FP essentials
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Heart failure (HF) with reduced ejection fraction (HFrEF) is becoming more prevalent as the US population ages. Although the clinical presentation of HFrEF is remarkably similar to that of HF with preserved ejection fraction (HFpEF), the primary etiology may be different. In particular, cardiac ischemia is a common cause of HFrEF and should be considered in any patient with new-onset HFrEF. ⋯ It is vital to ensure that all patients with HFrEF are adhering to goal-directed management and therapy within 6 months of diagnosis to reduce morbidity and mortality. Some patients with HFrEF will benefit from device therapy with an implantable cardioverter-defibrillator and/or cardiac resynchronization therapy. Referral to a cardiology subspecialist is recommended for select patients with HFrEF.
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From 2013-2016, 34.5% of US adults had prediabetes. The U. S. ⋯ Although no drugs are approved by the Food and Drug Administration (FDA) for diabetes prevention, strong evidence supports the use of metformin in adults with prediabetes. In children, metformin use for the prevention of diabetes requires more study. Rates of progression from prediabetes to type 2 diabetes range from 5.8% to 18.3% per year, depending on the population studied.
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Hospice care consists of palliative care provided at the end of life that provides comprehensive comfort care for patients and support for family members. This includes medical care, pain management, and emotional and spiritual support tailored to patient needs and wishes. Eligibility rules require a physician to determine that the prognosis for the patient involves an estimated life expectancy of 6 months or less if the illness runs its expected course. ⋯ Although most hospice care is delivered in the home of the patient, it also may be provided in long-term care facilities, hospice facilities, and in the hospital when needed for symptom control. Hospice care has been associated with better symptom relief, better achievement of patient end-of-life wishes, and higher overall rating of quality of end-of-life care compared with standard care. Family physicians have the ideal skills to manage and coordinate patient hospice care needs.
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The phases of emergency management are mitigation, preparedness, response, and recovery. Optimal disaster response requires knowledge and understanding of the US disaster response structure. In a disaster, the local government is the first to start a response. ⋯ Principles of the crisis standard of care are used in disaster response when health care needs overwhelm available resources. Alert systems are critical to inform personnel and the public about weather conditions, evacuation orders, and closures of roads and health care facilities. Family physicians can play an important role during disaster response, including patient notification and immediate discharge or transfer of patients with less serious acute conditions from the hospital and emergency department to free beds.
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Opioids are not first-line therapy for chronic noncancer pain or nonsevere acute pain. Overall, evidence does not show that opioids are superior to nonopioid interventions, and opioids pose a high risk of harm. A trial of opioid therapy may be considered for patients who have persistent severe pain plus functional limitations despite adherence to multiple appropriate nonopioid therapies. ⋯ Caution is indicated when 50 or more morphine milligram equivalents (MME)/day of opioids are prescribed, and dosages of 90 MME/day or more should be avoided. Naloxone should be provided for patients at high risk of overdose. If harms outweigh benefits, opioids should be tapered and discontinued.