Clinical Inquiries, 2022
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Item How does gender-affirming hormone therapy affect QOL in transgender patients?(Family Physicians Inquiries Network, 2022-12) Wilhelm, Sarah; Kelsberg, Gary; Safranek, Sarah; Guthmann, RickQ: How does gender-affirming hormone therapy affect QOL in transgender patients? Evidence-based answer: There are modest effects on depression but not anxiety. Gender-affirming hormone therapy (GAHT) is associated with modest improvements in standardized scores for quality of life (QOL) and depression in adult male-to-female and female-to-male transgender people and modest improvements in depression scores in transgender adolescents, but the effect on anxiety is uncertain (strength of recommendation [SOR]: B, based on a preponderance of low-quality prospective cohort studies with inconsistent results). GAHT is associated with reduced gender dysphoria and decreased suicidality (SOR: B, based on a prospective cohort study). However, there is insufficient evidence to determine any effect on suicide completion. No studies associated GAHT with worsened QOL, depression, or anxiety scores.Item How accurate is transcutaneous bilirubin testing in newborns with darker skin tones?(Family Physicians Inquiries Network, 2022-11) Boden, Brandi; Buescher, Brittany; Kim, Amanda; Neher, Jon O.; Safranek, Sarah; Guthmann, RickQ: How accurate is transcutaneous bilirubin testing in newborns with darker skin tones? Evidence-based answer: Fairly accurate. Photometric transcutaneous bilirubin (TcB) testing may overestimate total serum bilirubin (TSB) in neonates with darker skin tones by a mean of 0.68 to > 2 mg/dL (strength of recommendation [SOR]: C, diagnostic cohort studies with differing reference standards). Overall, TcB meters retain acceptable accuracy in infants of all skin tones across a range of bilirubin levels, despite being more likely to underestimate lighter skin tones and overestimate darker ones (SOR: C, diagnostic cohort studies with differing reference standards). It is unclear if the higher readings prompt an increase in blood draws or otherwise alter care.Item Does an early COPD diagnosis improve long-term outcomes?(Family Physicians Inquiries Network, 2022-10) Bernet, Dan; Randolph, Charles; Neher, Jon O.; Safranek, SarahQ Does an early COPD diagnosis improve long-term outcomes? Evidence-based answer: It depends. A diagnosis of chronic obstructive pulmonary disease (COPD) made using screening spirometry in patients without symptoms does not change the course of the disease or alter smoking rates (strength of recommendation [SOR]: A, preponderance of evidence from multiple randomized controlled trials [RCTs]). However, once a patient develops symptoms of lung disease, a delayed diagnosis is associated with poorer outcomes (SOR: B, cohort studies). Active case finding (including the use of spirometry) is recommended for patients with risk factors for COPD who present with consistent symptoms (SOR: C, expert opinion).Item What barriers delay treatment in patients with hepatitis C?(Family Physicians Inquiries Network, 2022-09) Crosby, Kimberly; Bigelow, Simone; Sachs, Viviane; Weakley, Jennifer; Skaftason, Helga; Hoberecht, ToniQ: What barriers delay treatment in patients with hepatitis C? Evidence-based answer: Multiple patient-specific and provider-perceived factors delay initiation of treatment in patients with hepatitis C. Patient-specific barriers to initiation of treatment for hepatitis C virus (HCV) include age, race, gender, economic status, insurance status, and comorbidities such as HIV coinfection, psychiatric illness, and other psychosocial factors. Provider-perceived patient factors include substance abuse history, older age, psychiatric illness, medical comorbidities, treatment adverse effect risks, and factors that might limit adherence (eg, comprehension level). Study limitations included problems with generalizability of the populations studied and variability in reporting or interpreting data associated with substance or alcohol use disorders (strength of recommendation: B, based on 2 prospective and 5 retrospective cohort studies).Item Does platelet-rich plasma improve patellar tendinopathy symptoms?(Family Physicians Inquiries Network, 2022-05) Wolfenden, Emily; Vukelic, Brian; DeMarco, Matthew; Knox, Jordan; Ose, DominikQ: Does platelet-rich plasma improve patellar tendinopathy symptoms? Evidence-based answer: IT’S UNCLEAR. High-quality data have not consistently established the effectiveness of platelet-rich plasma (PRP) injections to improve symptomatic recovery in patellar tendinopathy, compared to placebo (strength of recommendation [SOR]: A, based on 3 small randomized controlled trials [RCTs]). The 3 small RCTs included only 111 patients, total. One found no evidence of significant improvement with PRP compared to controls. The other 2 studies showed mixed results, with different outcome measures favoring different treatment groups and heterogeneous results depending on follow-up duration.