Am Fam Physician. 2024;109(1):87
What is the first-line treatment for chronic rhinosinusitis?
Consistent evidence from randomized controlled trials shows that intranasal saline irrigation and intranasal corticosteroids improve sinonasal symptoms in patients with chronic rhinosinusitis.
When should a child with cryptorchidism (undescended testicle) be referred to a urologist?
Referral for surgical consultation is recommended by six months of age or at the time of diagnosis in older patients.
Is there a difference in the rate of major adverse cardiovascular events when comparing chlorthalidone with hydrochlorothiazide to treat hypertension?
According to a trial of more than 13,000 patients, both medications are effective, and there is no difference in cardiovascular outcomes when hydrochlorothiazide is compared with chlorthalidone. There is a slightly higher risk of hypokalemia with chlorthalidone.
What are the effects of intra-articular steroid injections on hyperglycemia in patients with diabetes mellitus?
In patients with well-controlled type 2 diabetes, blood glucose levels may reach peak values of 165 to 500 mg per dL (9.16 to 27.75 mmol per L) at two to 84 hours after intra-articular steroid injections and return to baseline in 18 hours to 21 days. Patients with poorly controlled diabetes should be informed of the potential risk of transient hyperglycemia following an intra-articular steroid injection and should closely monitor glucose levels, particularly for one to three days after injection.
How can you increase deprescribing rates while overseeing a benzodiazepine taper?
Cognitive behavior therapy with gradual tapering may increase success rates of deprescribing compared with tapering alone. Consider adjunct pharmacotherapy using tricyclic antidepressants, paroxetine, carbamazepine, or pregabalin (Lyrica) to facilitate benzodiazepine tapering and reduce withdrawal symptoms.
Is it safe to use antihistamines during pregnancy?
Consistent evidence from case-control and cohort studies shows that first- and second-generation antihistamines are safe to use throughout pregnancy.
Additional Online Only AFP Clinical Answers
Can delirium in hospitalized older adults be prevented?
The Hospital Elder Life Program is a multidisciplinary strategy that addresses sleep hygiene, cognitive impairment, immobility, visual and hearing impairments, and dehydration and should be used to prevent delirium. Antipsychotic medications should not be used for the prevention of delirium in hospitalized adults.
How effective is varenicline in helping willing adults to quit smoking?
A 2023 Cochrane review compared the effectiveness of varenicline (Chantix) with different strategies for smoking cessation. Existing high-certainty evidence indicates that varenicline is more effective than placebo, no medication, bupropion, or nicotine replacement monotherapy for smoking cessation. The number needed to treat is eight to be abstinent from smoking at six months or more. The number needed to harm was 166 for serious adverse events. Notably, there was no significant difference in neuropsychiatric symptoms or cardiac adverse events.
What screening is recommended for diagnosing hypertension in adults?
The U.S. Preventive Services Task Force recommends screening for hypertension in adults with office blood pressure measurements and then confirming with home measurements or 24-hour ambulatory monitoring before starting antihypertensive medications.
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