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Dear All, Greetings from Al-Ain the oasis city. The current issue of JSCAN, a health professionals' newsletter is now on line. You can access JSCAN @ http://www.uaeu.ac.ae/jscan. Please find below the topics covered in this issue. If you do visit JSCAN and have a minute to spare drop us a line on your thoughts on this continuing professional development activity. (Apologies for the X postings as I have posted this message both to EB&Public health lists) Evidence based practice Determinants of mortality in patients with severe blunt head injury. Schreiber MA, Aoki N et al. Arch Surg. 2002;137:285-290 The Question: What factors predict outcome in patients with severe blunt head trauma? Answer in a nutshell: Glasgow Coma Scale score and age when used together are significant predictors of mortality. Systemic hypotension and intracranial hypertension are the only independent risk factors for mortality that can be readily treated during the initial management of patients with severe head injuries. Are recommendations about routine antenatal care in Australia consistent and evidence-based? Hunt JM, Lumley J. MJA 2002l;1766:255-259 The Question: Are recommendations about routine antenatal care in Australia consistent and evidence-based? Answer in a nutshell: Antenatal care recommended in protocols used in Australia varies, and is not always consistent with national policies or research evidence. Use of ramipril in preventing stroke: double blind randomised trial. Bosch J, Yusuf S et al. BMJ 2002;324:699 The Question: How effective is the angiotensin converting enzyme inhibitor ramipril in the secondary prevention of stroke? Answer in a nutshell: The authors of this randomised controlled trial concluded that “Ramipril reduces the incidence of stroke in patients at high risk, despite a modest reduction in blood pressure”. Obstacles to answering doctors' questions about patient care with evidence: qualitative study. Ely JW, Osheroff JA et al. BMJ 2002;324:710 The Question: What are the obstacles encountered when attempting to answer doctors' questions with evidence? Answer in a nutshell: The six major obstacles identified were: the excessive time required to find information, difficulty modifying the original question, which was often vague and open to interpretation, difficulty selecting an optimal strategy to search for information, failure of a seemingly appropriate resource to cover the topic, uncertainty about how to know when all the relevant evidence has been found so that the search can stop, and inadequate synthesis of multiple bits of evidence into a clinically useful statement. Randomised controlled trial of short bursts of a potent topical corticosteroid versus prolonged use of a mild preparation for children with mild or moderate atopic eczema. Thomas KS, Armstrong S et al. BMJ 2002;324:768 The Question: Is the three day burst of a potent corticosteroid more effective than a mild preparation used for seven days in children with mild or moderate atopic eczema. Answer in a nutshell: A short burst of a potent topical corticosteroid is as effective as prolonged use of a milder preparation for controlling mild or moderate atopic eczema in children. Age at acquisition of Helicobacter pylori infection: a follow-up study from infancy to adulthood. Malaty HM, El-Kasabany A et al. Lancet 2002; 359: 931-35. The Question: When do patients acquire Helicobacter pylori infection? Answer in a nutshell: Most H pylori infections are acquired before age 10 years and treatment and preventive strategies should be aimed at children in this age-group. Cardiovascular morbidity and mortality in the Losartan Intervention For Endpoint reduction in hypertension study (LIFE): a randomised trial against atenolol. Dahlöf B, Devereux RB et al for the LIFE study group. Lancet 2002; 359: 995-1003 The Question: What is the efficacy of Losartan compared to atenolol in reducing cardiovascular morbidity and mortality in patients with hypertension? Answer in a nutshell: Losartan prevents more cardiovascular morbidity and death than atenolol for a similar reduction in blood pressure and is better tolerated. Losartan seems to confer benefits beyond reduction in blood pressure Duration of prophylaxis against venous thromboembolism with Enoxaparin after surgery for cancer. Bergqvist D, Agnelli G et al for the ENOXACAN II Investigators. N Engl J Med 2002;346:975-980. The Question: What is the optimal duration of postoperative thromboprophylaxis in patients undergoing abdominal cancer surgery? Answer in a nutshell: According to this randomised trial Enoxaparin prophylaxis for four weeks after surgery for abdominal or pelvic cancer is safe and significantly reduces the incidence of venographically demonstrated thrombosis, as compared with enoxaparin prophylaxis for one week. Effect of Nonoxynol-9 gel on urogenital gonorrhea and chlamydial infection. A randomized controlled trial. Roddy RE, Zekeng L et al. JAMA. 2002;287:1117-1122 The Question: Does the use of nonoxynol-9 gel along with condom prevents the male-to-female transmission of urogenital gonococcal and chlamydial infection as compared to use of only condoms? Answer in a nutshell: This randomised controlled trial showed that