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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...
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...
Are overweight children more likely to be overweight adults?
(Family Physicians Inquiries Network, 2009)
Overweight at any age in childhood increases the risk for overweight in adulthood. The relative risk (RR) ranges from 1.9 to 10.1 and increases as children get older. Not all overweight children become overweight adults, ...
How often should you follow up on a patient with newly diagnosed hypothyroidism?
(Family Physicians Inquiries Network, 2009)
Six to 8 weeks after the start of levothyroxine therapy you should reexamine
patients and measure their serum thyroid-stimulating hormone (TSH) (strength of
recommendation [SOR]: C, common practice and expert opinion). If ...
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...
Which treatments work best for hemorrhoids?
(Family Physicians Inquiries Network, 2009)
Excision is the most effective treatment for
thrombosed external hemorrhoids (strength of recommendation [SOR]: B, retrospective studies). For prolapsed internal hemorrhoids, the best definitive treatment
is traditional ...
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 should acute nonvenereal conjunctivitis be treated with topical antibiotics?
(Family Physicians Inquiries Network, 2002)
Children with suspected or culture-proven acute nonvenereal bacterial conjunctivitis should be treated with topical antibiotics, which hastens clinical and microbiological remission and may prevent potentially serious morbidity. In light of recent...
Should a nylon brush be used for Pap smears from pregnant women?
(Family Physicians Inquiries Network, 2005)
Use of a nylon brush (Cytobrush and others) with spatula to obtain Papanicolaou (Pap) smears from pregnant women is more likely to obtain sufficient endocervical cells, without adverse consequence for the mother or for the ...
Do patients at high risk of Alzheimer's disease benefit from early treatment?
(Family Physicians Inquiries Network, 2009)
Treating patients with early-stage Alzheimer's disease yields statistically significant, though perhaps not clinically significant, improvement in cognition and global function (strength of recommendation [SOR]: A, consistent evidence from multiple...
Is nedocromil effective in preventing asthmatic attacks in patients with asthma?
(Family Physicians Inquiries Network, 2004)
In general, about 50% to 70% of patients respond to nedocromil (SOR: A, multiple RCTs and meta-analyses). Unfortunately, which patients respond is not predictable from clinical parameters. Nedocromil is worth trying in mild persistent asthma...
How should you evaluate an asymptomatic patient with a femoral or iliac artery bruit?
(Family Physicians Inquiries Network, 2009)
(SOR:
B, extrapolation from randomized clinical
trials [RCTs])....
Effective Management of Flatulence
(Family Physicians Inquiries Network, 2009)
Probiotics and rifaximin (Xifaxan) have been shown to reduce total number of flatus episodes and associated discomfort. (Strength of Recommendation [SOR]: B, based on small randomized controlled trials [RCTs]). Oral ...
Do hyaluronic acid injections relieve OA knee pain?
(Family Physicians Inquiries Network, 2009)
-analyses). The various HA products all appear to be equally effective in reducing pain (SOR: B, randomized clinical trials [RCTs]). Data concerning the effect of HA on functional ability are conflicting....
Are Selective COX-2 Inhibitors as Effective as NSAIDs in Patients with Rheumatoid Arthritis?
(Family Physicians Inquiries Network, 2004)
The efficacy of COX-2 inhibitors is similar to that of nonselective NSAIDs in reducing the symptoms of rheumatoid arthritis. [Strength of Recommendation: A]
Antiepileptic Drug Level Monitoring
(Family Physicians Inquiries Network, 2008)
monitoring may be clinically useful in special populations, including patients with suspected drug toxicity or noncompliance, pregnant patients, and patients with renal failure. Monitoring dosage increases of drugs with nonlinear kinetics, such as phenytoin...
Does a low-salt diet reduce morbidity and mortality in congestive heart failure?
(Family Physicians Inquiries Network, 2002)
of congestive heart failure exacerbation.(Grade of recommendation: D.) Clinical trials of multifactorial, nondrug interventions have shown an association of sodium restriction with reduced morbidity and improved quality of life in some populations...
Can nonantidepressants help treat depression?
(Family Physicians Inquiries Network, 2009)
lithium, triiodothyronine (T3), and atypical
antipsychotics are all effective adjuncts. Lithium (serum levels >0.5 mEq/L) can produce clinical improvement when added to ineffective antidepressant treatment (strength of recommendation [SOR]: A, meta...
What are appropriate screening tests for adolescents?
(Family Physicians Inquiries Network, 2006)
Screen all women of childbearing age, including adolescents, for rubella susceptibility (strength of recommendation [SOR]: B). Screen all sexually active adolescent females for chlamydia (SOR: A), gonorrhea (SOR: B), and ...
Menstrual disturbances in perimenopausal women: What's best?
(Family Physicians Inquiries Network, 2009)
It's best to start with nonsteroidal anti- inflammatory drugs (NSAIDs), which effectively reduce heavy menstrual bleeding
(strength of recommendation [SOR]: B,
systematic review of randomized clinical
trials [RCTs]). Perimenopausal women with heavy...