Essential evidence medicine that matters ; InfoPOEMs

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adam_text Contents Preface xxi Taking an Evidence-Based Approach to the Care of Patients xxii How to Become an Information Master: Feeling Good about NOT Knowing Everything xxvii InfoPOEMs (Patient-Oriented Evidence that Matters) 1 Cancer 3 Breast cancer 3 Most women with breast cancer have no risk factors 3 Raloxifene reduces breast cancer risk (CORE) 4 Raloxifene and tamoxifen equally effective in reducing breast cancer risk 5 Raloxifene decreases breast cancer risk, no effect on cardiovascular disease risk (RUTH) 6 MRI more accurate than mammogram in high-risk patients 7 MRI more sensitive than mammography in high-risk women (MARIBS) 8 Digital mammography more sensitive for younger women 9 Mammography results in overdiagnosis 10 Annual mammography starting at 40 doesn t lower breast cancer mortality 11 Gynecologic cancers 12 Many unnecessary Pap smears are performed after hysterectomy 12 Specific HPV strains are associated with cervical cancer risk 13 Vaccine effective against HPV 14 Bivalent vaccine against HPV effective for 4.5 years 15 Liquid-based not better than conventional Pap 16 Endometrial sampling adequate for diagnosing endometrial cancer 17 Melanoma 18 Melanoma incidence really not rising 18 Lifetime risk of mole transforming to melanoma very low 19 0.7% of congenital melanocytic nevi become malignant 20 Dermoscopy with validated criteria more sensitive than unaided eye 21 Larger margins better in melanoma 2mm thick 22 Prevention and screening 23 Antioxidants don t prevent Cl cancers, and may increase overall mortality 23 Vitamin E doesn t lower women s risk of cardiovascular disease or cancer 24 Antioxidants don t prevent colorectal cancer 25 Mammography, FOBT and CXR don t reduce all-cause mortality 26 Spiral CT detects early lung cancer, but screening use is premature 27 Cancer linked to some diabetes treatments 28 Prostate cancer 29 Finasteride of mixed benefit in preventing prostate cancer 29 Prostate cancer screening every 4 years as good as annually 30 False-positive PSA associated with increased worry, fears 31 Elevated PSA should be confirmed before biopsy 32 Radical prostatectomy improves outcomes in symptom-detected prostate cancer 33 Cardiology 34 Acute myocardial infarction and acute coronary syndromes 34 Early metoprolol in acute Ml: no benefit, possible harm (COMMIT; CCS-2) 34 Insulin/dextrose infusion ineffective in AMI (HI-5) 35 Early initiation of statins following ACS does not improve outcomes 36 Antibiotics not effective in acute coronary syndromes 37 ABCDE approach to non-ST-segment elevation ACS 38 Door-to-balloon time important in STEMI 39 Routine invasive strategy may be preferred for ACS 40 Intensive medical tx + selective PCI preferred for non-ST ACS 41 Invasive tx slightly better in non-ST-elevation ACS (RITA3) 42 In ACS, 5years of invasive tx decreases Ml but not all cause mortality (FRISC-II) 43 Captopril = losartan for reducing all-cause mortality after Ml 44 Captopril better than valsartan or combination post-MI 45 Implantable defibrillators are not effective post-MI 46 Anticoagulation management 47 Start warfarin at lOmg faster for outpatient anticoagulation 47 Use an algorithm to start warfarin in older patients 48 Self-monitoring of anticoagulation safe, effective 49 Self-monitoring anticoagulation superior at preventing venous thromboembolics events 50 INR 1.5-1.9 less effective than 2.0-3.0 for idiopathic DVT 51 Oral vitamin K works faster than subcutaneous 52 Oral vitamin K effective for warfarin overdose 53 Atrial fibrillation 54 Clinical decision rules accurately predict stroke risk in atrial fibrillation 54 Thromboembolism just as likely with atrial flutter 55 Warfarin prevents more strokes than clopidorel + ASA in atrial fibrillation (ACTIVE) 56 Ximelagatran effective in preventing stroke in atrial fibrillation 57 Quality of life with rate or rhythm control in atrial fibrillation (AFFIRM) 58 Rate control better than rhythm control in atrial fibrillation (AFFIRM) 59 Amiodarone sotalol placebo for maintaining NSR in atrial fibrillation (SAFE-T) 60 Coronary artery disease 61 Mediterranean diet associated with lower all cause mortality 