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YEARS Clinical Decision Tool Decreases CTA in Patients with Suspected Pulmonary ...

Nov 15, 2017 - In this study, using a simplified algorithm in patients with suspected pulmonary embolism can safely decrease the number of CTAs.

American Family Physician : POEMs

https://www.aafp.org/afp/2017/1115/od3.html

Use of Mindfulness or Self-Hypnosis Provides Immediate Pain Relief to Hospitalized ...

Nov 15, 2017 - Compared with psychoeducation, a single 15-minute session of training in mindfulness or self-hypnosis leads to greater immediate pain relief for hospitalized patients with at least moderate pain at baseline.

American Family Physician : POEMs

https://www.aafp.org/afp/2017/1115/od6.html

Mite-Impermeable Covers Decrease Hospital Visits in Kids with Asthma - POEMs - American...

Nov 15, 2017 - In children with house dust mite allergies and asthma, the use of mite-impermeable bedding decreases the frequency of asthma exacerbations.

American Family Physician : POEMs

https://www.aafp.org/afp/2017/1115/od4.html

No Benefit with Addition of TMP/SMX to Cephalexin for Nonpurulent Cellulitis - POEMs - ...

Sep 15, 2017 - Compared with cephalexin alone, covering for methicillin-resistant Staphylococcus aureus (MRSA) and streptococci with cephalexin plus TMP/SMX does not improve rates of clinical cure when treating nonpurulent cellulitis. However, a trend favoring the combination regimen was found in a ...

American Family Physician : POEMs

https://www.aafp.org/afp/2017/0915/p399.html

Newer Oral Hypoglycemics Do Not Increase or Decrease Mortality - POEMs - American ...

Oct 15, 2017 - This seems like a strange question considering that the goal is to decrease mortality with drug therapy. Nevertheless, this study showed that the new kids on the diabetes block—exenatide (Byetta), dulaglutide (Trulicity), sitagliptin (Januvia), saxagliptin (Onglyza), and others—do not ...

American Family Physician : POEMs

https://www.aafp.org/afp/2017/1015/od2.html

Tranexamic Acid Decreased Death from Bleeding but Not All-Cause Mortality in Women with...

Oct 15, 2017 - In this really large study, tranexamic acid did not decrease the frequency of the primary outcome of death or hysterectomy in women with postpartum hemorrhage. However, there was a very small reduction in the rate of death from bleeding in the women treated with tranexamic acid.

American Family Physician : POEMs

https://www.aafp.org/afp/2017/1015/od1.html

Corticosteroid Injections Ineffective for Knee Osteoarthritis - POEMs - American Family...

Sep 15, 2017 - This well-done study found that regular three-month intra-articular injections of triamcinolone for two years resulted in no significant difference in pain and function assessments compared with saline. However, a significant increase in cartilage loss and damage did occur in patients ...

American Family Physician : POEMs

https://www.aafp.org/afp/2017/0915/p406.html

Steroid Treatment Adds No Benefit to Antihistamines for Acute Hives - POEMs - American ...

Sep 15, 2017 - The combination approach of steroids and antihista-mines offers no added benefit to antihistamines alone for the treatment of simple urticaria.

American Family Physician : POEMs

https://www.aafp.org/afp/2017/0915/p399a.html

In Very High-Risk Patients with Vascular Disease, Evolocumab Slightly Reduces Nonfatal ...

Oct 1, 2017 - In an extremely high-risk group of patients with known vascular disease, taking evolocumab instead of placebo in addition to standard statin therapy for slightly more than two years will prevent one myocardial infarction (MI) for every 83 persons treated and prevent one stroke for every...

American Family Physician : POEMs

https://www.aafp.org/afp/2017/1001/p470.html

Dexamethasone May Reduce Sore Throat Symptoms in Adults at 48 Hours - POEMs - American ...

Aug 15, 2017 - A single dose of oral dexamethasone is no more effective than placebo in resolving acute sore throat symptoms at 24 hours in adults who do not receive immediate antibiotic therapy. However, among a multitude of exploratory secondary outcomes, the authors found that, compared with ...

American Family Physician : POEMs

https://www.aafp.org/afp/2017/0815/p260a.html

More Accurate Prediction of the Pretest Probability of Cardiovascular Disease with ...

May 15, 2017 - The European approach to determining the pretest likelihood of coronary artery disease (CAD) in patients with chest pain is superior to that of the Diamond-Forrester approach recommended by U.S. guidelines, and will result in less need for immediate invasive treatment.

American Family Physician : POEMs

https://www.aafp.org/afp/2017/0515/od1.html

Combination of Resistance and Aerobic Exercise Best for Older Persons with Obesity - ...

Sep 1, 2017 - In older patients with obesity embarking on a program to improve their health, weight loss accompanied by resistance training and aerobic training resulted in the biggest gains in functional status and physical performance.

American Family Physician : POEMs

https://www.aafp.org/afp/2017/0901/p331.html

Pregabalin Does Not Decrease the Pain of Sciatica - POEMs - American Family Physician

Aug 15, 2017 - Pregabalin does not relieve pain in patients with sciatica.

