American family physician最新文献

IF 3.8 3区医学

American family physician Pub Date : 2024-08-01

Kelly Latimer, Michael Layne, Maya Payne

{"title":"Pulmonary Hypertension.","authors":"Kelly Latimer, Michael Layne, Maya Payne","doi":"","DOIUrl":"","url":null,"abstract":"Pulmonary hypertension includes a diverse set of conditions defined by a mean pulmonary artery pressure greater than 20 mm Hg found during right heart catheterization that can lead to right-sided heart failure and death if untreated. The most common cause of pulmonary hypertension is left-sided heart failure, followed by chronic obstructive lung disease. Pulmonary hypertension presents as unexplained dyspnea on exertion and possible findings of right-sided heart failure. The diagnosis is commonly delayed because the symptoms are often attributed to underlying heart or lung disease. Echocardiography is the initial study of choice, and findings can suggest a low, intermediate, or high risk of pulmonary hypertension. Right heart catheterization is the standard of care for diagnosing and classifying pulmonary hypertension, and the results may inform treatment. Patients with pulmonary hypertension should be referred to a center specializing in treatment. Patients with pulmonary hypertension have a high risk of perioperative complications, and detailed specialty preoperative evaluation is recommended. Physicians should counsel patients of childbearing age with pulmonary hypertension to prevent pregnancy to avoid worsening the severity of pulmonary hypertension and fetal loss. Pulmonary hypertension is severe, chronic, progressive, and challenging to treat; therefore, family physicians should update the patient's immunization status, screen for and address mental health conditions, and discuss goals of care and advance directives with patients.","PeriodicalId":7713,"journal":{"name":"American family physician","volume":null,"pages":null},"PeriodicalIF":3.8,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142035013","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Resistant Bacterial Infections: Guidelines From the Infectious Diseases Society of America. 耐药细菌感染：美国传染病学会指南》。

IF 3.8 3区医学

American family physician Pub Date : 2024-08-01

Michael J Arnold

引用次数: 0

Scottish Screening: No Cases of Invasive Cervical Cancer in Women Who Received at Least One Dose of Bivalent HPV Vaccine at 12 or 13 Years of Age. 苏格兰筛查：在 12 或 13 岁时至少接种过一剂二价 HPV 疫苗的女性中未发现侵袭性宫颈癌病例。

IF 3.8 3区医学

American family physician Pub Date : 2024-08-01

Henry C Barry

引用次数: 0

Intensive Perioperative Glycemic Control in People With Diabetes Mellitus. 糖尿病患者围术期强化血糖控制。

IF 3.8 3区医学

American family physician Pub Date : 2024-08-01

Kelsie Pegram, Joseph Marquez

引用次数: 0

Nirmatrelvir/Ritonavir Does Not Significantly Reduce Symptoms or Hospitalization in Vaccinated High-Risk Patients and Unvaccinated Patients. 尼马瑞韦/利托那韦不能显著减少接种疫苗的高危患者和未接种疫苗的患者的症状或住院治疗。

