brand logo

Am Fam Physician. 2021;103(6):333

Does a lack of early symptom improvement in patients treated for depression predict treatment failure?

In patients with severe depression, judging treatment success after two weeks may not be helpful. In a large meta-analysis, an early response to treatment was a sign of long-term benefit, but a lack of early response did not predict treatment failure. Approximately one-third of patients who did not show an early response did show improvement by six weeks. No individual symptom response predicted eventual improvement.

Which patients should be immunized against human papillomavirus (HPV)?

Catch-up HPV vaccination is recommended for all people through 26 years of age, with two or three doses depending on age at initial vaccination. Shared clinical decision-making regarding vaccination for people 27 to 45 years of age is recommended.

How should primary pulmonary coccidioidomycosis (valley fever) be treated and monitored?

Antifungal agents are not recommended for the treatment of uncomplicated primary pulmonary coccidioidomycosis unless risks for disseminated disease are present. When indicated, antifungals for the treatment of primary pulmonary coccidioidomycosis include oral fluconazole (Diflucan) or itraconazole (Sporanox) for nonpregnant, nonbreastfeeding adults; oral fluconazole for breastfeeding adults; oral fluconazole for children; and intravenous amphotericin B for pregnant adults. After a diagnosis of primary pulmonary coccidioidomycosis is confirmed, complement fixation titers should be monitored and chest radiography performed every one to three months for at least one year, and any symptoms of dissemination evaluated, including fungal meningitis. Pregnant adults with a history of coccidioidomycosis should be monitored with complement fixation titers every six to 12 weeks.

When should patients with upper gastrointestinal bleeding receive urgent endoscopy?

Perform urgent endoscopy (e.g., within 24 hours of presentation) after fluid resuscitation and stabilization in patients with upper gastrointestinal bleeding and hemodynamic instability. A repeat endoscopy is recommended in persons with rebleeding.

When is neuroimaging indicated in patients with frequent headaches?

Neuroimaging is indicated in patients who have headaches with new features or neurologic deficits, trigeminal autonomic cephalalgias (e.g., cluster headache, paroxysmal hemicrania, hemicrania continua, short-lasting neuralgiform headache), or a suspected intracranial abnormality.

Tip for Using AFP at the Point of Care

Are you looking for more POEMS? You can find AFP's collection of POEMS at https://www.aafp.org/afp/poems. All department collections are accessible from the AFP home page at https://www.aafp.org/afp.

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

Already a member/subscriber?  Log In

Subscribe

From $145
  • Immediate, unlimited access to all AFP content
  • More than 130 CME credits/year
  • AAFP app access
  • Print delivery available
Subscribe

Issue Access

$59.95
  • Immediate, unlimited access to this issue's content
  • CME credits
  • AAFP app access
  • Print delivery available

Article Only

$25.95
  • Immediate, unlimited access to just this article
  • CME credits
  • AAFP app access
  • Print delivery available
Purchase Access:  Learn More

Continue Reading

More in AFP

More in Pubmed

Copyright © 2021 by the American Academy of Family Physicians.

This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP.  See permissions for copyright questions and/or permission requests.