Q&A

Among white patients with symptomatic systolic dysfunction on stable treatment with diuretics and angiotensin-converting enzyme (ACE) inhibitors, the addition of the nonselective beta-blocker carvedilol extends survival by 17% per year compared with metoprolol. This benefit translates into a number needed to treat (NNT) of 17 for 5 years. This extrapolates to an added 1.4 years of life.

It is unclear whether this benefit holds true for nonwhite patients. Carvedilol should be considered over metoprolol for treating patients with congestive heart failure to improve survival.

Among white patients with symptomatic systolic dysfunction on stable treatment with diuretics and angiotensin-converting enzyme (ACE) inhibitors, the addition of the nonselective beta-blocker carvedilol extends survival by 17% per year compared with metoprolol. This benefit translates into a number needed to treat (NNT) of 17 for 5 years. This extrapolates to an added 1.4 years of life.

It is unclear whether this benefit holds true for nonwhite patients. Carvedilol should be considered over metoprolol for treating patients with congestive heart failure to improve survival.

Among white patients with symptomatic systolic dysfunction on stable treatment with diuretics and angiotensin-converting enzyme (ACE) inhibitors, the addition of the nonselective beta-blocker carvedilol extends survival by 17% per year compared with metoprolol. This benefit translates into a number needed to treat (NNT) of 17 for 5 years. This extrapolates to an added 1.4 years of life.

It is unclear whether this benefit holds true for nonwhite patients. Carvedilol should be considered over metoprolol for treating patients with congestive heart failure to improve survival.

Both red clover extracts and placebo equally reduce the frequency of hot flushes. Providers should encourage patients to avoid spending money on supplements and instead add soy to their diet. In general, however, if patients are already convinced that something works, don’t discourage them.

Both red clover extracts and placebo equally reduce the frequency of hot flushes. Providers should encourage patients to avoid spending money on supplements and instead add soy to their diet. In general, however, if patients are already convinced that something works, don’t discourage them.

Both red clover extracts and placebo equally reduce the frequency of hot flushes. Providers should encourage patients to avoid spending money on supplements and instead add soy to their diet. In general, however, if patients are already convinced that something works, don’t discourage them.

For women with cervical cytology results showing atypical squamous cell of undetermined significance (ASCUS) and positive results on DNA testing of a cervical sample for human papillomavirus (HPV) high-risk types, about 1 out of 8 progress to cervical intraepithelial neoplasia (CIN) grades 2 or 3 within 2 years of initial colposcopy results showing not more than CIN 1. Since women with cytology results of lowgrade squamous intraepithelial lesion (LSIL) progress to CIN 2 or 3 in the same proportion, management protocols for HPV-positive ASCUS and LSIL should be identical.

For women with cervical cytology results showing atypical squamous cell of undetermined significance (ASCUS) and positive results on DNA testing of a cervical sample for human papillomavirus (HPV) high-risk types, about 1 out of 8 progress to cervical intraepithelial neoplasia (CIN) grades 2 or 3 within 2 years of initial colposcopy results showing not more than CIN 1. Since women with cytology results of lowgrade squamous intraepithelial lesion (LSIL) progress to CIN 2 or 3 in the same proportion, management protocols for HPV-positive ASCUS and LSIL should be identical.

For women with cervical cytology results showing atypical squamous cell of undetermined significance (ASCUS) and positive results on DNA testing of a cervical sample for human papillomavirus (HPV) high-risk types, about 1 out of 8 progress to cervical intraepithelial neoplasia (CIN) grades 2 or 3 within 2 years of initial colposcopy results showing not more than CIN 1. Since women with cytology results of lowgrade squamous intraepithelial lesion (LSIL) progress to CIN 2 or 3 in the same proportion, management protocols for HPV-positive ASCUS and LSIL should be identical.

A short course of oral prednisone in the outpatient setting prevents relapse and decreases dyspnea in patients with an exacerbation of chronic obstructive pulmonary disease (COPD). However, physicians should be aware of the potential for weight gain, increased appetite, and insomnia in patients taking this medication.

A short course of oral prednisone in the outpatient setting prevents relapse and decreases dyspnea in patients with an exacerbation of chronic obstructive pulmonary disease (COPD). However, physicians should be aware of the potential for weight gain, increased appetite, and insomnia in patients taking this medication.

A short course of oral prednisone in the outpatient setting prevents relapse and decreases dyspnea in patients with an exacerbation of chronic obstructive pulmonary disease (COPD). However, physicians should be aware of the potential for weight gain, increased appetite, and insomnia in patients taking this medication.

For patients with an average risk of having streptococcal pharyngitis, a number of testing strategies can rule out infection, including a single negative rapid strep antigen test, which has a negative predictive value of more than 95%. In patients at higher risk of having strep, based on clinical criteria, all the test strategies being studied are more likely to be falsely negative.

While it is reasonable to rely on a variety of strategies to exclude strep throat in average-risk patients, high-risk patients with a negative rapid antigen test should have an additional rapid strep test or a throat culture to exclude strep with a certainty of greater than 95%.

For patients with an average risk of having streptococcal pharyngitis, a number of testing strategies can rule out infection, including a single negative rapid strep antigen test, which has a negative predictive value of more than 95%. In patients at higher risk of having strep, based on clinical criteria, all the test strategies being studied are more likely to be falsely negative.

While it is reasonable to rely on a variety of strategies to exclude strep throat in average-risk patients, high-risk patients with a negative rapid antigen test should have an additional rapid strep test or a throat culture to exclude strep with a certainty of greater than 95%.

For patients with an average risk of having streptococcal pharyngitis, a number of testing strategies can rule out infection, including a single negative rapid strep antigen test, which has a negative predictive value of more than 95%. In patients at higher risk of having strep, based on clinical criteria, all the test strategies being studied are more likely to be falsely negative.

While it is reasonable to rely on a variety of strategies to exclude strep throat in average-risk patients, high-risk patients with a negative rapid antigen test should have an additional rapid strep test or a throat culture to exclude strep with a certainty of greater than 95%.

The evidence is not strong enough to recommend routine use of recombinant tissue plasminogen activator (rtPA) in the setting of acute ischemic stroke.

Although independence in activities of daily living 3 to 6 months later is better in those who receive rtPA, acute adverse events (including fatal intracranial hemorrhage) also significantly increase. Given the potentially fatal risks and heterogeneity of results among trials, thrombolytic therapy in the setting of acute ischemic stroke needs more investigation. In the future, we may be able to define a more specific group of patients for whom the potential benefits clearly outweigh the risks.

The evidence is not strong enough to recommend routine use of recombinant tissue plasminogen activator (rtPA) in the setting of acute ischemic stroke.

Although independence in activities of daily living 3 to 6 months later is better in those who receive rtPA, acute adverse events (including fatal intracranial hemorrhage) also significantly increase. Given the potentially fatal risks and heterogeneity of results among trials, thrombolytic therapy in the setting of acute ischemic stroke needs more investigation. In the future, we may be able to define a more specific group of patients for whom the potential benefits clearly outweigh the risks.

The evidence is not strong enough to recommend routine use of recombinant tissue plasminogen activator (rtPA) in the setting of acute ischemic stroke.

Although independence in activities of daily living 3 to 6 months later is better in those who receive rtPA, acute adverse events (including fatal intracranial hemorrhage) also significantly increase. Given the potentially fatal risks and heterogeneity of results among trials, thrombolytic therapy in the setting of acute ischemic stroke needs more investigation. In the future, we may be able to define a more specific group of patients for whom the potential benefits clearly outweigh the risks.