Canadian family physician Médecin de famille canadien
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Meta Analysis
Opioid use disorder in primary care: PEER umbrella systematic review of systematic reviews.
To summarize the best available evidence regarding various topics related to primary care management of opioid use disorder (OUD). ⋯ There is reasonable evidence that patients with OUD should be managed in the primary care setting. Diagnostic criteria for OUD remain elusive, with 1 reasonable case-finding tool. Methadone and buprenorphine improve treatment retention, while medication-related contingency methods could worsen retention. Counseling is beneficial when added to pharmacotherapy.
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Meta Analysis
Systematic review of systematic reviews for medical cannabinoids: Pain, nausea and vomiting, spasticity, and harms.
To determine the effects of medical cannabinoids on pain, spasticity, and nausea and vomiting, and to identify adverse events. ⋯ There is reasonable evidence that cannabinoids improve nausea and vomiting after chemotherapy. They might improve spasticity (primarily in multiple sclerosis). There is some uncertainty about whether cannabinoids improve pain, but if they do, it is neuropathic pain and the benefit is likely small. Adverse effects are very common, meaning benefits would need to be considerable to warrant trials of therapy.
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Review Meta Analysis
Use of over-the-counter cough and cold medications in children.
Every winter I see numerous children in my office with cold symptoms. Is it safe and effective to use over-the-counter cough and cold medications to alleviate their symptoms? ⋯ Over-the-counter cough and cold medications are not effective in treating children with the common cold and might cause serious side effects, including death. New recommendations restricting use in Canada to those older than 6 years of age are effective immediately, with relabeling of products starting in the fall of 2009.
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Meta Analysis
How advance directives affect hospital resource use. Systematic review of the literature.
To assess whether advance directives influence resource use by hospitalized patients. ⋯ Little evidence supports the hypothesis that advance directives reduce resource use by hospitalized patients. Some retrospective studies have shown savings, but their conclusions are weakened by shortcomings in study design. Prospective trials, which have better experimental methods, have demonstrated no evidence of cost savings with the use of advance directives.