[Top 5 Research Studies of the month for Italian Primary Care Physicians: May 2024.] / La Top 5 di maggio 2024. Gli studi clinici che vale la pena conoscere se lavori nelle cure primarie in Italia.

ABSTRACT

This monthly article provides a collection of summaries of the most relevant studies identified as POEMs (patient-oriented evidence that matters) for Italian primary care physicians. 1) The 2023 updated American college of cardiology/American heart association guideline provide new recommendations for the diagnosis and treatment of atrial fibrillation. In a nutshell, screening is not recommended, and treatment decisions should be guided by risk assessment via CHA2DS2-VASC or a similar tool. For most patients, a direct oral anticoagulant (Doac) at a standard dose is recommended. 2) The use of gabapentin or pregabalin is associated with severe exacerbation of chronic obstructive pulmonary disease (Copd). Various government agencies warn about the use of those gabapentinoids in patients with respiratory risk factors. 3) In children 3 months to 5 years of age with an uncomplicated febrile urinary tract infection, 5 days of antibiotic treatment results in similar resolution of symptoms and 30-day recurrence rates as 10 days of treatment. 4) In adults with type 2 diabetes, bariatric surgery results in superior glycemic control and weight loss compared with medical plus lifestyle management. However, no significant differences occurred in major adverse cardiovascular events or all-cause mortality. Other (non-cardiovascular) adverse events occurred significantly more often in the surgery group, so it is uncertain whether the overall quality of life, morbidity or mortality are better or worse with surgery. 5) Prescribing a specific exercise program, whether aerobic or strength training, produces clinically meaningful and statistically significant benefits in patients with major depressive disorder. The advice can't be simply to "exercise more" but should be a specific exercise prescription, just like a medication prescription, specifying the frequency, intensity, time (duration), and type of exercise.