giovedì 16 agosto 2007

Pausa estiva per Doctorbebop




Una breve pausa del Blog fino al 3 settembre. Buone vacanze a tutti !

domenica 12 agosto 2007

Prevenzione dello stroke e terapia anticoagulante

The Lancet Table of Contents Volume 370 Issue 9586

Warfarin versus aspirin for stroke prevention in an elderly community population with atrial fibrillation (the Birmingham Atrial Fibrillation Treatment of the Aged Study, BAFTA): a randomised controlled trial
Jonathan Mant, FD Richard Hobbs, Kate Fletcher, Andrea Roalfe, David Fitzmaurice, Gregory YH Lip, Ellen Murray, on behalf of the BAFTA investigators, the Midland Research Practices Network (MidReC)


Nella saga infinita sulla maggiore o minore efficacia della terapia anticoagulante nella prevenzione dell'ictus in pazienti con fibrillazione atriale si aggiunge un nuovo capitolo, o meglio un nuovo studio dalla prestigiosa ribalta del Lancet. Il risultato è ancora una volta a favore della terapia anticoagulante rispetto all'aspirina, mostrando tra l'altro un eguale numero di complicanze emorragiche tra i due gruppi, risultato a detta degli autori sorprendente.


Warfarin is more effective than aspirin in preventing stroke, intracranial hemorrhage, and arterial embolism among elderly patients with atrial fibrillation, the Lancet reports.

Researchers randomized 973 patients over 75 years of age with atrial fibrillation either to warfarin (target INR, 2 to 3) or to 75 mg of aspirin daily. After an average follow-up of 2.7 years, the warfarin group had an annual relative risk of 0.48 for stroke, intracranial hemorrhage, or embolism. The number needed to treat for 1 year to prevent a primary event was 50. There was no difference between the groups in the risk for major hemorrhage -- a result the authors called "surprising."

Editorialists, citing the study's "unprecedented number of patients in an age group that has been largely under-represented in randomised trials," say it "firmly establishes the superior efficacy of warfarin as a stroke-prevention strategy in elderly patients with atrial fibrillation."

martedì 7 agosto 2007

Kenny Drew



Mi fa piacere ricordare in un caldo pomeriggio di Agosto un grande pianista. tra i tanti dimenticati, alle prese con uno spumeggiante St.Thomas.
Qui il link

domenica 5 agosto 2007

Otite media acuta nei bambini: scarsa aderenza da parte dei medici alle indicazioni della letteratura

Numerosi studi e soprattutto le Linee Guida dell'American College of Pediatrics suggeriscono nelle infezioni dell'orecchio nei bambini di 2 anni o più grandi un atteggiamento "wait and see" volto a contenere l'uso eccessivo e inutile di antibiotici.
Un recente studio pubblicato su Pediatrics evidenzia come questo approccio sia disatteso da gran parte dei Pediatri Americani (e credo anche Italiani) che lo utilizzano in meno del 20% dei casi.
Le cause addotte sono le difficoltà nel rapporto con i genitori e nel poter controllare giornalmente i bambini.


Physicians Not Following Guidelines for Treating Ear Infections

Physicians are not adhering to the guidelines for treating acute otitis media outlined by the American Academy of Pediatrics and American Academy of Family Physicians in 2004, according to a study in Pediatrics.

The guidelines endorse an observation option, rather than antibiotics, for some children with ear infections, particularly those who are aged 2 or older who do not have severe symptoms.

Over 200 physicians responded to surveys in 2004 and again in 2006. In both years, about 80% of the physicians considered the observation option reasonable for some children. However, they reported using the observation option in a median of 15% of the cases they had diagnosed in the past 3 months.

Nearly two-thirds of the physicians said parental reluctance was the top barrier to using the observation option. One-third of the physicians said the cost and difficulty in following-up with children were important barriers. (New York State's Department of Health offers a "viral prescription" to make it easier to explain to parents that viral infections don't respond to antibiotics.)