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EVIDENCE-BASED-HEALTH  December 2001

EVIDENCE-BASED-HEALTH December 2001

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Subject:

Current issue of JSCAN now on line

From:

padmanabhan badrinath <[log in to unmask]>

Reply-To:

padmanabhan badrinath <[log in to unmask]>

Date:

Sun, 30 Dec 2001 12:57:42 +0000

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Apologies for X posting as I have posted this message both to EB & Public
health mail base lists.

Dear All,

Season's greetings from Al-Ain. Please find below the list of topics covered
in the current issue of JSCAN. You can access JSCAN @
http://www.uaeu.ac.ae/jscan

If you do visit JSCAN drop us a line about this continuing professional
developmental activity of our department. Wishing you all a HAPPY,
PROSPEROUS & PRODUCTIVE NEW YEAR.

Evidence Based Practice

Evaluating the quality of systematic reviews in the emergency medicine
literature. Kelly KD, Travers A et al. Ann Emerg Med 2001;38:518-526.
The Question: What is the scientific quality of systematic reviews published
in leading emergency medicine journals?
Answer in a nutshell: This systematic review of systematic reviews found
that many of the systematic reviews published in the emergency medicine
literature contain major flaws and reviews with poor methodology may limit
the validity of reported results.

Development and validation of a multifactorial risk index for predicting
postoperative pneumonia after major noncardiac surgery. Arozullah AM, Khuri
SF et al for the Participants in the National Veterans Affairs Surgical
Quality Improvement Program. Ann Intern Med. 2001;135:847-857
The Question: Is it possible to predict postoperative pneumonia using a
mutifactorial risk index in patients undergoing non-cardiac surgery?
Answer in a nutshell: The postoperative pneumonia risk index developed by
the authors identifies patients at risk for postoperative pneumonia and may
be useful in guiding perioperative respiratory care.

Extended out-of-hospital low-molecular-weight heparin prophylaxis against
deep venous thrombosis in patients after elective hip arthroplasty: A
systematic review. Hull RD, Pineo GF et al. Ann Intern Med. 2001;135:858-869
The Question: What is the safety and efficacy of extended low molecular
weight heparin (LMWH) for venographic deep venous thrombosis and symptomatic
venous thromboembolism?
Answer in a nutshell: In this systematic review extended LMWH prophylaxis
showed consistent effectiveness and safety in the trials (regardless of
study variations in clinical practice and length of hospital stay) for
venographic deep venous thrombosis and symptomatic venous thromboembolism.

Potential role of pharmacogenomics in reducing adverse drug reactions – A
systematic review. Phillips KA, Veenstra DL et al. JAMA. 2001;286:2270-2279
The Question: Is there a role for pharmacogenomics in reducing the incidence
of adverse drug reactions?
Answer in a nutshell: The results of this systematic review suggests that
drug therapy based on individuals' genetic makeups (pharmacogenomics) may
result in a clinically important reduction in adverse outcomes.

Morbidity and mortality in breastfed and formula-fed infants of
HIV-1–Infected women. A randomised clinical trial. Mbori-Ngacha D, Nduati R
et al. JAMA. 2001;286:2413-2420
The Question: Is there a difference in survival among formula-fed and
breastfed infants of HIV-1–infected women?
Answer in a nutshell: According to this randomised clinical trial, both
formula fed and breastfed infants had similar mortality rates and incidence
of diarrhoea and pneumonia during the first 2 years of life. However,
HIV-1–free survival at 2 years was significantly higher in the formula fed
group.

Superiority of an intranasal corticosteroid compared with an oral
antihistamine in the as-needed treatment of seasonal allergic rhinitis.
Kaszuba SM, Baroody FM et al. Arch Intern Med. 2001;161:2581-2587.
The Question: How effective is as-needed use of H1 receptor antagonists
compared to intranasal corticosteroids in the treatment of seasonal allergic
rhinitis?
Answer in a nutshell: As-needed intranasal corticosteroids reduce allergic
inflammation and are more effective than as-needed H1 receptor antagonists
in the treatment of seasonal allergic rhinitis.

