Difference between revisions of "Brown"
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<span style="font-family: Arial,Helvetica,sans-serif; font-size: 130%;">'''Pseudoephedrine reduced the incidence of middle ear barotrauma in novice divers.'''</span> | <span style="font-family: Arial,Helvetica,sans-serif; font-size: 130%;">'''Pseudoephedrine reduced the incidence of middle ear barotrauma in novice divers.'''</span> | ||
| − | <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Clinical bottom line:''' </span> | + | <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Clinical bottom line:''' </span> <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">Administration of 60mg oral pseudoephedrine reduced the incidence of middle ear barotrauma in novice divers.</span> |
| − | <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">Administration of 60mg oral pseudoephedrine reduced the incidence of middle ear barotrauma in novice divers. </span> | ||
| − | <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Citation:''' Brown M, Jones J, Krohmer J. Pseudoephedrine for the Prevention of Barotitis Media: A Controlled Clinical Trial in Underwater Divers. Annals of Emergency Medicine 1992;21(7):106-109. </span> | + | <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Citation:''' Brown M, Jones J, Krohmer J. Pseudoephedrine for the Prevention of Barotitis Media: A Controlled Clinical Trial in Underwater Divers. Annals of Emergency Medicine 1992;21(7):106-109. </span> <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Lead author's name and fax:''' Michael Brown, MD, Department of Emergency Medicine, Grand Rapids, Michigan 49503</span> |
| − | <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Lead author's name and fax:''' Michael Brown, MD, Department of Emergency Medicine, Grand Rapids, Michigan 49503 </span> | ||
| − | <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Three-part Clinical Question:''' Among first time divers, does the administration of oral pseudoephedrine, compared to placebo, reduce the incidence or severity of middle ear barotraumas? </span> | + | <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Three-part Clinical Question:''' Among first time divers, does the administration of oral pseudoephedrine, compared to placebo, reduce the incidence or severity of middle ear barotraumas? </span> <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Search Terms:''' Hyperbaric oxygenation, Barotrauma, Otitis</span> |
| − | <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Search Terms:''' Hyperbaric oxygenation, Barotrauma, Otitis </span> | ||
| − | <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''The Study:''' Double-blind concealed randomised controlled trial with intention-to-treat. </span> | + | <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''The Study:''' Double-blind concealed randomised controlled trial with intention-to-treat. </span> <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''The Study Patients:''' Fit and healthy volunteers undergoing their first certification dive, aged between 18 and 35. </span> <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Control group:''' (N = 56; 56 analysed): Oral placebo administered at least 30 minutes prior to undertaking standard open water dive training. </span> <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Experimental group:''' (N = 60; 60 analysed): 60mg of oral pseudoephedrine administered as above.</span> |
| − | <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''The Study Patients:''' Fit and healthy volunteers undergoing their first certification dive, aged between 18 and 35. </span> | ||
| − | <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Control group:''' (N = 56; 56 analysed): Oral placebo administered at least 30 minutes prior to undertaking standard open water dive training. </span> | ||
| − | <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Experimental group:''' (N = 60; 60 analysed): 60mg of oral pseudoephedrine administered as above. </span> | ||
<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''The Evidence:'''</span> | <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''The Evidence:'''</span> | ||
| − | {| | + | {| |
| − | |||
|- | |- | ||
| − | | <span | + | | <span><span>'''Outcome'''</span></span> |
| + | | <span><span>'''Time to Outcome'''</span></span> | ||
| + | | <span><span>'''Placebo rate'''</span></span> | ||
| + | | <span><span>'''Active rate'''</span></span> | ||
| + | | <span><span>'''Relative risk reduction'''</span></span> | ||
| + | | <span><span>'''Absolute risk reduction'''</span></span> | ||
| + | | <span><span>'''NNT'''</span></span> | ||
|- | |- | ||
| − | | <span | + | | <span>'''ME Barotrauma'''</span> |
| + | | <span><span>Immediate</span></span> | ||
| + | | <span><span>0.32</span></span> | ||
| + | | <span><span>0.08</span></span> | ||
| + | | <span><span>74%</span></span> | ||
| + | | <span><span>0.24</span></span> | ||
| + | | <span><span style="display: block; font-family: Arial,Helvetica,sans-serif; font-size: 110%; text-align: center;">4</span></span> | ||
|- | |- | ||
| − | | <span | + | | <span>95%CI</span> |
| + | | | ||
| + | | | ||
| + | | | ||
| + | | <span><span>30%–100%</span></span> | ||
| + | | <span><span>0.1–0.38</span></span> | ||
| + | | <span><span style="display: block; font-family: Arial,Helvetica,sans-serif; font-size: 110%; text-align: center;">3 - 10</span></span> | ||
|- | |- | ||
| − | | <span | + | | <span>'''Teed score >0'''</span> |
| + | | <span><span>Immediate</span></span> | ||
| + | | <span><span>0.46</span></span> | ||
| + | | <span><span>0.22</span></span> | ||
| + | | <span><span>53%</span></span> | ||
