What nonhormonal therapies are effective for postmenopausal vasomotor symptoms?

Regular exercise may reduce vasomotor symptoms of menopause (strength of recommendation [SOR]: C--single observational study). Soy products/isoflavones, either through diet or supplementation, may reduce the incidence of hot flushes (SOR: D--inconsistent results of randomized trials). Clonidine, as an oral or transdermal preparation, reduces hot flushes (SOR: A--randomized clinical trials), as does gabapentin (SOR: A-- single randomized clinical trial). In cancer patients who have had surgical menopause, selective serotonin reuptake inhibitors and megestrol (Megase) have been effective in reducing hot flushes (SOR: A; B for extrapolation to the general population). Other therapies--including Bellergal (a combination of belladonna, ergotamine, and phenobarbital), methyldopa, evening primrose oil, maiquan, flaxseed, ginseng, and topical wild yam extract--have not been effective. Black cohosh may be effective, but the evidence for this is of poor quality (SOR: C)

Antiviral Agents for Pregnant Women with Genital Herpes

There is no evidence that the use of antiviral agents in women who are pregnant and have a history of genital herpes prevents perinatal transmission of herpes simplex virus (HSV) to neonates. [Strength of recommendation: A, based on multiple systematic reviews] However, treatment with antivirals during the last month of pregnancy does reduce the rate of HSV outbreaks in pregnant women and the resultant need for cesarean delivery. [Strength of recommendation: A, based on multiple systematic reviews

What environmental modifications improve pediatric asthma?

Reducing environmental tobacco smoke exposure decreases health care utilization among poor asthmatic children. Dust mite reduction by chemical measures is potentially harmful. (Grade of recommendations: B, based on single randomized controlled trial.) Evidence is insufficient for or against dust mite reduction by physical means, use of synthetic or feather bedding, removal of cats, use of air filters or reducing indoor humidity. (Grade of recommendations: D, inconsistent studies.

How accurate is stress radionuclide imaging for diagnosis of CAD?

Stress radionuclide testing is a moderately accurate test compared with coronary angiography for the diagnosis of coronary artery disease (CAD) in intermediate-risk individuals. Variations in technique of imaging (planar or single-photon emission computed tomography [SPECT]) and stress (exercise or pharmacologic) do not significantly alter the accuracy of this test, although there is some evidence for decreased accuracy in women (strength of recommendation [SOR]: A, based on multiple meta-analyses). Abnormal stress radionuclide screening in vascular surgical candidates also predicts an increased rate of perioperative cardiac events (SOR: A, based on meta-analysis)

Does microalbuminuria screening in diabetes prevent complications?

Screening diabetic patients for microalbuminuria identifies those who may benefit from treatments that delay progression to renal failure (strength of recommendation: B, based on extrapolation from Level 1 treatment studies of patients with microalbuminuria). No research has determined the best method for screening for microalbuminuria, or whether screening in primary care populations will produce better long-term outcomes. No studies have examined the role of microalbuminuria screening after angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) have been instituted for other indications

What are the indications for bariatric surgery?

No studies evaluate the commonly used indications for bariatric surgery. Consensus guidelines suggest that the surgical treatment of obesity should be reserved for patients with a body-mass index (BMI) >40 kg/m2 or with BMI >35 kg/m2 and 1 or more significant comorbid conditions, when less invasive methods of weight loss have failed and the patient is at high risk for obesity-associated morbidity and mortality (strength of recommendation: C, based on consensus guidelines)

Does digoxin decrease morbidity for those in sinus rhythm with heart failure?

In patients with congestive heart failure due to systolic dysfunction who are in normal sinus rhythm, digoxin therapy reduces rates of hospitalization, as well as clinical deterioration, defined as worsening New York Heart Association (NYHA) classification or an increase in clinical signs and symptoms (strength of recommendation [SOR]: A, systematic review of randomized controlled trials [RCT]). These benefits appear to be more pronounced for men. Patients treated with digoxin are at increased risk of developing supraventricular dysrhythmias and second- or third-degree atrioventricular block (SOR: A, large RCT). It is unclear if patients with diastolic dysfunction experience similar benefits or harms (SOR: A, systematic review of RCTs). Digoxin has not been shown to have any effect on mortality for men with congestive heart failure in sinus rhythm (SOR: A, systematic review of RCTs). Digoxin use for women may be associated with an increased risk of mortality (SOR: B, extrapolation from RCT)

Are breast self-exams or clinical exams effective for screening breast cancer?

Breast self-examination has little or no impact on breast cancer mortality and cannot be recommended for cancer screening (strength of recommendation [SOR]: A, based on a systematic review of high-quality randomized, controlled trials [RCTs]). Clinical breast examination is an important means of averting some deaths from breast cancer, but demands careful attention to technique and thoroughness (SOR: B, extrapolating from a high-quality RCT)

Is prostate-specific antigen (PSA) screening indicated for any subgroup of men?

Although African American men, men with a first-degree relative with prostate cancer (CaP), and older men constitute higher-risk subgroups, no well-designed randomized controlled trials are available that show PSA testing to improve mortality or quality of life for these or any other groups of men. A trend toward detecting more localized cancers and a possible decreasing mortality rate from CaP in all men may be related to PSA testing, lead-time bias, or both. (Grade of recommendation: C, based on inadequate reference standards and an unclear clinical decision rule.

What is the most effective treatment for external genital warts?

Podofilox (Condylox), imiquimod (Aldara), cryotherapy, and surgical options all seem reasonable alternatives that are superior to podophyllin. (Grade of recommendation: B, based on systematic review.) No studies of surgical options versus home use preparations have been reported. Trichloroacetic acid and 5-fluorouracil (5-FU) have not been sufficiently studied