Anne Mounsey's research while affiliated with University of North Carolina at Chapel Hill and other places

Publications (108)

Article
Which history and exam findings have high predictive value for different causes of chest pain? Which decision tool can best assess for CAD in your practice setting?
Article
A 17-year-old man with no significant medical history presented with new-onset seizure activity and altered mental status manifesting as bizarre behaviour, which included rapid pressured and tangential speech, psychomotor agitation, insomnia and delusions. He also had autonomic dysregulation, manifested in labile blood pressures. He had been recent...
Article
Guidelines for the diagnosis and treatment of Clostridioides difficile infection have recently been updated. Risk factors include recent exposure to health care facilities or antibiotics, especially clindamycin. C. difficile infection is characterized by a wide range of symptoms, from mild or moderate diarrhea to severe disease with pseudomembranou...
Article
Functional dyspepsia is defined as at least one month of epigastric discomfort without evidence of organic disease found during an upper endoscopy, and it accounts for 70% of dyspepsia. Symptoms of functional dyspepsia include postprandial fullness, early satiety, and epigastric pain or burning. Functional dyspepsia is a diagnosis of exclusion; the...
Article
Full-text available
We typically take a blood pressure within 3 minutes of a patient rising from a supine to a standing position. But is that too long?
Article
What physical findings should raise your suspicion? How are tumors treated and what follow-up care can you provide? Here's what you need to know.
Article
Background Computer-based learning (CBL) is considered by many to be an effective means of education. However, features of computer-based modules purported to contribute to learning have not been studied with medical student education. Objective This study was designed to evaluate the effect of auditory supplements in a computer-based instructiona...
Article
A meta-analysis reveals that there may be advantages associated with SGLT-2 inhibitors and GLP-1 agonists that are not associated with DPP-4 inhibitors.
Article
No. Niacin doesn't reduce cardiovascular disease (CVD) morbidity or mortality in patients with established disease (strength of recommendation [SOR]: A, meta-analyses of randomized controlled trials [RCTs] and subsequent large RCTs). Niacin may be considered as monotherapy for patients intolerant of statins (SOR: B, one well-done RCT).
Article
Certain medications used for migraine prevention in adults do not perform the same way in children and adolescents and can actually cause harm.
Article
&NA; Eswaran SL, Chey WD, Han‐Markey T, Ball S, Jackson K. A randomized controlled trial comparing the low FODMAP diet vs. modified NICE guidelines in US adults with IBS‐D. Am J Gastroenterol. 2016; 111(12):1824–1832.
Article
A 24-year-old G2P1 at 24 weeks' gestation presents to your clinic for a routine prenatal visit. Her older daughter has asthma and she is inquiring as to whether there is anything she can do to lower the risk of her second child developing asthma in the future. What do you recommend?
Article
EVIDENCE‐BASED ANSWER We do not know the answer yet. No studies have evaluated the development of diabetes in prediabetic children treated with metformin. Metformin therapy does, however, decrease body mass index (BMI), fasting glucose, and fasting insulin levels (SOR: B, RCTs).
Article
EVIDENCE‐BASED ANSWER Risk of pelvic inflammatory disease (PID) does not differ between same‐day or delayed insertion for women without overt cervicitis (SOR: A, meta‐analysis of RCTs and prospective cohort). Same‐day insertion increases probability of continued IUD use compared with delayed ins...
Article
&NA; Prandoni P, Lensing AW, Prins MH, Ciammaichella M, Perlati M, Mumoli N, et al. Prevalence of pulmonary embolism among patients hospitalized for syncope. N Engl J Med. 2016; 375(16):1524–1531.
Article
EVIDENCE‐BASED ANSWER Yes, depending on dose. Compared with untreated controls, carbamazepine, lamotrigine, levetiracetam, and phenytoin, higher doses of valproate (≥800 mg/d) are associated with lower IQ scores at age 6 and delays in cognitive development at age 2 (SOR: B, based on prospective cohort studies).
Article
EVIDENCE‐BASED ANSWER Yes, by most measures. Amitriptyline leads to large reductions in the frequency of migraines compared with placebo over 24 weeks (SOR: B, meta‐analysis of conflicting RCTs). Amitriptyline leads to 1 less migraine per month compared with placebo at 12 weeks and about twice as many patients reportin...
