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Am Fam Physician. 2020;102(4):209

When should a mother receive follow-up care postpartum?

Initial follow-up should happen within three weeks after delivery, in person or by phone. Women with hypertensive disorders should have their blood pressure checked within seven days postpartum. A comprehensive visit should occur within 12 weeks postpartum and include a biopsychosocial assessment.

Which symptoms are common after hospitalization for COVID-19?

In an Italian study, patients who had been hospitalized for coronavirus disease 2019 (COVID-19) but then met criteria for discontinuing quarantine (afebrile for three days, symptoms improved, and two negative polymerase chain reaction tests 24 hours apart) were invited to attend a COVID-19 follow-up clinic. Of 179 eligible patients, 165 agreed to participate, but 22 had a positive polymerase chain reaction test result and were excluded. The mean age of patients was 57 years and 63% were men. Patients were a mean of 60 days past symptom onset, and 87% were still reporting symptoms, with 32% reporting one or two symptoms and 55% reporting three or more persistent symptoms.

Approximately 44% reported a clinically significant 10-point decline on a 100-point quality-of-life scale compared with their pre–COVID-19 state. The most common post–COVID-19 symptoms noted at follow-up were fatigue (53%), dyspnea (43%), joint pain (27%), chest pain (22%), cough (17%), and anosmia (16%). Strengths of the study included a standard protocol for data collection and a good response rate among invited patients. This is valuable prognostic information for patients who were sick enough to be hospitalized; longer-term follow-up in these patients and in those who were less symptomatic will be important. Comparison with patients who have survived other serious pulmonary infections such as community-acquired pneumonia and acute respiratory distress syndrome is also necessary to provide context.

What is the evidence for augmentation therapy in patients with treatment-resistant depression?

Based on randomized controlled trials, there is weak research to guide treatment decisions for patients who have not responded to two adequate courses of antidepressant treatment. One study of cognitive behavior therapy showed benefit over placebo. Aripiprazole (Abilify) had a small effect, but no other antipsychotic or lithium provided benefit over placebo.

Does vitamin D supplementation prevent cardiovascular events or cancer in patients without known vascular disease or cancer?

In the first adequately powered, randomized controlled U.S. trial, vitamin D supplementation did not prevent cardiovascular events or cancer in adults who were mostly nondiabetic (men 50 years and older, women 55 years and older).

Tip for Using AFP at the Point of Care

Do you need more information about COVID-19? Visit https://www.aafp.org/afp/COVID-19.html. You can also search for resources by adding “AAFP” or “AFP” with the search term “COVID” in your browser.

A collection of AFP Clinical Answers published in AFP is available at https://www.aafp.org/afp/answers.

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