Pure sesame oil vs isotonic sodium chloride solution as treatment for dry
nasal mucosa. Johnsen J, Bratt B-M et al. Arch Otolaryngol Head Neck Surg.
2001;127:1353-1356.
The Question: Is there a difference in efficacy between pure sesame oil
(Nozoil) and isotonic sodium chloride solution (ISCS) in the treatment of
nasal mucosa dryness due to dry winter climate?
Answer in a nutshell: Pure sesame oil appears to be significantly more
effective than ISCS in the treatment of dry mucosa.

Predictive factors of Barrett Esophagus - Multivariate analysis of 502
patients with Gastroesophageal Reflux disease. Campos GMR, DeMeester ST et
al. Arch Surg. 2001;136:1267-1273.
The Question: What are the risk factors for Barrett esophagus (BE) in
patients with gastroesophageal reflux disease (GERD)?
Answer in a nutshell: This study identified seven risk factors for BE. They
include abnormal bile reflux, hiatal hernia larger than 4 cm, a defective
lower oesophageal sphincter, male sex, defective distal oesophageal
contraction, abnormal number of reflux episodes lasting longer than 5
minutes, and GERD symptoms lasting for more than 5 years.

Does bed rest after cervical or lumbar puncture prevent headache? A
systematic review and meta-analysis. Thoennissen J, Herkner H et al. CMAJ
2001;165:1311-6
The Question: Is longer bed rest better than immediate mobilization or short
bed rest in preventing headache after cervical or lumbar puncture?
Answer in a nutshell: This meta-analysis found no evidence that longer bed
rest after cervical or lumbar puncture was better than immediate
mobilization or short bed rest in reducing the incidence of headache.

Past exposure to vaccines and subsequent risk of Alzheimer's disease.
Verreault R, Laurin D et al. CMAJ 2001;165:1495-8.
The Question: Is there an association between past exposure to conventional
vaccines and subsequent risk of Alzheimer's disease?
Answer in a nutshell: Past exposure to vaccines against diphtheria or
tetanus, poliomyelitis and influenza may protect against subsequent
development of Alzheimer's disease.

A simple risk index for rapid initial triage of patients with ST-elevation
myocardial infarction: an InTIME II substudy. Lancet 2001; 358: 1571-75
The Question: Is it possible to use simple risk in rapidly triaging patients
with ST-elevation myocardial infarction (STEMI)?
Answer in a nutshell: A simple risk index based on characteristics easily
assessed by any paramedical or clinical personnel captures most of the
information from more complex tools, and is likely to be useful in the rapid
triage of patients with STEMI outside hospital or on first arrival in the
hospital.

Oral triptans (serotonin 5-HT1B/1D agonists) in acute migraine treatment: a
meta-analysis of 53 trials. Ferrari MD, Roon KI et al. Lancet 2001; 358:
1668-75.
The Question: How effective are triptans, selective serotonin 5-HT1B/1D
agonists in managing acute migraine?
Answer in a nutshell: According to this meta-analysis at marketed doses, all
oral triptans are effective and are well tolerated. 10 mg rizatriptan, 80 mg
eletriptan, and 12·5 mg almotriptan provide the highest likelihood of
consistent success.


Fondaparinux compared with Enoxaparin for the prevention of venous
thromboembolism after hip-fracture surgery. Eriksson BI, Bauer KA et al for
the steering committee of the Pentasaccharide in hip-fracture surgery study.
N Engl J Med 2001; 345:1298-1304.
The Question: What is the efficacy of Fondaparinux, a synthetic
pentasaccharide in the prevention of venous thrmboembolism as compared to
Enoxaparin?
Answer in a nutshell: Fondaparinux appears to be  more effective than
enoxaparin in preventing venous thromboembolism in patients undergoing
surgery for hip fracture.

Sperm morphology, motility, and concentration in fertile and infertile men.
Guzick DS, Overstreet JW et al for the National Cooperative Reproductive
Medicine Network. N Engl J Med 2001; 345:1388-1393
The Question: Can sperm concentration, motility, and morphology be used to
classify men by fertility status?
Answer in a nutshell: Threshold values for sperm concentration, motility,
and morphology can be used to classify men as subfertile, of indeterminate
fertility, or fertile. None of these measures, however, are diagnostic of
infertility.

