Less Is More

Simpler & Better Medicine

Morning-only one-gallon polyethylene glycol improves bowel cleansing for afternoon colonoscopies. — March 24, 2017

Morning-only one-gallon polyethylene glycol improves bowel cleansing for afternoon colonoscopies.

Summary: For patients having colonoscopy in the afternoon, prep with one gallon of polyethylene glycol (PEG) the morning of the procedure appears to be associated with improved efficacy of bowel cleansing and less difficulty with loss of sleep or insomnia, but no difference in overall adenoma detection, compared to prep with one gallon of PEG the evening before.

https://www.ncbi.nlm.nih.gov/m/pubmed/20606677/

Strength of Recommendation = B

Immediate oral feeding in patients with mild acute pancreatitis may accelerate recovery–a randomized clinical study. — March 17, 2017

Immediate oral feeding in patients with mild acute pancreatitis may accelerate recovery–a randomized clinical study.

Summary: For patients with mild acute pancreatitis, an approach of immediate oral feeding may lead to a shorter hospital stay than an approach of fasting, without any worsening of pain, gastrointestinal symptoms, or laboratory monitoring parameters.

https://www.ncbi.nlm.nih.gov/m/pubmed/17719703/

Strength of Recommendation = B

Endoscopic release for carpal tunnel syndrome — March 14, 2017

Endoscopic release for carpal tunnel syndrome

Summary: For patients needing surgical treatment for carpal tunnel syndrome, endoscopic carpal tunnel release (ECTR) may be associated with a shorter time to return-to-work, improved post-operative grip strength, and fewer minor surgical complications compared to open carpal tunnel release (OCTR).

https://www.ncbi.nlm.nih.gov/m/pubmed/24482073/

Strength of Recommendation = B

Primary Care–Based Psychological Intervention and Symptoms of Common Mental Disorders in Zimbabwe. — March 10, 2017

Primary Care–Based Psychological Intervention and Symptoms of Common Mental Disorders in Zimbabwe.

Summary: For patients in low-income settings facing depression or anxiety, an intervention consisting of individual problem-solving therapy plus peer support may lead to a lower likelihood of depression and fewer overall symptoms than a “usual care” intervention consisting of counseling, information, education, and support plus an option for medications. 

https://www.ncbi.nlm.nih.gov/m/pubmed/28027368/

Strength of Recommendation = B

Blood-Pressure Lowering in Patients with Acute Cerebral Hemorrhage — March 7, 2017

Blood-Pressure Lowering in Patients with Acute Cerebral Hemorrhage

Summary: For patients with acute intracerebral hemorrhage, less-intense lowering of blood pressure to a target systolic blood pressure (SBP) range of 140 to 179 mm Hg may lead to a lower likelihood of adverse renal events (and possibly a lower overall likelihood of serious adverse events) than more-intense lowering blood pressure to a target SBP range of 110 to 139 mm Hg, and the less-intense SBP target appears to be associated with the same rate of death or disability as the more-intense SBP target.

https://www.ncbi.nlm.nih.gov/m/pubmed/27276234/

Strength of Recommendation = B

Mortality in Individuals Aged 80 and Older with Type 2 Diabetes Mellitus in Relation to Glycosylated Hemoglobin, Blood Pressure, and Total Cholesterol. — March 3, 2017

Mortality in Individuals Aged 80 and Older with Type 2 Diabetes Mellitus in Relation to Glycosylated Hemoglobin, Blood Pressure, and Total Cholesterol.

Summary: For patients over 80 with type 2 diabetes, mortality risk may be lower with intermediate levels of glycosylated hemoglobin, blood pressure, and cholesterol, compared to higher mortality risk in patients with lower levels of glycosylated hemoglobin, blood pressure, and cholesterol.

https://www.ncbi.nlm.nih.gov/m/pubmed/27295278/

Strength of Recommendation = B

Oral Risperidone, Haloperidol, or Placebo for Symptoms of in Palliative Care. — February 24, 2017

Oral Risperidone, Haloperidol, or Placebo for Symptoms of in Palliative Care.

