Q&A

Response to treatment with a proton pump inhibitor does not identify patients as having gastroesophageal reflux disease. As a result, an initial response should not consign the patient to long-term therapy. These results agree with other research showing that patients can use short-term treatment (2 weeks), stop treatment, and then begin treatment again if symptoms recur, which won’t happen in approximately half of them (BMJ 1999; 318:502–507). (LOE=1a)

Response to treatment with a proton pump inhibitor does not identify patients as having gastroesophageal reflux disease. As a result, an initial response should not consign the patient to long-term therapy. These results agree with other research showing that patients can use short-term treatment (2 weeks), stop treatment, and then begin treatment again if symptoms recur, which won’t happen in approximately half of them (BMJ 1999; 318:502–507). (LOE=1a)

Response to treatment with a proton pump inhibitor does not identify patients as having gastroesophageal reflux disease. As a result, an initial response should not consign the patient to long-term therapy. These results agree with other research showing that patients can use short-term treatment (2 weeks), stop treatment, and then begin treatment again if symptoms recur, which won’t happen in approximately half of them (BMJ 1999; 318:502–507). (LOE=1a)

Although diagnostic tests often are good for both identifying and excluding disease, sometimes tests do one better than the other. A normal D-dimer test result can be relied upon to rule out suspected pulmonary embolism or deep vein thrombosis. It is not particularly helpful, by itself, to rule in the diagnosis. The results of this meta-analysis confirm an earlier meta-analysis (Ann Emerg Med 2002; 40:133–144). (LOE=1a)

Although diagnostic tests often are good for both identifying and excluding disease, sometimes tests do one better than the other. A normal D-dimer test result can be relied upon to rule out suspected pulmonary embolism or deep vein thrombosis. It is not particularly helpful, by itself, to rule in the diagnosis. The results of this meta-analysis confirm an earlier meta-analysis (Ann Emerg Med 2002; 40:133–144). (LOE=1a)

Although diagnostic tests often are good for both identifying and excluding disease, sometimes tests do one better than the other. A normal D-dimer test result can be relied upon to rule out suspected pulmonary embolism or deep vein thrombosis. It is not particularly helpful, by itself, to rule in the diagnosis. The results of this meta-analysis confirm an earlier meta-analysis (Ann Emerg Med 2002; 40:133–144). (LOE=1a)

In this systematic review, nonsurgical treatments of carpal tunnel syndrome using injected or oral steroids provided temporary relief. Spontaneous resolution is more common than you may think: nearly 50% of patients receiving placebos improved.

Long-term data on most treatments are lacking. In the few studies with long-term follow up, as many as 50% of patients had surgery during the first year after enrollment. (LOE=1a–)

In this systematic review, nonsurgical treatments of carpal tunnel syndrome using injected or oral steroids provided temporary relief. Spontaneous resolution is more common than you may think: nearly 50% of patients receiving placebos improved.

Long-term data on most treatments are lacking. In the few studies with long-term follow up, as many as 50% of patients had surgery during the first year after enrollment. (LOE=1a–)

In this systematic review, nonsurgical treatments of carpal tunnel syndrome using injected or oral steroids provided temporary relief. Spontaneous resolution is more common than you may think: nearly 50% of patients receiving placebos improved.

Long-term data on most treatments are lacking. In the few studies with long-term follow up, as many as 50% of patients had surgery during the first year after enrollment. (LOE=1a–)

Many American women who have had a hysterectomy with removal of the cervix for benign disease continue to undergo routine Papanicolaou (Pap) testing despite a lack of supporting evidence and a clear recommendation from the United States Preventive Services Task Force against it.

Conversely, the vast majority of American women who die from cervical cancer were either underscreened or never screened for cervical disease, most likely as a result of real or perceived cost barriers. The money saved by not inappropriately performing Pap tests on low-risk women would pay for the cost of screening the 17 million women in the United States who are currently underscreened for cervical cancer (J Womens Health Gender Based Med 2002; 11:103–109). (Level of evidence [LOE]=2b)

Many American women who have had a hysterectomy with removal of the cervix for benign disease continue to undergo routine Papanicolaou (Pap) testing despite a lack of supporting evidence and a clear recommendation from the United States Preventive Services Task Force against it.

Conversely, the vast majority of American women who die from cervical cancer were either underscreened or never screened for cervical disease, most likely as a result of real or perceived cost barriers. The money saved by not inappropriately performing Pap tests on low-risk women would pay for the cost of screening the 17 million women in the United States who are currently underscreened for cervical cancer (J Womens Health Gender Based Med 2002; 11:103–109). (Level of evidence [LOE]=2b)

Many American women who have had a hysterectomy with removal of the cervix for benign disease continue to undergo routine Papanicolaou (Pap) testing despite a lack of supporting evidence and a clear recommendation from the United States Preventive Services Task Force against it.

