Afpm j vol 3 no 1.pmd

Malaysian Family Physician 2008; Volume 3, Number 1
ISSN: 1985-207X (print), 1985-2274 (electronic)
Academy of Family Physicians of Malaysia
Online version: http://www.ejournal.afpm.org.my/
P.E.A.R.L.S Practical Evidence About Real Life Situations
P.E.A.R.L.S are succinct summaries of Cochrane Systematic • Bupropion and nortriptyline aid long-term smoking Reviews for primary care practitioners. The main organisers cessation but selective serotonin uptake inhibitors of the Cochrane Primary Care Field are Bruce Arroll (1), Jaap van Binsbergen (2), Tom Fahey (3), Tim Kenealy (1), • Cardioselective beta blockers do not produce adverse respiratory effects in chronic obstructive pulmonarydisease The Cochrane Primary Health Care Field is a collaboration • Chinese herbal medicine promising for menstrual pain • Cognitive behavioural therapy (CBT) has a positive (1) New Zealand Branch of the Australasian Cochrane effect on some of the qualitative aspects of tinnitus Centre at the Department of General Practice and • Colchicine is a second line therapy for acute gout Primary Health Care, University of Auckland and • Combined psychotherapy plus antidepressants or funded by the New Zealand Guidelines Group; psychotherapy alone is an effective first line treatment (2) Academic Departments of General Practice in The for panic disorder with or without agoraphobia, Practitioners, and the Netherlands Institute for Health • Contracts for improving patients’ adherence cannot (3) Department of General Practice, Royal College of • Contracts between patients and healthcare practitioners for improving patients’ adherence totreatment, prevention and health promotion activities PEARLS are prepared as an educational resource and do not • Effectiveness of prolotherapy injections for chronic low- replace clinician judgment in the management of individual • Exercise beneficial in fibromyalgia syndrome • Exercise improves balance in older people View P.E.A.R.L.S online at www.cochraneprimarycare.org • Glue may be better than stitches, staples or adhesive Subscribe to P.E.A.R.L.S at http://lists.cochrane.org/mailman/ listinfo/primarycare. Subscribers get the P.E.A.R.L.S directly • Is routine therapeutic monitoring of antiepileptic drugs in their mailbox on a regular basis.
• Lamotrigine unlikely to benefit chronic pain or The P.E.A.R.L.S published so far are as follows: • Antibiotics appear to have no benefit in treating acute • Local corticosteroid injections for carpal tunnel • Antibiotics or ‘watch and wait’ for acute otitis media • Local oestrogen for vaginal atrophy in postmenopausal • Anticholinergics are effective for overactive bladder • Low molecular weight heparin (LMWH) and non- • Antidepressants are effective for neuropathic pain steroidal anti-inflammatory drugs (NSAIDs) are the • Antihistamines and/or decongestants not best treatment for superficial thrombophlebitis (ST) recommended in children with otitis media with effusion • Nasal saline irrigations effective for chronic • Aquatic exercise beneficial in knee and hip • Nicotine receptor partial agonists help people stop • A simple whisper test is effective for diagnosing • Oral erythromycin may be effective in treating the • Autoinflation for otitis media with effusion helpful in • Oral tetracyclines are effective for acne vulgaris • Brief alcohol interventions (BAIs) in primary care • Prophylactic antibiotics in mammalian bites may populations are effective in reducing alcohol Malaysian Family Physician 2008; Volume 3, Number 1
ISSN: 1985-207X (print), 1985-2274 (electronic)
Academy of Family Physicians of Malaysia
Online version: http://www.ejournal.afpm.org.my/
• Proton pump inhibitors (PPIs) most effective treatment • Topical pimecrolimus is less effective for treating eczema than moderate and potent corticosteroids and • Psychological therapy based on cognitive behavioural therapy (CBT) principles is effective in reducing anxiety • Topical treatments for chronically discharging ears with symptoms for short-term treatment of generalised underlying eardrum perforations (CSOM) are better • Response rates to postal questionnaires can be • Vitamin C supplementation may have preventive effects in populations with a high incidence of • School feeding programs may have some small pneumonia, and may have therapeutic effects in populations with low plasma vitamin C levels • Screening for abdominal aortic aneurysm.
