Does this patient have strep throat? Ebell MH, Smith MA et al. JAMA 2000;284:2912-2918.
The Question: What is the precision and accuracy of the clinical examination in diagnosing patients with group A b hemolytic streptococcal pharyngitis (strep throat)?
Answer in a nutshell: Though no single element of history taking or physical examination is sufficiently accurate to exclude or diagnose strep throat the most useful findings for evaluating the likelihood of strep throat are presence of tonsillar exudate, pharyngeal exudate, or exposure to strep throat infection in the previous 2 weeks.
Diurnal variation in fasting plasma glucose. Implications for diagnosis of diabetes in patients examined in the afternoon Troisi RJ, Cowi CC et al. JAMA. 2000;284:3157-3159.
The Question: Is there a diurnal variation in the fasting plasma glucose and does it affect the diagnosis of diabetes in people not known to have diabetes?
Answer in a nutshell: Mean fasting plasma glucose level is significantly higher in the morning and if current diabetes diagnostic criteria are applied to patients seen in the afternoon, approximately half of all cases of undiagnosed diabetes in these patients will be missed
Does drug treatment of patients with acute bronchitis reduce additional care seeking? Evidence from the practice partner research network Hueston WJ, Jenkins R et al. Arch Fam Med. 2000;9:997-1001.
The Question: Is antibiotic treatment as compared to bronchodilator treatment associated with differences in follow-up visit rates for patients with acute bronchitis?
Answer in a nutshell: Initial prescribing of an antibiotic reduces early follow-up for acute bronchitis in younger patients but seems to have no effect in adults. However, reductions in future follow-up visits might be outweighed by increases in antibiotic consumption because patients who return for a follow-up visit seem to receive additional antibiotic prescriptions.
Efficacy and safety of acetaminophen in the treatment of migraine. Results of a randomized, double-blind, placebo-controlled, population-based study. Lipton RB, Baggish JS et al. Arch Intern Med. 2000;160:3486-3492.
The Question: Is 1000 mg of oral acetaminophen safe and effective in the treatment of single acute migraine attack?
Answer in a nutshell: Acetaminophen is highly effective for treating pain, functional disability, photophobia, and phonophobia in a population-based sample of persons with migraine, excluding the most disabled persons with migraine. The drug also has an excellent safety profile and is well tolerated.
Risk factors for delayed healing of neuropathic diabetic foot ulcers - A pooled analysis. Margolis DJ, Kantor J et al. Arch Dermatol. 2000;136:1531-1535
The Question: Does standard care lead to healing of neuropathic diabetic foot ulcers?
Answer in a nutshell: Diabetic neuropathic foot ulcers that are small and of short duration heal well with a standard care regimen.
Guidelines on migraine: Part 5. Recommendations for specific prophylactic drugs Morey SS Am Family Physician 2000;62:2535-9.
The Question: What are the current guidelines for chemoprophylaxis of migraine?
Answer in a nutshell: The U.S. Headache Consortium guidelines for the treatment of migraine has summarized data from clinical studies of various drugs used in preventive therapy of migraine and these drugs and their levels of evidence are presented in a table comprehensively.
Caffeine intake and the risk of first-trimester spontaneous abortion Cnattingius S, Signorello LB et al. N Engl J Med 2000;343:1839-45.
The Question: Does coffee drinking increase the risk of spontaneous abortion?
Answer in a nutshell: The ingestion of caffeine may increase the risk of an early spontaneous abortion among nonsmoking women carrying fetuses with normal karyotypes
Health outcomes associated with calcium antagonists compared with other first-line antihypertensive therapies: a meta-analysis of randomised controlled trials. Pahor M, Psaty BM et al. Lancet 2000; 356: 1949-54
The Question: What are the effects of calcium antagonists on major cardiovascular events as compared to other antihypertensive drugs?
Answer in a nutshell: Results of this meta-analysis shows that calcium antagonists are inferior to other types of antihypertensive drugs as first-line agents in reducing the risks of several major complications of hypertension.
