Less Is More

Simpler & Better Medicine

Early Versus Delayed Feeding in Patients With Acute Pancreatitis — May 23, 2017

Early Versus Delayed Feeding in Patients With Acute Pancreatitis

Summary: For patients hospitalized for mild to moderate acute pancreatitis, an approach of early refeeding (at less than 48 hours after admission) may be associated with a shorter length of hospital stay than an approach of delayed refeeding (waiting 48 hours or more after admission), without any increased risk of adverse events.

https://www.ncbi.nlm.nih.gov/m/pubmed/28505667/

Strength of Recommendation = A

Comparative effectiveness of exercise and drug interventions on mortality outcomes — May 16, 2017

Comparative effectiveness of exercise and drug interventions on mortality outcomes

Summary: For patients who have had a stroke, exercise-based rehabilitation (including cardiorespiratory and muscle strengthening exercises) is more effective than medication (either anti-platelet agents or anticoagulants) for reducing mortality; while for patients with established coronary artery disease both medications and exercise-based rehabilitation provide the same (small) reduction in mortality; and for patients with pre-diabetes neither exercise-based rehabilitation nor medications are effective at reducing mortality.

https://www.ncbi.nlm.nih.gov/m/pubmed/26476429/

Strength of Recommendation = A

Timing of oral refeeding in acute pancreatitis. — April 28, 2017
Effects of Intensive Glycemic Control on Cardiovascular Outcomes. — January 20, 2017
Sterile vs Nonsterile Gloves in Cutaneous Surgery and Common Outpatient Dental Procedures — January 6, 2017

Sterile vs Nonsterile Gloves in Cutaneous Surgery and Common Outpatient Dental Procedures

Summary: For patients having outpatient cutaneous surgical procedures, use of clean non-sterile gloves is associated with the rate of surgical site infection (approximately 2%) as use of sterile gloves, but the financial costs of non-sterile gloves are much lower.

https://www.ncbi.nlm.nih.gov/m/pubmed/27487033/

Strength of Recommendation = A

Abdominal drainage versus no abdominal drainage for laparoscopic cholecystectomy. — November 25, 2016

Abdominal drainage versus no abdominal drainage for laparoscopic cholecystectomy.

Summary: For patients undergoing laparascopic cholecystectomy, an approach of not placing an abdominal drain may be associated with a shorter operative time and less post-operative pain than an approach of routinely placing an abdominal drain during the laparascopic procedure, without any increased risk of adverse events.

https://www.ncbi.nlm.nih.gov/m/pubmed/27871803/

Strength of Recommendation = A

Kangaroo mother care to reduce morbidity and mortality in low birthweight infants. — October 11, 2016

Kangaroo mother care to reduce morbidity and mortality in low birthweight infants.

Summary: For low birthweight (LBW) infants born in resource-limited settings, kangaroo maternal care (KMC)* appears to be associated with a lower risk of mortality, nosocomial infection, or hypothermia, and with improved gains in weight and head circumference compared to conventional neonatal care. Additionally, for relatively stable LBW infancts, early onset KMC appears to be associated with a shorter hospital stay compared to late-onset KMC.

* Generally defined as skin-to-skin contact between  mother and child, frequent and nearly exclusive breastfeeding, and early hospital discharge.

https://www.ncbi.nlm.nih.gov/m/pubmed/27552521/

Strength of Recommendation = A

Antipsychotic Medication for Prevention and Treatment of Delirium in Hospitalized Adults: A Systematic Review and Meta-Analysis. — September 13, 2016

Antipsychotic Medication for Prevention and Treatment of Delirium in Hospitalized Adults: A Systematic Review and Meta-Analysis.

Summary: For older patients hospitalized for surgery, an approach of not using anti-psychotic medications post-operatively for delirium prevention may be associated with the same incidence of delirium as an approach of administering antipsychotic medications for delirium prevention.

Additionally, for hospitalized older patients who develop delirium, an approach of not using anti-psychotic medications for treatment of delirium may be associated with the same duration and severity of delirium, as well as hospital and ICU length of stay and mortality, as an approach of administering antipsychotic medications for delirium prevention.

http://www.ncbi.nlm.nih.gov/m/pubmed/27004732/

Strength of Recommendation = A

Paracetamol for low back pain. — September 6, 2016

Paracetamol for low back pain.

