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Dear All, Greetings from Al-Ain the oasis city of the Middle East. April issue of JSCAN a professional news letter we produce from UAE in now on line and you can access the same @ http://www.uaeu.ac.ae/jscan. Please find below the contents of this issue. As always we will gratefully receive all your comments. Evidence Based Practice Beta blockers in congestive heart failure - A Bayesian meta-analysis. Brophy JM, Joseph L Rouleau JL. Ann Int Med 2001;134:550-560. The Question: Is treating stable congestive heart failure patients with Beta-blockers effective in reducing mortality in morbidity? Answer in a nutshell: According to this Bayesian meta-analysis Beta-blocker therapy is associated with clinically meaningful reductions in mortality and morbidity in patients with stable congestive heart failure and should be routinely offered to all patients similar to those included in trials. Evidence base for management of acute exacerbations of chronic obstructive pulmonary disease. Snow V, Lascher S, Mottur-Pilson C for the Joint Expert Panel on Chronic Obstructive Pulmonary Disease of the American College of Chest Physicians and the American College of Physicians-American Society of Internal Medicine. Ann Intern Med. 2001;134:595-599 The Question: Where I can find evidence-based information on the management of an acute exacerbation of chronic obstructive pulmonary disease? Answer in a nutshell: The American College of Physicians-American Society of Internal Medicine (ACP-ASIM) and the American College of Chest Physicians (ACCP) have developed an evidence-based clinical practice guideline in collaboration and the entire guideline can be accessed free on line from Annals of Internal Medicine web site @http://www.annals.org/issues/v134n7/full/200104030-00015.html Low-dose oral contraceptive use and the risk of myocardial infarction. Rosenberg L, Palmer JR et al. Arch Intern Med. 2001;161:1065-1070. The Question: Does the use of newer lower-dose oral contraceptives (OC) increase the risk of myocardial infarction (MI)? Answer in a nutshell: Current use of low-dose OCs available in the United States does not increase the risk of MI among nonsmokers and light smokers, but for heavy smokers the risk of MI may be 25 times higher as compared to non-smoking non OC users. Randomized trial comparing traditional Chinese medical acupuncture, therapeutic massage, and self-care education for chronic low back pain. Cherkin DC, Eisenberg D et al. Arch Intern Med. 2001;161:1081-1088 The Question: How effective are acupuncture, therapeutic massage or self-care education in the management of persistent low back pain? Answer in a nutshell: Therapeutic massage appears to be is effective for persistent low back pain, and provides long-lasting benefits. Traditional Chinese Medical acupuncture is relatively ineffective in the management of this condition. Effects of Atorvastatin on early recurrent ischemic events in acute coronary syndromes - The MIRACL study: a randomized controlled trial. Schwartz GG, Olsson AG et al for the Myocardial Ischemia Reduction with Aggressive Cholesterol Lowering (MIRACL) Study Investigators. JAMA. 2001;285:1711-1718 The Question: Does treatment with atorvastatin, 80 mg/d, initiated 24 to 96 hours after an acute coronary syndrome, reduces death and nonfatal ischemic events. Answer in a nutshell: Patients treated with lipid-lowering drug atorvastatin, 80 mg/day, does not have a lower risk of death, nonfatal myocardial infarction, or cardiac arrest as compared to the untreated. How ever in the treated there is a reduction in recurrent ischemic events in the first 16 weeks, mostly recurrent symptomatic ischemia requiring rehospitalization. Measurement of blood pressure: an evidence based review. McAlister FA, Straus SE. BMJ 2001;322:908-911 . The Question: Where I can find an evidence-based approach to measure blood pressure? Answer in a nutshell: This first of the five parts of series on hypertension from the BMJ, which provides many useful tips on measuring blood pressure and full free text is available from the BMJ @ http://www.bmj.com/cgi/content/full/322/7291/908 Fluvoxamine for the treatment of anxiety disorders in children and adolescents - The research unit on pediatric psychopharmacology anxiety study group, Walkup JT, Labellarte MJ et al. N Engl J Med 2001;344:1279-85 The Question: Is it efficacious and safe to use selective serotonin-reuptake inhibitors (SSRI) in children with anxiety disorders? Answer in a nutshell: Fluvoxamine, a SSRI is an effective treatment for children and adolescents with social phobia, separation anxiety disorder, or generalized anxiety disorder. A randomized, placebo-controlled trial of antimicrobial treatment for children with clinically diagnosed acute sinusitis. Garbutt JM, Goldstein M et al. Pediatrics 2001;107:619-625 The Question: Do antibiotics offer any clinical benefit in children with acute sinusitis? Answer in a nutshell: Neither amoxicillin nor amoxicillin-clavulanate offered any clinical benefit compared with placebo