Clinical Inquiries, 2001
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Item Should we change formula for a formula-fed infant with persistent spitting up, but with adequate weight gain?(Family Physicians Inquiries Network, 2001) Jiang, Jennifer C.; Ewigman, BernardWe found no controlled trials evaluating the efficacy of changing formulas in the management of uncomplicated regurgitation. However, the evidence suggests that no benefit can be expected from changing formulas, including the discontinuation of iron-fortified formulas. Additionally, changing formulas leads many mothers to believe that their child has a disease or illness. Although controlled trials of infants with gastroesophageal reflux disease (GERD) show that formula thickening (eg, with rice cereal) decreases spitting-up, and expert consensus panels recommend formula thickening (along with parental reassurance) as first-line therapy in the management of uncomplicated regurgitaion, one could question whether these outcomes in infants with GERD would hold for infants with uncomplicated regurgitation. Flat-prone positioning and avoiding the seated position is beneficial in infants with GERD, but the association of prone positioning with sudden infant death syndrome limits this intervention. (Grade of recommendation: D, based on a synthesis of information from controlled trials performed in other patient populations, retrospective surveys, physiologic evidence, and consensus expert opinion.)Item What are the benefits of treating sleep apnea?(Family Physicians Inquiries Network, 2001) Tipton, John W.There is little benefit to treating patients with sleep apnea who do not have daytime sleepiness. For patients with symptoms, treating those with moderate to severe sleep apnea is more reliably associated with benefits than treating those with a mild case. Benefits include: decreased daytime sleepiness; improvements in subjective sleep quality in patient and sleep partner; improved psychologic well-being, cognitive function, and quality of life; decreased numbers of traffic accidents; and small decreases in blood pressure. (Grade of recommendation: B-, based primarily on cohort studies and case series and a small number of randomized controlled trials [RCTs])Item What are the current treatment and monitoring recommendations for hepatitis C virus (HCV)?(Family Physicians Inquiries Network, 2001) Kivlahan, ColeenPatients diagnosed with HCV should have serum liver function tests and get a baseline HCV RNA level (viral load), since treatment decisions are affected by these laboratory values. Genotype testing is indicated for treatment decisions and prognosis. Therapy with interferon and ribavirin (dual therapy) has been shown in randomized placebo-controlled trials to lead to sustained viral response in 30% to 50% of patients compared with 6% to 21% with PEG-interferon alpha-2b (Viraferson PEG) therapy only. Genotype 1 should be treated with dual therapy for 48 weeks and all other types treated for 24 weeks. Evidence is lacking on the optimum monitoring approach for patients taking dual therapy; consensus recommendations are given in the TABLE 1. Recent evidence shows that treatment with PEG-interferon alpha-2b and ribavirin with weight-based dosing achieved an 82% sustained viral response. (Grade of recommendation: A [dual therapy]; D [all other recommendations].)Item Which patients with gastroesophageal reflux disease (GERD) should have esophagogastroduoudenoscopy (EGD)?(Family Physicians Inquiries Network, 2001) Danis, Peter G.No evidence was identified that provides a basis for determining whether EGD leads to improved outcomes in patients with GERD. However, patients with GERD referred for elective EGD who were found to have Barrett's esophagus were more likely to have symptoms for more than 1 year than patients who did not have Barrett's esophagus. Patients with esophageal adenocarcinoma were more likely to have frequent, severe, or longer duration of GERD symptoms. The calculated odds ratios (OR) for esophageal adenocarcinoma increased with increasing frequency, severity, or duration of GERD symptoms, independently or in combination.Item When should we stop mammography screening for breast cancer in elderly women?(Family Physicians Inquiries Network, 2001) Parnes, Bennett L.; Smith, Peter C.; Conry, Colleen M.There is insufficient evidence to recommend for or against routine screening mammography beyond the age of 69 years. The best candidates to stop screening are elderly women who have significant comorbidities, poor functional status, low bone mineral density (BMD), little interest in preventive care, or an unwillingness to accept the potential harm of screening. (Grade of Recommendation: C, based on retrospective cohort studies.)