Practical Clinical Topics, Digging Deeper into COVID-19, Social Determinants of Health, and Equity
J Am Board Fam Med. 2021 Sep-Oct;34(5):883-885. doi: 10.3122/jabfm.2021.05.210303.ABSTRACTAs a discipline, we continue to learn lessons from Coronavirus disease 2019 (COVID-19)-lessons for practice, systems, and patient care. This issue also includes articles focused on 2 other topics that attract increasing attention by family physicians. First, articles describe how the social determinants of health impact health and how family physicians can overcome those obstacles with their patients. Patients want assistance from health systems for 1 specific need related to social determinants of their health. Second, we see increas...
Source: American Family Physician - September 18, 2021 Category: Primary Care Authors: Marjorie A Bowman Dean A Seehusen Christy J W Ledford Source Type: research

Family Physicians' Perception of the New mRNA COVID-19 Vaccines
This study was conducted to assess family physicians' perception of the US Food and Drug Administration-approved mRNA Coronavirus disease 2019 (COVID-19) vaccines, their plans to be vaccinated with an approved mRNA COVID-19 vaccine, and their support for vaccination of patients and family members.METHODS: The authors conducted a cross-sectional survey of 307 practicing family physicians, full-time faculty physicians, and resident physicians in Kansas from December 14, 2020, to December 31, 2020. The study participants completed an anonymous, 20-item survey assessing family physicians' concerns about exposure to COVID-19 an...
Source: American Family Physician - September 18, 2021 Category: Primary Care Authors: Samuel Ofei-Dodoo Rick Kellerman Taylor Russell Source Type: research

Rural Adolescent Immunization: Delivery Practices and Barriers to Uptake
J Am Board Fam Med. 2021 Sep-Oct;34(5):937-949. doi: 10.3122/jabfm.2021.05.210107.ABSTRACTBACKGROUND: Rural adolescent vaccination rates lag behind urban. We sought to assess rural-urban differences in barriers to adolescent vaccination, perceived parental vaccine attitudes, and immunization delivery practices among public health nursing (PHN), pediatric (Peds), and family medicine (FM) clinicians.METHODS: Internet and mail survey of Colorado PHN, Peds, and FM clinicians from June-August 2019. Study population was recruited from local health plans and the American Medical Association Physician Masterfile. Rural and urban r...
Source: American Family Physician - September 18, 2021 Category: Primary Care Authors: Jessica R Cataldi Sarah E Brewer Cathryn Perreira Anna Furniss Andrea Nederveld Krithika Suresh Charnetta Williams Sean T O'Leary Amanda F Dempsey Source Type: research

Management of Eye Trauma for the Primary Care Physician
This article elucidates a methodological approach to eye trauma. The first step is to address any life-threatening conditions. Then a focused history and exam is discussed, starting externally. Then, key history, physical, pathophysiology, and basic management of common, serious eye injuries are discussed: chemical injury, orbital fractures, open globe, traumatic hyphema, retinal detachment, traumatic optic neuropathy, and eyelid laceration. Finally, we highlight the practicality of telemedicine for areas where ophthalmology coverage is lacking.PMID:34535529 | DOI:10.3122/jabfm.2021.05.210121 (Source: American Family Physician)
Source: American Family Physician - September 18, 2021 Category: Primary Care Authors: Jonathan Y Rho Stephen C Dryden Brian M Jerkins Brian T Fowler Source Type: research

PRESSS: A New Patient-Centered Name for an Old Problem
J Am Board Fam Med. 2021 Sep-Oct;34(5):1030-1032. doi: 10.3122/jabfm.2021.05.200647.ABSTRACTThere are many words for what physicians commonly refer to as Somatoform Disorder. However, none is particularly patient-centered; to greater or lesser extent, they are all framed by medical jargon. Based on his experience as a seasoned clinician, the author suggests family physicians consider adopting the word PRESSS-an acronym for "Physical Reaction to Emotional Stress of Some Sort"-when describing and explaining to patients with Somatoform Disorder the cause of their suffering. Using examples from practice, the author n...
Source: American Family Physician - September 18, 2021 Category: Primary Care Authors: William Ventres Source Type: research

