Q&A

The addition of candesartan (Atacand) to an angiotensin-converting enzyme (ACE) inhibitor and other treatment reduces cardiovascular death and hospital admissions of patients with congestive heart failure (CHF). As in studies conducted with valsartan (Diovan), candesartan added to an ACE inhibitor does not decrease overall mortality. Clinicians should add candesartan to the medical regimen in nonallergic CHF patients with an ejection fraction of 40% or lower who are already on an optimal dose of an ACE inhibitor.

The addition of candesartan (Atacand) to an angiotensin-converting enzyme (ACE) inhibitor and other treatment reduces cardiovascular death and hospital admissions of patients with congestive heart failure (CHF). As in studies conducted with valsartan (Diovan), candesartan added to an ACE inhibitor does not decrease overall mortality. Clinicians should add candesartan to the medical regimen in nonallergic CHF patients with an ejection fraction of 40% or lower who are already on an optimal dose of an ACE inhibitor.

The addition of candesartan (Atacand) to an angiotensin-converting enzyme (ACE) inhibitor and other treatment reduces cardiovascular death and hospital admissions of patients with congestive heart failure (CHF). As in studies conducted with valsartan (Diovan), candesartan added to an ACE inhibitor does not decrease overall mortality. Clinicians should add candesartan to the medical regimen in nonallergic CHF patients with an ejection fraction of 40% or lower who are already on an optimal dose of an ACE inhibitor.

Hydroxymethyl glutaryl coenzyme A (HMG-CoA) reductase inhibitor (statin) therapy that effectively reduces low-density lipoprotein (LDL) cholesterol increases life expectancy at least as much among those with diabetes mellitus without cardiovascular disease as among those with established cardiovascular disease alone.

While this result is only based on a validated theoretical model, it was extrapolated to the entire American population, and is consistent with randomized clinical trials. Public health programs and health care providers should give as much emphasis to treating elevated LDL among those with diabetes who are still free of cardiovascular disease as among those with already established cardiovascular disease.

Hydroxymethyl glutaryl coenzyme A (HMG-CoA) reductase inhibitor (statin) therapy that effectively reduces low-density lipoprotein (LDL) cholesterol increases life expectancy at least as much among those with diabetes mellitus without cardiovascular disease as among those with established cardiovascular disease alone.

While this result is only based on a validated theoretical model, it was extrapolated to the entire American population, and is consistent with randomized clinical trials. Public health programs and health care providers should give as much emphasis to treating elevated LDL among those with diabetes who are still free of cardiovascular disease as among those with already established cardiovascular disease.

Hydroxymethyl glutaryl coenzyme A (HMG-CoA) reductase inhibitor (statin) therapy that effectively reduces low-density lipoprotein (LDL) cholesterol increases life expectancy at least as much among those with diabetes mellitus without cardiovascular disease as among those with established cardiovascular disease alone.

While this result is only based on a validated theoretical model, it was extrapolated to the entire American population, and is consistent with randomized clinical trials. Public health programs and health care providers should give as much emphasis to treating elevated LDL among those with diabetes who are still free of cardiovascular disease as among those with already established cardiovascular disease.

Patients with venous thromboembolism (VTE) and no obvious underlying cause or major clotting protein abnormalities whose D-dimer levels are <250 ng/mL have a significantly reduced long-term risk of recurrent VTE. Physicians should consider obtaining this test and providing this information to patients.

Given the burgeoning numbers of tests being developed to assess thrombophilia risk, the attraction of the D-dimer is that it may represent a global measure of risk of recurrent disease. Physicians should understand, however, that clinical research is still preliminary and look for further evidence of the prognostic performance of D-dimer across populations with different ethnicity and the outcomes of long-term treatment on patients at higher risk of VTE as measured by D-dimer.

Patients with venous thromboembolism (VTE) and no obvious underlying cause or major clotting protein abnormalities whose D-dimer levels are <250 ng/mL have a significantly reduced long-term risk of recurrent VTE. Physicians should consider obtaining this test and providing this information to patients.

Given the burgeoning numbers of tests being developed to assess thrombophilia risk, the attraction of the D-dimer is that it may represent a global measure of risk of recurrent disease. Physicians should understand, however, that clinical research is still preliminary and look for further evidence of the prognostic performance of D-dimer across populations with different ethnicity and the outcomes of long-term treatment on patients at higher risk of VTE as measured by D-dimer.

Patients with venous thromboembolism (VTE) and no obvious underlying cause or major clotting protein abnormalities whose D-dimer levels are <250 ng/mL have a significantly reduced long-term risk of recurrent VTE. Physicians should consider obtaining this test and providing this information to patients.

Given the burgeoning numbers of tests being developed to assess thrombophilia risk, the attraction of the D-dimer is that it may represent a global measure of risk of recurrent disease. Physicians should understand, however, that clinical research is still preliminary and look for further evidence of the prognostic performance of D-dimer across populations with different ethnicity and the outcomes of long-term treatment on patients at higher risk of VTE as measured by D-dimer.

Administration of influenza vaccine to children aged 6 to 24 months to prevent acute otitis media is not recommended.

Administration of influenza vaccine to children aged 6 to 24 months to prevent acute otitis media is not recommended.

Administration of influenza vaccine to children aged 6 to 24 months to prevent acute otitis media is not recommended.

For now, a 3-month regimen of azithromycin should not be used to prevent recurrent coronary heart disease (CHD) events in patients with a previous myocardial infarction and evidence of exposure to Chlamydia pneumoniae. This does not exclude the possibility that other antibiotic regimens may produce a significant benefit in reducing morbidity and mortality from CHD.

