Oklahoma Physicians
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Clinical Inquires (Clin-IQ) Program
Clinical Inquiries (Clin-IQ) is an ongoing program of the Oklahoma Clinical and Translational Research Institute (OSCTRI) that makes it possible and mutually beneficial for residents, faculty, and community clinicians to identify, ask and answer clinical questions through evidence-based assessment of the published literature. The Clin-IQ process helps residency programs comply with ACGME Residency Review Committee (RRC) requirements for resident and faculty involvement in scholarly activity. It also helps community clinicians (e.g., in a PBRN) to be involved in generating relevant, practice-based questions and disseminate answers in their professional organizations. Clin-IQ creates a critically important link between academia and community practitioners that can inform both education and research.
Clinical practice questions are collected annually from OKPRN clinicians, residents, and faculty of medical schools in Oklahoma and placed in a question bank. They are then prioritized by OKPRN clinicians based on their importance, relevance to practice, value of a potential answer, and feasibility of obtaining an answer. Questions are distributed to pairs of residents in residency programs throughout the state who conduct a literature review to formulate the best answer with the help of a faculty mentor.
Finally, answers are disseminated via academic, PBRN, and professional venues, in addition to publication in local medical journals. The Journal of Patient-Centered Research & Review (JPCRR) has begun publishing Clin-IQs. This new journal joins the Journal of the Oklahoma State Medical Association Journal (JOSMA) and the Journal of the Oklahoma Osteopathic Association (JOOA) as journals that are interested in publishing Clin-IQs. More possible Clin-IQ publication venues are being pursued.
A combined Clin-IQ Instruction Packet is available for residents, mentors, and program personnel. If you need more information about the Clin-IQ program, please contact the program coordinator:
Elizabeth Wickersham, MD, MS
Assistant Professor
Department of Family & Preventive Medicine
Oklahoma Clinical and Translational Sciences Institute
900 NE 10th Street
Oklahoma City, OK 73104
elizabeth-wickersham@ouhsc.edu
Phone: (405) 271-2370
Cell: (405) 227-6000
Clin-IQ Questions and Answers 2017-2018
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1. In elderly adults who are in long-term care facilities, are there successful interventions for reducing falls and fall related morbidity?
Answer: Yes.
Level of Evidence: B. (Link to resource in development)
2. Does excess sodium intake increase the risk of hypertension among children less than 18 years of age?
Answer: No.
Level of Evidence: B. (Link to resource in development)
3. In patients with osteoarthritis, does the use of glucosamine and/or chondroitin improve outcomes compared to analgesics?
Answer: Yes
Level of Evidence: B (Link to resource in development)
4. Is there less opioid abuse in states where marijuana use has been decriminalized, either for medicinal or recreational use?
Answer: Yes.
Level of Evidence: B. (Link to resource in development)
5. Is supervised physical therapy more beneficial for non-athletes with lateral ankle sprains compared with RICE and home exercises?
Answer: No
Level of Evidence: B (Link to resource in development)
6. In children, age 5-18, who are overweight or obese, do body composition and screening measures (such as BMI, Insulin and Lipid panel) help identify children who are at higher risk for Cardiovascular Disease?
Answer: Yes.
Level of Evidence: B. (Link to resource in development)
7. In adults with diabetes or cardiovascular risk factors, does a Mediterranean diet compared to normal diet or other diet interventions improve glycemic control and/or rates of type 2 diabetes?
Answer: Yes.
Level of Evidence: A. (Link to resource in development)
8. In adults, does adding Omega-3 Fatty Acid to statins compared to statins alone improve cardiovascular disease risk?
Answer: No.
Level of Evidence: A. (Link to resource in development)
9. In adults with knee osteoarthritis, are knee braces useful for delaying or preventing progression to surgical intervention?
Answer: No.
Level of Evidence: B. (Link to resource in development)
10. Does acupuncture reduce the frequency of migraine in patients when used as prophylactic treatment in comparison to no treatment or sham acupuncture?
Answer: Yes.
