Less Is More

Simpler & Better Medicine

Gluten consumption in adults without celiac disease and risk of coronary heart disease. — May 30, 2017

Gluten consumption in adults without celiac disease and risk of coronary heart disease.

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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

Timing of oral refeeding in acute pancreatitis. — April 28, 2017
Morning-only one-gallon polyethylene glycol improves bowel cleansing for afternoon colonoscopies. — March 24, 2017

Morning-only one-gallon polyethylene glycol improves bowel cleansing for afternoon colonoscopies.

Summary: For patients having colonoscopy in the afternoon, prep with one gallon of polyethylene glycol (PEG) the morning of the procedure appears to be associated with improved efficacy of bowel cleansing and less difficulty with loss of sleep or insomnia, but no difference in overall adenoma detection, compared to prep with one gallon of PEG the evening before.

https://www.ncbi.nlm.nih.gov/m/pubmed/20606677/

Strength of Recommendation = B

Immediate oral feeding in patients with mild acute pancreatitis may accelerate recovery–a randomized clinical study. — March 17, 2017

Immediate oral feeding in patients with mild acute pancreatitis may accelerate recovery–a randomized clinical study.

Summary: For patients with mild acute pancreatitis, an approach of immediate oral feeding may lead to a shorter hospital stay than an approach of fasting, without any worsening of pain, gastrointestinal symptoms, or laboratory monitoring parameters.

https://www.ncbi.nlm.nih.gov/m/pubmed/17719703/

Strength of Recommendation = B

Early post-operative complications in patients undergoing loop colostomy with and without a stoma rod. — January 13, 2017

Early post-operative complications in patients undergoing loop colostomy with and without a stoma rod.

Summary: For patients having placement of a loop colostomy, an approach of not using a supporting stoma rod may be associated with a lower likelihood of stomal necrosis, stomal edema, and stomal congestion, as well as a lower likelihood of hospital readmission compared to an approach of routinely using a stoma rod; with no increased likelihood of stomal retraction.

https://www.ncbi.nlm.nih.gov/m/pubmed/28067986/

Strength of Recommendation = B

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

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

Dilute Apple Juice and Preferred Fluids vs Electrolyte Maintenance Solution on Treatment Failure Among Children With Mild Gastroenteritis — May 13, 2016

Dilute Apple Juice and Preferred Fluids vs Electrolyte Maintenance Solution on Treatment Failure Among Children With Mild Gastroenteritis

Summary: For children aged 6 months to 5 years old with gastroenteritis and minimal dehydration, oral rehydration with apple juice diluted 1:1 with water (or the child’s preferred oral fluid intake) may be associated with a lower likelihood of treatment failure and a lower likelihood of needing intravenous rehydration, compared to rehydration with an electrolyte maintenance solution.

http://www.ncbi.nlm.nih.gov/m/pubmed/27131100/

Strength of Recommendation = B

Association of Proton Pump Inhibitors With Risk of Dementia: A Pharmacoepidemiological Claims Data Analysis. — April 8, 2016
A Randomized Trial of Low-Cost Mesh in Groin Hernia Repair — February 12, 2016
Specific oral medications decrease the need for surgery in adhesive partial small-bowel obstruction. — December 2, 2015

Specific oral medications decrease the need for surgery in adhesive partial small-bowel obstruction.

Summary: For patients with partial small-bowel obstruction, addition of a specific oral regimen three times daily (magnesium oxide + Lactobacillus acidophilus + simethicone) to standard treatment with intravenous hydration and nasogastric decompression, may be associated with a higher likelihood of successful non-operative treatment than ordering nothing-by-mouth during intravenous hydration and nasogastric decompression.

http://www.ncbi.nlm.nih.gov/m/pubmed/16546494/

Strength of Recommendation = B

Transfusion strategies for acute upper gastrointestinal bleeding. — November 30, 2015

Transfusion strategies for acute upper gastrointestinal bleeding.

Summary: For patients with severe acute upper gastrointestinal bleeding, a more restrictive transfusion threshold (Hb < 7) may lead to a lower risk of death by 6 weeks (as well as a lower risk of re-bleeding and a lower risk of adverse events) than a more liberal transfusion threshold (Hb < 9).

http://www.ncbi.nlm.nih.gov/m/pubmed/23281973/

Strength of Recommendation = B

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

Antibiotic Therapy vs Appendectomy for Treatment of Uncomplicated Acute Appendicitis: The APPAC Randomized Clinical Trial. — August 31, 2015

Antibiotic Therapy vs Appendectomy for Treatment of Uncomplicated Acute Appendicitis: The APPAC Randomized Clinical Trial.

