Tuesday, August 4, 2015

Urinary Tract Prophylaxis: An Underpowered Trial with No Conclusions

Randomized trials are great, provided they are well designed. Some flaws in this study pretty much guaranteed we wouldn't learn much from it.

Source: Lee SJ, Lee JW. Probiotics prophylaxis in infants with primary vesicoureteral reflux. Pediatr Nephrol. 2015;30(4):609-613; doi:10.1007/s00467-014-2988-z. See AAP Grand Rounds commentary by Dr. Pamela Singer (subscription required). 

PICO Question: Among children aged 1 week to 12 months with primary vesicoureteral reflux, what is the incidence of recurrent urinary tract infection with probiotic prophylaxis compared to antibiotic prophylaxis?
Question type: Intervention
Study type: Randomized trial

Saturday, August 1, 2015

It's Heating Up for August's AAP Grand Rounds

We are nearing the end of summer, and the AAP Grand Rounds August edition is out with some hot topics, including a look at changes in pneumococcal disease after the 13-valent vaccine came into use, maternal smoking and heart defects, childhood pneumonia links to lung function in adults, and much more.

This month's issue provided me with an opportunity to look at 4 randomized controlled trials (RCTs), covering hypothermia for cardiac arrest, school lunches, tendon transfer procedures, and probiotics as UTI prophylaxis. Join me each week, and you'll see that not all RCTs are created equal.

Tuesday, July 28, 2015

Jousting Guidelines for Teenage Statin Use: Which is Correct?

I love a good controversy, and pharmacologic treatment of elevated low-density lipoprotein cholesterol (LDL-C) definitely qualifies as one. The long-term health of billions of individuals world-wide is at stake, not to mention the billions of dollars pouring into the pharmaceutical industry.

Source: Gooding HC, Rodday AM, Wong JB, et al. Application of pediatric and adult guidelines for treatment of lipid levels among US adolescents transitioning to young adulthood. JAMA Pediatrics 2015; 169(6):569-74. doi:10.1001/jamapediatrics.2015.0168. See AAP Grand Rounds commentary by Dr. Charlene Wong (subscription required).

PICO Question: Among adolescents and young adults 17-21 years old, what proportion meet criteria for pharmacologic treatment of elevated low-density lipoprotein cholesterol under pediatric versus adult dyslipidemia guidelines?
Question type: Descriptive
Study design: Cross-sectional survey

Tuesday, July 21, 2015

Another Downside for Maternal Obesity/Diabetes in Pregnancy?

Drs. Ross and Kasper state in their AAP Grand Rounds commentary that "fatty liver disease has become an epidemic of the 21st century." Is it possible this condition has its origins during fetal life?

Source: Patel KR, White FV, Deutsch GH. Hepatic steatosis is prevalent in stillborns delivered to women with diabetes mellitus. J Pediatr Gastroenterol Nutr. 2015;60(2):152-158; doi:10.1097/MPG.0000000000000520. See AAP Grand Rounds commentary by Drs. Albert Ross and Vania Kasper (subscription required). 

PICO Question: Among autopsied stillborn infants, is there an association between neonatal fatty liver disease and maternal diabetes?
Question type:  Causation
Study design: Retrospective Cohort

Tuesday, July 14, 2015

All Terrain Vehicles - Patterns of Use Spell Disaster

Right after I received the advance list from AAP Grand Rounds about the July issue contents, I saw a man riding a bicycle with an approximately 18 month old child sitting on the top tube of the frame, sort of held between the man's (his father's?) legs. At that point, I knew I needed to comment on this article.

Source: Shults RA, West BA. ATV riding and helmet use among youth aged 12-17 years, USA, 2011: results from the YouthStyles survey. InjPrev. 2015;21(1):10-14; doi:10.1136/injuryprev-2013-041138. See AAP Grand Rounds commentary by Dr. Eliot Nelson (subscription required).

PICO Question: Among US youth 12-17 years old, what proportion report having ridden an all-terrain vehicle in the year, and what are their patterns of helmet use?
Question type: Descriptive
Study design: Cross-sectional survey

Tuesday, July 7, 2015

Did You Miss Out on the Barker Hypothesis? I Did.

