta-analysis of randomised placebo controlled trials. Gustavo C Machado, PhD student1, Chris G Maher, director1, Paulo H Ferreira, senior lecturer2, Marina B Pinheiro, PhD student2, Chung-Wei Christine Lin, associate professor1, Richard O Day, professor34, Andrew J McLachlan, professor56, Manuela L Ferreira, associate professor17Author affiliationsCorrespondence to: G C Machado firstname.lastname@example.orgAccepted 4 February 2015 Abstract.