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https://www.readbyqxmd.com/read/29313655/lung-cancer-management
#1
Timothy F Mott
Lung cancer management that is individualized for age, comorbidities, cancer type, cancer stage, and patient preference has long been a cornerstone of management. New to this realm of individualized management are the emerging biologic therapies, immunotherapies, and targeted therapies for non-small-cell lung cancer provided by advances in genetics and molecular medicine. These techniques have led to a new field of precision medicine based on the unique molecular characteristics of a specific patient and the specific cancer...
January 2018: FP Essentials
https://www.readbyqxmd.com/read/29313654/lung-cancer-clinical-presentation-and-diagnosis
#2
Kelly M Latimer
In the absence of screening, most patients with lung cancer are not diagnosed until later stages, when the prognosis is poor. The most common symptoms are cough and dyspnea, but the most specific symptom is hemoptysis. Digital clubbing, though rare, is highly predictive of lung cancer. Symptoms can be caused by the local tumor, intrathoracic spread, distant metastases, or paraneoplastic syndromes. Clinicians should suspect lung cancer in symptomatic patients with risk factors. The initial study should be chest x-ray, but if results are negative and suspicion remains, the clinician should obtain a computed tomography scan with contrast...
January 2018: FP Essentials
https://www.readbyqxmd.com/read/29313653/lung-cancer-screening-and-evaluation-of-patients-with-solitary-pulmonary-nodules
#3
Timothy F Mott
Low-dose computed tomography (CT) scan is the only modality currently considered acceptable for lung cancer screening in high-risk populations. Screening recommendations vary. The US Preventive Services Task Force recommends annual low-dose CT scan to screen high-risk patients (ie, asymptomatic patients ages 55 to 80 years with a 30 pack-year smoking history and who currently smoke or have quit within the previous 15 years). The American Academy of Family Physicians recommends a shared decision-making discussion between the clinician and patient regarding the benefits and potential harms of screening...
January 2018: FP Essentials
https://www.readbyqxmd.com/read/29313652/lung-cancer-smoking-cessation
#4
Kelly M Latimer
Smoking cessation for patients who smoke should be a top priority for physicians. Nicotine dependence should be considered a chronic disease, with the expectation that relapse is normal. The US Preventive Services Task Force (USPSTF) recommends that physicians screen all adults for tobacco use, advise them to stop using tobacco, and provide behavioral interventions and Food and Drug Administration-approved pharmacotherapy for cessation to adults who use tobacco. It also recommends use of the 5 As (ie, Ask, Advise, Assess, Assist, Arrange) in discussing tobacco use with patients...
January 2018: FP Essentials
https://www.readbyqxmd.com/read/29313651/lung-cancer-foreword
#5
Karl T Rew
No abstract text is available yet for this article.
January 2018: FP Essentials
https://www.readbyqxmd.com/read/29210557/improving-patient-safety-improving-communication
#6
Heather Bittner-Fagan, Joshua Davis, Margot Savoy
Communication among physicians, staff, and patients is a critical element in patient safety. Effective communication skills can be taught and improved through training and awareness. The practice of family medicine allows for long-term relationships with patients, which affords opportunities for ongoing, high-quality communication. There are many barriers to effective communication, including patient factors, clinician factors, and system factors, but tools and strategies exist to address these barriers, improve communication, and engage patients in their care...
December 2017: FP Essentials
https://www.readbyqxmd.com/read/29210556/improving-patient-safety-prevention-of-hospital-readmission
#7
Margot Savoy, Joshua Davis, Heather Bittner-Fagan
Identifying and preventing avoidable hospital admissions have become cornerstone quality metrics that influence reimbursement and provision of quality care. Many initiatives focus on improving communication with other clinicians and patients, coordinating care after discharge, and improving care quality during the initial admission to prevent future readmissions. The Centers for Medicare and Medicaid Services define a readmission as an admission to any acute care hospital for any reason within 30 days of discharge from an acute care hospital...
December 2017: FP Essentials
https://www.readbyqxmd.com/read/29210555/improving-patient-safety-care-transitions
#8
Joshua Davis, Margot Savoy, Heather Bittner-Fagan
Care transitions are times of high risk of harm to patients. The transition from hospital care to outpatient care is perhaps the most well-studied transition and is encountered commonly in the family medicine setting. For discharge transitions, several hospital-based interventions for patients with major diagnoses have resulted in improvements in readmission rates, costs, and patient satisfaction. Prompt scheduling of a follow-up appointment with patients after discharge is crucial. Key issues to consider in the first post-discharge appointment include drug reconciliation and follow-up of any pending tests and results...
December 2017: FP Essentials
https://www.readbyqxmd.com/read/29210554/improving-patient-safety-common-outpatient-medical-errors
#9
Joshua Davis, Heather Bittner-Fagan, Margot Savoy
Medical errors are common and can lead to patient harm and death. Most research on errors has focused on inpatient care, yet errors are at least as common in the outpatient setting and likely are underreported. Common types of errors in the outpatient setting are diagnostic, drug, and testing errors. The most effective specific interventions for reducing errors in the outpatient setting remain unknown. Considering the current lack of data, the authors recommend a quality improvement approach to understanding local factors in patient safety...
December 2017: FP Essentials
https://www.readbyqxmd.com/read/29210553/improving-patient-safety-foreword
#10
Mindy A Smith
No abstract text is available yet for this article.
