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..........Alternative Medicine

Is ginger more effective than placebo for treatment of nausea and vomiting of pregnancy? Is ginger safe during pregnancy?
Ginger is effective in treatment nausea and vomiting during pregnancy. [Evidence level B, lower quality RCT] In these studies, no neonatal or maternal adverse events were demonstrated [Evidence level B, lower quality RCT]
Bryan Myers	April 2004	LOE
Fischer-Rasmussen W, Kjaer S, Dahl C, Asping U. Ginger treatment of hyperemesis gravidarum. European Journal of Obstetrics and Gynecology and Reproductive Biology 1990; 38: 19-24. Sripramote M, Lekhyananda N. A randomized comparison of ginger and vitamin B6 in the treatment of nausea and vomiting of pregnancy. J Med Assoc Thai 2003;86(9)846-853. Vutyavanich T, Kraisarin T, Ruangsri R. Ginger for nausea and vomiting in pregnancy: Randomized, double-blind, placebo-controlled trial. Obst and Gyn 2001; 97(4):577-582. Willetts KE, Ekangaki A, Eden JA. Effect of ginger on pregnancy-induced nausea: A randomised controlled trial. Aust N Z J Obstet Gyn 2003; 43: 139-144.

..........Cardiovascular

Is Cilostazol (Pletal) effective in increasing maximal walking distance in patients with intermittent claudication?
Meta-analysis: Cilostazol is superior to placebo in increasing mean total walking distance and pain-free walking distance in patients with intermittent claudication Cilostazol is superior to both placebo and pentoxifylline in increasing both mean walking distance (MWD) and pain free walking distance(PFWD) Average 50 meters additional MWD and 20+m add’l PFWD Higher number of adverse events with Cilostazol, including: Headaches, palpitations, diarrhea/abnl stool-but did not seem to effect drop-out rate Evidence does not support that pentoxifylline is superior to placebo, and may be inferior to exercise program alone
Meagan Tkachuk	March 2004	LOE 1A
Dawson, et al. Cilostazol Has Beneficial Effects in Treatment of Intermittent Claudication: Results From a Multicenter, Randomized, Prospective, Double-blind Trial Circulation August 1998 98(7) 678-86.\ Beebe, et al. A New Pharmacological Treatment for Intermittent Claudication: Results of a Randomized, Multicenter Trial Arch Intern Med September 1999 (159) 2041-50. Hood, et al. Management of Intermittent Claudication With Pentoxifylline: a Meta-analysis of Randomized Controlled Trials Can Med Assoc J October 1996 155(8) 1053-59.

..........Dermatology

•In adults with recurrent herpes labialis infections that also experience a prodrome period, does initiation of antiviral therapy at the first symptom of an outbreak improve outcomes?
n •No effective therapy shown to block recurrences of herpes labialis at prodrome (ideal outcome) •Topical antiviral or oral antiviral effective at reducing attack by ~1 day and pain cessation ~0.5 day (topical studies LOE 1a, oral studies LOE 1b) •Both topical and oral antivirals well tolerated with low side-effect profile in target population •No good data on children
Lynne Desotel	December 2004	LOE 1A-1B
Chosidow O, et al. Valacyclovir as a single dose during prodrome of herpes facialis: a pilot randomized double-blind clinical trial. British Journal of Dermatology. 2003;148: 142-146. Laiskonis A, et al. Valacyclovir in the Treatment of Facial Herpes Simplex Virus Infection. Journal of Infectious Disease. 2002; 186 (Supp 1) S66-70. Lin L, et al. Topical application of penciclovir cream for the treatment of herpes simplex facialis/labialis: a randomized, double-blind, muticentre, aciclovir-controlled trial. Journal of Dermatologic Treatment. 2002; 13, 67-72 Raborn G, et al. Effective treatment of herpes labialis with penciclovir cream: combined results of two trials. JADA, March 2002: Vol. 133, 303-309. Spruance S, et al. High-Dose, Short-Duration, Early Valacyclovir Therapy for Episodic Treatment of Cold Sores: Results of Two Randomized, Placebo-Controlled, Multicenter Studies. Antimicrobial Agents and Chemotherapy. March 2003, p. 1072-1080. Spruance S, et al. Penciclovir Cream for the Treatment of Herpes Simplex Labialis: a randomized, multicenter, double-blind, placebo-controlled trial. JAMA. 1997;277: 1374-1379. Spruance S, et al. Acyclovir Cream for Treatment of Herpes Simplex Labialis: Results of Two Randomized, Placebo-Controlled, Multicenter Studies. Antimicrobial Agents and Chemotherapy, July< 2002, p2238-2243.

