Q&A

Amoxicillin-clavulanate was no more effective than placebo in quickly relieving symptoms in patients diagnosed clinically with acute sinusitis in a general practice setting. It was, however, much more likely to cause diarrhea. Because most patients will improve spontaneously, antibiotics should be reserved for patients with prolonged symptoms. An inexpensive, narrow-spectrum drug such as amoxicillin is a good initial choice.

Amoxicillin-clavulanate was no more effective than placebo in quickly relieving symptoms in patients diagnosed clinically with acute sinusitis in a general practice setting. It was, however, much more likely to cause diarrhea. Because most patients will improve spontaneously, antibiotics should be reserved for patients with prolonged symptoms. An inexpensive, narrow-spectrum drug such as amoxicillin is a good initial choice.

Amoxicillin-clavulanate was no more effective than placebo in quickly relieving symptoms in patients diagnosed clinically with acute sinusitis in a general practice setting. It was, however, much more likely to cause diarrhea. Because most patients will improve spontaneously, antibiotics should be reserved for patients with prolonged symptoms. An inexpensive, narrow-spectrum drug such as amoxicillin is a good initial choice.

Nail plate biopsy followed by periodic acid–Schiff staining is the most accurate method for diagnosing onychomycosis. The positive predictive value (PV+) of periodic acid–Schiff staining was equal to both potassium hydroxide (KOH) preparation and fungal culture, with a greater negative predictive value (PV–) due to superior sensitivity.

However, availability of periodic acid–Schiff staining may vary geographically, and the cost of the diagnostic tests is not addressed in this study. Thus, it makes clinical sense to start with the most accessible test, using periodic acid–Schiff staining if other methods are negative and clinical suspicion is high.

Nail plate biopsy followed by periodic acid–Schiff staining is the most accurate method for diagnosing onychomycosis. The positive predictive value (PV+) of periodic acid–Schiff staining was equal to both potassium hydroxide (KOH) preparation and fungal culture, with a greater negative predictive value (PV–) due to superior sensitivity.

However, availability of periodic acid–Schiff staining may vary geographically, and the cost of the diagnostic tests is not addressed in this study. Thus, it makes clinical sense to start with the most accessible test, using periodic acid–Schiff staining if other methods are negative and clinical suspicion is high.

Nail plate biopsy followed by periodic acid–Schiff staining is the most accurate method for diagnosing onychomycosis. The positive predictive value (PV+) of periodic acid–Schiff staining was equal to both potassium hydroxide (KOH) preparation and fungal culture, with a greater negative predictive value (PV–) due to superior sensitivity.

However, availability of periodic acid–Schiff staining may vary geographically, and the cost of the diagnostic tests is not addressed in this study. Thus, it makes clinical sense to start with the most accessible test, using periodic acid–Schiff staining if other methods are negative and clinical suspicion is high.

This meta-analysis shows that the use of aspirin in pregnant women predisposed to preeclampsia significantly reduces the rates of preeclampsia and perinatal death, without evidence of harm. A recent Cochrane review showed similar results.¹It is reasonable to recommend low-dose aspirin therapy to women who have 1 or more risk factors for preeclampsia.

This meta-analysis shows that the use of aspirin in pregnant women predisposed to preeclampsia significantly reduces the rates of preeclampsia and perinatal death, without evidence of harm. A recent Cochrane review showed similar results.¹It is reasonable to recommend low-dose aspirin therapy to women who have 1 or more risk factors for preeclampsia.

This meta-analysis shows that the use of aspirin in pregnant women predisposed to preeclampsia significantly reduces the rates of preeclampsia and perinatal death, without evidence of harm. A recent Cochrane review showed similar results.¹It is reasonable to recommend low-dose aspirin therapy to women who have 1 or more risk factors for preeclampsia.

Therapeutic knee taping decreases pain and disability in patients with knee osteoarthritis who are not extremely overweight (body mass index [BMI] <38). The patients with therapeutic knee taping were 7 times more likely to report reduced pain, and 1 patient would receive benefit for every 2 treated. Therapeutic taping provides an additional way to help patients control pain and maintain function.

