AFP Clinical Answers

Venous Ulcers, Dementia Care, SARS-CoV-2 Swabs, Telehealth


Am Fam Physician. 2020 Jul 15;102(2):83.

How should venous ulcers be treated?

Compression therapy is beneficial for venous ulcer treatment and is the standard of care. Dressings are recommended to cover venous ulcers and promote moist wound healing. No one dressing type has been shown to be superior when used with appropriate compression therapy. Pentoxifylline is effective when used as monotherapy or with compression therapy for venous ulcers. Early endovenous ablation to correct superficial venous reflux improves ulcer healing rates.

How should patient care be modified after diagnosis of dementia?

If cognitive impairment or dementia is present, adequate rapport and a patient-centered discussion will reduce distress associated with a new diagnosis. The presence of dementia provides an important “pause point” to align health care delivery with the patient's goals of care, such as prompting the completion or reconsideration of these goals. Reprioritization of the patient's health care needs is important, including reduced chronic disease management and increased sensitivity to the potential of iatrogenic harm of inpatient hospitalization. Alternatives to inpatient hospitalization, such as the Hospital at Home model, provide an environment for ambulatory-sensitive conditions that can mitigate risks of delirium and other inpatient complications.

Are self-collected swabs accurate in detecting SARS-CoV-2?

Researchers in the United States identified 530 symptomatic patients seen in ambulatory clinics in the Puget Sound area of Washington. After brief training, the patients were asked to collect tongue, nasal (inserted vertically into nasal passage), and midturbinate (inserted horizontally) samples, in that order. Afterwards, trained staff collected swab samples from the nasopharynx. The authors estimated that 48 patients would need to test positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to have adequate



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