•In primary repair of lacerations and closure of excisions, does absorbable suture as compared to nonabsorbable suture result in similar cosmetic outcomes without increasing complications?
n • 2 small RCTs and several other controlled trials suggest that absorbable suture gives comparable results to non-absorbable suture for primary closure of uncomplicated wounds, in terms of cosmetic results and wound strength without increasing infection rates. These results cannot be extrapolated to bites, infected wounds, or wounds in immune-compromised patients
Ruth Lindberg	October 2005	SORT LOR B
Karounis, et al. A randomized, controlled trial comparing long-term cosmetic outcomes of traumatic pediatric lacerations repaired with absorbable plain gut versus nonabsorbable nylon sutures. Academic Emergency Medicine Volume 11, Number 7 730-735 Holger et al. Cosmetic outcomes of facial lacerations repaired with tissue-adhesive, absorbable, and nonabsorbable sutures. American Journal of Emergency Medicine 2004; 22:254-257. Parell et al. Comparison of absorbable with nonabsorbable sutures in closure of facial skin wounds. Archives of Facial Plastic Surgery 2003; 5:488-490. Guyuron B, Vaugahn C. A comparison of absorbable and non-absorbable suture materials for skin repair. Plast Reconstr Surg. 1992; 89:234–6.

..........Endocrine

In a patient with well controlled diabetes, what medications have been shown to decrease pain from diabetic neuropathy? In a patient with painful diabetic neuropathy, does Duloxetine or Pregabalin provide better pain control than traditional neuropathic pain treatments?
Amitriptyline, gabapentin, duloxetine, and pregabalin are all effective treatments for painful diabetic neuropathy. (Evidence rating: A) Pregabalin may be more effective at treating diabetic neuropathy than amitriptyline, gabapentin, and duloxetine. (Evidence rating: B) Amitriptyline is better tolerated and much less expensive than pregabalin and duloxetine. (Evidence rating: B)
Bryan Myers	November 2005	LOE
Backonja M, Beydoun A, Edwards KR, Schwartz SL, Fonseca V, Hes M, LaMoreaux L, Garofalo E. Gabapentin for the symptomatic treatment of painful neuropathy in patients with diabetes mellitus. JAMA. 1998 Dec;280(21):1831-6. Freyhagen R, Strojek K, Griesing T, Balkenohl M. Efficacy of pregabalin in neuropathic pain evaluated in a 12-week, randomized, double-blind, multicentre, placebo-controlled trial of flexible and fixed-dose regimens. Pain. 2005 Jun;115(3):254-63. Gorson KC, Rand WM. Gabapentin in the treatment of painful diabetic neuropathy: a placebo controlled, double blind, crossover trial. J Neurol Neurosurg Psychiatry. 1999 Feb;66:251-2. Goldstein DJ, Lu Y, Detke MJ, Iyengar S. Duloxetine vs. placebo in patients with painful diabetic neuropathy. Pain. 2005 Jul;116(1-2):109-18. Kumar D, Alvaro MS, Julka IS, Marshall HJ. Diabetic peripheral neuropathy. Effectiveness of electrotherapy and amitriptyline for symptomatic relief. Diabetes Care. 1998 Aug;21(8):1322-5. Lesser H, Sharma U, LaMoreaux L, Poole RM. Pregabalin relieves symptoms of painful diabetic neuropathy: a randomized controlled trial. Neurology. 2004 Dec;63(11):2104-10. Morello CM, Leckband SG, Stoner CP, Moorhouse DF, Sahagian GA. Randomized double-blind study comparing the efficacy of gabapentin with amitriptyline on diabetic peripheral neuropathy pain. Arch Intern Med. 1999 Sep;159(16):1931-7. Rosenstock J, Tuchman M, LaMoreaux L, Sharma U. Pregabalin for the treatment of painful diabetic peripheral neuropathy: a double-blind, placebo-controlled trial. Pain. 2004 Aug;110(3):628-38 Vrethem M, Boivie J, Arnqvist H, Holmgren H, Lindstrom T, Thorell LH. A comparison of amitriptyline and maprotiline in the treatment of painful polyneuropathy in diabetics and nondiabetics. Clin J Pain. 1997 Dec;13(4):313-23.

