| Topic | POEM Title | Clinical Action to De-Adopt |
|---|---|---|
| Diagnostics | Annual screening chest radiograph does not reduce lung cancer mortality | Annual screening chest radiograph |
| Negative high-sensitivity troponin rules out AMI | Repeat measurement of HS-troponin within 12 hours of presenting to the emergency department | |
| Repeat BMD testing: little, if any, value in elderly men and women | Repeat testing of BMD | |
| Guideline: When to screen for and treat chronic kidney disease | Screening eGFR test, urine for albumin | |
| Older adults feel a “moral obligation” to undergo screening | Cessation of periodic screening tests in the elderly without taking the time to discuss the issue | |
| Colorectal neoplasia yield similar for FIT every 1, 2, or 3 years | Annual FIT | |
| Most tests for rotator cuff disease are inaccurate | Selected maneuvers to test for rotator cuff disease | |
| Medical interventions | ASA: not for primary prevention | ASA for primary prevention of cardiovascular disease |
| Intermittent steroids effective for children with recurrent wheezing | Daily inhaled steroids in children with recurrent wheezing | |
| ACP guideline: Universal VTE prophylaxis not recommended for hospitalized medical and stroke patients | Anticoagulation for all medical inpatients | |
| Evidence for combination antipyretics is limited | Combining antipyretics in management of fever in children | |
| 24 Months of clopidogrel after stent is no better than 6 months | More than 6 months of clopidogrel after stent | |
| Mean duration of cough is 18 days; patients expect about 1 week | Antibiotics for acute bronchitis | |
| Negative CT after mild blunt head trauma in children: send them home | Hospitalization after negative CT in children with mild blunt head trauma | |
| Statins of modest benefit for low- to moderate-risk persons (NNT, ∼80) | Statins for low- to moderate-risk persons | |
| Niacin not effective in CAD with low HDL-cholesterol (AIM-HIGH) | Niacin for low HDL-cholesterol | |
| Nasal steroids ineffective for ET dysfunction | Nasal steroids for eustachian tube dysfunction, including otitis media with effusion | |
| Treatment for mild hypertension is ineffective | Antihypertensive treatment of mild hypertension | |
| Cutaneous warts in children: half disappear within a year | Routine treatment without a discussion about prognosis of warts in children | |
| Fasting is not necessary before lipid panels | Fasting before lipid panels | |
| Steroid injection for lateral epicondylitis worse than saline after 1 year | Steroid injection for epicondylitis | |
| 5-Day steroid treatment effective for acute COPD exacerbation | More than 5 days of oral steroids for acute COPD exacerbation | |
| Epidural steroids for sciatica are minimally effective in the short term | Epidural steroids for sciatica | |
| Testosterone does not improve the effectiveness of sildenafil | Testosterone for erectile dysfunction treated with sildenafil | |
| Limited evidence: manipulation ineffective for acute low-back pain | Spinal manipulation for acute low-back pain | |
| Placebo almost as effective as hypnotics in adults | Nightly hypnotic in adults | |
| Surgical interventions | Asymptomatic gallstones rarely lead to cholecystectomy and may go away | Cholecystectomy for asymptomatic gallstones |
| Surgery + PT similar to PT alone for adults with meniscal tear and OA | Repair of torn meniscus in adults with OA | |
| Knee injury: rehab = ACL reconstruction for many young adults | ACL reconstruction for all young adults |
ACL, anterior cruciate ligament; ACP, American College of Physicians; AMI, acute myocardial infarction; ASA, aspirin; BMD, bone mineral density; CAD, coronary artery disease; COPD, chronic obstructive pulmonary disease; CT, computed tomography; eGFR, estimated glomerular filtration rate; ET, eustachian tube; FIT, fecal immunochemical test; HDL, high-density lipoprotein; HS, high sensitivity; NNT, number needed to treat; OA, osteoarthritis; PT, physical therapy; VTE, venous thromboembolism.