Articles related to Family Medicine/General Practice

Key practice-changing points from the latest guidelines: • 1st line therapy is sacubitril plus valsartan, as this combination increases survival and reduces hospitalizations versus ACE inhibitors and ARBs.• ACE inhibitors should be used only in patients who cannot tolerate sacubitril-valsartan, and ARBs used only in those who cannot tolerate either the 1st- or 2nd-line recommended therapies.• Patients whose ejection fraction increases to more than 40% under therapy should continue to receive therapy.

In this target trial emulation involving nearly 44,000 patients with primary hyperparathyroidism (PHPT), similar declines in kidney function at 5 and 10 years were seen in patients managed with parathyroidectomy and in those managed nonoperatively. Thus, in this study, parathyroidectomy had no effect on long-term kidney function in older adults with PHPT.

Diagnosing – and treating – ADHD in adults is not difficult and can be life-changing, with patients noting improvements in relationships, functional ability, and overall quality of life.

Other than anterior cervical and occipital lymphadenopathy, the physical examination and vitals are unremarkable. The patient is also requesting HIV pre-exposure prophylaxis initiation. HIV testing negative. What’s the best management?

Per the Standards, “diabetes management in older adults requires regular assessment of medical, psychological, functional, and social domains. Older adults with diabetes have higher rates of premature death, functional disability, accelerated muscle loss, and coexisting illnesses … and … are also at greater risk for several common geriatric syndromes, such as polypharmacy, cognitive impairment, depression, urinary incontinence, injurious falls, persistent pain, and frailty. All these can impair their self-management.”

In a study including 73 meta-analyses and 8,601 unique articles, sugar consumption was associated with 18 endocrine/metabolic outcomes, 10 cardiovascular outcomes, seven cancer outcomes, and 10 other outcomes. Endocrine/metabolic outcomes included weight gain, ectopic fat accumulation, obesity, and cardiovascular disease, which were largely attributed to excessive consumption of fructose containing sugars.