61 Coffee does not increase risk of developing CAD 62 Vitamin E has no effect on cardiovascular disease 63 Lowering homocysteine does not reduce cardiovascular disease (HOPE 2) 64 Omega 3 fatty acids do not affect mortality 65 Fotic acid supplementation does not reduce cardiovascular disease risk nor mortality 66 Fenofibrate doesn t prevent coronary events in DM (FIELD) 67 Optimal oral antiplatelet therapy for vascular disease 68 Clopidogrel + ASA no better than ASA alone for high-risk patients 69 Clopidogrel beneficial added to ASA, fibrinolytic in STEMI 70 Aspirin reduces risk of CV events, increases risk of bleeding 71 Aspirin + PPI safer than clopidogrel if history of Cl bleed 72 Electron beam tomography not helpful 73 Chest pain relief by NTC doesn t predict active CAD 74 Ranolazine adds little to maximum antianginal therapy (ERICA) 75 Better outcomes with CABC than PCI with stent for 2,3 vessel disease 76 Adding ACEI doesn t improve outcomes in stable angina w/nl LVEF (PEACE) 77 COX-2 inhibitors and heart disease 78 Rofecoxib increases risk of cardiovascular events 78 Celecoxib increases risk of cardiovascular complications 79 Rofecoxib, diclofenac and indomethacin increase risk of CVD 80 Heart failure 81 BNP improves outcomes in evaluation of dyspnea 81 BNP testing beneficial with CHF + pulmonary dx 82 Serial BNP levels predict risk of death and CHF after ACS 83 Higher BNP and N-ANP predict CV events 84 ARBs = ACEIs for all-cause mortality in heart failure 85 Optimal digoxin range for men 0.5 to 0.8ng/ml 86 Digoxin increases mortality in women with heart failure 87 Nesiritide for CHF may increase mortality risk 88 Implantable defibrillators reduces mortality in NYHA Class II heart failure 89 Hypertipidemia 90 Herbs may reduce cholesterol, no data on clinical outcomes 90 Statins prevent CAD 91 Cholesterol lowering cost-effective in high-risk elderly 92 Intensive lipid lowering of marginal benefit even if high-risk 93 Varying effects of lipid drugs on overall mortality 94 Statins equivalent for CVD prevention 95 Intensive lipid lowering with statins unnecessary with stable CAD (IDEAL) 96 Hypertension 97 JNC 7 report on prevention/evaluation/treatment of hypertension 97 Work stress has no meaningful effect on blood pressure 98 Pseudoephedrine has a minimal effect on blood pressure 99 Habitual caffeine intake does not increase risk of hypertension in women 100 Home blood pressure monitoring valuable 101 Office measurements usually overestimate blood pressure 102 Hypertension follow-up: 3 months = 6 months 103 Patients with HTN + high lipids may benefit less from statins (ALLHAT) 104 Excessive lowering of blood pressure causes more harm than good 105 Diuretics clearly first line agent for HTN (ALLHAT) 106 Meta-analysis supports diuretics as first line for HTN 107 Outcomes for thiazides similar 108 ACEI better than diuretic in older men for hypertension 109 Atenolol of questionable efficacy for HTN 110 Beta-blockers placebo, not other drugs, in preventing HTN complications 111 Renal function similarly affected by antihypertensives (ALLHAT) 112 Peripheral vascular disease and aneurysm 113 Screening program for abdominal aortic aneurysm ineffective 113 Fewer aneurysm deaths but not overall deaths with AAA screening 114 CABG not helpful before AAA or peripheral vascular surgery 115 EVAR worse than open repair of AAA (EVAR Trial 1) 116 Bypass = angioplasty for severe leg ischemia, but costs more (BASIL) 117 Pulmonary hypertension 118 Sildenafil effective for primary pulmonary hypertension 118 Sildenafil = bosentan in pulmonary hypertension (SERAPH) 119 Thrombophilias 120 Testing for prothrombotic defects not necessary after first DVT 120 Management of antiphospholipid antibody syndrome 121 Venous thromboembolism 122 Fixed-dose, subcutaneous, unfractionated heparin effective for VTE 122 Compression stockings prevent post-thrombotic syndrome 123 Routine use of vena cava filters doesn t reduce mortality 124 At least 6 months of anticoagulation optimal to prevent recurrent VTE 125 LMWH better than warfarin in preventing recurrent DVT in cancer patients 126 Venous thromboembolism diagnosis and prognosis 127 Best tests to rule in, rule out PE 127 Clinical prediction rules accurate for PE