FP essentials最新文献

Obesity Management. 肥胖管理。

FP essentials Pub Date : 2026-04-01

Michelle Nelson

引用次数: 0

Obesity Management: Surgical Interventions. 肥胖管理：手术干预。

FP essentials Pub Date : 2026-04-01

Mark Shaffer, Matthew Nodelman, A Miles Scott, Morgan A Rhodes

{"title":"Obesity Management: Surgical Interventions.","authors":"Mark Shaffer, Matthew Nodelman, A Miles Scott, Morgan A Rhodes","doi":"","DOIUrl":"","url":null,"abstract":"Metabolic and bariatric surgery (MBS) is surgery on the gastrointestinal tract aimed at weight loss and resolution of metabolic disease. These surgeries can result in remission of diabetes, hypertension, and sleep apnea in many patients, and can prolong life expectancy by 5 to 9 years. Because of the proven benefits, the American Society for Metabolic and Bariatric Surgery recommends surgery for all patients with a body mass index of 35 kg/m2 or higher, except for patients with diabetes whose threshold is 30 kg/m2 regardless of prior nonsurgical weight loss efforts. For children 13 years and older, MBS is recommended and has not been shown to negatively affect height or develop- ment. The MBS procedures have a very low risk of surgical complications but require careful preoperative counseling due to the major long-term effect expected on lifestyle. Family physicians are well suited to discuss MBS as an option for appropriate patients, refer to a qualified center, and monitor patients postoperatively. Attention must be given to effects on diet, fertility, and mental health, and adjustments must be made for long-term medications. These surgeries should not be viewed as a last resort for only patients with severe obesity but as an effective intervention to consider early in the treatment of obesity, especially when complicated by metabolic conditions.","PeriodicalId":38325,"journal":{"name":"FP essentials","volume":"563 ","pages":"32-39"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147843956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Obesity Management: Evaluation. 肥胖管理：评估。

FP essentials Pub Date : 2026-04-01

A Miles Scott, Morgan A Rhodes, Mark Shaffer, Matthew Nodelman

{"title":"Obesity Management: Evaluation.","authors":"A Miles Scott, Morgan A Rhodes, Mark Shaffer, Matthew Nodelman","doi":"","DOIUrl":"","url":null,"abstract":"Obesity is a multifactorial, chronic condition that substantially affects individual and public health, reduces life expectancy, and increases the risk for a wide range of comorbid conditions (eg, cardiovascular disease, hypertension, depression, liver disease, type 2 diabetes, certain cancers). It is defined using body mass index in adults and further stratified into classes. In children and adolescents, obesity is defined using body mass index at or above the 95th percentile for age and sex. In the United States, more than 40% of adults and approximately 20% of children and adolescents are affected by obesity. Disparities persist, with higher rates among Hispanic and non-Hispanic Black populations and individuals with lower socioeconomic status. Other risk factors include adverse childhood experiences, behavioral influences, certain drugs, genetic predisposition, and medical conditions. Obesity-related stigma and social determinants of health pose barriers to effective care. Effective management requires a respectful, patient-centered approach that includes comprehensive assessment and multidisciplinary support. Recognizing obesity as an adiposity-based chronic disease may enhance care delivery and reduce bias, promoting better out- comes and health equity across populations.","PeriodicalId":38325,"journal":{"name":"FP essentials","volume":"563 ","pages":"7-13"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147843916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Obesity Management: Pharmacotherapy. 肥胖管理：药物治疗。

