COPD in the Primary Care Setting: Comprehensive Strategies for Diagnosis and Management. Chronic obstructive pulmonary disease (COPD) affects approximately 10% of people 40 years old and older and is the fourth leading cause of death in the United States. In 2007, twelve million people were diagnosed with COPD. However, it is believed an additional 12 million people have COPD, but remain undiagnosed, and there were no improvements in hospitalization rates in patients with COPD aged 45 and older between 1995 and 2006.

Guidelines for the Diagnosis and Management of Anaphylaxis: Insights for the Primary Care Practitioner. Anaphylaxis is a severe, potentially life-threatening allergic reaction that results in an estimated 30,000 emergency department visits annually. Although clinical guidelines for the diagnosis and management of anaphylaxis exist, several studies suggest that anaphylaxis is often underdiagnosed. Primary care clinicians play an important role in the diagnosis of anaphylaxis, as they have long-term access to patients who may be at risk for anaphylaxis.

Best Practices in Primary Care: Dyslipidemia and the Chronic Kidney Disease Patient. Cardiovascular disease (CVD) is the leading cause of morbidity and mortality among people with chronic kidney disease (CKD). While the link between CVD and CKD is apparent, primary care providers are not effectively screening and treating patients with renal disease who are at enhanced risk for cardiovascular disease and events.

The Diagnosis, Treatment, and Management of Acute Migraine. Migraine is a highly prevalent disease characterized by recurrent episodes of disabling headache, associated nausea, and sensory hypersensitivity. Migraine attacks generally begin early in life and continue over many decades of a person’s life. The significant disability associated with migraine is observed during an acute episode, but is more aptly understood through the accumulated disability of recurrent attacks over time.

When You Can’t Fall Asleep, Maybe it’s Your Clock That’s Broken. Delayed sleep phase disorder is the most common circadian rhythm sleep disorder and may be present in as many as 10% of adolescence though the numbers decline in older cohorts. It is under recognized, misdiagnosed as insomnia, and too often mistreated resulting in excessive daytime sleepiness, social, work, and scholastic dysfunction, and even depression.

Improving Patient Outcomes: A Guidelines-based Approach to the Diagnosis and Management of Chronic Obstructive Pulmonary Disease. Chronic obstructive pulmonary disease is a debilitating disease that affects millions of Americans and may go unrecognized and underdiagnosed. Overall, approximately 10% of people 40 years and older have moderately severe airflow obstruction measured by spirometry. In 2007, about 12 million Americans were diagnosed with COPD, but an additional 12 million may have had COPD that was undiagnosed.

Improving the Diagnosis and Treatment of Anaphylaxis: Updated Clinical Guidelines. Anaphylaxis is an acute, life-threatening systemic reaction that can occur by either immunologic or nonimmunologic mechanisms. The clinical manifestations of anaphylaxis, and their severity, result from the sudden release of mediators from mast cells and basophils.

Best Practices in Recognition, Diagnosis, and Treatment of Circadian Rhythm Disorders: An Online Activity for Primary Care Clinicians. Underlying human physiology and behavior are rhythms which wax and wane with 24-hour periodicity, regulating core body temperature, insulin secretion, alertness, mood, and other biologic parameters. To ensure homeostatic balance these and other circadian rhythms must be synchronized by various timekeepers, particularly the environmental light/dark cycle.

OBESITY: Addressing the Perils of a Growing Epidemic. The prevalence of obesity is at epidemic proportions in the United States and worldwide, representing the second leading cause of preventable death. Over the past decade, the incidence of obesity in adults in the United States has consistently represented more than one-fourth of the population, with men and women being equally affected.

Understanding HPV Epidemiology, Diseases, and Vaccines in Male and Female Patients. Primary care clinicians are at the frontline of vaccination to protect women against HPV; gynecologists are traditionally not ones to provide vaccines. Primary care providers most often do not think of HPV and sexually transmitted infections (STI), often leaving them to annual gynecologic examinations. Together, these factors have led to poor vaccination rates with what is deemed a critical vaccine for women by the CDC.

Obstructive Sleep Apnea: Recognition, Treatment, and Adherence in the Primary Care Setting. The National Institutes of Health report that approximately 18 million Americans suffer from obstructive sleep apnea. Despite the prevalence of this common condition, studies show that 90% of people with OSA remain undiagnosed.

Anemia Is not a Normal Consequence of Aging: Determing the Etiologic Cause and Optimal Treatment of Geriatric Anemia. Anemia is often considered a normal consequence of aging, but is neither normal nor harmless and may have far-reaching effects. While two-thirds of geriatric anemia cases are caused by nutritional deficiency or by chronic disease, the cause is unidentified in up to one-third of cases. Unidentified anemia may be the result of an occult but serious underlying bone marrow failure condition, such as myelodysplastic syndromes.

Managing Your Patients With Osteoporosis. Diagnosis of osteoporosis is suboptimal leading to undertreatment of this disease. There is underrecognition of the risk for osteoporosis and deficient assessment of patients who are in need of evaluation. Nearly one-half of adults with osteoporosis remain untreated with pharmacologic therapy after sustaining a fracture. Underutilization of assessment tools such as dual X-ray absorptiometry (DXA) and the FRAX® calculator further contribute to this problem. Although guidelines for the diagnosis and management of patients with osteoporosis have been recently updated, some clinicians are not familiar with them, presenting challenges to the diagnosis and treatment of osteoporosis.

Evaluating the Etiologic Cause and Optimal Treatment of Geriatric Anemia in the Primary Care Setting: A Case-Based Study. Anemia is a very common problem in the elderly, making this clinical finding a growing concern as the proportion of older individuals in the US population continues to increase. According to current US Census Bureau projections, by 2030 there will be approximately 114.1 million Americans aged 65 years and older representing nearly 25% of the total population. By 2050, that number is anticipated to reach 156 million, more than double the estimated current population of 64.7 million persons older than 65 years.

Obstructive Sleep Apnea Syndrome: Recognition, Treatment, and Adherence - Part II. Management of obstructive sleep apnea syndrome (OSAS) consists of not only specific interventions but also appropriate education. The patient needs to be educated about the importance of OSAS, the risk factors, and the importance of treatment, as well as the consequences of untreated OSAS. In addition, education should include discussion about the potential for accidents, particularly motor vehicle accidents, as well as job-related accidents, and accidents around the home.