Less Is More

Simpler & Better Medicine

Preoperative hair removal to reduce surgical site infection. — September 19, 2017

Preoperative hair removal to reduce surgical site infection.

Summary: While too little research in this area has been conducted to allow firm conclusions, there is low-quality evidence that when pre-operative hair removal is needed, there may be fewer surgical-site infections (SSIs) with clipping than with shaving.

https://www.ncbi.nlm.nih.gov/m/pubmed/22071812/

Strength of Recommendation = B

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Oxygen Therapy in Suspected Acute Myocardial Infarction — September 12, 2017

Oxygen Therapy in Suspected Acute Myocardial Infarction

Summary: For patients with suspected acute myocardial infarction (AMI) and an oxygen saturation 90% or higher at baseline, an approach of providing ambient air only (ie, no supplemental oxygen) may be associated with no difference in the risk of death from any cause within 1 year or rehospitalization with AMI within 1 year compared to an approach of providing supplemental oxygen (6 liters per minute for 6 to 12 hours).

https://www.ncbi.nlm.nih.gov/m/pubmed/28844200/

Strength of Recommendation = B

Over-the-counter transdermal lidocaine 3.6% menthol 1.25%, Rx lidocaine 5% and placebo for back pain and arthritis. — September 5, 2017
Effect of Natriuretic Peptide-Guided Therapy on Hospitalization or Cardiovascular Mortality in Patients With Heart Failure. — August 29, 2017

Effect of Natriuretic Peptide-Guided Therapy on Hospitalization or Cardiovascular Mortality in Patients With Heart Failure.

Summary: For patients with chronic heart failure and an ejection fraction ≤40%, outpatient management in accordance with published guidelines may be associated with the same time-to-first HF hospitalization and the same likelihood of cardiovascular mortality as outpatient management guided by titrating therapy with a goal of achieving a target NT-proBNP of less than 1000 pg/mL.

https://www.ncbi.nlm.nih.gov/m/pubmed/28829876/

Strength of Recommendation = B

Gestational Diabetes Mellitus and Frequency of Blood Glucose Monitoring — August 25, 2017

Gestational Diabetes Mellitus and Frequency of Blood Glucose Monitoring

Summary: For pregnant women with well-controlled gestational diabetes mellitus, an approach of advising blood sugar testing 4x daily every other day may lead to higher rates of adherence to testing than an approach of advising blood sugar testing 4x daily every day, with no differences in the need for medical treatment, likelihood of induction, gestational age at delivery, mode of delivery, rate of preeclampsia, likelihood of shoulder dystocia, or likelihood of macrosomia.

https://www.ncbi.nlm.nih.gov/m/pubmed/28594772/

Strength of Recommendation = B

Nonoperative Versus Operative Treatment of Acute Acromio-Clavicular Joint Dislocation. — July 18, 2017

Nonoperative Versus Operative Treatment of Acute Acromio-Clavicular Joint Dislocation.

Summary: For adult patients with complete (grade III, IV, and V) dislocations of the acromio-clavicular (AC) joint, non-operative management with a sling for 4 weeks followed by an exercise program may be associated with a lower level of disability at 6 weeks and 3 months as well as a lower likelihood of needing subsequent surgery, compared to an approach of operative repair with hook plate fixation; although the degree of disability at 2-year follow up may be the same for both approaches.

https://www.ncbi.nlm.nih.gov/m/pubmed/26489055/

Strength of Recommendation = B

Glycemic Control in Severely Burned Patients Using Metformin. — July 5, 2017
Single-Dose Oral Dexamethasone Versus Multidose Prednisolone for Acute Exacerbations of Asthma in Children Who Attend the Emergency Department. — June 27, 2017

Single-Dose Oral Dexamethasone Versus Multidose Prednisolone for Acute Exacerbations of Asthma in Children Who Attend the Emergency Department.

Summary: For children with seeking emergency care for an acute exacerbation of asthma, treatment with a single dose of oral dexamethasone (0.3 mg/kg) may be associated with the no differences on the Pediatric Respiratory Assessment Measure (PRAM) score at 4 days compared to treatment with oral prednisolone (1 mg/kg per day for 3 days), but treatment with dexamethasone can be accomplished with fewer doses of medication (once vs daily for 3 days); with dexamethasone associated with lower likelihood of vomiting but a higher likelihood of needing further systemic steroids within 14 days.

https://www.ncbi.nlm.nih.gov/m/pubmed/26460983/

Strength of Recommendation = B

Intra-articular Triamcinolone vs Saline for Patients With Knee Osteoarthritis — June 13, 2017

Intra-articular Triamcinolone vs Saline for Patients With Knee Osteoarthritis

Summary: For patients with symptomatic knee osteoarthritis, an approach of NOT using intra-articular corticosteroid injections may lead to less loss of knee cartilage, compared to an approach of using regular (every-3-month) intra-articular injections of triamcinolone, without any difference pain or function.

https://www.ncbi.nlm.nih.gov/m/pubmed/28510679/

Strength of Recommendation = B

Comparing melatonin 3 mg, amitriptyline 25 mg and placebo for migraine prevention. — June 6, 2017

Comparing melatonin 3 mg, amitriptyline 25 mg and placebo for migraine prevention.

