 |
 |
Evidence Based Practice
Effects on blood pressure of reduced dietary sodium and the dietary approaches to stop hypertension (DASH) diet. Sacks FM, Svetkey LP et al for the DASH-Sodium Collaborative Research Group. N Engl J Med 2001;344:3-10.
The Question: What is the effect of different levels of dietary sodium, in conjunction with the Dietary Approaches to Stop Hypertension (DASH) diet on blood pressure in people with and without hypertension?
Answer in a nutshell: The reduction of sodium intake to levels below the current recommendation of 100 mmol per day and the DASH diet both lowered blood pressure substantially, with greater effects in combination than singly both in people with and without hypertension.
Low-dose aspirin and vitamin E in people at cardiovascular risk: a randomised trial in general practice. Collaborative Group of the Primary Prevention Project (PPP). Lancet 2001; 357: 89-95
The Question: How effective is low dose aspirin and Vitamin E in the primary prevention of cardiovascular events in people with one or more major risk factors?
Answer in a nutshell: In women and men at risk of having a cardiovascular event, low-dose aspirin given in addition to treatment of specific risk factors contributes an additional preventive effect, with an acceptable safety profile whereas the primary preventive effects of vitamin E are inconclusive.
Comparison of formoterol and terbutaline for as-needed treatment of asthma: a randomised trial. Tattersfield AE, Löfdahl CG et al. Lancet 2001; 357: 257-61
The Question: What is the safety and efficacy of 4·5 µg inhaled formoterol compared with 0·5 mg terbutaline, each as needed, in patients with moderate to severe asthma taking an inhaled corticosteroid?
Answer in a nutshell: This randomized trial showed that when taken as needed, formoterol 4·5 µg provided better asthma control than terbutaline 0·5 mg in patients requiring moderate doses of relief medication despite inhaled corticosteroid treatment.
(This trial has been critically appraised in this issue of JSCAN)
Long-term effects of glucosamine sulphate on osteoarthritis progression: a randomised, placebo-controlled clinical trial. Reginster JY, Deroisy R et al. Lancet 2001; 357: 251-56
The Question: Does glucosamine sulphate the sulphate derivative of the natural aminomonosaccharide glucosamine affect the progression of symptoms and joint structure changes in osteoarthritis?
Answer in a nutshell: Gluosamine sulphate causes favorable structure modifying and symptom-modifying effects in patients with osteoarthritis.
The use of diltiazem for treating rapid atrial fibrillation in the out-of-hospital setting. Wang HE, O’Connor RE et al. Ann Emerg Med 2001;37:38-45.
The Question: Is diltiazem useful in the treatment of atrial fibrillation or flutter (RAF) in the out-of-hospital setting?
Answer in a nutshell: Diltiazem produces higher ventricular response rate (VRR) and overall therapeutic response in patients with rapid atrial fibrillation or flutter (RAF) in the out-of-hospital setting.
Effects of reducing children's television and video game use on aggressive behavior. A randomized controlled tial. Robinson TN, Wilde ML et al. Arch Pediatr Adolesc Med. 2001;155:17-23
The Question: What ate the effects of reducing television, videotape, and video game use on aggressive behavior in school children?
Answer in a nutshell: Interventions to reduce television, videotape, and video game use decreases aggressive behavior in elementary schoolchildren. These findings support the causal influences of these media on aggression and the potential benefits of reducing children's media use.
Comparison of auscultatory and oscillometric blood pressures.
Park MK, Menard SW et al. Arch Pediatr Adolesc Med. 2001;155:50-53
The Question: Are there differences in blood pressure readings between the auscultatory and oscillometric (Dinamap model 8100; Critikon, Tampa, Fla) methods in school children?
Answer in a nutshell: Dinamap readings appear to be higher in school children as compared to the auscultatory method and these findings preclude the interchange of readings by the 2 methods.
