American family physician
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The goals of laceration repair are to achieve hemostasis and optimal cosmetic results without increasing the risk of infection. Many aspects of laceration repair have not changed over the years, but there is evidence to support some updates to standard management. Studies have been unable to define a "golden period" for which a wound can safely be repaired without increasing risk of infection. ⋯ Wounds heal faster in a moist environment and therefore occlusive and semiocclusive dressings should be considered when available. Tetanus prophylaxis should be provided if indicated. Timing of suture removal depends on location and is based on expert opinion and experience.
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American family physician · May 2017
ReviewTop 20 Research Studies of 2016 for Primary Care Physicians.
This article summarizes the top 20 original research studies and four practice guidelines of 2016, based on regular literature surveillance and as selected by members of the Canadian Medical Association. The studies, known as POEMs (patient-oriented evidence that matters), were rated highly because of their relevance, validity, and potential to change practice. Key hypertension treatment findings include reduced mortality (a benefit not demonstrated in lower-risk persons or persons with diabetes mellitus) but also an increase in harms with a more aggressive blood pressure target in high-risk persons with hypertension and without diabetes. ⋯ Regarding diabetes and obesity, the Mediterranean diet is more effective than a low-fat diet for weight loss, and aggressive blood pressure targets are not recommended in patients with diabetes, especially older persons. Other recommendations include use of an oral syringe rather than a medicine cup to measure liquid medications for children, and abrupt smoking cessation preceded by two weeks of nicotine replacement via a patch, rather than a slow phasing out of tobacco use. Finally, although azithromycin has a slightly higher failure rate than doxycycline for the treatment of chlamydia, it still cured 97% of patients in a randomized trial.
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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 cardiovascular disease, including myocardial infarction and stroke. Major guidelines concur that women at average risk of breast cancer benefit from screening mammography at least every other year from 50 to 74 years of age. ⋯ Screening for ovarian cancer is not recommended. Clinicians should consider screening for sexually transmitted infections in older women at high risk. Postmenopausal women should be routinely screened for depression, alcohol abuse, and intimate partner violence.