Corticosteroids for acute exacerbations of COPD

Systemic corticosteroids for acute exacerbations of chronic obstructive pulmonary disease[Cochrane Database Syst Rev. 2014] – PubMed – NCBI

Oral steroids are effective for treating acute exacerbations of COPD. Enteral Rx offers no additional benefit.

There is high-quality evidence to support treatment of exacerbations of COPD with systemic corticosteroid by the oral or parenteral route in reducing the likelihood of treatment failure and relapse by one month, shortening length of stay in hospital inpatients not requiring assisted ventilation in ICU and giving earlier improvement in lung function and symptoms. There is no evidence of benefit for parenteral treatment compared with oral treatment with corticosteroid on treatment failure, relapse or mortality. There is an increase in adverse drug effects with corticosteroid treatment, which is greater with parenteral administration compared with oral treatment.

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Oral or transdermal opioids for osteoarthritis of the knee or hip?

Oral or transdermal opioids for osteoarthritis of the knee or hip. [Cochrane Database Syst Rev. 2014] – PubMed – NCBI

Bugger. The benefits of opioids in osteoarthritis are probably outweighed by the negatives.

The small mean benefit of non-tramadol opioids are contrasted by significant increases in the risk of adverse events. For the pain outcome in particular, observed effects were of questionable clinical relevance since the 95% CI did not include the minimal clinically important difference of 0.37 SMDs, which corresponds to 0.9 cm on a 10-cm VAS.

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The best diet is the one people will stick to

Comparison of weight loss among named diet programs in overweight and obese adults: a meta-analysis.:

More evidence that you can lose weight on any diet. The trick is keeping it off.

“Significant weight loss was observed with any low-carbohydrate or low-fat diet. Weight loss differences between individual named diets were small. This supports the practice of recommending any diet that a patient will adhere to in order to lose weight.”

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Strategies for discontinuation of PPIs

Strategies for discontinuation of proton pump inhibitors: a systematic review.

According to this review in ‘Family Practice’, “Discontinuation of PPIs is feasible in a clinical setting, and a substantial number of the patients treated without a clear indication can safely reduce or discontinue treatment. Tapering seems to be the most effective way of doing this.”

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Do steroid injections help lumbar spinal stenosis?

A randomized trial of epidural glucocorticoid injections for spinal stenosis.

Unfortunately, in this trial published in the NEJM recently, at 6 weeks there were no differences between those given steroid injections + lignocaine vs those given just lignocaine.

Back to the drawing board – again!

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