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Social Support: An Undervalued and Underused Clinical Resource
Is Open Access Appointing the Answer?
HPV testing may replace Pap smears for primary screening
Using human papillomavirus (HPV) testing is likely to replace Papanicolaou (Pap) testing for primary screening for cervical cancer for a variety of reasons—detection of the etiologic factor should predate the development of disease; urine testing for HPV may remove patient barriers to screening; and reduced interpretation error. This study can’t really provide the kind of data to support this, however. It is even more likely that vaccination against HPV may render both these technologies obsolete. (LOE=2b)
Using human papillomavirus (HPV) testing is likely to replace Papanicolaou (Pap) testing for primary screening for cervical cancer for a variety of reasons—detection of the etiologic factor should predate the development of disease; urine testing for HPV may remove patient barriers to screening; and reduced interpretation error. This study can’t really provide the kind of data to support this, however. It is even more likely that vaccination against HPV may render both these technologies obsolete. (LOE=2b)
Using human papillomavirus (HPV) testing is likely to replace Papanicolaou (Pap) testing for primary screening for cervical cancer for a variety of reasons—detection of the etiologic factor should predate the development of disease; urine testing for HPV may remove patient barriers to screening; and reduced interpretation error. This study can’t really provide the kind of data to support this, however. It is even more likely that vaccination against HPV may render both these technologies obsolete. (LOE=2b)
Annual proteinuria screening not cost-effective
Annual screening of adults to detect proteinuria and prevent end-stage renal disease (ESRD) is not cost-effective unless directed only at high-risk groups (that is, those patients with diabetes and hypertension). Screening every 10 years beginning at the age 60 years, however, is highly cost-effective. (LOE=1b)
Annual screening of adults to detect proteinuria and prevent end-stage renal disease (ESRD) is not cost-effective unless directed only at high-risk groups (that is, those patients with diabetes and hypertension). Screening every 10 years beginning at the age 60 years, however, is highly cost-effective. (LOE=1b)
Annual screening of adults to detect proteinuria and prevent end-stage renal disease (ESRD) is not cost-effective unless directed only at high-risk groups (that is, those patients with diabetes and hypertension). Screening every 10 years beginning at the age 60 years, however, is highly cost-effective. (LOE=1b)
Hyaluronic acid minimally effective for knee osteoarthritis
Intra-articular hyaluronic acid (Provisc, Synvisc, Suplasyn) is minimally, if at all, more effective than placebo in the treatment of knee osteoarthritis. The evidence of publication bias against negative trials in this meta-analysis suggests that any overall positive effect is overestimated. The highest-molecular-weight hyaluronic acid (Synvisc) may be more effective than lower-molecular-weight hyaluronic acid. (LOE=1a–)
Intra-articular hyaluronic acid (Provisc, Synvisc, Suplasyn) is minimally, if at all, more effective than placebo in the treatment of knee osteoarthritis. The evidence of publication bias against negative trials in this meta-analysis suggests that any overall positive effect is overestimated. The highest-molecular-weight hyaluronic acid (Synvisc) may be more effective than lower-molecular-weight hyaluronic acid. (LOE=1a–)
Intra-articular hyaluronic acid (Provisc, Synvisc, Suplasyn) is minimally, if at all, more effective than placebo in the treatment of knee osteoarthritis. The evidence of publication bias against negative trials in this meta-analysis suggests that any overall positive effect is overestimated. The highest-molecular-weight hyaluronic acid (Synvisc) may be more effective than lower-molecular-weight hyaluronic acid. (LOE=1a–)
Ximelagatran effective in preventing stroke in a nonvalvular atrial fibrillation
In this manufacturer-sponsored, open-label study, patients with atrial fibrillation and at increased risk for stroke treated with either ximelagatran or warfarin have comparable outcomes. If these results are confirmed independently, ximelagatran may become the preferred treatment, since it doesn’t require monitoring and may cause fewer bleeding complications. (LOE=2b).
In this manufacturer-sponsored, open-label study, patients with atrial fibrillation and at increased risk for stroke treated with either ximelagatran or warfarin have comparable outcomes. If these results are confirmed independently, ximelagatran may become the preferred treatment, since it doesn’t require monitoring and may cause fewer bleeding complications. (LOE=2b).
In this manufacturer-sponsored, open-label study, patients with atrial fibrillation and at increased risk for stroke treated with either ximelagatran or warfarin have comparable outcomes. If these results are confirmed independently, ximelagatran may become the preferred treatment, since it doesn’t require monitoring and may cause fewer bleeding complications. (LOE=2b).
Metformin-induced lactic acidosis extremely rare
The link between metformin and lactic acidosis, when used as prescribed, is tenuous. The bigger question is whether lactic acidosis risk truly increases when we relax criteria and give it to patients previously forbidden to take it. (LOE=1a)
The link between metformin and lactic acidosis, when used as prescribed, is tenuous. The bigger question is whether lactic acidosis risk truly increases when we relax criteria and give it to patients previously forbidden to take it. (LOE=1a)
The link between metformin and lactic acidosis, when used as prescribed, is tenuous. The bigger question is whether lactic acidosis risk truly increases when we relax criteria and give it to patients previously forbidden to take it. (LOE=1a)
Are We Treating PTSD with Debridement and Lavage?
High-dose azithromycin or amoxicillin-clavulanate for recurrent otitis media?
Use high-dose azithromycin for 3 days if antibiotics are needed, instead of a 10-day course of high-dose amoxicillin-clavulanate for the treatment of recurrent or persistent acute otitis media. For every 10 children using azithromycin instead of amoxicillin-clavulanate, there is 1 additional clinical cure at 1 month and 1 less episode of diarrhea. However, no difference in clinical success is seen at 2 weeks.
Use high-dose azithromycin for 3 days if antibiotics are needed, instead of a 10-day course of high-dose amoxicillin-clavulanate for the treatment of recurrent or persistent acute otitis media. For every 10 children using azithromycin instead of amoxicillin-clavulanate, there is 1 additional clinical cure at 1 month and 1 less episode of diarrhea. However, no difference in clinical success is seen at 2 weeks.
Use high-dose azithromycin for 3 days if antibiotics are needed, instead of a 10-day course of high-dose amoxicillin-clavulanate for the treatment of recurrent or persistent acute otitis media. For every 10 children using azithromycin instead of amoxicillin-clavulanate, there is 1 additional clinical cure at 1 month and 1 less episode of diarrhea. However, no difference in clinical success is seen at 2 weeks.
First-trimester tests for trisomies 21 and 18 as sensitive as triple screen
First-trimester screening for trisomies 21 and 18 with maternal serum markers and ultra-sonographic measurement of fetal nuchal translucency is more sensitive than second-trimester “triple screen.” Application of this finding to general practice is limited by lack of access to radiologists trained in this more specialized prenatal ultrasound measurement.
First-trimester screening for trisomies 21 and 18 with maternal serum markers and ultra-sonographic measurement of fetal nuchal translucency is more sensitive than second-trimester “triple screen.” Application of this finding to general practice is limited by lack of access to radiologists trained in this more specialized prenatal ultrasound measurement.
First-trimester screening for trisomies 21 and 18 with maternal serum markers and ultra-sonographic measurement of fetal nuchal translucency is more sensitive than second-trimester “triple screen.” Application of this finding to general practice is limited by lack of access to radiologists trained in this more specialized prenatal ultrasound measurement.