Clinical Inquiries, 2020
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Item Introduction to Clinical Inquiries : new series by the Family Physicians Inquiries Network(Family Physicians Inquiries Network, 2020) Mott, Timothy; Guthmann, RichardIntroduction to Clinical Inquiries and FPIN. The Clinical Inquiries were included in Canadian Family Physician beginning March 2020.Item Acupuncture for low back pain(Family Physicians Inquiries Network, 2020) Clemente Fuentes, Roselyn; Organ, Brooke; Creech, Julie; Broszko, Christine M.; Nashelsky, JoanClinical Inquiries question: Is acupuncture effective in improving pain relief for low back pain? Evidence-based answer: Acupuncture is an effective treatment for relief from low back pain, even when compared with other interventions (sham acupuncture, usual care, or no treatment), with stronger effects observed immediately after treatment. Clinically significant reduction in pain is more reliably observed in chronic rather than acute low back pain (strength of recommendation: A, based on systematic review and meta-analysis of randomized controlled trials [RCTs]).Item Efficacy of a low-carbohydrate or ketogenic diet in preventing patient morbidity and mortality(Family Physicians Inquiries Network, 2020) Clemente Fuentes, Roselyn W.; Broszko, Christine M.; Pietralcyzk, Elizabeth S.; Nashelsky, JoanClinical Inquiries question: What is the efficacy of a low-carbohydrate or ketogenic diet in the prevention of patient morbidity and mortality? Evidence-based answer: Ketogenic diets can reduce seizure incidence in refractory epilepsy (strength of recommendation [SOR] A: based on randomized controlled trials [RCTs] and systematic review). Low-carbohydrate diets are associated with weight loss in obese patients, although long-term evidence of weight-loss maintenance is not available (SOR A: based on meta-analysis of RCTs). Treatment of type 2 diabetes mellitus with low-carbohydrate diets demonstrated a decrease in hemoglobin A1c (HbA1c) levels (SOR C: disease-oriented evidence based on meta-analysis or RCTs). Low-carbohydrate diets paired with animal-based proteins are associated with increased mortality compared with moderate-carbohydrate diets, whereas low-carbohydrate diets with plant-based protein are associated with decreased mortality (SOR B: based on meta-analysis of prospective cohort studies).Item Hypoglycemia with insulin and sulfonylureas(Family Physicians Inquiries Network, 2020) Kolman, Karyn B.; Freeman, Joshua; Howe, Carol L.Clinical Inquiries question: In patients with type 2 diabetes mellitus (T2DM), does the combination of insulin and sulfonylurea (SU) increase the risk of hypoglycemia? Evidence-based answer: The incidence of severe hypoglycemia in patients with T2DM taking insulin alone, SU alone, or the combination of insulin and SU is low (strength of recommendation [SOR] A based on a systematic review of randomized controlled trials). The combination of insulin and SU in patients with T2DM does increase the risk of hypoglycemia; however, the clinical significance of this risk is small (SOR B based on 4 large retrospective cohort studies). Of note, patients 65 years and older are at an increased risk of hypoglycemia compared with younger patients, although the clinical significance has not been specified (SOR B based on 2 large retrospective cohort studies).Item Chlamydia test-of-cure in pregnancy(Family Physicians Inquiries Network, 2020) Pettit, Jessie; Howe, Carol; Freeman, JoshuaClinical Inquiries question: What is the optimal interval between treatment and test-of-cure (TOC) in pregnant women with Chlamydia trachomatis (CT)? Evidence-based answer: The optimal interval between treatment and TOC in pregnant women with CT is 3 to 4 weeks (strength of recommendation C: several small prospective and retrospective cohort studies; a high-quality nonsystematic review; and a consensus guideline). Testing before 3 weeks might give false-positive results, while waiting longer than 4 weeks might delay detecting new infections or result in treatment failure.