The Journal of family practice
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More than 80% of women with a first-trimester spontaneous abortion have complete natural passage of tissue within 2 to 6 weeks with no higher complication rate than that from surgical intervention (strength of recommendation [SOR]: A, based on multiple randomized controlled trials [RCTs] and cohort studies). Expectant management is successful within 2 to 6 weeks without increased complications in 80% to 90% of women with first-trimester incomplete spontaneous abortion and 65% to 75% of women with first-trimester missed abortion or anembryonic gestation (presenting with spotting or bleeding and ultrasound evidence of fetal demise) (SOR: B, based on multiple cohort studies). There is no difference in short-term psychological outcomes between expectant and surgical management (SOR: B, based on RCT). Women experiencing spontaneous abortion with unstable vital signs, uncontrolled bleeding, or evidence of infection should be considered for surgical evacuation (SOR: C, expert opinion).
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Athletes sustaining a concussion should be held from contact activities a minimum of 7 days; they must be asymptomatic and their coordination and neuropsychological tests should have returned to their pre-injury baseline (strength of recommendation [SOR]: B, based on multiple prospective cohort studies). High-risk athletes (eg, those with a history of previous concussion, high-school age or younger, or female) may need to avoid contact even after all these criteria are met (SOR: C, expert opinion).
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A 48-year-old Hispanic woman came to the clinic as a new patient--her chief complaint was a rash that appeared on her face 3 months before and had recently spread to her chest and hands. It itched occasionally and seemed to worsen after exposure to the sun. She also said that for the last month she had been feeling very weak-she had difficulty rising from a seated position and walking up the stairs to her apartment. ⋯ The patient was otherwise healthy with no known medical conditions, and she was not taking any medications. Her family history was noncontributory. What is your diagnosis? What diagnostic tests would you order for confirmation?