Reliability of the urinalysis for predicting urinary tract infections in young febrile children. Bachur R, Harper MB. Arch Pediatr Adolesc Med. 2001;155:60-65
The Question: How sensitive is the standard urinalysis (UA) as a screening test for urinary tract infections (UTI) and is it possible to calculate the risk of missing a UTI due to a false-negative UA result?
Answer in a nutshell: The sensitivity of the standard UA is 82% and does not vary with age in febrile children younger than 2 years. A negative likelihood ratio and estimates of prevalence of UTI can be used to calculate the risk of missing a UTI due to a false-negative UA result.
Predicting mortality and morbidity of patients operated on for perforated peptic ulcers. Lee FYJ, Leung KL et al. Arch Surg. 2001;136:90-93
The Question: Is it possible to predict morbidity and mortality in patients operated for peptic ulcers?
Answer in a nutshell: APACHE II score predicts both mortality and morbidity in patients operated for perforated peptic ulcers, and the Boey score predicts only mortality. Boey score also might select appropriate patients for laparoscopic repair.
Early statin treatment following acute myocardial infarction and 1-Year survival. Stenestrand U, Wallentin L for the Swedish Register of Cardiac Intensive Care (RIKS-HIA). JAMA. 2001;285:430-436.
The Question: Is there an association between statin treatment initiated before or at the time of hospital discharge and 1-year mortality after AMI?
Answer in a nutshell: Early initiation of statin treatment in patients with AMI is associated with reduced 1-year mortality. These results emphasize the importance of implementing the results of randomized statin trials in unselected AMI patients.
Prophylactic treatment of migraine with angiotensin converting enzyme inhibitor (lisinopril): randomised, placebo controlled, crossover study. Schrader H, Stovner LJ et al. BMJ 2001;322:19.
The Question: What is the efficacy of an angiotensin converting enzyme inhibitor lisinopril) in the prophylaxis of migraine?
Answer in a nutshell: This randomized cross over trial found that the angiotensin converting enzyme inhibitor, lisinopril, has a clinically important prophylactic effect in migraine.
Cardiovascular effects of tamoxifen in women with and without heart disease: Breast Cancer Prevention Trial. Reis SE, Costantino JP et al for the National Surgical Adjuvant Breast Bowel Project Breast Cancer Prevention Trial. investigators. JNCJ 2001;93:16-21
The Question: What are the cardiovascular effects of tamoxifen in women with and without coronary heart disease (CHD)?
Answer in a nutshell: When used for breast cancer prevention in women with or without heart disease, tamoxifen is not associated with beneficial or adverse cardiovascular effects.
Diagnosis of primary HIV-1 infection. Daar ES, Little S et al for the Los Angeles County Primary HIV Infection Recruitment Network. Ann Intern Med. 2001;134:25-29.
The Question: How useful are the symptoms and virologic tests for diagnosing primary HIV-1 infection?
Answer in a nutshell: No sign or symptom is useful in targeted screening for primary infection.Although assays for HIV RNA are more sensitive than those for p24 antigen in diagnosing primary infection, they are more expensive and are more likely to yield false-positive results.
Assessing clinical probability of pulmonary embolism in the emergency ward - A simple score. Wicki J, Perneger TV et al. Arch Intern Med 2001;161:92-97.
The Question: Is it possible to stratify emergency ward patients with clinically suspected pulmonary embolism (PE) into groups with a high, intermediate, or low probability of PE using a simple standardized clinical score?
Answer in a nutshell: A clinical score, based on easily available and objective variables, provides a standardized assessment of the clinical probability of PE. Applying this score to emergency ward patients suspected of having PE could allow a more effective diagnostic process.
Antihypertensive drug therapies and the risk of ischemic stroke. Klungel OH, Heckberf SR et al. Arch Intern Med. 2001;161:37-43
The Question: What is the association between first ischemic stroke and use of antihypertensive drugs?
Answer in a nutshell: Antihypertensive drug regimens that do not include a thiazide diuretic are associated with an increased risk of ischemic stroke compared with regimens that include a thiazide.
