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Am Fam Physician. 2018;98(7):412

AAFP Adds Five New Choosing Wisely Recommendations

The American Academy of Family Physicians (AAFP) has added five recommendations to its Choosing Wisely list: (1) do not perform pelvic examinations in asymptomatic nonpregnant women unless necessary for guideline-appropriate screening for cervical cancer; (2) do not routinely recommend daily home glucose monitoring for patients who have type 2 diabetes mellitus and are not using insulin; (3) do not screen for genital herpes simplex virus infection in asymptomatic adults, including pregnant women; (4) do not screen for testicular cancer in asymptomatic adolescent and adult males; and (5) do not transfuse more than the minimum red blood cell units necessary to relieve symptoms of anemia or to return a patient to a safe hemoglobin range. A 2015 Family Practice Management article titled “How to Help Your Patients Choose Wisely” provides an overview of tactics that can help family physicians implement Choosing Wisely recommendations, and American Family Physician provides a searchable database of recommendations from the campaign at For more information, go to

Study Shows Value of Varied Communication Styles Between Physicians, Nurses

Authors of a study published in BMJ Quality & Safety, titled “Formative Evaluation of the Video Reflexive Ethnography (VRE) Method, as Applied to the Physician-Nurse Dyad,” recorded communication between physicians and nurses during patient care rounds. Physician and nurse participants then reviewed the footage separately and together, and were interviewed about their reactions. The authors concluded that showing medical professionals their varied communication styles could have value in hospitals and practices, with specific implications for actions such as end-of-shift handovers and infection control practices. “VRE brings into the foreground clinicians' expertise and abilities to assess their own (and their colleagues') behaviors, uncovering ‘the actual and potential richness hidden in everyday activity and front-line staff relationships,’” the authors wrote. “As a result, when researchers use VRE, answers to questions of how and why specific events occur align more closely with the reality of everyday practice, promoting better understanding of the phenomenon under investigation so that interventions can be more effective.” For more information, go to

Analysis Shows Record High Number of New Diagnoses for Three STIs

Nearly 2.3 million cases of chlamydia, gonorrhea, and syphilis were diagnosed in the United States in 2017, according to preliminary data released by the Centers for Disease Control and Prevention, marking the fourth consecutive year of increases in these sexually transmitted infections (STIs). The analysis of STI cases reported for 2013 and preliminary data for 2017 shows that gonorrhea diagnoses increased 67% overall and nearly doubled among men; primary and secondary syphilis diagnoses increased 76%; and chlamydia remained the most common condition, with more than 1.7 million cases diagnosed in 2017. A renewed commitment from health care professionals, who are encouraged to make STI screening and timely treatment a standard part of medical care, is an important component to reverse current trends. For more information, go to

Meta-Analysis Shows Obesity at Young Age Increases Cancer Risk Later

Results of a recent systematic review and meta-analysis published in Obesity Reviews provide evidence that persons 30 years or younger who are obese are at increased risk of developing various types of cancer later in life, including diffuse large B-cell lymphoma, esophageal adenocarcinoma, gastric cardia cancer, hepatocellular carcinoma, multiple myeloma, pancreatic cancer, renal cell cancer, and thyroid cancer. Overall incerases in cancer risk ranged from 12% for thyroid cancer to 88% for esophageal adenocarcinoma. The authors stated that it was difficult to determine exactly when obesity early in life is most likely to increase the development of cancer later in life. However, they pointed to other studies showing that persons who were obese as children, teenagers, or young adults were more likely to remain obese into middle and late adulthood. The authors also noted that obesity and cancer share several contributing factors, such as poor diet and lack of physical activity, and that obesity is a risk factor for the onset of a variety of diseases that also contribute to the development of cancer. Given that evidence, the authors stressed the importance of early intervention to prevent obesity in young persons. For more information, go to


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