..........Gastroenterology

In patients with IBS, not responding to conventional treamtne(High fiber diet and symptomatic treatment), do SSRI's alleviate symptoms better than placebo
Although limited data (small, moderate quality data), paroxetine appears promising for treatment of IBS not responding to HFD, although studies with larger numbers and/or head to head trials with other therapies would be helpful Especially good for overall quality of life improvement Interesting to note that although it may not be obvious from the survey results (improvements), patients felt better enough on paroxetine that significant numbers chose to remain on the medication in both studies
Leah Schrupp	May 2005	LOE
Creed F, Fernandes L, Guthrie E, Palmer S, Ratcliffe J, Read N, Rigby C, Thompson D, Tomenson B; North of England IBS Research Group. “The cost-effectiveness of psychotherapy and paroxetine for severe irritable bowel syndrome.” Gastroenterology. 2003 Feb;124(2):303-17. Tabas G, Beaves M, Wang J, Friday P, Mardini H, Arnold G. “Paroxetine to treat irritable bowel syndrome not responding to high-fiber diet: a double-blind, placebo-controlled trial.” Am J Gastroenterol. 2004 May;99(5):914-20.

..........Geriatrics

In patients with involuntary weight loss, is dronabinol (Marinol)more effective than placebo in improving appetite and weight?
Dronabinol is more effective than placebo at improving appetite and weight gain in patients with involuntary weight loss secondary to chronic diseases such as AIDS and dementia – LOE B, RTC Dronabinol appears to be well tolerated with no significant side-effects when compared to placebo – LOE B, RTC Dronabinol may be used to increase appetite and promote weight gain in patients with involuntary weight loss secondary to chronic disease – LOR B, RCT
Nate Grunwald	July 2005	LOE B
Dronabinol as a Treatment for Anorexia Associated with Weight Loss in Patients with AIDS Beal, Jeffery E. Et. al Journal of Pain and Symptom Management 1995; 10(2):89-97 Short-Term Effects of Cannaboids in Patients with HIV-1 Infection Abrams, Donald Et. al Annals of Internal Medicine 2003; 139(4):258-267 Effects of Dronabinol on Anorexia and Disturbed Behavior in Patients with Alzheimer’s Disease Volicer, Ladislav Et. al International Journal of Geriatric Psychiatry 1997; 12:913-19

In postmenopausal women with osteoporosis diagnosed by DEXA, is calcitonin or bisphosphonate a better treatment to reduce risk of fracture
In women with osteoporosis as defined by T score < -2.5, bisphosphonates should be first line therapy to prevent fractures. (Grade A) 2 Bisphosphonate studies (vs placebo) show reduction of vertebral and hip fractures in women with BMD <-2.5 (NNT 15 - 27) Calcitonin 200 IU decreased new vertebral fx in women with previous fractures P<0.05, no fracture reduction at other sites
Renee Blavat	2004	LOE 1
Chesnut, C. H. Et al. A randomized trial of Nasal spray Salmon Calcitonin in Postmenopausal women with established osteoporosis: The prevent recurrence of Osteoporotic fractures study. The American Journal of Medicine. Vol 109(4) Sept 2000. Pg 267-276. Cummings S. R. et al. Effects of Alendronate on Risk of Fracture on Women with Low Bone Density without Vertebral Fracture. Journal of American Medical Association. Vol 280(24). Dec 1998. Pg 2077-82. Down, R. W. et al. Comparison of Alendronate and Intranasal Calcitonin for Treatment of Osteoporosis in Postmenopausal women. The Journal of Clinical Endocrinology and Metabolism. Vol 85(5). May 2000. Pg 1783-8. McClung, M. R. et al. Effect of Risendronate on the risk of Hip Fracture in Elderly women. New England Journal of Medicine. Vol 344(5). Feb 2001. pg 333-340. Reginster, J. Y. Et al. Randomized Trial of the effects of Risendronate on Vertebral Fractures in Women with Established Postmenopausal Osteoporosis. Osteoporosis International. Vol 11. 2000. Pg 83-91.