diagnosis 128 Validated algorithm for evaluating suspected PE 129 Optimal algorithm for evaluating suspected DVT 130 Multidetector CT accurate for PE, but requires clinical context 131 Negative CT scan to rule out PE equal to angiography 132 Determining major bleeding risk with warfarin for DVT 133 D-dimer useful for excluding DVT and PE 134 D-dimer 250ng/mL predicts low risk of VTE recurrence 135 Care of Infants and Children 136 ADHD 136 Restricted diet improves parental perception of hyperactive behavior 136 Stimulants similarly effective for ADHD 137 Responders to atomoxetine do welt with lower doses 138 Anemia 139 Anemia not prevented by iron in infants 139 Anemia doesn t predict iron deficiency among toddlers 140 Asthma 141 Long-term budesonide does not effect adrenal function in children 141 Amoxicillin for 3 days effective for pediatric pneumonia 142 Educational programs effective for young asthmatics 143 Diarrhea 144 Nitazoxanide reduces rotavirus duration in hospitalized kids 144 Oral rotavirus vaccines safe and effective 145 Intense diet-behavior-physical activity effective for obese children 146 Evidence lacking for milk s benefit in children 147 Prevention 148 Vaccine exposure does not increase risk of infectious disease hospitalization 148 Dental restoration with amalgam (mercury) safe in children 149 School-based violence prevention programs not proved 150 Otitis media 151 Delayed prescription for AOM reduces unnecessary antibiotics 151 Parent satisfaction okay with no treatment of AOM 152 Parents prefer shared decision-making for AOM 153 Tubes marginally effective in otitis media with effusion 154 Early tympanostomy tubes do not improve outcomes after 3 or more years 155 Prompt tympanostomy tube insertion doesn t improve 9year outcomes 156 Other pediatric problems 157 Bed and pillow covers ineffective for allergic rhinitis 157 Risk scoring system predicts mortality in pediatric ICU 158 Petroleum jelly doesn t reduce recurrent pediatric epistaxis 159 Effective and ineffective interventions for infant colic 160 Respiratory infections and fever 161 Ear thermometry is unreliable in detecting fever 161 Acetaminophen, ibuprofen comparable for pain, fever in children 162 Cough suppressants ineffective in children 163 Delayed prescriptions for URIs reduce antibiotic use 164 Amoxicillin for 3 days effective for pediatric pneumonia 165 Sore throat 166 Herbal tea effective for symptoms of acute pharyngitis 166 Steroids provide brief relief of pain in mononucleosis 167 Echinacea purpurea ineffective for treating URI in kids 168 Complementary and Alternative Medicine 169 Diarrhea 169 Yogurt prevents antibiotic-associated diarrhea 169 Probiotics helpful for antibiotic-associated diarrhea 170 Probiotics effective in preventing acute diarrhea, but not traveler s diarrhea 171 Diet and exercise 172 Popular diets equally effective for losing weight 172 Mediterranean diet associated with lower all cause mortality 173 Omega 3 fatty acids do not affect mortality 174 Diet and exercise prevent diabetes in high-risk patients 175 Mental health problems 176 Restricted diet improves parental perception of hyperactive behavior 176 Variable support for CAM therapies for anxiety 177 Antioxidants do not prevent dementia 178 Lowering homocysteine with B vitamins doesn t improve cognition 179 Vitamin E, donepezil ineffective for mild cognitive impairment 180 Light therapy as effective as fluoxetine for seasonal affective disorder 181 Musculoskeletal problems 182 Acupuncture effective for chronic back pain 182 Tai chi improves symptoms of osteoarthritis 183 Acupuncture effective for OA of the knee 184 Acupuncture ineffective for fibromyalgia 185 Acupuncture better than sham treatment for neck pain 186 Prevention of cancer 187 Vitamin E not helpful, perhaps harmful 187 Vitamin E doesn t lower women s risk of cardiovascular disease or cancer 188 Vitamin E has no effect on cardiovascular disease 189 Antioxidants don t prevent Gl cancers, and may increase overall mortality 190 Antioxidants don t prevent colorectal cancer 191 Green tea consumption is associated with reduced mortality 192 DHEA, testosterone not effective in aging patients 193 Lowering homocysteine does not reduce cardiovascular disease (HOPE 2) 194 