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.

Jul 15, 2011 Issue
Usefulness of Procalcitonin Measurement in Reducing Antibiotic Use and Identifying Serious Bacterial Illness
Measurement of procalcitonin is being pushed as a way to determine the presence or absence of bacterial infection and, therefore, as a way to reduce antibiotic use. But, how well does it work in the patients family physicians see? Why are the results of this study not as convincingly positive as the results of other studies?

May 15, 2011 Issue
Clinical Significance of Meniscal Damage on Knee MRI
Can you make the assumption that, in a patient with knee pain, meniscal damage found on MRI is responsible for his or her symptoms? Meniscal findings on knee MRI do not correlate well with pain.

Mar 15, 2011 Issue
Donepezil to Manage Alzheimer Disease: New vs. Standard Dosing
Does donepezil benefit patients with Alzheimer disease, and is the new dosage superior to the standard dosage? This study showed benefit, but the data are misleading.

Nov 15, 2010 Issue
Can ECG Rule Out ACS if Performed While the Patient Is Having Chest Pain?
Is negative ECG performed while the patient is having chest pain good at ruling out acute coronary syndrome? Although this study says yes, other higher-quality studies say it does not rule out cardiac disease. Observational studies are not ideal for testing some hypotheses.

Sep 15, 2010 Issue
Autism and Childhood Vaccinations: Debunking the Myth
Are childhood vaccinations associated with subsequent development of autism? This month's article provides the science and statistics to dispel the theory that childhood vaccinations induce autism.

May 15, 2010 Issue
Antidepressants for Initial Treatment of Depression
Which antidepressants should be used for the initial treatment of depression? This quality multiple-treatment meta-analysis gives physicians a good starting point for choosing an antidepressant. Sertraline and escitalopram should be considered first-line agents whereas bupropion, fluoxetine, paroxetine, and duloxetine were least tolerated.

Mar 15, 2010 Issue
Beta Blockers and Noncardiac Surgery: Why the POISE Study Alone Should Not Change Your Practice
Should we stop using beta blockers to prevent myocardial infarction in persons undergoing noncardiac surgery? The data remain inconclusive. Although the POISE study is an important contribution to the literature, it uses a protocol that is unrealistic and should not change current practice.

Jan 15, 2010 Issue
Cancer Risks Associated with CT Scanning

Nov 15, 2009 Issue
Is Telmisartan Effective for Stroke Prevention?
Does telmisartan therapy after stroke prevent recurrence and adverse cardiovascular events? Despite lowering blood pressure, telmisartan did not provide preventative benefit. This study reflects problems with publication bias and that surrogate markers, such as blood pressure control, may not reflect patient outcomes.

Sep 15, 2009 Issue
Is the San Francisco Syncope Rule Reliable?
Can the San Francisco Syncope Rule successfully determine which patients can be safely discharged after an acute syncopal episode? External validation suggests that the sensitivity of the rule is lower than first reported. Physicians need to apply their clinical acumen and override the results of a clinical decision rule when necessary.

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