American family physician (AM FAM PHYSICIAN)

Publications in this journal

• Article: Short course of antibiotics for acute otitis media treatment.

  Mark H Ebell
  American family physician 01/2011; 83(1):37.
• Source

  Available from: uthscsa.edu

  Article: Atrial fibrillation: diagnosis and treatment.

  Cecilia Gutierrez, Daniel G Blanchard
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  ABSTRACT: Atrial fibrillation is the most common cardiac arrhythmia. It impairs cardiac function and increases the risk of stroke. The incidence of atrial fibrillation increases with age. Key treatment issues include deciding when to restore normal sinus rhythm, when to control rate only, and how to prevent thromboembolism. Rate control is the preferred management option in most patients. Rhythm control is an option for patients in whom rate control cannot be achieved or who have persistent symptoms despite rate control. The current recommendation for strict rate control is a resting heart rate of less than 80 beats per minute. However, one study has shown that more lenient rate control of less than 110 beats per minute while at rest was not inferior to strict rate control in preventing cardiac death, heart failure, stroke, and life-threatening arrhythmias. Anticoagulation therapy is needed with rate control and rhythm control to prevent stroke. Warfarin is superior to aspirin and clopidogrel in preventing stroke despite its narrow therapeutic range and increased risk of bleeding. Tools that predict the risk of stroke (e.g., CHADS2) and the risk of bleeding (e.g., Outpatient Bleeding Risk Index) are helpful in making decisions about anticoagulation therapy. Surgical options for atrial fibrillation include disruption of abnormal conduction pathways in the atria, and obliteration of the left atrial appendage. Catheter ablation is an option for restoring normal sinus rhythm in patients with paroxysmal atrial fibrillation and normal left atrial size. Referral to a cardiologist is warranted in patients who have complex cardiac disease; who are symptomatic on or unable to tolerate pharmacologic rate control; or who may be candidates for ablation or surgical interventions.
  American family physician 01/2011; 83(1):61-8.
• Article: Stress fractures: diagnosis, treatment, and prevention.

  Deepak S Patel, Matt Roth, Neha Kapil
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  ABSTRACT: Stress fractures are common injuries in athletes and military recruits. These injuries occur more commonly in lower extremities than in upper extremities. Stress fractures should be considered in patients who present with tenderness or edema after a recent increase in activity or repeated activity with limited rest. The differential diagnosis varies based on location, but commonly includes tendinopathy, compartment syndrome, and nerve or artery entrapment syndrome. Medial tibial stress syndrome (shin splints) can be distinguished from tibial stress fractures by diffuse tenderness along the length of the posteromedial tibial shaft and a lack of edema. When stress fracture is suspected, plain radiography should be obtained initially and, if negative, may be repeated after two to three weeks for greater accuracy. If an urgent diagnosis is needed, triple-phase bone scintigraphy or magnetic resonance imaging should be considered. Both modalities have a similar sensitivity, but magnetic resonance imaging has greater specificity. Treatment of stress fractures consists of activity modification, including the use of nonweight-bearing crutches if needed for pain relief. Analgesics are appropriate to relieve pain, and pneumatic bracing can be used to facilitate healing. After the pain is resolved and the examination shows improvement, patients may gradually increase their level of activity. Surgical consultation may be appropriate for patients with stress fractures in high-risk locations, nonunion, or recurrent stress fractures. Prevention of stress fractures has been studied in military personnel, but more research is needed in other populations.
  American family physician 01/2011; 83(1):39-46.
• Article: Comforting a grieving parent.

  Richard Dew
  American family physician 01/2011; 83(1):79-80.
• Article: STEPS approach allows patient to participate in decision making.

  Jonathan D Ference
  American family physician 01/2011; 83(1):8.
• Article: Copper intrauterine device vs. depot medroxyprogesterone acetate for contraception.

  Janelle Guirguis-Blake
  American family physician 01/2011; 83(1):35-6.
• Article: The geriatric assessment.

