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.

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.


Nov 1, 2016 Issue
Getting an Infant to Sleep: Graduated Extinction and Sleep Fading are Effective
This study found that graduated extinction (increasing intervals between comforting the infant) and sleep fading (putting the child to bed progressively later until the parent finds the sweet spot) are both effective at decreasing sleep latency and the number of awakenings and decreasing maternal and infant stress. Neither approach affected the likelihood of secure child-parent attachment.


Nov 1, 2016 Issue
Hypertensive Urgency Not Really an Urgent Problem
It seems that rapid treatment of patients with hypertensive urgency is unsuccessful and unnecessary. In this study of almost 60,000 patients, 80% did not have controlled blood pressure (less than 140/90 mm Hg) after one month of treatment, including patients who were hospitalized. On the other hand, the risk of a major cardiovascular event was also low: one in 1,000 over the next seven days.


Oct 15, 2016 Issue
Third-Generation Oral Contraceptives Associated with Greater Risk of PE, Stroke, and MI
Although there is risk with any current oral contraceptive combination, those that contain lower doses of estrogen, and levonorgestrel instead of desogestrel or gestodene, are associated with the least risk of ischemic stroke, myocardial infarction (MI), or pulmonary embolism (PE). These safer products are older so are often less expensive.


Oct 15, 2016 Issue
All Analgesics Are Better Than Placebo in Patients with Knee or Hip DJD
In patients with hip or knee DJD, all analgesics are more effective than placebo in relieving pain and improving function. Although paracetamol (acetaminophen) is the least effective of all the drugs studied, it still may be the first treatment for these patients because of its safety profile.


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