Article
EVIDENCE&hyphen;BASED ANSWER Maternal periodontitis is associated with increased risk of low birth weight &lpar;<2,500 g&rpar; &lpar;SOR&colon; B, prospective cohort study&rpar;. Maternal periodontitis may be associated with shorter gestation &lpar;SOR&colon; B, conflicting prospective cohort and cross&hyphen;sectional studies, with better quality...
Article
PRACTICE CHANGER The Step&hyphen;by&hyphen;Step approach is the most sensitive algorithm for the management of infants with fevers without a source in the emergency department &lpar;ED&rpar;, allowing providers to decrease invasive testing and antibiotic treatment of low&hyphen;risk infants. Strength of recommendation&colon; B, based on a multicent...
Article
&NA; Marso SP, Daniels GH, Brown&hyphen;Frandsen K, Kristensen P, Mann JF, Nauck MA, et al. Liraglutide and cardiovascular outcomes in type 2 diabetes. N Engl J Med. 2016&semi; 375&lpar;4&rpar;&colon;311–322.
Article
With various formulations available, which combined OC should you recommend to minimize not only the risk of PE, but also the risk of stroke and MI? Copyright © 2017. The Family Physicians Inquiries Network. All rights reserved.
Article
&NA; Weill A, Dalichampt M, Raguideau F, Ricordeau P, Blotière PO, Rudant J, et al. Low dose oestrogen combined oral contraception and risk of pulmonary embolism, stroke, and myocardial infarction in five million French women&colon; cohort study. BMJ. 2016&semi; 353&colon;i2002.
Article
&NA; Hollis BW, Wagner CL, Howard CR, et al. Maternal versus infant vitamin D supplementation during lactation&colon; a randomized controlled trial. Pediatrics. 2015&semi; 136&lpar;4&rpar;&colon;625–634.
Article
EVIDENCE&hyphen;BASED ANSWER The answer is unclear for all Latino farmworkers. However, immigrant farmworkers from Mexico have higher levels of depression than US&hyphen;born farmworkers of Mexican ancestry &lpar;SOR&colon; C, retrospective cohort study&rpar;. Immigrant farmworkers are at a higher risk of experiencing psychological distress, having...
Article
Counsel patients who want to quit smoking that doing so abruptly leads to higher cessation rates than does quitting gradually.
Article
&NA; Lonn EM, Bosch J, López&hyphen;Jaramillo P, et al. Blood&hyphen;pressure lowering in intermediate&hyphen;risk persons without cardiovascular disease. N Engl J Med. 2016&semi; 374&lpar;21&rpar;&colon;2009–2020
Article
&NA; Yusuf S, Lonn E, Pais P, et al. Blood&hyphen;pressure and cholesterol lowering in persons without cardiovascular disease. N Engl J Med. 2016&semi; 374&lpar;21&rpar;&colon;2032–2043.
Article
Yes, this technology can help in the short term. Mobile technology compared with minimal or no intervention increases short-term (⟨6 months) weight loss (1.4 to 2.7 kg) in overweight and obese patients. Interventions that combine nonelectronic measures with mobile technology increase weight loss more effectively (3.7 kg) than no intervention.
Article
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.
Article
Parents no longer need to struggle to get their kids to drink electrolyte solutions during episodes of mild gastroenteritis; apple juice works just as well.
Article
Both home-based interventions (HBIs) and clinic-based interventions (CBIs) reduce readmission rates for patients with heart failure (HF) by 24% and 31%, respectively, over usual care (SOR: A, systematic review of RCTs). all-cause readmission rates do not differ between HBI and CBI (SOR: B, single RCT).
Article
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 likelihood ratio of 8.36, and negative likelihood ratio of 0.09.
Article
EVIDENCE&hyphen;BASED ANSWER No. Garcinia cambogia plus diet and exercise does not cause a meaningful increase in weight loss over diet and exercise alone &lpar;SOR&colon; B, meta&hyphen;analysis of poor&hyphen;quality RCTs and 2 RCTs&rpar;.
Article
This study's findings regarding the risk of miscarriage may mean it's time to forego fluconazole in favor of topical azoles as first-line treatment.
Article
Evidence&hyphen;Based Answer Probably not by itself, but it may help. Additional telephone counseling with text message support after a 2&hyphen;month intensive weight loss program does not decrease body mass index &lpar;BMI&rpar;, BMI z&hyphen;score, or waist&hyphen;to&hyphen;height ratio compared with no additional contact &lpar;SOR&colon; B, sin...
