Dear All,
Greetings from Al-Ain, the oasis city of the middle east. The January issue
of JSCAN, a professional news letter for health professionals in our
district is now online and you can access the same @
http://www.uaeu.ac.ae/jscan
If you do visit the site, we will be grateful for your comments, as we find
them extremely useful both to improve ourselves and as a moral booster. As
suggested by many of you I am providing the list of topics covered in this
issue. I am afraid it is a bit lengthy and if you are not interested in
reading any further please delete it straight away.
Cheers and warm regards and a good week end to colleagues in the Arab world
as our week end commenced this morning.
Badri
Dr.P.Badrinath M.D.,M.Phil.,(Epid) PhD(Cantab)
Assistant Professor and Epidemiologist,
Department of Community Medicine,
UAE University, PO Box 17666, Al Ain,
United Arab Emirates.
Tel: 00 971 3 5039 652
Fax: 00 971 3 672022.
[log in to unmask]
For a quick up date on current health literature with an emphasis
on evidence based practice please visit
http://www.uaeu.ac.ae/jscan
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Please find below JAN JSCAN titles.
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Many of our readers will be travelling to Mecca for Hajj this year. JSCAN is
pleased to include the advice given by the Ministry of Health, Saudi Arabia
for the Hejaj.
Advise for travellers to Saudi Arabia
The Ministry of Health of Saudi Arabia has issued requirements for the
forthcoming Hajj season, which has been published in the 7th January issue
of the Weekly Epidemiological Record of the World Health Organisation. You
can access the entire issue on line @ the
following URL and print off pages 7-8. For the benefit of some our readers
who may not have easy Internet access, the paper version of JSCAN contains
the print-out of the advice sheet from the Weekly Epidemiological Record.
http://www.who.int/wer/pdf/2000/wer7501.pdf
Evidence Based Practice:
Treatment of functional gastrointestinal disorders with antidepressant
medications: a meta-analysis. Jackson JL, O'Malley PG et al. Am J Med
2000;108:65-72.
The Question: What is the efficacy of antidepressant medications in the
treatment of functional gastrointestinal disorders?
Answer in a nutshell: Treatment of functional gastrointestinal disorders
with antidepressants is effective as measured by improvement in pain score.
On an average, 4 patients needed to be treated (95% CI: 2.1 to 6.5 patients)
to improve 1 patient's symptom (NNT of 4).
Meta-analysis of benzodiazepine use in the treatment of insomnia. Holbrook
AM, Crowther R et al. CMAJ 2000;162:225-33.
The Question: What are the benefits and risks associated with the use of
benzodiazepines to treat insomnia in adults?
Answer in a nutshell: The use of benzodiazepines in the treatment of
insomnia is associated with an increase in sleep duration, but this is
countered by a number of adverse effects.
Hypertrophic pyloric stenosis in infants following pertussis prophylaxis
with erythromycin-Knoxville, Tennessee, 1999. MMWR. 1999;48:1117-1120.
The Question: Does erythromycin increase the risk of hypertrophic pyloric
stenosis in infants?
Answer in a nutshell: Erythromycin increases the risk of hypertrophic
pyloric stenosis in a group of infants who were given prophylaxis for
pertussis. The risk ranged from 1.7 to infinity.
Effect of calcium supplementation on serum cholesterol and blood pressure -
a randomized, double-blind, placebo-controlled, clinical trial. Bostick RB,
Fosdick L. Arch Fam Med. 2000;9:31-39.
The Question: What is the effect of daily calcium supplementation on serum
total and high-density lipoprotein cholesterol (HDL-C) levels and blood
pressure in adults?
Answer in a nutshell: Calcium supplementation does not lead to a
statistically significant reduction in total cholesterol or HDL-C levels or
blood pressure.
The need for antibiotic prophylaxis in elective laparoscopic
cholecystectomy: A prospective randomized study. Tocchi A, Lepre L et al.
Arch Surg. 2000;135:67-70
The Question: Does routine antibiotic prophylaxis reduce the incidence of
postoperative infections in patients undergoing elective laparoscopic
cholecystectomy?
Answer in a nutshell: In patients undergoing elective laparoscopic
cholecystectomy, antibiotic treatment does not affect the incidence and
severity of post operative infections or the degree of bile contamination.
The value of routine preoperative medical testing before cataract surgery.
Schein OD,Katz J et al, for the Study of Medical Testing for Cataract
Surgery. N Engl J Med 2000;342:168-75.
