AFP's Top 20 Articles of 2018

Did you miss any AFP articles published last year? Read the ones that were most popular with AFP readers, according to page views on the website, in 2018. The following 20 articles are in order of most views.

Type 2 Diabetes Mellitus: Outpatient Insulin Management

Amanda Howard-Thompson, Muneeza Khan, Morgan Jones, and Chritsa M. George
In patients with type 2 diabetes mellitus, insulin may be used to augment therapy with oral glycemic medications or as insulin replacement therapy. Insulin regimens should be adjusted every three or four days until self-monitoring of blood glucose targets are reached. Goals should be individualized.
January 1, 2018

Acute Migraine Headache: Treatment Strategies

Laura Mayans and Anne Walling
Migraine is a chronic condition characterized by recurrent attacks. Acetaminophen, nonsteroidal anti-inflammatory drugs, triptans, antiemetics, ergot alkaloids, and combination analgesics have evidence supporting their effectiveness. Learn about the three treatment strategies recommended for migraine and when to consider prophylactic therapy.
February 15, 2018

Vitamin D Screening and Supplementation in Community-Dwelling Adults: Common Questions and Answers

Michael L. LeFevre and Nicholas M. LeFevre
Measuring vitamin D levels and prescribing oral vitamin D supplementation is common in clinical practice, although the health benefits have not been established. Clinical trials have not found vitamin D to be beneficial for chronic nonskeletal conditions, and screening and supplementation are not recommended in asymptomatic individuals.
February 15, 2018

Knee Pain in Adults and Adolescents: The Initial Evaluation

Christopher W. Bunt, Christopher E. Jones, and Jennifer G. Chang
Knee pain affects nearly 25% of adults. This article reviews the initial primary care office evaluation of knee pain and describes systematic approaches to evaluation. It also defines instances in which radiographic imaging, musculoskeletal ultrasound, magnetic resonance imaging, and laboratory tests should be performed.
November 1, 2018

Mechanical Low Back Pain

Joshua Scott Will, David C. Bury, and John A. Miller
Repetitive trauma and overuse are common causes of chronic mechanical low back pain. The history and physical examination can point toward a specific etiology, and imaging should generally be used only in the presence of red flags. Evidence-based therapies include nonsteroidal anti-inflammatory drugs, topiramate, and physical therapy.
October 1, 2018

Hemorrhoids: Diagnosis and Treatment Options

Timothy Mott, Kelly Latimer, and Chad Edwards
Treatment of hemorrhoids begins with conservative therapies, such as a high-fiber diet, increased water intake, warm water baths, fiber supplementation, stool softeners, and topical preparations. If these are unsuccessful, office-based and surgical procedures are warranted. Office-based procedures are generally more effective for lower-grade hemorrhoids.
February 1, 2018

Heel Pain: Diagnosis and Management

Priscilla Tu
The differential diagnosis of heel pain is extensive, but a mechanical etiology is the most common. Learn the most likely causes of heel pain based on the specific anatomic location affected.
January 15, 2018

Diets for Health: Goals and Guidelines

Amy Locke, Jill Schneiderhan, and Suzanna M. Zick
Patients and physicians often have difficulty staying abreast of diet trends, many of which focus primarily on weight loss rather than nutrition and health. Find out which dietary approaches have proven benefits for cardiovascular disease, cancer, type 2 diabetes mellitus, and obesity.
June 1, 2018

Well-Child Visits for Infants and Young Children

Katherine Turner
Well-child visits involve comprehensive assessment of a child. Complete history, head-to-toe examination, review of immunizations, and screening for postpartum depression in mothers of infants are performed. The physician answers questions and provides age-appropriate guidance.
September 15, 2018

Ear Pain: Diagnosing Common and Uncommon Causes

John Scott Earwood, Tyler Sherrod Rogers, and Nicholas Alan Rathjen
When patients present with otalgia, the first step is to determine whether the pain is originating from inside or outside the ear. Review the history and physical examination findings that can help identify the diagnosis, as well as the risk factors that may indicate a more serious condition.
January 1, 2018

