Primary care
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Grief and bereavement are frequent concerns of primary care physicians. This article outlines grief in terminally ill patients and discusses interventions. Also included in this article is a review of the process of anticipatory grief and mourning and a discussion on normal and complicated grief. A portion of this article also covers grief in children and discusses interventions for grieving children.
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Vaginal bleeding during pregnancy provokes physical and emotional stress to patients and physicians. Physicians must be prepared to assess the medical implications of acute blood loss to these patients and their unborn children quickly. When mother and fetus are stable, the recognition and treatment of the underlying cause is essential to decreasing additional maternal and fetal morbidity and mortality associated with the bleeding episode.
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Obesity has a critical role in the pathophysiology of type 2 diabetes mellitus, and prevention of weight gain and treatment after onset of obesity is crucial to the management of the disease. A recent National Institutes of Health (NIH) report on the evaluation and treatment of overweight and obesity serves as a model for managing obese individuals with type 2 diabetes. ⋯ If adjunctive therapy is indicated, it will only be successful long term if lifestyle therapy remains central to treatment. The objective of this review is to integrate the recommendations of the NIH into the primary care management of the obese individual with type 2 diabetes.
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Tobacco use continues to occur in epidemic proportions and with it, significant morbidity and mortality. One third of smokers will die prematurely of a smoking-related disease. This article reviews the adverse health effects of tobacco use so that clinicians can be aware of the benefits patients will reap when they stop using this lethal substance.
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Smokeless tobacco use is increasing in the United States, especially among young men, but there are few resources to assist users in quitting their use of moist snuff or chewing tobacco. This article reviews some unique aspects of smokeless tobacco use and provides a systematic four-step clinical plan for providing cessation. ⋯ The procedures and measures have been validated in randomized clinical trials and provide empirical support for the recommended cessation procedures. Finally, a review of brief cessation interventions in the context of health care is provided.