Tamsulosin for patients with ureteral stones?

Tamsulosin for patients with ureteral stones? Yes, but only for some. Find out which of your patients can benefit. PRACTICE CHANGER: Prescribe tamsulosin for stone expulsion in patients with distal ureteral stones 5 to 10 mm in size.Authors: Pamela Hughes, MD; Corey Lyon, DO Nellis AFB Family Medicine Residency, Las Vegas, Nev (Dr. Hughes); University of Colorado Family Medicine Residency, Denver (Dr. Lyon)

Steroids during late preterm labor: better later than never

Review of: Gyamfi-Bannerman C, Thom EA, Blackwell SC, et al; NICHD Maternal-Fetal Medicine Units Network. Antenatal betamethasone for women at risk for late preterm delivery. N Engl J Med. 2016;374:1311-1320.Steroids during late preterm labor: Better later than never. Steroids--even when administered in the last leg of the late preterm period--still reduce the likelihood of respiratory complications in newborns. Practice changer: Use steroids in women at risk of preterm delivery, even if they are 36 weeks, 6 days-pregnant, because steroids may reduce respiratory complications in the newborn with minimal risk for neonatal or maternal complications

A new protocol for RhD-negative pregnant women?

Can cell-free DNA testing reduce unnecessary use of anti-D immunoglobulin in RhD-negative women and still prevent harm to their RhD-positive infants? PRACTICE CHANGER: Employ cell-free DNA testing at 27 weeks' gestation in your RhD-negative obstetric patients to reduce unnecessary use of anti-D immunoglobulin.Authors: Corey Lyon, DO; Aimee English, MD, University of Colorado Family Medicine Residency Program, Denver, Col

Do-it-yourself cervical cancer screening?

Enlisting patients to self-collect specimens for human papillomavirus testing is an effective way to detect cervical precancer in those who might not otherwise undergo cervical cancer screening. PRACTICE CHANGER: Have patients who decline a pelvic examination self-collect a specimen for human papillomavirus polymerase chain reaction testing as an alternative to a clinician-collected one. STRENGTH OF RECOMMENDATION: Meta-analysis of observational trials

Do probiotics reduce C diff risk in hospitalized patients?

Review of: Shen NT, Maw A, Tmanova LL, et al. Timely use of probiotics in hospitalized adults prevents Clostridium difficile infection: a systematic review with meta-regression analysis. Gastroenterology. 2017;152:1889-1900. e9.Do probiotics reduce C diff risk in hospitalized patients? A systematic review and meta-analysis says, "Yes," but that doesn't necessarily mean they will start appearing on hospital formularies. Practice changer: Start probiotics within 1 to 2 days of starting antibiotics in hospitalized patients to reduce the risk of Clostridium difficile infection.Matthew Simpson, MD, MPH; Corey Lyon, DO, University of Colorado, Family Medicine Residency, DenverIncludes bibliographical reference

Are inhaled steroids effective for a postviral cough?

Q: Are inhaled steroids effective for a postviral cough? Evidence-based answer: No. Inhaled corticosteroids (ICS) don't improve postviral cough in adults with subacute (3-8 weeks) or chronic (>8 weeks) cough, adolescents with a history of asthma but without recent asthma activity, or children with a history of episodic viral wheezing without asthma (strength of recommendation [SOR]: B, preponderance of small randomized controlled trials [RCTs])

What is the best treatment for nocturnal enuresis in children?

For children with primary nocturnal enuresis, treatment with enuresis alarms reduced the number of wet nights by almost 4 per week, with almost half of patients remaining dry for 3 months after treatment (strength of recommendation [SOR]: A, based on a systematic review of homogeneous randomized control trials [RCTs]). Desmopressin (DDAVP) and tricyclic drugs reduce the number of wet nights by 1 to 2 per week during treatment, although the effect is not sustained after treatment is finished (SOR: A, based on a SR of homogeneous RCTs). Dry bed training with an alarm results in an additional reduction of wet nights over alarms alone (SOR: A, based on a systematic review of homogeneous RCTs]

Nutritional vitamin D deficiency: a case report

We present a 6-month-old African American male child with a chief complaint of failure to appropriately gain weight despite adequate caloric intake via breastfeeding. While he has met developmental milestones he appears small for age and is diagnosed with failure to thrive after crossing two major growth curve percentiles. After appropriate diagnostic workup, a diagnosis of nutritional vitamin D deficiency (rickets) was reached and supplementation was initiated with ensuing adequate catch-up growth

Do corticosteroid injections improve carpal tunnel syndrome symptoms?

Q: Do corticosteroid injections improve carpal tunnel syndrome symptoms? Evidence-based answer: Yes. injected corticosteroids reduce symptoms of carpal tunnel syndrome (CTS) more effectively than placebo or systemic steroids, but no better than anti-inflammatory medication and splinting, from one to 12 weeks after therapy (strength of recommendation [SOR]: A, meta-analysis of randomized controlled trials [RCTs] and consistent RCT). A 40-mg injection of methylprednisolone reduces symptoms as effectively as an 80-mg injection for as long as 10 weeks, but the 80-mg dose reduces progression to surgery at one year (SOR: B, RCT). Long-term effects of injections decrease by 12 months (SOR: B, RCT). After corticosteroid injections, 14% of patients proceed to surgery at one year, and 33% proceed to surgery at 5 years (SOR: B, cohort trial)

Need an add-on to metformin? Consider this

Review of: Ou SM, Shih CJ, Chao PW, et al. Effects of clinical outcomes of adding dipeptidyl peptidase-4 inhibitors versus sulfonylureas to metformin therapy in patients with type 2 diabetes mellitus. Ann Intern Med. 2015;163:663-672.1.Need an add-on to metformin? Consider this. Sulfonylureas have been the preferred add-on therapy to metformin for T2DM, but a study finds that DPP-4s have lower risks of death, CV events, and hypoglycemia. Practice changer: Consider a dipeptidyl peptidase-4 inhibitor before a sulfonylurea for patients with type 2 diabetes mellitus who require therapy in addition to metformin