Low Back Pain in Children, CVD and Obstetric History, Sarcoidosis, Penicillin Allergies, Myocardial Infarction, Venous Ulcers
Am Fam Physician. 2024;109(4):312
When should children with low back pain be referred to a spine surgeon?
If there is progressive or high-grade spondylolisthesis (anterior slippage of the vertebrae to grade 3 or higher), development of any neurologic deficits, or no improvement following at least 6 months of conservative management, the patient should be referred to a spine surgeon.
What is the role of obstetric history when assessing CVD risk?
Adverse pregnancy conditions, such as preeclampsia and gestational diabetes mellitus, should be considered risk-enhancing factors when addressing cardiovascular disease (CVD) risk for statin therapy.
What is first-line treatment for pulmonary sarcoidosis?
Oral corticosteroids are first-line treatment in patients with pulmonary sarcoidosis because they improve chest radiograph appearance, spirometry, and symptoms; however, they do not appear to improve long-term disease progression.
Is an amoxicillin oral provocation challenge safe and accessible for distinguishing an erroneous penicillin allergy from a true one in adults and children?
A retrospective cohort study reported that the outcome of an amoxicillin oral provocation challenge—conducted in 99 adults and children who were initially labeled as having a penicillin allergy—subsequently identified the participants by history to be at low risk of having a true allergy. A total of 96 patients (97%) completed an amoxicillin oral provocation challenge with no reaction, which resulted in removal of an erroneous penicillin allergy label. The three patients who had an allergic reaction had mild symptoms and required minimal intervention (i.e., no epinephrine). Use of this method to identify the millions of adults and children who have been incorrectly labeled as having a penicillin allergy may result in significant health care savings by eliminating the use of alternative antibiotics that are less effective and safe and more expensive.
What should be recommended to all patients with a recent history of myocardial infarction?
Influenza vaccination, smoking cessation counseling, and referral to cardiac rehabilitation improve mortality in patients with recent myocardial infarction.
Is compression therapy with bandages, stockings, or other devices safe and effective for treating venous ulcers in adults?
According to a Cochrane review of 14 randomized controlled trials, therapy involving compression bandages or stockings results in faster and more complete ulcer healing over 12 months, reduced pain, and improved disease-specific quality of life compared with treatment featuring no compression. It is unclear whether compression increases adverse effects or is cost-effective.
Additional Online Only AFP Clinical Answers
What intervention decreases the risk of relapse for patients admitted to an acute care setting for an asthma exacerbation?
Children and adults admitted to an acute care setting for an asthma exacerbation should be discharged with oral corticosteroids.
Should gastroesophageal reflux be treated with medications in infants?
Gastroesophageal reflux occurs in up to two-thirds of healthy infants, usually beginning at two to three weeks of age and peaking between four to five months of age. The American Academy of Pediatrics and Choosing Wisely recommend against the use of antireflux medications (histamine H2 receptor antagonists or proton pump inhibitors) in infants with reflux that is effortless, painless, and not affecting growth.
What is an option for pain relief in patients with osteoarthritis of the knee?
Intra-articular corticosteroid injections offer short-term relief of pain caused by osteoarthritis of the knee. Find information on injection techniques in the January issue of AFP.
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