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Dear All,
Greetings from Al-Ain. We have just up loaded the current issue of JSCAN.
Please find below the list of articles covered in this issue.
You can access JSCAN on line @ http://www.uaeu.ac.ae/jscan
If you do access JSCAN and have a minute to spare drop us a line on your
impressions of JSCAN. Critiques, comments and complements will be gratefully
accepted and will appear in our next issue.
EVIDENCE BASED PRACTICE
Fish and shellfish consumption in relation to death from myocardial
infarction among men in Shanghai, China. Yuan JM, Ross RK et al. Am J
Epidemiol 2001;154:809-816.
The Question: Is there an association between fish and shellfish consumption
and subsequent mortality due to myocardial infarction?
Answer in a nutshell: This prospective study from China found that men who
consumed >=200 g of fish/shellfish per week had a relative risk of 0.41 (95%
confidence interval: 0.22, 0.78) for fatal acute myocardial infarction
compared with men consuming <50 g per week suggesting a protective effect of
fish/shellfish consumption against fatal myocardial infarction in
middle-aged and older men.
Validation of the Ottawa knee rules. Emparanza JI, Aginaga JR, for the
Estudio Multicéntrico en Urgencias de Osakidetza: Reglas de Ottawa (EMUORO)
Group Ann Emerg Med 2001;38:364-368.
The Question: What is the utility of Ottawa knee rules for determining the
need for radiography in patients with acute knee injury?
Answer in a nutshell: This prospective validation study showed that the
Ottawa Knee Rules to be 100% sensitive for identifying fractures of the knee
and to have the potential to allow physicians to reduce the use of
radiography in patients with acute knee injuries.
The Canadian C-Spine rule for radiography in alert and stable trauma
patients. Stiell IG, Wells GA et al. JAMA. 2001;286:1841-1848.
The Question: Is it feasible to develop a clinical decision rule that is
highly sensitive for detecting acute C-spine injury and will allow emergency
department (ED) physicians to be more selective in use of radiography in
alert and stable trauma patients?
Answer in a nutshell: Through this prospective study involving 10 Canadian
emergency departments (ED), the authors have developed a highly sensitive
decision rule for use of C-spine radiography in alert and stable trauma
patients.
How well is the clinical importance of study results reported? An assessment
of randomised controlled trials. Chan KBY, Man-Son-Hing M et al. CMAJ
2001;165:197-202.
The Question: What is the quality of reporting of factors related to
clinical importance in published randomised controlled trials (RCTs)?
Answer in a nutshell: Authors of RCTs published in major general medical and
internal medicine journals do not consistently provide their own
interpretation of the clinical importance of their results, and they often
do not provide sufficient information to allow readers to make their own
interpretation.
Quality of Cochrane reviews: assessment of sample from 1998. Olsen O,
Middleton P et al. BMJ 2001;323:829-832.
The Question: What is the quality of Cochrane reviews?
Answer in a nutshell: This audit of Cochrane reviews found that too often,
reviewers' conclusions over-rated the benefits of new interventions and
readers of Cochrane reviews should remain cautious, especially regarding
conclusions that favour new interventions. The Cochrane Collaboration has
taken steps to improve the quality of reviews.
Ibuprofen versus acetaminophen with codeine for the relief of perineal pain
after childbirth: a randomized controlled trial. Peter EA, Janssen PA et al.
CMAJ 2001;165(9):1203-9
The Question: Is the effectiveness, side effects, cost, and patient
preference any different for ibuprofen or a combination of acetaminophen
with codeine for the management of postpartum perineal pain?
Answer in a nutshell: Ibuprofen and acetaminophen with codeine has similar
analgesic properties in the first 24 hours postpartum and significantly
fewer subjects in the ibuprofen group
Single vs weekly courses of antenatal corticosteroids for women at risk of
preterm delivery. A randomised controlled trial. Guinn Da, Atkinson ME et
al. JAMA. 2001;286:1581-1587
The Question: What is the efficacy of weekly administration of antenatal
corticosteroids compared with a single course in reducing the incidence of
neonatal morbidity in women at risk of preterm delivery?
Answer in a nutshell: Weekly courses of antenatal corticosteroids do not
reduce composite neonatal morbidity compared with a single course of
treatment and hence weekly courses of antenatal corticosteroids should not
be routinely prescribed for women at risk of preterm delivery.
Natural limits of pregnancy testing in relation to the expected menstrual
period.
Wlicox AJ, Baird DD et al. JAMA. 2001;286:1759-1761
The Question: How sensitive are pregnancy tests when used on the first day
of the expected period?
