Hawthorn extract improves chronic heart failure

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PRACTICE RECOMMENDATIONS

Based on the findings of this meta-analysis, hawthorn extract can be recommended as an adjunctive therapy to improve the physical performance and ameliorate heart failure–related symptoms of patients with chronic heart failure. It should not replace standard therapy.

The most effective dose is unknown, but these studies used 160–1800 mg/d. Longterm data on hawthorn extract’s impact upon prognosis is still lacking.

 
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Pittler MH, Schmidt K, Ernst E. Hawthorn extract for treating chronic heart failure: meta-analysis of randomized trials. Am J Med 2003; 114:665–674.

Laura Jeanne Eaton, MD, MPH
Scott Kinkade, MD
Department of Family and Community Medicine, University of Missouri–Columbia. E-mail: [email protected]

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Pittler MH, Schmidt K, Ernst E. Hawthorn extract for treating chronic heart failure: meta-analysis of randomized trials. Am J Med 2003; 114:665–674.

Laura Jeanne Eaton, MD, MPH
Scott Kinkade, MD
Department of Family and Community Medicine, University of Missouri–Columbia. E-mail: [email protected]

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Pittler MH, Schmidt K, Ernst E. Hawthorn extract for treating chronic heart failure: meta-analysis of randomized trials. Am J Med 2003; 114:665–674.

Laura Jeanne Eaton, MD, MPH
Scott Kinkade, MD
Department of Family and Community Medicine, University of Missouri–Columbia. E-mail: [email protected]

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PRACTICE RECOMMENDATIONS

Based on the findings of this meta-analysis, hawthorn extract can be recommended as an adjunctive therapy to improve the physical performance and ameliorate heart failure–related symptoms of patients with chronic heart failure. It should not replace standard therapy.

The most effective dose is unknown, but these studies used 160–1800 mg/d. Longterm data on hawthorn extract’s impact upon prognosis is still lacking.

 
PRACTICE RECOMMENDATIONS

Based on the findings of this meta-analysis, hawthorn extract can be recommended as an adjunctive therapy to improve the physical performance and ameliorate heart failure–related symptoms of patients with chronic heart failure. It should not replace standard therapy.

The most effective dose is unknown, but these studies used 160–1800 mg/d. Longterm data on hawthorn extract’s impact upon prognosis is still lacking.

 
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Antioxidant vitamins do not prevent cardiovascular disease

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Antioxidant vitamins do not prevent cardiovascular disease
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This meta-analysis of randomized controlled trials showed that neither beta-carotene nor vitamin E appears to prevent all-cause or cardiovascular mortality in patients with known heart disease or those at risk for heart disease. Similarly, use of these antioxidant vitamins did not affect number of stroke events. The use of beta-carotene and vitamin E should not be recommended for primary and secondary prevention of cardiovascular disease.

 
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Vivekananthan DP, Penn MS, Sapp SK, Hsu A, Topol EJ. Use of antioxidant vitamins for the prevention of cardiovascular disease: meta-analysis of randomised trials. Lancet 2003; 361:2017–2023.

Promita Roychoudhury, MD
Kendra Schwartz, MD, MSPH
Wayne State University Family Practice Residency Program, Detroit, Mich. [email protected].

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Vivekananthan DP, Penn MS, Sapp SK, Hsu A, Topol EJ. Use of antioxidant vitamins for the prevention of cardiovascular disease: meta-analysis of randomised trials. Lancet 2003; 361:2017–2023.

Promita Roychoudhury, MD
Kendra Schwartz, MD, MSPH
Wayne State University Family Practice Residency Program, Detroit, Mich. [email protected].

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Vivekananthan DP, Penn MS, Sapp SK, Hsu A, Topol EJ. Use of antioxidant vitamins for the prevention of cardiovascular disease: meta-analysis of randomised trials. Lancet 2003; 361:2017–2023.

Promita Roychoudhury, MD
Kendra Schwartz, MD, MSPH
Wayne State University Family Practice Residency Program, Detroit, Mich. [email protected].

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PRACTICE RECOMMENDATIONS

This meta-analysis of randomized controlled trials showed that neither beta-carotene nor vitamin E appears to prevent all-cause or cardiovascular mortality in patients with known heart disease or those at risk for heart disease. Similarly, use of these antioxidant vitamins did not affect number of stroke events. The use of beta-carotene and vitamin E should not be recommended for primary and secondary prevention of cardiovascular disease.

