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FP Essentials

Charles W Shafer, Jay R Allison, Amy L Hogue, Mark K Huntington
Health care-associated infections (HAIs) are a major cause of morbidity and mortality, with 2 million US patients per year developing HAIs. This results in 90,000 deaths and billions of dollars in preventable expenses annually. Common HAIs include central line-associated bloodstream infection, catheter-related urinary tract infection, surgical site infection, hospital-acquired pneumonia (HAP), ventilator-associated pneumonia (VAP), methicillin-resistant Staphylococcus aureus (MRSA) infection, Clostridium difficile infection (CDI), and others...
January 2019: FP Essentials
Amy L Hogue, Jay R Allison, Charles W Shafer, Mark K Huntington
Emerging infectious diseases are those that are newly discovered, recently have increased in prevalence, or are expected to increase in prevalence in the future. Family physicians play an important role in leading community response to emerging infectious diseases. As with other types of disasters, the general approach to outbreaks has four stages: preparedness, response, recovery, and mitigation. Preparedness includes promotion of community health, maintenance of high vaccination rates, development of protocols for hospitals and family medicine practices, preparation of patients for international travel, and consideration of volunteering in case of disasters...
January 2019: FP Essentials
Mark K Huntington, Jay R Allison, Amy L Hogue, Charles W Shafer
Bedbugs, mites, and scabies are ectoparasites that commonly affect humans. Bedbugs ( Cimex species) were once rare in the United States but are now common. They cause intensely pruritic lesions on areas of exposed skin. The bites are highly allergenic and can cause asthma exacerbations or anaphylaxis. Management of bedbug bites involves symptomatic relief of itching and dealing with patient anxiety. Identification and elimination of infestation are most important. Another ectoparasite of concern is lice ( Pediculus and Pthirus species), which causes head, body, and pubic infestations...
January 2019: FP Essentials
Jay R Allison, Amy L Hogue, Charles W Shafer, Mark K Huntington
Due to rapid globalization and ease of travel, mosquito-borne viral infections are now a concern for family physicians throughout the United States. Zika virus infection is one such concern. It is spread via mosquito bites or by sexual contact with an infected individual. Most patients are asymptomatic, and when symptoms occur, they are mild and nonspecific. The main concern is the potential of the infection to cause fetal anomalies. Dengue is another mosquito-borne viral infection. Symptoms of initial infection are mild, and may include arthralgias...
January 2019: FP Essentials
Barry D Weiss
No abstract text is available yet for this article.
January 2019: FP Essentials
Terrill Bravender
Rates of depression and suicide in adolescents have increased over the past decade, particularly among adolescent girls. Because depression frequently is underdiagnosed, the US Preventive Services Task Force recommends that physicians screen all adolescents ages 12 to 18 years at least annually for major depressive disorder. Adolescents with suicidal thoughts should work with their health care team and family members to create a safety plan that emphasizes a safe environment and provides for escalating levels of support in times of crisis...
December 2018: FP Essentials
Catherine Miller, Terrill Bravender
Eating disorders are common. The typical onset of eating disorders is in mid- to late adolescence, affecting females more often than males. However, rates of eating disorders are increasing among younger children, males, and minority groups. Warning signs include abrupt changes in weight or growth percentiles, a preoccupation with calories or weight, altered eating habits, excessive exercise, loss of menses, pubertal delay, and a distorted perception of body size. For patients with eating disorders that include dietary restriction (eg, anorexia nervosa, avoidant restrictive food intake disorder), common short-term medical sequelae include weight loss, bradycardia, hypotension, fatigue, and irritability...
December 2018: FP Essentials
Thomas W Bishop
Learning disabilities are estimated to affect 5% to 9% of US children. Risk factors include a family history of learning disabilities, environmental factors during gestation or birth, and social adversity. Individuals with learning disabilities may experience social exclusion and bullying, poor self-image, or underachievement. They may struggle with tasks and in settings that depend on reading, mathematical skills and reasoning, or written and verbal communication. The family physician often is the first to be approached by parents regarding learning delays in children...
December 2018: FP Essentials
Barbara T Felt
Attention-deficit/hyperactivity disorder (ADHD) is a neurobehavioral condition that affects more than 9% of US children and adolescents and often is seen in family medicine settings. A comprehensive evaluation for ADHD gathers information across time and settings; considers common comorbid or alternative conditions, such as learning disabilities and disorders of mood or anxiety, vision, hearing, and sleep; and includes a thorough physical examination. The need for additional evaluation is determined by the history and physical examination results...