American Family Physician : POEMs

https://www.aafp.org/afp/2017/0815/p260.html

High False-Positive Rate with Lung Cancer Screening - POEMs - American Family Physician

Jul 15, 2017 - If you are thinking about adding lung cancer screening to your delivery of preventive care, be sure to prepare patients. They are likely to receive a positive result, most of the positive results will not be lung cancer, and one in four patients will require additional tracking (i.e., ...

American Family Physician : POEMs

https://www.aafp.org/afp/2017/0715/p128a.html

Niacin Does Not Decrease Mortality in Patients with Coronary Artery Disease or Low HDL ...

Jul 15, 2017 - We are now flush with data about the effects of niacin in patients with elevated cholesterol levels. Despite its ability to raise high-density lipoprotein (HDL) serum cholesterol levels, it does not add additional mortality or morbidity benefit to statin treatment. Patients with ...

American Family Physician : POEMs

https://www.aafp.org/afp/2017/0715/p129.html

No Increased Risk of ASD, ADHD, or SGA with First-Trimester Antidepressant Use - POEMs ...

Aug 15, 2017 - This study found that maternal antidepressant use during the first trimester of pregnancy is associated with an increased risk of preterm birth, but not SGA, ASD, or ADHD. Another study in the same issue also reported no increased risk of ASD with in utero exposure to selective ...

American Family Physician : POEMs

https://www.aafp.org/afp/2017/0815/p261.html

Probiotic Ineffective for Treatment of Acute Gastroenteritis in Young Children - POEMs ...

Jun 1, 2019 - << Previous article Next article >> Jun 1, 2019 Issue POEMs Patient-Oriented Evidence That Matters Probiotic Ineffective for Treatment of Acute Gastroenteritis in Young Children Am Fam Physician. 2019 Jun 1;99(11):717-718. Clinical Question Is the probiotic Lactobacillus rhamnosus GG...

American Family Physician : POEMs

https://www.aafp.org/afp/2019/0601/p717a.html

Bariatric Surgery Improves Quality of Life and Results in More Weight Loss Than ...

Jun 15, 2017 - Bariatric surgery using Roux-en-Y gastric bypass or sleeve gastrectomy was more effective than intensive medical therapy at improving quality of life and helping patients lose weight and reduce the need for medications. Anemia was more common with sleeve gastrectomy, and approximately ...

American Family Physician : POEMs

https://www.aafp.org/afp/2017/0615/p805.html

Greater Benefit with Rivaroxaban Than Aspirin for Extended Treatment of VTE - POEMs - ...

Jul 15, 2017 - Compared with aspirin, the use of rivaroxaban (Xarelto) to extend anticoagulation beyond the initial six to 12 months to treat provoked or unprovoked VTE reduces the risk of recurrent symptomatic VTE without increasing the risk of bleeding. You would need to treat approximately 30 to 33...

American Family Physician : POEMs

https://www.aafp.org/afp/2017/0715/p128.html

Arthroscopic Meniscal Surgery Is Equivalent to Nonoperative Management - POEMs - ...

Jul 1, 2017 - The existing research base, with biases that typically make interventions look better, is unable to demonstrate that arthroscopy for meniscal injuries is any better than nonoperative approaches. Because this is a costly intervention and is being used more often, perhaps insurance ...

American Family Physician : POEMs

https://www.aafp.org/afp/2017/0701/p55.html

Bare Arm Best for Blood Pressure Measurement - POEMs - American Family Physician

Jun 1, 2017 - To get the most accurate measure, let patients sit for a few minutes, and then measure their blood pressure on a completely bare arm. Does a difference of 4 mm systolic and 6 to 7 mm diastolic matter?

American Family Physician : POEMs

https://www.aafp.org/afp/2017/0601/p733.html

Antibiotics May Equal Surgery for Children with Appendicitis - POEMs - American Family ...

Jun 1, 2017 - Antibiotic treatment appears to be effective for children with uncomplicated appendicitis without evidence of perforation or rupture, with 97% of children discharged without surgery. Approximately one in seven children will eventually have recurrence and require surgery. A couple of ...

American Family Physician : POEMs

https://www.aafp.org/afp/2017/0601/p737.html

Testosterone Does Not Improve Cognition in Memory-Impaired Older Men with Low ...

Jun 1, 2017 - Testosterone supplementation for men 65 years or older with age-associated memory impairment and a low baseline testosterone level was not associated with significant improvements in memory or other cognitive functions.

American Family Physician : POEMs

https://www.aafp.org/afp/2017/0601/p733a.html

Steroids at 34 to 36 Weeks’ and Before Term Cesarean Decrease Respiratory Distress ...

Feb 15, 2017 - For women admitted for imminent premature delivery at 34 to 36 weeks of gestation, one or two doses of betamethasone or dexamethasone (8 to 12 mg) decrease the likelihood of neonatal respiratory distress syndrome and shorten lengths of stay in the intensive care unit.

American Family Physician : POEMs

https://www.aafp.org/afp/2017/0215/od2.html

Repeat Cytology Within Six Months Equals Colposcopy for Younger Women with ASCUS or ...

