The Journal of family practice
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The diagnosis of acute pelvic pain in the woman of reproductive age represents a major clinical challenge. In approaching such a patient, the clinician must differentiate between pregnancy-related causes, gynecologic disorders, and nonreproductive tract causes. ⋯ Diagnostic laparoscopy represents the reference standard for diagnosis of many of its possible causes and can obviate the need for exploratory laparotomy. Once competing diagnoses have been adequately excluded, an empiric trial of antibiotic therapy for acute pelvic inflammatory disease, coupled with close clinical follow-up, should be considered in patients with acute pelvic pain found to have cervical motion tenderness and bilateral adnexal tenderness on examination.
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Review Randomized Controlled Trial Comparative Study Clinical Trial
Colloids versus crystalloids in fluid resuscitation: an analysis of randomized controlled trials.
Controversy about fluid therapy in resuscitation has existed since the 1960s. The difficulty could be that fluid behavior at the lung capillary membrane level may vary depending on the patient's particular pathology. ⋯ Because there is no significant mortality-rate advantage to using colloids, and because the cost-effectiveness ratio for crystalloids is much lower than for colloids, it is concluded that crystalloids should always be used in resuscitation efforts.
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Review Comparative Study
The gap between patient reading comprehension and the readability of patient education materials.
Patient education materials and hospital forms are given to patients with little regard for their ability to read them. Nationwide sampling and data from the 1980 census suggest that a high proportion of patients cared for in public hospitals are functionally illiterate. In this study, 151 adult primary care patients in five different ambulatory care settings were tested for reading comprehension. ⋯ The average reading comprehension of public clinic patients was 6th grade 5th month. Most tested patient education materials required a reading level of 11th to 14th grade, and standard institutional consent forms required a college-level reading comprehension. In the public clinics there was a gap of more than 5 years between patient reading levels and the comprehension levels required by written patient materials.
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Family physicians are often requested to provide preoperative evaluation of elderly patients. Age independently increases the risk of morbidity and mortality in the perioperative period. In addition, the altered physiology of the older patient, in combination with the increased number of disease processes, increases the potential for complications. ⋯ Evaluation includes a thorough history, physical examination, and laboratory testing. Special considerations in preoperative assessment of the elderly patient include the assessment of nutrition, functional capabilities, and evaluation of the cognitive and emotional status of the patient. Special concerns include prophylaxis for deep vein thrombosis and pulmonary embolus, and antibiotic prophylaxis for endocarditis and for patients with joint prostheses.
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Concern that febrile infants younger than 3 months of age are at high risk of serious infection has prompted a management policy of routine hospitalization with antibiotic administration. Ten published studies of febrile infants younger than 3 months of age were reviewed, and data were statistically combined to develop estimates of the risk of bacteremia and serious infection. Factors that predicted increased risk were similarly evaluated. ⋯ Younger age, higher fever, and elevated white blood cell count were associated with increased risk of serious infection. Data from these studies do not support the belief that febrile infants younger than 3 months are uniformly at greater risk of serious infection than older infants. Judicious evaluation of younger infants could lead to more selective, cost-efficient management.