• Articles

    Recent-Onset Altered Mental Status: Evaluation and Management

    Brian Veauthier, Jaime R. Hornecker, Tabitha Thrasher

    Potential precipitating factors for the recent onset of altered mental status can be multifactorial and include central nervous system insults, systemic infections, metabolic disturbances, toxin exposure, medications, chronic systemic diseases, and psychiatric conditions....

    Vocal Cord Dysfunction: Rapid Evidence Review

    John Malaty, Velyn Wu

    Vocal cord dysfunction can be severe and impair breathing or, more commonly, less severe and impact the patient's voice. Nasolaryngoscopy and pulmonary function testing can help in the diagnosis. Management includes treatment of triggers and referral for therapeutic breathing...

    Medical Clearance for Common Dental Procedures

    Kevin R. Herrick, Jennifer M. Terrio, Crispin Herrick

    Integrating patients' medical and dental health care is important because there are correlations between periodontal disease and some medical conditions. Medical consultations before dental procedures present opportunities to integrate cross-disciplinary preventive care and...

    Fetal Growth Restriction Before and After Birth

    Andrea Westby, Laura Miller

    Fetal growth restriction, formerly known as intrauterine growth restriction, is a condition in which estimated fetal weight is below the 10th percentile for gestational age. Early detection and management are essential. All pregnant patients should be screened for fetal...

    End-Stage Renal Disease: Medical Management

    NOAH WOUK

    End-stage renal disease is diagnosed when kidney function is no longer adequate for long-term survival without kidney transplantation or dialysis. This article provides an overview of the medical management of end-stage renal disease, as well as its comorbidities and...

    Breast Implants: Common Questions and Answers

    Sarina Schrager, Sarah M. Lyon, Samuel O. Poore

    Breast implants are used for a range of cosmetic and reconstructive purposes. Several factors are important to consider preoperatively, including the impact on mammography, future lactation, and potential long-term implant complications.

    AFP Photo Contest Winners!

    Sumi Sexton, Matthew Neff

    This summer we held the first American Family Physician photo competition, which was intended to encourage students and residents to share their stories through photographs about how they use the AFP journal.

    Editorials

    Asthma Management Guidelines: Focused Updates for 2020

    Kurtis S. Elward

    The 2020 Focused Updates to the asthma management guidelines represent the first revision of the National Asthma Education and Prevention Program guidelines in more than 10 years. The report differs from the Global Initiative for Asthma recommendations because of the focused...

    Translating the 2020–2025 U.S. Dietary Guidelines into Clinical Practice

    Amy B. Locke, Rachel Goossen

    The answer to the simple question “What should we eat?” is remarkably contentious and fraught with strongly held personal beliefs and preferences, as well as substantial financial and disease implications. It is a question that patients and families often ask their physicians...

    AFP Clinical Answers

    Nerve Injury, Survivors of Sexual Assault, Obstructive Sleep Apnea, Bipolar Disorder, Meningitis

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

    Cochrane for Clinicians

    Coenzyme Q10 for Heart Failure

    Carlton Covey

    In patients with chronic heart failure, supplementation with coenzyme Q10 may reduce all-cause mortality. Adverse effects are generally mild and may be only slightly increased with coenzyme Q10 supplementation.

    Basal Cell Carcinoma: Comparison of Surgical and Nonsurgical Interventions

    Ray Antonelli, Scott Plensdorf

    The recurrence rate after surgical management of BCC by standard surgical excision or Mohs micrographic surgery is very low. Recurrence after management with imiquimod (Aldara) is also low and may result in more favorable cosmetic outcomes. Other nonsurgical options may have...

    Implementing AHRQ Effective Health Care Reviews

    Acute Treatments for Episodic Migraine in Adults

    Tyler Barreto

    How effective are pharmacologic and nonpharmacologic acute treatments for episodic migraine in adults?

    FPIN's Clinical Inquiries

    Should Allele Testing Be Done Before Prescribing Allopurinol to Prevent Severe Cutaneous Adverse Reactions?

    Elizabeth Close, Andrew Keyes, Jonathan Burden, Corey Bray, Alyssa Migdalski

    Moderate evidence supports allele testing for HLA-B*58:01 before initiating allopurinol to decrease the incidence of SCARs in higher risk populations. Patient populations who are not at increased risk should not be screened.

    Putting Prevention Into Practice

    Screening for Vitamin D Deficiency in Adults

    Howard Tracer, Robert West

    A 49-year-old Black man with a history of hypertension, type 2 diabetes mellitus, and class I obesity (body mass index of 31.4 kg per m2) presents for a wellness examination. The patient's hypertension and diabetes are well controlled with lisinopril and metformin; they do...