 
PRACTICE RECOMMENDATIONS

This meta-analysis of randomized controlled trials showed that neither beta-carotene nor vitamin E appears to prevent all-cause or cardiovascular mortality in patients with known heart disease or those at risk for heart disease. Similarly, use of these antioxidant vitamins did not affect number of stroke events. The use of beta-carotene and vitamin E should not be recommended for primary and secondary prevention of cardiovascular disease.

 
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Tapering inhaled steroids effective for chronic asthma

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Chronic stable asthma patients who use at least 1000 μg beclomethasone or its equivalent daily may reduce their dose of inhaled corticosteroids by as much as 50% without compromising control of symptoms.

 
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Hawkins G, McMahon A, Twaddle S, Wood S, Ford I, Thompson N. Stepping down inhaled corticosteroids in asthma: randomised controlled trial. BMJ 2003; 326:1115–1118.

Sharon See PharmD
St. John’s University College of Pharmacy and Allied Health Professions, Jamaica, NY

Susan Rubin, MD
Beth Israel Program in Urban Family Health, Phillips Family Practice, New York, NY. [email protected].

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Hawkins G, McMahon A, Twaddle S, Wood S, Ford I, Thompson N. Stepping down inhaled corticosteroids in asthma: randomised controlled trial. BMJ 2003; 326:1115–1118.

Sharon See PharmD
St. John’s University College of Pharmacy and Allied Health Professions, Jamaica, NY

Susan Rubin, MD
Beth Israel Program in Urban Family Health, Phillips Family Practice, New York, NY. [email protected].

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Hawkins G, McMahon A, Twaddle S, Wood S, Ford I, Thompson N. Stepping down inhaled corticosteroids in asthma: randomised controlled trial. BMJ 2003; 326:1115–1118.

Sharon See PharmD
St. John’s University College of Pharmacy and Allied Health Professions, Jamaica, NY

Susan Rubin, MD
Beth Israel Program in Urban Family Health, Phillips Family Practice, New York, NY. [email protected].

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PRACTICE RECOMMENDATIONS

Chronic stable asthma patients who use at least 1000 μg beclomethasone or its equivalent daily may reduce their dose of inhaled corticosteroids by as much as 50% without compromising control of symptoms.

 
PRACTICE RECOMMENDATIONS

Chronic stable asthma patients who use at least 1000 μg beclomethasone or its equivalent daily may reduce their dose of inhaled corticosteroids by as much as 50% without compromising control of symptoms.

 
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Ginkgo ineffective for tinnitus

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Although the results of published trials are inconsistent, Ginkgo biloba is probably not effective for the treatment of tinnitus. Positive results of earlier small studies with serious methodological limitations are not supported by larger, more rigorous trials. However, the lack of any established pharmacological treatment for chronic tinnitus, combined with ginkgo’s excellent safety profile, make it an option for patients who desire to try it.

 
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Ernst E, Stevinson C. Ginkgo biloba for tinnitus: a review. Clin Otolaryngol 1999; 24:164–167.

Michael DeBisschop, PharmD
University of Wyoming Family Practice Residency, Casper, Wyoming. [email protected] .

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Ernst E, Stevinson C. Ginkgo biloba for tinnitus: a review. Clin Otolaryngol 1999; 24:164–167.

Michael DeBisschop, PharmD
University of Wyoming Family Practice Residency, Casper, Wyoming. [email protected] .

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Ernst E, Stevinson C. Ginkgo biloba for tinnitus: a review. Clin Otolaryngol 1999; 24:164–167.

Michael DeBisschop, PharmD
University of Wyoming Family Practice Residency, Casper, Wyoming. [email protected] .

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PRACTICE RECOMMENDATIONS

Although the results of published trials are inconsistent, Ginkgo biloba is probably not effective for the treatment of tinnitus. Positive results of earlier small studies with serious methodological limitations are not supported by larger, more rigorous trials. However, the lack of any established pharmacological treatment for chronic tinnitus, combined with ginkgo’s excellent safety profile, make it an option for patients who desire to try it.

