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American family physician

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58 papers 500 to 1000 followers Follow me on twitter @andrewbuelt or listen to our free podcast on iTunes Questioning Medicine or if you need CME check out Primary Care RAP
By Andrew Buelt Questioningmedicine, intern in residency
Raine Sihvonen, Martin Englund, Aleksandra Turkiewicz, Teppo L N Järvinen
BACKGROUND: Recent evidence shows that arthroscopic partial meniscectomy (APM) offers no benefit over conservative treatment of patients with a degenerative meniscus tear. However, patients who report mechanical symptoms (sensations of knee catching or locking) may benefit from APM. OBJECTIVE: To assess whether APM improves mechanical symptoms better than sham surgery. DESIGN: Randomized, patient- and outcome assessor-blinded, sham surgery-controlled, multicenter trial...
April 5, 2016: Annals of Internal Medicine
Timothy P Hofer, Jeremy B Sussman, Rodney A Hayward
No abstract text is available yet for this article.
May 17, 2016: Annals of Internal Medicine
Karen Falloon, C Raina Elley, Antonio Fernando, Arier C Lee, Bruce Arroll
BACKGROUND: Insomnia is common in primary care. Cognitive behavioural therapy for insomnia (CBT-I) is effective but requires more time than is available in the general practice consultation. Sleep restriction is one behavioural component of CBT-I. AIM: To assess whether simplified sleep restriction (SSR) can be effective in improving sleep in primary insomnia. DESIGN AND SETTING: Randomised controlled trial of patients in urban general practice settings in Auckland, New Zealand...
August 2015: British Journal of General Practice: the Journal of the Royal College of General Practitioners
David M Studdert, Marie M Bismark, Michelle M Mello, Harnam Singh, Matthew J Spittal
BACKGROUND: The distribution of malpractice claims among physicians is not well understood. If claim-prone physicians account for a substantial share of all claims, the ability to reliably identify them at an early stage could guide efforts to improve care. METHODS: Using data from the National Practitioner Data Bank, we analyzed 66,426 claims paid against 54,099 physicians from 2005 through 2014. We calculated concentrations of claims among physicians. We used multivariable recurrent-event survival analysis to identify characteristics of physicians at high risk for recurrent claims and to quantify risk levels over time...
January 28, 2016: New England Journal of Medicine
Vinay Prasad, Jeanne Lenzer, David H Newman
No abstract text is available yet for this article.
2016: BMJ: British Medical Journal
Laurent Malisoux, Nicolas Chambon, Nicolas Delattre, Nils Gueguen, Axel Urhausen, Daniel Theisen
BACKGROUND/AIM: This randomised controlled trial investigated if the usage of running shoes with a motion control system modifies injury risk in regular leisure-time runners compared to standard shoes, and if this influence depends on foot morphology. METHODS: Recreational runners (n=372) were given either the motion control or the standard version of a regular running shoe model and were followed up for 6 months regarding running activity and injury. Foot morphology was analysed using the Foot Posture Index method...
April 2016: British Journal of Sports Medicine
Alan J Garber, Martin J Abrahamson, Joshua I Barzilay, Lawrence Blonde, Zachary T Bloomgarden, Michael A Bush, Samuel Dagogo-Jack, Ralph A DeFronzo, Daniel Einhorn, Vivian A Fonseca, Jeffrey R Garber, W Timothy Garvey, George Grunberger, Yehuda Handelsman, Robert R Henry, Irl B Hirsch, Paul S Jellinger, Janet B McGill, Jeffrey I Mechanick, Paul D Rosenblit, Guillermo E Umpierrez
No abstract text is available yet for this article.
January 2016: Endocrine Practice
Roman Prymula, Claire-Anne Siegrist, Roman Chlibek, Helena Zemlickova, Marie Vackova, Jan Smetana, Patricia Lommel, Eva Kaliskova, Dorota Borys, Lode Schuerman
BACKGROUND: Although fever is part of the normal inflammatory process after immunisation, prophylactic antipyretic drugs are sometimes recommended to allay concerns of high fever and febrile convulsion. We assessed the effect of prophylactic administration of paracetamol at vaccination on infant febrile reaction rates and vaccine responses. METHODS: In two consecutive (primary and booster) randomised, controlled, open-label vaccination studies, 459 healthy infants were enrolled from ten centres in the Czech Republic...
October 17, 2009: Lancet
Sarah Jefferies, Irene Braithwaite, Steven Walker, Mark Weatherall, Lance Jennings, Michelle Luck, Kevin Barrett, Robert Siebers, Timothy Blackmore, Richard Beasley, Kyle Perrin
BACKGROUND AND OBJECTIVE: Anti-pyretic treatment is recommended in the management of influenza infection. In animal models anti-pyretic treatment increases mortality from influenza. We investigated the effects of paracetamol on viral and clinical outcomes in adults with influenza infection. METHODS: This is a randomized, double-blind, placebo-controlled trial of adults aged 18-65 years with influenza-like illness and positive influenza rapid antigen test. Treatments were 1 g paracetamol four times a day, or matching placebo, for 5 days...
