• Articles

    Unintentional Weight Loss in Older Adults

    Heidi L. Gaddey, Kathryn K. Holder

    Unintentional weight loss in people older than 65 years is associated with increased morbidity and mortality. Treatment should focus on feeding assistance, addressing contributing medications, providing appealing foods, and social support.

    Top 20 Research Studies of 2020 for Primary Care Physicians

    Roland Grad, Mark H. Ebell

    The annual installment of this series summarizes the top studies of 2020. These studies were summarized as POEMs (patient-oriented evidence that matters) and were highly rated by Canadian Medical Association members for their clinical relevance. This group of the highest...

    Complex Regional Pain Syndrome

    Emillia C. O. Lloyd, Bradley Dempsey, Lindsey Romero

    Complex regional pain syndrome is a rare, chronic disorder that leads to pain that may last for years. The disease typically develops four to six weeks after direct trauma, such as an injury or surgery. Diagnosis is made clinically using standardized diagnostic criteria. The...

    Management of Infants Born to Mothers with HIV Infection

    Vini Vijayan, Fouzia Naeem, Angela F. Veesenmeyer

    Strategies to prevent mother-to-child transmission include maternal and infant antiretroviral therapy and formula-feeding instead of breastfeeding. All infants born to mothers with HIV infection should receive antiretroviral postexposure prophylaxis within six to 12 hours...

    Pharmacologic Therapy for Acute Pain

    Octavia Amaechi, Miranda McCann Human, Kaleigh Featherstone

    Acetaminophen and nonsteroidal anti-inflammatory drugs are the first-line treatment options for most patients with mild to moderate acute pain. Severe acute pain may necessitate reserved short-term use of opioids with attention to minimizing risk.

    Costochondritis: Rapid Evidence Review

    Timothy Mott, Gregory Jones, Kimberly Roman

    Costochondritis is a common cause of chest pain. The diagnosis is largely based on history and a physical examination that demonstrates reproduction of pain through palpation of the parasternal region of the chest wall, performance of a crowing rooster maneuver, and/or a...

    Editorials

    Prioritizing Primary Care Can Save the U.S. Health Care System

    Ada D. Stewart

    Can prioritizing primary care save the U.S. health care system?

    Pharmacogenetic Gene-Drug Associations: FDA Perspective on What Physicians Need to Know

    Wendy S. Rubinstein, Michael Pacanowski

    To share its perspective on the state of the science, the FDA has published a table of pharmacogenetic associations related to genetic variants that can affect drug concentrations, therapeutic responses, or adverse events.

    AFP Clinical Answers

    Heavy Menstrual Bleeding, Acute Pyelonephritis, Bacteriuria, IgA Vasculitis, Febrile UTIs

    Key clinical questions and their evidence-based answers directly from the journal’s content, written by and for family physicians.

    Medicine by the Numbers

    Levonorgestrel-Releasing Intrauterine System for Regression of Endometrial Hyperplasia

    Sabrina Silver, James J. Arnold

    A Cochrane review compared the levonorgestrel-releasing intrauterine system with progesterone for the treatment of endometrial hyperplasia.

    Cochrane for Clinicians

    Acromioclavicular Joint Dislocation: Surgical vs. Conservative Interventions

    Joseph R. Yancey, Michelle Szczepanik

    Surgical treatment for AC joint dislocation of the shoulder does not appear to be superior to conservative management in adults. Surgical therapy increases the risk of hardware complications, infection, and continued discomfort.

    Rapid Point-of-Care Antigen and Molecular Tests for Diagnosis of SARS-CoV-2 Infection

    Sean Simmons, Aaron Saguil

    SARS-CoV-2 antigen tests have an average sensitivity of 68.9% and an average specificity of 99.6%. Accuracy depends on symptom status, time from symptom onset, and test brand.

    Putting Prevention Into Practice

    Screening for Lung Cancer

    Howard Tracer, James Pierre

    S.J., a 68-year-old Black man, comes to your office to establish care after recently moving to the area. S.J. has a history of allergic rhinitis, osteoarthritis, and gastroesophageal reflux disease. Additionally, he has a 39-pack-year history of smoking but quit six years ago.

    Photo Quiz

    Skin Inflammation After Immunization

    Michael Grover

    A patient develops erythema and warmth on the arm two weeks after receiving the first dose of the mRNA-1273 vaccine against the SARS-CoV-2 virus.

    Nontender Rash on the Soles of the Feet in a Febrile Adult

    Samuel Tiglao, Nickolas Hadley, Christopher Hodge

    A patient with multiple medical conditions presented with nonpurulent cellulitis and MRSA bacteremia.

