Top 20 Research Studies of 2015 for Primary Care Physicians
Am Fam Physician. 2016 May 1;93(9):756-762.
The full text of the POEMs discussed in this article is available at http://www.aafp.org/afp/poems2015
Author disclosure: Dr. Ebell is cofounder and editor-in-chief of Essential Evidence Plus, published by Wiley-Blackwell, Inc. Dr. Grad has no relevant financial affiliations.
In 2015, a group of primary care clinicians with expertise in evidence-based practice performed monthly surveillance of more than 110 English-language clinical research journals. They identified 251 studies that addressed a primary care question and had the potential to change practice if valid (patient-oriented evidence that matters, or POEMs). Each study was critically appraised and disseminated to subscribers via e-mail, including members of the Canadian Medical Association who had the option to use a validated tool to assess the clinical relevance of each POEM and the benefits they expect for their practice. This article, the fifth installment in this annual series, summarizes the 20 POEMs based on original research studies judged to have the greatest clinical relevance for family physicians. Key recommendations include questioning the need for backup throat cultures; avoiding early imaging and not adding cyclobenzaprine or oxycodone to naproxen for patients with acute low back pain; and encouraging patients with chronic or recurrent low back pain to walk. Other studies showed that using a nicotine patch for more than eight weeks has little benefit; that exercise can prevent falls that cause injury in at-risk older women; and that prostate cancer screening provides a very small benefit, which is outweighed by significant potential harms of screening and associated follow-up treatment. Additional highly rated studies found that tight glycemic control provides only a small cardiovascular benefit in patients with type 2 diabetes mellitus at the expense of hypoglycemic episodes; that treating mild hypertension can provide a modest reduction in stroke and all-cause mortality; that sterile gloves are not needed for minor uncomplicated skin procedures; that vasomotor symptoms last a mean of 7.4 years; and that three regimens have been shown to provide the best eradication rates for Helicobacter pylori infection.
Since 1994, a group of primary care clinicians with expertise in evidence-based practice has performed monthly surveillance of more than 110 English-language research journals.1 Of approximately 20,000 research studies published during 2015 in these journals, 251 met prespecified criteria for validity, relevance, and practice change. A study was considered valid if it was well designed and avoided important biases such as failure to conceal allocation or failure to mask outcome assessment. Relevance depended on the research question (i.e., is it relevant to a primary care clinician?) and on the outcomes reported; only studies that reported patient-oriented outcomes, such as morbidity, mortality, or quality of life, were considered relevant. Finally, studies with the potential to change practice for a substantial number of physicians were prioritized over those that merely confirmed existing practice (i.e., they matter). Studies that meet all of these criteria are called POEMs, for patient-oriented evidence that matters.2 Each POEM is summarized in a structured critical appraisal written by one of the six expert reviewers and peer reviewed by faculty and fellows of the University of Missouri Department of Family Medicine. Writing and disseminating the POEMs is supported by subscriptions, without industry support.
Since 2005, the Canadian Medical Association has sponsored a subscription to POEMs for its members. Each member has the option to receive the daily POEM by e-mail, and the option to rate it using a brief survey through the Information Assessment Method. The questionnaire for the Information Assessment Method is a validated tool that addresses relevance to clinicians, cognitive impact, use for practice, and expected health benefits if the results of the POEM would be applied.3 For this article, we identified the 20 POEMs of 2015 that were rated highest for clinical relevance by Canadian Medical Association members. Each POEM was rated by at least 500 physicians, and at least 52% of respondents rated each of these top 20 POEMs as “totally relevant for at least one of your patients,” whereas less than 18% rated each as “not relevant for at least one of your patients.”
In the fifth installment of this annual series,4–7 we summarize the clinical question and bottom-line answer for each of the 20 POEMs critically appraising an original research study, organized by topic and followed by a brief discussion. The bottom-line answers have been rewritten slightly from the original to stand alone without the complete synopsis and appraisal. We also briefly discuss POEMs summarizing practice guidelines that were judged to be highly relevant. The full POEMs are available online at http://www.aafp.org/afp/poems2015.
editor's note: This article was cowritten by Dr. Mark Ebell, who was a member of the U.S. Preventive Services Task Force (USPSTF) from 2012 to 2015 and currently serves as a consultant to the USPSTF. This article does not necessarily represent the views and policies of the USPSTF. Dr. Ebell is deputy editor for American Family Physician (AFP) and cofounder and editor-in-chief of Essential Evidence Plus, published by Wiley-Blackwell, Inc. The POEMs described in this article stem from work that Dr. Ebell and his colleagues have been doing for the past two decades. Medical journals occasionally publish an article summarizing the best studies in a certain field from the previous year; however, those articles are limited by being one person's idiosyncratic collection of a handful of studies. In contrast, this article by Drs. Ebell and Roland Grad is validated in two ways: (1) the source material (POEMs) was derived from a systematic review of thousands of articles using a rigorous criterion-based process, and (2) these “best of the best” summaries were rated by thousands of Canadian primary care physicians for relevance and benefits to practice.
