Dear All,
Warm greetings from Al-Ain, the oasis city of the Middle East. Some of you
may recall JSCAN, a professional news letter we produce here in the
Emirates. Please find below the topics covered in the summer maga issue
(covering the months of June, July & August). Apart from summer JSCAN comes
out monthly.
You can access JSCAN on line @ http://www.uaeu.ac.ae/jscan
Please fee free to send in your comments which we greatly value and
appreciate.
With warm regards,
Badri
Evidence Based Practice
The efficacy of "Distant Healing": A systematic review of randomized trials.
Astin JA, Harkness E, Ernst E. Ann Intern Med. 2000;132:903-910.
The Question: Is there any evidence from randomized controlled trials that
distant healing as a treatment for any medical condition is effective?
Answer in a nutshell: This meta-analysis showed that more than half (57%) of
the trials on this subject show a positive effect of distant healing on
medical conditions.
Pharmacologic treatment of the irritable bowel syndrome: A systematic review
of randomized, controlled trials. Jailwala J, Imperiale TF, Kroenke K. Ann
Intern Med. 2000;133:136-147.
The question: What is the efficacy of pharmacological treatment of irritable
bowel syndrome?
Answer in a nutshell: This systematic review shows that when abdominal pain
is the predominant symptom smooth-muscle relaxants are beneficial. The
efficacy of bulking agents has not been established. Loperamide is effective
for diarrhea. The evidence for use of psychotropic agents is and the
evidence for the efficacy of 5-HT-receptor antagonists appears to be
favorable.
Reduction in obesity and related comorbid conditions after diet-induced
weight loss or exercise-induced weight loss in men - A randomized,
controlled trial. Ross R, Dagnone D, Jones PJH et al. Ann Intern Med.
2000;133:92-103.
The Question: What is the effect of equivalent diet- or exercise-induced
weight loss and exercise without weight loss on subcutaneous fat, visceral
fat, skeletal muscle mass, and insulin sensitivity in obese men?
Answer in a nutshell: Weight loss induced by increased daily physical
activity without caloric restriction substantially reduces obesity
(particularly abdominal obesity) and insulin resistance in men. Exercise
without weight loss reduces abdominal fat and prevents further weight gain.
Association between depression and mortality in older adults - The
cardiovascular health study. Schulz R, Beach SR, Ives DG et al. Arch Intern
Med. 2000;160:1761-1768.
The Question: Is there a relation between baseline depressive symptoms and
all-cause mortality in older persons, after controlling for potential
confounders?
Answer in a nutshell: High levels of depressive symptoms are an independent
risk factor for mortality in community-residing older adults.
Do triglycerides provide meaningful information about heart disease risk.
Avins AL, Neuhaus JM. Arch Intern Med. 2000;160:1937-1944.
The Question: Is there any additional value in measuring triglyceride
levels, in addition to cholesterol levels and subfractions, for predicting
CHD in men?
Answer in a nutshell: In men, measurement of serum triglyceride levels does
not provide clinically meaningful information about CHD risk beyond that
obtainable by measurement of serum cholesterol subfractions alone.
>From the pages of Archives of Family Medicine: Solutions to often asked
clinical problems (SOAP)
Bacterial vaginosis and treatment of sexual partners. Hamrick M, Chambliss
ML.
The Question: Should partners of patients with recurrent bacterial vaginosis
be treated?
Answer in a nutshell: There is no evidence that treating male partners of
patients with recurrent BV improves cure or recurrence rates. Although many
textbooks recommend considering partner treatment, the emotional
ramifications of implying that BV is sexually transmitted should be taken
into consideration before implementing a treatment of no proven benefit.
Combined analgesia and local anesthesia to minimize pain during
circumcision. Taddio A, Pollock N, Gilbert-MacLeod C et al. Arch Pediatr
Adolesc Med 2000;154:620-623.