Folic acid supplementation does not reduce cardiovascular disease risk nor mortality 195 Herbs may reduce cholesterol, no data on clinical outcomes 196 Upper respiratory problems 197 Herbal tea effective for symptoms of acute pharyngitis 197 Petroleum jelly doesn t reduce recurrent pediatric epistaxis 198 Saline nasal irrigation effective for frequent sinusitis 199 Forcing fluids during a respiratory infection unsupported by studies 200 Zinc nasal gel reduces duration of common cold 201 Echinacea purpurea ineffective for treating URI in kids 202 Echinacea doesn t shorten or lessen cold symptoms 203 Women s health 204 Black cohosh ineffective for vasomotor symptoms 204 Acupuncture ineffective for hot flashes 205 Lactobacillus doesn t prevent post-antibiotic vaginitis 206 Immersion exercise reduces leg edema in pregnancy 207 Endocrinology 208 Diabetes 208 Diet and exercise prevent diabetes in high-risk patients 208 Treating prediabetes does not affect progression 209 Rosiglitazone delays developing diabetes mellitus (DREAM) 210 Hypertension control most important aspect of diabetes care 211 Fenofibrate doesn t prevent coronary events in diabetes mellitus (FIELD) 212 Home glucose monitoring makes little difference in type 2 diabetes 213 Rosiglitazone more likely to succeed as monotherapy clinical outcomes no better 214 ACE inhibitors beneficial in diabetics 215 ARB no better than ACEI for prevention of nephropathy progression 216 Pioglitazone ineffective in secondary prevention of macrovascular complications (PROactive) 217 Cancer linked to some diabetes treatments 218 Duloxetine decreases pain of diabetic neuropathy 219 Obesity 220 Weight loss interventions have little effect on quality of life 220 Popular diets equally effective for losing weight 221 Intense diet-behavior-physical activity effective for obese children 222 Rimonabant minimally effective for weight loss 223 Topiramate beneficial for binge eating disorder with obesity 224 Bariatric surgery effective for morbid obesity 225 Eye, Ear, Nose and Throat 226 Allergic rhinitis 226 Bed and pillow covers ineffective for allergic rhinitis 226 Pollen blocker cream effective for allergic rhinitis 227 Montelukast alone ineffective for allergic rhinitis 228 Epistaxis 229 Petroleum jelly doesn t reduce recurrent pediatric epistaxis 229 Eye problems 230 Lutein improves vision with macular degeneration in men 230 Three indicators herald bacterial conjunctivitis in adults 231 Antibiotics for conjunctivitis decreases symptom duration 232 Diet high in beta carotene, vitamins C and E, and zinc may reduce risk of macular degeneration 233 Otitis media 234 Parent satisfaction okay with no treatment of AOM 234 Parents prefer shared decision-making for AOM 235 Delayed prescription for AOM reduces unnecessary antibiotics 236 Tubes marginally effective in otitis media with effusion 237 Early tympanostomy tubes do not improve outcomes after 3 or more years 238 Prompt tympanostomy tube insertion doesn t improve 9year outcomes 239 Sinusitis 240 Saline nasal irrigation effective for frequent sinusitis 240 Intranasal steroids alone effective for acute uncomplicated sinusitis 241 Sore throat 242 Herbal tea effective for symptoms of acute pharyngitis 242 Steroids provide brief relief of pain in mononucleosis 243 URI 244 Gargling with water prevents colds 244 Delayed prescriptions for URIs reduce antibiotic use 245 Forcing fluids during a respiratory infection unsupported by studies 246 Zinc nasal gel reduces duration of common cold 247 Echinacea purpurea ineffective for treating URI in kids 248 Antibiotics slightly effective for purulent rhinitis 249 Echinacea doesn t shorten or lessen cold symptoms 250 Gastrointestinal Problems 251 Diarrhea and gastroenteritis 251 Yogurt prevents antibiotic-associated diarrhea 251 Probiotics helpful for antibiotic-associated diarrhea 252 Probiotics effective in preventing acute diarrhea, but not traveler s diarrhea 253 Nitazoxanide reduces rotavirus duration in hospitalized kids 254 Oral rotavirus vaccines safe and effective 255 Ondansetron effective for gastroenteritis with vomiting 256 Dyspepsia and gastrointestinal bleeding 257 Omeprazole 20mg = 40mg for primary care acid-related dyspepsia 257 Omeprazole, ranitidine effective