Summary: For patients with CT-confirmed uncomplicated appendicitis (ie, no suspicion of appendicolith, perforation, abscess, or tumor on CT imaging), treatment with intravenous antibiotics (3 days of IV ertapenem, then 7 days of oral levofloxacin + metronidazole) may both markedly decrease the need for surgical appendectomy, and lead to a lower post-operative complication rate in those patients who do require an appendectomy after initial antibiotic treatment.

http://www.ncbi.nlm.nih.gov/m/pubmed/26080338/

Strength of Recommendation = B

Chemotherapy Use, Performance Status, and Quality of Life at the End of Life. — August 20, 2015

Chemotherapy Use, Performance Status, and Quality of Life at the End of Life.

Summary: For patients with end-stage cancer (less than 6 months’ life expectancy) who have good performance status, avoiding late palliative chemotherapy may lead to a better quality of death than if palliative chemotherapy is used. (In other words, the quality of death for patients with end-stage cancer is not improved, and can be harmed, by chemotherapy use near death.)

http://www.ncbi.nlm.nih.gov/m/pubmed/26203912/

Strength of Recommendation = B

Randomized clinical trial on the effect of coffee on postoperative ileus following elective colectomy. — July 24, 2015
Chewing gum for postoperative recovery of gastrointestinal function. — July 22, 2015

Chewing gum for postoperative recovery of gastrointestinal function.

Summary: There is some evidence, mainly from low-quality trials, that use of chewing gum after colorectal surgery or cesarean section (rather than a traditional nothing-by-mouth approach) might improve the recovery of gastro-intestinal function, and perhaps slightly decrease the length of hospital stay.

http://www.ncbi.nlm.nih.gov/m/pubmed/25914904/

Strength of Recommendation = B

Safety and sterilization of mosquito net mesh for humanitarian inguinal hernioplasty. — July 21, 2015
Nonsurgical management of partial adhesive small-bowel obstruction with oral therapy: a randomized controlled trial. — July 16, 2015

Nonsurgical management of partial adhesive small-bowel obstruction with oral therapy: a randomized controlled trial.

Summary: For patients with partial adhesive small-bowel obstruction, oral therapy with magnesium oxide (two 250-mg tablets), L. acidophilus (one 0.3-g tablet) and simethicone (one 40 mg tablet), in addition to intravenous hydration and nasogastric-tube decompression, may decrease the need for surgery and may markedly reduce the length of hospitalization compared to traditional treatment (strict NPO, plus hydration and nasogastric-tube decompression).

http://www.ncbi.nlm.nih.gov/m/pubmed/16275967/

Strength of Recommendation = B

Comparing hospice and nonhospice patient survival among patients who die within a three-year window. — July 6, 2015
Low-cost mesh for inguinal hernia repair in resource-limited settings. — June 23, 2015

Low-cost mesh for inguinal hernia repair in resource-limited settings.

Summary: For inguinal hernia repair in resource-limited settings, there may be no significant differences in surgical outcomes (eg, recurrence rates, incidence of wound infections) using sterilized mosquito netting or an indigenous bilayer device, compared to using commercial surgical mesh; and mosquito netting or a low-cost locally-manufactured device may be markedly less expensive.

http://www.ncbi.nlm.nih.gov/m/pubmed/21607572

Strength of Recommendation = B

The use of sterilized mosquito nets for hernioplasty: a systematic review. — June 11, 2015
Trial of short-course antimicrobial therapy for intra-abdominal infection. — June 10, 2015

Trial of short-course antimicrobial therapy for intra-abdominal infection.

Summary: For patients with intra-abdominal infections who have had an appropriate source-control surgical procedure, fixed-duration antibiotic therapy (approximately 4 days) may lead to similar outcomes (including rates of surgical-site infection, recurrent intra-abdominal infection, or death) compared to treating with antibiotics until 2 days after the resolution of fever, leukocytosis, and ileus, with a maximum of 10 days of therapy, while allowing for decreased overall antibiotic exposure.

http://www.ncbi.nlm.nih.gov/m/pubmed/25992746/

Strength of Recommendation = B

Randomized clinical trial of the effect of gum chewing on postoperative ileus and inflammation in colorectal surgery. — May 11, 2015

Randomized clinical trial of the effect of gum chewing on postoperative ileus and inflammation in colorectal surgery.

Summary: Gum chewing after colorectal surgery increases the likelihood of passing flatus within 48 hours and passing stool within 4 days, and might reduce the length of hospital stay. Gum chewing appears to be a safe and simple treatment to reduce post-operative ileus following colorectal surgery.

http://www.ncbi.nlm.nih.gov/m/pubmed/25524125/

Strength of Recommendation = B

Management of asymptomatic inguinal hernia: a systematic review of the evidence. — May 8, 2015

Management of asymptomatic inguinal hernia: a systematic review of the evidence.

Summary: For patients with asymptomatic inguinal hernia, there may be no difference in pain and discomfort, general health status, complications, or risk of life-threatening with “watchful waiting” compared to immediate surgery – both treatment options for asymptomatic inguinal hernia are safe, but most patients will develop symptoms (mainly pain) over time and will require operation.

http://www.ncbi.nlm.nih.gov/m/pubmed/22430913/

Strength of Recommendation = B

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