Dear All,
Greetings from Al-Ain the oasis city of the Middle East. Feb issue of JSCAN
(a professional news letter we produce from the UAE)
is now on line and can be accessed at http://www.uaeu.ac.ae/jscan
Please find below the list of topics covered in this issue. As always we
greatly appreciate and value your comments and if you have the time please
mail us a line or two.
Regards,
Badri
Evidence Based Practice
Mortality reduction with air bag and seat belt use in head-on passenger car
collisions. Crandall CS, Olson LM et al. Am Journal of Epid 2001:
153:219-224.
The Question: Does the use of air bag and seat belt reduce the mortality in
head-on passenger car collisions?
Answer in a nutshell: Air bag deployment and seat belts individually or in
combination significantly reduce mortality in head-on passenger car
collisions.
Coffee consumption and serum lipids: A meta-analysis of randomized
controlled clinical trials. Jee SH, He J et al. Am J Epidemio
2001:153;353-362.
The Question: Is there an association between coffee drinking and levels of
serum cholesterol?
Answer in a nutshell: This meta-analysis fond that consumption of
unfiltered, but not filtered, coffee increases serum levels of total and LDL
cholesterol.
Inhaled human insulin treatment in patients with type 2 diabetes mellitus.
Cefalu WT, Skyler JS et al for the Inhaled Insulin Study Group. Ann Intern
Med 2001;134:203-207.
The Question: Is it safe and efficacious to use inhaled (pulmonary delivery)
insulin in patients with Type 2 diabetes mellitus?
Answer in a nutshell: Pulmonary delivery of insulin in type 2 diabetic
patients who require insulin improved glycemic control, was well tolerated,
and demonstrated no adverse pulmonary effects.
Efficacy of inhaled human insulin in type 1 diabetes mellitus: a randomised
proof-of-concept study. Skyler JS, Cefalu WT et al for The Inhaled Insulin
Phase II Study Group. Lancet 2001; 357: 331-35.
The Question: Can preprandial inhaled insulin be used as a substitute for
preprandial insulin injections without loss of glycaemic control?
Answer in a nutshell: This proof-of-concept study shows that preprandial
insulin can be given by inhalation in individuals with insulin-deficient
type 1 diabetes as a less invasive alternative to conventional preprandial
insulin injections.
Glucose tolerance and cardiovascular mortality. Comparison of fasting and
2-hour diagnostic criteria. DECODE Study Group; on behalf of the European
Diabetes Epidemiology Group. Arch Intern Med. 2001; 161:397-404
The Question: How well does fasting blood glucose (FBG) perform as compared
to 2-hour glucose (2h-BG) in predicting mortality?
Answer in a nutshell: The 2h-BG is a better predictor of deaths from all
causes and cardiovascular disease than is FBG.
Selective versus universal screening for gestational diabetes mellitus: an
evaluation of predictive risk factors. Davey RX, Hamblin PS. MJA 2001;174:
118-121.
The Question: Can selective screening for gestational diabetes mellitus
(GDM) on the basis of risk-factor assessment be used as a practicable
alternative to universal screening?
Answer in a nutshell: Selective screening for GDM based on prior risk
assessment can reduce the need for testing, with negligible loss of
diagnostic efficiency.
Aspirin and the treatment of heart failure in the elderly. Krumholz HM, Chen
YT et al. Arch Intern Med. 2001;161:577-582
The Question: How often is aspirin prescribed among patients 65 years or
older and hospitalized with both heart failure and coronary artery disease
and what is their survival pattern at one year after discharge?
Answer in a nutshell: Of patients without contraindications to aspirin
therapy less than half the number of patients receive aspirin and the
mortality is considerably lower in these patients.
Effectiveness of Oseltamivir in preventing influenza in household contacts.
A randomized controlled trial. Welliver R, Monto AS et al for the
Oseltamivir Post Exposure Prophylaxis Investigator Group. JAMA.
2001;285:748-754
The Question: What is the efficacy of oseltamivir in preventing spread of
influenza to household contacts of influenza-infected index cases?
Answer in a nutshell: This double blind randomized placebo controlled trial
found that postexposure prophylaxis with oseltamivir, 75 mg once daily for 7
days, protected close contacts of influenza-infected persons against
influenza illness, prevented outbreaks within households, and was well
tolerated.
Osteoporosis prevention, diagnosis, and therapy. NIH consensus development
panel on osteoporosis prevention, diagnosis, and therapy. JAMA.
2001;285:785-795
The Question: Where can I find evidence based, up to date information on the
prevention, diagnosis and treatment of osteoporosis?
Answer in a nutshell: The NIH consensus development panel report on
osteoporosis published in the JAMA clarifies the factors associated with
prevention, diagnosis, and treatment of osteoporosis, and also provides the
most recent information available in these areas.
Longitudinal follow-up of tinnitus complaints. Andersson G, Vretblad P et
al. Arch Otolaryngol Head Neck Surg. 2001;127:175-179.