IF 3.8 3区医学

American family physician Pub Date : 2024-08-01

Mark H Ebell

引用次数: 0

Mastitis: Rapid Evidence Review. 乳腺炎：快速证据审查。

IF 3.8 3区医学

American family physician Pub Date : 2024-08-01

Erin F Morcomb, Carmen M Dargel, Sydney A Anderson

{"title":"Mastitis: Rapid Evidence Review.","authors":"Erin F Morcomb, Carmen M Dargel, Sydney A Anderson","doi":"","DOIUrl":"","url":null,"abstract":"Mastitis represents a spectrum of inflammatory conditions. Lactational mastitis is the most common, with an approximate incidence of 10% in the United States, and it usually occurs in the first 3 months postpartum. Diagnosis is made clinically based on the presence of symptoms such as fever, malaise, focal breast tenderness, and overlying skin erythema or hyperpigmentation without the need for laboratory tests or imaging. However, obtaining milk cultures should be considered to guide antibiotic therapy, and ultrasonography should be performed to identify abscesses in immuno-compromised patients or those with worsening or recurrent symptoms. Because most cases of mastitis are caused by inflammation and not a true infection, a 1- to 2-day trial of conservative measures (i.e., nonsteroidal anti-inflammatory drugs, ice application, feeding the infant directly from the breast, and minimizing pumping) is often sufficient for treatment. If there is no improvement in symptoms, narrow-spectrum antibiotics may be prescribed to cover common skin flora (e.g., Staphylococcus, Streptococcus). Most patients can be treated as outpatients with oral antibiotics; however, if the condition worsens or there is a concern for sepsis, intravenous antibiotics and hospital admission may be required. Use of probiotics for treatment or prevention is not supported by good evidence. Factors that increase the risk of mastitis include overstimulation of milk production and tissue trauma from aggressive breast massage; therefore, frequent overfeeding, excessive pumping to empty the breast, heat application, and breast massage are no longer recommended because they may worsen the condition. The best prevention is a proper lactation technique, including a good infant latch, and encouraging physiologic breastfeeding rather than pumping, if possible.","PeriodicalId":7713,"journal":{"name":"American family physician","volume":null,"pages":null},"PeriodicalIF":3.8,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142035009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Imaging Guidelines for Children With Mild Traumatic Brain Injury. 轻度脑外伤儿童成像指南》。

IF 3.8 3区医学

American family physician Pub Date : 2024-08-01

Allen F Shaughnessy

引用次数: 0

Diagnosing Dementia and Cognitive Impairment in Symptomatic Patients. 诊断有症状患者的痴呆症和认知障碍。

IF 3.8 3区医学

American family physician Pub Date : 2024-08-01

Kiyomi K Goto, Juan Qiu, John James

引用次数: 0

Attention-Deficit/Hyperactivity Disorder in Adults. 成人注意力缺陷/多动症。

IF 3.8 3区医学

American family physician Pub Date : 2024-08-01

Amanda E Olagunju, Faraz Ghoddusi

{"title":"Attention-Deficit/Hyperactivity Disorder in Adults.","authors":"Amanda E Olagunju, Faraz Ghoddusi","doi":"","DOIUrl":"","url":null,"abstract":"Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder involving functionally disruptive inattentive and/or hyperactive/impulsive behaviors, such as being easily distracted, regularly failing to follow through on tasks, being restless, or often interrupting others. ADHD diagnosed in childhood often persists into adulthood, with 14.6% of U.S. adults meeting the Diagnostic and Statistical Manual of Mental Disorders, 5th ed., criteria for ADHD. When evaluating for adult ADHD, other mental disorders should be included in the differential diagnosis due to the substantial overlap of symptoms and ADHD concurrence with anxiety/stress, mood, personality, impulse control, and substance use disorders. An ADHD diagnosis requires a comprehensive clinical history and evaluation, patient symptom and function assessment (e.g., Adult ADHD Self-Report Scale, Conners Adult ADHD Rating Scales), and gathering of collateral information. Clinical guidelines recommend a subset of amphetamine and methylphenidate stimulants as first-line pharmacotherapy, which may be more effective when combined with psychotherapy. For adults unable to take stimulants or with concurrent anxiety/depression, options include atomoxetine, viloxazine, and bupropion. To monitor for patient misuse or diversion of stimulants, physicians should consider employing controlled substance agreements and prescription drug monitoring programs.","PeriodicalId":7713,"journal":{"name":"American family physician","volume":null,"pages":null},"PeriodicalIF":3.8,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142034995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Practice Alert: Measles Continues to Be a Threat to Health in the United States. 实践警示：麻疹继续威胁美国人的健康。

IF 3.8 3区医学

American family physician Pub Date : 2024-08-01

Doug Campos-Outcalt

引用次数: 0