Current acute coronary syndrome (ACS) protocols recommend against the administration of nitroglycerin to patients with inferior ST-elevation myocardial infarction (STEMI). Due to nitroglycerin's vasodilatory effects, whi...Current acute coronary syndrome (ACS) protocols recommend against the administration of nitroglycerin to patients with inferior ST-elevation myocardial infarction (STEMI). Due to nitroglycerin's vasodilatory effects, which decrease preload and cardiac output, protocols warn of a possible critical drop in blood pressure with the drug's use that could be detrimental to patients with inferior STEMI. Research has shown, however, that nitroglycerin-induced hypotension occurs at similar rates in both inferior STEMI and non-inferior STEMI. Rather than the location of the culprit lesion, the development of hypotension depends on individual patient epidemiologic factors. An amendment to current ACS protocols for patients with inferior STEMI is warranted to reflect nitroglycerin's benefits in the preservation of myocardial function. Removing this barrier to the care of inferior STEMI would lead to therapeutic relief and improve patient survival overall.
Hemorrhage is a leading preventable cause of trauma-related death. Early hemorrhage control and resuscitation with blood products are both critical for survival. The use of whole blood and low-titer type O blood has been...Hemorrhage is a leading preventable cause of trauma-related death. Early hemorrhage control and resuscitation with blood products are both critical for survival. The use of whole blood and low-titer type O blood has been shown to reduce overall transfusion volume, mitigating the effects of dilutional coagulopathy. Historically, Rh(D)-negative blood products have been prioritized for people of childbearing potential given the feared risk of alloimmunization and hemolytic disease of the fetus and newborn. However, the survival benefit of whole blood resuscitation seems to outweigh the estimated risks associated with sensitization, although no prospectively collected data provide a definitive solution to this ongoing health equity and ethical dilemma.
Sexual health is an important indicator of one's overall well-being and quality of life. Although sexual dysfunction can significantly impact women, it is often underreported and underdiscussed in routine clinical encoun...Sexual health is an important indicator of one's overall well-being and quality of life. Although sexual dysfunction can significantly impact women, it is often underreported and underdiscussed in routine clinical encounters. This article provides an overview of female sexual dysfunction, including its classifications, risk factors, pathophysiology, symptoms, screening, and diagnosis. It also highlights emerging and established treatment options for affected patients.
Pediatric vaccination rates are declining in the United States, with the Centers for Disease Control and Prevention (CDC) reporting decreases in immunization coverage against measles-mumps-rubella (MMR), diphtheria-tetan...Pediatric vaccination rates are declining in the United States, with the Centers for Disease Control and Prevention (CDC) reporting decreases in immunization coverage against measles-mumps-rubella (MMR), diphtheria-tetanus-acellular pertussis (DTaP), polio, and varicella. The recent measles outbreaks have resulted in tragic outcomes, highlighting the urgent need for clinician concern and proactive measures to prevent illness, hospitalizations, missed school and caregiver workdays, and deaths. According to the World Health Organization, MMR vaccination rates below 95% compromise herd immunity, increasing the risk of sustained outbreaks. This article reviews the decreasing rates of pediatric vaccine uptake and the measles outbreak; examines the role of health and vaccine literacy in shaping parental decision-making amid these crises; and explores factors contributing to disparities in vaccination rates including ethnicity, residence location, and birth country. Finally, it outlines strategies primary care clinicians can use to improve pediatric vaccination rates and summarizes CDC and American Academy of Pediatrics recommendations aimed at reducing morbidity and mortality from vaccine-preventable diseases.
Menopause is often accompanied by vasomotor symptoms that negatively impact daily functioning and overall well-being. Hormone therapy remains the gold standard for relief; however, contraindications and patient preferenc...Menopause is often accompanied by vasomotor symptoms that negatively impact daily functioning and overall well-being. Hormone therapy remains the gold standard for relief; however, contraindications and patient preferences may limit its use. To address this gap, nonhormonal therapies have been developed and investigated. Two newer options, fezolinetant and elinzanetant, directly target hypothalamic pathways involved in thermoregulation through modulation of neurokinin B. Clinical studies of these selective neurokinin B receptor antagonists demonstrate reduced frequency of vasomotor symptoms with their use, positioning them as promising options for individuals who are unable or unwilling to pursue hormone-based treatment.
This study examines patient and provider perceptions of nutrition risk, compares these perceptions with objective measures, and suggests practices to support improved nutrition-related health outcomes. Using observationa...This study examines patient and provider perceptions of nutrition risk, compares these perceptions with objective measures, and suggests practices to support improved nutrition-related health outcomes. Using observational methods, surveys were disseminated to uninsured, low-income patients (N = 150) and providers (N = 5) to assess diet quality, malnutrition risk, and food insecurity. Analyses, which used descriptive statistics and Spearman's Rho correlations, included three objective nutrition risk indicator scores based on validated tools, perceptions of nutrition risk, and perceptions of nutrition risk indicator impact on overall nutrition risk. Patient perceptions of nutrition risk correlated with objective measures: diet quality, malnutrition risk, and food insecurity. Provider perception of nutrition risk indicators correlated only with objective malnutrition risk. No correlation was observed between provider- and patient-perceived nutrition risk. Patients identified nutrition risk indicators more effectively than providers. Patient care and PA education may be improved through use of tools to identify and address nutrition risk indicators.
