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Are major bleeding events from falls more likely in patients on warfarin?
(Family Physicians Inquiries Network, 2006)
There is no evidence of increased risk for major bleeding as a result of falls in hospitalized patients taking warfarin (strength of recommendation [SOR]: B, based on retrospective cohort studies). In the average patient taking warfarin for atrial...
What is the best duration of steroid therapy for contact dermatitis (rhus)?
(Family Physicians Inquiries Network, 2006)
Scant evidence exists for the best duration of steroid therapy for contact dermatitis due to plants (rhus). Review articles recommend 10 to 21 days of treatment with topical or oral corticosteroids for moderate to severe contact dermatitis due...
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 evidence identifying the best...
Should we screen adults for asymptomatic microhematuria?
(Family Physicians Inquiries Network, 2004)
Screening patients for asymptomatic microhematuria does not appear to improve outcomes, since screening does not identify a population with increased prevalence of urologic malignancy (strength of recommendation [SOR]: A, based on prospective cohort...
What is the best diagnostic approach to postmenopausal vaginal bleeding in women taking hormone replacement therapy?
(Family Physicians Inquiries Network, 2001)
continues. (Grade of recommendation: C, based on case series.) Evaluation of this bleeding should begin with a pelvic examination and Papanicolaou (Pap) test (if not done in the previous 12 months), then transvaginal ultrasound (TVUS), followed...
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.)...
Is intra-articular platelet-rich plasma injection an effective treatment for knee OA?
(Family Physicians Inquiries Network, 2019)
Q: Is intra-articular platelet-rich plasma injection an effective treatment for knee OA? EVIDENCE-BASED ANSWER: PROBABLY NOT, based on the balance of evidence. While low-quality evidence may suggest potential benefit, the balance of evidence...
What is the best approach to prevention and treatment of osteoporosis?
(Family Physicians Inquiries Network, 2001)
evidence for osteoporotic fracture prevention. Concurrent calcium and vitamin D may also prevent fractures. Physical exercise and smoking cessation have been associated with increased bone density, but fracture prevention has not been reported (Grade...
Is lower BP worth it in higher-risk patients with diabetes or coronary disease?
(Family Physicians Inquiries Network, 2016)
Q: Is lower BP worth it in higher-risk patients with diabetes or coronary disease? Evidence-based answer: There is no simple answer; the risk/benefit picture is complicated. Controlling blood pressure to a target of 130/80 mm Hg or lower produces...
Are liver function tests required for patients taking isoniazid for latent TB?
(Family Physicians Inquiries Network, 2004)
% of patients because of abnormal lab results. This is 10 to 60 times the hepatitis rate found in case series using a symptom-based monitoring strategy. Data are insufficient, however, to conclude that routine liver function test monitoring leads to a lower rate...
At what age do patients no longer need colorectal cancer screening?
(Family Physicians Inquiries Network, 2001)
Good evidence supports fecal occult blood testing (FOBT) for patients up to age 75 (grade of recommendation: A, based on systematic review of randomized controlled trials). There is insufficient evidence to recommend for or against colorectal cancer...
What is the best beta-blocker for systolic heart failure?
(Family Physicians Inquiries Network, 2015)
Q: What is the best beta-blocker for systolic heart failure? Evidence-based answer: Three beta-blockers--carvedilol, metoprolol succinate, and bisoprolol--reduce mortality equally (by about 30% over one year) in patients with Class III or IV...
What's the best secondary treatment for patients who fail initial triple therapy for H pylori?
(Family Physicians Inquiries Network, 2018)
Q: What's the best secondary treatment for patients who fail initial triple therapy for H pylori? Evidence-based answer: treating patients with Helicobacter pylori infection who have failed clarithromycin-based triple therapy with either...
Is therapy based on endoscopy results better than empiric therapy for dyspepsia?
(Family Physicians Inquiries Network, 2005)
In the initial management of dyspepsia for patients without "alarm" symptoms (weight loss, recurrent vomiting, dysphagia, anemia, evidence of bleeding, onset of dyspepsia after age 45 years), therapy based on the results of early endoscopy...
Do corticosteroid injections improve carpal tunnel syndrome symptoms?
(Family Physicians Inquiries Network, 2016)
Q: Do corticosteroid injections improve carpal tunnel syndrome symptoms? Evidence-based answer: Yes. injected corticosteroids reduce symptoms of carpal tunnel syndrome (CTS) more effectively than placebo or systemic steroids, but no better than anti...
Can mobile technology improve weight loss in overweight and obese patients?
(Family Physicians Inquiries Network, 2017)
Q: Can mobile technology improve weight loss in overweight and obese patients? Evidence-based answer: Yes, this technology can help in the short term. Mobile technology compared with minimal or no intervention increases short-term (<6 months) weight...
What is a reasonable initial approach to the patient with fatigue?
(Family Physicians Inquiries Network, 2001)
with sedimentation rate, blood count, and glycohemoglobin and thyroid stimulating hormone (TSH) levels, particularly in older patients. Grade of Recommendation: C, based on case series and 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...
How do hyaluronic acid and corticosteroid injections compare for knee OA relief?
(Family Physicians Inquiries Network, 2017)
for symptomatic knee osteoarthritis (OA), but that insufficient evidence exists to recommend HA injections (SOR: B, evidence-based guidelines)....
What is the best treatment for impacted cerumen?
(Family Physicians Inquiries Network, 2002)
Docusate sodium given 15 minutes before irrigation is most effective for facilitating cerumen removal during a single office visit. (Grade of recommendation: B, based on head-to-head trials that lacked irrigationonly arms.) Treatment with 5% urea...