Physicians have a legal and ethical duty to protect their patients and support them during times of clinical need; the decision to end a doctor-patient relationship should not be made lightly. However, in a recent survey of 794 primary care practices, 90% reported discharging patients in the...
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Once-Weekly Semaglutide in Adults with Overweight or Obesity
Background: Obesity is a global health challenge with few pharmacologic options. Whether adults with obesity can achieve weight loss with once-weekly semaglutide at a dose of 2.4 mg as an adjunct to lifestyle intervention has not been confirmed.
Methods: ...
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Diagnosis and Management of Transient Ischemic Attack and Acute Ischemic Stroke: A Review
Importance: Stroke is the fifth leading cause of death and a leading cause of disability in the United States, affecting nearly 800 000 individuals annually.
Observations: Sudden neurologic dysfunction caused by focal brain ischemia with imaging evidence...
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Mobile phone text messaging and app-based interventions for smoking cessation
Background: Mobile phone-based smoking cessation support (mCessation) offers the opportunity to provide behavioural support to those who cannot or do not want face-to-face support. In addition, mCessation can be automated and therefore provided affordably even in resource-poor...
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Mild bleeding disorders in adults
About 11% of patients in primary care reported bleeding symptoms in a 2010 Canadian study.1 Mild bleeding disorders should be considered in patients with disproportionate bleeding (i.e., excessive postsurgical bleeding...
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Individualized approach to primary prevention of substance use disorder: age-related risks
Background: The misuse of legal and illegal substances has led to an increase in substance use disorder (SUD) in the United States. Although primary prevention strategies have been successfully used to target chronic physical diseases, these strategies have been less effective...
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Creation of an algorithm for clinical decision support for treatment of opioid use disorder with buprenorphine in primary care
Background: The treatment capacity for opioid use disorder (OUD) lags far behind the number of patients in need of treatment. Capacity is limited, in part, by the limited number of physicians who offer office based OUD treatment with buprenorphine. Measurement based care (MBC)...
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The relationship between exacerbated diabetic peripheral neuropathy and metformin treatment in type 2 diabetes mellitus
Metformin-treated diabetics (MTD) showed a decrease in cobalamin, a rise in homocysteine, and methylmalonic acid, leading to accentuated diabetic peripheral neuropathy (DPN). This study aimed to determine whether or not metformin is a risk factor for DPN. We compared MTD to non-metformin-treated...
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Challenges and Approaches to Population Management of Long-Term Opioid Therapy Patients
Purpose: Primary care is challenged with safely prescribing opioids for patients with chronic noncancer pain (CNCP), specifically to address risks for overdose, opioid use disorder, and death. We identify sociotechnical challenges, approaches, and recommendations in primary care...
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The opioid crisis: a contextual, social-ecological framework
The prevalence of opioid use and misuse has provoked a staggering number of deaths over the past two and a half decades. Much attention has focused on individual risks according to various characteristics and experiences. However, broader social and contextual domains are also essential...
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