I certainly learn something new every day, but from time to time I run across an entire topic I think I should have been more familiar with. Such is the case with the Barker Hypothesis, aka Thrifty Phenotype Hypothesis. Read on.

Source: Kotecha SJ, Watkins WJ, Henderson AJ, et al. The effect of birth weight on lung spirometry in white, school-aged children and adolescents born at term: a longitudinal population based observational cohort study. J Pediatr. 2015;166(5):1163-1167; doi:10.1016/j.jpeds.2015.01.002. See AAP Grand Rounds commentary by Dr. Shelley Springer (subscription required).

PICO Question: Among children and adolescents who had been born at term, is lower birth weight associated with decreased lung function?
Question type: Causation
Study design: Prospective cohort

Wednesday, July 1, 2015

A Hot July for AAP Grand Rounds and Me

Greetings and a premature Happy 4th of July! This month's issue of AAP Grand Rounds has a number of interesting commentaries on articles I just couldn't fit into the blog this month: osteoarthritis in ex-premature infants, heath effects of prenatal exposure to air pollutants, herd immunity with rotavirus immunization, and a review of population-based cohort studies, among others.

In Evidence eMended this month, I'll be covering the long-term effects of term infant birth weight on lung spirometry in later life, trends in all-terrain vehicle riding and safety, fetal hepatic steatosis associated with maternal diabetes mellitus, and, my favorite this month, dueling dyslipidemia guidelines for adolescents and young adults.

I hope you can join me online.

Tuesday, June 30, 2015

Debunking Sunscreen Myths

June is one of those fortuitous (for me) months with 5 Tuesdays, meaning I allow myself one free rant on the final Tuesday, not necessarily tied to AAP Grand Rounds reviews. This fifth Tuesday's rhapsody, however, has a tie to my review a few weeks ago regarding sunscreen use. Shortly after I wrote the review, an article appeared in the Washington Post debunking 5 "myths" about sunscreen. It was well written and seemingly well researched; I even learned to pay more attention to expiration dates on the sunscreen containers.

However, the article had no references, and, as loyal readers would perhaps predict of me, I felt compelled to find the quality of evidence behind the 5 myths.* First, I went to the online version of the article, and that turned out to be a treasure trove of background information. In all I found 21 hyperlinks to various sources. I went through them all to see how solid the "evidence" was and whether the myths truly were discredited.
Be familiar with 2011 FDA sunscreen labeling rules.
From Bluerasberry via Wikimedia

Of the 21 links, only 4 directly linked to original articles published in the scientific literature. Two were purely basic-science oriented and not applicable directly to human medicine, though I was intrigued to know that the red "sweat" of the hippopotamus has sunscreen properties. Of the other 2 original articles, 1 was a review, more or less equivalent to a book chapter, and the other I might generously call a systematic review of sun care advertising in popular US magazines. The remaining 17 were online commentaries of varying degrees of quality (sort of like this blog?). Some originated from medical or scientific web sites: Skin Cancer Foundation, American Academy of Dermatology, WebMD, and Chemical & Engineering News; further investigation from these sites usually led to high-quality original sources but took a lot of time, Most links in the Post article, however, were from non-scientific media: 3 from the Washington Post itself, 1 from National Public Radio, 1 from the National Weather Service (well, maybe that's a bit scientific), 1 from US News and World Report, and 1 from Dr. Oz (if you're thinking I should put Dr. Oz in the medical or scientific web site category, read my appraisal of the Dr. Oz show, which was actually much too kind to him).

Ultimately I think the Post article was pretty much on target, but it took a lot of work to get to the origins of some of the evidence. I was thinking it would have been nice to provide links more directly useful to all types of consumers.

And, next time you're out of sunscreen, try rubbing up against a friendly hippo.

*The 5 myths mentioned in the Post article, which in my opinion were effectively debunked and therefore are false, are
1. You need sunscreen only on sunny days.
2. The SPF is what matters.
3. Darker-skinned people have less need for sunscreen.
4. That old bottle is just fine.
5. Sunscreen is toxic.

  © Blogger template Shush by Ourblogtemplates.com 2009

Back to TOP