American Family Physician

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POEMs

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POEMs: Early Imaging for Low Back Pain in Older Adults Raises Costs Without Improving ...

Aug 15, 2015 - Among adults 65 years or older who present to primary care clinicians for a new episode of back pain, early imaging (before six weeks) resulted in no improved outcomes at one year, but increased overall health care costs by almost 30%.

American Family Physician : POEMs

http://www.aafp.org/afp/2015/0815/p310.html

POEMs: Two-Hour Algorithm to Rule In or Rule Out Acute MI - American Family Physician

Aug 1, 2015 - A simple rule (see synopsis) using high-sensitivity cardiac troponin levels measured on presentation and two hours later is an effective way to identify patients with or without MI. This rule was developed in one group of patients and validated in a second group. At a prevalence of 9%, ...

American Family Physician : POEMs

http://www.aafp.org/afp/2015/0801/p228a.html

POEMs: Walking Program Effective for Chronic Low Back Pain - American Family Physician

Aug 1, 2015 - Giving patients a pedometer, a walking diary, and instructions to walk at least four days per week, then gradually increase the walk's duration and intensity (see synopsis) results in improvement in pain and disability similar to usual physical therapy or a group exercise program.

American Family Physician : POEMs

http://www.aafp.org/afp/2015/0801/p230.html

POEMs: Hand Washing Children's Dishes Associated with Fewer Allergies - American Family...

Aug 1, 2015 - These results add further credence to the idea that the gastrointestinal system plays a big role in the development of our immune system (i.e., the hygiene hypothesis). Washing children's bottles and eating utensils by hand instead of using an automatic dishwasher was associated with a ...

American Family Physician : POEMs

http://www.aafp.org/afp/2015/0801/p228.html

POEMs: Are Some Antidepressants Safer than Others Regarding Suicide Risk? - American ...

Jul 1, 2015 - Mirtazapine (Remeron) and venlafaxine are associated with higher rates of completed suicide in primary care patients. Rates of suicide attempts and completion are similar with the use of selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants.

American Family Physician : POEMs

http://www.aafp.org/afp/2015/0701/p52a.html

POEMs: 9-Valent HPV Vaccine Offers Only Small Advantage Over Quadrivalent Vaccine - ...

Jul 1, 2015 - A new 9-valent HPV vaccine is generally similar in effectiveness to the older quadrivalent vaccine. There is a small benefit of the new vaccine compared with the older vaccine for women who are initially uninfected (2.4 vs. 4.2 cases per 1,000 person-years), but you would have to ...

American Family Physician : POEMs

http://www.aafp.org/afp/2015/0701/p54.html

POEMs: NSAID Use Associated with Increased Risk of Serious Bleeding and CV Events After...

Jul 1, 2015 - The use of concomitant NSAIDs in adults who receive antithrombotic therapy after MI increases the risk of serious bleeding complications and recurrent adverse CV events. This study found the highest risk among users of celecoxib (Celebrex) and diclofenac, and the lowest risk among users...

American Family Physician : POEMs

http://www.aafp.org/afp/2015/0701/p60.html

POEMs: CEA vs. Stenting: Mixed Results, Mostly Bad - American Family Physician

Jul 1, 2015 - These two randomized trials, one with short-term outcomes and the other with five-year outcomes, demonstrate that carotid artery stenting results in more frequent strokes (clinical and radiographically detected) than carotid endarterectomy (CEA). However, the rate of fatal and disabling...

American Family Physician : POEMs

http://www.aafp.org/afp/2015/0701/p52.html

POEMs: Valsartan/Sacubitril Reduces Mortality More Than Enalapril 10 mg Twice Daily in ...

Apr 1, 2015 - The combination of an angiotensin receptor blocker (valsartan) and neprilysin inhibitor (sacubitril) reduces cardiovascular mortality more than an angiotensin-converting enzyme (ACE) inhibitor (enalapril [Vasotec]) alone, with an acceptable safety and tolerability profile. The choice of...

American Family Physician : POEMs

http://www.aafp.org/afp/2015/0401/p490a.html

POEMs: Patients with Initial Unprovoked DVT or PE Benefit from Long-Term Low-Dose ...

Jun 15, 2015 - Aspirin improves long-term cardiovascular and thrombotic outcomes in patients who have had an initial unprovoked episode of VTE. The risk of bleeding was no higher in the aspirin group, perhaps because those at risk of bleeding were uncovered during the initial period of anticoagulation.

American Family Physician : POEMs

http://www.aafp.org/afp/2015/0615/p872.html

POEMs: Individualizing Target Goals and Treatment in Patients with Type 2 Diabetes - ...

Jun 1, 2015 - This statement from American and European diabetes societies suggests that tighter control of hyperglycemia be attempted only in patients with a recent diagnosis and a low risk of hypoglycemia; who have a long life expectancy with few or no comorbidities, including cardiovascular ...

American Family Physician : POEMs

http://www.aafp.org/afp/2015/0601/p788.html

POEMs: Sterile Gloves Not Necessary for Minor Skin Surgery - American Family Physician

Jun 15, 2015 - Infection rates in patients undergoing uncomplicated minor skin surgery were not different when sterile gloves, rather than simply clean gloves, were worn. A previous study similarly found no difference in infection rates between sterile and nonsterile gloves in patients undergoing ...

