(Apologies for the X posting - I have posted this message both to EBH and PH
Greetings from Al-Ain. The current issue of JSCAN, an on line health
professionals'news letter can now be accessed on line @
http://www.uaeu.ac.ae/jscan. Please find below the topics covered in this
If you have a few minutes to spare please drop us a note on your impressions
of JSCAN. We always look forward to your valuable comments and suggestions.
Evidence Based Practice
Diagnostic tests for renal artery stenosis in patients suspected of having
renovascular hypertension: A meta-analysis. Vasbinder BC, Nelemans PJ et al.
Ann Intern Med 2001;135:401-411.
The Question: How valid are the various tests used in the diagnosis of renal
artery stenosis in patients suspected of having renovascular hypertension?
Answer in a nutshell: This meta-analysis found that computed tomography
angiography and gadolinium-enhanced three-dimensional magnetic resonance
angiography appears to be superior tests in the evaluation of patients
referred for suspected renovascular hypertension.
Does tea affect cardiovascular disease? A meta-analysis. Peters U, Poole C
et al. Am J Epidemiol 2001;154:495-503
The Question: What is the effect of tea consumption on the risk of
Answer in a nutshell: This meta-analysis found that the effects of tea
consumption had varying impact on the risk of cardiovascular diseases. The
risk of myocardial infarction increased with tea consumption in UK, whereas
in other European countries tea consumption was protective.
Sustained-release Bupropion for pharmacologic relapse prevention after
smoking cessation - A randomised controlled trial. Hays T, Hurt RD et al.
Ann Intern Med. 2001;135:423-433.
The Question: Is sustained-release Bupropion effective in preventing smoking
relapse after pharmacological treatment for smoking cessation?
Answer in a nutshell: This randomised controlled trial showed that
sustained-release bupropion for 12 months delayed smoking relapse and
resulted in less weight gain.
Oral corticosteroid use is effective for cutaneous hemangiomas. An
evidence-based evaluation. Bennett ML, Fleischer AB et al. Arch Dermatol
The Question: Are systemic corticosteroids effective in treating cutaneous
Answer in a nutshell: Systemic corticosteroid treatment is effective in the
treatment of problematic cutaneous hemangiomas of infancy.
Timing of initial administration of low-molecular-weight heparin prophylaxis
against deep vein thrombosis in patients following elective hip arthroplasty
A systematic review. Hull RD, Pineo GF et al. Arch Intern Med.
The Question: What is the efficacy and safety of low-molecular-weight
heparin administered at different times in relation to surgery as compared
to oral anticoagulant prophylaxis?
Answer in a nutshell: The results of this systematic review indicate that
low-molecular-weight heparin initiated in close proximity to surgery
resulted in absolute risk reductions of 11% to 13% for deep vein thrombosis,
as compared to oral anticoagulants. Using half the usual dose of low
molecular weight heparin in close proximity to surgery was not associated
with a increase in major bleeding.
Evidence and consensus-based practice guidelines for the diagnosis of
irritable bowel syndrome. Fass R, Longstreth GF et al. Arch Intern Med.
The Question: Where can I find a guideline for the diagnosis of irritable
bowel syndrome (IBS)?
Answer in a nutshell: Archives of Internal Medicine has published an
evidence and consensus based guideline and the abstract of the guideline is
http://archinte.ama-assn.org/issues/v161n17/abs/ira00109.html. Readers with
full text access can find the guideline @
Systemic hypotension and the development of acute sensorineural hearing loss
in young healthy subjects. Pirodda A, Ferri GG et al. Arch Otolaryngol Head
Neck Surg. 2001;127:1049-1052
The Question: Is systemic hypotension a risk factor for acute sensorineural
hearing loss in young healthy subjects?
Answer in a nutshell: According to this observational study systemic
hypotension should be considered as one of the potential aetiological agents
for acute sensorineural hearing loss in young healthy subjects.
Usefulness of the triple test score for palpable breast masses. Morris KT,
Pommier RF et al. Arch Surg. 2001;136:1008-1013.
The Question: What is the utility of triple test score in the diagnostic
evaluation of breast masses?
Answer in a nutshell: Triple test score (TTS) reliably guides evaluation and
treatment of palpable breast masses. Masses scoring less than or equal to 4
have a specificity of 100% and a TTS greater than or equal to 6 has a
sensitivity of 100%.
