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Donepezil minimally effective for patients with vascular dementia
Donepezil (Aricept—a potent acetylcholin-esterase inhibitor) had small effects on mentation for patients with mild to moderate vascular dementia as measured by validated instruments of cognition.
Donepezil’s side effects are similar to placebo at 5 mg but double at 10 mg, with no improvement in the patient’s cognition. Even though this medication was minimally effective, there are no other highly effective medical treatments for vascular dementia. Therefore, if a patient chooses a trial of donepezil, the lower, 5-mg dose should be offered.
The medication’s effect is likely a class effect and not an individual drug effect; therefore, rivastigmine (Exelon) and galantamine(Reminyl) are 2 other acetylcholinesterase inhibitors that should also be considered. Cost is similar for all 3 drugs at about $130.00 per month.
Donepezil (Aricept—a potent acetylcholin-esterase inhibitor) had small effects on mentation for patients with mild to moderate vascular dementia as measured by validated instruments of cognition.
Donepezil’s side effects are similar to placebo at 5 mg but double at 10 mg, with no improvement in the patient’s cognition. Even though this medication was minimally effective, there are no other highly effective medical treatments for vascular dementia. Therefore, if a patient chooses a trial of donepezil, the lower, 5-mg dose should be offered.
The medication’s effect is likely a class effect and not an individual drug effect; therefore, rivastigmine (Exelon) and galantamine(Reminyl) are 2 other acetylcholinesterase inhibitors that should also be considered. Cost is similar for all 3 drugs at about $130.00 per month.
Donepezil (Aricept—a potent acetylcholin-esterase inhibitor) had small effects on mentation for patients with mild to moderate vascular dementia as measured by validated instruments of cognition.
Donepezil’s side effects are similar to placebo at 5 mg but double at 10 mg, with no improvement in the patient’s cognition. Even though this medication was minimally effective, there are no other highly effective medical treatments for vascular dementia. Therefore, if a patient chooses a trial of donepezil, the lower, 5-mg dose should be offered.
The medication’s effect is likely a class effect and not an individual drug effect; therefore, rivastigmine (Exelon) and galantamine(Reminyl) are 2 other acetylcholinesterase inhibitors that should also be considered. Cost is similar for all 3 drugs at about $130.00 per month.
Geranium extract reduces bronchitis symptoms
This study provides very good evidence that geranium root (Pelargonium sidoides) extract significantly reduces the severity and duration of acute bronchitis symptoms with minimal side effects. Clinicians should recommend this extract for acute bronchitis.
Umcka, a geranium root extract, is marketed in the US, but clinicians should keep in mind that purity and standardization of herbal products are not regulated, and that this report did not include children or pregnant women.
This study provides very good evidence that geranium root (Pelargonium sidoides) extract significantly reduces the severity and duration of acute bronchitis symptoms with minimal side effects. Clinicians should recommend this extract for acute bronchitis.
Umcka, a geranium root extract, is marketed in the US, but clinicians should keep in mind that purity and standardization of herbal products are not regulated, and that this report did not include children or pregnant women.
This study provides very good evidence that geranium root (Pelargonium sidoides) extract significantly reduces the severity and duration of acute bronchitis symptoms with minimal side effects. Clinicians should recommend this extract for acute bronchitis.
Umcka, a geranium root extract, is marketed in the US, but clinicians should keep in mind that purity and standardization of herbal products are not regulated, and that this report did not include children or pregnant women.
Epinephrine is efficacious for outpatient treatment of bronchiolitis
Epinephrine provides small short-term benefits in ambulatory patients with acute bronchiolitis; however, it is not definitely better than albuterol.
Data do not support using epinephrine for inpatient bronchiolitis. This question remains unanswered due to the small size of the studies included in this meta-analysis and the absence of a reliable clinical scoring system to measure response in bronchiolitis.
Epinephrine provides small short-term benefits in ambulatory patients with acute bronchiolitis; however, it is not definitely better than albuterol.
