Tools for Practice

Tools for Practice #386 – The Bland Supremacy: Salt and cardiovascular disease

Does reducing sodium intake or substituting table salt with sodium-potassium alternatives improve cardiovascular outcomes?

Based on one large randomized, controlled trial (RCT) in patients with hypertension/previous stroke with above average daily salt intake (example 4.8 g/day), replacing table salt with a salt substitute may decrease mortality (from ~4.5% to ~4%) and stroke (from ~3.5% to 3%) per year. Whether reducing sodium by other means reduces mortality or cardiovascular events is unknown. Read More

Tools for Practice #383 – A single dose for treating yeast infections: Is it really this simple?

Does route or duration of antifungals matter when treating uncomplicated vulvovaginal candidiasis in non-pregnant women?

Route and duration do not impact efficacy; only a single dose of oral fluconazole or intravaginal antifungal (example clotrimazole) is needed. Patient preference should guide treatment choice. Read More

Tools for Practice #382 – Exercise for Parkinson’s Disease: More movement = Better movement?

How effective is exercise in Parkinson’s disease?

In patients with Parkinson’s Disease, exercise results in clinically meaningful improvements in motor symptoms similar to changes seen with medications (4-9 points better on a 108-point scale) compared to control over 1-6 months. It doesn’t provide clear improvements in quality of life. Six more patients out of 100 who exercise will avoid one or more falls over 6-12 months compared to control. Read More

Tools for Practice #381 – Pharm for Fibro, Round 2: Can gabapentinoids ease the pain?

Do gabapentinoids reduce pain in patients with fibromyalgia?

About 40% of people with fibromyalgia on pregabalin 300-600mg/day experience a meaningful reduction in pain (pain reduced by ≥30%) versus 30% on placebo at 8-14 weeks. Lower doses (example: 150mg) may not be effective; however, higher doses cause more harm, with up to ~30% of people stopping due to side effects (versus 10% on placebo). Based on one small randomized, controlled trial (RCT), gabapentin is also effective. Read More

Tools for Practice #380 Is the secret to treating depression hidden in your genes?

Can genetic testing improve the efficacy and safety of antidepressants?

Pharmacogenomics testing to guide treatment in patients with depression might increase response and remission rates at 8 weeks by about 5% (example response rate 29% with pharmacogenomics versus 25% usual care), with no clear effects on tolerability. Studies have significant limitations. Cost (up to > $2000) and genes tested vary widely. Read More