Critically Appraised Topic Articles

MMR vaccine and autism: Is there a link?

Melissa L. Kemp, MPAS, PA-C; M. Beth Hart, MD, FAAP June 15, 2010

A focused search identifies three studies that disprove the theory of a causal relationship between autism and vaccines.
 

Should patients at low-to-moderate cardiac risk receive beta-blockers before undergoing noncardiac surgery?

Jennifer S. Williams, MMS, PA-C; Kristen K. Will, MHPE, PA-C; Zachary C. Hartsell, MPAS, PA-C; Adriane I. Budavari, MD March 29, 2010

A search of the literature does not support using beta-blocker therapy in patients at lower risks for cardiac events prior to noncardiac surgery.
 

Is black cohosh a safe and effective substitute for hormone replacement therapy?

Elizabeth Becker; Tanya Letham; James D. Stoehr, PhD September 29, 2009

A search of the literature found that patients who wish to avoid hormone replacement therapy are not likely to find relief of their symptoms with this alternative.
 

Does treatment of new-onset hypertension reduce risk of stroke in the elderly?

Ashley D. Finch, PA-C; Karen Graham, MPAS, PA-C August 12, 2009

A search of the medical literature turned up three studies in which the benefits of treating hypertension in persons 80 years and older was demonstrated.
 

Is metformin beneficial for the treatment of infertility in women with PCOS?

Meredith Wisniewski, MPA, PA-C; Martha Petersen, MPH, PA-C April 27, 2009

The conventional initial treatment for women who have infertility due to PCOS has been clomiphene. Do recent studies suggest that metformin is more effective?
 

Does the use of episiotomy protect against postpartum incontinence?

Laura A. Neilsen; Alison Essary, MHPE, PA-C; James Stoehr, PhD March 17, 2009

A 26-year-old woman presents for a routine prenatal visit. She is a primigravida, 34 weeks pregnant, and has been healthy throughout her pregnancy. She has never smoked and stopped social alcohol use before conception. The patient is currently taking prenatal vitamins. She has no known allergies. Her vital signs are within normal limits, and her physical examination findings are all normal.
 

Do thiazolidinediones increase the risk of cardiovascular events?

Jennifer Ribowsky MS, PA-C; Jean Covino, DHSc, MPA, PA-C August 01, 2008

A 56-year-old woman, a nonsmoker, presents to your office seeking better control of her type 2 diabetes mellitus (DM). The diagnosis was made 6 years ago.
 

Can B vitamin therapy help to prevent future vascular events?

Zachary Hartsell, MPAS, PA-C, Adriane I. Budavari, MD May 01, 2007

A 70-year-old man with a history of type 2 diabetes, dyslipidemia, and MI (in 2000) is admitted to the hospital after experiencing difficulty speaking and right hemiparesis upon awakening.
 

Do triptans increase the risk of thromboembolic stroke?

Mark E. Archambault, MHS, RPA-C July 01, 2006

A 32-year-old nonsmoking female migraineur presents to your primary care office seeking more effective abortive treatment for her migraines. She is having one to two headaches per month that are only partially relieved by NSAIDs. Each headache lasts 2 to 3 days and negatively impacts her ability to work and to care for her two children. She is currently asymptomatic. Her medical history is negative for diabetes mellitus, hypertension, and dyslipidemia.
 

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