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Once-daily topical steroid dosing effective for atopic eczema
Patients should begin with once-daily dosing of topical corticosteroids for atopic eczema, increasing to twice or 3 times per day only if symptoms are not well controlled. (LOE=1a–)
Patients should begin with once-daily dosing of topical corticosteroids for atopic eczema, increasing to twice or 3 times per day only if symptoms are not well controlled. (LOE=1a–)
Patients should begin with once-daily dosing of topical corticosteroids for atopic eczema, increasing to twice or 3 times per day only if symptoms are not well controlled. (LOE=1a–)
Anemia does not predict iron deficiency among toddlers
These study results present a quandary: We cannot feel assured that a young child doesn’t have anemia if they show a normal hemoglobin level, and we can’t be sure that he or she has anemia if the hemoglobin level is low. Screening for iron deficiency in toddlers by checking serum hemoglobin misses most children with a deficiency, and most of the children with anemia do not have an iron deficiency. As the author of this study suggests, it might make more sense to continue low-dose supplementation of iron in all children rather than use a policy of screen and treat. (LOE=1c)
These study results present a quandary: We cannot feel assured that a young child doesn’t have anemia if they show a normal hemoglobin level, and we can’t be sure that he or she has anemia if the hemoglobin level is low. Screening for iron deficiency in toddlers by checking serum hemoglobin misses most children with a deficiency, and most of the children with anemia do not have an iron deficiency. As the author of this study suggests, it might make more sense to continue low-dose supplementation of iron in all children rather than use a policy of screen and treat. (LOE=1c)
These study results present a quandary: We cannot feel assured that a young child doesn’t have anemia if they show a normal hemoglobin level, and we can’t be sure that he or she has anemia if the hemoglobin level is low. Screening for iron deficiency in toddlers by checking serum hemoglobin misses most children with a deficiency, and most of the children with anemia do not have an iron deficiency. As the author of this study suggests, it might make more sense to continue low-dose supplementation of iron in all children rather than use a policy of screen and treat. (LOE=1c)
Antibiotic choice makes little difference in CAP
Strange, but true: Oral beta-lactam antibiotics— amoxicillin, amoxicillin/clavulanate (Augmentin), or a cephalosporin—are as effective in the treatment of community-acquired pneumonia as antibiotics active against atypical pathogens, even in patients infected with Mycoplasma pneumoniae or Chlamydia pneumoniae. These old standbys can be used instead of the more expensive drugs for most patients.
Legionella infection still requires treatment with an antibiotic effective against atypical pathogens, but in these studies only 1.1% of the patients with nonsevere pneumonia had Legionella. These results are backed up by similar findings from clinical practice (Hedlund J, et al. Scand J Infect Dis 2002; 34:887–892). (LOE=1a)
Strange, but true: Oral beta-lactam antibiotics— amoxicillin, amoxicillin/clavulanate (Augmentin), or a cephalosporin—are as effective in the treatment of community-acquired pneumonia as antibiotics active against atypical pathogens, even in patients infected with Mycoplasma pneumoniae or Chlamydia pneumoniae. These old standbys can be used instead of the more expensive drugs for most patients.
Legionella infection still requires treatment with an antibiotic effective against atypical pathogens, but in these studies only 1.1% of the patients with nonsevere pneumonia had Legionella. These results are backed up by similar findings from clinical practice (Hedlund J, et al. Scand J Infect Dis 2002; 34:887–892). (LOE=1a)
Strange, but true: Oral beta-lactam antibiotics— amoxicillin, amoxicillin/clavulanate (Augmentin), or a cephalosporin—are as effective in the treatment of community-acquired pneumonia as antibiotics active against atypical pathogens, even in patients infected with Mycoplasma pneumoniae or Chlamydia pneumoniae. These old standbys can be used instead of the more expensive drugs for most patients.
