Are fondaparinux (Arixtra) injections preferable to warfarin (Coumadin) for management of anticoagulation in postoperative hip-fracture patients and those recovering from joint replacement surgery? Warfarin works just fine and prevents deep venous thrombosis (DVT) and pulmonary embolism for prolonged periods of time.—Patricia White, ARNP, Vero Beach, Fla. I was unable to find a head-to-head trial in…
Level 2: Mid-level evidence The efficacy of psychotherapeutic support was evaluated in a randomized trial of 271 patients having surgery for cancer of the liver/gallbladder, pancreas, colon/rectum, esophagus, or stomach (J Clin Oncol. 2007;25:2702-2708). Patients were randomized to support provided by psychotherapists during both pre- and postoperative hospital stay. Psychotherapists provided emotional and cognitive support…
Level 1: Likely reliable evidence A randomized trial evaluated 133 women with mild pelvic inflammatory disease (PID). They were treated with ceftriaxone 250 mg IM and then randomized to azithromycin 1 g orally once weekly for two weeks vs. doxycycline 200 mg once daily for 14 days (test dose 200 mg once given on days…
Level 1: Likely reliable evidence …BUT AVOIDING HIGH CAFFEINE DOSES IS GENERALLY RECOMMENDED Level 2: Mid-level evidence A randomized trial evaluated the effect of caffeine in 1,207 pregnant women who drank at least three cups of coffee per day (BMJ. 2007;334:409; full-text available online free of charge at: www.bmj.com/cgi/, accessed November 12, 2007). Women were…
Level 1: Likely reliable evidence A systematic Cochrane review evaluated 47 randomized placebo-controlled trials of inhaled corticosteroids (ICS) involving 13,139 patients with stable chronic obstructive pulmonary disease (COPD) (Cochrane Database Syst Rev. 2007[2]:CD002991). Most trials were of good quality. Comparing ICS vs. placebo, there were no significant differences in mortality: 8% vs. 8% in nine…
Level 2: Mid-level evidence The risk of cancer was evaluated as a secondary outcome in a randomized trial of 1,024 healthy, community-dwelling, postmenopausal women older than 55 years in rural Nebraska (Am J Clin Nutr. 2007;85:1586-1591). The subjects were randomly assigned to receive 1,400-1,500 mg of supplemental calcium/day alone, supplemental calcium plus 1,100 IU vitamin…
Cervical, ovarian, and uterine cancer are potentially deadly. Follow these prevention and detection strategies to reduce their toll. One of every three women in the United States will develop cancer at some point, according to the American Cancer Society (ACS).1 Of the 10 most common malignancies, three are gynecologic—cervical, ovarian, and uterine. By incorporating prevention…
Even though HIV is preventable, about 40,000 Americans are newly infected every year. Primary-care clinicians can help reduce that number.
Most suicidal persons give their primary-care provider an opportunity to intervene, but clinicians often let it slip by. Here’s what you should be alert for. As many as three out of four people who commit suicide have seen a primary-care provider within 30 days, statistics show. Yet, in a new study in which actresses portrayed…
There are changes in the wind for patients with osteoporosis and their clinicians. But don’t underestimate currently available therapies.