The Question: Is there a difference in pain experienced by infants
circumcised using the Mogen clamp and combined analgesia during surgery as
compared to those In whom Gomco clamp and lidocaine-prilocaine cream were
used?
Answer in a nutshell: Infants circumcised with the Mogen clamp and combined
analgesia have substantially less pain than those circumcised with the Gomco
clamp and lidocaine-prilocaine cream.
>From the pages of Bandolier
Reducing antibiotic prescribing
Do you want manage dyspepsia in the EBM way. Then you should access this
piece in the Canadian Medical Association Journal.
Relationship of baseline serum cholesterol levels in 3 large cohorts of
younger men to long-term coronary, cardiovascular, and all-cause mortality
and to longevity. Stamler J, Daviglus ML, Garside DB et al. JAMA.
2000;284:311-318
The question: What is the long term impact of unfavorable serum cholesterol
levels on risk of death from coronary heart disease (CHD), cardiovascular
disease (CVD) and all causes in younger men aged under 40?
Answer in a nutshell: There is a continuous, graded relationship of serum
cholesterol level to long-term risk of CHD, CVD, and all-cause mortality,
and the risk is substantially increased for younger men with elevated serum
cholesterol levels, and estimated life expectancy is longer for younger men
with favorable serum cholesterol levels.
Effect of treating isolated systolic hypertension on the risk of developing
various types and subtypes of stroke - The Systolic Hypertension in the
Elderly Program (SHEP). Perry HM Jr, Davis BR, Price TR et al. for the
Systolic Hypertension in the Elderly Program (SHEP) Cooperative Research
Group. JAMA. 2000;284:465-471
The Question: Does treating men and women aged 60 years or older with
isolated systolic hypertension reduces the incidence of various types of
stroke, stroke mortality and residual effects?
Answer in a nutshell: Antihypertensive drug treatment reduces the incidence
of both hemorrhagic and ischemic (including lacunar) strokes. Stroke
incidence is reduced when specific systolic blood pressure goals are
attained.
Validity of a set of clinical criteria to rule out injury to the cervical
spine in patients with blunt trauma. Hoffman JR, Mower WR, Wolfson AB et al
for the National Emergency X-Radiography Utilization Study Group. N Engl J
Med 2000;343:94-9
The Question: Can a simple decision instrument based on clinical criteria
help physicians to identify reliably the patients who need radiography of
the cervical spine after blunt trauma?
Answer in a nutshell: This simple decision instrument based on clinical
criteria can help physicians to identify reliably the patients who need
radiography of the cervical spine after blunt trauma. Application of this
instrument could reduce the use of imaging in such patients.
A comparison of suture repair with mesh repair for incisional hernia.
Luijendijk RW, Hop WCJ, van den Tol MP et al. N Engl J Med 2000;343:392-8
The Question: In patients with abdominal incisional hernias, is mesh repair
superior to suture repair in preventing hernia recurrence?
Answer in a nutshell: Among patients with midline abdominal incisional
hernias, mesh repair is superior to suture repair with regard to the
recurrence of hernia, regardless of the size of the hernia.
Comparison of wet combing with malathion for treatment of head lice in the
UK: a pragmatic randomised controlled trial. Roberts RJ, Casey D, Morgan DA
et al. Lancet 2000; 356: 540 - 544
The Question: How effective is the mechanical removal of head lice (bug
busting which is wet combing with a fine-toothed comb) compared to
application of the insecticide malathoin for the treatment of head lice in
school children?
Answer in a nutshell: This pragmatic trial found that malathion lotion was
twice as effective as mechanical removal (bug busting), even in areas with
intermediate resistance.
Users' guides to the medical literature - XX. Integrating research evidence
with the care of the individual patient McAlister FA, Straus SE, MD; Guyatt
GH et al. for the Evidence-Based Medicine Working Group. JAMA.
2000;283:2829-2836
Chronic diseases
Brief screening for family psychiatric history - The family history screen.