Data do not support using epinephrine for inpatient bronchiolitis. This question remains unanswered due to the small size of the studies included in this meta-analysis and the absence of a reliable clinical scoring system to measure response in bronchiolitis.
Epinephrine provides small short-term benefits in ambulatory patients with acute bronchiolitis; however, it is not definitely better than albuterol.
Data do not support using epinephrine for inpatient bronchiolitis. This question remains unanswered due to the small size of the studies included in this meta-analysis and the absence of a reliable clinical scoring system to measure response in bronchiolitis.
3-year interval between Pap smears adequate for women with prior negative results
This study predicts that among women aged 30 to 64 years with 3 recent, negative Papanicolaou (Pap) smears, extending the interval for cervical cancer screening from 1 to 3 years would lead to an excess risk of cervical cancer of 3 in 100,000.
For women aged 30 to 44 years, preventing 1 case of cervical cancer through yearly Pap smears would require an additional 69,665 Pap smears and 3861 colposcopies (compared with screening 3 years after the last negative Pap smear). Clinicians should feel comfortable extending the interval for Pap smears from 1 to 3 years in women with prior normal results and a high likelihood of follow-up.
This study predicts that among women aged 30 to 64 years with 3 recent, negative Papanicolaou (Pap) smears, extending the interval for cervical cancer screening from 1 to 3 years would lead to an excess risk of cervical cancer of 3 in 100,000.
For women aged 30 to 44 years, preventing 1 case of cervical cancer through yearly Pap smears would require an additional 69,665 Pap smears and 3861 colposcopies (compared with screening 3 years after the last negative Pap smear). Clinicians should feel comfortable extending the interval for Pap smears from 1 to 3 years in women with prior normal results and a high likelihood of follow-up.
This study predicts that among women aged 30 to 64 years with 3 recent, negative Papanicolaou (Pap) smears, extending the interval for cervical cancer screening from 1 to 3 years would lead to an excess risk of cervical cancer of 3 in 100,000.
For women aged 30 to 44 years, preventing 1 case of cervical cancer through yearly Pap smears would require an additional 69,665 Pap smears and 3861 colposcopies (compared with screening 3 years after the last negative Pap smear). Clinicians should feel comfortable extending the interval for Pap smears from 1 to 3 years in women with prior normal results and a high likelihood of follow-up.
Posttraumatic Stress Disorder: A Sign of Weakness or of Strength?
Conjunctivitis: Diagnostic usefulness of signs and symptoms unknown
Despite recommendations in ophthalmologic texts for differentiating bacterial from viral conjunctivitis, no research supports the usefulness of any signs or symptoms to make this distinction. This raises validity questions about treatment studies based on clinically diagnosed bacterial conjunctivitis.
Despite recommendations in ophthalmologic texts for differentiating bacterial from viral conjunctivitis, no research supports the usefulness of any signs or symptoms to make this distinction. This raises validity questions about treatment studies based on clinically diagnosed bacterial conjunctivitis.
Despite recommendations in ophthalmologic texts for differentiating bacterial from viral conjunctivitis, no research supports the usefulness of any signs or symptoms to make this distinction. This raises validity questions about treatment studies based on clinically diagnosed bacterial conjunctivitis.
Four-year prostate cancer screening interval is effective
This study found a relatively low rate of prostate cancer diagnoses during a 4-year interval between screenings in Danish men aged 55 to 74 years. For those men choosing to undergo prostate cancer screening, these results show that annual screening is not necessary. Whether screening reduces prostate cancer-specific mortality is yet to be determined.
This study found a relatively low rate of prostate cancer diagnoses during a 4-year interval between screenings in Danish men aged 55 to 74 years. For those men choosing to undergo prostate cancer screening, these results show that annual screening is not necessary. Whether screening reduces prostate cancer-specific mortality is yet to be determined.