Because of Dr. Ebell's dual roles and ties to Essential Evidence Plus, the concept for this article was independently reviewed and approved by a group of AFP's medical editors. In addition, the article underwent peer review and editing by four of AFP's medical editors. Dr. Ebell was not involved in the editorial decision-making process.—Jay Siwek, MD, Editor, American Family Physician
The authors thank Wiley-Blackwell, Inc., for giving permission to excerpt the POEMs; Drs. Allen Shaughnessy, Henry Barry, David Slawson, Nita Kulkarni, and Linda Speer for their work in selecting and writing the original POEMs; the academic family medicine fellows and faculty of the University of Missouri–Columbia, for their work as peer reviewers; Pierre Pluye, PhD, for his work in codeveloping the Information Assessment Method; and Maria Vlasak for her assistance with copyediting the POEMs for the past 22 years.
REFERENCESshow all references
1. Ebell MH, Barry HC, Slawson DC, Shaughnessy AF. Finding POEMs in the medical literature. J Fam Pract. 1999;48(5):350–355....
2. Shaughnessy AF, Slawson DC, Bennett JH. Becoming an information master: a guidebook to the medical information jungle. J Fam Pract. 1994;39(5):489–499.
3. Pluye P, Grad RM, Johnson-Lafleur J, et al. Evaluation of email alerts in practice: part 2. Validation of the information assessment method. J Eval Clin Pract. 2010;16(6):1236–1243.
4. Ebell MH, Grad R. Top 20 research studies of 2014 for primary care physicians. Am Fam Physician. 2015;92(5):377–383.
5. Ebell MH, Grad R. Top 20 research studies of 2013 for primary care physicians. Am Fam Physician. 2014;90(6):397–402.
6. Ebell MH, Grad R. Top 20 research studies of 2012 for primary care physicians. Am Fam Physician. 2013;88(6):380–386.
7. Ebell MH, Grad R. Top 20 research studies of 2011 for primary care physicians. Am Fam Physician. 2012;86(9):835–840.
8. Lean WL, Arnup S, Danchin M, Steer AC. Rapid diagnostic tests for group A streptococcal pharyngitis: a meta-analysis. Pediatrics. 2014;134(4):771–781.
9. Ehrlich JE, Demopoulos BP, Daniel KR Jr, Ricarte MC, Glied S. Cost-effectiveness of treatment options for prevention of rheumatic heart disease from group A streptococcal pharyngitis in a pediatric population. Prev Med. 2002;35(3):250–257.
10. Moore M, Stuart B, Coenen S, et al.; GRACE consortium. Amoxicillin for acute lower respiratory tract infection in primary care: subgroup analysis of potential high-risk groups [published correction appears in Br J Gen Pract. 2014;64(620):126]. Br J Gen Pract. 2014;64(619):e75–e80.
11. Gillies M, Ranakusuma A, Hoffmann T, et al. Common harms from amoxicillin: a systematic review and meta-analysis of randomized placebo-controlled trials for any indication. CMAJ. 2015;187(1):E21–E31.
12. Jain S, Self WH, Wunderink RG, et al.; CDC EPIC Study Team. Community-acquired pneumonia requiring hospitalization among U.S. adults. N Engl J Med. 2015;373(5):415–427.
13. Jarvik JG, Gold LS, Comstock BA, et al. Association of early imaging for back pain with clinical outcomes in older adults [published correction appears in JAMA. 2015;313(17):1758]. JAMA. 2015;313(11):1143–1153.
14. Machado GC, Maher CG, Ferreira PH, et al. Efficacy and safety of paracetamol for spinal pain and osteoarthritis: systematic review and meta-analysis of randomised placebo controlled trials. BMJ. 2015;350:h1225.
15. Friedman BW, Dym AA, Davitt M, et al. Naproxen with cyclobenzaprine, oxycodone/acetaminophen, or placebo for treating acute low back pain: a randomized clinical trial. JAMA. 2015;314(15):1572–1580.
16. Fritz JM, Magel JS, McFadden M, et al. Early physical therapy vs usual care in patients with recent-onset low back pain: a randomized clinical trial. JAMA. 2015;314(14):1459–1467.
17. Hurley DA, Tully MA, Lonsdale C, et al. Supervised walking in comparison with fitness training for chronic back pain in physiotherapy: results of the SWIFT single-blinded randomized controlled trial. Pain. 2015;156(1):131–147.
18. Schnoll RA, Goelz PM, Veluz-Wilkins A, et al. Long-term nicotine replacement therapy: a randomized clinical trial. JAMA Intern Med. 2015;175(4):504–511.
