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EVIDENCE-BASED-HEALTH  May 2002

EVIDENCE-BASED-HEALTH May 2002

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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:

Tue, 14 May 2002 08:55:40 +0000

Content-Type:

text/plain

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text/plain (435 lines)

Dear All,

Greetings from Al-Ain the oasis city. The current issue of JSCAN, a health
professionals' newsletter is now on line. You can access JSCAN @
http://www.uaeu.ac.ae/jscan. Please find below the topics covered in this
issue.
If you do visit JSCAN and have a minute to spare drop us a line on your
thoughts on this continuing professional development activity.

(Apologies for the X postings as I have posted this message both to
EB&Public health lists)

Evidence based practice

Determinants of mortality in patients with severe blunt head injury.
Schreiber MA, Aoki N et al. Arch Surg. 2002;137:285-290
The Question: What factors predict outcome in patients with severe blunt
head trauma?
Answer in a nutshell: Glasgow Coma Scale score and age when used together
are significant predictors of mortality. Systemic hypotension and
intracranial hypertension are the only independent risk factors for
mortality that can be readily treated during the initial management of
patients with severe head injuries.

Are recommendations about routine antenatal care in Australia consistent and
evidence-based? Hunt JM, Lumley J. MJA 2002l;1766:255-259
The Question: Are recommendations about routine antenatal care in Australia
consistent and evidence-based?
Answer in a nutshell: Antenatal care recommended in protocols used in
Australia varies, and is not always consistent with national policies or
research evidence.

Use of ramipril in preventing stroke: double blind randomised trial. Bosch
J,  Yusuf S et al. BMJ 2002;324:699
The Question: How effective is the angiotensin converting enzyme inhibitor
ramipril in the secondary prevention of stroke?
Answer in a nutshell: The authors of this randomised controlled trial
concluded that “Ramipril reduces the incidence of stroke in patients at high
risk, despite a modest reduction in blood pressure”.

Obstacles to answering doctors' questions about patient care with evidence:
qualitative study. Ely JW, Osheroff JA et al. BMJ 2002;324:710
The Question: What are the obstacles encountered when attempting to answer
doctors' questions with evidence?
Answer in a nutshell: The six major obstacles identified were: the excessive
time required to find information, difficulty modifying the original
question, which was often vague and open to interpretation, difficulty
selecting an optimal strategy to search for information, failure of a
seemingly appropriate resource to cover the topic, uncertainty about how to
know when all the relevant evidence has been found so that the search can
stop, and inadequate synthesis of multiple bits of evidence into a
clinically useful statement.


Randomised controlled trial of short bursts of a potent topical
corticosteroid versus prolonged use of a mild preparation for children with
mild or moderate atopic eczema. Thomas KS, Armstrong S et al. BMJ
2002;324:768
The Question: Is the three day burst of a potent corticosteroid more
effective than a mild preparation used for seven days in children with mild
or moderate atopic eczema.
Answer in a nutshell: A short burst of a potent topical corticosteroid is as
effective as prolonged use of a milder preparation for controlling mild or
moderate atopic eczema in children.

Age at acquisition of Helicobacter pylori infection: a follow-up study from
infancy to adulthood. Malaty HM, El-Kasabany A et al. Lancet 2002; 359:
931-35.
The Question: When do patients acquire Helicobacter pylori infection?
Answer in a nutshell: Most H pylori infections are acquired before age 10
years and treatment and preventive strategies should be aimed at children in
this age-group.