  Bassem Elsawy, Kim E Higgins
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  ABSTRACT: The geriatric assessment is a multidimensional, multidisciplinary assessment designed to evaluate an older person's functional ability, physical health, cognition and mental health, and socioenvironmental circumstances. It is usually initiated when the physician identifies a potential problem. Specific elements of physical health that are evaluated include nutrition, vision, hearing, fecal and urinary continence, and balance. The geriatric assessment aids in the diagnosis of medical conditions; development of treatment and follow-up plans; coordination of management of care; and evaluation of long-term care needs and optimal placement. The geriatric assessment differs from a standard medical evaluation by including nonmedical domains; by emphasizing functional capacity and quality of life; and, often, by incorporating a multidisciplinary team. It usually yields a more complete and relevant list of medical problems, functional problems, and psychosocial issues. Well-validated tools and survey instruments for evaluating activities of daily living, hearing, fecal and urinary continence, balance, and cognition are an important part of the geriatric assessment. Because of the demands of a busy clinical practice, most geriatric assessments tend to be less comprehensive and more problem-directed. When multiple concerns are presented, the use of a "rolling" assessment over several visits should be considered. Academy of Family Physicians.
  American family physician 01/2011; 83(1):48-56.
• Article: Yellowish papules on a middle-aged man. Eruptive xanthoma.

  Jeffrey S Henning, Michael G Fazio
  American family physician 01/2011; 83(1):73-4.
• Source

  Available from: aafp.org

  Article: Avoiding sore throat morbidity and mortality: when is it not "just a sore throat?".

  Robert M Centor, Ralph Samlowski
  American family physician 01/2011; 83(1):26, 28.
• Article: Acute stroke diagnosis.

  Kenneth S Yew, Eric Cheng
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  ABSTRACT: Stroke can be categorized as ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage. Awakening with or experiencing the abrupt onset of focal neurologic deficits is the hallmark of ischemic stroke diagnosis. The most common presenting symptoms for ischemic stroke are difficulty with speech and weakness on one half of the body. Many stroke mimics exist; two of the most common are a postictal seizure and hypoglycemia. Taking a detailed history and performing ancillary testing will usually exclude stroke mimics. Neuroimaging is required to differentiate ischemic stroke from intracerebral hemorrhage, as well as to diagnose entities other than stroke. The choice of neuroimaging depends on its availability, eligibility for acute stroke interventions, and the presence of patient contraindications. Subarachnoid hemorrhage presents most commonly with severe headache and may require analysis of cerebrospinal fluid when neuroimaging is not definitive. Public education of common presenting stroke symptoms is needed for patients to activate emergency medical services as soon as possible after the onset of stroke.
  American family physician 08/2009; 80(1):33-40.
• Article: When a patient's chronic pain gets worse.

  Matthew Hollon
  American family physician 08/2009; 80(1):77-8.
• Source

  Available from: aafp.org

  Article: Identifying and using good practice guidelines.

  Kenneth W Lin, David C Slawson
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  ABSTRACT: Performance measurement and payment are increasingly linked to goals established by practice guidelines. The best guidelines are based on systematic reviews and patient-oriented evidence, use an evidence-rating system such as the Strength of Recommendation Taxonomy, and are prospectively validated. The guidelines also should have a transparent development process, identify potential conflicts of interest, and offer flexibility in various clinical situations.
  American family physician 08/2009; 80(1):67-70.
• Source

  Available from: aafp.org

  Article: Helping patients who drink too much: an evidence-based guide for primary care clinicians.

  Mark L Willenbring, Suena H Massey, Maureen B Gardner
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  ABSTRACT: Excessive alcohol consumption is a leading cause of preventable morbidity and mortality, but few heavy drinkers receive treatment. Primary care physicians are in a position to address heavy drinking and alcohol use disorders with patients, and can do so quickly and effectively. The National Institute on Alcohol Abuse and Alcoholism has published a guide for physicians that offers an evidence-based approach to screening, assessing, and treating alcohol use disorders in general health care settings. Screening can be performed by asking patients how many heavy drinking days they have per week. Assessing patients' willingness to change their drinking behaviors can guide treatment. Treatment recommendations should be presented in a clear, nonjudgmental way. Patients who are not alcohol-dependent may opt to reduce drinking to lower risk levels. Patients with alcohol dependence should receive pharmacotherapy and brief behavioral support, as well as disease management for chronic relapsing dependence. All patients with alcohol dependence should be encouraged to participate in community support groups
  American family physician 08/2009; 80(1):44-50.
• Source

  Available from: aafp.org

  Article: Diagnosis and management of gestational diabetes mellitus.