This study found a relatively low rate of prostate cancer diagnoses during a 4-year interval between screenings in Danish men aged 55 to 74 years. For those men choosing to undergo prostate cancer screening, these results show that annual screening is not necessary. Whether screening reduces prostate cancer-specific mortality is yet to be determined.
Azithromycin (3 days) better than amoxicillin-clavulanate (10 days) for sinusitis?
It is reasonable to try a 3-day course of azithromycin (Zithromax) 500 mg/d for patients with a firm diagnosis of acute bacterial sinusitis.
However, keep in mind that antibiotics in general do not provide a clinically meaningful advantage when compared with placebo. Azithromycin is well tolerated, and patients are more likely to complete a 3-day course than a 10-day one. Recall that amoxicillin is as effective as macrolides clinically, and that most cases of sinusitis are not bacterial.
It is reasonable to try a 3-day course of azithromycin (Zithromax) 500 mg/d for patients with a firm diagnosis of acute bacterial sinusitis.
However, keep in mind that antibiotics in general do not provide a clinically meaningful advantage when compared with placebo. Azithromycin is well tolerated, and patients are more likely to complete a 3-day course than a 10-day one. Recall that amoxicillin is as effective as macrolides clinically, and that most cases of sinusitis are not bacterial.
It is reasonable to try a 3-day course of azithromycin (Zithromax) 500 mg/d for patients with a firm diagnosis of acute bacterial sinusitis.
However, keep in mind that antibiotics in general do not provide a clinically meaningful advantage when compared with placebo. Azithromycin is well tolerated, and patients are more likely to complete a 3-day course than a 10-day one. Recall that amoxicillin is as effective as macrolides clinically, and that most cases of sinusitis are not bacterial.
Antidepressant treatment reduces poststroke mortality
Treatment with either fluoxetine or nortripty-line for 12 weeks during the first 6 months poststroke reduced the mortality risk of both depressed and nondepressed patients. Strong consideration should be given to treating clinically depressed and nondepressed post-stroke patients who are at significant risk of developing depression (family history or personal history of mood disorders) with antidepressant medication.
Treatment with either fluoxetine or nortripty-line for 12 weeks during the first 6 months poststroke reduced the mortality risk of both depressed and nondepressed patients. Strong consideration should be given to treating clinically depressed and nondepressed post-stroke patients who are at significant risk of developing depression (family history or personal history of mood disorders) with antidepressant medication.
Treatment with either fluoxetine or nortripty-line for 12 weeks during the first 6 months poststroke reduced the mortality risk of both depressed and nondepressed patients. Strong consideration should be given to treating clinically depressed and nondepressed post-stroke patients who are at significant risk of developing depression (family history or personal history of mood disorders) with antidepressant medication.
Vaccinations containing thimerosal do not increase rates of autism
This retrospective cohort study found that autism rates in children receiving vaccines containing thimerosal were not statistically different than for children receiving thimerosal-free vaccines.
This study refutes any connection between the thimerosal preservative and autistic disorders, but does not evaluate the risk of autistic disorders in vaccinated children compared with those who are not vaccinated. No routine pediatric vaccinations currently used in the United States contain thimerosal.
This retrospective cohort study found that autism rates in children receiving vaccines containing thimerosal were not statistically different than for children receiving thimerosal-free vaccines.
This study refutes any connection between the thimerosal preservative and autistic disorders, but does not evaluate the risk of autistic disorders in vaccinated children compared with those who are not vaccinated. No routine pediatric vaccinations currently used in the United States contain thimerosal.
This retrospective cohort study found that autism rates in children receiving vaccines containing thimerosal were not statistically different than for children receiving thimerosal-free vaccines.
This study refutes any connection between the thimerosal preservative and autistic disorders, but does not evaluate the risk of autistic disorders in vaccinated children compared with those who are not vaccinated. No routine pediatric vaccinations currently used in the United States contain thimerosal.