Nonoxynol-9 gel does not protect against urogenital gonococcal or chlamydial infection. Coffee intake and risk of hypertension. The Johns Hopkins precursors study. Klag MJ, Wang NY et al. Arch Intern Med. 2002;162:657-662. The Question: Does long term coffee drinking increase the risk of hypertension? Answer in a nutshell: Over many years of follow-up, coffee drinking is associated with small increases in blood pressure, but appears to play a small role in the development of hypertension. Prognostic value of systolic and diastolic blood pressure in treated hypertensive men. Benetos A, Thomas F et al. Arch Intern Med. 2002;162:577-581 The Question: What is the prognostic value of systolic and diastolic hypertension (SBP) in hypertensive men? Answer in a nut shell: In hypertensive men treated in clinical practice SBP is a good predictor of CVD and CHD risk. Diastolic blood pressure, which remains the main criterion used by most physicians to determine drug efficacy, appears to be of little value in determining cardiovascular risk. The impact of empirical management of acute cystitis on unnecessary antibiotic use. McIsaac WJ, Low DE et al. Arch Intern Med. 2002;162:600-605 The Question: Does use of empirical treatment with antibiotics in women with symptoms of acute cystitis lead to unnecessary antibiotic dispensation? Answer in a nutshell: Empirical antibiotic treatment of acute cystitis in women without testing for pyuria promotes unnecessary antibiotic use. The reliability of vital sign measurements. Edmonds ZV, Mower WR et al. Ann Emerg Med 2002;39:233-237. The Question: How reproducible are the measurement of non invasive vital signs in clinical setting? Answer in a nutshell: The reproducibility of vital sign measurements may be limited by significant inter observer variability. Clinicians should recognize this inherent variability and interpret vital signs with caution. Chronic diseases Snoring as a risk factor for type II diabetes mellitus: A prospective study. Wael K. Al-Delaimy AK, Manson JE et al. Am J Epidemiol 2002;155:387-393. The Question: Is there an association between snoring and the risk of developing type II diabetes mellitus? Answer in a nutshell: Results from the Nurses Health Study suggest that snoring is independently associated with elevated risk of type II diabetes. Statin Use, bone mineral density, and fracture Risk Geelong Osteoporosis Study. Pasco JA, Kotowicz MA et al. Arch Intern Med. 2002;162:537-540 The Question: What is the association between statin use, risk of fracture and bone mineral density (BMD)? Answer in a nutshell: Use of statins is associated with a 60% reduction in fracture risk and this reduction in risk is greater than would be expected from increases in BMD alone. Is this patient clinically depressed? Williams HW Jr, Noël PH et al. JAMA. 2002;287:1160-1170 The Question: How precise and reliable are the questionnaires and clinical examination used for diagnosing depression? Answer in a nutshell: Many practical questionnaires that are available to help clinicians identify and diagnose patients with major depression have reasonable performance characteristics Diagnostic confirmation by mental health care professionals using a clinical interview or by primary care physicians using a semistructured interview can be made with high reliability. Women’s health Effect of caffeine exposure during pregnancy on birth weight and gestational age. Clausson R, Granath F et al. Am J Epidemiol 2002;155:429-436. The Question: What is the effect of caffeine intake during pregnancy, on birth weight and foetal growth? Answer in a nutshell: According to this cohort study there appears to be no association between moderate caffeine consumption and reduced birth weight, gestational age, or foetal growth. Residential magnetic fields and the risk of breast cancer. Davis S, Mirick DK, Stevens RG. Am J Epidemiol 2002;155:446-454 The Question: Does chronic exposure to residential magnetic fields increase the risk of breast cancer in women? Answer in a nutshell: The results of this population case control study from Seattle, USA did not find an increased risk of breast cancer in women chronically exposed to residential magnetic fields. Effect of oral contraceptives on risk of cervical cancer in women with human papillomavirus infection: the IARC multicentric case-control study. Moreno V, Bosch FX et al for the International Agency for Research on Cancer (IARC) Multicentric Cervical Cancer Study Group. Lancet 2002; 359: 1085-192. The Question: Does oral contraceptives increase the risk of cervical cancer in women with increased in women with human papillomavirus (HPV) infection? Answer in a nutshell: Long-term use of oral contraceptives could be a cofactor that increases risk of cervical carcinoma by up to four-fold in women who are positive for cervical HPV DNA. Role of parity and human papillomavirus in cervical cancer: the IARC multicentric case-control study. Muñoz N, Franceschi S et al for the International Agency for Research on Cancer (IARC) Multicentric Cervical Cancer Study Group. Lancet 2002; 359: 1093-101 The Question: How does parity affects the risk of cervical cancer in women with HPV infection? Answer in a nutshell: High parity increases the risk of squamous-cell carcinoma of the cervix among HPV-positive women. Health services research Coping with medical mistakes and errors in judgment. Goldberg RM, Kuhn G et al. Ann Emerg Med. March 2002;39:287-292 The Question: Where can I find information on the affective aspects of physician errors and the strategies to cope with them? Answer in a nutshell: This article focuses on the affective aspects of physician errors and presents a strategy for coping with them. Association of dissatisfaction with care and psychiatric morbidity with poor treatment compliance. Renzi C, Picardi A et al. Arch Dermatol. 