Top 20 Research Studies of 2022 for Primary Care Physicians.

This article summarizes the top 20 research studies of 2022 identified as POEMs (patient-oriented evidence that matters), excluding COVID-19. Statins for primary prevention of cardiovascular disease produce only a small absolute reduction in a person's likelihood of dying (0.6%), having a myocardial infarction (0.7%), or having a stroke (0.3%) over three to six years. Supplemental vitamin D does not reduce the risk of a fragility fracture, even in people with low baseline vitamin D levels or a previous fracture. Selective serotonin reuptake inhibitors are preferred medical therapy for panic disorder, and patients who discontinue antidepressants are more likely to relapse (number needed to harm = 6) compared with those who continue. Combination therapy using a selective serotonin reuptake inhibitor, serotonin-norepinephrine reuptake inhibitor, or tricyclic antidepressant with mirtazapine or trazodone is more effective than monotherapy for first-line treatment of acute severe depression and when monotherapy fails. Using hypnotic agents for insomnia in adults comes with a significant trade-off between effectiveness and tolerability. In patients with moderate to severe asthma, using a combination of albuterol and glucocorticoid inhalers as rescue therapy reduces exacerbations and need for systemic steroids. Observational research shows an increased risk of gastric cancer in patients taking proton pump inhibitors (number needed to harm = 1,191 over 10 years). The American College of Gastroenterology updated its guideline for gastroesophageal reflux disease, and a new guideline provides sound advice for the evaluation and management of irritable bowel syndrome. Adults older than 60 years with prediabetes are more likely to become normoglycemic than to develop diabetes mellitus or die. Treatment of prediabetes via intensive lifestyle intervention or metformin has no impact on long-term cardiovascular outcomes. Persons with painful diabetic peripheral neuropathy have similar degrees of improvement with monotherapy using amitriptyline, duloxetine, or pregabalin and greater improvement with combination therapy. When communicating with patients about disease risk, most patients prefer numbers over words because people overestimate word-based probabilities. In terms of drug therapy, the duration of an initial varenicline prescription should be 12 weeks. Many drugs can interact with cannabidiol. No important difference was found among ibuprofen, ketorolac, and diclofenac for treatment of acute nonradicular low back pain in adults.

Explainable Machine Learning Model to Predict COVID-19 Severity Among Older Adults in the Province of Quebec.

Context: Patients over the age of 65 years are more likely to experience higher severity and mortality rates than other populations from COVID-19. Clinicians need assistance in supporting their decisions regarding the management of these patients. Artificial Intelligence (AI) can help with this regard. However, the lack of explainability-defined as "the ability to understand and evaluate the internal mechanism of the algorithm/computational process in human terms"-of AI is one of the major challenges to its application in health care. We know little about application of explainable AI (XAI) in health care. Objective: In this study, we aimed to evaluate the feasibility of the development of explainable machine learning models to predict COVID-19 severity among older adults. Design: Quantitative machine learning methods. Setting: Long-term care facilities within the province of Quebec. Participants: Patients 65 years and older presented to the hospitals who had a positive polymerase chain reaction test for COVID-19. Intervention: We used XAI-specific methods (e.g., EBM), machine learning methods (i.e., random forest, deep forest, and XGBoost), as well as explainable approaches such as LIME, SHAP, PIMP, and anchor with the mentioned machine learning methods. Outcome measures: Classification accuracy and area under the receiver operating characteristic curve (AUC). Results: The age distribution of the patients (n=986, 54.6% male) was 84.5□19.5 years. The best-performing models (and their performance) were as follows. Deep forest using XAI agnostic methods LIME (97.36% AUC, 91.65 ACC), Anchor (97.36% AUC, 91.65 ACC), and PIMP (96.93% AUC, 91.65 ACC). We found alignment with the identified reasoning of our models' predictions and clinical studies' findings-about the correlation of different variables such as diabetes and dementia, and the severity of COVID-19 in this population. Conclusions: The use of explainable machine learning models, to predict the severity of COVID-19 among older adults is feasible. We obtained a high-performance level as well as explainability in the prediction of COVID-19 severity in this population. Further studies are required to integrate these models into a decision support system to facilitate the management of diseases such as COVID-19 for (primary) health care providers and evaluate their usability among them.

Epidemiological and clinical perspectives of long COVID syndrome.

Long COVID, or post-acute COVID-19 syndrome, is characterized by multi-organ symptoms lasting 2+ months after initial COVID-19 virus infection. This review presents the current state of evidence for long COVID syndrome, including the global public health context, incidence, prevalence, cardiopulmonary sequelae, physical and mental symptoms, recovery time, prognosis, risk factors, rehospitalization rates, and the impact of vaccination on long COVID outcomes. Results are presented by clinically relevant subgroups. Overall, 10-35% of COVID survivors develop long COVID, with common symptoms including fatigue, dyspnea, chest pain, cough, depression, anxiety, post-traumatic stress disorder, memory loss, and difficulty concentrating. Delineating these issues will be crucial to inform appropriate post-pandemic health policy and protect the health of COVID-19 survivors, including potentially vulnerable or underrepresented groups. Directed to policymakers, health practitioners, and the general public, we provide recommendations and suggest avenues for future research with the larger goal of reducing harms associated with long COVID syndrome.

Top 20 Research Studies of 2021 for Primary Care Physicians.

