American family physician
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For patients with chest discomfort, noninvasive cardiac testing can be used for the diagnosis of acute coronary syndrome and for the evaluation of the risk of future cardiovascular events and disease severity in patients with known coronary artery disease. Clinical prediction rules can guide risk assessment for patients with acute or stable chest discomfort. For acute chest discomfort, patients with low risk do not need urgent testing, and those at high risk should have invasive coronary angiography. ⋯ Exercise or pharmacologic stress testing with imaging allows dynamic assessment of ventricular function and perfusion. For stable chest discomfort in patients with low risk, coronary artery calcium scoring can be used to exclude calcified plaque or exercise stress testing can be used for the evaluation of future cardiac risk and prognosis. For stable chest discomfort in patients with intermediate or high risk, exercise stress testing or stress testing with imaging (ie, echocardiography, myocardial perfusion imaging, or cardiac magnetic resonance imaging) may be used for the evaluation for myocardial ischemia.
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American family physician · Dec 2024
Opioid Prescribing Has Significantly Decreased in Primary Care.
Prescription opioids continue to be commonly used for chronic non-cancer pain, despite inherent risks. Primary care physicians and advanced practice clinicians have been integral to driving change in opioid prescribing, preventing overuse, and reducing risk. The authors of this article assessed the current extent of opioid prescribing using publicly available data to identify which specialties are most likely to prescribe opioids and to what extent.