 
PRACTICE RECOMMENDATIONS

Although the results of published trials are inconsistent, Ginkgo biloba is probably not effective for the treatment of tinnitus. Positive results of earlier small studies with serious methodological limitations are not supported by larger, more rigorous trials. However, the lack of any established pharmacological treatment for chronic tinnitus, combined with ginkgo’s excellent safety profile, make it an option for patients who desire to try it.

 
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Neuraminidase inhibitors slightly beneficial for shortening flu symptoms

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PRACTICE RECOMMENDATIONS

Oseltamivir (Tamiflu) and zanamivir (Relenza) are effective for reducing the duration of symptoms of influenza by about 1 day when given to healthy individuals aged <65 years, and if given early in the course of the disease. Benefit to individuals aged >65 years and those with chronic medical conditions were not established.

Important outcomes, such as prevention of death and hospitalization due to influenza, were not discussed. No head-to-head trials were included, and these drugs could be considered interchangeable. Patients in the studies had laboratory confirmation of influenza, something that is not always done in general practice.

Given that these drugs are expensive (about $60 for a typical course), routine use for all flu patients may not be cost-effective. Rather, balancing the cost of treatment against risks and benefits need to be individualized. Use of these drugs should not replace primary prevention strategies.

 
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Cooper NJ, Sutton AJ, Abrams KR, Wailoo A, Turner DA, Nicholson KG. Effectiveness of neuraminidase inhibitors in treatment and prevention of influenza A and B: systematic review and meta-analyses of randomised controlled trials. BMJ 2003; 326:1235–1240.

Grant T. Phillips, MD
Washington Hospital Family Practice Residency Program, Washington, Pa. [email protected].

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Cooper NJ, Sutton AJ, Abrams KR, Wailoo A, Turner DA, Nicholson KG. Effectiveness of neuraminidase inhibitors in treatment and prevention of influenza A and B: systematic review and meta-analyses of randomised controlled trials. BMJ 2003; 326:1235–1240.

Grant T. Phillips, MD
Washington Hospital Family Practice Residency Program, Washington, Pa. [email protected].

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Cooper NJ, Sutton AJ, Abrams KR, Wailoo A, Turner DA, Nicholson KG. Effectiveness of neuraminidase inhibitors in treatment and prevention of influenza A and B: systematic review and meta-analyses of randomised controlled trials. BMJ 2003; 326:1235–1240.

Grant T. Phillips, MD
Washington Hospital Family Practice Residency Program, Washington, Pa. [email protected].

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PRACTICE RECOMMENDATIONS

Oseltamivir (Tamiflu) and zanamivir (Relenza) are effective for reducing the duration of symptoms of influenza by about 1 day when given to healthy individuals aged <65 years, and if given early in the course of the disease. Benefit to individuals aged >65 years and those with chronic medical conditions were not established.

Important outcomes, such as prevention of death and hospitalization due to influenza, were not discussed. No head-to-head trials were included, and these drugs could be considered interchangeable. Patients in the studies had laboratory confirmation of influenza, something that is not always done in general practice.

Given that these drugs are expensive (about $60 for a typical course), routine use for all flu patients may not be cost-effective. Rather, balancing the cost of treatment against risks and benefits need to be individualized. Use of these drugs should not replace primary prevention strategies.

 
PRACTICE RECOMMENDATIONS

Oseltamivir (Tamiflu) and zanamivir (Relenza) are effective for reducing the duration of symptoms of influenza by about 1 day when given to healthy individuals aged <65 years, and if given early in the course of the disease. Benefit to individuals aged >65 years and those with chronic medical conditions were not established.

Important outcomes, such as prevention of death and hospitalization due to influenza, were not discussed. No head-to-head trials were included, and these drugs could be considered interchangeable. Patients in the studies had laboratory confirmation of influenza, something that is not always done in general practice.

Given that these drugs are expensive (about $60 for a typical course), routine use for all flu patients may not be cost-effective. Rather, balancing the cost of treatment against risks and benefits need to be individualized. Use of these drugs should not replace primary prevention strategies.

 
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Frequency of Symptoms and Clinical Diagnoses Among the "Chosin Few"

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Residual Effects of Cold Injury

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Mark S. Nelson, MD

Dr. Nelson is the assistant administrative chief of staff for ambulatory care at the VA North Texas Health Care System, Dallas, TX.

