Top 20 Research Studies of 2016 for Primary Care Physicians
Am Fam Physician. 2017 May 1;95(9):572-579.
The full text of the POEMs discussed in this article is available at http://www.aafp.org/afp/poems2016. A list of top POEMs from previous years is available at http://www.aafp.org/journals/afp/authors/ebm-toolkit/resources/top-poems.html.
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.
This article summarizes the top 20 original research studies and four practice guidelines of 2016, based on regular literature surveillance and as selected by members of the Canadian Medical Association. The studies, known as POEMs (patient-oriented evidence that matters), were rated highly because of their relevance, validity, and potential to change practice. Key hypertension treatment findings include reduced mortality (a benefit not demonstrated in lower-risk persons or persons with diabetes mellitus) but also an increase in harms with a more aggressive blood pressure target in high-risk persons with hypertension and without diabetes. Additionally, one study found that cardiovascular events are rare in patients who meet the criteria for hypertensive urgency. Regarding respiratory conditions, the combination of fluticasone and salmeterol is preferred to fluticasone alone in patients with moderate to severe asthma; nasal irrigation but not steam inhalation is beneficial for patients with chronic sinus symptoms; and delayed prescriptions reduce antibiotic use in patients with symptoms of acute respiratory infection. Studies on musculoskeletal topics found that of the nonsteroidal anti-inflammatory drugs currently available, diclofenac is most likely to be effective for hip or knee osteoarthritis; the benefits of opioids in patients with chronic low back pain are limited and not clearly superior to nonsteroidal anti-inflammatory drugs; and hip radiography is not helpful for diagnosing osteoarthritis of the hip. Regarding diabetes and obesity, the Mediterranean diet is more effective than a low-fat diet for weight loss, and aggressive blood pressure targets are not recommended in patients with diabetes, especially older persons. Other recommendations include use of an oral syringe rather than a medicine cup to measure liquid medications for children, and abrupt smoking cessation preceded by two weeks of nicotine replacement via a patch, rather than a slow phasing out of tobacco use. Finally, although azithromycin has a slightly higher failure rate than doxycycline for the treatment of chlamydia, it still cured 97% of patients in a randomized trial.
Each year, thousands of studies are published that are potentially relevant to primary care physicians. To help physicians identify the most important new research, the POEMs (patient-oriented evidence that matters) criteria were developed. According to these criteria, the most important research—defined as research that, if true, has the greatest potential to change practice—should be relevant and valid (i.e., at low risk of bias), and report patient-oriented outcomes such as morbidity, mortality, or quality of life.1 Since 1994, a team of primary care clinicians with expertise in evidence-based practice has performed monthly surveillance of more than 110 English-language research journals.2 Although more than 20,000 studies were published in these journals during 2016, only 264 met the POEMs criteria for validity, relevance, use of patient-oriented outcomes, and practice change. 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 are supported by subscriptions, without industry support.
The Canadian Medical Association (CMA) sponsors a subscription to the Daily InfoPOEMs for their members. Each member has the option to receive the daily POEM by e-mail and rate it using a brief survey called the Information Assessment Method. This validated survey is a tool to document clinical relevance, cognitive impact, use of the information in practice, and expected health benefits for patients if the results of the POEM are applied.3 This article presents the 20 POEMs of 2016 that were most highly rated by CMA members for clinical relevance to one or more of their patients.
In the sixth installment of this annual series,4–8 we summarize the clinical question and bottom-line answer for each of the 20 top-rated POEMs. The POEMs have been organized by topic, and each is accompanied by a brief discussion. The bottom-line answers have been rewritten somewhat from the original to better stand alone without the complete synopsis. We also briefly discuss four POEMs that summarize highly relevant practice guidelines. The full POEMs are available online at http://www.aafp.org/afp/poems2016.
The first group of POEMs focuses on hypertension (Table 1).9–14 Study 1, the SPRINT (Systolic Blood Pressure Intervention Trial) study, reported a reduction in all-cause and cardiovascular (CV) mortality in older high-risk patients without diabetes mellitus who were randomized
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 three 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 23 years.
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POEMs are provided by Essential Evidence Plus, a point-of-care clinical decision support system published by Wiley-Blackwell, Inc. For more information, visit http://www.essentialevidenceplus.com.
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