Answer in a nutshell: Even an extremely sensitive assay for human chorionic
gonadotropin (hCG), will not be able to detect 10% of clinical pregnancies
on the first day of missed menses.
Efficacy of progesterone and progestogens in management of premenstrual
syndrome: systematic review. Wyatt K, Dimmock P et al. BMJ 2001;323:776
The Question: What is the efficacy of progesterone and progestogens in the
management of premenstrual syndrome?
Answer in a nutshell: This meta-analysis did not find any evidence to
support the use of progesterone or progestogens in the management of
premenstrual syndrome.
Impact of first-line vs second-line antibiotics for the treatment of acute
uncomplicated sinusitis. Piccirillo JF, Mager DE et al. JAMA.
2001;286:1849-1856.
The Question: Is there a difference in effectiveness and cost of first-line
antibiotics as compared to second-line antibiotics for the treatment of
acute uncomplicated sinusitis in adults?
Answer in a nutshell: Patients treated with a first-line antibiotic for
acute uncomplicated sinusitis did not have clinically significant
differences in outcomes as compared to those treated with a second-line
antibiotic. However, cost of care was significantly higher for patients
treated with a second-line antibiotic
Pneumonia in long-term care - A prospective case-control study of risk
factors and impact on survival. Vergis EN, Brennen C et al. Arch Intern Med.
2001;161:2378-2381
The Question: What is the impact of pneumonia on survival and what are the
modifiable risk factors for its occurrence in long term care facilities?
Answer in a nutshell: An episode of pneumonia is associated with significant
excess mortality that persists for up to 2 years. Large-volume aspiration
and receipt of sedating medication were two risk factors identified that are
potentially avoidable.
A clinical trial of estrogen-replacement therapy after ischemic stroke.
Viscoli CM, Brass LM et al. N Engl J Med 2001;345:1243-1249
The Question: Is there a role for estrogen therapy in postmenopausal women
who had recently had an ischemic stroke or transient ischemic attack?
Answer in a nut shell: Estrogen does not reduce mortality or the recurrence
of stroke in postmenopausal women with cerebrovascular disease. This therapy
should not be prescribed for the secondary prevention of cerebrovascular
disease.
Mega-dose vitamin C in treatment of the common cold: a randomised controlled
trial. Audera C, Patulny RV et al. MJA 2001; 175: 359-362
The Question: How effective is a large dose of vitamin C in the treatment of
common cold?
Answer in a nutshell: Doses of vitamin C in excess of 1g daily taken shortly
after onset of a cold does not reduce the duration or severity of cold
symptoms in healthy adult volunteers when compared with a vitamin C dose
less than the minimum recommended daily intake.
The impact of airbags and seat belts on the incidence and severity of
maxillofacial injuries in automobile accidents in New York State. Mouzakes
J, Koltai PJ et al. Arch Otolaryngol Head Neck Surg. 2001;127:1189-1193
The Question: What is the effect of driver-side and passenger-side airbags
on the incidence and severity of maxillofacial trauma in victims of
automobile accidents?
Answer in a nutshell: This retrospective analysis of accident data from New
York State found that the use of driver-side airbags, when combined with use
of seat belts, lead to a reduction in the incidence and severity of
maxillofacial trauma.
An evidence-based approach to managing seizures associated with fever in
children. Offringa M, Moyer VA . West J Med 2001;175:254-259.
The Question: How to approach the management of seizure associated with
fever in evidence based way?
Answer in a nutshell: This article in the Western Medical Journal presents a
detailed step by step on how to approach this clinical scenario using
evidence based approach. Full free text available @
http://www.ewjm.com/cgi/content/full/175/4/254
INFECTIOUS DISEASES
Determinants of Vancomycin resistance and mortality rates in enterococcal
bacteremia - A prospective multicenter study. Vergis EN, Hayden MK et al.
Ann Intern Med. 2001;135:484-492.
The Question: Is Vancomycin resistance an independent predictor of death in
patients with enterococcal bacteremia and can appropriate antimicrobial
therapy influence the outcome in these patients?
Answer in a nutshell: Vancomycin resistance is an independent predictor of
death from enterococcal bacteremia and early, effective antimicrobial
therapy is associated with a significant improvement in survival.
Vaccine and vaccination Ada G. N Engl J Med 2001;345:1042-1053
The Question: Where can I find an up date on vaccine and vaccination?
Answer in a nutshell: This excellent review provides extensive information
on vaccines against 14 bacterial, 14 viruses, a parasite and a fungal
infection.
Chronic diseases
Ramipril and the development of diabetes. Yusuf S, Gerstein H et al for the
HOPE study investigators. JAMA. 2001;286:1882-1885
The Question: Is ramipril, an angiotensin-converting enzyme inhibitor
effective in preventing diabetes among high-risk persons?
