Are tympanostomy tubes indicated for recurrent acute otitis media?

For children with recurrent acute otitis media (here defined as 3 or more episodes in 6 months, or 4 or more in a year), tympanostomy tubes are indicated if middle -ear effusion is present. Tubes reduce the frequency of recurrent acute otitis media by 2 to 3 episodes per year in these patients (strength of recommendation [SOR]: A; based on randomized controlled trials). Further benefits include improved quality of life for both child and caregiver and greater parental satisfaction (SOR: B; based on trials that included patients with recurrent acute otitis media or otitis media with effusion). Tympanostomy tubes do not decrease the number of recurrent acute otitis media episodes in children without middle-ear effusion (SOR: A, based on randomized controlled trials). These children run the risk of adverse outcomes of tube placement, including transient or recurrent otorrhea, tympanosclerosis, focal atrophy, perforation, and cholesteatoma (SOR: A; based on meta-analysis)

What treatments are safe and effective for mild to moderate hypertension in pregnancy?

There is considerable debate concerning the treatment of mild to moderate essential hypertension during pregnancy. Evidence suggests that because of the potential risk of fetal intrauterine growth restriction, treatment of hypertension should be delayed until maternal blood pressure reaches 150-160 mm Hg systolic or 100-110 mm Hg diastolic, as long as the mother has no preexisting end organ damage. Methyldopa has been the drug of choice for oral treatment, as it is the only medication to have any extended follow-up study. However, a recent meta-analysis raised the possibility of increased fetal mortality (strength of recommendation [SOR]: A, based on systematic review of randomized controlled trials)

Does yoga speed healing for patients with low back pain?

The use of yoga is consistent with recommendations for activity, as tolerated, for patients with low back pain. Literature evaluating the effectiveness of yoga for low back pain is scant, so it is unclear if yoga is equivalent to, or superior to, standard therapies (strength of recommendation: C, based on 1 randomized pilot study and limited case series)

What are the most effective ways you can help patients stop smoking?

Brief counseling, nicotine replacement therapy, antidepressants, and varenicline all work well. Physician intervention should begin with routine assessment of smoking status for all patients. Brief (3 minutes or less) smoking cessation counseling improves quit rates (strength of recommendation [SOR]: A, Cochrane systematic review). Nicotine replacement therapy (NRT), antidepressants (bupropion and nortriptyline), and the nicotine receptor partial agonist varenicline are effective and should be offered to help smokers quit (SOR: A, Cochrane systematic reviews and randomized controlled trials [RCTs])

Do routine eye exams reduce occurrence of blindness from type 2 diabetes?

Screening eye exams for patients with type 2 diabetes can detect retinopathy early enough so treatment can prevent vision loss. Patients without diabetic retinopathy who are systematically screened by mydriatic retinal photography have a 95% probability of remaining free of sight-threatening retinopathy over the next 5 years. If background or preproliferative retinopathy is found at screening (Figure), the 95% probability interval for remaining free of sight-threatening retinopathy is reduced to 12 and 4 months, respectively (strength of recommendation [SOR]: B, based on 1 prospective cohort study). A reliably sensitive screening exam requires mydriatic retinal photography augmented by ophthalmoscopy when photographs are inconclusive (SOR: A, based on a systematic review). For patients with diabetes not differentiated by type, photocoagulation significantly decreases visual deterioration and reduces the chances of blindness (SOR: A, based on randomized controlled trials [RCT])

Do steroid injections help with osteoarthritis of the knee?

Intra-articular steroid injections appear to provide 2 to 6 weeks of pain relief for patients with knee osteoarthritis (strength of recommendation [SOR]: A). Higher-dose steroids with or without joint lavage can provide pain relief up to 24 weeks (SOR: A). Steroid injections may be an appropriate adjunct in the treatment of osteoarthritis, which includes nonpharmacologic treatments (education, weight loss, physical therapy) and pharmacologic therapy (nonsteroidal anti-inflammatory drugs [NSAIDs], topical and opioid analgesics)

Embedding Computational Thinking into Authentic Technology Practice

This paper presents the findings from a pilot study aimed to investigate how the computational thinking aspect of digital technologies can be embedded authentically into students’ technological practice. The project explored teaching and learning computational thinking in context and particularly focus on technological needs and practice for young Māori learners. There is recognition internationally about the need for digital technologies within the curriculum. Computational thinking is a critical component of this and is defined as an approach to problem-solving, designing computer systems, and understanding related human behaviours, while drawing on fundamental ideas of computing. Therefore, it is critical that all students acquire computational thinking skills. Technology practice is most successful when embedded within authentic contexts, thus this paper presents a study that facilitated the learning of two concepts of computational thinking: sequencing and orientation within culturally embedded technology practice. The study’s vision is to assist mainstream Māori learners from low socio-economic backgrounds to develop an understanding of related concepts of computational thinking. The research design drew on Māori values and practice that situates learning within authentic Māori contexts. Kaupapa Māori pedagogies were used in our design-based intervention programme to achieve the research goal. The focus of the project was to improve digital technologies learning outcomes to ensure Māori tamariki (children) see themselves as comfortably situated in a digital world

The MoXFo Initiative : using consensus methodology to move forward towards internationally shared vocabulary in multiple sclerosis exercise research

Background: Multiple sclerosis (MS) exercise terminology lacks consistency across disciplines, hindering research synthesis. Objective: The ‘Moving exercise research in MS forward initiative’ (MoXFo) aims to establish agreed definitions for key MS exercise terms. Methods: The Lexicon development methodology was employed. A three-step process identified key exercise terminology for people with multiple sclerosis (pwMS): (1) consensus and systematic review, (2) Delphi round 1 and consideration of existing definitions and (3) Delphi round 2 for consensus among MoXFo steering group and exercise experts. Final definitions and style harmonisation were agreed upon. Results: The two-stage Delphi process resulted in the selection and scoring of 30 terminology definitions. The agreement was 100% for resistance exercise, balance and physical activity. Most terms had agreement >75%, but ‘posture’ (60%) and ‘exercise’ (65%) had a lower agreement. Conclusion: This study identified key terms and obtained agreement on definitions for 30 terms. The variability in agreement for some terms supports the need for clearly referencing or defining terminology within publications to enable clear communication across disciplines and to support precise synthesis and accurate interpretation of research