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https://www.readbyqxmd.com/read/30152671/allergy-and-asthma-asthma-management
#1
Nathan Falk
Asthma is a heterogeneous condition involving various levels of chronic airway inflammation, bronchoconstriction, airway hyperresponsiveness, and mucus production. Although inhaled corticosteroids and long-acting bronchodilators have improved patient outcomes, asthma remains uncontrolled for at least 10% of patients, even when use of these therapies is maximized. Improved understanding of the biology, genetics, and role of immune cell signaling in asthma has led to the development of immunobiologic therapies...
September 2018: FP Essentials
https://www.readbyqxmd.com/read/30152670/allergy-and-asthma-anaphylaxis
#2
Robert Vandervoort
Anaphylaxis is an allergic reaction that occurs rapidly after exposure and is life-threatening. After symptoms of anaphylaxis occur, there is no way to reliably predict whether the patient's condition could progress quickly and become life-threatening. Immediate injection of intramuscular epinephrine is the first-line emergency treatment for anaphylaxis. Other drugs such as corticosteroids or antihistamines are secondary options and should not delay epinephrine administration. The most commonly prescribed form of epinephrine is the costly brand name autoinjector, but less expensive alternatives exist, including generic autoinjectors and prefilled epinephrine syringes...
September 2018: FP Essentials
https://www.readbyqxmd.com/read/30152669/allergy-and-asthma-food-allergies
#3
Raj Mehta
Food allergies are immune-mediated allergic adverse reactions that occur after exposure to specific foods. The most commonly recognized food allergies are immunoglobulin E (IgE)-mediated reactions (eg, urticaria, angioedema, anaphylaxis) that result from exposure to milk, egg, peanut, tree nuts, shellfish, fish, wheat, or soy. However, other foods can cause food allergies. Oral allergy syndrome is a common but underrecognized condition characterized by transient oropharyngeal symptoms that result from ingestion of uncooked fruits or vegetables...
September 2018: FP Essentials
https://www.readbyqxmd.com/read/30152668/allergy-and-asthma-allergic-rhinitis-and-allergic-conjunctivitis
#4
Raj Mehta
Allergic rhinitis and allergic conjunctivitis are among the most common conditions seen in family medicine practice. Most cases are due to seasonal allergens, such as pollens, or year-round allergens, such as dust mites, mold, and animal dander. The clinical diagnosis can be made when symptoms of nasal congestion, sneezing, rhinorrhea, nasal or ocular pruritus, or eye tearing are present along with physical findings, such as clear rhinorrhea, pale nasal mucosa, or red watery eyes. Patients should be assessed for any comorbid conditions, such as asthma or eczema, and for symptoms that indicate impaired quality of life, such as poor sleep, daytime somnolence, or irritability...
September 2018: FP Essentials
https://www.readbyqxmd.com/read/30152667/allergy-and-asthma-foreword
#5
Karl T Rew
No abstract text is available yet for this article.
September 2018: FP Essentials
https://www.readbyqxmd.com/read/30107107/physician-well-being-financial-aspects
#6
Deborah Teasley
The US health care system has an unequal distribution of physician supply, is poorly accessible in some areas, and has wide disparities in patient health status. The Patient Protection and Affordable Care Act (ACA) was intended to address these issues by providing affordable health insurance coverage, Medicaid expansion, and care delivery system redesign (particularly through physician payment reform). As part of payment reform, the Medicare Access and CHIP Reauthorization Act (MACRA) went into effect in January 2017...
August 2018: FP Essentials
https://www.readbyqxmd.com/read/30107106/physician-well-being-organizational-strategies-for-physician-burnout
#7
Kathryn M Andolsek
Until recently, most initiatives to address physician burnout have focused on improving the resilience of individual physicians. These measures are necessary but insufficient since it is now recognized that organizations have a major role in causing, preventing, and mitigating physician burnout. Burnout must be addressed by organizational change. The first steps to improving clinician well-being are measurement and monitoring. Several validated scales are available to assess well-being. Results of assessments can be used to engage clinicians in open conversations on issues and potential solutions...
August 2018: FP Essentials
https://www.readbyqxmd.com/read/30107105/physician-well-being-improving-office-efficiency
#8
Lenny Salzberg
Improving office efficiency can contribute to physician well-being by increasing the amount of time physicians spend with patients while decreasing the amount of time spent on administrative and regulatory requirements. Delegation of administrative tasks (such as those involving electronic health records [EHRs]) to scribes and prior authorization duties to staff members improves job satisfaction. Customization of EHR templates can expedite workflow and improve quality of care. Optimization of drug prescribing can reduce the number of refill requests needed and decrease workload...
August 2018: FP Essentials
https://www.readbyqxmd.com/read/30107104/physician-well-being-physician-burnout
#9
Matt Martin
Physician burnout affects patients and physicians. Recent studies estimate that more than half of all physicians in the United States currently are experiencing burnout. Burnout can include symptoms of emotional exhaustion, depersonalization, cognitive weariness, physical fatigue, and disengagement. It can lead to physical and psychological conditions in physicians and decrease patient safety, quality of care, and satisfaction. The health care work environment appears to be the main contributing factor in the current high rates of physician burnout...
August 2018: FP Essentials
https://www.readbyqxmd.com/read/30107103/physician-well-being-foreword
#10
Kate Rowland
No abstract text is available yet for this article.
August 2018: FP Essentials
https://www.readbyqxmd.com/read/29963846/musculoskeletal-therapies-acupuncture-dry-needling-cupping
#11
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
#12
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
#13
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
#14
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
#15
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
#16
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
#17
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
#18
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
#19
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
#20
Karl T Rew
No abstract text is available yet for this article.
June 2018: FP Essentials
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