February 2016: Respirology: Official Journal of the Asian Pacific Society of Respirology
M Whitton, M Pinart, J M Batchelor, J Leonardi-Bee, U Gonzalez, Z Jiyad, V Eleftheriadou, K Ezzedine
Vitiligo affects around 1% of the world's population. Despite it being relatively common, there is still no effective treatment. The objective of this study was to update the Cochrane systematic review of randomized clinical trials (RCTs) to evaluate the efficacy of treatments for vitiligo. We carried out searches of a range of databases to October 2013 for RCTs of interventions for vitiligo regardless of language or publication status. At least two reviewers independently assessed study eligibility and methodological quality and extracted data using data extraction forms approved by the Cochrane Skin Group...
May 2016: British Journal of Dermatology
W Michael Hooten, Steven P Cohen
Low back pain (LBP) is a leading cause of disability worldwide. In the absence of a classification system for pain syndromes, classification of LBP on the basis of the distribution of pain as axial (pain generally localized to the low back) or radicular neuropathic (pain radiating to the lower extremities) is relevant to clinical practice because the distribution of pain is often a corollary of frequently occurring disease processes involving the lumbar spine. Common sources of axial LBP include the intervertebral disc, facet joint, sacroiliac joint, and paraspinal musculature, whereas common sources of radicular pain include a herniated intervertebral disc and spinal stenosis...
December 2015: Mayo Clinic Proceedings
Chao Zeng, Jie Wei, Hui Li, Yi-lun Wang, Dong-xing Xie, Tuo Yang, Shu-guang Gao, Yu-sheng Li, Wei Luo, Guang-hua Lei
This study aimed to investigate the effectiveness and safety of glucosamine, chondroitin, the two in combination, or celecoxib in the treatment of knee osteoarthritis (OA). PubMed, Embase and Cochrane Library were searched through from inception to February 2015. A total of 54 studies covering 16427 patients were included. Glucosamine plus chondroitin, glucosamine alone, and celecoxib were all more effective than placebo in pain relief and function improvement. Specifically, celecoxib is most likely to be the best treatment option, followed by the combination group...
2015: Scientific Reports
Michael Gottlieb, Damali Nakitende
Clinical question Do calcium channel blockers or alpha blockers improve renal stone passage when compared with placebo? Article chosen Pickard R, Starr K, MacLennan G, et al. Medical expulsive therapy in adults with ureteric colic: a multicentre, randomised, placebo-controlled trial. Lancet 2015;386(9991):25-31, doi: 10.1016/S0140-6736(15)60933-3.
November 20, 2015: CJEM
Mika Kivimäki, Markus Jokela, Solja T Nyberg, Archana Singh-Manoux, Eleonor I Fransson, Lars Alfredsson, Jakob B Bjorner, Marianne Borritz, Hermann Burr, Annalisa Casini, Els Clays, Dirk De Bacquer, Nico Dragano, Raimund Erbel, Goedele A Geuskens, Mark Hamer, Wendela E Hooftman, Irene L Houtman, Karl-Heinz Jöckel, France Kittel, Anders Knutsson, Markku Koskenvuo, Thorsten Lunau, Ida E H Madsen, Martin L Nielsen, Maria Nordin, Tuula Oksanen, Jan H Pejtersen, Jaana Pentti, Reiner Rugulies, Paula Salo, Martin J Shipley, Johannes Siegrist, Andrew Steptoe, Sakari B Suominen, Töres Theorell, Jussi Vahtera, Peter J M Westerholm, Hugo Westerlund, Dermot O'Reilly, Meena Kumari, G David Batty, Jane E Ferrie, Marianna Virtanen
BACKGROUND: Long working hours might increase the risk of cardiovascular disease, but prospective evidence is scarce, imprecise, and mostly limited to coronary heart disease. We aimed to assess long working hours as a risk factor for incident coronary heart disease and stroke. METHODS: We identified published studies through a systematic review of PubMed and Embase from inception to Aug 20, 2014. We obtained unpublished data for 20 cohort studies from the Individual-Participant-Data Meta-analysis in Working Populations (IPD-Work) Consortium and open-access data archives...
