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Journal of Family Practice

Alexis Tracy, Jacqueline Bucher, Richard Usatine
A 39-year-old woman presented to the emergency department for evaluation of diffuse redness, itching, and tenderness of her skin. The patient said the eruption began 4 months earlier as localized plaques on her scalp, elbows, and beneath both breasts. Over the course of a few days, the redness became more diffuse, affecting most of her body. She also noticed swelling and skin desquamation on her lower extremities. WHAT IS YOUR DIAGNOSIS? HOW WOULD YOU TREAT THIS PATIENT?
March 2018: Journal of Family Practice
Brooke Hall, Sarah Daly
In adults treated with opioids for chronic pain, point-of-care urine drug screens (immunoassays) for detecting opioids show a false-negative rate of 1.9%, a sensitivity of 92%, and a specificity of 93% compared with the gold-standard liquid chromatography tandem mass spectrometry. Oxycodone has the highest rate of false-negative results at 25%; methadone has the lowest rate at 4% to 6% (strength of recommendation: A, 2 blinded diagnostic accuracy studies with similar results).
March 2018: Journal of Family Practice
Corey Lyon, Rebecca Mullen, Brandy Deffenbacher, Alex Reed, Joan Nashelsky
No. Exercise doesn't decrease the frequency or severity of vasomotor menopausal symptoms in perimenopausal and postmenopausal women (strength of recommendation: A, systematic review of randomized controlled trials [RCTs] and consistent RCT).
March 2018: Journal of Family Practice
Somya Abubucker, Bernard Cohen
A mother brought her 8-year-old daughter to our office for evaluation of vitiligo "down there". The skin eruption first appeared on her vulva a year earlier and was intermittently pruritic. The lesions were initially smaller and red, but had since lightened in color, coalesced, and had begun to spread to the perianal area. The patient's mother had received a call from her daughter's teacher who observed that her daughter was scratching the area and might be masturbating in class. WHAT IS YOUR DIAGNOSIS? HOW WOULD YOU TREAT THIS PATIENT?...
March 2018: Journal of Family Practice
Doug Campos-Outcalt
The Advisory Committee on Immunization Practices made relatively few new vaccine recommendations in 2017. One pertained to prevention of hepatitis B virus infection in infants born to HBV-infected mothers. Another recommended a new vaccine to prevent shingles. A third advised considering an additional dose of mumps vaccine during an outbreak.
March 2018: Journal of Family Practice
Laura Morris
A fussy 6-month-old infant is brought into the emergency department with a rectal temperature of 101.5 degrees F. She is consolable, breathing normally, and appears well hydrated. You find no clear etiology for her fever and suspect that a urinary tract infection may be the source of her illness. How do you proceed with obtaining a urine sample?
March 2018: Journal of Family Practice
Hannah Shehata, Jerry Hizon
A 12-year-old girl presented to my office (JH) with bilateral wrist pain. She had fallen on both wrists palmar-flexed and then, while trying to get up, landed on both wrists dorsi-flexed. The patient did not hear any "pops," but felt immediate pain when her wrists hyperextended. Hand, wrist, and forearm x-rays were negative bilaterally for fractures. She was placed in bilateral thumb spica splints.
March 2018: Journal of Family Practice
Wendy S Biggs, Erin T Carey, Jeannette M McIntyre
This article reviews the limited evidence for treating chronic pelvic pain and offers recommendations for the primary care physician on providing symptomatic relief in the absence of diagnosed pathology.
March 2018: Journal of Family Practice
Christiaan H Koster, Annelieke Mk Harmsen, Miranda C Lichtenberg, Frank W Bloemers
Three physical examination tests are most commonly used to evaluate cruciate ligament injury. The best known and most frequently used technique is the anterior drawer test. The other 2 tests, the Lachman test and the pivot shift test, are more difficult to perform and are used less often, especially by physicians untrained in their use. In addition, there is a relatively new diagnostic test: the lever sign test. The aim of our article is to provide a short, clinically relevant overview of the literature and to assess the diagnostic value of physical examination for the primary care physician...
March 2018: Journal of Family Practice
Tochi Iroku-Malize, Maureen Grissom
Situations involving agitated patients are not uncommon in health care settings. And no matter where on the spectrum an incident involving an agitated patient falls, it can leave those involved with various levels of physical, emotional, and psychological harm. It can also leave everyone asking themselves: "How can I better prepare for such occurrences?" This article offers some answers by providing tips and guidelines for handling agitated and/or violent patients in various settings.
