AFP DEPARTMENT COLLECTION
These guides offer evidence-based tools to assist family physicians in improving their decision-making at the point of care.
Aug 15, 2018 Issue
Identifying Patients with Headache Who Are at Risk of Subarachnoid Hemorrhage
When is urgent imaging warranted in patients presenting with sudden, severe, nontraumatic headache and normal findings on a neurologic examination?
Jun 15, 2018 Issue
Identifying Patients with Newly Diagnosed Acute Pulmonary Embolism Who Are at Low Risk of Death
Standard management of acute PE includes five days of inpatient treatment with parenteral anticoagulation, followed by long-term oral anticoagulation as an outpatient. However, guidelines from the American College of Chest Physicians state that early discharge before five days can be considered in some low-risk patients who have adequate home circumstances.
Jun 1, 2018 Issue
Ruling Out Pulmonary Embolism in the Primary Care Setting
What is the best approach to evaluate patients with suspected pulmonary embolism in the outpatient, primary care setting?
Feb 15, 2018 Issue
Diagnosis of Urinary Tract Infections in Children
A recent observational study found that 2.2% of acutely ill children younger than five years met criteria for a UTI when their urine was cultured. However, in the same study, overall clinician impression that a UTI was present (fairly to very certain) identified only 28 out of 60 children with a microbiologically confirmed UTI.
Jan 1, 2018 Issue
Young Febrile Infants: Step-by-Step Evaluation
A fever without an obvious source in an infant younger than three months is highly concerning. Although some infants have a potentially life-threatening invasive bacterial infection, such as meningitis, bacteremia, or sepsis, most have less serious conditions, such as a viral syndrome.
Oct 1, 2017 Issue
Assessing Bleeding Risk in Patients Taking Anticoagulants
Family physicians are often faced with the dilemma of balancing the benefit of stroke prevention with the risk of major bleeding when deciding on anticoagulation treatment in patients with atrial fibrillation. Over the past 10 years, several decision support tools have been developed and validated to assess the risk of major bleeding in patients taking anticoagulants.
Jun 15, 2017 Issue
Nonalcoholic Fatty Liver Disease: Identifying Patients at Risk of Inflammation or Fibrosis
NAFLD is defined as hepatic steatosis on imaging or histology in the absence of other etiologies for secondary fat accumulation. It is usually identified during the evaluation of elevated transaminase levels in a patient without heavy alcohol intake, or found incidentally on imaging studies.
May 1, 2017 Issue
Estimating Cardiovascular Risk
The primary prevention of cardiovascular disease (CVD) depends on accurate estimation of cardiovascular risk. However, a recent systematic review identified 363 prediction models.
Dec 15, 2016 Issue
Prognosis Following Mild Head Injury in Children
Concussion, also referred to as mild traumatic brain injury, is a common injury in children. It is defined as a transient disturbance in mental status following head trauma, and it can cause a variety of physical, cognitive, and emotional sequelae. Symptoms continuing for more than 28 days after the initial trauma are referred to as persistent postconcussion symptoms and affect approximately one-third of children with concussion.
Sep 15, 2016 Issue
Clinical Diagnosis of Gout Without Joint Aspirate
Gout is ideally diagnosed through identification of characteristic negatively birefringent crystals under polarized light microscopy in fluid aspirated from end-organ deposits, typically from a joint. However, fewer than 10% of patients with gout see a rheumatologist, and most cases of gout are diagnosed in the primary care setting based on signs, symptoms, and serum uric acid level. But how accurate is a clinical diagnosis, and can it be done better?