Testosterone replacement and improved memory

Dr Lyon is Associate Professor of Family Medicine, Dr Wong is an instructor and fellow in family medicine, and Ms DeSanto is a clinical librarian, all at the University of Colorado in Denver.Clinical Inquires question: Does testosterone replacement improve cognition in memory-impaired older men with low testosterone? Evidence-based answer: Testosterone therapy does not appear to improve cognition in older men with low testosterone and memory impairment (strength of recommendation B, based on systematic reviews of small, low-quality randomized controlled trials [RCTs] and individual, small RCTs).Corey Lyon, DO; Alicia Wong, MD, MPH, MA; Kristen DeSanto, MSLS, MS, RD, AHIPCan Fam Physician 2021;67:e9. DOI: 10.46747/cfp.6701e9Includes bibliographical reference

How effective is spironolactone for treating resistant hypertension?

Q: How effective is spironolactone for treating resistant hypertension? EVIDENCE-BASED ANSWER: VERY EFFECTIVE. Spironolactone reduces systolic blood pressure (SPB) by 11 to 17 mm Hg and diastolic blood pressure (DPB) by up to 6 mm Hg in patients with resistant hypertension taking 3 or more medications (strength of recommendation [SOR]: C, meta-analysis of randomized controlled trials [RCTs] of disease-oriented evidence).Corey Lyon, DO; Brigitte Utter, MD, University of Colorado, Family Medicine Residency, Denver; Kristen DeSanto, MSLS, MS, RD, University of Colorado, Health Sciences Library, Denve

What is the best treatment for wrist ganglion cysts?

Q: What is the best treatment for wrist ganglion cysts? Evidence-based answer: Open surgical excision of wrist ganglion cysts is associated with a lower recurrence rate than aspiration with or without corticosteroid injection (strength of recommendation [SOR]: B, systematic review of randomized clinical trials [RCTs] and observational trials and RCT). Even though the recurrence rate with aspiration is about 50%, most patients are satisfied with aspiration and report a decrease in symptoms involving pain, function, and range of motion (SOR: B, individual cohort and case series).Corey Lyon, DO; Stephanie V. Eldred, MD (University of Colorado Family Medicine Residency, Denver); Kristen DeSanto, MSLS, MS, RD, AHIP (University of Colorado Health Sciences Library, Denver)Includes bibliographical reference

How do hyaluronic acid and corticosteroid injections compare for knee OA relief?

Authors: Corey Lyon, DO; Emily Spencer, MD; Jack Spittler, MD University of Colorado Family Medicine Residency, Denver; Kristen Desanto, MSLS, MS, RD, AHIP University of Colorado Health Sciences Library, Aurora.Q How do hyaluronic acid and corticosteroid injections compare for knee OA relief? A: Inconsistent evidence shows a small amount of pain relief early (one week to 3 months) with corticosteroid (CS) injections and an equally small improvement in pain relief and function later (3 to 12 months) with hyaluronic acid (HA) injections (strength of recommendation [SOR]: B, meta-analysis of a randomized controlled trial [RCT] and inconsistent RCTs). Guidelines state that CS injections can be considered for symptomatic knee osteoarthritis (OA), but that insufficient evidence exists to recommend HA injections (SOR: B, evidence-based guidelines)

How do oral NSAIDs compare to other oral analgesics right after an acute musculoskeletal injury?

Q: How do oral NSAIDs compare to other oral analgesics right after an acute musculoskeletal injury? A: nonsteroidal anti-inflammatory drugs(NSAIDs) are at least as effective as other oral analgesics (opioids, acetaminophen) in relieving pain in the first few days after an acute musculoskeletal injury. Evidence also indicates that using NSAIDs results in fewer adverse events than using narcotics (strength of recommendation [SOR]: A, systematic review of randomized controlled trials [RCTs], as well as individual RCTs).Authors: Corey Lyon, DO; Susan Piggott, MD, MPH; Shannon Langner, MD University of Colorado Family Medicine Residency, Denver; Kristen DeSanto, MSLS, MS, RD University of Colorado Health Sciences Library, Denver

Are antipsychotics effective adjunctive Tx for patients with moderate-to-severe depression?

