AFP Clinical Answers
Flu Vaccine, Car Seats, PTSD, Kidney Stones, Bridging Warfarin
Am Fam Physician. 2019 Oct 15;100(8):462.
Do influenza vaccines reduce the risk of influenza in healthy children, healthy adults, and older adults?
Influenza vaccination reduces rates of laboratory-confirmed influenza and symptomatic influenza-like illness in healthy children, healthy adults, and older adults. Numbers needed to treat vary from 3 in children younger than 16 years in areas with high influenza risk to 500 in children younger than two years in areas with low influenza risk. There is no consistent evidence that influenza vaccination reduces school absenteeism in children, parental absenteeism from work, or adult hospitalizations, nor is there conclusive evidence that influenza vaccination decreases mortality.
When is the optimal time for children to transition to a booster seat or sit in the front seat of the car?
When children have outgrown the forward-facing seat limits for the car seat, they should use a booster seat until the lap and shoulder parts of the seat belt fit correctly. All children younger than 13 years should be restrained in the rear seats of vehicles for optimal protection.
What are the benefits and harms of psychotherapies and pharmacologic agents for the treatment of adults with posttraumatic stress disorder (PTSD)?
Cognitive behavior therapy (CBT) and CBT-mixed treatments have a high strength of evidence for benefit in improving PTSD-related outcomes, such as reduced PTSD symptoms, reduced depression symptoms, and resolution of PTSD diagnosis. Cognitive processing therapy, cognitive therapy, eye movement desensitization and reprocessing, and narrative exposure therapy had a moderate strength of evidence for benefit. Fluoxetine (Prozac), paroxetine (Paxil), and venlafaxine had moderate strength of evidence for reducing PTSD symptoms. There was insufficient evidence to compare psychotherapy with pharmacotherapy and to compare serious adverse events among treatments.
What are the first-line treatment recommendations for kidney stones?
In patients with kidney stones, nonsteroidal anti-inflammatory drugs are the first choice for pain relief and alpha blockers are the first choice for medical expulsive therapy.
Is bridging warfarin before screening colonoscopy in patients with atrial fibrillation beneficial for reducing the risk of stroke?
A limited number of trials that examined the risk of temporary interruption of anticoagulation before a variety of procedures did not find a reduction in the risk of stroke, but they did show an increased risk of bleeding events and venous thromboembolism in patients who were bridged during warfarin (Coumadin) interruption.
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