Family practice research journal最新文献

Objective: Alcoholism is estimated to affect at least 10% of American adults. Despite the fact that early diagnosis is possible and early treatment can prevent great suffering, American physicians typically diagnose and treat alcoholism less than half the time. Several authors have suggested additional physician education as a possible way to improve alcoholism assessment skills and increase the diagnosis rate.

Methods: A baseline audit, an educational intervention, and a post-intervention audit were done with physicians and nurse practitioners in an urban family practice group, using information recorded during everyday patient care.

Results: A significant increase in specific alcohol intake histories and a significant decrease in recorded abstention were found. The proportion of patients with a recorded diagnosis of alcoholism was 2.5% before and 4.1% after the intervention.

Conclusions: After this intervention, physicians' and FNP's skills in alcohol history-taking and assessment increased, and were incorporated into their daily patient care. Education alone was not enough to remedy a low diagnosis rate; many other factors are involved.

Objective: Screening for tuberculosis in children can be done with the multiple-puncture Tine test. Determination of the extent of induration following the test may be reported by a child's caregiver via a mailed Tine card. We report the rate of return of these cards, and factors associated with return, in a family medicine health center.

Methods: Retrospective review of the medical charts of 152 mother and child pairs seen in the health center over a two-year period.

Results: Of the 98 children who had received a Tine test by age one, 16.3% of their Tine cards were returned to the health center. Children whose delivery was insured by Medicaid were less likely to have a Tine card returned than were those without Medicaid (OR for non-return = 4.3, 95% CI = 1.2, 15.4). Physicians often documented a tuberculosis screening result without a Tine card.

Conclusions: Given the low return rates, health care professionals responsible for tuberculosis screening should be cautious when relying on caregivers to interpret, record and return tuberculosis screening results, particularly in the most disadvantaged populations. More valid data are likely to be obtained from a clinical reading of tuberculosis tests.

Objective: To describe results achieved by family physicians performing colposcopy in our private practice.

Methods: A chart review was performed one year after initiating colposcopy services.

Results: Forty-five patients underwent 47 colposcopic exams, most often for mild dysplasia or persistent atypia on Papanicolaou smears. Of the 21 patients with persisting atypia on smear, 16 (76.2%) showed dysplasia on biopsy. Twenty-five patients (55.6%) underwent cryotherapy, which successfully eradicated the abnormality in 16 of the 20 (80%) for whom follow-up is complete. Ten patients (22.2%) were referred to gynecologists for further evaluation and/or treatment. Six patients (13.3%) had not received the recommended follow-up after either colposcopy or cryotherapy.

Conclusions: Family physicians in private practice performing colposcopy and cryotherapy can provide complete care for 75% of patients with abnormal Papanicolaou smears. Patients with squamous atypia on smear may have dysplasia on biopsy more often than previously reported. A recall system and regular chart audits are recommended to improve follow-up.

Objective: The purpose of this study was to determine the prevalence of chlamydia in women attending a family planning clinic and to explore the feasibility of making chlamydia screening part of the routine procedure for all women. This study also investigated clinical and demographic parameters that may be associated with chlamydial infections.

Methods: Subjects were 239 female patients who attended the Planned Parenthood Clinic in Wichita, Kansas, during July 1990. Subjects included all patients receiving pelvic examinations regardless of indication. Each subject was screened for C. trachomatis using Testpack Chlamydia (Abbott Labs).

Results: Of the 239 women screened, 11 (4.6%) had positive Testpack Chlamydia tests. Young age (< 24 years), self-reported bleeding, and inflammation found on Papanicolaou exams were positively associated with chlamydial infection.

Conclusion: These parameters provide additional information for the clinician deciding who should be screened for chlamydia infections.

Objective: We suspected our senior medical student rural family practice preceptorship was a positive influence on students' selection of family practice as a specialty.

Methods: A five-year study of 598 students' specialty choices before and after their preceptorship was done and compared to eventual residency choice.

Results: Of these students, 565 (94.5%) appeared to be uninfluenced by the preceptorship. Of the 33 students who reported a change in residency choice after completing the rural preceptorship, 15 (2.5%) chose a family practice residency.

Conclusions: The rural preceptorship was found to have a positive influence on students' choice of family practice residency positions.

Objective: This paper explores the advantages and disadvantages of implementing a clinical drug trial in a closed community.

Methods: In the study we conducted a randomized, double-blind, placebo-controlled clinical trial to evaluate the effects of an antacid containing aluminum hydroxide on serum lipoproteins in hypercholesterolemic adults.

Results: The results of the trial, which was conducted on two Israeli kibbutzim (rural cooperative communities), have been published previously.

Conclusions: The kibbutz presents a unique setting for the conduct of a clinical trial. There were opportunities to uphold inclusion and exclusion criteria carefully, to obtain informed consent, to enhance dietary and drug adherence, to ensure the quality of data collection, to maintain the interest of the participants in the study, and to monitor closely adverse effects and patient safety. This report describes the unique circumstances under which the trial was conducted and the role of the clinician as a clinical investigator and discusses their implications for the internal validity and generalizability of the trial.

Objective: To evaluate the relationships between demographic and clinical characteristics and the stage and site of colon cancer at the time of presentation.

Methods: New cases of colon cancer identified through a tumor registry at a teaching hospital during 1989 were reviewed retrospectively. Of the 110 cases, 53% of the subjects were female, 95% were white, and 63% were more than 70 years of age.

Results: Early stages of colon cancer (Dukes A [11%] or B [41%]) occurred in 52%, and late stages (Dukes C [26%] or D [22%]) in 48%. Most patients (88%) presented with symptoms; 12% of the cases were detected in asymptomatic patients. Of the 13 asymptomatic patients, 7 were identified by positive occult blood in the stool, 5 by colonoscopy, and 1 during a hysterectomy. The stage of colon cancer was more likely to be early in asymptomatic patients (85% Dukes A or B) compared to those with symptoms (47% Dukes A or B) (p < 0.02). Sixty-two percent (62%) of the cecum/ascending colon cancer were early compared to 46% of the cancers in other locations (p = 0.11). Seventy-seven percent (77%) of the asymptomatic cancers were located in the cecum/ascending colon compared to 33% of the symptomatic patients (p < 0.02). Age and gender were not associated with site or stage of colon cancer.

Conclusion: The majority of patients with colon cancer are diagnosed when symptomatic. When colon cancer is diagnosed while still asymptomatic, it is more likely to be at an early stage. The most common screening procedure leading to diagnosis in asymptomatic patients is the identification of fecal occult blood. Colon cancer is more likely to be located in the cecum/ascending colon when diagnosed at an asymptomatic stage.