Articles related to Family Medicine/General Practice

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.

Internal medicine physicians play a crucial role in addressing osteoporosis challenges. Many at-risk patients are not screened or educated about fracture prevention, and a significant number of individuals with high fracture risk remain undiagnosed and untreated. Efforts should focus on recognizing fractures as diagnostic indicators, expanding screening, and implementing effective treatments. The recent clinical guideline emphasizes bisphosphonates as first-line therapy, denosumab as second-line, and injectable medications for high-risk cases. Primary care physicians should take an active role in screening, diagnosing, and treating osteoporosis to prevent future fractures, even without immediate subspecialist care. Risk assessment tools, healthy lifestyles, and consideration of benefits, harms, patient values, and costs in medication selection are important. Empowering primary care doctors is vital in bridging the treatment gap and preventing fractures.

Adding to the evidence that good nutrition supports healthy aging, this study shows that blood levels of certain saturated fatty acids, along with omega-6, -7 and -9 fatty acids, correlated with improved memory as well as larger frontal, temporal, parietal lobes.