The Medical clinics of North America
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The burden of depression in the United States is substantial. Evidence supports the benefits of screening for depression in all adults, including older patients and pregnant and postpartum women, when coupled with appropriate resources for management of disease. ⋯ Initial treatment for depression should include psychotherapy, pharmacotherapy, or a combination of both. Collaborative care models are evidence-based approaches to depression treatment and follow-up that can be feasibly initiated in the primary care setting.
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Med. Clin. North Am. · Jul 2017
ReviewPrevention of Prostate Cancer Morbidity and Mortality: Primary Prevention and Early Detection.
More than any other cancer, prostate cancer screening with the prostate-specific antigen (PSA) tests increases the risk a man will have to face a diagnosis of prostate cancer. The best evidence from screening trials suggests a small but finite benefit from prostate cancer screening in terms of prostate cancer-specific mortality, about 1 fewer prostate cancer death per 1000 men screened over 10 years. The more serious harms of prostate cancer screening, such as erectile dysfunction and incontinence, result from cancer treatment with surgery or radiation, particularly for men whose PSA-detected cancers were never destined to cause morbidity or mortality.
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Colorectal cancer (CRC) contributes a major burden of cancer mortality in the United States. There are multiple effective screening approaches that can reduce CRC mortality. ⋯ Offering patients stool-based screening is important for increasing screening uptake. However, programs that offer stool testing must support the population health infrastructure needed to promote adherence to repeat testing and follow-up of abnormal tests.
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A rapid and severe increase in blood pressure resulting in new or progressive end-organ damage is defined as hypertensive emergency. Clinicians should effectively use the patient interview, physical examination, and additional testing to differentiate hypertensive emergency from nonemergent hypertension. ⋯ Knowledge of appropriate hypertensive emergency management and the ability to initiate this care in the clinic could help reduce patient morbidity in certain situations. Patients presenting with nonemergent hypertension can continue to be safely managed in the clinic.
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Med. Clin. North Am. · May 2017
ReviewPsychiatric Emergencies: Assessing and Managing Suicidal Ideation.
The assessment of suicide risk is a daunting, but increasingly frequent task for outpatient practitioners. Guidelines for depression screening identify more individuals at risk for treatment and mental health resources are not always easily accessible. For those patients identified as in need of a formal suicide risk assessment, this article reviews established risk and protective factors for suicide and provides a framework for the assessment and management of individuals at risk of suicide. The assessment should be explicitly documented with a summary of the most relevant risk/protective factors for that individual with a focus on interventions that may mitigate risk.