American family physician最新文献_第10页

Endometrial Cancer: Rapid Evidence Review. 子宫内膜癌：快速证据回顾。

IF 3.8 3区医学

American family physician Pub Date : 2025-06-01

Carl Bryce, Renee Gazda, Hadass Fuerst

{"title":"Endometrial Cancer: Rapid Evidence Review.","authors":"Carl Bryce, Renee Gazda, Hadass Fuerst","doi":"","DOIUrl":"","url":null,"abstract":"Incidence and mortality rates associated with endometrial cancer are increasing in the United States. Risk factors include obesity, unopposed estrogen states, estrogen-producing tumors, younger age at menarche, nulliparity, late menopause, and tamoxifen use. There are no recommendations for endometrial cancer screening in individuals at average risk. Abnormal uterine bleeding, especially postmenopausal bleeding, is the most common symptom. Patients who present with postmenopausal bleeding should be evaluated with pelvic ultrasonography or endometrial biopsy. The diagnosis of endometrial cancer is made with endometrial biopsy, most often with Pipelle endometrial sampling. Dilation and curettage is recommended if an adequate sample cannot be obtained, the diagnosis is unclear, or a focal lesion such as an endometrial polyp or mass is present. Treatment of early-stage disease is primarily surgical. Radiation therapy decreases recurrence rates but not survival rates in early-stage cancers. Chemotherapy, hormone therapy, and biologic therapy are used to treat advanced endometrial cancer, and clinical trials are ongoing. Complementary medicine therapies can improve quality of life and survival rates in patients undergoing treatment. Patients should be referred to a gynecologic oncologist; early-stage treatment is associated with longer survival rates. Endometrial cancer survivors should undergo periodic surveillance that includes a history and physical examination.","PeriodicalId":7713,"journal":{"name":"American family physician","volume":"111 6","pages":"526-531"},"PeriodicalIF":3.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144324190","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

Acute Monoarthritis: Diagnosis in Adults. 急性单关节炎：成人诊断。

IF 3.8 3区医学

American family physician Pub Date : 2025-06-01

Jeremy Swisher, Zachary Sitton, Kimberly Burbank, Chris Nelson

{"title":"Acute Monoarthritis: Diagnosis in Adults.","authors":"Jeremy Swisher, Zachary Sitton, Kimberly Burbank, Chris Nelson","doi":"","DOIUrl":"","url":null,"abstract":"Acute monoarthritis, characterized by pain or swelling in a single joint, is a diagnostic challenge in the primary care setting. Intra-articular conditions typically manifest with reduced active and passive range of motion, whereas patients with periarticular conditions such as tendinitis or bursitis often maintain passive range of motion. When evaluating a patient with acute monoarthritis, it is essential to remember that many polyarthritic processes can initially present in a single joint. A broad differential diagnosis for monoarthritis should include septic arthritis, osteoarthritis, gout, trauma, and Lyme arthritis. Of these, septic arthritis is the most urgent and requires prompt intervention. Bacterial culture of the synovial fluid is the most accurate diagnostic test for a septic joint. However, diagnostic accuracy can be increased in the short term by evaluating additional markers such as synovial white blood cell count, synovial lactate, and serum biomarkers. These supplementary tests aid in early decision-making while awaiting bacterial culture results. Osteoarthritis is often clinically diagnosed and may be confirmed with radiography. Gout, the most prevalent crystalline arthropathy, can be diagnosed using specialized calculators, ultrasonography, and dual energy computed tomography. Gout is typically most painful at night or in the early morning. Ultrasonography is useful for identifying effusions in less-visible joints and facilitating precise joint aspiration.","PeriodicalId":7713,"journal":{"name":"American family physician","volume":"111 6","pages":"497-506"},"PeriodicalIF":3.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144324181","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

Educational Interventions Improve Adverse Drug Reaction Reporting. 教育干预提高药物不良反应报告。

IF 3.8 3区医学

American family physician Pub Date : 2025-06-01

Elizabeth Chiang, Rashmi Rode, Arindam Sarkar

引用次数: 0

Invasive Strategy Is No Better Than Conservative Strategy for Older Patients With NSTEMI. 对于老年非stemi患者，侵入性治疗并不比保守治疗好。

IF 3.8 3区医学

American family physician Pub Date : 2025-06-01

Mark H Ebell

引用次数: 0

Zoledronate Given Twice 5 Years Apart to Women With Normal Bone Density or Osteopenia Reduces Fracture Risk. 对于骨密度正常或骨质减少的女性，间隔5年给予两次唑来膦酸钠可降低骨折风险。

IF 3.8 3区医学

American family physician Pub Date : 2025-06-01

Mark H Ebell

引用次数: 0

Long-Term Opioid Therapy for Nonterminal Pain. 长期阿片类药物治疗非终末期疼痛。

IF 3.8 3区医学

American family physician Pub Date : 2025-06-01

Kento Sonoda, Mako Wakabayashi

{"title":"Long-Term Opioid Therapy for Nonterminal Pain.","authors":"Kento Sonoda, Mako Wakabayashi","doi":"","DOIUrl":"","url":null,"abstract":"Chronic pain, defined as persistent pain lasting longer than 12 weeks, affects approximately 20% of US adults and often results in mental and social burdens. In general, nonopioid therapies are preferred for chronic nonterminal pain, and opioid therapy should not be considered a first-line treatment modality. Health disparities in pain management affect vulnerable populations, including racially and ethnically marginalized groups and those with cognitive impairment. Clinicians first must acknowledge the existing health inequities and the stigma surrounding chronic pain and then need to provide culturally tailored pain management. Opioid use should be limited to circumstances wherein benefits outweigh risks, such as in cases of nonterminal pain refractory to multiple other interventions. Harms of opioid therapy include constipation, depression, hormonal dysregulation, opioid-induced hyperalgesia, and overdose. Given the high prevalence of behavioral health disorders in individuals with chronic pain, it is crucial to address mental health in conjunction with pain management. Before prescribing opioids, it is essential to review risk factors for opioid use disorder and respiratory depression and to set realistic goals for improving function. Ongoing monitoring should include assessments of functional progress, urine drug testing, and review of data from the state prescription drug monitoring program. Buprenorphine is an effective medication for chronic pain management and may be safer than full opioid agonists, especially in individuals at risk for opioid use disorder, opioid misuse, or overdose.","PeriodicalId":7713,"journal":{"name":"American family physician","volume":"111 6","pages":"508-514"},"PeriodicalIF":3.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144324209","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

Assessing the Risk of Developing Atrial Fibrillation. 评估发生心房颤动的风险。

IF 3.8 3区医学

American family physician Pub Date : 2025-06-01

Mark H Ebell

引用次数: 0

Bullous Rash on the Face and Neck. 面部和颈部出现大疱性皮疹。

IF 3.8 3区医学

American family physician Pub Date : 2025-06-01

Jason Burchett

引用次数: 0

Fidaxomicin vs Vancomycin for Clostridioides difficile infection. 非达霉素与万古霉素治疗艰难梭菌感染。