Summary: For older patients in palliative care for a life-limiting illness, management of delirium with supportive care and individualized treatment of delirium precipitants may lead to improved delirium scores and fewer extra-pyramidal side effects compared to management with supportive care plus haloperidol or risperidone, and management with supportive care alone may lead to improved overall survival compared to management with supportive care plus haloperidol.

https://www.ncbi.nlm.nih.gov/m/pubmed/27918778/

Strength of Recommendation = B

Chondroitin Sulfate and Glucosamine Sulfate Show No Superiority Over Placebo for Reduction of Joint Pain and Functional Impairment in Patients With Knee Osteoarthritis. — February 17, 2017

Chondroitin Sulfate and Glucosamine Sulfate Show No Superiority Over Placebo for Reduction of Joint Pain and Functional Impairment in Patients With Knee Osteoarthritis.

Summary: For patients with moderate to severe pain from radiographically proven knee osteoarthritis, 6 months treatment with placebo may provide more pain relief at 6 months’ follow up than treatment with chondroitin sulfate and glucosamine sulfate.

https://www.ncbi.nlm.nih.gov/m/pubmed/27477804/

Strength of Recommendation = B

Tactile Assessment of Fever in Children by Caregivers. — February 7, 2017
Short- and long-term outcomes of metformin compared with insulin alone in pregnancy. — February 3, 2017

Short- and long-term outcomes of metformin compared with insulin alone in pregnancy.

Summary: For women with gestational or Type 2 diabetes mellitus, using metformin during pregnancy may be associated with lower risks of neonatal hypoglycemia, large for gestational age babies, pregnancy-induced hypertension and total maternal pregnancy weight gain compared to using insulin; however there remains little information on long-term outcomes.

https://www.ncbi.nlm.nih.gov/m/pubmed/27150509/

Strength of Recommendation = B

Comparison of radiography and point-of-care ultrasonography in the diagnosis and management of metatarsal fractures — January 17, 2017

Comparison of radiography and point-of-care ultrasonography in the diagnosis and management of metatarsal fractures

Summary: For patients witn suspected metatarsal fracture due to a low-impact injury, point-of-care ultrasound (POCUS) may provide more diagnostic information that radiography, with the same sensitivity and specificity for detecting fracture as radiography, while at the same time being potentially available for use in settings without radiography equipment.

https://www.ncbi.nlm.nih.gov/m/pubmed/28069140/

Strength of Recommendation = B

Early post-operative complications in patients undergoing loop colostomy with and without a stoma rod. — January 13, 2017

Early post-operative complications in patients undergoing loop colostomy with and without a stoma rod.

Summary: For patients having placement of a loop colostomy, an approach of not using a supporting stoma rod may be associated with a lower likelihood of stomal necrosis, stomal edema, and stomal congestion, as well as a lower likelihood of hospital readmission compared to an approach of routinely using a stoma rod; with no increased likelihood of stomal retraction.

https://www.ncbi.nlm.nih.gov/m/pubmed/28067986/

Strength of Recommendation = B

Confirmatory Testing Before Treatment of Onychomycosis? — January 10, 2017
Early Participation in Physical Activity Following Acute Concussion and Persistent Postconcussive Symptoms in Children and Adolescents. — December 21, 2016

Early Participation in Physical Activity Following Acute Concussion and Persistent Postconcussive Symptoms in Children and Adolescents.

Summary: For children between ages 5 and 18 years old who have experienced an acute concussion, early participation in physical activity within 7 days of the injury may be associated with a lower risk of persistent postconcussive symptoms (PPCS) at 28 days post-injury than an approach of having no physical activity within the first 7 days post-concussion.

Note – the authors of this study emphasize that 1) caution in the immediate post-injury period remains vital, 2) activities that entail a risk of repeat head injury should remain prohibited in the early post-concussion period, and 3) an adequate randomized controlled is needed to better understand the benefits of early physical activity following concussion.

https://www.ncbi.nlm.nih.gov/m/pubmed/27997652/

Strength of Recommendation = B

Shared decision making in patients with low risk chest pain. — December 13, 2016

Shared decision making in patients with low risk chest pain.

