Diabetic Peripheral Neuropathy, Influenza Vaccine, Delirium, Peanut Ball in Labor, Pancreatic Cancer, Gallstone Disease
Am Fam Physician. 2024;110(1):21
What are first-line options for the treatment of painful diabetic peripheral neuropathy?
Duloxetine (Cymbalta) and pregabalin (Lyrica) are first-line agents for the treatment of painful diabetic peripheral neuropathy; amitriptyline and gabapentin are considered alternative first-line agents because they have more adverse effects.
Is a high-dose recombinant influenza vaccine (FluBlok) more effective than a standard-dose, egg-based vaccine in adults 50 to 64 years of age?
A U.S.-based cluster randomized controlled trial of 1.6 million participants found that high-dose, egg-free recombinant vaccines offer a very small absolute reduction in the risk of influenza but have no effect on hospitalization. The recombinant vaccines may be less likely to have a mismatch due to antigenic drift from year to year, but this has not been proven because the match for these vaccines was relatively poor during the study years.
Does melatonin prevent hospital-acquired delirium?
According to a systematic review and meta-analysis of 14 randomized controlled trials with more than 1,700 hospitalized adults, melatonin should not be used to prevent hospital-acquired delirium because it does not reduce the incidence, duration, or complications of delirium, including increased length of stay or mortality.
Does using a peanut ball with pregnant patients with an epidural improve labor outcomes?
A meta-analysis of randomized controlled trials found that using a peanut ball with epidural anesthesia and regular position changes decreases the duration of first-stage labor by 87 minutes compared with usual care.
What imaging should be ordered for patients with suspected pancreatic cancer?
Pancreas-protocol, contrast-enhanced abdominal computed tomography should be performed to evaluate for suspected pancreatic cancer.
Is it safe to wait-and-watch patients with symptomatic, uncomplicated gallstone disease?
According to a randomized controlled trial of more than 400 patients, uncomplicated gallstones can be managed over time with analgesia and monitoring, although approximately 25% of patients will undergo cholecystectomy within 18 months. It appears there is no need to rush to surgery without evidence of common bile duct blockage or acute pancreatitis.
Additional Online Only AFP Clinical Answers
Does cognitive behavior therapy improve fatigue in patients with long COVID?
A randomized controlled trial of 114 Dutch adults found that cognitive behavior therapy significantly improves symptoms compared with usual care in patients with severe fatigue for at least 3 months after having COVID-19.
When suggesting weight loss to patients, is a framework highlighting the benefits of weight loss better than one that highlights the risks of excessive weight?
According to a prospective cohort study of more than 200 recorded conversations, presenting weight loss as an opportunity is a better approach than scolding patients for their weight. Framing weight loss in terms of its positive effects, rather than listing the risks of excessive weight, increased weight loss and participation in a weight-loss program.
To what extent does the wrong cuff size affect blood pressure readings?
A randomized crossover trial of 195 outpatient participants found that using a regular cuff on arms that are larger than average can falsely raise blood pressure readings by almost 5 mm Hg, and a regular cuff on an especially thin arm can lower readings by 3.6 mm Hg. More than one-half of the study group required a large or extra-large cuff.
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