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.

Jan 15, 2017 Issue
In Patients with Vascular Disease, Treating Sleep Apnea Does Not Reduce the Risk of Cardiovascular Events
Compared with usual care, the use of CPAP provides a modest improvement in daytime sleepiness, but does not reduce the likelihood of cardiovascular events, even in a high-risk population.


Jan 15, 2017 Issue
CA 125 Relatively Specific for Diagnosing Endometriosis
For women with symptoms suggestive of endometriosis, serum CA 125 is a relatively specific (93%) and noninvasive test. It can be used to make a presumptive diagnosis in cases for which a medical management approach is being considered without having to perform a (diagnostic standard) laparoscopic procedure to confirm.


Jan 15, 2017 Issue
Chocolate Consumption May Make Acne Vulgaris Worse
This study found a statistically significant increase in facial acne lesions among college students 48 hours after ingesting chocolate instead of jelly beans (average compared with baseline: 4.8 new lesions vs. 0.7 fewer lesions, respectively).


Jan 15, 2017 Issue
Tamsulosin Beneficial for Passage of 5- to 10-mm Distal Ureteral Stones
Tamsulosin promotes stone passage of distal ureteral stones that are 5 to 10 mm in size. You would need to treat five such patients to get one stone passage. Smaller stones tend to pass on their own at a rate of 86% in this study.


Dec 1, 2016 Issue
Lumbar Fusion No Better Than Exercise and Therapy in the Long Term
This trial is a good example of how to do just about everything wrong to get the results you want. The authors did not conceal allocation, did not mask anyone in the study, used an unvalidated and subjective primary outcome, and downplayed the intention-to-treat analysis. Funding for the original study came from industry, and the authors have numerous conflicts of interest.


Dec 1, 2016 Issue
Step-by-Step Approach to Ruling Out Infant Infection Is Accurate
The Step-by-Step approach, using a basic physical examination and readily available urine and blood tests (without lumbar puncture; see the Synopsis section), can successfully identify low-risk infants younger than 90 days who will not need empiric antibiotic treatment and lumbar puncture.


Dec 1, 2016 Issue
Larger Bottles Associated with Greater Weight in Infants
In nonbreastfed infants, using large bottles (at least 6 oz [180 mL]) to feed infants two months of age was associated with greater weight gain by six months of age. The authors did not report adverse effects associated with bottle size. This is an interesting study that suggests that smaller bottles may prevent overfeeding.


Dec 1, 2016 Issue
Cervical Treatment Associated with Adverse Obstetric Outcomes
Cervical treatments for dysplasia and early cervical carcinoma are associated with subsequent risk of preterm birth. Excisional treatments carry higher risk than ablative treatments, and multiple treatments carry higher risk than single treatments. The frequency and severity of prematurity-related outcomes increase with increasing cone depth and volume.


Nov 1, 2016 Issue
Venous Samples Are a Less-Painful Starting Point for the Evaluation of Patients with Acute Exacerbation of COPD
There is very good agreement between arterial and venous measurements of pH and bicarbonate, and fairly good agreement at higher levels between arterial and peripheral measures of oxygen saturation. These authors suggest an algorithm for patients with acute exacerbation of COPD that includes an arterial blood gas analysis only if the patient's initial pulse oximetry is less than 80% or if the venous pH is less than 7.35, which would obviate the need for two-thirds of arterial blood gasses.


Nov 1, 2016 Issue
Opioid Analgesia Hard to Tolerate and Not Effective for Chronic Low Back Pain
Effective pain control in patients with low back pain is still elusive. Approximately one-half of all patients with low back pain who take an opioid analgesic will stop treatment because of ineffectiveness or adverse effects. Patients staying the course will experience, on average, a small decrease in pain relative to patients who take placebo (similar to the benefit from nonsteroidal anti-inflammatory drugs) and will not have improved function.


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