Am Fam Physician. 2023;108(4):345
What treatment options are available for vasomotor symptoms associated with menopause?
Estrogen-containing systemic hormone therapy is an effective treatment for vasomotor symptoms (i.e., hot flashes and night sweats). Physicians should prescribe the lowest effective dose for the shortest duration necessary to improve symptoms because of the potential risks of long-term use of hormone therapy. Nonhormonal medications, including selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, fezolinetant (Veozah), gabapentin, clonidine, and oxybutynin, are reasonable alternatives.
Which nonpharmacologic treatments are recommended for lower urinary tract symptoms due to benign prostatic hypertrophy?
Limiting evening fluid intake, reducing caffeine and alcohol intake, toilet and bladder training, sitting to urinate, urethral milking, double voiding, bladder retraining, pelvic floor exercises, and mindfulness techniques are recommended to improve symptoms.
What test should be used to screen for tuberculosis in people at risk?
Interferon-gamma release assay (IGRA) and tuberculin skin testing (TST) are the preferred methods of testing for tuberculosis in people at risk. Advantages of IGRA testing include no requirement for a follow-up visit to interpret results and greater sensitivity and specificity. Disadvantages of IGRA testing include cost, and it is not recommended for use in children younger than two years. Advantages of TST include less expense and no need for a laboratory. Disadvantages include the need for more than one visit, trained staff to complete testing, and lower specificity and sensitivity.
What is the preferred treatment for latent tuberculosis infection?
Preferred treatment regimens for latent tuberculosis infection are three to four months in duration and include isoniazid plus rifapentine (Priftin), rifampin alone, or isoniazid plus rifampin.
When should you initiate a medical evaluation for infertility?
For female patients younger than 35 years, begin evaluation after 12 months of regular, unprotected intercourse. For females between 35 and 40 years of age, begin evaluation after six months. Immediate evaluation is recommended for female patients older than 40 years or in those with risk factors for infertility (e.g., history of endometriosis).
How often should you screen children for eye conditions?
The U.S. Preventive Services Task Force and the American Academy of Family Physicians recommend screening children between three and five years of age at least once for amblyopia or its risk factors to improve visual acuity.
Additional Online Only AFP Clinical Answers
What is the treatment for recurrent, symptomatic supraventricular tachycardia?
According to consensus guidelines from the American College of Cardiology and the European Society of Cardiology, catheter ablation is typically recommended as the first-line treatment for recurrent symptomatic supraventricular tachycardia.
When is oxygen indicated for patients with chronic obstructive pulmonary disease?
Guidelines from several organizations recommend prescribing long-term oxygen for patients with chronic obstructive pulmonary disease who experience severe resting hypoxemia, defined as resting oxygenation saturation of 88% or less, to improve mortality. Patients should be instructed to use oxygen for at least 15 hours per day with a goal of oxygen saturation between 88% and 92%. Long-term oxygen therapy is not recommended for patients with moderate resting, nocturnal, or exertional hypoxemia.
How effective is the eradication of Helicobacter pylori for the treatment of functional dyspepsia?
According to a systematic review of 29 studies, H. pylori eradication effectively treats and often cures functional dyspepsia. Patients with proven eradication had a greater likelihood of symptomatic improvement.
Tip for Using AFP at the Point of Care
Do you need to refresh your procedural skills? The AFP video collection includes short, educational videos that have accompanied AFP articles or were submitted as freestanding videos. All videos are peer-reviewed. Available at https://www.aafp.org/afp/videos.html.
A collection of AFP Clinical Answers is available at https://www.aafp.org/afp/answers.