2002;138:337-342 The Question: What are the factors associated with compliance in dermatological patients? Answer in a nutshell: Dissatisfaction with care and psychiatric morbidity are associated with poor compliance in dermatology practice. Racial disparities in the quality of care for enrollees in Medicare managed care. Schneider EC, Zaslavsky AM et al. JAMA. 2002;287:1288-1294 The Question: Is there a difference in the quality of health care by race in US medicare beneficiaries? Answer in a nutshell: Among Medicare beneficiaries enrolled in managed care health plans, blacks received poorer quality of care than whites. Risk factors, hospital management and outcomes after acute myocardial infarction in South Asian Canadians and matched control subjects. Gupta M, Doobay AV et al. CMAJ 2002 166: 717-722 The Question: Are there differences in presentation, risk factors and management of myocardial infarction (MI) between South Asian Canadians and other Canadians? Answer in a nutshell: There are clear differences in the risk factor profile between Canadians of South Asian origin and those of non-South Asian origin who have acute MI. However, treatment of acute MI and in-hospital outcomes, including mortality was similar between the South Asian and matched control groups. Ethnic differences in invasive management of coronary disease: prospective cohort study of patients undergoing angiography. Feder G, Crook AM et al. BMJ 2002;324:511-516. The Question: Is there a difference in the rates of revascularisation in south Asian and white patients undergoing coronary angiography in relation to the appropriateness of revascularisation and clinical outcome in the United Kingdom? Answer in a nutshell: In a London tertiary health care centre, among patients deemed appropriate for coronary artery bypass grafting, south Asian patients are less likely than white patients to receive it. Medical Education Are medical students ready for the digital age? Bailey-Geraghty EM. West J Med 2002;176:137-138 Burnout and self-reported patient care in an internal medicine residency program. Shanafelt TD, Bradley KA et al. Ann Intern Med. 2002;136:358-367. The Question: What is the prevalence of burnout in medical residents and what is its relationship to self-reported patient care practices? Answer in a nutshell: In an University based residency programme in USA, burnout was common among resident physicians and was associated with self-reported suboptimal patient care practices. Stress in medical residency: Status quo after a decade of reform? Collier VC, McCue JD et al. Ann Intern Med. 2002;136:384-390. The Question: What is the current status of stress levels in American medical residents? Answer in a nutshell: An alarming number of current American medicine residents report depressive symptoms, increasing cynicism, and decreasing humanism, which are associated with increasing educational debt and a need to moonlight for financial survival. Worklife and satisfaction of general internists. Wetterneck TB, Linzer M et al for the Society of General Internal Medicine Career Satisfaction Study Group. Arch Intern Med. 2002;162:649-656 The Question: What is the level of job satisfaction among general internists and what are its correlates? Answer in a nutshell: General internists' role of caring for patients with complex problems is associated with lower levels of satisfaction than for internal medicine subspecialists (IMSSs) and family physicians (FPs). Adjusting caseload for patient complexity, expanding time for office visits, and additional training in the care of patients with psychosocially complex problems may improve the job satisfaction of general internists and medical student recruitment into the specialty. Two educational interventions to improve pediatricians' knowledge and skills in performing ankle and knee physical examinations. Hergenroeder AC, Chorley JN et al. Arch Pediatr Adolesc Med. 2002;156:225-229 The Question: Does skill building sessions in addition to using, videotape improves the knowledge and skills of paediatricians performance in ankle and knee examinations? Answer in a nutshell: Both teaching interventions were associated with improved skills and knowledge among paediatricians. Paediatrics The usefulness of children’s drawings in the diagnosis of headache. Stafstrom CE, Rostasy K et al. Paediatrics 2002; 109: 460-472. The Question: Can drawings aid in the differential diagnosis of headaches in children? Answer in a nutshell: Children’s headache drawings are a simple, inexpensive aid in the diagnosis of headache type, with a very high sensitivity, specificity, and predictive value for migraine versus nonmigraine