Summary: For patients with “low-risk” chest pain (ie, patients with chest pain being considered for observation and further cardiac testing, but without ischemic ECG changes, abnormal troponin levels, known coronary artery disease, recent cocaine use, or other exclusion factors),  use by the the treating physician of a decision aid to guide discussion of further testing and management options may lead to improved patient knowledge and patient engagement in decision making, with lower a likelihood of hospital admission and a lower likelihood of subsequent cardiac stress testing, compared to “usual care.”

https://www.ncbi.nlm.nih.gov/m/pubmed/27919865/

Strength of Recommendation = B

Thromboprophylaxis after Knee Arthroscopy and Lower-Leg Casting. — December 9, 2016

Thromboprophylaxis after Knee Arthroscopy and Lower-Leg Casting.

Summary: For patients who have arthroscopic knee surgery or casting of the lower leg, an approach of not administering prophylactic-dose low-molecular weight heparin (LMWH) appears to be associated with the same risks of deep-vein thrombosis (DVT) and pulmonary embolism (PE) as an approach of administering LWMH (for 8 days after arthroscopy or for the duration of casting), but without the added patient care burden of daily injections.

https://www.ncbi.nlm.nih.gov/m/pubmed/27959702/

Strength of Recommendation = B

Long-Term Oxygen for COPD with Moderate Desaturation. — December 6, 2016

Long-Term Oxygen for COPD with Moderate Desaturation.

Summary: For patients with chronic obstructive pulmonary disease (COPD) and moderate resting or exertional oxygen desaturation, an approach of not using supplemental oxygen may be associated with the same life expectancy and the same likelihood of hospitalization or COPD exacerbation as an approach of using supplemental oxygen, without the risks associated with supplemental oxygen use (such as tripping over equipment, fires or burns).

https://www.ncbi.nlm.nih.gov/m/pubmed/27783918/

Strength of Recommendation = B

5-Day versus 10-Day Course of Fluoroquinolones in Outpatient Males with a Urinary Tract Infection (UTI). — December 2, 2016

5-Day versus 10-Day Course of Fluoroquinolones in Outpatient Males with a Urinary Tract Infection (UTI).

Summary: For males with a urinary tract infection, a 5-day course of levofloxacin (750 mg once daily) may provide the same likelihood of clinical treatment success as a 10 day course of ciprofloxacin (400 mg IV or 500 mg PO twice daily), and 5 day course of levofloxacin may provide a higher likelihood of clinical treatment success than a for 10 day course of ciprofloxacin for males with catheters, neurogenic bladder, or urinary retention.

https://www.ncbi.nlm.nih.gov/m/pubmed/28076247/

Strength of Recommendation = C

Does bariatric surgery prior to total hip or knee arthroplasty reduce complications and improve outcomes for obese patients? — November 29, 2016

Does bariatric surgery prior to total hip or knee arthroplasty reduce complications and improve outcomes for obese patients?

Summary: For obese patients needing total hip or knee arthroplasty, an approach of not undergoing bariatric surgery prior to arthroplasty may be associated with the same rates of wound infection, venous thromboembolism, subsequent revision, and mortality as an approach of undergoing bariatric surgery PRIOR to arthroplasty, while allowing patients to potentially avoid one major surgery.

https://www.ncbi.nlm.nih.gov/m/pubmed/27587514/

Strength of Recommendation = B

Do unsutured second-degree perineal lacerations affect postpartum functional outcomes? — November 22, 2016

Do unsutured second-degree perineal lacerations affect postpartum functional outcomes?

Summary: For women sustaining second-degree perineal lacerations during delivery, an approach of not repairing the second-degree laceration may be associated with a decreased need for post-partum pain medication in hospital compared to an approach of suturing the second-degree laceration, without any increase in adverse long-term outcomes.

https://www.ncbi.nlm.nih.gov/m/pubmed/17823462/

Strength of Recommendation = B

Unloading Shoes for Self-management of Knee Osteoarthritis. — November 18, 2016

Unloading Shoes for Self-management of Knee Osteoarthritis.

Summary: For adults with symptomatic osteoarthritis of the knee, regular use of commercially available neutral walking shoes may provide the same improvements in pain and function as regular use of commercially available “unloading” walking shoes, but with a lower associated risk of developing foot or ankle pain.

https://www.ncbi.nlm.nih.gov/m/pubmed/27398991/

Strength of Recommendation = B

Effect of Hydrocortisone on Development of Shock Among Patients With Severe Sepsis. — November 15, 2016

Effect of Hydrocortisone on Development of Shock Among Patients With Severe Sepsis.

