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Old September 24th, 2001, 20:38
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1999.10.31 Primary Care Pearls

MEDICAL TREATMENT OF LOW RISK CAD EFFECTIVE. In patients with stable, single vessel coronary artery disease, and a LVEF of > 39%, aggressive lipid lowering therapy was found to be as effective as angioplasty in terms of reducing subsequent cardiac ischemic events. Pitt B et al. NEJM 1999;341(Jul 8):70.

BREAST-FEEDING REDUCES OBESITY. Breast-feeding for 3 to 5 months compared with not breast-feeding at all, lowered the rate of childhood obesity at age 5 to 6 years old. Obesity was defined as a body mass index (BMI) above the 97th percentile for age. Rates of obesity were as follows: Never breast-fed (4.5%), less than 3 months (3.8%), 3 to 5 months (2.3%), 6 to 12 months (1.7%), and over 12 months (0.8%). 9357 children living in southern Germany were studied. Breast-feeding made it 25% less likely that a child would be obese at 5 to 6 years of age. von Kries R et al. BMJ 1999(Jul 17);319:147.

WEIGHT LOSS STRATEGIES FLAWED. In this study of 107804 adult US men and women, 30% to 40% were actively trying to lose weight. The most common strategy was to reduce dietary fat intake, but not reduce overall calories and not increase activity-- clearly an ineffective strategy (in order to lose weight either calories must be reduced, activity increased, or both). The results suggest a fundamental misunderstanding of how to lose weight among this population. Serdula MK et al. JAMA 1999;282:1353.

HOME BP MEASUREMENTS USUALLY ACCURATE. In this study of 54 adults, home blood pressure measurements were accurate 3 out of 4 times. Physicians should encourage patients to take their blood pressures at home. Battegay E et al. BMJ 1999;319:1172.

EXERCISE EFFECTIVE TREATMENT FOR LOW BACK PAIN. This study of 187 patients, aged 18 - 60 years old, found that exercise decreased pain and disability after the acute onset of non-traumatic back pain. Moffett JK et al. BMJ 1999;319:279.

PNEUMONIA DOUBLES MORTALITY RATE. In a study of 4167 people over 60 years old, those patients who had initially survived a bout of community acquired pneumonia were twice as likely to die during the follow-up period of 12 years. The authors concluded that preventive measures such as a flu shot and pneumococcal vaccination are especially important in this age group. Koivula I et al. Arch Intern Med 1999;159:1550.

HYPERBARIC OXYGEN NOT HELPFUL IN CARBON MONOXIDE POISONING. Going against standard practice, this study found that hyperbaric oxygen not only doesn't help treat, but may be harmful in patients with carbon monoxide poisoning. Normal pressure high flow oxygen worked better than the hyperbaric oxygen in this randomized, double-blind study of 191 patients. Scheinkestel CD et al. Med J Australia 1999;170:203.
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