J Am Board Fam Med
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Addressing the opioid epidemic would benefit from primary care clinicians identifying and managing opioid use disorder (OUD) during routine clinical encounters, but current rates are low. Clinical decision support (CDS) systems are a promising way to facilitate such interactions, but will clinicians use them? ⋯ With the right design and a supportive organization, these primary care clinicians believe a CDS could help them regularly identify and address OUD among their patients as long as it incorporates their concerns about relationships, competing priorities, patient complexity, and user simplicity.
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To study the relationship between adherence to chronic medications and adherence to preventive medicine recommendations among persons with diabetes mellitus and hypertension. ⋯ A positive association was observed between adherence to chronic medications and adherence to preventive medicine among persons with hypertension and diabetes.
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Clinical prediction rules (CPRs) can assist clinicians by focusing their clinical evaluation on the most important signs and symptoms, and if used properly can reduce the need for diagnostic testing. This study aims to perform an updated systematic review of clinical prediction rules and classification and regression tree (CART) models for the diagnosis of influenza. ⋯ Well-designed validation studies, studies of interrater reliability between telehealth an in-person assessment, and studies using novel data mining and artificial intelligence strategies are needed to improve diagnosis of this common and important infection.
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The accuracy of individual symptoms, signs, and several easily obtainable hematologic parameters for diagnosing infectious mononucleosis (IM) still needs to be confirmed. Improving the diagnosis of IM based on the clinical findings could prompt physicians to identify better which patients need a diagnostic test for IM. This study performed a systematic review to determine the accuracy of symptoms, signs, and hematologic parameters in patients with suspected IM that used heterophile antibody test or viral capsid antigen tests as the reference standard. ⋯ Although most symptoms and signs were unhelpful, the likelihood of IM is appreciably increased by several examination findings. Hematologic parameters were more accurate than symptoms and signs. Since most clinical findings have limited diagnostic value in ruling out the disease, physicians should not rely on the absence of any individual symptom or clinical sign for ruling out IM.
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Editorial Review
Research on the Issues Family Physicians Face Today: Controlled Substances, COVID-19, Hypertension, and "Slow Medicine," Among Many More Topics.
This issue of the JABFM features research on a broad array of clinical topics. The topics of 5 articles involve controlled substances, including a sobering article on the risks of amphetamines in older adults. An excellent quick reference guide for managing common COVID-19 symptoms is presented. ⋯ A review of the existing literature on "slow medicine" comes to important conclusions. Some health systems are partnering with local resources to practically address such social determinants as food insecurity. Not surprisingly, family physicians are filling gaps in emergency care around the country.