AFP Clinical Answers
Animal Bites, Fall Risk, Croup, Scoliosis, Recurrent VTE, Postpartum Perineal Pain
Am Fam Physician. 2019 Jan 15;99(2):80.
Is there a role for primary closure of animal bites?
Dog bites can have a primary closure at the time of injury. Primary closure of dog bites does not increase the rate of wound infections compared with nonclosure. Primary closure of mammalian bites (e.g., dogs, cats, humans) is associated with low infection rates, and more than two-thirds will have optimal cosmetic results.
How should physicians screen older patients for a risk of future falls?
Physicians should screen older patients for risk of future falls using a single question, “Have you fallen in the past year?” In-depth, multifactorial risk assessment for falls should be reserved for patients who respond affirmatively or those who take longer than 12 seconds to perform a Timed Up and Go Test.
How should croup be managed?
Corticosteroids should be administered to patients with croup of any severity. Nebulized epinephrine should be administered to patients with moderate to severe croup. Humidified air inhalation does not improve symptoms in patients with moderate croup.
Is home therapy for deep venous thrombosis superior to in-hospital treatment in reducing recurrent VTE?
Patients treated at home with low-molecular-weight heparin have lower rates of recurrent venous thromboembolism (VTE) than those treated in a hospital (number needed to treat [NNT] = 23). There were no clear differences in the occurrence of minor or major bleeding or death. Individual studies showed some improvement in quality-of-life measures with home therapy. Costs were lower for home treatment of VTE, with a savings of 3% to 64% over three to six months of therapy.
Are NSAIDs effective in the treatment of postpartum perineal pain?
Women with third- or fourth-degree perineal lacerations or who received an episiotomy can be given oral nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce perineal pain in the first six hours postpartum. Women who received an episiotomy may have a reduction in postpartum pain scores after receiving NSAID rectal suppositories and are less likely to request more analgesia.
Does the USPSTF recommend screening adolescents for scoliosis?
The U.S. Preventive Services Task Force (USPSTF) concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening. The USPSTF found no direct evidence on the effects of screening for adolescent idiopathic scoliosis on health outcomes, and no evidence on the direct harms of screening (such as psychological impact or harms from radiography). It found inadequate evidence on treatment with exercise and surgery, and inadequate evidence on harms of treatment.
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