Abstract：
:Persons whose experienced or expressed gender differs from their sex assigned at birth may identify as transgender. Transgender and gender-diverse persons may have gender dysphoria (i.e., distress related to this incongruence) and often face substantial health care disparities and barriers to care. Gender identity is distinct from sexual orientation, sex development, and external gender expression. Each construct is culturally variable and exists along continuums rather than as dichotomous entities. Training staff in culturally sensitive terminology and transgender topics (e.g., use of chosen name and pronouns), creating welcoming and affirming clinical environments, and assessing personal biases may facilitate improved patient interactions. Depending on their comfort level and the availability of local subspecialty support, primary care clinicians may evaluate gender dysphoria and manage applicable hormone therapy, or monitor well-being and provide primary care and referrals. The history and physical examination should be sensitive and tailored to the reason for each visit. Clinicians should identify and treat mental health conditions but avoid the assumption that such conditions are related to gender identity. Preventive services should be based on the patient's current anatomy, medication use, and behaviors. Gender-affirming hormone therapy, which involves the use of an estrogen and antiandrogen, or of testosterone, is generally safe but partially irreversible. Specialized referral-based surgical services may improve outcomes in select patients. Adolescents experiencing puberty should be evaluated for reversible puberty suppression, which may make future affirmation easier and safer. Aspects of affirming care should not be delayed until gender stability is ensured. Multidisciplinary care may be optimal but is not universally available.
journal_name
Am Fam Physicianjournal_title
American family physicianauthors
Klein DA,Paradise SL,Goodwin ETsubject
Has Abstractpub_date
2018-12-01 00:00:00pages
645-653issue
11eissn
0002-838Xissn
1532-0650pii
d13977journal_volume
98pub_type
杂志文章,评审abstract：:Senile dementia of the Binswanger's type is a term used to describe a dementia syndrome characterized by onset in the sixth or seventh decade of life, subcortical neurologic deficits, psychiatric disorders and evidence of hypertension or systemic vascular disease. The status of senile dementia of the Binswanger's type...
journal_title：American family physician
pub_type： 杂志文章,评审
doi：
更新日期：1998-12-01 00:00:00
abstract：:The principle of confidentiality is one of the clearest and firmest rules of professional ethics. However, situations can arise in which confidentiality ought to be abridged in favor of other, weightier values. In the case of a teenager who asks a family physician to prescribe birth control pills for her without infor...
journal_title：American family physician
pub_type： 杂志文章
doi：
更新日期：1982-01-01 00:00:00
abstract：:Health care-associated infections cause approximately 75,000 deaths annually, in addition to increasing morbidity and costs. Over the past decade, a downward trend in health care-associated infections has occurred nationwide. Basic prevention measures include administrative support, educating health care personnel, an...
journal_title：American family physician
pub_type： 杂志文章
doi：
更新日期：2014-09-15 00:00:00
abstract：:Historically, osteopathic physicians have made an important contribution to the primary care workforce. More than one half of osteopathic physicians are primary care physicians, and most of these are family physicians. However, the proportion of osteopathic students choosing family medicine, like that of their allopat...
journal_title：American family physician
pub_type： 杂志文章
doi：
更新日期：2005-08-15 00:00:00
abstract：:Down syndrome (trisomy 21) is the most commonly recognized genetic cause of mental retardation. The risk of trisomy 21 is directly related to maternal age. All forms of prenatal testing for Down syndrome must be voluntary. A nondirective approach should be used when presenting patients with options for prenatal screen...
journal_title：American family physician
pub_type： 杂志文章,评审
doi：
更新日期：2000-08-15 00:00:00
abstract：:Synovial osteochondromatosis is a benign disorder in which cartilaginous loose bodies develop about the large joints, usually the knee. It is caused by synovial metaplasia of unknown etiology. Symptoms are due either to mechanical problems caused by the loose bodies or to the degenerative arthritis that usually follow...
journal_title：American family physician
pub_type： 杂志文章
doi：
更新日期：1987-02-01 00:00:00
abstract：:Osteoporosis is the most common bone disorder in the United States. Bone mass is decreased, and porosity and fragility are increased. Dual-beam photon absorptiometry is currently considered the best detection technique. Prevention involves increased calcium intake and avoidance of diets high in protein and phosphates,...
journal_title：American family physician
pub_type： 杂志文章
doi：
更新日期：1985-11-01 00:00:00
abstract：:Jellyfish stings are usually mild except those caused by species in the South Pacific. The box jellyfish can produce a severe cardiorespiratory insult. The sting of the Portuguese man-of-war is more potent than that of the common jellyfish. The Indo-Pacific area is the source of the most venomous bony fish. Many injur...