Article
Treatment of influenza virus infection with oral oseltamivir reduces time to alleviation of symptoms in adults and children by approximately one day compared with placebo. It reduces symptom duration even when initiated more than 2 days after symptom onset.
Article
While bright light therapy already has a place in the treatment of seasonal affective disorder, a recent trial spotlights its utility beyond the winter months.
Article
Evidence&hyphen;Based Answer Hospital telemetry in adult patients with syncope has a diagnostic yield ranging from 5&percnt; to 16&percnt; &lpar;SOR&colon; B, cohort studies&rpar;. The diagnostic yield can be increased with the use of diagnostic algorithms such as the San Francisco Syncope Rule &lpar;SOR&colon; B, cohort studies&rpar;.
Article
The SPRINT trial demonstrated the benefits--and risks--of reaching a systolic target <120 mm Hg in non-diabetic patients at high risk for CV events. Here's who might benefit.
Article
Favorable results from the 2 studies reviewed here have prompted ACOG to recommend that cell-free DNA screening be discussed with all pregnant patients.
Article
Non-sterile gloves are just as effective as sterile gloves in preventing surgical site infection after minor skin surgeries.
Article
Evidence&hyphen;Based Answer Effective pharmacologic treatment of depression results in a moderate improvement in alcohol consumption in patients with comorbid alcohol use disorder &lpar;SOR&colon; A, meta&hyphen;analysis of RCTs&rpar;. Simultaneous treatment of depression and alcohol use disorder with pharmacotherapy or psychotherapy likely improv...
Article
Chronic constipation is common in adults older than 60 years, and symptoms occur in up to 50% of nursing home residents. Primary constipation is also referred to as functional constipation. Secondary constipation is associated with chronic disease processes, medication use, and psychosocial issues. Fecal impaction should be treated with mineral oil...
Article
Evidence&hyphen;Based Answer About 10&percnt; more patients with acute sinusitis who use intranasal corticosteroids &lpar;INCS&rpar; will have complete or partial improvement than patients given placebo &lpar;SOR&colon; A, meta&hyphen;analysis&rpar;. Patients who receive INCS therapy and antibiotics may have better outcomes than those given antibio...
Article
Evidence&hyphen;Based Answer “Kangaroo mother care” &lpar;KMC&rpar; or skin&hyphen;to&hyphen;skin care with nearly exclusive breastfeeding reduces morbidity, mortality, severe infection, nosocomial infection, hypothermia, and length of hospital stay in low&hyphen;birthweight &lpar;LBW&rpar; and preterm infants in low&hyphen; to middleincome countri...
Article
&NA; Eng C, Kramer CK, Zinman B, et al. Glucagon&hyphen;like peptide&hyphen;1 receptor agonist and basal insulin combination treatment for the management of type 2 diabetes&colon; a systematic review and meta&hyphen;analysis. Lancet. 2014&semi; 384&lpar;9961&rpar;&colon;2228–2234.
Article
&NA; Rahimi RS, Singal AG, Cuthbert JA, Rockey DC. Lactulose vs polyethylene glycol 3350&hyphen;electrolyte solution for treatment of overt hepatic encephalopathy&colon; the HELP randomized clinical trial. JAMA Intern Med. 2014&semi; 174&lpar;11&rpar;&colon;1727–1733.
Article
Naltrexone can help prevent relapse in recently detoxified patients with alcohol use disorder. The evidence for acamprosate is not quite as strong.
Article
&NA; Cheng YW, Shaffer BL, Nicholson JM, et al. Second stage of labor and epidural use&colon; a larger effect than previously suggested. Obstet Gynecol. 2014&semi; 123&lpar;3&rpar;&colon; 527–535.
Article
&NA; Jonas DE, Amick HR, Feltner C, et al. Pharmacotherapy for adults with alcohol use disorders in outpatient settings&colon; a systematic review and meta&hyphen;analysis. JAMA. 2014&semi; 311&lpar;18&rpar;&colon;1889–1900.
Article
&NA; Sihvonen R, Paavola M, Malmivaara A, et al&semi; Finnish Degenerative Meniscal Lesion Study &lpar;FIDELITY&rpar; Group. Arthroscopic partial meniscectomy versus sham surgery for a degenerative meniscal tear. N Engl J Med. 2013&semi; 369&lpar;26&rpar;&colon;2515–2524.
