American family physician
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Obstructive sleep apnea is a common disorder that causes patients to temporarily stop or decrease their breathing repeatedly during sleep. This results in fragmented, nonrestful sleep that can lead to symptoms such as morning headache and daytime sleepiness. Obstructive sleep apnea affects persons of all ages, with an increasing prevalence in those older than 60 years. ⋯ Continuous positive airway pressure is the first-line treatment; adherence rates are variable and seem to improve with early patient education and support. Other treatment modalities include weight reduction, oral appliance therapy, and surgery to correct anatomic obstructions, although there is insufficient evidence to support these types of surgeries. Bariatric surgery can improve sleep parameters and symptoms in obese patients with obstructive sleep apnea and can result in remission in many patients.
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American family physician · Aug 2016
ReviewSystemic Lupus Erythematosus: Primary Care Approach to Diagnosis and Management.
Systemic lupus erythematosus is an autoimmune disease that affects many systems, including the skin, musculoskeletal, renal, neuropsychiatric, hematologic, cardiovascular, pulmonary, and reproductive systems. Family physicians should be familiar with the manifestations of lupus to aid in early diagnosis, monitoring patients with mild disease, recognizing warning signs that require referral to a rheumatologist, and helping to monitor disease activity and treatment in patients with moderate to severe disease. The American College of Rheumatology has 11 classification criteria for lupus. ⋯ Patients with mild disease that does not involve major organ systems can be monitored by their family physician. Patients with increased disease activity, complications, or adverse effects from treatment should be referred to a rheumatologist. To optimize treatment, it is important that a rheumatologist coordinate closely with the patient's family physician to improve chronic care as well as preventive health services.
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American family physician · Aug 2016
ReviewTreating Painful Diabetic Peripheral Neuropathy: An Update.
Painful diabetic peripheral neuropathy occurs in approximately 25% of patients with diabetes mellitus who are treated in the office setting and significantly affects quality of life. It typically causes burning pain, paresthesias, and numbness in a stocking-glove pattern that progresses proximally from the feet and hands. Clinicians should carefully consider the patient's goals and functional status and potential adverse effects of medication when choosing a treatment for painful diabetic peripheral neuropathy. ⋯ Isosorbide dinitrate spray and transcutaneous electrical nerve stimulation may provide relief in some patients and can be considered at any point during therapy. Opioids and selective serotonin reuptake inhibitors are optional third-line medications. Acupuncture, traditional Chinese medicine, alpha lipoic acid, acetyl-l-carnitine, primrose oil, and electromagnetic field application lack high-quality evidence to support their use.
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American family physician · Aug 2016
ReviewPremenstrual Syndrome and Premenstrual Dysphoric Disorder.
Premenstrual disorders affect up to 12% of women. The subspecialties of psychiatry and gynecology have developed overlapping but distinct diagnoses that qualify as a premenstrual disorder; these include premenstrual syndrome and premenstrual dysphoric disorder. These conditions encompass psychological and physical symptoms that cause significant impairment during the luteal phase of the menstrual cycle, but resolve shortly after menstruation. ⋯ They can be used continuously or only during the luteal phase. Oral contraceptives and calcium supplements may also be used. There is insufficient evidence to recommend treatment with vitamin D, herbal remedies, or acupuncture, but there are data to suggest benefit from cognitive behavior therapy.