Level of Evidence: B. (Link to resource in development)
11. In a residency training program, are there interventions that can help increase continuity of care?
Answer: Yes.
Level of Evidence: B. (Link to resource in development)
12. Do practice-level care process interventions improve adolescent HPV vaccination rates?
Answer: Yes.
Level of Evidence: C. (Link to resource in development)
13. In patients at increased risk for post-partum hemorrhage, does administration of tranexamic acid (Txa) reduce blood loss compared to oxytocin alone during active management of third and fourth stages of labor?
Answer: Yes.
Level of Evidence: A. (Link to resource in development)
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Clin-IQ Questions and Answers 2016-2017
1. Can Stress ulcer-related GI bleeding (SURGIB) risk scoring system allow for appropriate use of Stress Ulcer Prophylaxis among non-critically ill patients?
Answer: Inconclusive.
Level of Evidence: B. (Link to resource in development)
2. In adult patients with osteoarthritis of the knee, does ultrasound-guided steroid injection improve function and/or decrease pain better than steroid injection without ultrasound guidance?
Answer: Yes.
Level of Evidence: A. (Link to resource in development)
3. In non-professional athletes ages 8-26 does cognitive rest affect the return-to-play time in post-concussive patients?
Answer: Inconclusive.
Level of Evidence: B. (Link to resource in development)
4. In patients with myofascial trigger points, does dry needling improve short-term and/or long-term pain relief compared to lidocaine injections?
Answer: Inconclusive.
Level of Evidence: A. (Link to resource in development)
5. In hospitalized adults diagnosed with sepsis, are CRP and/or Procalcitonin levels/trends helpful in predicting sepsis and/or response to sepsis treatment as opposed to the usual manner of monitoring patients with sepsis?
Answer: Inconclusive. Procalcitonin is likely useful, but expensive.
Level of Evidence: A. (Link to resource in development)
6. In adults with congestive heart failure, does restricting sodium intake improve outcomes (hospitalizations, morbidity, mortality)?
Answer: Inconclusive.
Level of Evidence: C. (Link to resource in development)
7. In adults with Type 2 diabetes, should two or three oral antidiabetic drug regimens be considered prior to commencing insulin therapy?
Answer: Yes.
Level of Evidence: B. (Link to resource in development)
8. In pregnant women smokers, are nicotine patches effective for reducing cigarette smoking compared to placebo patch?
Answer: No.
Level of Evidence: B. (Link to resource in development)
9. In pregnant women, does restricting or eliminating caffeine consumption improve fetal and overall outcomes of pregnancy?
Answer: Yes.
Level of Evidence: A. (Link to resource in development)
10. Does injectable intra-articular hyaluronic acid decrease knee pain from osteoarthritis compared to placebo?
Answer: No.
Level of Evidence: A. (Link to resource in development)
11. Should mandatory prophylaxis of ophthalmia neonatorum be reconsidered?
Answer: Yes.
Level of Evidence: B. (Link to resource in development)
12. Patient Perspectives on Discussions of Electronic Cigarettes in Primary Care
Prospective research paper. (LINK TO PAPER)
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Clin-IQ Questions and Answers 2015-2016
1. Can a clinical assessment be administered in outpatient settings that may predict fall risk in community-dwelling geriatric patients?
Answer: Uncertain.
Level of Evidence: A. (Link to resource in development)
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2. In adults with suspected statin-induced myalgia, does adding coenzyme Q10 (CoQ10) reduce muscle pain?
Answer: No.
Level of Evidence: A. (Link to resource in development)
3. In adults with Type 2 diabetes mellitus, is aggressive glucose control with insulin effective at reducing overall cardiovascular mortality?
Answer: No.
Level of Evidence: A (Link to resource in development)
4. Are systemic glucocorticoids useful in the treatment of acute musculoskeletal low back pain?
Answer: No.
Level of Evidence: A. (Link to resource in development)
5. Are people with Severe Mental Illness more likely to be victimized than the general population?
Answer: Yes.
