Ischemic Heart Disease, Hearing Screening, Olfactory Dysfunction, Gestational Diabetes, More
Am Fam Physician. 2023;108(6):online
For patients with moderate to severe reversible ischemic heart disease, does adding an initial invasive strategy to medical therapy reduce mortality more than medical therapy alone?
Based on a large, randomized controlled trial, an early invasive strategy for patients with moderate to severe ischemic heart disease does not reduce mortality; at best, it shifts mortality from cardiovascular to noncardiovascular causes for those with multivessel disease.
How often should children be screened for hearing impairment according to guidelines?
The American Academy of Pediatrics Bright Futures guideline recommends universal hearing screening at birth; four, five, six, eight, and 10 years of age; and once between 11 and 14, 15 and 17, and 18 and 21 years of age.
What can you offer patients distressed by olfactory dysfunction?
Evidence from systematic reviews and meta-analyses shows that olfactory training (self-administered mindful exposure therapy) may improve olfactory function.
What treatments should be offered for patients diagnosed with gestational diabetes mellitus?
Practice guidelines recommend starting with glucose monitoring and education on nutrition and exercise. Although insulin is the preferred medication for treating gestational diabetes due to long-term evidence of safety, metformin may also be considered because of its improved perinatal outcomes compared with insulin after discussing risks and uncertainties. Glyburide can be considered as a third-line option.
Is letrozole superior to clomiphene for infertility treatment for individuals with polycystic ovary syndrome?
A meta-analysis of randomized controlled trials showed that for individuals with polycystic ovary syndrome, treatment of infertility with letrozole compared with clomiphene resulted in a higher rate of ovulation induction, more pregnancies, and more live births. The conclusions are less than certain due to the high risk of bias in some studies.
Can peripartum depression be prevented?
The U.S. Preventive Services Task Force recommends referring pregnant patients at risk of peripartum depression for psychotherapy (cognitive behavior therapy or interpersonal psychotherapy). Therapy can reduce the risk of developing peripartum depression by 39%.
Additional Online Only AFP Clinical Answers
How should you assess for the risk of developing pressure injuries?
Consensus guidelines recommend using a standardized risk assessment tool, such as the Braden Score, to determine the risk of pressure injuries. Individuals at higher risk should have regular skin examinations to evaluate skin integrity, erythema, firmness, moisture, pain, and variations in heat.
Does patient-initiated home management of asthma exacerbations with increased doses of ICSs reduce the need for further intervention compared with a daily maintenance dosage?
According to a Cochrane review, children and adults with mild to moderate persistent asthma and symptoms consistent with an acute asthma exacerbation who are treated with increased doses of inhaled corticosteroids (ICSs) show no reduction in the need for further intervention with primarily systemic corticosteroids vs. patients treated with stable doses of ICSs. Similarly, increased doses of ICSs do not reduce unscheduled visits to physicians, acute care facilities, emergency departments, or hospital admissions compared with stable doses of ICSs.
What are the four abilities a patient must demonstrate to ensure they can make an informed medical decision?
To provide informed consent for a medical treatment, a patient must demonstrate the ability to: 1) understand information about their medical condition; 2) appreciate the implications of the proposed treatment options; 3) exhibit logical reasoning about the options; and 4) communicate a choice.
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