Top 20 Research Studies of 2018 for Primary Care Physicians

摘要

In 2018, through regular surveillance of more than 110 English-language research journals, 255 research studies met the criteria to become POEMs (patient-oriented evidence that matters). Using a validated tool, physician members of the Canadian Medical Association rated these POEMs for their relevance to patients in their practices. This article summarizes the clinical questions and bottom-line answers from the top 20 POEMs of 2018, as determined by these physicians. The top POEMs summarize potentially practice-changing research on the importance of accurate blood pressure measurement, the unclear benefits of lower blood pressure targets for hypertension, the lack of evidence regarding treatment of cough, advantages of shorter over longer courses of antibiotics for several common infections, the value of increased fluid intake for preventing recurrent urinary tract infections, and the benefit of nitrofurantoin over fosfomycin for the treatment of urinary tract infection. Other conclusions include the lack of benefit of anticonvulsants for low back pain, the value of nonopioid pain management compared with opioids, the risk of anxiety recurrence when an antidepressant is discontinued, the value of exercise for reducing the risk of depression, and the increased risk of fractures with the use of Z-drug hypnotics. Regarding clinical preventive services, adherence is better with fecal immunochemical tests than with older guaiac-based fecal occult blood tests for colon cancer screening; statins showed no benefit for patients 75 years or older; aspirin showed no benefit for cardiovascular disease prevention; and exercise, vision assessment, and environmental assessments may reduce the risk of falls. Finally, we identify the top POEMs summarizing clinical practice guidelines from the American College of Physicians, American College of Cardiology/American Heart Association, and the U.S. Preventive Services Task Force. Copyright (C) 2019 American Academy of Family Physicians.