The Journal of the American Board of Family Practice / American Board of Family Practice
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J Am Board Fam Pract · Mar 1997
Review Case ReportsPenetrating BB shot head wound in an asymptomatic 9-year-old girl: the ultimate teaching moment.
Air rifle BB injuries represent a common type of childhood accident. The purpose of this case report is to encourage all providers of pediatric care to include nonpowder firearm safety education with standard well-child anticipatory guidance. ⋯ Firearm education is not a standard part of every well-child encounter. Injuries by all types of firearms are increasing at epidemic rates. Questioning about the accessibility of both powder- and non-powder-based weapons (ie, air rifle) and providing routine safety education should become the standard of care at all well-child encounters.
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J Am Board Fam Pract · May 1995
Review Case ReportsSeptic olecranon bursitis: recognition and treatment.
The superficial location of the olecranon bursa places it at high risk for injury, possibly leading to the entry of bacteria into the bursal sac. Early differentiation between septic and nonseptic olecranon bursitis is paramount to direct therapy, to hasten recovery, and to prevent chronic inflammation. ⋯ Olecranon bursitis is a common condition that requires the treating physician to be aware of the predisposing factors, clinical signs and symptoms, and laboratory findings of both septic and nonseptic olecranon bursitis. With early recognition, prompt therapy, and preventive measures, the morbidity of septic olecranon bursitis can be considerably reduced, but surgical incision and drainage or excision could be required if conservative therapy fails.
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J Am Board Fam Pract · Jul 1994
ReviewPreventive health care and screening of Latin American immigrants in the United States.
The Central and South American immigrant population in the United States is large and growing. A review of the preventive health care needs of this population has not previously been done but would be helpful to clinicians caring for immigrants in this country. ⋯ Screening is recommended for intestinal parasites and schistosomiasis, tuberculosis, hepatitis B in prenatal patients, leprosy in immigrants from high-risk areas, yearly Papanicolaou smears, malnutrition, iron-deficiency anemia, incomplete immunizations, dental problems, history of violence, and depression. Screening for sickle cell trait in prenatal patients from South America and universal hepatitis B screening are less clearly indicated but could be appropriate. Screening for American trypanosomiasis (Chagas disease), malaria, and gastric cancer is not recommended. Screening for HIV infection, functional impairment in the elderly, alcohol use, cigarette smoking, physical inactivity, and hypertension should be the same as for the general population.
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J Am Board Fam Pract · Mar 1994
Review Case Reports"Snowboarder's fracture": fracture of the lateral process of the talus.
As physicians caring for patients who sustain snowboarding ankle injuries, we have noted that fracture of the lateral process of the talus occurs frequently. The incidence of this fracture, however, is very low in other accounts of ankle injuries. We report a case of fracture of the lateral process of the talus and review the pertinent literature of this injury. ⋯ Physicians caring for snowboarders should look specifically for fracture of the lateral process of the talus in a snowboarder with a lateral ankle or foot injury. This fracture can mimic a lateral ankle sprain, yet the fracture is easily missed on plain radiographs of the ankle. Because displaced or comminuted fractures can cause long-term disability, primary care physicians and specialists alike need to be aware of the association of this fracture with snowboarding.
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J Am Board Fam Pract · Mar 1992
ReviewBenzodiazepine dependence and withdrawal: identification and medical management.
Primary care physicians prescribe benzodiazepines for the treatment of anxiety. Although most patients use the benzodiazepines appropriately, some patients experience benzodiazepine abuse, addiction, or physical dependence, each one of which is a distinct syndrome. Benzodiazepine dependence, which relates to the development of tolerance and an abstinence syndrome, can be produced by three disparate benzodiazepine use patterns. These distinct benzodiazepine use patterns can in turn create distinct withdrawal syndromes. High-dose benzodiazepine use between 1 and 6 months can produce an acute sedative-hypnotic withdrawal syndrome. In contrast, low-dose therapeutic range benzodiazepine use longer than 6 months can produce a prolonged, subacute low-dose benzodiazepine withdrawal syndrome. Daily, high-dose benzodiazepine use for more than 6 months can cause a combination of an acute high-dose benzodiazepine withdrawal and a prolonged, subacute low-dose withdrawal syndrome. In addition, patients may experience syndrome reemergence. ⋯ Medical management for acute benzodiazepine withdrawal includes the graded reduction of the current benzodiazepine dosage, substitution of a long-acting benzodiazepine, and phenobarbital substitution. However, the medical management of benzodiazepine dependence does not constitute treatment of benzodiazepine addiction. Primary care physicians can accept complete, moderate, or limited medical responsibility regarding patients with substance use disorders. However, all physicians should provide diagnostic and referral services.