Apr 1, 2017 - Among women 22 to 27 years of age with an index cervical cytology showing abnormal squamous cells of undetermined significance (ASCUS) or low-grade squamous intraepithelial lesion (LSIL), the incidence of invasive cervical cancer did not differ between repeat cytology within six months ...

American Family Physician : POEMs

https://www.aafp.org/afp/2017/0401/p455.html

Topiramate and Amitriptyline Not Effective for Migraine in Children - POEMs - American ...

May 15, 2017 - Topiramate, amitriptyline, and placebo all led to a similar, substantial improvement in migraine frequency and disability. How to harness this strong placebo effect for our patients is an important, but unanswered, question.

American Family Physician : POEMs

https://www.aafp.org/afp/2017/0515/od2.html

Pelvic Floor Exercises Modestly Improve Pelvic Floor Prolapse Symptoms - POEMs - ...

May 15, 2017 - In women with mild to moderate pelvic floor prolapse, a formal program including physiotherapist-guided pelvic floor exercises only modestly improved symptoms.

American Family Physician : POEMs

https://www.aafp.org/afp/2017/0515/od3.html

One-Third of Adults with Diagnosed Asthma Can Be Weaned Off All Asthma Medications - ...

May 1, 2017 - This study found that current asthma was ruled out after repeated testing in one-third of adults with physician-diagnosed asthma. Patients ruled out for current asthma were less likely to be using asthma medications or daily controlling medications and less likely to have undergone ...

American Family Physician : POEMs

https://www.aafp.org/afp/2017/0501/p586.html

Antipsychotics Worsen Symptoms in Patients with Delirium Who Receive Palliative Care - ...

Mar 15, 2017 - For hospitalized patients with acute delirium and symptoms of distress who are receiving palliative care, the use of risperidone (Risperdal) or haloperidol at conservative oral doses worsens symptoms and may shorten overall survival.

American Family Physician : POEMs

https://www.aafp.org/afp/2017/0315/od3.html

If You Give Amoxicillin/Clavulanate to Six- to 23-Month-Olds with AOM, 10 Days Is ...

Apr 1, 2017 - These authors begin with the assumption that we should treat children who have AOM with amoxicillin/clavulanate. The greatest benefit was in children one to two years of age who had more severe pain and fever. In children with less severe symptoms, observation should still be the ...

American Family Physician : POEMs

https://www.aafp.org/afp/2017/0401/p457.html

PCI Has More Benefits and Harms Than CABG for Selected Patients with Left Main Coronary...

Apr 1, 2017 - Patients undergoing PCI had fewer early myocardial infarctions, but more later deaths and later myocardial infarctions. There are other benefits to PCI, including shorter hospital stay, lower cost, and faster recovery. But patients should be informed of the tradeoffs, and it is ...

American Family Physician : POEMs

https://www.aafp.org/afp/2017/0401/p455a.html

Placebo Plus Message of Benefit Decreases Chronic Low Back Pain - POEMs - American ...

Apr 1, 2017 - These investigators gave twice daily placebo to patients with chronic back pain and told them it was placebo. They also told them that placebos can have a pronounced effect (which is true). The addition of placebo to usual care improved patients' pain and disability scores over the ...

American Family Physician : POEMs

https://www.aafp.org/afp/2017/0401/p456.html

CA 125 Relatively Specific for Diagnosing Endometriosis - POEMs - American Family ...

Jan 15, 2017 - For women with symptoms suggestive of endometriosis, serum CA 125 is a relatively specific (93%) and noninvasive test. It can be used to make a presumptive diagnosis in cases for which a medical management approach is being considered without having to perform a (diagnostic standard) ...

American Family Physician : POEMs

https://www.aafp.org/afp/2017/0115/p122.html

Semaglutide Reduces CV Events in High-Risk Patients with Type 2 Diabetes Mellitus - ...

Mar 15, 2017 - Semaglutide significantly reduced the composite outcome of CV death, nonfatal myocardial infarction, and nonfatal stroke (number needed to treat [NNT] = 43 over 2.1 years). It was generally well tolerated, and it reduced body weight by approximately 6.4 to 9.5 lb (2.9 to 4.3 kg).

American Family Physician : POEMs

https://www.aafp.org/afp/2017/0315/p396.html

Detrimental Effect of Tight Glucose Control on CV Mortality Persists Over Nine Years - ...

Mar 15, 2017 - The initial Action to Control Cardiovascular Risk in Diabetes (ACCORD) study, which compared standard treatment with intensive control, found that despite good intentions, cardiovascular (CV) and overall mortality are significantly higher when blood glucose levels are lower.

American Family Physician : POEMs

https://www.aafp.org/afp/2017/0315/od2.html

Chocolate Consumption May Make Acne Vulgaris Worse - POEMs - American Family Physician

Jan 15, 2017 - This study found a statistically significant increase in facial acne lesions among college students 48 hours after ingesting chocolate instead of jelly beans (average compared with baseline: 4.8 new lesions vs. 0.7 fewer lesions, respectively).

American Family Physician : POEMs

https://www.aafp.org/afp/2017/0115/p122a.html

Low-Dose Morphine Less Effective Than Diclofenac or Acetaminophen for Renal Colic - ...

