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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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.

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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.

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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.

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