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.

Read the rest of this entry »

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.

Read the rest of this entry »

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.

Read the rest of this entry »

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.

Read the rest of this entry »

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.

Read the rest of this entry »

Nov 23

Is glucosamine effective for osteoarthritis pain?

Journal reference: Wandel S, Jüni P, Tendal B, et al. Effects of glucosamine, chondroitin, or placebo in patients with osteoarthritis of hip or knee: network meta-analysis. BMJ 2010; 341: c4675

Link: http://dx.doi.org/10.1136/bmj.c4675

Published: 17 September 2010

Evidence cookie says…

Glucosamine does not appear to be effective for knee or hip osteoarthritis pain.

The evidence is robust.  Even using the most favourable interpretation of the estimate of effect, glucosamine does not have a clinically significant effect on knee or hip osteoarthritis pain.

Read the rest of this entry »

Sep 28

Can exercise be a treatment for depression?

Journal reference: Chalder M, Wiles NJ, Campbell J, Hollinghurst SP, Haase AM, Taylor AH, Fox KR, et al. Facilitated physical activity as a treatment for depressed adults: randomised controlled trial. BMJ 2012; 344:e2758

Link: http://dx.doi.org/10.1136/bmj.e2758

Published: 6 June 2012

Evidence cookie says…

Recommending structured moderate or vigorous exercise in addition to routine GP care is not effective for the treatment of depression.

This was a well conducted study and the evidence is strong.  Exercise has other general benefits, but exercise programs specifically as a form of depression therapy should not be considered evidence-based.

Read the rest of this entry »

Aug 03

Does warming LAs reduce the pain of injection?

Journal reference: Hogan ME, VanderVaart S, Perampaladas K, et al. Systematic review and meta-analysis of the effect of warming local anesthetics on injection pain. Ann Emerg Med 2011 Jul; 58(1): 86-98.e1

Link: http://dx.doi.org/10.1016/j.annemergmed.2010.12.001

Published: 14 February 2011

Evidence cookie says…

Warming the local anaesthetic probably does reduce pain in general, but not by much in most individuals. 

There is uncertainty in the evidence as the magnitude of this effect, which appears to straddle the the boundary of clinical relevance.

Read the rest of this entry »

Jun 08

Antibiotic drops for conjunctivitis in children

Journal reference: Rose PW, Harnden A, Brueggemann AB, et al. Chloramphenicol treatment for acute infective conjunctivitis in children in primary care: a randomised double-blind placebo-controlled trial. Lancet 2005; 366(9479): 37-43

Link: http://dx.doi.org/10.1016/S0140-6736(05)66709-8

Published: 2 July 2005

Evidence cookie says…

The majority of children are cured by day 7 regardless of treatment.

Chloramphenicol is best reserved in cases of severe bacterial conjunctivitis in children.

Read the rest of this entry »

Apr 13

Is vitamin C effective in treating the common cold?

Journal reference: Hemilä H, Chalker E, Douglas B. Vitamin C for preventing and treating the common cold. Cochrane Database of Systematic Reviews 2007, Issue 3. Art. No.: CD000980.

Link: http://dx.doi.org/10.1002/14651858.CD000980.pub3

Published: 18 July 2007

Evidence cookie says…

Oral vitamin C is not an effective treatment for the common cold in the general community.

There is good evidence that vitamin C prophylaxis does not reduce the incidence of colds, but does appear to have a modest effect on the duration and severity of an episode.

Read the rest of this entry »

Older posts «

» Newer posts