American Family Physician : POEMs

http://www.aafp.org/afp/2015/0615/p872a.html

POEMs: Amoxiclav Causes Diarrhea in 1 of 8 Persons Who Take It - American Family Physician

Jun 15, 2015 - The risk of diarrhea is significantly higher with amoxicillin/clavulanate (amoxiclav; Augmentin) than placebo, with a number needed to treat to harm (NNTH) of 8, which is not dissimilar from the number needed to treat for conditions such as otitis media. Contrary to popular belief, the ...

American Family Physician : POEMs

http://www.aafp.org/afp/2015/0615/p877.html

POEMs: Beta-Lactam Not as Effective as Beta-Lactam Plus Macrolide for Treating CAP in ...

May 15, 2015 - In this noninferiority trial, monotherapy with a beta-lactam was not as effective as combination therapy with a beta-lactam and a macrolide for achieving clinical stability in seven days for hospitalized patients with moderately severe CAP.

American Family Physician : POEMs

http://www.aafp.org/afp/2015/0515/p720.html

POEMs: Back-up Culture Not Needed for Negative Rapid Strep Test Results - American ...

May 1, 2015 - Although rheumatic heart disease due to group A streptococcal infection has all but disappeared in wealthy countries, some countries still go to great lengths to test for streptococcal throat infections, including the United States. As a result, we spend more than $8 million per each ...

American Family Physician : POEMs

http://www.aafp.org/afp/2015/0501/p643a.html

POEMs: No Long-Term Benefit of Arthroscopic Surgery for Meniscal Tears in Middle-Aged ...

May 1, 2015 - Arthroscopic repair of degenerative meniscal tears in middle-aged adults does not significantly improve long-term pain or function. Patients should do physical therapy and try to avoid surgery if possible.

American Family Physician : POEMs

http://www.aafp.org/afp/2015/0501/p643.html

POEMs: Increased GI Bleeding After Switch from Warfarin to Dabigatran - American Family...

May 1, 2015 - The risk of bleeding increases (though remains small) when patients with atrial fibrillation are switched from warfarin to dabigatran to prevent stroke or transient ischemic attack. This study, conducted almost exclusively in male veterans, found an increase in gastrointestinal (GI) ...

American Family Physician : POEMs

http://www.aafp.org/afp/2015/0501/p648.html

POEMs: Low-Carbohydrate Diet Better Than Low-Fat Diet to Reduce Cardiovascular Risk ...

Feb 15, 2015 - More than 40 years ago, Dr. Robert Atkins wrote his first book advocating for a low-carbohydrate diet to cause and sustain weight loss. This study (of mostly women) found that a low-carbohydrate diet—though not as severe a diet as the Atkins approach—caused an average 3.5 kg (7.7 lb) ...

American Family Physician : POEMs

http://www.aafp.org/afp/2015/0215/p262.html

POEMs: No Benefit to Screening with CTA for Asymptomatic CAD in Adults with Diabetes - ...

Apr 15, 2015 - Using coronary CTA to screen for CAD in adults with type 1 or type 2 diabetes and no indication of existing CAD does not improve outcomes more than standard care.

American Family Physician : POEMs

http://www.aafp.org/afp/2015/0415/p566.html

POEMs: CIN Treatment May Increase Miscarriages but Does Not Affect Fertility - American...

Apr 1, 2015 - In this analysis of 15 observational studies (it would be difficult and unethical to do randomized research on this topic), excision using any method for CIN did not affect fertility, although second trimester miscarriages were more likely. A study published at the same time found the ...

American Family Physician : POEMs

http://www.aafp.org/afp/2015/0401/p490.html

POEMs: Optimal Treatment of Acute Venous Thromboembolism - American Family Physician

Apr 1, 2015 - This complex network meta-analysis of eight treatment regimens for acute venous thromboembolism found that a combination of unfractionated heparin and vitamin K antagonists is associated with the least effective strategy with the highest risk of recurrent events.

American Family Physician : POEMs

http://www.aafp.org/afp/2015/0401/p492.html

POEMs: Mixed Benefits of Gluten-Free Diet in Asymptomatic Patients with Celiac Disease ...

Mar 15, 2015 - Screening of asymptomatic relatives of patients with known celiac disease identified approximately 5% who were antibody-positive. Compared with their normal diet, a gluten-free diet improved some yet unrecognized symptoms but seemed to interfere with normal social activities in these ...

American Family Physician : POEMs

http://www.aafp.org/afp/2015/0315/p402.html

POEMs: Diagnosing and Managing Acute Heart Failure Guidelines: NICE - American Family ...

Feb 15, 2015 - There is not much new in these guidelines except some caveats on what not to do. Diagnose new acute heart failure with a natriuretic peptide measurement and, if the level is high, follow with transthoracic echocardiography. Do not routinely treat with opiates, nitrates, inotropes, ...

American Family Physician : POEMs

http://www.aafp.org/afp/2015/0215/p260.html

POEMs: Post-Myocardial Infarction Beta Blockers Do Not Decrease Mortality - American ...

Mar 15, 2015 - Although recommended by guidelines and used as a so-called quality indicator of hospital care, the use of beta blockers following myocardial infarction, when combined with optimal acute and chronic treatment, does not provide a further survival benefit.

American Family Physician : POEMs

http://www.aafp.org/afp/2015/0315/p402a.html

POEMs: Injection Equals Physical Therapy for Shoulder Impingement - American Family ...

Feb 15, 2015 - Both physical therapy and corticosteroid injection decrease pain and disability by about 50% within one month of beginning treatment. However, average scores will not improve beyond that over the course of the year, and the average person will have pain, disability, and an altered ...

American Family Physician : POEMs

http://www.aafp.org/afp/2015/0215/p260a.html

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