American family physician
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American family physician · Nov 2012
ReviewDiagnosis of deep venous thrombosis and pulmonary embolism.
Venous thromboembolism manifests as deep venous thrombosis (DVT) or pulmonary embolism, and has a mortality rate of 6 to 12 percent. Well-validated clinical prediction rules are available to determine the pretest probability of DVT and pulmonary embolism. When the likelihood of DVT is low, a negative D-dimer assay result excludes DVT. ⋯ Ventilation-perfusion scanning is an acceptable alternative to computed tomography angiography in select settings. Pulmonary angiography is needed only when the clinical suspicion for pulmonary embolism remains high, even when less invasive study results are negative. In unstable emergent cases highly suspicious for pulmonary embolism, echocardiography may be used to evaluate for right ventricular dysfunction, which is indicative of but not diagnostic for pulmonary embolism.
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American family physician · Nov 2012
ReviewAntibiotic use in acute upper respiratory tract infections.
Upper respiratory tract infections account for millions of visits to family physicians each year in the United States. Although warranted in some cases, antibiotics are greatly overused. This article outlines the guidelines and indications for appropriate antibiotic use for common upper respiratory infections. ⋯ Persistent cases of rhinosinusitis may necessitate the use of antibiotics if symptoms persist beyond a period of observation. Antibiotics should not be considered in patients with the common cold or laryngitis. Judicious, evidence-based use of antibiotics will help contain costs and prevent adverse effects and drug resistance.
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American family physician · Nov 2012
ReviewTop 20 research studies of 2011 for primary care physicians.
In 2011, through regular surveillance of more than 100 English-language research journals, a group of seven clinicians identified approximately 250 studies with the potential to improve the practice of primary care physicians and the outcomes of patients (designated as POEMs [patient-oriented evidence that matters]). Using a validated tool, Canadian primary care physicians have been rating the relevance of each POEM as they receive it in their e-mail. ⋯ We believe this approach has greater relevance and validity than a subjective list of studies selected by experts or editors, because it is based on the actual ratings of practicing primary care physicians. These POEMs address topics that include how to best measure blood pressure, the lack of benefit of intensive glucose control, quantification of the benefit of statins for prevention of cardiac events, treatments for functional abdominal disorders, and management of low back pain.