For fibromyalgia, which treatments are the most effective?

There is no single most effective modality for the treatment of fibromyalgia syndrome, and no objective comparison of the results from the different studies is available. Low-dose tricyclic antidepressants (TCAs) improve sleep quality and global well-being and have a moderate beneficial effect on tenderness and stiffness (strength of recommendation [SOR]: A, based on a systematic review of randomized controlled trials [RCTs]). Selective serotonin reuptake inhibitors (SSRIs) may moderately improve fibromyalgia-related symptoms (SOR: B, based on a few RCTs). The serotonin and norepinephrine reuptake inhibitors (SNRIs) duloxetine (Cymbalta) and milnacipran (Ixel, not currently available in the US) improve pain and other symptoms (SOR: B, based on single RCTs). Tramadol (Ultram) improves pain and other outcomes (SOR: A, based on a few RCTs). Cyclobenzaprine (Flexeril) improves both pain and sleep quality (SOR: A, based on a systematic review of RCTs). Aerobic exercise improves overall functional capacity and sense of well-being for patients with fibromyalgia (SOR: A, based on a systematic review of RCT). Cognitive behavioral therapy improves patients' self-reported symptoms (SOR: A, based on RCTs)

Are overweight children more likely to be overweight adults?

Overweight at any age in childhood increases the risk for overweight in adulthood. The relative risk (RR) ranges from 1.9 to 10.1 and increases as children get older. Not all overweight children become overweight adults, however (strength of recommendation: A, systematic review of consistent prospective and retrospective cohort studies)

What is the best management for patients who have a TIA while on aspirin therapy?

Alternative antiplatelet therapy for stroke prevention is indicated for patients who experience transient ischemic attacks (TIAs) while on aspirin therapy (strength of recommendation [SOR]: A, based on 1 meta- analysis and 1 randomized controlled trial). The combination of aspirin and extended- release dipyridamole reduces the risk of stroke following a TIA (SOR: A). Thienopyridines (eg, clopidogrel and ticlopidine) are an alternative for patients at high risk for a cardioembolic event. Ticlopidine reduces the risk of stroke following TIA, specifically showing benefit for patients previously on aspirin (SOR: A). Clopidogrel has not shown significant reduction in reoccurrence of stroke and has not been studied for patients with a previous TIA. Aspirin and a thienopyridine do not provide significant additional reduction in secondary strokes (SOR: A)

Sleep apnea in adults: How accurate is clinical prediction?

Questionnaires, physical examination, and clinical prediction rules estimate the pretest probability of obstructive sleep apnea hypopnea syndrome (OSAHS), but are not specific enough to make the diagnosis (strength of recommendation [SOR]: B, meta- analyses, prospective cross-sectional studies). The Epworth Sleepiness Scale is a reliable measure of daytime sleepiness (SOR: B, factor analysis). The Berlin Questionnaire, Mallampati score, and truncal obesity can be used to assess pretest probability of OSAHS (SOR: B, multivariate analyses, cross-sectional studies)

What are the most effective nonpharmacologic therapies for irritable bowel syndrome?

Herbal formulations, certain probiotics, elimination diets based on immunoglobulin G (IgG) antibodies, cognitive behavioral therapy, and self-help books have been shown to decrease global symptoms of irritable bowel syndrome (IBS) and improve overall quality of life (strength of recommendation [SOR ]: B). For patients with severe refractory IBS, hypnosis has been shown to relieve symptoms (SOR : B). Soluble fiber is more effective than insoluble fiber at improving global IBS symptom ratings (SOR : C)

Should we screen women for hypothyroidism?

Testing for thyroid-stimulating hormone (TSH) finds more cases of unrecognized hypothyroidism than history and physical examination (strength of recommendation [SOR]: A, based on cohort studies). Women with an initial screening TSH >10 mU/L are more likely to develop complications of hypothyroidism and to benefit from treatment (SOR: A, based on prospective cohort studies). Treating women who have asymptomatic hypothyroidism and a screening TSH >10 mU/L prevents progression to symptomatic overt disease (SOR: A, based on prospective cohort studies) and reduces serum lipid levels (SOR: A, based on randomized controlled trials). Treating women who have subclinical hypothyroidism found by screening does not reduce symptoms (SOR: A, small randomized controlled trials), and its effect on cardiac disease remains controversial. Treatment may increase bone loss in premenopausal women (SOR: A, based on randomized controlled trials and controlled cross-sectional studies), and it may cause symptoms in certain individuals (SOR: C, based on observational studies)

How best to diagnose asthma in infants and toddlers?

No reliable way exists to diagnose asthma in infants and toddlers. Recurrent wheezing, especially apart from colds, combined with physician diagnosed eczema or atopic dermatitis, eosinophilia, and a parental history of asthma, increase the probability of a subsequent asthma diagnosis in the absence of other causes (strength of recommendation: B, 2 good-quality cohort studies)

The State of the Parties (Seventh Edition)

Continuing a three-decade tradition, The State of the Parties 7th edition brings together leading experts to evaluate change and continuity in American electoral politics. Political parties in America have never been more contentious and divided than they are right now. Even splits within the parties themselves have the power to elevate relatively unknown candidates to power and topple established incumbents. With sections devoted to polarization and the electorate, polarization and political elites, tea party politics, super PACS, and partisan resources and partisan activities, the contributors survey the American political landscape. They pay special attention to polarization between and within the parties in the aftermath of the 2012 election, demographic changes to America\u27s political parties, the effects of new media and campaign finance laws on national and local electoral results, the Tea Party\u27s rise and, as always, the implications of all these factors on future policymaking and electoral prospects. The State of the Parties 7th edition offers an indispensable guide to American politics for scholars, students, and practitioners.https://ideaexchange.uakron.edu/state_of_the_parties7/1000/thumbnail.jp

The State of the Parties 2018 (Eight Edition)

The State of the Parties 2018 brings together leading scholars of parties, elections, and interest groups to provide an indispensable overview of American political parties today. The 2016 presidential election was extraordinary, especially the unexpected nomination and election of Donald Trump to the White House. What role did political parties play in these events? How did the party organizations fare? What are the implications for the future? Scholars and practitioners from throughout the United States explore the current state of American party organizations, constituencies and resources at the national, state and local level.https://ideaexchange.uakron.edu/state_of_the_parties8/1000/thumbnail.jp

Recent Decisions

Comments on recent decisions by Paul B. Coffey, Joseph A. Marino, Thomas Kavadas, Jr., John C. Hirschfeld, Thomas L. Shaffer, W. R. Kennedy, John R. Martzell, and John F. Beggan