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Medicine by the numbers

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Mildly Elevated Liver Transaminase Levels: Causes and Evaluation - American Family ...

Dec 1, 2017 - Mild, asymptomatic elevations (less than five times the upper limit of normal) of alanine transaminase and aspartate transaminase levels are common in primary care. It is estimated that approximately 10% of the U.S. population has elevated transaminase levels. An approach based on the ...

American Family Physician : Article

https://www.aafp.org/afp/2017/1201/p709.html

Syncope: Evaluation and Differential Diagnosis - American Family Physician

Mar 1, 2017 - Syncope is an abrupt and transient loss of consciousness caused by cerebral hypoperfusion. It accounts for 1% to 1.5% of emergency department visits, resulting in high hospital admission rates and significant medical costs. Syncope is classified as neurally mediated, cardiac, and ...

American Family Physician : Article

https://www.aafp.org/afp/2017/0301/p303.html

Evaluation of Suspected Dementia - American Family Physician

Mar 15, 2018 - Dementia is a significant and costly health condition that affects 5 million adults and is the fifth leading cause of death among Americans older than 65 years. The prevalence of dementia will likely increase in the future because the number of Americans older than 65 years is expected ...

American Family Physician : Article

https://www.aafp.org/afp/2018/0315/p398.html

The Adult Well-Male Examination - American Family Physician

Dec 15, 2018 - The adult well-male examination should provide evidence-based guidance toward the promotion of optimal health and well-being. The medical history should focus on tobacco and alcohol use, risk of human immunodeficiency virus and other sexually transmitted infections, and diet and ...

American Family Physician : Article

https://www.aafp.org/afp/2018/1215/p729.html

Palpitations: Evaluation in the Primary Care Setting - American Family Physician

Dec 15, 2017 - Palpitations are a common problem in the ambulatory primary care setting, and cardiac causes are the most concerning etiology. Psychiatric illness, adverse effects of prescription and over-the-counter medications, and substance use should also be considered. Distinguishing cardiac from ...

American Family Physician : Article

https://www.aafp.org/afp/2017/1215/p784.html

Vitamin D Screening and Supplementation in Community-Dwelling Adults: Common Questions ...

Feb 15, 2018 - Measurement of vitamin D levels and supplementation with oral vitamin D have become commonplace, although clinical trials have not demonstrated health benefits. The usefulness of serum 25-hydroxyvitamin D levels to assess adequate exposure to vitamin D is hampered by variations in ...

American Family Physician : Article

https://www.aafp.org/afp/2018/0215/p254.html

Chronic Kidney Disease: Detection and Evaluation - American Family Physician

Dec 15, 2017 - Chronic kidney disease affects 47 million people in the United States and is associated with significant health care costs, morbidity, and mortality. Because this disease can silently progress to advanced stages, early detection is critical for initiating timely interventions. Multiple ...

American Family Physician : Article

https://www.aafp.org/afp/2017/1215/p776.html

Acute Coronary Syndrome: Diagnostic Evaluation - American Family Physician

Feb 1, 2017 - Myocardial infarction (MI), a subset of acute coronary syndrome, is damage to the cardiac muscle as evidenced by elevated cardiac troponin levels in the setting of acute ischemia. Coronary artery disease is the leading cause of mortality in the United States. Chest pain is a common ...

American Family Physician : Article

https://www.aafp.org/afp/2017/0201/p170.html

Evaluation of the Solitary Pulmonary Nodule - American Family Physician

Dec 15, 2015 - A solitary pulmonary nodule is a common radiologic finding that is often discovered incidentally and may require significant workup to establish a definitive diagnosis. A solitary pulmonary nodule is a well-circumscribed round lesion measuring up to 3 cm in diameter and surrounded by ...

American Family Physician : Article

https://www.aafp.org/afp/2015/1215/p1084.html

Urine Drug Tests: Ordering and Interpreting Results - American Family Physician

Jan 1, 2019 - Urine drug testing is an essential component of monitoring patients who are receiving long-term opioid therapy, and it has been suggested for patients receiving long-term benzodiazepine or stimulant therapy. Family physicians should be familiar with the characteristics and capabilities ...