• Skin grafting effective for venous leg ulcers Some examples of P.E.A.R.L.S are provided in the
• Stimulating the involvement of older patients in their following pages, courtesy of
• Stop using beta-blockers as first-line treatment for Bruce Arroll MBChB, PhD, FRNZCGP, FAFPHM
Professor and Head of Department of General Practice
• Surgical discectomy can benefit some patients and Primary Health Care
• There is no evidence supporting the use of Chinese University of Auckland
Private Bag 92019
Auckland
Email: [email protected]
Malaysian Family Physician 2008; Volume 3, Number 1
ISSN: 1985-207X (print), 1985-2274 (electronic)
Academy of Family Physicians of Malaysia
Online version: http://www.ejournal.afpm.org.my/
P.E.A.R.L.S Practical Evidence About Real Life Situations
Glue may be better than stitches, staples or adhesive tape for simple cuts
What is the best way to repair traumatic skin lacerations in childrenand adults? Pain scores and procedure time significantly favoured tissue adhesivesover standard wound care (stitches, staples or adhesive tape). Therewas no significant difference in cosmetic appearance between tissueadhesive and standard wound care on either a Cosmetic VisualAnalogue Scale or Wound Evaluation Score.
There were small but statistically significant risk differences fordehiscence (favouring standard wound care, NNH 25*) and erythema(favouring tissue adhesives, NNH10). Although there are a few differenttypes of glue available (based on butlycyanoacrylate andoctylcyanoacrylate), no one glue seems to be superior. *NNH = numberneeded to treat to cause harm in one individual.
Lacerations need to be closed to ensure proper healing and to preventinfection or unattractive scarring. This is the first systematic reviewcomparing glue with standard wound closure.
Farion K, Osmond MH, Hartling L, Russell K, Klassen T, Crumley E,Wiebe N. Tissue adhesives for traumatic lacerations in children andadults. Cochrane Database of Systematic Reviews 2001, Issue 4. Art.
No.: CD003326. DOI: 10.1002/14651858.CD003326. This reviewcontains 10 studies involving 522 participants.
PEARLS No. 8, August 2007, written by Brian R McAvoy Malaysian Family Physician 2008; Volume 3, Number 1
ISSN: 1985-207X (print), 1985-2274 (electronic)
Academy of Family Physicians of Malaysia
Online version: http://www.ejournal.afpm.org.my/
P.E.A.R.L.S Practical Evidence About Real Life Situations
Local corticosteroid injections improve symptoms of carpal tunnel syndrome
How effective are local corticosteroid injections for carpal tunnelsyndrome (CTS)? Local corticosteroid injections for CTS provide greater clinicalimprovement in symptoms one month after injection compared toplacebo (NNT* 2). They also provide significantly greater clinicalimprovement compared to oral corticosteroids up to three months aftertreatment. Two injections do not provide significant further clinicalimprovement of symptoms. *NNT = number needed to treat to benefitone individual. Significant symptom relief beyond one month has not beendemonstrated.
CTS is a common problem with a prevalence of 3.8% in the generalpopulation. Up to 1/3 of patients can have spontaneous improvementin their symptoms without any formal medical treatment.
Marshall S, Tardif G, Ashworth N. Local corticosteroid injection for carpaltunnel syndrome. Cochrane Database of Systematic Reviews 2007,Issue 2. Art. No.: CD001554. DOI: 10.1002/14651858.CD001554.pub2.
This review contains 12 trials with 671 participants.
PEARLS No. 12. September 2007, written by Brian R McAvoy Malaysian Family Physician 2008; Volume 3, Number 1
ISSN: 1985-207X (print), 1985-2274 (electronic)
Academy of Family Physicians of Malaysia
Online version: http://www.ejournal.afpm.org.my/
P.E.A.R.L.S Practical Evidence About Real Life Situations
Ultrasound screening for abdominal aortic aneurysm may reduce mortality in men
aged 65 to 79 years
How effective is ultrasound screening for abdominal aortic aneurysm(AAA)? Ultrasound screening, followed by appropriate management,significantly reduced deaths from AAA in men aged 65 to 79 years(NNS *322 to 1312). There was insufficient evidence to demonstratebenefit in women. The cost-effectiveness of a coordinated population-based screening programme may be acceptable but this needs furtherexpert analysis. *NNS = number needed to screen to prevent a deathfrom AAA The incidence of AAA in women is lower than for men. All-case mortalitywas not significantly different between screened and unscreenedgroups three to five years after screening, which is to be expectedgiven the relative infrequency of AAA as a cause of death. The “highNNS” is similar to other screening procedures.
AAA is found in 5-10% of men aged 65 to 79 years. The majorcomplication is rupture, which has a mortality of 80% for patientsreaching hospital, and 50% for those undergoing surgery for emergencyrepair. Currently elective surgical repair is recommended for aneurysmsdiscovered to be larger than 5.5 cm to prevent rupture.
Cosford PA, Leng GC. Screening for abdominal aortic aneurysm.
Cochrane Database of Systematic Reviews 2007, Issue 2. Art. No.:CD002945. DOI:10.1002/14651858.CD002945.pub2. Thisreviewcontains 4 trials involving127,891 men and 9,342 women.
PEARLS No. 14. October 2007, written by Brian R McAvoy

Source: http://www.afpm.org.my/elearning/2008v3n1/pdf/EBM_Pearls.pdf