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  1. Article ; Online: Insomnia: Pharmacologic Therapy.

    Matheson, Eric / Hainer, Barry L

    American family physician

    2017  Volume 96, Issue 1, Page(s) 29–35

    Abstract: Insomnia accounts for more than 5.5 million visits to family physicians each year. Although behavioral interventions are the mainstay of treatment, pharmacologic therapy may be necessary for some patients. Understanding the risks and benefits of insomnia ...

    Abstract Insomnia accounts for more than 5.5 million visits to family physicians each year. Although behavioral interventions are the mainstay of treatment, pharmacologic therapy may be necessary for some patients. Understanding the risks and benefits of insomnia medications is critical. Controlled-release melatonin and doxepin are recommended as first-line agents in older adults; the so-called z-drugs (zolpidem, eszopiclone, and zaleplon) should be reserved for use if the first-line agents are ineffective. For the general population with difficulty falling asleep, controlled-release melatonin and the z-drugs can be considered. For those who have difficulty staying asleep, low-dose doxepin and the z-drugs should be considered. Benzodiazepines are not recommended because of their high abuse potential and the availability of better alternatives. Although the orexin receptor antagonist suvorexant appears to be relatively effective, it is no more effective than the z-drugs and much more expensive. Sedating antihistamines, antiepileptics, and atypical antipsychotics are not recommended unless they are used primarily to treat another condition. Persons with sleep apnea or chronic lung disease with nocturnal hypoxia should be evaluated by a sleep specialist before sedating medications are prescribed.
    MeSH term(s) Benzodiazepines/administration & dosage ; Benzodiazepines/therapeutic use ; Doxepin/administration & dosage ; Doxepin/therapeutic use ; Humans ; Hypnotics and Sedatives/administration & dosage ; Hypnotics and Sedatives/therapeutic use ; Melatonin/administration & dosage ; Melatonin/agonists ; Melatonin/therapeutic use ; Sleep Initiation and Maintenance Disorders/drug therapy
    Chemical Substances Hypnotics and Sedatives ; Benzodiazepines (12794-10-4) ; Doxepin (1668-19-5) ; Melatonin (JL5DK93RCL)
    Language English
    Publishing date 2017-07-01
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 412694-4
    ISSN 1532-0650 ; 0002-838X ; 0572-3612
    ISSN (online) 1532-0650
    ISSN 0002-838X ; 0572-3612
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article: Vaccine administration: making the process more efficient in your practice.

    Hainer, Barry L

    Family practice management

    2007  Volume 14, Issue 3, Page(s) 48–53

    MeSH term(s) Documentation ; Efficiency, Organizational ; Equipment and Supplies ; Family Practice/economics ; Family Practice/organization & administration ; Forms and Records Control ; Humans ; Immunization Programs/economics ; Immunization Programs/organization & administration ; Reminder Systems ; United States ; Vaccines/administration & dosage ; Vaccines/supply & distribution
    Chemical Substances Vaccines
    Language English
    Publishing date 2007-03
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1226804-5
    ISSN 1069-5648
    ISSN 1069-5648
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Approach to acute headache in adults.

    Hainer, Barry L / Matheson, Eric M

    American family physician

    2013  Volume 87, Issue 10, Page(s) 682–687

    Abstract: Approximately one-half of the adult population worldwide is affected by a headache disorder. The International Headache Society classification and diagnostic criteria can help physicians differentiate primary headaches (e.g., tension, migraine, cluster) ... ...

