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Should a nylon brush be used for Pap smears from pregnant women?
(Family Physicians Inquiries Network, 2005)
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 ...
Counseling or Antidepressants for Treating Depression?
(Family Physicians Inquiries Network, 2005)
Both antidepressant medications and psychologic treatment are beneficial for adult patients with mild to moderate depression, with no consistent evidence that one type of treatment is more effective than the other. [Strength ...
When is neuroimaging warranted for headache?
(Family Physicians Inquiries Network, 2005)
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 ...
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: ...
Intravenous Fluids for Children with Gastroenteritis
(Family Physicians Inquiries Network, 2005)
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 ...
Are breast self-exams or clinical exams effective for screening breast cancer?
(Family Physicians Inquiries Network, 2005)
]). 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)....
How should a DEXA scan be used to evaluate bisphosphonate therapy for osteoporosis?
(Family Physicians Inquiries Network, 2005)
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] ...
Should we recommend universal neonatal hearing screening?
(Family Physicians Inquiries Network, 2005)
Universal neonatal hearing screening leads to both earlier detection and earlier treatment of infants with hearing loss (strength of recommendation [SOR]: A, based on a systematic review). Available evidence suggests early ...
What illnesses contraindicate immunization?
(Family Physicians Inquiries Network, 2005)
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: ...
Do preparticipation clinical exams reduce morbidity and mortality for athletes?
(Family Physicians Inquiries Network, 2005)
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...
What interventions reduce the risk of contrast nephropathy for high-risk patients?
(Family Physicians Inquiries Network, 2005)
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...
How does tissue adhesive compare with suturing for superficial lacerations?
(Family Physicians Inquiries Network, 2005)
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 ...
Does digoxin decrease morbidity for those in sinus rhythm with heart failure?
(Family Physicians Inquiries Network, 2005)
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...
In menopausal women, does fatigue indicate disease?
(Family Physicians Inquiries Network, 2005)
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...
Do insulin-sensitizing drugs increase ovulation rates for women with PCOS?
(Family Physicians Inquiries Network, 2005)
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]). ...
Should liver enzymes be checked in a patient taking niacin?
(Family Physicians Inquiries Network, 2005)
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 ...
Can we prevent splenic rupture for patients with infectious mononucleosis?
(Family Physicians Inquiries Network, 2005)
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...
What is the best treatment for gastroesophageal reflux and vomiting in infants?
(Family Physicians Inquiries Network, 2005)
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...
What is the best way to distinguish type 1 and 2 diabetes?
(Family Physicians Inquiries Network, 2005)
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...
What is the initial work-up in the diagnosis of hypertension?
(Family Physicians Inquiries Network, 2005)
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, ...