What is the best next step in managing this patient?

From the Guidelines

The best next step in management of this patient is to provide them with education and information about their condition and management options. This approach is supported by high-quality clinical practice guidelines, as outlined in a systematic review published in the British Journal of Sports Medicine in 2020 1. The key aspects of this educational approach include:

• Providing patients with a clear understanding of their musculoskeletal pain condition
• Discussing the available management options
• Involving patients in the decision-making process to ensure they are actively engaged in their care
• Ensuring that patients have the necessary information to make informed decisions about their treatment This educational approach is essential for empowering patients to take an active role in managing their condition, which can lead to improved outcomes, including reduced morbidity, mortality, and enhanced quality of life. By prioritizing patient education, healthcare providers can help patients make informed decisions about their care, which is critical for achieving optimal health outcomes. The educational content should be tailored to the individual patient's needs, taking into account their unique circumstances, preferences, and values. Ultimately, providing patients with education and information about their condition and management options is a crucial step in delivering high-quality, patient-centered care.

From the Research

Evaluation of Nausea and Vomiting

• The patient's symptoms of nausea and vomiting can be evaluated based on history and physical examination, as stated in the study 2.
• The likely cause of acute nausea and vomiting can usually be determined by history and physical examination, and basic laboratory testing may include urinalysis, urine pregnancy testing, complete blood count, comprehensive metabolic panel, amylase and lipase levels, thyroid-stimulating hormone level, and stool studies with cultures.
• Imaging studies such as abdominal radiography, ultrasonography, and computed tomography may be necessary to determine the cause of nausea and vomiting.

Next Steps in Management

• Based on the study 2, alarm signs such as dehydration, acidosis caused by an underlying metabolic disorder, or an acute abdomen warrant additional evaluation.
• If the patient has risk factors for gastric malignancies or alarm symptoms, evaluation with esophagogastroduodenoscopy should be considered, as stated in the study 2.
• For patients with chronic nausea and vomiting, treatment should be based on a thoughtful discussion of benefits, side effects, and costs, according to the study 3.

Shared Decision Making

• The study 4 suggests that clinicians should formulate a recommendation using a shared decision-making framework, which involves evaluating the prognosis and treatment options, understanding the patient's priorities, and basing the recommendation on the patient's priorities.
• The study 5 emphasizes the importance of patient understanding in clinical practice and proposes criteria for assessing patient understanding, including grasping a body of information, reasonably reflecting a responsible body of medical professionals' best estimate of the truth, and meeting a context-specific threshold.

Clinical Practice Guidelines

• The study 6 provides guidance on the definitions of terms commonly used for clinical practice recommendations, including clinical practice guidelines, consensus statements, position statements, and practice alerts.
• This guidance aims to improve transparency and clarity regarding the definitions of these terminologies and promote an evidence-based approach to clinical decision-making.