What are effective treatments for oppositional defiant behaviors in adolescents?

Psychological interventions for the family-- such as parenting skills training and behavioral therapy for the child, the parents, or the whole family--reduce conflict behaviors in adolescents with oppositional defiant disorder (ODD) (strength of recommendation [SOR]: C, based on extrapolation from systematic reviews of younger children with ODD and adolescents with conduct disorder). ODD most commonly does not occur as a solitary diagnosis.When ODD is associated with attention deficit/ hyperactivity disorder (ADHD) or other medication-responsive comorbid conditions, medical treatment reduces overall symptoms (SOR: B, based on a meta-analysis of adolescent and younger children with both ODD and ADHD)

Postcholecystectomy diarrhea: What relieves it?

A trial of a bile acid binder such as cholestyramine or colestipol may benefit patients with postcholecystectomy diarrhea (strength of recommendation [SOR]: C, case series). Although postcholecystectomy diarrhea is uncommon and rarely severe, it can be debilitating (SOR: B, prospective case-control study)

Can patients with steatohepatitis take statins?

Patients with steatohepatitis who take HMG Co-A reductase inhibitors (statins) lower their elevated liver enzymes and show evidence of improvement in fatty liver on follow-up imaging (strength of recommendation [SOR]: C, based on very small, short-term prospective studies). Statins do not further increase transaminase levels for patients with pre-existing transaminase elevations (SOR: B, based on 2 retrospective cohort studies). However, for patients with decompensated liver disease or advanced cirrhosis, balance the benefits of statins against the risks (SOR: C, based on expert opinion)

Are antibiotics effective for otitis media with effusion?

Antibiotics provide little or no long-term benefit for children with otitis media with effusion (OME), defined as fluid in the middle ear without signs or symptoms of infection. Most meta-analyses show a modest, short-term reduction in effusion rates. However, the most rigorous meta-analysis shows no benefit (strength of recommendation [SOR]: D, based on conflicting meta- analyses). No significant effect was noted on longer-term (>1 month) outcomes after treatment (SOR: A, based on a meta-analysis of 8 trials). In addition, there is no reliable evidence regarding patient-oriented outcomes (hearing loss, speech delay)

How should we monitor men receiving testosterone replacement therapy?

Monitor hematocrit and bone mineral density (BMD) (strength of recommendation [SOR]: B, meta-analysis of non−patient-oriented outcomes). Monitoring prostate-specific antigen (PSA), performing prostate digital rectal examination, and observing symptom response to testosterone are also recommended, although direct evidence is lacking (SOR: C, consensus opinion). Monitoring lipid levels is unnecessary (SOR: A, based on several meta-analyses), as is monitoring testosterone levels (SOR C, consensus opinion). Unless the patient is taking oral testosterone, no evidence exists for or against monitoring liver function (SOR: C, consensus opinion)

How effective are exercise and physical therapy for chronic low back pain?

Exercise is more effective for chronic low back pain than treatment with medication plus return to usual activity and as effective as conventional physiotherapy. The evidence is less consistent in showing that any particular exercise format provides greater benefit or that exercise provides a long-term increase in function or a decrease in pain or disability. (Grade of recommendation: A, based on systematic reviews of randomized controlled trials [RCTs].

Thiazolidinedione Therapy for Managing Metabolic Syndrome

There is no patient-oriented evidence supporting the use of TZD therapy in patients in the general population who have metabolic syndrome. Rosiglitazone (Avandia) use decreases cardiovascular morbidity and mortality in patients with metabolic syndrome who are undergoing coronary stenting. (Strength of Recommendation: B, based on a single randomized controlled trial). Effects of TZD therapy on nonglycemic markers of metabolic syndrome are inconsistent compared with the effects of other hypoglycemic medications

When should we screen children for hyperlipidemia?

Children should be screened for hyperlipidemia when there is a history of familial hypercholesterolemia (strength of recommendation [SOR]: C). No clear evidence supports screening all children or just those with family history of cardiovascular disease (CVD) or hyperlipidemia (SOR: C)

What are the indications for evaluating a patient with cough for pertussis?

Pertussis should be considered in infants with apnea or severe coughing illnesses of any duration, and in older children or adults with prolonged cough (eg, longer than 2 weeks), especially if accompanied by inspiratory whoop or household exposure to a prolonged cough illness (strength of recommendation [SOR]: B, based on consecutive cohort studies with poor reference standards). Coughing paroxysms, posttussive vomiting, and absence of fever, while typical of pertussis, are of little help in distinguishing it from other causes of prolonged coughing illnesses (SOR: B, based on consecutive cohort studies with poor reference standards)

What is the most effective treatment for acute low back pain?

Nonsteroidal anti-inflammatory drugs (NSAIDs) are more effective than placebo for pain relief in patients with acute low back pain (grade of recommendation: A). There is no consistent evidence that NSAIDs are more effective than acetaminophen (grade: D). Muscle relaxants are effective for short-term relief of acute low back pain (grade: A), but there is no added benefit when they are used in combination with NSAIDs (grade: B). Advice to remain active speeds recovery compared with short-term bed rest (grade: A). There is no consistent evidence that epidural steroid injections are effective for acute low back pain (grade: D). Spinal manipulation or back exercises are no more effective than medications alone (grade: B)