for HP negative dyspepsia (CADET-HN) 258 4 drugs for 1 day eliminates H. pylori 259 Aspirin + PPI safer than clopidogrel if history of Cl bleed 260 Castroesophageal reflux disease 261 A PPI test does not improve diagnosis of CERD 261 Lifestyle changes of little benefit in CERD 262 All PPIs equivalent for treatment of CERD 263 Hepatobiliary disorders 264 Acetaminophen does not affect liver function in alcoholics 264 Evaluation of abnormal liver chemistries 265 Enteral nutrition preferred in pancreatitis 266 Antibiotic prophylaxis reduces mortality in hospitalized cirrhotics 267 Cynecology 268 Cervical and endometrial cancer 268 Many unnecessary Pap smears are performed after hysterectomy 268 Specific HPV strain are associated with cervical cancer risk 269 Vaccine effective against HPV 270 Bivalent vaccine against HPV effective for 4.5 years 271 Liquid-based not better than conventional Pap 272 Endometrial sampling adequate for diagnosing endometrial cancer 273 Infertility and contraception 274 Avoid nonoxynol-9 spermicides with less than 100g per dose 274 Metformin increases fertility in PCOS 275 Menopause 276 HRT with estrogen alone increases stroke, decreases fractures 276 Clonidine, gabapentin, and some SSRIs effective for hot flashes 277 Black cohosh ineffective for vasomotor symptoms 278 Acupuncture ineffective for hot flashes 279 HRT increases risk of stress, urge urinary incontinence 280 Vaginitis 281 Weekly fluconazole reduces recurrent candidiasis, though costly 281 Lactobacillus doesn t prevent post-antibiotic vaginitis 282 Hematology 283 Anemia 283 Anemia not prevented by iron in infants 283 Anemia doesn t predict iron deficiency among toddlers 284 Repeated blood testing causes anemia 285 Oral as good as IM vitamin B12 replacement 286 Thrombophilias 287 LMWH better than warfarin in preventing recurrent DVT in cancer patients 287 Testing for prothrombotic defects not necessary after first DVT 288 Management of antiphospholipid antibody syndrome 289 Infectious Disease 290 Prevention 290 Oral rotavirus vaccines safe and effective 290 Acellular pertussis vaccine 63% to 92% effective 291 Vaccine exposure does not increase risk of infectious disease hospitalization 292 Antibacterial household products don t reduce infectious symptoms 293 Prescribing practices 294 Cephalosporins often safe in PCN-allergic patients 294 Prescribing antibiotics does not save time 295 Delayed prescription for AOM reduces unnecessary antibiotics 296 Delayed prescriptions for URIs reduce antibiotic use 297 Respiratory infections 298 Flu shots are effective in elderly 298 Useful signs and symptoms for diagnosis of influenza 299 Steroids provide brief relief of pain in mononudeosis 300 Kidney Diseases 301 Diabetic nephropathy 301 ACE inhibitors beneficial in diabetics 301 ARB no better than ACEI for prevention of nephropathy progression 302 Gout 303 Meat, seafood, and little dairy are risk factors for gout 303 Febuxostat = allopurinol for gout prophylaxis 304 Renal failure 305 Low-dose dopamine ineffective for acute renal failure 305 Furosemide doesn t prevent acute renal failure 306 Urinary tract infection and dysuria 307 Treating negative dipstick dysuria decreases symptoms 307 Immediate- and extended-release ciprofloxacin similar for UTI 308 Musculoskeletal Problems 309 Back and neck pain 309 Acupuncture effective for chronic back pain 309 Surgery better than no surgery for spinal stenosis 310 Acupuncture better than sham treatment for neck pain 311 Useful treatments for fibromyalgia syndrome 312 Acupuncture ineffective for fibromyalgia 313 Degenerative joint disease 314 Acetaminophen = celecoxib in DJD 314 Knee taping useful for osteoarthritis pain 315 Tai chi improves symptoms of osteoarthritis 316 Acupuncture effective for OA of the knee 317 Rofecoxib increases risk of cardiovascular events 318 Celecoxib increases risk of cardiovascular complications 319 Rofecoxib, diclofenac and indomethacin increase risk of CVD 320 Rofecoxib cardiovascular risks known in 2000 321 Arthroscopy ineffective for osteoarthritis of knee 322 Obesity does not effect 5-year knee replacement outcomes 323 Osteoporosis and fractures 324 Monthly vitamin D prevents fractures 324 Calcium/vitamin D effective for prevention of first