Journal of Family Practice

Extended treatment for a previous condition provided a key to the diagnosis.

Many students want to skip school from time to time. But when absenteeism becomes chronic, it may indicate a more serious underlying issue.

► large joint arthralgias ► history of type 1 diabetes, seizures, migraines.

► headache and neck pain radiating to ears and eyes ► severe hypertension.

No abstract text is available yet for this article.

These agents are as effective as traditional acute and preventive treatments, cause fewer adverse effects, and can simplify regimens.

YES. Low-dose naltrexone is as effective as amitriptyline in the treatment of painful diabetic neuropathy and has a superior safety profile (strength of recommendation [SOR], B; single randomized controlled trial [RCT]). Low-dose naltrexone significantly reduced pain by 32% in inflammatory conditions and 44% in neuropathic conditions (SOR, B; single retrospective cohort study). Doses as low as 5.4 mg were found to reduce pain in 95% of patients with fibromyalgia (SOR, B; single prospective dose-response study)...

While treatment with metformin or lifestyle modification reduces risk for T2D in patients with prediabetes, neither intervention ultimately offers a mortality benefit.

The evidence supports patient use of this simple equation to evaluate the nutrition labels of packaged carbohydrate foods in the grocery aisle in order to make healthier decisions.

This study demonstrated the value of using electrical impedance spectroscopy in primary care to manage and diagnose pigmented skin lesions.

The developmental origins of health and disease (DOHaD) hypothesis suggests prenatal nutrition sets the stage for the developing brain, with effects that last into adulthood. Macronutrient and micronutrient requirements increase in pregnancy and deficiencies can influence fetal neurodevelopment and cognition. Foods such as eggs, meat, and seafood contain many of the nutrients needed for healthy neurodevelopment and intake should be encouraged among women of reproductive age. Family practice clinicians play an important role in providing nutrition recommendations surrounding food and prenatal supplements to consume before, during, and after pregnancy...

Acute pain is a common and nearly universal experience that usually has a sudden onset and is limited in duration. It is a normal physiologic response to a noxious stimulus that can become pathologic if untreated or not treated effectively. Acute pain has a limited duration (<1 month) and often is caused by injury, trauma, or medical treatments such as surgery. Primary care practitioners (PCPs) who encounter patients with acute pain can help preserve function and quality of life and prevent progression to chronic pain by implementing appropriate management strategies...

Stroke is a significant cause of mortality worldwide, and diabetes is an independent risk factor for ischemic stroke occurrence and recurrence. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) lower the risk of ischemic stroke through beneficial effects on traditional stroke risk factors such as hyperglycemia, hypertension, and dyslipidemia. Primary care practitioners (PCPs) can play a substantial role in reducing ischemic stroke; studies have indicated that patients who have a PCP at the time of first stroke have a lower risk of stroke recurrence...

Primary care practitioners (PCPs) play a key role in asthma management since most patients with asthma are treated in primary care settings. Despite continual advances in asthma care, important practice gaps remain, and the high burden of asthma exacerbations persists, with 43% of children with asthma and 41% of adults with asthma in the United States experiencing an asthma exacerbation in 2020. Uncontrolled asthma, incomplete assessment of exacerbation and asthma control history, reliance on systemic corticosteroids (SCS) or short-acting beta2-agonist (SABA)-only therapy, and lack of patient adherence to anti-inflammatory maintenance therapies are challenges clinicians face today with asthma care...

New updates in the Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2023 report include major changes to initial disease assessment and pharmacologic therapy, highlighting the clinical relevance of exacerbations. The updated GOLD 2023 algorithms offer a shorter path to consideration of triple therapy, including both initial and follow-up treatment. Most mild- or moderate-severity chronic obstructive pulmonary disease (COPD) exacerbations can be successfully managed in outpatient settings; primary care clinicians have many opportunities to identify, diagnose, and treat patients with COPD earlier to reduce lung damage and disease progression...

Type 1 diabetes (T1D) is an autoimmune disease mediated by T cells that target and destroy insulin-producing beta cells. Individuals with genetic risk of T1D will progress at variable rates through 3 stages of immune activation and development of islet autoimmunity. Measuring pancreatic islet cell autoantibodies predicts risk for progression that can take weeks to years before the onset of T1D. Screening options available to family physicians can identify persons at risk or in the early stages of T1D, such as first- and second-degree relatives or those with a family history of autoimmune disorders, to ultimately offer proven interventions that may delay or prevent the condition...

At the end of the activity, participants will be able to: Implement a staged strategy for the diagnostic evaluation of irritable bowel syndrome with constipation (IBS-C) and chronic idiopathic constipation (CIC) based on history and physical examination, including the Rome IV criteria. Discuss the evidence and guideline recommendations for self-care as well as over-the-counter (OTC) and prescription therapies to treat IBS-C and CIC, Individualize treatment for IBS-C and CIC emphasizing patient-centered care to address patient concerns, improve outcomes, and enhance quality of life...

At the end of the activity, participants will be able to: Identify the risks of kidney disease and their consequences in patients with type 2 diabetes (T2D). Appropriately screen for the presence of chronic kidney disease (CKD) in patients with T2D. Initiate evidence-based therapy to slow the progression of kidney disease in patients with T2D and CKD. Become familiar with the novel nonsteroidal mineralocorticoid receptor antagonist finerenone and its role in the treatment of patients with T2D and CKD.

Insomnia is a distinct disorder that is common, yet underrecognized and undertreated in primary care. Treating insomnia has been shown to improve outcomes, including reduced risk of developing cardiovascular and mental health disorders. Insomnia is influenced by the brain's regulation of sleep and wake, which are mutually exclusive events. Insomnia should be treated as a distinct condition, even when occurring with a comorbid diagnosis such as depression or anxiety. Clinicians should implement a multimodal approach to insomnia management, including nonpharmacologic interventions and pharmacologic therapy (when indicated)...

After reading this review article, participants should be able to: Prepare the practice for continuous glucose monitoring (CGM). Understand options available to the practice for professional (practice-owned) and personal (patient-owned) CGM. Locate and interpret CGM data, using the ambulatory glucose profile (AGP), to determine if the patient is achieving targets established by the International Consensus on Time in Range. Modify a patient's treatment plan based on CGM data to improve patient outcomes.