Rethinking daily aspirin for primary prevention

An updated meta-analysis of newer RCTs seems to settle the matter as to whether to use aspirin in individuals with no known history of atherosclerotic CVD. PRACTICE CHANGER: Do not routinely use aspirin for primary prevention of cardiovascular disease (CVD). There is no identifiable mortality benefit for those without established CVD--regardless of risk factors. And aspirin therapy increases the risk of major bleeding. STRENGTH OF RECOMMENDATION: Based on a meta-analysis of 11 randomized trials involving 157,248 patients who received aspirin for primary prevention

No pain, if you've got game

Review of: Inan G, Inal S. The impact of 3 different distraction techniques on the pain and anxiety levels of children during venipuncture: a clinical trial. Clin J Pain. 2019;35:140-147.No pain, if you've got game. Allowing children to engage in active distraction techniques--such as playing a video game--during venipuncture can lead to reduced pain and anxiety. PRACTICE CHANGER: Employ active distraction, such as playing a video game, rather than passive distraction (eg, watching a video) to reduce pain and anxiety during pediatric venipuncture. STRENGTH OF RECOMMENDATION: B: Based on a single, high-quality, randomized controlled trial (RCT).Benjamin J. McCollum, MD; Stephen J. Conner, MD; J. Scott Earwood, MD (Family Medicine Residency Program, Eisenhower Army Medical Center, Fort Gordon, GA)Includes bibliographical reference

Which anticoagulant is safest for frail elderly patients with nonvalvular A-fib?

Consider apixaban, which demonstrated a lower adverse event (AE) rate than warfarin regardless of frailty status, for anticoagulation treatment of older patients with nonvalvular atrial fibrillation (AF); by comparison, AE rates for dabigatran and rivaroxaban were lower vs warfarin only among nonfrail individuals.J. Scott Earwood, MD; Justin L. Wilkie, MD; Jennifer L. Fernandez-Vasquez, MD, (Dwight David Eisenhower Army Medical Center, Fort Gordon)Includes bibliographical reference

Can sleep apnea be accurately diagnosed at home?

Review of: Corral J, Sánchez-Quiroga MÁ, Carmona-Bernal C, et al. Conventional polysomnography is not necessary for the management of most patients with suspected obstructive sleep apnea. Noninferiority, randomized controlled trial. Am J Respir Crit Care Med. 2017;196:1181-1190.Can sleep apnea be accurately diagnosed at home? A recent study says Yes, and that it offers advantages: it can be scheduled faster, is less expensive, and is more acceptable to many patients than lab testing. PRACTICE CHANGER: Consider orderinghome respiratory polygraphy vs laboratory sleep studies for patients suspected of having obstructive sleep apnea. STRENGTH RECOMMENDATION: B: Based on a multicenter, noninferiority randomized controlled trial and cost analysis study.E. Ashley Suniega, MD; Christina M. Thoma, MD; J. Scott Earwood, MD; Dean A. Seehusen, MD, MPH; Dwight D. Eisenhower Army Medical Center, Family Medicine Residency, Program, Fort Gordon, Ga (Drs. Suniega, Thoma, and Earwood); Augusta University, Augusta, Ga (Dr. Seehusen

Improving women's experience during speculum examinations at routine gynaecological visits: randomised clinical trial

Objectives To determine if a standardised method of leg positioning without stirrups reduces the physical discomfort and sense of vulnerability and increases the sense of control among women undergoing speculum examination as part of a routine gynaecological examination. Design Randomised clinical trial. Setting Family medicine outpatient clinic. Patients 197 adult women undergoing routine gynaecological examination and cervical smear. Intervention Examination with or without stirrups. Main outcome measures Women's perceived levels of physical discomfort, sense of vulnerability, and sense of control during the examination, measured on 100 mm visual analogue scales. Results Women undergoing examination without stirrups had a reduction in mean sense of vulnerability from 23.6 to 13.1 (95% confidence interval of the difference - 16.6 to - 4.4). Mean physical discomfort was reduced from 30.4 to 17.2 (- 19.7 to - 6.8). There was no significant reduction in sense of loss of control. Conclusion Women should be able to have gynaecological examinations without using stirrups to reduce the stress associated with speculum examinations. Trial registration US Army Central Investigation Regulatory Office. Trial No DDEAMC 05-11