Domestic minor sex trafficking: missed clinical opportunities

Domestic minor sex trafficking: missed clinical opportunities

An awareness of the risks and red flags among adolescent patients who are being trafficked for sex is key to intervention in this vulnerable population.

Pesticides and 
Parkinson's disease

Pesticides and 
Parkinson's disease

Increasing evidence has shown a link between pesticide exposure and the risk for Parkinson's disease. How real is this link on the golf course?

Osteoarthritis: conservative treatment options

Osteoarthritis: conservative treatment options

Osteoarthritis is one of the most common problems encountered in primary care, and conservative treatment can improve patients' quality of life.

Medical nutrition
 therapy in diabetes

Medical nutrition
 therapy in diabetes

Developing personalized nutrition goals with a registered dietitian
can be effective in managing non-insulin-dependent diabetes.

Current and emerging medications for psoriasis

Current and emerging medications for psoriasis

A number of therapeutic options exist for patients with psoriasis, including phototherapy and systemic and biologic agents.

Infantile hemangiomas: benign lesions with potential complications

Infantile hemangiomas: benign lesions with potential complications

Although usually benign, some infantile hemangiomas have complications that are potentially fatal or physically debilitating if untreated.

Cryptogenic organizing pneumonia

Cryptogenic organizing pneumonia

Patients with COP generally have positive outcomes following a definitive diagnosis and the initiation of appropriate treatment.

Signs and symptoms of hepatitis C virus infection

Signs and symptoms of hepatitis C virus infection

Education of high risk populations and regular testing are crucial steps clinicians can take to stem the spread of hepatitis C infection.

Crohn disease: diagnosis and treatment

Crohn disease: diagnosis and treatment

A condition prone to recurrence, Crohn disease has a complicated presentation and pathophysiology, but multiple treatment options are available.

Primary care clinician risk assessment for hereditary breast cancer

Primary care clinician risk assessment for hereditary breast cancer

Primary care clinicians should be proficient at assessing the potential for hereditary breast cancer risk in their patients.

A clinician's guide for managing patient perceptions of the flu vaccine

A clinician's guide for managing patient perceptions of the flu vaccine

By presenting research on the safety and efficacy of the flu vaccine, clinicians can successfully promote vaccination to patients in their care.

Personalizing anticoagulant treatments for nonvalvular atrial fibrillation

Personalizing anticoagulant treatments for nonvalvular atrial fibrillation

Multiple considerations come into play when choosing anticoagulant therapy for a patient with atrial fibrillation, a condition that greatly increases the risk for stroke.

Cervical cancer screening: Why less is best

Cervical cancer screening: Why less is best

ACOG's current recommendations regarding Pap smear testing for cervical cancer may be the best evidence-based practice for patients.

Influenza: How serious is it?

Influenza: How serious is it?

Providers should educate their patients on the prevalence of influenza, its potential complications, and the available prevention options.

The IUD rumor mill: Common misconceptions

The IUD rumor mill: Common misconceptions

Disseminating accurate information can help women make informed decisions and potentially increase the overall use of intrauterine devices.

Diagnosing anxiety 
disorders in primary care

Diagnosing anxiety 
disorders in primary care

The challenge associated with assessing for anxiety disorders is that the clinical features of one disorder can closely resemble those of another.

Effective management of opioid addiction in pregnancy

Effective management of opioid addiction in pregnancy

Caring for a woman who is pregnant and dependent on opioids is an opportunity to make life-changing interventions for the sake of her health and the health of her unborn child.

Obtaining a sexual
 history in MSM

Obtaining a sexual
 history in MSM

Understanding the nontraditional terminology used by men who have sex with men will help form a successful patient-provider relationship.

Sexual assault—Intervention in primary care

Sexual assault—Intervention in primary care

Recognizing red flag symptoms, such as anxiety, depression, and increased substance use, is important in helping victims who are reluctant to report the assault.

