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 ...

Neuroimaging is warranted to evaluate headaches when patients present to an emergency department with signs or symptoms of an intracranial lesion. These signs or symptoms include abrupt onset of headache, focal neurological ...

]). Clinical breast examination is an important means of averting some deaths from breast cancer, but demands careful attention to technique and thoroughness (SOR: B, extrapolating from a high-quality RCT)....

Most children with gastroenteritis do not require intravenous fluids and will respond favorably to ORT. Intravenous fluids do not shorten the duration of gastroenteritis and are more likely to cause adverse effects than ...

If bone density is evaluated after initiating bisphosphonate drug therapy, it should be tested no earlier than 2 years (strength of recommendation [SOR]: B, based on case series of dual energy x-ray absorptiometry [DEXA] ...

Though clinical preparticipation exams (PPE) are recommended by experts and required in most states, we found no medium- or better-quality evidence that demonstrates they reduce mortality or morbidity. PPEs detect only a very small percentage...

The Advisory Council on Immunization Practices (ACIP) reports that the only contraindication for all vaccines is a history of severe allergic reaction to a previous vaccine or vaccine constituent (strength of recommendations: ...

Several interventions may reduce the risk of contrast nephropathy for high-risk patients; however, most evidence uses surrogate markers for clinically relevant outcomes. Because dehydration is a risk factor for developing contrast nephropathy...

Tissue adhesives are effective and yield results comparable to those with conventional suturing of superficial, linear, and low-tension lacerations. The cosmetic outcome is similar; wound complications, such as infection ...

In patients with congestive heart failure due to systolic dysfunction who are in normal sinus rhythm, digoxin therapy reduces rates of hospitalization, as well as clinical deterioration, defined as worsening New York Heart Association (NYHA...

Though fatigue is a commonly reported symptom, high-quality studies evaluating it as a marker for diseases among menopausal women are lacking. Middle-aged women who report fatigue are more apt to screen positive for clinical depression or anxiety...

Short-term use of metformin (Glucophage) improves ovulation rates for women with polycystic ovary syndrome (PCOS) (strength of recommendation [SOR]: A, based on systematic reviews of randomized controlled trials [RCT]). ...

All patients with infectious mononucleosis should be considered at risk for splenic rupture since clinical severity, laboratory results, and physical exam are not reliable predictors of rupture (strength of recommendation [SOR]: B, case...

No randomized trials directly address the question of frequency of liver enzyme monitoring with niacin use. Niacin use is associated with early and late hepatotoxicity (strength of recommendation [SOR]: B, based on incidence ...

The literature on pediatric reflux can be divided into studies addressing clinically apparent reflux (vomiting or regurgitation) and reflux as measured by pH probe or other methods. Sodium alginate reduces vomiting and improves parents' assessment...

No clinical characteristic or diagnostic test is available to readily distinguish type 1 from type 2 diabetes mellitus. Although C-peptide levels, autoantibodies, and adiponectin-to-leptin ratios show some utility, they do not yet have a standard...

Patients with a new diagnosis of hypertension should be evaluated with a history and physical exam and the following initial studies: serum potassium and creatinine, fasting serum glucose and lipid panel, hematocrit, ...

No studies evaluate the commonly used indications for bariatric surgery. Consensus guidelines suggest that the surgical treatment of obesity should be reserved for patients with a body-mass index (BMI) >40 kg/m2 or with ...

Patients exhibiting stroke symptoms should have brain imaging immediately within 3 hours of symptom onset (strength of recommendation [SOR]: A, based on systematic review). In the first 3 hours after a suspected cerebrovascular ...

-ray (strength of recommendation: A, based on a clinical decision rule validated in 2 high-quality cohort studies)....