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Mark S. Nelson, MD

Dr. Nelson is the assistant administrative chief of staff for ambulatory care at the VA North Texas Health Care System, Dallas, TX.

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Mark S. Nelson, MD

Dr. Nelson is the assistant administrative chief of staff for ambulatory care at the VA North Texas Health Care System, Dallas, TX.

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Residual Effects of Cold Injury
Residual Effects of Cold Injury

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Frequency of Symptoms and Clinical Diagnoses Among the "Chosin Few"
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Oral topiramate effective for alcoholism

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PRACTICE RECOMMENDATIONS

Oral topiramate is effective in the treatment of alcohol dependence. Patients taking topiramate consumed less alcohol, had fewer heavy drinking days, and had more days abstinent within a 12-week period. This medication adds a significant adjunct to our current treatment of alcoholism and can be considered for use in treating those alcoholics who desire sobriety.

 
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Johnson BA, Ait Daoud N, Bowden CL, et al. Oral topiramate for treatment of alcohol dependence: a randomized controlled trial. Lancet 2003; 361:1677–1685.

Noble Anderson, MD
Norman M. Oliver, MD
Department of Family Medicine, University of Virginia, Charlottesville. E-mail: [email protected].

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Johnson BA, Ait Daoud N, Bowden CL, et al. Oral topiramate for treatment of alcohol dependence: a randomized controlled trial. Lancet 2003; 361:1677–1685.

Noble Anderson, MD
Norman M. Oliver, MD
Department of Family Medicine, University of Virginia, Charlottesville. E-mail: [email protected].

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Johnson BA, Ait Daoud N, Bowden CL, et al. Oral topiramate for treatment of alcohol dependence: a randomized controlled trial. Lancet 2003; 361:1677–1685.

Noble Anderson, MD
Norman M. Oliver, MD
Department of Family Medicine, University of Virginia, Charlottesville. E-mail: [email protected].

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PRACTICE RECOMMENDATIONS

Oral topiramate is effective in the treatment of alcohol dependence. Patients taking topiramate consumed less alcohol, had fewer heavy drinking days, and had more days abstinent within a 12-week period. This medication adds a significant adjunct to our current treatment of alcoholism and can be considered for use in treating those alcoholics who desire sobriety.

 
PRACTICE RECOMMENDATIONS

Oral topiramate is effective in the treatment of alcohol dependence. Patients taking topiramate consumed less alcohol, had fewer heavy drinking days, and had more days abstinent within a 12-week period. This medication adds a significant adjunct to our current treatment of alcoholism and can be considered for use in treating those alcoholics who desire sobriety.

 
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Warfarin started at 10 mg achieves therapeutic INR faster than 5 mg

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Warfarin started at 10 mg achieves therapeutic INR faster than 5 mg
PRACTICE RECOMMENDATIONS

Starting warfarin with 10 mg rather than 5 mg achieves a therapeutic international normalized ratio (INR) >1.9 one day earlier (4.2 vs 5.6 days) in selected outpatients at low risk for major bleeding complications with confirmed acute venous thromboembolism.

This strategy saves the time and expense of 1 daily INR determination, and it may decrease the number of days that low-molecular-weight heparin is required by 1 day— although all patients in this study, due to the nature of the design, received a minimum of 5 days of low-molecular-weight heparin.

No conclusions regarding differences in safety or efficacy between the 10-mg and 5-mg nomogram can be drawn from the results of this study, as it was underpowered to detect differences in these important endpoints.

 
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Kovacs MJ, Rodger M, Anderson DR, et al. Comparison of 10-mg and 5-mg warfarin initiation nomograms together with low-molecular weight heparin for outpatient treatment of acute venous thromboembolism. A randomized, double-blind, controlled trial. Ann Intern Med 2003; 138:714–719.

Alan Cementina, MD
Eric A. Jackson, PharmD
University of Connecticut School of Medicine and Saint Francis Hospital and Medical Center, Hartford, Conn. E-mail: [email protected].

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Kovacs MJ, Rodger M, Anderson DR, et al. Comparison of 10-mg and 5-mg warfarin initiation nomograms together with low-molecular weight heparin for outpatient treatment of acute venous thromboembolism. A randomized, double-blind, controlled trial. Ann Intern Med 2003; 138:714–719.