Electronic cigarettes—The primary care provider's response

Electronic cigarettes—The primary care provider's response

Although e-cigarettes may not be considered healthy, they may be the lesser of two evils when compared with traditional tobacco cigarettes.

Beach medicine pearls (and seashell lacerations)

Beach medicine pearls (and seashell lacerations)

Fun at the beach exposes children and adults to a number of hazards—some avoidable, such as sunburn, and some less so.

Understanding Dupuytren disease

Understanding Dupuytren disease

Needle aponeurotomy and collagenase Clostridium histolyticum are both viable options for treating patients with Dupuytren disease.

What mobile apps are useful for your clinical practice?

What mobile apps are useful for your clinical practice?

Mobile apps have great potential for use in patient-centered care,
 follow-up, and improving health outcomes.

Major depressive disorder: a guide for primary-care clinicians

Major depressive disorder: a guide for primary-care clinicians

Ruling out a physiological reason for symptoms is a good starting point for NPs and PAs caring for patients with a new psychiatric disorder.

Meningococcal meningitis: Managing outbreaks among adolescents and young adults

Meningococcal meningitis: Managing outbreaks among adolescents and young adults

Each year clusters of meningitis cases break out in the U.S. in the fall and winter months, particularly among adolescents and young adults.

Managing anal fissures

Managing anal fissures

Anal fissures can be confused with hemorrhoids in everyday primary practice but require their own treatment protocol.

Preventing and treating periodontitis

Preventing and treating periodontitis

NPs and PAs must work in collaboration with oral health clinicians to effectively educate patients in the prevention of periodontal disease.

Insomnia: Using cognitive behavioral therapy in primary care

Insomnia: Using cognitive behavioral therapy in primary care

Cognitive behavioral therapy may have long-term positive effects 
in patients with insomnia who have chronic use of hypnotic drugs.

When abdominal pain is not appendicitis

When abdominal pain is not appendicitis

Clinicians might need to consider an uncommon array of causes when faced with a pediatric patient suffering from abdominal ailments.

Breaking the silence about congenital cytomegalovirus

Breaking the silence about congenital cytomegalovirus

Congenital cytomegalovirus is a very common cause of birth defects, yet many primary-care providers are not well-informed about this infection.

Don't overlook the resurgence of rubella

Don't overlook the resurgence of rubella


The current infectious-disease focus is on ebola and enterovirus D68, but an old foe, rubella, is once again demanding attention.

Adolescent risk-taking: salt and ice challenge

Adolescent risk-taking: salt and ice challenge

Young people might not understand the health consequences of participating in stunts that help them feel like part of the crowd.

Provider/pharmacist collaboration reduces flu visits

Provider/pharmacist collaboration reduces flu visits

A key element of the collaborative practice agreement is communication.

Q&A: Over-the-counter medicine use during flu season

Q&A: Over-the-counter medicine use during flu season


The Clinical Advisor asked infectious-diseases specialist Michael E. Klepser, PharmD, about the role over-the-counter agents play in seasonal influenza.

Identifying obstructive sleep apnea

Identifying obstructive sleep apnea


Airflow disturbances during sleep need to be recognized and evaluated before harm comes to the patients themselves or those around them.

The case for vegetarianism in the fight against heart disease

The case for vegetarianism in the fight against heart disease

Multiple studies show that just about any low-meat or no-meat diet reduces almost all controllable risk factors for cardiovascular disease.

Epistaxis: the common and not-so-common nosebleed

Epistaxis: the common and not-so-common nosebleed

Approximately 90% of epistaxis cases seen can be treated successfully by primary-care providers. The remainder of cases require an otolaryngologist referral.

The two most common forms of skin cancer

The two most common forms of skin cancer

The start of the "sun-worshipping season" is a good time to review the primary-care basics of basal cell and squamous cell carcinomas.