Summary: For adult patients with severe sepsis (but not in septic shock), an approach of not administering glucocorticoids may be associated with the same risks of developing septic shock and of in-hospital or 28-day mortality as an approach of routinely administering a continuous infusion of hydrocortisone for 5 days, but avoiding routine use of glucocorticoids may be associated with a lower risk of hyperglycemia.

https://www.ncbi.nlm.nih.gov/m/pubmed/27695824/

Strength of Recommendation = B

Long-term effects of Tailored Physical Activity or Chronic Pain Self-Management Programme on return-to-work. — November 11, 2016

Long-term effects of Tailored Physical Activity or Chronic Pain Self-Management Programme on return-to-work.

Summary: For adults sick-listed due to pain in the back or the upper body, providing a 90-minute session of health coaching centered on lifestyle, motivation, resources and “power to act” may be associated with the same likelihood of returning to work within the next 11 months as approaches using either supervised tailored group physical activity for 10 weeks or 6 workshops (2.5 hours each) on chronic pain self-management; however the health coaching approach involves much less time commitment and could potentially be far less costly.

https://www.ncbi.nlm.nih.gov/m/pubmed/27786344/

Strength of Recommendation = B

Coffee consumption and mortality after acute myocardial infarction: the Stockholm Heart Epidemiology Program. — November 8, 2016

Coffee consumption and mortality after acute myocardial infarction: the Stockholm Heart Epidemiology Program.

Summary: Among patients admitted to hospital with a confirmed first acute myocardial infarction (MI), a prior history of regularly consuming 3 or more cups of coffee daily may be associated with a lower risk of subsequent postinfarction mortality than a prior history of regularly consuming less than 3 cups of coffee daily (or avoiding coffee altogether).

https://www.ncbi.nlm.nih.gov/m/pubmed/19249420/

Strength of Recommendation = B

Defibrillator Implantation in Patients with Nonischemic Systolic Heart Failure. — November 4, 2016
Amitriptyline, Topiramate, or Placebo for Pediatric Migraine — November 1, 2016

Amitriptyline, Topiramate, or Placebo for Pediatric Migraine

Summary: For children or adolescents (aged 8 to 17 years) with a history of age with migraine occurring at least 4 days monthly, an approach of giving neither amitriptyline nor topiramate for headache prevention may be associated with the same degree of reduction in headache frequency, headache-related disability, and headache days as an approach of using either amitriptyline or topiramate for headache prevention, but with a lower likelihood of side effects such as fatigue, dry mouth, paresthesia, and weight loss. (In other words, amitriptyline and placebo appear to work no better for prophylaxis of pediatric migraine than placebo, but both medications are associated with higher rates of adverse events.)

https://www.ncbi.nlm.nih.gov/m/pubmed/27788026/

Strength of Recommendation = B

Effect of Conservative vs Conventional Oxygen Therapy on Mortality Among Patients in an Intensive Care Unit. — October 28, 2016

Effect of Conservative vs Conventional Oxygen Therapy on Mortality Among Patients in an Intensive Care Unit.

Summary: For patients who are expected to spend 72 hours or more in an intensive care unit (ICU), providing supplemental oxygen titrated to a goal Spo2 between 94% and 98% may be associated with lower risk of mortality than providing supplemental oxygen titrated to a goal Spo2 between 97% and 100%.

https://www.ncbi.nlm.nih.gov/m/pubmed/27706466/

Strength of Recommendation = B

 

 

Levosimendan and Acute Organ Dysfunction in Sepsis. — October 26, 2016

Levosimendan and Acute Organ Dysfunction in Sepsis.

Summary: For adults in hospital with sepsis, an approach of avoiding use of levosimendan appears to be associated with a higher likelihood of successful weaning from mechanical ventilation and a lower likelihood of supraventricular tachydysrhythmia than an approach of administering levosimendan for treatment of sepsis.

https://www.ncbi.nlm.nih.gov/m/pubmed/27705084/

Strength of Recommendation = B

Coffee and risk of death after acute myocardial infarction. — October 21, 2016
Close Contact Casting vs Surgery for Initial Treatment of Unstable Ankle Fractures. — October 18, 2016

Close Contact Casting vs Surgery for Initial Treatment of Unstable Ankle Fractures.