Low-dose dopamine in patients with early renal dysfunction: a placebo-controlled randomised trial Allison Burger Australian and New Zealand Intensive Care Society (ANZICS) Clinical Trials Group. Lancet 2000; 356: 2139-43.
The Question: Does the administration of low dose dopamine to critically ill patients reduce the risk of renal failure by increasing renal blood flow?
Answer in a nutshell: According to the results of this randomized trial administration of low-dose dopamine by continuous intravenous infusion to critically ill patients at risk of renal failure does not confer clinically significant protection from renal dysfunction.
The risk of menstrual abnormalities after tubal sterilization. Peterson HB, Jeng G et al for the U.S. Collaborative Review of Sterilization Working Group. N Engl J Med 2000;343:1681-7.
The Question: Does tubal sterilization increase the risk of subsequent menstrual abnormalities?
Answer in a nutshell: Tubal sterilization does not increase the risk of menstrual abnormalities. Women who have undergone tubal sterilization are no more likely than other women to have menstrual abnormalities.
Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomised trials. Rodgers A, Walker N et al. BMJ 2000;321:1493-1497.
The Question: What is the effect of neuraxial blockade with epidural or spinal anaesthesia on postoperative morbidity and mortality?
Answer in a nutshell: This systematic review found that neuraxial blockade reduces postoperative mortality and other serious complications.
Impact of prenatal glucose screening on the diagnosis of gestational diabetes and on pregnancy outcomes. Wen SW, Liu S et al. Am. J. Epidemiol. 2000 152: 1009-1014
The Question: What is the impact of universal screening on the diagnosis of gestational diabetes and its complications?
Answer in a nutshell: In Canada universal screening caused substantial increase in gestational diabetes with no evidence of beneficial effects on pregnancy outcomes.
Triage of patients for a rapid (5-minute) electrocardiogram: A rule based on presenting chief complaints. Graff L, Palmer AC et al. Ann Emerg Med. 2000;36:554-560.
The Question: Can chief complaints identify patients with myocardial infarction (MI) for immediate ECG and decrease delays in treatment?
Answer in a nutshell: Use of a rule based on chief complaints can identify patients with MI for immediate ECG and decrease delays in performing ECGs and administration of thrombolytic agents
Lactation reduces breast cancer risk in Shandong province, China Zheng T, Duan L et al. Am J Epidemiol 2000; 152: 1129-1135.
The Question: Does breast-feeding reduce the risk of breast cancer?
Answer in a nutshell: Results of a case control study from China showed that prolonged lactation reduced the risk of breast cancer with a significant dose response relation between duration and the risk.
Women’s Health
Urinary incontinence in women: evaluation and management Culligan PJ, Heit M. Am Fam Physician 2000;62:2433-44,2447,2452.
The Question: Where I can find information on a comprehensive approach to the evaluation and management of urinary incontinence in women.
Answer in a nutshell: This clinical review in the American Family Physician provides a detailed description on the evaluation and management of urinary incontinence in women.
Performance of screening mammography among women with and without a first-degree relative with breast cancer. Kerlikowske K, Carney PA et al. Ann Intern Med. 2000;133:855-863.
The Question: What is the performance of screening mammography in women with a first-degree family history of breast cancer as compared to women of similar age without such history.
Answer in a nutshell: Cancer detection rates in women who have a first-degree relative with a history of breast cancer are similar to those in women a decade older without such a history. The sensitivity of screening mammography is influenced primarily by age.
Developments in cervical and ovarian cancer screening: Implications for current practice. Gina Rollins Ann Intern Med. 2000; 133:1021–1024.
Birth characteristics and subsequent risk for breast cancer in very young women Innes K, Byers T et al. American Journal of Epidemiology 2000:152; 1121-1128.
The Question: Is there a relation between early life factors and subsequent risk of breast cancer in women?
Answer in a nutshell: There appears to be a relation between various early life factors including preterm birth and birth weight.
