Articles related to Family Medicine/General Practice

A 37-year-old man presented with persistent swelling, limited range of motion, and loss of hand dexterity in both hands. He had a history of IV drug use, including opiates and methamphetamine. The examination showed diffuse swelling without joint inflammation. Lab tests were normal, and imaging revealed soft-tissue swelling. The diagnosis was puffy hand syndrome, a common complication of IV drug use. Treatment options are mainly symptomatic, including discontinuation of IV drug use and the use of low-stretch bandages and compression gloves. Puffy hand syndrome, often unrecognized by general practitioners, should be considered in patients with swelling and limited hand function who have a history of IV drug use. The syndrome involves progressive fibrosis of subcutaneous tissues due to repeated injection-induced vascular and dermal sclerosis. Diagnosis is based on clinical presentation, history, and evaluation ruling out other conditions. Treatment focuses on symptomatic relief and cessation of IV drug use.

In this video, Zack Shinar, MD, discusses the future of cardiac arrest and the role of extracorporeal membrane oxygenation (ECMO) in the emergency department (ED). Dr. Shinar is a leading expert in ECMO and has been instrumental in developing new protocols for its use in the ED. Dr. Shinar begins by discussing the current state of CPR. He notes that CPR is only effective in about 10% of cases, and that even when it is successful, patients often suffer significant brain damage. He then discusses ECMO, which is a life-support machine that can oxygenate the blood outside of the body. ECMO has been shown to be effective in saving the lives of patients with cardiac arrest, and Dr. Shinar believes that it should be used more widely in the ED. Dr. Shinar then discusses the challenges of using ECMO in the ED. He notes that ECMO is a complex procedure that requires specialized training and equipment. He also notes that ECMO can be expensive, and that it is not always available in all hospitals.

To reduce overuse of vitamin D across 11 hospitals and 70 clinics, a best practice advisory was created to be triggered when a clinician placed an order for 25-hydroxyvitamin D 25(OH)D level testing sooner than three months after a previous test. The advisory reduced testing by 44–46% across 11 hospitals and 70 ambulatory centers.

According to census data, there are 49.2 million older persons in the United States, with 21 million (42.6%) earning less than 200% of the federal poverty threshold. With the majority of older persons having their natural dentition, there will be an increased demand for oral health (OH) treatments among this demographic. Although the causative links between oral and systemic diseases are still developing and not entirely established, there is undeniably a bidirectional relationship between OH, cardiovascular disease, and diabetes in older persons.

Clinicians are directed to the American College of Cardiology/American Heart Association pooled cohort equation, which takes into account age, gender, blood pressure, lipids, diabetes mellitus, and tobacco use but not family history. The USPSTF now advises against starting aspirin therapy in individuals 60 and older since there is no net benefit and the risk of damage may outweigh the benefit. The USPSTF guidelines are based on evidence from 13 trials, which show that aspirin has a slight advantage for select adults aged 40 to 59, but no net benefit (with the potential for harm) for patients aged 60 and older.

Phosphodiesterase-5 inhibitors (PDE5i) have been found to reduce the risk of major adverse cardiovascular events in men with both coronary artery disease (CAD) and erectile dysfunction (ED), with tadalafil showing greater cardiac benefits compared to sildenafil, according to a study presented at the American Urological Association’s annual meeting. The retrospective study analyzed over 41,000 men with CAD and ED and found that those who took tadalafil or sildenafil had significantly lower 5-year risks of heart failure, myocardial infarction, and overall mortality compared to those who received no PDE5i treatment. Tadalafil recipients had even lower risks than sildenafil recipients across all categories. The study suggests that understanding the specific differences among PDE5i medications is crucial for addressing cardiac outcomes in patients with ED and CAD, with tadalafil potentially offering superior benefits due to differences in pharmacokinetics and longer duration of efficacy. However, further research is needed before definitive conclusions can be made regarding preferential prescription of tadalafil over other PDE5i medications.