Weissman MM, Wickramaratne P, Adams P et al. Arch Gen Psychiatry
2000;57:675-682.
The Question: How effective is the Family History Screen (FHS) as a tool in
identifying psychiatric morbidity?
Answer in a nutshell: The FHS is a promising brief screen for collecting
lifetime psychiatric history on an informant and/or first-degree relatives.
It is valid for major depression, anxiety disorders, substance dependence
and suicide attempts.
Prevalence, clinical characteristics, and mortality among patients with
myocardial infarction presenting without chest pain. Canto JG, Shlipak MG,
Rogers WJ et al. JAMA. 2000;283:3223-9.
The Question: What is the frequency of MI patients presenting without chest
pain and is there a difference in their management and outcome?
Answer in a nutshell: Nearly one third of patients with MI present without
chest pain and are at an increased risk of delays in seeking medical
attention, get less aggressive treatments, and experience increased
in-hospital mortality.
Characteristics and outcomes of older patients presenting to the emergency
department after a fall: a retrospective analysis. Bell AJ, Talbot-Stern JK,
Hennessy A. MJA 2000; 173: 179-182.
The Question: What ate the factors associated with fall, the pattern of
injuries and the outcome in old patients presenting to the emergency
department after a fall?
Answer in a nutshell: One third of the falls were due to accidental causes.
Previous fall and alcohol misuse increased the risk of falling. Elderly
after a fall had high injury rates, high admission rates and often prolonged
hospitalisation.
Effect of anti-inflammatory drugs on overall risk of common cancer:
case-control study in general practice research database Langman MJS, Cheng
KK, Gilman EA et al. BMJ 2000;320:1642-1646.
The Question: Does anti-inflammatory drug treatment protect against the
commoner
cancers in the United Kingdom?
Answer in a nutshell: Anti-inflammatory drugs appear to protect against
oesophageal and gastric cancer as well as colon and rectal cancer.
Women' Health
Teenaged girls, carbonated beverage consumption, and bone fractures. Wyshak
G. Arch Pediatr Adolesc Med 2000;154:610-613.
The Question: Is there an association between carbonated beverage
consumption and bone fractures among teenaged girls?
Answer in a nutshell: Carbonated beverage consumption appears to increase
the risk of bone fracture by three folds and this association appears to be
stronger in physically active girls.
Physical activity and risk of stroke in women. Hu FB, Stampfer MJ, Colditz
GS et al. JAMA. 2000;283:2961-2967.
The Question: Is there an association between physical activity and risk of
total stroke and stroke subtypes in women?
Answer in a nutshell: Physical activity, including moderate-intensity
exercise such as walking, is associated with substantial reduction in risk
of total and ischemic stroke, which shows a dose response relationship.
Infectious diseases
Primary care: Health advice and immunizations for travelers. Ryan ET, Kain
KC. N Engl J Med. 2000;342:1716-25.
Evaluating the febrile patient with a rash. Mckinnon HD, JR, Howard T. Am
Fam Physician 2000;62:804-16.
Health Services Research
A study of patient clues and physician responses in primary care and
surgical settings. Levinson W, Gorawara-Bhat R,Lamb J. JAMA.
2000;284:1021-1027
The Question: How often do patients present clues and how do physicians
respond to these clues in primary care and surgical setting?
Answer in a nutshell: Fifty-two percent and 53% of the visits in primary
care and surgery, respectively, included 1 or more clues. Physicians
responded positively to patient emotions in 38% of cases in surgery and 21%
in primary care, but more frequently they missed opportunities to adequately
acknowledge patients' feelings.
Hospital mortality in relation to staff workload:a 4-year study in an adult
intensive-care unit. Tarnow-Mordi WO, Hau C, Warden A et al. Lancet 2000;
356:185 -189.
The Question: Does the workload of hospital staff affect the mortality rates
of inpatients in an adult intensive care unit?
