By Arlene Seid, MD, MPH, and Brian S. Alper, MD, MSPH, Author at Clinical Advisor

By Arlene Seid, MD, MPH, and Brian S. Alper, MD, MSPH

All articles by By Arlene Seid, MD, MPH, and Brian S. Alper, MD, MSPH

CT showing a large infarct in the left hemisphere of a stroke patient

t-PA increases intracranial hemorrhage, but functional outcomes are inconsistent

Level 1: Likely reliable evidenceThe randomized placebo-controlled European Cooperative Acute Stroke Study III (ECASS III) evaluated alteplase (Activase, tissue-type plasminogen activator [t-PA]) in 821 patients aged 18-80 years with acute ischemic stroke (N Engl J Med. 2008;359:1317-1329). Alteplase 0.9 mg/kg (up to 90 mg) or placebo was given IV within 3-4.5 hours of non-severe stroke…

Exercise reduces pain and improves function in patients with knee osteoarthritis

Level 1: Likely reliable evidenceTherapeutic exercise of the knee (strength training in particular) reduces pain and improves physical function in patients with knee osteoarthritis, based on two systematic reviews. A Cochrane review of 32 randomized trials compared land-based therapeutic exercise vs. nonexercise (Cochrane Database Syst Rev. 2008[4]:CD004376). Exercise reduced knee pain in a meta-analysis with…

Early insulin infusion vor VLBW infants may increase mortality and hypoglycemia

Level 2: Mid-level evidenceEarly continuous insulin infusion in very-low-birth-weight (VLBW) infants aged 1-7 days is associated with significantly increased mortality at 28 days and increased hypoglycemia, based on an open-label randomized trial involving 389 participants (N Engl J Med. 2008;359:1873-1884). In infants receiving insulin, mortality at 28 days was 11.9% (vs. 5.7% with standard care);…

CT colonography identified 90% of asymptomatic adults with polyps >10 mm

Level 1: Likely reliable evidenceA prospective cohort study evaluated 2,600 participants aged 50 years and older who had colon cancer screening with multidetector CT colonography and same-day colonoscopy (N Engl J Med. 2008;359:1207-1217). Analysis included 2,531 participants (97%) with complete colonographic and colonoscopic results. The reference standard was colonoscopy with histologic confirmation. Prevalence of lesions…

IV ceftriaxone no more effective than oral doxycycline for mild Lyme neuroborreliosis

Level 2: Mid-level evidenceThe efficacy of oral doxycycline was compared with that of IV ceftriaxone (Rocephin) in a randomized trial of 118 patients with Lyme neuroborreliosis (Lancet Neurol. 2008;7:690-695). Patients were randomized to oral doxycycline 200 mg plus IV placebo vs. IV ceftriaxone 2 g plus oral placebo once daily for 14 days. Analysis based…

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