Asunto(s)
Delirio , Melatonina , Humanos , Melatonina/uso terapéutico , Delirio/prevención & control , HospitalesAsunto(s)
Analgesia Epidural , Humanos , Embarazo , Femenino , Analgesia Epidural/métodos , Analgesia Obstétrica/métodosAsunto(s)
Oxitócicos , Hemorragia Posparto , Embarazo , Femenino , Humanos , Hemorragia Posparto/prevención & control , OxitocinaRESUMEN
NO. In general, nonoral estrogen use for menopausal symptoms is associated with a lower cardiovascular (CV) risk profile than oral estrogen use (strength of recommendation [SOR], B; meta-analysis of cohort studies). Vaginal estrogen use is associated with lower risk for coronary heart disease (CHD) and similar risk for myocardial infarction (MI), stroke, and deep vein thrombosis/pulmonary embolism (DVT/ PE) compared with nonuse (SOR, B; cohort studies). Vaginal estrogen therapy also is associated with lower CV-related mortality for 3 to 5 years compared withnonuse (SOR, B; cohort study). No high-quality randomized trials address this topic.
Asunto(s)
Enfermedad Coronaria , Infarto del Miocardio , Embolia Pulmonar , Femenino , Humanos , Estudios de Cohortes , Estrógenos/efectos adversos , Infarto del Miocardio/inducido químicamente , Infarto del Miocardio/epidemiología , Factores de RiesgoAsunto(s)
Calcáneo , Osteocondritis/terapia , Adolescente , Niño , Humanos , Aparatos Ortopédicos , Dimensión del Dolor , ZapatosRESUMEN
It depends. A diagnosis of chronic obstructive pulmonary disease (COPD) made using screening spirometry in patients without symptoms does not change the course of the disease or alter smoking rates (strength of recommendation [SOR]: A, preponderance of evidence from multiple randomized controlled trials [RCTs]). However, once a patient develops symptoms of lung disease, a delayed diagnosis is associated with poorer outcomes (SOR: B, cohort studies). Active case finding (including the use of spirometry) is recommended for patients with risk factors for COPD who present with consistent symptoms (SOR: C, expert opinion).
Asunto(s)
Enfermedad Pulmonar Obstructiva Crónica , Humanos , Enfermedad Pulmonar Obstructiva Crónica/diagnóstico , Espirometría , Fumar/efectos adversos , Diagnóstico PrecozRESUMEN
YES. Long-term sodium bicarbonate therapy slightly slows the loss of renal function in patients with chronic kidney disease (CKD) and may moderately reduce progression to end-stage renal disease (strength of recommendation [SOR]: B, meta-analyses of lower-quality randomized controlled trails [RCTs]). Therapy duration of 1 year or less may not be beneficial (SOR: C, secondary analyses in meta-analyses).
Asunto(s)
Fallo Renal Crónico , Insuficiencia Renal Crónica , Bicarbonatos , Progresión de la Enfermedad , Femenino , Humanos , Fallo Renal Crónico/tratamiento farmacológico , Fallo Renal Crónico/prevención & control , Masculino , Insuficiencia Renal Crónica/tratamiento farmacológico , Bicarbonato de Sodio/uso terapéuticoRESUMEN
Evidence-Based Answer: Yes. Compared to the use of a transcervical balloon alone, combined cervical ripening with a balloon catheter and oxytocin shortens the time to overall delivery by 3 hours and the time to vaginal delivery by 4 hours, without altering the rate of cesarean section (strength of recommendation [SOR]: A, network meta-analysis). The effect is more pronounced in nulliparous patients (SOR: A, meta-analysis).When combined therapy is used, 6 hours of balloon time may result in faster delivery than 12 hours (SOR: B, single randomized controlled trial [RCT]). Fixed-dose oxytocin and titrated oxytocin appear to have similar effect when combined with a cervical ripening balloon (SOR: C, underpowered RCT).
Asunto(s)
Maduración Cervical , Oxitócicos , Cesárea , Femenino , Humanos , Trabajo de Parto Inducido , Oxitócicos/farmacología , Oxitócicos/uso terapéutico , Oxitocina/farmacología , Oxitocina/uso terapéutico , EmbarazoRESUMEN
Fairly accurate. Photometric transcutaneous bilirubin (TcB) testing may overestimate total serum bilirubin (TSB) in neonates with darker skin tones by a mean of 0.68 to > 2 mg/dL (strength of recommendation [SOR]: C, diagnostic cohort studies with differing reference standards).Overall, TcB meters retain accept able accuracy in infants of all skin tones across a range of bilirubin levels, despite being more likely to underestimate lighter skin tones and overestimate darker ones (SOR: C, diagnostic cohort studies with differing reference standards). It is unclear if the higher readings prompt an increase in blood draws or otherwise alter care.
