June 01, 2007 Archives - Page 3 of 7 - Clinical Advisor

Print Issue: June 01, 2007

SOY MILK AND THE MENSTRUAL CYCLE

Can regular consumption of soy milk cause changes in a woman’s menstrual cycle?—Laura Sullivan, MD, Downey, Calif. Soy milk contains relatively low concentrations of plant estrogens (isoflavones). Therefore, it is extremely unlikely that regular consumption of soy milk will alter normal menstrual cyclicity. In one study in which Asian soy foods containing about 32 mg…

C PEPTIDE IN DIABETES MANAGEMENT

What is the role of C peptide in managing uncontrolled type 2 diabetes?—Ndukwe H. Odeluga, MD, Bakersfield, Calif. Cleaved from proinsulin to make mature insulin, C peptide can be considered a marker of endogenous insulin secretion. It is used in research studies on diabetes patients to help classify the etiology of their disease, as low…

PREOPERATIVE INSPIRATORY MUSCLE TRAINING REDUCES 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…

MAMMOGRAPHY SCREENING FROM AGE 40-48 YEARS MIGHT REDUCE BREAST CANCER MORTALITY

Level 2: Mid-level evidence A randomized trial conducted in England, Wales, and Scotland evaluated mammography screening in 160,921 women aged 39-41 years (Lancet. 2006;368:2053-2060). Women were randomized to annual mammography screening to age 48 years vs. usual medical care. At mean follow-up of 10.7 years, overall mortality was 1.66 per 1,000 women-years with annual mammography,…

DEXAMETHASONE MORE EFFECTIVE THAN PREDNISOLONE FOR CROUP

Level 1: Likely reliable evidence The efficacy of two different corticosteroid treatments for croup was evaluated in a randomized trial of 133 children aged 3-142 months with mild-to-moderate croup in a pediatric emergency department (ED) (Arch Dis Child. 2006;91:580-583). Participants were randomized to a single oral dose of dexamethasone 0.15 mg/kg vs. prednisolone 1 mg/kg.…

CPAP REDUCES SLEEPINESS IN MILD-TO-MODERATE SLEEP APNEA

Level 1: Likely reliable evidence Continuous positive airway pressure (CPAP) has been found to be effective in reducing sleepiness and improving quality of life in moderate-to-severe obstructive sleep apnea (OSA), based on a systematic review of 36 randomized trials that evaluated nocturnal CPAP (for at least two weeks) in 1,718 adults with OSA (Cochrane Database…

FRAMINGHAM RISK SCORES MAY BE INACCURATE FOR PREDICTING CVD

Level 2: Mid-level evidence A systematic review evaluated prediction of coronary or cardiovascular disease (CVD) risk with Framingham risk scores (Anderson or Wilson methods) in 27 studies with 71,727 participants (Heart. 2006;92:1752-1759). For the outcome of coronary heart disease (CHD), evaluated in 20 studies, the predicted-to-observed ratios ranged from 0.43 (underprediction) in people with a…

RULE FOR TERMINATION OF RESUSCITATION OF OUT-OF-HOSPITAL CARDIAC ARREST

Level 2: Mid-level evidence For out-of-hospital cardiac arrest, a clinical prediction rule recommends termination of resuscitation when three criteria are met: (1) no return of spontaneous circulation before transport to the hospital, (2) no shock given before transport to the hospital, (3) arrest not witnessed by emergency medical services (EMS) personnel. This rule was evaluated…

CELECOXIB AND SUSTAINED-RELEASE ACETAMINOPHEN HAVE SIMILAR EFFICACY IN MOST PATIENTS WITH OSTEOARTHRITIS

Level 1: Likely reliable evidence Seventy-nine adults with osteoarthritis pain for at least one month were enrolled in a trial program to compare sustained-release paracetamol (acetaminophen) 1.33 g three times daily vs. celecoxib (Celebrex) 200 mg once daily (or twice daily if patient was already using celecoxib) (Rheumatology. 2007;46:135-140). Treatments were given for two weeks…

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