Effects of exercise on glycemic control and body mass in type 2 Diabetes
Mellitus - A meta-analysis of controlled clinical trials. Boule NG, Haddad E
et al. JAMA. 2001;286:1218-1227.
The Question: What is the effect of exercise on glycemic control measured by
glycosylated hemoglobin (HbA1c) and body mass in patients with type 2
Answer in a nutshell: This meta-analysis found that exercise reduces HbA1c
by an amount that should decrease the risk of diabetic complications, but
there was no significant reduction in body mass index as compared to control
Long-term weight loss with Sibutramine. A randomised controlled trial. Wirth
A, Krause J. JAMA. 2001;286:1331-1339
The Question: What is the efficacy of two distinct regimens of Sibutramine
compared to the placebo?
Answer in a nutshell: Sibutramine, administered for 48 weeks to a typically
obese population, results in clinically relevant weight loss compared with
placebo. Regarding effectiveness, continuous and intermittent sibutramine
therapies are equivalent and the safety profiles for both treatments are
Interventions for the treatment and management of chronic fatigue syndrome
- A systematic review. Whiting P, Bagnall AM et al. JAMA.
The Question: What interventions are effective in the treatment or
management of chronic fatigue syndrome (CFS) in adults or children?
Answer in a nutshell: This systematic review found many methodological
deficiencies on studies of CFS. Interventions, which have shown promising
results in the management of CFS, included cognitive behavioural therapy and
graded exercise therapy.
Severe pulmonary embolism associated with air travel. Lapostolle F, Surget V
et al. NEJM 2001;345:779-83.
The Question: Does the duration air travel affect is related to the risk of
Answer in a nutshell: This retrospective study found that distance travelled
is a significant contributing risk factor for pulmonary embolism associated
with air travel.
Validity of the Agency for Healthcare Research and Quality clinical practice
guidelines - How quickly do guidelines become outdated? Shekelle PG, Ortiz E
et al. JAMA. 2001;286:1461-1467
The Question: How quickly do guidelines go out of date?
Answer in a nutshell: This study found that more than three quarters of the
Agency for Healthcare Research and Quality (AHRQ) guidelines need updating
and suggest a general rule that guidelines should be reassessed for validity
every 3 years.
Helicobacter pylori infection and the development of gastric cancer. Uemura
N, Okamoto S et al. NEJM 2001;345:784-89.
The Question: Is there a relation between H.Pylori infection and the
subsequent development of gastric cancer?
Answer in a nutshell: Gastric cancer develops in persons infected with H.
pylori but not in uninfected persons. Those with histological findings of
severe gastric atrophy, corpus-predominant gastritis, or intestinal
metaplasia are at increased risk. Persons with H. pylori infection and
nonulcer dyspepsia, gastric ulcers, or gastric hyperplastic polyps are also
at risk, but the risk is not increased in those with duodenal ulcers.
Ninety-minute accelerated critical pathway for chest pain evaluation. Ng SM,
Krishnaswamy P et al. Am J Cardiol 200;88:611-7.
The Question: How well does an accelerated critical pathway for patients
with suspected coronary ischemia performs in an emergency department?
Answer in a nutshell: This observational study found that a simple,
inexpensive, yet aggressive critical pathway that utilizes high-risk
features from clinical history, electrocardiographic changes, and rapid
point-of-care testing of 3 cardiac markers allows for accurate triaging of
chest pain patients within 90 minutes of presenting to the emergency
Effects of inhaled glucocorticoids on bone density in premenopausal women.
Israel E, Banerjee TR et al. NEJM 2001;345:941-47.
The Question: What is the relation between the dose of inhaled
glucocorticoids and the rate of bone loss in premenopausal women with
Answer in a nutshell: Inhaled glucocorticoids lead to a dose-related loss of
bone at the hip in premenopausal women.
Prevalence of gastrointestinal symptoms associated with diabetes mellitus -
A population-based survey of 15 000 adults. Bytzer P, Talley NJ et al. Arch
Intern Med. 2001;161:1989-1996.
The Question: Do diabetics have an increased risk of gastrointestinal
Answer in a nutshell: Diabetes mellitus is associated with an increased
prevalence of upper and lower gastrointestinal symptoms. This effect may be
linked to poor glycemic control but not to duration of diabetes or type of
Body mass index and the incidence of visually significant age-related
maculopathy in men. Schaumberg DA, Christen WG et al. Arch Ophthalmol.
