Clinical Inquiries, 2019
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Item Does using e-cigarettes cigarette smoking in adolescents?(Family Physicians Inquiries Network, 2019) Asher, Tim; Belden, Jenna Leah; Kelsbert, Gary; Safranek, SarahQ: Does using e-cigarettes cigarette smoking in adolescents? Evidence-based answer: Probably. Electronic cigarette (e-cigarette) use by adolescents is associated with a 2- to 4-fold increase in cigarette smoking over the next year (strength of recommendation: A, meta-analysis and subsequent prospective cohort studies).Item Does tranexamic acid reduce mortality in women with postpartum hemorrhage?(Family Physicians Inquiries Network, 2019) Dresang, Lee; Kredit, Sheila; Vellardita, LiaQ: Does tranexamic acid reduce mortality in women with postpartum hemorrhage? EVIDENCE-BASED ANSWER: Yes. When used in conjunction with the standard of care, 1 g intravenous (IV) tranexamic acid given 1 to 3 hours after delivery is associated with a significant reduction in maternal mortality from postpartum hemorrhage (PPH) (strength of recommendation: A, randomized controlled trial [RCT] and Cochrane review). No known significant risks are associated with the use of tranexamic acid to treat PPH.Item Time to conception after miscarriage : how long to wait?(Family Physicians Inquiries Network, 2019) Farahi, Narges; Mounsey, Anne; Auten, BethQ: Time to conception after miscarriage: how long to wait? Evidence-based answer: an interpregnancy interval (IPI) of < 6 months following miscarriage is associated with an increased live birth rate in subsequent pregnancy, lower risks of preterm birth and subsequent miscarriage, and no difference in rates of stillbirth, pre-eclampsia, and low birth weight infants (strength of recommendation [SOR]: A, well-done metaanalysis). (IPI is defined as the time between the end of one pregnancy and the last menstrual period of a subsequent one.) A very short IPI (< 3 months), when compared with an IPI of 6 to 18 monts, is associated with the lowest rate of subsequent miscarriage (SOR: B, cohort study). However, for women who experience a pregnancy loss at 14 to 19 weeks' gestation, an IPI < 3 months is associated with an increased risk of miscarriage or birth before 24 weeks' gestation (SOR: B, cohort study). Women with a short IPI following miscarriage may be at increased risk for anxiety and depression in the first trimester of subsequent pregnancy (SOR: B, cohort study).Item How safe and effective is ondansetron for nausea and vomiting in pregnancy?(Family Physicians Inquiries Network, 2019) Collins, Kimberly L.; Wilson, Megan; Vincent, E. Chris; Safranek, SarahQ: How safe and effective is ondansetron for nausea and vomiting in pregnancy? Evidence-based answer: oral ondansetron is more effective than a combination of pyridoxine and doxylamine for outpatient treatment of nausea and vomiting in pregnancy (strength of recommendation [SOR]: B, randomized controlled trial [RCT]). For moderate to severe nausea and vomiting, intravenous (IV) ondansetron is at least as effective as IV metoclopramide and may cause fewer adverse reactions (SOR: B, RCTs). Disease registry, case-control, and cohort studies report a slight increase in the risk of cardiac defects with ondansetron use in first-trimester pregnancies, but no major or other birth defects are associated with ondansetron exposure (SOR: B, a systematic review of observational trials and a single retrospective cohort study). A specialty society guideline recommends weighing the risks and benefits of ondansetron use before 10 weeks' gestational age and suggests reserving ondansetron for patients who have persistent nausea and vomiting unresponsive to first- and second-line treatments (SOR: C, expert opinion).Item Which oral nonopioid agents are most effective for OA pain?(Family Physicians Inquiries Network, 2019) Gilmer, Benjamin; Hulkower, Stephen; Wilson, Courtenay Gilmore; Macdonald, Brittney; Pozner, Jonathan; Stigleman, SueQ Which oral nonopioid agents are most effective for OA pain? Evidence-based answer: nonsteroidal anti-inflammatory drugs (nsaids), when used at the maximum clinically effective dose, reduce osteoarthritis (OA) pain in large joints more effectively than either placebo or acetaminophen (strength of recommendation [SOR]: A, network meta-analysis of randomized controlled trials [RCTs]). When ranked for efficacy, diclofenac 150 mg/d was the most effective (SOR: A, network meta-analysis of RCTs). The selective COX-2 inhibitors, such as celecoxib, are not more effective at reducing pain than the nonselective NSAIDs (SOR: A, metaanalysis of RCTs). Meloxicam is superior to placebo but marginally inferior to other NSAIDs (SOR: A, systematic review of RCTs). Acetaminophen is no more effective than placebo (SOR: A, meta-analysis of RCTs).