June 01, 2009 Archives - Clinical Advisor

Print Issue: June 01, 2009

Prostate cancer screening may not reduce mortality

Level 2: Mid-level evidenceIn two recent randomized trials, prostate cancer screening did not appear to show clinically significant benefits. The large European Randomized Study of Screening for Prostate Cancer (ERSPC) evaluated prostate-specific antigen (PSA) testing in 182,000 men with median follow-up of nine years (N Engl J Med. 2009;360:1320-1328; available at content.nejm.org/cgi/content/full/360/13/1320, accessed May 12,…

PCI with paclitaxel-eluting stent might be alternative to CABG

Level 1: Likely reliable evidenceIn patients with three-vessel and/or left main coronary artery disease (CAD), percutaneous coronary intervention (PCI) with paclitaxel-eluting stents is equivalent to coronary artery bypass grafting (CABG) for overall mortality and MI rate at 12 months. PCI patients had increased risk for repeat revascularization procedures but a reduced risk of subsequent stroke…

Nevada revamps its medical board

Nevada has overhauled the state medical board’s discipline procedures in an effort to make them more responsive to dangerous practices and more open to public scrutiny.

Dronedarone may reduce both hospitalization and cardiovascular mortality in AF patients

Level 2: Mid-level evidenceRhythm control strategies for atrial fibrillation (AF) have not been shown to be generally more beneficial compared with rate control. Most patients with rhythm control will have some amount of intermittent AF that necessitates anticoagulation. The principal benefit is for patients who cannot tolerate the symptoms of AF.  A recent randomized trial…

The truth about drinking

When obtaining a social history, ask “How much do you drink?” rather than “Do you drink?” This question is less judgmental and more likely to get a truthful answer. The response can be most revealing (especially if the patient is an adolescent or young adult).—APRIL SCRUGGS, MSN, FNP-C, Evington, Va. (128-16)

Laparoscopic hernia repair in children increases pain and surgery time

Level 1: Likely reliable evidenceA randomized trial compared laparoscopic and open surgery in 90 children aged 4 months to 16 years with unilateral inguinal hernia (Pediatrics. 2009;123:332-337). Laparoscopic repair was associated with longer times in the operating room (63 vs. 38 minutes, P <.001) and day surgery ward (300 vs. 230 minutes, P <.001) and…

Non-group A strep: A continuing debate

Since Dr. Spak believes we should treat non-group A strep and I do not (Items 114-25 and 115-26), I would like to see conclusive evidence-based data that “treatment is definitely indicated” in patients with significant clinical complaints and positive testing for non-group A strep. A number of references, including some from the Infectious Diseases Society…

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