October 31, 2015: Lancet
Michael A Becker, David Fitz-Patrick, Hyon K Choi, Nicola Dalbeth, Chris Storgard, Matt Cravets, Scott Baumgartner
OBJECTIVES: Allopurinol is the most widely prescribed serum uric acid-lowering therapy (ULT) in gout. To achieve serum uric acid (sUA) concentrations associated with clinical benefit, allopurinol is serially uptitrated with sUA monitoring. Suboptimal dosing is a key contributor to poor clinical outcomes, but few data are available on the safety and efficacy of dose-titrated allopurinol, particularly at doses > 300 mg/d. The objective of this open-label study was to investigate the safety and efficacy of allopurinol under conditions where investigators were encouraged to titrate to optimal, medically appropriate doses...
October 2015: Seminars in Arthritis and Rheumatism
Jose Rosa-Olivares, Amanda Porro, Marielys Rodriguez-Varela, Gloria Riefkohl, Iran Niroomand-Rad
.On the basis of research evidence, a recommended strategy for improving the care of middle ear infections is to identify the subset of patients least likely to benefit from antibiotic therapy. They include children ages 6 months to 23 months with unilateral disease without severe signs and symptoms (moderate or severe otalgia, otalgia lasting more than 48 hours,or temperature of 39°C [102.2°F]), and those older than 2 years ofage with unilateral or bilateral disease who have mild signs andsymptoms.(9) On the basis of research evidence, the initial treatment of otitis media with effusion is watchful observation...
November 2015: Pediatrics in Review
Jackson T Wright, Jeff D Williamson, Paul K Whelton, Joni K Snyder, Kaycee M Sink, Michael V Rocco, David M Reboussin, Mahboob Rahman, Suzanne Oparil, Cora E Lewis, Paul L Kimmel, Karen C Johnson, David C Goff, Lawrence J Fine, Jeffrey A Cutler, William C Cushman, Alfred K Cheung, Walter T Ambrosius
BACKGROUND: The most appropriate targets for systolic blood pressure to reduce cardiovascular morbidity and mortality among persons without diabetes remain uncertain. METHODS: We randomly assigned 9361 persons with a systolic blood pressure of 130 mm Hg or higher and an increased cardiovascular risk, but without diabetes, to a systolic blood-pressure target of less than 120 mm Hg (intensive treatment) or a target of less than 140 mm Hg (standard treatment). The primary composite outcome was myocardial infarction, other acute coronary syndromes, stroke, heart failure, or death from cardiovascular causes...
November 26, 2015: New England Journal of Medicine
Jens D Lundgren, Abdel G Babiker, Fred Gordin, Sean Emery, Birgit Grund, Shweta Sharma, Anchalee Avihingsanon, David A Cooper, Gerd Fätkenheuer, Josep M Llibre, Jean-Michel Molina, Paula Munderi, Mauro Schechter, Robin Wood, Karin L Klingman, Simon Collins, H Clifford Lane, Andrew N Phillips, James D Neaton
BACKGROUND: Data from randomized trials are lacking on the benefits and risks of initiating antiretroviral therapy in patients with asymptomatic human immunodeficiency virus (HIV) infection who have a CD4+ count of more than 350 cells per cubic millimeter. METHODS: We randomly assigned HIV-positive adults who had a CD4+ count of more than 500 cells per cubic millimeter to start antiretroviral therapy immediately (immediate-initiation group) or to defer it until the CD4+ count decreased to 350 cells per cubic millimeter or until the development of the acquired immunodeficiency syndrome (AIDS) or another condition that dictated the use of antiretroviral therapy (deferred-initiation group)...
August 27, 2015: New England Journal of Medicine
(no author information available yet)
The 2015 American Geriatrics Society (AGS) Beers Criteria are presented. Like the 2012 AGS Beers Criteria, they include lists of potentially inappropriate medications to be avoided in older adults. New to the criteria are lists of select drugs that should be avoided or have their dose adjusted based on the individual's kidney function and select drug-drug interactions documented to be associated with harms in older adults. The specific aim was to have a 13-member interdisciplinary panel of experts in geriatric care and pharmacotherapy update the 2012 AGS Beers Criteria using a modified Delphi method to systematically review and grade the evidence and reach a consensus on each existing and new criterion...
November 2015: Journal of the American Geriatrics Society
Dipak Kotecha, Jonathan P Piccini
Heart failure (HF) and atrial fibrillation (AF) are two conditions that are likely to dominate the next 50 years of cardiovascular (CV) care. Both are increasingly prevalent and associated with high morbidity, mortality, and healthcare cost. They are closely inter-related with similar risk factors and shared pathophysiology. Patients with concomitant HF and AF suffer from even worse symptoms and poorer prognosis, yet evidence-based evaluation and management of this group of patients is lacking. In this review, we evaluate the common mechanisms for the development of AF in HF patients and vice versa, focusing on the evidence for potential treatment strategies...
December 7, 2015: European Heart Journal
2015-10-16 14:36:54
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