Q: Are antipsychotics effective adjunctive Tx for patients with moderate-to-severe depression? Evidence-based answer: YES. Augmentation with second-generation antipsychotics, especially aripiprazole and quetiapine, appears to be effective in patients with moderate-to-severe depression who have had a suboptimal response to a selective serotonin reuptake inhibitor or a serotonin-norepinephrine reuptake inhibitor (strength of recommendation [SOR]: A, based on a systematic review of randomized controlled trials [RCTs] and an individual RCT). Augmenting antidepressant therapy with cariprazine, ziprasidone, or olanzapine also appears to improve depressive symptoms over the short term. All antipsychotics studied carried an increased likelihood of adverse effects that could lead to discontinuation (SOR: A, based on a systematic review of RCTs).Heather Bleacher, MD, MPH; Lindsay Koerperich, MD; Naomi Malam, MD, MSPH (University of Colorado Family Medicine Residency, Denver) Kristen DeSanto, MSLS, MS, RD (University of Colorado Health Sciences Library, Denver)Includes bibliographical reference

Effectiveness of dermoscopy in skin cancer diagnosis

Clinical Inquiries question: Does dermoscopy improve the effectiveness of skin cancer diagnosis when used for skin cancer screening? Evidence-based answer: Dermoscopy added to visual inspection is more accurate than visual inspection alone in the diagnosis of melanoma and basal cell carcinoma (BCC). However, there is insufficient evidence to draw conclusions on the effectiveness of dermoscopy in the diagnosis of squamous cell carcinoma (SCC; strength of recommendation B: based on systematic reviews of randomized controlled trials [RCTs], and prospective and retrospective observational studies).Sydney Davis, MD; Cleveland Piggott, MD, MPH; Corey Lyon, DO; Kristen DeSanto, MSLS, MS, RD, AHIPDr Davis is a resident family physician, Dr Piggott is Assistant Professor and Director of Diversity & Health Equity for Family Medicine, Dr Lyon is Associate Professor in the Department of Family Medicine, and Ms DeSanto is Clinical Librarian in the Strauss Health Sciences Library, all at the University of Colorado in Denver.Includes bibliographical reference

Do behavioral interventions improve nighttime sleep in children < 1 year old?

Q: Do behavioral interventions improve nighttime sleep in children < 1 year old? Evidence-based answer: YES. Infants respond to behavioral interventions, although objective data are limited. Behavioral interventions include establishing regular daytime and sleep routines for the infant, reducing environmental noises or distractions, and allowing for self-soothing at bedtime (strength of recommendation: B, based on multiple randomized and nonrandomized studies).Morgan Hungenberg, DO; BreAnna Houss, MD; Madhav Narayan, MD; Corey Lyon, DO (University of Colorado Family Medicine Residency, Denver) Kristen DeSanto, MSLS, MS, RD (University of Colorado Health Sciences Library, Denver)Includes bibliographical reference

Does hormone replacement therapy prevent cognitive decline in postmenopausal women?

Q: Evidence-based answer: NO. Hormone replacement therapy (HRT) does not prevent cognitive decline in postmenopausal women—and in fact, it may slightly increase risk (strength of recommendation, A; systematic review, meta-analysis of randomized controlled trials [RCTs], and individual RCT).Madeline Gates, MD; Melissa Beagle, MD, MPH; Lauren Bull, MD; Roxanne Radi, MD, MPH; Corey Lyon, DO (University of Colorado, Family Medicine Residency), Kristen DeSanto, MSLS, MS, RD (University of Colorado, Health Sciences Library), Rick Guthmann, MD, MPH (Advocate Health Care Illinois Masonic Medical Center Program)Includes bibliographical reference