Health Services Research
The effect of a community intervention trial on parental knowledge and awareness of antibiotic resistance and appropriate antibiotic use in children. Trepka MJ, Belongia EA et al. PEDIATRICS Vol. 107 No. 1 January 2001, p. e6.
The Question: Does a community-wide educational intervention effective in changing the parental knowledge and awareness about antibiotic indications and antibiotic resistance?
Answer in a nutshell: This community intervention trial from Canada found that educational interventions directed at parents and clinicians lead to changes in parental knowledge and awareness about antibiotic indications and antibiotic resistance.
Pediatric Health
Relationships between use of television during meals and children's food consumption patterns. Coon KA, Goldberg J et al. PEDIATRICS Vol. 107 No. 1 January 2001, p. e7.
The Question: What are the impact of children’s food consumption patterns and presence of television during meals?
Answer in a nutshell: The dietary patterns of children from families in which television viewing is a normal part of meal routines may include fewer fruits and vegetables and more pizzas, snack foods, and sodas than the dietary patterns of children from families in which television viewing and eating are separate activities.
Validation of an outcomes instrument for tonsil and adenoid disease.
Stewart MG, Friedman EM et al. Arch Otolaryngol Head Neck Surg. 2001;127:29-35
The Question: Is a Tonsil and Adenoid Health Status Instrument useful in children with tonsil and adenoid disease?
Answer in a nutshell: This Tonsil and Adenoid Health Status Instrument developed by the authors is a valid, reliable, and sensitive with 6 distinct subscales. This instrument has significant utility for outcomes research in children with tonsil and adenoid disease.
Efficacy of meningococcal serogroup C conjugate vaccine in teenagers and toddlers in England. Ramsay ME, Andrews N et al. Lancet 2001;357:20th January.
The Question: What is the efficacy of Meningococcal C conjugate (MCC) in teenagers and toddlers?
Answer in a nutshell: Surveillance data from England show that short-term efficacy of the MCC vaccine in England is 97% (95% CI 77-99) for teenagers and 92% (65-98) for toddlers. These early results confirm the superiority of MCC over plain C polysaccharide vaccines, which are ineffective in young children.
Chronic Diseases
Cellular-Telephone use and brain tumors. Inskip PD, Tarone RE et al. N Engl J Med 2001;344:79-86.
The Question: Is there a link between use of cellular telephones and the occurrence of brain tumors?
Answer in a nutshell: Results of this case control study from the United States do not support the hypothesis that the recent use of hand-held cellular telephones causes brain tumors, but they are not sufficient to evaluate the risks among long-term, heavy users and for potentially long induction periods.
Glycated haemoglobin, diabetes, and mortality in men in Norfolk cohort of European Prospective Investigation of Cancer and Nutrition (EPIC-Norfolk). Khaw KT, Wareham N et al. BMJ 2001; 322: 15.
The Question: Does glycated haemoglobin (HbA1c) concentration, a marker of blood glucose concentration, predicts death from cardiovascular and all causes in men?
Answer in a nutshell: Glycated haemoglobin concentration seems to explain most of the excess mortality risk of diabetes in men and to be a continuous risk factor through the whole population distribution.
Is the risk of developing Alzheimer's disease greater for women than for men? Hebert LE, Scherr PA et al. Am J Epidemiol 2001;153:132-136.
The Question: Is female gender a risk factor for Alzheimer’s disease (AD)?
Answer in a nutshell: Data from US suggest that the excess number of women with AD is due to the longer life expectancy of women rather than sex-specific risk factors for the disease.
Smokers’ Corner
Brand appearances in contemporary cinema films and contribution to global marketingof cigarettes. Sargent JD, Dalton MA et al. Lancet 2001; 357: 29-32
The Question: How common are tobacco brand appearances in US films and do they have a advertisement motive?
Answer in a nutshell: Tobacco-brand appearances are common in films and are becoming increasingly endorsed by actors. The most highly advertised US cigarette brands account for most brand appearances, which suggests an advertising motive to this practice.
Health effects related to environmental tobacco smoke exposure in children in the United States. Data from the Third National Health and Nutrition Examination Survey. Mannino DM, Moorman JE et al. Arch Pediatr Adolesc Med. 2001;155:36-41.
