Q&A

Despite similar reductions in blood pressure, angiotensin-converting enzyme (ACE) inhibitors demonstrate lower combined rates of cardiovascular events or all-cause mortality in elderly hypertensive patients compared with diuretics. This benefit is most evident in men.

These results may differ from those of the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack (ALLHAT) trial because that study included younger patients, had a greater representation of patients with African ancestry, used different brands of medication, and had a slightly different primary outcome. Despite these differences, both treatments offer an inexpensive means for reducing blood pressure and preventing hypertension-related complications.

Despite similar reductions in blood pressure, angiotensin-converting enzyme (ACE) inhibitors demonstrate lower combined rates of cardiovascular events or all-cause mortality in elderly hypertensive patients compared with diuretics. This benefit is most evident in men.

These results may differ from those of the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack (ALLHAT) trial because that study included younger patients, had a greater representation of patients with African ancestry, used different brands of medication, and had a slightly different primary outcome. Despite these differences, both treatments offer an inexpensive means for reducing blood pressure and preventing hypertension-related complications.

Despite similar reductions in blood pressure, angiotensin-converting enzyme (ACE) inhibitors demonstrate lower combined rates of cardiovascular events or all-cause mortality in elderly hypertensive patients compared with diuretics. This benefit is most evident in men.

These results may differ from those of the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack (ALLHAT) trial because that study included younger patients, had a greater representation of patients with African ancestry, used different brands of medication, and had a slightly different primary outcome. Despite these differences, both treatments offer an inexpensive means for reducing blood pressure and preventing hypertension-related complications.

Despite the limitations in this review, it seems appropriate to administer analgesics to patients with generalized abdominal pain, even before a surgical evaluation. Surgeons can be assured that they will not be misled as a result of analgesia.

Despite the limitations in this review, it seems appropriate to administer analgesics to patients with generalized abdominal pain, even before a surgical evaluation. Surgeons can be assured that they will not be misled as a result of analgesia.

Despite the limitations in this review, it seems appropriate to administer analgesics to patients with generalized abdominal pain, even before a surgical evaluation. Surgeons can be assured that they will not be misled as a result of analgesia.

A 12-hour emergency department observation period is safe for patients with cocaine-associated chest pain, provided they have symptoms consistent with low-to-intermediate likelihood of unstable angina according to the Braunwald classification, and normal serial troponin I levels and cardiogram.

Patients with traditional cardiac risk factors should undergo cardiac stress testing within 2 weeks following the chest pain event, as atherosclerosis enhances the vasoconstrictive effects of cocaine. All patients should be referred for substance abuse counseling, as recurrent cocaine use was associated with subsequent nonfatal myocardial infarction (MI).

A 12-hour emergency department observation period is safe for patients with cocaine-associated chest pain, provided they have symptoms consistent with low-to-intermediate likelihood of unstable angina according to the Braunwald classification, and normal serial troponin I levels and cardiogram.

Patients with traditional cardiac risk factors should undergo cardiac stress testing within 2 weeks following the chest pain event, as atherosclerosis enhances the vasoconstrictive effects of cocaine. All patients should be referred for substance abuse counseling, as recurrent cocaine use was associated with subsequent nonfatal myocardial infarction (MI).

A 12-hour emergency department observation period is safe for patients with cocaine-associated chest pain, provided they have symptoms consistent with low-to-intermediate likelihood of unstable angina according to the Braunwald classification, and normal serial troponin I levels and cardiogram.

Patients with traditional cardiac risk factors should undergo cardiac stress testing within 2 weeks following the chest pain event, as atherosclerosis enhances the vasoconstrictive effects of cocaine. All patients should be referred for substance abuse counseling, as recurrent cocaine use was associated with subsequent nonfatal myocardial infarction (MI).

Transdermal progesterone cream, at the dose used in this study, did not improve menopausal symptoms compared with placebo. The study, however, might not have been large enough to detect a difference if one really exists.

In light of recent safety concerns over the use of other types of hormone replacement therapy, treatment of menopausal symptoms with transdermal progesterone should not be used unless better information supporting its benefit becomes available.

Transdermal progesterone cream, at the dose used in this study, did not improve menopausal symptoms compared with placebo. The study, however, might not have been large enough to detect a difference if one really exists.

In light of recent safety concerns over the use of other types of hormone replacement therapy, treatment of menopausal symptoms with transdermal progesterone should not be used unless better information supporting its benefit becomes available.

Transdermal progesterone cream, at the dose used in this study, did not improve menopausal symptoms compared with placebo. The study, however, might not have been large enough to detect a difference if one really exists.

In light of recent safety concerns over the use of other types of hormone replacement therapy, treatment of menopausal symptoms with transdermal progesterone should not be used unless better information supporting its benefit becomes available.

The optimal serum drug concentration for digoxin among men in sinus rhythm with stable heart failure is 0.5 to 0.8 ng/mL. This range is associated with decreased risk of hospitalization and mortality compared with placebo. Higher levels are associated with either no reduction, or an increased risk of hospitalization and mortality compared with placebo.

The optimal serum drug concentration for digoxin among men in sinus rhythm with stable heart failure is 0.5 to 0.8 ng/mL. This range is associated with decreased risk of hospitalization and mortality compared with placebo. Higher levels are associated with either no reduction, or an increased risk of hospitalization and mortality compared with placebo.

The optimal serum drug concentration for digoxin among men in sinus rhythm with stable heart failure is 0.5 to 0.8 ng/mL. This range is associated with decreased risk of hospitalization and mortality compared with placebo. Higher levels are associated with either no reduction, or an increased risk of hospitalization and mortality compared with placebo.