American Family Physician : Article

https://www.aafp.org/afp/2019/0101/p33.html

Assessment of Asymptomatic Microscopic Hematuria in Adults - American Family Physician

Dec 1, 2013 - Although routine screening for bladder cancer is not recommended, microscopic hematuria is often incidentally discovered by primary care physicians. The American Urological Association has published an updated guideline for the management of asymptomatic microscopic hematuria, which is ...

American Family Physician : Article

https://www.aafp.org/afp/2013/1201/p747.html

Flexible Sigmoidoscopy or Fecal Occult Blood Testing for Colorectal Cancer Screening in...

Aug 1, 2019 - This meta-analysis provides high-quality evidence that flexible sigmoidoscopy and fecal occult blood testing both reduce the risk of death from colorectal cancer. The study did not provide a clear answer regarding a superior screening modality, so the decision to choose one test over ...

American Family Physician : Medicine by the Numbers

https://www.aafp.org/afp/2019/0801/od1.html

Preoperative Assessment in Older Adults: A Comprehensive Approach - American Family ...

Aug 15, 2018 - Surgical outcomes are significantly influenced by patients’ overall health, function, and life expectancy. A comprehensive geriatric preoperative assessment of older adults requires expanding beyond an organ-based or disease-based assessment. At a preoperative visit, it is important to ...

American Family Physician : Article

https://www.aafp.org/afp/2018/0815/p214.html

Primary Care for Persons Who Inject Drugs - American Family Physician

Jan 15, 2019 - More than 750,000 persons in the United States inject opioids, methamphetamine, cocaine, or ketamine, and that number is increasing because of the current opioid epidemic. Persons who inject drugs (PWID) are at higher risk of infectious and noninfectious skin, pulmonary, cardiac, ...

American Family Physician : Article

https://www.aafp.org/afp/2019/0115/p109.html

Colorectal Cancer Screening and Surveillance in Individuals at Increased Risk - ...

Jan 15, 2018 - Individuals at increased risk of developing colorectal cancer include those with a personal or family history of advanced adenomas or colorectal cancer, a personal history of inflammatory bowel disease, or genetic polyposis syndromes. In general, these persons should undergo more ...

American Family Physician : Article

https://www.aafp.org/afp/2018/0115/p111.html

Hoarseness in Adults - American Family Physician

Dec 1, 2017 - Hoarseness is a common presentation in primary care practices. Combined with other voice-related changes, it falls under the umbrella diagnosis of dysphonia. Hoarseness has a number of causes, ranging from simple inflammatory processes to less common psychiatric disorders to more ...

American Family Physician : Article

https://www.aafp.org/afp/2017/1201/p720.html

Unintentional Weight Loss in Older Adults - American Family Physician

May 1, 2014 - Unintentional weight loss in persons older than 65 years is associated with increased morbidity and mortality. The most common etiologies are malignancy, nonmalignant gastrointestinal disease, and psychiatric conditions. Overall, nonmalignant diseases are more common causes of ...

American Family Physician : Article

https://www.aafp.org/afp/2014/0501/p718.html

The Adult Well Male Examination - American Family Physician

May 15, 2012 - The adult well male examination should incorporate evidence-based guidance toward the promotion of optimal health and well-being, including screening tests shown to improve health outcomes. Nearly one-third of men report not having a primary care physician. The medical history should ...

American Family Physician : Article

https://www.aafp.org/afp/2012/0515/p964.html

Colorectal Cancer Screening and Prevention - American Family Physician

May 15, 2018 - Colorectal cancer is a common cause of morbidity and mortality in the United States. Most colorectal cancers arise from preexisting adenomatous or serrated polyps. The incidence and mortality of colorectal cancer can be reduced with screening of average-risk adults 50 to 75 years of ...

American Family Physician : Article

https://www.aafp.org/afp/2018/0515/p658.html

Chronic Pelvic Pain in Women - American Family Physician

Mar 1, 2016 - Chronic pelvic pain in women is defined as persistent, noncyclic pain perceived to be in structures related to the pelvis and lasting more than six months. Often no specific etiology can be identified, and it can be conceptualized as a chronic regional pain syndrome or functional ...