What to know about home genetic-test kits

What to know about home genetic-test kits

Consumers becoming more involved in do-it-yourself genetic testing need primary-care clinicians to put the results into context for them.

Save a life with early detection of melanoma

Save a life with early detection of melanoma

Brush up on the basics of preventing, recognizing and addressing melanoma among your patient ranks.

Prostate cancer data, dilemmas and decisions

Prostate cancer data, dilemmas and decisions

Prostate cancer is the most common male-related malignancy in the US, the second most common cause of cancer-related death among men.

Solving the mystery 
of rheumatic disease

Solving the mystery 
of rheumatic disease

Selecting appropriate lab tests when evaluating persons with symptoms suggesting a rheumatic condition often requires a bit of detective work.

Diagnosing diseases
 of the vulva

Diagnosing diseases
 of the vulva

Vulvar biopsy is a helpful tool that should be utilized to diagnose 
and to guide the management of vulvar abnormalities.

A better understanding of barefoot running

A better understanding of barefoot running

Research on the relationship between footwear and injury rates is limited. A switch to a minimalist shoe or barefoot running should be done gradually.

The facts and fictions of chelation therapy

The facts and fictions of chelation therapy

Originally used to treat lead poisoning and hypercalcemia, chelation has shown promise among individuals with heart disease and other conditions.

What's the lifespan of mononucleosis?

What's the lifespan of mononucleosis?

A short review of the human herpesvirus mononucleosis, testing options and recurrence.

Treating ­hypertension in older patients

Treating ­hypertension in older patients

In those older than age 65 years, high BP heightens risk for various forms of heart disease as well as for chronic kidney disease and diabetes mellitus.

What you should know about medical marijuana

What you should know about medical marijuana

Federal criminalization of this drug—most commonly used in the treatment
of HIV, pain and glaucoma—has limited research into its effectiveness.

What's new with EHRs?

What's new with EHRs?

Advances are outpacing arrival speed for this potentially lifesaving technology.

Critics question DSM-5 methodology, transparency

Critics question DSM-5 methodology, transparency

Widespread over-diagnosis of certain conditions with new criteria among top concerns.

Understanding the 
changes in DSM-5

Understanding the 
changes in DSM-5

The latest revision of the diagnostic manual does away with the complex 
multiaxial organization in favor of a simpler chapter order of disorders.

Gout management 
in patients with CKD

Gout management 
in patients with CKD

The most recent guidelines from the American College of Rheumatology
include pharmacologic and nonpharmacologic therapy for hyperuricemia.

The most common causes of hair loss among women

The most common causes of hair loss among women

When treating an adult female patient with the chief complaint of alopecia, 
the clinician should pay particular attention to the pattern of hair loss.

Options for pelvic congestion syndrome

Options for pelvic congestion syndrome

This challenging diagnosis presents as a dull, throbbing and achy pain in 
the vulvar region and may require referral to an interventional radiologist.

Traumatic brain injury in youth athletes

Traumatic brain injury in youth athletes

Accurate identification, assessment and evaluation of concussions will enable clinicians to determine when it is safe for young athletes to return to competition.

Early diagnosis of malignant melanoma

Early diagnosis of malignant melanoma

Surveillance on the part of primary-care clinicians is critical to the 
timely identification of cancerous lesions in at-risk individuals.

Improving the quality of geriatric cancer survivorship

Improving the quality of geriatric cancer survivorship

A collaborative approach to cancer treatment, incorporating the entire oncology team and the PCP, provides the best outcomes for quality patient care.

Avoiding costly ­diagnostic mistakes

Avoiding costly ­diagnostic mistakes

How should a clinician 
handle a difference of 
opinion with the attending physician on duty?

A case study of nocturnal enuresis

A case study of nocturnal enuresis

A healthy and thriving boy aged 8 years, has never been able to achieve complete nighttime dryness since being potty trained at age 3 years.