Asunto(s)
Ictericia Neonatal , Humanos , Recién Nacido , Ictericia Neonatal/diagnóstico , Pigmentación de la Piel , Bilirrubina , Tamizaje Neonatal , Estudios de Cohortes , PielRESUMEN
Yes, a link has been established but not a cause-effect relationship. Shorter reported sleep duration in childhood is associated with an increased risk of overweight or obesity years later (strength of recommendation [SOR]: B, meta-analyses of prospective cohort trials with high heterogeneity). In toddlers, accelerometer documentation of short sleep duration is associated with elevation of body mass index (BMI) at 1-year follow-up (SOR: B, prospective cohort). Adequate sleep is recommended to help prevent excessive weight gain in children (SOR: C, expert opinion).
Asunto(s)
Obesidad Infantil , Trastornos del Sueño-Vigilia , Índice de Masa Corporal , Humanos , Sobrepeso/complicaciones , Obesidad Infantil/complicaciones , Obesidad Infantil/epidemiología , Estudios Prospectivos , Factores de Riesgo , Sueño , Privación de Sueño/complicaciones , Trastornos del Sueño-Vigilia/etiologíaRESUMEN
Likely yes. Point-of-care ultrasound (POCUS) screening for abdominal aortic aneurysm (AAA) by nonradiologist physicians is 98% sensitive and 99% specific, compared with imaging performed by radiologists (strength of recommendation [SOR]: B, meta-analysis of diagnostic accuracy studies mostly involving emergency medicine physicians). European family physicians demonstrated 100% concordance with radiologist readings (SOR: C, very small subsequent diagnostic accuracy studies).
Asunto(s)
Aneurisma de la Aorta Abdominal/diagnóstico , Competencia Clínica/normas , Tamizaje Masivo/normas , Médicos de Familia/normas , Sistemas de Atención de Punto/normas , Radiólogos/normas , Ultrasonografía/normas , Adulto , Anciano , Anciano de 80 o más Años , Competencia Clínica/estadística & datos numéricos , Humanos , Masculino , Tamizaje Masivo/estadística & datos numéricos , Persona de Mediana Edad , Médicos de Familia/estadística & datos numéricos , Sistemas de Atención de Punto/estadística & datos numéricos , Guías de Práctica Clínica como Asunto , Radiólogos/estadística & datos numéricos , Factores de Riesgo , Ultrasonografía/estadística & datos numéricos , Estados UnidosRESUMEN
MAYBE, but it's too soon to tell. There is limited evidence that ketamine by itself is effective in the very short term. Single-dose intravenous (IV) ketamine is more likely than placebo (odds ratio = 11-13) to produce improvement (> 50%) in standardized depression scores in 1 to 3 days, lasting up to a week. Twice- or thriceweekly IV ketamine improves symptom scores by 20%-25% over 2 weeks (strength of recommendation [SOR]: B, meta-analysis of small, low-quality, randomized controlled trials [RCTs] and a single small RCT).Augmentation of sertraline with daily oral ketamine moderately improves symptom scores for 6 weeks in patients with moderate depression (SOR: B, small, lowquality RCTs).Augmentation of oral antidepressants (duloxetine, escitalopram, sertraline, venlafaxine) with intranasal esketamine spray improves response and remission rates at 4 weeks (16% for both outcomes) in patients with predominantly treatment-resistant major depression (SOR: A, meta-analysis of RCTs).Ketamine therapy is associated with confusion, emotional blunting, headache, dizziness, and blurred vision (SOR: A, metaanalyses).Nasal esketamine spray produces the adverse effects of dizziness, vertigo, and blurred vision severe enough to cause discontinuation in 4% of patients; it also can produce transient elevation of blood pressure (SOR: A, meta-analyses).
Asunto(s)
Antidepresivos/efectos adversos , Trastorno Depresivo Resistente al Tratamiento/tratamiento farmacológico , Ketamina/efectos adversos , Administración Intranasal , Administración Oral , Adulto , Antidepresivos/uso terapéutico , Depresión/tratamiento farmacológico , Trastorno Depresivo Resistente al Tratamiento/prevención & control , Esquema de Medicación , Humanos , Ketamina/uso terapéutico , Inducción de Remisión , Resultado del TratamientoAsunto(s)
Traumatismos del Tobillo , Extremidad Inferior/lesiones , Obesidad Infantil/complicaciones , Cicatrización de Heridas/fisiología , Adolescente , Índice de Masa Corporal , Niño , Estudios Transversales , Humanos , Articulaciones/lesiones , Países Bajos , Estudios Prospectivos , Estudios Retrospectivos , Medición de Riesgo , Factores de TiempoRESUMEN
Fecal microbial transplant (fmt) is reasonably safe and effective. In patients who have had multiple Clostridium difficile infections (CDIs), fecal microbial transplant (FMT) results in a 65% to 80% cure rate with one treatment and 90% to 95% cure rate with repeated treatments compared with a 25% to 27% cure rate for antibiotics (strength of recommendation [SOR]: B, small open-label randomized controlled trials [RCTs]). Fresh and frozen donor feces, administered by either nasogastric tube or colonoscope, produce equal results (SOR B, RCTs). FMT has an overall adverse event rate of 30%, primarily involving abdominal discomfort, but also, rarely, severe infections (0.7%) and death (0.1%) (SOR: B, systematic review not limited to RCTs).