Dec 05

Milk thistle for chronic hepatitis B

Journal reference: Rambaldi A, Jacobs BP, Gluud C. Milk thistle for alcoholic and/or hepatitis B or C virus liver diseases. Cochrane database Syst Rev 2007 Oct 17(4):CD003620

Link: https://dx.doi.org/10.1002/14651858.CD003620.pub3

Published: October 2007

Evidence cookie says…

Milk thistle products cannot be recommended for chronic hepatitis B.

  • There is limited/minimal research evidence available.
  • What evidence exists is of unclear quality.

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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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