headaches. Relationship of prenatal diagnosis and pregnancy termination to overall infant mortality in Canada. Liu S, Joseph KS et al for the Fetal and Infant Health Study Group of the Canadian Perinatal Surveillance System. JAMA. 2002;287:1561-1567. The Question: What is the impact of congenital anomaly–related fetal and infant deaths on overall population-based infant mortality? Answer in a nutshell: A large decrease in infant deaths due to congenital anomalies was associated with the most recent decline in infant mortality in Canada, suggesting that increases in prenatal diagnosis and pregnancy termination for congenital anomalies are related to decreases in overall infant mortality at the population level. Infectious diseases The sequence of camelpox virus shows it is most closely related to variola virus, the cause of smallpox. Gubser C, Smith GL. J Gen Virol 2002;83(Pt 4):855-72 The Question: Which virus has the closest sequence to small pox virus? Answer in a nutshell: Camelpox virus (CMPV) is the closest known virus to variola virus, the cause of smallpox. A European study on the relationship between antimicrobial use and antimicrobial resistance. Bronzwaer SLAM, Cars O et al and participants in the European Antimicrobial Resistance Surveillance System. http://www.cdc.gov/ncidod/eid/vol8no3/01-0192.htm The Question: Is there a correlation between use of antibiotics and the emergence of resistance across Europe? Answer in a nutshell: According to this ecological study iantimicrobial resistance of S. pneumoniae to penicillin is correlated with use of beta-lactam antibiotics and macrolides in Europe. Money matters Cost effectiveness of continuing professional development in health care: a critical review of the evidence. Brown A, Belfield CR et al. BMJ 2002;324:652-655 The Question: What is the status of literature on cost effectiveness of continuing professional development in health care? Answer in a nutshell: According to this review literature on this topic is limited and the evidence base simply does not allow any empirical conclusions to be drawn about the economic value of continuing professional development Miscellaneous Adverse drug events in emergency department patients. Hafner JW Jr, Belknap SM et al Ann Emerg Med. March 2002;39:258-267. The Question: What is the epidemiology of adverse drug events (ADEs) in emergency department patients? Answer in a nutshell: ADEs constitute under 2% of emergency department encounters. Insulin and Warfarin were the common drugs responsible for ADEs and economic costs of ADEs were substantial. Postoperative serious adverse events in a teaching hospital: a prospective study. Bellomo R, Goldsmith D et al. MJA 2002;176 :216-218 The Question: How common are serious adverse events (SAEs) among inpatients having surgery in a tertiary hospital and what are its risk factors? Answer in a nutshell: SAEs are common and result in high mortality, especially in older surgical inpatients and those having unscheduled surgery. Flipped out of control: single-vehicle rollover accidents in the Northern Territory. Treacy PJ, Jones K, Mansfield C. MJA 2002;176:260-63. The Question: What is the incidence and factors associated with single-vehicle rollover (SVRO) accidents in the "Top End" of the Northern Territory (NT) in Australia? Answer in a nutshell: SVRO accidents are a major cause of morbidity and mortality in the Top End of the NT in Australia and the study identified many risk factors including speeding, male driver and defect in the vehicle. Smokers’ corner Smoking and risk of acute myeloid leukaemia: Results from a Los Angeles county case-control study. Pogoda JM, Preston-Martin S et al. Am J Epidemiol 2002;155:546-553 The Question: Is smoking increase the risk of specific sub type of acute myeloid leukaemia (AML)? Answer in a nutshell: Smoking increases the risk of FAB subtype M2 over two folds and the risk was not increased for AML over all or for other sub types. Five million deaths despite royal college's warning 40 years ago. Burke K. BMJ 2002;324:564 From the pages of Bandolier http://www.jr2.ox.ac.uk/bandolier/band97/b97-4.html Measles vaccination schedules News from the Region In Iran, gender segregation becoming a fact of medical life. Azarmina P CMAJ 2002; 166 (March 5) A view from UK on the same issue BMA negotiator calls for more male medical students BMJ 2002;324:754 Drug watch Meningitis associated with Rofecoxib. Bonnel RB, Villalba ML et al. Arch Intern Med. 2002;162:713-715 Fatal allergic vasculitis associated with celecoxib. Schneider F, Meziani F et al. Lancet. 2002;359:852-3. Mixed hepatocellular-cholestatic liver injury after Pioglitazone therapy. May LD, Lefkowitch JH et al. Ann Intern Med. 2002;136:449-452. Herbal kava: reports of liver toxicity – http://www.cmaj.ca/cgi/content/full/166/6/777 Other sections include book/multimedia watch, Web watch and What U say. Cheers & regards, Badri Dr.P.Badrinath M.D,M.Phil,(Epid)PhD(Cantab)DFPHM(UK),MPH(Distinc) Clinical Assistant Professor & Hon Consultant in Preventive Medicine, 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/" - BMJ 3rd June 2000, Netlines _________________________________________________________________ Chat with friends online, try MSN Messenger: http://messenger.msn.com