Summary: For adults having 2-8 migraine attacks per month (with or without aura), use of melatonin 3 mg daily may provide more people with at least a 50% reduction in headache frequency than amitriptyline 25 mg daily, with a lower likelihood of side effects (such as sleepiness, dry mouth, weight gain or constipation).

https://www.ncbi.nlm.nih.gov/m/pubmed/27165014/

Strength of Recommendation = B

Gluten consumption in adults without celiac disease and risk of coronary heart disease. — May 30, 2017

Gluten consumption in adults without celiac disease and risk of coronary heart disease.

Early Versus Delayed Feeding in Patients With Acute Pancreatitis — May 23, 2017

Early Versus Delayed Feeding in Patients With Acute Pancreatitis

Summary: For patients hospitalized for mild to moderate acute pancreatitis, an approach of early refeeding (at less than 48 hours after admission) may be associated with a shorter length of hospital stay than an approach of delayed refeeding (waiting 48 hours or more after admission), without any increased risk of adverse events.

https://www.ncbi.nlm.nih.gov/m/pubmed/28505667/

Strength of Recommendation = A

Comparative effectiveness of exercise and drug interventions on mortality outcomes — May 16, 2017

Comparative effectiveness of exercise and drug interventions on mortality outcomes

Summary: For patients who have had a stroke, exercise-based rehabilitation (including cardiorespiratory and muscle strengthening exercises) is more effective than medication (either anti-platelet agents or anticoagulants) for reducing mortality; while for patients with established coronary artery disease both medications and exercise-based rehabilitation provide the same (small) reduction in mortality; and for patients with pre-diabetes neither exercise-based rehabilitation nor medications are effective at reducing mortality.

https://www.ncbi.nlm.nih.gov/m/pubmed/26476429/

Strength of Recommendation = A

Timing of oral refeeding in acute pancreatitis. — April 28, 2017
Sitting vs. standing and perception of clinician time at the hospital bedside — April 26, 2017

Sitting vs. standing and perception of clinician time at the hospital bedside

Summary: For patients being seen in hospital, if the physician sits while seeing the patient during hospital rounds, this may lead to the patient perceiving the visit to have been longer than if the physician stands; physician sitting rather than standing may also lead to patients reporting a more positive interaction and a better understanding of their condition.

https://www.ncbi.nlm.nih.gov/m/pubmed/21719234/

Strength of Recommendation = B

Total Laparoscopic Hysterectomy vs Total Abdominal Hysterectomy and Disease-Free Survival Among Women With Stage I Endometrial Cancer — March 31, 2017

Total Laparoscopic Hysterectomy vs Total Abdominal Hysterectomy and Disease-Free Survival Among Women With Stage I Endometrial Cancer

Summary: For women with stage I endometrial cancer, laparoscopic hysterectomy appears to be associated with the same likelihood of overall survival and disease-free survival at 4.5 years as total abdominal hysterectomy, while laparoscopic hysterectomy may be associated with fewer postoperative surgical complications.

https://www.ncbi.nlm.nih.gov/m/pubmed/28350928/

Strength of Recommendation = B

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

Follow-up of ASCUS or LSIL: Colposcopy vs repeat cytology — February 14, 2017

Follow-up of ASCUS or LSIL: Colposcopy vs repeat cytology

Summary: For women between 22 to 27 years of age who have a pap test showing atypical squamous cells of undetermined significance (ASCUS) or low-grade squamous intraepithelial lesion (LSIL), following up with repeat cervical cytology at 6 months may be associated with the same rates of invasive cervical cancer at 6.5 years as following up with colposcopy and biopsy at 6 months, at potentially lower cost.

https://www.ncbi.nlm.nih.gov/m/pubmed/27457115/

Strength of Recommendation = C

Lung ultrasound for diagnosis of pneumonia. — February 10, 2017
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

Effects of Intensive Glycemic Control on Cardiovascular Outcomes. — January 20, 2017
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
Sterile vs Nonsterile Gloves in Cutaneous Surgery and Common Outpatient Dental Procedures — January 6, 2017

Sterile vs Nonsterile Gloves in Cutaneous Surgery and Common Outpatient Dental Procedures

Summary: For patients having outpatient cutaneous surgical procedures, use of clean non-sterile gloves is associated with the rate of surgical site infection (approximately 2%) as use of sterile gloves, but the financial costs of non-sterile gloves are much lower.

https://www.ncbi.nlm.nih.gov/m/pubmed/27487033/

Strength of Recommendation = A

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

Watchful Waiting Strategy May Reduce Low-Value Diagnostic Testing. — December 16, 2016

Watchful Waiting Strategy May Reduce Low-Value Diagnostic Testing.

Summary: For patients requesting testing that is expected to be low-value, use of a “watchful waiting” strategy (“allowing a negotiated period of time to pass before making a firm testing decision“) may be associated with lower likelihood of subsequent use of low-value tests than standard care such as providing “reassurance” and “evidence-based recommendations.”

https://www.ncbi.nlm.nih.gov/m/pubmed/28076254/

Strength of Recommendation = C

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

Abdominal drainage versus no abdominal drainage for laparoscopic cholecystectomy. — November 25, 2016

Abdominal drainage versus no abdominal drainage for laparoscopic cholecystectomy.

Summary: For patients undergoing laparascopic cholecystectomy, an approach of not placing an abdominal drain may be associated with a shorter operative time and less post-operative pain than an approach of routinely placing an abdominal drain during the laparascopic procedure, without any increased risk of adverse events.

https://www.ncbi.nlm.nih.gov/m/pubmed/27871803/

Strength of Recommendation = A

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

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