FP essentials
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Eating disorders are common. The typical onset of eating disorders is in mid- to late adolescence, affecting females more often than males. However, rates of eating disorders are increasing among younger children, males, and minority groups. ⋯ Most children and adolescents with eating disorders can be treated with outpatient management with medical monitoring, psychotherapy, and support from a dietitian. Family-based treatment is the recommended approach for adolescents with anorexia nervosa. Some patients need medical or psychological stabilization in the hospital, and others benefit from day management or residential programs for additional structure and support.
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Among patients in the emergency department (ED), most severe, sudden-onset headaches are primary, such as migraine or tension-type headache. Only 10% to 15% of patients have serious underlying pathology. However, guidelines for evaluation of patients with severe headache emphasize detection of subarachnoid hemorrhage (SAH) and other cerebrovascular conditions. ⋯ CT or magnetic resonance angiography of the brain that shows multiple focal areas of vasoconstriction is diagnostic of RCVS. Lumbar puncture is indicated for patients with suspected meningitis. The management, follow-up, and prognosis of patients with severe headache depend on the etiology.
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Food allergies are immune-mediated allergic adverse reactions that occur after exposure to specific foods. The most commonly recognized food allergies are immunoglobulin E (IgE)-mediated reactions (eg, urticaria, angioedema, anaphylaxis) that result from exposure to milk, egg, peanut, tree nuts, shellfish, fish, wheat, or soy. However, other foods can cause food allergies. ⋯ These allergies are best managed by avoidance of the food or foods related to the allergy because they require ingestion rather than contact to precipitate symptoms. Injectable epinephrine should be prescribed for patients at risk of anaphylaxis. Careful food label reading and food preparation, awareness, and education are keys to prevention.
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Anaphylaxis is an allergic reaction that occurs rapidly after exposure and is life-threatening. After symptoms of anaphylaxis occur, there is no way to reliably predict whether the patient's condition could progress quickly and become life-threatening. Immediate injection of intramuscular epinephrine is the first-line emergency treatment for anaphylaxis. ⋯ The most commonly prescribed form of epinephrine is the costly brand name autoinjector, but less expensive alternatives exist, including generic autoinjectors and prefilled epinephrine syringes. Epinephrine prescriptions should be combined with action plans that guide parents and caregivers on appropriate use. Access to epinephrine at schools, even for students who do not have a prescription, is an important component of preparedness for anaphylaxis.
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Until recently, most initiatives to address physician burnout have focused on improving the resilience of individual physicians. These measures are necessary but insufficient since it is now recognized that organizations have a major role in causing, preventing, and mitigating physician burnout. Burnout must be addressed by organizational change. ⋯ Results of assessments can be used to engage clinicians in open conversations on issues and potential solutions. Specific leadership behaviors and positive organizational cultures decrease burnout and enhance engagement. There must be an institutional commitment to enhancing physician autonomy and transparent communication, improving the meaning of work, reducing administrative and regulatory burdens, and reducing the stigma related to seeking care.