Clinical Inquiries, 2015
Permanent URI for this collection
Browse
Recent Submissions
Item What's the best way to predict the success of a trial of labor after a previous C-section?(Family Physicians Inquiries Network, 2015) Warren, Johanna B.; Hamilton, AndrewQ: What's the best way to predict the success of a trial of labor after a previous C-section? Evidence-based answer: while 8 scoring tools predict success rates for a trial of labor after previous cesarean section (TOLAC), it's unclear which is the best because no trials have compared prediction tools against each other, and each tool has a unique set of variables. A "close-to-delivery"� scoring nomogram predicting the success rate of TOLAC correlates well (90% accuracy) with actual outcomes (strength of recommendation [SOR]: B, prospective and retrospective cohort studies) and has been externally validated with multiple additional cohorts. All other point-prediction scoring tools are accurate within 10% when predicting the success rate of TOLAC (SOR: B, prospective and retrospective cohort studies).Item Is arthroscopic subacromial decompression effective for shoulder impingement?(Family Physicians Inquiries Network, 2015) Ashbaugh, Andrew; Neher, Jon O.; Safranek, SarahQ: Is arthroscopic subacromial decompression effective for shoulder impingement? Evidence-based answer: It's impossible to say for certain in the absence of randomized controlled trials. However, in patients whose impingement symptoms don't improve after 3 to 6 months, arthroscopic subacromial decompression (ASD) is associated with modest (about 10%) long-term improvement in pain and function compared with open acromioplasty or baseline (strength of recommendation [SOR]: B, cohort studies). Patients older than 57 years may do better with surgery than physical therapy (SOR: B, single cohort study).Item Does high dietary soy intake affect a woman's risk of primary or recurrent breast cancer?(Family Physicians Inquiries Network, 2015) Eakin, Angie; Kelsberg, Gary; Safranek, SarahQ. Does high dietary soy intake affect a woman's risk of primary or recurrent breast cancer? Evidence-based answer: No, it doesn't affect the risk of primary breast cancer, but it does (favorably) affect the risk of cancer recurrence. Compared with diets low in soy, high dietary intake of soy protein or soy isoflavones isn't associated with any alteration in the risk of developing primary breast cancer (strength of recommendation [SOR]: B, systematic review of prospective cohort studies). In patients with breast cancer, however, consuming a diet high in soy is associated with a 25% decrease in cancer recurrence and a 15% decrease in mortality (SOR: B, prospective cohort studies).Item How effective are opioids for chronic low back pain?(Family Physicians Inquiries Network, 2015) Freund, Jeffrey; Kraus, Connie; Hooper-Lane, ChristopherQ: How effective are opioids for chronic low back pain? Evidence-based answer: Short-term (<4 months) treatment with opioids provides modest relief of chronic low back pain, but only minimal improvement in function compared with placebo (strength of recommendation [SOR]: B, systematic review of lower-quality randomized controlled trials [RCTs]). Tramadol isn't superior to nonsteroidal anti-inflammatory drugs (NSAIDs) for pain relief (SOR: A, consistent results from RCTs). In addition, oxycodone with titrated morphine isn't better than naproxen for relieving pain or improving function (SOR: C, a low-quality RCT). Although no long-term RCTs have been done, cohort studies have shown that 6 to 12 months of opioid use is associated with a small decrease in pain and either very minimal improvement in, or worsening of, disability (SOR: B, prospective cohort trials).Item Does qHPV vaccine prevent anal intraepithelial neoplasia and condylomata in men?(Family Physicians Inquiries Network, 2015) Shum, Johnny; Kelsberg, Gary; Safranek, SarahQ: Does qHPV vaccine prevent anal intraepithelial neoplasia and condylomata in men? Evidence-based answer: Yes. Quadrivalent human papillomavirus (qHPV) vaccine reduces rates of anal intraepithelial neoplasia (AIN) by 50% to 54%, and persistent anal infection by 59%, associated with the 4 types of HPV in the vaccine (6, 11, 16, and 18) in young men who have sex with men (MSM); it also reduces external genital lesions by 66%, and persistent HPV infection associated with the same 4 HPV types by 48 to 59% in all young men, heterosexual men, and MSM (strength of recommendation [SOR]: B, randomized, placebo-controlled trials [RCTs]). In addition, the vaccine is associated with a 50% to 55% decrease in recurrent high-grade AIN and anogenital condylomata in older MSM (SOR: B, cohort studies).