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Glycemic Control in Patients with Type 2 Diabetes
(Family Physicians Inquiries Network, 2007)
There is no clearly superior oral agent for glycemic control in patients with type 2 diabetes. (Strength of Recommendation [SOR]: C) Metformin (Glucophage) has shown additional benefit when compared with other treatments (including insulin...
Counseling or Antidepressants for Treating Depression?
(Family Physicians Inquiries Network, 2005)
Both antidepressant medications and psychologic treatment are beneficial for adult patients with mild to moderate depression, with no consistent evidence that one type of treatment is more effective than the other. [Strength ...
Metformin Therapy and Diabetes Prevention in Adolescents Who Are Obese
(Family Physicians Inquiries Network, 2007)
No studies have addressed the question of whether metformin reduces development of diabetes among adolescents who are obese. Metformin treatment in adolescents who are obese can modestly reduce risk factors for type 2 diabetes, including elevated...
Which infants need lumbar puncture for suspected sepsis?
(Family Physicians Inquiries Network, 2003)
of recommendation [SOR]: B, based on prospective and retrospective cohort studies). However, expert opinion suggests lumbar puncture on all infants aged 0 to 28 days with suspected sepsis, and all infants aged >2 months who are to receive empiric antibiotics (SOR: C...
Sleep apnea in adults: How accurate is clinical prediction?
(Family Physicians Inquiries Network, 2009)
Questionnaires, physical examination, and clinical prediction rules estimate the pretest probability of obstructive sleep apnea hypopnea syndrome (OSAHS), but are not specific enough to make the diagnosis (strength of recommendation [SOR]: B, meta...
When should you suspect community-acquired MRSA? How should you treat it?
(Family Physicians Inquiries Network, 2009)
There are no clinical or epidemiologic features that will help you to clearly distinguish community-acquired methicillin-resistant Staphylococcus aureus infections (CA-MRSA) from methicillin-sensitive (CA-MSSA) infections (strength of recommendation...
When are antibiotics indicated for acute COPD exacerbations?
(Family Physicians Inquiries Network, 2006)
). Antibiotics may be prescribed in the outpatient setting for those with severe exacerbations (SOR: C, based on expert opinion)....
Should liver enzymes be checked in a patient taking niacin?
(Family Physicians Inquiries Network, 2005)
No randomized trials directly address the question of frequency of liver enzyme monitoring with niacin use. Niacin use is associated with early and late hepatotoxicity (strength of recommendation [SOR]: B, based on incidence ...
Do imaging studies aid diagnosis of acute sinusitis?
(Family Physicians Inquiries Network, 2003)
Accurate diagnosis of acute sinusitis in both children and adults depends on the history and clinical examination of the patient. While the clinical signs and symptoms of acute sinusitis are often difficult to distinguish from viral upper...
Can we prevent splenic rupture for patients with infectious mononucleosis?
(Family Physicians Inquiries Network, 2005)
All patients with infectious mononucleosis should be considered at risk for splenic rupture since clinical severity, laboratory results, and physical exam are not reliable predictors of rupture (strength of recommendation [SOR]: B, case...
What are effective therapies for Clostridium difficile- associated diarrhea?
(Family Physicians Inquiries Network, 2005)
select for colonization with vancomycin-resistant enterococci, leading the American College of Gastroenterology to recommend oral metronidazole as preferred therapy (SOR: C, expert opinion). They recommend therapy with vancomycin for those who...
What is the best way to treat tinea cruris?
(Family Physicians Inquiries Network, 2006)
After clinical diagnosis and microscopic confirmation, tinea cruris is best treated with a topical allylamine or an azole antifungal (strength of recommendation: A, based on multiple randomized controlled trials [RCTs]). Differences in current...
How useful is high-sensitivity CRP as a risk factor for coronary artery disease?
(Family Physicians Inquiries Network, 2005)
risk for cardiovascular disease, with some evidence suggesting its use if the results of the test will alter treatment recommendations (strength of recommendation [SOR]: C, based on extrapolation of consistent level 2 studies). Research to date...
What nonhormonal therapies are effective for postmenopausal vasomotor symptoms?
(Family Physicians Inquiries Network, 2003)
Regular exercise may reduce vasomotor symptoms of menopause (strength of recommendation [SOR]: C--single observational study). Soy products/isoflavones, either through diet or supplementation, may reduce the incidence of hot flushes (SOR: D...
Do TZDs increase the risk of heart failure for patients with diabetes?
(Family Physicians Inquiries Network, 2005)
retrospective cohort study). Still, patients starting any TZD should be warned of the possibility of CHF and should be monitored for its development. TZDs are contraindicated for patients with class III and IV CHF (SOR: C, based on expert opinion)....
Angiotensin blockade for diabetes: Monitor microalbuminuria?
(Family Physicians Inquiries Network, 2007)
No studies address whether continued screening for microalbuminuria once a patient is taking an angiotensin-converting enzyme (ACE) inhibitor or angiotensin-2 receptor blocker (ARB) improves outcomes. Indirect evidence and expert opinion suggest...
What are the causes of hypomagnesemia?
(Family Physicians Inquiries Network, 2005)
, and malnutrition (strength of recommendation: C, based on expert opinion, physiology, and case series). Evidence suggests that magnesium deficiency is both more common and more clinically significant than generally appreciated....
How should we follow up a positive screen for anemia in a 1-year old?
(Family Physicians Inquiries Network, 2005)
complete blood count, mean corpuscular volume, red cell distribution width (RDW), serum ferritin concentration, as well as hemoglobinopathy screening when appropriate, may be effective in determining the cause of anemia (SOR: C, expert opinion)....
What's the best way to screen for anxiety and panic disorders?
(Family Physicians Inquiries Network, 2007)
The GAD-7 has the best evidence and utility in the primary care setting for generalized anxiety disorder (strength of recommendation [SOR]: A), while the proprietary Quick PsychoDiagnostics Panel (QPD) has the best operating ...
Does early detection of suspected atherosclerotic renovascular hypertension change outcomes
(Family Physicians Inquiries Network, 2005)
We found no evidence for changed outcomes from early detection of renal artery stenosis (RAS). Treatment of RAS in refractory hypertension modestly improves blood pressure control. There was a trend toward improved clinical outcomes but studies were...