Clinical question	Bottom-line answer
17. Which oral anticoagulants have the lowest risk of causing upper gastrointestinal tract bleeding, and does cotherapy with a PPI lower that risk?31	Among four oral anticoagulants, apixaban had the lowest rate of upper gastrointestinal tract bleeding, which was further reduced by cotherapy with a PPI. Among patients using oral anticoagulants alone, the risk of hospitalization for upper gastrointestinal tract bleeding is highest with rivaroxaban (Xarelto) and lowest with apixaban (Eliquis). Cotherapy with a PPI reduces the risk among patients using any oral anticoagulant.
18. In patients with acute pain, does a higher dose of ibuprofen produce greater pain relief?32	For pain relief, lower doses of ibuprofen work as well as higher doses. Higher doses of ibuprofen for acute pain relief offer no more benefit at 60 minutes than a single 400-mg dose. The same has been shown for chronic treatment of osteoarthritis; an anti-inflammatory dose is not needed. Furthermore, another study showed equivalence between 200-mg and 400-mg doses of ibuprofen.
19. Which herpes zoster vaccine is more effective?33	Shingrix works better than Zostavax. The adjuvant recombinant zoster vaccine (Shingrix) is much more effective than the live, attenuated vaccine (Zostavax). However, Shingrix is much more likely to cause injection site pain. Unlike the live vaccine, it requires two doses and—although not demonstrated in the trials—a few days of acute arm soreness might limit patients' enthusiasm for the required second dose, and both doses are required for an adequate immune response.
20. In older patients, do exercise classes or a prescribed exercise regimen decrease the risk of falls, injuries, or more serious outcomes?34	Exercise helps prevent falls. Regular moderate-intensity exercise two to three times per week can decrease the overall likelihood of falls and resulting injuries in older patients but does not decrease the overall risk of hospitalization and does not decrease mortality.