Cardiovascular morbidity and mortality in the Losartan Intervention For
Endpoint reduction in hypertension study (LIFE): a randomised trial against
atenolol. Dahlöf B, Devereux RB et al for the LIFE study group. Lancet 2002;
359: 995-1003
The Question: What is the efficacy of Losartan compared to atenolol in
reducing cardiovascular morbidity and mortality in patients with
hypertension?
Answer in a nutshell: Losartan prevents more cardiovascular morbidity and
death than atenolol for a similar reduction in blood pressure and is better
tolerated. Losartan seems to confer benefits beyond reduction in blood
pressure

Duration of prophylaxis against venous thromboembolism with Enoxaparin after
surgery for cancer. Bergqvist D, Agnelli G et al for the ENOXACAN II
Investigators. N Engl J Med 2002;346:975-980.
The Question: What is the optimal duration of postoperative
thromboprophylaxis in patients undergoing abdominal cancer surgery?
Answer in a nutshell: According to this randomised trial Enoxaparin
prophylaxis for four weeks after surgery for abdominal or pelvic cancer is
safe and significantly reduces the incidence of venographically demonstrated
thrombosis, as compared with enoxaparin prophylaxis for one week.

Effect of Nonoxynol-9 gel on urogenital gonorrhea and chlamydial infection.
A randomized controlled trial. Roddy RE, Zekeng L et al.  JAMA.
2002;287:1117-1122
The Question: Does the use of nonoxynol-9 gel along with condom prevents the
male-to-female transmission of urogenital gonococcal and chlamydial
infection as compared to use of only condoms?
Answer in a nutshell: This randomised controlled trial showed that
Nonoxynol-9 gel does not protect against urogenital gonococcal or chlamydial
infection.

Coffee intake and risk of hypertension. The Johns Hopkins precursors study.
Klag MJ, Wang NY et al. Arch Intern Med. 2002;162:657-662.
The Question: Does long term coffee drinking increase the risk of
hypertension?
Answer in a nutshell: Over many years of follow-up, coffee drinking is
associated with small increases in blood pressure, but appears to play a
small role in the development of hypertension.

Prognostic value of systolic and diastolic blood pressure in treated
hypertensive men. Benetos A, Thomas F et al. Arch Intern Med.
2002;162:577-581
The Question: What is the prognostic value of systolic and diastolic
hypertension (SBP) in hypertensive men?
Answer in a nut shell: In hypertensive men treated in clinical practice SBP
is a good predictor of CVD and CHD risk. Diastolic blood pressure, which
remains the main criterion used by most physicians to determine drug
efficacy, appears to be of little value in determining cardiovascular risk.

The impact of empirical management of acute cystitis on unnecessary
antibiotic use. McIsaac WJ, Low DE et al. Arch Intern Med. 2002;162:600-605
The Question: Does use of empirical treatment with antibiotics in women with
symptoms of acute cystitis lead to unnecessary antibiotic dispensation?
Answer in a nutshell: Empirical antibiotic treatment of acute cystitis in
women without testing for pyuria promotes unnecessary antibiotic use.

The reliability of vital sign measurements. Edmonds ZV, Mower WR et al. Ann
Emerg Med 2002;39:233-237.
The Question: How reproducible are the measurement of non invasive vital
signs in clinical setting?
Answer in a nutshell: The reproducibility of vital sign measurements may be
limited by significant inter observer variability. Clinicians should
recognize this inherent variability and interpret vital signs with caution.

Chronic diseases

Snoring as a risk factor for type II diabetes mellitus: A prospective study.
Wael K. Al-Delaimy AK, Manson JE et al. Am J Epidemiol 2002;155:387-393.
The Question: Is there an association between snoring and the risk of
developing type II diabetes mellitus?
Answer in a nutshell: Results from the Nurses Health Study suggest that
snoring is independently associated with elevated risk of type II diabetes.

Statin Use, bone mineral density, and fracture Risk   Geelong Osteoporosis
Study. Pasco JA, Kotowicz MA et al. Arch Intern Med. 2002;162:537-540
The Question: What is the association between statin use, risk of fracture
and bone mineral density (BMD)?
Answer in a nutshell: Use of statins is associated with a 60% reduction in
fracture risk and this reduction in risk is greater than would be expected
from increases in BMD alone.

