Priority Updates from the Research Literature (PURLs) distill the literature to those few articles that are relevant, practice-changing, and able to be implemented immediately. They generate new evidence-based recommendations for practice for family physicians and other primary care clinicians. PURLs are published exclusively in the Journal of Family Practice.

Recent Submissions

  • Monotherapy for nonvalvular A-fib with stable CAD? 

    Garigan, Thomas P.; Earwood, John S.; Poplawski, Michal (Family Physicians Inquiries Network, 2021-10)
    Monotherapy for nonvalvular A-fib with stable CAD? A meta-analysis found oral anticoagulant (OAC) monotherapy provided efficacy comparable to OAC plus single antiplatelet therapy—with lower bleeding risk. PRACTICE CHANGER: ...
  • Skip that repeat DXA scan in these postmenopausal women 

    Zweid, Alexander; Tunink, Carl; Morria, Laura (Family Physicians Inquiries Network, 2021-12)
    Skip that repeat DXA scan in these postmenopausal women. Repeat bone density measurement offers no advantage in predicting fracture risk in postmenopausal women who do not have osteoporosis. PRACTICE CHANGER: Do not routinely ...
  • Validated scoring system identifies low-risk syncope patients 

    Lewton, Amanda Kay; Morris, Laura Elizabeth (Family Physicians Inquiries Network, 2021-11)
    Validated scoring system identifies low-risk syncope patients, This study validated the Canadian Syncope Risk Score for predicting 30-day serious outcomes in patients presenting to the ED within 24 hours of syncope. PRACTICE ...
  • Updated USPSTF screening guidelines may reduce lung cancer deaths 

    Marshall, Robert C.; Tiglao, Samuel Miguel; Thiel, Derrick (Family Physicians Inquiries Network, 2021-09)
    Updated USPSTF screening guidelines may reduce lung cancer deaths. By nearly doubling the number of patients eligible for screening, as many as 60,000 US lives may be saved—but concerns may limit acceptance. PRACTICE ...
  • Prescribe an SGLT2 inhibitor for heart failure in the absence of diabetes? 

    Koenigsberger, Debra; Marquez, Alexander; Hughes, Pamela R. (Family Physicians Inquiries Network, 2021-07)
    Prescribe an SGLT2 inhibitor for heart failure in the absence of diabetes? An RCT demonstrates that dapagliflozin produces better cardiovascular outcomes than placebo for heart failure patients with and without diabetes. ...
  • This is not the time to modify a HTN regimen 

    Grubbs, Calvin; Morris, Laura (Family Physicians Inquiries Network, 2021-07)
    This is not the time to modify a HTN regimen. Intensifying hypertension regimens at discharge increases risk in older patients. PRACTICE CHANGER: Avoid intensifying antihypertensive medication regimens at hospital discharge ...
  • Antibiotics and COPD : time to ordr a C-reactive protein test? 

    Piggott, Cleveland; Lyon, Corey (Family Physicians Inquiries Network, 2021-06)
    Antibiotics and COPD: Time to order a C-reactive protein test? This RCT provided valuable insights as to whether CRP-guided prescribing could safely reduce antibiotic use during acute COPD exacerbations. PRACTICE CHANGER: ...
  • Confidently rule out CAP in the outpatient setting 

    Mott, Timothy; Echeverri, David; Fondren, Luke; Hunter, Ashley (Family Physicians Inquiries Network, 2021)
    Confidently rule out CAP in the outpatient setting. A focus on specific signs and symptoms -- without imaging -- may rule out community-acquired pneumonia in outpatients. PRACTICE CHANGER: You can safely rule out ...
  • Automated office BP measurement : the new standard in HTN screening 

    Tiglao, Samuel Miguel; Meisenheimer, Erica S.; Marshall, Robert C. (Family Physicians Inquiries Network, 2021)
    Automated office BP measurement: The new standard in HTN screening. Obtain greater accuracy in blood pressure measurement with an automated office device. PRACTICE CHANGER: Measure patients' blood pressure (BP) using an ...
  • An alternative regimen to reduce risk of asthma exacerbations 

