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Management of Acute Achilles Tendon Rupture - FPIN's Clinical Inquiries - American ...

Jun 1, 2015 - There are no clear evidence-based criteria to decide which patients should undergo operative vs. nonoperative management of acute Achilles tendon rupture.

American Family Physician : FPIN's Clinical Inquiries

https://www.aafp.org/afp/2015/0601/p794.html

Individualizing Target Goals and Treatment in Patients with Type 2 Diabetes - POEMs - ...

Jun 1, 2015 - This statement from American and European diabetes societies suggests that tighter control of hyperglycemia be attempted only in patients with a recent diagnosis and a low risk of hypoglycemia; who have a long life expectancy with few or no comorbidities, including cardiovascular ...

American Family Physician : POEMs

https://www.aafp.org/afp/2015/0601/p788.html

Aclidinium for Stable COPD - Cochrane for Clinicians - American Family Physician

Jun 1, 2015 - Aclidinium did not decrease all-cause mortality or exacerbations requiring oral steroids, antibiotics, or both. However, aclidinium decreased the number of patients with exacerbations requiring hospitalization and improved quality of life in those with stable COPD.

American Family Physician : Cochrane for Clinicians

https://www.aafp.org/afp/2015/0601/p760.html

Common Questions About the Management of Gastroesophageal Reflux Disease - American ...

May 15, 2015 - Common questions that arise regarding treatment of gastroesophageal reflux disease (GERD) include which medications are most effective, when surgery may be indicated, which patients should be screened for Barrett esophagus and Helicobacter pylori infection, and which adverse effects ...

American Family Physician : Article

https://www.aafp.org/afp/2015/0515/p692.html

Common Questions About Chronic Low Back Pain - American Family Physician

May 15, 2015 - More than 30% of U.S. adults report having experienced low back pain within the preceding three months. Although most low back pain is nonspecific and self-limiting, a subset of patients develop chronic low back pain, defined as persistent symptoms for longer than three months. Low back...

American Family Physician : Article

https://www.aafp.org/afp/2015/0515/p708.html

Acute Infective Sore Throat - Clinical Evidence Handbook - American Family Physician

May 15, 2015 - What are the effects of interventions to reduce symptoms of acute infective sore throat?

American Family Physician : Clinical Evidence Handbook

https://www.aafp.org/afp/2015/0515/p689.html

Beta-Lactam Not as Effective as Beta-Lactam Plus Macrolide for Treating CAP in the ...

May 15, 2015 - In this noninferiority trial, monotherapy with a beta-lactam was not as effective as combination therapy with a beta-lactam and a macrolide for achieving clinical stability in seven days for hospitalized patients with moderately severe CAP.

American Family Physician : POEMs

https://www.aafp.org/afp/2015/0515/p720.html

Provision of Contraception: Key Recommendations from the CDC - American Family Physician

May 1, 2015 - The Centers for Disease Control and Prevention has released comprehensive recommendations for provision of family planning services. Contraceptive services may be addressed in five steps, and counseling may be provided in a tiered approach, whereby the most effective options are ...

American Family Physician : Article

https://www.aafp.org/afp/2015/0501/p625.html

Treatments for Sciatica - FPIN's Clinical Inquiries - American Family Physician

May 1, 2015 - Surgical diskectomy can be offered to patients with refractory sciatica, but there is only modest, short-term improvement in leg pain and disability scores. Epidural steroid injections may be offered to patients with sciatica of more than six months' duration.

American Family Physician : FPIN's Clinical Inquiries

https://www.aafp.org/afp/2015/0501/p612.html

No Long-Term Benefit of Arthroscopic Surgery for Meniscal Tears in Middle-Aged Persons ...

May 1, 2015 - Arthroscopic repair of degenerative meniscal tears in middle-aged adults does not significantly improve long-term pain or function. Patients should do physical therapy and try to avoid surgery if possible.

American Family Physician : POEMs

https://www.aafp.org/afp/2015/0501/p643.html

Increased GI Bleeding After Switch from Warfarin to Dabigatran - POEMs - American ...

