Other than anticoagulation, what is the best therapy for those with atrial fibrillation?

Rate control with long-term anticoagulation is recommended for most patients with atrial fibrillation (strength of recommendation [SOR]: A, based on randomized controlled trials [RCTs]). A rhythm-control strategy provides no survival or quality-of life benefit when compared with rate control and causes more adverse drug effects and increased hospitalizations (SOR: A, based on RCTs)

Which diuretics are safe and effective for patients with a sulfa allergy?

Diuretics that do not contain a sulfonamide group (eg, amiloride hydrochloride, eplerenone, ethacrynic acid, spironolactone, and triamterene) are safe for patients with an allergy to sulfa. The evidence is contra-dictory as to whether a history of allergy to sulfonamide antibiotics increases the risk of subsequent allergic reactions to commonly used sulfonamide-containing diuretics (eg, carbonic anhydrase inhibitors, loop diuretics, and thiazides) (strength of recommendation: C, based on case series and poor quality case-control and cohort studies)

What is the most effective diagnostic evaluation of streptococcal pharyngitis?

Standardized clinical decision rules, such as the Centor criteria, can identify patients with low likelihood of group A beta-hemolytic streptococ-cal (GABHS) pharyngitis who require no further evaluation or antibiotics (strength of recommendation [SOR]: A, based on validated cohort studies). For patients at intermediate and higher risk by clinical prediction rules, a positive rapid anti-gen detection (RAD) test is highly specific for GABHS (SOR: A, based on systematic reviews of diagnostic trials). A negative RAD test result, using the best technique, approaches the sensitivity of throat culture (SOR: B, based on retrospective cohort studies). In children and populations with an increased prevalence of GABHS and GABHS complications, adding a backup throat culture reduces the risk of missing GABHS due to false-negative RAD results (SOR: C, based on expert opinion)

Does pneumococcal conjugate vaccine prevent otitis media?

Yes, if the pneumococcal conjugate vaccine (PCV) series is given before 12 months of age. Vaccination before 12 months is associated with a statistically significant reduction in the incidence of both acute (AOM) and recurrent (ROM) otitis media (strength of recommendation [SOR]: A, a systematic review of randomized controlled trials [RCTs] and a large retrospective cohort trial). The benefit disappears if the series is started after 12 months (SOR: B, a systematic review of RCTs with inconsistent results). PCV reduces tympanostomy tube placement for ROM (SOR: A, a large RCT and retrospective cohort trials)

Do nasal decongestants relieve symptoms?

Oral and topical nasal decongestants result in a statistically significant improvement in subjective symptoms of nasal congestion and objective nasal airway resistance in adults' common colds (strength of recommendation [SOR]: A, based on randomized controlled trials). Evidence is lacking to support the use of decongestants in acute sinusitis

Does early detection of suspected atherosclerotic renovascular hypertension change outcomes

We found no evidence for changed outcomes from early detection of renal artery stenosis (RAS). Treatment of RAS in refractory hypertension modestly improves blood pressure control. There was a trend toward improved clinical outcomes but studies were underpowered to demonstrate this (strength of recommendation [SOR]: A, based on systematic review of RCTs)

What treatments relieve arthritis and fatigue associated with systemic lupus erythematosus?

Q: What treatments relieve arthritis and fatigue associated with systemic lupus erythematosus? A: Hydroxychloroquine and chloroquine improve the arthritis associated with mild systemic lupus erythematosus (SLE)--producing a 50% reduction in arthritis flares and articular involvement--and have few adverse effects (strength of recommendation [SOR]: a, systematic review of randomized controlled trials [RCTs]). Methotrexate reduces arthralgias by as much as 79%, but produces adverse effects in up to 70% of patients (SOR: b, systematic review of RCTs with limited patient-oriented evidence). Nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids are often used for SLE joint pain (SOR: c, expert opinion). Omega-3 fatty acids may reduce arthritis symptoms by about 35% (SOR: b, RCTs with inconsistent evidence). Abatacept and dehydroepiandrosterone don't produce clinically meaningful improvements in fatigue associated with SLE, and abatacept causes significant adverse effects (SOR: b, posthoc analysis of a single RCT). Aerobic exercise may help fatigue (SOR: b, systematic review with inconsistent evidence)

Hormone Therapy for Postmenopausal Women with Urinary Incontinence

Postmenopausal women should not receive oral hormone therapy for treatment of urinary incontinence. Hormone therapy is associated with worsening urinary incontinence in postmenopausal women who are incontinent at baseline (Strength of Recommendation [SOR]: A, based on a systematic review) and is associated with an increased risk of developing urinary incontinence in those who are continent at baseline (SOR: A, based on two large randomized controlled trials [RCTs])

What is the initial work-up in the diagnosis of hypertension?

Patients with a new diagnosis of hypertension should be evaluated with a history and physical exam and the following initial studies: serum potassium and creatinine, fasting serum glucose and lipid panel, hematocrit, urinalysis, and electrocardiogram (strength of recommendation [SOR]: C, based on a consensus of expert opinion). Consensus is lacking for measuring serum sodium, calcium, and uric acid. Testing for microalbuminuria is optional in the work-up for a patient without diabetes (SOR: C, expert consensus). Some expert panels list limited echocardiography as another option