fracture 325 Calcium/vitamin D not effective for secondary prevention of fracture (RECORD) 326 1000mg calcium/400 IU vit D not very effective for fracture prevention (WHI) 327 HRT with estrogen alone increases stroke, decreases fractures 328 Long-term PPI use increases hip fracture risk 329 Most women quickly stop taking bisphosphonates 330 Evidence lacking for milk s benefit in children 331 Folate and vitamin B12 lowers fracture risk after stroke 332 Falls prevented in elderly by formal assessment or exercise program 333 Early mobilization better for acute limb injuries 334 Other musculoskeletal problems 335 Nonsurgical treatment effective for carpal tunnel 335 PET scan best in chronic osteomyelitis diagnosis 336 Extracorporeal shock wave therapy is ineffective for tennis elbow 337 Tennis elbow: injection better short-term, worse long-term 338 Neurology 339 Headache 339 Metoclopramide (Reglan) effective in migraine 339 Intranasal zolmitriptan effective for cluster headaches 340 Specific headache criteria useful for migraine diagnose, neuroimaging 341 Herpes zoster 342 Herpes zoster vaccine safe and effective for older adults 342 Tricyclics drug of choice for post-herpetic neuralgia 343 Insomnia 344 Melatonin effective for some sleep disorders 344 Cognitive therapy superior to zopiclone for insomnia 345 Syncope and vertigo 346 Simple maneuvers can decrease vasovagal syncope episodes 346 Steroid effective for vestibular neuritis, valacyclovir is not 347 Stroke 348 ASA prevents stroke, not Ml, in women 348 ASA + dipyridamole better than ASA for cerebral ischemia (ESPRIT) 349 Warfarin increases mortality in intracranial arterial stenosis 350 Lipid-lowering prevents stroke in patients with or without CHD 351 High-dose atorvastatin reduces recurrent stroke, not mortality (SPARCL) 352 ABCD rule predicts 7-day stroke risk in TIA 353 ABCD rule predicts 7- and 30-day stroke risk in patients with TIA 354 Eight clinical findings distinguish stroke from stroke mimics 355 Noninvasive carotid imaging can replace invasive imaging 356 Three percent of TIA patients have a stroke within 30 days (BASIC) 357 Endarterectomy best within 2 weeks of stroke or TIA 358 Carotid stent inferior to carotid endarterectomy 359 PEG tubes worsen quality of life in stroke (FOOD) 360 Pregnancy Care 361 Labor management 361 Fetal pulse oximetry does not reduce operative delivery 361 Suction before delivery of shoulders doesn t prevent meconium aspiration 362 VBAC with prior vaginal delivery safer than cesarean 363 Prenatal care 364 Risk-based screening for CDM effective 364 Steroids effective for hyperemesis gravidarum 365 Immersion exercise reduces leg edema in pregnancy 366 Aspirin = enoxaparin for prevention of recurrent miscarriage 367 Preterm labor 368 Prenatal vaginal infection screening + treating reduces preterm delivery 368 Oral clindamycin for BV prevents prematurity 369 Psychology and Substance Abuse 370 ADHD 370 Restricted diet improves parental perception of hyperactive behavior 370 Stimulants similarly effective for ADHD 371 Responders to atomoxetine do well with lower doses 372 Antipsychotics and schizophrenia 373 Newer antipsychotics similar to older agents (CATIE) 373 Atypical antipsychotics minimally effective, poorly tolerated in Alzheimer s disease 374 Older, newer antipsychotics both increase mortality in elderly 375 Anxiety and stress 376 Variable support for CAM therapies for anxiety 376 Work stress has no meaningful effect on blood pressure 377 Dementia 378 Antioxidants do not prevent dementia 378 Lowering homocysteine with B vitamins doesn t improve cognition 379 Reasoning training slows age-related functional decline 380 Statins not associated with decreased dementia 381 Vitamin E, donepezil ineffective for mild cognitive impairment 382 Drug therapy minimally effective for neuropsych symptoms of dementia 383 Minimal effect of cholinesterase inhibitors for Alzheimer s 384 Haloperidol shortens duration, intensity but not frequency of post-up delirium 385 Small increased risk of death with atypical antipsychotics for dementia 386 Older, newer antipsychotics both increase mortality in elderly 387 Depression 388 Two question screening for depression effective 388 No difference among new antidepressants 389 