Febrile seizure. Caring for patients--and their parents.

Management of febrile seizure involves diagnosis and treatment of the underlying cause and assessment of risk factors for recurrence. What should physicians tell anxious parents about this frightening occurrence? Is prophylaxis with anticonvulsant agents appropriate? The authors address these questions and discuss the changing approach to management of febrile seizure.

Management of the anticoagulated patient for elective surgery.

The authors discuss treatment of the anticoagulated patient prior to elective surgery. They review factors that increase and decrease patient response to this therapy. Recommended procedure for dealing with the anticoagulated surgical patient is then presented.

Chilaiditi's syndrome. A diagnostic challenge.

Chilaiditi's syndrome should be considered in the differential diagnosis of abdominal and chest pain. Although interposition of the right colon is a relatively common radiologic finding, there is a distinct paucity of information in the medical literature. Chilaiditi's syndrome is usually asymptomatic, but when symptoms occur, conservative treatment is usually effective.

The effects of oxandrolone on genital development in uncomplicated growth retardation.

Oxandrolone therapy of children with uncomplicated growth retardation caused a marked increase in penile growth. The penile length percentile also showed a significant increase at the end of the therapy. Although the older boys fell into lower percentiles than the younger boys, it appears that they showed significant penile catch-up growth.

Hospital-sponsored rural health clinics: an effective diversification alternative for rural hospitals.

Changes in rural health care are resulting in new challenges for the administrators of rural hospitals. The lack of available care, economic deterioration, and demographic changes in rural America are contributing factors to rural health care problems and are detrimental to the financial well-being of rural hospitals. Diversification is becoming commonplace in these hospitals as administrators seek strategies to gain financial viability for their facilities.

Hormone replacement therapy. How to select the best preparation and regimen.

Hormone replacement therapy is a mainstay of preventive healthcare for the maturing female population. Estrogen deficiency that comes with menopause can have serious effects and is especially important in light of the increasing life expectancy of women. Various estrogen and progesterone preparations are available, and their best application requires understanding of the different potencies and metabolic effects.

Community screening for hypercholesterolemia.

This study focused on a cholesterol screening and education program conducted in Scottsdale, Arizona, to determine the prevalence of hypercholesterolemia among the volunteer participants, and whether such a program motivates lifestyle changes and physician follow-up. The study also examined whether participants used the program to monitor known hypercholesterolemia. During the 6-month program, 1228 individuals were screened.

Predicting elderly patients' mobility using fall history and physician assessment.

This study tested whether a patient's history of falls or an office clinician's general assessment can predict which ambulatory elderly patients will do poorly on mobility testing. Ambulatory patients making routine visits who were age 65 or older, mentally competent, and not acutely ill were eligible. Fifty-two (91%) of these patients participated by completing a fall history questionnaire and undergoing mobility testing.

Improvement in rural neonatal mortality: a case study of medical community intervention.

Previous studies have demonstrated that maternity care by family physicians can produce statistically similar outcomes to obstetric management in some communities. Obstetrical and perinatal literature suggest that those specialties may be able to decrease rural neonatal mortality. However, family practice literature has not shown any examples of direct intervention decreasing neonatal mortality in rural areas.

Adverse drug reactions causing hospital admission in an elderly population: experience with a decision algorithm.

An adverse drug reaction (ADR) decision algorithm was used in the review of 100 consecutive hospital admissions of elderly patients cared for by family physicians. The algorithm is a valid methodologic alternative to using pharmacological experts for verification of an ADR. In this study, the algorithm was easily applied by family physicians, and the results were similar to those reported by expert clinical pharmacologists.

A prospective study of type A behavior and running injuries.

A prospective study was developed to examine whether personality factors predispose runners to injury. Forty runners who completed a type A behavior screening were followed for 1 year during which they documented their training mileage, injuries, and time lost from training because of injury. Runners with high scores on the type A behavior screening questionnaire experienced significantly more injuries, especially multiple injuries.

Withdrawal from maternity care. A comparison of family physicians in Ontario, Canada, and the United States.

To determine the relative importance of factors influencing the withdrawal of family physicians from maternity care, two studies, one done in Ontario, Canada, and the other done in the United States, were compared. The proportion of residency-trained family physicians who provide maternity care at the initiation of their careers and the proportion who have given up maternity care are nearly identical in the United States and Canada. Both studies found that about one half of the family physicians who currently provide maternity care were giving consideration to stopping.

Focusing the preparticipation sports examination.

Athletic preparticipation evaluations are among the most common routine health screening tools, yet no standardized approach to these evaluations has been adopted. This paper presents a focused preparticipation examination form developed by the authors with the assistance of the North Carolina Academy of Family Physicians' Task Force on Sports Medicine. After reviewing the major studies of preparticipation examinations, 11 basic questions that identify specific risks for sports participation were selected.

Recidivism following spouse abuse abatement counseling: treatment program implications.

This paper examined demographic and personality characteristics of violence-free completers (n = 74) and violence repeating completers (n = 32) of a spouse abuse abatement counseling program. Chi-square analyses on categorical data, and analyses of variance on personality test data revealed several predicted findings. Compared to violence-free completers, recidivists reported higher levels of substance abuse both before and after treatment.

Abdominal pain. Chlamydia as culprit.

Chlamydia trachomatis infection in the lower part of the genital tract of young girls and women may ascend to produce endometritis, salpingitis, perihepatitis, and other localized or generalized abdominal diseases. The resultant pain syndromes mimic a number of other common conditions that must be differentiated. A careful history and physical examination, with attention to historical and physical evidence of sexually transmitted disease, will alert the clinician to the possibility of chlamydial infection.

Factors influencing changes in obstetric care provided by family physicians: a national study.

In an effort to determine the factors underlying changes in obstetric practice by family physicians, a random sample of 505 residency-trained family physicians was surveyed by mailed questionnaire. Of the 329 who responded, 65% had at some time practiced obstetrics, but only 45% were practicing obstetrics at the time of the survey. Rising malpractice insurance premiums and fear of lawsuit were factors most likely to influence a family physician's decision to cease obstetric practice.

Chlamydia and incidental carcinoid tumor in spontaneous abortion.

Maternal Chlamydia trachomatis infections have been associated with premature rupture of the membranes, preterm labor, premature birth, and fetal wastage. Women with acute infection may be at particular risk. We report the case of an unexplained second trimester spontaneous abortion with serologic evidence of recent infection with C.

Anorexia and weight loss in the elderly. Causes range from loose dentures to debilitating illness.

Differentiating between anorexia (loss of appetite) and weight loss (documented loss of pounds) can be difficult, but the same causes and treatments apply to both. Gastrointestinal and metabolic disorders, cardiopulmonary disease, the presence of a neoplasm or infection, and use of certain drugs are possible medical causes. Inadequate nutritional intake can result from the inability to obtain and prepare foods, dietary restrictions, intolerance to certain foods, and poor oral and dental health.

Fee structure as a determinant of patient's choice to undergo mammography.

Mammography, although an effective screening tool, has generally been underutilized. Although many factors may contribute to low utilization rates, the degree to which fee structure influences women's decision to have mammography has not been determined. This study compared women having mammography at the regular fee with those women having mammography at a special reduced rate.

The effect of a rural preceptorship during residency on practice site selection and interest in rural practice.

Rural areas of the United States face serious shortages in health care personnel. This report evaluates the effect of a rural preceptorship during the second or third year of a family practice residency on interest in rural practice and on practice site selection. A majority of participants (n = 123) felt that this experience influenced their choice of a practice site.