Tools for Practice

Tools for Practice #423 – Estrogen – an answer to a burning question?

Does estrogen reduce urinary tract infections (UTIs) in post-menopausal women?

In women with recurrent UTIs or urogenital symptoms, vaginal estrogens reduce the number of women with UTIs from 24% to 10% at ~1 year. Women with recurrent UTIs may see the largest benefit. Oral estrogens are not effective. Read More

Tools for Practice #422 – What’s the Scoop on Creatine? Effects on strength

How does creatine supplementation affect strength in adults?

Evidence supporting creatine is unreliable due to small, short trials, lack of blinding, and few intention-to-treat analyses. At best, over ~5 weeks, creatine may improve bench press (~1kg) and squat (~6kg) strength, but not leg press or hand-grip strength. In the largest and longest trials, no consistent improvements were observed. Adverse effects appear similar to placebo. Read More

Tools for Practice #421 – Happiness is a Dry Bed: Desmopressin for pediatric nocturnal enuresis

Does desmopressin reduce bedwetting for children with nocturnal enuresis?

Desmopressin increases the proportion of children achieving 14 consecutive dry nights (“complete response”) at 2 weeks from 10% (placebo) to 32%. Desmopressin also decreases wet nights by ~2 per week over placebo with similar adverse effects. Short-term efficacy is similar to enuresis alarms but alarms may have lower relapse rates. More children will have complete response with desmopressin-alarm combination (53%) versus desmopressin alone (42%). Read More

Tools for Practice #420 – Scratching the Surface: What is the most effective treatment for scabies?

For adults and children with classic scabies, how effective are treatment options and what is the duration of treatment?

At 4 weeks, treatment success for scabies occurs in 89-93% of patients treated with topical permethrin 5% cream versus 72-86% treated with oral ivermectin. Permethrin should be applied to entire body (may include face and scalp), including skin folds and under nails. Two doses (day 0 and day 7-14) generally recommended, especially if mites present at 7-14 days. Pruritus can persist for weeks after treatment. Adverse effects similar between groups (4-6%). Read More

Tools for Practice #419 – Vitamin B12 Deficiency: Monthly shots or daily pills?

In patients with vitamin B12 deficiency, is oral vitamin B12 as effective as intramuscular (IM) vitamin B12?

Oral vitamin B12 is as effective as IM for most patients with deficiency. Daily oral intake required: 1mg dose is the most studied. Read More