Is this patient clinically depressed?  Williams HW Jr, Noël PH et al.  JAMA.
2002;287:1160-1170
The Question: How precise and reliable are the questionnaires and clinical
examination used for diagnosing depression?
Answer in a nutshell: Many practical questionnaires that are available to
help clinicians identify and diagnose patients with major depression have
reasonable performance characteristics Diagnostic confirmation by mental
health care professionals using a clinical interview or by primary care
physicians using a semistructured interview can be made with high
reliability.

Women’s health

Effect of caffeine exposure during pregnancy on birth weight and gestational
age. Clausson R, Granath F et al. Am J Epidemiol 2002;155:429-436.
The Question: What is the effect of caffeine intake during pregnancy, on
birth weight and foetal growth?
Answer in a nutshell: According to this cohort study there appears to be no
association between moderate caffeine consumption and reduced birth weight,
gestational age, or foetal growth.

Residential magnetic fields and the risk of breast cancer.  Davis S, Mirick
DK, Stevens RG. Am J Epidemiol 2002;155:446-454
The Question: Does chronic exposure to residential magnetic fields increase
the risk of breast cancer in women?
Answer in a nutshell: The results of this population case control study from
Seattle, USA did not find an increased risk of breast cancer in women
chronically exposed to residential magnetic fields.

Effect of oral contraceptives on risk of cervical cancer in women with human
papillomavirus infection: the IARC multicentric case-control study. Moreno
V, Bosch FX et al for the International Agency for Research on Cancer (IARC)
Multicentric Cervical Cancer Study Group. Lancet 2002; 359: 1085-192.
The Question: Does oral contraceptives increase the risk of cervical cancer
in women with increased in women with human papillomavirus (HPV) infection?
Answer in a nutshell: Long-term use of oral contraceptives could be a
cofactor that increases risk of cervical carcinoma by up to four-fold in
women who are positive for cervical HPV DNA.

Role of parity and human papillomavirus in cervical cancer: the IARC
multicentric case-control study. Muñoz N, Franceschi S et al for the
International Agency for Research on Cancer (IARC) Multicentric Cervical
Cancer Study Group. Lancet 2002; 359: 1093-101
The Question: How does parity affects the risk of cervical cancer in women
with HPV infection?
Answer in a nutshell: High parity increases the risk of squamous-cell
carcinoma of the cervix among HPV-positive women.

Health services research

Coping with medical mistakes and errors in judgment. Goldberg RM, Kuhn G et
al. Ann Emerg Med. March 2002;39:287-292
The Question: Where can I find information on the affective aspects of
physician errors and the strategies to cope with them?
Answer in a nutshell: This article focuses on the affective aspects of
physician errors and presents a strategy for coping with them.

Association of dissatisfaction with care and psychiatric morbidity with poor
treatment compliance. Renzi C, Picardi A et al. Arch Dermatol.
2002;138:337-342
The Question: What are the factors associated with compliance in
dermatological patients?
Answer in a nutshell: Dissatisfaction with care and psychiatric morbidity
are associated with poor compliance in dermatology practice.

Racial disparities in the quality of care for enrollees in Medicare managed
care.  Schneider EC, Zaslavsky AM et al. JAMA. 2002;287:1288-1294
The Question: Is there a difference in the quality of health care by race in
US medicare beneficiaries?
Answer in a nutshell: Among Medicare beneficiaries enrolled in managed care
health plans, blacks received poorer quality of care than whites.

Risk factors, hospital management and outcomes after acute myocardial
infarction in South Asian Canadians and matched control subjects. Gupta M,
Doobay AV et al. CMAJ 2002 166: 717-722
The Question: Are there differences in presentation, risk factors and
management of myocardial infarction (MI) between South Asian Canadians and
other Canadians?
Answer in a nutshell: There are clear differences in the risk factor profile
between Canadians of South Asian origin and those of non-South Asian origin
who have acute MI. However, treatment of acute MI and in-hospital outcomes,
including mortality was similar between the South Asian and matched control
groups.