Conversely, the vast majority of American women who die from cervical cancer were either underscreened or never screened for cervical disease, most likely as a result of real or perceived cost barriers. The money saved by not inappropriately performing Pap tests on low-risk women would pay for the cost of screening the 17 million women in the United States who are currently underscreened for cervical cancer (J Womens Health Gender Based Med 2002; 11:103–109). (Level of evidence [LOE]=2b)

In this highly selective group of patients with recurrent epistaxis, petroleum jelly (Vaseline) applied twice daily for 4 weeks did not reduce the number of bleeds in the subsequent 4 weeks. This should make you question this commonly recommended treatment. But don’t abandon it just yet, since it may work in children with less severe disease in the primary care setting, and because there was potential for recall bias by parents in this study. (LOE=2b)

In this highly selective group of patients with recurrent epistaxis, petroleum jelly (Vaseline) applied twice daily for 4 weeks did not reduce the number of bleeds in the subsequent 4 weeks. This should make you question this commonly recommended treatment. But don’t abandon it just yet, since it may work in children with less severe disease in the primary care setting, and because there was potential for recall bias by parents in this study. (LOE=2b)

In this highly selective group of patients with recurrent epistaxis, petroleum jelly (Vaseline) applied twice daily for 4 weeks did not reduce the number of bleeds in the subsequent 4 weeks. This should make you question this commonly recommended treatment. But don’t abandon it just yet, since it may work in children with less severe disease in the primary care setting, and because there was potential for recall bias by parents in this study. (LOE=2b)

Although laparoscopic repair is associated with a small reduction in pain and it gets your patient back to work a day sooner, it carries a greater risk of serious complications and recurrence. (LOE=1b)

Although laparoscopic repair is associated with a small reduction in pain and it gets your patient back to work a day sooner, it carries a greater risk of serious complications and recurrence. (LOE=1b)

Although laparoscopic repair is associated with a small reduction in pain and it gets your patient back to work a day sooner, it carries a greater risk of serious complications and recurrence. (LOE=1b)

Routine measurement of peak expiratory flow rate does not predict subsequent asthma exacerbations. Therefore, routine measuring of lung function in this way is not useful. A peak flow meter does have a role in asthma management, but spot-checking in the office, other than to evaluate technique, is not helpful. (LOE=1b)

Routine measurement of peak expiratory flow rate does not predict subsequent asthma exacerbations. Therefore, routine measuring of lung function in this way is not useful. A peak flow meter does have a role in asthma management, but spot-checking in the office, other than to evaluate technique, is not helpful. (LOE=1b)

Routine measurement of peak expiratory flow rate does not predict subsequent asthma exacerbations. Therefore, routine measuring of lung function in this way is not useful. A peak flow meter does have a role in asthma management, but spot-checking in the office, other than to evaluate technique, is not helpful. (LOE=1b)

Intra-articular steroids produced some measure of improvement greater than placebo, with approximately 2 to 4 patients requiring treatment for an additional 1 patient to benefit. This meta-analysis, however, included relatively few patients, and the magnitude of the benefit was not quantified in this study. (LOE=1a)

Intra-articular steroids produced some measure of improvement greater than placebo, with approximately 2 to 4 patients requiring treatment for an additional 1 patient to benefit. This meta-analysis, however, included relatively few patients, and the magnitude of the benefit was not quantified in this study. (LOE=1a)

Intra-articular steroids produced some measure of improvement greater than placebo, with approximately 2 to 4 patients requiring treatment for an additional 1 patient to benefit. This meta-analysis, however, included relatively few patients, and the magnitude of the benefit was not quantified in this study. (LOE=1a)

Interventions with some evidence of effectiveness for infantile colic include hypoallergenic diets and formula, soy formula, decreased infant stimulation, herbal tea, and dicyclomine (Bentyl). Reports of severe adverse effects of dicyclomine in infants younger than 7 weeks caused a black-box warning for use in those aged less than 6 months. The following interventions are essentially equal to or worse than placebo treatment: simethicone (Mylicon, Gas-X), scopolamine, lactase enzyme (Lactulose), fiber-enriched formula, increased carrying, car-ride simulators, and sucrose. (Level of evidence [LOE]=1a–)

Interventions with some evidence of effectiveness for infantile colic include hypoallergenic diets and formula, soy formula, decreased infant stimulation, herbal tea, and dicyclomine (Bentyl). Reports of severe adverse effects of dicyclomine in infants younger than 7 weeks caused a black-box warning for use in those aged less than 6 months. The following interventions are essentially equal to or worse than placebo treatment: simethicone (Mylicon, Gas-X), scopolamine, lactase enzyme (Lactulose), fiber-enriched formula, increased carrying, car-ride simulators, and sucrose. (Level of evidence [LOE]=1a–)

Interventions with some evidence of effectiveness for infantile colic include hypoallergenic diets and formula, soy formula, decreased infant stimulation, herbal tea, and dicyclomine (Bentyl). Reports of severe adverse effects of dicyclomine in infants younger than 7 weeks caused a black-box warning for use in those aged less than 6 months. The following interventions are essentially equal to or worse than placebo treatment: simethicone (Mylicon, Gas-X), scopolamine, lactase enzyme (Lactulose), fiber-enriched formula, increased carrying, car-ride simulators, and sucrose. (Level of evidence [LOE]=1a–)