Summary: For adults over 60 with an unstable acute ankle fracture, use of a molded below-knee cast with minimal padding (applied under anesthesia by a trained surgeon) may lead to the same functional outcomes for the ankle at 6 months as surgical internal fixation but with lower likelihood of infection and less operating room time. (However, casting may be associated with a higher rate of radiologic malunion than surgery).

https://www.ncbi.nlm.nih.gov/m/pubmed/27727383/

Strength of Recommendation = B

Cold Water Immersion Versus Whole Body Cryotherapy for Recovery From Exercise-Induced Muscle Damage. — October 14, 2016

Cold Water Immersion Versus Whole Body Cryotherapy for Recovery From Exercise-Induced Muscle Damage.

Summary: For physically active individuals, cold water immersion (10 minutes at 10°C) after intense exercise appears to be more effective for accelerating recovery kinetics, for relief of soreness, and for perceived recovery than whole-body cryotherapy. (Although not specifically addressed, it is likely cold-water immersion would also be significantly less expensive)

https://www.ncbi.nlm.nih.gov/m/pubmed/27396361/

Strength of Recommendation = B

10-Year Outcomes after Monitoring, Surgery, or Radiotherapy for Localized Prostate Cancer. — October 7, 2016

10-Year Outcomes after Monitoring, Surgery, or Radiotherapy for Localized Prostate Cancer.

Summary: For men between 50 and 69 years old with clinically localized prostate cancer detected by prostate-specific antigen (PSA) screening, active monitoring * appears to result in the same 10-year prostate-cancer-specific survival (~98%) and all-cause-mortality survival as either radiotherapy or prostatectomy.

 * – “Active monitoring” in this study consisted of frequent scheduled PSA levels, with a 50% increase in PSA value triggering clinical review and reassessment of management options; see full article for details.

http://www.ncbi.nlm.nih.gov/m/pubmed/27626136/

Strength of Recommendation = B

Using venous blood gas analysis in the assessment of COPD exacerbation. — September 30, 2016

Using venous blood gas analysis in the assessment of COPD exacerbation.

Summary: For a patient with an acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and an initial pulse-oximetry reading of > 80%, management guided by venous blood gas (if pH > 7.35) may be just as effective as management guided by arterial blood gas sampling but with less patient discomfort. (http://thorax.bmj.com/content/71/3/210/F5.large.jpg)

http://www.ncbi.nlm.nih.gov/m/pubmed/26628461/

Strength of Recommendation = B

 

Duration of Antibiotic Treatment in Community-Acquired Pneumonia. — September 27, 2016

Duration of Antibiotic Treatment in Community-Acquired Pneumonia.

Summary: For adult patients hospitalized with community-acquired pneumonia (CAP), a practice of stopping antibiotics after 5 days’ treatment if the patient has been afebrile for 48 hours and has no more than one sign of clinical instability*, appears to be associated with a shorter overall duration of antibiotic treatment and a lower likelihood of hospital re-admission over the next 30 days (with no worse rates of clinical improvement or symptom improvement) compared to a practice of stopping antibiotics based on the clinical determination or impression of the treating physician.

* – Signs of clinical instability in CAP: Systolic blood pressure  < 90 mm Hg, heart rate >  100/min, respiratory rate > 24 /min,  oxygen saturation < 90%, or Pao2 < 60 mm Hg on room air.

http://www.ncbi.nlm.nih.gov/m/pubmed/27455166/

Strength of Recommendation = B

Wearable Technology Combined With a Lifestyle Intervention and Long-term Weight Loss — September 26, 2016

Wearable Technology Combined With a Lifestyle Intervention and Long-term Weight Loss

Summary: For overweight and obese young adults participating in a weight-loss program (incorporating calorie restriction, exercise, counseling, and support for self-monitoring), efforts at weight loss withOUT the use of a wearable activity monitor may lead to more loss of weight than efforts at weight loss pursued with regular monitoring by a wearable activity monitor.

https://www.ncbi.nlm.nih.gov/m/pubmed/27654602/

Strength of Recommendation = B

Outcomes of Patients Presenting With Hypertensive Urgency in the Office Setting. — September 20, 2016

Outcomes of Patients Presenting With Hypertensive Urgency in the Office Setting.