One-Third of Family Physicians Remain in Independently Owned Practice, 2017-2019
J Am Board Fam Med. 2021 Sep-Oct;34(5):1033-1034. doi: 10.3122/jabfm.2021.05.210051.ABSTRACTThe rise of health system and hospital ownership of primary care practices raises policy questions about the survival of independent physician-owned practices. Our data indicate that a substantial proportion of FPs in 2017-2019 remained in independently owned practice: 81% of solo practitioners and 35% of FPs in practices with 2-5 clinicians. These findings suggest that independent practice is surviving, and that it's incumbent on researchers, payers, and policymakers to better understand their unique contributions and challenges in...
Source: American Family Physician - September 18, 2021 Category: Primary Care Authors: Diane R Rittenhouse Andrew W Bazemore Zachary J Morgan Lars E Peterson Source Type: research

Alcohol Withdrawal Syndrome: Outpatient Management
Am Fam Physician. 2021 Sep 1;104(3):253-262.ABSTRACTApproximately one-half of patients with alcohol use disorder who abruptly stop or reduce their alcohol use will develop signs or symptoms of alcohol withdrawal syndrome. The syndrome is due to overactivity of the central and autonomic nervous systems, leading to tremors, insomnia, nausea and vomiting, hallucinations, anxiety, and agitation. If untreated or inadequately treated, withdrawal can progress to generalized tonic-clonic seizures, delirium tremens, and death. The three-question Alcohol Use Disorders Identification Test-Consumption and the Single Alcohol Screening ...
Source: American Family Physician - September 15, 2021 Category: Primary Care Authors: Samuel M Tiglao Erica S Meisenheimer Robert C Oh Source Type: research

Using Race with Caution in the ASCVD Calculator
Am Fam Physician. 2021 Sep 1;104(3):292-294.NO ABSTRACTPMID:34523875 (Source: American Family Physician)
Source: American Family Physician - September 15, 2021 Category: Primary Care Authors: Mara Gordon Isha Marina Di Bartolo Source Type: research

Applying a Clinical Prediction Rule to Distinguish Lower Extremity Cellulitis from Its Mimics
Am Fam Physician. 2021 Sep 1;104(3):309-310.NO ABSTRACTPMID:34523876 (Source: American Family Physician)
Source: American Family Physician - September 15, 2021 Category: Primary Care Authors: Lia Pierson Bruner Source Type: research

Hyperpigmentation of the Hands, Feet, and Tongue
Am Fam Physician. 2021 Sep 1;104(3):301-302.NO ABSTRACTPMID:34523877 (Source: American Family Physician)
Source: American Family Physician - September 15, 2021 Category: Primary Care Authors: Jacob Tuttle Shea Giaquinto Source Type: research

Screening for Colorectal Cancer
Am Fam Physician. 2021 Sep 1;104(3):295-296.NO ABSTRACTPMID:34523879 (Source: American Family Physician)
Source: American Family Physician - September 15, 2021 Category: Primary Care Authors: Tina Fan Ruth Stefanos Source Type: research

Diary of a Family Physician
Am Fam Physician. 2021 Sep 1;104(3):313.NO ABSTRACTPMID:34523880 (Source: American Family Physician)
Source: American Family Physician - September 15, 2021 Category: Primary Care Authors: Priscilla Auguste Source Type: research

Efficient Approach to the Evaluation of Syncope
Am Fam Physician. 2021 Sep 1;104(3):305-308.NO ABSTRACTPMID:34523881 (Source: American Family Physician)
Source: American Family Physician - September 15, 2021 Category: Primary Care Authors: Andy Lazris Alan R Roth Helen Haskell John James Source Type: research

Fecal Calprotectin for the Evaluation of Inflammatory Bowel Disease
Am Fam Physician. 2021 Sep 1;104(3):303-304.NO ABSTRACTPMID:34523882 (Source: American Family Physician)
Source: American Family Physician - September 15, 2021 Category: Primary Care Authors: Carl Bryce Merima Bucaj Source Type: research

