Level 1: Likely reliable evidence The efficacy of zoledronic acid after hip fracture was evaluated in 2,127 patients (1,619 women and 508 men) aged 50 years and older (N Engl J Med. 2007;357:1799-1809). The Health Outcomes and Reduced Incidence with Zoledronic Acid Once Yearly (HORIZON) Recurrent Fracture Trial randomized patients within 90 days after surgical…
Level 2: Mid-level evidence A systematic review of 15 randomized trials evaluated short course (≤7 days) vs. extended course (>7 days) antibiotic monotherapy in 2,796 patients older than 12 years with radiographically confirmed mild-to-moderate community-acquired pneumonia (CAP) (Am J Med. 2007;120:783-790). Ten trials with 1,093 patients evaluated short-course azithromycin [Zithromax] (three days in six trials,…
Level 1: Likely reliable evidence A fixed combination of perindopril (an ACE inhibitor) plus indapamide (a diuretic), available under the brand name Preterax, was evaluated in a randomized trial (Lancet. 2007;370:829-840). Patients older than 55 years with type 2 diabetes diagnosed after age 30 and a history of or risk factor for cardiovascular disease were…
Level 3: Lacking direct evidence The Effect of Combination Ezetimibe and High-Dose Simvastatin vs. Simvastatin Alone on the Atherosclerotic Process in Patients with Heterozygous Familial Hypercholesterolemia (ENHANCE) randomized trial evaluated the effect of ezetimibe 10 mg plus simvastatin 80 mg (Vytorin) on arterial plaque growth (Merck/Schering-Plough Manufacturer Press Release. 2008; January 14; full-text available online…
Three authors of the new report answer our questions about what the dietary recommendations mean for primary-care clinicians. Shortly after the “Prevention of Cancer” report was made public, we sought out three members of the panel to comment on the findings: Walter C. Willett, MD, DrPH, is chair of the department of nutrition and Fredrick…
Based on a review of the best evidence, a scientific panel has issued 10 recommendations to pass along to patients for lowering the risk of cancer.
Managing the condition involves allergen avoidance, pharmacologic therapy, and immunotherapy. Here is guidance on each of these steps.
The predominant presentation of this mast-cell disorder is development of pruritic lesions—especially after rubbing or exposure to heat. A 2-year-old girl presented with a history of several brown macules located over her trunk and extremities. Her parents reported that the lesions had been present for two months and that some of them became “red and…
A woman and her husband suffer a debilitating skin disease they believe their granddaughter brought home from day care. A 54-year-old woman presents as a new patient with complaints of skin infections during the past two years. She has no other significant past medical history. The woman and her husband had been healthy until their…
The chronically ill and frail elderly are often unable to get to your office. If you cannot make house calls, you can still direct good care their way. Mrs. D, age 85, has diabetes mellitus and osteoarthritis of the knees and hips. Because she has fallen several times and is afraid of walking outside, she…
