Lippincott's primary care practice最新文献

Physical therapy is an important component of today's health care system. Although physical therapists can be found in many inpatient and outpatient settings, they frequently treat patients with common musculoskeletal problems referred by primary care providers. The physical therapy consultation involves an examination by the physical therapist, diagnosis, prognosis, and initiation of a plan of care that includes specific interventions. Specific interventions include therapeutic exercise, functional training, manual techniques, fitting for assistive devices, application of physical agents such as heat or cold, and electotherapeutic modalities. This article will focus on the use of the physical therapy process for common musculoskeletal problems seen in primary care.

Acute ankle injury is a problem observed in people performing daily and work activities as well as in the athlete. The ankle is the most commonly injured joint in the body. Understanding the anatomy and mechanism of injury facilitates evaluation, diagnosis, and management. Evaluation, diagnostic imaging, and treatment options are presented. Most injuries can be managed conservatively in the primary care setting. A systematic approach to ankle evaluation can differentiate between injuries requiring orthopedic referral and those that can be managed by the nurse practitioner.

The primary care practitioner assumes chief responsibility for patients with arthritis. More than 40 million Americans experience some form of arthritis. Management of the patient with arthritis may include a referral to an orthopedic surgeon for surgical intervention. As estimated, up to 500,000 total joint replacement procedures are performed by orthopedic surgeons each year in the United States. Presurgical evaluation for a total joint replacement is imperative to ensure that the patient can safely undergo this surgical procedure. Postsurgical care of a patient with total joint replacement involves coordinating care with the physical therapist and orthopedic surgeon to ensure adequate follow-through with the recommended rehabilitation program, prophylactic antibiotic coverage, and observation for any complications including infection, deep-vein thrombosis, or loosening of the total-joint prosthesis.

Evaluation of knee problems is common in primary care. A basic understanding of relevant anatomy as well as clinical and diagnostic tests can assist the primary care practitioner (PCP) in determining the correct diagnosis, deciding whether to refer, and ordering appropriate treatment. Specific clinical tests, common causes of knee pain, and appropriate workup are reviewed, along with initial primary care treatment.

Hepatitis C, transmitted through body fluid exchange, affects approximately 1.8% of the U.S. population, roughly 3.9 million persons. Transfusion of blood and blood products was once an important source of hepatitis C transmission. Since the initiation of the hepatitis C screening program in 1985, however, injection drug use has become a major route. Hepatitis C is a leading cause of chronic liver disease. In 80% to 85% of those infected with the virus, chronic hepatitis C eventually develops, which can lead to cirrhosis and hepatocellular carcinoma, with alcohol abuse and coinfection with hepatitis B as additional risk factors. Screening for hepatitis C can be achieved with serologic assays. Molecular assays are helpful in confirming the diagnosis, assessing viral load, and characterizing the genetic nature of the viruses. Interferon alpha (IFN-alpha) and a combination of IFN-alpha 2B and ribavirin are therapies available in treatment of hepatitis C, but sustained response to the treatment has been unsatisfactory. Further studies are indicated to obtain more effective therapies for eradication of the disease. Hepatitis C is preventable, and clinicians should use every opportunity possible in their practice to assess those at risk and actively engage them in risk factor reductions.