Radonovich et al. JAMA 2019 Sep 3;322(9):824-33
The advantage of N95 respirators over surgical masks in controlled settings were not demonstrated in preventing staff influenza infection in routine primary care.
Steels E, et al. Inflammopharmacology 2019 Jun;27(3):475-85.
Palmitoylethanolamide (PEA) cannot be recommended as a routine therapy for knee osteoarthritis in Australian primary care,
Osani et al. Korean J Intern Med 2019 Mar 15
Duloxetine (60-120 mg daily) appears to have a small to moderate beneficial effect on knee osteoarthritis pain and function at 3 months, compared to placebo.
Beadle et al. Ann Emerg Med 2016 Jul;68(1):1-9 e1.
Nasal inhalation of isopropyl alcohol provides clinically important relief from acute nausea, of at least a short duration, in community ambulatory patients
Bisson et al. Cochrane database of systematic reviews 2013 Dec 13(12):CD003388
Eye movement desensitisation and reprocessing (EMDR) appears to be effective for post-traumatic stress disorder (PTSD) symptoms.
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Journal reference: Kowey PR, Reiffel JA, Ellenbogen KA, et al. Efficacy and safety of prescription omega-3 fatty acids for the prevention of recurrent symptomatic atrial fibrillation. JAMA 2010; 304(21): 2363-72 [1]
Link: http://dx.doi.org/10.1001/jama.2010.1735
Published: 15 November 2010
 Evidence cookie says... |
High dose omega-3 fatty acids were not associated with a benefit in prevention of recurrent symptomatic atrial fibrillation (AF).
The evidence is not definitive due to the narrow range of study participants (see more below).
Nevertheless, GPs should avoid recommending ω-3 FA for treatment of atrial fibrillation unless contrary compelling evidence becomes available. |
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Permanent link to this article: https://evidencebasedmedicine.com.au/?p=1264
Journal reference: Rothwell PM, Fowkes GR, Belch JFF, et al. Effect of daily aspirin on long-term risk of death due to cancer: analysis of individual patient data from randomised trials. Lancet 2011; 377(9759): 31-41 [1]
Link: http://dx.doi.org/10.1016/S0140-6736(10)62110-1
Published: 7 December 2010
Evidence cookie says... |
Daily aspirin (≥ 75 mg) taken by participants in cardiovascular studies reduced the risk of cancer death.
The risk of cancer death was:
- ↓ 34% after 5 years follow up
- ↓ 20% maintained at long-term 20 years follow up
Aspirin specifically reduced the risk of death from oesophageal cancer, colorectal cancer, lung cancer, and adenocarcinomas.
General practitioners could consider discussing the risks and benefits of daily aspirin with older patients.
Note: this study does not provide evidence on the effect of long-term daily aspirin, nor the effect on cancer incidence. The effect on all-cause mortality was small. The rate of major bleeding (not including haemorrhagic stroke) on daily aspirin is 0.1% (1 in 1000 people) per year [2]. |
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Permanent link to this article: https://evidencebasedmedicine.com.au/?p=723
Journal reference: Athyros VG, Tziomalos K, Gossios TD, et al. Safety and efficacy of long-term statin treatment for cardiovascular events in patients with coronary heart disease and abnormal liver tests in the Greek Atorvastatin and Coronary Heart Disease Evaluation (GREACE) Study: a post-hoc analysis. Lancet 2010; 376: 1916–22 [1]
Link: http://dx.doi.org/10.1016/S0140-6736(10)61272-X
Published: 24 November 2010
Evidence cookie says... |
Statin are effective and safe in patients with established coronary heart disease but with mild-to-moderate abnormal liver function tests.
In the study population, those who received statins had:
- ↓ 68% relative risk of any cardiovascular event
- improved liver function tests
Liver-related adverse events (ALT or ALT > 3x upper limit of normal) was rare.
Mild-to-moderate abnormal liver function tests should not preclude the use of statins in those who satisfy lipid lowering criteria. |
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Permanent link to this article: https://evidencebasedmedicine.com.au/?p=686
Journal reference: Tibballs J, Watson T. Symptoms and signs differentiating croup and epiglottitis. Journal of Paediatrics and Child Health. (2010) 10.1111/j.1440-1754.2010.01892.x (published online, 21 November 2010) [1]
Link: http://dx.doi.org/10.1111/j.1440-1754.2010.01892.x
Published: 21 November 2010
Evidence cookie says... |
Cough and drooling can be helpful in differentiating croup and epiglottitis in children with acute stridor.
- cough + absence of drooling → consider croup
- drooling + absence of cough → consider epiglottitis
Note: the study results have some severe limitations and must be taken with care. |
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Permanent link to this article: https://evidencebasedmedicine.com.au/?p=562
Journal reference: Bangalore S, Kumar S, Kjeldsen SE, et al. Antihypertensive drugs and risk of cancer: network meta-analyses and trial sequential analyses of 324 168 participants from randomised trials. Lancet Oncol (2010) 10.1016/S1470-2045(10)70260-6 (published online, 30 Nov 2010) [1]
Link: http://dx.doi.org./10.1016/S1470-2045(10)70260-6
Published: 30 November 2010
Evidence cookie says... |
Antihypertensive drugs do not appear to increase cancer risk or cancer-related deaths.