    Curbside Consultation

    Addressing Loneliness and Social Isolation in Older Adults

    Rita M. Lahlou, Timothy P. Daaleman

    Social isolation and loneliness are increasingly recognized as complex clinical and public health problems, particularly in older adults, leading to adverse mental and physical health outcomes. The COVID-19 pandemic has led to physical distancing policies, which have...

    Diagnostic Tests

    GeneSight Psychotropic Genetic Testing for Psychiatric Medication Selection

    Natasha Pyzocha

    The GeneSight test may assist in drug selection and dosing for individuals having difficulty finding an effective option or who have had intolerable adverse effects after trials of several drugs. However, because only a small population of patients are expected to have...

    FPIN's Clinical Inquiries

    Pharmacologic Management of Agitation in Patients with Dementia

    Aaron Gale, Kirsten Stoesser, Katherine Fortenberry, Dominik Ose, Alyssa Migdalski

    Selective serotonin reuptake inhibitors and risperidone are moderately effective at decreasing agitation in all types of dementia. Olanzapine and risperidone reduce dementia-related agitation much longer than placebo. Dextromethorphan/quinidine may be effective at reducing...

    STEPS

    Clascoterone (Winlevi) for the Treatment of Acne

    Chelsea Harris

    More comparative data are needed to justify the use of clascoterone over less expensive, currently available therapies for moderate to severe acne. However, systemic absorption of clascoterone is low, and it may serve as a safe alternative for patients 12 years and older who...

    POEMs

    Low-Carb Diets May Produce Short-Term Diabetes Remission

    Allen F. Shaughnessy

    Patients with type 2 diabetes can try cutting out bread and pasta, leaving the skin on chicken, or eating nuts and avocados to lower their blood glucose levels. Six months of a low-carbohydrate diet (less than 26% of calories from carbohydrates) was more likely than other...

    Single-Dose Opioid Analgesics Offer No Benefit over Nonopioid Analgesia for Musculoskeletal Pain

    Allen F. Shaughnessy

    A single dose of opioid analgesics provides similar acute pain relief compared with a single dose of a combination of acetaminophen and ibuprofen in patients with acute musculoskeletal pain in the emergency department.

    Once-Weekly Semaglutide Is an Effective Adjunct for Weight Loss in Adults without Diabetes Who Are Overweight or Obese

    David C. Slawson

    Once-weekly subcutaneous semaglutide used as an adjunct to intensive behavioral therapy significantly improves the likelihood that adults without diabetes who are overweight or obese will lose at least 5% of their baseline body weight compared with placebo.

    Cryoablation Preferred as Initial Therapy for Paroxysmal Atrial Fibrillation

    Mark H. Ebell

    Initial cryoablation for patients with paroxysmal AF is superior to initial antiarrhythmic drug therapy. Another study in the same issue of New England Journal of Medicine compared cryoablation with medical therapy and had similar findings.

    Practice Guidelines

    Treatment of Chronic Obstructive Pulmonary Disease: Guidelines from the VA/DoD

    Michael J. Arnold, Andrew Buelt

    The U.S. Department of Veterans Affairs and U.S. Department of Defense published guidelines for the primary care management of COPD.

    Treatment of Chronic Obstructive Pulmonary Disease Exacerbations: Guidelines from the American Academy of Family Physicians

    Michael J. Arnold

    The American Academy of Family Physicians has published guidelines for treating acute exacerbations of COPD based on a systematic review.

    Treatment of Chronic Obstructive Pulmonary Disease: Guidelines from the American Thoracic Society

    Michael J. Arnold

    The American Thoracic Society published guidelines for pharmacologic management of COPD and long-term oxygen therapy for COPD and interstitial lung disease based on systematic reviews.

    Pharmacologic Management of COPD Exacerbations: A Clinical Practice Guideline from the AAFP

    James J. Stevermer, Lynn Fisher, Kenneth W. Lin, Robyn Liu, Daniel Goodenberger, Kenneth Schellhase, Bill Vaughan, Melanie D. Bird

    The American Academy of Family Physicians has published guidelines for treating acute exacerbations of COPD.

    Letters to the Editor

    Mild Creatine Kinase Elevations Do Not Necessarily Reflect Rhabdomyolysis

    The Role of Weight Stigma in the Development of Eating Disorders

    Additional Differential Diagnosis for Adult Hip Pain

    Well-Woman Chart Is Useful in Guiding Preventive Care

    Information from Your Family Doctor

    Preventing HIV Infection in Your Baby

    HIV is the virus that causes AIDS. It is possible to have HIV infection for a long time before developing AIDS.



    Disclosure

    All editors in a position to control content for this activity, AFP journal, are required to disclose any relevant financial relationships. View disclosures.


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