..........GU

In a population of patients with genital warts does treatment with imiquimod versus podofilox yield better outcomes?
Imiquimod and podofilox are superior to placebo, with approximately ½ to 2/3 of patients responding with clearance of lesions (LOE B, 3 RCTs) Imiquimod appears to be more effective in women than in men (LOE B, 2 RCTs) Recurrence after either treatment is common, and we have no longer term data are available to counsel patients about long-term recurrence rates Side effect profiles and costs are also similar Imiquimod is Pregnancy Category C; podofilox is Pregnancy Category C (podophyllin, by contrast, is Category X)
Dawn Owens-Watterson	Jan 2006	LOE B
Dronabinol as a Treatment for Anorexia Associated with Weight Loss in Patients with AIDS Beal, Jeffery E. Et. al Journal of Pain and Symptom Management 1995; 10(2):89-97 Short-Term Effects of Cannaboids in Patients with HIV-1 Infection Abrams, Donald Et. al Annals of Internal Medicine 2003; 139(4):258-267 Effects of Dronabinol on Anorexia and Disturbed Behavior in Patients with Alzheimer’s Disease Volicer, Ladislav Et. al International Journal of Geriatric Psychiatry 1997; 12:913-19

..........ID

nIn adults and adolescents with influenza-like illness, does treatment with oseltamivir (vs placebo) reduce the incidence of hospitalization and complications related to influenza?
¨Tamiflu will decrease hospitalizations in overall population, but NNT is fairly high, thus cost becomes a consideration, both to individual and to society ¨Tamiflu had no significant effect on hospitalizations in at-risk population ¨Tamiflu did decrease the overall use of antibiotics use in patients infected with influenza
Shane Hall	January 2005	LOE 1B
1. 5.Kaiser L, Wat C, Mills T, Mahoney P, Ward P, Hayden F. Impact of oseltamivir treatment on influenza-related lower respiratory tract complications and hospitalizations. Arch Intern Med. 2003 Jul 28;163(14):1667-72 Robert Welliver; Arnold S. Monto; Otmar Carewicz; Edwig Schatteman; Michael Hassman; James Hedrick; Helen C. Jackson; Les Huson; Penelope Ward; John S. Oxford; for the Oseltamivir Post Exposure Prophylaxis Investigator Group. Effectiveness of Oseltamivir in Preventing Influenza in Household Contacts: A Randomized Controlled Trial. JAMA 2001 285: 748-754 Hayden FG, Belshe R, Villanueva C, Lanno R, Hughes C, Small I, Dutkowski R, Ward P, Carr J. Management of influenza in households: a prospective, randomized comparison of oseltamivir treatment with or without postexposure prophylaxis. J Infect Dis. 2004 Feb 1;189(3):440-9. Epub 2004 Jan 26. 8. 8. n 6. 7.

..........Neurology

In patients with frequent migraine, is Topamax more effective at prophylaxis than placebo, and at least as effective as conventional therapy (if conventional therapy fails)?
Topamax 100 mg or 200 mg per day is more effective than placebo with an approximately 33% greater responder rate (LOE 1B) Topamax 100 mg per day is similar to 200 mg per day with fewer side effects and withdrawal (LOE 1B) Topamax 100 mg per day is probably as effective as Propanolol 160 mg per day (LOE 2B)
Charles Running	Feb 2005	LOE 1B-2B
Brandes et al. Topiramate for Migraine Prevention: A Randomized Controlled Trial . JAMA 2004 Feb 25;291(8)965-73 Silberstein, et al. Topiramate in Migraine Prevention:Results of a Large Controlled Trial. Arch Neurol: 2004 Apr 61(4):490-5. Dierner et all. Topiramate in Migraine Prophylaxis: Results from a placebo-controlled trial with propranolol as an active control. J Neuro. 2004 Aug; 251(8):943-50.