American Family Physician : Article

https://www.aafp.org/afp/2016/0301/p380.html

Neuropsychological Evaluations in Adults - American Family Physician

Jan 15, 2019 - Neuropsychologists provide detailed assessments of cognitive and emotional functioning that often cannot be obtained through other diagnostic means. They use standardized assessment tools and integrate the findings with other data to determine whether cognitive decline has occurred, to ...

American Family Physician : Article

https://www.aafp.org/afp/2019/0115/p101.html

Approach to Acute Headache in Adults - American Family Physician

May 15, 2013 - Approximately one-half of the adult population worldwide is affected by a headache disorder. The International Headache Society classification and diagnostic criteria can help physicians differentiate primary headaches (e.g., tension, migraine, cluster) from secondary headaches (e.g., ...

American Family Physician : Article

https://www.aafp.org/afp/2013/0515/p682.html

Screening for Cancer: Concepts and Controversies - American Family Physician

Nov 1, 2014 - Early detection of cancer is a core task in family medicine, and patients have come to expect screening tests, sometimes out of proportion to what evidence can justify. To understand the controversies surrounding screening and to provide sound advice to patients, family physicians ...

American Family Physician : Article

https://www.aafp.org/afp/2014/1101/p625.html

Detecting Elder Abuse and Neglect: Assessment and Intervention - American Family Physician

Mar 15, 2014 - Elder mistreatment includes intentional or neglectful acts by a caregiver or trusted person that harm a vulnerable older person. It can occur in a variety of settings. One out of 10 older adults experiences some form of abuse or neglect by a caregiver each year, and the incidence is ...

American Family Physician : Article

https://www.aafp.org/afp/2014/0315/p453.html

Disability Evaluations: More Than Completing a Form - American Family Physician

Jan 15, 2015 - According to the World Health Organization, more than 1 billion persons worldwide have a disability. In the United States, more than 56 million American workers have some form of disability; of these, more than 38 million persons have a severe disability. Blacks and Hispanics are among ...

American Family Physician : Article

https://www.aafp.org/afp/2015/0115/p102.html

Prostate Cancer Screening - American Family Physician

Oct 15, 2015 - Among American men, prostate cancer is the most commonly diagnosed cancer and the second leading cause of cancer-related death. Although prostate-specific antigen (PSA) testing has been used to screen for prostate cancer for more than 25 years, the test has low sensitivity and ...

American Family Physician : Article

https://www.aafp.org/afp/2015/1015/p683.html

Health Maintenance in Postmenopausal Women - American Family Physician

May 1, 2017 - Cardiovascular disease is the leading cause of death and disability in postmenopausal women older than 50 years. Clinicians should use the pooled cohort risk assessment equations or another risk calculator every three to five years to estimate a woman’s 10-year risk of atherosclerotic ...

American Family Physician : Article

https://www.aafp.org/afp/2017/0501/p561.html

Evaluation of Nausea and Vomiting: A Case-Based Approach - American Family Physician

Sep 15, 2013 - In the absence of acute abdominal pain, significant headache, or recent initiation of certain medications, acute nausea and vomiting is usually the result of self-limited gastrointestinal infections. Nausea and vomiting is also a common adverse effect of radiation therapy, chemotherapy,...

American Family Physician : Article

https://www.aafp.org/afp/2013/0915/p371.html

Diagnostic Approach to Chronic Constipation in Adults - American Family Physician

Aug 1, 2011 - Constipation is traditionally defined as three or fewer bowel movements per week. Risk factors for constipation include female sex, older age, inactivity, low caloric intake, low-fiber diet, low income, low educational level, and taking a large number of medications. Chronic ...

American Family Physician : Article

https://www.aafp.org/afp/2011/0801/p299.html

Health Maintenance in Women - American Family Physician

Jan 1, 2013 - The health maintenance examination is an opportunity to focus on disease prevention and health promotion. The patient history should include screening for tobacco use, alcohol misuse, intimate partner violence, and depression. Premenopausal women should receive preconception counseling ...