Alan Cementina, MD
Eric A. Jackson, PharmD
University of Connecticut School of Medicine and Saint Francis Hospital and Medical Center, Hartford, Conn. E-mail: [email protected].

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Kovacs MJ, Rodger M, Anderson DR, et al. Comparison of 10-mg and 5-mg warfarin initiation nomograms together with low-molecular weight heparin for outpatient treatment of acute venous thromboembolism. A randomized, double-blind, controlled trial. Ann Intern Med 2003; 138:714–719.

Alan Cementina, MD
Eric A. Jackson, PharmD
University of Connecticut School of Medicine and Saint Francis Hospital and Medical Center, Hartford, Conn. E-mail: [email protected].

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PRACTICE RECOMMENDATIONS

Starting warfarin with 10 mg rather than 5 mg achieves a therapeutic international normalized ratio (INR) >1.9 one day earlier (4.2 vs 5.6 days) in selected outpatients at low risk for major bleeding complications with confirmed acute venous thromboembolism.

This strategy saves the time and expense of 1 daily INR determination, and it may decrease the number of days that low-molecular-weight heparin is required by 1 day— although all patients in this study, due to the nature of the design, received a minimum of 5 days of low-molecular-weight heparin.

No conclusions regarding differences in safety or efficacy between the 10-mg and 5-mg nomogram can be drawn from the results of this study, as it was underpowered to detect differences in these important endpoints.

 
PRACTICE RECOMMENDATIONS

Starting warfarin with 10 mg rather than 5 mg achieves a therapeutic international normalized ratio (INR) >1.9 one day earlier (4.2 vs 5.6 days) in selected outpatients at low risk for major bleeding complications with confirmed acute venous thromboembolism.

This strategy saves the time and expense of 1 daily INR determination, and it may decrease the number of days that low-molecular-weight heparin is required by 1 day— although all patients in this study, due to the nature of the design, received a minimum of 5 days of low-molecular-weight heparin.

No conclusions regarding differences in safety or efficacy between the 10-mg and 5-mg nomogram can be drawn from the results of this study, as it was underpowered to detect differences in these important endpoints.

 
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MR angiography effective for diagnosing carotid artery stenosis

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MR angiography effective for diagnosing carotid artery stenosis
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Magnetic resonance angiography (MRA) is better than duplex ultrasound for diagnosing severe (70%–99%) carotid artery stenosis. Both tests are highly accurate for diagnosing total carotid artery occlusion.

Whether this advantage translates into improved patient outcomes is not known. While cost was not addressed in this study, MRA is 2 to 3 times more expensive than duplex ultrasound.

If cost and effectiveness data support these results, then MRA and duplex ultrasound might replace digital subtraction angiography for carotid artery surgery selection.

 
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Nederkoorn PJ, VanderGraaf Y, Hunink MGM. Duplex ultrasound and magnetic resonance angiography compared with digital subtraction angiography in carotid artery stenosis: a systematic review. Stroke 2003; 34:1324–1332.

Elizabeth Laffey, MD
Department of Community and Family Medicine, Saint Louis University,
Scott M. Strayer, MD, MPH
Department of Family Medicine, University of Virginia Health System, Charlottesville. E-mail: [email protected].

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Nederkoorn PJ, VanderGraaf Y, Hunink MGM. Duplex ultrasound and magnetic resonance angiography compared with digital subtraction angiography in carotid artery stenosis: a systematic review. Stroke 2003; 34:1324–1332.

Elizabeth Laffey, MD
Department of Community and Family Medicine, Saint Louis University,
Scott M. Strayer, MD, MPH
Department of Family Medicine, University of Virginia Health System, Charlottesville. E-mail: [email protected].

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Nederkoorn PJ, VanderGraaf Y, Hunink MGM. Duplex ultrasound and magnetic resonance angiography compared with digital subtraction angiography in carotid artery stenosis: a systematic review. Stroke 2003; 34:1324–1332.

Elizabeth Laffey, MD
Department of Community and Family Medicine, Saint Louis University,
Scott M. Strayer, MD, MPH
Department of Family Medicine, University of Virginia Health System, Charlottesville. E-mail: [email protected].