The Question: What is the the long-term outcome of patients with tinnitus,
the long-term effects of cognitive behavioral therapy, and what are the
properties of tinnitus that predict distress at follow-up?
Answer in a nutshell: Severe tinnitus shows some signs of improvement over
time, especially when psychological treatment has been given. Tinnitus
maskability is an important prognostic factor of future tinnitus annoyance
The addition of Ceftriaxone to oral therapy does not improve outcome in
febrile children with urinary tract infections. Baker PC, Nelson DS et al.
Arch Pediatr Adolesc Med. 2001;155:135-139.
The Question: Does the addition of a single dose of ceftriaxone sodium to a
10-day course of trimethoprim and sulfamethoxazole hastens urine
sterilization or resolution of clinical symptoms in febrile children with
urinary tract infections?
Answer in a nutshell: This randomized trial found that addition of a single
dose of intramuscular ceftriaxone to a 10-day course of oral
trimethoprim-sulfamethoxazole for urinary tract infection with fever
resulted in no difference at 48 hours in the urine sterilization rate,
degree of clinical improvement, or subsequent hospital admission rate.
Effect of risedronate on the risk of hip fracture in elderly women. McClung
MR, Geusens P et al for the Hip Intervention Program Study Group. N Engl J
Med 2001;344:333-40.
The Question: Does risedronate reduce the risk of hip fracture among elderly
women with osteoporosis?
Answer in a nutshell: Risedronate significantly reduces the risk of hip
fracture among elderly women with confirmed osteoporosis but not among
elderly women selected primarily on the basis of risk factors other than low
bone mineral density.
Efficacy of a pneumococcal conjugate vaccine against acute otitis media.
Eskola J, Kilpi T et al for the Finnish Otitis Media Study Group. N Engl J
Med 2001;344:403-9.
The Question: What is the efficacy and safety of pneumococcal conjugate
vaccine in preventing acute otitis media?
Answer in a nutshell: The heptavalent pneumococcal polysaccharide-CRM197
conjugate vaccine is safe and efficacious in the prevention of acute otitis
media caused by the serotypes included in the vaccine.
Risk of adverse birth outcome and miscarriage in pregnant users of
non-steroidal anti-inflammatory drugs: population based observational study
and case-control study. Nielsen GL, Sorensen HT et al. BMJ 2001; 322:
266-270.
The Question: What is the risk of adverse birth outcome in women who take
non-steroidal anti-inflammatory drugs during pregnancy?
Answer in a nutshell: Use of non-steroidal anti-inflammatory drugs during
pregnancy does not seem to increase the risk of adverse birth outcome but is
associated with increased risk of miscarriage.
Antiplatelet drugs for prevention of pre-eclampsia and its consequences:
systematic review. Duley L, Henderson-Smart D et al. BMJ 2001;322:329-333.
The Question: What is the efficacy and safety of of antiplatelet drugs for
the prevention of pre-eclampsia and its consequences?
Answer in a nutshell: Antiplatelet drugs, largely low dose aspirin, have
small to moderate benefits when used for the prevention of pre-eclampsia.
Radiography of the lumbar spine in primary care patients with low back pain:
randomised controlled trial. Kendrick D, Fielding K et al. BMJ
2001;322:400-405.
The Question: Is performing radiography of the lumbar spine in primary care
patients with low back pain leads to improved clinical outcomes or
satisfaction with care?
Answer in a nutshell: Radiography of the lumbar spine in primary care
patients with low back pain of at least six weeks' duration is not
associated with improved patient functioning, severity of pain, or overall
health status but is associated with an increase in doctor workload.
Pragmatic randomised controlled trial of two prescribing strategies for
childhood acute otitis media. Little P, Gould C et al. BMJ
2001;322:336-342.
The Question: Can a wait and see approach appropriate in children with acute
otitis media?
Answer in a nutshell: For children who are not very unwell systemically, a
wait and see approach seems feasible and acceptable to parents and should
substantially reduce the use of antibiotics for acute otitis media.
Infectious disease
Plasma viral load testing in the management of HIV infection. Eleftherios M,
Paliou J et al. Am Fam Physician 2001;63:483-90,495-6.
The Question: Where can I find information on the utility of plasma viral
load testing (PVL) in the management of HIV infection?
Answer in a nutshell: This review article from the American Family Physician
contains information on the reasons for ordering PVL, clinical use of PVL
testing, figure showing natural history of HIV, table showing PVL and CD4+
cell cutoff values for antiretroviral therapy, and a table showing causes of
false-negative ELISA or indeterminate Western Blot tests.
Influenza vaccine for the coming season:
Chronic disease
Effective use of statins to prevent coronary heart disease. Crouch MA. Am
Fam Physician 2001;63:309-20,323-4.
The Question: Where can primary care physicians find information on the
appropriate use of statins to prevent coronary heart disease?