FP essentials Pub Date : 2026-04-01

Morgan A Rhodes, A Miles Scott, Matthew Nodelman, Mark Shaffer

{"title":"Obesity Management: Pharmacotherapy.","authors":"Morgan A Rhodes, A Miles Scott, Matthew Nodelman, Mark Shaffer","doi":"","DOIUrl":"","url":null,"abstract":"Anti-obesity drugs should be offered as initial treatment of overweight and obesity for adults with weight-related comorbidities and for those at high risk of complications, and as a component of first-line treatment for patients with obesity and overweight without comorbidities. Currently, US Food and Drug Administration-approved drugs for obesity include centrally acting drugs, gastrointestinal lipase inhibitors, and incretin mimetics. Other drugs are used off-label to promote weight loss. The incretin mimetics, glucagon-like peptide-1 receptor agonists (eg, semaglutide, liraglutide) and dual glucose-dependent insulinotropic polypeptide/glucagon-like peptide-1 receptor ago- nist (ie, tirzepatide), demonstrate the greatest weight loss benefits, with tirzepatide achieving reductions exceeding 20% in some patients. Drug selection should be individualized based on comorbidities (eg, cardiovascular disease, obstructive sleep apnea), cost, and patient preference. Despite growing evidence of benefit, barriers (eg, prescriber hesitancy, high costs, limited insurance coverage) persist. With multiple drugs in development, continued innovation in pharmacotherapy management offers promise, but expanding education and access remains critical to improving obesity care.","PeriodicalId":38325,"journal":{"name":"FP essentials","volume":"563 ","pages":"22-31"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147843888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Obesity Management: Lifestyle Interventions. 肥胖管理：生活方式干预。

FP essentials Pub Date : 2026-04-01

Matthew Nodelman, Mark Shaffer, Morgan A Rhodes, A Miles Scott

{"title":"Obesity Management: Lifestyle Interventions.","authors":"Matthew Nodelman, Mark Shaffer, Morgan A Rhodes, A Miles Scott","doi":"","DOIUrl":"","url":null,"abstract":"Obesity management in primary care should begin with lifestyle interventions for patients ready to engage in behavior change. Using the 5As counseling model (assess, advise, agree, assist, arrange) in a patient-centered, nonjudgmental manner enhances motivation and adherence. Comprehensive lifestyle interventions (combining reduced caloric intake, increased physical activity, and behavioral changes) are most effective, typically achieving 5% to 10% weight loss over 6 months. Physicians should refer patients to multidisciplinary programs when possible or recommend digital or commercial alternatives with personalized feedback. Key components include setting specific, measurable, achievable, relevant, and time-based (SMART) goals; calculating caloric deficits; and promoting self-monitoring. Various dietary approaches can be effective and should be tailored to patient preferences. Physical activity lasting at least 150 minutes per week at moderate intensity or at least 75 minutes per week of vigorous activity is recommended. Digital tools (eg, apps, wearable trackers) can enhance engagement and outcomes. Physicians should also address barriers such as food insecurity, time constraints, and lack of support. Although adjunctive strategies such as sleep optimization and workplace modifications may be beneficial, they should not replace core lifestyle changes.","PeriodicalId":38325,"journal":{"name":"FP essentials","volume":"563 ","pages":"14-21"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147843898","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Cardiovascular Signs and Symptoms: Edema. 心血管症状：水肿。

FP essentials Pub Date : 2026-03-01

Jenna Greenberg, Joshua Greenberg, Anna Laurie

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Cardiovascular Signs and Symptoms. 心血管症状和体征。

FP essentials Pub Date : 2026-03-01

Ryan D Kauffman

引用次数: 0

Cardiovascular Signs and Symptoms: Chest Pain: Evaluation in the Office Setting. 心血管症状和体征：胸痛：评估在办公室设置。

FP essentials Pub Date : 2026-03-01

Jenna Greenberg, Anna Laurie, Joshua Greenberg

{"title":"Cardiovascular Signs and Symptoms: Chest Pain: Evaluation in the Office Setting.","authors":"Jenna Greenberg, Anna Laurie, Joshua Greenberg","doi":"","DOIUrl":"","url":null,"abstract":"Chest pain is responsible for approximately 1% of primary care encounters. Although most etiologies are benign and self-limited, some reflect underlying pathology associated with significant morbidity and mortality. The initial office evaluation for patients presenting with chest pain should include a comprehensive clinical history, physical examination, and 12-lead electrocardiography to identify those with potential cardiac etiologies. Patients with clinical evidence of acute coronary syndrome or other life-threatening causes of acute chest pain should be transported to the emergency department by emergency medical services. Pretest probability models such as the risk factor-weighted clinical likelihood are helpful for risk-stratifying outpatients with stable chest pain. Risk stratification tools such as the Marburg Heart Score and the International Working Group on Chest Pain in Primary Care rule are also used to stratify outpatients with stable chest pain and identify those at low risk of coronary artery disease who do not require additional testing. For patients with stable angina and intermediate or high risk of coronary artery disease, additional diagnostic testing with coronary computed tomography angiography or stress imaging is recommended. Clinical risk stratification tools such as the Wells criteria should be used to evaluate for pulmonary embolism. Patients with low or intermediate risk of pulmonary embolism should be evaluated with a d-dimer test, whereas those with high risk should have imaging.","PeriodicalId":38325,"journal":{"name":"FP essentials","volume":"562 ","pages":"7-16"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147469558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Cardiovascular Signs and Symptoms: Palpitations and Monitoring. 心血管体征和症状：心悸和监测。