Alternative medications are similarly effective for depression treatment failures (STAR*D) 390 Suicide rates equal regardless of antidepressant type 391 Antidepressant drugs increase suicidal behavior in children 392 Newer antidepressants increase suicidality in youths 393 Light therapy as effective as fluoxetine for seasonal affective disorder 394 Tobacco abuse 395 Smoking cessation 6-8 weeks before surgery reduces complications 395 12 weeks of varenicline is effective for smoking cessation 396 6 weeks of varenicline is also effective for smoking cessation 397 Respiratory Problems 398 Asthma 398 Educational programs effective for young asthmatics 398 Bed and pillow covers ineffective for asthma 399 Exhaled nitric oxide and sputum analysis useful for asthma diagnosis 400 Intermittent = continuous therapy for mild persistent asthma 401 Salmeterol + fluticasone better than fluticasone for asthma (COAL) 402 Don t double steroid dose in deteriorating asthma 403 Long-term budesonide does not effect adrenal function in children 404 COPD 405 Procalcitonin test can reduce antibiotic use in COPD 405 Corticosteroids benefit patients with moderate to severe COPD 406 Anticholinergics are better than beta-agonists in COPD treatment 407 Lower respiratory infections 408 Cough suppressants ineffective in children 408 No antibiotics necessary for lower respiratory infection 409 Chest cold instead of bronchitis decreases unnecessary antibiotic use 410 Pelargonium effective for acute bronchitis symptoms 411 Single oral dose dexamethasone effective for even mild croup 412 Data on treating bronchiolitis severely limited 413 Pneumonia 414 Blood cultures add little to pneumonia care 414 Antibiotics with atypical bacteria coverage unnecessary 415 Outpatient = inpatient for low-risk patients with pneumonia 416 Antibiotic choice makes little difference in community-acquired pneumonia 417 Pneumonia: 3 days of antibiotics for uncomplicated course 418 Amoxicillin for 3 days effective for pediatric pneumonia 419 7-day levofloxacin slightly better than 1-day azithromycin for pneumonia 420 Skin Diseases 421 Acne vulgaris 421 Milk intake correlates with increased risk of acne in women 421 Dapsone gel effective for acne vulgaris treatment 422 Dermatitis 423 Effective prevention and treatment of contact dermatitis 423 Immunosuppressives = steroids for atopic dermatitis 424 Once-daily topical steroid dosing just as effective for atopic eczema 425 Herpes zoster 426 Herpes zoster vaccine safe and effective for older adults 426 Tricyclics drug of choice for post-herpetic neuralgia 427 Melanoma 428 Melanoma incidence really not rising 428 Lifetime risk of mole transforming to melanoma very low 429 0.7% of congenital melanocytic nevi become malignant 430 Dermoscopy with validated criteria more sensitive than unaided eye 431 Other skin problems 432 Effective methods for preventing pressure ulcers 432 Duct tape seems effective for warts 433 Effective treatments for rosacea 434 Surgery + Procedures 435 Cancer 435 Larger margins better in melanoma 2 mm thick 435 Radical prostatectomy improves outcomes in symptom-detected prostate cancer 436 Implantable defibrillators 437 Implantable defibrillators are not effective post-MI 437 Implantable defibrillators reduce mortality in NYHA Class li heart failure 438 Minor procedures 439 Small punch biopsies don t require sutures 439 Suturing of hand lacerations not necessary 440 Sterile gloves not necessary for laceration repair 441 Hot water (45 C) immersion best for jellyfish, man-of-war stings 442 Orthopeidcs and sports medicine 443 Surgery better than no surgery for spinal stenosis 443 Knee taping useful for osteoarthritis pain 444 Arthroscopy ineffective for osteoarthritis of knee 445 Extracorporeal shock wave therapy is ineffective for tennis elbow 446 Tennis elbow: injection better short-term, worse long-term 447 Otitis media 448 Tubes marginally effective in otitis media with effusion 448 Early tympanostomy tubes do not improve outcomes after 3 or more years 449 Prompt tympanostomy tube insertion doesn t improve 9year outcomes 450 Preoperative care 451 Beta-blockade reduces cardiac events in major noncardiac surgery 451 High-risk but not low-risk patients benefit from perioperative