P.E.A.R.L.S: un simple susurro es efectivo en el diagnostico de dificultad auditiva

A simple whisper test is effective for diagnosing hearing impairment

Clinical Question	How useful are simple screening tests for diagnosing hearing impairment?
Bottom Line	The whispered voice tests and the audio scope are very accurate for ruling out hearing impairment (i.e if patient can hear whisper, they are unlikely to be deaf)
Context	Compared to the Weber and Rinne tuning fork tests the whispered voice test is the most accurate and may be better than the expensive audioscope, with pooled positive and negative likelihood ratios of 6.1 and 0.03 respectively.
Caveat	There is no single standard method for the whispered voice test but modified Paul Glasziou suggests the following: stand behind the patient at arm’s length (hands on their shoulders), then cover one ear (by rubbing a piece of paper over the external meatus). Exhale fully and whisper letters and numbers with different types of sound. (e.g. b, 6, k, 2, m, 9). Ask the patient to repeat the letters/numbers after each sound. Allow 1-2 errors and repeat each sound once if necessary.
Reference	Bagai A, et al. Does this patient have hearing impairment ? JAMA 2006;295:416-28
Date (Author) #20	January 2007 (Bruce Arroll/Brian McAvoy)

P.E.A.R.L.S: Inhibidores de la bomba de protones, mas efectivos en la esofagitis

Proton pump inhibitors (PPPIs)  most effective treatment for oesophagitis

 

Clinical Question	What is the most effective treatment for reflux oesophagitis?
Bottom Line	Proton pump inhibitor (PPI) therapy is the most effective treatment for short-term (8wks) management of gastro- oesophageal reflux disease (GORD)  – NNT= 1 to 2 (for PPI vs placebo). PPI better than H2 receptor antagonist (H2RA)  but both superior to placebo. There is a paucity of evidence on prokinectic therapy but no evidence that it is superior to placebo.
Context	GORD is a common problem with an estimated prevalence of 20% in adults. PPIs and H2RAs relieve symptoms by reducing acid secretion in the stomach.
Caveat	In equivalent dosage different PPI preparations do not show statistically significant differences in their healing effects. Although there was an apparently higher disease persistence rate at the end of the treatment with double dose PPI compared to standard dose, this difference was not statistically significant.
Reference	Mostafizur Khan, Jose Santana, Clare Donnellan, Cathryn Preston, Paul Moayyedi. Medical treatments in the short term management of reflux oesophagitis. Cochrane Database of Systematic Reviews 2007, Issue 2. Art. No.: CD003244. DOI: 10.1002/14651858.CD003244.pub2. This review contains 134 trials with 35978 participants. Cochrane Reviews 2007, Issue 1.
Date (Author)  #19	May 2007 (Brian R McAvoy)

 

NNT = numbers needed to treat to benefit one person

NNH = numbers needed to harm to benefit one person

Both NNT and NNH are only reported if the studies or pooling of studies is statistically significant

Disclaimer : The P.E.A.R.L.S. are for educational use only and are not meant to guide clinical activity nor are they a clinical guideline.