The Question: Is there a relation between body mass index (BMI) visually
significant dry and neovascular age-related maculopathy?
Answer in a nutshell: Obesity is a risk factor for visually significant ARM
in men, in particular for dry ARM. The relationship of BMI with dry ARM
appears to be J-shaped, and the leanest individuals also appear to be at
Physical activity and breast cancer risk in Hispanic and non-Hispanic White
women. Gilliland FD, Li YF et al. Am J Epidemiol 2001;154:442-450.
The Question: What is the effect of physical activity on the subsequent risk
of breast cancer in women?
Answer in a nutshell: Vigorous physical activity is associated with a
reduced risk of breast cancer both in non Hispanic White and Hispanic women.
Oral contraceptive use and hormone replacement therapy are associated with
microalbuminuria. Monster TBM, Janssen WM et al for the prevention of Renal
and Vascular End Stage Disease Study Group. Arch Intern Med.
The Question: Is there an association between oral contraceptive use or
hormone replacement therapy and microalbuminuria?
Answer in a nutshell: Regular and long-term oral contraceptive use and
hormone replacement therapy are associated with an increased risk for
microalbuminuria and cardiovascular disease. The risk was higher for second
generation oral contraceptives and with increasing duration of hormone
WHO multicentre randomised trial of misoprostol in the management of the
third stage of labour. Gülmezoglu AM, Villar J et al for the WHO
Collaborative Group To Evaluate Misoprostol in the Management of the Third
Stage of Labour. Lancet 2001; 358: 689-95.
The Question: Is oral misoprostol is as effective as oxytocin during the
third stage of labour?
Answer in a nutshell: This multi centre randomised controlled trial found
that 10 IU oxytocin (intravenous or intramuscular) is preferable to 600 µg
oral misoprostol in the active management of the third stage of labour in
hospital settings where active management is the norm.
Folic acid supplements during pregnancy and risk of miscarriage. Jacqueline
Gindler J, Li Z et al for the Jiaxing City Collaborative Project on Neural
Tube Defect Prevention. Lancet 2001; 358: 796-800
The Question: Does the use of folic acid supplements during pregnancy
affects the occurrence of miscarriage?
Answer in a nutshell: This population-based study found no evidence that
daily consumption of 400 µg of folic acid before and during early pregnancy
influenced their risk for miscarriage.
Teenage pregnancy and risk of adverse perinatal outcomes associated with
first and second births: population based retrospective cohort study. Smith
GCS, Pell JP. BMJ 2001;323:476-479.
The Question: Do first and second births among teenagers are associated with
increased risk of adverse perinatal outcomes?
Answer in a nutshell: First teenage births are not independently associated
with an increased risk of adverse pregnancy outcome and are at decreased
risk of delivery by emergency caesarean section. However, second teenage
births are associated with an almost threefold risk of preterm delivery and
Vitamin D deficiency in veiled or dark-skinned pregnant women. Grover SR,
Morley R. MJA 2001;175: 251-252.
The Question: What is the vitamin D status of veiled or dark-skinned
pregnant women in Australia?
Answer in a nutshell: A large majority of these women have 25 OHD3 values
below the test reference range.
Vitamin D deficiency in mothers of infants with rickets. Nozza JM, Rodda C.
MJA 2001;175: 253-255.
The Question: What are the vitamin D levels of mothers whose children are
treated for rickets in Australia?
Answer in a nutshell: Mother of children with rickets and the siblings of
these children have low levels of vitamin D and vitamin D deficiency
continues to occur in children of migrant families.
Toxicity of over-the-counter cough and cold medications. Gunn VL, Taha SH et
al. PEDIATRICS Vol. 108 No. 3 September 2001, p. e52
The Question: Are there any adverse effects of over the counter (OTC) coulg
and cold medications given to children?
Answer in a nutshell: Over the period of 13 months the authors observed 3
cases of children who suffered significant morbidity from OTC cough and cold
preparations requiring admission and treatment in a tertiary care hospital;
they ranged from a self-limited reaction requiring an intensive care unit
admission to death in 1 patient.
Anthrax as a biological weapon - Medical and Public Health Management.
Inglesby TV, Henderson DA, for the Working Group on Civilian Biodefense..