May 1, 2015 - The risk of bleeding increases (though remains small) when patients with atrial fibrillation are switched from warfarin to dabigatran to prevent stroke or transient ischemic attack. This study, conducted almost exclusively in male veterans, found an increase in gastrointestinal (GI) ...

American Family Physician : POEMs

https://www.aafp.org/afp/2015/0501/p648.html

Options for Women with Unintended Pregnancy - American Family Physician

Apr 15, 2015 - Unintended pregnancy refers to unwanted, unplanned, or mistimed pregnancies. One-half of all pregnancies in the United States are unintended, and family physicians are often asked to provide counseling, support, and resources for women with unintended pregnancies. Options include ...

American Family Physician : Article

https://www.aafp.org/afp/2015/0415/p544.html

Naltrexone/Bupropion (Contrave) for Weight Loss - STEPS - American Family Physician

Apr 15, 2015 - Naltrexone/bupropion produces clinically significant weight loss when combined with a diet and exercise program. It decreases body weight in patients with diabetes, but its effect on diabetic outcomes is not known. A significant proportion of patients will experience adverse effects.

American Family Physician : STEPS

https://www.aafp.org/afp/2015/0415/p554.html

ACE Inhibitors vs. ARBs for Primary Hypertension - Cochrane for Clinicians - American ...

Apr 15, 2015 - ACE inhibitors and ARBs have similar effects on cardiovascular outcomes and total mortality in head-to-head trials. However, slightly more adverse effects were noted in patients assigned to ACE inhibitor therapy.

American Family Physician : Cochrane for Clinicians

https://www.aafp.org/afp/2015/0415/p522.html

Counseling Patients with Unintended Pregnancy - Curbside Consultation - American Family...

Apr 15, 2015 - Nearly one-half of all pregnancies in the United States are unintended. Risk factors for unintended pregnancy include limited access to contraception, less than a college education, poor social support, age between 20 and 24 years, and black race. Family physicians are often the initial...

American Family Physician : Curbside Consultation

https://www.aafp.org/afp/2015/0415/p574.html

Magnesium Sulfate for Prevention of Preterm Birth - Cochrane for Clinicians - American ...

Apr 1, 2015 - Magnesium sulfate does not delay delivery when used in patients with preterm labor. Although magnesium sulfate is not associated with any serious adverse maternal outcomes, it may be associated with an increase in total fetal, neonatal, and infant mortality.

American Family Physician : Cochrane for Clinicians

https://www.aafp.org/afp/2015/0401/p444.html

Advance Directives: Navigating Conflicts Between Expressed Wishes and Best Interests - ...

Apr 1, 2015 - Clinicians and surrogates can be faced with challenging decisions when a patient loses the capacity to participate in medical decision making. A significant number of hospitalized and critically ill adults lose decision-making capacity during hospital stays and cannot make treatment ...

American Family Physician : Curbside Consultation

https://www.aafp.org/afp/2015/0401/p480.html

Ondansetron for Gastroenteritis in Children and Adolescents - Medicine by the Numbers -...

Apr 1, 2015 - Studies show vomiting stopped in 1 in 5 patients and diarrhea was a consistent adverse effect. Find out more.

American Family Physician : Medicine by the Numbers

https://www.aafp.org/afp/2015/0401/od3.html

Immediate-Release Methylphenidate for the Treatment of ADHD in Adults - Cochrane for ...

Apr 1, 2015 - In adults with ADHD, immediate-release methylphenidate improves symptoms of hyperactivity, impulsiveness, and inattentiveness compared with placebo. Short-term adverse effects such as weight loss and decreased appetite do not appear to be serious. However, larger studies of longer ...

American Family Physician : Cochrane for Clinicians

https://www.aafp.org/afp/2015/0401/p445.html

CIN Treatment May Increase Miscarriages but Does Not Affect Fertility - POEMs - ...

Apr 1, 2015 - In this analysis of 15 observational studies (it would be difficult and unethical to do randomized research on this topic), excision using any method for CIN did not affect fertility, although second trimester miscarriages were more likely. A study published at the same time found the ...

American Family Physician : POEMs

https://www.aafp.org/afp/2015/0401/p490.html

Valsartan/Sacubitril Reduces Mortality More Than Enalapril 10 mg Twice Daily in ...