Oct 15, 2016 - This is a good example of how a well-done study can lead to erroneous conclusions. The comparator most likely to be effective here—titrated morphine—was used at a low dose and found to be less effective than intramuscular diclofenac or intravenous paracetamol (acetaminophen).

American Family Physician : POEMs

https://www.aafp.org/afp/2016/1015/p665.html

Sertraline Reduces Risk of Depression in Adults After Traumatic Brain Injury - POEMs - ...

Feb 1, 2017 - This study found that sertraline is more effective than placebo (number needed to treat = 6) in preventing the onset of a major depressive disorder in adults following a TBI. This study included patients with mild, moderate, and severe TBI.

American Family Physician : POEMs

https://www.aafp.org/afp/2017/0201/p194.html

Active Surveillance for Localized Prostate Cancer: No Increased Mortality, but Higher ...

Feb 1, 2017 - This landmark study compared active surveillance with radical prostatectomy or radiation therapy for patients with T1c or T2 prostate cancer. The benefits of active surveillance include avoiding radical therapy in one-half of the patients, with no effect on disease-specific survival or ...

American Family Physician : POEMs

https://www.aafp.org/afp/2017/0201/p196.html

Tamsulosin Beneficial for Passage of 5- to 10-mm Distal Ureteral Stones - POEMs - ...

Jan 15, 2017 - Tamsulosin promotes stone passage of distal ureteral stones that are 5 to 10 mm in size. You would need to treat five such patients to get one stone passage. Smaller stones tend to pass on their own at a rate of 86% in this study.

American Family Physician : POEMs

https://www.aafp.org/afp/2017/0115/p123a.html

Brief Interventions for Weight Management in Kids Are Not Effective - POEMs - American ...

Feb 1, 2017 - Calculating the BMI of children and adolescents in primary care practices and counseling those who are overweight is ineffective to reduce BMI in children over several years of follow-up.

American Family Physician : POEMs

https://www.aafp.org/afp/2017/0201/p194a.html

In Patients with Vascular Disease, Treating Sleep Apnea Does Not Reduce the Risk of ...

Jan 15, 2017 - Compared with usual care, the use of CPAP provides a modest improvement in daytime sleepiness, but does not reduce the likelihood of cardiovascular events, even in a high-risk population.

American Family Physician : POEMs

https://www.aafp.org/afp/2017/0115/p123.html

Getting an Infant to Sleep: Graduated Extinction and Sleep Fading are Effective - POEMs...

Nov 1, 2016 - 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 ...

American Family Physician : POEMs

https://www.aafp.org/afp/2016/1101/p750.html

Hypertensive Urgency Not Really an Urgent Problem - POEMs - American Family Physician

Nov 1, 2016 - 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 ...

American Family Physician : POEMs

https://www.aafp.org/afp/2016/1101/p750a.html

Step-by-Step Approach to Ruling Out Infant Infection Is Accurate - POEMs - American ...

Dec 1, 2016 - 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 ...

American Family Physician : POEMs

https://www.aafp.org/afp/2016/1201/p933.html

Lumbar Fusion No Better Than Exercise and Therapy in the Long Term - POEMs - American ...

Dec 1, 2016 - 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 ...

American Family Physician : POEMs

https://www.aafp.org/afp/2016/1201/p937.html

Cervical Treatment Associated with Adverse Obstetric Outcomes - POEMs - American Family...

Dec 1, 2016 - 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 ...

American Family Physician : POEMs

https://www.aafp.org/afp/2016/1201/p933a.html

Larger Bottles Associated with Greater Weight in Infants - POEMs - American Family ...

Dec 1, 2016 - 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 ...

American Family Physician : POEMs

https://www.aafp.org/afp/2016/1201/p936.html

Third-Generation Oral Contraceptives Associated with Greater Risk of PE, Stroke, and MI...

Oct 15, 2016 - 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). ...

American Family Physician : POEMs

https://www.aafp.org/afp/2016/1015/p663.html

Venous Samples Are a Less-Painful Starting Point for the Evaluation of Patients with ...

Nov 1, 2016 - 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 ...

American Family Physician : POEMs

https://www.aafp.org/afp/2016/1101/p757.html

Opioid Analgesia Hard to Tolerate and Not Effective for Chronic Low Back Pain - POEMs -...

Nov 1, 2016 - 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 ...

American Family Physician : POEMs

https://www.aafp.org/afp/2016/1101/p753.html

Single-Dose Dexamethasone Equals Three Days of Steroids in Children with Acute Asthma -...

Aug 15, 2016 - In addition to usual beta-agonist treatment, a single dose of oral dexamethasone is as effective as three days of prednisolone (with less vomiting) in decreasing respiratory symptoms without increasing hospitalizations, follow-up visits, and days lost from school. Additional treatment ...

American Family Physician : POEMs

https://www.aafp.org/afp/2016/0815/p317.html

Procalcitonin Guidance Safely Decreases Antibiotic Use in Critically Ill Patients - ...

Oct 15, 2016 - For patients in the intensive care unit (ICU) who receive antibiotics for presumed or proven bacterial infections, the use of procalcitonin levels to determine when to stop antibiotic therapy results in decreased duration and consumption of antibiotics without increasing mortality.