Ethnic differences in invasive management of coronary disease: prospective
cohort study of patients undergoing angiography. Feder G, Crook AM et al.
BMJ 2002;324:511-516.
The Question: Is there a difference in the rates of revascularisation in
south Asian and white patients undergoing coronary angiography in relation
to the appropriateness of revascularisation and clinical outcome in the
United Kingdom?
Answer in a nutshell: In a London tertiary health care centre, among
patients deemed appropriate for coronary artery bypass grafting, south Asian
patients are less likely than white patients to receive it.

Medical Education

Are medical students ready for the digital age? Bailey-Geraghty EM. West J
Med 2002;176:137-138

Burnout and self-reported patient care in an internal medicine residency
program. Shanafelt TD, Bradley KA et al. Ann Intern Med. 2002;136:358-367.
The Question: What is the prevalence of burnout in medical residents and
what is its relationship to self-reported patient care practices?
Answer in a nutshell: In an University based residency programme in USA,
burnout was common among resident physicians and was associated with
self-reported suboptimal patient care practices.

Stress in medical residency: Status quo after a decade of reform? Collier
VC, McCue JD et al. Ann Intern Med. 2002;136:384-390.
The Question: What is the current status of stress levels in American
medical residents?
Answer in a nutshell: An alarming number of current American medicine
residents report depressive symptoms, increasing cynicism, and decreasing
humanism, which are associated with increasing educational debt and a need
to moonlight for financial survival.

Worklife and satisfaction of general internists. Wetterneck TB, Linzer M et
al for the Society of General Internal Medicine Career Satisfaction Study
Group. Arch Intern Med. 2002;162:649-656
The Question: What is the level of job satisfaction among general internists
and what are its correlates?
Answer in a nutshell: General internists' role of caring for patients with
complex problems is associated with lower levels of satisfaction than for
internal medicine subspecialists (IMSSs) and family physicians (FPs).
Adjusting caseload for patient complexity, expanding time for office visits,
and additional training in the care of patients with psychosocially complex
problems may improve the job satisfaction of general internists and medical
student recruitment into the specialty.

Two educational interventions to improve pediatricians' knowledge and skills
in performing ankle and knee physical examinations. Hergenroeder AC, Chorley
JN et al. Arch Pediatr Adolesc Med. 2002;156:225-229
The Question: Does skill building sessions in addition to using, videotape
improves the knowledge and skills of paediatricians performance in ankle and
knee examinations?
Answer in a nutshell: Both teaching interventions were associated with
improved skills and knowledge among paediatricians.

Paediatrics

The usefulness of children’s drawings in the diagnosis of headache.
Stafstrom CE, Rostasy K et al. Paediatrics 2002; 109: 460-472.
The Question: Can drawings aid in the differential diagnosis of headaches in
children?
Answer in a nutshell: Children’s headache drawings are a simple, inexpensive
aid in the diagnosis of headache type, with a very high sensitivity,
specificity, and predictive value for migraine versus nonmigraine headaches.

Relationship of prenatal diagnosis and pregnancy termination to overall
infant mortality in Canada. Liu S, Joseph KS et al for the Fetal and Infant
Health Study Group of the Canadian Perinatal Surveillance System. JAMA.
2002;287:1561-1567.
The Question: What is the impact of congenital anomaly–related fetal and
infant deaths on overall population-based infant mortality?
Answer in a nutshell: A large decrease in infant deaths due to congenital
anomalies was associated with the most recent decline in infant mortality in
Canada, suggesting that increases in prenatal diagnosis and pregnancy
termination for congenital anomalies are related to decreases in overall
infant mortality at the population level.

Infectious diseases

The sequence of camelpox virus shows it is most closely related to variola
virus, the cause of smallpox. Gubser C, Smith GL. J Gen Virol 2002;83(Pt
4):855-72
The Question: Which virus has the closest sequence to small pox virus?
Answer in a nutshell: Camelpox virus (CMPV) is the closest known virus to
variola virus, the cause of smallpox.