The Question: Does routine medical testing before cataract surgery reduce
the rate of complications during the perioperative period?
Answer in a nutshell: Routine medical testing before cataract surgery has no
impact on the perioperative and postoperative complications.
Fluoride in drinking water and risk of hip fracture in the UK: a
case-control study. Hillier S, Cooper C et al. Lancet 2000; 355: 265- 269.
The Question: Is there an increased risk of hip fracture for people
ingesting fluoride in drinking water at concentrations of about 1 ppm?
Answer in a nutshell: There appears to be no increased risk of hip fractures
in subject ingesting fluoride in drinking water at a level of >=0.9ppm.
Practice guidelines developed by specialty societies: the need for a
critical appraisal. Grilli R, Magrini N et al. Lancet 2000; 355:103-106.
The Question: What is the quality and reliability of practice guidelines
developed by specialty societies?
Answer in a nutshell: Though there has been some improvement over time, the
quality of practice guidelines developed by specialty societies is generally
unsatisfactory.
Chronic diseases:
Serum carotenoids and atherosclerosis: The Rotterdam Study.
Klipstein-Grobusch K,Launer LJ. Atherosclerosis 2000;148:49-56.
The Question: Is there an association between atherosclerosis of aorta and
serum carotenoids levels?
Answer in a nutshell: There exists a modest inverse association between
levels of serum lycopene and presence of atherosclerosis, and this
association is most pronounced in current and former smokers.
Excess risk of myocardial infarction in patients treated with antidepressant
medications: association with use of tricyclic agents. Cohen HW, Gibson G,
Alderman MH. Am J Med 2000;108:2-8.
The Question: Is there an association between the use of antidepressant
medications and the risk of myocardial infarction, and if it exists, does it
vary by type of medication?
Answer in a nutshell: The risk of myocardial infarction is significantly
increased in users of antidepressants as compared to non-users. When
classified by medication, the increase in myocardial infarction risk appears
to be restricted to tricyclic agents.
Male pattern baldness and coronary heart disease. The Physicians' Health
Study. Lotufo PA, Chae CU et al. Arch Intern Med.2000;160:165-71.
The Question: Is there an association between male (vertex) pattern baldness
and the risk of coronary heart disease (CHD) events?
Answer in a nutshell: Vertex pattern baldness appears to be a marker for
increased risk of CHD events in males possibly due to the high androgen
levels. This risk was more pronounced in men with hypertension or high
cholesterol levels.
Women's health:
Menopausal estrogen and estrogen-progestin replacement therapy and breast
cancer risk. Schairer C, Lubin J et al. JAMA. 2000;283:485-491
The Question: Is there a difference in breast cancer risk between women on
estrogen-progestin combination hormone replacement therapy as compared to
women on estrogen alone?
Answer in a nutshell: The risk of breast cancer in women taking
estrogen-progestin regimen is higher than those using estrogen alone.
Men's health:
Urinary and sexual function after radical prostatectomy for clinically
localized prostate cancer - The Prostate Cancer Outcomes Study. Stanford JL,
Feng Z et al. JAMA. 2000;283:354-360.
The Question: What are the changes in urinary and sexual function in men who
have undergone radical prostatectomy for clinically localized prostate
cancer?
Answer in a nutshell: Radical prostatectomy is associated with significant
erectile dysfunction and some decline in urinary function at 18 months or
more after surgery.
Infectious diseases:
Hepatic decompensation in patients with Cirrhosis during infection with
influenza. Duchini A, Viernes ME et al. Arch Intern Med. 2000;160:113-115
The Question: What is the effect of influenza A infection in patients with
liver cirrhosis?
Answer in a nutshell: Influenza A infection can cause hepatic decompensation
and hospitalisation in patients having cirrhosis of the liver; these
patients need close monitoring
Group B Streptococcal disease in the era of intrapartum antibiotic
prophylaxis. Schrag SJ, Zywicki S et al. N Engl J Med 2000;342:15-20.
The Question: What is the impact of intrapartum chemoprophylaxis for group B
streptococci on the invasive group B streptococcal disease?
Answer in a nutshell: There is a substantial reduction in the incidence of
invasive disease after the initiation of chemoprophylaxis in the United
States of America (please see the figure in the online JSCAN).
Effects of influenza vaccination of health-care workers on mortality of
elderly people in long-term care: a randomised controlled trial. Carman WF,
Elder AG et al. Lancet 2000; 355: 93 - 97.