    Abstract Approximately one-half of the adult population worldwide is affected by a headache disorder. The International Headache Society classification and diagnostic criteria can help physicians differentiate primary headaches (e.g., tension, migraine, cluster) from secondary headaches (e.g., those caused by infection or vascular disease). A thorough history and physical examination, and an understanding of the typical features of primary headaches, can reduce the need for neuroimaging, lumbar puncture, or other studies. Some red flag signs and symptoms identified in the history or during a physical examination can indicate serious underlying pathology and will require neuroimaging or other testing to evaluate the cause of headache. Red flag signs and symptoms include focal neurologic signs, papilledema, neck stiffness, an immunocompromised state, sudden onset of the worst headache in the patient's life, personality changes, headache after trauma, and headache that is worse with exercise. If an intracranial hemorrhage is suspected, head computed tomography without contrast media is recommended. For most other dangerous causes of headache, magnetic resonance imaging or computed tomography is acceptable.
    MeSH term(s) Acute Disease ; Adult ; Cluster Headache/diagnosis ; Cluster Headache/etiology ; Diagnosis, Differential ; Headache/diagnosis ; Headache/etiology ; Humans ; Medical History Taking ; Migraine Disorders/diagnosis ; Migraine Disorders/etiology ; Physical Examination
    Language English
    Publishing date 2013-05-15
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 412694-4
    ISSN 1532-0650 ; 0002-838X ; 0572-3612
    ISSN (online) 1532-0650
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  4. Article ; Online: Vaginitis.

    Hainer, Barry L / Gibson, Maria V

    American family physician

    2011  Volume 83, Issue 7, Page(s) 807–815

    Abstract: Bacterial vaginosis, trichomoniasis, and vulvovaginal candidiasis are the most common infectious causes of vaginitis. Bacterial vaginosis occurs when the normal lactobacilli of the vagina are replaced by mostly anaerobic bacteria. Diagnosis is commonly ... ...

    Abstract Bacterial vaginosis, trichomoniasis, and vulvovaginal candidiasis are the most common infectious causes of vaginitis. Bacterial vaginosis occurs when the normal lactobacilli of the vagina are replaced by mostly anaerobic bacteria. Diagnosis is commonly made using the Amsel criteria, which include vaginal pH greater than 4.5, positive whiff test, milky discharge, and the presence of clue cells on microscopic examination of vaginal fluid. Oral and topical clindamycin and metronidazole are equally effective at eradicating bacterial vaginosis. Symptoms and signs of trichomoniasis are not specific; diagnosis by microscopy is more reliable. Features of trichomoniasis are trichomonads seen microscopically in saline, more leukocytes than epithelial cells, positive whiff test, and vaginal pH greater than 5.4. Any nitroimidazole drug (e.g., metronidazole) given orally as a single dose or over a longer period resolves 90 percent of trichomoniasis cases. Sex partners should be treated simultaneously. Most patients with vulvovaginal candidiasis are diagnosed by the presence of vulvar inflammation plus vaginal discharge or with microscopic examination of vaginal secretions in 10 percent potassium hydroxide solution. Vaginal pH is usually normal (4.0 to 4.5). Vulvovaginal candidiasis should be treated with one of many topical or oral antifungals, which appear to be equally effective. Rapid point-of-care tests are available to aid in accurate diagnosis of infectious vaginitis. Atrophic vaginitis, a form of vaginitis caused by estrogen deficiency, produces symptoms of vaginal dryness, itching, irritation, discharge, and dyspareunia. Both systemic and topical estrogen treatments are effective. Allergic and irritant contact forms of vaginitis can also occur.
    MeSH term(s) Administration, Intravaginal ; Administration, Oral ; Anti-Bacterial Agents/therapeutic use ; Anti-Infective Agents/therapeutic use ; Antifungal Agents/therapeutic use ; Atrophic Vaginitis/diagnosis ; Atrophic Vaginitis/drug therapy ; Atrophic Vaginitis/etiology ; Atrophic Vaginitis/physiopathology ; Bacterial Load/drug effects ; Bacterial Load/methods ; Candidiasis, Vulvovaginal/diagnosis ; Candidiasis, Vulvovaginal/drug therapy ; Candidiasis, Vulvovaginal/microbiology ; Candidiasis, Vulvovaginal/physiopathology ; Clindamycin/therapeutic use ; Estrogens/therapeutic use ; Female ; Gynecological Examination/methods ; Humans ; Hydrogen-Ion Concentration ; Metronidazole/therapeutic use ; Microscopy/methods ; Treatment Outcome ; Trichomonas Vaginitis/diagnosis ; Trichomonas Vaginitis/drug therapy ; Trichomonas Vaginitis/microbiology ; Trichomonas Vaginitis/physiopathology ; Vaginal Discharge/microbiology ; Vaginosis, Bacterial/diagnosis ; Vaginosis, Bacterial/drug therapy ; Vaginosis, Bacterial/microbiology ; Vaginosis, Bacterial/physiopathology
    Chemical Substances Anti-Bacterial Agents ; Anti-Infective Agents ; Antifungal Agents ; Estrogens ; Metronidazole (140QMO216E) ; Clindamycin (3U02EL437C)
    Language English
    Publishing date 2011-04-01
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 412694-4
    ISSN 1532-0650 ; 0002-838X ; 0572-3612
    ISSN (online) 1532-0650
    ISSN 0002-838X ; 0572-3612
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Diagnosis, treatment, and prevention of gout.

