Concussion in Children, Ill Returning Traveler, RSV Vaccination, Hypertension in Pregnancy, More
Am Fam Physician. 2024;109(2):online
Is prescribing rest an appropriate treatment for children who are recovering from a concussion?
A meta-analysis based on 10 randomized controlled trials concluded that children who have experienced a concussion should not be placed on bed rest but may return to their previous activity level as allowed with monitoring for the development of new and worsening symptoms.
What is an important alarm feature in an ill returning traveler?
Urgently evaluate all febrile travelers for malaria if they have recently returned from a malarious area. Suspicion of Plasmodium falciparum malaria is a medical emergency.
Does maternal respiratory syncytial virus (RSV) vaccination safely reduce the likelihood of RSV in their newborns?
An industry-sponsored, randomized, double-blinded, controlled clinical trial of more than 7,000 pregnant women found that a bivalent RSV vaccine administered between 24 and 36 weeks' gestation safely reduces the likelihood of severe RSV in their newborns (number needed to treat = 81 at six months of age).
Is there an association between people living with HIV/AIDS and suicide attempts?
A systematic review of cross-sectional and cohort studies found that people living with HIV/AIDS have significantly higher rates of suicide attempts than the general population. Screening should be performed regularly in this population for suicidal thoughts.
Should medication be prescribed for mild chronic hypertension in pregnancy?
Evidence and expert opinion support treating mild chronic hypertension (i.e., blood pressure less than 160/100 mm Hg) in pregnancy with approved antihypertensives.
What is the most appropriate first step in managing a patient with acute onset of confusion and ataxia and a serum sodium level of 123 mEq per L?
Patients with a sodium concentration of less than 125 mEq per L and moderate or severe symptoms can be treated with bolus or continuous infusions of 3% hypertonic saline without increased risk of osmotic demyelination syndrome or mortality. Bolus infusion improves sodium concentration more quickly with less overcorrection.
Additional Online Only AFP Clinical Answers
How should you determine the need for imaging in a patient with a new, severe headache?
The Ottawa Subarachnoid Hemorrhage Rule should be applied to patients older than 15 years who present with a new, severe, nontraumatic headache that peaks in one hour. Patients who have one or more positive variables should be referred for imaging.
What is the initial recommended workup for a patient presenting after syncope?
A history, physical examination (including orthostatic blood pressure), and electrocardiography should be performed. Neurologic imaging, including carotid ultrasonography and computed tomography or magnetic resonance imaging of the head, should not be ordered as part of the evaluation for syncope in the absence of neurologic signs or symptoms.
What are strategies for approaching a difficult patient encounter?
Consider motivational interviewing as a tool when working with patients, such as asking open-ended questions, affirming the patient's priorities, reflective listening, summarizing the decision, and confirming the treatment plan. Motivational interviewing improves the therapeutic alliance and can effectively influence behavior change.
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