Clinical Inquiries, 2013
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Item Do oral contraceptives carry a significant risk of stroke for women with migranes?(Family Physicians Inquiries Network, 2013) McClester, Mallory; Mounsey, Anne L.; Mackler, LeslieEvidence-based answer: Estrogen-containing oral contraceptives may raise the risk of ischemic stroke in women with migraine, particularly migraine with aura (strength of recommendation [SOR]: C, small case-control studies with methodological flaws and conflicting results).Item What is the best age to start vitamin D supplementation to prevent rickets in breastfed newborns?(Family Physicians Inquiries Network, 2013) Bly, Eleanor; Huntington, Jane; Harper, AmyEvidence-based answer: It's unclear what age is best to start vitamin D supplementation because no comparison studies exist. That said, breastfed infants who take vitamin D beginning at 3 to 5 days of life don't develop rickets (strength of recommendation SOR]: B, randomized trial). Starting infants on vitamin D supplementation at one to 36 months of age reduces the risk of rickets (SOR: B, a controlled and a randomized controlled trial).Item How do antidepressants affect sexual function?(Family Physicians Inquiries Network, 2013) Clark, Molly S.; Jansen, Kate; Breshahan, MeganEvidence-based answer: patients treated with elective serotonin reuptake inhibitors (SSRIs) and the serotonin/norepinephrine reuptake inhibitor (SNRI) venlafaxine have significantly higher rates of overall sexual dysfunction--including desire, arousal, and orgasm--than patients treated with placebo (strength of recommendation [SOR]: B, randomized controlled trials [RCTs] with heterogeneous results). Patients treated with bupropion, a norepinephrine-dopamine reuptake inhibitor (NDRI), have rates of overall sexual dysfunction comparable to placebo (SOR: B, RCTs with heterogeneous results).Item What clinical clues differentiate migraine from sinus headaches?(Family Physicians Inquiries Network, 2013) Boisselle, Christopher; Guthmann, Richard A.; Cable, KathyEvidence-based answer: Patients with sinus headaches have thick nasal discharge, fever, chills, sweats, or abnormally malodorous breath (SOR: B, cross-sectional study). The 5 symptoms that are most predictive of migraine are: pulsatile quality, duration of 4 to 72 hours, unilateral location, nausea or vomiting, and disabling intensity (SOR: B, retrospective cohort). As the number of these symptoms increases, so too, does the likelihood that the patient has a migraine (SOR: B, systematic review of retrospective cohort studies). Most patients diagnosed with sinus headache actually have a migraine headache (SOR: B, 2 cross-sectional studies).Item Testosterone Therapy and Risk of Recurrence After Treatment for Prostate Cancer(Family Physicians Inquiries Network, 2013) Meza, James; Weaver, Karen; Martin, Sandra I.Evidence-Based Answer: Men with symptomatic androgen deprivation who have had clinically curative treatment for organ-confined prostate cancer may have symptomatic improvement with testosterone replacement therapy. (Strength of Recommendation [SOR]: C, based on two small case series.) There are no studies evaluating the risk of cancer recurrence in patients receiving testosterone replacement therapy. However, testosterone replacement therapy may be associated with increased prostate-specific antigen (PSA) levels. (SOR: C, based on one case report.) Some men discontinue therapy because their symptoms do not improve. (SOR: C, based on a small case series.)