Simple treatment for pediatric bedwetting

Simple treatment for pediatric bedwetting

When treating a young patient for monosymptomatic enuresis, be sure to assess the physical, emotional, and developmental maturity of the child.

ADHD Medication Chart

ADHD Medication Chart

A chart of medications available to treat Attention Deficit Hyperactivity Disorder (ADHD).

Assessing ­peritonsillar abscesses

Assessing ­peritonsillar abscesses

This infection manifests as a collection of pus and is often a complication of tonsillitis that may require referral to a specialist or hospitalization.

Vaccinations to 
protect adolescents

Vaccinations to 
protect adolescents

Often at increased risk for disease transmission, many teens and preteens
 do not receive the recommended immunizations in a timely manner.

Vaginal bleeding in the early stages of pregnancy

Vaginal bleeding in the early stages of pregnancy

A number of potential causes of vaginal bleeding in early pregnancy must be considered when deciding what type of management is required.

Sexual risk behavior 
among older adults

Sexual risk behavior 
among older adults

Societal changes and pharmaceutical advances have led to a rise in sexual 
activity in this population, and clinicians must adapt to a new reality.

What is BPA and how harmful is it to kids?

What is BPA and how harmful is it to kids?

Primarily used in food and drink packaging, ingestion of bisphenol A has recently been linked to obesity, diabetes, and reproductive disorders.

Managing UTIs in women

Managing UTIs in women

Urinalysis and physical exam determine if the infection is complicated or uncomplicated, primary or recurrent and guide treatment strategy.

Are climate change and obesity linked?

Are climate change and obesity linked?

Mounting evidence suggests current food production, transport and land use may negatively impact both climate and obesity outcomes.

Treating the older adult with HIV

Treating the older adult with HIV

Clinicians need to be prepared for the unique challenges presented by the growing number of older patients with HIV.

Communicating Concerns About Nonspecific Changes on ECG

Communicating Concerns About Nonspecific Changes on ECG

Exercise caution when a patient presents with acute chest pain. The ability to explain the situation as clearly as possible is essential.

Vasomotor rhinitis and allergic conjunctivitis

Vasomotor rhinitis and allergic conjunctivitis

The ability to differentiate between the allergic and nonallergic form of these conditions is crucial when determining treatment.

Case Report: High-Dose Methylphenidate for Adult ADHD

Case Report: High-Dose Methylphenidate for Adult ADHD

Long-acting ADHD medications improve adherence and demonstrate efficacy similar to that of immediate-release dose formulations.

Postpartum depression in a primary-care setting

Postpartum depression in a primary-care setting

Experienced by up to one in five mothers, postpartum depression often goes untreated. Learn what risk factors to be alert for.

The effects of exercise on LDL

The effects of exercise on LDL

As LDL goals become more aggressive, therapeutic lifestyle changes are increasingly important in achieving recommended lipid levels.

mHealth apps may make chronic disease management easier

mHealth apps may make chronic disease management easier

mHealth apps can help empower patients and improve management of chronic diseases like asthma, diabetes and heart disease.

Osteoarthritis and 
Rheumatoid ­Arthritis 2012: Pathophysiology, Diagnosis, 
and Treatment

Osteoarthritis and 
Rheumatoid ­Arthritis 2012: Pathophysiology, Diagnosis, 
and Treatment

This article highlights the differences in the pathophysiology and diagnostic criteria for OA and RA, and also describes current and potentially new treatment options for these conditions.

Managing infants with bronchiolitis

Managing infants with bronchiolitis

The symptoms of this common lung infection usually dissipate after a week, but some cases can become severe and require hospitalization.

What to do with a positive hepatitis C test

What to do with a positive hepatitis C test

If the treatment goal of viral eradicatication cannot be met, strive to slow disease progression, lower risk of liver cancer, and improve quality of life.

Identifying and treating hypogonadism

Identifying and treating hypogonadism

Clinicians should check how well patients are responding to testosterone replacement therapy every three to four months during the first year.

