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British Hypertension Society guidelines (BHS-IV)
The British Hypertension Society guidelines (BHS-IV) and the American Joint National Committee guidelines (JNC-7) are very similar in treatment goals. However, the BHS-IV guidelines do not require treatment until both the systolic and diastolic numbers are greater than 160/100 mm Hg, respectively, for patients without cardiovascular disease, diabetes, or other organ damage, whereas the JNC-7 guidelines start drug treatment in all patients with both numbers greater than 140/90 mm Hg. The BHS-IV suggests initial treatment with any 1 of 4 drugs (see the ABCD rule in the synopsis), whereas the bedrock of treatment recommended by the JNC-7 is diuretics, primarily because of the lower cost. (LOE=5)
The British Hypertension Society guidelines (BHS-IV) and the American Joint National Committee guidelines (JNC-7) are very similar in treatment goals. However, the BHS-IV guidelines do not require treatment until both the systolic and diastolic numbers are greater than 160/100 mm Hg, respectively, for patients without cardiovascular disease, diabetes, or other organ damage, whereas the JNC-7 guidelines start drug treatment in all patients with both numbers greater than 140/90 mm Hg. The BHS-IV suggests initial treatment with any 1 of 4 drugs (see the ABCD rule in the synopsis), whereas the bedrock of treatment recommended by the JNC-7 is diuretics, primarily because of the lower cost. (LOE=5)
The British Hypertension Society guidelines (BHS-IV) and the American Joint National Committee guidelines (JNC-7) are very similar in treatment goals. However, the BHS-IV guidelines do not require treatment until both the systolic and diastolic numbers are greater than 160/100 mm Hg, respectively, for patients without cardiovascular disease, diabetes, or other organ damage, whereas the JNC-7 guidelines start drug treatment in all patients with both numbers greater than 140/90 mm Hg. The BHS-IV suggests initial treatment with any 1 of 4 drugs (see the ABCD rule in the synopsis), whereas the bedrock of treatment recommended by the JNC-7 is diuretics, primarily because of the lower cost. (LOE=5)
Cephalosporins better for streptococcus infections in children
Treating streptococcal tonsillopharyngitis in children with a cephalosporin instead of penicillin produces significantly more bacteriologic and clinical cures. One additional child will benefit for every 13 children treated with a cephalosporin rather than penicillin. Only the cephalosporins cefaclor (Ceclor) and loracarbef (Lorabid) did not show an advantage over penicillin. The effect of cephalosporin treatment on prevention of rheumatic heart disease is not known. (LOE=1a)
Treating streptococcal tonsillopharyngitis in children with a cephalosporin instead of penicillin produces significantly more bacteriologic and clinical cures. One additional child will benefit for every 13 children treated with a cephalosporin rather than penicillin. Only the cephalosporins cefaclor (Ceclor) and loracarbef (Lorabid) did not show an advantage over penicillin. The effect of cephalosporin treatment on prevention of rheumatic heart disease is not known. (LOE=1a)
Treating streptococcal tonsillopharyngitis in children with a cephalosporin instead of penicillin produces significantly more bacteriologic and clinical cures. One additional child will benefit for every 13 children treated with a cephalosporin rather than penicillin. Only the cephalosporins cefaclor (Ceclor) and loracarbef (Lorabid) did not show an advantage over penicillin. The effect of cephalosporin treatment on prevention of rheumatic heart disease is not known. (LOE=1a)
Disclosure of errors preferred by patients
Given a hypothetical situation in which harm occurred as the result of a medical error, patients overwhelmingly report that they would want to be told of the error. Full disclosure increases patient satisfaction, trust, and positive emotional responses.
Although this disclosure may make them feel better, it may not decrease their desire to sue. Most patients (83%) would want financial compensation for an injury that occurs because an error, and 13% expressed a desire for compensation even if harm didn’t occur. A questionnaire of this type does not evaluate the role of bedside manner during the process of disclosure. (LOE=2c)
Given a hypothetical situation in which harm occurred as the result of a medical error, patients overwhelmingly report that they would want to be told of the error. Full disclosure increases patient satisfaction, trust, and positive emotional responses.
Although this disclosure may make them feel better, it may not decrease their desire to sue. Most patients (83%) would want financial compensation for an injury that occurs because an error, and 13% expressed a desire for compensation even if harm didn’t occur. A questionnaire of this type does not evaluate the role of bedside manner during the process of disclosure. (LOE=2c)
Given a hypothetical situation in which harm occurred as the result of a medical error, patients overwhelmingly report that they would want to be told of the error. Full disclosure increases patient satisfaction, trust, and positive emotional responses.