Hereditary Hemochromatosis: Rapid Evidence Review
Am Fam Physician. 2021 Sep 1;104(3):263-270.ABSTRACTHereditary hemochromatosis is an autosomal recessive disorder that disrupts iron homeostasis, resulting in systemic iron overload. It is the most common inherited disorder among people of northern European ancestry. Despite the high prevalence of the gene mutation, there is a low and variable clinical penetrance. The deposition of excess iron into parenchymal cells leads to cellular dysfunction and the clinical manifestations of the disease. The liver, pancreas, joints, heart, skin, and pituitary gland are the most commonly involved organs. Hereditary hemochromatosis is u...
Source: American Family Physician - September 15, 2021 Category: Primary Care Authors: Shawn F Kane Caroline Roberts Ryan Paulus Source Type: research

Home Blood Pressure Monitoring
Am Fam Physician. 2021 Sep 1;104(3):237-243.ABSTRACTHome blood pressure monitoring provides important diagnostic information beyond in-office blood pressure readings and offers similar results to ambulatory blood pressure monitoring. Home blood pressure monitoring involves patients independently measuring their blood pressure with an electronic device, whereas ambulatory blood pressure monitoring involves patients wearing a portable monitor for 24 to 48 hours. Although ambulatory blood pressure monitoring is the diagnostic standard for measurement, home blood pressure monitoring is more practical and accessible to patients...
Source: American Family Physician - September 15, 2021 Category: Primary Care Authors: Jeffrey M Weinfeld Kathryn M Hart Jose D Vargas Source Type: research

Kawasaki Disease and Multisystem Inflammatory Syndrome in Children: An Overview and Comparison
Am Fam Physician. 2021 Sep 1;104(3):244-252.ABSTRACTKawasaki disease (KD) and multisystem inflammatory syndrome in children (MIS-C) are inflammatory conditions that present diagnostic and therapeutic challenges to the physician. Although many of their features overlap, they are two distinct conditions. KD is a febrile illness most commonly affecting children younger than five years. It manifests with prolonged fever and at least four of the following features: bilateral bulbar conjunctivitis, mucositis, diffuse maculopapular rash, extremity changes, and cervical lymphadenopathy of 1.5 cm or more in diameter. Patients with ...
Source: American Family Physician - September 15, 2021 Category: Primary Care Authors: John B Darby Jennifer M Jackson Source Type: research

Neglected Parasitic Infections: What Family Physicians Need to Know-A CDC Update
Am Fam Physician. 2021 Sep 1;104(3):277-287.ABSTRACTChagas disease, cysticercosis, and toxoplasmosis affect millions of people in the United States and are considered neglected parasitic diseases. Few resources are devoted to their surveillance, prevention, and treatment. Chagas disease, transmitted by kissing bugs, primarily affects people who have lived in Mexico, Central America, and South America, and it can cause heart disease and death if not treated. Chagas disease is diagnosed by detecting the parasite in blood or by serology, depending on the phase of disease. Antiparasitic treatment is indicated for most patients...
Source: American Family Physician - September 15, 2021 Category: Primary Care Authors: Paul T Cantey Susan P Montgomery Anne Straily Source Type: research

Neonatal Abstinence Syndrome: A Call for Mother-Infant Dyad Treatment Approach
Am Fam Physician. 2021 Sep 1;104(3):222-223.NO ABSTRACTPMID:34523889 (Source: American Family Physician)
Source: American Family Physician - September 15, 2021 Category: Primary Care Authors: Roschanak Mossabeb Kevin Sowti Source Type: research

Parasitic Infections: Do Not Neglect Strongyloidiasis
Am Fam Physician. 2021 Sep 1;104(3):224-225.NO ABSTRACTPMID:34523890 (Source: American Family Physician)
Source: American Family Physician - September 15, 2021 Category: Primary Care Authors: Johnnie Yates Source Type: research

Remdesivir (Veklury) for the Treatment of COVID-19 in Hospitalized Patients
Am Fam Physician. 2021 Sep 1;104(3):311-312.NO ABSTRACTPMID:34523893 (Source: American Family Physician)
Source: American Family Physician - September 15, 2021 Category: Primary Care Authors: Shyam Odeti Venkata K Yellepeddi Source Type: research

