Am Fam Physician. 2024;109(5):online
Are patients with nonerosive gastroesophageal reflux disease at an increased risk of esophageal cancer compared with the average population?
A prospective cohort study followed more than 480,000 patients in Scandinavia for 32 years after undergoing endoscopy and found that nonerosive gastroesophageal reflux disease does not increase the likelihood of esophageal cancer. However, erosive gastroesophageal reflux disease is associated with a doubled, but still low, risk of developing cancer, with the likelihood increasing over time.
What should be included when counseling individuals who desire a levonorgestrel intrauterine device?
Approximately 35% of patients with a levonorgestrel intrauterine device will experience frequent or prolonged bleeding in the first 3 months after insertion, but systematic reviews have shown that most patients will experience a reduction in bleeding within 12 months of use.
What is the risk of sexually transmitting HIV when viral loads are less than 1,000 copies per mL?
A systematic review of eight studies of more than 7,000 HIV-discordant couples across 25 countries found that when the viral load was less than 1,000 copies per mL, there was nearly no chance of sexual transmission.
How long should patients wait to become pregnant after undergoing bariatric surgery?
Practice guidelines from multiple organizations recommend avoiding pregnancy for 12 to 24 months because this is the period of most rapid weight loss and potential nutritional deficiencies.
Which hospitalized patients should receive prophylaxis to prevent venous thromboembolism?
Prophylaxis is recommended for all hospitalized patients to reduce the risk of deep venous thrombosis, pulmonary embolism, and death from any cause, except for patients classified as low risk by a clinical prediction score.
Which agents are most effective in relieving pain in adults with renal colic?
In a network meta-analysis, acetaminophen and ketorolac were more effective than morphine in alleviating pain and were less likely to cause adverse effects and a need for rescue analgesia.
Additional Online Only AFP Clinical Answers
Does inhaled corticosteroid monotherapy improve exacerbation outcomes in patients with stable chronic obstructive pulmonary disease (COPD)?
A Cochrane review of 36 randomized controlled trials found that inhaled corticosteroid monotherapy decreases the likelihood of exacerbations in patients with stable COPD compared with placebo.
What treatments for type 2 diabetes mellitus reduce mortality and other cardiac-related outcomes?
A meta-analysis of randomized controlled trials found that sodium-glucose cotransporter-2 (SGLT-2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists reduce all-cause and cardiovascular mortality and other cardiac-related problems. Older treatments, including insulin, do not affect long-term outcomes. Metformin was not found to be more effective than standard treatment in preventing important outcomes. More information on the pros and cons of prescribing metformin for type 2 diabetes is in AFP's March 2024 issue.
What is the first-line treatment for chronic insomnia?
Cognitive behavior therapy for insomnia should be used as first-line treatment for chronic insomnia because it improves sleep quality, insomnia severity, daytime fatigue, total sleep time, and beliefs and attitudes about sleep.
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