CLINICAL PEARLS: INSTANT RECOMMENDATIONS

NSAIDS vs. Oral Analgesics: Is there a difference?

     NO. NSAID’s (ibuprofen, naproxen, celecoxib) are of equal efficacy compared to other analgesics, including acetaminophen and opioids, for acute sprains and strains. There was no significant difference between NSAID’s and acetaminophen at one to two hours, one to three days, or seven days or more following treatment. The same was true when compared to opioids especially after 7-10 days where NSAID patients had greater return to function. No difference was found between NSAID’s and the combination of an opioid and acetaminophen. 

Rec: Patients should use oral NSAID’s or acetaminophen rather than opioids for acute musculoskeletal pain, excluding back pain.

What lifestyle changes prevent diverticulitis?

     A high fiber diet, tobacco cessation, reduced meat intake, physical activity, and weight loss are recommended to prevent diverticulitis and avoid recurrences. Contrary to popular thought, popcorn, nuts, and seeds are not significant risk factors for diverticulitis.

Do all patients with diverticulitis require antibiotics?

     NO. Uncomplicated diverticulitis can be treated without antibiotics, and patients who were not had shorter hospital stays than those treated with antibiotics.

Who should be screened for abdominal aortic aneurysms?

     Men age 65-75 who ever smoked and those who never smoked but have risk factors for AAA—hypertension, family history of AAA. Women age 65-75 who ever smoked and have a family history of AAA. 

Is intravenous iron infusion superior to oral iron for patients who refuse blood transfusion?

     NO. Oral iron and IV iron infusion are equally inferior to blood transfusion. In an emergency situation, oral and IV iron can be given, but are clearly inadequate. 

Who should be screened for lung cancer?

     Low-dose computed tomography (LDCT) is recommended to screen for lung cancer in people age 50-80 with a 20-pack-year history who continue smoke or have quit within 15 years of screening. Screening should be done every two years, but for higher risk patients annually.

Does physical activity help patients with Type 2 Diabetes Mellitus?

     YES. Combined aerobic and resistance exercise leads to greater improvement in A1C levels than either form of exercise alone. High-intensity periods of exercise lead to greater blood sugar control in less total exercise time, but can cause transient post-exercise elevated blood sugar because of muscle fiber injury. 

Is resistance to antibiotics increasing worldwide?

     YES. Bacteria that cause many common infections have increased their ability to resist (render ineffective) antibiotics which previously were effective. This problem puts millions of lives at risk of several common bacterial infections that heretofore were easily treated.

 Is Type II Diabetes increasing in teens and young adults?

     YES. Worldwide, over a 30-year time period, the incidence of Type II diabetes among young people aged 15-39 increased 56%. Women younger than 30 years had a higher incidence than men, but after age 30 the ratio reversed. High body mass index (obesity) was the main contributing factor. Air pollution, smoking, and poor nutrition contributed as well.

References: PRACTICE GUIDELINES. “Lung Cancer Screening: Guidelines From the American  College of Chest Physicians” Am Fam Phys 2023 January;107(1):100-102.

PRACTICE GUIDELINES. “Physical Activity in Patients with Type 2 Diabetes Mellitus: Updated Consensus Statement from the American College of Sports Medicine” Am Fam Phys 2923 January;107(1):103-104.

AFP Clinical Answers. Am Fam Phys 2023 January;107(1):22.

Cochrane for Clinicians. Clebak KT, Weaver LK, Croad JR “Oral NSAID’s vs. Other Oral Analgesic Agents for Acute Soft Tissue Injury” Am Fam Phys 2023 January;107(1):23.

GLOBAL HEALTH: Increasing antimicrobial resistence poses global threat. JAMA 2023 January 17;329(3):200.

GLOBAL HEALTH: More adolescents and young adults developing Type II diabetes around the world. JAMA 2923 January 17;329(3):200.