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Am Fam Physician. 2023;107(3):230

What vaccination is recommended to prevent pneumococcal infection in people 65 years and older?

Adults 65 years and older who have not previously received a pneumococcal conjugate vaccine (PCV) should receive one dose of PCV15 (Vaxneuvance) or PCV20 (Prevnar 20). If PCV15 is administered, it should be followed by a dose of 23-valent pneumococcal polysaccharide vaccine (PPSV23; Pneumovax 23) after one year; however, the interval can be shortened to eight weeks for people with immunocompromising conditions, cerebral spinal fluid leak, or cochlear implant. If PCV20 is used for the first pneumococcal immunization, a subsequent dose of PPSV23 is not indicated.

What treatment in addition to glucocorticoids may be considered in patients with polymyalgia rheumatica?

Early addition of methotrexate to glucocorticoid therapy should be considered in patients with polymyalgia rheumatica who are at high risk of relapse (e.g., those with high baseline erythrocyte sedimentation rate), glucocorticoid-related adverse effects, or comorbidities that are likely to be exacerbated by glucocorticoids (e.g., diabetes mellitus, osteoporosis).

What additional imaging should be performed in patients with newly diagnosed giant cell arteritis?

In patients with newly diagnosed giant cell arteritis, noninvasive vascular imaging (i.e., magnetic resonance imaging or computed tomography angiography) of the neck, chest, abdomen, and pelvis should be performed to evaluate for large vessel involvement. Patients who have hypertension when giant cell arteritis is diagnosed are at higher risk of thoracic or aortic aneurysm and should be evaluated for large vessel involvement with angiography or ultrasonography.

Does early aerobic exercise following concussion improve or impair recovery in adolescent patients?

Early aerobic exercise for symptoms of concussion more than 72 hours after injury may decrease symptom severity and frequency and time to recovery from the day of injury.

What is the preferred treatment for malaria?

The World Health Organization recommends treating uncomplicated cases of malaria with artemisinin combination therapy (e.g. artemether/lumefantrine [Coartem]), except in the first trimester of pregnancy, regardless of the geographic region of infection. Artemisinin combination therapies are well tolerated and highly effective against all Plasmodium species.

Additional Online Only AFP Clinical Answers

What validated nutrition questionnaire can help obtain a nutrition history and identify patients who would benefit from a referral or a brief intervention?

The Rapid Eating Assessment for Participants–Shortened Version, v.2 can be used to assess nutrient intake in ambulatory patients with omnivorous, vegetarian, and vegan diet patterns.

What interventions are recommended to assist in smoking cessation?

All nonpregnant adults who smoke cigarettes should be offered pharmacotherapy and behavior interventions to help with cessation attempts. Behavior interventions combined with pharmacotherapy improve smoking cessation rates.

What strategies should be recommended to patients with fatigue after the acute phase of COVID-19?

An individualized, structured, symptom-guided, phased return to activity program is recommended for patients with fatigue or postexertional malaise. Energy conservation strategies such as the four P’s framework (pacing, prioritizing, positioning, and planning) and the stop, rest, pace strategy, and avoiding relapsing triggers are recommended to help patients with fatigue related to COVID-19.

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