Answer in a nutshell: This review published in the American family physician
provides information on National cholesterol education programme (NCEP)
identified risk factors for CHD, NCEP recommendations for LDL levels in
primary prevention of CHD, data on CHD Prevention from five major controlled
trials of statins, NCEP recommendations for LDL Levels in secondary
prevention of coronary events in patients with CHD. Also information on
average percentage of reduction in LDL levels with different efficacy of
statin drugs, suggestions for prescribing statin drugs in a cost-effective
manner and estimated cost of different dosages of statin drugs are provided.
Sex differences in 2-Year mortality after hospital discharge for myocardial
infarction. Vaccarino V, Krumholz HM et al. Ann Intern Med 2000;134:173-81.
The Question: What is the effect of age and sex on long-term mortality after
myocardial infarction?
Answer in a nutshell: Younger, but not older, women who survive
hospitalization for myocardial infarction have a higher long-term mortality
rate than men.
Treatment of congestive heart failure. Guidelines for the primary care
physician and the heart failure specialist. Gomberg-Maitland M, Baran DA et
al. Arch Intern Med. 2001;161:342-352.
The Question: Where can primary care physicians find up to date information
on the management of congestive heart failure?
Answer in a nutshell: This review published in the Archives of Internal
medicine discusses the current evidence based strategies for the management
of heart failure aimed at both the generalist and specialist.
Evaluation of acute headaches in adults Clinch CR. Am Fam Physician
2001;63:685-92.
The Question: Where can primary care physicians find information on how to
evaluate patients with headache?
Answer in a nutshell: This review published in the American Family Physician
provides the following information; acute primary and secondary headache
disorders, Questions to ask while eliciting headache history, DD and
possible workup, diagnostic criteria for different types of headache, and
criteria for migraine.
Women's health
Menstrual history and risk of hip fractures in postmenopausal women - The
Iowa Women's Health Study. Nicodemus KK, Folsom AR et al. Am J Epidemiol
2001; 153 :251-255.
The Question: Is there a relation between menstrual irregularities in early
life and increased risk of hip fractures in postmenopausal women?
Answer in a nutshell: This prospective study from Iowa showed that that
women with menstrual irregularities are at increased risk of hip fracture
and the authors propose that this is probably because these women are
estrogen or progesterone deficient.
Paediatric health
The continuing value of the Apgar score for the assessment of newborn
infants. Casey BM, McIntire DD et al. N Engl J Med 2001;344:467-71.
The Question: Is the Apgar score still a useful predictor of neonatal
survival?
Answer in a nutshell: The Apgar scoring system remains as relevant for the
prediction of neonatal survival today as it was almost 50 years ago
Relation between consumption of sugar-sweetened drinks and childhood
obesity: a prospective, observational analysis. Ludwig DS, Peterson KE et
al. Lancet 2001; 357: 505-08
The Question: Is there a relation between obesity in children and
consumption of sugar-sweetened drinks?
Answer in a nutshell: There appears to be an association between consumption
of sugar-sweetened drinks and obesity in children.
Money Matters
Cost-effectiveness of endoscopy in irritable bowel syndrome. Suleiman S,
Sonnenberg A. Arch Intern Med. 2001;161:369-375.
The Question: Is it cost effective to use endoscopic procedures in the
workup for IBS?
Answer in a nutshell: Flexible sigmoidoscopy or colonoscopy constitute the
most costly portion of any workup for IBS, which amounts to 50% to 75% of
the overall costs. Hence in the diagnosis of IBS, inexpensive, noninvasive
tests should be used first to rule out other diagnoses.
Medical Education
Are "tomorrow's doctors" honest? Questionnaire study exploring medical
students' attitudes and reported behaviour on academic misconduct. Rennie
SC, Crosby JR BMJ 2001;322:274-275.
Medical education and the Internet: This changes everything. Le T, Stein ML
et al. http://www.ama-assn.org/sci-
pubs/msjama/articles/vol_285/no_5/jms0214016.htm
Miscellaneous
Bioethics for clinicians: 23. Disclosure of medical error. Hébert PC, Levin
AT et al. CMAJ 2001;164:509-13.
The Question: Where can I find some information on disclosing medical
errors?
Answer in a nutshell: This review published in the CMAJ discusses ethical,
legal and practical aspects of medical errors and whether and how they
should be disclosed to patients.
Impact of coronary heart disease on world leaders. Girardi AM, Pyenson LR et
al. Ann Intern Med. 2001;134:287-290
The Question: What is the incidence of and death from coronary heart disease
among world leaders and what is the effect of this disease on office-holding
ability?
Answer in a nutshell: Incidence and death from coronary heart disease among
office-holding world leaders has decreased over the past 30 years, possibly
because of increased use of cardiac procedures. A coronary event in a world
leader is unlikely to presage a change in government.
From the pages of Bandolier
MMR vaccination http://www.jr2.ox.ac.uk/bandolier/band84/MMR.html
For your patients
Participating in medical research
Plasma viral load testing
HIV infection and pregnancy - Protecting your baby and yourself.
Goals for lowering cholesterol
Drug Watch
New treatment for eczema. Schwetz BA, JAMA 2001:285 14TH Feb
This issue also contains the WebWatch and what U say sections.
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)
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