May 18, 2007 Archives - Page 3 of 7 - Clinical Advisor

Print Issue: May 18, 2007

MIGRAINE THERAPY FOR KIDS

What can be done for children under the age of 6 years who suffer from migraines?—Sharon R. Bass, MD, Morgan City, La. Recommendations for migraine therapy in children include lifestyle modifications, such as regular sleep habits, meals, and exercise, as well as avoidance of triggers, including chocolate, caffeine, or stress. For acute treatment, ibuprofen 7.5-10…

CONTINUOUS CARDIOTOCOGRAPHY MAY REDUCE NEONATAL SEIZURES

Level 2: Mid-level evidence In an assessment of electronic fetal monitoring during labor, a systematic review of 12 randomized and quasi-randomized trials evaluated continuous cardiotocography in more than 37,000 women (Cochrane Database Syst Rev. 2006[3]:CD006066). Only two of the trials were of high quality. The review was dominated by one well-done trial with nearly 13,000…

PHYSICAL COUNTERPRESSURE MAY REDUCE RECURRENT

Level 2: Mid-level evidence A randomized trial evaluated the effect of physical counterpressure maneuvers in patients with recurrent syncope (J Am Coll Cardiol. 2006;48:1652-1657). Patients (N=223, mean age 38.6 years) with recurrent vasovagal syncope and recognizable prodromal symptoms were randomized to conventional therapy plus physical counterpressure maneuvers vs. conventional therapy alone and followed for mean…

SELF-MANAGEMENT TRAINING REDUCES URINARY TRACT SYMPTOMS

Level 2: Mid-level evidence A randomized trial evaluated a self-management program in 140 men older than 40 years with uncomplicated lower urinary tract symptoms (LUTS) (BMJ. 2007;334:25; full-text available online without charge at: www.bmj.com/cgi/content/full/334/7583/25. Accessed April 17, 2007). Participants were randomized to the self-management program plus standard care or standard care alone. The self-management program…

MEMBRANE SWEEPING INCREASES RATE AND SPEED OF VAGINAL DELIVERY

Level 1: Likely reliable evidence Membrane sweeping, or membrane stripping, is commonly used at term to hasten the onset of labor. The maneuver involves intentional digital separation of chorionic membranes from the lower uterine segment with a gloved finger. This technique may be used alone or in addition to labor induction. In a recent study,…

MOST STATINS DO NOT INCREASE RISK OF MYALGIAS OR RHABDOMYOLYSIS

Level 1: Likely reliable evidence A systematic review of 39 English-language, randomized, double-blind, placebo-controlled trials, each involving at least 100 adults with hyperlipidemia, evaluated adverse effects associated with statin monotherapy (Circulation. 2006;114:2788-2797). Myalgias were defined as any musculoskeletal pain or symptoms without documented creatine kinase (CK) elevation; rhabdomyolysis was defined as CK elevation at least…

NONINVASIVE VENTILATION REDUCES MORTALITY IN CARDIOGENIC

Level 1: Likely reliable evidence For patients with acute cardiogenic pulmonary edema, noninvasive ventilation reduces mortality and the need to intubate (JAMA. 2005;294:3124-3130). This finding is based on a meta-analysis of 15 randomized trials comparing noninvasive ventilation to conventional oxygen therapy or another noninvasive ventilation modality. Nine of the trials compared continuous positive airway pressure…

TSH LEVELS TARGETED WITHIN NORMAL RANGE HAVE SIMILAR OUTCOME

Level 1: Likely reliable evidence A randomized crossover trial evaluated the efficacy of different l-thyroxine dosing strategies and different target thyroid-stimulating hormone (TSH) ranges in patients with treated hypothyroidism. Enrollment criteria were treatment for at least six months, stable l-thyroxine dosing 100-200 µg/day for at least two months, and TSH level 0.1-4.8 mU/L (J Clin…

SWITCH TO ORAL ANTIBIOTICS SAFE IN SEVERE COMMUNITY-ACQUIRED PNEUMONIA

Level 2: Mid-level evidence A randomized trial evaluated the effect of a modified antibiotic regimen in 302 adults hospitalized for severe community-acquired pneumonia (BMJ. 2006;333:1193; full-text available online free of charge at www.bmj.com/cgi/content/full/333/7580/1193. Accessed April 17, 2007). Patients were randomized to early switch (to oral antibiotics after three days of IV antibiotics) vs. standard care…

A quick guide to the newest diabetes drugs

So many new antiglycemic agents have been introduced that clinicians can’t keep up. An endocrinologist/diabetologist provides a refresher. We all know a diabetes epidemic is upon us, afflicting 21 million Americans and claiming more patients each day. But there’s good news too. Several new diabetes therapies have been introduced recently, including whole new classes of…

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