The Journal of family practice
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Continuity of care during pregnancy was examined in a family practice residency setting. The effect of provider continuity on the rate of pregnancy complications and patient satisfaction was studied prospectively in a sample of 61 patients. ⋯ Perceived waiting time in the office had the greatest effect on patient satisfaction. Provider continuity had no significant effect on either outcome.
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While 46 percent of febrile children, aged 3 months to 24 months, will be well without treatment within 24 to 48 hours, and another 12 percent well within 72 to 96 hours, approximately 6 percent will have serious bacterial infections. The incidence of such infections tends to increase with decreasing age and increasing degree of fever. ⋯ Children with these laboratory findings should then have a chest film and blood culture and, if the former is negative, should be considered for a lumbar puncture and urine culture. Whether further observation or treatment at this point can be done as an outpatient depends on physician judgment.
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Comparative Study
Full clinical departments of family practice: their relationship to hospital privileges in university hospitals.
All 52 family practice residency programs that hospitalize patients at a university hospital were surveyed to determine how many have full clinical departments of family practice and what effect having a full clinical department has on hospital privileges. A full clinical department is defined as one in which all hospital privileges for family physicians are reviewed and recommended by the family practice department without need for review by other specialties, even when the requested privileges overlap with another specialty. Responses were received from 100 percent of the surveyed hospitals. ⋯ When these hospitals were compared with the 36 (69.2 percent) at which there is no full clinical department, it was found that in every area of patient care, hospital privileges for family physicians are more extensive at hospitals with full clinical departments. The American Academy of Family Physicians is currently promoting the formation of full clinical departments of family practice as a method for improving hospital privileges for its members. The results of this study suggest that promoting the formation of full clinical departments will be an effective intervention.
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The mentally incapacitated patient is frequently encountered in the general medical hospital. Incapacity is the clinical state in which a patient is unable to participate in a meaningful way in medical decisions. Mentally incapacitated patients relinquish the authority, that is the competent patient's right, to choose among professionally acceptable alternative treatments. ⋯ Questions of incapacity or the authority of surrogate decision-makers also arose with comatose, mentally retarded, mentally ill, and physically handicapped patients. While standards to determine capacity remain unclear, a practical approach is to demonstrate that a patient is able to describe the physician's view of the situation and to understand the physician's opinion as to the best intervention. When a patient is deemed to be incapacitated, the physician should turn to family members, whenever possible, to make decisions.