AFP DEPARTMENT COLLECTION

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.

Apr 15, 2019 Issue
Bridging Warfarin Before Colonoscopy in Patients with Atrial Fibrillation
A limited number of trials that examined the risk of temporary interruption of anticoagulation before a variety of procedures did not find a reduction in the risk of stroke, but they did show an increased risk of bleeding events and venous thromboembolism (VTE) in patients who were bridged during warfarin interruption.


Feb 15, 2019 Issue
Metformin for Nonalcoholic Fatty Liver Disease and Nonalcoholic Steatohepatitis
Metformin does not seem to be an effective treatment for nonalcoholic steatohepatitis. There are no studies evaluating whether metformin improves long-term patient-oriented outcomes such as progression from NAFLD to nonalcoholic steatohepatitis, cirrhosis, hepatocellular carcinoma, or death from liver failure.


Jan 15, 2019 Issue
Intravenous Magnesium Sulfate for Acute Asthma Exacerbations
Patients presenting to the emergency department with an acute asthma exacerbation that has not responded to first-line therapy (bronchodilators and corticosteroids) can be treated effectively with intravenous magnesium sulfate.


Oct 15, 2018 Issue
Morning vs. Evening Administration of Levothyroxine
The effectiveness of levothyroxine for reducing TSH levels is most dependent on the timing of meals in relation to drug administration. There is conflicting evidence. In two studies, levothyroxine taken at least two hours after eating in the evening maintained or improved TSH levels compared with morning administration.


Jul 15, 2018 Issue
Physical Therapy for Low Back Pain
There is some evidence that early physical therapy may decrease posttreatment health care utilization for low back pain.


Apr 15, 2018 Issue
Antibiotic Prophylaxis for COPD Exacerbations
Prophylactic antibiotics may be used to reduce the overall rate of COPD exacerbations and delay their onset. However, the appropriate antibiotic regimen and target population are unclear.


Feb 15, 2018 Issue
Diabetes Education and Glycemic Control
Counseling by a diabetes educator or a team of educators delivered in a variety of formats may reduce A1C levels by 0.2% to 0.8% compared with usual care alone. Diabetes educators should be considered for patients who have higher baseline A1C levels (8% to 9%) because this group had greater improvement in glycemic control after diabetes self-management education.


Oct 15, 2017 Issue
Rivaroxaban vs. Warfarin for Treatment of DVT and PE
Rivaroxaban, along with the other factor Xa inhibitors, is as effective as or better in the short term (three months) than warfarin (Coumadin) for preventing recurrent DVT, nonfatal PE, and fatal PE, with no differences in mortality or bleeding events.


Jul 15, 2017 Issue
Treatment for Calcaneal Apophysitis
Several treatments for calcaneal apophysitis may produce modest short-term improvements in pain scores. Heel inserts and prefabricated orthotics may initially improve pain scores and dysfunction, but patients have equal improvement by three months with or without therapy.


Apr 15, 2017 Issue
Iron Deficiency in Heart Failure
Treatment of iron deficiency in patients with heart failure using intravenous iron improves function, fatigue, and quality of life, and decreases risk of hospitalizations compared with placebo.


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