By Brian S. Alper, MD, MSPH, and Colin P. Kopes-Kerr, MD, MPH, JD, Author at Clinical Advisor

By Brian S. Alper, MD, MSPH, and Colin P. Kopes-Kerr, MD, MPH, JD

All articles by By Brian S. Alper, MD, MSPH, and Colin P. Kopes-Kerr, MD, MPH, JD

Upper respiratory infection

Also called Common cold, upper respiratory tract infection (URTI), acute rhinitis, acute nasopharyngitis, acute rhinosinusitis ICD-9 codes 460 acute nasopharyngitis (common cold) 465.0 acute laryngopharyngitis 465.8 acute upper respiratory infections (URIs) of other multiple sites 465.9 acute URIs of unspecified site Incidence Average U.S. adult has two to four colds per year; average schoolchild has…

Evidence-based medicine on the Web

Tapping into the latest scientific findings is not just for the academic elite. All you need is access to the Internet. Here’s a review of four Web resources. The heart of evidence-based medicine is the application of the latest and best research to clinical practice. Thanks to online resources—including one that I developed—clinicians can conveniently…

STATINS MAY BE ASSOCIATED WITH INCREASED CANCER RISK IN OLDER PATIENTS

Level 2: Mid-level evidence In a systematic review, cancer outcomes were analyzed in 35 randomized trials of statins studied for cardiovascular benefits in a total of 109,143 patients (J Clin Oncol. 2006;24:4808-4817). The Prospective Study of Pravastatin in the Elderly at Risk (PROSPER) trial was the only one to show a statistically significant increase in…

EXTENDED ANTICOAGULATION REDUCES RISK OF RECURRENT VENOUS THROMBOEMBOLISM

Level 1: Likely reliable evidence A randomized trial evaluated the efficacy of extended anticoagulation in 608 patients aged 18-85 years with first episodes of symptomatic, unprovoked venous thromboembolism (deep venous thrombosis and/or pulmonary embolism) who completed at least three months of oral anticoagulation (warfarin or acenocoumarol to a target international normalized ratio of 2-3) (N…

ACETAMINOPHEN AND HYOSCINE BUTYLBROMIDE EACH MAY IMPROVE CRAMPY ABDOMINAL PAIN

Level 2: Mid-level evidence The efficacy of acetaminophen (Tylenol and others) and hyoscine butylbromide alone and in combination was evaluated in a study of 1,935 patients aged 18-70 years who had recurrent crampy abdominal pain for at least two months (Aliment Pharmacol Ther. 2006;23:1741-1748). The single-blind trial had a one-week placebo run-in period; bowel habits…

EARLY AMBULATION FOR DVT APPEARS SAFE AND MAY BE BENEFICIAL

Level 2: Mid-level evidence Early mobilization was associated with a lower incidence of deep venous thrombosis (DVT) progression in a randomized trial of 103 patients hospitalized for proximal DVT, but the results did not reach statistical significance (Curr Med Res Opin. 2006;22:593-602). Patients were randomized to five days of strict bed rest vs. early mobilization;…

INSPIRATORY MUSCLE TRAINING REDUCES PULMONARY COMPLICATIONS IN HIGH-RISK CABG PATIENTS

Level 1: Likely reliable evidence Preoperative inspiratory muscle training prevented pneumonia in a randomized trial of 279 patients undergoing coronary artery bypass graft (CABG) surgery who were at high risk for pulmonary complications (JAMA. 2006;296:1851-1857). High risk was defined as forced expiratory volume in one second (FEV1) <80% predicted and ratio of FEV1 to forced…

CAREGIVER SUPPORT DELAYS NURSING-HOME PLACEMENT FOR PATIENTS WITH ALZHEIMER’S DISEASE

Level 2: Mid-level evidence Caregiver support was evaluated in a randomized trial of 406 spouse-caregivers of community-dwelling patients with Alzheimer’s disease (AD) (Neurology. 2006;67:1592-1599). Caregivers were randomized to enhanced counseling and support intervention vs. usual care until the caregiver became too ill to participate or two years after the patient died. Caregivers had to be…

AMOXICILLIN TREATMENT FOR THREE DAYS vs. EIGHT DAYS

Level 2: Mid-level evidence A recent trial involved 121 adults hospitalized for community-acquired pneumonia who were improved after three days of IV amoxicillin (BMJ. 2006;332:1355; full-text available online without charge at: http://bmj.bmjjournals.com, accessed February 7, 2007). Following completion of the IV amoxicillin, patients were randomized to oral amoxicillin 750 mg three times daily for five…

EXTRACORPOREAL SHOCK WAVE THERAPY APPEARS INEFFECTIVE FOR LATERAL ELBOW PAIN

Level 2: Mid-level evidence Extracorporeal shock wave therapy (ESWT) for treatment of lateral elbow pain (tennis elbow) seemed ineffective in a Cochrane review, but the evidence is conflicting (Cochrane Database Syst Rev. 2005;[4]:CD003524). Nine randomized, placebo-controlled trials (involving 1,006 patients) and one comparison trial with steroid injections in 93 patients were systematically reviewed. Five of…

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