American family physician
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American family physician · Jul 2009
Practice GuidelineUpdate on ASCCP consensus guidelines for abnormal cervical screening tests and cervical histology.
New data have emerged since publication of the American Society for Colposcopy and Cervical Pathology's 2001 consensus guidelines for management of abnormal cervical cytology and histology. The 2006 guidelines include recommendations for special populations (i.e., adolescents and pregnant women). Human papillomavirus testing is now included for management of atypical glandular cytology, for follow-up after treatment for cervical intraepithelial neoplasia, and in combination with cytologic screening in women 30 years and older. ⋯ Conservative management of adolescents with any cytologic or histologic diagnosis except specified cervical intraepithelial neoplasia, grade 3 and adenocarcinoma in situ is recommended. Colposcopy is preferred for pregnant women with low-grade squamous intraepithelial lesion and high-grade squamous intraepithelial lesion, but evaluation of the former may be deferred until no earlier than six weeks postpartum. Treatment during pregnancy is unacceptable unless invasive carcinoma is identified.
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Up to two thirds of patients with major unipolar depression will not respond to the first medication prescribed. Depression may be considered resistant to treatment when at least two trials with antidepressants from different pharmacologic classes (adequate in dose, duration, and compliance) fail to produce a significant clinical improvement. Evidence regarding the effectiveness of psychotherapy for treatment-resistant depression is limited. ⋯ No treatment strategy appears to be better than another. Electroconvulsive therapy is effective as short-term therapy of treatment-resistant depression. There is no good-quality evidence that vagal nerve stimulation is an effective treatment for this condition.
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American family physician · Jul 2009
ReviewHelping patients who drink too much: an evidence-based guide for primary care clinicians.
Excessive alcohol consumption is a leading cause of preventable morbidity and mortality, but few heavy drinkers receive treatment. Primary care physicians are in a position to address heavy drinking and alcohol use disorders with patients, and can do so quickly and effectively. The National Institute on Alcohol Abuse and Alcoholism has published a guide for physicians that offers an evidence-based approach to screening, assessing, and treating alcohol use disorders in general health care settings. ⋯ Patients who are not alcohol-dependent may opt to reduce drinking to lower risk levels. Patients with alcohol dependence should receive pharmacotherapy and brief behavioral support, as well as disease management for chronic relapsing dependence. All patients with alcohol dependence should be encouraged to participate in community support groups