The Journal of the American Board of Family Practice / American Board of Family Practice
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Human brucellosis has a serious medical impact worldwide, and its eradication poses major difficulties. Although human brucellosis is relatively rare in the United States (approximately 100 cases per year), there is concern that this disease is largely underdiagnosed and underreported. Additionally, immigrants from endemic areas are arriving to this country, and Brucella species are considered to be biologic agents for terrorism. Human brucellosis affects all age-groups, and family physicians are not well versed in recognizing and treating this potentially life-threatening condition. ⋯ Appropriate antimicrobial therapy and duration of treatment of human brucellosis will reduce morbidity, prevent complications, and diminish relapses. Because of the nonspecific symptoms and rarity of human brucellosis in the United States, family physicians must acquire a detailed dietary and occupational history to diagnose the disease promptly. Family physicians must assume a responsible role in reporting this disease, as well as be aware of persons at high-risk for this disease and the potential sources of infection.
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J Am Board Fam Pract · Jan 2002
ReviewPhysician-patient communication in the primary care office: a systematic review.
The physician-patient interview is the key component of all health care, particularly of primary medical care. This review sought to evaluate existing primary-care-based research studies to determine which verbal and nonverbal behaviors on the part of the physician during the medical encounter have been linked in empirical studies with favorable patient outcomes. ⋯ Existing research is limited because of lack of consensus of what to measure, conflicting findings, and relative lack of empirical studies (especially of nonverbal behavior). Nonetheless, medical educators should focus on teaching and reinforcing behaviors known to be facilitative, and to continue to understand further how physician behavior can enhance favorable patient outcomes, such as understanding and adherence to medical regimens and overall satisfaction.
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Restless legs syndrome is a common but not well-recognized central nervous system disorder that leads to insomnia and daytime distress. ⋯ Restless legs syndrome occurs in about 6% of the adult population, more so in the elderly. Affected patients experience uncomfortable sensations in the legs with inactivity, more pronounced late in the day and at bedtime, which are temporarily relieved by moving the limbs. Affected patients can suffer from insomnia, disrupted sleep, daytime fatigue, and difficulty with sedentary activities. Most cases are idiopathic, although secondary causes, such as iron deficiency, should be excluded. Dopaminergic agents are highly effective in treating restless legs syndrome, but side effects can be problematic. Alternative medications include benzodiazepines, opioids, gabapentin, and clonidine.
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J Am Board Fam Pract · May 2001
ReviewChronic pain: treatment barriers and strategies for clinical practice.
Chronic pain is a clinical challenge for the practicing physician. Lack of knowledge about opioids, negative attitudes toward prescribing opioids, and inadequate pain-assessment skills combine to create major barriers to pain relief. Patient-related barriers, such as lack of communication and unwarranted fears of addiction, further complicate pain assessment and treatment. The health care system itself can hinder pain relief through practical constraints in the community and fear of regulatory scrutiny by the physician. ⋯ Concrete steps for the clinician engaged in the treatment of chronic pain include selection and administration of an effective opioid, dose titration, short- vs long-acting opioids, opioid rotation, ongoing assessment, and consideration of patient preferences. In addition, communication, coping behaviors, and pain education play important roles in the pain equation.
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Brown recluse spider bites are a serious medical problem in the southeastern United States. Although most bites are asymptomatic, envenomation can result in a constellation of systemic symptoms referred to as loxoscelism. Patients can also develop necrotic skin ulcers (necrotic arachnidism). These ulcers are often difficult to heal and can require skin grafting or amputation of the bitten appendage. ⋯ Most brown recluse spider bites are asymptomatic. All bites should be thoroughly cleansed and tetanus status updated as needed. Patients who develop systemic symptoms require hospitalization. Surgical excision of skin lesions is indicated only for lesions that have stabilized and are no longer enlarging. Steroids are indicated in bites that are associated with severe skin lesions, loxoscelism, and in small children. Dapsone should be used only in adult patients who experience necrotic arachnidism and who have been screened for glucose-6-phosphate dehydrogenase deficiency. Topical nitroglycerin can be of value in decreasing the enlargement of necrotic skin ulcers.