Summary: For patients with acute and chronic low back pain, treatment with paracetamol does not appear to provide any benefit beyond that experienced by patients treated with placebo. (In other words, paracetamol does not appear to provide any relief for patients with either acute or chronic low back pain)

http://www.ncbi.nlm.nih.gov/m/pubmed/27271789/

Strength of Recommendation = A

(additional commentary at: http://www.evidentlycochrane.net/paracetamol-widely-used-ineffective/)

Effectiveness of N95 respirators versus surgical masks in protecting health care workers — August 30, 2016
Clinically-indicated replacement versus routine replacement of peripheral venous catheters. — August 19, 2016

Clinically-indicated replacement versus routine replacement of peripheral venous catheters.

Summary: For hospitalized patients with peripheral intravenous (IV) catheters, a practice of waiting until clinically indicated to replace the IV catheter appears to be associated with the same risk of catheter-related bloodstream infection, local thrombophlebitis, or all-cause bloodstream infection, compared to a practice of routine IV catheter replacement every 72 to 96 hours.

http://www.ncbi.nlm.nih.gov/m/pubmed/26272489/

Strength of Recommendation = A

Self-monitoring and self-management of oral anticoagulation. — July 19, 2016

Self-monitoring and self-management of oral anticoagulation.

Summary: For patients on oral anticoagulant therapy, self-monitoring and self-management of anticoagulation may lead to a lower likelihood of thromboembolic events compared to standard monitoring and management, and self-management may be associated with a lower risk of all-cause mortality.

http://www.ncbi.nlm.nih.gov/m/pubmed/27378324/

Strength of Recommendation = A

Antibiotics versus appendicectomy for non-perforated acute appendicitis. (Meta-analysis) — June 28, 2016

Antibiotics versus appendicectomy for non-perforated acute appendicitis. (Meta-analysis)

Summary: For patients with acute uncomplicated appendicitis, initial treatment with antibiotics may lead to fewer patients (92/100) needing surgery within the next month (although 23/100 may have recurrent appendicitis within the next year), compared to initial treatment with appendectomy.

http://www.ncbi.nlm.nih.gov/m/pubmed/26990957/

Strength of Recommendation = A

Effect of antihypertensive treatment at different blood pressure levels in patients with diabetes mellitus — May 24, 2016

Effect of antihypertensive treatment at different blood pressure levels in patients with diabetes mellitus

Summary: For patients with type 2 diabetes (T2DM) and a systolic blood pressure less than 140 mmHg, avoiding additional antihypertensive treatment is associated with a lower risk of cardiovascular mortality compared to adding additional antihypertensive treatment to patients with T2DM and a SBP < 140 mmHg.

(Note: For patients with T2DM and a SBP > 140, this meta-analysis demonstrates benefits for all-cause mortality with treatment to further lower BP).

http://www.ncbi.nlm.nih.gov/m/pubmed/26920333/

Strength of Recommendation = A

Electrocardiogram ST Analysis During Labor: A Systematic Review and Meta-analysis of Randomized Controlled Trials. — March 18, 2016

Electrocardiogram ST Analysis During Labor: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

Summary: For women with singleton pregnancies, there appears to be no difference in the rates of adverse perinatal outcomes or cesarean deliveries when standard cardiotocography compared to cardiotocography plus ST-segment analysis.

http://www.ncbi.nlm.nih.gov/m/pubmed/26646135/

Strength of Recommendation = A

Hydrolysed formula and risk of allergic or autoimmune disease: systematic review and meta-analysis. — March 10, 2016

Hydrolysed formula and risk of allergic or autoimmune disease: systematic review and meta-analysis.

Summary: For infant feeding, use of standard infant formula appears to be associated with the same risk of subsequent eczema, type 1 diabetes mellitus, or food allergy or allergic sensitization as found with use of extensively hydrolyzed. (In other words, use of extensively hydrolyzed infant formula does not appear to convey any protection against subsequent allergy or auto-immune disease, compared to use of standard infant formula).

http://www.ncbi.nlm.nih.gov/m/pubmed/26956579/

Strength of Recommendation = A

Viscosupplementation for Osteoarthritis of the Knee: A Systematic Review of the Evidence. — March 8, 2016

Viscosupplementation for Osteoarthritis of the Knee: A Systematic Review of the Evidence.