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PRACTICE RECOMMENDATIONS

Magnetic resonance angiography (MRA) is better than duplex ultrasound for diagnosing severe (70%–99%) carotid artery stenosis. Both tests are highly accurate for diagnosing total carotid artery occlusion.

Whether this advantage translates into improved patient outcomes is not known. While cost was not addressed in this study, MRA is 2 to 3 times more expensive than duplex ultrasound.

If cost and effectiveness data support these results, then MRA and duplex ultrasound might replace digital subtraction angiography for carotid artery surgery selection.

 
PRACTICE RECOMMENDATIONS

Magnetic resonance angiography (MRA) is better than duplex ultrasound for diagnosing severe (70%–99%) carotid artery stenosis. Both tests are highly accurate for diagnosing total carotid artery occlusion.

Whether this advantage translates into improved patient outcomes is not known. While cost was not addressed in this study, MRA is 2 to 3 times more expensive than duplex ultrasound.

If cost and effectiveness data support these results, then MRA and duplex ultrasound might replace digital subtraction angiography for carotid artery surgery selection.

 
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Naturopathic ear drops minimally effective for acute otitis media

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Naturopathic ear drops minimally effective for acute otitis media
PRACTICE RECOMMENDATONS

In children aged 5 to 18 years with acute otitis media, naturopathic herbal ear drops accounted for a small change in reported otalgia over 48 hours.

This study does not provide strong evidence for using naturopathic herbal ear drops in the studied population, let alone the population we most often see with otalgia due to acute otitis media: infants aged 6 to 24 months. Since no adverse events were reported, it seems reasonable to allow parents this option if they desire a nonpharmacologic analgesic—although the study does, once again, point out that time is often the best treatment for acute otitis media.

 
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Sarrell EM, Cohen HA, Kahan E. Naturopathic treatment for ear pain in children. Pediatrics 2003; 111:e574–579.

David L. Fay, MD
Kenneth G. Schellhase, MD, MPH
Daniel Wujek, MD
Department of Family and Community Medicine, Medical College of Wisconsin, Milwaukee. E-mail: [email protected] .

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Sarrell EM, Cohen HA, Kahan E. Naturopathic treatment for ear pain in children. Pediatrics 2003; 111:e574–579.

David L. Fay, MD
Kenneth G. Schellhase, MD, MPH
Daniel Wujek, MD
Department of Family and Community Medicine, Medical College of Wisconsin, Milwaukee. E-mail: [email protected] .

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Sarrell EM, Cohen HA, Kahan E. Naturopathic treatment for ear pain in children. Pediatrics 2003; 111:e574–579.

David L. Fay, MD
Kenneth G. Schellhase, MD, MPH
Daniel Wujek, MD
Department of Family and Community Medicine, Medical College of Wisconsin, Milwaukee. E-mail: [email protected] .

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Article PDF
PRACTICE RECOMMENDATONS

In children aged 5 to 18 years with acute otitis media, naturopathic herbal ear drops accounted for a small change in reported otalgia over 48 hours.

This study does not provide strong evidence for using naturopathic herbal ear drops in the studied population, let alone the population we most often see with otalgia due to acute otitis media: infants aged 6 to 24 months. Since no adverse events were reported, it seems reasonable to allow parents this option if they desire a nonpharmacologic analgesic—although the study does, once again, point out that time is often the best treatment for acute otitis media.

 
PRACTICE RECOMMENDATONS

In children aged 5 to 18 years with acute otitis media, naturopathic herbal ear drops accounted for a small change in reported otalgia over 48 hours.

This study does not provide strong evidence for using naturopathic herbal ear drops in the studied population, let alone the population we most often see with otalgia due to acute otitis media: infants aged 6 to 24 months. Since no adverse events were reported, it seems reasonable to allow parents this option if they desire a nonpharmacologic analgesic—although the study does, once again, point out that time is often the best treatment for acute otitis media.

 
Issue
The Journal of Family Practice - 52(9)
Issue
The Journal of Family Practice - 52(9)
Page Number
664-688
Page Number
664-688
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Naturopathic ear drops minimally effective for acute otitis media
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Naturopathic ear drops minimally effective for acute otitis media
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