Will treatment with Donepezil (Aricept) slow loss of ability to carry out activities of daily living?
Overall the data support that there is a clinically significant benefit in terms of slowed loss of Activities of Daily Living (ADL) in pts with mild, moderate or severe dementia secondary to Alzheimers Dementia treated up to 52 wks with 5 or 10 mg/d of Donepezil .Modestly greater benefit at 10 mg was seen, but Adverse Events profile is worse. The Cochrane review of studies looking at global function lends added support to efficacy of Donepezil but suggests that further study is required to determine economic efficacy. Though we can expect a moderately slowed rate of loss of ADLs, current data is not available to support delayed Nursing Home Placement as a result.
Rob Margraf	June 2004	LOE
Burns A, Rossor M, Hecker J, Gauthier S, Petit H, Moller H, Rogers S, Friedhoff L. The effects of donepezil in Alzheimer’s disease- results from a multinational trial. Dement Geriatr Cogn disord. 1999 May-Jun;10;(3):237-44. Feldman H, Gauthier S, Hecker J, Vellas B, Emir B, Mastey V, Subbiah P, and The Donepezil MSAD Study Investigators Group. Efficacy of Donepezil on Maintenance of Activities of Daily Living in Patients with Moderate to Severe Alzheimer’s disease and the Effect on Caregiver Burden. JAGS 51:737-744, 2003. Mohs R, Doody R, Morris J, Ieni J, Rogers S, Perdomo C, Pratt R. A 1-year, placebo-controlled preservation of function survival study of donepezil in AD patients. Neurology 2001;57:481-488. Winblad B, Engedal K, Soininen H, Verhey F, Waldemar G, Wimo A, Wetterholm A, Zhang R, Haglund A, Subbiah P, and the Donepezil Nordic Study Group. A 1-year, randomized, placebo-controlled study of donepezil in patients with mild to moderate AD. Neurology 2001;57:489-95

In a patient population with peripheral causes of vertigo, does vestibular rehabilitation vs. placebo reduce the frequency or severity of dizziness/vertigo?
nVestibular rehabilitation may be a more effective treatment than “usual medical therapy” or placebo for patients with vertigo due to peripheral causes, with approximately one out of three patients improved by these measures nLOE B (based on small poorer quality RCT) nEffective vestibular rehabilitation programs can be taught to patients in a primary care setting nLOE B (based on small poorer quality RCT)
Jill Larson	March 2006	LOE
Burns A, Rossor M, Hecker J, Gauthier S, Petit H, Moller H, Rogers S, Friedhoff L. The effects of donepezil in Alzheimer’s disease- results from a multinational trial. Dement Geriatr Cogn disord. 1999 May-Jun;10;(3):237-44. Feldman H, Gauthier S, Hecker J, Vellas B, Emir B, Mastey V, Subbiah P, and The Donepezil MSAD Study Investigators Group. Efficacy of Donepezil on Maintenance of Activities of Daily Living in Patients with Moderate to Severe Alzheimer’s disease and the Effect on Caregiver Burden. JAGS 51:737-744, 2003. Mohs R, Doody R, Morris J, Ieni J, Rogers S, Perdomo C, Pratt R. A 1-year, placebo-controlled preservation of function survival study of donepezil in AD patients. Neurology 2001;57:481-488. Winblad B, Engedal K, Soininen H, Verhey F, Waldemar G, Wimo A, Wetterholm A, Zhang R, Haglund A, Subbiah P, and the Donepezil Nordic Study Group. A 1-year, randomized, placebo-controlled study of donepezil in patients with mild to moderate AD. Neurology 2001;57:489-95

..........Ortho/Sports Medicine

§Is back pain more common in gymnasts than in other women atheletes during and after their college career and does it impact their activities of daily living?
Back pain during college career is not different between gymnasts and other weight bearing atheletes Back pain post career also not significantly different between gymnasts and other atheletes Activities of daily life not effected by back pain
Amy Overlin	June 2005	LOE B
Women’s Intercollegiate Gymnastics, Waldley G, Albright J; The American Journal of Sports Medicine: 1993, 21(2): 314-320 nInjuries in Women’s Gymnastics, McAuley et al; The American Journal of Sports Medicine: 1987, 15(6): S124-131 nEpidemiology of Injury in Elite and Subelite Female Gymnasts: A Comparison of Retrospective and Prospective Findings, Kolt G, Kirkby R; The British Journal of Sports Medicine: 1999, 33: 312-318

