The Journal of family practice
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Advance directives have emerged in medicine as an important method by which patients can express future treatment wishes. The major reasons medical professionals have been reluctant to use advance directives are not because of theoretical defects with advance directives, but because of procedural difficulties. ⋯ Additionally, that they are often formulated in ambiguous terms and under situations where the patient's competence is in question can be minimized. More widespread and effective use of advance directives will occur if the family physician takes an active role in identifying patients for whom an advance directive would be desirable, effectively communicating information about advance directives, advising their patients about the most effective way to state their directive in medically precise terminology, and explaining when necessary the patient's wishes to other medical specialists and family members.
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The febrile infant is a common clinical problem for the primary health care provider. This paper employs the example of a young infant with fever to describe an important epidemiologic concept that is useful in the interpretation of diagnostic data--the likelihood ratio. ⋯ Using likelihood ratios in the practice of primary care medicine should reduce the number of patients with false-positive or false-negative results, sparing some patients needless therapy as well as minimizing the number of patients denied efficacious interventions. Support for likelihood ratios within the primary care medical community will hasten their availability in laboratories of clinical medicine.
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In a university-based family practice residency program, patients' computerized medical records were audited to determine how information about family health history was recorded. Family history items were listed on the problem lists for only 4.4 percent of all active patients and for only 2.7 percent of a systematic sample of 375 patients. A manual audit of 75 charts randomly selected from the systematic sample showed that the problem lists contained only 5.8 percent of the family history items reported by patients. Children's problem lists contained fewer family history items than did those of adults.