Primary Care Reports
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Insulin Therapy for Type 2 Diabetes: Social, Psychological, and Clinical Factors
The choices for insulin therapy are ever increasing with the development of new products that provide greater flexibility, greater range of effectiveness, lower risk of hypoglycemia, and lower pharmacokinetic and pharmacodynamic variability. These allow for individualization of treatment to match a patient’s daily life but typically at greater cost. This article will review the psychological, social, and clinical factors pertaining to the various insulin products, as well as strategies to initiate and intensify insulin therapy, to help clinicians supplement and enhance their clinical practices in diabetes management.
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Homeopathic Remedies and Dietary Supplements in 2018: Weighing Benefits and Risks
More than half of Americans are using supplements or over-the-counter medications. Practitioners need to understand how their patients are using supplements and be able to provide accurate, factual advice on dietary supplements and homeopathic preparations. This article will evaluate each category for benefits and risks and provide details on how to research each product for available information. In addition, the article will assess various recommendations, including examples in weight loss, energy enhancement, and performance products.
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Evaluation of Hair Loss in a Primary Care Setting
Hair loss is a common complaint for both male and female patients, who often first present to their family physician for evaluation. However, the vast array of underlying etiologies can present a diagnostic challenge for physicians. Reviewing the main principles of hair biology will help provide a better understanding of the basic science behind hair loss. One of the most important steps in patient evaluation is conducting a thorough history and physical exam. This article will discuss key questions to ask, as well as how to interpret exam findings. In general, hair loss is categorized into scarring alopecia, non-scarring alopecia, and structural hair disorders. This article will focus on the most common causes of scarring and non-scarring alopecia that will be encountered in a primary care setting, as well as first-line treatments for each.
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Use of a Low-carbohydrate, Ketogenic Diet to Treat Obesity
Overweight and obesity have reached epidemic proportions in the United States. For individuals affected by obesity, clinical studies have shown that carbohydrate restriction, including a low-carbohydrate, ketogenic diet, can be a safe and effective treatment. This article includes a narrative review of clinical research studies and a practical description of implementing a “keto” diet for obesity.
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Therapeutic Strategies for Hypertension
This article on hypertension will cover treatments (pharmacological and nonpharmacological), initial therapy, relationship to various disease conditions (diabetes, ischemic heart disease, heart failure, chronic kidney disease, cerebrovascular disease, ischemic stroke, stroke prevention, atrial fibrillation, valvular heart disease, aortic regurgitation, sexual dysfunction), resistant hypertension, hypertensive crises and emergencies, preoperative management, and adherence strategies.
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A Contemporary Review of Hypertension
Hypertension is a common and serious condition that contributes to an estimated 40% of deaths from coronary heart disease and stroke, and is the second leading cause of end-stage renal disease. Because of the importance and frequency of hypertension in primary care practices, we are devoting two issues to the subject. This issue focuses on the definition of blood pressure and current guidelines, risk factors, relationship to cardiovascular disease, blood pressure measurement, patient evaluation, and secondary causes. The next issue will cover treatments (pharmacological and non-pharmacological), initial therapy, relationship to various disease conditions (diabetes, ischemic heart disease, heart failure, chronic kidney disease, cerebrovascular disease, ischemic stroke, stroke prevention, atrial fibrillation, valvular heart disease, aortic regurgitation, sexual dysfunction), resistant hypertension, hypertensive crises and emergencies, preoperative management, and adherence strategies.
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All That Is Round Is Not Fungus: A Differential Diagnosis of Annular Lesions
Annular skin lesions commonly plague many primary care patients, but not all that is round is fungus. This article highlights the differential diagnosis of conditions that can mimic tinea.
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Diabetic Retinopathy, Associated Comorbidities, and Treatment Considerations
Diabetic retinopathy is a complex disorder of the microvascular and neuronal structure of the retina. Although poorly understood, the problem does not start in the retina, but rather begins through systemic metabolic dysfunction, which causes damage to retina vessels. This article will review the structure of the retina, the systemic pathophysiology of diabetes, the resulting damage to retinal structure and function, comorbidities, traditional treatments, and prevention and treatment for diabetic retinopathy and its comorbidities.
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Nonalcoholic Fatty Liver Disease
Nonalcoholic fatty liver disease (NAFLD) is the most common liver pathology worldwide and is the third leading cause of liver transplantation in the United States.This article reviews the pathogenesis, diagnosis, and natural history of NAFLD as well as known treatments and future therapies.
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Wound Care Management
Primary care physicians usually can care for minor wounds in their offices. This article highlights key elements in first-line management.