American family physician
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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.
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Community-acquired pneumonia is a potentially serious infection in children and often results in hospitalization. The diagnosis can be based on the history and physical examination results in children with fever plus respiratory signs and symptoms. Chest radiography and rapid viral testing may be helpful when the diagnosis is unclear. ⋯ Preschool-aged children with uncomplicated bacterial pneumonia should be treated with amoxicillin. Macrolides are first-line agents in older children. Immunization with the 13-valent pneumococcal conjugate vaccine is important in reducing the severity of childhood pneumococcal infections.
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Acute kidney injury is characterized by abrupt deterioration in kidney function, manifested by an increase in serum creatinine level with or without reduced urine output. The spectrum of injury ranges from mild to advanced, sometimes requiring renal replacement therapy. The diagnostic evaluation can be used to classify acute kidney injury as prerenal, intrinsic renal, or postrenal. ⋯ Management of acute kidney injury involves fluid resuscitation, avoidance of nephrotoxic medications and contrast media exposure, and correction of electrolyte imbalances. Renal replacement therapy (dialysis) is indicated for refractory hyperkalemia; volume overload; intractable acidosis; uremic encephalopathy, pericarditis, or pleuritis; and removal of certain toxins. Recognition of risk factors (e.g., older age, sepsis, hypovolemia/shock, cardiac surgery, infusion of contrast agents, diabetes mellitus, preexisting chronic kidney disease, cardiac failure, liver failure) is important. Team-based approaches for prevention, early diagnosis, and aggressive management are critical for improving outcomes.