for children with clinically diagnosed acute sinusitis. A randomized clinical trial of care for women with preterm labour: home management versus hospital management. Goulet C, Gévry H et al. CMAJ 2001;164:985-91 The Question: In women experiencing preterm labour how does home care management compares with hospital management? Answer in a nutshell: There appears to be no difference between the two modes of management and home care management appears to be an efficient and acceptable alternative to hospital care for women experiencing preterm labour. Use of Statins and risk of fractures. Van Staa TP, Wegman S et al. JAMA. 2001;285:1850-1855 The Question: What is the effect of taking Statins on the risk of hip fractures? Answer in a nutshell: Use of statins at dosages prescribed in clinical practice is not associated with a reduction in risk of fractures. Tramadol vs Diclofenac for posttonsillectomy analgesia. Courtney MJ, Cabraal D. Arch Otolaryngol Head Neck Surg. 2001;127:385-388 The Question: What is the analgesic efficacy of oral tramadol hydrochloride and oral diclofenac sodium for management of pain in posttonsillectomy patients? Answer in a nutshell: Oral tramadol is as effective as oral diclofenac in the management of posttonsillectomy pain. Women’s health Frequency of eating during pregnancy and its effect on preterm delivery. Siega-Riz AM, Herrmann TS, Savitz DA et al. Am J Epidemiol 2001;153: 647-652. The Question: What is the association between meal patterns during pregnancy and the subsequent occurrence of preterm delivery? Answer in a nutshell: Decreased eating during pregnancy is positively associated with the occurrence of preterm delivery i.e. it significantly increases the risk of (Odds ration 1.3) preterm delivery. Low blood pressure during pregnancy and poor perinatal outcomes: An obstetric paradox. Zhang J, Klebanoff MA. Am J Epidemiol 2001;153:642-646. The Question: Is there an association between low blood pressure during pregnancy and poor perinatal outcome? Answer in a nutshell: Low blood pressure by itself does not increase risk of poor perinatal outcomes at a population level. However, this conclusion may not apply to individual patients who also have a compromised plasma volume expansion or pathologic homeostasis. Soy product intake and hot flashes in Japanese women: Results from a community-based prospective study. Nagata C, Takatsuka N, et al. Am J Epidemiol 2001;153:790-793 The Question: Is there an association between intake of soy products and the occurrence of hot flashes in middle-aged women? Answer in a nutshell: Consumption of soy products is negatively associated with hot flushes and it offers protection against such hot flushes. Do obstetric complications explain high caesarean section rates among women over 30? A retrospective analysis. Bell JS, Campbell DM et al. BMJ 2001;322:894-895. The Question: Are the high caesarean section rates among women over 30 explained by obstetric complications? Answer in a nutshell: The higher rates seen in these women cannot be accounted for by obstetric complications. This could reflect physician or maternal preferences. Value of family history in identifying women at risk of venous thromboembolism during oral contraception: observational study. Cosmi B, Legnani C et al. BMJ 2001;322:1024-1025. The Question: What is the sensitivity and positive predictive value of a family history of venous thromboembolism in identifying common thrombophilic defects in women without thrombosis before taking oral contraceptives? Answer in a nutshell: Family history of venous thromboembolism has a unsatisfactory sensitivity (16%) and positive predictive (9%) value for identifying carriers of common thrombophilic defects before taking oral contraceptives. Oral contraceptives, other methods of contraception, and risk reduction for ovarian cancer. Ness RB, Grisso JA et al Study of Health and Reproduction (SHARE) Study Group. Epidemiology 2001;12:307-12. The Question: What is the relation between oral contraceptive use, other methods of contraception and risk of ovarian cancer? Answer in a nutshell: Various methods of contraception offer protection against ovarian cancer and this effect does not appear to result from contraceptive use being a nonspecific marker of fertility. Health Services Research Preventing needle stick injuries in health care settings. Tan L, Hawk CJ et al for the Council on Scientific Affairs, American Medical Association. Arch Intern Med. 2001;161:929-936. The Question: Where can I find up to date information on the prevention of needle stick injuries in the health care settings? Answer in a nutshell: This report by the Council of Scientific affairs of the American Medical Association published in the Archives of Internal Medicine reviews this topic and provides various recommendations. Full free text access to the report available @ http://archinte.ama-assn.org/issues/v161n7/rfull/isa00011.html Chronic diseases Impact of age on perioperative complications and length of stay in patients undergoing noncardiac surgery. Polanczyk CA, Marcantonio