FPIN's Clinical Inquiries

Clinical Inquiries from the Family Practice 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 15, 2014 Issue
Screening for Autism Spectrum Disorders
There are no studies directly comparing the various screening tools. The Modified Checklist for Autism in Toddlers (M-CHAT) is the tool most commonly used by physicians, followed by the Checklist for Autism in Toddlers (CHAT). All other tools account for about 3% of usage.

Sep 15, 2014 Issue
Prostaglandins to Induce Labor in Women with Asthma
There is little evidence evaluating whether prostaglandins used to induce labor increase the risk of bronchospasm in patients with asthma. The use of dinoprostone to induce labor is not associated with asthma exacerbations or reduced oxygen saturation in patients with active asthma or a history of asthma.

Aug 15, 2014 Issue
Cardiovascular Effects of NSAIDs
Aspirin does not elevate blood pressure. Among nonselective NSAIDs, ibuprofen increases the risk of hypertension and stroke. Diclofenac does not increase the risk of hypertension, but does increase the risk of stroke. Naproxen (Naprosyn) does not increase the risk of hypertension or stroke. Celecoxib (Celebrex) does not increase the risk of hypertension or stroke.

Jul 15, 2014 Issue
Intra-articular Corticosteroid Injections for Osteoarthritis of the Knee
Intra-articular corticosteroid injections can be used to reduce pain by about 20% in the short term (one to three weeks) in patients with osteoarthritis of the knee.

Jun 15, 2014 Issue
Topical Preparations for Wound Healing
Topical silver should not be used for treatment of nonburn wounds because it does not hasten healing. Medical-grade topical honey can be used to reduce healing time for partial-thickness burns, but it produces no effect on lacerations, surgical wounds, chronic wounds, or vascular ulcers. Topical antibiotics can be used to reduce the incidence of clinical infections in children with minor acute wounds.

May 15, 2014 Issue
Treatment of Jellyfish Envenomation
There is limited patient-oriented evidence upon which to base recommendations for treatment of jellyfish envenomation. Patients should be removed from the water, and an attempt should be made to prevent the discharge of adherent nematocysts (i.e., microscopic stinging cells), remove tentacles from the affected area, and treat pain.

Apr 15, 2014 Issue
Apolipoproteins for Cardiovascular Risk Assessment
Measurement of apolipoprotein B and apolipoprotein A-I is no better than traditional lipid measurements and should not be used to predict cardiovascular risk.

Mar 15, 2014 Issue
Surgical Treatment for Asymptomatic Cholelithiasis
Surgery should not be offered to patients with asymptomatic cholelithiasis. Cholecystectomy may be beneficial for patients who are at high risk of biliary cancer, infection, or other complications, including younger patients and those with choledocholithiasis, sickle cell disease, gallstones larger than 3 cm, or significant immunosuppression.

Feb 15, 2014 Issue
Fish Oil for Treatment of Dyslipidemia
Supplementation with omega-3 fatty acids decreases triglyceride and very low-density lipoprotein cholesterol levels. However, it can also increase low-density lipoprotein (LDL) cholesterol levels. Treatment with omega-3 fatty acids does not decrease total mortality, cardiovascular events, or cancer incidence, and therefore should not be recommended to patients to decrease their risk of dyslipidemia.

Jan 15, 2014 Issue
Methylphenidate for Management of Fatigue in the Palliative Care Setting
No recent evidence demonstrates that methylphenidate improves fatigue in patients receiving palliative care. Methylphenidate can be used to minimally improve fatigue symptom scores in patients with cancer-related fatigue.

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