Because sexual health concerns are quite common, family physicians should be prepared to discuss topics such as erectile dysfunction, dyspareunia, and arousal disorders.Point-of-care ultrasonography (POCUS) is performed by a physician at the bedside and is standard practice in obstetric, emergency, and musculoskeletal medicine. When compared with formal sonography, POCUS is equivalent in screening for abdominal aortic aneurysm and as accurate in diagnosing deep venous thrombosis. POCUS has high accuracy for diagnosing pneumonia and detecting acute decompensated heart failure but is less accurate than computed tomography for identifying pulmonary embolism. POCUS confirmation of intrauterine pregnancy rules out an ectopic pregnancy. In the third trimester of high-risk pregnancies, umbilical artery Doppler ultrasonography can improve perinatal outcomes. Musculoskeletal POCUS is used to diagnose and guide treatment of many joint and soft tissue conditions. It is as accurate as magnetic resonance imaging in the diagnosis of complete rotator cuff tears. Ultrasound guidance improves outcomes in the placement of central venous catheters and fluid drainage from body cavities and lumbar punctures. Ultrasonography can reduce the use of CT for diagnosis of appendicitis; however, negative scan results do not rule out disease. POCUS can accurately diagnose and rule out gallbladder pathology, and is effective for diagnosing urolithiasis. see more Focused cardiac ultrasonography can detect pericardial effusion and decreased systolic function, but is less accurate than lung ultrasonography at diagnosing acute heart failure. Limited evidence demonstrates a benefit of diagnosing testicular and gynecologic conditions. The American College of Emergency Physicians, the American Institute of Ultrasound in Medicine, the Society for Academic Emergency Medicine, the American College of Radiology, and others offer POCUS training. Training standards for POCUS have been defined for residency programs but are less established for credentialing.gammaCore is cleared by the FDA for acute and preventive treatment of cluster headache and the acute treatment of migraine in adults. Previously, only 2 treatments were approved for acute treatment of cluster headache while none were approved for preventive treatment. Following the initial FDA clearance, based on the ACT-1 and ACT-2 studies, a gammaCore Patient Registry (GPR) was designed to provide insights on the use of gammaCore and prescription patterns in the real-world setting and to characterize respective benefits and challenges during the acute treatment of episodic cluster headache. GPR was a prospective observational registry in which patients with episodic cluster headache (3rd edition of the International Classification of Headache Disorders criteria) who were prescribed gammaCore were invited to voluntarily enroll and provide information on their experiences between July 2017 and June 2018. Participants provided baseline information and were trained to self-administer treatment with gammaCore fo attacks was 2.7, the mean number of stimulations used was 3.6, and the pain score after 30 minutes was 1.3. At 30 minutes, the pain of 81 (70%) attacks was reduced to none (27%) or mild (43%) (a pain score of 0 or 1) and in 94 (81%) attacks, patients experienced a reduction of at least 1 point in the pain score. This real-world observational evidence suggests that gammaCore adds clinically meaningful value to patients with episodic cluster headache by providing rapid pain relief and confirms that there is significant interest among prescribers in providing this new treatment and technology. This evidence further supports the need to redefine gammaCore as no longer investigational or experimental during considerations for reimbursement.Migraine is a debilitating condition that affects approximately 16% of adults and is the fifth leading cause of emergency department visits in the United States. There are several treatment options for migraines; opioids are frequently prescribed. Results from a recent study showed that more than half of the patients with chronic migraine and a third of the patients with episodic migraine received an opioid prescription in the past year. The American Headache Society recognizes the magnitude of this issue and is working to educate providers on the danger of prescribing opioids in the migraine population The objective of this article is to assess the utilization trends of prescription opioid products and evaluate the impact of opioid utilization on healthcare costs in this patient population. This retrospective claims database analysis used real-world medical claims from multiple health plans. The study period was from January 1, 2009, to September 30, 2017. Patients were included if they were 18 years or olde $12,060 for no opioid use in control patients; P less then .0001. Patients with more than 2 comorbidities who were prescribed opioids had higher costs than patients with more than 2 comorbidities who were not prescribed opioids and patients with less than 2 comorbidities who were prescribed opioids ($65,980, $32,152, and $35,964, respectively, for patients with migraine, and $52,883, $24,641, and $35,748, respectively, for control patients; P less then .0001). Patients with migraine have more than twice the healthcare costs as patients without migraines. The additional increase in healthcare costs in patients with migraine who use opioids for treatment and/or have 2 or more comorbidities is significant. Control of the pain associated with migraine, specifically among those with multiple comorbid conditions, may contribute to