The Question: Where can I find consensus-based recommendations for measures
to be taken by medical and public health professionals following the use of
anthrax as a biological weapon against a civilian population?
Answer in a nutshell: This paper published in the JAMA in 1999 provides
Specific consensus recommendations regarding the diagnosis of anthrax,
indications for vaccination, therapy for those exposed, postexposure
prophylaxis, decontamination of the environment, and additional research
Health Service Research
Reasons for paediatrician nonadherence to asthma guidelines. Cabana MD, Rand
CS et al. Arch Pediatr Adolesc Med. 2001;155:1057-1062.
The Question: What are the barriers to paediatricians’ adherence to National
Heart, Lung, and Blood Institute (NHLBI) asthma guidelines?
Answer in a nutshell: The barriers were different for specific components of
the guidelines. These included for corticosteroid prescription, lack of
agreement; for peak flow meter use, lack of self-efficacy and lack of
outcome expectancy and for screening and counselling of patients and parents
for smoking, lack of self-efficacy.
Challenge of culture, conscience, and contract to general practitioners'
care of their own health: qualitative study. Thompson WT, Cupples ME et al.
The Question: How do general practitioners perceive the effects of their
profession and training on their attitudes to illness in themselves and
Answer in a nutshell: General practitioners perceive that their professional
position and training adversely influence their attitudes to illness in
themselves and their colleagues.
Training seniors in the operation of an automated external defibrillator: a
randomized trial comparing two training methods.Meischke HW, Rea T et al.
Ann Emerg Med 2001;38:216-22
The Question: Is there a difference in the performance of seniors in the use
of automated external defibrillator (AED) who are trained using two
Answer in a nutshell: This randomised trial found that there were no
clinically meaningful distinctions between the AED performance of seniors
trained with a video and seniors trained in a face-to-face setting at the
initial training or at the retention assessment.
Preparedness for clinical practice - Reports of graduating residents at
academic health centers. Blumenthal D, Gokhale M et al. JAMA.
The Question: What are the residents’ perceptions regarding their
preparedness to provide common clinical services during their last year of
graduate medical education?
Answer in a nutshell: Majority of residents across specialties perceive
themselves as prepared to manage most of the common conditions they would
encounter in their clinical career but 10% of residents in each specialty
felt that they are not prepared to undertake 1 or more tasks relevant to
Assessing telemedicine: a systematic review of the literature. Roine R,
Ohinmaa A et al. CMAJ 2001;165:765-71.
The Question: What is the current status of telemedicine?
Answer in a nutshell: Evidence regarding the effectiveness or
cost-effectiveness of telemedicine is still limited. Based on current
scientific evidence, only a few telemedicine applications can be recommended
for broader use.
Cost effectiveness of automated external defibrillators on airlines.
Groenveld PW, Kwong JL et al. JAMA. 2001;286:1482-1489.
The Question: Is it cost effective to deploy automated external
defibrillators (AEDs) on US passenger aircrafts?
Answer in a nutshell: The cost-effectiveness of placing AEDs on commercial
aircraft compares favourably with the cost-effectiveness of widely accepted
medical interventions and health policy regulations, but is critically
dependent on the passenger capacity of the aircraft.
Cost-effectiveness of a school-based tobacco-use prevention program. Wang
LY, Crossett LS et al. Arch Pediatr Adolesc Med. 2001;155:1043-1050.
The Question: How cost effective is a school based tobacco-use prevention
Answer in a nutshell: According to this decision analysis a school based
tobacco-use prevention program is highly cost-effective compared with other
widely accepted prevention interventions and school-based prevention
programs of this type warrant careful consideration by policy makers and
News from the region - Patient lipid profiles in Algeria
Blood lipid concentrations and risk of myocardial infarction.
Mediene-Benchekor S, Brousseau T et al and the ECTIM study group. Lancet
2001; 358: 1064-65
From the Pages of Banolier -
http://www.jr2.ox.ac.uk/bandolier/band91/b91-2.html Postnatal steroids in
All about A & B
Due to the recent happenings JSCAN presents a special section titled “All
about A & B (Anthrax and Bioterrorism) as a service to readers. This section
contains links to over 20 web pages.
Also in this issue we have the usual drug watch, book watch, web watch (17
web sites) and what U say sections.
Cheers & regards,
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.
"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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