| + | | <span><span>0.25</span></span> | ||
| + | | <span><span style="display: block; font-family: Arial,Helvetica,sans-serif; font-size: 110%; text-align: center;">4</span></span> | ||
|- | |- | ||
| + | | <span>95% CI</span> | ||
| + | | | ||
| + | | | ||
| + | | | ||
| + | | <span><span>17%-89%</span></span> | ||
| + | | <span><span>0.08-0.41</span></span> | ||
| + | | <span><span style="display: block; font-family: Arial,Helvetica,sans-serif; font-size: 110%; text-align: center;">2 to 13</span></span> | ||
|} | |} | ||
| − | <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Comments:''' </span> | + | <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Comments:''' </span> <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">1. Well designed and reliable trial. </span> <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">2. The pseudoephedrine dose is relatively high (2 tabs). </span> <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">3. No data on later performance – e.g. second dive of the day. </span> <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">4. Volunteers represent a young and healthy section of the population and results may not generalize to the general population (high dose of active drug), or even general diving population (lower prevalence of ME barotraumas). </span> <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">5. Authors conclude that severity of injury is reduced, but there is no evidence to support this.</span> |
| − | <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">1. Well designed and reliable trial. </span> | ||
| − | <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">2. The pseudoephedrine dose is relatively high (2 tabs). </span> | ||
| − | <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">3. No data on later performance – e.g. second dive of the day. </span> | ||
| − | <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">4. Volunteers represent a young and healthy section of the population and results may not generalize to the general population (high dose of active drug), or even general diving population (lower prevalence of ME barotraumas). </span> | ||
| − | <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">5. Authors conclude that severity of injury is reduced, but there is no evidence to support this. </span> | ||
| − | <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Appraised by:''' Mike Adams, Cardiff, UK, and Mike Bennett, POWH, Sydney. </span> | + | <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Appraised by:''' Mike Adams, Cardiff, UK, and Mike Bennett, POWH, Sydney. </span> <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">Thursday, 25 September 2003 '''Email:''' [[mailto:Seyking@hotmail.com| Seyking@hotmail.com]]</span> |
| − | <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">Thursday, 25 September 2003 '''Email:''' [[mailto:Seyking@hotmail.com | Seyking@hotmail.com]] </span> | ||
<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Kill or Update By:''' December 2021</span> | <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Kill or Update By:''' December 2021</span> | ||
| − | [[File: | + | [[File:Sumhorsa.gif|center|Sumhorsa.gif]] <span style="display: block; text-align: center;"></span> |
| − | <span style="display: block; text-align: center;"> | + | <p style="text-align: center;"><span style="font-size: 24px;">[[Diving_Medicine|BACK]]</span></p> |
| − | |||
| − | <span style="font-size: 24px;">[[ | ||
Latest revision as of 00:36, 28 December 2019
Pseudoephedrine reduced the incidence of middle ear barotrauma in novice divers.
Clinical bottom line: Administration of 60mg oral pseudoephedrine reduced the incidence of middle ear barotrauma in novice divers.
Citation: Brown M, Jones J, Krohmer J. Pseudoephedrine for the Prevention of Barotitis Media: A Controlled Clinical Trial in Underwater Divers. Annals of Emergency Medicine 1992;21(7):106-109. Lead author's name and fax: Michael Brown, MD, Department of Emergency Medicine, Grand Rapids, Michigan 49503
Three-part Clinical Question: Among first time divers, does the administration of oral pseudoephedrine, compared to placebo, reduce the incidence or severity of middle ear barotraumas? Search Terms: Hyperbaric oxygenation, Barotrauma, Otitis
The Study: Double-blind concealed randomised controlled trial with intention-to-treat. The Study Patients: Fit and healthy volunteers undergoing their first certification dive, aged between 18 and 35. Control group: (N = 56; 56 analysed): Oral placebo administered at least 30 minutes prior to undertaking standard open water dive training. Experimental group: (N = 60; 60 analysed): 60mg of oral pseudoephedrine administered as above.
The Evidence:
| Outcome | Time to Outcome | Placebo rate | Active rate | Relative risk reduction | Absolute risk reduction | NNT |
| ME Barotrauma | Immediate | 0.32 | 0.08 | 74% | 0.24 | 4 |
| 95%CI | 30%–100% | 0.1–0.38 | 3 - 10 | |||
| Teed score >0 | Immediate | 0.46 | 0.22 | 53% | 0.25 | 4 |
| 95% CI | 17%-89% | 0.08-0.41 | 2 to 13 |
Comments: 1. Well designed and reliable trial. 2. The pseudoephedrine dose is relatively high (2 tabs). 3. No data on later performance – e.g. second dive of the day. 4. Volunteers represent a young and healthy section of the population and results may not generalize to the general population (high dose of active drug), or even general diving population (lower prevalence of ME barotraumas). 5. Authors conclude that severity of injury is reduced, but there is no evidence to support this.
Appraised by: Mike Adams, Cardiff, UK, and Mike Bennett, POWH, Sydney. Thursday, 25 September 2003 Email: [Seyking@hotmail.com]
Kill or Update By: December 2021