Answer in a nutshell: Ramipril is associated with lower rates of new
diagnosis of diabetes in high-risk individuals. JSCAN calculated the NNT to
be 56 with 95% CI of 35 to 138. 56 high risk people need to be treated to
prevent 1 person developing diabetes.
WOMEN’S HEALTH
Oral contraceptive use and bone mineral density in premenopausal women:
cross-sectional, population-based data from the Canadian Multicentre
Osteoporosis Study. Prior JC, Kirkland SA et al for the CaMOS Research Group
CMAJ 2001;165:1023-9.
The Question: Is there an association between oral contraceptive (OC) use
and bone mineral density (BMD) in premenopausal women?
Answer in a nutshell: National, population-based data show from Canada show
lower BMD values for the trochanter and spine in premenopausal women who
have used OCs compared with those who have never used Ocs.
Case-Cohort analysis of agricultural pesticide applications near maternal
residence and selected causes of foetal death. Bell EM, Hertz-Picciotto I et
al. Am J Epidemiol 2001; 154:702-710.
The Question: Is there an association between foetal death and residential
proximity to agricultural pesticide applications?
Answer in a nutshell: There appears to be a slightly elevated risk of foetal
death when exposure occurs during gestational months 3 and 4 for carbamates
and carbamate inhibitors and during months 4 and 5 for halogenated
hydrocarbons.
Caesarean section rate for maternal indication in sub-Saharan Africa: a
systematic review. Dumont A, Bernis LD et al for the MOMA study group.
Lancet 2001; 358: 1328-33
The Question: What is the rate of caesarean section for maternal indication
in a West African population of pregnant women?
Answer in a nutshell: According to the authors of maternal indication in a
population of pregnant women in west Africa (MOMA survey) the rate of
caesarean section range from 3·6 to 6·5% with a median of 5·4%.
Paediatrics
Stability and change in children's intelligence quotient scores: A
comparison of two socioeconomically disparate communities. Breslau N,
Chilcoat HD et al. Am J Epidemiol 2001;154:711-717.
The Question: What is the effect of familial factors and community
disadvantage on children’s intelligence quotient (IQ)?
Answer in a nutshell: This prospective study found that the IQs of urban
children, regardless of birth weight, declined from age 6 to age 11 years
while there was a negligible change in suburban children. The study
concluded that growing up in a racially segregated and disadvantaged
community, more than individual and familial factors, may contribute to a
decline in IQ score in the early school years.
MONEY MATTERS
Costs of Hepatitis C. Leigh JP, Bowlus CL et al. Arch Intern Med.
2001;161:2231-2237
The Question: What are the cost implications hepatitis C virus (HCV) in the
United States?
Answer in a nutshell: The authors using detailed methods estimates the cost
of HCV to be $5.46 billion which is on par with the cost of asthma ($5.8
billion [1994]).
MEDICAL EDUCATION
Assessing diagnostic accuracy and tympanocentesis skills in the management
of otitis media. Pichichero ME, Poole MD. Arch Pediatr Adolesc Med.
2001;155:1137-1142.
The Question: How accurate are physicians in diagnosing acute suppurative
otitis media (AOM) and otitis media with effusion (OME) from findings of
physical examination and how competent they are in performing
tympanocentesis?
Answer in a nutshell: The use of video-presented examinations to assess
diagnostic ability suggests that AOM and OME may be misdiagnosed often by
physicians. Tympanocentesis was optimally performed by 89% of
otolaryngologists and by 83% of paediatricians.
HEALTH SERVICES RESEARCH
Primary health care services provided by nurse practitioners and family
physicians in shared practice. Jones WJ, Baskerville B et al. CMAJ
2001;165:1210-4.
The Question: what is the frequency of activity in primary health care by
nurses practitioners (NPs) and family physicians (FPs) and to what degree do
NPs and FPs share the care of their patients?
Answer in a nutshell: NPs were under utilised with regard to curative and
rehabilitative care in primary care settings and referral patterns indicate
little evidence of bi-directional referral which is a measure of shared
care.
Drug-related deaths in a department of internal medicine. Ebbesen J,
Buajordet I et al. Arch Intern Med. 2001;161:2317-2323
The Question: What is the incidence of fatal adverse drug events (ADEs) in a
major medical department and what are the possible patient characteristics
signifying ADE risk?
Answer in a nutshell: Fatal ADEs represent a major hospital problem,
especially in elderly patients with multiple diseases. A higher number of
drugs administered was associated with a higher frequency of fatal ADEs.