    Hainer, Barry L / Matheson, Eric / Wilkes, R Travis

    American family physician

    2014  Volume 90, Issue 12, Page(s) 831–836

    Abstract: Gout is characterized by painful joint inflammation, most commonly in the first metatarsophalangeal joint, resulting from precipitation of monosodium urate crystals in a joint space. Gout is typically diagnosed using clinical criteria from the American ... ...

    Abstract Gout is characterized by painful joint inflammation, most commonly in the first metatarsophalangeal joint, resulting from precipitation of monosodium urate crystals in a joint space. Gout is typically diagnosed using clinical criteria from the American College of Rheumatology. Diagnosis may be confirmed by identification of monosodium urate crystals in synovial fluid of the affected joint. Acute gout may be treated with nonsteroidal anti-inflammatory drugs, corticosteroids, or colchicine. To reduce the likelihood of recurrent flares, patients should limit their consumption of certain purine-rich foods (e.g., organ meats, shellfish) and avoid alcoholic drinks (especially beer) and beverages sweetened with high-fructose corn syrup. Consumption of vegetables and low-fat or nonfat dairy products should be encouraged. The use of loop and thiazide diuretics can increase uric acid levels, whereas the use of the angiotensin receptor blocker losartan increases urinary excretion of uric acid. Reduction of uric acid levels is key to avoiding gout flares. Allopurinol and febuxostat are first-line medications for the prevention of recurrent gout, and colchicine and/or probenecid are reserved for patients who cannot tolerate first-line agents or in whom first-line agents are ineffective. Patients receiving urate-lowering medications should be treated concurrently with nonsteroidal anti-inflammatory drugs, colchicine, or low-dose corticosteroids to prevent flares. Treatment should continue for at least three months after uric acid levels fall below the target goal in those without tophi, and for six months in those with a history of tophi.
    MeSH term(s) Anti-Inflammatory Agents, Non-Steroidal/therapeutic use ; Diagnosis, Differential ; Diet Therapy/methods ; Disease Management ; Glucocorticoids/therapeutic use ; Gout/diagnosis ; Gout/metabolism ; Gout/physiopathology ; Gout/therapy ; Gout Suppressants/therapeutic use ; Humans ; Patient Acuity ; Risk Factors ; Secondary Prevention/methods ; Uric Acid/metabolism
    Chemical Substances Anti-Inflammatory Agents, Non-Steroidal ; Glucocorticoids ; Gout Suppressants ; Uric Acid (268B43MJ25)
    Language English
    Publishing date 2014-12-15
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 412694-4
    ISSN 1532-0650 ; 0002-838X ; 0572-3612
    ISSN (online) 1532-0650
    ISSN 0002-838X ; 0572-3612
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article: Dermatophyte infections.

    Hainer, Barry L

    American family physician

    2003  Volume 67, Issue 1, Page(s) 101–108

    Abstract: Dermatophytes are fungi that require keratin for growth. These fungi can cause superficial infections of the skin, hair, and nails. Dermatophytes are spread by direct contact from other people (anthropophilic organisms), animals (zoophilic organisms), ... ...