The Question: What are the effects of prenatal and postnatal smoke exposure on the respiratory health of children in the United States?
Answer in a nutshell: Environmental tobacco exposure (ETS) is an important predictor of respiratory health of children of all ages although the exact effect may vary across Age groups.
Women’s Health
Serotypes of Chlamydia trachomatis and risk for development of cervical squamous cell carcinoma. Anttila T, Saikku P et al. JAMA. 2001;285:47-51
The Question: Is there an association between specific serotypes of Chlamydia trachomatis infection and subsequent risk of cervical squamous cell carcinoma in women?
Answer in a nutshell: This nested case control study from Nordic countries found Chlamydia trachomatis serotype G to be most strongly associated with subsequent development of cervical SCC. Also Increasing numbers of exposures to different C trachomatis serotypes increased the risk of cervical cancer.
Risk factors for uterine fibroids among women undergoing tuba sterilization. Chen CC, Buck GM et al. Am J Epidemiol 2001;153: 20-26.
The Question: What are the risk factors for uterine fibroids in a selected group of women?
Answer in a nutshell: Risk factors differed by race. Risk factors in white women were age 40–44 years,
Money Matters
Effect of improved glycemic control on health care costs and utilization. Wagner EH, Sandhu N et al. JAMA. 2001;285:182-189.
The Question: Does sustained improvements in hemoglobin A1c (HbA1c) levels among diabetic patients lead to reductions in health care utilization and costs?
Answer in a nutshell: Data from this historical cohort study from the United States suggest that a sustained reduction in HbA1c level among adult diabetic patients is associated with significant cost savings within 1 to 2 years of improvement.
Health & Religion
Bioethics for clinicians: 21. Islamic bioethics. Daar AS, Al Khitamy AB. CMAJ 2001;164:60-3.
Medical ethics and Islam: principles and practice. Gatrad AR, Sheikh A. Arch Dis Child 2001;84:72-75
The Question: Where I can find information on Islamic bioethics?
Answer in a nutshell: The above two articles provide extensive information key teachings in Islamic bioethics with their applications. There are also relevant case studies.
Medical Education
Computer assisted learning in undergraduate medical education. Greenhalgh T. BMJ 2001;322:134-137
Reforming the core clerkship in internal medicine: The SGIM/CDIM Project. Goroll AH, Morrison G et al. Ann Intern Med. 2001;134:30-37
Miscellaneous
Factors associated with earthquake deaths in the great Hanshin-Awaji earthquake, 1995. Osaki Y, Minowa M. Am J Epidemiol 2001;153:153-156.
The Question: What are the factors associated with deaths in the great Japanese earthquake in 1995?
Answer in a nutshell: This case control study found that the mortality was higher in people aged over 50 years, those lived in dwellings that were completely destroyed and in people with physical disabilities.
Anaphylaxis in the United States-An investigation into its epidemiology. Neugut AI,Ghatak AT et al. Arch Intern Med. 2001;161:15-21.
The Question: How big is the problem of anaphylaxis in the USA?
Answer in a nutshell: The occurrence of anaphylaxis in the US is not as rare as is generally believed. According to the authors, the problem of anaphylaxis may affect 1.21% to 15.04% of the US population.
For Your Patients
Diagnosing primary HIV infection, On STD infections, Screening for breast cancer, Breast-feeding
Webwatch: Over 10 sites of interest
What U Say: Your views on JSCAN
Dr.P.Badrinath M.D.,M.Phil.,(Epid) PhD(Cantab)
Clinical Assistant Professor and Epidemiologist,
Department of Community Medicine,
UAE University, PO Box 17666, Al Ain,
United Arab Emirates.
Tel: 00 971 3 7039 652
Fax: 00 971 3 7672022.
"For an excellent review of the current medical literature, go to Journals Scan www.uaeu.ac.ae/jscan/index.htm" - BMJ 3rd June 2000,Reviews(Netlines)