Background: Much of primary care involves helping patients manage symptoms. Nighttime sweating is a symptom linked to menopause, malignancies, autoimmune diseases, and infections. However, in primary care settings, night sweats are commonly reported by persons without these conditions.Methods: We conducted a literature review, focusing on questions about definition, mechanisms, incidence/prevalence, measurement, clinical causes, evaluation, treatment, and prognosis. We limited our search to English language studies of adult humans published since 1966. Because studies of estrogen and androgen deficiency states had been reviewed by others, we excluded them. Search criteria were developed for each question. Publications meeting criteria were reviewed by the first 2 authors and consensus was reached through discussion.Results: Prevalence estimates ranged from 10% among older primary care patients to 60% among women on an obstetrics inpatient unit. Life expectancy of primary care patients reporting night sweats did not appear to be reduced. Although many clinical causes have been suggested, most are not well supported. Algorithmic approaches to evaluation are not evidence-based. Alpha adrenergic blockers may reduce night sweats in patients taking serotonin reuptake inhibitors. Thalidomide and thioridazine may benefit some terminal cancer patients with night sweats.

The law of diminishing returns, first described by economists to explain why, beyond a certain point, additional inputs produce smaller and smaller outputs, offers insight into many situations encountered in clinical medicine. For example, when the risk of an adverse event can be reduced in several different ways, the impact of each intervention can generally be shown mathematically to be reduced by the previous ones. The diminishing value of successive interventions is further reduced by adverse consequences (eg, drug-drug, drug-disease, and drug-nutrient interactions), as well as by the total expenditures of time, energy, and resources, which increase with each additional intervention. It is therefore important to try to prioritize interventions based on patient-centered goals and the relative impact and acceptability of the interventions. We believe that this has implications for clinical practice, research, and policy. (J Am Board Fam Med 2010;23: 371-375.)

Objective:The objective was to determine whether having a confidant was associated with improved health-related quality of life (HRQoL) or survival in older, community-dwelling individuals.Methods

MPH, and the Oklahoma Physicians Resource/Research NetworkPurpose: The purpose of this study was to describe colorectal cancer screening (CRCS) practices across a variety of primary care clinics and identify the methods used by primary care physicians (PCPs) with higher rates of CRCS ("exemplars").Methods: Physician questionnaires, structured interviews, medical record abstractions, and practice observations were conducted for 48 PCPs in 25 practices within a regional practice-based research network followed by secondary in-depth interviews to further investigate the practices of PCPs in the top quartile of CRCS rates ("exemplars").Results: We abstracted 3596 medical records (mean of 75 records per PCP). Overall, exemplars had higher CRCS rates (median, 57.2% vs. 27.6%; P < .001). Patients of exemplars had higher screening rates for fecal occult blood testing (FOBT) and colonoscopy but not for flexible sigmoidoscopy or double-contrast barium enemas. Exemplars adopted few of the system-based innovations proposed by researchers to improve CRCS. Colonoscopy was promoted as the preferred CRCS method. FOBT was recommended for patients who could not afford or did not want colonoscopy. Flexible sigmoidoscopy or barium enemas were rarely recommended. Exemplars used brief CRCS promotion scripts that informally paralleled theory-driven counseling techniques.Conclusions: Experienced PCPs use brief CRCS promotion scripts including counseling techniques that improve CRCS performance. Future research should be directed toward whether these techniques can be used to create an intervention aimed at PCPs to improve CRCS. (J Am Board Fam Med 2013;26:498-507.)

Early detection of breast cancer is desirable to prevent progression to advanced disease. This subject has been one of significant study and debate for women at normal risk, and recommendations continue to evolve. However, with regard to women at high risk, the recommendations from various health care professional organizations, including the recent recommendations from the United States Preventative Services Task Force, are different and also inconsistent concerning when to begin screening and which modalities should be used. We review several randomized controlled trials and consensus opinions regarding when to begin screening for breast cancer and how to best screen women at high risk. Specifically, we address women with known personal history of breast cancer, prior mantle radiation, or specific family history (including genetic family history) of breast cancer. The purpose of this inquiry is to present current evidence and suggest a clinical pathway regarding the screening of women at high risk for breast cancer.

Journal of Patient-Centered Research and Reviews ( JPCRR) is a peerreviewed scientific journal whose mission is to communicate clinical and bench research findings, with the goal of improving the quality of human health, the care of the individual patient, and the care of populations. Recommended CitationGaskamp M, Blubaugh M, McCarthy LH, Scheid DC. Can bedside ultrasound inferior vena cava measurements accurately diagnose congestive heart failure in the emergency department? A Clin-IQ. J Patient Cent Res Rev. 2016;3:230-4 Clinical QuestionIn adults, 18 years of age and older, who present to the emergency department (ED) with dyspnea, are inferior vena cava (IVC) measurements using bedside ultrasound as accurate as B-type natriuretic peptide (BNP) levels for identifying heart failure? Brief AnswerYes. Bedside ultrasound measurement of the IVC is a highly specific and rapid tool for diagnosing heart failure in the ED setting compared with BNP. BNP costs less than bedside ultrasound but is less specific and may take up to one hour or more at a clinical juncture when rapid detection of volume overload can rule in or rule out heart failure. In the studies reviewed, the specificity of the IVC measurement was as good as, or better than, BNP values. Ultrasound IVC measurements may be especially useful for cases in which BNP values fall into a nondiagnostic "gray zone" range. Based on current evidence, it seems reasonable to conclude that ultrasound IVC measurements, taken by properly trained ED clinicians, alone or in combination with BNP, would likely increase accuracy of diagnosing heart failure, allow earlier initiation of appropriate treatment and potentially reduce morbidity and mortality.Date of Literature Search: March/April 2016. Level of Evidence: B. Search TermsUltrasound, heart failure, inferior vena cava, pro-Btype natriuretic peptide, NR-PRoBNP, emergency department, diagnosis Inclusion CriteriaCurrent systematic reviews, meta-analyses, cohort studies, clinical research trials investigating the AbstractCongestive heart failure (CHF) is a major cause of morbidity and mortality. Early diagnosis of CHF in patients presenting to the emergency department with undifferentiated dyspnea would allow clinicians to begin appropriate treatment more promptly. Current guidelines recommend B-type natriuretic peptide (BNP) levels for more accurate diagnosis of CHF in dyspneic patients. Although BNP levels are relatively inexpensive, the test is not usually performed at bedside and results may take up to an hour or more. BNP also may have a "gray zone" in which the values can neither confirm nor rule out CHF. BNP has a reported sensitivity of 87% and specificity of 74% at a cutoff of 400 pg/ml. Studies investigating bedside ultrasound inferior vena cava (IVC) measurements for identifying CHF report a specificity of 84% to 96% and sensitivity values ranging from 37% to 93%, depending on the study. efficacy of ultrasound measurements of the IVC for diagnosing heart failure in the ED. Exclusion CriteriaChildren less than 1...

Data from a randomized controlled trial and systematic review support the claim that switching from tobacco cigarettes to electronic cigarettes (e-cigarettes) can reduce the short-term negative health effects of smoking. In adult smokers unwilling or unable to quit, exhaled carbon monoxide levels, total number of cigarettes smoked, and exposure to nitrosamine chemicals were reduced within a 12-month period. While the electronic cigarette industry remains largely unregulated thus far, these studies provide encouraging hope in the uphill battle toward helping patients make informed and healthy choices.

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