A European study on the relationship between antimicrobial use and
antimicrobial resistance. Bronzwaer SLAM, Cars O et al and participants in
the European Antimicrobial Resistance Surveillance System.
http://www.cdc.gov/ncidod/eid/vol8no3/01-0192.htm
The Question: Is there a correlation between use of antibiotics and the
emergence of resistance across Europe?
Answer in a nutshell: According to this ecological study iantimicrobial
resistance of S. pneumoniae to penicillin is correlated with use of
beta-lactam antibiotics and macrolides in Europe.

Money matters

Cost effectiveness of continuing professional development in health care: a
critical review of the evidence. Brown A, Belfield CR et al. BMJ
2002;324:652-655
The Question: What is the status of literature on cost effectiveness of
continuing professional development in health care?
Answer in a nutshell: According to this review literature on this topic is
limited and the evidence base simply does not allow any empirical
conclusions to be drawn about the economic value of continuing professional
development

Miscellaneous

Adverse drug events in emergency department patients. Hafner JW Jr, Belknap
SM et al Ann Emerg Med. March 2002;39:258-267.
The Question: What is the epidemiology of adverse drug events (ADEs) in
emergency department patients?
Answer in a nutshell: ADEs constitute under 2% of emergency department
encounters. Insulin and Warfarin were the common drugs responsible for ADEs
and economic costs of ADEs were substantial.

Postoperative serious adverse events in a teaching hospital: a prospective
study. Bellomo R, Goldsmith D et al. MJA 2002;176 :216-218
The Question: How common are serious adverse events (SAEs) among inpatients
having surgery in a tertiary hospital and what are its risk factors?
Answer in a nutshell: SAEs are common and result in high mortality,
especially in older surgical inpatients and those having unscheduled
surgery.

Flipped out of control: single-vehicle rollover accidents in the Northern
Territory. Treacy PJ, Jones K, Mansfield C. MJA 2002;176:260-63.
The Question: What is the incidence and factors associated with
single-vehicle rollover (SVRO) accidents in the "Top End" of the Northern
Territory (NT) in Australia?
Answer in a nutshell: SVRO accidents are a major cause of morbidity and
mortality in the Top End of the NT in Australia and the study identified
many risk factors including speeding, male driver and defect in the vehicle.

Smokers’ corner

Smoking and risk of acute myeloid leukaemia: Results from a Los Angeles
county case-control study. Pogoda JM, Preston-Martin S et al. Am J Epidemiol
2002;155:546-553
The Question: Is smoking increase the risk of specific sub type of acute
myeloid leukaemia (AML)?
Answer in a nutshell: Smoking increases the risk of FAB subtype M2 over two
folds and the risk was not increased for AML over all or for other sub
types.

Five million deaths despite royal college's warning 40 years ago. Burke K.
BMJ 2002;324:564

From the pages of Bandolier

http://www.jr2.ox.ac.uk/bandolier/band97/b97-4.html
Measles vaccination schedules

News from the Region

In Iran, gender segregation becoming a fact of medical life. Azarmina P CMAJ
2002; 166 (March 5)

A view from UK on the same issue
BMA negotiator calls for more male medical students BMJ 2002;324:754

Drug watch

Meningitis associated with Rofecoxib. Bonnel RB, Villalba ML et al. Arch
Intern Med. 2002;162:713-715

Fatal allergic vasculitis associated with celecoxib. Schneider F, Meziani F
et al. Lancet. 2002;359:852-3.

Mixed hepatocellular-cholestatic liver injury after Pioglitazone therapy.
May LD, Lefkowitch JH et al. Ann Intern Med. 2002;136:449-452.

Herbal kava: reports of liver toxicity –
http://www.cmaj.ca/cgi/content/full/166/6/777

Other sections include book/multimedia watch, Web watch and What U say.

Cheers & regards,

Badri

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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