Clinical outcomes in patients with type 2 diabetes managed by a diabetes resource nurse in a primary care practice.

Objectives: The purpose of this observational cohort study was to observe outcomes in geriatric (aged > or =65 years) and nongeriatric (<65 years) patients after employing a diabetes resource nurse (DRN) case manager in a suburban 12-physician family practice.

Study Design: Data were collected by retrospective chart review of 106 patients enrolled in the diabetes care project who completed at least 6 months of the project between March 1999 and January 2001.

Population: Patients were recruited by either referral from their primary physician or invitation from the DRN.

Identifying gaps between guidelines and clinical practice in the evaluation and treatment of patients with hypertension.

Purpose: Hypertension remains uncontrolled in the majority of affected patients despite treatment. Our goal was to identify specific action items in the Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI) guidelines that are not being translated into clinical practice.

Methods: We transformed the major JNC VI tables into a chart review instrument that was used to retrospectively analyze the medical records of 249 patients with newly diagnosed hypertension who had been followed for 18 months at one of six community-based primary care clinics.

Puerperal diastasis of the pubic symphysis. A case report.

Background: Puerperal diastasis of the symphysis pubis is an uncommon intrapartum complication. Patients often respond to conservative measures. A small percentage of patients will develop chronic pain and require surgical treatment, which involves debridement or fusion of the symphysis pubis.

Markedly elevated beta-hCG levels in a normal singleton gestation with hyperreactio luteinalis.

Background: Human chorionic gonadotropin (hCG) is produced by the trophoblast early in pregnancy and peaks at a level of approximately 100,000 IU/liter around the ninth week of gestation. Abnormally high levels are usually noted in association with multiple gestation, molar gestation, and specific ovarian or gestational malignancies.

Cases: A multiparous patient in the second trimester was referred for evaluation after a maternal triple marker screen was incalculable due to a beta-hCG level of 2.