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Estrogen plus progestin may increase incidence of dementia
Estrogen plus progestin does not decrease— and may actually increase—the incidence of dementia, mild cognitive impairment, and cognitive dysfunction in elderly postmenopausal women. The effect of unopposed estrogen on these outcomes is still unknown. With these new findings and the recently reported results of the Women’s Health Initiative, for most women the benefits of estrogen plus progestin do not outweigh the risks.
Estrogen plus progestin does not decrease— and may actually increase—the incidence of dementia, mild cognitive impairment, and cognitive dysfunction in elderly postmenopausal women. The effect of unopposed estrogen on these outcomes is still unknown. With these new findings and the recently reported results of the Women’s Health Initiative, for most women the benefits of estrogen plus progestin do not outweigh the risks.
Estrogen plus progestin does not decrease— and may actually increase—the incidence of dementia, mild cognitive impairment, and cognitive dysfunction in elderly postmenopausal women. The effect of unopposed estrogen on these outcomes is still unknown. With these new findings and the recently reported results of the Women’s Health Initiative, for most women the benefits of estrogen plus progestin do not outweigh the risks.
Hawthorn extract improves chronic heart failure
Based on the findings of this meta-analysis, hawthorn extract can be recommended as an adjunctive therapy to improve the physical performance and ameliorate heart failure–related symptoms of patients with chronic heart failure. It should not replace standard therapy.
The most effective dose is unknown, but these studies used 160–1800 mg/d. Longterm data on hawthorn extract’s impact upon prognosis is still lacking.
Based on the findings of this meta-analysis, hawthorn extract can be recommended as an adjunctive therapy to improve the physical performance and ameliorate heart failure–related symptoms of patients with chronic heart failure. It should not replace standard therapy.
The most effective dose is unknown, but these studies used 160–1800 mg/d. Longterm data on hawthorn extract’s impact upon prognosis is still lacking.
Based on the findings of this meta-analysis, hawthorn extract can be recommended as an adjunctive therapy to improve the physical performance and ameliorate heart failure–related symptoms of patients with chronic heart failure. It should not replace standard therapy.
The most effective dose is unknown, but these studies used 160–1800 mg/d. Longterm data on hawthorn extract’s impact upon prognosis is still lacking.
Antioxidant vitamins do not prevent cardiovascular disease
This meta-analysis of randomized controlled trials showed that neither beta-carotene nor vitamin E appears to prevent all-cause or cardiovascular mortality in patients with known heart disease or those at risk for heart disease. Similarly, use of these antioxidant vitamins did not affect number of stroke events. The use of beta-carotene and vitamin E should not be recommended for primary and secondary prevention of cardiovascular disease.
This meta-analysis of randomized controlled trials showed that neither beta-carotene nor vitamin E appears to prevent all-cause or cardiovascular mortality in patients with known heart disease or those at risk for heart disease. Similarly, use of these antioxidant vitamins did not affect number of stroke events. The use of beta-carotene and vitamin E should not be recommended for primary and secondary prevention of cardiovascular disease.
This meta-analysis of randomized controlled trials showed that neither beta-carotene nor vitamin E appears to prevent all-cause or cardiovascular mortality in patients with known heart disease or those at risk for heart disease. Similarly, use of these antioxidant vitamins did not affect number of stroke events. The use of beta-carotene and vitamin E should not be recommended for primary and secondary prevention of cardiovascular disease.
Tapering inhaled steroids effective for chronic asthma
Chronic stable asthma patients who use at least 1000 μg beclomethasone or its equivalent daily may reduce their dose of inhaled corticosteroids by as much as 50% without compromising control of symptoms.
Chronic stable asthma patients who use at least 1000 μg beclomethasone or its equivalent daily may reduce their dose of inhaled corticosteroids by as much as 50% without compromising control of symptoms.
Chronic stable asthma patients who use at least 1000 μg beclomethasone or its equivalent daily may reduce their dose of inhaled corticosteroids by as much as 50% without compromising control of symptoms.
