Non-sterile gloves for abscess I&D?
The clinic nurse was setting up for an incision and drainage (I&D) of an abscess. After opening the dressing pack and laying out the necessary equipment, she inquired about my glove size. I replied “small”. She said, “oh no, Doc, what size STERILE gloves?” This made me question a...
Magnesium for leg cramps…just as good as placebo?
Clinical question: does magnesium work for leg cramps? Findings 1: Cochrane review, 2012 Both magnesium & placebo reduce the frequency of leg cramps with a non-significant difference between the two groups. The Cochrane review analysed four RCTs (n=322), two of which were deemed to have a high risk of...
Q. Is bed rest an effective treatment for anything?
Meta-analysis on 39 randomised control trials for 15 different conditions (5777 patients) Following a medical procedure: Out 24 RCTs-No outcomes improved significantly 8 worsened significantly in some procedures Lumbar puncture – vertigo, nausea and vomiting (no significant improvement in headache) Spinal anaesthesia – headache, back pain Radiculography – headache,...
Even Short-term Oral Steroids Carry Serious Risk
Short term use of oral corticosteroids and related harms among adults in the United States: population based cohort study BMJ 2017; 357 doi: https://doi.org/10.1136/bmj.j1415 (Published 12 April 2017)Cite this as: BMJ 2017;357:j1415 Cohort study of more than 1.5 million adults 30 days of initiating these drugs, even at relatively low...
Smoking cessation: Is abrupt quitting more effective than a gradual approach?
Lindson-Hawley N, Banting M, West R, Michie S, Shinkins B, Aveyard P. Gradual versus abrupt smoking cessation. A randomized, controlled noninferiority trial. Ann Intern Med 2016;164(9):585-592. Patients in the “abrupt cessation group” were asked to stop smoking on their quit day. Participants in the “gradual cessation group” were also...
What is the best duration for nicotine replacement therapy?
525 smokers enrolled. Randomized groups for nicotine replacement via patch at 8, 24, 52 weeks 6 month cessation rates were significantly higher if patches used for 24 wks. vs 8 wks. No adverse effects noted Cost effective benefit long term. No additional therapeutic advantage with long term treatment...
POEM 16.03.17
Q. How do I treat resistant Mycoplasma Genitalium? Management of Mycoplasma genitalium infections – can we hit a moving target? BMC Infect Dis. 2015 Review and meta-analysis of 19 studies Azithromycin standard single dose failure (40%) No randomised controlled trial has compared azithromycin 1 g single dose with extended azithromycin...
POEM 15.03.17
Q How well can we predict the risk of developing asthma in preschool children? A simple asthma prediction tool for preschool children with wheeze or cough. J Allergy Clin Immunol. 2014 10 predictors with total score between 0 -15: sex, age, wheeze without colds, wheeze frequency, activity disturbance,...
POEM 14.03.17
Patient Oriented Evidence that Matters Q. Is it ok to give droperidol to this psychotic gentleman? The Safety and Effectiveness of Droperidol for Sedation of Acute Behavioral Disturbance in the Emergency Department. Ann Emerg Med. 2015 1403 patients 10mg droperidol IM, IV Mean time to sedation 20mins Additional dosing required...
POEM 10.03.17
Patient Oriented Evidence that Matters Q. Low dose Perindopril…whats the point? RAS inhibitors’ dose-dependent efficacy: myth or reality?[Curr Med Res Opin. 2015] Perindopril is the only ACE inhibitor to show a real dose-response curve for BP decrease. While the effectiveness of RAS blockers on target organ damage is dose...