Summary: For patients with knee osteoarthritis (OA), placebo, “sham” or no-treatment works just as well as injectable hyaluronic acid (HA) for improving pain, stiffness, or function, and is less invasive. (In other words, HA injection for knee OA does not appear to provide any clinically significant benefit when compared to placebo)

http://www.ncbi.nlm.nih.gov/m/pubmed/26677239/

Strength of Recommendation = A

A Randomized Trial of Low-Cost Mesh in Groin Hernia Repair — February 12, 2016
Severity assessment tools for predicting mortality in hospitalised patients with community-acquired pneumonia. Systematic review and meta-analysis. — February 2, 2016

Severity assessment tools for predicting mortality in hospitalised patients with community-acquired pneumonia. Systematic review and meta-analysis.

Summary: For patients with pneumonia, the 5 item CURB65 and 4 item CRB65 severity scores perform just as well as the much longer and more complicated Pneumonia Severity Index at predicting low, intermediate or high risk of 30-day mortality, but are much simpler to  use; in addition, the CURB65 and CRB65 scores may perform better than the PSI at predicting which patients are at high risk of 30 day mortality.

http://www.ncbi.nlm.nih.gov/m/pubmed/20729231/

Strength of Recommendation = A

Suicidality and aggression during antidepressant treatment: systematic review and meta-analyses based on clinical study reports. — February 1, 2016

Suicidality and aggression during antidepressant treatment: systematic review and meta-analyses based on clinical study reports.

Summary: For children and adolescents, avoiding use of selective serotonin and serotonin-norepinephrine reuptake inhibitor antidepressants (specifically, duloxetine, fluoxetine, paroxetine, sertraline, or venlafaxine) may be associated with a lower risk of adverse outcomes (specifically, suicidality or aggression) compared to treatment with these antidepressants.

http://www.ncbi.nlm.nih.gov/m/pubmed/26819231/

Strength of Recommendation = A

Health care-associated infection after red blood cell transfusion: a systematic review and meta-analysis. — January 6, 2016

Health care-associated infection after red blood cell transfusion: a systematic review and meta-analysis.

Summary: A more restrictive use of red blood cell (RBC) transfusions (eg, using a hemoglobin threshold of <7.0 g/dL) may be associated with a lower risk of serious infections than a more liberal approach to transfusions, especially for orthopedic patients and for patients presenting with sepsis.

http://www.ncbi.nlm.nih.gov/m/pubmed/24691607/

Strength of Recommendation = A

Implementation of the Canadian C-Spine Rule: prospective 12 centre cluster randomised trial. — December 11, 2015

Implementation of the Canadian C-Spine Rule: prospective 12 centre cluster randomised trial.

Summary: For patients with suspected neck injury, use of the Canadian C-spine Rule may allow for appropriate clinical assessment for neck injury with a decreased need for imaging without injuries being missed and without any increase in patient morbidity.

https://www.ncbi.nlm.nih.gov/m/pubmed/19875425/

Strength of Recommendation = A

Transfusion thresholds for guiding allogeneic red blood cell transfusion. — October 16, 2015

Transfusion thresholds for guiding allogeneic red blood cell transfusion.

Summary: Using a more restrictive transfusion threshold (eg, a hemoglobin level of 7 to 8 g/dL) may be associated with a lower risk of in-hospital mortality, without any reduction in functional recovery, ICU length of stay, or hospital length of stay.

http://www.ncbi.nlm.nih.gov/m/pubmed/22513904/

(See JAMA commentary at: http://www.ncbi.nlm.nih.gov/m/pubmed/23280228/)

Strength of Recommendation = A

Benefits and risks of tight glucose control in critically ill adults: a meta-analysis. — October 2, 2015

Benefits and risks of tight glucose control in critically ill adults: a meta-analysis.

Summary: For critically ill adult patients (ie, adults in intensive care for a medical illness), “usual” glucose control is associated with a lower risk of hypoglycemia than “tight” glucose control without any significant increase in hospital mortality (however, “usual” glucose control may be associated with a slightly increased risk of septicemia)

www.ncbi.nlm.nih.gov/m/pubmed/18728267

Strength of Recommendation = A

Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour. — September 24, 2015

Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour.

Summary: For women in labor, use of continuous cardiotocography (CTG) rather than intermittent auscultation may be associated with an increased likelihood of having a caesarean section or an instrumental vaginal birth, without reducing the likelihood of cerebral palsy or infant mortality (however, CTG may be associated with a reduced risk of neonatal seizures).

http://www.ncbi.nlm.nih.gov/m/pubmed/23728657/

Strength of Recommendation = A

Episiotomy for vaginal birth. — August 3, 2015

Episiotomy for vaginal birth.

Summary: A practice of more restrictive use of episiotomy may lead to less posterior perineal trauma, less suturing and fewer complications, with no differences on most pain measures, compared to a practice of routine episiotomy for vaginal birth. (However, there may be an increased risk of anterior perineal trauma with restrictive episiotomy).

http://www.ncbi.nlm.nih.gov/m/pubmed/19160176

Strength of Recommendation = A

Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes. — July 14, 2015
Efficacy and safety of steroid injections for shoulder and elbow tendonitis: a meta-analysis of randomised controlled trials. — June 29, 2015

Efficacy and safety of steroid injections for shoulder and elbow tendonitis: a meta-analysis of randomised controlled trials.

Summary: For patients with shoulder or elbow tendonitis, use of either physiotherapy or non-steroidal anti-inflammatory medications (NSAIDs) may provide better long-term improvements in function and pain than use of corticosteroid injection.

http://www.ncbi.nlm.nih.gov/m/pubmed/19054817/

Strength of Recommendation = A

Arthroscopic surgery for degenerative knee: systematic review and meta-analysis of benefits and harms. — June 17, 2015

Arthroscopic surgery for degenerative knee: systematic review and meta-analysis of benefits and harms.

Summary: For patients with knee pain who are middle aged or older, whether or not they have knee osteoarthritis, there may be no long-term difference in physical function outcomes between arthroscopic and non-operative management, while arthroscopic surgery may be associated with increased risk of deep-vein thrombosis, infection, pulmonary embolism, or death. (In other words, patients with knee pain who are treated non-operatively may function just as well over time as those who have arthroscopic surgery, without the risks that may accompany arthroscopic surgery.)

http://www.ncbi.nlm.nih.gov/m/pubmed/26080045/

Strength of Recommendation = A

Systematic review of randomized controlled trials examining written action plans in children: what is the plan? — June 16, 2015
Written action plans for asthma in children. —

Written action plans for asthma in children.

Summary: For children with asthma, use of an asthma-action plan (AAP) that is based on symptoms may lead to a lower risk of acute care visits than use of an (AAP) based on peak-flow (PF) measurements, and may be more acceptable to patients (although a PF based AAP may lead to a greater reduction in the number of symptomatic days per week).

http://www.ncbi.nlm.nih.gov/m/pubmed/16856090/

Strength of Recommendation = A

The use of sterilized mosquito nets for hernioplasty: a systematic review. — June 11, 2015
Parenteral metoclopramide for acute migraine: meta-analysis of randomised controlled trials. — May 11, 2015

Parenteral metoclopramide for acute migraine: meta-analysis of randomised controlled trials.

Summary: Metoclopramide is more effective than placebo for treatment of migraine headache, metoclopramide shows mixed effectiveness when compared with other single agents for treatment of migraine, and combination treatments for migraine that include metoclopramide might be more effective than comparison treatments for pain, nausea, and relapse outcomes.

http://www.ncbi.nlm.nih.gov/m/pubmed/15550401

Strength of Recommendation = A

Outcomes of routine episiotomy: a systematic review. —

Outcomes of routine episiotomy: a systematic review.

Summary: Evidence from clinical trials suggests that short-term maternal outcomes of routine episiotomy, such as severity of perineal laceration, pain, and pain medication use, are not better than those with restrictive use of episiotomy; relevant studies demonstrate no benefit from episiotomy for prevention of fecal and urinary incontinence, and pain with intercourse may be more common among women with episiotomy. In short, evidence does not support maternal benefits traditionally ascribed to routine episiotomy.

http://www.ncbi.nlm.nih.gov/m/pubmed/15870418

Strength of Recommendation = A

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