FP essentials Pub Date : 2026-03-01

Jenna Greenberg, Anna Laurie, Joshua Greenberg

{"title":"Cardiovascular Signs and Symptoms: Palpitations and Monitoring.","authors":"Jenna Greenberg, Anna Laurie, Joshua Greenberg","doi":"","DOIUrl":"","url":null,"abstract":"Palpitations are a common symptom, characterized by the unpleasant or alarming awareness of heartbeats. Patients may describe sensations of rapid heart rate, fluttering, pounding, or skipped beats, typically localized to the precordium, neck, or throat. Palpitations may be associated with regular or irregular heartbeats. Palpitations are responsible for 16% of all primary care visits and are the second leading cause of referral to cardiologists. The differential diagnosis for palpitations is broad and includes arrhythmic and nonarrhythmic causes. Although most cases of palpitations are benign, the challenge for primary care physicians is to differentiate between benign etiologies and those requiring urgent management. Taking a detailed family and personal history is essential for evaluation. All patients presenting with palpitations should have 12-lead electrocardiography performed. Ambulatory electrocardiographic monitoring remains the mainstay of evaluation. Echocardiography may be appropriate in adult patients presenting with palpitations to evaluate for structural heart disease that may contribute to arrhythmias. Consumer-available wearable devices with ambulatory heart rhythm-monitoring capabilities have demonstrated diagnostic accuracy for detection of atrial fibrillation and promote greater patient engagement in care. The management of palpitations depends on the underlying etiology and can include conservative measures and reassurance, pharmacologic interventions, and invasive procedures.","PeriodicalId":38325,"journal":{"name":"FP essentials","volume":"562 ","pages":"17-26"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147469549","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Cardiovascular Signs and Symptoms: Syncope and Presyncope. 心血管体征和症状：晕厥和晕厥前期。

FP essentials Pub Date : 2026-03-01

Anna Laurie, Jenna Greenberg, Joshua Greenberg

{"title":"Cardiovascular Signs and Symptoms: Syncope and Presyncope.","authors":"Anna Laurie, Jenna Greenberg, Joshua Greenberg","doi":"","DOIUrl":"","url":null,"abstract":"Syncope is an abrupt, transient, and complete loss of consciousness associated with an inability to maintain postural tone, followed by rapid and spontaneous recovery. Syncope is caused by temporary cerebral hypoperfusion. Presyncope describes symptoms such as lightheadedness and vision changes that may or may not precede syncope. Syncope can be classified by its mechanism: reflex (neurally mediated), orthostatic hypotension, or cardiac. Initial evaluation of loss of consciousness should include a careful history and detailed physical examination with orthostatic vital signs and 12-lead electrocardiography. The history should evaluate whether the episode was a true loss of consciousness and clarify whether it has a syncopal or nonsyncopal etiology. Although there is no evidence-based standard for the diagnosis of syncope, consensus suggests diagnostic criteria concordant with the three syncope mechanisms. The treatment of syncope is specific to its mechanism. Multiple risk stratification tools exist; however, these do not outperform clinician judgment in predicting serious outcomes of syncope in the short term. When evaluating and treating syncope, additional consideration should be given to special populations including children and adolescents, older adults, athletes, and patients with postural orthostatic tachycardia syndrome.","PeriodicalId":38325,"journal":{"name":"FP essentials","volume":"562 ","pages":"27-35"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147469566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0