substantial reductions in healthcare costs.This study evaluates the impact of concomitant medical conditions on patients with and without migraine, assessing healthcare utilization, and total cost of care. Medical and pharmacy claims from multiple health plans, both nationally and internationally, were examined to evaluate overall real-world trends in commercially insured patients diagnosed with migraine. A total of 53,608 patients with diagnosis codes for migraine met the study criteria and were matched 11 with controls (81.8% female; mean age, 42 years; mean Charlson Comorbidity Index score, 0.34). During the 3-year measurement period, mean medical costs per patient in the migraine cohort were about 1.7 times that of the control group ($22,429 vs $13,166). Unique encounters and cost per patient by medical service type for the migraine cohort compared with the control group were as follows emergency department, 4.13 ($4000) versus 2.94 ($2639); hospital inpatient, 3.15 ($17,748) versus 2.67 ($16,010); hospital outpatient, 5.14 ($365) versus 4.85 ($396); physician office, 36.78 ($6803) versus 21.39 ($4069); laboratory, 10.12 ($1433) versus 7.71 ($1057); radiology, 7.64 ($2609) versus 5.94 ($1733). Mean pharmacy costs per patient were approximately 1.8 times higher in the migraine cohort compared with the control cohort ($8441 vs $4588, respectively; P less then .0001). These results suggest that patients with migraine have more comorbidities compared with those without migraine. These patients also utilize healthcare resources at a significantly higher rate compared with similar patients without a migraine diagnosis. An unmet need exists for new treatment modalities in this patient population. More effective interventions and proper management may lead to improved patient outcomes and healthcare costs for patients with migraine.in English, French Contexte En 2012, l’American Society of Clinical Oncology (ASCO) a publié sa liste de 5 interventions à « Choisir avec soin », dans laquelle elle recommandait notamment de ne pas recourir aux techniques d’imagerie de pointe pour le dépistage des métastases chez les patientes atteintes d’un cancer du sein peu avancé et asymptomatique. Nos lignes directrices provinciales pour la stadification du cancer du sein ont été mises à jour en conséquence. Nous faisons aujourd’hui état de l’utilisation injustifiée de la scintigraphie osseuse (SO), de la tomodensitométrie (TDM), de l’imagerie par résonnance magnétique (IRM) non mammaire et de la tomographie par émission de positrons (TEP) chez les femmes ayant reçu un diagnostic de cancer du sein peu avancé (stade 0-II) en Alberta entre 2011 et 2015. Méthodes La cohorte a été réunie de manière rétrospective à partir du registre albertain du cancer. Nous avons utilisé d’autres sources de données provinciales pour obtenir des renseignements sur les épreuvde nos lignes directrices provinciales concernant la stadification du cancer du sein. Il faudra se pencher sur des stratégies pour améliorer l’adoption de lignes directrices relatives aux soins véritablement utiles pour les patientes atteintes d’un cancer du sein peu avancé.in English, French Contexte L’hidradénite suppurée (HS) est une maladie invalidante chronique du follicule pilo-sébacé qui affecte la peau principalement au niveau de l’aisselle, de l’aine, du pli sous-mammaire et du siège. Une intervention chirurgicale pourrait être une option appropriée dans certains cas, mais il y a un risque de récurrence. Le but de cette étude était d’évaluer les résultats d’une excision locale large (ELL) jusqu’aux tissus adipeux sous-cutanés sains suivie de cicatrisation secondaire chez des patients atteints d’HS recevant concomitamment des soins chirurgicaux et dermatologiques. link2 Méthodes Nous avons procédé à une revue rétrospective de 192 consultations consécutives pour HS dans un service de chirurgie générale et nous avons recensé les patients traités par ELL. Les cas impliquant des interventions mineures (par incisiondrainage) ont été exclus. Les données démographiques, le site chirurgical, la méthode de suture, les complications et les récurrences ont été enregistrés à partir des doaxillaire ont connu des restrictions dans leur capacité de lever les bras et ont dû faire de la physiothérapie. Le suivi médian a été de 14,5 (éventail de 1 à 55) mois. Conclusion La résection jusqu’aux tissus adipeux sous-cutanés sains durant l’ELL permet de maîtriser la maladie aussi bien que les résections plus profondes, mais simplifie les soins.in English, French Contexte L’Initiative pour la qualité de la chirurgie vasculaire de la Société canadienne de chirurgie vasculaire (IQCV-SCCV) est une base de données qui donne un aperçu des normes thérapeutiques et souligne les possibilités d’améliorations de la qualité en faisant la comparaison entre les tendances institutionnelles et les tendances locales, régionales et nationales. link3 La réparation endovasculaire d’anévrisme (REVA) est une intervention fréquente. La durée du séjour hospitalier postopératoire varie d’un établissement à l’autre. Nous avons examiné la morbidité et la mortalité chez les patients ayant subi une REVA dans notre établissement et mesuré l’impact économique d’un séjour hospitalier prolongé chez ces patients. De plus, nous avons tenté de dégager les facteurs modifiables associés à un séjour prolongé. Méthodes Nous avons recensé tous les patients ayant subi une REVA entre le 1er janvier 2011 et le 31 décembre 2014. Nous avons pris en compte les caractéristiques préopératoires des patients, les détails peropératoires, les facteurs postopératoires, les résultats à long terme (1 an) et les coûts.