Primary hyperparathyroidism is the most common cause of hypercalcemia in the outpatient setting and is typically caused by a single benign parathyroid adenoma. Most patients with hyperparathyroidism are postmenopausal women. Patients can be asymptomatic or minimally symptomatic. Parathyroidectomy is the definitive cure for primary hyperparathyroidism, and no medical therapies have been approved by the Food and Drug Administration for this disorder. Guidelines for surgery have been established by a National Institutes of Health consensus panel, but many patients do not meet these guidelines or have comorbid conditions that prohibit surgery. This review describes alternative treatment options for patients who decide against or are unable to proceed with surgery.

Surgical results, economic consequences, and shortterm health of obese patients were evaluated before and after bariatric surgery. Of 35 patients in Mayo Health Plan Arizona eligible for bariatric surgery and scheduled for gastric restriction with Roux-en-Y gastrojejunostomy, 22 (7 men, 15 women) completed pre- and postoperative (6- and 12-mo) short form (SF)-12 Health Surveys. Nineteen patients had open bariatric procedures and 3 had laparoscopic procedures. Comorbid conditions, hospital course, weight loss, and complications were examined. Health care utilization (actual dollars paid by plan) for the preceding year and at 1- and 2-yr follow-up were compared. Major comorbid conditions included diabetes mellitus or impaired fasting glucose, hyperlipidemia, sleep apnea, and hypertension. Mean length of hospital stay was 4.8 d after open procedures and 2 d after laparoscopic procedures. No serious operative or postoperative complications occurred. From a baseline average body mass index (BMI) of 51.9, the 6- and 12-mo BMI averages were 39.6 (23.7% decrease) and 35.3 (32% decrease), respectively. Both physical and mental status improved. From baseline, physical health changed 18 and 21.2 points at 6 and 12 mo, respectively (p < 0.001), and mental health changed 9.3 points at each interval (p =0.003). Each postoperative year, resource utilization decreased (mean= $1300 per patient). Our findings of good surgical outcomes, significant weight loss, improved health status, and potential financial savings in this small sample may help patients, insurers, and self-funded employer groups evaluate the appropriateness of bariatric procedures.

Context: Athletes are a unique group of patients whose activities, particularly in high-contact sports such as wrestling and football, place them at high risk of developing skin conditions. The correct diagnosis of sports dermatoses requires familiarity with their clinical characteristics. It is critical that primary care physicians recognize the most common skin disorders to provide prompt treatment and prevent transmission. Evidence Acquisition: The Mayo Clinic library obtained articles from 2012 onward related to dermatologic conditions in athletes. Study Design: Review article. Level of Evidence: Level 3. Results: Dermatologic diseases in athletes are often infectious and contagious due to close-contact sports environments. Sports-related dermatoses include bacterial infections, such as impetigo, ecthyma, folliculitis, abscesses, furuncles, carbuncles, erysipelas, and cellulitis; fungal infections, such as tinea and intertrigo; viral infections, such as herpes, verrucae, and molluscum contagiosum; and noninfectious conditions, such as acne, blisters, and contact dermatitis. Conclusion: This article aims to address the manifestations of the most common cutaneous diseases in athletes on the first primary care visit. It discusses the appropriate tests and most recent evidence-based treatments for each ailment. It also addresses return-to-play recommendations related to the guidelines and regulations of selected sports organizations in the United States. Strength of Recommendation Taxonomy (SORT): C.

The role of primary care physicians in identifying potential candidates for bariatric surgery and providing them with long-term postoperative care is gaining rapidly in importance. With the increased use of surgical procedures as treatment options for obesity, a knowledge of bariatric surgery is essential for providing optimal care. During the past decade, the number of bariatric procedures has increased, and refinements of these procedures have made them safer and more effective. Primary care physicians should know how to identify appropriate surgical candidates and be familiar with available procedures, aware of potential complications and benefits, and able to provide lifelong monitoring and follow-up care. Thus, the primary care physician must be informed about surgical criteria, types of procedures, outcomes, complications, and the long-term monitoring needs of these patients. Clin Proc. 2004;79(9):1158-1166 BMI = body mass index; RNYGB = Roux-en-Y gastric bypass; VBG = vertical-banded gastroplasty P rimary care physicians frequently play a key role in assisting overweight or obese patients in their efforts to control excess weight. Both dietary and exercise counseling, along with occasional medication use, have been the primary treatments available to health care providers. However, these approaches are not successful for most patients. MayoObesity continues to grow at epidemic proportions in the United States and other developed nations. 1 More than 50% of the US population is overweight, and at least 22% of the population is obese. 2,3 Obesity is now the second most common cause of death in the United States. 4 The estimated cost of obesity in 1995 exceeded $99 billion, $50 billion of which was for medication and medical care; the rest was for indirect losses such as decreased work productivity. 2 Citizens in the United States spend an additional $30 billion annually for diet programs and supplements. 5 However, the safety, efficacy, and long-term results of these programs remain questionable. 6 Bariatric surgery to restrict the reservoir size of the stomach or to cause purposeful malabsorption resulting in weight loss was introduced in the 1960s. Although the early procedures produced suboptimal results, improved procedures continue to be developed. In the past decade, bariatric procedures as a treatment of obesity have elicited increasing interest. As more obese patients seek bariatric surgery, the role of primary care physicians has increased and is more likely to include identifying possible surgical candidates, screening patients, and providing long-term follow-up.Physicians unfamiliar with newer data may be unaware that significant refinements of bariatric surgical procedures have made these procedures safer and more effective, reducing morbidity and mortality and resulting in beneficial weight loss and more predictable long-term outcomes. 4,7,8 OBESITY DEFINITION Body mass index (BMI) is one of the most reliable methods used to report the relationship between body weight and frame size or height....

The nurse practitioner (NP) and physician assistant (PA) professions are rapidly growing. Historically, these professions have filled a health care delivery gap caused by lack of health care access and physician shortages. Many medical practices are more accustomed to adding new physicians as compared with adding new NPs or PAs. This article describes one institution's approach to develop and implement a successful NP/PA onboarding program.Several key components are discussed, including (1) established roles and responsibilities, (2) a clear timeline of the onboarding period including a foundational curriculum, (3) the mentor-mentee relationship, (4) the onboarding checklist, and ( 5) the onboarding itinerary. The objective was to have our NPs/PAs on a regular patient calendar within the 6-month period. The success rate with this has been 86%. In addition, there has been a 90% retention of NP/PA hires over the past 3 years. The authors believe this approach to NP/PA onboarding serves the patients well, providing excellent patient outcomes and patient experience.

The role of primary care physicians in identifying potential candidates for bariatric surgery and providing them with long-term postoperative care is gaining rapidly in importance. With the increased use of surgical procedures as treatment options for obesity, a knowledge of bariatric surgery is essential for providing optimal care. During the past decade, the number of bariatric procedures has increased, and refinements of these procedures have made them safer and more effective. Primary care physicians should know how to Identify appropriate surgical candidates and be familiar with available procedures, aware of potential complications and benefits, and able to provide lifelong monitoring and follow-up care. Thus, the primary care physician must be informed about surgical criteria, types of procedures, outcomes, complications, and the long-term monitoring needs of these patients.

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