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.

Apr 15, 2018 Issue
Routine Oxygen Supplementation After Acute Stroke Does Not Improve Functional Outcomes
For nonhypoxic patients with acute stroke, routine oxygen therapy for 72 hours, either continuously or at night only, does not improve functional outcomes at 90 days. Long-term outcomes were not assessed in this study, and the question remains whether 90 days is an adequate length of time to see most of the meaningful recovery from stroke.


Apr 1, 2018 Issue
Clinical Diagnosis of Lyme Disease Frequently Misses the "Bull’s Eye"
For children with suspected Lyme disease but without a classic bull's-eye lesion (erythema migrans of at least 5 cm), check serology rather than rely on your clinical impression. In this study, 12% of the children not suspected of having Lyme disease did have Lyme disease, and 31% of children thought to have Lyme disease did not have serologic findings at that time or within 30 days.


Apr 1, 2018 Issue
Broad-Spectrum Antibiotics Increase Adverse Events in Children with Acute Respiratory Infections with Minimal Benefit
Broad-spectrum antibiotics are no more effective than narrow-spectrum antibiotics for treating acute respiratory tract infections in infants and children, and adverse events are significantly more common in children treated with broad-spectrum antibiotics.


Apr 1, 2018 Issue
Early PT for Acute Low Back Pain Is Cost-Effective, but Gain in Quality of Life Is Likely Too Small to Notice
At $30,000 per quality-adjusted life year (QALY) gained, early PT for acute low back pain in primary care is cost-effective by the usual criteria of $50,000 to $100,000 per QALY. However, the magnitude of improvement in quality of life is small and is probably not clinically meaningful.


Mar 15, 2018 Issue
High-Sensitivity Troponin I of Less Than 5 ng per L Has Negative Predictive Value of 99.9% for Cardiac Death at One Year
A cardiac troponin I concentration of less than 5 ng per L in adults who present with potential acute coronary syndrome has a negative predictive value (NPV) of at least 99.9% for cardiac death at 30 days and at one year.


Mar 15, 2018 Issue
Minimal Effect of ERT on Sexual Function in Menopausal Women
Transdermal, but not oral, estrogen produced a small improvement in sexual function scores in menopausal women. The increases were very small and may not be noticeable by most women.


Mar 15, 2018 Issue
Ibuprofen and Morphine Provide Similar Post-op Pain Relief in Kids; Ibuprofen Has Fewer Harms
This carefully designed and adequately powered study found no difference in pain reduction between ibuprofen and oral morphine in children with postoperative pain. Adverse effects, however, were much more likely with morphine.


Mar 1, 2018 Issue
Ibuprofen Plus Acetaminophen Equals Opioid Plus Acetaminophen for Acute Severe Extremity Pain
In adults presenting to the emergency department with acute extremity pain severe enough to warrant radiologic investigation, ibuprofen plus acetaminophen was equally effective in reducing pain intensity at two hours compared with three different opioid and acetaminophen combination analgesics.


Feb 15, 2018 Issue
Lorazepam Added to Haloperidol Effective for Agitated Delirium in End-of-Life Cancer Patients
Using a single dose of lorazepam in combination with haloperidol decreases agitation in end-of-life patients with cancer who had persistent agitated delirium despite scheduled haloperidol. A recent POEM reported that haloperidol increases symptoms of distress in patients with cancer and acute delirium who are receiving palliative care.


Feb 15, 2018 Issue
No Effect on Mortality with Oxygen Therapy in Nonhypoxemic Patients with Suspected MI
In patients with suspected MI and normal oxygen levels, giving immediate supplemental oxygen therapy does not improve mortality at one year. Although this study was underpowered because of fewer than expected deaths in the control group, the results were consistent across all subgroups, as well as with findings from other literature.


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