Splenomegaly: Diagnosis and Management in Adults
Am Fam Physician. 2021 Sep 1;104(3):271-276.ABSTRACTSplenomegaly can be due to several mechanisms but is almost always a sign of a systemic condition. Patient habits, travel, and medical conditions can increase risk of splenomegaly and suggest etiology. Symptoms can suggest infectious, malignant, hepatic, or hematologic causes. Physical examination will typically reveal splenomegaly, but abdominal ultrasonography is recommended for confirmation. Physical examination should also assess for signs of systemic illness, liver disease, and anemia or other hematologic issues. The most common causes of splenomegaly in the United S...
Source: American Family Physician - September 15, 2021 Category: Primary Care Authors: Sommer Aldulaimi Ana M Mendez Source Type: research

Slow-Growing, Painless Periungual Nodule
Am Fam Physician. 2021 Sep 1;104(3):299-300.NO ABSTRACTPMID:34523898 (Source: American Family Physician)
Source: American Family Physician - September 15, 2021 Category: Primary Care Authors: Jay Haynes Corley Pruneda Amanda Hernandez Source Type: research

Comparison of Treatment Regimens for Helicobacter pylori Infection
Am Fam Physician. 2021 Sep 1;104(3):Online.NO ABSTRACTPMID:34523899 (Source: American Family Physician)
Source: American Family Physician - September 15, 2021 Category: Primary Care Authors: Brit Long Michael Gottlieb Source Type: research

Checking Your Blood Pressure at Home
Am Fam Physician. 2021 Sep 1;104(3):Online.NO ABSTRACTPMID:34523901 (Source: American Family Physician)
Source: American Family Physician - September 15, 2021 Category: Primary Care Source Type: research

Cervical Cancer Screening: Updated Guidelines from the American Cancer Society
Am Fam Physician. 2021 Sep 1;104(3):314-315.NO ABSTRACTPMID:34523873 (Source: American Family Physician)
Source: American Family Physician - September 15, 2021 Category: Primary Care Authors: Priscilla Auguste Source Type: research

Alcohol Withdrawal Syndrome: Outpatient Management
Am Fam Physician. 2021 Sep 1;104(3):253-262.ABSTRACTApproximately one-half of patients with alcohol use disorder who abruptly stop or reduce their alcohol use will develop signs or symptoms of alcohol withdrawal syndrome. The syndrome is due to overactivity of the central and autonomic nervous systems, leading to tremors, insomnia, nausea and vomiting, hallucinations, anxiety, and agitation. If untreated or inadequately treated, withdrawal can progress to generalized tonic-clonic seizures, delirium tremens, and death. The three-question Alcohol Use Disorders Identification Test-Consumption and the Single Alcohol Screening ...
Source: American Family Physician - September 15, 2021 Category: Primary Care Authors: Samuel M Tiglao Erica S Meisenheimer Robert C Oh Source Type: research

Using Race with Caution in the ASCVD Calculator
Am Fam Physician. 2021 Sep 1;104(3):292-294.NO ABSTRACTPMID:34523875 (Source: American Family Physician)
Source: American Family Physician - September 15, 2021 Category: Primary Care Authors: Mara Gordon Isha Marina Di Bartolo Source Type: research

Applying a Clinical Prediction Rule to Distinguish Lower Extremity Cellulitis from Its Mimics
Am Fam Physician. 2021 Sep 1;104(3):309-310.NO ABSTRACTPMID:34523876 (Source: American Family Physician)
Source: American Family Physician - September 15, 2021 Category: Primary Care Authors: Lia Pierson Bruner Source Type: research

Hyperpigmentation of the Hands, Feet, and Tongue
Am Fam Physician. 2021 Sep 1;104(3):301-302.NO ABSTRACTPMID:34523877 (Source: American Family Physician)
Source: American Family Physician - September 15, 2021 Category: Primary Care Authors: Jacob Tuttle Shea Giaquinto Source Type: research

Chronic Musculoskeletal Pain, NAFLD, Peripheral Neuropathy, Myocardial Infarction
Am Fam Physician. 2021 Sep 1;104(3):232.NO ABSTRACTPMID:34523878 (Source: American Family Physician)
Source: American Family Physician - September 15, 2021 Category: Primary Care Source Type: research

Screening for Colorectal Cancer
Am Fam Physician. 2021 Sep 1;104(3):295-296.NO ABSTRACTPMID:34523879 (Source: American Family Physician)
Source: American Family Physician - September 15, 2021 Category: Primary Care Authors: Tina Fan Ruth Stefanos Source Type: research