This includes angiotensin receptor antagonists/blockers (ARBs).
The exception is the combination of ARBs and angiotensin converting enzyme inhibitors (ACEIs); together they are associated with an increased risk of cancer. This finding is of unclear significance and causation should not be assumed.
Following a precautionary principle, it is reasonable to avoid the combination of ARBs and ACEIs unless there is a clear clinical indication. |
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Permanent link to this article: https://evidencebasedmedicine.com.au/?p=549
Journal reference: Tähtinen PA, Laine MK, Huovinen P, et al. A placebo-controlled trial of antimicrobial treatment for acute otitis media. N Engl J Med 2011; 364: 116-26 [1]
Link: http://dx.doi.org/10.1056/NEJMoa1007174
Evidence cookie says... |
Children aged 6-35 months with acute otitis media may benefit from amoxicillin-clavulanate but at the cost of adverse events.
The likelihood of benefit from antibiotics is similar to the likelihood of harm.
The Antibiotic Therapeutic Guidelines recommendations remain a useful guide [2]
- immediate antibiotic therapy for AOM with systemic features
- symptomatic treatment with potential delayed antibiotic therapy for AOM without systemic features
Note: it is likely that the favourable results found for amoxicillin-clavulanate in this study cannot be generalised to the Australian setting. See below for more details.
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Permanent link to this article: https://evidencebasedmedicine.com.au/?p=1065
Journal reference: van Nieuwkoop C, Hoppe BPC, Bonten TN, et al. Predicting the need for radiologic imaging in adults with febrile urinary tract infection. Clinical Infectious Diseases 2010;51(11):1266–1272 [1]
Link: http://dx.doi.org/10.1086/657071
Evidence cookie says... |
A simple clinical prediction rule may predict patients with febrile urinary tract infection (UTI) who would not benefit from radiologic imaging.
Those with:
- no history of urolithiasis, and
- urinary pH < 7.0, and
- eGFR > 40 mL/min/1.73 m3
… are very unlikely to have an urgent urologic disorder diagnosed on radiologic imaging.
Note: this study has some significant limitations. See below for details.
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Permanent link to this article: https://evidencebasedmedicine.com.au/?p=363
Journal reference: Vickers AJ, Cronin AM, Björk T, et al. Prostate specific antigen concentration at age 60 and death or metastasis from prostate cancer: case-control study. BMJ 2010;341:c4521 [1]
Link: http://dx.doi.org/10.1136/bmj.c4521
Evidence cookie says... |
Men aged 60 years with a PSA < 1.0 ng/mL have less than a 0.5% risk of prostate cancer metastasis or prostate cancer death by age 85.
It is extremely unlikely that these men (about half at this age) will benefit from a PSA screening program for asymptomatic prostate cancer.
Note: prostate cancer screening with PSA is not currently recommended in men of any age in Australian guidelines. [2] [3] |
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Permanent link to this article: https://evidencebasedmedicine.com.au/?p=289
Journal reference: Matchar DB, Jacobson A, Dolor R, et al. Effect of home testing of international normalised ratio on clinical events. N Engl J Med 2010;363:1608-20 [1]
Link: http://dx.doi.org/10.1056/NEJMoa1002617
Evidence cookie says... |
Home INR self-testing does not appear to improve or worsen strokes, major bleeds or death when compared to high quality practice based management of anticoagulation.
There are no compelling health outcome based reasons for patients to purchase a personal point-of-care INR testing device but their use is likely safe in the hands of sensible patients.
Note: there are substantial limitations in evidence from this study. Please see below for more details. |
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Permanent link to this article: https://evidencebasedmedicine.com.au/?p=282
Journal reference: Bruggink SC, Gussekloo J, Berger M, et al. Cryotherapy with liquid nitrogen versus topical salicylic acid application for cutaneous warts in primary care: a randomized controlled trial. CMAJ. October 19, 2010; 182 (15) [1]
Link: http://dx.doi.org/10.1503/cmaj.092194
Evidence cookie says... |
Cryotherapy with liquid nitrogen is more effective than topical salicylic acid ointment for treatment of cutaneous common warts.
In the Dutch primary health care study participants, it achieved over double the cure rate (49% vs 15%) at 13 weeks.
The study cryotherapy treatment protocol [1]:
- treatment session every fortnight until warts resolve
- in each session, application of a wad of cotton wool saturated with liquid nitrogen until a frozen halo of 2 mm around the base of the wart
- three serial applications of cryotherapy per session
There is no significant difference between cryotherapy, topical salicylic acid, and a “wait and see” approach in the treatment of plantar warts.
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Permanent link to this article: https://evidencebasedmedicine.com.au/?p=807
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