FP essentials
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Eating disorders are common. The typical onset of eating disorders is in mid- to late adolescence, affecting females more often than males. However, rates of eating disorders are increasing among younger children, males, and minority groups. ⋯ Most children and adolescents with eating disorders can be treated with outpatient management with medical monitoring, psychotherapy, and support from a dietitian. Family-based treatment is the recommended approach for adolescents with anorexia nervosa. Some patients need medical or psychological stabilization in the hospital, and others benefit from day management or residential programs for additional structure and support.
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Among patients in the emergency department (ED), most severe, sudden-onset headaches are primary, such as migraine or tension-type headache. Only 10% to 15% of patients have serious underlying pathology. However, guidelines for evaluation of patients with severe headache emphasize detection of subarachnoid hemorrhage (SAH) and other cerebrovascular conditions. ⋯ CT or magnetic resonance angiography of the brain that shows multiple focal areas of vasoconstriction is diagnostic of RCVS. Lumbar puncture is indicated for patients with suspected meningitis. The management, follow-up, and prognosis of patients with severe headache depend on the etiology.
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Until recently, most initiatives to address physician burnout have focused on improving the resilience of individual physicians. These measures are necessary but insufficient since it is now recognized that organizations have a major role in causing, preventing, and mitigating physician burnout. Burnout must be addressed by organizational change. ⋯ Results of assessments can be used to engage clinicians in open conversations on issues and potential solutions. Specific leadership behaviors and positive organizational cultures decrease burnout and enhance engagement. There must be an institutional commitment to enhancing physician autonomy and transparent communication, improving the meaning of work, reducing administrative and regulatory burdens, and reducing the stigma related to seeking care.
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Physician burnout affects patients and physicians. Recent studies estimate that more than half of all physicians in the United States currently are experiencing burnout. Burnout can include symptoms of emotional exhaustion, depersonalization, cognitive weariness, physical fatigue, and disengagement. ⋯ Although individual- and organizational-level interventions appear to be effective in reducing burnout, there is no conclusive evidence regarding which intervention or combination of interventions alleviates symptoms. Physicians can reduce burnout with use of mindfulness and stress management techniques. Beyond the level of the individual physician, employers and payers should recognize the benefits of supporting physician well-being and making medical practice a rewarding and healthy experience.
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Integrative medicine, including acupuncture, dry needling, and cupping, is being used increasingly in the United States. Evidence regarding their efficacy in the management of musculoskeletal conditions is heterogeneous and subject to several limitations. Despite these limitations, acupuncture consistently has been shown to be more effective than no treatment and is relatively safe. ⋯ Wet cupping appears to decrease low back and neck pain. Patients should be referred to appropriately credentialed clinicians. Health insurance companies may not provide coverage for these therapies.