Diary of a Family Physician
Am Fam Physician. 2021 Sep 1;104(3):313.NO ABSTRACTPMID:34523880 (Source: American Family Physician)
Source: American Family Physician - September 15, 2021 Category: Primary Care Authors: Priscilla Auguste Source Type: research

Efficient Approach to the Evaluation of Syncope
Am Fam Physician. 2021 Sep 1;104(3):305-308.NO ABSTRACTPMID:34523881 (Source: American Family Physician)
Source: American Family Physician - September 15, 2021 Category: Primary Care Authors: Andy Lazris Alan R Roth Helen Haskell John James Source Type: research

Fecal Calprotectin for the Evaluation of Inflammatory Bowel Disease
Am Fam Physician. 2021 Sep 1;104(3):303-304.NO ABSTRACTPMID:34523882 (Source: American Family Physician)
Source: American Family Physician - September 15, 2021 Category: Primary Care Authors: Carl Bryce Merima Bucaj Source Type: research

Hereditary Hemochromatosis: Rapid Evidence Review
Am Fam Physician. 2021 Sep 1;104(3):263-270.ABSTRACTHereditary hemochromatosis is an autosomal recessive disorder that disrupts iron homeostasis, resulting in systemic iron overload. It is the most common inherited disorder among people of northern European ancestry. Despite the high prevalence of the gene mutation, there is a low and variable clinical penetrance. The deposition of excess iron into parenchymal cells leads to cellular dysfunction and the clinical manifestations of the disease. The liver, pancreas, joints, heart, skin, and pituitary gland are the most commonly involved organs. Hereditary hemochromatosis is u...
Source: American Family Physician - September 15, 2021 Category: Primary Care Authors: Shawn F Kane Caroline Roberts Ryan Paulus Source Type: research

Home Blood Pressure Monitoring
Am Fam Physician. 2021 Sep 1;104(3):237-243.ABSTRACTHome blood pressure monitoring provides important diagnostic information beyond in-office blood pressure readings and offers similar results to ambulatory blood pressure monitoring. Home blood pressure monitoring involves patients independently measuring their blood pressure with an electronic device, whereas ambulatory blood pressure monitoring involves patients wearing a portable monitor for 24 to 48 hours. Although ambulatory blood pressure monitoring is the diagnostic standard for measurement, home blood pressure monitoring is more practical and accessible to patients...
Source: American Family Physician - September 15, 2021 Category: Primary Care Authors: Jeffrey M Weinfeld Kathryn M Hart Jose D Vargas Source Type: research

Kawasaki Disease and Multisystem Inflammatory Syndrome in Children: An Overview and Comparison
Am Fam Physician. 2021 Sep 1;104(3):244-252.ABSTRACTKawasaki disease (KD) and multisystem inflammatory syndrome in children (MIS-C) are inflammatory conditions that present diagnostic and therapeutic challenges to the physician. Although many of their features overlap, they are two distinct conditions. KD is a febrile illness most commonly affecting children younger than five years. It manifests with prolonged fever and at least four of the following features: bilateral bulbar conjunctivitis, mucositis, diffuse maculopapular rash, extremity changes, and cervical lymphadenopathy of 1.5 cm or more in diameter. Patients with ...
Source: American Family Physician - September 15, 2021 Category: Primary Care Authors: John B Darby Jennifer M Jackson Source Type: research

Melatonin to Treat Insomnia in Older Adults
Am Fam Physician. 2021 Sep 1;104(3):297-298.NO ABSTRACTPMID:34523886 (Source: American Family Physician)
Source: American Family Physician - September 15, 2021 Category: Primary Care Authors: Jon O Neher Anna Goebel Diana K N Louden Source Type: research

In Older Adults, Aspirin Increases the Risk of Metastatic or Stage 4 Cancers and Cancer Mortality
Am Fam Physician. 2021 Sep 1;104(3):Online.NO ABSTRACTPMID:34523887 (Source: American Family Physician)
Source: American Family Physician - September 15, 2021 Category: Primary Care Authors: Henry C Barry Source Type: research