American Family Physician : Article

https://www.aafp.org/afp/2013/0101/p30.html

Cancer Screening in Older Patients - American Family Physician

Apr 15, 2016 - Although cancer is the second leading cause of death among persons 65 years and older, there is a paucity of clinical trial data about the effectiveness and harms of cancer screening in this population. Given the heterogeneous nature of the older population, cancer screening in these ...

American Family Physician : Article

https://www.aafp.org/afp/2016/0415/p659.html

Diagnostic Imaging of Acute Abdominal Pain in Adults - American Family Physician

Apr 1, 2015 - Acute abdominal pain is a common presentation in the outpatient setting and can represent conditions ranging from benign to life-threatening. If the patient history, physical examination, and laboratory testing do not identify an underlying cause of pain and if serious pathology remains...

American Family Physician : Article

https://www.aafp.org/afp/2015/0401/p452.html

Diagnostic Approach to Pleural Effusion in Adults - American Family Physician

Apr 1, 2006 - The first step in the evaluation of patients with pleural effusion is to determine whether the effusion is a transudate or an exudate. An exudative effusion is diagnosed if the patient meets Light's criteria. The serum to pleural fluid protein or albumin gradients may help better ...

American Family Physician : Article

https://www.aafp.org/afp/2006/0401/p1211.html

Preventive Health Care for Men Who Have Sex with Men - American Family Physician

Jun 15, 2015 - Men who have sex with men (MSM) comprise at least 4% of males in the United States. MSM may describe themselves as gay, bisexual, or heterosexual. Because current medical practice does not always facilitate discussion of sexual behaviors, this group of men may face barriers to receiving...

American Family Physician : Article

https://www.aafp.org/afp/2015/0615/p844.html

PSA Screening for Prostate Cancer - Medicine by the Numbers - American Family Physician

May 1, 2015 - Studies show no deaths were prevented and 1 in 5 underwent a prostate biopsy for a false-positive test. Read more.

American Family Physician : Medicine by the Numbers

https://www.aafp.org/afp/2015/0501/od3.html

Common Breast Problems - American Family Physician

Aug 15, 2012 - A palpable mass, mastalgia, and nipple discharge are common breast symptoms for which patients seek medical attention. Patients should be evaluated initially with a detailed clinical history and physical examination. Most women presenting with a breast mass will require imaging and ...

American Family Physician : Article

https://www.aafp.org/afp/2012/0815/p343.html

Breast Cancer Screening Update - American Family Physician

Feb 15, 2013 - Breast cancer is the most common non–skin cancer and the second leading cause of cancer death in North American women. Mammography is the only screening test shown to reduce breast cancer–related mortality. There is general agreement that screening should be offered at least biennially ...

American Family Physician : Article

https://www.aafp.org/afp/2013/0215/p274.html

The Case Against Coronary Artery Calcium Scoring for Cardiovascular Disease Risk ...

Dec 15, 2019 - Although coronary artery calcium testing may slightly improve future risk prediction, this theoretical benefit is outweighed by its potential harms.

American Family Physician : Editorials

https://www.aafp.org/afp/2019/1215/p734.html

Applying a Clinical Decision Rule for CAD in Primary Care to Select a Diagnostic Test ...

May 1, 2019 - Using the INTERCHEST chest pain decision rule to decide next steps when a patient presents to a primary care physician with chest pain.

American Family Physician : Point-of-Care Guides

https://www.aafp.org/afp/2019/0501/p584.html

Approach to the Adult Patient with Fever of Unknown Origin - American Family Physician

Dec 1, 2003 - Fever of unknown origin (FUO) in adults is defined as a temperature higher than 38.3 degrees C (100.9 degrees F) that lasts for more than three weeks with no obvious source despite appropriate investigation. The four categories of potential etiology of FUO are classic, nosocomial, ...

