The Journal of family practice
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Physicians have little evidentiary guidance for pharmacologic agent selection for atrial fibrillation (AF). ⋯ Although multiple antiarrhythmic agents had strong evidence of efficacy compared with control treatment for MSR, ibutilide/dofetilide and flecainide had particularly strong evidence of efficacy compared with control treatment for AF conversion. There is sparse and inconclusive evidence on direct agent comparisons and adverse event rates. Obtaining information regarding these relative efficacies should be a research priority.
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Meta Analysis
A systematic review of troponin T and I values as a prognostic tool for patients with chest pain.
The accuracy of the troponin T and I test as a prognostic tool for patients with chest pain varies considerably depending on the patient population, the cutoff for an abnormal test result, and other factors. The goal of our systematic review was to synthesize the best available evidence on this topic. ⋯ If the peak troponin T or I level measured at least 6 hours after the onset of chest pain symptoms is in the normal range in a patient with a normal electrocardiogram, it is very unlikely that the patient will die or have a nonfatal MI in the next 30 days (< or =1%). The initial troponin value is not as helpful as the peak value at least 6 hours after the onset of chest pain. An abnormal troponin test result for patients with unstable angina or non-Q-wave MI identifies a subset at greater risk of death.
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Most clinicians prescribe antibiotics for acute bronchitis in spite of recommendations against this practice. Because the results of individual clinical trials have been mixed, we conducted a meta-analysis to determine whether antibiotics are effective treatment for acute bronchitis. ⋯ Antibiotics may be modestly effective for a minority of patients with acute bronchitis. It is not clear which patient subgroups might benefit, and the failure of some studies to report negative findings may have resulted in overestimates of the benefits of antibiotics. Antibiotics are not necessary for every patient with acute bronchitis.
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Eye patching is commonly recommended for treating corneal abrasions. This advice seems based more on anecdotes or disease-oriented evidence theorizing that there is faster healing or less pain when the eye is patched. This meta-analysis was performed to determine if eye patching is a useful treatment for corneal abrasions. ⋯ Eye patching was not found to improve healing rates or reduce pain in patients with corneal abrasions. Given the theoretical harm of loss of binocular vision and possible increased pain, we recommend the route of harmless nonintervention in treating corneal abrasions.