Neglected Parasitic Infections: What Family Physicians Need to Know-A CDC Update
Am Fam Physician. 2021 Sep 1;104(3):277-287.ABSTRACTChagas disease, cysticercosis, and toxoplasmosis affect millions of people in the United States and are considered neglected parasitic diseases. Few resources are devoted to their surveillance, prevention, and treatment. Chagas disease, transmitted by kissing bugs, primarily affects people who have lived in Mexico, Central America, and South America, and it can cause heart disease and death if not treated. Chagas disease is diagnosed by detecting the parasite in blood or by serology, depending on the phase of disease. Antiparasitic treatment is indicated for most patients...
Source: American Family Physician - September 15, 2021 Category: Primary Care Authors: Paul T Cantey Susan P Montgomery Anne Straily Source Type: research

Neonatal Abstinence Syndrome: A Call for Mother-Infant Dyad Treatment Approach
Am Fam Physician. 2021 Sep 1;104(3):222-223.NO ABSTRACTPMID:34523889 (Source: American Family Physician)
Source: American Family Physician - September 15, 2021 Category: Primary Care Authors: Roschanak Mossabeb Kevin Sowti Source Type: research

Parasitic Infections: Do Not Neglect Strongyloidiasis
Am Fam Physician. 2021 Sep 1;104(3):224-225.NO ABSTRACTPMID:34523890 (Source: American Family Physician)
Source: American Family Physician - September 15, 2021 Category: Primary Care Authors: Johnnie Yates Source Type: research

Pelvic Floor Muscle Training to Prevent and Treat Urinary and Fecal Incontinence in Antenatal and Postnatal Patients
Am Fam Physician. 2021 Sep 1;104(3):234-235.NO ABSTRACTPMID:34523891 (Source: American Family Physician)
Source: American Family Physician - September 15, 2021 Category: Primary Care Authors: Pamela Vnenchak Source Type: research

The Risk of Progression from Prediabetes to Diabetes in Older Adults Is Low
Am Fam Physician. 2021 Sep 1;104(3):Online.NO ABSTRACTPMID:34523892 (Source: American Family Physician)
Source: American Family Physician - September 15, 2021 Category: Primary Care Authors: Allen F Shaughnessy Source Type: research

Remdesivir (Veklury) for the Treatment of COVID-19 in Hospitalized Patients
Am Fam Physician. 2021 Sep 1;104(3):311-312.NO ABSTRACTPMID:34523893 (Source: American Family Physician)
Source: American Family Physician - September 15, 2021 Category: Primary Care Authors: Shyam Odeti Venkata K Yellepeddi Source Type: research

Take-and-Hold Prescriptions for Children with Respiratory Tract Infections Decrease Antibiotic Use with Similar Outcomes
Am Fam Physician. 2021 Sep 1;104(3):Online.NO ABSTRACTPMID:34523894 (Source: American Family Physician)
Source: American Family Physician - September 15, 2021 Category: Primary Care Authors: Allen F Shaughnessy Source Type: research

Reducing Saturated Fat Intake to Decrease the Risk of Cardiovascular Disease
Am Fam Physician. 2021 Sep 1;104(3):235-236.NO ABSTRACTPMID:34523895 (Source: American Family Physician)
Source: American Family Physician - September 15, 2021 Category: Primary Care Authors: Drew Baird Vanessa Rivera Source Type: research

Epidural Corticosteroid Injections Provide Minimal, If Any, Benefit in Low Back Pain with Sciatica
Am Fam Physician. 2021 Sep 1;104(3):Online.NO ABSTRACTPMID:34523896 (Source: American Family Physician)
Source: American Family Physician - September 15, 2021 Category: Primary Care Authors: Mark H Ebell Source Type: research

Splenomegaly: Diagnosis and Management in Adults
Am Fam Physician. 2021 Sep 1;104(3):271-276.ABSTRACTSplenomegaly can be due to several mechanisms but is almost always a sign of a systemic condition. Patient habits, travel, and medical conditions can increase risk of splenomegaly and suggest etiology. Symptoms can suggest infectious, malignant, hepatic, or hematologic causes. Physical examination will typically reveal splenomegaly, but abdominal ultrasonography is recommended for confirmation. Physical examination should also assess for signs of systemic illness, liver disease, and anemia or other hematologic issues. The most common causes of splenomegaly in the United S...
Source: American Family Physician - September 15, 2021 Category: Primary Care Authors: Sommer Aldulaimi Ana M Mendez Source Type: research