March 2018: Journal of Family Practice
John Hickner
No abstract text is available yet for this article.
March 2018: Journal of Family Practice
Barbara Yawn, Victor Kim
Primary care physicians manage the care of approximately 80% of patients with chronic obstructive pulmonary disease (COPD). This provides the opportunity to engage patients in management goal-setting that facilitates more tailored treatments, and can improve adherence to therapy, which is historically poor in patients with COPD, thereby improving outcomes.
February 2018: Journal of Family Practice
Rajiv Dhand, Tricia Cavanaugh, Neil Skolnik
Understanding the advantages and limitations of inhaler devices for chronic obstructive pulmonary disease helps clinicians in choosing the proper device for the individual patient's clinical needs and preferences. However, with the wide range of permutations of drug combinations now possible, inhaler selection remains challenging. For all inhaler devices, adequate training for patients on how to use their device is required to achieve optimal therapeutic benefits.
February 2018: Journal of Family Practice
Abebaw Mengistu Yohannes, Alan Kaplan, Nicola A Hanania
Ensuring that anxiety and depression are recognized and treated effectively in patients with chronic obstructive pulmonary disease (COPD) is essential for optimizing outcomes. Primary care practitioners are well placed to diagnose anxiety and depression, and to ensure these conditions are suitably managed alongside treatments of COPD.
February 2018: Journal of Family Practice
Nathaniel Marchetti, Alan Kaplan
Physical inactivity is often considered to be a major contributor to the progression of chronic obstructive pulmonary disease, and is linked to hospitalizations and increased all-cause mortality. There is, therefore, a need to recognize symptoms early and treat them accordingly.
February 2018: Journal of Family Practice
Alexander M Sy, Nora V Bergasa
A 34-year-old woman was referred to the hepatology clinic for evaluation of an increased serum alkaline phosphatase (ALP) level. She was gravida 5 and in her 38th week of gestation. Her obstetric history was significant for 2 uncomplicated spontaneous term vaginal deliveries resulting in live births and 2 spontaneous abortions. The patient reported generalized pruritus for 2 months prior to the visit. She had no comorbidities and denied any other symptoms. She reported no family history of liver disease or complications during pregnancy in relatives...
February 2018: Journal of Family Practice
Frances K Wen, James Millar, Linda Oberst-Walsh, Joan Nashelsky
No. Megestrol acetate (MA) is neither safe nor effective for stimulating appetite in malnourished nursing home residents. It increases the risk of deep vein thrombosis (strength of recommendation [SOR]: C, 2 retrospective chart reviews), but isn't associated with other new or worsening events or disorders (SOR: B, single randomized controlled trial [RCT]). Over a 25-week period, MA wasn't associated with increased mortality (SOR: B, single RCT). After 44 months, however, MA-treated patients showed decreased median survival (SOR: B, single case-control study)...
February 2018: Journal of Family Practice
Corey Lyon, Susan Piggott, Shannon Langner, Kristen DeSanto
Nonsteroidal anti-inflammatory drugs (NSAIDs) are at least as effective as other oral analgesics (opioids, acetaminophen) in relieving pain in the first few days after an acute musculoskeletal injury. Evidence also indicates that using NSAIDs results in fewer adverse events than using narcotics (strength of recommendation [SOR]: A, systematic review of randomized controlled trials [RCTs], as well as individual RCTs).
February 2018: Journal of Family Practice
Theresa Vo, Richard P Usatine
A 49-year-old Hispanic woman presented with a 4-month history of scaling and a macerated rash localized between her toes. The rash was malodorous, mildly erythematous, and sometimes associated with pruritus. The patient had no relevant medical history. Potassium hydroxide testing was performed and found to be negative. So a Wood's lamp was used to examine the patient's toes--and it revealed the diagnosis. WHAT IS YOUR DIAGNOSIS? HOW WOULD YOU TREAT THIS PATIENT?
February 2018: Journal of Family Practice
Rajesh Rajesh, Rajesh Tampi
Steven R, a 21-year-old man, visited the clinic accompanied by his mother. He did not speak much, and his mother provided his history. Over the previous 2 months, she had overheard him whispering in an agitated voice, even though no one else was nearby. And, lately, he refused to answer or make calls on his cell phone, claiming that if he did it would activate a deadly chip that had been implanted in his brain by evil aliens. He also stopped attending classes at the community college. He occasionally had a few beers with his friends, but he had never been known to abuse alcohol or use other recreational drugs...
February 2018: Journal of Family Practice
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