  David C Serlin, Robert W Lash
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  ABSTRACT: Gestational diabetes occurs in 5 to 9 percent of pregnancies in the United States and is growing in prevalence. It is a controversial entity, with conflicting guidelines and treatment protocols. Recent studies show that diagnosis and management of this disorder have beneficial effects on maternal and neonatal outcomes, including reduced rates of shoulder dystocia, fractures, nerve palsies, and neonatal hypoglycemia. Diagnosis is made using a sequential model of universal screening with a 50-g one-hour glucose challenge test, followed by a diagnostic 100-g three-hour oral glucose tolerance test for women with a positive screening test. Treatment consists of glucose monitoring, dietary modification, exercise, and, when necessary, pharmacotherapy to maintain euglycemia. Insulin therapy is the mainstay of treatment, although glyburide and metformin may become more widely used. In women receiving pharmacotherapy, antenatal testing with nonstress tests and amniotic fluid indices beginning in the third trimester is generally used to monitor fetal well-being. The method and timing of delivery are controversial. Women with gestational diabetes are at high risk of subsequent development of type 2 diabetes. Lifestyle modification should therefore be encouraged, along with regular screening for diabetes.
  American family physician 08/2009; 80(1):57-62.
• Article: Anticoagulation for the long-term treatment of VTE in patients with cancer.

  Janelle Guirguis-Blake
  American family physician 08/2009; 80(1):30.
• Article: Early intervention may prevent adolescent, adult obesity.

  Dausen Harker, Aaron Saguil
  American family physician 08/2009; 80(1):16.
• Article: Dopamine agonists for early Parkinson disease.

  Nathan Hitzeman, Flora Rafii
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  ABSTRACT: BACKGROUND: Dopamine agonists are being used increasingly as first-line treatment for Parkinson disease, but uncertainty remains about their clinical- and cost-effectiveness relative to levodopa. OBJECTIVES: This meta-analysis aims to quantify more reliably the benefits and risks of dopamine agonists compared with placebo or levodopa in early Parkinson disease. SEARCH STRATEGY: The search sources included CENTRAL (The Cochrane Library), Medline, EMBASE, PubMed, LILACS, and Web of Science, plus major journalism in the field, abstract books, conference proceedings, and reference lists of retrieved publications. SELECTION CRITERIA: Randomized trials comparing an orally administered dopamine agonist (with or without levodopa) versus placebo or levodopa or both placebo and levodopa in participants with early Parkinson disease. DATA COLLECTION AND ANALYSIS: Two authors independently extracted data on physician-rated disability, motor complications, other adverse effects, treatment concordance, levodopa dose, and mortality. MAIN RESULTS: Identified were 29 eligible trials involving 5,247 participants. Participants randomized to a dopamine agonist were less likely to develop dyskinesia (odds ratio [OR] = 0.51; 95% confidence interval [CI], 0.43 to 0.59; P < .00001), dystonia (OR = 0.64; 95% CI, 0.51 to 0.81; P = .0002), and motor fluctuations (OR = 0.75; 95% CI, 0.63 to 0.90; P = .002) than participants treated with levodopa. However, various nonmotor adverse effects, including edema (OR = 3.68; 95% CI, 2.62 to 5.18; P < .00001), somnolence (OR = 1.49; 95% CI, 1.12 to 2.00; P = .007), constipation (OR = 1.59; 95% CI, 1.11 to 2.28; P = .01), dizziness (OR = 1.45; 95% CI, 1.09 to 1.92; P = .01), hallucinations (OR = 1.69; 95% CI, 1.13 to 2.52; P = .01), and nausea (OR = 1.32; 95% CI, 1.05 to 1.66; P = .02) were all increased in agonist-treated participants (compared with levodopa-treated participants). Participants treated with agonists were also significantly more likely to discontinue treatment because of adverse events (OR = 2.49; 95% CI, 2.08 to 2.98; P < .00001). Symptomatic control of Parkinson disease was better with levodopa than with agonists, but data were reported too inconsistently and incompletely to meta-analyze. AUTHORS' CONCLUSIONS: This meta-analysis confirms that motor complications are reduced with dopamine agonists compared with levodopa, but also establishes that other important adverse effects are increased and symptom control is poorer with agonists. Larger, long-term comparative trials assessing patient-rated quality of life are needed to assess more reliably the balance of benefits and risks of dopamine agonists compared with levodopa.
  American family physician 08/2009; 80(1):28-30.
• Article: Multiple pulmonary nodules.

  Wei Chen, Wu-Huei Hsu
  American family physician 08/2009; 80(1):75-6.
• Article: Making a difference with patients who drink too much.

  William R Miller, Bronwyn E Wilson
  American family physician 08/2009; 80(1):21-2.
• Source

  Available from: onehealthohioproviders.com

  Article: Telephone triage of patients with influenza.

  Jonathan L Temte
  American family physician 07/2009; 79(11):943-5.