American family physician最新文献_第3页

Parenteral Agents for Mitigating Migraine Relapse. 缓解偏头痛复发的肠外药物。

IF 3.5 3区医学

American family physician Pub Date : 2025-09-01

Brit Long, Michael Gottlieb

引用次数: 0

Vasectomy: Common Questions and Answers. 输精管结扎术：常见问题与答案。

IF 3.5 3区医学

American family physician Pub Date : 2025-09-01

James J Arnold, David Villanueva, Melissa Jane Puntkattalee

{"title":"Vasectomy: Common Questions and Answers.","authors":"James J Arnold, David Villanueva, Melissa Jane Puntkattalee","doi":"","DOIUrl":"","url":null,"abstract":"Vasectomy is a highly effective form of permanent contraception. It is as effective as tubal sterilization and is safer, less costly, and associated with quicker recovery. In the United States, only 4% of men ages 18 to 45 years have had a vasectomy, indicating that it is underused despite the benefits. Vasectomy is typically performed in the outpatient setting, and most patients return to regular physical and sexual activity after 1 week. Opioids and antibiotics are not routinely needed. The no-scalpel vasectomy and other minimally invasive techniques for approaching and isolating the vas deferens have the lowest occurrence of adverse events such as hematoma, infection, sperm granuloma, recanalization, and chronic scrotal pain. After the vas deferens is isolated and segment is removed, mucosal cautery alone or facial interposition with mucosal cautery of both ends or abdominal end have occlusion failure rates of less than 1%. The addition of fascial interposition improves rates and decreases the time to azoospermia on semen analysis without a significant increase in adverse outcomes. Sterility is confirmed 3 months after vasectomy with a semen analysis that shows rare, nonmotile sperm (100,000/mL or fewer) on microscopy. Although vasectomy should be considered permanent, up to 6% of patients seek reversal. Successful reversal rates (return of sperm to semen) are high; however, pregnancy rates are variable.","PeriodicalId":7713,"journal":{"name":"American family physician","volume":"112 3","pages":"264-269"},"PeriodicalIF":3.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145079556","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

Autism Spectrum Disorder in Primary Care. 初级保健中的自闭症谱系障碍。

IF 3.5 3区医学

American family physician Pub Date : 2025-09-01

Andrea Westby, Mikaela Coburn-Pierce

{"title":"Autism Spectrum Disorder in Primary Care.","authors":"Andrea Westby, Mikaela Coburn-Pierce","doi":"","DOIUrl":"","url":null,"abstract":"Autism is a lifelong neurodevelopmental condition that affects approximately 1 in 31 US children and 1 in 45 US adults; autism spectrum disorder includes a wide range of neurologic diversity, symptoms, challenges, strengths, and abilities. The Diagnostic and Statistical Manual of Mental Disorders, 5th ed., text revision criteria for autism spectrum disorder require deficits in three areas of communication and social interaction across multiple settings, with at least two restricted or repetitive behaviors, not explained by another condition, and causing functional impairment. The American Academy of Pediatrics recommends screening for autism at ages 18 and 24 months in addition to routine developmental surveillance, whereas screening in adults is not recommended. Diagnosis should include a multidisciplinary team and a multidimensional assessment. Autistic individuals have a 20- to 30-year lower life expectancy than nonautistic people and experience higher rates of many chronic conditions, such as diabetes, epilepsy, gastrointestinal concerns, feeding disorders, and mental health disorders (eg, attention-deficit/hyperactivity disorder, depression, anxiety, schizophrenia). Treatment of children with autism spectrum disorder focuses on minimizing core deficits, maximizing functional independence, and preventing problem behaviors. Pharmacologic therapy may be indicated for related conditions or symptoms, such as sleep disorders, seizures, mental health conditions, behavior problems, and gastrointestinal issues. Melatonin effectively reduces sleep symptoms and improves daytime behaviors with minimal adverse effects. The SPACE (sensory, predictability, acceptance, communication, empathy) framework provides specific interventions that make health care more accessible and affirming to autistic patients.","PeriodicalId":7713,"journal":{"name":"American family physician","volume":"112 3","pages":"301-312"},"PeriodicalIF":3.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145079353","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

Responses to Editorial on Prescribing GLP-1 Agonists for Weight Loss. 对GLP-1激动剂用于减肥的社论的回应。

IF 3.5 3区医学

American family physician Pub Date : 2025-09-01

Jeanne Spencer, Jessica Masser

引用次数: 0

Donanemab (Kisunla) for the Slowing of Alzheimer Disease. Donanemab （Kisunla）用于延缓阿尔茨海默病。

