Tools for Practice

Tools for Practice articles have been produced by the PEER team in collaboration with the ACFP since 2009.
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Recent Tools for Practice

Tools for Practice #366 Looking for Closure: Managing simple excisions or wounds efficiently

What are some options for efficiency in wound closure?

Punch biopsies 4mm do not require closure but 8mm do. Skin-glue is similar to tape or sutures for simple wounds for clinician-rated cosmesis and patient satisfaction with similar infection rates of 4-7%. However, dehiscence occurs in ~5% with skin-glue compared to 1% with suture. Absorbable sutures have similar outcomes to non-absorbable sutures. Read More

Tools for Practice #365 Shrooms for Glooms: Evidence for psilocybin for depression

What are the benefits and harms of psilocybin for treatment-resistant/recurrent depression?

Psilocybin, given in treatment facilities with >10 hours psychological support, improves short-term (≤6 weeks) depression scores, helping 20-30% more patients attain response over control. Effects biased by unblinding, short-term trials and mostly inactive comparators. Psychological distress during treatment is common (75-90%) and requires monitoring/supports. Read More

Tools for Practice #364 Facing the Evidence in Acne, Part II: Oral Antibiotics

How effective are oral antibiotics in treating acne of at least mild-moderate severity?

Approximately 17% of patients achieve “success” on oral minocycline versus 9% on placebo at 12 weeks. Oral antibiotics reduce acne lesion count by 10-24% more than placebo. Evidence of the efficacy of adding oral antibiotics to topical agents (example: retinoids, benzoyl peroxide) is limited. Efficacy appears similar between individual antibiotics. Discontinuations due to adverse events are comparable to placebo. Read More

Tools for Practice #363 Making a difference in indifference? Medications for apathy in dementia

In patients with dementia, how safe and effective are stimulants, antidepressants, and antipsychotics for treating apathy?

Methylphenidate may improve apathy scores by a small but potentially clinically meaningful amount compared to placebo (example: 5 points more on a 72-point scale) at ~12 weeks. Methylphenidate does not impact cognition in randomized, controlled trials (RCTs). Antipsychotics and antidepressants do not improve apathy compared to placebo. Read More

Tools for Practice #362 – Facing the Evidence in Acne, Part I: Oral contraceptives and spironolactone in females

How effective are combined oral contraceptives (COC) and spironolactone for treating acne of at least mild-moderate severity in females?

At ~24 weeks, ~80-90% of females report improvement in their acne with COCs, compared to 50-80% placebo, and 30-50% will have clear-almost clear skin versus 10-40% on placebo. Efficacy appears similar between individual COCs. Spironolactone, typically added to topical agents, has similar outcomes. Discontinuations due to adverse events appear comparable to placebo. Read More

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