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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...
What Clinical Findings Can Be Used to Diagnose Deep Venous Thrombosis?
(Family Physicians Inquiries Network, 2004)
No single clinical finding can accurately diagnose DVT. [Strength of recommendation: A, based on a systematic review of homogeneous validating cohort studies with good reference standards.] However, when organized into clinical decision rules (CDRs...
Is MRI useful for evaluation of acute low back pain?
(Family Physicians Inquiries Network, 2003)
in the detection of cancer or infection, but it is not particularly specific when evaluating lumbar radiculopathy. Poor specificity can lead to finding clinically irrelevant abnormalities.1 The overall evidence for the appropriate use of MRI in low back pain...
What is the best way to manage benign paroxysmal positional vertigo?
(Family Physicians Inquiries Network, 2003)
A simple repositioning maneuver, such as the Epley maneuver, performed by an experienced clinician, can provide symptom relief from benign paroxysmal positional vertigo (BPPV) lasting at least 1 month (strength of ...
Is screening urinalysis in children worthwhile?
(Family Physicians Inquiries Network, 2003)
Screening urinalysis in asymptomatic children has not been shown to be beneficial (strength of recommendation: B; based on extrapolation from 1 meta-analysis). It is unlikely to be cost-effective and should be discontinued. ...
Is Fluoxetine an Effective Therapy for Weight Loss in Obese Patients?
(Family Physicians Inquiries Network, 2003)
Fluoxetine (Prozac) use may result in an average, short-term weight loss of up to 3.3 kg (7 lb, 4 oz) in obese patients, but the longterm effects and maintenance of weight loss after discontinuation of the drug have not ...
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...
Are antibiotics helpful for acute maxillary sinusitis?
(Family Physicians Inquiries Network, 2003)
The inability of clinical criteria to accurately differentiate bacterial from viral disease makes routine use of antibiotics inappropriate for clinically diagnosed maxillary sinusitis (strength of recommendation [SOR]: C, based on inconsistent...
Does cranberry juice prevent or treat urinary tract infection?
(Family Physicians Inquiries Network, 2003)
Cranberry juice (200 mL daily to 250 mL 3 times daily) or cranberry concentrate tablets (at least 1:30 parts concentrated juice twice daily) reduce recurrent, symptomatic urinary tract infection (UTI) in women by 12% to ...
Do nasal decongestants relieve symptoms?
(Family Physicians Inquiries Network, 2003)
Oral and topical nasal decongestants result in a statistically significant improvement in subjective symptoms of nasal congestion and objective nasal airway resistance in adults' common colds (strength of recommendation ...
What is the prognosis of postherpetic neuralgia?
(Family Physicians Inquiries Network, 2003)
Postherpetic neuralgia occurs rarely among patients aged <50 years with herpes zoster. The incidence, duration, and severity of post-herpetic neuralgia increases with age, but older patients usually have only mild pain. ...
What findings distinguish acute bacterial sinusitis?
(Family Physicians Inquiries Network, 2003)
No combination of clinical findings can reliably distinguish acute viral rhinosinusitis from acute bacterial rhinosinusitis in primary care. Although unreliable, the best clinical predictor of acute bacterial sinusitis is the combination...
What nonhormonal therapies are effective for postmenopausal vasomotor symptoms?
(Family Physicians Inquiries Network, 2003)
--inconsistent results of randomized trials). Clonidine, as an oral or transdermal preparation, reduces hot flushes (SOR: A--randomized clinical trials), as does gabapentin (SOR: A-- single randomized clinical trial). In cancer patients who have had surgical menopause...
Heat or ice for acute ankle sprain?
(Family Physicians Inquiries Network, 2003)
at any time after injury (SOR: B, based on head-to-head randomized trials). Ice therapy also reduces edema, but the clinical significance of this finding is unclear....
What regimens eradicate Heliobacter pylori?
(Family Physicians Inquiries Network, 2003)
Fourteen-day triple therapy with a proton pump inhibitor (PPI) plus clarithromycin and either amoxicillin or metronidazole is superior to 7-day therapy in eradicating Heliobacter pylori (strength of recommendation [SOR]: ...
Is osteoporosis screening in postmenopausal women effective?
(Family Physicians Inquiries Network, 2003)
fracture is reduced with therapy, such as alendronate 10 mg/day or risedronate 5 mg/day plus adequate daily calcium and vitamin D (SOR: A - meta-analysis of randomized clinical trials). Women under 60 years should not be screened (SOR: B--clinical decision...
Is neurosurgery referral warranted for small brain aneurysms?
(Family Physicians Inquiries Network, 2003)
The risk of rupture of a small cerebral aneurysm (<10 mm) is very low in asymptomatic patients who have never had a subarachnoid hemorrhage. Because the risk of morbidity and mortality from surgical intervention significantly ...
Is pneumococcal vaccine effective in nursing home patients?
(Family Physicians Inquiries Network, 2003)
Evidence from clinical trials supports the use of pneumococcal polysaccharide vaccine for prevention of pneumonia in nursing home patients (strength of recommendation: B, based on randomized, nonblinded clinical trials). Case-control studies have...
Does stimulant therapy help adult ADHD?
(Family Physicians Inquiries Network, 2003)
Central nervous system stimulants improve symptoms of attention deficit-hyperactivity disorder (ADHD) in adults (strength of recommendation: B, based on an older, inconclusive systematic review, a lesser-quality systematic ...
What is the best treatment for plantar fasciitis?
(Family Physicians Inquiries Network, 2003)
Mechanical therapies -- such as taping, tension night splinting, and rigid arch support -- are the most effective treatment for plantar fasciitis (strength of recommendation: A, based on randomized controlled trials). If ...