April 2022

Patients with oral disease may present to their family physician before a dentist. Some lesions are purely localized to the mouth, and others have systemic manifestations. Common conditions include aphthous stomatitis, candidiasis, herpetic stomatitis, leukoplakia…

This article will help physicians assess risks and benefits of prolonged anticoagulation treatment and address considerations in specific populations to reduce the risk of recurrent venous thromboembolism.

Screening for chlamydial and gonococcal infections is key to preventing transmission because most infections are asymptomatic. This article discusses which populations should be screened and how often, diagnostic testing and treatment options, and follow-up care.

The Institute of Medicine estimates that 50 million to 70 million adults in the United States report chronically disturbed sleep. Sleep disturbances have been associated with motor vehicle collisions, hypertension, decreased quality of life, and increased all-cause mortality.

This rapid evidence review summarizes risk factors, symptoms, and testing for ulcerative colitis. Treatment depends on severity and can include pharmacologic, surgical, complementary, and behavioral interventions. Preventive care considerations and recommendations for patients…

The diagnosis of alcoholic hepatitis is primarily clinical, including acute-onset jaundice, specific laboratory abnormalities, and a history of long-term heavy alcohol use. Treatment consists of abstaining from alcohol, optimizing nutrition, managing comorbid conditions, and…

Clinical practice guidelines, essential tools for evidence-based practice, have proliferated over the past few decades but remain controversial for several reasons.

Guidance to clinicians about how to approach use of the Alzheimer treatment aducanumab (Aduhelm) and other newly approved medications.

The COVID-19 pandemic has underscored the need for a more effective and equitable health care system in the United States. County-level variations in COVID-19 positivity rates, hospitalizations, and number of deaths demonstrate that community-level factors are essential to the…

Key clinical questions and their evidence-based answers directly from the journal’s content, written by and for family physicians.

Cilostazol improves initial and absolute walking distances in patients with intermittent claudication secondary to PAD and appears to be equivalent in effect to pentoxifylline (Trental). Adverse effects of cilostazol include headache, diarrhea, dizziness, and palpitations.

Clinical resolution of symptoms is similar for oral and intravaginal antifungal medications at both short-term (five to 15 days) and long-term (two to 12 weeks) follow-up. However, mycological cure rates (fungal spores cleared from vaginal secretions) are higher in patients…

First-person accounts from the front lines of family medicine.

An 11-month-old girl presented with a fever and right neck mass a week after being diagnosed with hand-foot-and-mouth disease.

A 65-year-old man presented with an erythematous mass on his thumb that had been slowing enlarging for the past 10 years.

Patient education interventions, specifically those including face-to-face interactions with trained educators or nurses, improve A1C values in patients by 0.3% to 1.4% compared with usual diabetes care.

Both SSRIs and SNRIs are effective at relieving vasomotor symptoms of menopause. No studies have directly compared the two classes of medication. SNRIs are associated with more adverse effects. Venlafaxine is preferred in women with breast cancer because SSRIs may interfere…

The Global Down Syndrome Foundation (GLOBAL) has published the first medical care guidelines for adults with Down syndrome.

The American Diabetes Association (ADA) has released updated guidelines for the prevention or delay of diabetes.

The USPSTF recommends the use of low-dose aspirin (81 mg/day) as preventive medication after 12 weeks of gestation in persons who are at high risk for preeclampsia.

In patients who have heart failure with preserved ejection fraction, empagliflozin, 10 mg once daily, reduces the likelihood of hospitalization for heart failure. There is no effect on cardiovascular or all-cause mortality.

Midodrine is a vasoconstrictor used to prevent orthostatic hypotension and may reduce the likelihood of recurrence of vasovagal syncope in patients with frequent episodes. It seems to work completely or not at all; during this study, the patients who had at least one episode of…

This study found no evidence that supports a benefit of platelet-rich plasma injections compared with saline placebo injections for improving function or reducing pain in adults with symptomatic ankle osteoarthritis.

Primary care patients who discontinued antidepressant medications were more likely to experience relapse of their depression than those who continued to take their antidepressants. The interpretation is that 44% of patients with depression who discontinue their antidepressant…

Learn more about splint vs. cast for forearm buckle fracture in children.

Letter

Chlamydia (kluh-MID-ee-uh) is the most common sexually transmitted infection, or STI. It can affect the penis, vagina, or rectal area.

Gonorrhea (gon-or-REE-uh) is a sexually transmitted infection, or STI. It can affect the penis, vagina, throat, or rectal area. Rarely, if it is not treated, it can spread to other places like the blood, joints, skin, heart, and brain.