OBJECTIVES: Gestational diabetes is a common complication of pregnancy. Its management requires diabetes expertise, prompt assessment, and frequent follow-up, all of which increasingly strains already overburdened specia...OBJECTIVES: Gestational diabetes is a common complication of pregnancy. Its management requires diabetes expertise, prompt assessment, and frequent follow-up, all of which increasingly strains already overburdened specialty clinics. We aimed to assess the safety and effectiveness of a physician associate (PA)-led gestational diabetes clinic. METHODS: We conducted a retrospective cohort study comparing outcomes between a PA-led interdisciplinary team clinic with a physician-led interdisciplinary team clinic. RESULTS: After adjustment for differences in patient characteristics, maternal and neonatal outcomes were comparable between the clinic models. Initiation of pharmacotherapy was lower in the PA-led clinic group (adjusted odds ratio 0.19; 95% CI, 0.11-0.31), likely due to differences in referral triage process. CONCLUSIONS: The PA was able to manage half of the gestational diabetes referrals during the study period while maintaining a high level of care.
OBJECTIVE: This study aimed to evaluate the rates of depression screening between patient groups at an academic medical center (AMC)-associated family medicine clinic (FMC) that adopted universal annual depression screen...OBJECTIVE: This study aimed to evaluate the rates of depression screening between patient groups at an academic medical center (AMC)-associated family medicine clinic (FMC) that adopted universal annual depression screening. METHODS: This study is a retrospective data analysis of electronic health records for patients seen within the AMC health system between June 1, 2021, and December 31, 2022, and whose assigned primary care provider practiced at the FMC. The demographic groups of interest were race, ethnicity, language preference, and insurance status. RESULTS: Of the 12,428 patients included, 78.7% were 30 years of age or older, 59.9% identified as female, 82.9% as White, and 88.7% as not Hispanic or Latino/a/x; 97.2% preferred English and 72.3% had commercial insurance. Patients were less likely to be screened if they identified as male, identified as a non-White race, had a non-English language preference, or were uninsured. CONCLUSION: Focused interventions are needed to address the disparities in depression screening rates among these groups.
Obesity is a complex, multifactorial disease. Rates of obesity are rising worldwide. Bariatric surgery is the most effective treatment for obesity, as it results in the greatest weight loss as well as significant improve...Obesity is a complex, multifactorial disease. Rates of obesity are rising worldwide. Bariatric surgery is the most effective treatment for obesity, as it results in the greatest weight loss as well as significant improvement in or resolution of obesity-related comorbidities. Despite the efficacy of bariatric surgery, postoperative weight gain is a reality for up to 37% of patients. Significant weight regain is associated with recurrence or worsening of comorbidities as well as reduced quality of life. Early identification of those at risk and prompt intervention can minimize the amount of postoperative weight regain. Reinforcing lifestyle modifications, assessing mental health, and scheduling frequent office visits are necessary to minimize weight regain. Phentermine/topiramate, the glucagon-like peptide-1 (GLP-1) receptor agonists liraglutide and semaglutide, and the dual incretin tirzepatide are effective for treating postoperative weight regain. Referral to a bariatric surgeon may be indicated for those needing surgical revision. Further research is necessary to create a formal clinical treatment guideline for identifying and managing weight regain after bariatric surgery.
Ulcerative colitis (UC) is a type of chronic, relapsing inflammatory bowel disease (IBD) characterized by mucosal inflammation of the colon and rectum. Symptoms such as bloody diarrhea, abdominal pain, and fecal urgency...Ulcerative colitis (UC) is a type of chronic, relapsing inflammatory bowel disease (IBD) characterized by mucosal inflammation of the colon and rectum. Symptoms such as bloody diarrhea, abdominal pain, and fecal urgency significantly affect patient quality of life. Early recognition of UC is critical to facilitate specialist referral and initiate management. Recent advances in the therapeutic landscape include the introduction of novel biologic agents, small molecules, and biosimilars, which have expanded access to effective and affordable treatment options. Clinicians must remain informed of updates and indications for both pharmacologic and nonpharmacologic interventions, as treatment selection is based on disease severity, location, and individualized patient needs. Adjunctive therapies also play a role in comprehensive care and health maintenance. Optimizing therapy is essential for inducing and maintaining remission, promoting mucosal healing, and preventing disease progression. A multidisciplinary approach, involving primary care clinicians, gastroenterologists, colorectal surgeons, dietitians, and mental health professionals, is essential for delivering individualized care and improving long-term outcomes.
Psychodermatology examines the relationship between psychological factors and skin conditions. This overview introduces clinicians to key psychodermatologic disorders and their theoretical foundations, clinical presentat...Psychodermatology examines the relationship between psychological factors and skin conditions. This overview introduces clinicians to key psychodermatologic disorders and their theoretical foundations, clinical presentations, and treatment approaches. Although theoretical support for various treatments is abundant, randomized controlled trials are limited due to funding challenges for generic medications. Despite this limitation, this article presents the most valuable and widely used treatment options for these conditions.