Efficacy of nonsteroidal anti-inflammatory drugs in the treatment of acute renal colic. A meta-analysis.

OBJECTIVE: To evaluate the efficacy of nonsteroidal anti-inflammatory drugs (NSAIDs) compared with placebo or analgesic agents in the treatment of acute renal colic. DATA SOURCES: The MEDLINE and EMBASE databases were searched using the following terms: anti-inflammatory agent, colic, kidney diseases, and ureteral diseases. The Family Medicine Library Index, references of retrieved articles, and documentation centers of pharmaceutical companies were also consulted. STUDY SELECTION: Among 60 retrieved articles, 19 were selected by consensus of a group of four physicians, based on the following criteria: randomized controlled trials, NSAID compared with placebo or analgesic agent in the treatment of acute renal colic, and articles written in either French or English. DATA EXTRACTION: Independent data extraction by four evaluators using a 20-item checklist. Final assessment was by group consensus. DATA SYNTHESIS: The 19 articles presented 20 studies, most comparing parenteral diclofenac or indomethacin (18 of 20) with placebo (n = 4) or analgesic agents (n = 16), most of which were narcotic agents. The results of pain relief 20 to 30 minutes after drug administration were pooled using the Mantel-Haenszel method for three distinct groups of studies: (1) NSAIDs vs placebo (n = 4): relative risk (RR), 2.34 (95% confidence interval [CI], 1.79 to 3.07); (2) NSAIDs vs analgesic agents, partial pain relief (n = 9): RR, 1.07 (95% CI, 1.02 to 1.12); and (3) NSAIDs vs analgesic agents, complete pain relief (n = 9): RR, 1.19 (95% CI, 1.03 to 1.37). CONCLUSIONS: Parenteral NSAIDs are more effective than placebo and as effective as analgesic agents in the treatment of acute renal colic.

[Can physicians efficaciously promote the purchase of bicycle helmets?]. / Les médecins, peuvent-ils efficacement promouvoir l'achat de casques de vélo?

OBJECTIVE: To evaluate the effectiveness of physician intervention in the purchase of bicycle helmets. DESIGN: Randomized single-blind controlled trial; randomization by clusters. SETTING: July 11, 1992, cycling path in Beauport, Quebec. PARTICIPANTS: Non-helmeted cyclists riding alone and groups of two to six cyclists in which at least one member was not wearing a helmet were invited to participate in the study; 274 individuals or groups of cyclists (total n = 485 cyclists) were randomized for the study. INTERVENTION: For the study group a physician handed out and explained the Canadian Medical Association's (CMA) pamphlet on bicycle helmets. This pamphlet includes a discount coupon for the purchase of a helmet. All of the participants in both the study group and the control group completed a questionnaire, including queries about sociodemographic characteristics, name, and telephone number. MAIN OUTCOME MEASURE: Proportion of previously non-helmeted cyclists purchasing a helmet within 2 to 3 weeks of the intervention. RESULTS: Telephone contact was made with 340 of the 416 non-helmeted cyclists (from 224 groups of cyclists). Of the 174 cyclists who had received a CMA pamphlet, 13.8% (n = 24) had purchased a helmet, compared to 3.0% (n = 5) of the 166 control group cyclists (RR = 4.6, 95% CL = 1.8-11.7). Similar results were achieved by cluster analysis of cyclists. CONCLUSION: Physician intervention using the CMA pamphlet could be effective in promoting the purchase of bicycle helmets.

[Interobserver reliability of a portable tympanometer, the MicroTymp]. / Reproductibilité interobservateur d'un tympanomètre portatif, le MicroTymp.

OBJECTIVE: To determine the interobserver reliability of tympanograms obtained with the MicroTymp, a portable tympanometer. SETTING: Family medicine teaching unit in a tertiary care hospital. PATIENTS: Thirty-three patients who presented to the ear, nose and throat clinic in August 1990 for an ear problem. INTERVENTION: Three residents in family medicine independently attempted to record with the MicroTymp one tympanogram for the 66 ears. We excluded the results for seven ears for which tympanograms could not be obtained. MAIN OUTCOME MEASURE: Using objective criteria, two family physicians and two residents in family medicine independently classified the 177 tympanograms into five categories (normal, possible effusion, possible perforation, possible tympano-ossicular dysfunction and unclassifiable). Reliability was estimated by means of the kappa (kappa) coefficient on 161 tympanograms from 59 ears for which the interpretation of the three tympanograms agreed. MAIN RESULTS: The interpretation of the three tympanograms agreed for 34 of the 59 ears (0.58) (kappa = 0.52, 95% confidence limits 0.45 and 0.59). There was no significant difference in interobserver reliability between pairs of observers or between symptomatic and asymptomatic ears. CONCLUSIONS: The interobserver reliability of the MicroTymp is moderate. The tympanograms obtained with the instrument should be interpreted in the context of the clinical findings.

L'ABC de la supervision clinique par discussion de cas.

Beginning with a review of the literature and a survey of instructors in family medicine, the authors show that supervision through case discussions is one of the least studied teaching tools in medicine, even though it is one of the most frequently used. On the basis of individual and collective consideration, they suggest the basic elements that seem to be requisite to this type of teaching activity: clarification of the aims of the supervisor and the resident by means of a verbal contract; a method of practice based on a clinical approach; provision of several examples of problems and various strategies for raising or solving problems.