FPIN's Help Desk Answers

Dec 1, 2017 Issue
Local Anesthesia for IUD Insertion or Endometrial Biopsy
Topical application of lidocaine/prilocaine cream to the cervix reduces mean pain scores during IUD insertion. Intrauterine instillation of liquid anesthesia reduces median pain scores during endometrial biopsy.

Dec 1, 2017 Issue
Screening Tools for Unhealthy Alcohol Use
A single-question alcohol use screen and the Alcohol Use Disorders Identification Test–Consumption (AUDIT-C) can be used to detect unhealthy alcohol use and alcohol use disorder. Their performance is similar between sexes and across races.

Nov 15, 2017 Issue
Home Sleep Testing for Diagnosing Obstructive Sleep Apnea
Home portable monitoring can be used as a substitute for in-laboratory polysomnography for the diagnosis of OSA in patients with a high pretest probability. Most patients prefer home monitoring, and clinical outcomes among patients diagnosed by either method are comparable regarding sleepiness, sleep-related quality of life, and compliance with continuous positive airway pressure (CPAP) therapy.

Nov 1, 2017 Issue
History and Physical Examination for Identifying Rotator Cuff Tears
There are no historical features that reliably identify full-thickness rotator cuff tears. The physical examination maneuvers that best identify the presence of a full-thickness rotator cuff tear are the internal rotation lag test, the external rotation lag test, and a positive “belly-off” sign. The best maneuver to help confirm the absence of a full-thickness rotator cuff tear of the subscapularis is a negative internal rotation lag test.

Nov 1, 2017 Issue
Risk of Preterm Birth with Vaginal Progesterone in Twin Pregnancies
Women with twin pregnancies should not routinely receive vaginal progesterone because it does not reduce the risk of preterm birth. Vaginal progesterone should be administered to reduce adverse neonatal outcomes in women with twin pregnancies and a short cervix (25 mm or less).

Oct 1, 2017 Issue
Food Consumption by Children and Adults

Oct 1, 2017 Issue
Treatments for Nocturnal Leg Cramps
Calcium channel blockers or B vitamins may lead to short-term improvement in nocturnal leg cramps. Stretching has mixed results. Quinine is effective but is no longer recommended, and it is not approved for treatment of leg cramps because of potential toxicity.

Sep 1, 2017 Issue
Predictors of Acute Myocardial Infarction
The most useful element for ruling in acute MI is chest pain with radiation to both arms, followed by radiation to the right arm. The most useful elements for ruling out acute MI are pleuritic chest pain, sharp pain, and pain reproduced by palpation.

Aug 15, 2017 Issue
Health Literacy Tools in the Outpatient Setting
Single-question screening tools regarding the need for help with understanding and completing medical forms and reading materials can be effective for detecting inadequate health literacy in the outpatient setting.

Jul 1, 2017 Issue
Gluten-Free Diet for Irritable Bowel Syndrome
The evidence is conflicting on whether gluten-free diets improve symptoms of IBS. Gluten-free diets may improve symptoms such as abdominal pain, stool consistency, and tiredness, and they can be recommended to patients with IBS.

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