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.

Jul 1, 2006 Issue
A1C Testing in the Diagnosis of Diabetes Mellitus
A1C testing is highly specific compared with a two-hour oral glucose tolerance test (OGTT) or a fasting plasma glucose test. However, because A1C testing is not sensitive enough to rule out diabetes if levels are normal, the test should not be used for diagnosing diabetes.

Jun 1, 2006 Issue
Warfarin for Prevention of Ischemic Stroke Recurrence?
There is no evidence that anticoagulation with warfarin, initiated after a noncardioembolic ischemic stroke, significantly reduces stroke recurrence. Furthermore, anticoagulation significantly increases the risk of fatal and nonfatal hemorrhagic stroke and extracranial hemorrhage in these patients. However, warfarin clearly is indicated for patients who have embolic strokes caused by underlying conditions such as atrial fibrillation or myxoma.

Apr 1, 2006 Issue
Glucosamine and Chondroitin for Osteoarthritis
Glucosamine reduces pain and improves function in patients with knee or hip osteoarthritis.

Mar 1, 2006 Issue
Treatment of Herpes Zoster
Resolution of acute pain related to herpes zoster is accelerated with any of the following: oral acyclovir (Zovirax) 800 mg five times daily for seven days; valacyclovir (Valtrex) 1,000 mg three times daily for seven days; or famciclovir (Famvir) 750 mg once daily, 500 mg twice daily, or 250 mg three times daily for seven days.

Feb 1, 2006 Issue
Vaginal Misoprostol for Cervical Ripening in Term Pregnancy
Low-dose (25 mcg) intravaginal misoprostol appears to be safe and effective for cervical ripening in term pregnancy for patients without a history of cesarean section. Compared with other cervical ripening methods, misoprostol has an increased rate of vaginal delivery within 24 hours without significant differences in cesarean section rates or fetal outcomes.

Jan 1, 2006 Issue
Urine Dipstick for Diagnosing Urinary Tract Infection
The sensitivity and specificity of the urine dipstick varies somewhat with the setting and population, as does its recommended interpretation. Women with classic urinary tract infection (UTI) symptoms have a high pretest probability of infection, and use of the dipstick adds little to the diagnosis. In women with nonspecific urogenital symptoms, positive or negative dipstick results may require a backup urine culture depending on the clinical situation. In low-risk patients with a low pretest probability of UTI, the urine dipstick alone is useful to exclude infection if both nitrites and leukocyte esterase are negative.

Dec 1, 2005 Issue
Counseling or Antidepressants for Treating Depression?
Both antidepressant medications and psychologic treatment are beneficial for adult patients with mild to moderate depression, with no consistent evidence that one type of treatment is more effective than the other.

Nov 1, 2005 Issue
Antiviral Agents for Pregnant Women with Genital Herpes
There is no evidence that the use of antiviral agents in women who are pregnant and have a history of genital herpes prevents perinatal transmission of herpes simplex virus (HSV) to neonates.

Oct 1, 2005 Issue
Combined Oral Contraceptives for Mothers Who Are Breastfeeding
There is currently no evidence of harm; however, few patients have been studied and existing studies have many limitations. Therefore, it is not possible to definitively answer this question at this time. The existing low-quality evidence suggests that combined oral contraceptives may reduce the volume of breast milk but not affect the growth of infants.

Sep 1, 2005 Issue
Statin Therapy in Patients with Type 2 Diabetes
Based on current evidence, statin therapy should be offered to all patients with type 2 diabetes who are known to have coronary artery disease.

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