Summary of the top 10 POEMs of 2022 for choosing wisely in medicine: Four of the top 10 POEMs in 2022 were aligned with a Choosing Wisely Canada recommendation.
| POEM TITLE | ADDITIONAL INFORMATION |
|---|---|
| No benefit of varenicline therapy after 12 weeks or when combined with nicotine replacement therapy for smoking cessation | For increasing smoking cessation rates, this study found no additional benefit with varenicline plus nicotine replacement therapy vs varenicline monotherapy, or with varenicline treatment for 24 weeks vs 12 weeks. These results were not affected by sex, race, treatment site, or level of tobacco dependence22 |
| Amoxicillin for children with CAP: low dose for 3 days is noninferior to high dose for 7 days3 | Regarding the need for retreatment of CAP in children discharged from an emergency department or inpatient setting within 48 hours, this study found that low-dose outpatient oral amoxicillin was noninferior to the high-dose version and that taking the medication for 3 days was noninferior to taking it for 7 days23 |
| Treatment of prediabetes with metformin or intensive lifestyle therapy for at least 3 years has no long-term benefits | In patients with prediabetes, neither an intensive lifestyle intervention nor metformin had any impact on the long-term risk of cardiovascular outcomes24 |
| Persons older than 60 years with prediabetes are more likely to become normoglycemic than to develop diabetes or die | In a cohort study of more than 2000 adults (average age 70.6 years), those with prediabetes were more likely to become normoglycemic than to develop diabetes or die during 8 years of follow-up25 |
| Intensive urate lowering for erosive gout is difficult to achieve and does not improve outcomes | In adults with erosive gout, intensive urate lowering is difficult to achieve, requires many medications, and does not improve outcomes26 |
| Proton pump inhibitor use associated with an increased risk of gastric cancer3 | This is the strongest evidence to date that there is a small but clinically significant increase in the risk of gastric cancer for patients taking a PPI (NNH=1191 over 10 years). Physicians initiating antacid therapy for patients should begin by prescribing an H2RA, and if prescribing a PPI, should use the lowest dose and duration possible27 |
| White blood cells do not equate to bacterial cells in the urine of hospitalized patients3 | Approximately 1 in 7 women and 1 in 38 men have pyuria without bacterial infection. Pyuria, identified in this study by microscopy, is not a good indicator of bacteria in hospitalized patients with suspected urinary tract infection; even at a cutoff of 25 cells per high-power field, only about half of patients will have positive culture results28 |
| American College of Gastroenterology guideline for diagnosing and managing GERD3 | The American College of Gastroenterology has updated its guideline for the diagnosis and management of GERD. The paper has several useful tables and algorithms that may be of use to primary care clinicians29 |
| British Society of Gastroenterology guidelines for the management of IBS | This high-quality, evidence-based guideline provides good advice for the evaluation and management of IBS in primary care30 |
| USPSTF 2022 guideline update recommends against initiating ASA for primary prevention of CVD in adults 60 years or older | The USPSTF recommends against initiating low-dose ASA (81 mg/d) for the primary prevention of CVD in adults 60 years or older (GRADE D recommendation). The task force recommends using shared decision making when initiating low-dose ASA for the primary prevention of CVD in adults 40 to 59 years with a 10% or greater risk of CVD and without an increased risk of bleeding (GRADE C recommendation). Risk factors for bleeding include older age, history of peptic ulcer disease, alcoholism, liver disease, long-term nonsteroidal anti-inflammatory drug or steroid use, and anticoagulant therapy31 |
ASA—acetylsalicylic acid; CAP—community-acquired pneumonia; CVD—cardiovascular disease; GERD—gastroesophageal reflux disease; GRADE—Grading of Recommendations Assessment, Development and Evaluation; H2RA—histamine-2 receptor antagonist; IBS—irritable bowel syndrome; NNH—number needed to harm; POEM—Patient-Oriented Evidence that Matters; PPI—proton pump inhibitor; USPSTF—US Preventive Services Task Force.