AFP Clinical Answers
Vaginitis, Coronary Artery Disease, Hypertension in Children, COPD, Alzheimer Disease
Am Fam Physician. 2019 May 1;99(9):543.
What are key tips on diagnosing and treating vaginitis?
Office-based or laboratory testing should be used with the history and physical examination findings to make the diagnosis. Do not obtain culture for the diagnosis of bacterial vaginosis because it represents a polymicrobial infection. Treatment of bacterial vaginosis during pregnancy improves symptoms but does not reduce the risk of preterm birth. In nonpregnant women, oral and vaginal treatment options for uncomplicated vulvovaginal candidiasis have similar clinical cure rates.
What medical therapy is indicated for stable coronary artery disease?
High-intensity statin therapy is recommended for all patients younger than 75 years with stable coronary artery disease (CAD), unless contraindicated. Daily low-dose aspirin is recommended for all patients with stable CAD, unless contraindicated. Beta blockers should be continued for up to three years after myocardial infarction in patients with abnormal left ventricular function.
How should hypertension be screened and managed in children and adolescents?
According to the American Academy of Pediatrics, blood pressure (BP) should be measured yearly in patients three years and older. It should be measured at every visit for patients who are obese; have renal disease, diabetes mellitus, or a history of aortic obstruction or coarctation; or are taking medications associated with elevated BP. Ambulatory BP monitoring should be performed in the setting of suspected white coat hypertension, elevated category of blood pressure for at least one year, or with stage 1 hypertension at three separate office visits. The goal of treatment in children should be to reduce systolic and diastolic BP to less than the 90th percentile and less than 130/80 mm Hg in those 13 years and older.
Do written action plans for self-management of COPD reduce the severity of acute exacerbations?
Written self-management plans, especially those that include guidance on smoking cessation, increase health-related quality of life in patients with chronic obstructive pulmonary disease (COPD). They also decrease the need for respiratory-related hospital admissions among patients with high or low baseline risk.
Do patients with Alzheimer disease who are treated with short-term antipsychotics have a higher mortality rate than those not taking antipsychotics?
Physicians should consider not using antipsychotics in patients with dementia. Patients with dementia, including Alzheimer disease, who are treated with antipsychotics for any length of time have a higher mortality rate than those not taking antipsychotics.
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