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Many practicing physicians and family medicine residents in training are interested in clinical reasearch. They investigate common everyday problems, and from that, make practical recommendations that help to settle differences of opinion. One or more of the following topics may pertain to you.

DIABETES:  Over 90% of older adults (mid 70’s age group) with pre-diabetes will NOT develop Diabetes. Those folks in their mid 70’s, over a 6.5 year time span, will maintain A1C levels at pre-diabetic levels, or normalize, 90% of the time.

Tight control of diabetes leads to unnecessary hospitalizations in older patients. Low blood sugar is the reason for this outcome, especially in patients on a class of drugs called sulfonylureas. 

MUSCULOSKELETAL CONDITIONS: Exercise is the main intervention that produces sustained improvement in chronic low back pain. It works better than any drug combination.

Muscle relaxants are not reliably effective for treating low back pain. NSAID’s like ibuprofen or naproxen are better.

For acute muscle pain, oral Tylenol (acetaminophen) plus ibuprofen is safer than combinations that contain opioids and is just as effective. A single dose of 400 mg of ibuprofen is just as effective as 800 mg of ibuprofen. A single dose of acetaminophen and ibuprofen combined is as effective of a single dose of an opioid. 

Multiple non-drug therapies (exercise, yoga, massage, etc.) are effective for chronic musculoskeletal pain. They are inexpensive and don’t require interaction with the health system.

Topical NSAID’s are first line therapy for non-low back musculoskeletal injuries. Oral NSAID’s, acetaminophen, acupressure, or nerve stimulator (TENS) may also be used. Topical diclofenac is the drug of choice. 

GASTROINTESTINAL CONDITIONS: Regular fecal immunochemical testing (FIT) is an effective screening method for colorectal cancer. Screen every other year for at least 6 years. More patients are willing to perform FIT than they are sigmoidoscopy or colonoscopy.

Polyethylene glycol (Miralax/Glycolax) and senna are the best initial treatments for chronic constipation. These are more effective than fiber supplements.

Dysphagia, changes in bowel habits, and rectal bleeding are the most worrisome abdominal symptoms for cancer or IBD (Inflammatory Bowel Disease).

CARDIOVASCULAR DISEASE: The best daily dose of aspirin for secondary prevention of ASCVD is 81mg a day. There is no benefit to taking 325 mg.

Eggs do not increase the risk of cardiovascular disease. Eating more than one egg per day was associated with an 11% decreased likelihood of coronary artery disease. 

MISCELLANEOUS: Combinations of gabapentin (Neurontin) and pregabalin (Lyrica) and duloxetine (Cymbalta) and venlafaxine (Effexor) improve chronic neuropathic pain. 

Low doses of selected antidepressants work just as well as higher doses. 

Take-and-hold prescriptions for upper respiratory infections reduce antibiotic use and adverse effects. These are antibiotic prescriptions filled and taken only if symptoms persist or worsen. 

Five days of antibiotics should be used for community-acquired pneumonia, COPD exacerbations, cellulitis, and uncomplicated kidney infections (pyelonephritis). Longer courses may be necessary if the patient doesn’t improve. 

Physicians should screen all adults for tobacco use and provide smoking cessation behavioral sessions or drug therapy. 

There you have it! The practical conclusions from the study of common sense, every day type of clinical problems are reported here. Hopefully, one of them was helpful for you personally.

Reference: Ebell MH, Grad R. Top 20 Research Studies of 2021 for Primary Care Physicians. AM FAM PHYS 2022 July;106(1):61-69. 

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