FPIN's Clinical Inquiries

Clinical Inquiries from the Family Physicians 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.

May 01, 2022 Issue
Does Performing Dating Ultrasonography Before a First-Trimester Uterine Evacuation Improve Outcomes or Safety?
Routine use of ultrasonography before a first-trimester abortion is not necessary. In patients seeking medical or surgical abortion in the first trimester, date of the last menstrual period (LMP) alone can appropriately determine gestational age for treatment (before 63 to 90 days' gestation) in 93.8% to 97.6% of patients. Bimanual examination and LMP together accurately determine candidacy for treatment in 98.4% of patients. Ultrasonography does not appear to affect the rate of missed ectopic pregnancies or reduce incomplete abortions or ongoing pregnancy rates.

Apr 01, 2022 Issue
Patient Education Interventions Improve A1C Values
Patient education interventions, specifically those including face-to-face interactions with trained educators or nurses, improve A1C values in patients by 0.3% to 1.4% compared with usual diabetes care.

Mar 01, 2022 Issue
Thumb Spica Casts for Scaphoid Fractures
The type of cast used does not appear to impact outcomes. A short arm cast allows the patient to have better function and mobility during immobilization without compromising the healing process. Thumb spica casts are no better than casts that do not include the thumb in fracture healing rates or long-term improvement in range of motion, strength, or pain.

Feb 01, 2022 Issue
Topical Nitroglycerin for Lower Extremity Tendinopathy
In non-insertional Achilles tendinopathy, topical NTG patches are minimally better than placebo at 24 weeks. Topical NTG plus physical therapy is not superior for pain relief or functional improvement compared with placebo patches plus physical therapy. In chronic patellar tendinopathy, NTG patches provide no significant pain relief vs. placebo patches at up to 12 weeks.

Jan 01, 2022 Issue
Is the Use of Hormonal Contraception Associated With Suicide and Suicide Attempts?
There may be an association between the use of hormonal contraception and suicide. Women using oral contraceptives had an increase in completed suicides and suicidal behaviors (i.e., suicidal thoughts and suicide attempts without success).

Dec 01, 2021 Issue
Virtual Reality in the Treatment of Generalized Anxiety Disorder
Virtual reality does not appear to be effective and should not be used in the treatment of generalized anxiety disorder. In trials including anxiety disorders such as phobias and fear of flying, virtual reality may be better than no treatment, but it is not superior to traditional behavioral therapy or cognitive behavior therapy.

Nov 01, 2021 Issue
Should Allele Testing Be Done Before Prescribing Allopurinol to Prevent Severe Cutaneous Adverse Reactions?
Moderate evidence supports allele testing for HLA-B*58:01 before initiating allopurinol to decrease the incidence of SCARs in higher risk populations. Patient populations who are not at increased risk should not be screened.

Oct 01, 2021 Issue
Does Light Therapy Decrease Depression in Older Adults?
Light therapy appears to be mildly effective in treating depression in older adults, but ideal wavelength, intensity, and length of treatment are unknown.

Sep 01, 2021 Issue
Melatonin to Treat Insomnia in Older Adults
Melatonin preparations reduce sleep-onset latency, increase total sleep time, and slightly improve sleep efficiency. Prolonged-release melatonin reduces sleep-onset latency in older adults and has rates of adverse effects similar to those of placebo.

Aug 01, 2021 Issue
Physical Activity and the Prevention of Depression
Physical activity appears to be associated with a lower risk of developing depression and depressive symptoms.

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