The Journal of the American Board of Family Practice / American Board of Family Practice
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J Am Board Fam Pract · Jan 1992
Review Case ReportsAmputation: preoperative psychological preparation.
More than 90 percent of all amputations are now due to the complications of chronic disease. Because most amputations can be anticipated, the preoperative period allows the opportunity for psychological preparation of the patient. This article highlights the important contribution family physicians can make before patients undergo amputation. ⋯ Our experience and review of the literature suggest that psychological intervention during the preoperative period is associated with a less complicated postoperative adjustment and grieving experience. The family physician can promote patient adjustment by providing accurate information, eliciting unspoken fears, and encouraging the involvement of the patient's family. By emphasizing the patient's enduring characteristics and his or her past coping ability, we believe that family physicians can lessen the psychological distress of amputation and facilitate adaptation.
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J Am Board Fam Pract · Sep 1991
ReviewAn approach to difficult management problems in otitis media in children.
Otitis media is one of the most common pediatric diseases encountered by family physicians. While isolated, acute episodes pose little clinical difficulty, recurrent infections and persistent middle ear effusions can be perplexing problems. ⋯ Recurrent infections can be treated with a trial of daily prophylactic antibiotics to decrease the rate of recurrence. Should infections continue to recur despite the daily prophylaxis, polyethylene tube placement is warranted to drain surgically the middle ear effusions that give rise to the recurrent infections. Acute episodes of otitis media are commonly followed by prolonged, asymptomatic periods of middle ear effusion. Patients with this disease have decreased hearing leading to potential deficits in their speech and academic development. If such effusions do not spontaneously resolve within 2 months, repeated courses of antibiotics with the possible addition of a course of oral steroids are warranted to speed resolution of the effusion before proceeding to placement of polyethylene tubes.
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As the population ages, an increasing number of elderly patients will need surgery. An organized medical evaluation that focuses on the patient's cardiopulmonary and nutritional status should be performed before the patient undergoes surgery. The initial history and physical examination should be performed up to 8 weeks before surgery. ⋯ The need for additional tests is indicated by the history and physical examination. Following this assessment, therapeutic and prophylactic measures to reduce surgical morbidity and mortality can be implemented. With timely identification and management of medical disease in geriatric surgical patients, the risks of surgery can be minimized.
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J Am Board Fam Pract · Jan 1990
Review Comparative StudyFamily physicians and internists: differences in practice styles and proposed reasons.
This is a review of published reports comparing family physicians with internists. The results show that family physicians are more likely to stay in their field of training; to locate more frequently in rural and underserved areas; to see fewer referred patients; to have similar case severity; and to engage in more obstetrics and gynecology, surgery, trauma, acute illness, and pediatrics. ⋯ The reasons for the practice style differences between family physicians and internists are likely to be multiple, but they probably include such factors as: training, decision-making expertise, patient demands, types of visits, office staff, economics, and attitude. The implications of the proposed reasons for the differences are discussed.
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J Am Board Fam Pract · Apr 1988
ReviewEvaluation and treatment of AIDS-associated illnesses: an approach for the primary physician.
The acquired immunodeficiency syndrome (AIDS) has become a problem of enormous clinical importance in the United States. This article describes the major clinical syndromes in adults with AIDS and offers approaches to their evaluation and treatment.