Although this disclosure may make them feel better, it may not decrease their desire to sue. Most patients (83%) would want financial compensation for an injury that occurs because an error, and 13% expressed a desire for compensation even if harm didn’t occur. A questionnaire of this type does not evaluate the role of bedside manner during the process of disclosure. (LOE=2c)
Antibiotics ineffective for prevention of recurrent MI
Antibiotic therapy with a macrolide, aimed at eradicating C pneumoniae, was ineffective at reducing recurrence of a coronary event or decreasing mortality in patients who had experienced either a myocardial infarction or acute coronary syndrome. The door is closing on this intriguing hypothesis. (LOE=1a)
Antibiotic therapy with a macrolide, aimed at eradicating C pneumoniae, was ineffective at reducing recurrence of a coronary event or decreasing mortality in patients who had experienced either a myocardial infarction or acute coronary syndrome. The door is closing on this intriguing hypothesis. (LOE=1a)
Antibiotic therapy with a macrolide, aimed at eradicating C pneumoniae, was ineffective at reducing recurrence of a coronary event or decreasing mortality in patients who had experienced either a myocardial infarction or acute coronary syndrome. The door is closing on this intriguing hypothesis. (LOE=1a)
Statins prevent strokes in high-risk patients
In a select group of compliant, high-risk patients, simvastatin (Zocor) slightly reduced the rate of stroke, except in those patients with known cerebrovascular disease. We would need to treat 72 patients for 4.3 years to prevent 1 stroke. (LOE=1b)
In a select group of compliant, high-risk patients, simvastatin (Zocor) slightly reduced the rate of stroke, except in those patients with known cerebrovascular disease. We would need to treat 72 patients for 4.3 years to prevent 1 stroke. (LOE=1b)
In a select group of compliant, high-risk patients, simvastatin (Zocor) slightly reduced the rate of stroke, except in those patients with known cerebrovascular disease. We would need to treat 72 patients for 4.3 years to prevent 1 stroke. (LOE=1b)
Useful signs and symptoms to evaluate vaginal complaints
In the diagnosis of vaginitis, useful symptoms include information about itching. Useful signs include odor and the presence of inflammatory changes. Office microscopy is the most accurate laboratory test. (LOE=3a)
In the diagnosis of vaginitis, useful symptoms include information about itching. Useful signs include odor and the presence of inflammatory changes. Office microscopy is the most accurate laboratory test. (LOE=3a)
In the diagnosis of vaginitis, useful symptoms include information about itching. Useful signs include odor and the presence of inflammatory changes. Office microscopy is the most accurate laboratory test. (LOE=3a)
3 days ciprofloxacin adequate for UTI in older women
This reasonably large study found that 3 days of ciprofloxacin (Cipro) twice daily is as effective and better tolerated than 7 days of treatment for healthy older women with urinary tract infection (UTI). Although a much larger study might find a small difference in outcomes, it is unlikely to be clinically meaningful; this study was powered to detect a modest 10% difference in outcomes. (LOE=1b)
This reasonably large study found that 3 days of ciprofloxacin (Cipro) twice daily is as effective and better tolerated than 7 days of treatment for healthy older women with urinary tract infection (UTI). Although a much larger study might find a small difference in outcomes, it is unlikely to be clinically meaningful; this study was powered to detect a modest 10% difference in outcomes. (LOE=1b)
This reasonably large study found that 3 days of ciprofloxacin (Cipro) twice daily is as effective and better tolerated than 7 days of treatment for healthy older women with urinary tract infection (UTI). Although a much larger study might find a small difference in outcomes, it is unlikely to be clinically meaningful; this study was powered to detect a modest 10% difference in outcomes. (LOE=1b)
No long-term benefit shown for bones after HRT
Women taking short-term hormone replacement therapy (HRT) for symptom relief cannot expect long-term bone protection. Hip fracture risk is at least as great for women who stop postmenopausal hormone therapy as that for women who have never used it. The loss of protection occurs within 5 years of cessation of treatment. (LOE=1b)
Women taking short-term hormone replacement therapy (HRT) for symptom relief cannot expect long-term bone protection. Hip fracture risk is at least as great for women who stop postmenopausal hormone therapy as that for women who have never used it. The loss of protection occurs within 5 years of cessation of treatment. (LOE=1b)
Women taking short-term hormone replacement therapy (HRT) for symptom relief cannot expect long-term bone protection. Hip fracture risk is at least as great for women who stop postmenopausal hormone therapy as that for women who have never used it. The loss of protection occurs within 5 years of cessation of treatment. (LOE=1b)
Prochlorperazine more effective than ketorolac for pediatric migraine
Prochlorperazine (Compazine) is more effective than ketorolac (Toradol) in the treatment of children presenting to the emergency department with migraine. One additional child will experience headache relief for every 4 children receiving prochlorperazine instead of ketorolac. (LOE=1b)
Prochlorperazine (Compazine) is more effective than ketorolac (Toradol) in the treatment of children presenting to the emergency department with migraine. One additional child will experience headache relief for every 4 children receiving prochlorperazine instead of ketorolac. (LOE=1b)
Prochlorperazine (Compazine) is more effective than ketorolac (Toradol) in the treatment of children presenting to the emergency department with migraine. One additional child will experience headache relief for every 4 children receiving prochlorperazine instead of ketorolac. (LOE=1b)
Fetal fibronectin does not affect outcomes of preterm labor
Use of fetal fibronectin in the assessment of women presenting to labor and delivery units with symptoms of preterm labor does not affect the gestational age at delivery, frequency of use of medical interventions, length of stay in labor and delivery, or rate of inpatient admissions. (Level of evidence [LOE]=1b)
Use of fetal fibronectin in the assessment of women presenting to labor and delivery units with symptoms of preterm labor does not affect the gestational age at delivery, frequency of use of medical interventions, length of stay in labor and delivery, or rate of inpatient admissions. (Level of evidence [LOE]=1b)
Use of fetal fibronectin in the assessment of women presenting to labor and delivery units with symptoms of preterm labor does not affect the gestational age at delivery, frequency of use of medical interventions, length of stay in labor and delivery, or rate of inpatient admissions. (Level of evidence [LOE]=1b)