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Suspect carpal tunnel? : Try this
(Family Physicians Inquiries Network, 2013)
For best results, use the modified Phalen's test (MPT) rather than the traditional Phalen's when you suspect carpal tunnel syndrome (CTS).
Interventions for lower-extremity lymphedema
(Family Physicians Inquiries Network, 2013)
.) There is insufficient evidence about the safety and effectiveness of oral benzopyrones to determine whether they are useful for the treatment of lymphedema. (SOR: A, based on a systematic review.)...
Pharmacologic therapy for eustachian tube dysfunction
(Family Physicians Inquiries Network, 2013)
There are no medications that improve patient-oriented outcomes in children or adults with eustachian tube dysfunction. (Strength of Recommendation [SOR]: A, based on a systematic review of randomized controlled trials [RCTs].) Oral corticosteroids...
Corticosteroids for presumed pneumocystis pneumonia in patients with HIV infection
(Family Physicians Inquiries Network, 2013)
opportunistic conditions. (Strength of recommendation: A, based on a systematic review of randomized controlled trials [RCTs].)...
What is the best treatment for plant-induced contact dermatitis?
(Family Physicians Inquiries Network, 2013)
It's unclear which treatment is best, because there have been no head-to-head comparisons of treatments for Rhus (plant-induced) contact dermatitis. That said, topical high-potency steroids slightly improve pruritus and ...
What is the best age to start vitamin D supplementation to prevent rickets in breastfed newborns?
(Family Physicians Inquiries Network, 2013)
Evidence-based answer: It's unclear what age is best to start vitamin D supplementation because no comparison studies exist. That said, breastfed infants who take vitamin D beginning at 3 to 5 days of life don't develop rickets (strength...
How best to treat agitation in patients with irreversible dementia?
(Family Physicians Inquiries Network, 2013)
Atypical antipsychotics modestly reduce agitation compared with placebo but have significant adverse effects (strength of recommendation [SOR]: A, systematic reviews of randomized controlled trials [RCTs]). Haloperidol ...
Do oral contraceptives carry a significant risk of stroke for women with migranes?
(Family Physicians Inquiries Network, 2013)
Evidence-based answer: Estrogen-containing oral contraceptives may raise the risk of ischemic stroke in women with migraine, particularly migraine with aura (strength of recommendation [SOR]: C, small case-control studies with methodological flaws...
How do antidepressants affect sexual function?
(Family Physicians Inquiries Network, 2013)
Evidence-based answer: patients treated with elective serotonin reuptake inhibitors (SSRIs) and the serotonin/norepinephrine reuptake inhibitor (SNRI) venlafaxine have significantly higher rates of overall sexual dysfunction--including desire...
Testosterone Therapy and Risk of Recurrence After Treatment for Prostate Cancer
(Family Physicians Inquiries Network, 2013)
Evidence-Based Answer: Men with symptomatic androgen deprivation who have had clinically curative treatment for organ-confined prostate cancer may have symptomatic improvement with testosterone replacement therapy. (Strength of Recommendation [SOR...
What clinical clues differentiate migraine from sinus headaches?
(Family Physicians Inquiries Network, 2013)
Evidence-based answer: Patients with sinus headaches have thick nasal discharge, fever, chills, sweats, or abnormally malodorous breath (SOR: B, cross-sectional study). The 5 symptoms that are most predictive of migraine are: pulsatile quality...
Management of ADHD in preschool-aged children
(Family Physicians Inquiries Network, 2013)
RCTs.) Alternative therapies, such as elimination diets, have limited evidence of success and should generally be avoided or used in conjunction with standard therapies. (SOR: B, based on a systematic review of a small number of heterogeneous RCTs.)...
Dipstick urinalysis for the diagnosis of acute UTI
(Family Physicians Inquiries Network, 2013)
. (Strength of Recommendation [SOR]: A, based on systematic reviews of cross-sectional studies and a validated clinical decision rule.) A positive nitrite test is more useful than a positive leukocyte esterase (LE) test, although both increase the odds of a...
Should you test or treat pregnant women with a history of pregnancy-related VTE?
(Family Physicians Inquiries Network, 2013)
No high-quality evidence supports testing for thrombophilia in pregnant patients who have experienced venous thromboembolism (VTE) in a previous pregnancy. Antepartum and postpartum anticoagulation with LMWH produces lower rates of VTE in patients...
Corticosteroids for a sore throat?
(Family Physicians Inquiries Network, 2013)
Consider prescribing a single dose of corticosteroids for patients with sore throat, which has been found to bring quicker pain relief and resolution of symptoms. Stength of recommendationA: Based on a meta-analysis of randomized controlled trials...
Time to routinely screen for intimate partner violence?
(Family Physicians Inquiries Network, 2013)
Use a validated tool to screen women of childbearing age for intimate partner violence (IPV) and follow up with any woman with a positive screen. Stength of recommendation: B: Based on a systematic review of 10 randomized controlled trials, 11...
Consider this strategy for upper GI bleeds
(Family Physicians Inquiries Network, 2013)
Do not order transfusions of red blood cells for patients with acute upper gastrointestinal bleeding unless their hemoglobin level <7 g/dL. A: Based on a single randomized controlled trial (RCT) consistent with other RCTs on recommendations...
Is this pregnancy viable?
(Family Physicians Inquiries Network, 2013)
of recommendation: A: Based on a systematic review and meta-analysis of 26 diagnostic accuracy studies....
Should you screen for postpartum depression?
(Family Physicians Inquiries Network, 2013)
Should you screen for postpartum depression? Yes. Evidence suggests that screening new moms for depression leads to better outcomes, and should be routine. Practice changer: Make depression screening a routine part of the postpartum visit....
Do patients with type 2 diabetes who aren't taking insulin benefit from self-monitoring blood glucose?
(Family Physicians Inquiries Network, 2013)
reviews and meta-analyses of disease-oriented evidence). Patients with a baseline HbA1c <8% who self-monitor don't reduce their HbA1c levels, but patients with a baseline HbA1c >8% do (SOR: B, systematic reviews and meta-analyses of disease...