Vaginitis: Diagnosis and Treatment

Heather L. Paladine and Urmi A. Desai
Review the diagnosis and treatment strategies for the three main causes of vaginitis: bacterial vaginosis, vulvovaginal candidiasis, and trichomoniasis. Treatment during pregnancy and treatment of recurrent episodes are also discussed.
March 1, 2018

The Adult Well-Male Examination

Joel J. Heidelbaugh
The goal of the adult well male examination is to promote optimal health and well-being, prevent premature morbidity and mortality from chronic diseases, and provide appropriate cancer screening and immunizations. This article summarizes evidence-based guidelines for counseling and screening in men.
December 15, 2018

Geriatric Assessment: An Office-Based Approach

Paul E. Tatum III, Shaida Talebreza, and Jeanette S. Ross
The goal of the geriatric assessment is to evaluate factors that influence patients’ overall well-being and to identify problems that impair quality of life. Typical domains to assess include functional status, fall risk, medications, nutrition, vision, hearing, cognition, mood, and toileting. Medicare’s Annual Wellness Visit provides an opportunity to address these elements in a single office visit.
June 15, 2018

Common Running Injuries: Evaluation and Management

Michael J. Arnold and Aaron L. Moody
Most running injuries are due to overuse and typically respond to conservative treatment. Learn which tests can help diagnose patellar tendinopathy, patellofemoral pain syndrome, iliotibial band syndrome, Achilles tendinopathy, plantar fasciopathy, and tibial and hamstring injuries, and the recommended treatments for each condition.
April 15, 2018

Rheumatologic Tests: A Primer for Family Physicians

Yousaf Ali
Patients with a suspected connective tissue disorder should undergo serologic testing to confirm the diagnosis and in some cases, to monitor disease activity and predict flares. However, many serologic tests are nonspecific, and further testing may be necessary. Physicians should order these tests only when patients have a high pretest probability of a specific connective tissue disorder.
August 1, 2018

Stable Coronary Artery Disease: Treatment

Michael M. Braun, William A. Stevens, and Craig H. Barstow
Treatment of stable coronary artery disease involves risk factor management, antiplatelet therapy, and antianginal medications. Treatment of comorbidities should be optimized to reduce cardiovascular risk. This article includes a management algorithm and a stepwise approach for antiplatelet therapy.
March 15, 2018

Acute Appendicitis: Efficient Diagnosis and Management

Matthew J. Snyder, Marjorie Guthrie, and Stephen Cagle
Appendicitis is one of the most common causes of acute abdominal pain in adults and children. Find out which clinical decision rules are most useful in specific patient populations, when to use ultrasonography vs. computed tomography or magnetic resonance imaging, and which patients may be safely treated with antibiotics only.
July 1, 2018

Caring for Transgender and Gender-Diverse Persons: What Clinicians Should Know

David A. Klein, Scott L. Paradise, and Emily T. Goodwin
Transgender persons often face substantial health care disparities and barriers to care. Find out how to establish a safe and welcoming environment for these patients, and get the information you need to decide whether to take an active role in their care by evaluating for gender dysphoria and managing hormone therapy, or an adjunctive role by monitoring well-being and providing referrals.
December 1, 2018

Top 20 Research Studies of 2017 for Primary Care Physicians

Mark H. Ebell and Roland Grad
The latest installment of the top 20 research studies for primary care physicians includes studies on cardiovascular disease and hypertension, infections, diabetes mellitus, musculoskeletal problems, and cancer screening, among other topics. The five highest-rated practice guidelines are also summarized.
May 1, 2018

Evaluation of Suspected Dementia

Nathan Falk, Ariel Cole and T. Jason Meredith
Patients with suspected dementia can be screened in the primary care office setting with a brief screening tool. A positive screening result warrants more in-depth screening tests. Evaluation for depression, laboratory studies for possible medical conditions that affect memory, and magnetic resonance imaging of the brain should be performed if cognitive impairment is confirmed.
March 15, 2018