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.

Aug 1, 2007 Issue
Angiotensin Blockade in Patients with Diabetic Nephropathy
When used to delay the progression of early nephropathy in patients with type 2 diabetes mellitus, angiotensin receptor blockers (ARBs) are not superior to angiotensin-converting enzyme (ACE) inhibitors.

Jul 1, 2007 Issue
Evaluation of Apparent Life-threatening Events in Infants
A comprehensive, detailed history and physical examination with pulse oximetry and nondilated funduscopy (to look for traumatic retinal hemorrhage) helps to determine the underlying etiology of an ALTE in 70 percent of infants.

Jun 1, 2007 Issue
Monitoring Therapy for Patients with Alzheimer's Disease
Patients with Alzheimer's disease who undergo treatment of any kind should be monitored eight weeks after initiation of therapy and at least every six months thereafter.

Apr 1, 2007 Issue
Glycemic Control in Patients with Type 2 Diabetes
There is no clearly superior oral agent for glycemic control in patients with type 2 diabetes.

Mar 1, 2007 Issue
Treatment of Impetigo
Topical mupirocin (Bactroban) and fusidic acid (not available in the United States) are more effective than placebo and at least as effective as oral antibiotics for the treatment of limited impetigo, and are better tolerated.

Feb 1, 2007 Issue
Which Lipoprotein Measurements Are Clinically Useful?
Emerging lipid risk factors for cardiovascular disease include lipoprotein remnants, lipoprotein (a), small LDL particles, HDL subspecies, apolipoprotein B, apolipoprotein A-I, and oxidized LDL. Measurement of these levels should not be used for routine cardiovascular risk screening.

Jan 1, 2007 Issue
Treatment of Acute Sciatica
In patients with acute sciatica, bed rest and advice to stay active have similar outcomes on their functional status and perceived improvement.

Dec 1, 2006 Issue
Risks and Benefits of Combination Contraceptives
The risks of using oral combination contraceptives include: a three- to sixfold increase in the incidence of venous thromboembolism (VTE) apparent by the fourth month of use and highest between six and 12 months of use; a two- to sixfold increase in the risk of ischemic stroke among women with a history of migraine; and an increase in cervical cancer risk after five or more years of use.

Nov 1, 2006 Issue
Psychosocial Interventions Delivered by Primary Care Physicians to Patients with Depression
Few high-quality studies have been conducted examining the effectiveness of psychosocial interventions performed by primary care physicians for patients with major depression. Two randomized controlled clinical trials (RCTs) found that a psychosocial intervention, specifically problem-solving therapy, is as effective as pharmacotherapy for symptoms of major depression.

Aug 1, 2006 Issue
Treatments for Chronic Prostatitis
Because the etiology of chronic nonbacterial prostatitis is unknown, a variety of treatments have been proposed. The best-designed, largest clinical trials have not found the most commonly used therapies (i.e., alpha blockers, quinolone antibiotics, non-steroidal anti-inflammatory drugs, finaste-ride [Propecia]) to be effective.

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