American Family Physician : POEMs

https://www.aafp.org/afp/2016/1015/p663a.html

All Analgesics Are Better Than Placebo in Patients with Knee or Hip DJD - POEMs - ...

Oct 15, 2016 - 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 ...

American Family Physician : POEMs

https://www.aafp.org/afp/2016/1015/p664.html

Knee Surgery Does Not Reduce Knee Catching or Locking in Patients with Meniscal Tear - ...

Aug 15, 2016 - Removing the torn bits of meniscus in middle-aged patients who have intermittent knee catches or locking does not decrease their likelihood of experiencing symptoms in the following year compared with diagnostic arthroscopy (i.e., looking but not touching). In general, meniscectomy does...

American Family Physician : POEMs

https://www.aafp.org/afp/2016/0815/p317a.html

CBT Effective in Adolescents with Depression Who Do Not Want Medication - POEMs - ...

Sep 1, 2016 - In adolescents who eschew drug treatment of major depression, short-term CBT is more effective than treatment as usual in inducing recovery, with a number needed to treat of 4 to 10. CBT also produced faster results.

American Family Physician : POEMs

https://www.aafp.org/afp/2016/0901/p384.html

Inhaled Fluticasone-Salmeterol Better Than Fluticasone Alone for Moderate to Severe ...

Sep 1, 2016 - The combination of fluticasone and salmeterol (Advair), with the steroid dose adjusted for disease severity, reduces the number of severe asthma exacerbations more than fluticasone (Flovent) alone (number needed to treat [NNT] = 50 over 26 weeks), with no difference in terms of ...

American Family Physician : POEMs

https://www.aafp.org/afp/2016/0901/p387.html

Flibanserin Ineffective for Hypoactive Sexual Desire Disorder in Women - POEMs - ...

Sep 1, 2016 - Flibanserin produces a minimal effect on sexual desire and minimally increases the number of satisfying sexual events in women (less than one-half an event per month increase). Many women will be unable to tolerate the adverse effects.

American Family Physician : POEMs

https://www.aafp.org/afp/2016/0901/p384a.html

Newer Sulfonylureas Not Associated with Increased Mortality, MIs, or Strokes - POEMs - ...

Sep 1, 2016 - In multiple randomized trials, the long-term use of second- or third-generation sulfonylureas in patients with type 2 diabetes is not associated with more deaths, myocardial infarctions (MIs), or strokes. The included trials tended not to report other safety data.

American Family Physician : POEMs

https://www.aafp.org/afp/2016/0901/p386.html

Stop Using Antipsychotics to Treat or Prevent Delirium—They Are No Better Than Placebo ...

Aug 15, 2016 - The available data indicate that antipsychotic medications are ineffective in preventing or treating delirium in hospitalized patients. Because there are concerns about falls and extrapyramidal effects with antipsychotics (not reported in this study), we should stop using them.

American Family Physician : POEMs

https://www.aafp.org/afp/2016/0815/p318.html

Pioglitazone After Stroke or TIA Reduces Stroke and MI, but Also Has Significant Harms ...

Aug 15, 2016 - In patients with a recent stroke or TIA and evidence of insulin resistance, pioglitazone reduces the likelihood of myocardial infarction (MI) or stroke (number needed to treat [NNT] = 36 over five years) but increases the risk of significant weight gain (number needed to treat to harm ...

American Family Physician : POEMs

https://www.aafp.org/afp/2016/0815/p319.html

No Reduction in Readmissions with Telemonitoring, Coaching for Patients with Heart ...

Jul 15, 2016 - A care transition intervention that incorporates remote monitoring of weight, blood pressure, and heart rate with scheduled telephone coaching did not reduce readmission rates at 30 days or 180 days for patients with heart failure. However, patients in the study were only modestly ...

American Family Physician : POEMs

https://www.aafp.org/afp/2016/0715/p168a.html

Genetic Test Results That Identify Increased Risk Do Not Change Behavior - POEMs - ...

Jul 15, 2016 - Patients informed via genetic test results that they were at increased risk of disease did not subsequently alter their behaviors. For example, persons at increased risk of diabetes mellitus or hypertension were no more likely to change their diet or increase their physical activity. ...

American Family Physician : POEMs

https://www.aafp.org/afp/2016/0715/p168.html

Mediterranean Diet Produces Moderate Weight Loss - POEMs - American Family Physician

Jul 1, 2016 - In addition to improving cardiovascular outlook, a Mediterranean diet produced greater sustained weight loss than a low-fat diet and similar weight loss to other diets in patients who were overweight or obese, most of whom had type 2 diabetes mellitus.

American Family Physician : POEMs

https://www.aafp.org/afp/2016/0701/p59.html

Blood Pressure Goal of 140 to 150 mm Hg Is Best for Patients with Diabetes - POEMs - ...

Jul 1, 2016 - Although most recent practice guidelines have relaxed the blood pressure goals for patients with diabetes, there are still a few holdouts that suggest aggressive treatment. This analysis shows that the ideal range for hypertension control in patients with diabetes is between 140 and 150...

