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https://www.readbyqxmd.com/read/29714995/issues-in-geriatric-care-medical-decision-making
#1
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
#2
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
#3
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
#4
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
#5
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
#6
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
#7
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
#8
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
#9
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
#10
Kate Rowland
No abstract text is available yet for this article.
April 2018: FP Essentials
https://www.readbyqxmd.com/read/29528207/functional-gastrointestinal-disorders-functional-gastrointestinal-disorders-in-children
#11
Abdul Waheed, Michael Malone, Samiullah Samiullah
Functional gastrointestinal disorders (FGIDs) are common among children and cause tremendous distress for patients and families. Family physicians should know how to diagnose and manage some of the more common childhood FGIDs. These include infant regurgitation, infant colic, infant dyschezia, cyclic vomiting syndrome, functional nausea and vomiting, functional diarrhea and constipation, abdominal migraine, and nonspecific functional abdominal pain. Diagnosis requires a thorough history and physical examination to rule out red flag signs and symptoms for structural or organic etiologies...
March 2018: FP Essentials
https://www.readbyqxmd.com/read/29528206/functional-gastrointestinal-disorders-functional-lower-gastrointestinal-disorders-in-adults
#12
Michael Malone, Abdul Waheed, Samiullah Samiullah
Functional lower gastrointestinal disorders include irritable bowel syndrome (IBS), functional constipation, functional fecal incontinence, and functional anorectal pain. These disorders are common and have significant medical and social effects. They also can be challenging to manage. Patients with mild symptoms may benefit from lifestyle modification. IBS is classified into two subtypes: diarrhea-predominant and constipation-predominant. Depending on the IBS subtype and its likely etiology, patients may benefit from treatment with antispasmodics, antidepressants, guanylate cyclase-C agonists, chloride channel activators, antidiarrheal agents, probiotics, and/or antibiotics...
March 2018: FP Essentials
https://www.readbyqxmd.com/read/29528205/functional-gastrointestinal-disorders-functional-upper-gastrointestinal-disorders-in-adults
#13
Michael Malone, Abdul Waheed, Samiullah Samiullah
Functional upper gastrointestinal disorders are common and cause significant patient distress and health care cost. These disorders typically are classified as either esophageal or gastroduodenal. Functional esophageal disorders include functional heartburn, reflux hypersensitivity, and functional dysphagia. Functional gastroduodenal disorders include functional dyspepsia and cyclic vomiting syndrome. Cyclic vomiting syndrome should be suspected in any patient with multiple episodes of vomiting with no apparent cause that completely resolve between episodes...
March 2018: FP Essentials
https://www.readbyqxmd.com/read/29528204/functional-gastrointestinal-disorders-approach-to-patients-with-functional-gastrointestinal-disorders
#14
Samiullah Samiullah, Michael Malone, Abdul Waheed
Functional gastrointestinal disorders (FGIDs) are among the most challenging conditions to diagnose and manage. FGIDs are a heterogeneous group of conditions with varying and sometimes vague symptomatology. The Rome IV classification is the most comprehensive resource on FGIDs. FGIDs are common and are associated with significant social and economic burdens. The patient perspective includes anxiety, emotional distress, and mistrust of health care. Psychological stressors and concomitant psychiatric illness are common but not always present...
March 2018: FP Essentials
https://www.readbyqxmd.com/read/29528203/functional-gastrointestinal-disorders-foreword
#15
Mindy A Smith
No abstract text is available yet for this article.
March 2018: FP Essentials
https://www.readbyqxmd.com/read/29381043/foot-and-ankle-conditions-midfoot-and-forefoot-conditions
#16
Katherine M Edenfield, Charlie Michaudet, Guy W Nicolette, Peter J Carek
The midfoot and forefoot are the regions of the foot distal to the talus and calcaneus and are critical to weight bearing and movement. They help support the arch of the foot, provide shock absorption, and convert vertically oriented forces into horizontal forward and propulsive movement. A spectrum of acute, subacute, and chronic conditions in these regions can cause pain and decreased function. A thorough history and physical examination should include foot and leg biomechanics, alignment, and posture in addition to palpation of painful areas...
February 2018: FP Essentials
https://www.readbyqxmd.com/read/29381042/foot-and-ankle-conditions-chronic-lateral-ankle-pain
#17
Guy W Nicolette, Katherine M Edenfield, Charlie Michaudet, Peter J Carek
Chronic ankle pain is relatively common in family medicine. Sequelae from lateral ankle sprains are the most common cause. Other etiologies include peroneal tendinopathy or subluxation, osteochondral injury, lateral ankle impingement, sinus tarsi syndrome, cuboid syndrome, bony stress injury, and other unusual factors. A thorough history focusing on the mechanism of injury (if traumatic) and the nature of the pain along with a targeted physical examination typically will provide the information needed to make the diagnosis...
February 2018: FP Essentials
https://www.readbyqxmd.com/read/29381041/foot-and-ankle-conditions-pes-planus
#18
Charlie Michaudet, Katherine M Edenfield, Guy W Nicolette, Peter J Carek
Pes planus or pes planovalgus (ie, flatfoot) is a common condition among young children and also is encountered in adults. In children, congenital pes planus typically resolves with age as the foot musculature strengthens. Flexible pes planus is defined as a normal arch during non-weight-bearing activity or tiptoeing, with a flattening arch on standing. In rigid pes planus, the arch remains stiff and collapsed with or without weight bearing. Patients with rigid pes planus should be referred for subspecialist treatment...
February 2018: FP Essentials
https://www.readbyqxmd.com/read/29381040/foot-and-ankle-conditions-plantar-fasciitis
#19
Peter J Carek, Katherine M Edenfield, Charlie Michaudet, Guy W Nicolette
Plantar fasciitis is the most common cause of heel pain in adults. It involves painful symptoms occurring along the plantar fascia with or without the presence of a bony heel spur. Heel pain that occurs on standing after a prolonged non-weight-bearing period is a prominent symptom of plantar fasciitis. On physical examination, palpation along the medial plantar calcaneal region reproduces the painful symptoms. Routine imaging studies usually are not necessary but can be used to rule out pathologies or confirm chronic or recalcitrant plantar fasciitis...
February 2018: FP Essentials
https://www.readbyqxmd.com/read/29381039/foot-and-ankle-conditions-foreword
#20
Kate Rowland
No abstract text is available yet for this article.
February 2018: FP Essentials
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