Ethical theories and clinical practice. One family physician's approach.

Many physicians find clinical ethics unhelpful in managing real-life patient care conflicts. In part, this is because different ethical theories often analyze situations in different ways. I review several clinical ethics methods that I have found useful in different patient care situations and discuss how this eclectic approach to ethical problems is consistent with primary care in general.

HIV infection in women: an escalating health concern.

The proportion of women infected with the human immunodeficiency virus (HIV) continues to increase. Over one-half of women acquire the virus through heterosexual contact. The diagnoses that define the acquired immunodeficiency syndrome and the use of antiretroviral therapy are similar in men and women, except in pregnancy.

Accuracy of prenatal sonography performed by family practice residents.

Background And Objectives: Sonographic evaluation of the fetus is a common procedure in modern antepartum management. This study investigates the accuracy of family physicians at different levels of training in performing common prenatal sonographic measurements.

Methods: Records of prenatal sonographic measurements of gestational age (279 scans) and estimated birth weight (62 scans) performed by family practice residents and family medicine teaching faculty at Silas B.

BCG vaccination and the PPD test: what the clinician needs to know.

The resurgence in tuberculosis necessitates careful surveillance and sensitive detection of cases. The purified protein derivative (PPD) test is the foundation of tuberculosis control. Primary care clinicans are encountering increasing numbers of persons immigrating from countries in which BCG (bacille Calmette-Guérin) vaccination is common.

Respiratory dysfunction associated with traumatic injury to the central nervous system.

Pulmonary dysfunction is a common complication of head trauma and spinal cord injury. Abnormal breathing patterns reflect the influence of altered neural integration. Early arterial hypoxemia can result from ventilation-perfusion mismatching, microatelectasis, aspiration, fat embolism, or the development of the adult respiratory distress syndrome.

The incidence of tuberculosis among North Carolina migrant farmworkers, 1991.

All locatable subjects (n = 94) for whom tuberculosis prevalence had been determined in an earlier study were tested with purified protein derivative (PPD) and control antigens, sputum sampling, and chest x-rays. Of the 46 who had been tuberculin negative (confirmed with control antigens) 3 years earlier, 2 had developed active tuberculosis in the interim and 14 (30%) were tuberculin positive. All had been engaged continuously in migrant farmwork.

A volume and pH determination of tracheal residue postaspiration.

An endotracheal tube containing pH sensors for rapid detection of episodic acid aspiration was combined with a design that provides a means of suctioning tracheal residue resulting from gastric regurgitation and aspiration. The efficacy of the tube operation was demonstrated in two patients who aspirated gastric contents.

Tension gastrothorax complicating acute traumatic diaphragmatic rupture.

Herniation of abdominal viscera into the thorax following traumatic diaphragmatic hernia can simulate acute tension pneumothorax. A case is presented of a blunt trauma victim with apparent acute diaphragmatic rupture, tension hemothorax, or tension hemopneumothorax. Nasogastric tube insertion demonstrated tension gastrothorax, but was followed by acute clinical decompensation.

The future of family practice training in California.

Although the number of physicians in California has doubled since 1963, the number of family and general practice physicians has declined. The ratio of office-based primary care physicians to population has also decreased. Graduate medical education is funded largely from patient care revenues, but the low rate of reimbursement for ambulatory care makes training in primary care specialties especially dependent on public support.

Congenital anomalies associated with maternal exposure to oxydemeton-methyl.

Thirty-five workers became ill after they entered a cauliflower field contaminated with residues of three different insecticides, the organophosphates oxydemeton-methyl (Metasystox-R) and mevinphos (Phosdrin), and a carbamate, methomyl (Lannate). One crew member was pregnant with a 4-week-old fetus. At birth, the 3200-g female infant had multiple cardiac defects, bilateral optic nerve colobomas, microphthalmia of the left eye, cerebral and cerebellar atrophy, and facial anomalies.

Public policy and the supply of primary care physicians.

The decline in general practice, the arrested growth of family medicine training programs, and the increased subspecialization of internal medicine and pediatrics are responsible for the continuing decrease in the proportion of physicians in the United States who practice a primary care specialty. Since 1963, the number of physicians has more than doubled, but the ratio of office-based primary care physicians to the national population has decreased. This trend has been especially pronounced in rural areas and impoverished urban communities.