E, Goldman L et al. Ann Int Med 2001;134:637-643. The Question: Does age influence the occurrence of perioperative cardiac and noncardiac complications and length of stay in patients undergoing noncardiac surgery? Answer in a nutshell: Older patients (those aged over 70 years) have a higher rate of cardiac and non cardiac complications and have slightly longer length of stay as compared to younger patients (aged 50-59 years). Prior alcohol consumption and mortality following acute myocardial infarction. Mukamal KJ, Maclure M et al. JAMA. 2001; 285:1965-1970. The Question: What is the effect of prior alcohol consumption on long-term mortality in survivors of myocardial infarction? Answer in a nutshell: Self-reported moderate alcohol consumption in the year prior to AMI is associated with reduced mortality following infarction. Effect of lipid-lowering therapy on early mortality after acute coronary syndromes: an observational study. Aronow HD, Topol EJ et al. Lancet 2001; 357:1063-68. The Question: What is the effect of lipid lowering therapy on short-term mortality immediately after an acute coronary syndrome? Answer in a nutshell: Prescription of a lipid-lowering drug at hospital discharge was independently associated with reduced short-term mortality among patients after an acute coronary syndrome Correlation of unilateral urolithiasis with sleep posture. Shekarriz B, Lu HF, Stoller ML. J Urol 2001;165:1085-1087. The Question: Is there an association between sleep posture and unilateral urolithiasis? Answer in a nutshell: There appears to be a positive relation between sleeping on a particular side and occurrence of the renal calculi. The positive predictive values of right and left side down sleep posture for formation of ipsilateral calculi were 82% and 70%, respectively. Medical Education Beyond requirements - Residency management through the internet. Civetta JM, Morejón OV et al. Arch Surg. 2001;136:412-417 The Question: Is it possible to use the Internet to document and manage a residency-training programme? Answer in a nutshell: A Internet based application system satisfied the requirements of the residency review committee, provided and processed data that are of better quality and more complete than the previously employed paper system. Money matters Randomised controlled trial of Helicobacter pylori testing and endoscopy for dyspepsia in primary care. Delaney BC, Wilson S et al. BMJ 2001;322:898. The Question: Is it cost effective to undertake near patient Helicobacter pylori testing and endoscopy for managing dyspepsia? Answer in a nutshell: The test and endoscopy strategy increases endoscopy rates over usual practice in primary care. The additional cost is not offset by benefits in symptom relief or quality of life. Miscellaneous Advancing paternal age and the risk of Schizophrenia. Malaspina D, Harlap S et al. Arch Gen Psychiatry. 2001;58:361-367 The Question: Does advancing paternal age associated with the occurrence of Schizophrenia in their offspring? Answer in a nutshell: The risk of Schizophrenia increases with advancing paternal age and it may be associated, in part, with de novo mutations arising in paternal germ cells. The weak connection between venous thromboembolism and air travel. Weir E.CMAJ 2001;164:1037. The Question: Where can I find up to date information on the suggested association between venous thromboembolism and air travel? Answer in a nutshell: This update published in the CMAJ reviews the epidemiology of this association and summarises the current research evidence. Full free text available @ http://www.cma.ca/cmaj/vol-164/issue-7/1037.asp The teratogenicity of anticonvulsant drugs. Holmes LB, Harvey EA et al. N Engl J Med 2001;344:1132-8. The Question: Does the anticonvulsant drugs taken during pregnancy increase the risk of fetal abnormalities? Answer in a nutshell: Anticonvulsant drugs appear to cause a distinctive pattern of physical abnormalities. Smokers’ corner Cigarette smoking, alcohol consumption, and risk of hip fracture in women. Baron JA, Farahmand BY et al. Arch Intern Med. 2001;161:983-988. The Question: What is the relation between smoking, alcohol consumption and risk of his fractures in postmenopausal women? Answer in a nutshell: Cigarette smoking increases the risk of hip fracture among postmenopausal women and the risk decrease after cessation. Alcohol consumption has a weak inverse association with risk. From the pages of Bandolier http://www.jr2.ox.ac.uk/bandolier/band86/b86-2.html Low dose aspirin - harm and benefits Web Watch – This section contains over 30 websites of interest to health professionals. For your patients http://www.annals.org/issues/v134n7/200104030-00004.pdf http://jama.ama-assn.org/issues/v285n16/fpdf/jpg0425.pdf If you do visit the site drop us a line on JSCAN. Cheers & regards, Badri 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/badrishanthi "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) _________________________________________________________________ Get your FREE download of MSN Explorer at http://explorer.msn.com