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.

Dec 15, 2013 Issue
Treatments for Symptoms of the Common Cold
There is no single treatment that produces significant improvements in symptoms of the common cold. Intranasal ipratropium (Atrovent) can be given to reduce rhinorrhea. Oral zinc can be given therapeutically to shorten cold duration and severity, and can be taken prophylactically to reduce the risk of colds.

Nov 15, 2013 Issue
Risks of Bisphosphonate Use
Bisphosphonates are associated with a small risk of atypical femoral shaft fractures, which increases with duration of use. Bisphosphonates are associated with a small risk of osteonecrosis of the jaw, which is more common in patients who are older, female, or have poor dental hygiene or cancer.

Oct 15, 2013 Issue
Testosterone Therapy and Risk Recurrence After Treatment of Prostate Cancer
Men with symptomatic androgen deprivation who have had clinically curative treatment for organ-confined prostate cancer may have symptomatic improvement with testosterone replacement therapy. There are no studies evaluating the risk of cancer recurrence in patients receiving testosterone replacement therapy.

Sep 15, 2013 Issue
Management of ADHD in Preschool-Aged Children
Behavior therapy interventions, such as parent training, are first-line treatment for ADHD in preschool-aged children (three to five years of age). Medication is an option for children with moderate to severe ADHD if behavior therapy has not been effective and if the benefits outweigh the harms.

Aug 15, 2013 Issue
Interventions for Lower-Extremity Lymphedema
Complete decongestive physiotherapy (i.e., a noninvasive protocol consisting of skin care, lymph drainage massage, exercises, and compression bandaging1) effectively improves edema, rates of infection, and quality of life in patients with lower-extremity lymphedema.

Jul 15, 2013 Issue
Corticosteroids for Presumed Pneumocystis Pneumonia in Patients with HIV Infection
Adjunctive corticosteroids decrease mortality in patients with HIV infection who have moderate to severe hypoxemia and suspected or confirmed pneumocystis pneumonia. Corticosteroids lead to a higher incidence of herpetic lesions, but not other opportunistic conditions.

Jun 15, 2013 Issue
Pharmacologic Therapy for Eustachian Tube Dysfunction
There are no medications that improve patient-oriented outcomes in children or adults with eustachian tube dysfunction. Oral corticosteroids, with or without antibiotics, improve pneumatic otoscopy and tympanometry findings in the short term, but these agents have no long-term benefit.

May 15, 2013 Issue
Dipstick Urinalysis for the Diagnosis of Acute UTI
Approximately two-thirds of women who present with classic symptoms of acute UTI have bacterial infection of the bladder. Dipstick urinalysis moderately improves the accuracy of clinical symptoms in establishing or excluding acute UTI in women.

Apr 15, 2013 Issue
Metformin Use in Adolescents
There are no studies evaluating whether metformin prevents or delays the onset of diabetes in adolescents who are obese. In adults, metformin is as effective as lifestyle interventions in preventing increases in A1C and fasting glucose levels, but it is less effective in preventing or delaying the onset of overt type 2 diabetes. Metformin use reduces body mass index (BMI) for up to six months in adolescents who are obese.

Mar 15, 2013 Issue
Screening for Hepatocellular Carcinoma in Patients with Hepatitis C Virus Infection
There is no evidence that it is beneficial to screen for hepatocellular carcinoma in symptomatic patients with HCV.

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