Therapeutic knee taping decreases pain and disability in patients with knee osteoarthritis who are not extremely overweight (body mass index [BMI] <38). The patients with therapeutic knee taping were 7 times more likely to report reduced pain, and 1 patient would receive benefit for every 2 treated. Therapeutic taping provides an additional way to help patients control pain and maintain function.

Therapeutic knee taping decreases pain and disability in patients with knee osteoarthritis who are not extremely overweight (body mass index [BMI] <38). The patients with therapeutic knee taping were 7 times more likely to report reduced pain, and 1 patient would receive benefit for every 2 treated. Therapeutic taping provides an additional way to help patients control pain and maintain function.

Angioplasty within 2 hours of presentation for acute myocardial infarction (MI) is superior to thrombolysis, primarily due to a lower reinfarction rate. This is true whether a patient presents to a healthcare facility with angioplasty capability or one that transfers a patient.

Angioplasty within 2 hours of presentation for acute myocardial infarction (MI) is superior to thrombolysis, primarily due to a lower reinfarction rate. This is true whether a patient presents to a healthcare facility with angioplasty capability or one that transfers a patient.

Angioplasty within 2 hours of presentation for acute myocardial infarction (MI) is superior to thrombolysis, primarily due to a lower reinfarction rate. This is true whether a patient presents to a healthcare facility with angioplasty capability or one that transfers a patient.

Nebulized epinephrine does not improve clinical status or reduce the length of the hospital stay in infants aged <1 year with acute bronchiolitis. It also does not reduce clinical scores during or shortly after medication administration.

In this study, infants requiring oxygen and intravenous fluids—presumably the sickest infants in the study—required longer hospital stays if they received epinephrine. A wheezing infant may be presenting with a first episode of asthma, so a trial of bronchodilators would seem reasonable; however, it appears that the primary intervention for bronchiolitis is supportive treatment, with supplemental oxygen, intravenous fluids, and ventilatory support when needed.

Nebulized epinephrine does not improve clinical status or reduce the length of the hospital stay in infants aged <1 year with acute bronchiolitis. It also does not reduce clinical scores during or shortly after medication administration.

In this study, infants requiring oxygen and intravenous fluids—presumably the sickest infants in the study—required longer hospital stays if they received epinephrine. A wheezing infant may be presenting with a first episode of asthma, so a trial of bronchodilators would seem reasonable; however, it appears that the primary intervention for bronchiolitis is supportive treatment, with supplemental oxygen, intravenous fluids, and ventilatory support when needed.

Nebulized epinephrine does not improve clinical status or reduce the length of the hospital stay in infants aged <1 year with acute bronchiolitis. It also does not reduce clinical scores during or shortly after medication administration.

In this study, infants requiring oxygen and intravenous fluids—presumably the sickest infants in the study—required longer hospital stays if they received epinephrine. A wheezing infant may be presenting with a first episode of asthma, so a trial of bronchodilators would seem reasonable; however, it appears that the primary intervention for bronchiolitis is supportive treatment, with supplemental oxygen, intravenous fluids, and ventilatory support when needed.

A strategy of routine induction at or just after 41 weeks for uncomplicated pregnancies reduces cesarean sections without improving or adversely affecting neonatal outcomes. Family physicians should provide this information to their patients and continue to look for studies that provide clinical detail and directly compare the strategy of routine induction after 41 weeks with expectant management and induction after 42 weeks.

A strategy of routine induction at or just after 41 weeks for uncomplicated pregnancies reduces cesarean sections without improving or adversely affecting neonatal outcomes. Family physicians should provide this information to their patients and continue to look for studies that provide clinical detail and directly compare the strategy of routine induction after 41 weeks with expectant management and induction after 42 weeks.

A strategy of routine induction at or just after 41 weeks for uncomplicated pregnancies reduces cesarean sections without improving or adversely affecting neonatal outcomes. Family physicians should provide this information to their patients and continue to look for studies that provide clinical detail and directly compare the strategy of routine induction after 41 weeks with expectant management and induction after 42 weeks.

