Am Fam Physician. 2024;110(5):463
What type of anticoagulation is recommended to treat atrial fibrillation?
Patients with atrial fibrillation requiring anticoagulation should be treated with a direct oral anticoagulant to reduce the risk of stroke, embolic events, and all-cause mortality, because there is less risk of major bleeding compared with warfarin. Warfarin is preferred in patients with moderate to severe mitral stenosis or a mechanical heart valve.
What is the treatment of choice for acute pericarditis?
All patients with acute pericarditis should receive a nonsteroidal anti-inflammatory drug plus colchicine or glucocorticoid plus colchicine to reduce the risk of recurrence.
What is the recommended treatment for pregnant patients with a history of group B streptococcus (GBS) colonization who are undergoing spontaneous vaginal delivery?
To decrease the risk of GBS early-onset disease in the newborn, patients with GBS colonization on a universal 36-week screening culture, GBS bacteriuria during pregnancy, a history of a newborn with GBS infection, or unknown GBS status in those at risk of GBS early-onset disease should receive intravenous antibiotic prophylaxis during labor. This should be initiated in active labor or after premature rupture of membranes, aiming for at least 4 hours before delivery.
What is the recommended systemic treatment for moderate to severe rosacea?
A course of low-dose doxycycline, 40 mg, is the first-line systemic therapy for moderate to severe rosacea with papules and pustules.
What pharmacotherapies are recommended for carpal tunnel syndrome?
Local corticosteroid injections improve symptoms and function in patients with carpal tunnel syndrome for up to 6 months and decrease the need for surgery at 1 year. Short courses of prednisone (ie, less than 2 weeks) provide short-term relief of symptoms but are less effective than local corticosteroid injections. Over-the-counter analgesics, including nonsteroidal anti-inflammatory drugs and acetaminophen, have not shown benefit for carpal tunnel syndrome.
What are the recommended nonpharmacologic treatments for mild to moderate carpal tunnel syndrome?
Splinting may relieve mild to moderate carpal tunnel symptoms. Neutral splints are more effective than extension splints, and night-only wear is as effective as continuous wear.
Is oxygen therapy recommended for patients with pulmonary arterial hypertension?
Patients with pulmonary arterial hypertension whose arterial blood oxygen pressure is less than 60 mm Hg should receive long-term oxygen therapy. Some recommendations suggest oxygen use to maintain oxygen saturation greater than 90% at sea level.
Read more: Pulmonary Hypertension; August 2024
Additional Online Only AFP Clinical Answers
Are adolescents with a history of cannabis use more likely to develop increased suicidality in adulthood?
A systematic review and meta-analysis of 11 prospective cohort studies (n = 23,317) found that adolescents with a history of cannabis use have a significantly increased likelihood of developing suicidality in adulthood.
FPIN's Help Desk Answers: Adolescent Cannabis Use and Suicidality; April 2024
What alternative treatments are recommended for patients with sleep apnea who are intolerant or nonadherent to positive airway pressure therapy?
Physicians can offer educational or behavioral resources, a nasal mask, humidified air, mandibular advancement devices, or a referral for upper airway surgery. In patients with moderate to severe obstructive sleep apnea and a body mass index less than 32 kg per m2 who are nonadherent to positive airway pressure therapy, referral for hypoglossal nerve stimulation surgery should be considered.
Are cranberry products effective for preventing recurrent urinary tract infections (UTIs)?
A Cochrane review including randomized controlled trials showed that cranberry products likely reduced the risk of UTI in women with recurrent UTI, children, and individuals susceptible to UTI postintervention compared with placebo or no treatment. More research is needed to determine the optimal dosage and form of cranberry products.
Medicine by the Numbers: Cranberry Products for Preventing Urinary Tract Infections; July 2024
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