Tuesday, October 21, 2014

Osteopathic Treatment for Ear Infection: Expanding the Evidence Base

It's extremely difficult to show conclusively that any treatment helps a condition with a very high spontaneous resolution rate, and acute otitis media is such an example. This study represents a first step towards resolving the question of whether osteopathic manipulation offers some benefit.

Source: Steele KM, Carreiro, JE, Viola JH, et al. Effect of osteopathic manipulative treatment on middle ear effusion following acute otitis media in young children: a pilot study. J Am Osteopath Assoc. 2014;114(6):436-447; doi:10.7556/jaoa.2014.094. See AAP Grand Rounds commentary by Dr. Robert Lee (subscription required). 

PICO Question: Among young children with acute otitis media and an abnormal tympanogram, does osteopathic manipulative treatment hasten resolution of middle ear effusion?
Question type: Intervention

Study design: Randomized controlled 

Tuesday, October 14, 2014

Another Failed Attempt to Legislate Healthy Fast Food?

I think I had forgotten about San Francisco's 2010 ordinance to push restaurants to set healthy nutrition standards for children's meals. Here's an interesting study with a design we don't often cover in these pages.

Source: Otten JJ, Saelens BE, Kapphahn KI, et al. Impact of San Francisco’s toy ordinance on restaurants and children’s food purchases. 2011-2012. Prev Chronic Dis. 2014; 11:E122. doi:10.5888/pcd11.140026. See AAP Grand Rounds commentary by Dr. Shelley Springer (subscription required).

PICO Question: Among children eating at fast food restaurants, do nutritional regulations positively impact their nutrition?
Question type: Intervention
Study design: Pre-post survey

Tuesday, October 7, 2014

Parasites: They're Not All Bad

Most clinicians I think would prefer to forget those agonizing parasite quizzes in medical school. In the US most primary care providers only deal with a few parasitic diseases at most, and it's hard to remember details for the others. So, I suspect receipt of a positive ova and parasite exam for Dientamoeba fragilis would send you scurrying to the books. Unfortunately, it's not always that simple.

Source: Röser D, Simonsen J, Stensvold CR, et al. Metronidazole therapy for treating dientamoebiasis in children is not associated with better clinical outcomes: a randomized, double-blinded and placebo-controlled clinical trial. Clin Infect Dis. 2014;58(12):1692-1699; doi:10.1093/cid/ciu188. See AAP Grand Rounds commentary by Dr. Rebecca Brady (subscription required).

PICO Question: Among children with Dientamoeba fragilis infection and chronic gastrointestinal symptoms, does metronidazole therapy improve clinical outcomes?
Question type: Intervention
Study design: Randomized controlled

Monday, October 6, 2014

On Deck for October

My apologies, I've been so busy I didn't even know a new month was upon us and forgot to send this announcement to the blog site.

Just a reminder about the latest AAP Grand Rounds edition, with discussion on pertussis vaccination, long-term sequelae of being a "cool kid," (I never had to worry about that!), celiac disease, and more.

This month in Evidence eMended, I hope to pique your interest on the outcome of a unique food ordinance in San Francisco, osteopathic manipulation for middle ear effusion, treatment of one of those intestinal parasites you always need to look up, and an ethical look at what is meant by "the best interests of the child."

Please join me!

Tuesday, September 30, 2014

Evidence as a Moving Target - Ebola and Enterovirus D68

One of the most difficult tasks in medical practice is keeping current. EBM is all about interpreting and using new information to inform patient choices, and clinicians should be very familiar with changing practice as better information unfolds. But what about when conditions change so quickly that we don't have time to publish, much less read, clinical trials? I've had to practice EBM-MT a lot lately.

Tuesday, September 23, 2014

Biliary Atresia and the Evidence Pyramid

Are randomized controlled trials always the best form of evidence? Of course not, and this study on steroids in biliary atresia provides a good opportunity to discuss one of most controversial and misunderstood principles of evidence-based medicine.

Source: Bezerra JA, et al. Use of corticosteroids after hepatoportoenterostomy for bile drainage in infants with biliary atresia: the START randomized clinical trial. JAMA.2014;311(17):1750-1759; doi:10.1001/jama.2014.2623. See AAP Grand Rounds commentary by Drs. Michael Herzlinger and Neil LeLeiko (subscription required).

PICO Question: Among infants with biliary atresia, who have the Kasai hepatoportoenterostomy, does treatment with post-operative steroids result in improved outcomes compared with placebo?
Question type: Intervention
Study design: Prospective randomized controlled

Tuesday, September 16, 2014

The Poetry of Flu and Pneumococcus

Very few research studies provide strong enough evidence to change how we provide care. However, studies falling short of that measure still can be of high quality and be noteworthy. This study is an example of one that fails the "POEM" test but should be of interest to primary care providers.

Source: Grijalva CG, Griffin MR, Edwards KM, et al. The role of influenza and parainfluenza infections in nasopharyngeal pneumococcal acquisition among young children. Clin Infect Dis. 2014;58(10):1369-1376; doi:10.1093/cid/ciu148. See AAP Grand Rounds commentary by Dr. Rebecca Brady (subscription required).

PICO Question: Among children younger than 3 years old does a viral acute respiratory illness (ARI) result in increased risk of nasopharyngeal acquisition of Streptococcus pneumoniae compared to absence of ARI?
Question type: Occurrence
Study design: Prospective case control

Tuesday, September 9, 2014

Balancing Radiation Risk and Accuracy in Cranial Imaging

The authors of this study chose what I think is an unusual study design: a non-inferiority analysis of a retrospective patient group. It seems like a recipe for biased results, but let's dig a little deeper.

Source: Boyle TP, Paldino M, Amir A, et al. Comparison of rapid cranial MRI to CT for ventricular shunt malfunction. Pediatrics. 2014;134(1):e47-e54; doi:10.1542/peds.2013-3739. See AAP Grand Rounds commentary by Dr. Harris Cohen (subscription required).

PICO Question: Among children evaluated for possible ventricular shunt malfunction, is rapid cranial MRI as accurate as CT?
Question type: Diagnosis
Study design: Retrospective cohort

  © Blogger template Shush by Ourblogtemplates.com 2009

Back to TOP