Oct 10

Sterile water injections for acute low back pain

Journal reference: Cui JZ, Geng ZS, Zhang YH, Feng JY, Zhu P, Zhang XB. Effects of intracutaneous injections of sterile water in patients with acute low back pain: a randomized, controlled, clinical trial. Braz J Med Biol Res 2016 Mar;49(3)

Link: http://dx.doi.org/10.1590/1414-431X20155092

Published: March 2016

Evidence cookie says…

Sterile water injections are of uncertain value in acute low back pain.

  • Routine use of this intervention cannot be recommended based on a single study that has important threats to its internal validity.
  • It may have a role in patients who consent after being informed to its uncertain value.

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Aug 08

Does co-enzyme Q10 reduce statin-related muscle pain?

Journal reference: Banach M, Serban C, Sahebkar A, et al. Effects of coenzyme Q10 on statin-induced myopathy: a meta-analysis of randomized controlled trials. Mayo Clin Proc 2015 Jan;90(1):24-34.

Link: http://dx.doi.org/10.1016/j.mayocp.2014.08.021

Published: January 2015

Evidence cookie says…

The effect of CoQ10 on muscle pain in people on statin therapy is uncertain.

  • The research evidence is of limited quality and inconsistent.
  • The range of best estimates includes no effect.
  • CoQ10 cannot be recommended as a matter of routine supplementation to prevent muscle pain in people taking statins.

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Jun 14

Metformin as prevention in people taking antipsychotic medication

Journal reference: Zheng W, Li XB, Tang YL, Xiang YQ, Wang CY, de Leon J. Metformin for Weight Gain and Metabolic Abnormalities Associated With Antipsychotic Treatment: Meta-Analysis of Randomized Placebo-Controlled Trials. J Clin Psychopharmacol 2015 Oct;35(5):499-509.

Link: http://dx.doi.org/10.1097/JCP.0000000000000392

Published: October 2015

Evidence cookie says…

The effect of metformin on cardiovascular disease in people living without diabetes on long-term antipsychotic medication is unknown.

  • evidence exists on a number of surrogate endpoints that are CVD risks factors
  • this evidence is heterogenous and its quality is not high
  • metformin may have a small-to-moderate effect on weight gain

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Feb 19

Aspirin as DVT prophylaxis for high risk long-haul travellers

Journal reference: Cesarone MR, Belcaro G, Nicolaides AN, et al. Venous thrombosis from air travel: the LONFLIT3 study–prevention with aspirin vs low-molecular-weight heparin (LMWH) in high-risk subjects: a randomized trial. Angiology 2002 Jan-Feb;53(1):1-6.

Link: http://www.ncbi.nlm.nih.gov/pubmed/11863301

Published: Jan 2002

Evidence cookie says…

It is unclear whether aspirin is effective as DVT prophylaxis for high risk long-haul travellers.

  • the single, poorly described study suggests that it may be less effective than enoxaparin (Clexane)
  • the lack of evidence should preclude it from being recommended

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Oct 30

Starting allopurinol in acute gout

Journal reference: Hill EM, Sky K, Sit M, Collamer A, Higgs J. Does starting allopurinol prolong acute treated gout? A randomized clinical trial. J Clin Rheumatol 2015;21(3):120-5.

Link: http://www.ncbi.nlm.nih.gov/pubmed/25807090

Published: April 2015

Evidence cookie says…

It is unclear what effect starting allopurinol in acute has on symptoms, due to the lack of good evidence.

  • it may be preferable to avoid starting allopurinol in an acute attack
  • this should not be a dogmatic stance

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Sep 04

Corticosteroid injections for tennis elbow

Journal reference: Olaussen M, Holmedal O, Lindbaek M, Brage S, Solvang H. Treating lateral epicondylitis with corticosteroid injections or non-electrotherapeutical physiotherapy: a systematic review. BMJ Open 2013;3(10):e003564

Link: http://dx.doi.org/10.1136/bmjopen-2013-003564

Published: 29 October 2013

Evidence cookie says…

Corticosteroid injections should be generally avoided for tennis elbow (lateral epicondylitis).

They are associated with:

  • increased likelihood of improvement in the short term (4-12 weeks)
  • reduced likelihood of improvement in the intermediate (26 weeks) and long term (52 weeks)

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Jul 10

Pelargonium sidoides extract (Kaloba (R)) for the common cold

Journal reference: Timmer A, Günther J, E Motschall, Rücker G, Antes G, Kern WV. Pelargonium sidoides extract for acute respiratory tract infections Treating. Cochrane Database of Systematic Reviews 2013, Issue 10. Art. No .: CD006323.

Link: http://dx.doi.org/10.1002/14651858.CD006323.pub3

Published: 22 October 2013

Evidence cookie says…

There exists only very-low quality evidence of the effect of Pelargonium sidoides extract (Kaloba ®, Umckaloabo) on the common cold.

This precludes it from being recommended routinely in primary care settings.

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May 15

Paracetamol for acute low-back pain

Journal reference: Williams CM, Maher CG, Latimer J, McLachlan AJ, Hancock MJ, Day RO, et al. Efficacy of paracetamol for acute low-back pain: a double-blind, randomised controlled trial. Lancet 2014;384(9954):1586-96.

Link: http://dx.doi.org/10.1016/S0140-6736(14)60805-9

Published: 1 November 2014

Evidence cookie says…

Paracetamol (regular and intermittent dosing) does not have an effect on time to recovery for acute low-back pain in the general practice setting.

Recommendations for the use of regular adult dosing of paracetamol should be reconsidered.

The median time to recovery from acute low-back pain is 16-17 days.

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Mar 13

Yoghurt to prevent antibiotic-associated diarrhoea in children

Journal reference: Fox MJ, Ahuja KD, Robertson IK, Ball MJ, Eri RD. Can probiotic yogurt prevent diarrhoea in children on antibiotics? A double-blind, randomised, placebo-controlled study. BMJ Open 2015;5(1): e006474. DOI: 10.1136/bmjopen-2014-006474

Link: http://dx.doi.org/10.1136/bmjopen-2014-006474

Published: 14 January 2015

Evidence cookie says…

Probiotic yoghurt appears to reduce the incidence of diarrhoea in children receiving antibiotics in general practice settings.

The dose was 2 x 100 g tubs of Vaalia-brand yoghurt daily during the antibiotic course of treatment.

This is a reasonable preventive intervention to advise – especially for children who enjoy yoghurt.

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Nov 07

St John’s wort for minor depression

Journal reference: Rapaport MH, Nierenberg AA, Howland R, Dording C, Schettler PJ, Mischoulon D. The treatment of minor depression with St. John’s Wort or citalopram: failure to show benefit over placebo. Journal of Psychiatric Research 2011; 45(7): 931-941. DOI: 10.1016/j.jpsychires.2011.05.001

Link: http://dx.doi.org/10.1016/j.jpsychires.2011.05.001

Published: July 2011

Evidence cookie says…

St John’s wort is probably ineffective for minor depression.

Of the little evidence available, there appears to be no benefit over placebo, and evidence of side-effects.

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