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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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

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

Wearable Technology Combined With a Lifestyle Intervention and Long-term Weight Loss — September 26, 2016

Wearable Technology Combined With a Lifestyle Intervention and Long-term Weight Loss

Summary: For overweight and obese young adults participating in a weight-loss program (incorporating calorie restriction, exercise, counseling, and support for self-monitoring), efforts at weight loss withOUT the use of a wearable activity monitor may lead to more loss of weight than efforts at weight loss pursued with regular monitoring by a wearable activity monitor.

https://www.ncbi.nlm.nih.gov/m/pubmed/27654602/

Strength of Recommendation = B

Long-Acting Opioids and Mortality in Patients With Chronic Noncancer Pain — June 15, 2016
Diagnostic Accuracy of Digital Screening Mammography With and Without Computer-Aided Detection. — March 1, 2016

Diagnostic Accuracy of Digital Screening Mammography With and Without Computer-Aided Detection.

Summary: For breast cancer screening, digital screening mammography performed withOUT computer-assisted detection (CAD) is less costly than digital mammography performed WITH CAD, without any loss of sensitivity or specificity. (In other words, use of CAD as an adjust to digital mammography screening adds cost without adding any improvement in screening performance.)

http://www.ncbi.nlm.nih.gov/m/pubmed/26414882/

Strength of Recommendation = B

Home- or community-based programmes for treating malaria. — October 19, 2015

Home- or community-based programmes for treating malaria.

Summary: Training of basic-level health workers or mothers in the administration of anti-malarials, either presumptively based on the presence of a fever or based on the result of a rapid diagnostic test, may increase the number of people receive an appropriate antimalarial within 24 hours of evaluation and may reduce all-cause mortality, compared to standard medical evaluation and care.

http://www.ncbi.nlm.nih.gov/m/pubmed/23728693/

Strength of Recommendation = B

Teaching mothers to provide home treatment of malaria in Tigray, Ethiopia: a randomised trial. — October 12, 2015

Teaching mothers to provide home treatment of malaria in Tigray, Ethiopia: a randomised trial.

Summary: In areas of sub-Saharan Africa with holoendemic malaria, training local mother coordinators to teach mothers to give under-5 children antimalarial drugs may reduce under-5 mortality by up to 40%, compared to a community-health-worker, facility-based approach to evaluation and treatment.

http://www.ncbi.nlm.nih.gov/m/pubmed/10950232/

Strength of Recommendation = B

Medicare costs in urban areas and the supply of primary care physicians. — September 11, 2015
In California, Primary Care Continuity Was Associated With Reduced Emergency Department Use And Fewer Hospitalizations. — August 24, 2015
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

Exercise and vitamin D in fall prevention among older women: a randomized clinical trial. — July 13, 2015
Primary care physicians and specialists as personal physicians. Health care expenditures and mortality experience. — July 10, 2015

Primary care physicians and specialists as personal physicians. Health care expenditures and mortality experience.

Summary: Having a primary care physician as one’s personal doctor may be associated with up to 33% lower annual health care expenditures and a lower adjusted rate of mortality, compared to having a specialist as one’s personal physician.

http://www.ncbi.nlm.nih.gov/m/pubmed/9722797/

Strength of Recommendation = B

Comparing hospice and nonhospice patient survival among patients who die within a three-year window. — July 6, 2015
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