Clinical Inquiries, 2005
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Item Which treatments for persistent otitis media with effusion are beneficial?(Family Physicians Inquiries Network, 2005) Satre, Thomas J.; Nashelsky, JoanTreatments such as antibiotics, steroids, antihistamines/decongestants, and mucolytics afford no long-term benefit in the treatment of patients with otitis media with effusion (OME). [Strength of recommendation: A] Surgical treatments such as ventilation tubes and adenoidectomy improve hearing. [Strength of recommendation: A] However, surgery has conflicting effects on improving language development and behavior. [Strength of recommendation: B] There is inconclusive evidence that autoinflation of the eustachian tube with a nasal balloon improves resolution of OME. [Strength of recommendation: B]Item Treatment of Calf Deep Venous Thrombosis(Family Physicians Inquiries Network, 2005) Rotert, Eric M.; Basarich, John R.; Nashelsky, JoanPatients with a first episode of calf DVT with a transient risk factor should receive heparin therapy followed by oral anti- coagulation for six to 12 weeks. [Strength of recommendation: A, based on systematic review of randomized controlled trials (RCTs)] If anticoagulation is contra-indicated, physicians should monitor for proximal thrombus extension with duplex ultrasound twice weekly for two weeks. [Strength of recommendation: C, based on consensus guideline]Item Treatment of Early Parkinson's Disease(Family Physicians Inquiries Network, 2005) Dickerson, Lori M.; Young, Sara E.; Simpson, William M.; Nashelsky, JoanTreatment of early Parkinson's disease with either selegiline (Eldepryl), a dopamine agonist (pramipexole [Mirapex], ropinirole [Requip], or bromocriptine [Parlodel]), or the combination of levodopa and carbidopa (Sinemet) or levodopa and cabidopa with entacapone (Stalevo) improves symptoms and quality of life, but all medication regimens are associated with significant side effects (Table 1). There is no compelling evidence favoring a medication option, so treatment should be individualized. [Strength of recommendation: A, based on systematic reviews of randomized controlled trials (RCTs)]Item Colorectal Cancer Screening(Family Physicians Inquiries Network, 2005) Gaskie, SeanBoth fecal occult blood testing (FOBT) and flexible sigmoidoscopy are effective in screening for colorectal cancer. FOBT can reduce mortality from colorectal cancer. [Strength of recommendation: A, based on high-quality systematic reviews of randomized controlled trials (RCTs)] Flexible sigmoidoscopy has a higher diagnostic yield, but its effect on colorectal cancer mortality has been less rigorously demonstrated. [Strength of recommendation: B, based on high-quality systematic reviews of well-designed case-control studies]Item Statin Therapy in Patients with Type 2 Diabetes(Family Physicians Inquiries Network, 2005) Lo, Vincent; Noviasky, John; Nashelsky, JoanBased on current evidence, statin therapy should be offered to all patients with type 2 diabetes who are known to have coronary artery disease. [Strength of recommendation: A] For patients older than 40 years with type 2 diabetes who are not known to have cardiovascular disease, statins are recommended if other cardiovascular risk factors are present, regardless of the initial low-density lipoprotein (LDL) level, if the patient has failed to reach the target LDL goal of less than 100 mg per dL (2.6 mmol per L) by lifestyle modification for primary prevention. [Strength of recommendation: A]