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Family Medicine - Adult Neurology and Psychiatry

Timing of restarting anticoagulation after intracranial hemorrhage (June 2022)


The American Heart Association/American Stroke Association published updated guidelines for the management of patients with spontaneous intracerebral hemorrhage (ICH).3 These guidelines suggest restarting anticoagulation up to eight weeks after ICH for selected patients when the risks and benefits favor resumption, based on limited observational data. We continue to suggest delaying resumption for four to eight weeks after ICH for most patients who restart anticoagulation, and use ICH size and thromboembolic risks to help guide the specific timing in individual patients.


Dermatology - Atopic Dermatitis and Other Dermatitis

Underrecognition of radiation dermatitis in patients with breast cancer undergoing radiotherapy (May 2022)


Radiation dermatitis is the most common adverse effect of radiation therapy (RT) but may be underrecognized in some patients. In a cohort study that included nearly 10,000 patients from the United States with breast cancer who received RT and completed a patient-reported outcome questionnaire, 99 percent were matched to physician Common Terminology Criteria for Adverse Events (CTCAE) assessments.4 Among over 5500 individuals reporting at least one RT symptom of breast pain, pruritus, edema, and fatigue, underrecognition by the physician occurred in 53 percent. Factors independently associated with underrecognition included age <50 years, being of Black or other than White ethnicity, receiving conventional fractionation, and male physician sex. Assessing subjective symptoms in patients undergoing RT may help reduce potential disparities in the diagnosis and management of radiation dermatitis.


Family Medicine - Screening

Screening for eating disorders (May 2022)


Although eating disorders (ED; eg, binge eating disorder, bulimia nervosa, anorexia nervosa) are associated with significant morbidity and mortality, the United States Preventive Services Task Force concluded that for asymptomatic individuals with a normal or high body mass index, the evidence is insufficient to determine the balance between the benefits and harms (unnecessary referrals, treatment, labeling, anxiety, stigma) of screening.1 We suggest screening patients who are at increased risk for ED, such as those who manifest signs or symptoms of ED or who have a history of trauma (eg, experiencing or witnessing an event that may cause or threaten death, serious injury, or sexual violence).


Increased rates of metastatic prostate cancer in the United States (May 2022)


The United States Preventive Services Task Force (USPSTF) recommended against routine screening for prostate cancer for men over 75 years beginning in 2008 and for all men in 2012. There is concern that this shift may have resulted in increased rates of advanced disease. A new analysis of population-based data from the United States from 2004 to 2018 demonstrates that since the change in recommendations, there has been an increase in the incidence of metastatic cancer in men of all ages, and especially in men aged 75 years or older (annual increase of 6.5 percent in 2018 compared with 2011).2 We continue to use shared decision-making in our approach to prostate cancer screening, incorporating research findings and patient preferences; the USPSTF amended their recommendations in 2018 to emphasize shared decision-making for men ages 55 to 69 years.


1. US Preventive Services Task Force, Davidson KW, Barry MJ, et al. Screening for Eating Disorders in Adolescents and Adults: US Preventive Services Task Force Recommendation Statement. JAMA. 2022;327(11):1061. [Context Link]


2. Desai MM, Cacciamani GE, Gill K, et al Trends in Incidence of Metastatic Prostate Cancer in the US. JAMA Netw Open. 2022;5:e222246. [Context Link]


3. Greenberg SM, Ziai WC, Cordonnier C, et al 2022 Guideline for the Management of Patients With Spontaneous Intracerebral Hemorrhage: A Guideline From the American Heart Association/American Stroke Association. Stroke. 2022. [Context Link]


4. Jagsi R, Griffith KA, Vicini F, et al Identifying Patients Whose Symptoms Are Underrecognized During Treatment With Breast Radiotherapy. JAMA Oncol. 2022. [Context Link]


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