AFP Clinical Answers
Postoperative Pain, Acute Stroke, Hormone Therapy, Diet to Improve Cardiovascular Risk, Ovarian Cancer
Am Fam Physician. 2019 May 15;99(10):606.
Which is the better oral pain reliever for children with postoperative pain: ibuprofen or morphine?
A carefully designed and adequately powered study found no difference in pain reduction between ibuprofen and oral morphine in children with postoperative pain. Adverse effects, however, were much more likely with morphine.
Does routine low-dose oxygen therapy following an acute stroke improve functional outcomes?
For nonhypoxic patients with acute stroke, a randomized controlled trial found that routine oxygen therapy for 72 hours, either continuously or at night only, does not improve functional outcomes at 90 days. Long-term outcomes were not assessed in this study, and the question remains whether 90 days is an adequate length of time to see most of the meaningful recovery from stroke.
Is hormone therapy with combined estrogen and progestin recommended to reduce risk of chronic conditions?
Although the use of combined estrogen and progestin hormone therapy in postmenopausal women is associated with some benefits, including a reduced risk of fractures, diabetes mellitus, and colorectal cancer, the U.S. Preventive Services Task Force (USPSTF) found convincing evidence that its use is associated with significant harms, including an increased risk of invasive breast cancer, venous thromboembolism, and coronary heart disease. It also found adequate evidence that combined hormone therapy is associated with an increased risk of stroke, dementia, gallbladder disease, and urinary incontinence. The USPSTF concluded with moderate certainty that the use of combined estrogen and progestin has no net benefit for the primary prevention of chronic conditions in most postmenopausal women, and therefore recommends against its use.
What dietary pattern should physicians recommend to improve patients' cardiovascular risk factors?
A dietary pattern that emphasizes vegetables, fruits, legumes, and whole grains and minimizes free sugars and red meats lowers blood pressure and cholesterol levels. One-half of each meal should consist of fruits and vegetables, and free sugars should be limited to less than 10% of daily calories.
What is the USPSTF recommendation on screening for ovarian cancer?
The USPSTF recommends against screening for ovarian cancer (D recommendation) in asymptomatic women regardless of age or screening methodology. The USPSTF found that the harms of screening outweigh the benefits. Studies showed no benefit in reduced ovarian cancer mortality, while the the harms of screening were found to be moderate to substantial.
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