Treatment of acute hepatitis C with interferon Alfa-2b. Jaeckel E, Cornberg
M et al for the German Acute Hepatitis C Therapy Group. N Engl J Med 2001;
345:1452-1457
The Question: Does treatment with interferon alfa-2b in the acute phase of
hepatitis C infection effective in preventing chronic infection?
Answer in a nutshell: Treatment of acute hepatitis C with interferon alfa-2b
is effective in preventing chronic infection.

Interferon alfa with or without ribavirin for chronic hepatitis C:
systematic review of randomised trials.. Kjaergard LJ, Krogsgaard K et al.
BMJ 2001;323:1151-1155
The Question: What is the therapeutic efficacy of interferon alfa with or
without ribavirin for treatment of chronic hepatitis C?
Answer in a nutshell: Treatment with interferon alfa plus ribavirin has a
significant beneficial effect on the virological and histological responses
of patients with chronic hepatitis C, irrespective of previous treatment.

Is the pleural fluid transudate or exudate? A revisit of the diagnostic
criteria. Joseph J, Badrinath P et al. Thorax 2001;56:867-70.
The Question: What is the best test for the diagnostic separation of plural
effusion in to transudates and exudates?
Answer in a nutshell: This analysis using receiver operator characteristics
(ROC) methods found that pleural fluid absolute lactic dehydrogenase level
(FLDH) is the most accurate marker for the diagnostic separation of
transudates and exudates.

Comparison of laboratory values obtained by means of routine venipuncture
versus peripheral intravenous catheter after a normal saline solution bolus.
Zlotowski SJ, Kupas DF et al Ann Emerg Med 2001;38:497-504.
The Question: For which laboratory tests is it appropriate to use peripheral
intravenous catheter as compared to routine venipuncture?
Answer in a nutshell: This study results suggest the use of blood samples
obtained by means of aspiration from a peripheral catheter when testing for
CBC, blood urea nitrogen, creatinine, liver function tests, and PT/INR in
healthy-appearing patients.

Chronic diseases

Assessment of frequency of progression to hypertension in non-hypertensive
participants in the Framingham Heart Study: a cohort study. Vasan RS, Larson
MG et al. Lancet 2001; 358: 1682-86
The Question: How often should adults with different base line blood
pressures are to be screened to detect the development of hypertension?
Answer in a nutshell: According to the data from the Framingham study, high
normal BP and normal BP frequently progress to hypertension over a period of
4 years, especially in older adults and these findings support
recommendations for monitoring individuals with high normal BP once a year,
and monitoring those with normal BP every 2 years.

Impact of high-normal blood pressure on the risk of cardiovascular disease.
Vasan RS, Larson MG et al. N Engl J Med 2001;345:1291-1297
The Question: Is there an association between presence of high-normal blood
pressure (systolic pressure of 130 to 139 mm Hg, diastolic pressure of 85 to
89 mm Hg, or both and subsequent risk of cardiovascular disease?
Answer in a nutshell: As compared with optimal blood pressure, high-normal
blood pressure is associated with an increased risk of cardiovascular
disease both in men and women.

Nonsteroidal antiinflammatory drugs and the risk of Alzheimer's disease. In
't Veld BA, Ruitenberg A. N Engl J Med 2001; 345:1515-1521
The Question: Is there an association between use of nonsteroidal
antiinflammatory drugs (NSAIDs) and the development of Alzheimer's disease
(AD)?
Answer in a nutshell: According to this cohort study long-term use of NSAIDs
may protect against Alzheimer's disease but not against vascular dementia.

Unrecognized myocardial infarction Sheifer SE, Manolio TA et al. Ann Intern
Med. 2001;135:801-811
The Question: Where can I find an up date on unrecognised myocardial
infarction (UMI)?
Answer in a nutshell: This review from the Annals of Internal Medicine
provides an up date on myocardial infarction that escapes clinical
recognition. Information on the prevalence, predisposing factors and
prognosis of UMI are presented in this review.

Legume consumption and risk of coronary heart disease in US men and women -
NHANES I epidemiologic follow-up study. Bazzano LA, He J et al. Arch Intern
Med. 2001;161:2573-2578.
The Question: Is there an association between legume intake and risk of
coronary heart disease (CHD)?
Answer in a nutshell: Analysis of data from the First National Health and
Nutrition Examination Survey Epidemiologic Follow-up Study (NHEFS) showed an
significant inverse relationship between legume intake and risk of CHD.