Article
&NA; Suissa S, Patenaude V, Lapi F, Ernst P. Inhaled corticosteroids in COPD and the risk of serious pneumonia. Thorax. 2013&semi; 68&lpar;11&rpar;&colon;1029–1036.
Article
For patients with knee pain from a torn medial meniscus, but no osteoarthritis, arthroscopic partial meniscectomy may not be necessary.
Article
&NA; Darney BG, Snowden JM, Cheng YW, et al. Elective induction of labor at term compared with expectant management&colon; maternal and neonatal outcomes. Obstet Gynecol. 2013&semi; 122&lpar;4&rpar;&colon;761–769.
Article
There's a better way to clear secretions from a neonate's mouth and nose, and it's less likely to cause adverse effects.
Article
Yes, yoga can reduce symptoms of anxiety and depression. Across multiple RCTs using varied yoga interventions and diverse study populations, yoga typically improves overall symptom scores for anxiety and depression by about 40%, both by itself and as an adjunctive treatment. It produces no reported harmful side effects.
Article
Do not routinely initiate beta-blockers in patients undergoing intermediate- or high-risk noncardiac surgery. Beta-blockers appear to increase the 30-day risk of all-cause mortality.
Article
Evidence&hyphen;Based Answer High&hyphen;dose, oral acyclovir &lpar;800 mg 5 times daily for 7–10 days&rpar; appears effective in clearing the rash of pityriasis rosea &lpar;PR&rpar; and is superior to oral erythromycin in shortening the interval of the disease &lpar;SOR&colon; B, RCTs&rpar;. Erythromycin may be effective against PR &lpar;SOR&colon...
Article
A 4-week course of American ginseng, taken while patients are undergoing radiation or chemotherapy, can reduce cancer-related fatigue.
Article
A 40-year-old woman with a history of bilateral tubal ligation and a recent diagnosis of metastatic neuroendocrine tumour in the liver presented with severe nausea, vomiting, diarrhoea and dehydration. She had an inconclusive urine pregnancy test in the emergency department that was followed by an extremely high serum β-human chorionic gonadotropin...
Article
Allopurinol and febuxostat reduce the frequency of gout attacks equally after 8 weeks of treatment.
Article
Full-text available
Hepatitis C is a common cause of cirrhosis, hepatocellular carcinoma, and liver transplant. Although it is usually asymptomatic, new screening recommendations will lead to increased recognition by primary care physicians. Rapidly evolving treatment recommendations are making this a treatable infection for many patients. Recognition of the infection...
Article
&NA; Leuppi JD, Schuetz P, Bingisser R, et al. Short&hyphen;term vs. conventional glucocorticoid therapy in acute exacerbations of chronic obstructive pulmonary disease&colon; the REDUCE randomized clinical trial. JAMA. 2013&semi; 309&lpar;21&rpar;&colon;2223–2231.
Article
While most physicians are accustomed to evaluating randomized placebo-controlled studies, many are less familiar with the purpose and takeaway of noninferiority trials. Here's help.
Article
Measurement of troponin levels provides the most sensitive and accurate serologic information in evaluating a patient with acute coronary syndrome (ACS); troponin elevations are more sensitive than elevations of creatine kinase-MB (CK-MB). Isolated elevation of troponin levels increases the likelihood of myocardial infarction (MI) or death, whereas...
Article
High-dose aspirin is an effective treatment for acute migraine. So why aren't more physicians recommending it?
Article
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.
Article
For patients at high risk for cardiovascular disease, a Mediterranean diet may be the best bet.
Article
Perhaps. Estrogen-containing oral contraceptives may raise the risk of ischemic stroke in women with migraine, particularly migraine with aura.
Article
It is. There is no down side to self-collection, this study suggests.
Article
Probably not. A new meta-analysis adds to a growing body of evidence that omega-3 fatty acids do little to protect against heart disease.
Data
Is this pregnancy viable? When bleeding or pain occur in early pregnancy and ultrasound is inconclusive, a single progesterone test can often answer that question. PRACTICE CHANGER Measure serum progesterone levels of wom-en with bleeding or pain and inconclusive ultrasound in early pregnancy to rule out vi-ability, potentially eliminating the need...
Article
Full-text available
Finally, we have a safe and effective alternative to OTC cough and cold remedies for young children with upper respiratory infections.