Ginkgo ineffective for tinnitus
Although the results of published trials are inconsistent, Ginkgo biloba is probably not effective for the treatment of tinnitus. Positive results of earlier small studies with serious methodological limitations are not supported by larger, more rigorous trials. However, the lack of any established pharmacological treatment for chronic tinnitus, combined with ginkgo’s excellent safety profile, make it an option for patients who desire to try it.
Although the results of published trials are inconsistent, Ginkgo biloba is probably not effective for the treatment of tinnitus. Positive results of earlier small studies with serious methodological limitations are not supported by larger, more rigorous trials. However, the lack of any established pharmacological treatment for chronic tinnitus, combined with ginkgo’s excellent safety profile, make it an option for patients who desire to try it.
Although the results of published trials are inconsistent, Ginkgo biloba is probably not effective for the treatment of tinnitus. Positive results of earlier small studies with serious methodological limitations are not supported by larger, more rigorous trials. However, the lack of any established pharmacological treatment for chronic tinnitus, combined with ginkgo’s excellent safety profile, make it an option for patients who desire to try it.
Neuraminidase inhibitors slightly beneficial for shortening flu symptoms
Oseltamivir (Tamiflu) and zanamivir (Relenza) are effective for reducing the duration of symptoms of influenza by about 1 day when given to healthy individuals aged <65 years, and if given early in the course of the disease. Benefit to individuals aged >65 years and those with chronic medical conditions were not established.
Important outcomes, such as prevention of death and hospitalization due to influenza, were not discussed. No head-to-head trials were included, and these drugs could be considered interchangeable. Patients in the studies had laboratory confirmation of influenza, something that is not always done in general practice.
Given that these drugs are expensive (about $60 for a typical course), routine use for all flu patients may not be cost-effective. Rather, balancing the cost of treatment against risks and benefits need to be individualized. Use of these drugs should not replace primary prevention strategies.
Oseltamivir (Tamiflu) and zanamivir (Relenza) are effective for reducing the duration of symptoms of influenza by about 1 day when given to healthy individuals aged <65 years, and if given early in the course of the disease. Benefit to individuals aged >65 years and those with chronic medical conditions were not established.
Important outcomes, such as prevention of death and hospitalization due to influenza, were not discussed. No head-to-head trials were included, and these drugs could be considered interchangeable. Patients in the studies had laboratory confirmation of influenza, something that is not always done in general practice.
Given that these drugs are expensive (about $60 for a typical course), routine use for all flu patients may not be cost-effective. Rather, balancing the cost of treatment against risks and benefits need to be individualized. Use of these drugs should not replace primary prevention strategies.
Oseltamivir (Tamiflu) and zanamivir (Relenza) are effective for reducing the duration of symptoms of influenza by about 1 day when given to healthy individuals aged <65 years, and if given early in the course of the disease. Benefit to individuals aged >65 years and those with chronic medical conditions were not established.
Important outcomes, such as prevention of death and hospitalization due to influenza, were not discussed. No head-to-head trials were included, and these drugs could be considered interchangeable. Patients in the studies had laboratory confirmation of influenza, something that is not always done in general practice.
Given that these drugs are expensive (about $60 for a typical course), routine use for all flu patients may not be cost-effective. Rather, balancing the cost of treatment against risks and benefits need to be individualized. Use of these drugs should not replace primary prevention strategies.
Frequency of Symptoms and Clinical Diagnoses Among the "Chosin Few"
Oral topiramate effective for alcoholism
Oral topiramate is effective in the treatment of alcohol dependence. Patients taking topiramate consumed less alcohol, had fewer heavy drinking days, and had more days abstinent within a 12-week period. This medication adds a significant adjunct to our current treatment of alcoholism and can be considered for use in treating those alcoholics who desire sobriety.
Oral topiramate is effective in the treatment of alcohol dependence. Patients taking topiramate consumed less alcohol, had fewer heavy drinking days, and had more days abstinent within a 12-week period. This medication adds a significant adjunct to our current treatment of alcoholism and can be considered for use in treating those alcoholics who desire sobriety.
