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How effective are complementary/alternative medicine (CAM) therapies for fibromyalgia?
(Family Physicians Inquiries Network, 2001)
Acupuncture, biofeedback, and S-adenosyl methionine (SAMe) have been shown to have some efficacy in the treatment of fibromyalgia in randomized controlled trials. Spa treatments, hypnotherapy, massage, and meditation may be effective, but they have...
What is a reasonable initial approach to the patient with fatigue?
(Family Physicians Inquiries Network, 2001)
should perform a physical examination, take a thorough history, and screen patients for depression using a validated primary care instrument, such as the Beck Depression Inventory or Prime-MD. Physicians may also consider a directed laboratory evaluation...
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...
Should induction of labor be considered in a woman with a macrosomic baby?
(Family Physicians Inquiries Network, 2001)
Currently, there is no evidence to support labor induction in women with suspected fetal macrosomia (grade of recommendation: B, based on 2 randomized controlled trials with small sample sizes). Cesarean delivery may be considered for suspected...
How can I improve patient adherence to prescribed medication?
(Family Physicians Inquiries Network, 2001)
. These interventions include combinations of patient and family education, home monitoring of disease status, and increased convenience of care, such as workplace access. (Grade of Recommendation: B, based on randomized controlled trials)...
What are the indications for treatment with angiotensin-converting enzyme (ACE) inhibitors in patients with diabetes?
(Family Physicians Inquiries Network, 2001)
Tight control of hypertension treatment is key in preventing the vascular complications of diabetes. ACE inhibitors appear to have a protective effect that is independent of their antihypertensive effect. Unless there is ...
What medications are safe and effective for heartburn during pregnancy?
(Family Physicians Inquiries Network, 2001)
Ranitidine is the best-studied agent effective for treatment of heartburn in pregnancy. Some antacids are effective, but it may be prudent to avoid them in the first trimester until better safety studies are published. Although sucralfate...
Is surgery effective for reducing symptoms in adults with obstructive sleep apnea?
(Family Physicians Inquiries Network, 2001)
Current evidence is insufficient to recommend surgery for symptom relief for patients with obstructive sleep apnea. More convincing evidence exists supporting the use of Continuous Positive Airway Pressure (CPAP) or dental ...
What is the best diagnostic approach to postmenopausal vaginal bleeding in women taking hormone replacement therapy?
(Family Physicians Inquiries Network, 2001)
Women on standard estrogen/progestin hormone replacement therapy (HRT) regimens frequently have irregular bleeding during the first 12 months of treatment. Therefore, those taking HRT should usually be evaluated after 1 ...
What is the best approach to the evaluation and treatment of chronic cough?
(Family Physicians Inquiries Network, 2001)
Potentially cough-inducing agents, such as tobacco products and angiotensin-converting enzyme (ACE) inhibitors, should be eliminated first. Evaluation and treatment for postnasal drip syndrome (PNDS), asthma, and ...
What laboratory monitoring is appropriate to detect adverse drug reactions in patients on cholesterol-lowering agents?
(Family Physicians Inquiries Network, 2001)
Recommendations for measuring serum aminotransferase levels before initiating pharmacologic treatment for hypercholesterolemia, after 12 weeks of therapy, and periodically afterward are based on expert opinion. It is not ...
How soon should serum potassium levels be monitored for patients started on diuretics?
(Family Physicians Inquiries Network, 2001)
diuretics should have a potassium level checked in the first 2 to 8 weeks after initiating therapy. Mild hypokalemia (3.1 to 3.4 mmol/L) may be transient, so a repeat measurement may be considered before initiating potassium replacement. Dietary sodium...
What are the most effective treatments for bacterial vaginosis in nonpregnant women?
(Family Physicians Inquiries Network, 2001)
Either oral or vaginal metronidazole or vaginal clindamycin provides equivalent treatment for bacterial vaginosis in nonpregnant women. Oral clindamycin 300 mg twice daily for 7 days is an effective alternative. There is ...
At what age do patients no longer need colorectal cancer screening?
(Family Physicians Inquiries Network, 2001)
(CRC) screening after age 75 (grade of recommendation: D, based on expert opinion). CRC screening may be discontinued between ages 75 and 80, preferably after at least 1 negative screening examination result. Unusually healthy individuals may choose...
Should we change formula for a formula-fed infant with persistent spitting up, but with adequate weight gain?
(Family Physicians Inquiries Network, 2001)
We found no controlled trials evaluating the efficacy of changing formulas in the management of uncomplicated regurgitation. However, the evidence suggests that no benefit can be expected from changing formulas, including ...
Is there any benefit to Papanicolaou (Pap) test screening in women who have had a hysterectomy for benign disease?
(Family Physicians Inquiries Network, 2001)
The primary motivation to screen asymptomatic women after a hysterectomy is to prevent morbidity and mortality from gynecologic cancer. However, primary vaginal cancer is rare, the vaginal Pap test is not particularly ...
When should we stop mammography screening for breast cancer in elderly women?
(Family Physicians Inquiries Network, 2001)
There is insufficient evidence to recommend for or against routine screening mammography beyond the age of 69 years. The best candidates to stop screening are elderly women who have significant comorbidities, poor functional ...
What is the best oral antifungal medication for tinea capitis?
(Family Physicians Inquiries Network, 2001)
Terbinafine is effective, safe for use in children, and relatively inexpensive, and it offers a shorter course of therapy than griseofulvin. Unfortunately, it is not available in liquid form. Fluconazole is available in ...
Which patients with gastroesophageal reflux disease (GERD) should have esophagogastroduoudenoscopy (EGD)?
(Family Physicians Inquiries Network, 2001)
No evidence was identified that provides a basis for determining whether EGD leads to improved outcomes in patients with GERD. However, patients with GERD referred for elective EGD who were found to have Barrett's esophagus ...
Financial decision making in stepfamilies (2001)
(University of Missouri--Columbia. Extension Division, 2001)