ADHD & antisocial personality disorder: Minimizing the risks

ADHD & antisocial personality disorder: Minimizing the risks

Around 20% of pediatric patients with ADHD will develop antisocial personality disorder in adulthood.

Vitamin D deficiency: Beyond bone health

Vitamin D deficiency: Beyond bone health

Vitamin D promotes absorption of calcium in the intestine and maintains adequate serum phosphate and calcium concentrations.

Improving melanoma awareness in men

Improving melanoma awareness in men

Men typically seek treatment after melanoma has already progressed to later stages, accounting for higher mortally rates compared with women.

Minimize admissions for heart failure

Minimize admissions for heart failure

The need to educate patients and help them make difficult lifestyle changes requires clinicians to think differently and offer novel treatment approaches.

Mixing herbal and 
prescription meds

Mixing herbal and 
prescription meds

Patients often consider supplements and herbs harmless, but combining them with other drugs can have devastating consequences.

Dismiss a problem
 patient in 10 safe steps

Dismiss a problem
 patient in 10 safe steps

Most clinicians have dealt with a dissatisfied or noncompliant patient. 
But how do you end the relationship without putting yourself at risk?

Smartphone apps screen for melanoma

Smartphone apps screen for melanoma

Smart phones or tablets are being used to revolutionize clinical diagnosis and patient care, but they pose a number of risks and benefits.

Salary Survey 2012: How are you doing?

Salary Survey 2012: How are you doing?

Find out how your income compares with the more than 9,000 nurse practitioners and physician assistants who completed our 2012 salary survey.

Optimizing technology for diabetes care

Optimizing technology for diabetes care

Advancements in diabetes care abound, but busy practice schedules 
make staying current difficult.

The special challenge of chronic pain

The special challenge of chronic pain

Failure to properly treat patients suffering legitimate chronic pain syndromes can result in a compounding of prescription pain-medication abuse.

Pain management: Lessons from patients

Pain management: Lessons from patients

These women experienced debilitating pain episodes that challenged even the most knowledgeable clinicians. You can learn from their case histories.

Elder abuse: Primary care strategies for screening

Elder abuse: Primary care strategies for screening

The primary-care provider may be the only contact homebound elders have outside the abuse situation.

"Predisease": A concept whose time has come?

"Predisease": A concept whose time has come?

Treating patients before they develop a disease is tempting, but the old 
adage still applies: First, do no harm.

What causes a metallic taste and burning tongue?

What are the differential diagnoses for a woman aged 60 years with a metallic taste in her mouth and the sensation of a burning tongue?

Demystifying the liver and its diseases

Demystifying the liver and its diseases

An understanding of the liver and its functions will provide the tools to perform a basic workup of patients suspected of having hepatic disease.

Getting young patients to take their medicine

Getting young patients to take their medicine

The problem is challenging, but there are steps clinicians can take to eliminate barriers to medication adherence in children.

Update on pediatric diarrheal illnesses

Update on pediatric diarrheal illnesses

Since the introduction of the rotavirus vaccine, rotavirus-associated diarrhea has declined and clinicians must now worry about other diarrhea-causing organisms.

Making the right choice in hormone therapy

Making the right choice in hormone therapy

A young cancer survivor prompts consideration of best practice in prescribing estrogen replacement therapy for herself and for others.

Alleviating treatment-resistant depression

Alleviating treatment-resistant depression

Anywhere from 10% to 30% of individuals taking a single antidepressant face obstacles to successful treatment, including undiagnosed illness.

Updated information 
on MRSA infections

Updated information 
on MRSA infections

The number of hospital-acquired MRSA infections is down; however, 
community-acquired MRSA infections continue to rise.

Alternative therapy for gestational diabetes

Alternative therapy for gestational diabetes

Insulin is the only agent recommended to lower glucose levels in pregnant 
women, but a second-generation sulfonylurea may provide another option.

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