Answer in a nutshell: The mortality of intensive care unit inpatients
exposed to high staff workload defined by average nursing requirement per
occupied bed and peak occupancy is doubled as compared to patients exposed
to low staff workload.
Medical Education
Self-study from Web-based and printed guideline materials. A randomized,
controlled trial among resident physicians. Bell DS, Fonarow GC, Hays RD et
al. Ann Intern Med. 2000;132:938-946
The Question: Do on-line tutorials produce better learning efficiency and
satisfaction as compared to print materials?
Answer in a nutshell: Though on-line tutorials may produce greater learning
efficiency and satisfaction than print materials one self-study exposure may
be insufficient for long-term knowledge retention.
The objective structured clinical examination - A step in the direction of
competency- based evaluation. Carraccio C, Englander R. Arch Pediatr Adolesc
Med. 2000;154:736-741.
The Question: How reliable and valid is the objective structured clinical
examination?
Answer in a nutshell: With appropriate attention to design, acceptable
reliability and validity can be achieved for the OSCE.
Learning surgery online: Ireland's leading school for surgery has joined
with an electronic-learning specialist to provide what they claim is the
world's first online surgical training program.
Miscellaneous
Update in general internal medicine. Roach K, Stern S, Altkorn D et al. Ann
Intern Med. 2000;133:209-217
Is caffeine a flavoring agent in cola soft drinks? Griffiths RR, Vernotica
EM. Arch Fam Med 2000;9:727-34.
The Question: Is caffeine an integral part of the flavor profile of soft
drinks in cola beverages?
Answer in a nutshell: Only a very low percentage of regular cola drinkers
could detect the favoring effect of caffeine which goes against the claims
of soft drink manufacturers that caffeine is added to soft drinks because it
plays an integral role in the flavor profile.
Recommendations for nutrition and physical activity for Australian children
MJA 2000; 173: S1-S16.
A note on computer virus
Smokers' corner
Effect of restrictions on smoking at home, at school, and in public places
on teenage smoking: cross sectional study. Wakefield MA, Chaloupka FJ,
Kaufman NJ et al. BMJ 2000;321:333-337
The Question: Is there a relation between extent of restrictions on smoking
at home, at
school, and in public places and smoking uptake and smoking prevalence among
school students.
Answer in a nut shell: There is a negative association between restrictions
on smoking at home, bans on smoking in public places, and enforced bans on
smoking at school and smoking uptake and smoking prevalence among school
students.
News from the region
CCHF in Iran
Rift Valley Fever in Yemen and Saudi Arabia
West Nile fever in Israel:
Drug watch
Thrombotic thrombocytopenic purpura associated with clopidogrel. Bennett CL,
Connors JM, Carwile JM et al. N Engl J Med 2000;342:1773-7.
The risk of the hemolytic-uremic syndrome after antibiotic treatment of
Escherichia coli O157:H7 Infections. Wong CS, Jelacic S, Habeeb RL et al. N
Engl J Med 2000;342:1930-6
WebWatch
http://www.icmje.org/
www.ahrq.gov/consumer/diaginfo.htm
www.rohcg.on.ca/sleep.html
www.css.to
www.geocities.com/HotSprings/1837/
www.users.cloud9.net/~thorpy
http://bisleep.medsch.ucla.edu
http://www.nlm.nih.gov/hmd/arabic/arabichome.html
http://www.grantsnet.org/
http://www.freemedicaljournals.com/
www.b4baby.com
http://www.med-library.com/medlibrary/
For your patients:
http://www.aafp.org/afp/20000701/160ph.html
http://www.aafp.org/afp/20000801/605ph.html
http://jama.ama-assn.org/issues/v283n22/fpdf/jpg0614.pdf
http://jama.ama-assn.org/issues/v283n24/fpdf/jpg0628.pdf
http://jama.ama-assn.org/issues/v284n7/fpdf/jpg0816.pdf
Apologies for this lengthy message.
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 7039 652
Fax: 00 971 3 7672022.
[log in to unmask]
"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)
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