- Kenny Lin, MD, MPH and Jennifer Middleton, MD, MPH
Some themes that emerged from this year's list of most-read posts included avoiding overtreatment, challenging medical dogma in management of low back pain and myocardial infarction, and estimating efficacy and adverse effects of depression therapies in primary care settings. Happy holidays and best wishes for the New Year!
1. Advise patients to steer clear of these six orthopedic procedures (March 16) - 1804 views
What accounts for the continued popularity of ineffective orthopedic procedures? Excessive magnetic resonance imaging (MRI) plays a role. Patients who perceive surgery to be a "quick fix" may not have the patience to stick with physical therapy and rehabilitation. And there is the inescapable reality that, necessary or not, these procedures pay well.
2. Can treating mild hypertension be too much medicine? (January 2) - 935 views
Key take-home points are that the absolute benefits of treating otherwise healthy persons with mild hypertension are relatively small; lifestyle modification should generally precede medication; and blood pressure measurement should be performed and repeated carefully to ensure accurate identification of hypertensive patients.
3. ACC/AHA and Framingham calculators overestimate cardiovascular risk (March 3) - 841 views
Men in the Multi-Ethnic Study of Atherosclerosis cohort with a calculated ACC/AHA risk score of 7.5 to 10 percent had an actual event rate of only 3 percent; and just over 5 percent of women with a similar risk score experienced cardiovascular events.
4. Acetaminophen ineffective for chronic low back pain - now what? (April 6) - 826 views
Intuitively, acetaminophen seems like a reasonable choice for treating chronic LBP. It's inexpensive and relatively safe when used at recommended doses. This 2015 meta-analysis overturns that recommendation and should prompt a change in the clinical guidelines.
5. Stop beta-blockers 30 days after acute MI? (March 23) - 794 views
The greatest challenge for family physicians managing patients following up after an AMI admission may be the decision to stop a beta-blocker. Discontinuing therapies may be difficult for physicians.
6. Guest post: quality medical care makes patients feel at home (Sept. 7) - 766 views
In my view, the definition of good care includes communication, patience, concern, and perseverance. A high quality, "patient-centered" medical home is based on these human characteristics and not on outcome criteria, EHR meaningful use, or other measures.
7. Announcing the #AFPTop20 Tweet Chat on August 26th (August 17) - 760 views
On Wednesday, August 26th at 4 PM Eastern, @AFPJournal held its first #AFPTop20 Tweet Chat to take a deeper dive into the findings of some of the top POEMs of the year and their ramifications for family physicians.
8. Which antidepressants have the highest suicide risk? (July 6) - 748 views
In a United Kingdom cohort of 240,000 adult patients with depression, the adjusted hazard ratios for venlafaxine and mirtazapine for suicidal behavior were 1.70 (1.44 to 2.02) and 1.85 (1.61 to 2.13), respectively, compared with citalopram.
9. How to make sure your patients understand health information (July 15) - 713 views
A large body of evidence demonstrates strong associations between low health literacy and poorer health outcomes; compared to patients with high health literacy, patients with low literacy have more hospitalizations, more emergency department visits, and are less likely to receive appropriate preventive and chronic care services.
10. Depression treatment: the evidence base from a primary care perspective (Feb. 23) - 695 views
This systematic review provides guidance for family physicians treating patients with mild to moderate depression as well as severe depression; it provides reassurance to patients unable to attend multiple psychotherapy sessions that even a few sessions can provide benefit.