..........Pediatrics

§ In infants/children less than 2 years of age with nonsynostotic plagiocephaly does a cranial molding helmet versus conservative treatment result in improved cranial deformity and prevent long term sequelae?
lBased on small studies of limited quality, both repositioning and orthotic helmets improve cranial symmetry by objective measures. (LOE B, SORT criteria, lower quality cohort data) lLimited evidence suggests that helmets achieve symmetry to a higher degree and more rapidly. (LOE B, SORT criteria, lower quality cohort data) lNo studies were found that address other important outcomes such as visual impairment, hearing, TMJ function, or long-term parental satisfaction lImportant disadvantages (discomfort, rash, cost, stigma) are not adequately addressed in the literature. l lBottom line: While the literature doesn’t absolutely support guidelines, the trends of the data make the guidelines reasonablel
Christina Fergus	June 2006	LOE B
1.Wendy Biggs, Diagnosis and Management of Positional Head Deformity. American Family Physician. 67(9):1953-6, 2003 May 1. 2.Hairdar Kabbani, M.D. and Talkad S. Raghuveer, Craniosynostosis. American Family Physician. 69(12):2863-7, 2004 June 15. 3.Siatkowski, R Michael et al. Visual field defects in deformational posterior plagiocephaly. American Association for Pediatric Ophthalmology & Strabismus. 9(3):274-8, 2005 Jun. 4.Losee JE, Mason AC, Deformational plagiocephaly: diagnosis, prevention and treatment. Clinics in Plastic Surgery. 32(1): 53-64, viii, 2005 Jan. 5.Balan P., Kushnerenko E et al. Auditory ERPs reveal brain dysfunction in infants with plagiocephaly. J Craniofac surg 2002; 13(4)520-5. 6.Panchal J. Amirsheybani, et al. Neurodevelopment in children with single-suture craniosynostosis and plagiocephaly with snostosis. Plast Reconstr Surg 2001; 108(6): 1492-500. 7.Miller RI, Clarren SK. Long-term developmental outcomes in patients with deformational plagiocephaly. Pediatrics 2000; 105(2): e26

..........Pulmonary

§Is Montelukast an appropriate first-line agent as a controller medication, and does it result in clinically important outcomes (i.e, improved symptoms, fewer ER visits, fewer hospitalizations, increased school attendance, reduced use of rescue meds,) in children with mild-persistent asthma?
Current evidence does not support the use of Montelukast as a first-line controller agent in children with mild to moderate persistent asthma. There is some evidence to suggest that certain pts that do not respond to corticosteroids well may benefit from LTRA’s Physicians should prescribe inhaled corticosteroids as the drugs of choice if a controller medication is required.
Robert Margraf	September 2005	LOE 1 B
Ducharme, FM; Di Salvio, F. Anti-leukotriene agents compared to inhaled corticosteroids in the management of recurrent and/or chronic asthma in adults and children. Cochrane Database of Systematic Reviews. 3, 2005. Knorr, et al. Montelukast for Chronic Asthma in 6 to 14-year old Children. JAMA. 1998;279:1181-1186. Szefler, et al. Characterization of within-subject responses to fluticasone and montelukast in childhood asthma. Journal of Allergy Clin Immunol. 2005;115:233-42. Karaman, et al. Evaluation of montelukast in 8 to 14 year old children with mild persistent asthma and compared with inhaled corticosteroids. Kemp, et al. Montelukast once daily inhibits exercise-induced bronchoconstriction in 6 to 14 year old children with asthma. Journal of Pediatrics 1998;133:424-8. Kim, et al. Prolonged effect of montelukast in asthmatic children with exercise induced bronchoconstriction. Pediatric Pulmonology. 2005;39:162-166. Meyer, et al. Response to montelukast among subgroups of children aged 2 to 14 years with asthma. J Allergy Clin Immunol 2003;111:757-62. Becker, et al. Montelukast in asthmatic patients 6 years -14 years old with an FEV1>75%. Current Medical Research and Opinion. 2004;20(10):1651-1659.

..........Renal/Urology

§ In patients suspected of having hypertension due to renal artery stenosis, which non-invasive diagnostic test is superior: magnetic resonance angiography (MRA) or doppler ultrasound (DUS)?
MRA w/ better sensitivity (90-100%, 3 studies); specificities similar between MRA and DUS (86-93%) Recommend MRA as non-invasive test of choice- (LOE B: small RCTs) Special considerations may apply –suspicion of fibromuscular dysplasia –claustrophobic or extremely obese pts–cost differential
Noel Sonnek	August 2003	LOE B
Leung, DA; Hoffman, U; et al. Magnetic Resonance Angiography Versus Duplex Sonography for Diagnosing Renovascular Disease. Hypertension. 1999; 33: 726-731. DeCobelli, F; Venturini, M; et al. Renal Artery Stenosis: Prospective Comparison of Color Doppler US and Breath-hold, Three-dimensional, Dynamic, Gadolinium- enhanced MR Angiography. Radiology. 2000; 214: 373-380. Voilescu, A; Hofer, M; et al. Noninvasive Investigation for Renal Artery Stenosis: Contrast-Enhanced Magnetic Resonance Angiography and Color Doppler Sonography as Compared to Digital Subtraction Angiography. Clinical and Experimental Hypertension. 2001; 23(7): 521-531.