Men’s Health
Leisure-time physical activity, television watching, and plasma biomarkers of obesity and cardiovascular disease risk. Fung TT, Hu FB et al. American Journal of Epidemiology 2000;152: 1171-1178.
The Question: Is there an association between leisure time physical activity, television watching and biomarkers of cardiovascular disease (CVD) markers in healthy men?
Answer in a nutshell: Physical activity is positively associated with high-density lipoprotein (HDL) whereas hours of television watching showed a significant positive association with low density lipoprotein cholesterol and a negative association with HDL.
Paraphimosis: current treatment options Choe JM. Am Fam Physician 2000;62:2623-6,2628.
The Question: Where I can find information on the current management strategies for paraphimosis?
Answer in a nutshell: The review below provides information on the etiology, pathophysiology, clinical presentation, evaluation and treatment modalities for paraphimosis.
Chronic Diseases
Handheld cellular telephone use and risk of brain cancer. Muscat JE, Malkin MG et al. JAMA. 2000;284:3001-3007.
The Question: Is there a relation between the use of hand held cellular telephones and the subsequent risk of primary brain cancer?
Answer in a nutshell: This case control study performed in 5 US academic centers found no association between the use of hand held cellular telephones and the risk of brain cancer for all histologic categories except for uncommon neuroepitheliomatous cancers which had a non significant increase in the risk of brain cancer.
Hepatitis B vaccination and hepatocellular carcinoma rates in boys and girls. Chang M-H, Shau W-Y et al. JAMA. 2000;284:3040-3042
The Question: Is there a gender difference in the protection offered by Hepatitis B vaccination against Hepatocellular carcinoma (HCC)?
Answer in a nutshell: Data from Taiwan shows that boys may benefit more from HBV vaccination than girls in the prevention of HCC
Coffee consumption and the risk of coronary heart disease and death. Kleemola P, Jousilahti P et al. Arch Intern Med. 2000;160:3393-3400
The Question: Is there an association between coffee drinking and coronary heart disease (CHD) and death?
Answer in a nutshell: Coffee drinking does not increase the risk of CHD or death and any increase in increased mortality from CHD and all causes in heavy coffee drinkers is largely explained by the effects of smoking and a high serum cholesterol level.
An epidemiologic study of risk factors for deep vein thrombosis in medical outpatients - The Sirius study. Samama MM for the Sirius Study Group. Arch Intern Med 2000;160:3415-3420.
The Question: What are the risk factors for deep vein thrombosis in non hospitalized patients?
Answer in a nutshell: This case control study identified a variety of intrinsic factors such as history of VTE, venous insufficiency, chronic heart failure, obesity, immobile standing position and history of more than 3 pregnancies. The triggering factors included pregnancy, violent effort, or muscular trauma, deterioration of general condition, immobilization, long-distance travel, and infectious disease.
Infectious Diseases
Serogroup W135 meningococcal disease in Hajj pilgrims. Taha MK, Achtman M et al. The Lancet 23 December 2000.
The Question: What was the serotype that was associated with meningococcal disease and hajj pilgrims in year 2000?
Answer in a nutshell: Serogroup W135 meningococci was associated with hajj pilgrimage in the year 2000.
Varicella outbreaks among mexican adults - Alabama, 2000
http://archderm.ama-assn.org/issues/v136n12/ffull/dmm00005-1.html
The Question: What should be the response of the public health professionals when there is an outbreak of varicella in adults?
Answer in a nutshell: This report in the Archives of Dermatology discusses the key steps to be taken in dealing with an adult varicella outbreak and presents an example from Alabama, USA.
Paediatrics
Management of fever without source in infants and children. Baraff LJ. Ann Emerg Med 2000;36:602-614.
The Question: Where can I find information on the management of fever in infants and children without an appropriate source of infection?
Answer in a nutshell: This narrative review published in the Annals of Emergency Medicine provides appropriate management strategies for tackling Fever without source (FWS) in infants and children.
