Clinical question	Bottom-line answer	Clinical actions to consider for Choosing Wisely
In patients with acute pain, does a higher dose of ibuprofen produce greater pain relief?A1	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.	For pain relief, a 400-mg dose of ibuprofen works as well as higher doses.
What signs and symptoms are most useful for excluding the diagnosis of pneumonia in community-dwelling adults with an acute respiratory infection?A2	Community-dwelling adults who present as outpatients with symptoms of acute respiratory tract infection but normal vital signs and normal findings on a pulmonary examination have only a 0.4% likelihood of community-acquired pneumonia.	The combination of normal vital signs and normal lung examination findings essentially rules out community-acquired pneumonia.
Does low-dose aspirin prevent cardiovascular events and cardiovascular-related death in otherwise healthy older people?A3	Low-dose aspirin does not reduce the likelihood that these patients will experience a major cardiovascular event during nearly five years of follow-up.	Do not use low-dose aspirin for the primary prevention of cardiovascular events in otherwise healthy older adults.
Does aspirin improve disability-free survival in otherwise healthy older people?A4	In this landmark study of a contemporary population, in which risk factors such as hyperlipidemia and hypertension are more likely to be addressed, aspirin did not provide a benefit in terms of death, dementia, or disability in a group of largely White older patients.	Do not use aspirin for noncardiovascular primary prevention in otherwise healthy older adults.
How long do colds last in children?A5	Most respiratory illnesses in children are mild, do not require medical care, and do not result in school absences; however, symptoms can last up to three weeks.	Because cold symptoms can last up to three weeks, clinicians should counsel parents of children with respiratory symptoms to be patient.
Can strep throat in children and adults be treated with five days of oral penicillin V?A6	Five days of penicillin V, 800 mg four times per day, was not inferior to 10 days of penicillin V, 1,000 mg three times per day, with shorter symptom duration. This is not the first study to show similar benefits with a shorter duration of oral amoxicillin/clavulanate (Augmentin), amoxicillin, or a cephalosporin.	Consider a five-day course of higher-dose penicillin V for symptom relief in patients with streptococcal pharyngitis.
Are statins effective in patients older than 75 years?A7	Statins are effective in preventing major coronary events in patients older than 75 years, but this effect is significant only in those with established cardiovascular disease. This is consistent with the results from the ALLHAT trial, which also showed no benefit for primary prevention and additionally showed a trend toward harm in those older than 75 years.	In patients older than 75 years without cardiovascular disease, do not initiate statins for primary prevention.
Is fully automated blood pressure measurement more accurate than manual sphygmomanometry?A8	There are two takeaways from this analysis. (1) Automated measurement aligns better with ambulatory blood pressure monitoring (the best predictor of cardiovascular events) than manual measurement. (2) Manual readings are an average of 13.4 to 14.5 mm Hg (systolic) higher than daytime ambulatory or automated readings in patients with hypertension.	Use automated blood pressure measurements to guide treatment decisions.
What is the yield of a screening program based on FIT every two years for 10 years?A9	Over 10 years, the detection rates for colorectal cancer and advanced adenomas using FIT are similar to those seen in studies of screening colonoscopy. This is reassuring, but it does not prove that FIT reduces morbidity and mortality due to colorectal cancer as effectively as colonoscopy. Modeling concludes that a FIT-based screening program will result in one-half as many colonoscopies as a colonoscopy-based program, as well as a significant reduction in cost, burden, and harm of screening.	For colorectal cancer screening, consider FIT testing because it compares favorably with colonoscopy.
Does a lack of early symptom improvement in patients treated for depression predict treatment failure?A10	Response to treatment within the first two weeks predicts eventual response or remission, but a lack of early response does not predict treatment failure. Approximately one-third of patients who do not show an early response will respond by six weeks. No individual symptom response predicts eventual improvement.	Stay the course with depression treatment; one-third of early nonresponders responded by six weeks of treatment.
Is modern FIT for occult blood in the stool less accurate in patients who are taking aspirin, an anticoagulant, or a nonsteroidal anti-inflammatory drug?A11	The use of these drugs has no clinically important effects on the positive predictive value of FIT in a screening population.	Do not avoid FIT testing in patients taking aspirin, oral anticoagulants, or nonsteroidal anti-inflammatory drugs. These drugs do not reduce test accuracy.