..........Prevention

§ In obese adults, does dietary calcium supplementation augment caloric restriction for promoting weight loss and decreasing body fat?
Increased calcium intake & calorie restriction decrease: Weight Body fat Waist circumference Increasing dairy calcium intake does not change weight loss or body fat loss from calorie restriction Overweight and obese adults (n = 54) High dairy intake improves weight and fat loss with calorie restriction African American Adults (n = 63) No difference in efficacy of 800mg vs 1400mg of dairy calcium Obese Adults (n = 59)
Parren McNeely	June 2006	LOE B
Leung, DA; Hoffman, U; et al. Magnetic Resonance Angiography Versus Duplex Sonography for Diagnosing Renovascular Disease. Hypertension. 1999; 33: 726-731. DeCobelli, F; Venturini, M; et al. Renal Artery Stenosis: Prospective Comparison of Color Doppler US and Breath-hold, Three-dimensional, Dynamic, Gadolinium- enhanced MR Angiography. Radiology. 2000; 214: 373-380. Voilescu, A; Hofer, M; et al. Noninvasive Investigation for Renal Artery Stenosis: Contrast-Enhanced Magnetic Resonance Angiography and Color Doppler Sonography as Compared to Digital Subtraction Angiography. Clinical and Experimental Hypertension. 2001; 23(7): 521-531.

..........Rheumatology

§ In patients with fibromyalgia by standard criteria, does acupuncture vs placebo (sham acupuncture) result in improved outcomes?
Limited amount of high-quality evidence to support the efficacy of acupuncture alone for treatment of fibromyalgia (LOE B, small RCT) There is evidence to support the use of acupuncture as adjunctive or second line treatment for fibromyalgia (LOE B, small RCT) Strong evidence for low-dose amitriptyline (25-50 mg) and cyclobenzaprine (10-30 mg) (LOE A, RCT) A study looking at synergistic effects of acupuncture with antidepressants would be beneficial
Bridget Reis	April 2006	LOE B
Leung, DA; Hoffman, U; et al. Magnetic Resonance Angiography Versus Duplex Sonography for Diagnosing Renovascular Disease. Hypertension. 1999; 33: 726-731. DeCobelli, F; Venturini, M; et al. Renal Artery Stenosis: Prospective Comparison of Color Doppler US and Breath-hold, Three-dimensional, Dynamic, Gadolinium- enhanced MR Angiography. Radiology. 2000; 214: 373-380. Voilescu, A; Hofer, M; et al. Noninvasive Investigation for Renal Artery Stenosis: Contrast-Enhanced Magnetic Resonance Angiography and Color Doppler Sonography as Compared to Digital Subtraction Angiography. Clinical and Experimental Hypertension. 2001; 23(7): 521-531.

..........Women's Health

In otherwise low risk pregnancy, how well do women understand the reasons for, the results/meaning of the results of maternal serum screening in the prenatal period?
n Estimates of PPV are 2%-5% for most wormen There is a paucity of data on what women understand about the screening test and its resultsWhat there is says women do not understand the test Most studies were done in women on high socioeconomic status
Rene Blavat	Aug 2005	LOE -IIb
Gekas et al. Informed Consent to Serum Screening for Down Syndrome: Are women Given Adequate Information? Prenatal Diagnosis. vol 19. pp. 1-7. 1999. Goel, V. et al. Evaluating patient’s knowledge of maternal serum screening. Prenatal Diagnosis. vol 16. pp. 425-430. 1995

nIn women aged 17-40 who desire an IUD for contraception and have no contraindications to IUD placement, is there a significant difference between the levonorgestrel or Copper IUD in the rate of discontinuation secondary to bleeding problems, pain, hormonal side effects or expulsion?