Am Fam Physician. 2022;105(1):19
Are positional therapies effective for treating obstructive sleep apnea?
Positional therapies for obstructive sleep apnea produce moderate improvements (16% to 40% improvement in Epworth Sleepiness Scale) compared with no treatment. Positional therapies are not as effective as continuous positive airway pressure (CPAP).
Is ibuprofen or acetaminophen more effective at reducing fever or pain in children younger than two years?
Ibuprofen is more effective at reducing temperature and pain at various follow-up periods compared with acetaminophen. Further study is needed to evaluate combination therapy, specific dosing, and use in patients younger than six months.
In patients requiring mobility assistive devices, when would it be appropriate to prescribe a cane vs. a walker?
A cane is preferred when only one upper limb is needed to aid in balance or weight-bearing. If both upper limbs are needed, crutches or a walker is more appropriate.
How should pain be managed in labor?
Continuous labor support (such as from a doula) has been shown to increase rates of spontaneous vaginal delivery, decrease the mother's negative feelings about the childbirth experience, and decrease the use of pharmacologic anesthesia. Inhaled analgesia may be beneficial to patients in labor who desire some form of noninvasive pain relief. Parenteral opioids provide pain relief that is superior to nitrous oxide but inferior to regional anesthesia. Neuraxial regional anesthesia provides superior pain relief compared with systemic analgesia, without increasing rates of assisted vaginal delivery or cesarean delivery.
Does lung cancer screening with low-dose computed tomography decrease mortality in smokers?
A systematic review of nine studies showed that people screened with low-dose computed tomography were less likely to die from lung cancer (number needed to treat = 250). Although all-cause mortality was slightly lower in the screened group, this was not statistically significant.
Is consumption of eggs associated with an increased risk of cardiovascular disease?
According to a recent meta-analysis, egg consumption is not associated with an increased occurrence of cardiovascular events over an average of 12 years. Eating more than one egg per day, on average, was associated with an 11% decrease in the likelihood of coronary artery disease. However, this may be due to a healthy user bias (i.e., eating eggs may be associated with healthy habits).
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Is exercise an effective treatment for primary dysmenorrhea?
Low-intensity exercise, such as stretching or core strengthening, and high-intensity exercise, such as Zumba or aerobic training, improve menstrual pain intensity compared with no exercise. It is unclear whether any one type of exercise is superior to another at improving overall menstrual symptoms, mental quality of life, or physical quality of life. There is not enough evidence to determine the benefit or harm of exercise compared with nonsteroidal anti-inflammatory drugs or oral contraceptives.
How should forearm fractures in children be diagnosed and treated?
Ultrasonography is an alternative to radiography for the detection of forearm fractures, with a sensitivity of 97% and specificity of 95%. Distal radius and ulnar buckle fractures in children are treated with short-arm (below-the-elbow) immobilization. Several options are available, including removable splints, wraps or soft casts, without evidence to support one option over another. Recent evidence favors immobilizing nondisplaced distal radius fractures for three weeks rather than the traditional six weeks.
Does colchicine reduce the risk of cardiovascular events in patients with coronary artery disease?
According to a randomized controlled trial of 5,522 patients with documented coronary artery disease, once daily colchicine (0.5 mg) significantly reduces the risk of myocardial infarction and ischemia-driven revascularization. For the compositive outcome of cardiovascular death, myocardial infarction, or ischemic stroke, the number needed to treat was 67 over 29 months.
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