Apr 1, 2015 - The combination of an angiotensin receptor blocker (valsartan) and neprilysin inhibitor (sacubitril) reduces cardiovascular mortality more than an angiotensin-converting enzyme (ACE) inhibitor (enalapril [Vasotec]) alone, with an acceptable safety and tolerability profile. The choice of...

American Family Physician : POEMs

https://www.aafp.org/afp/2015/0401/p490a.html

Thrombolysis for DVT: Has the Time Arrived? - AFP Journal Club - American Family Physician

Apr 1, 2015 - Catheter-directed thrombolysis for proximal DVT is experimental but may be considered in a patient with phlegmasia and resulting compartment syndrome.

American Family Physician : AFP Journal Club

https://www.aafp.org/afp/2015/0401/p430.html

Optimal Treatment of Acute Venous Thromboembolism - POEMs - American Family Physician

Apr 1, 2015 - This complex network meta-analysis of eight treatment regimens for acute venous thromboembolism found that a combination of unfractionated heparin and vitamin K antagonists is associated with the least effective strategy with the highest risk of recurrent events.

American Family Physician : POEMs

https://www.aafp.org/afp/2015/0401/p492.html

Primary Hypothyroidism - Clinical Evidence Handbook - American Family Physician

Mar 15, 2015 - What are the effects of treatments for clinical (overt) hypothyroidism and subclinical hypothyroidism?

American Family Physician : Clinical Evidence Handbook

https://www.aafp.org/afp/2015/0315/p359.html

Mixed Benefits of Gluten-Free Diet in Asymptomatic Patients with Celiac Disease - POEMs...

Mar 15, 2015 - Screening of asymptomatic relatives of patients with known celiac disease identified approximately 5% who were antibody-positive. Compared with their normal diet, a gluten-free diet improved some yet unrecognized symptoms but seemed to interfere with normal social activities in these ...

American Family Physician : POEMs

https://www.aafp.org/afp/2015/0315/p402.html

ART for HIV: Recommendations from the International Antiviral Society—USA Panel - ...

Mar 15, 2015 - The International Antiviral Society—USA Panel has provided recommendations for management of HIV infection with antiretroviral therapy (ART). Evidence has shown that ART for treatment of human immunodeficiency virus (HIV) infection is effective in preventing transmission among couples. ...

American Family Physician : Practice Guidelines

https://www.aafp.org/afp/2015/0315/p396.html

Post-Myocardial Infarction Beta Blockers Do Not Decrease Mortality - POEMs - American ...

Mar 15, 2015 - Although recommended by guidelines and used as a so-called quality indicator of hospital care, the use of beta blockers following myocardial infarction, when combined with optimal acute and chronic treatment, does not provide a further survival benefit.

American Family Physician : POEMs

https://www.aafp.org/afp/2015/0315/p402a.html

Practical Selection of Antiemetics in the Ambulatory Setting - American Family Physician

Mar 1, 2015 - Nausea and vomiting are mediated primarily by three neurotransmitter pathways: visceral stimulation releases dopamine and serotonin; vestibular and central nervous system activation release histamine and acetylcholine; and chemoreceptor trigger zone activation releases dopamine and ...

American Family Physician : Article

https://www.aafp.org/afp/2015/0301/p293.html

Vortioxetine (Brintellix) for the Treatment of Depression - STEPS - American Family ...

Mar 1, 2015 - Current evidence does not support the routine use of vortioxetine in the treatment of depression. Family physicians most often encounter patients with mild to moderate depression, and vortioxetine has not been studied in this population. There is no clear benefit of using vortioxetine ...

American Family Physician : STEPS

https://www.aafp.org/afp/2015/0301/p325.html

Risk of Venous Thromboembolism with Use of Combined Oral Contraceptives - Cochrane for ...

Mar 1, 2015 - All combined oral contraceptives increase VTE risk. The risk is greater for those containing desogestrel, drospirenone, gestodene (not available in the United States), and cyproterone acetate (not available in the United States) when compared with levonorgestrel. All combined oral ...