The Question: Does vaccination of health-care workers against influenza
reduce mortality and frequency of laboratory-proven influenza infection in
elderly patients in long-term-care hospitals?
Answer in a nutshell: Influenza vaccination of health-care workers reduces
the mortality substantially but does not lead to a decrease in the frequency
of non-fatal influenza infection in elderly patients of long-term-care
hospitals.
Penicillin for acute sore throat: randomised double blind trial of seven
days versus three days treatment or placebo in adults. Zwart S, Sachs APE.
BMJ 2000;320:150-154.
The Question: How effective is a three-day therapy with penicillin at
accelerating resolution of symptoms compared to a seven day therapy or
placebo in patients with sore throat?
Answer in a nutshell: Penicillin treatment for seven days is superior to
treatment for three days or placebo in resolving symptoms of sore throat in
patients with group A streptococcal pharyngitis and, possibly, in those with
non-group A streptococcal pharyngitis.
Health Services research:
Primary care outcomes in patients treated by nurse practitioners or
physicians. A randomized trial. Mundinger MO, Kane RL et al. JAMA.
2000;283:59-68.
The Question: Does the patients' outcome differ if they receive care by
nurse practitioners or physicians in the primary care setting?
Answer in a nutshell: No significant differences are observed between the
groups receiving primary care by nurse practitioners and physicians,
including patients'health status, physiological test results for patients
with diabetes or asthma, later rates of health services utilisation and over
all patient satisfaction.
Miscellaneous:
Physicians and the pharmaceutical industry - Is a gift ever just a gift?
Wazana J.JAMA. 2000;283:373-380.
The question: What is the impact of the relationship between physicians and
the pharmaceutical industry and its representatives on the knowledge,
attitudes, and behaviour of physicians?
Answer in a nutshell: Physician-industry interactions appear to affect
prescribing and professional behaviour. Attending sponsored CME events and
accepting funding for travel or lodging for educational symposia are
associated with increased prescription rates of the sponsor's medication.
Attending presentations given by pharmaceutical
representative speakers is also associated with nonrational prescribing.
News from the region:
First Report of Q Fever in Oman. Scrimgeour EM, Johnston WJ et al. Emerging
infectious diseases Vol. 6, No. 1, January-February 2000.
http://www.cdc.gov/ncidod/eid/vol6no1/scrimgeour.htm
>From the pages of Bandolier
http://www.ebando.com/band71/b71.html
No evidence for ginseng. January: 2000. Bandolier
The Question: What is the evidence that Ginseng root extracts improve
vitality, immune function, and help in cancer, cardiovascular disease and
sexual problems?
Answer in a nutshell: The evidence for the beneficial effect of Ginseng is
weak and there is no evidence, to show that ginseng slows the ageing process
or helps mental or physical functioning in the elderly.
Metoclopramide is ineffective in preventing postoperative nausea and
vomiting. January 2000: Bandolier.
For your patients:
Information sheet on type 2 diabetes - For your patients
This issue of JAMA's patient page section is on type 2 diabetes. In simple
language this sheet provides information on symptoms, risk factors, and
treatment. Handy and useful tool for your patients. You can print off a copy
from the Internet @the
following URL.
http://jama.ama-assn.org/issues/v283n2/pdf/jpg0112.pdf
Smokers' corner:
Time for a smoke? One cigarette reduces your life by 11 minutes.
(Letter)Shaw M, Mitchell R, Dorling D. BMJ 2000;320:53.
DRUG Watch:
Hepatic failure in a patient taking rosiglitazone. Forman LM, Simmons DA,
Diamond RH et al. Annals Int Med 2000;132:118-121.
New Drug for Stroke - JAMA 5th Jan 2000
Deterioration of rheumatoid arthritis with Troglitazone: A Rare and
Unexpected Adverse effect. Sakurai A, Hashizume K. Arch Intern Med.
2000;160:118-9
Webwatch
http://www.quackwatch.com/
This can be your Guide to Health Fraud, Quackery, and Intelligent Decisions.
http://www.medmatrix.org/
The Medical Matrix Project is devoted to posting, and continuously updating
"full content, unrestricted access, Internet clinical medicine resources"
for its visitors.
http://www.cyberdiet.com/
Do you need some help for losing weight and for healthy eating? Then you
should visit this site.
http://www.nhsdirect.nhs.uk/listen/
The intention of this site is to improve access to health information for
patients and the public in the United Kingdom.
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