    Abstract Dermatophytes are fungi that require keratin for growth. These fungi can cause superficial infections of the skin, hair, and nails. Dermatophytes are spread by direct contact from other people (anthropophilic organisms), animals (zoophilic organisms), and soil (geophilic organisms), as well as indirectly from fomites. Dermatophyte infections can be readily diagnosed based on the history, physical examination, and potassium hydroxide (KOH) microscopy. Diagnosis occasionally requires Wood's lamp examination and fungal culture or histologic examination. Topical therapy is used for most dermatophyte infections. Cure rates are higher and treatment courses are shorter with topical fungicidal allylamines than with fungistatic azoles. Oral therapy is preferred for tinea capitis, tinea barbae, and onychomycosis. Orally administered griseofulvin remains the standard treatment for tinea capitis. Topical treatment of onychomycosis with ciclopirox nail lacquer has a low cure rate. For onychomycosis, "pulse" oral therapy with the newer imidazoles (itraconazole or fluconazole) or allylamines (terbinafine) is considerably less expensive than continuous treatment but has a somewhat lower mycologic cure rate. The diagnosis of onychomycosis should be confirmed by KOH microscopy, culture, or histologic examination before therapy is initiated, because of the expense, duration, and potential adverse effects of treatment.
    MeSH term(s) Antifungal Agents/therapeutic use ; Arthrodermataceae/isolation & purification ; Arthrodermataceae/pathogenicity ; Clinical Trials as Topic ; Dermatomycoses/diagnosis ; Dermatomycoses/drug therapy ; Diagnosis, Differential ; Humans ; Hydroxides ; Potassium Compounds
    Chemical Substances Antifungal Agents ; Hydroxides ; Potassium Compounds ; potassium hydroxide (WZH3C48M4T)
    Language English
    Publishing date 2003-01-01
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 412694-4
    ISSN 0002-838X ; 0572-3612
    ISSN 0002-838X ; 0572-3612
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  7. Article: Electrosurgery for the skin.

    Hainer, Barry L

    American family physician

    2002  Volume 66, Issue 7, Page(s) 1259–1266

    Abstract: The purposes of electrosurgery are to destroy benign and malignant lesions, control bleeding, and cut or excise tissue. The major modalities in electrosurgery are electrodesiccation, fulguration, electrocoagulation, and electrosection. Electrosurgery can ...

    Abstract The purposes of electrosurgery are to destroy benign and malignant lesions, control bleeding, and cut or excise tissue. The major modalities in electrosurgery are electrodesiccation, fulguration, electrocoagulation, and electrosection. Electrosurgery can be used for incisional techniques that produce full-thickness excision of nevi, for shave techniques that produce partial-thickness removal of superficial lesions, and for removing vascular lesions such as hemangiomas or pyogenic granulomas. The correct output power can be determined by starting low and increasing the power until the desired outcome is attained (destruction, coagulation, or cutting). Smaller cherry angiomas can be electrocoagulated lightly. Larger cherry angiomas may be easier to treat by shaving them first, then electrocoagulating or desiccating the base. The elevated portion of pyogenic granulomas can be shaved off with a scalpel or a loop electrode using a cutting/coagulation current. The base of the lesion is curetted to remove the remaining tissue and then electrodesiccated. Complications such as burns, shocks, and transmission of infection can be prevented by careful use of the electrosurgical equipment.
    MeSH term(s) Current Procedural Terminology ; Electrosurgery/economics ; Electrosurgery/education ; Electrosurgery/instrumentation ; Electrosurgery/methods ; Family Practice ; Humans ; Intraoperative Complications/prevention & control ; Referral and Consultation ; Skin Diseases/surgery ; Treatment Outcome ; Wounds and Injuries/therapy
    Language English
    Publishing date 2002-10-01
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 412694-4
    ISSN 0002-838X ; 0572-3612
    ISSN 0002-838X ; 0572-3612
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