Legionella infection still requires treatment with an antibiotic effective against atypical pathogens, but in these studies only 1.1% of the patients with nonsevere pneumonia had Legionella. These results are backed up by similar findings from clinical practice (Hedlund J, et al. Scand J Infect Dis 2002; 34:887–892). (LOE=1a)
Melatonin effective for some sleep disorders
Melatonin in doses from 0.1 mg to 10 mg is effective in helping adults and children who have difficulty falling asleep. It is particularly helpful in patients whose circadian rhythm is permanently off-kilter (delayed sleep phase syndrome). It increases sleep length, but not sleep quality, in patients who perform shift work or who have jet lag. (LOE=1a)
Melatonin in doses from 0.1 mg to 10 mg is effective in helping adults and children who have difficulty falling asleep. It is particularly helpful in patients whose circadian rhythm is permanently off-kilter (delayed sleep phase syndrome). It increases sleep length, but not sleep quality, in patients who perform shift work or who have jet lag. (LOE=1a)
Melatonin in doses from 0.1 mg to 10 mg is effective in helping adults and children who have difficulty falling asleep. It is particularly helpful in patients whose circadian rhythm is permanently off-kilter (delayed sleep phase syndrome). It increases sleep length, but not sleep quality, in patients who perform shift work or who have jet lag. (LOE=1a)
Aspirin plus PPI safer than clopidogrel if there is history of GI bleeding
For patients with a history of bleeding peptic ulcer, the combination of aspirin and a proton pump inhibitor (PPI) twice a day was safer than clopidogrel in terms of bleeding side effects. Although esomeprazole (Nexium) was used in this study, generic omeprazole 20 mg give twice a day provides nearly the same degree of acid suppression at a much lower cost. This study calls into question the overall safety of clopidogrel (Plavix), which has been claimed to not significantly increase the risk of bleeding. (LOE=1b)
For patients with a history of bleeding peptic ulcer, the combination of aspirin and a proton pump inhibitor (PPI) twice a day was safer than clopidogrel in terms of bleeding side effects. Although esomeprazole (Nexium) was used in this study, generic omeprazole 20 mg give twice a day provides nearly the same degree of acid suppression at a much lower cost. This study calls into question the overall safety of clopidogrel (Plavix), which has been claimed to not significantly increase the risk of bleeding. (LOE=1b)
For patients with a history of bleeding peptic ulcer, the combination of aspirin and a proton pump inhibitor (PPI) twice a day was safer than clopidogrel in terms of bleeding side effects. Although esomeprazole (Nexium) was used in this study, generic omeprazole 20 mg give twice a day provides nearly the same degree of acid suppression at a much lower cost. This study calls into question the overall safety of clopidogrel (Plavix), which has been claimed to not significantly increase the risk of bleeding. (LOE=1b)
Popular diets equally effective for losing weight
All 4 diets are equally effective for helping adults lose weight and reduce cardiac risk factors. Since success in this study directly correlated with adherence to the diet, it makes sense to help patients choose the diet that is easiest for them to follow, and not preferentially encourage one diet over any other. (LOE=1b–)
All 4 diets are equally effective for helping adults lose weight and reduce cardiac risk factors. Since success in this study directly correlated with adherence to the diet, it makes sense to help patients choose the diet that is easiest for them to follow, and not preferentially encourage one diet over any other. (LOE=1b–)
All 4 diets are equally effective for helping adults lose weight and reduce cardiac risk factors. Since success in this study directly correlated with adherence to the diet, it makes sense to help patients choose the diet that is easiest for them to follow, and not preferentially encourage one diet over any other. (LOE=1b–)
High-dose zafirlukast in emergency department provides small benefit in acute asthma
A high dose of zafirlukast (Accolate) slightly reduces the number of patients who have an extended stay in the emergency department (number needed to treat [NNT]=20). Continuing zafirlukast at a dose of 20 mg twice a day slightly improves outpatient outcomes, as well (NNT=20 to prevent relapse).
Other studies have shown that inhaled corticosteroids are better long-term monotherapy for patients with asthma than leukotriene inhibitors. It is difficult to say whether this approach should be widely adopted—although the results are intriguing, I’d like to see at least one confirmatory study. This approach is, however, simple and relatively inexpensive. (LOE=1b)
A high dose of zafirlukast (Accolate) slightly reduces the number of patients who have an extended stay in the emergency department (number needed to treat [NNT]=20). Continuing zafirlukast at a dose of 20 mg twice a day slightly improves outpatient outcomes, as well (NNT=20 to prevent relapse).
