Assuntos
Analgesia Epidural , Humanos , Gravidez , Feminino , Analgesia Epidural/métodos , Analgesia Obstétrica/métodosAssuntos
Delírio , Melatonina , Humanos , Melatonina/uso terapêutico , Delírio/prevenção & controle , HospitaisRESUMO
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.
Assuntos
Doença das Coronárias , Infarto do Miocárdio , Embolia Pulmonar , Feminino , Humanos , Estudos de Coortes , Estrogênios/efeitos adversos , Infarto do Miocárdio/induzido quimicamente , Infarto do Miocárdio/epidemiologia , Fatores de RiscoAssuntos
Ocitócicos , Hemorragia Pós-Parto , Gravidez , Feminino , Humanos , Hemorragia Pós-Parto/prevenção & controle , OcitocinaRESUMO
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.
Assuntos
Icterícia Neonatal , Humanos , Recém-Nascido , Icterícia Neonatal/diagnóstico , Pigmentação da Pele , Bilirrubina , Triagem Neonatal , Estudos de Coortes , PeleRESUMO
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).
Assuntos
Doença Pulmonar Obstrutiva Crônica , Humanos , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Espirometria , Fumar/efeitos adversos , Diagnóstico PrecoceRESUMO
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).
Assuntos
Falência Renal Crônica , Insuficiência Renal Crônica , Bicarbonatos , Progressão da Doença , Feminino , Humanos , Falência Renal Crônica/tratamento farmacológico , Falência Renal Crônica/prevenção & controle , Masculino , Insuficiência Renal Crônica/tratamento farmacológico , Bicarbonato de Sódio/uso terapêuticoRESUMO
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).
Assuntos
Maturidade Cervical , Ocitócicos , Cesárea , Feminino , Humanos , Trabalho de Parto Induzido , Ocitócicos/farmacologia , Ocitócicos/uso terapêutico , Ocitocina/farmacologia , Ocitocina/uso terapêutico , GravidezRESUMO
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).
Assuntos
Aneurisma da Aorta Abdominal/diagnóstico , Competência Clínica/normas , Programas de Rastreamento/normas , Médicos de Família/normas , Sistemas Automatizados de Assistência Junto ao Leito/normas , Radiologistas/normas , Ultrassonografia/normas , Adulto , Idoso , Idoso de 80 Anos ou mais , Competência Clínica/estatística & dados numéricos , Humanos , Masculino , Programas de Rastreamento/estatística & dados numéricos , Pessoa de Meia-Idade , Médicos de Família/estatística & dados numéricos , Sistemas Automatizados de Assistência Junto ao Leito/estatística & dados numéricos , Guias de Prática Clínica como Assunto , Radiologistas/estatística & dados numéricos , Fatores de Risco , Ultrassonografia/estatística & dados numéricos , Estados UnidosRESUMO
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).
Assuntos
Antidepressivos/efeitos adversos , Transtorno Depressivo Resistente a Tratamento/tratamento farmacológico , Ketamina/efeitos adversos , Administração Intranasal , Administração Oral , Adulto , Antidepressivos/uso terapêutico , Depressão/tratamento farmacológico , Transtorno Depressivo Resistente a Tratamento/prevenção & controle , Esquema de Medicação , Humanos , Ketamina/uso terapêutico , Indução de Remissão , Resultado do TratamentoRESUMO
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).