This small, poorly described study suggests that nebulized 3% hypertonic saline improves outcomes for nonhospitalized infants with bronchiolitis more than the use of normal saline.

While this study has significant flaws, the intervention appears safe. It would be reasonable to use nebulized 3% saline while waiting for larger, better studies.

This small, poorly described study suggests that nebulized 3% hypertonic saline improves outcomes for nonhospitalized infants with bronchiolitis more than the use of normal saline.

While this study has significant flaws, the intervention appears safe. It would be reasonable to use nebulized 3% saline while waiting for larger, better studies.

This small, poorly described study suggests that nebulized 3% hypertonic saline improves outcomes for nonhospitalized infants with bronchiolitis more than the use of normal saline.

While this study has significant flaws, the intervention appears safe. It would be reasonable to use nebulized 3% saline while waiting for larger, better studies.

Assuming that a given patient is reliable for follow-up and that a clinical system is in place to handle a more individualized screening protocol, the investigators suggest the following approach: 3-year intervals for patients with no retinopathy and no risk factors (risk factors being diabetes for longer than 20 years or use of insulin); annual screening for patients with no retinopathy and 1 or both risk factors or for patients with background retinopathy; and 4-month intervals for patients with mild preproliferative retinopathy.

These intervals provide at least a 95% probability of remaining free of sight-threatening diabetic retinopathy between screenings.

Assuming that a given patient is reliable for follow-up and that a clinical system is in place to handle a more individualized screening protocol, the investigators suggest the following approach: 3-year intervals for patients with no retinopathy and no risk factors (risk factors being diabetes for longer than 20 years or use of insulin); annual screening for patients with no retinopathy and 1 or both risk factors or for patients with background retinopathy; and 4-month intervals for patients with mild preproliferative retinopathy.

These intervals provide at least a 95% probability of remaining free of sight-threatening diabetic retinopathy between screenings.

Assuming that a given patient is reliable for follow-up and that a clinical system is in place to handle a more individualized screening protocol, the investigators suggest the following approach: 3-year intervals for patients with no retinopathy and no risk factors (risk factors being diabetes for longer than 20 years or use of insulin); annual screening for patients with no retinopathy and 1 or both risk factors or for patients with background retinopathy; and 4-month intervals for patients with mild preproliferative retinopathy.

These intervals provide at least a 95% probability of remaining free of sight-threatening diabetic retinopathy between screenings.

Minimum effective dosage and ranges for antidepressants have not been established. While studies suggest that lower-dose tricyclic antidepressants (TCAs) may be as effective as higherdose TCAs, dose comparison studies with other antidepressants have not been conducted.

Low-dose TCAs may not be as effective as standard doses, but they do have fewer treatment dropouts due to side effects, and thus patients may have better long-term compliance. Regular monitoring of patient rate of reduction in severity of depression should be used to help determine optimal individual dosing.

Minimum effective dosage and ranges for antidepressants have not been established. While studies suggest that lower-dose tricyclic antidepressants (TCAs) may be as effective as higherdose TCAs, dose comparison studies with other antidepressants have not been conducted.

Low-dose TCAs may not be as effective as standard doses, but they do have fewer treatment dropouts due to side effects, and thus patients may have better long-term compliance. Regular monitoring of patient rate of reduction in severity of depression should be used to help determine optimal individual dosing.

Minimum effective dosage and ranges for antidepressants have not been established. While studies suggest that lower-dose tricyclic antidepressants (TCAs) may be as effective as higherdose TCAs, dose comparison studies with other antidepressants have not been conducted.

Low-dose TCAs may not be as effective as standard doses, but they do have fewer treatment dropouts due to side effects, and thus patients may have better long-term compliance. Regular monitoring of patient rate of reduction in severity of depression should be used to help determine optimal individual dosing.

Ultrasonography for diagnosis and management of possible hip instability may lead to less splinting and surgery in the first 2 years of life, with no significant difference in radiographic abnormalities. Cost-effectiveness, long-term hip mobility, and consistency of ultrasound interpretation is not proven.

Ultrasonography for diagnosis and management of possible hip instability may lead to less splinting and surgery in the first 2 years of life, with no significant difference in radiographic abnormalities. Cost-effectiveness, long-term hip mobility, and consistency of ultrasound interpretation is not proven.

Ultrasonography for diagnosis and management of possible hip instability may lead to less splinting and surgery in the first 2 years of life, with no significant difference in radiographic abnormalities. Cost-effectiveness, long-term hip mobility, and consistency of ultrasound interpretation is not proven.

The use of regular sputum eosinophil counts to initiate and follow treatment in patients with asthma produced a small decrease in the number of hospitalizations and asthma exacerbations in compliant, moderate-to-severe asthmatics.

The definition of asthma exacerbation used in this study (a 30% decrease in morning peak expiratory flow on 2 consecutive days or initiation of oral corticosteroids) may not be clinically relevant.

The use of regular sputum eosinophil counts to initiate and follow treatment in patients with asthma produced a small decrease in the number of hospitalizations and asthma exacerbations in compliant, moderate-to-severe asthmatics.

The definition of asthma exacerbation used in this study (a 30% decrease in morning peak expiratory flow on 2 consecutive days or initiation of oral corticosteroids) may not be clinically relevant.

The use of regular sputum eosinophil counts to initiate and follow treatment in patients with asthma produced a small decrease in the number of hospitalizations and asthma exacerbations in compliant, moderate-to-severe asthmatics.

The definition of asthma exacerbation used in this study (a 30% decrease in morning peak expiratory flow on 2 consecutive days or initiation of oral corticosteroids) may not be clinically relevant.