Common Finger Fractures and Dislocations.

Finger fractures and dislocations are commonly seen in the primary care setting. Patients typically present with a deformity, swelling, and bruising with loss of function. Anteroposterior, lateral, and oblique radiography should be performed to identify fractures and distinguish uncomplicated injuries from those requiring referral.

Neck Pain: Initial Evaluation and Management.

Neck pain is a common presenting symptom in the primary care setting and causes significant disability. The broad differential diagnosis requires an efficient but global assessment; therefore, emphasis is typically placed on red flags that can assist in the early recognition and treatment of more concerning diagnoses, such as traumatic injuries, infection, malignancy, vascular emergencies, and other inflammatory conditions. The critical element in appropriate diagnosis and management of these conditions is an accurate patient history.

Nonspecific Low Back Pain and Return To Work.

Nonspecific low back pain refers to a condition without a distinct etiology to explain its associated symptoms. This pain may become chronic and is a major cause of work loss around the world. Without a specific explanation for a patient's symptoms, the family physician is charged with providing reassurance, while also guiding the patient toward a return to function, which often includes maintaining employment.

Common Foot Problems: Over-the-Counter Treatments and Home Care.

Most foot disorders do not require podiatry referral or complex interventions. After the clinical diagnosis is made, these conditions can typically be managed with over-the-counter (OTC) and home remedies, with guidance from the primary care physician. Stretching and strengthening exercises, along with the use of heel cups, resolve most plantar fasciitis cases and are at least as effective as nonsteroidal anti-inflammatory drugs or steroid injections.

Spine Conditions: Occupational Spine Conditions.

Neck and back conditions have significant effects on employee health and productivity. More than $7 billion in lost revenue in the United States annually can be attributed to workplace back pain among employees ages 40 to 65 years. According to the Bureau of Labor Statistics, in 2012 back pain was the most prevalent musculoskeletal condition resulting in workplace absenteeism.

Spine Conditions: Cervical Spine Conditions.

There are a variety of causes of neck pain, including trauma and degenerative changes. The history of onset helps to direct evaluation, including the need for imaging or ancillary testing. Patterns of pain, weakness, and other specific physical examination findings also aid in diagnosis.

Nonoperative Management of Cervical Radiculopathy.

Cervical radiculopathy describes pain in one or both of the upper extremities, often in the setting of neck pain, secondary to compression or irritation of nerve roots in the cervical spine. It can be accompanied by motor, sensory, or reflex deficits and is most prevalent in persons 50 to 54 years of age. Cervical radiculopathy most often stems from degenerative disease in the cervical spine.

Refining the Practice of Prescribing: Teaching Physician Learners How to Talk to Patients About a New Prescription.

Background: Clinician counseling about medication can improve patient understanding and adherence. This study developed a teaching session for physician learners about medication prescribing and communication, with evaluation at the physician and patient levels.

Objective: We analyzed whether patients would perceive and report more comprehensive clinician presentation of medication information when receiving prescriptions from their physician in the intervention clinic.

Resident scholarship expectations and experiences: sources of uncertainty as barriers to success.

Background: Scholarly activity during residency is vital to resident learning and ultimately to patient care. Incorporating that activity into training is, however, a challenge for medical educators. Most research on medical student and resident attitudes toward scholarly activity to date has been quantitative and has focused on level of interest, desire to perform scholarship, and perceived importance of scholarship.

The practice of prescribing: discovering differences in what we tell patients about prescription medications.

Objective: This study explored patient recall of clinician presentation of information about prescription medication, looking specifically for communication patterns and differences by patient individual characteristics and by medication availability type.

Methods: A cross sectional survey collected information about 216 patients' perceptions of clinician presentations of medication information.

Results: Demographically, males recalled receiving more information about reasons, risks, and regimen in medication discussions.

Management of chronic tendon injuries.

Chronic tendon injuries present unique management challenges. The assumption that these injuries result from ongoing inflammation has caused physicians to rely on treatments demonstrated to be ineffective in the long term. Nonsteroidal anti-inflammatory drugs should be limited in the treatment of these injuries.

Extending Physician ReACH: influencing patient activation and behavior through multichannel physician communication.

Objective: Despite evidence-based recommendations, physical activity as a self-management technique is underutilized. Many physical activity interventions require significant resources, ranging from repeated phone follow-up with nursing staff to intensive sessions with cooperating physical therapists. This intervention, Extending Physician ReACH (Relationship And Communication in Healthcare), examined physician to patient communication tactics for promoting walking exercise to patients with type 2 diabetes, using limited clinic time and financial resources.

Exploring patient activation in the clinic: measurement from three perspectives.

Objective: To further conceptualize and operationalize patient activation (PA), using measures from patient, physician, and researcher perspectives.

Data Source/study Setting: Multimethod observation in 2010 within a family medicine clinic.

Study Design: Part of an intervention with 130 patients with type 2 diabetes, this observational study further looked at PA in 19 physician-patient dyads.

Exertional collapse in the runner: evaluation and management in fieldside and office-based settings.

Exertional collapse is a commonly encountered phenomenon among runners, particularly in the setting of long distances and extreme environments. Although exertional collapse is generally a benign event occurring in an exhausted finisher at race completion, the multifactorial nature of this disorder creates a broad differential diagnosis. The ability of the sports provider to appropriately recognize and treat these various potential concerns is critical, because collapse may represent several life-threatening conditions.

Practical management: a systematic approach to the evaluation of exercise-related syncope in athletes.

Syncope and presyncope are relatively common presentations among athletes. The distinction between post-exercise and during-exercise syncope is critically important. While the great majority of these episodes occur just after exercise and are benign, syncope can be an indication of serious underlying cardiovascular disease if it occurs during exercise.