Clinical Inquiries, 2010
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Item Thiazolidinedione Therapy for Managing Metabolic Syndrome(Family Physicians Inquiries Network, 2010) Geurin, Michael D.; St. Anna, LeilaniThere is no patient-oriented evidence supporting the use of TZD therapy in patients in the general population who have metabolic syndrome. Rosiglitazone (Avandia) use decreases cardiovascular morbidity and mortality in patients with metabolic syndrome who are undergoing coronary stenting. (Strength of Recommendation: B, based on a single randomized controlled trial). Effects of TZD therapy on nonglycemic markers of metabolic syndrome are inconsistent compared with the effects of other hypoglycemic medications.Item Sunscreen Use for Skin Cancer Prevention(Family Physicians Inquiries Network, 2010) Bouknight, Patricia; Bowling, Andrew; Kovach, Fran E.Daily sunscreen use reduces the incidence of squamous cell carcinoma but not the incidence of basal cell carcinoma. (Strength of Recommendation [SOR]: B, based on a single randomized controlled trial with less than 13 years of follow-up). It is unclear whether there are longer-term effects. There is no consistent, conclusive evidence that sunscreen use prevents melanoma. (SOR: C, meta-analysis of case-control studies).Item Management of Alcohol Withdrawal Syndrome(Family Physicians Inquiries Network, 2010) Ricks, Janet; Replogle, William H.; Cook, Nakia JoyceAWS may be managed with outpatient therapy if the patient has mild to moderate symptoms. (Strength of Recommendation [SOR]: B, based on one randomized, prospective trial). The Clinical Institute Withdrawal Assessment Scale for Alcohol, Revised (CIWA-Ar) may be used to assess symptom severity. (SOR: C, based on consistent reliability and validity from case series studies). The decision to prescribe medication is based on the severity of symptoms. High-quality randomized controlled trials and meta-analyses suggest that long-acting benzodiazepines are generally preferred for managing AWS in the inpatient setting. (SOR: A). However, there is also evidence that benzodiazepines are safe in the outpatient setting. (SOR: B, based on one randomized prospective trial).Item Combination Therapy for Postmenopausal Osteoporosis(Family Physicians Inquiries Network, 2010) Tagliarino, Heather; Howard, EllenThere is insufficient evidence to recommend combination therapy for the routine management of postmenopausal osteoporosis. (Strength of Recommendation [SOR]: C, based on expert opinion). Combination therapy with parathyroid hormone (PTH) and a bisphosphonate is less effective than treatment with PTH alone, and should not be used. (SOR: C, based on a randomized trial using disease-oriented end points). However, combination therapy with raloxifene (Evista) and a bisphosphonate or PTH, and sequential treatment with PTH followed by alendronate (Fosamax) have been shown to increase bone mineral density (BMD) more than single-agent therapy and may be considered in patients with severe or refractory postmenopausal osteoporosis. (SOR: C, based on expert opinion).Item When should you treat tongue-tie in a newborn?(Family Physicians Inquiries Network, 2010) Cho, Anthony; Kelsberg, Gary; Safranek, SarahConsider treatment when the infant is having difficulty breastfeeding. Infants with mild to moderate tongue-tie, or ankyloglossia, are likely to breastfeed successfully and usually require no treatment (strength of recommendation [SOR]: B, a prospective controlled trial and a case-control study). However, mothers of infants with any degree of tongue-tie who have difficulty with breastfeeding despite lactation support report immediate improvement after frenotomy is performed on the baby. Complications from the procedure are minimal (SOR: B, a small randomized controlled trial [RCT] and multiple uncontrolled cohort studies and case series).