This article summarizes the top 20 research studies of 2021 identified as POEMs (patient-oriented evidence that matters) that did not address the COVID-19 pandemic. Sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide-1 receptor agonists prevent adverse cardiovascular and renal outcomes in patients with type 2 diabetes mellitus and also reduce all-cause and cardiovascular mortality. Most older adults (mean age, 75 years) with prediabetes do not progress to diabetes. Among patients in this age group with type 2 diabetes treated with medication, an A1C level of less than 7% is associated with increased risk of hospitalization for hypoglycemia, especially when using a sulfonylurea or insulin. For patients with chronic low back pain, exercise, nonsteroidal anti-inflammatory drugs, duloxetine, and opioids were shown to be more effective than control in achieving a 30% reduction in pain, but self-discontinuation of duloxetine and opioids was common. There is no clinically important difference between muscle relaxants and placebo in the treatment of nonspecific low back pain. In patients with chronic pain, low- to moderate-quality evidence supports exercise, yoga, massage, and mindfulness-based stress reduction. For acute musculoskeletal pain, acetaminophen, 1,000 mg, plus ibuprofen, 400 mg, without an opioid is a good option. Regarding screening for colorectal cancer, trial evidence supports performing fecal immunochemical testing every other year. For chronic constipation, evidence supports polyethylene glycol, senna, fiber supplements, magnesium-based products, and fruit-based products. The following abdominal symptoms carry a greater than 3% risk of cancer or inflammatory bowel disease: dysphagia or change in bowel habits in men; rectal bleeding in women; and abdominal pain, change in bowel habits, or dyspepsia in men and women older than 60 years. For secondary prevention in those with established arteriosclerotic cardiovascular disease, 81 mg of aspirin daily appears to be effective. The Framingham Risk Score and the Pooled Cohort Equations both overestimate the risk of cardiovascular events. Over 12 years, no association between egg consumption and cardiovascular events was demonstrated. Gabapentin, pregabalin, duloxetine, and venlafaxine provide clinically meaningful improvements in chronic neuropathic pain. In patients with moderate to severe depression, initial titration above the minimum starting dose of antidepressants in the first eight weeks of treatment is not more likely to increase response. In adults with iron deficiency anemia, adding vitamin C to oral iron has no effect. In children with pharyngitis, rhinosinusitis, acute bronchitis, or acute otitis media, providing education combined with a take-and-hold antibiotic prescription results in 1 in 4 of those children eventually taking an antibiotic.

Characteristics and outcomes of family-practice patients with coronavirus disease 2019: a case series.

BACKGROUND: The clinical history and outcomes of coronavirus disease 2019 among people not hospitalized is not yet well characterized. To better inform clinical evaluation, we set out to characterize the natural history of coronavirus disease 2019 in primary health care. METHODS: Case series of all patients rostered to physicians at a university-affiliated Family Medicine clinic. Cases met the Centers for Disease Control and Prevention definition of coronavirus disease 2019 from March 1 to May 21 2020. RESULTS: In total, 89 patients meeting Centers for Disease Control and Prevention criteria for coronavirus disease 2019 were documented. Their average age was 55.6 years (range 6-95 years), and all but one was symptomatic. Fifty-seven cases (64%) had a polymerase chain reaction test for coronavirus disease 2019, of whom 77.2% tested positive. Thirty cases (33.7%) reported contact with a confirmed or probable case of coronavirus disease 2019. Based on the Charlson Comorbidity Index, 28 cases (31.5%) had no comorbid conditions. The median number of days from symptom onset to first polymerase chain reaction test was 6 days (interquartile range 2.3-11 days). The median duration of fever was 3.5 days (interquartile range 1-7 days). Twenty-four cases (27%) visited the Emergency Department, and 10 were admitted to hospital. The median number of days between symptom onset and first Emergency Department visit was 8 days (interquartile range 3.5-27 days). CONCLUSIONS: At the start of this pandemic, the implementation of basic measures such as diagnostic testing was delayed. If we are to improve our control over the spread of coronavirus disease 2019, we will need to substantially reduce the time from symptom onset to diagnostic testing, and subsequent contact tracing. To minimize unnecessary Emergency Department visits, we propose a testable strategy for Family Medicine to engage with coronavirus disease 2019 patients in the acute phase of their illness.

Top POEMs of 2019 Consistent with the Principles of the Choosing Wisely Campaign.

In this article, we discuss the POEMs (patient-oriented evidence that matters) of 2019 judged to be most consistent with the principles of Choosing Wisely, an international campaign to reduce unnecessary testing and treatments. We selected these POEMs through a crowdsourcing strategy of the daily POEMs information service for the Canadian Medical Association's physician members. We present recommendations from these top POEMs of primary research or meta-analysis that identify interventions to encourage or consider avoiding in practice. The recommendations cover musculoskeletal conditions (e.g., do not recommend platelet-rich plasma injections for rotator cuff disease or knee osteoarthritis), respiratory disease (e.g., in clinically stable patients with community-acquired pneumonia, antibiotics can be stopped after five days), screening or preventive care (e.g., patients who take their blood pressure at home or in a pharmacy should know what to do when they have an elevated reading), and miscellaneous topics (e.g., in healthy adults treated for dermatophyte infection, do not obtain baseline or follow-up alanine transaminase level, aspartate transaminase level, or complete blood count). These POEMs describe interventions whose benefits are not superior to other options, are sometimes more expensive, or put patients at increased risk of harm. Knowing more about these POEMs and their connection with the Choosing Wisely campaign will help clinicians and patients engage in conversations better informed by high-quality evidence.