Level of Evidence: B. (Link to resource in development)
6. Is there a role for self (outpatient) management of COPD exacerbation with antibiotics and oral corticosteroids?
Answer: Inconclusive.
Level of Evidence: B. (Link to resource in development)
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7. In adults with diagnosed plantar fasciitis, is Extracorporeal Shockwave Therapy (EWST) an effective treatment modality compared to conservative management?
Answer: Yes.
Level of Evidence: B. (Link to resource in development)
8. Does prenatal yoga improve maternal comfort and labor pain?
Answer: Yes.
Level of Evidence: A. (Link to resource in development)
9. Are there exercise interventions (pre-exercise, during exercise and/or post-exercise) that have been shown to improve recovery?
Answer: Yes.
Level of Evidence: A. (Link to resource in development)
10. In athletes 18 years and older with shoulder injury, does the use of Kinesiotape decrease the severity of pain after injury compared to sham taping?
Answer: Yes.
Level of Evidence: B. (Link to resource in development)
11. What are the patients’ views on the role of the PCP in counseling on E-cigarettes?
Prospective research paper. (FULL PAPER)
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Clin-IQ Questions and Answers 2012-2013
1. In peri-menopausal and menopausal women, have nontraditional therapies proven effective at relieving symptoms (hot flashes, irritability, etc.) compared to traditional hormone replacement therapy (HRT)?
Answer: Yes, there are several effective therapies effective for treating symptoms of menopause. However, no single therapy is more effective than traditional HRT.
Level of Evidence: A. (FULL PAPER)
2. In adults what is the best diagnostic test for restless leg syndrome?
Answer: Yes.
Level of Evidence: A. (FULL PAPER)
3. In patients with concussions, is the probability of permanent neurological damage predicted better by total number of concussions than by severity and duration of individual concussions?
Answer: No.
Level of Evidence: B (FULL PAPER)
4. Does prolonged (one year or more) breast feeding result in adverse behavioral outcomes compared to bottle fed children?
Answer: No.
Level of Evidence: B (FULL PAPER)
5. In patients receiving joint injections, does ultrasound guidance increase the probability that the injection is in the correct location compared to using anatomical landmarks?
Answer: Yes.
Level of Evidence: A. (FULL PAPER)
6. Among all adult males independent of comorbidities, which adult males should be tested for testosterone deficiency?
Answer: All males who are symptomatic for low libido, fatigue, muscle wasting.
Level of Evidence: B. (FULL PAPER)
7. In adult athletes with partial thickness rotator cuff tears, is conservative management superior to surgery in allowing the athlete to return to competitive function?
Answer: No.
Level of Evidence: B (FULL PAPER)
8. In women with complete hysterectomy and history of cervical cancer how often should a Papanicolaou smear be done to detect early stage recurrence?
Answer: Depends on stage at diagnosis. Patients diagnosed at early stages without adjuvant therapies like chemotherapy and radiation should be screened every 6 months for the first 2 years and then annually, while patients with advanced disease and use of adjuvant therapies should receive screening every 3 months for the first year after treatment, then every 6 months for years 2 through 5 returning to annual screening.
Level of Evidence: B. (FULL PAPER)
9. In adults with coronary artery disease or at high risk of stroke, does taking 81 mg of aspirin daily result in improved outcomes compared to those taking 325 mg aspirin per day?
Answer: No.
Level of Evidence: A. (FULL PAPER)
10. In adults with normal cardiovascular function, at what level of consumption (daily, weekly, etc.) is wine or other alcohol found to be cardio-protective compared to cardio-adverse?
Answer: 1-3 drinks per day.
Level of Evidence: B. (FULL PAPER)
11. Are antibiotics helpful in the treatment of non-necrotizing ischemic colitis?
Answer: Inconclusive.
Level of Evidence: C (FULL PAPER)
12. In women over 35 years of age who smoke, does Mirena (levonorgestrel-releasing intrauterine system) reduce the risk of DVTs compared to oral contraceptives?
Answer: Yes.
Level of Evidence: B. (FULL PAPER)