Oral topiramate is effective in the treatment of alcohol dependence. Patients taking topiramate consumed less alcohol, had fewer heavy drinking days, and had more days abstinent within a 12-week period. This medication adds a significant adjunct to our current treatment of alcoholism and can be considered for use in treating those alcoholics who desire sobriety.
Warfarin started at 10 mg achieves therapeutic INR faster than 5 mg
Starting warfarin with 10 mg rather than 5 mg achieves a therapeutic international normalized ratio (INR) >1.9 one day earlier (4.2 vs 5.6 days) in selected outpatients at low risk for major bleeding complications with confirmed acute venous thromboembolism.
This strategy saves the time and expense of 1 daily INR determination, and it may decrease the number of days that low-molecular-weight heparin is required by 1 day— although all patients in this study, due to the nature of the design, received a minimum of 5 days of low-molecular-weight heparin.
No conclusions regarding differences in safety or efficacy between the 10-mg and 5-mg nomogram can be drawn from the results of this study, as it was underpowered to detect differences in these important endpoints.
Starting warfarin with 10 mg rather than 5 mg achieves a therapeutic international normalized ratio (INR) >1.9 one day earlier (4.2 vs 5.6 days) in selected outpatients at low risk for major bleeding complications with confirmed acute venous thromboembolism.
This strategy saves the time and expense of 1 daily INR determination, and it may decrease the number of days that low-molecular-weight heparin is required by 1 day— although all patients in this study, due to the nature of the design, received a minimum of 5 days of low-molecular-weight heparin.
No conclusions regarding differences in safety or efficacy between the 10-mg and 5-mg nomogram can be drawn from the results of this study, as it was underpowered to detect differences in these important endpoints.
Starting warfarin with 10 mg rather than 5 mg achieves a therapeutic international normalized ratio (INR) >1.9 one day earlier (4.2 vs 5.6 days) in selected outpatients at low risk for major bleeding complications with confirmed acute venous thromboembolism.
This strategy saves the time and expense of 1 daily INR determination, and it may decrease the number of days that low-molecular-weight heparin is required by 1 day— although all patients in this study, due to the nature of the design, received a minimum of 5 days of low-molecular-weight heparin.
No conclusions regarding differences in safety or efficacy between the 10-mg and 5-mg nomogram can be drawn from the results of this study, as it was underpowered to detect differences in these important endpoints.
MR angiography effective for diagnosing carotid artery stenosis
Magnetic resonance angiography (MRA) is better than duplex ultrasound for diagnosing severe (70%–99%) carotid artery stenosis. Both tests are highly accurate for diagnosing total carotid artery occlusion.
Whether this advantage translates into improved patient outcomes is not known. While cost was not addressed in this study, MRA is 2 to 3 times more expensive than duplex ultrasound.
If cost and effectiveness data support these results, then MRA and duplex ultrasound might replace digital subtraction angiography for carotid artery surgery selection.
Magnetic resonance angiography (MRA) is better than duplex ultrasound for diagnosing severe (70%–99%) carotid artery stenosis. Both tests are highly accurate for diagnosing total carotid artery occlusion.
Whether this advantage translates into improved patient outcomes is not known. While cost was not addressed in this study, MRA is 2 to 3 times more expensive than duplex ultrasound.
If cost and effectiveness data support these results, then MRA and duplex ultrasound might replace digital subtraction angiography for carotid artery surgery selection.
Magnetic resonance angiography (MRA) is better than duplex ultrasound for diagnosing severe (70%–99%) carotid artery stenosis. Both tests are highly accurate for diagnosing total carotid artery occlusion.
Whether this advantage translates into improved patient outcomes is not known. While cost was not addressed in this study, MRA is 2 to 3 times more expensive than duplex ultrasound.
If cost and effectiveness data support these results, then MRA and duplex ultrasound might replace digital subtraction angiography for carotid artery surgery selection.