Article
When you prescribe antibiotics, tell patients that taking probiotics for the entire course of treatment will help prevent diarrhea.
Article
For obese patients with type 2 diabetes, surgery may be the best bet.
Article
Closure of the tibial growth plate--the definitive remedy for Osgood-Schlatter disease--may be years away. Adolescent athletes sidelined by pain need relief now.
Article
Computer-based learning (CBL) is an effective form of medical education. Educators have developed recommendations for instructional design but there is only minimal research that evaluates these recommendations. To evaluate the effect of case-based questions contained in computer modules on learning efficacy. The authors conducted a randomized cont...
Article
Strongyloides is endemic in parts of the United States. Most often it is asymptomatic but it has a wide range of clinical presentations. Because of the unusual capacity of strongyloides for autoinfection, it can cause hyperinfection, when it effects the pulmonary and gastrointestinal systems, or disseminated infection, when other organs are involve...
Article
Full-text available
Tiotropium outperformed salmeterol in reducing the frequency of exacerbations in patients with moderate-to-severe COPD.
Article
Adding this drug to the medication regimen of patients with Class II heart failure can help to reduce hospitalization and death rates.
Article
Most patients with hemorrhoids experience only mild symptoms that can be treated with nonprescription topical preparations. Patients usually seek treatment when symptoms increase. Internal hemorrhoids typically present with prolapse or painless rectal bleeding. External hemorrhoids also bleed and can cause acute pain if thrombosed. Medical therapy...
Article
Full-text available
Routine PSA testing leads to more diagnoses of prostate cancer, but does not save lives. At least one group of men, however, may reap a small benefit.

Citations

... She was advised the following: an FM/a test could be useful in diagnosing or ruling out fibromyalgia [4]. A complete autoimmune antibody panel and endocrinology studies should be performed to rule out conditions such as thyroid, pituitary, and adrenal disorders, myasthenia gravis, and celiac disease. ...
... So far, no concrete evidence has been found to be the main cause of dysbiosis-related inflammation. As a result, no compound or drug has been found for effective treatment of inflammation through the dysbiosis mechanism other fecal microbiota transplantation for antibiotic resistant Clostridioides difficile infections [306,307]. Due to this association between inflammatory events and dysbiosis, some researchers have suggested that the excessive inflammatory mechanism in COVID-19 may have been caused by the disorder of the intestinal microbiota in patients [308]. While some researchers have even recommended prebiotics and probiotics for the treatment of the inflammatory process in COVID-19, others have recommended fecal transplantation [309][310][311]. ...
... Dyspepsia refers to chronic or recurrent pain or discomfort located in the epigastrium, that frequently occurs in patients with CKD [6]. Dyspepsia may be associated with certain disease (organic dyspepsia) or include gastroduodenal symptoms in the absence of any organic, systemic or metabolic disorders (functional dyspepsia) [7]. Clinically it is presented as: 1) postprandial distress syndrome (postprandial fullness, early satiety, bloating, nausea and excessive belching) and/or 2) epigastric pain syndrome (occasional epigastric pain that is not relieved by defecation or flatus passage) [8]. ...
... In terms of presentability, the participants awarded high scores for visual inputs compared to audio inputs. This is coherent with a previous study where visual computer-based learning did not show any significant difference with or without an auditory narrative (32). The pictures used able to catch my attention ...
... When compared with serology or stool antigen tests, this non-invasive and easy to perform test possesses the highest accuracy to detect H. pylori infection in patients without a recent use of antibiotics or PPIs [19]. In a recent systematic review, with specificity estimated at 90%, the sensitivity of these tests were 92% (95% CI; 89% to 94%) for 14 C-UBT, 84% (95% CI; 74% to 91%) for serology, and 83% (95% CI; 73% to 90%) for stool antigen test [20]. Therefore, 14 C-UBT is the most accurate test to diagnose and follow up eradication of H. pylori infection [19]. ...
... Whether this decline relates to the ageing process and whether replenishment of NAD + slows down ageing are the hot issues. Nevertheless, nicotinamide and related compounds have been and are currently being tested to treat conditions such as cardiovascular disease (8) and diabetes in humans. ...
... Oseltamivir is most effective when it is taken within the 48 hours from symptom onset 11,12 . It reduces the duration of symptoms by about one day 13 . There is no solid evidence that it may prevent severe illness [14][15][16] (http://www.cdc.gov/ ...