American Family Physician : POEMs

https://www.aafp.org/afp/2016/0701/p59a.html

Chondroitin/Glucosamine Equal to Celecoxib for Knee Osteoarthritis - POEMs - American ...

Jun 15, 2016 - or patients with painful knee osteoarthritis, a high-dose combination of glucosamine hydrochloride (1,500 mg) and chondroitin (1,200 mg) was as effective in lessening pain and stiffness and improving function as celecoxib (200 mg). Other studies have not found benefit.

American Family Physician : POEMs

https://www.aafp.org/afp/2016/0615/p1032.html

Behavioral Interventions Reduce Inappropriate Antibiotic Prescribing for Acute ...

Jun 15, 2016 - Requiring clinicians to justify antibiotic prescribing in the permanent electronic health record and to undergo periodic peer comparisons of prescribing rates are effective interventions for reducing inappropriate antibiotic prescribing for acute respiratory tract infections. Helpful ...

American Family Physician : POEMs

https://www.aafp.org/afp/2016/0615/p1037.html

Colorectal Cancer Screening Modalities: Variable Uptake, Variable Yield - POEMs - ...

Jun 15, 2016 - Based on the initial round of screening in this randomized trial, it appears that more patients complete fecal immunochemical testing than colonography or colonoscopy. Using the most conservative estimate, the yields of advanced adenomas and advanced neoplasms are similar.

American Family Physician : POEMs

https://www.aafp.org/afp/2016/0615/p1032a.html

Meta-Analysis: Intensive BP Control Decreases Major CV Events and Stroke, but Not MI, ...

Jun 15, 2016 - Patients with hypertension who are treated intensively are less likely to have major cardiovascular events, stroke, or progression of albuminuria or retinopathy than those treated less intensively, but intensive lowering had no meaningful effect on myocardial infarctions, heart failure,...

American Family Physician : POEMs

https://www.aafp.org/afp/2016/0615/p1036.html

Best Approaches to Physical Diagnosis of Acute Red Eye - POEMs - American Family Physician

Apr 1, 2016 - Eliciting photophobia via pupillary constriction and the presence of anisocoria (greater than 1 mm) in patients with an acute red eye are the best predictors of serious eye disease (e.g., uveitis, keratitis, corneal abrasion, scleritis) requiring prompt referral. Lack of morning eye ...

American Family Physician : POEMs

https://www.aafp.org/afp/2016/0401/p594.html

Useful Signs and Symptoms of Severe Intracranial Injury After Minor Head Trauma - POEMs...

Apr 1, 2016 - Specific individual risk factors, clinical signs, and symptoms are useful in identifying adults with minor head trauma who are at risk of severe intracranial injury. The absence of all features of the Canadian CT Head Rule and New Orleans Criteria is also highly accurate for identifying...

American Family Physician : POEMs

https://www.aafp.org/afp/2016/0401/p594a.html

Gluten Is Not the Culprit in Many Patients’ Symptoms - POEMs - American Family Physician

May 1, 2016 - Gluten may not be the cause of gastrointestinal symptoms in many patients with nonceliac gluten sensitivity. Only one-third of patients on a gluten-free diet experienced symptoms and correctly identified when they were given gluten-containing flour. Almost one-half (49%) of patients ...

American Family Physician : POEMs

https://www.aafp.org/afp/2016/0501/p788.html

Tamsulosin Effective as Expulsion Therapy for 5- to 10-mm Distal Ureteric Stones - ...

May 1, 2016 - Tamsulosin promotes stone passage of ureteric stones that are 5 to 10 mm. Five patients would need to be treated with tamsulosin to cause the expulsion of one such stone. Stones smaller than 5 mm have a high rate of spontaneous passage without any intervention.

American Family Physician : POEMs

https://www.aafp.org/afp/2016/0501/p788a.html

Long-Acting Nitrates No Good for Heart Failure with Preserved Ejection Fraction - POEMs...

May 1, 2016 - Patients who have heart failure with preserved ejection fraction had decreased levels of activity and more adverse events when they were receiving isosorbide mononitrate than when they were taking a placebo. Moreover, activity levels decreased with increases in the dose of the drug, ...

American Family Physician : POEMs

https://www.aafp.org/afp/2016/0501/p790.html

Hyaluronic Acid Equivalent to Sham Injections in Patients with Knee DJD - POEMs - ...

Apr 15, 2016 - The highest quality studies, which are now fairly plentiful, show that hyaluronic acid injections are only minimally better than sham injections in improving pain and function in patients with knee DJD.

American Family Physician : POEMs

https://www.aafp.org/afp/2016/0415/p704.html

Delayed Prescription for Respiratory Infections Produces Similar Results and ...

May 1, 2016 - In almost 400 Spanish primary care patients with mild to moderate symptoms of respiratory infection of less than one week's duration, both a take-and-hold prescription and a come back and pick up, if necessary prescription produced a similar clinical response—and similar patient ...

American Family Physician : POEMs

https://www.aafp.org/afp/2016/0501/p789.html

Low High-Sensitivity Troponin I Level Accurate in Identifying Patients at Low Risk of ...