In patients with cancer and venous thromboembolism, low-molecular-weight heparin effectively reduces symptomatic recurrent venous thromboembolism (VTE) more effectively than warfarin. Although cost and logistical considerations should be considered, this study demonstrates that the use of low-molecular-weight heparin is an effective approach for the prevention of recurrent VTE in cancer patients.

In patients with cancer and venous thromboembolism, low-molecular-weight heparin effectively reduces symptomatic recurrent venous thromboembolism (VTE) more effectively than warfarin. Although cost and logistical considerations should be considered, this study demonstrates that the use of low-molecular-weight heparin is an effective approach for the prevention of recurrent VTE in cancer patients.

In patients with cancer and venous thromboembolism, low-molecular-weight heparin effectively reduces symptomatic recurrent venous thromboembolism (VTE) more effectively than warfarin. Although cost and logistical considerations should be considered, this study demonstrates that the use of low-molecular-weight heparin is an effective approach for the prevention of recurrent VTE in cancer patients.

Allergen-impermeable bed covers, as a single intervention, are ineffective for the management of asthma symptoms in adults. They are also ineffective for patients with allergic rhinitis.¹

Allergen-impermeable bed covers, as a single intervention, are ineffective for the management of asthma symptoms in adults. They are also ineffective for patients with allergic rhinitis.¹

Allergen-impermeable bed covers, as a single intervention, are ineffective for the management of asthma symptoms in adults. They are also ineffective for patients with allergic rhinitis.¹

Treatment with finasteride will, over 7 years, decrease the prevalence of prostate cancer but increase the likelihood of developing a high-grade cancer. For every 1000 men given finasteride for prostate cancer, 62 will not develop prostate cancer. In addition, 35 men will not develop benign prostatic hypertrophy, 27 will have less urinary urgency or frequency, and 21 will report less urinary retention.

However, of those that develop prostate cancer, 13 will have higher-grade cancer (Gleason score 7 or higher), 59 will have erec-tile dysfunction, 58 will have a loss of libido, and 131 will have reduced volume of ejaculate. This study provides no information on the clinical significance of reducing the overall rate of cancer, while increasing higher-grade tumors. Since it is unclear whether finasteride reduces morbidity or mortality, it cannot be recommended for the routine prevention of prostate cancer.

Treatment with finasteride will, over 7 years, decrease the prevalence of prostate cancer but increase the likelihood of developing a high-grade cancer. For every 1000 men given finasteride for prostate cancer, 62 will not develop prostate cancer. In addition, 35 men will not develop benign prostatic hypertrophy, 27 will have less urinary urgency or frequency, and 21 will report less urinary retention.

However, of those that develop prostate cancer, 13 will have higher-grade cancer (Gleason score 7 or higher), 59 will have erec-tile dysfunction, 58 will have a loss of libido, and 131 will have reduced volume of ejaculate. This study provides no information on the clinical significance of reducing the overall rate of cancer, while increasing higher-grade tumors. Since it is unclear whether finasteride reduces morbidity or mortality, it cannot be recommended for the routine prevention of prostate cancer.

Treatment with finasteride will, over 7 years, decrease the prevalence of prostate cancer but increase the likelihood of developing a high-grade cancer. For every 1000 men given finasteride for prostate cancer, 62 will not develop prostate cancer. In addition, 35 men will not develop benign prostatic hypertrophy, 27 will have less urinary urgency or frequency, and 21 will report less urinary retention.

However, of those that develop prostate cancer, 13 will have higher-grade cancer (Gleason score 7 or higher), 59 will have erec-tile dysfunction, 58 will have a loss of libido, and 131 will have reduced volume of ejaculate. This study provides no information on the clinical significance of reducing the overall rate of cancer, while increasing higher-grade tumors. Since it is unclear whether finasteride reduces morbidity or mortality, it cannot be recommended for the routine prevention of prostate cancer.