Summary: For non-pregnant patients with an asymptomatic “hypertensive urgency” (systolic blood pressure  ≥180 mm Hg or diastolic blood pressure ≥110 mm Hg) outpatient management appears to be associated a lower rate of hospitalization over the following 30 days than inpatient management, with no increased risk of major adverse cardiovascular events (ie, acute coronary syndrome, stroke or transient ischemic attack).

http://www.ncbi.nlm.nih.gov/m/pubmed/27294333/

Strength of Recommendation = B

Treatment of mid-clavicular fractures: Figure-of-eight bandage versus a simple sling. — September 16, 2016
Analgesia for management of renal colic in the emergency department. — August 26, 2016

Analgesia for management of renal colic in the emergency department.

Summary: For patients with moderate to severe acute renal colic, intramuscular diclofenac (75 mg) or intravenous paracetamol (1g) may be more likely to provide a 50% reduction in pain at 30 minutes than low-dose intravenous morphine (0.1 mg/kg), and both diclofenac and paracetamol may be associated with a lower likelihood of adverse events compared to morphine.

http://www.ncbi.nlm.nih.gov/m/pubmed/26993881/

Strength of Recommendation = B

Intravenous paracetamol versus morphine for renal colic. — August 23, 2016
Healing of intraoral wounds closed using silk sutures and isoamyl 2-cyanoacrylate glue. — August 16, 2016

Healing of intraoral wounds closed using silk sutures and isoamyl 2-cyanoacrylate glue.

Summary: For patients having intra-oral procedures, surgical closure with cyanoacrylate glue appears to lead to the same degree of wound-healing by 2 weeks as does closure with silk sutures, but cyanoacrylate glue appears to be associated with less short-term inflammation.

http://www.ncbi.nlm.nih.gov/m/pubmed/23089654

Strength of Recommendation = B

Exercise therapy versus arthroscopic partial meniscectomy for degenerative meniscal tear in middle aged patients: randomised controlled trial with two year follow-up — August 12, 2016

Exercise therapy versus arthroscopic partial meniscectomy for degenerative meniscal tear in middle aged patients: randomised controlled trial with two year follow-up

Summary: For adults with a degenerative medial meniscal tear, treatment with 12 weeks of supervised neuromuscular and strength exercises may lead to the same level of function, pain reduction and quality of life over 2 years as treatment with arthroscopic partial meniscetomy, but patients treated with supervised exercise may have greater short-term (3 month) improvement in thigh muscle strength.

http://www.ncbi.nlm.nih.gov/m/pubmed/27440192/

Strength of Recommendation = B

Vaginal progesterone prophylaxis for preterm birth (OPPTIMUM study) — August 5, 2016

Vaginal progesterone prophylaxis for preterm birth (OPPTIMUM study)

Summary: For women at high-risk of pre-term birth, not using vaginal progesterone seems to be associated with the same rate of preterm birth as does the use of vaginal progesterone prophylaxis. (In otherwords, for women at high risk of pre-term birth, vaginal progesterone prophylaxis may not reduce that risk)

http://www.ncbi.nlm.nih.gov/m/pubmed/26921136/

Strength of Recommendation = A

Blood-Pressure Lowering in Intermediate-Risk Persons without Cardiovascular Disease. — August 2, 2016

Blood-Pressure Lowering in Intermediate-Risk Persons without Cardiovascular Disease.