December 2018: FP Essentials
Karl T Rew
No abstract text is available yet for this article.
December 2018: FP Essentials
Sarah Bradford, Anita Ramsetty, Scott Bragg, Jennifer Bain
Interest in slowing or reversing the process of aging continues to grow and has encouraged the growth of an entire anti-aging industry. However, there is a dearth of data based on randomized trials in humans to support proposed therapies to address the various complex processes involved in aging. Hormonal therapies, in particular, have little data to support safe use and are associated with some degree of risk. Experimental data in animal models suggest possible molecular targets but their use in clinical medicine is far in the future...
November 2018: FP Essentials
Anita Ramsetty, Scott Bragg, Sarah Bradford, Jennifer Bain
Incidentally discovered adrenal masses, referred to as adrenal incidentalomas, are fairly common given the routine use of imaging as part of clinical care in a variety of settings. Adrenal incidentalomas most frequently are benign and hormonally inactive tumors. However, approximately 11% to 15% are hormonally active, which can lead to diagnosis of clinically relevant conditions that affect morbidity and mortality. Thus, all adrenal incidentalomas should be tested for production of hormones at initial diagnosis...
November 2018: FP Essentials
Jennifer Bain, Scott Bragg, Anita Ramsetty, Sarah Bradford
Menopause is the cessation of menstruation due to loss of ovarian function and is diagnosed retrospectively after 12 consecutive months of amenorrhea. The average age of onset in the United States is 51 years but symptoms can be present for many years before and after. Vasomotor and genitourinary symptoms are the most common. Hormone replacement therapy (HRT) is the most effective management. Given the possible risks of cardiovascular disease and breast cancer, recommendations for HRT after the Women's Health Initiative study are to limit HRT to the lowest dose and shortest duration to relieve symptoms...
November 2018: FP Essentials
Scott Bragg, Jennifer Bain, Anita Ramsetty
Osteoporosis management has undergone several paradigm shifts over the past 20 years because of emerging technologies and new treatments and decision support tools to guide risk assessment. Practice guidelines in the United States and abroad differ widely on recommendations for screening, prevention, and management. Screening has evolved, with improvements in bone mineral density testing, vertebral fracture assessment, trabecular bone scores, and decision support tools. All of these have improved the identification of patients at high risk of fractures...
November 2018: FP Essentials
Mindy A Smith
No abstract text is available yet for this article.
November 2018: FP Essentials
M Chantel Long
Posttraumatic headache (PTHA) is defined as headache that develops within 7 days after a head trauma or injury. Reported rates of PTHA range from 30% to 90% among patients who meet criteria for traumatic brain injury. Approximately 20% of PTHAs persist at 1 year after the inciting injury, and nearly 25% of patients report headaches 4 years after the trauma. Confounding variables for prognosis include return to play decisions, injury biomechanics, pain coping resources, medication overuse headache, and mental conditions...
October 2018: FP Essentials
Anne Walling
Among patients in the emergency department (ED), most severe, sudden-onset headaches are primary, such as migraine or tension-type headache. Only 10% to 15% of patients have serious underlying pathology. However, guidelines for evaluation of patients with severe headache emphasize detection of subarachnoid hemorrhage (SAH) and other cerebrovascular conditions. Reversible cerebral vasoconstriction syndrome (RCVS) often is unrecognized and may be as common as SAH in patients with severe, sudden-onset headache in the ED...
October 2018: FP Essentials
Cassie Scripter
Tension-type headache (TTH) is the most common primary headache disorder, with a worldwide lifetime prevalence of 46% to 78%. TTH causes greater disability and accounts for more missed work days than migraine. The etiology of TTH is thought to be multifactorial, involving genetic and environmental factors. The three subtypes of TTH are infrequent episodic, frequent episodic, and chronic. Patients typically describe headache pain as pressing, dull, and with the sensation of a tight band around the head. Nonprescription analgesics are indicated for management of episodic TTH...
October 2018: FP Essentials
Laura Mayans
Migraine is a primary headache disorder and a common, recurrent, disabling condition that affects an estimated 18% of women and 6% of men. Commonly reported triggers that induce migraine include stress, fatigue, various foods, alcohol, drugs, smoking, weather changes, and odors. Migraine is diagnosed clinically, with diagnostic testing indicated only in patients with red flag signs and symptoms. Research is providing new insights into the underlying pathophysiology and genetics of migraine as well as novel pharmacotherapies for management and prevention...
October 2018: FP Essentials
Kate Rowland
No abstract text is available yet for this article.
October 2018: FP Essentials
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