Apr 15, 2016 - The high-sensitivity troponin I assay used in this study was fairly accurate in identifying patients with chest pain who are at low risk of cardiac events.

American Family Physician : POEMs

https://www.aafp.org/afp/2016/0415/p704a.html

Naproxen Alone May Be Best for Acute Low Back Pain - POEMs - American Family Physician

Feb 15, 2016 - Naproxen alone is as effective as naproxen plus oxycodone/acetaminophen or naproxen plus cyclobenzaprine (Flexeril) in reducing pain and improving function in adults with acute musculoskeletal LBP without radicular symptoms. Adverse events were significantly more common in patients ...

American Family Physician : POEMs

https://www.aafp.org/afp/2016/0215/p316.html

Epidural Steroid Not Better Than Placebo Injection for Sciatica and Spinal Stenosis ...

Feb 15, 2016 - It is hard to figure out what to do with these results. On the one hand, steroid injection did not provide a significant benefit compared with placebo injection in patients with radicular pain or spinal stenosis. However, part of the reason for this may be the significant and sustained ...

American Family Physician : POEMs

https://www.aafp.org/afp/2016/0215/p315a.html

Preexposure Prophylaxis with Tenofovir/Emtricitabine Prevents HIV Infection in Men Who ...

Mar 15, 2016 - Preexposure prophylaxis in high-risk men who have unprotected anal intercourse reduces the likelihood of developing HIV (number needed to treat = 17 per year). Participants averaged 15 pills per month, which costs approximately $700 per month ($8,400 per year). Condoms would be a much ...

American Family Physician : POEMs

https://www.aafp.org/afp/2016/0315/p520.html

Systolic BP of 120 Instead of 140 in High-Risk Older Patients Without Diabetes Leads to...

Mar 15, 2016 - In this group of older patients (mean age = 68 years) who do not have diabetes but are at high risk of cardiovascular disease, a more aggressive systolic BP target of 120 mm Hg instead of 140 mm Hg led to benefits (lower all-cause mortality, lower cardiovascular mortality, less heart ...

American Family Physician : POEMs

https://www.aafp.org/afp/2016/0315/p520a.html

Treating Low Vitamin D Levels Is Ineffective in Postmenopausal Women - POEMs - American...

Feb 15, 2016 - You do not have to treat a low vitamin D level if your patient is a typical community-dwelling postmenopausal woman younger than 75 years. The usual dosage of vitamin D, 800 IU (20 mcg) daily, will not increase levels even after a year of therapy and has little effect on calcium ...

American Family Physician : POEMs

https://www.aafp.org/afp/2016/0215/p315.html

In Patients with Type 2 Diabetes and CV Disease, Empagliflozin Reduces CV and All-Cause...

Mar 1, 2016 - In patients with established CV disease and type 2 diabetes, the addition of empagliflozin to standard therapy reduces all-cause mortality and CV mortality. This is notable because empagliflozin is the only drug other than metformin to demonstrate a mortality benefit, albeit for a ...

American Family Physician : POEMs

https://www.aafp.org/afp/2016/0301/p410.html

Steroids Beneficial As Adjunctive Treatment for Community-Acquired Pneumonia - POEMs - ...

Feb 1, 2016 - Moderate-quality to high-quality evidence suggests that steroids, when added to antibiotics and usual care, can improve outcomes in the treatment of CAP. Benefits include reduced hospital length of stay, decreased time to clinical stability, and lower rates of mechanical ventilation and...

American Family Physician : POEMs

https://www.aafp.org/afp/2016/0201/p227.html

Perioperative Bridging Anticoagulation Unhelpful for Invasive Procedures - POEMs - ...

Jan 15, 2016 - Bridging anticoagulation worsens outcomes for patients with atrial fibrillation who undergo an elective invasive procedure, resulting in more episodes of major bleeding and no difference in the rate of stroke or venous thromboembolism.

American Family Physician : POEMs

https://www.aafp.org/afp/2016/0115/p130.html

Routine CT Scans for Occult Malignancy Not Useful in Patients with Unprovoked VTE - ...

Jan 1, 2016 - There is no advantage to adding CT of the abdomen and pelvis to a basic screening protocol for occult malignancy in patients with unprovoked VTE.

American Family Physician : POEMs

https://www.aafp.org/afp/2016/0101/p59a.html

CBT Effective for Chronic Insomnia - POEMs - American Family Physician

Jan 1, 2016 - A five-component approach to changing patients' beliefs and behaviors surrounding sleep is effective, at least in the short term, in getting persons to fall asleep and stay asleep, although total sleep time is not increased.

American Family Physician : POEMs

https://www.aafp.org/afp/2016/0101/p60.html

More Nuanced Guidelines for Lipid Lowering to Prevent CVD - POEMs - American Family ...

Jan 1, 2016 - The authors of this guideline give a more nuanced and less aggressive approach to lipid lowering than other groups. For the primary prevention of CVD, check blood pressure and lipids (nonfasting is fine) to calculate the 10-year CVD risk. If greater than 12%, treat; if 12% or less, ...

