The Journal of family practice
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For patients with newly diagnosed type 2 diabetes, self-monitoring may do more harm than good
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No there is no well-tested, easily administered screening tool to detect drug-seeking behaviors in primary care patients taking long-term opioids or being considered for such therapy (strength of recommendation [SOR]: studies of intermediate outcomes). Several tools have undergone preliminary testing in pain centers and are being tested in different settings with larger numbers of patients. For primary care providers, a useful screening tool for predicting drug-seeking behaviors is the Screener and Opioid Assessment for Patients with Pain (SOAPP-R; SOR: studies of intermediate outcomes). Drug-seeking behavior in patients on long-term opioid therapy can be monitored with the Current Opioid Misuse Measure (COMM; SOR: studies of intermediate outcomes).
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*Assess asthma severity before initiating treatment; monitor asthma control to guide adjustments in therapy using measures of impairment and risk (National Heart, Lung, and Blood Institute [NHLBI] and National Asthma Education and Prevention Program [NAEPP] third expert panel report [EPR-3]). *Base treatment decisions on recommendations specific to each age group (0-4 years, 5-11 years, and >or=12 years). *Use spirometry in patients >or=5 years of age to diagnose asthma, classify severity, and assess control. *Provide each patient with a written asthma action plan with instructions for daily disease management, as well as identification of, and response to, worsening symptoms.
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Behavioral measures, such as weight loss, altered sleeping position, and avoidance of alcohol and sedatives, can benefit some patients with mild obstructive sleep apnea (OSA). The mainstay of therapy for OSA is administration of continuous positive airway pressure (CPAP). Oral appliances may benefit patients who are unable or unwilling to use CPAP or other forms of PAP therapy. The wakefulness-promoting agent modafinil is recommended for patients who experience residual sleepiness despite optimal CPAP therapy, provided CPAP compliance is closely monitored.
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Stop prescribing antibiotics for adults with a clinical diagnosis of acute sinusitis, unless the patient has severe symptoms. Antibiotics have little if any positive effects on the severity and duration of symptoms, and they cause adverse effects and create unnecessary expense.