19. Uusi-Rasi K, Patil R, Karinkanta S, et al. Exercise and vitamin D in fall prevention among older women: a randomized clinical trial. JAMA Intern Med. 2015;175(5):703–711.
20. Schröder FH, Hugosson J, Roobol MJ, et al.; ERSPC Investigators. Screening and prostate cancer mortality: results of the European Randomised Study of Screening for Prostate Cancer (ERSPC) at 13 years of follow-up. Lancet. 2014;384(9959):2027–2035.
21. Hayward RA, Reaven PD, Wiitala WL, et al.; VADT Investigators. Follow-up of glycemic control and cardiovascular outcomes in type 2 diabetes [published correction appears in N Engl J Med. 2015;373(2):198]. N Engl J Med. 2015;372(23):2197–2206.
22. Gerstein HC, Miller ME, Ismail-Beigi F, et al.; ACCORD Study Group. Effects of intensive glycaemic control on ischaemic heart disease: analysis of data from the randomised, controlled ACCORD trial. Lancet. 2014;384(9958):1936–1941.
23. Lind M, Svensson AM, Kosiborod M, et al. Glycemic control and excess mortality in type 1 diabetes. N Engl J Med. 2014;371(21):1972–1982.
24. Sundström J, Arima H, Jackson R, et al.; Blood Pressure Lowering Treatment Trialists' Collaboration. Effects of blood pressure reduction in mild hypertension: a systematic review and meta-analysis. Ann Intern Med. 2015;162(3):184–191.
25. Ikeda Y, Shimada K, Teramoto T, et al. Low-dose aspirin for primary prevention of cardiovascular events in Japanese patients 60 years or older with atherosclerotic risk factors: a randomized clinical trial. JAMA. 2014;312(23):2510–2520.
26. Berger JS, Lala A, Krantz MJ, Baker GS, Hiatt WR. Aspirin for the prevention of cardiovascular events in patients without clinical cardiovascular disease: a meta-analysis of randomized trials. Am Heart J. 2011;162(1):115–124.e2.
27. Li BZ, Threapleton DE, Wang JY, et al. Comparative effectiveness and tolerance of treatments for Helicobacter pylori: systematic review and network meta-analysis. BMJ. 2015;351:h4052.
28. Heal C, Sriharan S, Buttner PG, Kimber D. Comparing non-sterile to sterile gloves for minor surgery: a prospective randomised controlled non-inferiority trial. Med J Aust. 2015;202(1):27–31.
29. Perelman VS, Francis GJ, Rutledge T, Foote J, Martino F, Dranitsaris G. Sterile versus nonsterile gloves for repair of uncomplicated lacerations in the emergency department: a randomized controlled trial. Ann Emerg Med. 2004;43(3):362–370.
30. Avis NE, Crawford SL, Greendale G, et al.; Study of Women's Health Across the Nation. Duration of menopausal vasomotor symptoms over the menopause transition. JAMA Intern Med. 2015;175(4):531–539.
31. LeFevre ML; U.S. Preventive Services Task Force. Screening for thyroid dysfunction: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2015;162(9):641–650.
32. Siu AL; U.S. Preventive Services Task Force. Screening for high blood pressure in adults: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2015;163(10):778–786.
33. Selph S, Dana T, Blazina I, Bougatsos C, Patel H, Chou R. Screening for type 2 diabetes mellitus: a systematic review for the U.S. Preventive Services Task Force. Ann Intern Med. 2015;162(11):765–776.
34. Chou R; High Value Care Task Force of the American College of Physicians. Cardiac screening with electrocardiography, stress echocardiography, or myocardial perfusion imaging: advice for high-value care from the American College of Physicians. Ann Intern Med. 2015;162(6):438–447.
35. Sawaya GF, Kulasingam S, Denberg TD, Qaseem A. Cervical cancer screening in average-risk women: best practice advice from the Clinical Guidelines Committee of the American College of Physicians. Ann Intern Med. 2015;162(12):851–859.
36. Downs JR, O'Malley PG. Management of dyslipidemia for cardiovascular disease risk reduction: synopsis of the 2014 U.S. Department of Veterans Affairs and U.S. Department of Defense clinical practice guideline. Ann Intern Med. 2015;163(4):291–297.
37. Stone NJ, Robinson JG, Lichtenstein AH, et al. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines [published correction appears in J Am Coll Cardiol. 2014;63(25 pt B):3024–3025]. J Am Coll Cardiol. 2014;63(25 pt B):2889–2934.
38. January CT, Wann LS, Alpert JS, et al. 2014 AHA/ACC/HRS guidelines for the management of patients with atrial fibrillation: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the Heart Rhythm Society [published correction appears in Circulation. 2014;130(23):e272–e274]. Circulation. 2014;130(23):e199–e267.
POEMs are provided by Essential Evidence Plus, a point-of-care clinical decision support system published by Wiley-Blackwell, Inc. For more information, see http://www.essentialevidenceplus.com.
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