Recommended reading this week is A Walk in the Woods: Rediscovering America on the Appalachian Trail
This is a fascinating story of the Appalation Trail. Great reading, especially if it inspires you to go on a walk!
Recommended listening this week is Alan Parsons On Air
This is a very relaxing album, and a significant advance from his previous works. I initially approached this album with some trepidation--thinking that Alan Parsons had burned out, and had nothing new or better left. Was I wrong. You'll like this album, and its positive message will help your spirit--and improve your health!
Now for the Medical Pearls...
Once daily amoxicillin was as effective as TID penicillin in the treatment of streptococcal pharyngitis. Feder HM et al. Pediatrics JAN 1999;0103115:0047.
Attending religious services was shown to decrease mortality among the 2025 people in this study. Oman D et al. Am J Pub Health 1998;0088:1469.
Most women with estrogen deficiency (e.g. post-menopausal) are unaware that they have osteoporosis. Of 2314 women studied, 93% of those with osteoporosis were unaware they had it. CDC. MMWR 1998;0047:0969.
In this study of 3686 family physicians, those with evidence of greater medical knowledge were sued more often. This challenges the assumption that being sued for malpractice is associated with incompetence. The opposite actually appears to be true. Ely JW et al. J Fam Pract JAN 1999;0048:0023.
For adults with attention-deficit hyperactivity disorder (ADHD), both stimulant medications (e.g. Ritalin) and antidepressant medications (e.g. desipramine) are equally effective. Higgins ES. J Fam Pract JAN 1999;0048:0015.
In this meta-analysis of 7 studies enrolling 550 patients, patching corneal abrasions was not helpful, and in fact NOT patching the eye tending to be associated with less pain and better healing. Flynn CA et al. J Fam Pract 1998;0047:0264.
In this study of 434 children with an acute severe asthma attack, adding ipratropium bromide (Atrovent) to the standard albuterol nebulizer treatment was associated with a lower rate of hospital admission. The NNT is 6.6 to prevent 1 admission. Qureshi F et al. N Engl J Med 1998;0339:1030.
The D-dimer test is highly sensitive in detecting a deep venous thrombus, and thus a negative D-dimer test is very helpful in excluding the disease. The negative predictive value of a normal ultrasound combined with a normal D-dimer test was 99.8% Bernardi F. BMJ 1998;0317:1037.
In this study of 235 men and women, increasing daily "lifestyle" physical activity (e.g. gardening, housework) was as effective as a structured exercise program in lowering blood pressure and reducing the percent of body fat. Dunn AL et al. JAMA JAN 27 1999;0281:0327.
In this study of 40 obese women, increasing lifestyle activity (e.g. housework, gardening) was as effective as participating in a sturctured exercise program in losing weight, keeping the weight off for at least 1 year, and lowering cholesterol. Andersen RE et al. JAMA JAN 27 1999;0281:0335.
This editorial emphasizes that increasing physical activity--either through lifestyle or a structured exercise program--produces real health benefits. The key point is that physical activity of any type works. Pratt MP. JAMA JAN 27 1999;0281:0375.
In this record review of 200,000 patients with a heart attack, only 34% received a beta blocker at the time of hospital discharge; it was estimated that 19,000 deaths could have been prevented if beta blockers had been more widely used. Gottlieb SS et al. N Engl J Med AUG 1998;0339:0489.
White coat hypertension (high blood pressure induced by the stress of being in the doctor's office) cannot be considered a benign condition--in this study of 1677 men and women, those with white coat hypertension had a greater left ventricular mass. Muscholl et al. BMJ AUG 29 1998;0317:0565.
In this study of 115015 people over age 65 after a heart attack, 45308 were considered candidates for beta blocker therapy, but only 50% of these actually got beta blockers. The use of beta blockers was associated with a 14% lower mortality. Krumholz HM et al. JAMA AUG 19 1998;0280:0623.