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At least 685 records · Page 38Linked to original sources
PubMed1999

What nutrition knowledge and skills do primary care physicians need to have, and how should this be communicated?

The last Heelsum workshop agreed that general practitioners should concentrate on dietary advice for treatment or secondary prevention, though nutritional advice for health is part of the doctor's work with pregnancy, infants and the very old. Nutrition prescriptions contrast with drug prescriptions. For drugs information is authoritative, evidence-based and easily available. Drug prescriptions are potentially liable to litigation. Dietary prescriptions are less serious and more the patient's responsibility. Nutrition information comes in a plethora of different forms, some of it unscientific, some out of date, some commercially biased. While waiting for some system (?authoritative, ?electronic) that can help general practitioners (GPs) organise nutrition information, there are three modern books that have been written by nutrition specialists for GPs in the English language (there may be others in North America) and another was written for practice nurses. As well as general books like this most large countries have expert reports on some nutritional topics by government committees available for reference. In relating foods and food components to disease, most of the reliable evidence is about their effect on risk factors-plasma cholesterol, blood glucose, blood pressure or body weight. A smaller amount of evidence relates food intake data from large cohort studies to incidence of disease. Very few randomised controlled trials (the ultimate evidence-based medicine) have been achieved for nutrition. Dietary recommendations may have to change with time because of new research-and drugs. Advice for secondary prevention of coronary heart disease is shown as an example of this.

Coronary Disease↗
PubMed2000

Antibiotics for persistent nasal discharge (rhinosinusitis) in children.

BACKGROUND: Nasal discharge (rhinosinusitis) is the result of inflammation of the mucosa of the upper respiratory tract, and is usually due to either infection or allergy. OBJECTIVES: To determine the effectiveness of antibiotics versus placebo or standard therapy in treating children with persistent nasal discharge (>10 days). SEARCH STRATEGY: The Cochrane Controlled Trials Register, MEDLINE, EMBASE, and bibliographies of relevant articles were searched. Authors and pharmaceutical companies were contacted. Date of most recent searches: March 2000. SELECTION CRITERIA: All randomized controlled trials that compared antibiotics versus placebo or standard therapy (decongestants or nasal saline drops). Trials which included the use of other medications were included if all participants were allowed equal access to such medications or if the additional or alternative therapies were regarded as ineffective. Trials that only combined or compared antibiotics with surgery, or sinus puncture and lavage, were not included in the review. DATA COLLECTION AND ANALYSIS: Data were extracted by a single reviewer for the following outcomes: clinical failure, failure to improve, clinical improvement, time to resolution, complications, side-effects and bacteriologic failure. For the dichotomous outcome variables of each individual study, proportional and absolute risk reductions were calculated using a modified intention-to-treat analysis. The summary weighted risk ratio and 95% confidence interval (fixed effects model) were calculated using the inverse of the variance of each study result for weighting (Cochrane statistical package, REVMAN version 4.3). MAIN RESULTS: A total of five studies involving 401 children compared antibiotics with placebo or standard therapy. Only one of the seven outcomes (clinical failure) was reported in all studies. Around 45% of children did not have a clinical success documented when reviewed 2-6 weeks after randomization. The control event rate varied from to 47-71% (mean 56%). The risk ratio estimated using a fixed effects model was 0.72 (95% CI 0.59, 0.89). The estimated effect size was consistent in four of the five studies. REVIEWER'S CONCLUSIONS: For children with persistent nasal discharge or older children with radiographically confirmed sinusitis, the available evidence suggests that antibiotics given for 10 days will reduce the probability of persistence in the short to medium-term. The benefits appear to be modest and around six children must be treated in order to achieve one additional cure. No long term benefits have been documented. These conclusions are based on a small number of small randomized controlled trials and additional larger well-designed studies are indicated.

Adolescent↗
PubMed2001

Dissection versus diathermy for tonsillectomy.

BACKGROUND: Tonsillectomy is a commonly performed surgical procedure. There are several operative methods currently in use, but the superiority of one over another has not been clearly demonstrated. OBJECTIVES: To compare the morbidity associated with tonsillectomy by two different techniques - dissection and diathermy. SEARCH STRATEGY: Cochrane Controlled Trials Register, Medline (1966-2000), Embase (1974-2000). Reference lists were scanned for additional material. SELECTION CRITERIA: Randomised controlled trials of children and adults undergoing tonsillectomy or adenotonsillectomy by dissection or diathermy techniques. Trials were assessed for methodological quality according to the method outlined in the Cochrane Reviewers Handbook. DATA COLLECTION AND ANALYSIS: The reviewers assessed each trial and extracted data independently. MAIN RESULTS: Twenty-two potential studies were identified for further assessment. Twenty trials were not included because they did not meet the inclusion criteria for randomisation methods, controls or outcome criteria. Two trials met the inclusion criteria, one comparing monopolar dissection diathermy with conventional cold dissection in children, and the other comparing microscopic bipolar dissection with cold dissection in children and adults. These studies demonstrate reduced intraoperative bleeding, but increased pain in the diathermy group. There was no difference in the rate of secondary bleeding overall, although the power of both studies to detect a small difference was insufficient. REVIEWER'S CONCLUSIONS: There are insufficient data to show that one method of tonsillectomy is superior. There is evidence that pain may be greater after monopolar dissection. Large, well designed randomised controlled trials are necessary to determine the optimum method for tonsillectomy.

Adult↗