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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, ...
Does Lidocaine-Prilocaine Cream (EMLA) Decrease the Pain of Neonatal Circumcision?
(Family Physicians Inquiries Network, 2004)
EMLA cream reduces the pain experienced by newborns during circumcision compared with placebo. [Strength of recommendation: A, based on a systematic review of randomized controlled trials (RCTs)]. However, dorsal penile nerve block and ring block...
Does a Low-Sodium Diet Reduce Blood Pressure?
(Family Physicians Inquiries Network, 2004)
Reducing sodium intake does lead to a slightly lower average blood pressure. However, no evidence from controlled trials proves that reducing sodium intake decreases morbidity or mortality, or proves that modest sodium restriction is harmful...
What's the most practical way to rule out adrenal insufficiency?
(Family Physicians Inquiries Network, 2009)
A morning serum cortisol level >13 mcg/dL reliably rules out adrenal insufficiency, and the test is easy and safe to perform. Because of low specificity, patients with a level of ≤13 mcg/dL need further evaluation with the ...
Which interventions are best for alleviating nipple pain in nursing mothers?
(Family Physicians Inquiries Network, 2009)
to be superior to others for relieving nipple pain (SOR: B, inconsistent RCTs). Topical agents that show some evidence of benefit include expressed breast milk, lanolin, warm water compresses, tea bag compresses, hydrogel dressings, a chlorhexidinealcohol spray...
First- or second-generation antihistamines: which are more effective at controlling pruritus?
(Family Physicians Inquiries Network, 2004)
, antihistamines are no better than placebo (SOR: B, small RCTs and other studies). Other categories of pruritus are best treated with non-antihistamine agents (SOR: C, based on expert opinion and disease-oriented research)....
What measures relieve postherpetic neuralgia?
(Family Physicians Inquiries Network, 2009)
Tricyclic antidepressants, gabapentin, and pregabalin effectively reduce pain (strength of recommendation [SOR]: A, at least 2 good-quality randomized controlled trials [RCTs] and/or meta-analyses). Opioids have demonstrated ...
How should you evaluate an asymptomatic patient with a femoral or iliac artery bruit?
(Family Physicians Inquiries Network, 2009)
Perform an ankle-arm index (AAI, or ankle- brachial index) test to evaluate for peripheral artery disease (PAD) (strength of recommendation [SOR]: B, cohort studies). If the test detects PAD, recommend steps to modify ...
Do vitamin C supplements reduce mortality in patients with cardiovascular disease?
(Family Physicians Inquiries Network, 2004)
Vitamin C, when taken as a dietary supplement, does not appear to reduce mortality in patients with cardiovascular disease. [Strength of recommendation: B, based on reviews of cohort studies and a single randomized controlled trial (RCT).]...
Is there a role for theophylline in treating patients with asthma?
(Family Physicians Inquiries Network, 2002)
asthma attacks. Side effects and toxicity limit use of these medications in most settings. (Grade of recommendation: A, based on systematic reviews and randomized control trials [RCTs])....
How useful is a physical exam in diagnosing testicular torsion?
(Family Physicians Inquiries Network, 2009)
Physical exam is useful, but imperfect, in ruling out testicular torsion (strength of recommendation [SOR]: C, expert opinion). The cremasteric reflex or a nontender testicle usually excludes testicular torsion, but case ...
Does Screening for Tuberculosis in Children Decrease Morbidity or Mortality?
(Family Physicians Inquiries Network, 2004)
Routine screening of low-risk children for tuberculosis infection before entering kindergarten is not necessary. [Strength of recommendation: C] Targeted screening of high-risk children for tuberculosis infection using the ...
When should you consider implanted nerve stimulators for lower back pain?
(Family Physicians Inquiries Network, 2009)
Patients can gain more pain relief from spinal cord stimulation (SCS) than from reoperation (strength of recommendation [SOR]: A, 2 randomized controlled trials [RCTs]). SCS can also treat chronic low back pain effectively ...
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 recommended that serum...
Menstrual disturbances in perimenopausal women: What's best?
(Family Physicians Inquiries Network, 2009)
It's best to start with nonsteroidal anti- inflammatory drugs (NSAIDs), which effectively reduce heavy menstrual bleeding (strength of recommendation [SOR]: B, systematic review of randomized clinical trials [RCTs]). ...
What are the relative risks and benefits of progestin-only contraceptives?
(Family Physicians Inquiries Network, 2005)
Little evidence describes the risks and benefits of progestin-only contraceptives therapy. No good-quality evidence exists to determine the risk of cancer associated with progestin-only contraceptives. Data are insufficient to discern their effect...
Which factors increase the risk of an infant becoming an overweight child?
(Family Physicians Inquiries Network, 2009)
Variables that increase the risk of overweight in childhood include formula feeding, high birth weight, high rate of weight gain in the first 4 months of life, low socioeconomic status, and maternal obesity (strength of ...
How should you manage an overweight breastfed infant?
(Family Physicians Inquiries Network, 2009)
Monitor the growth of exclusively breastfed babies by plotting routine weights and lengths on the World Health Organization (WHO) growth curve (strength of recommendation [SOR]: A, systematic reviews). Reassure parents ...
Missouri hospitalist, issue 24 (2009 December 23)
(University of Missouri. Department of Medicine. Division of Hospital Medicine, 2009-12)
When should you suspect community-acquired MRSA? How should you treat it?
(Family Physicians Inquiries Network, 2009)
There are no clinical or epidemiologic features that will help you to clearly distinguish community-acquired methicillin-resistant Staphylococcus aureus infections (CA-MRSA) from methicillin-sensitive (CA-MSSA) infections ...