Which treatments work best for hemorrhoids?

Excision is the most effective treatment for thrombosed external hemorrhoids (strength of recommendation [SOR]: B, retrospective studies). For prolapsed internal hemorrhoids, the best definitive treatment is traditional hemorrhoidectomy (SOR: A, systematic reviews). Of nonoperative techniques, rubber band ligation produces the lowest rate of recurrence (SOR: A, systematic reviews)

Consider these medications to help patients stay sober

Naltrexone can help prevent relapse in recently detoxified patients with alcohol use disorder. The evidence for acamprosate is not quite as strong. Practice changer: Consider prescribing oral naltrexone (50 mg/d) for patients with alcohol use disorder who wish to maintain abstinence after a brief period of detoxification

A spoonful of honey helps a coughing child sleep

When a parent brings in a child (ages 1-5 years) with cough, runny nose, and other symptoms of a viral upper respiratory infection (URI), recommend that honey be given at bedtime. Stength of recommendation: A: Based on a well-designed, randomized controlled trial (RCT)

Mediterranean diet: Higher fat but lower risk

"For patients at high risk for cardiovascular disease, a Mediterranean diet may be the best bet."Counsel patients at high risk for cardiovascular disease and stroke to follow a Mediterranean diet, which is associated with a 30% risk reduction

Injection may be the best bet for young athletes' knee pain

Consider giving dextrose/lidocaine injections to adolescents with Osgood-Schlatter disease (OSD) that persists despite physical therapy. Stength of recommendation: A: Based on one well-designed, randomized controlled trial (RCT)

Surgery for persistent knee pain

Surgery for persistent knee pain? Not so fast. Practice changer: Do not refer patients with a degenerative medial meniscus tear for arthroscopic partial meniscectomy because outcomes are no better than those of conservative treatment

Treating migrane : the case for aspirin

"High-dose aspirin is an effective treatment for acute migraine. So why aren't more physicians recommending it?"Recommend aspirin 975 mg (3 adult tablets) as a viable first-line treatment for acute migraine. Consider prescribing metoclopramide 10 mg to be taken with aspirin to markedly decrease associated nausea and help achieve maximum symptom relief

Steroids for acute COPD - but for how long?

"Steroids for acute COPD--but for how long? Not only was a shorter course of glucocorticoid therapy as effective as a 14-day regimen, but there was no difference in the time to next exacerbation."Prescribe a 5-day regimen of glucocorticoid therapy for acute chronic obstructive pulmonary disease (COPD) exacerbations; the shorter course of treatment appears to be as effective as a 14-day regimen

How do clinical prediction rules compare with joint fluid analysis in diagnosing gout?

Q: How do clinical prediction rules compare with joint fluid analysis in diagnosing gout? Evidence-based answer: Clinical prediction rules effectively diagnose gout without joint fluid analysis. The American College of Rheumatology clinical prediction rules, the most accurate rules developed for research purposes, have a sensitivity of 92%, specificity of 89%, positive likelhood rati of 8.36, and negative likelihood ratio of 0.09 (strength of recommendation [SOR]: A, prospective cohort studies). The Netherlands criteria, developed for use in primary care, have a positive predictive value of more than 80%, a positive likelihood ratio of 3.48, and a negative likelihood ratio of 0.17 (SOR: A, prospective cohort study)