IF 3.5 3区医学

American family physician Pub Date : 2025-09-01

Megan Adelman, Megan L Hull

引用次数: 0

Shame Competent Response to Medical Error. 羞耻感对医疗失误的反应。

IF 3.5 3区医学

American family physician Pub Date : 2025-09-01

William Bynum, Steven Thornton, Luna Dolezal

引用次数: 0

Lymphadenopathy: Evaluation and Differential Diagnosis. 淋巴结病：评估和鉴别诊断。

IF 3.5 3区医学

American family physician Pub Date : 2025-09-01

Nathan Falk, Rosa Joseph, Marvin Dieujuste

{"title":"Lymphadenopathy: Evaluation and Differential Diagnosis.","authors":"Nathan Falk, Rosa Joseph, Marvin Dieujuste","doi":"","DOIUrl":"","url":null,"abstract":"Lymphadenopathy occurs in 0.6% of the population annually, usually from a benign cause. History should focus on lymph node location, duration of lymphadenopathy, associated symptoms (particularly fever, night sweats, and unintentional weight loss), past and current medical conditions, occupation, travel history, animal exposures, medication use, recent vaccine history, drug use, sexual history, and family history. Physical examination should first differentiate localized from generalized lymphadenopathy. Generalized lymphadenopathy is usually caused by underlying systemic disease. Although usually benign, localized lymphadenopathy may represent infection or malignancy, particularly if epitrochlear or supraclavicular nodes are affected. Lymph nodes that are larger than 2 cm, hard, or matted/fused to surrounding structures may indicate malignancy or granulomatous diseases, especially in children. When lymphadenopathy persists beyond four weeks or is accompanied by systemic symptoms, imaging and appropriate laboratory studies (eg, complete blood cell count, C-reactive protein, erythrocyte sedimentation rate, tuberculosis testing) should be obtained. Biopsy may be performed through fine-needle aspiration, core needle biopsy, or excisional biopsy. Antibiotics may be considered if a benign or self-limiting etiology (eg, bacterial lymphadenitis) is suspected. Corticosteroids should be avoided because they can mask the histologic diagnosis of lymphoma or other malignancy.","PeriodicalId":7713,"journal":{"name":"American family physician","volume":"112 3","pages":"286-293"},"PeriodicalIF":3.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145079457","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

Vitamin B12 Deficiency: Common Questions and Answers. 维生素B12缺乏症：常见问题和答案。

IF 3.5 3区医学

American family physician Pub Date : 2025-09-01

Hiten Patel, Rachael McGuirk

{"title":"Vitamin B12 Deficiency: Common Questions and Answers.","authors":"Hiten Patel, Rachael McGuirk","doi":"","DOIUrl":"","url":null,"abstract":"Vitamin B12 deficiency occurs in approximately 2% to 3% of adults in the United States. Risk factors include malabsorptive processes, limited dietary intake of vitamin B12, use of certain medications (eg, metformin, proton pump inhibitors), and older age. Symptoms vary based on the severity of vitamin B12 deficiency but may include fatigue, brain fog, depression, peripheral neuropathy, and ataxia. Although universal screening is not recommended, testing should be considered in patients with at least one risk factor for and one clinical feature of vitamin B12 deficiency. Initial testing includes total serum vitamin B12 level, which is diagnostic for deficiency if less than 180 pg/mL. Borderline levels (180-350 pg/mL) warrant a methylmalonic acid measurement, which is diagnostic for vitamin B12 deficiency if elevated. Patients without a clear cause of deficiency should undergo further testing for atrophic gastritis with a Helicobacter pylori test and evaluation for autoantibodies associated with autoimmune gastritis. Oral vitamin B12 supplementation can be used in most patients and is noninferior to intramuscular supplementation. Intramuscular administration should be considered in patients with severe deficiency or neurologic manifestations. Vitamin B12 levels that are persistently elevated (greater than 1,000 pg/mL on two measurements) have been associated with solid tumors, hematologic malignancy, and increased risk of cardiovascular death.","PeriodicalId":7713,"journal":{"name":"American family physician","volume":"112 3","pages":"294-300"},"PeriodicalIF":3.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145079507","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

CPCs Should Be a Resource for Patients With Unintended Pregnancy. cpc应该成为意外怀孕患者的资源。

IF 3.5 3区医学

American family physician Pub Date : 2025-08-01

Kathleen Castellanos

引用次数: 0

Diary of a Family Physician. 《一个家庭医生的日记》

IF 3.5 3区医学

American family physician Pub Date : 2025-08-01

Ramona Sharma, Stephen Dudley

引用次数: 0