Sunday, July 18, 2004

Too Aggressive? 

When I first heard about the newest cholesterol guidelines, my first thought was: "It's about time".
Unfortunately, they are:
1. Too aggressive (efficacy vs effective?, mortality benefit vs combined endpoint?).
2. Too complicated (my primary prevention patients already think their goal LDL is 70).
3. And, tainted.

Saturday, July 10, 2004

Journal Access 

I can't help but wish I had full text access to medical journals. The abstract is helpful but if I really care about something I need the entire article.

I can get the real thing from my hospital library but I like the convenience of computer files over traditional paper.

This (Wired 12.04: The 2004 Wired Rave Awards) is the right idea.

Wednesday, July 07, 2004

"We Don't Do Eyes Over the Phone..." 

is what we routinely tell patients but maybe we could.

Over the years, I've struggled with the management of acute conjunctivitis. When I'm on call, patients often page me to start Rx eye drops. Sending them to an after hours facility seems excessive. During office hours I have them come in. Neither decision is comfortable for me.

At least now for adult patients, I have an option: Rietveld et al., 10.1136/bmj.38128.631319.AE.

The prevalence of bacterial infection is higher than I expected.

I've already quit seeing uncomplicated dysuria in women in the office. Perhaps I could add adult conjunctivitis?

Tuesday, July 06, 2004

Definite Maybe 

Guidelines and evidence are rarely conclusive.

I use "do it, don't do it, and be conservative" to guide decisions.

Because some questions can't be answered yes or no I've thought about the language for a third choice. From the GRADE Working Group :
We suggest using the following categories for recommendations:

"Do it" or "don't do it"—indicating a judgment that most well informed people would make;

"Probably do it" or "probably don't do it"—indicating a judgment that a majority of well informed people would make but a substantial minority would not.

Saturday, July 03, 2004

Source Data 

Thanks to alert readers for showing me this post's source (bmj.com Isaacs and Fitzgerald 319 (7225): 1618).

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