American Family Physician : Cochrane for Clinicians

https://www.aafp.org/afp/2015/0301/p287.html

Improving Quality by Doing Less: Overtreatment - Editorials - American Family Physician

Mar 1, 2015 - The third in a series of AFP editorials that addresses the related issues of over-screening, overdiagnosis, and overtreatment. Overtreatment is an important harm that commonly follows overscreening and overdiagnosis.

American Family Physician : Editorials

https://www.aafp.org/afp/2015/0301/p289.html

Controlled-Release Oxycodone for Neuropathic Pain and Fibromyalgia in Adults - Cochrane...

Mar 1, 2015 - Oxycodone CR has limited effectiveness for the treatment of diabetic neuropathy or postherpetic neuralgia. Evidence is lacking regarding treatment benefit for other neuropathic pain syndromes or fibromyalgia. Adverse effects of oxycodone CR therapy are common.

American Family Physician : Cochrane for Clinicians

https://www.aafp.org/afp/2015/0301/p286.html

Injection Equals Physical Therapy for Shoulder Impingement - POEMs - American Family ...

Feb 15, 2015 - Both physical therapy and corticosteroid injection decrease pain and disability by about 50% within one month of beginning treatment. However, average scores will not improve beyond that over the course of the year, and the average person will have pain, disability, and an altered ...

American Family Physician : POEMs

https://www.aafp.org/afp/2015/0215/p260a.html

Metformin Associated with Less Need for a Second Medicine - POEMs - American Family ...

Feb 15, 2015 - n this retrospective analysis, which benefits from large numbers of patients but suffers from possible biases, patients who initially took an oral hypoglycemic other than metformin (Glucophage) were significantly more likely to require a second oral agent.

American Family Physician : POEMs

https://www.aafp.org/afp/2015/0215/p261.html

Common Questions About the Initial Management of Hypertension - American Family Physician

Feb 1, 2015 - Hypertension is the most common chronic condition treated by family physicians. Elevated blood pressure is associated with an increased risk of heart failure, myocardial infarction, cerebrovascular disease, and death. Treatment of hypertension reduces the risk of these events. Several ...

American Family Physician : Article

https://www.aafp.org/afp/2015/0201/p172.html

Cesarean Delivery: Counseling Issues and Complication Management - American Family ...

Feb 1, 2015 - Nearly one-third of all deliveries in the United States are cesarean deliveries. Compared with spontaneous vaginal delivery, cesarean delivery is associated with increased maternal and neonatal morbidity and mortality. Interventions that decrease the chance of a cesarean delivery ...

American Family Physician : Article

https://www.aafp.org/afp/2015/0201/p178.html

Angiotensin-Converting Enzyme Inhibitors vs. Angiotensin Receptor Blockers - FPIN's ...

Feb 1, 2015 - ACE inhibitors should be used in patients with hypertension because they reduce all-cause mortality, whereas ARBs do not.

American Family Physician : FPIN's Clinical Inquiries

https://www.aafp.org/afp/2015/0201/p193.html

Alpha Blockers to Speed Ureteral Stone Passage - Cochrane for Clinicians - American ...

Feb 1, 2015 - Compared with patients receiving standard therapy (e.g., fluids, analgesics), placebo, or calcium channel blockers, patients receiving alpha blockers had about three fewer days to ureteral stone expulsion and were less likely to be hospitalized. Adverse effects of alpha blocker therapy ...

American Family Physician : Cochrane for Clinicians

https://www.aafp.org/afp/2015/0201/p164.html

Buprenorphine Maintenance vs. Methadone Maintenance or Placebo for Opioid Use Disorder ...

Feb 1, 2015 - At dosages greater than 2 mg per day, buprenorphine maintains treatment retention better than placebo. When flexible dosing (doses adjusted based on patient symptoms) is used, the effectiveness of buprenorphine is comparable to that of methadone in suppressing opioid use.

American Family Physician : Cochrane for Clinicians

https://www.aafp.org/afp/2015/0201/p165.html

Colorectal Cancer Screening and Surveillance - American Family Physician

Jan 15, 2015 - Colorectal cancer is the third most common cancer in men and women. The incidence and mortality rate of the disease have been declining over the past two decades because of early detection and treatment. Screening in persons at average risk should begin at 50 years of age; the U.S. ...

