Sep
05

Does caffeine help with migraines?

Journal reference: Derry CJ, Derry S, Moore RA. Caffeine as an analgesic adjuvant for acute pain in adults. Cochrane Database of Systematic Reviews 2012, Issue 3. Art. No.: CD009281.

Link: http://dx.doi.org/10.1002/14651858.CD009281.pub2

Published: 14 March 2012

Evidence cookie says…

Oral caffeine (100 mg) as a single dose may have a modest effect on acute pain (including migraine) when used as an adjuvant to oral analgesia (including paracetamol).

There are significant uncertainties in the evidence-base and this finding should be treated cautiously.

There is an absence of evidence for repeated doses of caffeine.

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Jul
11

Echinacea and the common cold in children

Journal reference: Taylor JA, Webber W, Standish L, Quinn H, Goesling J, McGann M, Calabrese C. Efficacy and safety of echinacea in treating upper respiratory tract infections in children: a randomized controlled trial. JAMA 2003; 290(21): 2824-2830

Link: http://dx.doi.org/10.1001/jama.290.21.2824

Published: 3 December 2003

Evidence cookie says…

Echinacea does not appear to be an effective treatment for the common cold in children.

Side-effects (such as rash and allergic reactions) can occur and the UK regulatory body (MHRA) recommends against its use in children under 12 years.

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May
16

Newer oral contraceptives and risk of venous thrombosis

Journal reference: de Bastos M, Stegeman BH, Rosendaal FR, Van Hylckama Vlieg A, Helmerhorst FM, Stijnen T, Dekkers OM. Combined oral contraceptives: venous thrombosis. Cochrane Database of Systematic Reviews 2014, Issue 3. Art. No.: CD010813. DOI: 10.1002/14651858.CD010813.pub2.

Link: http://dx.doi.org/10.1002/14651858.CD010813.pub2

Published: 3 March 2014

Evidence cookie says…

Combined oral contraceptives containing drospirenone as compared to levonorgestrel are associated with twice the risk of venous thrombosis (and about 4x the risk of non-use).

However, the absolute risk difference is small: less than 0.1% increased probability of venous thrombosis per year (NNH ≈ 1500).

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Apr
16

Diagnostic utility of rheumatoid factor in low risk population

Journal reference: Nishimura K, Sugiyama D, Kogata Y, Tsuji G, Nakazawa T, Kawano S, et al. Meta-analysis: diagnostic accuracy of anti-cyclic citrullinated peptide antibody and rheumatoid factor for rheumatoid arthritis. Ann Intern Med 2007; 146(11): 797-808; and others.

Link: http://dx.doi.org/10.7326/0003-4819-146-11-200706050-00008

Published: 5 June 2007

Evidence cookie says…

There is no role for diagnostic rheumatoid factor (RF) testing in someone without inflammatory arthritis.

An elevated RF increases the odds of rheumatoid arthritis about 5-fold.  The post-test risk, however, depends on the pre-test risk.

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Mar
14

Mediterranean diets in type 2 diabetes

Journal reference: Ajala O, English P, Pinkney J. Systematic review and meta-analysis of different dietary approaches to the management of type 2 diabetes. Am J Clin Nutr 2013; 97(3): 505-516

Link: http://dx.doi.org/10.3945/ajcn.112.042457

Published: 30 January 2013

Evidence cookie says…

The Mediterranean diet appears to be as good as other diets at improving glycaemic control in patients with type 2 diabetes.

There is some evidence of that it may be superior, but this evidence is weak/uncertain.

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Nov
08

Are statins effective for primary prevention in people with low cardiovascular risk?

Journal reference: Tonelli M, Lloyd A, Clement F, Conly J, Husereau D, Hemmelgarn B, Klarenbach S, McAlister FA, Wiebe N, Manns B, Alberta Kidney Disease Network. Efficacy of statins for primary prevention in people at low cardiovascular risk: a meta-analysis. CMAJ 2011; 183(16): E1189-E1202

Link: http://dx.doi.org/10.1503/cmaj.111674

Published: 24 October 2011

Evidence cookie says…

Statins appear to have a (small) cardiovascular benefit, even in individuals at low CVD risk.

The clinical meaningfulness of this benefit needs to be considered in the context of side-effects, opportunity costs, and patient preferences.

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Sep
06

Is folate effective for methotrexate side effects?

Journal reference: Shea B, Swinden MV, Tanjong Ghogomu E, Ortiz Z, Katchamart W, Rader T, Bombardier C, Wells GA, Tugwell P. Folic acid and folinic acid for reducing side effects in patients receiving methotrexate for rheumatoid arthritis. Cochrane Database of Systematic Reviews 2013, Issue 5. Art. No.: CD000951

Link: http://dx.doi.org/10.1002/14651858.CD000951.pub2

Published: 31 May 2013

Evidence cookie says…

Low dose folic acid (≤ 7 mg/week) substantially reduces the likelihood of certain side-effects of methotrexate in patients with rheumatoid arthritis.

This appears to be very clinically significant – NNT of 7 for one patient not to withdraw from MTX therapy.

Low dose folic acid did not appear to reduce the effectiveness of MTX.

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Jul
12

Does zinc reduce the symptoms of the common cold?

Journal reference: Science M, Johnstone J, Roth DE, Guyatt G, Loeb M. Zinc for the treatment of the common cold: a systematic review and meta-analysis of randomized controlled trials. CMAJ 2012; 184(10): E551-E561

Link: http://dx.doi.org/10.1503/cmaj.111990

Published: 7 May 2012

Evidence cookie says…

Oral zinc reduces the duration of cold symptoms in adults, but at the cost of side-effects.

The evidence is of moderate grade strength – there is some major heterogeneity in the results between the included studies.

High doses of zinc (≥ 75 mg of ionised zinc per day), and zinc in the acetate formulation might be more effective.

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May
24

Is yoghurt helpful for antibiotic-associated diarrhoea?

Journal reference: Conway S, Hart A, Clark A, Harvey I. Does eating yogurt prevent antibiotic-associated diarrhoea? A placebo-controlled randomised controlled trial in general practice. British Journal of General Practice 2007; 57(545): 953-959

Link: http://dx.doi.org/10.3399/096016407782604811

Published: 1 December 2007

Evidence cookie says…

Yoghurt eaters in this study might have suffered less antibiotic-associated diarrhoea as compared to those who ate no yoghurt.

This evidence, however, is weak and no firm conclusions can be made.

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Mar
15

Do calcium supplements increase the risk of myocardial infarction?

Journal reference: Bolland M, Avenell A, Baron JA, Grey A, MacLennan GS, Gamble GD, Reid IR. Effect of calcium supplements on risk of myocardial infarction and cardiovascular events: meta-analysis. BMJ 2010; 341: c3691

Link: http://dx.doi.org/10.1136/bmj.c3691

Published: 30 July 2010

Evidence cookie says…

Calcium supplements may increase the risk of myocardial infarction, but, there is substantial uncertainty in the estimate.

For every 69 patients treated with calcium supplements for 5 years rather than placebo, there would be one extra myocardial infarction, i.e., the NNH is 69 (95% confidence interval is from about 30 to 1000).

Using the precautionary principle, regular calcium supplements should be avoided unless there is a clear compelling indication.

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