Tools for Practice

Tools for Practice #367 Oral Calcitonin Gene-related Peptide Antagonists: A painfully long name for the acute treatment of migraines

Are amyloid-targeting monoclonal antibodies safe and effective for mild cognitive impairment or Alzheimer’s dementia?

Randomized controlled trials (RCTs) of monoclonal antibodies for patients with dementia or mild cognitive impairment found no clinically meaningful improvements in cognitive scores. These medications have a high risk of serious adverse effects and are costly. They should not be used at this time. Read More

Tools for Practice #366 Looking for Closure: Managing simple excisions or wounds efficiently

What are some options for efficiency in wound closure?

Punch biopsies 4mm do not require closure but 8mm do. Skin-glue is similar to tape or sutures for simple wounds for clinician-rated cosmesis and patient satisfaction with similar infection rates of 4-7%. However, dehiscence occurs in ~5% with skin-glue compared to 1% with suture. Absorbable sutures have similar outcomes to non-absorbable sutures. Read More

Tools for Practice #365 Shrooms for Glooms: Evidence for psilocybin for depression

What are the benefits and harms of psilocybin for treatment-resistant/recurrent depression?

Psilocybin, given in treatment facilities with >10 hours psychological support, improves short-term (≤6 weeks) depression scores, helping 20-30% more patients attain response over control. Effects biased by unblinding, short-term trials and mostly inactive comparators. Psychological distress during treatment is common (75-90%) and requires monitoring/supports. Read More

Tools for Practice #364 Facing the Evidence in Acne, Part II: Oral Antibiotics

How effective are oral antibiotics in treating acne of at least mild-moderate severity?

Approximately 17% of patients achieve “success” on oral minocycline versus 9% on placebo at 12 weeks. Oral antibiotics reduce acne lesion count by 10-24% more than placebo. Evidence of the efficacy of adding oral antibiotics to topical agents (example: retinoids, benzoyl peroxide) is limited. Efficacy appears similar between individual antibiotics. Discontinuations due to adverse events are comparable to placebo. Read More

Tools for Practice #363 Making a difference in indifference? Medications for apathy in dementia

In patients with dementia, how safe and effective are stimulants, antidepressants, and antipsychotics for treating apathy?

Methylphenidate may improve apathy scores by a small but potentially clinically meaningful amount compared to placebo (example: 5 points more on a 72-point scale) at ~12 weeks. Methylphenidate does not impact cognition in randomized, controlled trials (RCTs). Antipsychotics and antidepressants do not improve apathy compared to placebo. Read More