Women’s health

Recreational physical activity and endometrial cancer risk.  Littman AJ,
Voigt LF et al. Am J Epidemiol 2001;154:924-933.
The Question: Is there an association between recreational physical activity
and the risk of endometrial cancer in women?
Answer in a nutshell: This population based case control study found that
lack of recreational physical activity increases the risk of endometrial
cancer but cautions that this association cannot be considered as causal
with the available evidence.

Long or highly irregular menstrual cycles as a marker for risk of type 2
diabetes mellitus. Solomon CG, Hu FB et al. JAMA. 2001;286:2421-2426
The Question: Is the risk of type 2 diabetes mellitus (DM) higher in women
with history of long or highly irregular menstrual cycles.
Answer in a nutshell: Women with long or highly irregular menstrual cycles
have a significantly increased risk for developing type 2 DM that is not
completely explained by obesity.

Paediatrics

Breastfeeding and asthma in young children  - findings from a
population-based study. Dell S, To T. Arch Pediatr Adolesc Med.
2001;155:1261-1265.
The Question: Is there an association between breastfeeding and asthma in
young children?
Answer in a nutshell: According to this prospective study from Canada longer
duration of breastfeeding appears to be protective against the development
of asthma and wheeze in young children.

Effects of 2 inhaled corticosteroids on growth  - Results of a randomised
controlled trial. de Benedictis FM, Teper A et al for the International
Study Group. Arch Pediatr Adolesc Med. 2001;155:1248-1254.
The Question: What are the long-term effect of treatment with fluticasone
propionate or beclomethasone dipropionate on growth in asthmatic children?
Answer in a nutshell: Children treated with fluticasone propionate had a
favourable growth velocity and lung function profile as compared to those
treated with beclomethasone dipropionate.

Intake of vitamin D and risk of type 1 diabetes: a birth cohort study.
Hypponen E, Laara E et al. Lancet 2001; 358: 1500-03
The Question: Can vitamin D supplementation or deficiency in infancy affect
the development of subsequent type 1 diabetes?
Answer in a nutshell: According to this birth cohort study dietary vitamin D
supplementation is associated with reduced risk of type 1 diabetes.

Infectious disease

Hepatitis B virus infection in children and adolescents in a hyperendemic
area: 15 years after mass Hepatitis B Vaccination. Ni Y-H, Chang M-H et al.
Ann Intern Med 2001;135:796-800.
The Question: What is the population impact of a mass vaccination program
against Hepatitis B (HBV) a decade after its implementation?
Answer in a nutshell: In Taiwan nearly 15 years after its implementation
universal vaccination significantly decreased the HBV carrier rate and
infection rate among children and adolescents born since the program began.

Deaths from chickenpox in England and Wales 1995-7: analysis of routine
mortality data
Rawson H, Crampin A et at. BMJ 2001;323:1091-1093.
The Question: What is the impact of chicken pox in adults in the United
Kingdom?
Answer in a nutshell: In the UK chickenpox is not a mild disease. Deaths in
adults are increasing, both in number and proportion due to this condition.

Severe complications of varicella in previously healthy children in Germany:
A 1-year survey. Ziebold C, von Kries R et al.  Paediatrics 2001; 108: 5
November, p. e79
The Question: What is the pattern of morbidity due to chickenpox in
immunologically healthy children?
Answer in a nutshell: The results of this nation wide surveillance study
found a considerable morbidity with a comparatively high rate of
encephalitis, osteomyelitis, and pyogenic arthritis due to chickenpox.
Although infectious complications were present in only 38.6% of the reported
cases, they contributed disproportionately to the cases with chronic
sequelae.

Health Services Research

Hospital preparedness for weapons of mass destruction incidents: an initial
assessment. Treat KN, Williams JM et al. Ann Emerg Med. 2001;38:562-565.
The Question: How prepared are hospitals in the USA to handle incidents
arising out of the use of weapons of mass destruction (WMD)?
Answer in a nutshell: According to this study hospitals in the Federal
Emergency Management Agency (FEMA) Region III do not appear to be prepared
to handle WMD events, especially in areas such as mass decontamination, mass
medical response, awareness among health care professionals, health
communications, and facility security.