American Family Physician : Article

https://www.aafp.org/afp/2003/1201/p2223.html

Diagnosis of Chronic Obstructive Pulmonary Disease - American Family Physician

Jul 1, 2008 - Chronic obstructive pulmonary disease affects more than 26 million adults in the United States. Family physicians provide care for most of these patients. Cigarette smoking is the leading risk factor for chronic obstructive pulmonary disease, although other risk factors, including ...

American Family Physician : Article

https://www.aafp.org/afp/2008/0701/p87.html

Initial Evaluation of the Patient with Suspected Dementia - American Family Physician

May 1, 2005 - Dementia is a common disorder among older persons, and projections indicate that the number of patients with dementia in the United States will continue to grow. Alzheimer's disease and vascular dementia account for the majority of cases of dementia. After a thorough history and ...

American Family Physician : Article

https://www.aafp.org/afp/2005/0501/p1745.html

Diagnosis of Acute Abdominal Pain in Older Patients - American Family Physician

Nov 1, 2006 - Acute abdominal pain is a common presenting complaint in older patients. Presentation may differ from that of the younger patient and is often complicated by coexistent disease, delays in presentation, and physical and social barriers. The physical examination can be misleadingly ...

American Family Physician : Article

https://www.aafp.org/afp/2006/1101/p1537.html

Mini-Mental State Examination for the Detection of Dementia in Older Patients - ...

Dec 1, 2016 - When scores are adjusted based on a patient's education level, the MMSE may be useful to rule out a diagnosis of dementia in clinically unevaluated patients 65 years and older (sensitivity = 97%; specificity = 70%). Scores of less than 24 may also be useful to rule in dementia in ...

American Family Physician : Cochrane for Clinicians

https://www.aafp.org/afp/2016/1201/p880.html

Prostate Cancer Screening: The Continuing Controversy - American Family Physician

Dec 15, 2008 - Prostate cancer is the second most common cancer in men, with a lifetime prevalence of 17 percent. Prostate cancer symptoms generally occur in advanced stages, making early detection desirable. Digital rectal examination and prostate-specific antigen testing are the most commonly used ...

American Family Physician : Article

https://www.aafp.org/afp/2008/1215/p1377.html

Screening for Osteoporosis to Prevent Fractures: Recommendation Statement - U.S. ...

Nov 15, 2018 - The USPSTF recommends screening for osteoporosis with bone measurement testing to prevent osteoporotic fractures in women 65 years and older.

American Family Physician : U.S. Preventive Services Task Force

https://www.aafp.org/afp/2018/1115/od1.html

Should Family Physicians Routinely Screen for Lung Cancer in High-Risk Populations? ...

Jul 15, 2014 - When offered to the appropriate population in the appropriate context, CT-based lung cancer screening will reduce the number of deaths caused by this difficult disease.

American Family Physician : Editorials: Controversies in Family Medicine

https://www.aafp.org/afp/2014/0715/od2.html

Ruling Out Pulmonary Embolism in the Primary Care Setting - Point-of-Care Guides - ...

Jun 1, 2018 - What is the best approach to evaluate patients with suspected pulmonary embolism in the outpatient, primary care setting?

American Family Physician : Point-of-Care Guides

https://www.aafp.org/afp/2018/0601/p750.html

Proteinuria in Adults: A Diagnostic Approach - American Family Physician

Sep 15, 2000 - Proteinuria is a common finding in adults in primary care practice. An algorithmic approach can be used to differentiate benign causes of proteinuria from rarer, more serious disorders. Benign causes include fever, intense activity or exercise, dehydration, emotional stress and acute ...

American Family Physician : Article

https://www.aafp.org/afp/2000/0915/p1333.html

Screening for Cervical Cancer: Recommendation Statement - U.S. Preventive Services Task...

Feb 15, 2019 - The USPSTF recommends screening for cervical cancer every 3 years with cervical cytology alone in women aged 21 to 29 years. For women aged 30 to 65 years, the USPSTF recommends screening every 3 years with cervical cytology alone, every 5 years with high-risk human papillomavirus ...

American Family Physician : U.S. Preventive Services Task Force

https://www.aafp.org/afp/2019/0215/od1.html

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