beta-blockade 452 Smoking cessation 6-8 weeks before surgery reduces complications 453 Vascular surgery and procedures 454 Better outcomes with CABC than PCI with stent for 2,3 vessel disease 454 Routine invasive strategy may be preferred for ACS 455 In ACS, 5years of invasive tx decreases Ml but not all cause mortality (FRISC-II) 456 CABC not helpful before AAA or peripheral vascular surgery 457 EVAR worse than open repair of AAA (EVAR Trial 1) 458 Bypass = angioplasty for severe leg ischemia, but costs more (BASIL) 459 Endarterectomy best within 2 weeks of stroke or TIA 460 Carotid stent inferior to carotid endarterectomy 461 Routine use of vena cava filters doesn t reduce mortality 462 Systems of Care 463 Care of children 463 School-based violence prevention programs not proved 463 Risk scoring system predicts mortality in pediatric ICU 464 Parent satisfaction okay with no treatment of AOM 465 Parents prefer shared decision-making for AOM 466 Critical care 467 Intensive insulin only helpful if MICU stay 3 days or longer 467 Normal saline similar to 4% albumin in ICU fluid resuscitation 468 No benefit from pulmonary artery catheters for critically ill patients 469 Pulmonary artery catheters: no harm, no benefit (PAC-Man) 470 Door-to-balloon time important in STEMI 471 Prescribing practices 472 Pharmaceutical ads are often inaccurate 472 Prescribing antibiotics does not save time 473 Delayed prescription for AOM reduces unnecessary antibiotics 474 Delayed prescriptions for URIs reduce antibiotic use 475 Process of care 476 Quality of care not related to spending 476 Disclosure of errors preferred by patients 477 Hypertension follow-up: 3 months = 6 months 478 Watchful waiting acceptable option for inguinal hernia 479 Self-monitoring 480 Self-monitoring of anticoagulation safe, effective 480 Self-monitoring anticoagulation superior at preventing venous thromboembolic events 481 Urology 482 Dysuria and urinary tract infection 482 Immediate- and extended-release ciprofloxacin similar for UTI 482 Treating negative dipstick dysuria decreases symptoms 483 Incontinence 484 Urinary incontinence diagnosis with 3 questions 484 HRT increases risk of stress, urge urinary incontinence 485 PT cures postpartum stress incontinence 486 No long-term continence with pelvic floor muscle training 487 Fewer complications with condom than Foley catheters 488 Nephrolithiasis 489 Tamsulosin effective for renal colic 489 Renal colic: NSAIDs more effective, less noxious than opioid analgesics 490 Medications help passage of kidney stones 491 Prostate cancer 492 Finasteride of mixed benefit in preventing prostate cancer 492 Prostate cancer screening every 4 years as good as annually 493 False-positive PSA associated with increased worry, fears 494 Elevated PSA should be confirmed before biopsy 495 Glossary 496 Index 498
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illustrated Not Illustrated
indexdate 2024-12-23T21:11:28Z
institution BVB
isbn 0470178906
9780470178904
language English
oai_aleph_id oai:aleph.bib-bvb.de:BVB01-016700586
oclc_num 154713038
open_access_boolean
physical XXX, 510 S.
publishDate 2007
publishDateSearch 2007
publishDateSort 2007
publisher Wiley-Interscience
record_format marc
spellingShingle Essential evidence medicine that matters ; InfoPOEMs
Evidence-Based Medicine Abstracts
Evidence-based medicine
title Essential evidence medicine that matters ; InfoPOEMs
title_auth Essential evidence medicine that matters ; InfoPOEMs
title_exact_search Essential evidence medicine that matters ; InfoPOEMs
title_full Essential evidence medicine that matters ; InfoPOEMs David Slawson ...
title_fullStr Essential evidence medicine that matters ; InfoPOEMs David Slawson ...
title_full_unstemmed Essential evidence medicine that matters ; InfoPOEMs David Slawson ...
title_short Essential evidence
title_sort essential evidence medicine that matters infopoems
title_sub medicine that matters ; InfoPOEMs
topic Evidence-Based Medicine Abstracts
Evidence-based medicine
topic_facet Evidence-Based Medicine Abstracts
Evidence-based medicine
url http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=016700586&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA
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