Money Matters
Health and economic benefits of increased b blocker use following myocardial infarction. Phillips KA, Shlipak MG et al. JAMA. 2000;284:2748-2754.
The Question: What are the potential health and economic impact of increased use of bblockers in patients who have had a myocardial infarction (MI)?
Answer in a nutshell: Coronary Heart Disease (CHD) Policy Model, a computer-simulated Markov model of CHD in the US population showed that increased use of b blockers after MI would lead to impressive gains!
in health and would save costs.
Potential clinical and economic effects of homocyst(e)ine lowering. Nallamothu BK, Fendrick MA et al. Arch Intern Med 2000;160:3406-12.
The Question: What are the clinical economic benefits of lowering homocysteine levels with folic acid and vitamin B12 supplementation?
Answer in a nutshell: This decision analysis found that homocysteine lowering with folic acid and vitamin B12 supplementation could result in substantial clinical benefits at reasonable costs. The analysis also showed that a screen and treat strategy is likely to be more cost-effective than universal supplementation for lowering the levels of homocysteine.
Association of the California tobacco control program with declines in cigarette consumption and mortality from heart disease. Fichtenberg CM, Glantz SA. N Engl J Med 2000;343:1772-7
The Question: Is there an association between an aggressive antitobacco program and subsequent reduction in deaths from heart disease in California?
Answer in a nutshell: This large and aggressive tobacco-control program in California was associated with a reduction in deaths from heart disease in the short run.
Miscellaneous
Sydney hailstorms: the health role in the recovery process. Lee LA, Collings A. MJA 2000; 173: 579-582
The Question: What is the experience of health agencies & professionals in dealing with the aftermath of a crisis caused by a natural disaster?
Answer in a nutshell: This report published in the MJA highlights the involvement of community health, public health and mental health staff in the recovery period after a natural disaster (hailstorm and ensuing wind and rain over three weeks) in Sydney, Australia.
Professional health portals in the UK. Kiley R. Health Information on the Internet. December 2000, Issue 18.
Smokers’ Corner
Passive cigarette smoke exposure of infants. Importance of nonparental sources
Ownby DR, Johnson CC et al. Arch Pediatr Adolesc Med 2000;154:1237-1241.
The Question: Does smoking by persons other than parents contribute significantly to environmental tobacco smoke (ETS) exposure of infants?
Answer in a nutshell: Smoking by multiple individuals, other than the parents, significantly contributes to the ETS exposure of infants.
Cigarette smoking and colorectal cancer mortality in the cancer prevention study II. Chao A, Thun MJ et al. JNCI 2000;92:1888-1896.
The Question: Is there an association between cigarette smoking and the risk of colorectal cancer?
Answer in a nutshell: Long-term cigarette smoking is associated with increased risk of colorectal cancer mortality in both men and women. Clear reduction in risk is observed with early smoking cessation
From the pages of Bandolier http://www.jr2.ox.ac.uk/Bandolier/band82/b82-4.html
Webwatch
http://www.albany.edu/sph/news/gis_series_2001.html
http://www.sph.unc.edu/toolbox
http://www.worldbank.org/wbi/healthflagship/learning/module1/index.htm
http://www.infotoday.com/supersearchers/ssmed.htm
http://www.wma.net/e/policy/17-c_e.html
http://www.web-nurse.com/
For your patients
How sensitive are screening mammograms in women with and without a family history of breast cancer?
http://www.annals.org/issues/v133n11/nts/200012050-00004.html
Here is a leaflet for women with urinary incontinence
http://www.aafp.org/afp/20001201/2447ph.html
This leaf let explains how to exercise pelvic Muscles and has a daily pelvic muscle exercise log
http://www.aafp.org/afp/20001201/2452ph.html
Paraphimosis: What It Is and How to Prevent It
http://www.aafp.org/afp/20001215/2628ph.html
You Have Diabetes--But You Don't Have to Get Heart Disease Too
http://www.aafp.org/afp/20001215/2645ph.html
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.
http://myprofile.cos.com
"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)