AFP DEPARTMENT COLLECTION

Cochrane for Clinicians

These are summaries of reviews from the Cochrane Library.

Dec 1, 2016 Issue
Impact of Exercise-Based Cardiac Rehabilitation
Exercise-based cardiac rehabilitation reduces cardiovascular mortality and hospitalization. There is no evidence that it reduces the rates of total mortality, myocardial infarctions, coronary artery bypass grafts, or percutaneous coronary interventions.


Dec 1, 2016 Issue
Mini-Mental State Examination for the Detection of Dementia in Older Patients
When scores are adjusted based on a patient's education level, the MMSE may be useful to rule out a diagnosis of dementia in clinically unevaluated patients 65 years and older (sensitivity = 97%; specificity = 70%). Scores of less than 24 may also be useful to rule in dementia in patients 65 years and older (sensitivity = 85%; specificity = 90%).


Nov 1, 2016 Issue
The Risk of MI and Ischemic Stroke with Combined Oral Contraceptives
The overall risk of MI and ischemic stroke is increased in women who use combined oral contraceptives. The relative risk of MI and ischemic stroke increases as estrogen dose rises, increasing by 60% with doses of 20 mcg and more than doubling when doses of 50 mcg or more are used.


Nov 1, 2016 Issue
Amiodarone for the Prevention of Sudden Cardiac Death
Although not a substitute for an implantable cardioverter-defibrillator (ICD), amiodarone is effective for the primary prevention of sudden cardiac death when compared with placebo (number needed to treat [NNT] = 47; 95% confidence interval [CI], 33 to 100), but it does not significantly lower all-cause mortality in those at high risk.


Oct 1, 2016 Issue
Selective Serotonin Reuptake Inhibitors for Fibromyalgia
SSRIs may have a small to moderate effect on pain (number needed to treat [NNT] = 10), global improvement (NNT = 7), and depression (NNT = 13) in patients with fibromyalgia, but the quality of evidence is very low because of bias and small studies. SSRIs do not reduce fatigue related to fibromyalgia.


Oct 1, 2016 Issue
Topical Tacrolimus for Eczema
For children and adults with moderate to severe eczema, topical tacrolimus is an effective, albeit costly, alternative to topical corticosteroids. Both tacrolimus strengths (0.03% and 0.1%) are superior to low-potency topical corticosteroids, whereas tacrolimus 0.1% has similar effectiveness to moderate- to high-potency topical corticosteroids. A mild, self-limited, local burning sensation is common with use.


Sep 1, 2016 Issue
Second-Generation H1-Antihistamines for Chronic Spontaneous Urticaria
There is good evidence that second-generation H1-antihistamines are helpful in the short- and intermediate-term suppression of urticaria. Cetirizine (Zyrtec) in a dosage of 10 mg daily is effective at completely suppressing symptoms of chronic spontaneous urticaria (number needed to treat [NNT] = 4).


Aug 1, 2016 Issue
Capsaicin for Nonallergic Rhinitis
Intranasal capsaicin is safe and effective for reducing symptoms of nonallergic rhinitis (number needed to treat = 4; 95% confidence interval [CI], 1 to 22). There is insufficient evidence to compare the effectiveness of capsaicin to other topical or systemic medications.


Aug 1, 2016 Issue
Acetaminophen for the Treatment of Pain in Newborns
Acetaminophen does not significantly reduce pain associated with heel lance, eye examinations, or assisted vaginal births in newborns. Acetaminophen may reduce the total amount of morphine a newborn needs in the first 48 hours following major abdominal or thoracic surgery.


Jul 1, 2016 Issue
Honey for Acute Cough in Children
For patients one to 18 years of age, providing honey for cough symptoms can reduce the frequency and severity of cough, as well as improve sleep for patients and parents, when compared with placebo or no treatment. Honey is no better than dextromethorphan for symptom control.


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