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How can I improve patient adherence to prescribed medication?
(Family Physicians Inquiries Network, 2001)
Two randomized clinical trials have shown that simplified dosing schedules have improved patient adherence to medication as prescribed. Some, but not all, randomized controlled trials show multidimensional interventions can also improve adherence...
Should induction of labor be considered in a woman with a macrosomic baby?
(Family Physicians Inquiries Network, 2001)
Currently, there is no evidence to support labor induction in women with suspected fetal macrosomia (grade of recommendation: B, based on 2 randomized controlled trials with small sample sizes). Cesarean delivery may be ...
What is the best approach to prevention and treatment of osteoporosis?
(Family Physicians Inquiries Network, 2001)
Randomized controlled trials (RCTs) have demonstrated decreased vertebral and nonvertebral fracture rates in postmenopausal osteoporotic women taking a bisphosphonate (alendronate or risedronate). Hormone replacement therapy ...
Is surgery effective for reducing symptoms in adults with obstructive sleep apnea?
(Family Physicians Inquiries Network, 2001)
Current evidence is insufficient to recommend surgery for symptom relief for patients with obstructive sleep apnea. More convincing evidence exists supporting the use of Continuous Positive Airway Pressure (CPAP) or dental ...
What is a reasonable initial approach to the patient with fatigue?
(Family Physicians Inquiries Network, 2001)
Half of all patients presenting with fatigue have a psychological cause. Patients with a history of anxiety or depression or those with a duration of symptoms for more than 3 months are more likely to remain symptomatic 6 ...
How effective are complementary/alternative medicine (CAM) therapies for fibromyalgia?
(Family Physicians Inquiries Network, 2001)
Acupuncture, biofeedback, and S-adenosyl methionine (SAMe) have been shown to have some efficacy in the treatment of fibromyalgia in randomized controlled trials. Spa treatments, hypnotherapy, massage, and meditation may ...
What are the indications for treatment with angiotensin-converting enzyme (ACE) inhibitors in patients with diabetes?
(Family Physicians Inquiries Network, 2001)
Tight control of hypertension treatment is key in preventing the vascular complications of diabetes. ACE inhibitors appear to have a protective effect that is independent of their antihypertensive effect. Unless there is ...
What is the best strategy for monitoring the lipid-lowering effects of medical therapy used for the primary prevention of coronary artery disease (CAD)?
(Family Physicians Inquiries Network, 2001)
There is good evidence that treatment for primary prevention of CAD decreases risk of major first coronary events and cardiovascular mortality, though all-cause mortality has not been shown to be reduced. There is no ...
What laboratory monitoring is appropriate to detect adverse drug reactions in patients on cholesterol-lowering agents?
(Family Physicians Inquiries Network, 2001)
Recommendations for measuring serum aminotransferase levels before initiating pharmacologic treatment for hypercholesterolemia, after 12 weeks of therapy, and periodically afterward are based on expert opinion. It is not ...
What is the best approach to the evaluation and treatment of chronic cough?
(Family Physicians Inquiries Network, 2001)
Potentially cough-inducing agents, such as tobacco products and angiotensin-converting enzyme (ACE) inhibitors, should be eliminated first. Evaluation and treatment for postnasal drip syndrome (PNDS), asthma, and ...
What are the current treatment and monitoring recommendations for hepatitis C virus (HCV)?
(Family Physicians Inquiries Network, 2001)
Patients 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 ...
What is the best diagnostic approach to postmenopausal vaginal bleeding in women taking hormone replacement therapy?
(Family Physicians Inquiries Network, 2001)
Women on standard estrogen/progestin hormone replacement therapy (HRT) regimens frequently have irregular bleeding during the first 12 months of treatment. Therefore, those taking HRT should usually be evaluated after 1 ...
Does tamoxifen prevent breast cancer?
(Family Physicians Inquiries Network, 2001)
Tamoxifen prevents breast cancer in women older than 60 years and in younger women with equally high risk because of breast disease and reproductive and family history, but there is no current evidence for or against ...
What is the value of screening for heart disease with an exercise stress test (EST) in an asymptomatic person?
(Family Physicians Inquiries Network, 2001)
There is insufficient evidence to recommend for or against an EST for screening asymptomatic individuals of any age. (Grade of Recommendation: C, based on case series.)
What medications are safe and effective for heartburn during pregnancy?
(Family Physicians Inquiries Network, 2001)
Ranitidine is the best-studied agent effective for treatment of heartburn in pregnancy. Some antacids are effective, but it may be prudent to avoid them in the first trimester until better safety studies are published. ...
What are the benefits of treating sleep apnea?
(Family Physicians Inquiries Network, 2001)
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 ...
What is the best test to diagnose urinary tract stones?
(Family Physicians Inquiries Network, 2001)
Over the past 3 years, helical (or spiral) computerized tomography (CT) has proved the best method of testing for urinary tract stones. All reviewed studies published since mid-1998 found helical CT scan to be the safest ...
Clinical Indicators of Obstructive Sleep Apnea
(Family Physicians Inquiries Network, 2011)
Clinical indicators (e.g., sex, snoring severity, history of apnea, age, menopausal status, waist-to-hip ratio, body habitus) can predict OSA as diagnosed using overnight polysomnography or sleep study. (Strength of Recommendation: B, based...
How accurate is the clinical diagnosis of pneumonia?
(Family Physicians Inquiries Network, 2003)
No element or combination of elements from the clinical history and physical examination are sufficiently sensitive or specific to confirm or exclude acute community-acquired pneumonia (CAP). A chest x-ray is recommended to make the diagnosis (Grade...
How soon should serum potassium levels be monitored for patients started on diuretics?
(Family Physicians Inquiries Network, 2001)
restriction may also help to conserve potassium, because this will decrease urinary flow rate and potassium loss. The frequency with which to check potassium levels should be guided by the patients' underlying clinical conditions and dietary potassium...