Clinical Inquiries, 2003
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Item Is Fluoxetine an Effective Therapy for Weight Loss in Obese Patients?(Family Physicians Inquiries Network, 2003) Epling, John W.Fluoxetine (Prozac) use may result in an average, short-term weight loss of up to 3.3 kg (7 lb, 4 oz) in obese patients, but the longterm effects and maintenance of weight loss after discontinuation of the drug have not been well studied. No evidence concerning other SSRIs was found. [Strength of recommendation: B, based on low-quality systematic reviews of randomized controlled trials (RCTs)]Item Who should have colposcopy?(Family Physicians Inquiries Network, 2003) Grimm, Kenneth J.; Meadows, Susan E.Colposcopy is the preferred test in the work-up of patients with abnormal cervical cytology: Low-grade squamous intraepithelial lesion (LSIL): mild dysplasia ; High-grade squamous intraepithelial lesion (HSIL): moderate to severe dysplasia. ; Atypical squamous cells of undetermined significance (ASC-US) with high-risk human papillo-mavirus (HPV) DNA ; Atypical squamous cells, cannot rule out HSIL (ASC-H) ; Atypical glandular cells (AGC) ; Adenocarcinoma in situ (AIS). Colposcopy is also recommended for patients with symptoms suggestive of cervical cancer (abnormal appearance of the cervix, persistent and undiagnosed vaginal discharge or bleeding) regardless of cytology results, and in the follow-up of patients previously treated for cervical dysplasia (Grade of Recommendation: B). Colposcopy is not recommended for routine cervical cancer screening.Item Which postmenopausal women should be offered combined HRT?(Family Physicians Inquiries Network, 2003) Oliver, M. Norman; Sheufelt, Janice; Deshpande, Prajakta; Grandage, Karen K.; St. Anna, LeilaniRecent studies have demonstrated a small but significant risk of adverse effects from combined hormone replacement therapy (HRT), including cardiovascular disease, thromboembolic disease, and breast cancer. Time-limited HRT will control intolerable menopausal symptoms and prevent risk of fractures in newly menopausal women. However, HRT achieves its maximum efficacy in 35 years, and the risk of adverse outcomes increases as time progresses. Women considering HRT, particularly those at higher risk for vascular disease and breast cancer, should be informed of the potential risks. There is inadequate evidence to determine the extent of these risks in women who have had a hysterectomy and are taking unopposed estrogen (strength of recommendation: A, based on large randomized controlled trials).Item Which infants need lumbar puncture for suspected sepsis?(Family Physicians Inquiries Network, 2003) Wilhelm, Sarah; Kelsberg, Gary; Safranek, SarahEvidence from prospective and retrospective clinical trials suggests that for infants <2 months old, only those at high risk for serious bacterial infection by standardized criteria (eg, Rochester classification) require lumbar puncture (strength of recommendation [SOR]: B, based on prospective and retrospective cohort studies). However, expert opinion suggests lumbar puncture on all infants aged 0 to 28 days with suspected sepsis, and all infants aged >2 months who are to receive empiric antibiotics (SOR: C, based on expert opinion).Item What treatments are effective for varicose veins?(Family Physicians Inquiries Network, 2003) Hagen, Michael D.; Johnson, E. DianeFor larger trunk varicose veins, as in the saphenous vein, therapeutic options include conservative measures (such as leg elevation and compression stockings), injection sclerotherapy, and surgical vein ligation, with or without stripping.Long-term outcomes appear superior with surgical treatment. For mid-sized reticular veins and spider telangiectasias, several options are available, including sclerotherapy, laser ablation, and thermal ablation. However, no randomized trials have compared the relative effectiveness of these treatments. Venotonic medications (primarily plantderived and synthetic flavonoids, such as horse chestnut seed extract, that improve venous tone) provide symptom relief. Head- to-head comparisons are needed to identify the most efficacious therapies (strength of recommendation: C, based on case series and extrapolations from small trials.)