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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 ...
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 thyroid function is normal...
How can you help prevent a recurrence of diverticulitis?
(Family Physicians Inquiries Network, 2009)
A high-fiber diet is often prescribed after recovery from acute diverticulitis, based on extrapolation from epidemiologic data showing an association between low-fiber diets and diverticulosis (strength of recommendation [SOR]: C, expert opinion...
Treatment for Anogenital Molluscum Contagiosum
(Family Physicians Inquiries Network, 2009)
lesions. (Strength of Recommendation: B, based on inconsistent or limited quality patient-oriented evidence). There are no comparative trials of other commonly used treatments, such as carbon dioxide laser, cryotherapy, or curettage....
Is MRI useful for evaluation of acute low back pain?
(Family Physicians Inquiries Network, 2003)
Magnetic resonance imaging (MRI) is rarely helpful in the evaluation of acute low back pain. Limited evidence suggests that MRI may be useful in further assessing "red flag" in the history or physical exam. MRI has a high sensitivity and specificity...
How should you treat trochanteric bursitis?
(Family Physicians Inquiries Network, 2009)
(strength of recommendation [SOR]: C, usual practice). Patients whose symptoms persist despite conservative therapy are likely to benefit from an injection of 24 mg betamethasone and 1% lidocaine (or equivalent) into the inflamed bursa (SOR: B, limited...
Which complementary therapies can help patients with PMS?
(Family Physicians Inquiries Network, 2009)
doses of pyridoxine can cause neuropathy (SOR: B, RCT and meta-analysis of lower-quality studies). Insufficient evidence exists to recommend magnesium. St. John's wort and evening primrose oil aren't effective for managing PMS (SOR: B, inconsistent...
Treatment of Otitis Media with Perforated Tympanic Membrane
(Family Physicians Inquiries Network, 2009)
Acute otitis media with tympanic membrane perforation in children should be treated with an oral antibiotic. (Strength of Recommendation [SOR]: A, based on meta- analysis of randomized controlled trials [RCTs]). Topical ciprofloxacin...
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...
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 [SOR]: A, based on randomized...
What is the best diagnostic approach to alopecia in women?
(Family Physicians Inquiries Network, 2009)
Indirect evidence and expert opinion indicate that a careful history and thorough physical examination usually suggest the underlying cause of alopecia. Ancillary laboratory evaluation and scalp biopsy are sometimes necessary to make or confirm...
Is the long-term use of proton pump inhibitors safe?
(Family Physicians Inquiries Network, 2004)
Long-term use of proton pump inhibitors (PPIs) appears safe, resulting in no clinically relevant adverse effects (strength of recommendation: B, based on nonsystematic reviews, cohort studies, or low-quality randomized controlled trials...
What is the role of prokinetic agents for constipation?
(Family Physicians Inquiries Network, 2009)
Erythromycin has a limited role in treating pediatric patients (strength of recommendation [SOR]: B, limited-quality, patient-oriented evidence). Tegaserod and cisapride are the only prokinetic agents available for constipated adults (SOR: A...
How best to manage the patient in term labor whose group B strep status is unknown?
(Family Physicians Inquiries Network, 2009)
Monitor the patient and treat her with intrapartum chemoprophylaxis based on identified risk factors, unless a rapid, highly sensitive (greater than or equal to 85%) polymerase chain reaction (PCR) test is immediately available to evaluate for group...
Antiviral Agents for Pregnant Women with Genital Herpes
(Family Physicians Inquiries Network, 2005)
There is no evidence that the use of antiviral agents in women who are pregnant and have a history of genital herpes prevents perinatal transmission of herpes simplex virus (HSV) to neonates. [Strength of recommendation: A, based on multiple...
What treatments work best for constipation in children?
(Family Physicians Inquiries Network, 2009)
limited evidence supports this approach (strength of recommendation [SOR]: B for fiber, 1 randomized controlled trial [RCT]; C for behavior modification, 1 small trial). For pharmacologic management, the best evidence supports osmotic laxatives (SOR: A, 6...
When is it OK for children to start drinking fruit juice?
(Family Physicians Inquiries Network, 2009)
Children should be at least 6 months of age (strength of recommendation [SOR]: C, expert opinion) and parents should provide only 100% fruit juice in a cup (not a bottle). Intake should be limited to 4 to 6 oz a day until 12 months of age (SOR: C...
What are the best prophylactic drugs for migraine?
(Family Physicians Inquiries Network, 2009)
Beta-blockers without intrinsic sympathomimetic activity, amitriptyline, divalproex sodium/sodium valproate, and topiramate are the most effective drugs for preventing episodic migraine (strength of recommendation: A, ...
What are the most practical primary care screens for post-traumatic stress disorder?
(Family Physicians Inquiries Network, 2009)
The 4-item Primary Care Post-Traumatic Stress Disorder screen (PC-PTSD) is a simple and effective tool to identify symptoms of post-traumatic stress disorder (PTSD) in primary care patients (strength of recommendation [SOR ...