Primary care update for Ob/Gyns最新文献

Women with breast cancer not only face cancer-related taboos but also face issues related to changes in sexuality, femininity, and fertility. Although increased emphasis on the woman’s participation in the medical decision-making process has afforded her more treatment options, it also gives her more responsibility in determining her course of treatment through the continuum of cancer care. In addition, although early detection has resulted in improved prognosis for breast cancer, repeated screening exams could be associated with increased anxiety.

Yersinia pestis, the causative organism of plague, has become of interest recently because of its potential as a weapon in bioterrorism. Y. pestis is a nonmotile, Gram-negative bacillus. Humans are accidental hosts in the natural cycle of plague. Rats, prairie dogs, and squirrels serve as the most common reservoirs of Y. pestis. Y. pestis invades a human host’s lymphoid tissue once introduced through a fleabite. This naturally occurring form of the plague is referred to as bubonic plague. Symptoms of bubonic plague include sudden onset of fever; chills; weakness; and a painful, swollen, erythematous lymph node known as a bubo. Another form of the disease, known as primary pneumonic plague, is transmitted in aerosolized form and infects the lungs, causing rapid death if not treated quickly. This aerosolized form of Y. pestis poses the biggest threat in biological warfare because person-to-person transmission occurs readily. Symptoms of primary pneumonic plague include dyspnea, cough, hemoptysis, and bronchopneumonia. Appropriate antibiotics for treatment of plague include streptomycin, gentamicin, tetracycline, doxycycline, ciprofloxacin, and chloramphenicol. At present, no vaccine is available that protects against pneumonic plague.

In 1933, latex allergy was characterized by a Massachusetts dermatologist. Since that time, the information that we have has become more specific, but the disease has not really changed and seems to be occurring with increasing frequency. The use of latex in medical care has increased after the adoption of “universal precautions.” It has been estimated that in the United States, we use about 7 billion pairs of latex gloves, with about 8 to 12% of health care workers demonstrating some form of latex allergy. At its most extreme, latex allergy might be potentially career ending for anywhere from 2 to 54% of these affected individuals. The identification and management of the three types of latex allergy are discussed.

Breast cancer has become the most common site of new cancers in women over the past two decades. The majority of patients survive the diagnosis and have to contend with repercussions of treatments, the possibility of recurrence, or the development of new cancers for the duration of their lives. The primary care physician may be the only professional following these women or may be in a position to evaluate symptoms that have developed since a woman’s last visit with her specialist. This article will present evidence-based recommendations on clinical follow-up by the primary care physician.

This paper is written in the aftermath of the September 11th attacks on New York and Washington D.C. and in the midst of partially controlled general panic over anthrax infection. By the time it is published, concerns may have moderated, or new acts of terrorism may have occurred. In either case, the psychological impact of terrorism will continue to affect primary care patients for years to come.

Obstetricians and gynecologists are increasingly involved in primary care. Acute bronchitis is among the most common ambulatory complaints. Although the cause of acute bronchitis is predominantly viral, 50–70% of patients presenting with this condition are treated with antibiotics. Because of the increasing bacterial resistance to antibiotics, the cost of prescription drugs, and the potential adverse reactions to them, the present management of acute bronchitis has important shortcomings. Also, inhaled bronchodilators are underused for symptomatic management. Improved awareness among physicians about the recommended management of acute bronchitis has been targeted as an important means of decreasing unnecessary antibiotic use. Patient satisfaction motivates physicians to prescribe antibiotics in managing acute bronchitis. However, patient satisfaction does not necessarily correlate with prescribing of antibiotics but rather with patient education. We present a review of the diagnosis and differential diagnosis of acute bronchitis and its management.

Domestic violence is an endemic problem in the United States. We report on the results of an organizational intervention designed to increase detection and intervention in cases of domestic violence among obstetric patients admitted to the hospital. Providers underwent a 2-hour educational session that was accompanied by changes in hospital policy and medical records that facilitated universal screening. Significant increases in provider knowledge and persistently elevated levels of screening long after the intervention are documented in this program evaluation. We conclude that domestic violence screening behavior can be increased through provider education and organizational change. (Prim Care Update Ob/Gyns 2002;9:94–97

Substance abuse has far-reaching and long-lasting implications not only for women, but for their children and families as well. Substance abuse disorders are related to a host of biopsychosocial problems including severe medical and obstetric complications, poverty and unemployment, relational and parenting problems, domestic violence, and child abuse. Despite the seriousness of the problem, because substance abuse has typically been considered a male disorder, it is one of the most commonly missed diagnoses among women. Further complicating matters is that women are significantly more likely to present veiled symptoms to their primary care physicians than to seek appropriate substance abuse treatment. Given this, it is incumbent on today’s obstetrician/gynecologists to help uncover this often secret, but significant problem among women. Recommendations are made regarding the assessment and treatment of women with substance-related disorders. Obstetrician/gynecologists are encouraged to make substance abuse assessment, using standardized screening measures (such as the TWEAK questionnaire) as well as open-ended dialogues, a part of their routine exams. Obstetrician/gynecologists can play a vital role not only in the initial diagnosis of substance-related disorders but also in encouraging patients to take steps towards sobriety and to seek appropriate treatment when indicated.