FPIN's Clinical Inquiries

Clinical Inquiries from the Family Physicians Inquiries Network (FPIN) provide short, concise, evidence-based answers to clinical questions common in family medicine. The answers include a summary of the evidence and commentary that puts the answers into perspective.

Oct 1, 2015 Issue
Risk of Gout with the Use of Thiazide Diuretics
Thiazide diuretics may be used in most patients with hypertension who have only minimally increased risk of gout.

Sep 15, 2015 Issue
Atopic Eczema and Early Introduction of Solid Foods
In most children, solid foods may be introduced before four to six months of age without increasing the risk of atopic eczema.

Aug 1, 2015 Issue
Micronutrient Supplementation During Pregnancy
A multimicronutrient supplement is an oral tablet containing the recommended daily allowance of several vitamins and minerals. The World Health Organization does not recommend multimicronutrient supplementation because of the potential for increased neonatal mortality in some situations.

Jun 1, 2015 Issue
Management of Acute Achilles Tendon Rupture
There are no clear evidence-based criteria to decide which patients should undergo operative vs. nonoperative management of acute Achilles tendon rupture.

May 1, 2015 Issue
Treatments for Sciatica
Surgical diskectomy can be offered to patients with refractory sciatica, but there is only modest, short-term improvement in leg pain and disability scores. Epidural steroid injections may be offered to patients with sciatica of more than six months' duration.

Apr 1, 2015 Issue
Exercise and Pregnancy Loss
Regular exercise for up to seven or more hours per week (including low-intensity and high-intensity aerobics, jogging, cycling, and swimming) is not associated with increased rates of miscarriage in the first to mid-second trimesters. Patients may continue bending and lifting at work, because these activities are not associated with increased first-trimester miscarriage rates.

Mar 1, 2015 Issue
Obesity and Joint Injuries in Children
Lower extremity injuries are 18% more likely in overweight children, 24% more likely in obese children, and 34% more likely in extremely obese children when compared with normal weight peers. The risk of lower extremity fractures is also increased by 17% in overweight children, 23% in obese children, and 45% in extremely obese children. Extremely obese prepubertal children have the greatest fracture risk at 2.2 times that of normal weight peers.

Feb 1, 2015 Issue
Angiotensin-Converting Enzyme Inhibitors vs. Angiotensin Receptor Blockers
ACE inhibitors should be used in patients with hypertension because they reduce all-cause mortality, whereas ARBs do not.

Jan 15, 2015 Issue
Medications for Treatment of Interstitial Cystitis
There are no long-term clinically effective oral medications. Pentosan (Elmiron) can improve overall symptom scores for interstitial cystitis over three to six months, but it does not improve scores for any of three individual symptoms (dysuria, urgency, frequency) compared with placebo.

Nov 15, 2014 Issue
Self-Administered GBS Testing in Pregnant Women
There is no difference in the sensitivity of swabs for detecting GBS when collected by patients vs. physicians; therefore, either method can be used. Patients do not express a consistent preference for self-collection of samples vs. collection by a physician.

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