journal_title：American family physician
pub_type： 杂志文章,评审
doi：
更新日期：1989-08-01 00:00:00
abstract：:Neck pain is a common presenting symptom in the primary care setting and causes significant disability. The broad differential diagnosis requires an efficient but global assessment; therefore, emphasis is typically placed on red flags that can assist in the early recognition and treatment of more concerning diagnoses,...
journal_title：American family physician
pub_type： 杂志文章,评审
doi：
更新日期：2020-08-01 00:00:00
abstract：:Atrial fibrillation is associated with potentially life-threatening strokes. Anticoagulation with warfarin or aspirin reduces the risk of embolic events in patients with chronic atrial fibrillation and mitral valve stenosis or other underlying heart disease. In patients with acute onset of atrial fibrillation, anticoa...
journal_title：American family physician
pub_type： 杂志文章,评审
doi：
更新日期：1992-06-01 00:00:00
abstract：:Transient organic causes of impotence include alcohol consumption, drug use or inflammatory genital disease. Many diagnoses of organic impotence, with diabetes, for example, have been premature and have resulted in iatrogenic, psychogenic impotence. After a stroke, heart attack or major surgery, depression may cause i...
journal_title：American family physician
pub_type： 杂志文章
doi：
更新日期：1978-02-01 00:00:00
abstract：:The acute and chronic effects of alcohol on bone, muscle and peripheral nerves are not well appreciated. Bone complications include traumatic fractures, osteoporosis and osteonecrosis. In muscle, a sustained bout of heavy drinking may cause rhabdomyolysis, while chronic alcohol abuse may produce proximal myopathy. In ...
journal_title：American family physician
pub_type： 杂志文章
doi：
更新日期：1986-11-01 00:00:00
abstract：:Emergency contraception decreases the risk of unintended pregnancy after unprotected sexual intercourse or after suspected failure of routine contraception (e.g., a condom breaking). Oral methods include combined contraceptive pills (i.e., Yuzpe method), single- or split-dose levonorgestrel, and ulipristal. The Yuzpe ...
journal_title：American family physician
pub_type： 杂志文章
doi：
更新日期：2014-04-01 00:00:00
abstract：:Carpal tunnel syndrome is the most common focal entrapment syndrome. Forceful repetitive activity and vibration may be important workplace risk factors for carpal tunnel syndrome. Although systematic study has suggested that carpal tunnel syndrome is work-related, no clear "dose-response" curve has been found between ...
journal_title：American family physician
pub_type： 杂志文章,评审
doi：
更新日期：1994-05-01 00:00:00
abstract：:Myocardial infarction and congestive heart failure are associated with high morbidity and mortality rates. The results of recent clinical trials support a beneficial role for angiotensin-converting enzyme (ACE) inhibitors in attenuating mortality from myocardial infarction and left ventricular dysfunction. Large-scale...
journal_title：American family physician
pub_type： 杂志文章,评审
doi：
更新日期：1995-11-01 00:00:00
abstract：:Delirium is characterized by a sudden deterioration in cognitive function and an inability to sustain attention. It is a medical emergency that occurs in more than 20 percent of hospitalized elderly patients. Misdiagnosis is common and contributes to high morbidity and mortality. Patients may present in hypoactive, hy...
journal_title：American family physician
pub_type： 杂志文章,评审
doi：
更新日期：1994-11-01 00:00:00
abstract：:Tonsillectomy and adenoidectomy (T&A) is the most commonly performed surgical procedure in the U.S. Considerable controversy surrounds this operation because all previous studies have demonstrated experimental flaws that compromise the value of the findings. While an apparent immunologic deficit following T&A has been...
journal_title：American family physician
pub_type： 杂志文章
doi：
更新日期：1977-09-01 00:00:00
abstract：:Kernicterus and neurologic sequelae caused by severe neonatal hyperbilirubinemia are preventable conditions. A structured and practical approach to the identification and care of infants with jaundice can facilitate prevention, thus decreasing rates of morbidity and mortality. Primary prevention includes ensuring adeq...
journal_title：American family physician
pub_type： 杂志文章,评审
doi：
更新日期：2008-05-01 00:00:00
abstract：:Hyperparathyroidism is a common cause of hypercalcemia. The hypercalcemia usually is discovered during a routine serum chemistry profile. Often, there has been no previous suspicion of this disorder. In most patients initially believed to be asymptomatic, previously unrecognized symptoms resolve with surgical correcti...
