AFP Journal Club

Three presenters review an interesting journal article on topics that affect family physicians and give their opinions about the clinical value of the studies.

Jun 15, 2013 Issue
Is Rivaroxaban Noninferior to Standard Warfarin Therapy in Preventing Recurrent PE and DVT?
A trial showing that one drug is noninferior to another does not mean that these drugs are equivalent. The noninferiority margin allows researchers to choose their own benchmark for what is considered a clinically significant difference between two drugs.

Mar 15, 2013 Issue
Does Screening Mammography Lead to Overdiagnosis of Invasive Breast Cancer?
Implementation of a universal mammographic screening program leads to an increase in the diagnosis of invasive breast cancer, because of improved detection of clinically significant cancer and overdiagnosis.

Nov 15, 2012 Issue
The Use of Coronary Computed Tomography Angiography to Rule Out CAD in the ED
Is coronary CTA good enough to allow for the safe discharge of low- to intermediate-risk patients with chest pain? Coronary CTA and standard care were equally effective at identifying a low-risk population. The test saved seven hospital hours, but at the expense of radiation exposure, higher costs, and more use of resources.

Sep 15, 2012 Issue
How Do Clinical Practice Guidelines Go Awry?
Many guidelines are dominated by recommendations from experts and are not based on sound clinical studies. The development of clinical practice guidelines needs to be transparent and devoid of commercial, financial, and political influences. Physicians should also be wary of outdated guidelines.

Jul 15, 2012 Issue
The "ARB-MI Paradox": Real or a Fluke?
The Journal Club authors discuss what factors make this meta-analysis, designed to determine whether the ARB-MI paradox is real or a statistical fluke, successful.

Jun 15, 2012 Issue
Transient Ischemic Attack: The Rules Have Changed
This scientific guideline includes three game changers for physicians regarding TIA. The Journal Club authors discuss why physicians should be wary of clinical guidelines that are based on expert opinion.

Mar 15, 2012 Issue
Rivaroxaban vs. Warfarin for Stroke Prevention in Patients with Nonvalvular Atrial Fibrillation
How does rivaroxaban compare with warfarin for stroke prevention in patients with nonvalvular atrial fibrillation? This study concluded that rivaroxaban is noninferior to warfarin. However, noninferiority trials do not meet the same rigorous design and statistical format of traditional superiority trials.

Jan 15, 2012 Issue
Antibiotics for Acute Otitis Media in Young Children: The Case of the Shifting End Points
A discussion of why the conclusion of a high-profile study, which suggests that antibiotics are beneficial in children six to 23 months of age with acute otitis media, is incorrect.

Nov 15, 2011 Issue
Antibiotics for Acute Otitis Media in Young Children
Two studies aim to clarify the appropriate use of antibiotic treatment in young children with acute otitis media.

Sep 15, 2011 Issue
Subarachnoid Hemorrhage and the CT Scan
Is CT sensitive enough to rule out subarachnoid hemorrhage? This study says yes, but rretrospective studies are inherently problematic. Normal head CT should be followed by a lumbar puncture.

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