Are there big differences among beta-blockers in treating essential hypertension?

Yes, a number of beta-blockers are effective in lowering blood pressure (strength of recommendation [SOR]: A, multiple, consistent randomized controlled trials [RCTs]). Cardioselective beta-blockers do not alter lung function studies for patients with chronic obstructive pulmonary disease (COP D) or reversible airway disease (SOR: A, meta-analysis of RCTs). Propranolol and timolol have greater risks of causing fatigue as a side effect (SOR: A, meta- analysis of RCTs). Recent meta-analyses have stirred debate on the effectiveness of the agents in preventing adverse outcomes. The level of evidence has reached the point where the practice of using beta-blockers as monotherapy should be questioned (SOR : C, expert opinion)

Does stopping a statin increase the short-term risk of a cardiovascular event?

When hydroxymethyl glutaryl coenzyme A (HMG CoA) inhibitors (statins) are stopped by asymptomatic patients, there appears to be no increased risk of cardiovascular events (strength of recommendation [SOR]: B). However, for patients who have recently experienced a cardiovascular event, discontinuation of statins increases the risk of further events and death (SOR: B)

Which oral antifungal is best for toenail onychomycosis?

Terbinafine, 250 mg taken daily for 12 weeks, is the best regimen for toenail onychomycosis due to better clinical and mycologic cure rates, tolerability, and cost effectiveness (strength of recommendation [SOR]: A, meta-analyses)

How should you treat Candida vaginitis in patients on antibiotics?

Oral and intravaginal antifungals for the treatment of uncomplicated vulvovaginal candidiasis (VVC) have similar effectiveness (strength of recommendation [SOR]: A, systematic review). However, no randomized controlled trials (RCTs) have addressed treatment options for patients taking antibiotics. Oral antifungals are contra-indicated in pregnancy. While shorter courses of intravaginal therapy can be used by nonpregnant women, 7-day treatment may be necessary during pregnancy (SOR: A, systematic review). Products containing Lactobacillus species do not prevent postantibiotic vulvovaginitis (SOR: A, systematic review and RCT)

What is the role of combination therapy (insulin plus oral medication) in type 2 diabetes?

Combination therapy using insulin plus metformin (Glucophage), a sulfonylurea, or both produces glycemic control comparable with using insulin alone, but there is less weight gain when metformin is used (strength of recommendation [SOR]: B, based on systematic review of randomized controlled trials [RCTs] with some heterogeneity). Combination therapy using insulin and pioglitazone (Actos) reduces glycosylated hemoglobin (HbA1c) more than either insulin alone or adding pioglitazone to a sulfonylurea, but results in more weight gain (SOR: A, based on RCT)

Should patients receive 23-valent pneumococcal vaccination more than once?

No patient-oriented evidence supports pneumococcal revaccination of any patient (high-risk or otherwise). Antibody levels may be augmented by revaccination; however, the clinical efficacy of revaccination, even among high-risk patients, is unknown. Revaccination is recommended by the Advisory Committee on Immunization Practices (ACIP) in certain circumstances. (strength of recommendation [SOR]: C, expert opinion based on physiology/bench research). Revaccination once appears to be safe, especially if provided 5 years or more after primary vaccination (SOR: B, based upon consistent results of cohort studies and nonrandomized prospective trials)

What steps can reduce morbidity and mortality caused by hip fractures?

Surgery within 24 hours of hip fracture is a critical step in reducing complications, and may decrease mortality compared with conservative care (strength of recommendation [SOR]: B, cohort studies). Give patients heparin at the time of admission to prevent venous thromboembolism (VTE) (SOR: A, systematic reviews of RCTs). Anticoagulation should be continued in some form for 10 days or until the patient is fully ambulatory (SOR: A). Patients should also get prophylactic antibiotics in the 2 hours before surgery (SOR: A, meta-analysis of RCT)

Should you treat carriers of pharyngeal group A strep?

The jury is out as to whether you should treat asymptomatic carriers of group A streptococci (GAS), because no studies specifically address the issue. In addition, many patients are unlikely to care about their carrier status, although they probably care about symptoms and treatment side effects. Nonetheless, you may want to consider treating GAS carriers under the certain circumstances (strength of recommendation [SOR]: C, expert opinion)

Brain Natriuretic Peptide Levels for Ruling Out Heart Failure

A BNP level less than 100 pg per mL (100 ng per L) can rule out heart failure. (Strength of Recommendation [SOR]: A, based on meta-analyses.) BNP levels should be used when the pretest probability of heart failure based on overall clinical assessment is of an intermediate likelihood. (SOR: A, based on meta-analyses.

What's the best diagnostic evaluation of night sweats?

There is no single best evidence-based approach to the diagnostic evaluation of night sweats, given the limited number of studies on the subject. A detailed history, however, does appear to be the most important initial diagnostic tool (strength of recommendation [SOR]: C, based on usual practice and clinical opinion). No clinical trials have directly studied symptomatic relief of night sweats alone