Less Is More

Simpler & Better Medicine

Follow-up of ASCUS or LSIL: Colposcopy vs repeat cytology — February 14, 2017

Follow-up of ASCUS or LSIL: Colposcopy vs repeat cytology

Summary: For women between 22 to 27 years of age who have a pap test showing atypical squamous cells of undetermined significance (ASCUS) or low-grade squamous intraepithelial lesion (LSIL), following up with repeat cervical cytology at 6 months may be associated with the same rates of invasive cervical cancer at 6.5 years as following up with colposcopy and biopsy at 6 months, at potentially lower cost.

https://www.ncbi.nlm.nih.gov/m/pubmed/27457115/

Strength of Recommendation = C

Advertisements
Lung ultrasound for diagnosis of pneumonia. — February 10, 2017
Watchful Waiting Strategy May Reduce Low-Value Diagnostic Testing. — December 16, 2016

Watchful Waiting Strategy May Reduce Low-Value Diagnostic Testing.

Summary: For patients requesting testing that is expected to be low-value, use of a “watchful waiting” strategy (“allowing a negotiated period of time to pass before making a firm testing decision“) may be associated with lower likelihood of subsequent use of low-value tests than standard care such as providing “reassurance” and “evidence-based recommendations.”

https://www.ncbi.nlm.nih.gov/m/pubmed/28076254/

Strength of Recommendation = C

Nutritional strategies for skeletal and cardiovascular health. — October 25, 2016
Does Electronic Messaging Reduce Incoming Telephone Calls? — October 4, 2016

Does Electronic Messaging Reduce Incoming Telephone Calls?

Summary: A practice of NOT using an internet patient communication portal might actually be associated with lower rates of telephone calls, compared to a practice of implementing an internet patient communication portal in an effort to reduce phone calls. (In other words, implementation of an internet portal may be associated with increased phone call volume)

http://www.ncbi.nlm.nih.gov/m/pubmed/27613794/

Strength of Recommendation = C

Effect of Statin Therapy on Mortality in Older Adults Hospitalized with Coronary Artery Disease. — September 23, 2016

Effect of Statin Therapy on Mortality in Older Adults Hospitalized with Coronary Artery Disease.

Summary: For patients over 80 years old admitted to hospital for acute myocardial infarction, unstable angina pectoris, or chronic CAD, retrospective data suggests an approach of not taking a statin after hospital discharge appears to be associated with the same risk of all-cause mortality over the next 3 years as an approach of starting statin therapy at the time of hospital discharge.

http://www.ncbi.nlm.nih.gov/m/pubmed/27295083/

Strength of Recommendation = C

 

Recovery following fractures of the clavicle treated conservatively. — September 9, 2016
Diagnostic accuracy of ultrasonography, MRI and MR arthrography in the characterisation of rotator cuff disorders. — September 2, 2016

Diagnostic accuracy of ultrasonography, MRI and MR arthrography in the characterisation of rotator cuff disorders.

Summary: For patients with rotator cuff disorder, ultrasound appears to be as sensitive and specific as magnetic resonance imaging or magnetic resonance arthrography for diagnosis of full-thickness rotator cuff tears, potentially at much lower cost.

http://www.ncbi.nlm.nih.gov/m/pubmed/25677796/

Strength of Recommendation = C

Trendelenburg position or passive leg raising for the initial treatment of hypovolemia — August 9, 2016

Trendelenburg position or passive leg raising for the initial treatment of hypovolemia

Summary: For patients with hypotension, passive leg-raising (supine position with straight passive elevation of both legs at an angle between 10 and 90 degrees) may lead to a more sustained increase in cardiac output than the Trendelenburg position (a total-body head-down tilt between 5 and 60 degrees).

http://www.ncbi.nlm.nih.gov/m/pubmed/23228872/

Strength of Recommendation = C

Cost-Effectiveness of Obtaining Blood Cultures in Children Hospitalized for Community-Acquired Pneumonia. — June 24, 2016

Cost-Effectiveness of Obtaining Blood Cultures in Children Hospitalized for Community-Acquired Pneumonia.

Summary: For children hospitalized with pneumonia, obtaining blood cultures only from those children at high risk for bacteremia (compared to obtaining blood cultures from all children hospitalized with pneumonia) might lead to an annual savings of over $3000 per 100 patients.

http://www.ncbi.nlm.nih.gov/m/pubmed/26456740/

Strength of Recommendation = C

Use of dietary linoleic acid for secondary prevention of coronary heart disease and death: re-evaluation of the Sydney Diet Heart Study — May 6, 2016

Use of dietary linoleic acid for secondary prevention of coronary heart disease and death: re-evaluation of the Sydney Diet Heart Study

Summary: Older data suggests that for men with a recent coronary event, avoiding replacement of saturated fats with omega 6 linoleic acid might actually be associated with lower rates of death, cardiovascular disease, and coronary heart disease. (In other words, for men with a recent coronary event, a diet replacing saturated fats with omega 6 linoleic acid from safflower oil and safflower oil polyunsaturated margarine may be associated with HIGHER rates of death, cardiovascular disease, and coronary heart disease).

http://www.ncbi.nlm.nih.gov/m/pubmed/23386268/

Strength of Recommendation = C

Re-evaluation of the traditional diet-heart hypothesis and data from Minnesota Coronary Experiment — May 3, 2016

Re-evaluation of the traditional diet-heart hypothesis and data from Minnesota Coronary Experiment

Summary: Older data suggests that while a diet that replaces saturated fat with linoleic acid from corn oil and corn oil polyunsaturated margarine appears to reduce serum levels of LDL cholesterol, it may also be associated with a higher risk of death, especially in those over 65.

http://www.ncbi.nlm.nih.gov/m/pubmed/27071971/

Strength of Recommendation = C

Improved endurance capacity following chocolate milk consumption compared with 2 commercially available sport drinks. — March 25, 2016
Pragmatic Method Using Blood Pressure Diaries to Assess Blood Pressure Control. — February 5, 2016

Pragmatic Method Using Blood Pressure Diaries to Assess Blood Pressure Control.

