American family physician
-
American family physician · Sep 2023
Delirium in Older Persons: Prevention, Evaluation, and Management.
Delirium is an acute disturbance in attention, cognition, and awareness that fluctuates over time. Delirium is characterized by three subtypes: hyperactive, hypoactive, and mixed. It occurs in 11% to 25% of older adults in inpatient settings and is associated with a significant financial burden. ⋯ The diagnosis is clinical but can be challenging due to overlapping symptoms with dementia and depression. The Confusion Assessment Method is a screening tool that is 94% to 100% sensitive haloperidol because of their faster onset of action and fewer adverse effects. Patients hospitalized with prolonged delirium have approximately three times the chance of dying in the following year compared with patients with a quick resolution of delirium or no symptoms; therefore, prevention and early detection should be emphasized.
-
American family physician · Sep 2023
Gestational Diabetes Mellitus: Update on Screening, Diagnosis, and Management.
Gestational diabetes mellitus (GDM) is a common condition of pregnancy with increasing prevalence in the United States. GDM increases risks of complications, including operative delivery, hypertensive disorders, shoulder dystocia, fetal macrosomia, large-for-gestational-age infants, neonatal hypoglycemia, and neonatal respiratory distress. In patients who are overweight or obese, prepregnancy weight loss and lifestyle modifications during pregnancy may prevent GDM. ⋯ Practice patterns vary, but evidence suggests that glucose management during labor can safely include decreased glucose testing and sliding-scale dosing of insulin as an alternative to a continuous intravenous drip. Insulin resistance typically resolves after delivery; however, patients with GDM have an increased risk of developing overt diabetes. Continued lifestyle modifications, breastfeeding, and use of metformin can reduce this risk.
-
American family physician · Sep 2023
Comment Practice GuidelineManagement of Heart Failure: Updated Guidelines From the AHA/ACC.
-
In the United States, more than 30 million adults have reported taking a benzodiazepine within the past year. Misuse-use of a drug in a way that a doctor did not direct-accounts for 17.2% of all benzodiazepine use. Family physicians face challenges when balancing the patient's perceived benefits of benzodiazepines with known risks and lack of evidence supporting their use. ⋯ Adjunctive treatment with antiepileptics, antidepressants, and pregabalin has been shown to lessen withdrawal symptoms. Deprescribing benzodiazepines for patients who use them chronically should be individualized with slow tapering over weeks to months, or longer, to minimize the intensity of withdrawal symptoms. Incorporating behavioral interventions, such as cognitive behavior therapy, improves deprescribing outcomes.