Other studies have shown that inhaled corticosteroids are better long-term monotherapy for patients with asthma than leukotriene inhibitors. It is difficult to say whether this approach should be widely adopted—although the results are intriguing, I’d like to see at least one confirmatory study. This approach is, however, simple and relatively inexpensive. (LOE=1b)
A high dose of zafirlukast (Accolate) slightly reduces the number of patients who have an extended stay in the emergency department (number needed to treat [NNT]=20). Continuing zafirlukast at a dose of 20 mg twice a day slightly improves outpatient outcomes, as well (NNT=20 to prevent relapse).
Other studies have shown that inhaled corticosteroids are better long-term monotherapy for patients with asthma than leukotriene inhibitors. It is difficult to say whether this approach should be widely adopted—although the results are intriguing, I’d like to see at least one confirmatory study. This approach is, however, simple and relatively inexpensive. (LOE=1b)
False-positive PSA associated with increased worry and fears
False-positive results of screening tests are not benign; they have a psychological cost. Men who received false-positive PSA test results reported having thought and worried more about prostate cancer despite receiving a negative follow-up (prostate biopsy) result. They also think that the false-positive result makes them more likely to develop prostate cancer. Screening can be bad for our patients’ mental health. (Level of evidence [LOE]=1b)
False-positive results of screening tests are not benign; they have a psychological cost. Men who received false-positive PSA test results reported having thought and worried more about prostate cancer despite receiving a negative follow-up (prostate biopsy) result. They also think that the false-positive result makes them more likely to develop prostate cancer. Screening can be bad for our patients’ mental health. (Level of evidence [LOE]=1b)
False-positive results of screening tests are not benign; they have a psychological cost. Men who received false-positive PSA test results reported having thought and worried more about prostate cancer despite receiving a negative follow-up (prostate biopsy) result. They also think that the false-positive result makes them more likely to develop prostate cancer. Screening can be bad for our patients’ mental health. (Level of evidence [LOE]=1b)
Clinical decision rules accurately predict stroke risk in atrial fibrillation
Clinical decision rules, especially the well-validated Stroke Prevention in Atrial Fibrillation (SPAF) score, can help identify which groups of patients with atrial fibrillation are likely and unlikely to benefit from anticoagulation. (LOE=1a)
Clinical decision rules, especially the well-validated Stroke Prevention in Atrial Fibrillation (SPAF) score, can help identify which groups of patients with atrial fibrillation are likely and unlikely to benefit from anticoagulation. (LOE=1a)
Clinical decision rules, especially the well-validated Stroke Prevention in Atrial Fibrillation (SPAF) score, can help identify which groups of patients with atrial fibrillation are likely and unlikely to benefit from anticoagulation. (LOE=1a)
Guidelines for the treatment of chronic stable angina
In patients who have either chronic stable angina without a history of myocardial infarction or a revascularization procedure in the past 6 months, as well as in asymptomatic patients with demonstrated coronary artery disease, the following should be routine: aspirin; a beta-blocker; an angiotensin-converting enzyme inhibitor; and a statin, if the cholesterol is above normal. (LOE=1a)
In patients who have either chronic stable angina without a history of myocardial infarction or a revascularization procedure in the past 6 months, as well as in asymptomatic patients with demonstrated coronary artery disease, the following should be routine: aspirin; a beta-blocker; an angiotensin-converting enzyme inhibitor; and a statin, if the cholesterol is above normal. (LOE=1a)
In patients who have either chronic stable angina without a history of myocardial infarction or a revascularization procedure in the past 6 months, as well as in asymptomatic patients with demonstrated coronary artery disease, the following should be routine: aspirin; a beta-blocker; an angiotensin-converting enzyme inhibitor; and a statin, if the cholesterol is above normal. (LOE=1a)