Summary: For patients with hypertension who monitor blood pressure at home, having 3 or more of the most recent 10 systolic blood pressure readings above 135 mmHg may predict elevated twenty-four-hour ambulatory blood pressure (ABP) and may also predict target organ damage.

http://www.ncbi.nlm.nih.gov/m/pubmed/26755785/

Strength of Recommendation = C

Cardiac auscultation training of medical students: a comparison of electronic sensor-based and acoustic stethoscopes. — January 26, 2016

Cardiac auscultation training of medical students: a comparison of electronic sensor-based and acoustic stethoscopes.

Summary: For medical students who are learning cardiac auscultation skills, training with a (less expensive) conventional stethoscope may result in the same performance on a test of cardiac auscultation as does training on a (more expensive) electronic stethoscope, at lower cost.

http://www.ncbi.nlm.nih.gov/m/pubmed/15882458/

Strength of Recommendation = C

Nasal Foreign Bodies: A Sweet Experiment. — December 11, 2015

Nasal Foreign Bodies: A Sweet Experiment.

Summary: When a child has placed a foreign body in the nose, if it can be confirmed from history that the foreign body is a candy (and not a potentially dangerous inorganic or corrosive object), then a “wait and see” approach may be reasonable, since most such candies will dissolve in less than an hour.

http://www.ncbi.nlm.nih.gov/m/pubmed/25639608/

Strength of Recommendation = C

HbA1c overtesting and overtreatment among US adults with controlled type 2 diabetes, 2001-13: observational population based study. — December 9, 2015

HbA1c overtesting and overtreatment among US adults with controlled type 2 diabetes, 2001-13: observational population based study.

Summary: Retrospective data suggests that for adults with type 2 diabetes who are not on insulin and have stable glycemic control, avoiding excessive testing of hemoglobin A1C levels may be associated with a lower risk of unwarranted treatment intensification (in other words, excessively frequent testing of hemoglobin A1C levels may lead to treatment intensification beyond what is recommended in current guidelines).

http://www.ncbi.nlm.nih.gov/m/pubmed/26646052/

Strength of Recommendation = C

Simplified sleep restriction for insomnia in general practice: a randomised controlled trial. — November 27, 2015
Randomized controlled trial of carvedilol versus variceal band ligation for the prevention of the first variceal bleed. — November 13, 2015

Randomized controlled trial of carvedilol versus variceal band ligation for the prevention of the first variceal bleed.

Summary: For patients with cirrhosis and esophageal varices, treatment with oral carvedilol may lead to a lower risk of a first variceal bleed compared to every-two-week variceal band ligation, with the added benefit of not requiring repeated endoscopy.

http://www.ncbi.nlm.nih.gov/m/pubmed/19610055/

Strength of Recommendation = C

A whole-of-population study of term and post-term gestational age at birth and children’s development. — November 6, 2015

A whole-of-population study of term and post-term gestational age at birth and children’s development.

Summary: Based on population-level data, it appears that for healthy pregnancies, a policy of nonintervention unless medically necessary up to 41 weeks’ gestation may be associated with a lower risk of the child having developmental vulnerability at school entry.

http://www.ncbi.nlm.nih.gov/m/pubmed/25754325/

Strength of Recommendation = C

When should the umbilical cord be clamped? — November 4, 2015
Effect of Noninvasive Ventilation vs Oxygen Therapy on Mortality Among Immunocompromised Patients With Acute Respiratory Failure: A Randomized Clinical Trial. — October 28, 2015

Effect of Noninvasive Ventilation vs Oxygen Therapy on Mortality Among Immunocompromised Patients With Acute Respiratory Failure: A Randomized Clinical Trial.

Summary: For critically ill immunocompromised adult patients, treatment with non-invasive ventilation may not be any better than treatment with oxygen alone for reducing the risk of mortality, oxygenation failure, or length of ICU or hospital stay.

http://www.ncbi.nlm.nih.gov/m/pubmed/26444879/

Strength of Recommendation = C

Fasting time and lipid levels in a community-based population: a cross-sectional study. — October 23, 2015
Use of rib belts in acute rib fractures. — October 5, 2015
CT coronary angiography in patients with suspected angina due to coronary heart disease (SCOT-HEART): an open-label, parallel-group, multicentre trial. — September 30, 2015

CT coronary angiography in patients with suspected angina due to coronary heart disease (SCOT-HEART): an open-label, parallel-group, multicentre trial.

Summary: For patients with chest pain suspected to be due to stable angina, avoiding the use of CT coronary angiography (CTCA) as part of the initial evaluation may lead to fewer coronary angiogram procedures with out any increase in symptom severity or hospital admissions for chest pain at 6 weeks.

http://www.ncbi.nlm.nih.gov/m/pubmed/25788230/

Strength of Recommendation = C

%d bloggers like this: