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https://www.readbyqxmd.com/read/29963846/musculoskeletal-therapies-acupuncture-dry-needling-cupping
#1
Jeffrey C Leggit
Integrative medicine, including acupuncture, dry needling, and cupping, is being used increasingly in the United States. Evidence regarding their efficacy in the management of musculoskeletal conditions is heterogeneous and subject to several limitations. Despite these limitations, acupuncture consistently has been shown to be more effective than no treatment and is relatively safe. For chronic back pain, it is recommended as a first-line noninvasive therapy. For neck pain, acupuncture provides benefits when it is combined with other treatments...
July 2018: FP Essentials
https://www.readbyqxmd.com/read/29963845/musculoskeletal-therapies-musculoskeletal-injection-therapy
#2
Chad Hulsopple
Injections often are used in the management of common musculoskeletal conditions. Physicians should understand the disease pathophysiology and evidence supporting available injections when determining appropriate therapy. These therapies include corticosteroid injections (CSIs), hyaluronic acid (HA) injections, hypertonic dextrose prolotherapy, platelet-rich plasma (PRP) injections, mesenchymal stem cell (MSC) injections, and trigger point injections (TPIs). CSIs are recommended conditionally by the American College of Rheumatology for osteoarthritis (OA) management...
July 2018: FP Essentials
https://www.readbyqxmd.com/read/29963844/musculoskeletal-therapies-adjunctive-physical-therapy
#3
Anthony Beutler
Physical therapy (PT) modalities are a diverse group of treatments for musculoskeletal pain. Iontophoresis, phonophoresis, kinesiology taping, laser therapy, and myofascial release are some of the most commonly used and are best considered as adjuncts to exercise. Each modality is relatively safe, but none is supported by high-quality evidence in the management of most musculoskeletal conditions. Individual patient response to such modalities is variable. Neither iontophoresis nor phonophoresis has been shown to have greater benefits for neck or back pain than supervised PT...
July 2018: FP Essentials
https://www.readbyqxmd.com/read/29963843/musculoskeletal-therapies-osteopathic-manipulative-treatment
#4
Christopher Jonas
Osteopathic manipulative treatment (OMT) is being used increasingly in the United States. OMT techniques can be categorized as direct, using an activating force to move tissue through range-of-motion barriers; indirect, disengaging dysfunctional body parts away from restrictive barriers; and combined techniques. Evidence supports the effectiveness of this therapy in management of musculoskeletal conditions, particularly for low back pain, but is limited for many other conditions. Physician opinion, patient reporting, and student attitudes about OMT primarily are positive, but rates of OMT use vary across different US regions...
July 2018: FP Essentials
https://www.readbyqxmd.com/read/29963842/musculoskeletal-therapies-foreword
#5
Mindy A Smith
No abstract text is available yet for this article.
July 2018: FP Essentials
https://www.readbyqxmd.com/read/29863320/hypertension-update-older-adults
#6
Anthony J Viera
Hypertension is prevalent in older adults, and blood pressure (BP) level lowering has been shown to be one of the most important clinical interventions to reduce the risk of cardiovascular events. The goal BP level for older adults is individualized based on age, cardiovascular risk, overall health status (particularly frailty), and patient preferences. Recent guidelines differ but a goal systolic BP level lower than 150 mm Hg is reasonable for nearly all adults 60 years and older. In patients with isolated systolic hypertension, the degree to which systolic BP level lowering can be tolerated may be limited if the diastolic BP level decreases below 60 to 65 mm Hg...
June 2018: FP Essentials
https://www.readbyqxmd.com/read/29863319/hypertension-update-resistant-hypertension
#7
Anthony J Viera
Resistant hypertension is a blood pressure (BP) level that remains above the goal level despite adherence to at least three appropriately dosed antihypertensive drugs of different classes, one of which is a diuretic. Evaluation of suspected resistant hypertension starts with confirming adherence to the drug regimen. White coat hypertension should be ruled out with out-of-office BP level measurements, ideally using 24-hour ambulatory BP monitoring. Obesity, significant alcohol intake, and interfering drugs and other substances can contribute to resistant hypertension...
June 2018: FP Essentials
https://www.readbyqxmd.com/read/29863318/hypertension-update-hypertensive-emergency-and-asymptomatic-severe-hypertension
#8
Anthony J Viera
Hypertensive emergency occurs when the blood pressure (BP) level is severely elevated (ie, higher than 180 mm Hg systolic or higher than 120 mm Hg diastolic) and acute organ damage is present. Patients with hypertensive emergencies are treated initially in the emergency department and then admitted to the intensive care unit. Management is directed at the specific situation, with the rate and extent of BP level lowering tailored to the type and extent of organ damage. Patients with severely elevated BP level but without symptoms have asymptomatic severe hypertension...
June 2018: FP Essentials
https://www.readbyqxmd.com/read/29863317/hypertension-update-current-guidelines
#9
Anthony J Viera
Hypertension affects at least 1 in 3 American adults and is a major contributor to premature mortality. Current guidelines recommend screening all adults for hypertension. Ambulatory blood pressure (BP) monitoring should be used to confirm the diagnosis of hypertension for most adults before starting antihypertensive drugs. Ambulatory BP monitoring is the preferred method but home BP monitoring is an acceptable alternative. Management of hypertension substantially reduces the risk of heart failure, stroke, and myocardial infarction...
June 2018: FP Essentials
https://www.readbyqxmd.com/read/29863316/hypertension-update-foreword
#10
Karl T Rew
No abstract text is available yet for this article.
June 2018: FP Essentials
https://www.readbyqxmd.com/read/29714995/issues-in-geriatric-care-medical-decision-making
#11
Jayesh Patel, Richard J Ackermann
Medical decision-making capacity (DMC), which is determined by clinicians, is the ability of patients to understand information about options for their care, express a choice among those options, appreciate the benefits and risks of those options, and explain the reasoning behind their particular choice. DMC differs from competence, which is a legal concept concerning the mental ability of individuals to be responsible for their decisions and actions. A variety of instruments can be used to assess DMC. If it is determined that a patient lacks DMC, clinicians have an ethical obligation to seek out a surrogate decision-maker...
May 2018: FP Essentials
https://www.readbyqxmd.com/read/29714994/issues-in-geriatric-care-alzheimer-disease
#12
Kathy Kemle, Richard J Ackermann
Alzheimer disease (AD) occurs in 8.8% of older US adults and is the sixth leading cause of death among older adults. Medicare annual wellness visits require screening for cognitive impairment but do not specify screening methods. Numerous screening instruments are available. If results are positive, evaluation with well-validated assessment tools is needed. If cognitive impairment is confirmed, laboratory tests and imaging studies should be obtained to rule out reversible etiologies. If patients meet diagnostic criteria for AD, clinicians should educate patients and families on the expected course and help them complete advance directives...
May 2018: FP Essentials
https://www.readbyqxmd.com/read/29714993/issues-in-geriatric-care-falls
#13
Dipesh Patel, Richard J Ackermann
One in three older adults falls each year. There are approximately 2.5 million falls among older adults treated in emergency departments. Falls account for 87% of all fractures in this age group. The biggest risk factor for falling is a history of falls. Other risk factors include frailty, sedative and anticholinergic drugs, polypharmacy, and a variety of medical conditions. Current recommendations are that all patients age 65 years and older should be asked about falls each year. Patients also can be screened for fall risk with a variety of approaches including questionnaires and the Timed Up & Go test...
May 2018: FP Essentials
https://www.readbyqxmd.com/read/29714992/issues-in-geriatric-care-maintaining-health-and-vigor
#14
Richard J Ackermann
Medicare covers annual wellness visits that are scheduled separately from regular medical appointments. These visits focus on prevention and health maintenance to help patients achieve successful aging, which is defined as living to old age without disability while also maintaining high physical and psychological levels of functioning and social engagement. To achieve these goals, most adults should perform at least 150 min/week of moderate-intensity exercise and maintain an optimal body mass index (ie, 23 to 32 kg/m2 )...
May 2018: FP Essentials
https://www.readbyqxmd.com/read/29714991/issues-in-geriatric-care-foreword
#15
Barry D Weiss
No abstract text is available yet for this article.
May 2018: FP Essentials
https://www.readbyqxmd.com/read/29683308/maternity-care-update-postpartum-care
#16
Andrew Smith, Wendy B Barr, Erin Bassett-Novoa, Nicholas LeFevre
Family physicians are uniquely situated to play a major role in postpartum care. Postpartum issues that should be monitored and addressed include reproductive and contraceptive planning, breastfeeding counseling and support, and maternal mental health. All women should be screened for postpartum depression using a validated tool at the postpartum visit and/or at well-child visits. Patients with positive screening results should be offered support and treatment. Women are more likely to breastfeed if they are provided with breastfeeding support and counseling routinely during the prenatal and postpartum periods...
April 2018: FP Essentials
https://www.readbyqxmd.com/read/29683307/maternity-care-update-labor-and-delivery
#17
Andrew Smith, Wendy B Barr, Erin Bassett-Novoa, Nicholas LeFevre
Labor is defined as contractions with cervical change and active labor starts when the cervix is dilated 6 cm. Updated labor curves and definitions should be used to define labor dystocia. Oxytocin and amniotomy have important roles in the management of labor dystocia. Structured intermittent fetal monitoring should be considered for women with low-risk pregnancies but continuous electronic fetal monitoring still is used most commonly. Moderate fetal heart rate variability is the most reliable marker of fetal well-being...
April 2018: FP Essentials
https://www.readbyqxmd.com/read/29683306/maternity-care-update-prenatal-care-and-specific-conditions
#18
Andrew Smith, Wendy B Barr, Erin Bassett-Novoa, Nicholas LeFevre
Early initiation of prenatal care is associated with improved health outcomes for women and newborns. An essential element of prenatal care is determining the estimated due date, ideally using a first-trimester ultrasound. Laboratory tests should be obtained to screen for conditions that can affect pregnancy. Routine immunizations for all pregnant women include influenza vaccine; tetanus toxoid, reduced diphtheria, acellular pertussis (Tdap) vaccine. All women should be screened for gestational diabetes mellitus in midpregnancy...
April 2018: FP Essentials
https://www.readbyqxmd.com/read/29683305/maternity-care-update-preconception-care
#19
Andrew Smith, Wendy B Barr, Erin Bassett-Novoa, Nicholas LeFevre
Family physicians are in a unique position to ensure that women receive preconception care. The Centers for Disease Control and Prevention, the American College of Obstetricians and Gynecologists, and the American Academy of Family Physicians recommend preconception care for all women, but particularly for women with comorbid conditions such as obesity, diabetes, and chronic hypertension. Family physicians should ask all women of reproductive age who are at risk of unintended pregnancy if they desire pregnancy within the next year and, based on this answer, provide counseling on contraception or preconception care...
April 2018: FP Essentials
https://www.readbyqxmd.com/read/29683304/maternity-care-update-foreword
#20
Kate Rowland
No abstract text is available yet for this article.
April 2018: FP Essentials
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