Are tympanostomy tubes indicated for recurrent acute otitis media?

For children with recurrent acute otitis media (here defined as 3 or more episodes in 6 months, or 4 or more in a year), tympanostomy tubes are indicated if middle -ear effusion is present. Tubes reduce the frequency of recurrent acute otitis media by 2 to 3 episodes per year in these patients (strength of recommendation [SOR]: A; based on randomized controlled trials). Further benefits include improved quality of life for both child and caregiver and greater parental satisfaction (SOR: B; based on trials that included patients with recurrent acute otitis media or otitis media with effusion). Tympanostomy tubes do not decrease the number of recurrent acute otitis media episodes in children without middle-ear effusion (SOR: A, based on randomized controlled trials). These children run the risk of adverse outcomes of tube placement, including transient or recurrent otorrhea, tympanosclerosis, focal atrophy, perforation, and cholesteatoma (SOR: A; based on meta-analysis)

What is the best treatment for pertussis?

A short-term course of erythromycin, azithromycin, or clarithromycin is as effective as a long-term (2-week) erythromycin therapy in eradicating Bordetella pertussis from the nasopharynx (strength of recommendation [SOR]: A; based on one meta-analysis of randomized controlled trials [RCTs]). Evidence is insufficient to determine the benefit of antibiotic prophylaxis for pertussis contacts. However, due to high mortality and morbidity, prophylaxis is recommended for families who have an infant less than 6 months old (SOR: C; based on expert opinion)

What treatments are safe and effective for mild to moderate hypertension in pregnancy?

There is considerable debate concerning the treatment of mild to moderate essential hypertension during pregnancy. Evidence suggests that because of the potential risk of fetal intrauterine growth restriction, treatment of hypertension should be delayed until maternal blood pressure reaches 150-160 mm Hg systolic or 100-110 mm Hg diastolic, as long as the mother has no preexisting end organ damage. Methyldopa has been the drug of choice for oral treatment, as it is the only medication to have any extended follow-up study. However, a recent meta-analysis raised the possibility of increased fetal mortality (strength of recommendation [SOR]: A, based on systematic review of randomized controlled trials)

What is the best treatment for hypertension in African Americans?

In African Americans with hypertension, therapy is best initiated with the low-sodium Dietary Approaches to Stop Hypertension (DASH) diet and a thiazide-type diuretic (strength of recommendation [SOR]: A, based on randomized controlled trials). If the blood pressure goal is not achieved with thiazide monotherapy, a calcium channel blocker, angiotensin-converting enzyme (ACE) inhibitor, angiotensin II receptor blocker (ARB), or a beta-blocker can be added. An initial combination treatment is recommended for patients with systolic blood pressure >15 mm Hg or diastolic blood pressure >10 mm Hg above target (SOR: C, expert opinion)

Do routine eye exams reduce occurrence of blindness from type 2 diabetes?

Screening eye exams for patients with type 2 diabetes can detect retinopathy early enough so treatment can prevent vision loss. Patients without diabetic retinopathy who are systematically screened by mydriatic retinal photography have a 95% probability of remaining free of sight-threatening retinopathy over the next 5 years. If background or preproliferative retinopathy is found at screening (Figure), the 95% probability interval for remaining free of sight-threatening retinopathy is reduced to 12 and 4 months, respectively (strength of recommendation [SOR]: B, based on 1 prospective cohort study). A reliably sensitive screening exam requires mydriatic retinal photography augmented by ophthalmoscopy when photographs are inconclusive (SOR: A, based on a systematic review). For patients with diabetes not differentiated by type, photocoagulation significantly decreases visual deterioration and reduces the chances of blindness (SOR: A, based on randomized controlled trials [RCT])

Does yoga speed healing for patients with low back pain?

The use of yoga is consistent with recommendations for activity, as tolerated, for patients with low back pain. Literature evaluating the effectiveness of yoga for low back pain is scant, so it is unclear if yoga is equivalent to, or superior to, standard therapies (strength of recommendation: C, based on 1 randomized pilot study and limited case series)

What are the most effective ways you can help patients stop smoking?

Brief counseling, nicotine replacement therapy, antidepressants, and varenicline all work well. Physician intervention should begin with routine assessment of smoking status for all patients. Brief (3 minutes or less) smoking cessation counseling improves quit rates (strength of recommendation [SOR]: A, Cochrane systematic review). Nicotine replacement therapy (NRT), antidepressants (bupropion and nortriptyline), and the nicotine receptor partial agonist varenicline are effective and should be offered to help smokers quit (SOR: A, Cochrane systematic reviews and randomized controlled trials [RCTs])

What is the best medical therapy for new-onset type 2 diabetes?

Sulfonylureas, metformin, thiazolidinediones, and non-sulfonylurea secretagogues differ little in their ability to decrease glycosylated hemoglobin (HbA1c) levels when used as initial monotherapy for diabetes mellitus type 2 (strength of recommendation [SOR]: A, based on systematic reviews); α-glucosidase inhibitors may also be as effective (SOR: B, based on systematic reviews with inconsistent results). Metformin is generally indicated in obese patients because it improves all-cause mortality and diabetes related outcomes (SOR: B, based on a single high-quality randomized controlled trial [RCT]). Insulin is generally not recommended as an initial agent (SOR: C, expert opinion)

Do steroid injections help with osteoarthritis of the knee?

Intra-articular steroid injections appear to provide 2 to 6 weeks of pain relief for patients with knee osteoarthritis (strength of recommendation [SOR]: A). Higher-dose steroids with or without joint lavage can provide pain relief up to 24 weeks (SOR: A). Steroid injections may be an appropriate adjunct in the treatment of osteoarthritis, which includes nonpharmacologic treatments (education, weight loss, physical therapy) and pharmacologic therapy (nonsteroidal anti-inflammatory drugs [NSAIDs], topical and opioid analgesics)

Are beta-2-agonists or anticholinergics more effective for treating COPD?

Both β2-agonists and anticholinergics appear to improve symptoms for patients with chronic obstructive pulmonary disease (COPD). Recent research indicates that adding a long-acting anti-cholinergic to a β2-agonist may improve quality of life for patients with stable COPD more than the use of β2-agonists alone. Both drug classes increase exercise capacity and alleviate symptoms of COPD, although neither alters disease progression (strength of recommendation [SOR]: A). Combination therapy can lead to greater improvements in forced expiratory volume in 1 second (FEV1) than either drug alone (SOR: A). However, until recently there were no convincing direct head-to-head comparisons of the 2 classes, and it is unclear whether this difference is clinically significant