Summary: In primary prevention patients at intermediate risk of cardiovascular disease (ie, at risk but without known disease), avoiding the addition of candesartan + hydrochlorothiazide appears to be associated with the same risk of cardiovascular death, non-fatal MI, or nonfatal stroke, but lower rates of hypotension, dizziness, or lightheadedness. (In otherwords, for a patients at intermediate risk of cardiovascular disease, treatment with candesartan + hydrochlorothiazide is not associated with any cardiovascular benefit over 5 years but may lead to more hypotension, dizziness, or lightheadedness)

NOTE: The average blood pressure of patients at enrollment in this study was ~ 138/82.

http://www.ncbi.nlm.nih.gov/m/pubmed/27041480/

Strength of Recommendation = B

Trial comparing three month and six month follow up of patients with hypertension by family practitioners — July 29, 2016
Effect of screening and lifestyle counseling on incidence of ischemic heart disease in general population — July 26, 2016

Effect of screening and lifestyle counseling on incidence of ischemic heart disease in general population

Summary: Patients receiving routine medical care (ie, no specific invitations for cardiovascular risk screening) appear to have the same 5-year likelihood of ischemic heart disease, stroke, and mortality as to those invited for screening, cardiovascular risk assessment, and lifestyle counseling. (In other words, cardiovascular risk screening and lifestyle counseling may not be effective for primary prevention of ischemic heart disease, stroke, and mortality over the next 5 years)

http://www.ncbi.nlm.nih.gov/m/pubmed/24912589/

Strength of Recommendation = A

Systematic versus opportunistic risk assessment for the primary prevention of cardiovascular disease — July 22, 2016

Systematic versus opportunistic risk assessment for the primary prevention of cardiovascular disease

Summary: Based on evidence of limited quality, it appears that opportunistic risk assessment or case finding of cardiovascular disease (CVD) or associated risk factors may be associated with the same reduction in all-cause and cardiovascular mortality as systematic screening for CVD or associated risk factors.

http://www.ncbi.nlm.nih.gov/m/pubmed/26824223/

Strength of Recommendation = B

Ticagrelor vs Aspirin in Acute Stroke or Transient Ischemic Attack. — July 15, 2016

Ticagrelor vs Aspirin in Acute Stroke or Transient Ischemic Attack.

Summary: For patients with acute stroke or transient ischemic attack (TIA), use of aspirin as antiplatelet therapy for secondary prevention appears to be associated with the same rate of stroke, myocardial infarction, or death over the next 90 days as is the use of ticagrelor, but at potentially much lower cost.

http://www.ncbi.nlm.nih.gov/m/pubmed/27160892/

Strength of Recommendation = B

Cancer risk in people exposed to computed tomography scans in childhood or adolescence. — July 12, 2016

Cancer risk in people exposed to computed tomography scans in childhood or adolescence.

Summary: Minimizing use of computed tomography (CT) scanning in children and adolescents appears to be associated with a slightly lower risk of developing a new cancer over the next (approximately) 9.5 years, and possibly with slightly lower lifetime risk of new cancer.

http://www.ncbi.nlm.nih.gov/m/pubmed/23694687/

Strength of Recommendation = B

Potassium Supplementation, Diet vs Pills: A Randomized Trial in Postoperative Cardiac Surgery Patients. — July 8, 2016

Potassium Supplementation, Diet vs Pills: A Randomized Trial in Postoperative Cardiac Surgery Patients.

Summary: For patients undergoing cardiac surgery who are treated with diuretics, potassium supplementation with potassium-rich foods (eg, raisins, bananas, potatoes) may lead better patient satisfaction and may lead to a shorter hospital stay than potassium supplementation with potassium chloride pills, and without any worsening in serum potassium levels. (While not specifically tested in this study, it also seems a reasonable extrapolation to assume this would apply to other surgical or medical patients treated with diuretics as well).

http://www.ncbi.nlm.nih.gov/m/pubmed/14769716/

Strength of Recommendation = B

Twenty five year follow-up for breast cancer incidence and mortality of the Canadian National Breast Screening Study: randomised screening trial — July 5, 2016

Twenty five year follow-up for breast cancer incidence and mortality of the Canadian National Breast Screening Study: randomised screening trial

Summary: For women living in areas with freely available access to appropriate adjuvant therapy for breast cancer, breast cancer screening by regular physical examination alone may be equivalent to breast cancer screening with regular mammography when evaluated in terms of 25 year risk of breast-cancer or all-cause mortality, but screening by physical examination alone may lead to a lower risk of over-diagnosis and a lower risk of over-treatment.

http://www.ncbi.nlm.nih.gov/m/pubmed/24519768/

Strength of Recommendation = B

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