December 2017: FP Essentials
https://www.readbyqxmd.com/read/29172414/contraception-update-sterilization
#11
Karen Antell, Prium Deshmukh, Elizabeth J Brown
Female sterilization procedures include postpartum partial salpingectomy via cesarean or minilaparotomy incision, interval laparoscopic procedures, or hysteroscopic placement of microinserts. Rates of failure and serious complications are low and comparable among the various methods. A hysteroscopic procedure requires a 3-month confirmatory hysterosalpingogram before it is considered effective for contraception. Hysteroscopic sterilization has been shown to be associated with a higher reoperation rate than laparoscopic procedures...
November 2017: FP Essentials
https://www.readbyqxmd.com/read/29172413/contraception-update-progestin-only-implants-and-injections
#12
Prium Deshmukh, Karen Antell, Elizabeth J Brown
Progestin-only contraception is a popular method of birth control in the United States and worldwide. Progestin-only implants and injections allow patients access to long-term contraception with simple options for reversal or removal. The implant is one of the most effective forms of contraception and there are few contraindications. Manufacturer-led training is required to become certified in insertion and removal. The most common adverse effect of the implant is a change in menstrual bleeding patterns. Little evidence has shown weight gain or decreased bone mineral density with use...
November 2017: FP Essentials
https://www.readbyqxmd.com/read/29172412/contraception-update-intrauterine-devices
#13
Karen Antell, Prium Deshmukh, Elizabeth J Brown
Copper-containing and hormonal intrauterine devices (IUD) are long-acting, highly effective contraceptive methods. They can be used safely by nulliparous patients, adolescents, patients with history of ectopic pregnancy, and patients with risk factors for sexually transmitted infections or a history of pelvic inflammatory disease (PID). These devices can be placed safely immediately postpartum and postabortion and should be inserted when physicians can be reasonably certain that the woman is not pregnant. If a woman with an IUD is shown to be pregnant, the device should be removed if strings are visible...
November 2017: FP Essentials
https://www.readbyqxmd.com/read/29172411/contraception-update-oral-contraception
#14
Elizabeth J Brown, Prium Deshmukh, Karen Antell
The oral contraceptive pill (OCP) is the most commonly used form of reversible contraception. The two types of OCPs are combination oral contraceptives (COCs), which contain estrogen and progesterone, and progestin-only pills (POPs). Both have failure rates of approximately 7.2% to 9% with typical use, and are safe for most patients. Because estrogen-containing contraceptives can increase the risk of venous thromboembolism, patients with conditions associated with a risk of cardiovascular events should not use COCs...
November 2017: FP Essentials
https://www.readbyqxmd.com/read/29172410/contraception-update-foreword
#15
Kate Rowland
No abstract text is available yet for this article.
November 2017: FP Essentials
https://www.readbyqxmd.com/read/29019642/spine-conditions-occupational-spine-conditions
#16
Marc A Childress
Neck and back conditions have significant effects on employee health and productivity. More than $7 billion in lost revenue in the United States annually can be attributed to workplace back pain among employees ages 40 to 65 years. According to the Bureau of Labor Statistics, in 2012 back pain was the most prevalent musculoskeletal condition resulting in workplace absenteeism. The incidence of these conditions is higher among individuals in certain professions, such as bus drivers, police officers, and correctional officers...
October 2017: FP Essentials
https://www.readbyqxmd.com/read/29019641/spine-conditions-lumbar-spinal-stenosis
#17
REVIEW
Steven D Trigg, Zachary Devilbiss
Lumbar spinal stenosis (LSS) is a frequent cause of chronic low back and lower extremity pain in older patients. Symptomatic LSS typically is described as neurogenic claudication consisting of pain, weakness, numbness, and/or fatigue arising in the back and radiating into the buttock, thigh, or lower leg. The diagnosis is complicated by lack of reliable clinical or x-ray criteria. North American Spine Society guidelines recommend magnetic resonance imaging study without contrast to confirm anatomic narrowing of the spinal canal or nerve root impingement...
October 2017: FP Essentials
https://www.readbyqxmd.com/read/29019640/spine-conditions-mechanical-and-inflammatory-low-back-pain
#18
Christopher Ledford
Mechanical low back pain (LBP) is an injury or derangement of an anatomic structure in the low back. When evaluating patients with LBP, clinicians should maintain clinical suspicion for vertebral fracture, cancer, and cauda equina syndrome. Management includes patient education focused on exercise, massage, and behavioral approaches such as cognitive behavioral therapy. Acupuncture can be an effective alternative and specific herbal supplements may provide short-term pain relief. The prognosis for patients with mechanical LBP is good...
October 2017: FP Essentials
https://www.readbyqxmd.com/read/29019639/spine-conditions-cervical-spine-conditions
#19
REVIEW
Marc A Childress
There are a variety of causes of neck pain, including trauma and degenerative changes. The history of onset helps to direct evaluation, including the need for imaging or ancillary testing. Patterns of pain, weakness, and other specific physical examination findings also aid in diagnosis. Management of most soft tissue injuries involves early mobilization, whereas fractures are managed based on patterns of instability. Acute spinal cord injury requires emergent care, to include possible decompressive surgery...
October 2017: FP Essentials
https://www.readbyqxmd.com/read/29019638/spine-conditions-foreword
#20
Mindy A Smith
No abstract text is available yet for this article.
October 2017: FP Essentials
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