Monday, December 23, 2019

The top ten AFP Community Blog posts of 2019

- Kenny Lin, MD, MPH

Looking back over the year, the posts that resonated most with readers explored cardiovascular prevention dilemmas, meaningful outcomes in type 2 diabetes, diagnosis and prevention of serious bacterial infections, and low-value medical care.

1. Should physicians de-prescribe statins in older adults? (May 13) - 4038 views

Deprescribing decisions will still require individualized shared decision making. An older adult without vascular events can likely stop a statin with minimal effect on risk, while a patient with a prior event will still benefit from continuing the statin, provided that he or she isn't experiencing adverse effects.

2. Has aspirin for primary prevention of CVD reached its expiration date? (June 8) - 1848 views

In a 2019 clinical practice guideline, the American College of Cardiology / American Heart Association largely recommended against prescribing aspirin for primary prevention of CVD in adults older than age 70 and downgraded its role in other adults at high risk to "may be considered" on a case-by-case basis.

3. The family physician's role in vaccine-preventable disease outbreaks (February 11) - 1574 views

Increasing vaccination rates is a critical but challenging component of the solution. With vaccine hesitancy now among the World Health Organization's (WHO) top 10 threats to global health, it's critical that we redouble our efforts to combat the spread of misinformation about vaccines.

4. Bye-bye Benadryl? (December 2) - 954 views

First-generation antihistamines (diphenhydramine, chlorpheniramine, and hydroxyzine) have more worrisome side effects than newer generation antihistamines (loratidine, cetirizine, and fexofenadine), and both generations have equal treatment efficacy.

5. Therapies for type 2 diabetes: improving outcomes that matter (February 19) - 771 views

When comparing therapies for type 2 diabetes, physicians, patients, and quality measures often get caught up in the disease-oriented outcome of glycemic control.

6. Is "prediabetes" a useful term? (August 12) - 770 views

Higher hemoglobin A1c levels (i.e., 6.0% to 6.4%), but also other important risk factors, such as family history of diabetes, higher fasting plasma glucose levels, and higher triglyceride levels, may predict greater risk of progression to diabetes.

7. Deliberate clinical inertia: protecting patients from low-value care (July 22) - 738 views

Ways to support deliberate clinical inertia in practice include: empathy and acknowledgment; symptom management; clinical observation; explanation of the natural course of the condition; managing expectations; and shared decision-making ("communicating rather than doing").

8. Does subspecialist medical care add sufficient value to be worth the added cost? (February 5) - 731 views

After adjustment for potential sources of confounding, respondents with primary care were more likely to receive high-value preventive care and counseling and to report better patient experiences than those without primary care.

9. Farewell to Close-ups (November 25) - 704 views

Our deepest gratitude goes to our patients for taking the time to tell their stories and their family physicians for transcribing and submitting them. The many patients and their physicians who have contributed to Close-ups are a testament to the strong bonds family physicians have with their patients.

10. Ruling out serious bacterial infections in the first weeks of life (October 7) - 684 views

We should resist the temptation to extrapolate this new decision rule to settings beyond the Emergency Department, though further studies in those settings could cement its role in helping us better predict which young infants with fever need aggressive testing and treatment - and which do not.

Seasons Greetings from all of us at American Family Physician!