Subject(s)
Colonoscopy , Colorectal Neoplasms , Humans , Mass Screening , Occult Blood , Colorectal Neoplasms/diagnosis , Early Detection of Cancer , FecesABSTRACT
NO. Insulin glargine may lead to less patient-reported, symptomatic, and nocturnal hypoglycemia, although overall, there may not be a difference in the risk for severe hypoglycemia orhypoglycemiarelated emergency department (ED) visits and hospitalizations (strength of recommendation [SOR]: B, systematic review of randomized controlled trials [RCTs], individual RCTs, and observational study).
Subject(s)
Diabetes Mellitus, Type 2/drug therapy , Hypoglycemia/chemically induced , Insulin Glargine/adverse effects , Insulin Glargine/therapeutic use , Insulin, Isophane/adverse effects , Insulin, Isophane/therapeutic use , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Treatment OutcomeSubject(s)
Anticoagulants/therapeutic use , Atrial Fibrillation/complications , Stroke/prevention & control , Vitamin K/antagonists & inhibitors , Warfarin/therapeutic use , Aged , Aged, 80 and over , Anticoagulants/adverse effects , Aspirin/therapeutic use , Fibrinolytic Agents/therapeutic use , Hemorrhage/chemically induced , Humans , Meta-Analysis as Topic , Randomized Controlled Trials as Topic , Risk Factors , Stroke/etiology , Warfarin/adverse effectsABSTRACT
No evidence exists to support a clinical benefit from annual pelvic examinations for asymptomatic women who receive Pap smears every 3 to 5 years. However, the American College of Obstetricians and Gynecologists (ACOG) committee on gynecologic practice recommends annual pelvic exams.
Subject(s)
Genital Neoplasms, Female/diagnosis , Gynecological Examination , Vaginal Smears , Asymptomatic Diseases , Female , Gynecological Examination/standards , Gynecological Examination/statistics & numerical data , Gynecology/standards , Humans , Reproducibility of ResultsSubject(s)
Headache/etiology , Migraine Disorders/diagnosis , Rhinitis/diagnosis , Sinusitis/diagnosis , Diagnosis, Differential , Humans , Migraine Disorders/complications , Nausea/etiology , Pain Measurement , Rhinitis/complications , Severity of Illness Index , Sinusitis/complications , Time Factors , Vomiting/etiologySubject(s)
Electric Stimulation Therapy/methods , Electrodes, Implanted , Low Back Pain/therapy , Analgesics/adverse effects , Analgesics/therapeutic use , Chronic Disease , Family Practice/standards , Family Practice/trends , Female , Humans , Low Back Pain/diagnosis , Male , Pain Measurement , Pain, Intractable/therapy , Patient Satisfaction , Risk Assessment , Spinal Fusion/adverse effects , Spinal Fusion/methods , Treatment Failure , Treatment OutcomeABSTRACT
Prior bacille Calmette-Guerin (BCG) vaccination increases the likelihood of a positive tuberculosis (TB) 5TU purified protein derivative (PPD) skin test. The PPD response following BCG vaccine varies with age at vaccination, number of years since the BCG vaccination, number of times vaccinated, and number of PPDs performed. An induration of greater than 14 mm is unlikely to be due to prior BCG vaccination (strength of recommendation [SOR]: A, based on meta-analysis of validation cohort studies). The variable reaction after BCG vaccination, along with the desire to detect all cases of TB, has led to recommendations that all patients with a positive PPD test be treated as true positives. These patients should undergo chest radiography and appropriate treatment, regardless of history of BCG vaccine (SOR: B, extrapolation from level 1 study). A recently developed alternative is the interferon-gamma assay (QuantiFERON-TB Gold test), which may be used in place of, or in addition to, the PPD skin test for patients who are known to have received a BCG vaccine (SOR: B, extrapolation from a validation cohort study).
Subject(s)
BCG Vaccine/administration & dosage , Tuberculin , Tuberculosis/prevention & control , Cohort Studies , Evidence-Based Medicine , Humans , Immunization, Secondary , Sensitivity and Specificity , Tuberculin Test/statistics & numerical data , Tuberculosis/diagnosis , Tuberculosis/epidemiologyABSTRACT
The best return visit interval to achieve blood pressure control is currently unknown. This study investigates the relationship between return visit interval and percent change in blood pressure. We reviewed a cohort of hypertensive patient charts from two large, urban family practice offices. Four hundred twenty-nine patients with 7910 intervals showed a mean return visit interval of 79.5 days. Blood pressure control occurred during 34.5% of office visits. Pearson's r correlation coefficients between return visit interval and percent change in systolic and diastolic blood pressure demonstrated a small but statistically significant correlation. Shorter return visit intervals were associated with better percent changes in blood pressure. The return visit interval may be a simple and useful tool to improve management of hypertension.
Subject(s)
Hypertension/prevention & control , Office Visits/statistics & numerical data , Outpatients/statistics & numerical data , Blood Pressure/physiology , Blood Pressure Monitoring, Ambulatory/statistics & numerical data , Blood Pressure Monitoring, Ambulatory/trends , Disease Progression , Female , Follow-Up Studies , Humans , Hypertension/physiopathology , Male , Middle Aged , Office Visits/trends , Patient Compliance , Retrospective Studies , Urban PopulationABSTRACT
Several interventions may reduce the risk of contrast nephropathy for high-risk patients; however, most evidence uses surrogate markers for clinically relevant outcomes. Because dehydration is a risk factor for developing contrast nephropathy, periprocedural hydration is routinely recommended (strength of recommendation [SOR]: C, expert opinion). Single studies have suggested that isotonic saline is associated with less risk than half-normal saline, and hydration with fluids containing sodium bicarbonate is more efficacious than those containing isotonic saline (SOR: B, single randomized controlled trial [RCT]). Oral acetylcysteine lowers the risk of postcontrast elevations in creatinine if taken more than 24 hours before contrast administration (SOR: A, RCTs). Acetylcysteine's low cost and favorable side effect profile make it an appealing option. Hypo-osmolar contrast media are less likely to induce contrast nephropathy than hyper-osmolar media (SOR: A, RCTs). Finally, hemofiltration might be considered for patients with extremely high risk of developing contrast nephropathy (SOR: B, single RCT).