Medical Education

Predicting performance on the Royal College of Physicians and Surgeons of
Canada internal medicine written examination. Brill-Edwards P, Couture L et
al. CMAJ 2001;165:1305-7
The Question: Is it possible to predict a candidate’s performance in the
written component of the Royal College of Physicians and Surgeons of Canada
(RCPSC) certification examinations?
Answer in a nutshell: American Internal Medicine In-Training Examination
(AIMI-TE) scores predict the performance of the candidates in the Canadian
examination.


To guide decision making: Style or substance? Barry HC, Ebell MH et al. J Am
Board Fam Pract 2001;14:437-442.
The Question: Does the format of medical abstracts affects physician
decision making?
Answer in a nutshell: Although the format of abstract has no effect on
physician decision making, having valid information available in the context
of a clinical scenario appears to influence physician decisions.

The internet and the globalisation of medical education. Harris Jr JM,
Salasche SJ et al. BMJ 2001;323:1106.
The Question: Is it possible to use Internet as a medium for continuing
medical education?
Answer in a nutshell: The experience of the authors demonstrates that it is
feasible to develop an online medical education program, receive appropriate
certification for continuing medical education, and market it, at low cost,
via the internet.

Getting the most from meetings Suresh K. BMJ 2001;323:S3-7322
The Question: How do we get most out of meetings?
Answer in a nutshell: The key tips include sharing responsibility, having
fore knowledge about what we want from the meeting, preparing, and knowing
when to interrupt.

Delivering constructive criticism McGuire R.
http://www.bmj.com/cgi/content/full/323/7323/S3-7323
The Question: How to deliver constructive criticism?
Answer in a nutshell: McGuire, a trainer in communication skilss provides
some in sight in to this question in the BMJ.

Money Matters

Potential cost-effectiveness of prophylactic use of the implantable
cardioverter defibrillator or Amiodarone after myocardial infarction.
Sanders GD, Hlatky MA et al. Ann Intern Med. 2001;135:870-883
The Question: How do the clinical benefits and cost of implantable
cardioverter defibrillators (ICD) compare with amiodarone in patients with
past myocardial infarction and severely depressed left ventricular function?
Answer in a nutshell: This cost utility analysis based on Markov mode found
that using ICD or amiodarone in patients with past myocardial infarction and
severely depressed left ventricular function provide substantial clinical
benefit at an acceptable cost.

Miscellaneous

Associations between daily cause-specific mortality and concentrations of
ground-level Ozone in Montreal, Quebec. Goldberg MS, Burnett RT et al. Am J
Epidemiol 2001;154:817-826.
The Question: Is there an association between ground level ozone levels and
mortality in the population?
Answer in a nutshell: Increasing gr4ound levels of ozone is associated with
an increase in deaths due to cardiovascular disease, respiratory disease,
cancer and deaths due to non-accidental causes.

Maternal infections and subsequent psychosis among offspring. Buka SL,
Tsuang MT et al. Arch Gen Psychiatry. 2001;58:1032-37.
The Question: Is there an association between maternal infections during
pregnancy and the subsequent development of schizophrenia and other
psychoses in adulthood?
Answer in a nutshell: The offspring of mothers with elevated levels of total
IgG and IgM immunoglobulins and antibodies to herpes simplex virus type 2
are at increased risk for the development of schizophrenia and other
psychotic illnesses in adulthood.

Intoxicated motor vehicle passengers  - An overlooked at-risk population.
Schermer CR, Qualla CR et al. Arch Surg. 2001;136:1244-1248.
The Question: Is the risk of recurrent health care encounters and mortality
increased in intoxicated motor vehicle passengers?
Answer in a nutshell: Intoxicated passengers injured in a motor vehicle
crash are similar to intoxicated drivers in recurrent hospitalisations and
emergency department visits. Intoxicated passengers have an increased
mortality rate in the 5 years following injury

A national survey of stress reactions after the September 11, 2001,
terrorist attacks.  Schuster MA, Stein BD et al. N Engl J Med 2001;
345:1507-1512
The Question: Can traumatic events affect people who are not physically
present at the event site?
Answer in a nutshell: Interviews with a random sample of Americans showed
that after the September 11 terrorist attacks a major traumatic event,
Americans across the country, including children, had developed substantial
symptoms of stress.

Cheers & regards,

Badrinath

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


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