AFP DEPARTMENT COLLECTION

POEMs

POEMs (Patient-Oriented Evidence that Matters) are summaries of research that is relevant to physicians and their patients and meet three criteria: address a question that primary care physicians face in day-to-day practice; measure outcomes important to physicians and patients, including symptoms, morbidity, quality of life, and mortality; and have the potential to change the way physicians practice.

Jul 15, 2017 Issue
Niacin Does Not Decrease Mortality in Patients with Coronary Artery Disease or Low HDL
We are now flush with data about the effects of niacin in patients with elevated cholesterol levels. Despite its ability to raise high-density lipoprotein (HDL) serum cholesterol levels, it does not add additional mortality or morbidity benefit to statin treatment. Patients with diabetes mellitus may also experience worse blood glucose control, as well as other niacin-related adverse effects.


Jul 15, 2017 Issue
High False-Positive Rate with Lung Cancer Screening
If you are thinking about adding lung cancer screening to your delivery of preventive care, be sure to prepare patients. They are likely to receive a positive result, most of the positive results will not be lung cancer, and one in four patients will require additional tracking (i.e., follow-up scans).


Jul 15, 2017 Issue
Greater Benefit with Rivaroxaban Than Aspirin for Extended Treatment of VTE
Compared with aspirin, the use of rivaroxaban (Xarelto) to extend anticoagulation beyond the initial six to 12 months to treat provoked or unprovoked VTE reduces the risk of recurrent symptomatic VTE without increasing the risk of bleeding. You would need to treat approximately 30 to 33 patients with full- or low-dose rivaroxaban to prevent one additional clot.


Jul 1, 2017 Issue
Arthroscopic Meniscal Surgery Is Equivalent to Nonoperative Management
The existing research base, with biases that typically make interventions look better, is unable to demonstrate that arthroscopy for meniscal injuries is any better than nonoperative approaches. Because this is a costly intervention and is being used more often, perhaps insurance companies should reevaluate whether to continue paying for it.


Jun 15, 2017 Issue
Bariatric Surgery Improves Quality of Life and Results in More Weight Loss Than Intensive Medical Therapy
Bariatric surgery using Roux-en-Y gastric bypass or sleeve gastrectomy was more effective than intensive medical therapy at improving quality of life and helping patients lose weight and reduce the need for medications. Anemia was more common with sleeve gastrectomy, and approximately 4% of patients in the surgical groups required a second surgery.


Jun 1, 2017 Issue
Antibiotics May Equal Surgery for Children with Appendicitis
Antibiotic treatment appears to be effective for children with uncomplicated appendicitis without evidence of perforation or rupture, with 97% of children discharged without surgery. Approximately one in seven children will eventually have recurrence and require surgery. A couple of days of intravenous antibiotics is an option before surgery.


Jun 1, 2017 Issue
Testosterone Does Not Improve Cognition in Memory-Impaired Older Men with Low Testosterone Levels
Testosterone supplementation for men 65 years or older with age-associated memory impairment and a low baseline testosterone level was not associated with significant improvements in memory or other cognitive functions.


Jun 1, 2017 Issue
Bare Arm Best for Blood Pressure Measurement
To get the most accurate measure, let patients sit for a few minutes, and then measure their blood pressure on a completely bare arm. Does a difference of 4 mm systolic and 6 to 7 mm diastolic matter?


May 15, 2017 Issue
More Accurate Prediction of the Pretest Probability of Cardiovascular Disease with European Risk Score
The European approach to determining the pretest likelihood of coronary artery disease (CAD) in patients with chest pain is superior to that of the Diamond-Forrester approach recommended by U.S. guidelines, and will result in less need for immediate invasive treatment.


May 15, 2017 Issue
Topiramate and Amitriptyline Not Effective for Migraine in Children
Topiramate, amitriptyline, and placebo all led to a similar, substantial improvement in migraine frequency and disability. How to harness this strong placebo effect for our patients is an important, but unanswered, question.


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