    Shelesky, Gretchen; Castelli, Gregory (Family Physicians Inquiries Network, 2021)
    An alternative regimen to reduce risk of asthma exacerbations This study supports the use of an ICS/LABA as needed for adults with intermittent, mild persistent, and moderate persistent asthma. Practice changer: PRACTICE ...
  • No pain, if you've got game 

    McCollum, Benjamin J.; Conner, Stephen J.; Earwood, J. Scott (Family Physicians Inquiries Network, 2021)
    No pain, if you've got game. Allowing children to engage in active distraction techniques--such as playing a video game--during venipuncture can lead to reduced pain and anxiety. PRACTICE CHANGER: Employ active distraction, ...
  • Can viscous fiber lower glycemic markers in type 2 diabetes? 

    Meisenheimer, Erica S.; Marshall, Bob; Tiglao, Samuel M.; Rogers, Tyler S.; Bury, David C.; Dickman, Michael M.; Oh, Robert C. (Family Physicians Inquiries Network, 2021)
    Can viscous fiber lower glycemic markers in type 2 diabetes? The first meta-analysis to focus on viscous dietary fiber in T2D suggests a potential role for this supplement in improving glycemic control. PRACTICE CHANGER: ...
  • Consider this Rx for patients with high triglycerides? 

    Leggott, Kyle; Claus, Liza (Family Physicians Inquiries Network, 2020)
    A daily dose of this prescription fish oil may be worth a trial in light of the cardiovascular benefits it affords statin-treated patients with high triglycerides. PRACTICE CHANGER: Consider icosapent ethyl, 2 g twice ...
  • Rethinking daily aspirin for primary prevention 

    Poplawski, Michal; Nelson, Nicole K.; Earwood, J. Scott (Family Physicians Inquiries Network, 2020)
    An updated meta-analysis of newer RCTs seems to settle the matter as to whether to use aspirin in individuals with no known history of atherosclerotic CVD. PRACTICE CHANGER: Do not routinely use aspirin for primary prevention ...
  • Ruling out PE in pregnancy 

    Svarverud, Jennifer; Hughes, Pamela (Family Physicians Inquiries Network, 2020)
    Can clinical probability and a high-sensitivity D-dimer test reliably and safely rule out pulmonary embolism during pregnancy? PRACTICE CHANGER: Use a clinical probability score to identify patients at low or intermediate ...
  • Is it better to take that antihypertensive at night? 

    Dickman, Michael; Marshall, Bob; Meisenheimer, Erica S. (Family Physicians Inquiries Network, 2020)
    A large RCT in a primary care setting comparing bedtime to upon-waking administration of antihypertensives answers the question. PRACTICE CHANGER: Advise patients to take blood pressure (BP) medication at bedtime rather ...
  • Do-it-yourself cervical cancer screening? 

    Hoss, Molly; Lyon, Corey (Family Physicians Inquiries Network, 2020)
    Enlisting patients to self-collect specimens for human papillomavirus testing is an effective way to detect cervical precancer in those who might not otherwise undergo cervical cancer screening. PRACTICE CHANGER: Have ...
  • USPSTF expands options for cervical cancer screening 

    Oyola, Sonia; VanGompel, Emily White (Family Physicians Inquiries Network, 2020)
    Women ages 30-65 years now have a third cervical cancer screening option. PRACTICE CHANGER: Offer women ages 30-65 years the option of being screened for cervical cancer using a high-risk human papillomavirus assay every ...
  • Immediate or delayed pushing in the second stage of labor? 

    Devitt, Jessica; Lyon, Corey (Family Physicians Inquiries Network, 2020)
    Immediate or delayed pushing in the second stage of labor? Is there any advantage to delaying pushing in the second stage of labor for nulliparous women receiving epidural analgesia? PRACTICE CHANGER: Recommend immediate, ...
  • NPH insulin : It remains a good option 

    Arthur, Ben; Smith, Ashley; Bennett, Nick; Bury, David; Marshall, Bob (Family Physicians Inquiries Network, 2005)
    NPH insulin: It remains a good option. NPH insulin holds its own against basal insulin analogs - and it's cheaper. PRACTICE CHANGER: Consider NPH insulin for patients who require initiation of long-acting insulin therapy ...

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