For now, a 3-month regimen of azithromycin should not be used to prevent recurrent coronary heart disease (CHD) events in patients with a previous myocardial infarction and evidence of exposure to Chlamydia pneumoniae. This does not exclude the possibility that other antibiotic regimens may produce a significant benefit in reducing morbidity and mortality from CHD.

For now, a 3-month regimen of azithromycin should not be used to prevent recurrent coronary heart disease (CHD) events in patients with a previous myocardial infarction and evidence of exposure to Chlamydia pneumoniae. This does not exclude the possibility that other antibiotic regimens may produce a significant benefit in reducing morbidity and mortality from CHD.

It is reasonable to consider screening for excessive alcohol consumption if time and circumstances permit, realizing the ultimate benefit will be extremely small.

Overall, if a practitioner screens 1000 patients, carries out further assessment in 90 (9%) who screen positive, and gives feedback, information, and advice to the 25 (2.5%) who qualify for brief intervention, 2 or 3 patients can be expected to have reduced their alcohol consumption to below recommended maximum levels after 12 months. This results in a number needed to screen with outcome measured at 1 year (NNS₁) of 500. To put this in perspective, the NNS₅ (to prevent 1 death in 5 years) for dyslipidemia is 418; for hypertension, 274–1307; for hemoccult testing, 1374; for mammography in those aged 50–59 years, 2451.

It is reasonable to consider screening for excessive alcohol consumption if time and circumstances permit, realizing the ultimate benefit will be extremely small.

Overall, if a practitioner screens 1000 patients, carries out further assessment in 90 (9%) who screen positive, and gives feedback, information, and advice to the 25 (2.5%) who qualify for brief intervention, 2 or 3 patients can be expected to have reduced their alcohol consumption to below recommended maximum levels after 12 months. This results in a number needed to screen with outcome measured at 1 year (NNS₁) of 500. To put this in perspective, the NNS₅ (to prevent 1 death in 5 years) for dyslipidemia is 418; for hypertension, 274–1307; for hemoccult testing, 1374; for mammography in those aged 50–59 years, 2451.

It is reasonable to consider screening for excessive alcohol consumption if time and circumstances permit, realizing the ultimate benefit will be extremely small.

Overall, if a practitioner screens 1000 patients, carries out further assessment in 90 (9%) who screen positive, and gives feedback, information, and advice to the 25 (2.5%) who qualify for brief intervention, 2 or 3 patients can be expected to have reduced their alcohol consumption to below recommended maximum levels after 12 months. This results in a number needed to screen with outcome measured at 1 year (NNS₁) of 500. To put this in perspective, the NNS₅ (to prevent 1 death in 5 years) for dyslipidemia is 418; for hypertension, 274–1307; for hemoccult testing, 1374; for mammography in those aged 50–59 years, 2451.

Sertraline (Zoloft) is effective and generally well tolerated for the short-term treatment of major depressive disorder in both children and adolescents.

Although the studies were not powered to detect a difference in efficacy and safety between age groups, decreased efficacy and increased side effects were seen in children ages 6 to 11 years. Because treatment with sertraline was only studied for 10 weeks, the efficacy and safety of long-term treatment remain unknown.

Sertraline (Zoloft) is effective and generally well tolerated for the short-term treatment of major depressive disorder in both children and adolescents.

Although the studies were not powered to detect a difference in efficacy and safety between age groups, decreased efficacy and increased side effects were seen in children ages 6 to 11 years. Because treatment with sertraline was only studied for 10 weeks, the efficacy and safety of long-term treatment remain unknown.

Sertraline (Zoloft) is effective and generally well tolerated for the short-term treatment of major depressive disorder in both children and adolescents.

Although the studies were not powered to detect a difference in efficacy and safety between age groups, decreased efficacy and increased side effects were seen in children ages 6 to 11 years. Because treatment with sertraline was only studied for 10 weeks, the efficacy and safety of long-term treatment remain unknown.

For patients with gastroesophageal reflux disease (GERD) who take proton pump inhibitors (PPIs) more than once daily, an attempt to reduce dosing to once daily will be successful in over 80%, with little change in quality of life.

Given the expense of these medications, clinicians should undertake a trial of once-daily dosing for patients on higher doses, after their initial symptoms are controlled for at least 8 weeks. Though dose reduction is harder to achieve when patients have been taking a PPI long-term, 84% of such patients who could not tolerate an initial dose reduction were able to do so on a subsequent attempt.

For patients with gastroesophageal reflux disease (GERD) who take proton pump inhibitors (PPIs) more than once daily, an attempt to reduce dosing to once daily will be successful in over 80%, with little change in quality of life.

Given the expense of these medications, clinicians should undertake a trial of once-daily dosing for patients on higher doses, after their initial symptoms are controlled for at least 8 weeks. Though dose reduction is harder to achieve when patients have been taking a PPI long-term, 84% of such patients who could not tolerate an initial dose reduction were able to do so on a subsequent attempt.

For patients with gastroesophageal reflux disease (GERD) who take proton pump inhibitors (PPIs) more than once daily, an attempt to reduce dosing to once daily will be successful in over 80%, with little change in quality of life.

Given the expense of these medications, clinicians should undertake a trial of once-daily dosing for patients on higher doses, after their initial symptoms are controlled for at least 8 weeks. Though dose reduction is harder to achieve when patients have been taking a PPI long-term, 84% of such patients who could not tolerate an initial dose reduction were able to do so on a subsequent attempt.

In young children with persistent otitis media with middle-ear effusions, the insertion of tympanostomy tubes does not improve cognitive, language, or speech development.

In young children with persistent otitis media with middle-ear effusions, the insertion of tympanostomy tubes does not improve cognitive, language, or speech development.

In young children with persistent otitis media with middle-ear effusions, the insertion of tympanostomy tubes does not improve cognitive, language, or speech development.