    Diagnostic Tests

    Aptima Assay for Detection of Mycoplasma genitalium Infection

    Karl T. Clebak, Jarrett K. Sell, Ashley Koontz

    The Aptima M. genitalium assay is highly sensitive and specific. The Centers for Disease Control and Prevention recommends the use of NAAT testing for M. genitalium infection in men with recurrent nongonococcal urethritis, in women with recurrent cervicitis, and possibly in...

    STEPS

    Tirbanibulin (Klisyri) for the Treatment of Actinic Keratosis

    Kamini Geer

    The cost and effectiveness profile of tirbanibulin make it a last-line option compared with current first-line therapies such as fluorouracil and imiquimod, which are less expensive and have a higher clearance rate of AK lesions. Further trials comparing the effectiveness of...

    Photo Quiz

    Firm Nodule on the Ear

    Matthew Helm, Brandon Ng, Anne Mogavero

    A patient presented with a crusted papule on the antihelix of the ear that had grown slowly over several years.

    Facial Rash in a Newborn

    Nicole T. Yedlinsky, David Embers

    An infant is born with a yellowish linear plaque on the cheek.

    Curbside Consultation

    Climate Change and the Local Environment: Communicating with Your Patients about Health Impacts

    Caroline E. Wellbery, Andrew Lewandowski, Cheryl Holder

    This case provides an example of how climate change and the environment can have significant impacts on the health of our patients. It also illustrates the complex interaction of local, regional, and global environmental harms. The wide scope of environmental threats to human...

    Practice Guidelines

    Asthma Management: Updated Guidelines from the National Heart, Lung, and Blood Institute

    Tyler J. Raymond, Nick F. Bennett, Maria I. Rodionova

    The National Heart, Lung, and Blood Institute (NHLBI) published asthma management guidelines in 1991 and 2007. In 2020, the NHLBI released an update focusing on six priority topics.

    Dietary Guidelines for Americans 2020–2025: Recommendations from the U.S. Departments of Agriculture and Health and Human Services

    Michael J. Arnold, Michael C. Harding, Anna T. Conley

    Key Points for Practice

    Medicine by the Numbers

    Nonsteroidal Anti-Inflammatory Drug Injections for Trigger Finger

    Kara Zerbini, Alexander Knobloch

    Learn more about nonsteroidal anti-inflammatory drug injections for trigger finger.

    POEMs

    Five Days of Antibiotic Therapy Is Comparable with 10 Days in Children with Community-Acquired Pneumonia

    Henry C. Barry

    In a limited study, children with community-acquired pneumonia who were treated with five days of high-dose amoxicillin had cure rates comparable with those who were treated for 10 days.

    Antibiotic Therapy Does Not Prevent Death or Acute Exacerbations in Adults with Idiopathic Pulmonary Fibrosis

    David C. Slawson

    The study found an increased number of adverse events without any significant benefit from antimicrobial therapy compared with usual care alone for adults with IPF. The study was terminated earlier than planned because of futility and the possibility of significantly...

    Dual Antiplatelet Therapy Is Superior to Aspirin in Preventing Short-Term Recurrent Stroke at the Cost of More Major Bleeding

    Henry C. Barry

    If the authors have found all the relevant studies, administering dual antiplatelet therapy within 24 hours of a mild to moderate stroke or TIA is more effective than aspirin at decreasing recurrent stroke over the subsequent 90 days. There is a low overall risk of major...

    Anticonvulsants, SNRIs, and Rubefacients Are Best Initial Choices for Chronic Pain Caused by Diabetic Neuropathy or Postherpetic Neuralgia

    Mark H. Ebell

    Given the balance of benefits and harms, there is moderately good evidence for anticonvulsants (pregabalin [Lyrica] and gabapentin [Neurontin] were similarly effective and well tolerated) and serotonin-norepinephrine reuptake inhibitors (SNRIs; with duloxetine [Cymbalta] and...

    Letters to the Editor

    In-flight Medical Emergencies and Medical Legal Issues

    Information from Your Family Doctor

    Vocal Cord Dysfunction

    It is when your vocal cords partly close while you are breathing. This may cause sudden, severe shortness of breath, tightness in your throat, or trouble speaking. Vocal cord dysfunction can sometimes be mistaken for asthma.

    Breast Implants

    Breast implants are fluid- or gel-filled devices that are put into your chest to change the shape or size of your breast. Most breast implants are used after breast cancer surgery (mastectomy) or when women want to increase their breast size (augmentation).

    Corrections

    Corrections

    Incorrect measurement. In the article “Management of Infants Born to Mothers with HIV Infection,” (July 2021, p. 58) the HIV RNA load threshold for recommending a cesarean delivery was incorrect in the second sentence of the Perinatal Transmission section on page 58. The...

    Corrections

    Missing reference. In the article “Out-of-Hospital Birth,” (June 1, 2021, p. 672) the citation for reference 60 was inadvertently omitted (page 679). The citation should have read: “Ecker J, Minkoff H. Home birth: what are physicians' ethical obligations when patient choices...



    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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