fitness first in olney md

  
FP Revolution
Dawn of a New Age of Health Information 

published by
  

 
 
Colin P Kopes-Kerr, MD
Santa Rosa Family Medicine Residency Program
Santa Rosa CA 95404
 

 
 
PEDIATRIC UPDATE
 
IS THERE A GOOD COUGH MEDICINE FOR CHILDREN? Honey has recently been proposed.(1) The relevant study evaluates 105 children with cough, surveyed at baseline and after randomization and administration of buckwheat honey, dextromethorphan (DM: artificially honey-flavored, 17 mg/5 mL), or placebo for cough. The blinding was only partial because the placebo group received an empty syringe instead of a dose. Here are the reported findings:
  • Dextromethorphan was not better than no treatment for any outcome.
  • Comparison of honey to dextromethorphan revealed no significant differences.
  • Honey was significantly superior to no treatment for the symptom of cough frequency (P=0.01) and for total combined symptom score (P=0.04). Those who received honey had a mean 1.89 point improvement on cough frequency as rated by their parents vs. a 1.39 point change for dextromethorphan vs. a 0.92 point change for placebo. Overall, parents rated their children's sleep better after receiving honey, with a 2.49 point improvement for the honey group vs. a 1.79 point improvement for the DM group, and a 1.57 point improvement for placebo, but these changes did not reach statistical significance.
    • COMMENT: Needless to say these results are not very impressive nor very clear. The authors could not achieve a simple clear result. Reasonable controversy exists about what we should measure. The authors preferred cough frequency, which is reasonable, but cough intensity, sleep quality, duration of illness would also be reasonable. How should these be measured? Is a parental 7-point Likert scale adequate?  It too is probably reasonable. Bottom line: Does it really matter clinically that honey beat dextromethorphan by .5 points on a 7-point Likert scale or that honey beat placebo by .97 points? Reasonable men and women, boys and girls may differ. I don't think we have a clear answer. What we can say, given the general badness associated with over-the-counter cough and cold medicines for cough, is that honey is an attractive, safe substitute even if its clinical efficacy is only marginal.
     
     
    A VIDEOCLIP IS WORTH A 1,000 WORDS!  In the British Medical Journal there is a letter to the editor with this title.(2) "To give health workers the experience to identify seriously ill children, modern technology, in the form of video clips, CDs, and DVDs, must play a larger part in training. 'Spotting the Sick Child' is a very good DVD produced for the Department of Health by Ffion Davies and colleagues in the accident and emergency departments of Leicester Royal Infirmary and the Royal London Hospital. A practical introduction and demonstration of a simple but rapid examination routine is followed by clips of many children with difficulty breathing, fever, dehydration, abdominal pain, etc. Some even show the progression of the condition. The second is a CD produced for the World Health Organization by Trevero Duke and others of Melbourne University, Australia. It supports and illustrates a recent WHO publication on hospital care for children..." (3,4)
     
     
     
         The most useful comment of all comes from a subsequent letter to the editor,(5) which cites two recent cases in which video footages obtain by parents by means of their cell phones provided valuable diagnostic information. In one case a previously