Clinical Inquiries, 2011
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Item What should you tell pregnant women about exposure to parvovirus?(Family Physicians Inquiries Network, 2011) Snyder, Matthew; Wallace, RickTell patients that parvovirus infections before 20 weeks' gestation confer a risk of fetal morbidity and mortality as high as 16%, but don't significantly increase long-term developmental sequelae (strength of recommendation [SOR]: B, prospective cohort studies). Parvovirus infection rates are similar in a variety of maternal workplace environments (SOR: A, prospective cohort studies); routinely excluding pregnant women from the workplace is unwarranted (SOR: C, expert opinion). Physicians should order immunologic assays for women who may have been exposed to parvovirus to assess maternal immunity and determine whether evaluation for fetal hydrops is necessary (SOR: C, expert opinion).Item Ferning in amniotic fluid: Is it a useful indicator of ruptured membranes?(Family Physicians Inquiries Network, 2011) Gaddey, Heidi; Bailey, Justin; Smith, RitaThe presence of arborized crystals (ferning) in amniotic fluid is both sensitive (74%-100%) and specific (77%-100%) for diagnosing rupture of membranes in laboring women who report loss of fluid (strength of recommendation [SOR]: A, multiple prospective cohort studies). However, it is much less sensitive and specific for women with fluid loss who aren't in labor (SOR: B, 1 prospective cohort study). Gross contamination of amniotic fluid with blood or antiseptic solutions may decrease the diagnostic accuracy of ferning, whereas contamination with meconium doesn't (SOR: C, bench research).Item Treatment of Nongenital Warts(Family Physicians Inquiries Network, 2011) Feigenbaum, Alyson L.; Ainsworth, Carla; St. Anna, LeilaniTopical salicylic acid, cryotherapy, and topical fluorouracil are effective for treating nongenital warts. (Strength of Recommendation [SOR]: A, based on a systematic review of randomized controlled trials [RCTs].) Fluorouracil is more expensive than salicylic acid and produces more adverse effects, such as pain and blisters. The combination of salicylic acid and cryotherapy may be better than either treatment alone, although salicylic acid may be more cost-effective than cryotherapy. Bleomycin and interferons should not be used to treat nongenital warts. (SOR: A, based on a meta-analysis.)Item What treatment is best for hypertrophic scars and keloids?(Family Physicians Inquiries Network, 2011) Williams, Carol C.; De Groote, SandyNo one treatment is best (strength of recommendation [SOR]: C, meta-analysis of heterogenous studies); no good evidence exists comparing treatments with each other. Triamcinolone injections, triamcinolone injections combined with excision, and cryotherapy all improve hypertrophic and keloid scars (SOR: C, case series studies). Silicone gel products have weak evidence of efficacy (SOR: C, Cochrane review with no clear recommendation).Item Should you test for H pylori in patients with nonulcer dyspepsia?(Family Physicians Inquiries Network, 2011) Lanier, J. Brian; Wilder, LauraHelicobacter pylori in creases the risk of developing peptic ulcer disease (strength of recommendation [SOR]: B, cohort study), but there is no evidence that treating H pylori reduces that risk. Treating H pylori in patients with nonulcer dyspepsia reduces symptoms, but doesn't improve quality of life in the short term (SOR: B, systematic review of randomized controlled trials [RCTs] with inconsistent results), but may alleviate symptoms in the long term (SOR: B, RCT with methodological flaws). Eradicating H pylori is relatively inexpensive (SOR: A, systematic review of economic analyses).