American Family Physician : Article

https://www.aafp.org/afp/2015/0115/p93.html

Common Questions About Wound Care - American Family Physician

Jan 15, 2015 - Lacerations, abrasions, burns, and puncture wounds are common in the outpatient setting. Because wounds can quickly become infected, the most important aspect of treating a minor wound is irrigation and cleaning. There is no evidence that antiseptic irrigation is superior to sterile ...

American Family Physician : Article

https://www.aafp.org/afp/2015/0115/p86.html

Medications for Treatment of Interstitial Cystitis - FPIN's Clinical Inquiries - ...

Jan 15, 2015 - There are no long-term clinically effective oral medications. Pentosan (Elmiron) can improve overall symptom scores for interstitial cystitis over three to six months, but it does not improve scores for any of three individual symptoms (dysuria, urgency, frequency) compared with placebo.

American Family Physician : FPIN's Clinical Inquiries

https://www.aafp.org/afp/2015/0115/p116.html

Absence Seizures in Children - Clinical Evidence Handbook - American Family Physician

Jan 15, 2015 - What are the effects of treatments for typical absence seizures in children?

American Family Physician : Clinical Evidence Handbook

https://www.aafp.org/afp/2015/0115/p114.html

AHA and ASA Release Guideline for Prevention of Future Stroke in Patients with Stroke ...

Jan 15, 2015 - The American Heart Association (AHA) and American Stroke Association (ASA) have updated their guideline on prevention of future stroke in patients with a history of stroke or transient ischemic attack (TIA). Currently, the average annual rate of future stroke in these patients is at a ...

American Family Physician : Practice Guidelines

https://www.aafp.org/afp/2015/0115/p136.html

Evidence Does Not Show Benefit of Treating Mycoplasma Pneumonia in Children - POEMs - ...

Jan 15, 2015 - After all these years of knowing about Mycoplasma pneumoniae as a cause of lower respiratory tract infections and the effectiveness of various antibiotics against it in a Petri dish, we still do not know whether treating mycoplasma pneumonia in children is effective. This study does not...

American Family Physician : POEMs

https://www.aafp.org/afp/2015/0115/p132.html

Antidepressants and Psychological Therapies Are Effective for IBS - POEMs - American ...

Jan 15, 2015 - Antidepressants and psychological therapies are effective in treating the symptoms of IBS. This study, an update of a similar systematic review and meta-analysis completed five years ago, found the same level of effectiveness for both treatment approaches as the previous analysis, ...

American Family Physician : POEMs

https://www.aafp.org/afp/2015/0115/p134.html

Increasing HDL Level Ineffective at Decreasing Cardiovascular Events - POEMs - American...

Jan 15, 2015 - Being the good cholesterol is not the same as being the useful cholesterol. Drug therapy aimed at increasing HDL cholesterol levels, when added to statin treatment, does not decrease patients' likelihood of experiencing a cardiovascular event or of dying earlier.

American Family Physician : POEMs

https://www.aafp.org/afp/2015/0115/p133.html

Surveillance of the Adult Cancer Survivor - American Family Physician

Jan 1, 2015 - The term cancer survivor refers to anyone living with a diagnosis of cancer. As the U.S. population ages, cancer screening increases, and cancer treatments improve, millions more Americans will be classified as cancer survivors in the future. Although many survivors wish to continue ...

American Family Physician : Article

https://www.aafp.org/afp/2015/0101/p29.html

Zinc Supplementation in Children Six Months to 12 Years of Age - Cochrane for ...

Jan 1, 2015 - Preventive zinc supplementation for children in low- and middle-income countries appears to reduce rates of diarrhea and may slightly reduce rates of growth failure.

American Family Physician : Cochrane for Clinicians

https://www.aafp.org/afp/2015/0101/p27.html

Methotrexate Therapy for Rheumatoid Arthritis - Cochrane for Clinicians - American ...

Jan 1, 2015 - Methotrexate monotherapy demonstrated statistically significant and clinically relevant improvement of symptoms and physical function compared with placebo at 12 to 52 weeks. Multiple adverse effects were reported with methotrexate use, and patients were twice as likely to discontinue ...

American Family Physician : Cochrane for Clinicians

https://www.aafp.org/afp/2015/0101/p26.html

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