American Family Physician : POEMs

https://www.aafp.org/afp/2016/0101/p59.html

Some Benefit to Treating Mild Hypertension to Prevent Stroke, CV Deaths, and Overall ...

Dec 1, 2015 - Treating mild hypertension over five years decreases the risk of stroke, cardiovascular (CV) death, and overall mortality in a small proportion of patients.

American Family Physician : POEMs

https://www.aafp.org/afp/2015/1201/p1020.html

CCTA and Radionuclide Stress Testing Similar for Evaluation of Chest Pain - POEMs - ...

Dec 1, 2015 - For the evaluation of chest pain in intermediate-risk patients, CCTA is comparable with myocardial perfusion imaging in its ability to select patients for invasive management. Both modalities are also similar when it comes to downstream resource use and adverse cardiovascular events. ...

American Family Physician : POEMs

https://www.aafp.org/afp/2015/1201/p1022.html

Adding Sitagliptin Does Not Reduce or Increase the Risk of Cardiovascular Outcomes - ...

Dec 1, 2015 - The glass half full is that sitagliptin does not increase the risk of cardiovascular events in patients with type 2 diabetes. The glass half empty is that it does not reduce the risk, either. And that is the important message: In patients with a mean glycated hemoglobin level of 7.2%, ...

American Family Physician : POEMs

https://www.aafp.org/afp/2015/1201/p1020a.html

An Oral Appliance Does Not Improve Sleep in Patients with Less Severe Sleep Apnea - ...

Dec 1, 2015 - An oral appliance does not improve daytime sleepiness or other measures of a good night's sleep. It does, however, decrease apnea scores, snoring, and restless legs. Although not studied, these improvements may be valuable for bed partners who sleep each night enduring patients' lower ...

American Family Physician : POEMs

https://www.aafp.org/afp/2015/1201/p1021.html

Gabapentin Equals Epidural Steroid for Radicular Pain - POEMs - American Family Physician

Nov 1, 2015 - After controlling for the placebo effect that may accompany an epidural steroid injection, treatment with gabapentin is as effective as the injection in reducing radicular leg pain in the short term (three months). A placebo bump in response, if present, is likely to be transient.

American Family Physician : POEMs

https://www.aafp.org/afp/2015/1101/p814a.html

CT Coronary Angiography in Patients with Suspected CAD: No Short-Term Benefit, ...

Nov 15, 2015 - For patients with suspected stable CAD, adding CT coronary angiography had no short-term effect on patient symptoms or hospitalizations but increased the number of coronary angiograms. Additionally, more patients who had CT coronary angiography underwent preventive treatment and ...

American Family Physician : POEMs

https://www.aafp.org/afp/2015/1115/p928.html

Citalopram Plus Methylphenidate Better Than Either Alone for Geriatric Depression - ...

Nov 1, 2015 - Combined treatment with citalopram plus methylphenidate provided faster improvement of depression symptoms in older patients with unipolar depression. Combined treatment was also more likely than either medication alone to lead to remission of depression at four weeks and 16 weeks.

American Family Physician : POEMs

https://www.aafp.org/afp/2015/1101/p820.html

Continuing Warfarin for 18 Months After Unprovoked PE Reduces Risk of Recurrent VTE - ...

Nov 1, 2015 - Continuing warfarin therapy for 18 months after an unprovoked PE reduces the risk of recurrent symptomatic venous thromboembolism (VTE). However, benefit beyond 18 months is not maintained after the warfarin is discontinued.

American Family Physician : POEMs

https://www.aafp.org/afp/2015/1101/p814.html

Acetaminophen (Paracetamol) Minimally Effective for Back Pain and Osteoarthritis - ...

Oct 1, 2015 - Although acetaminophen was hoped to be a safer alternative to nonsteroidal anti-inflammatory drugs and opioids for the treatment of common musculoskeletal problems, on average it provides only minimal pain relief and improvement in function for patients with low back pain or ...

American Family Physician : POEMs

https://www.aafp.org/afp/2015/1001/p642.html

Focused Extracorporeal Shock Wave Therapy Better Than Placebo to Relieve Pain in ...

Oct 1, 2015 - In this study, unlike others, patients with chronic plantar fasciitis treated with extra-corporeal shock wave therapy had greater pain relief than those treated with placebo.

American Family Physician : POEMs

https://www.aafp.org/afp/2015/1001/p635.html

Physician Assessment of COPD Does Not Match Spirometry Results - POEMs - American ...

Oct 1, 2015 - Using immediate, in-office spirometry results as the reference standard, seasoned physicians accurately identified COPD severity in approximately one in three patients, underestimating severity in 41% of patients and overestimating severity in 29% of patients. This mismatch seems to be ...

American Family Physician : POEMs

https://www.aafp.org/afp/2015/1001/p635a.html

High-Risk Subgroups Have Little, if Any, Net Benefit from Antibiotics for Acute LRTI - ...

Oct 1, 2015 - Patients with acute LRTI and green sputum or cardiopulmonary comorbidities experience a slightly greater benefit with amoxicillin treatment. That outcome must be balanced against the harms of antibiotics on the individual and population level.

American Family Physician : POEMs

https://www.aafp.org/afp/2015/1001/p640.html

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