From idea to market: The drug approval process. Lipsky MS, Sharp LK. J Am
Board Fam Pract 2001;14:362-367.
The Question: Where can I find information on the process of drug approval
by the Federal Drug administration (FDA) in the USA?
Answer in a nutshell: This review describes the drug development process
based on a review of the literature and Web sites addressing FDA processes
and policies.
Reducing infections among women undergoing cesarean section in Colombia by
means of continuous quality improvement methods. Weinberg M, Fuentes JM et
al.
Arch Intern Med. 2001;161:2357-2365
The Question: Is it possible to reduce infection rates after cesarean
section by means of quality improvement methods?
Answer in a nutshell: It is possible to use simple quality improvement
methods to optimise obstetric services and improve outcomes of care in
resource-limited settings.
Direct-to-consumer advertisements for prescription drugs: what are Americans
being sold? Woloshin S, Schwartz LM et al. Lancet 2001; 358: 1141-46
The Question: What are the messages communicated to the public by
pharmaceutical companies through direct-to-consumer advertisements for
prescription drugs in the USA?
Answer in a nutshell: Majority of advertisements (63%) were for drugs to
ameliorate symptoms, followed by (26%) those for to treat disease, and
nearly 1 in 10 were for drugs (11%) to prevent illness. This study also
found that provision of complete information about the benefit of
prescription drugs in advertisements would serve the interests of physicians
and the public.
Effect of practice variation on resource utilization in infants hospitalized
for viral lower respiratory illness. Willson DF, Horn SD et al. Paediatrics
2001; 108:851-855.
The Question: Is there any correlation between institutional practice
variation and severity and resource utilization in 10 children's medical
centres in the management of viral lower respiratory illness (VLRI)?
Answer in a nutshell: Institutional differences in care practices for
children with VLRI could not be explained by differences in patient severity
and did not affect the children's recovery but correlated significantly with
hospital costs and length of stay (LOS).
The future of health care in Canada. Lewis S, Donaldson C et al. BMJ
2001;323:926-929
The Question: What are the future directions for the health care system in
Canada?
Answer in a nutshell: Doubts have been raised about the sustainability of
comprehensive publicly funded health care system for Canadians in the future
and the health care system might move towards privatisation.
Identifying predictors of high quality care in English general practice:
observational study. Campbell SM, Hann M et al. BMJ 2001;323:784.
The Question: Are there variations in the quality of care in general
practice and what are the factors associated with high quality care?
Answer in a nutshell: Quality of care varies for both clinical care and
assessments by patients of access and interpersonal care. Practices with
longer booking intervals provide better management of chronic disease;
preventive care is less good in practices in deprived areas. No single type
of practice has a monopoly on high quality care. Good team climate reported
by staff was associated with a range of aspects of high quality care.
MISCELLANEOUS
Has misdiagnosis of appendicitis decreased over time? A population-based
analysis. Flum DR, Morris A et al. JAMA. 2001;286:1748-1753
The Question: Has the frequency of misdiagnosis preceding appendectomy
decreased with increasing availability of computed tomography,
ultrasonography, and laparoscopy?
Answer in a nutshell: According to the results of this population based
study neither the frequency of misdiagnosis leading to unnecessary
appendectomy has not changed with the introduction of computed tomography,
ultrasonography, and laparoscopy, nor the frequency of perforation
decreased.
Proximate and contextual socioeconomic determinants of mortality: Multilevel
approaches in a setting with universal health care coverage. Veugelers PJ,
Yip AM et al. Am J Epidemiol 2001;154:725-732.
The Question: What is the effect of contextual factors such as income
inequality, access to health and social services on mortality and morbidity
in a setting with Universal health care coverage?
Answer in a nutshell: This Canadian study found that well educated and high
earning persons were better off regarding morbidity and mortality. However,
within advantaged neighbourhoods, the importance of individual income and
education for mortality was higher as compared to the disadvantaged
The pharmacology and toxicology of "ecstasy" (MDMA) and related drugs.
Kalant H. CMAJ 2001;165:917-28
The Question: Where can I find information on the pharmacology and toxicity
of “ecstasy”?
Answer in a nutshell: This excellent review in the CMAJ provides a detailed
description on the above topic.
Apart from the above we have our usual Drug watch, Book watch, Web Watch (25
sites in this issue), From the pages of Bandolier and What U say sections.
Cheers & regards,
Badrinath
Dr.P.Badrinath M.D.,M.Phil.,(Epid) PhD(Cantab)DFPHM(UK).,MPH(Distinc)
Clinical Assistant Professor and 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,Reviews(Netlines)
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