Do ACE inhibitors decrease mortality in patients with hypertension?

When used to treat patients with hypertension, ACE inhibitors reduce cardiovascular and all-cause mortality as effectively as diuretics, beta blockers, and calcium channel blockers. [Strength of recommendation: A, based on meta-analyses of randomized controlled trials (RCTs) with patient-oriented outcomes

What is the most effective beta-blocker for heart failure?

Three beta-blockers--carvedilol, metoprolol, and bisoprolol--reduce mortality in chronic heart failure caused by left ventricular systolic dysfunction, when used in addition to diuretics and angiotensin converting enzyme (ACE) inhibitors (strength of recommendation [SOR]: A, based on large randomized placebo-controlled trials). No differences in mortality or patient tolerance have been demonstrated in studies comparing carvedilol and metoprolol (SOR: B, based on small head-to-head trials)

What is the best therapy for superficial thrombophlebitis?

For proximal saphenous vein thrombosis, anticoagulation is more effective than venous ligation (with or without stripping) in preventing deep venous thrombosis (DVT) and pulmonary embolus (PE) (strength of recommendation [SOR]: C, qualitative systematic review of primarily case series). For patients with superficial venous thrombophlebitis (SVTP) distal to the saphenous vein of the thigh, tenoxicam (a nonsteroidal anti-inflammatory agent [NSAID]) and low-molecular-weight heparin are similarly effective for reducing extension and subsequent DVT when administered along with compression therapy (SOR: B, 1 randomized controlled trial). Oral or topical NSAIDs, topical heparin, and topical nitroglycerin all alleviate symptoms and speed resolution of SVTP caused by infusion catheters (SOR: B, smaller, occasionally conflicting randomized trials)

What is the best macrolide for atypical pneumonia?

Erythromycin, clarithromycin, and azithromycin are equally effective in treating pneumonia caused by Mycoplasma pneumoniae or Chlamydophila (formerly Chlamydia) pneumoniae (strength of recommendation [SOR]: B, small head-to-head trials). Macrolide choice can be based on other considerations--cost, side effects, and effectiveness against other suspected pathogens (SOR: C, expert opinion)

Does antepartum perineal massage reduce intrapartum lacerations?

Yes--to a point. Antepartum perineal massage reduces both the incidence of perineal trauma requiring suturing and the likelihood of episiotomy in women who have never given birth vaginally. It reduces the incidence of postpartum perineal pain in women who have given birth vaginally. Perineal massage doesn't reduce the frequency of first- or second-degree lacerations or third- and fourth-degree perineal trauma. (Strength of recommendation [SOR]: A, systematic review of randomized controlled trials [RCTs].

When are antibiotics indicated for acute COPD exacerbations?

Antibiotics (including those given orally) reduce mortality and treatment failures for hospitalized patients with acute exacerbations of chronic obstructive pulmonary disease (COPD) (strength of recommendation [SOR]: A, based on systematic reviews). Antibiotics may be prescribed in the outpatient setting for those with severe exacerbations (SOR: C, based on expert opinion)

Do pedometers increase activity and improve health outcomes?

Q: Do pedometers increase activity and improve health outcomes? Evidence-based answer: yes. In overweight and obese patients, exercise interventions using a pedometer increase steps by about a mile per day over the same interventions without access to pedometer information (strength of recommendation [SOR]: A, meta-analysis of randomized controlled trials [RCTs]) and are associated with a modest 4 mm Hg reduction in systolic blood pressure (BP) over baseline (SOR: B, meta-analysis of RCTs and cohort studies). In overweight patients with diabetes, pedometer use with nutritional counseling is associated with 0.86 kg greater weight loss than nutritional counseling alone (SOR: B, meta-analysis of lower quality RCTs). Pedometers increase activity in patients with various musculoskeletal conditions and may help reduce pain (SOR: B, meta-analysis of RCTs with heterogeneous outcomes). In low-activity elderly patients, pedometers do not appear to increase total activity when added to an exercise program, but they do appear to increase walking (SOR: B, RCT). There is no evidence concerning the impact of pedometers on cardiovascular outcomes

When is neuroimaging warranted for headache?

Neuroimaging is warranted to evaluate headaches when patients present to an emergency department with signs or symptoms of an intracranial lesion. These signs or symptoms include abrupt onset of headache, focal neurological abnormalities (strength of recommendation [SOR]: B, based on a validating cohort study), decreased level of consciousness (SOR: B, based on a retrospective, nonconsecutive case study), occipitonuchal location, multiple associated symptoms, and age older than 55 years (SOR: B, based on a case-control study)

Do hyaluronic acid injections relieve OA knee pain?

Hyaluronic acid (HA) injections relieve pain more than placebo. The effect is small but similar to results from oral nonsteroidal anti-inflammatory drugs (NSAIDs) or steroid injection (strength of recommendation ([SOR]: B, conflicting meta-analyses). The various HA products all appear to be equally effective in reducing pain (SOR: B, randomized clinical trials [RCTs]). Data concerning the effect of HA on functional ability are conflicting

Does breastfeeding affect the risk of childhood obesity?

Q: Does breastfeeding affect the risk of childhood obesity? Evidence-based answer: Yes. Even having breastfed during the first year of life is associated with a 15% lower risk of overweight or obesity over the next 2 to 14 years compared with never having breastfed. Breastfeeding exclusively for 6 months is associated with a 30% to 50% reduction in risk (strength of recommendation [SOR]: B, meta-analysis of cohort studies and subsequent cohort studies). However, interventions that increase breastfeeding rates during the first 3 to 6 months of life don't appear to alter body mass index (BMI) at 11 to 12 years of age (SOR: B, randomized clinical trial [RCT]). Introducing complementary (solid) foods before 3 months is associated with a 30% greater risk of childhood obesity than later introduction; starting solid foods after 4 months isn't linked to increased obesity. High caloric density of complementary feedings may be associated with greater childhood obesity (SOR: C, systematic reviews of heterogeneous cohort studies). Scheduled feeding doubles the risk of rapid infant weight gain compared with on-demand feeding, although it's unclear whether a direct relationship exists between rapid infant weight gain and childhood obesity (SOR: B, cohort study)