journal_title：American family physician
pub_type： 杂志文章,评审
doi：
更新日期：1998-04-15 00:00:00
abstract：:Frostbite can cause loss of life and limbs. Proper treatment and follow-up care are essential in reducing morbidity and mortality. Management of the frostbite patient consists of three stages. Initial care includes protection of the extremity from trauma or partial thawing. The second stage consists of rapid rewarming...
journal_title：American family physician
pub_type： 杂志文章
doi：
更新日期：1984-12-01 00:00:00
abstract：:Schirmer's test is a simple, semiquantitative test of tear production. It is based on the physical tendency of a fluid to travel along a strip of porous material by capillary action due to surface tension. Sterile strips, standardized and prepackaged, are available from local scientific supply houses. The low cost and...
journal_title：American family physician
pub_type： 杂志文章
doi：
更新日期：1981-11-01 00:00:00
abstract：:Acute ankle injury, a common musculoskeletal injury, can cause ankle sprains. Some evidence suggests that previous injuries or limited joint flexibility may contribute to ankle sprains. The initial assessment of an acute ankle injury should include questions about the timing and mechanism of the injury. The Ottawa Ank...
journal_title：American family physician
pub_type： 杂志文章,评审
doi：
更新日期：2006-11-15 00:00:00
abstract：:Skin laceration repair is an important skill in family medicine. Sutures, tissue adhesives, staples, and skin-closure tapes are options in the outpatient setting. Physicians should be familiar with various suturing techniques, including simple, running, and half-buried mattress (corner) sutures. Although suturing is t...
journal_title：American family physician
pub_type： 杂志文章
doi：
更新日期：2008-10-15 00:00:00
abstract：:Mild elevations in levels of the liver enzymes alanine transaminase and aspartate transaminase are commonly discovered in asymptomatic patients in primary care. Evidence to guide the diagnostic workup is limited. If the history and physical examination do not suggest a cause, a stepwise evaluation should be initiated ...
journal_title：American family physician
pub_type： 杂志文章
doi：
更新日期：2011-11-01 00:00:00
abstract：:Eczematous dermatitis is a common condition that can interfere with social function, sleep and employment. Its persistence and accompanying pruritus may be stressful and frustrating for patients. The most common and best characterized type of eczema, atopic dermatitis, appears to be increasing in incidence. Other comm...
journal_title：American family physician
pub_type： 杂志文章,评审
doi：
更新日期：1996-09-15 00:00:00
abstract：:Federally funded health centers and the National Health Service Corps (NHSC) depend on family physicians (FPs) and general practitioners (GPs) to meet the needs of millions of medically underserved people. Policy makers and workforce planners should consider how changes in the production of FPs would affect these prog...
journal_title：American family physician
pub_type： 杂志文章
doi：
更新日期：2005-07-15 00:00:00
abstract：:The U.S. Preventive Services Task Force recommends that clinicians screen adults for alcohol misuse and provide persons engaged in risky or hazardous drinking behaviors with brief behavioral counseling to reduce alcohol misuse. However, only a minority of American adults with high-risk alcohol use receive treatment. T...
journal_title：American family physician
pub_type： 杂志文章,评审
doi：
更新日期：2016-03-15 00:00:00
abstract：:House calls can still serve many functions in the overall care of the patient. By improving the relationship between physician and patient, providing the physician with important information that can only be gained from a home visit and allowing the physician to remain active in the care of the homebound patient, hous...
journal_title：American family physician
pub_type： 杂志文章,评审
doi：
更新日期：1991-11-01 00:00:00
abstract：:Sarcoidosis is a systemic granulomatous disease of unknown cause affecting young and middle-aged adults. Patients commonly present with bilateral hilar lymphadenopathy, pulmonary infiltrates, and ocular and skin lesions. The heart, liver,spleen, salivary glands, muscles,bones, kidneys, and central nervous system also ...
journal_title：American family physician
pub_type： 杂志文章,评审
doi：
更新日期：2004-07-15 00:00:00
abstract：:Hoarseness is the term often used by patients to describe changes in their voice quality. The causes of hoarseness are determined after obtaining a detailed medical history of the circumstances preceding the onset of hoarseness and performing a thorough physical examination. The latter may include visualization of the...
journal_title：American family physician
pub_type： 杂志文章,评审
doi：
更新日期：1998-06-01 00:00:00
