Less Is More

Simpler & Better Medicine

Blood-Pressure Lowering in Patients with Acute Cerebral Hemorrhage — March 7, 2017

Blood-Pressure Lowering in Patients with Acute Cerebral Hemorrhage

Summary: For patients with acute intracerebral hemorrhage, less-intense lowering of blood pressure to a target systolic blood pressure (SBP) range of 140 to 179 mm Hg may lead to a lower likelihood of adverse renal events (and possibly a lower overall likelihood of serious adverse events) than more-intense lowering blood pressure to a target SBP range of 110 to 139 mm Hg, and the less-intense SBP target appears to be associated with the same rate of death or disability as the more-intense SBP target.

https://www.ncbi.nlm.nih.gov/m/pubmed/27276234/

Strength of Recommendation = B

Early Participation in Physical Activity Following Acute Concussion and Persistent Postconcussive Symptoms in Children and Adolescents. — December 21, 2016

Early Participation in Physical Activity Following Acute Concussion and Persistent Postconcussive Symptoms in Children and Adolescents.

Summary: For children between ages 5 and 18 years old who have experienced an acute concussion, early participation in physical activity within 7 days of the injury may be associated with a lower risk of persistent postconcussive symptoms (PPCS) at 28 days post-injury than an approach of having no physical activity within the first 7 days post-concussion.

Note – the authors of this study emphasize that 1) caution in the immediate post-injury period remains vital, 2) activities that entail a risk of repeat head injury should remain prohibited in the early post-concussion period, and 3) an adequate randomized controlled is needed to better understand the benefits of early physical activity following concussion.

https://www.ncbi.nlm.nih.gov/m/pubmed/27997652/

Strength of Recommendation = B

Amitriptyline, Topiramate, or Placebo for Pediatric Migraine — November 1, 2016

Amitriptyline, Topiramate, or Placebo for Pediatric Migraine

Summary: For children or adolescents (aged 8 to 17 years) with a history of age with migraine occurring at least 4 days monthly, an approach of giving neither amitriptyline nor topiramate for headache prevention may be associated with the same degree of reduction in headache frequency, headache-related disability, and headache days as an approach of using either amitriptyline or topiramate for headache prevention, but with a lower likelihood of side effects such as fatigue, dry mouth, paresthesia, and weight loss. (In other words, amitriptyline and placebo appear to work no better for prophylaxis of pediatric migraine than placebo, but both medications are associated with higher rates of adverse events.)

https://www.ncbi.nlm.nih.gov/m/pubmed/27788026/

Strength of Recommendation = B

Ticagrelor vs Aspirin in Acute Stroke or Transient Ischemic Attack. — July 15, 2016

Ticagrelor vs Aspirin in Acute Stroke or Transient Ischemic Attack.

Summary: For patients with acute stroke or transient ischemic attack (TIA), use of aspirin as antiplatelet therapy for secondary prevention appears to be associated with the same rate of stroke, myocardial infarction, or death over the next 90 days as is the use of ticagrelor, but at potentially much lower cost.

http://www.ncbi.nlm.nih.gov/m/pubmed/27160892/

Strength of Recommendation = B

Long-Acting Opioids and Mortality in Patients With Chronic Noncancer Pain — June 15, 2016
Association of Proton Pump Inhibitors With Risk of Dementia: A Pharmacoepidemiological Claims Data Analysis. — April 8, 2016
Outcomes of Basic Versus Advanced Life Support for Out-of-Hospital Medical Emergencies. — December 14, 2015

Outcomes of Basic Versus Advanced Life Support for Out-of-Hospital Medical Emergencies.

Summary: For older patients requiring emergency medical transport, 90-day survival may be higher after treatment with basic life support (BLS) rather than advanced cardiac life support (ACLS) in cases of trauma, stroke, or respiratory failure (although ACLS may be associated with higher likelihood of 90-day survival for acute MI (AMI)); and neurologic function at 90 days may be better with BLS for trauma, stroke, respiratory failure, and AMI.

http://www.ncbi.nlm.nih.gov/m/pubmed/26457627/

Strength of Recommendation = B

Simplified sleep restriction for insomnia in general practice: a randomised controlled trial. — November 27, 2015
Comparative effectiveness of generic versus brand-name antiepileptic medications. — September 28, 2015

Comparative effectiveness of generic versus brand-name antiepileptic medications.

Summary: Evidence from electronic medical record (EMR) and pharmacy claims data for Medicare beneficiaries, suggests that for patients initiating treatment with anti-epileptic drugs (AEDs) (specifically, lonazepam, gabapentin, oxcarbazepine, phenytoin, or zonisamide) use of a generic AED is associated with a lower risk of a seizure-related hospitalization, and a longer time to the first gap in medication use, compared to treatment with a brand-name AED.
Strength of Recommendation = C
Epidural steroid injections compared with gabapentin for lumbosacral radicular pain: multicenter randomized double blind comparative efficacy study. — September 4, 2015

Epidural steroid injections compared with gabapentin for lumbosacral radicular pain: multicenter randomized double blind comparative efficacy study.

Summary: For patients with lumbosacral radicular pain due to a herniated disc or spinal stenosis, treatment with gabapentin (up to 1200 mg three times daily) may provide provide the same degree of improvement in leg pain as a lumbar epidural steroid injection (LESI) when assessed at 3 months, without the need for an interventional procedure and potentially at lower cost.

www.ncbi.nlm.nih.gov/m/pubmed/25883095

Strength of Recommendation = B

Acetaminophen, aspirin, and caffeine versus sumatriptan succinate in the early treatment of migraine: results from the ASSET trial. — June 30, 2015

Acetaminophen, aspirin, and caffeine versus sumatriptan succinate in the early treatment of migraine: results from the ASSET trial.

Summary: For acute migraine headache, the combination of acetaminophen 500 mg + aspirin 500 mg +caffeine 130 mg (AAC) may be significantly more effective than sumatriptan 50 mg in the early treatment of migraine (specifically, AAC may provide significantly greater pain intensity reduction, may significantly reduce the need for rescue medication, and may lead to an increased likelihood of patients reporting little or no functional disability due to migraine).

http://www.ncbi.nlm.nih.gov/m/pubmed/16109110

Strength of Recommendation = B

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

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