摘要:

Background.Children and adolescents frequently have symptoms of anxiety. In addition, anxiety disorders are some of the most frequent psychiatric disorders in this age group.Methods.We used computerized literature searches (MEDLINE and PSYCHLIT) to identify clinical, research, and review articles on this subject. Various journals and textbooks from the psychiatric, medical, and psychology literature were accessed.Results.This review includes findings on the epidemiology, developmentally normal anxiety, clinical presentations, course and outcome, and treatment interventions.Conclusions.Pediatricians and family practitioners should be familiar with the spectrum of anxiety in children and adolescents. Guidelines for referral to a mental health practitioner are reviewed.

ISSN:0038-4348    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

1998 marked the acceptance of Physician Assistants (PAs) as members in the Southern Medical Association. We review the history of the PA profession and, more importantly, the physician/PA relationship. We also provide an overview of PA education and certification requirements. Variations in state law regarding PA utilization, including the delegation of prescribing privileges, are discussed. Current American Medical Association guidelines regarding physician/PA practice are provided.

ISSN:0038-4348    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0038-4348    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Background.Fallopian tube prolapse is reported to most commonly occur after vaginal hysterectomy. Both diagnosis and management have varied, resulting in differing efficacies of treatment.Methods.We reviewed the presentation, diagnosis, management, and outcomes of 18 cases of tubal prolapse in 17 women.Results.Most cases (65%) occurred after abdominal hysterectomy. The post-hysterectomy course was complicated by cuff cellulitis in three women, an infected cuff hematoma in one, and post-extubation pulmonary edema in one; four were observed for elevated temperature only. At presentation, 44% complained of dyspareunia, 39% vaginal bleeding, 33% vaginal discharge, 28% abdominal pain, and 28% were asymptomatic. Seven women had vaginal excision (one requiring an additional abdominal procedure), three had laparotomy with salpingectomy, and seven (41%) had spontaneous disappearance of prolapsed fallopian tube without treatment.Conclusions.In our series, tubal prolapse most commonly occurred after abdominal hysterectomy. Moreover, women with tubal prolapse may be asymptomatic, and observation alone may lead to resolution.

ISSN:0038-4348    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Background.Asymptomatic myocardial ischemia is commonly observed in patients with coronary artery disease. Numerous studies have shown that patients with asymptomatic ischemia are at higher risk for adverse outcome than those without ischemia. Several recent studies have investigated the therapeutic options available in the management of patients with asymptomatic myocardial ischemia.Methods.Recently published randomized controlled trials investigating the treatment of asymptomatic myocardial ischemia were reviewed.Results.The controlled trials suggest that (1) asymptomatic ischemia can be suppressed to various degrees using pharmacologic therapy or revascularization, (2) β-blockers are in general superior to calcium channel blockers or nitrates in relieving asymptomatic ischemia, and (3) revascularization is superior to pharmacologic therapy.Conclusions.A growing body of evidence suggests that in patients with coronary artery disease, treatment of asymptomatic ischemia may result in improved outcome. However, because of significant limitations in the published studies, additional studies with large sample sizes and broader inclusion criteria are needed.

ISSN:0038-4348    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Background.Widespread antibiotic use has fostered the emergence of antibiotic-resistant bacteria. Parental expectations have been cited as one reason for physicians to overprescribe antibiotics. The objective of this study was to determine parental knowledge about antibiotics and their use for common respiratory tract infections.Methods.A survey was administered to 100 adults at a rural pediatric office.Results.Many respondents had misconceptions about the etiology of common respiratory tract infections and the effects of antibiotic therapy. Only 54% knew that a virus is the usual cause of the common cold, and 33% thought that a virus causes strep throat. Almost half (46%) believed that antibiotics kill viruses, while 17% were not sure whether antibiotics kill viruses. Most respondents (60%) had never heard about antibiotic resistance.Conclusion.Parental knowledge about common respiratory tract infections and about antibiotic therapy is often lacking. Improved parent education may alter parents' expectations concerning antibiotic therapy for their ill children.

ISSN:0038-4348    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Background.Tobacco use causes significant morbidity and mortality. Resident physicians at the George Washington University Medical Center are trained to counsel patients to stop smoking.Methods.I retrospectively reviewed charts of 300 patients treated by resident physicians in the Department of Medicine (200) and the Department of Health Care Sciences (100).Results.In the 200 patients cared for by resident physicians in the traditional internal medicine training program, a smoking history was obtained in 93 (47%). Forty-seven patients (51%) smoked, and 7 smokers (15%) were counseled to stop smoking. In 100 patients cared for by resident physicians in the primary care internal medicine training program, a smoking history was obtained in 94 patients (94%). Twenty-three patients (24%) smoked, and 11 (48%) were counseled to stop smoking.Conclusion.Resident physicians in the primary care training program obtained more smoking histories and counseled more patients to stop smoking. Further study is necessary to evaluate strategies that can be used in residency training to encourage smoking-cessation counseling.

ISSN:0038-4348    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Background.People who have periods of low family income are at risk for increased health problems in the future, even if they present a similar clinical picture before the reduction in family income. The association between low income and health status was studied in residents of an area with relatively low-average family income and with a historically unstable economy.Methods.We surveyed a stratified, clustered sample of residents of Johnson County, Tennessee, using a structured interview. The responses were analyzed in conjunction with national and regional data (National Health Interview Survey).Results.Residents of the geographic area under study had a markedly higher prevalence of self-reported health problems than either the national average or rural areas in the southeast United States. The higher prevalence was accounted for by the combination of age and family income, which had equal effects on health status, but not by age differences alone.Conclusions.Family income and economic development are critically important to improving community health. Sensible capitation rates in managed care arrangements can be obtained only if the income distribution of an insured population is considered along with their age, sex, and physical health status.

ISSN:0038-4348    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Background.Data for this study came from South Carolina 1995 Hospital Inpatient Encounter Data Base. The population figures were 1995 South Carolina population estimates.Methods.We examined patient sociodemographic characteristics and costs associated with adult and pediatric ambulatory care sensitive condition (ACSC) hospitalization in South Carolina. Bivariate statistical comparisons were done to test the differences between ACSC and non-ACSC groups in specific sociodemographic characteristics. Logistic regression determined the relative significance of individual characteristics to hospitalizations for ACSC. Cost/charge ratios were used to estimate costs associated with ACSC hospitalizations.Results.Nonwhites, low-income individuals, and those residing in more rural areas had significantly more ACSC hospitalizations than their respective counterparts (ie, whites, high income individuals, and those residing in metropolitan statistical areas). Individuals without a primary care physician were more likely to be hospitalized with ACSC. Ambulatory care sensitive condition hospitalization charges were 12% of total hospital charges for adults and 20% for children. The average cost per ACSC hospitalization was $3,929 for adults and $1,818 for children.Conclusion.Providers can rapidly assess needs and barriers faced by vulnerable population groups by using regularly collected hospital discharge data at the national, state, and community level.

ISSN:0038-4348    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

A 43-year-old woman had full facial laser resurfacing for treatment of multiple actinic keratoses and aging skin. Healing was uneventful on most of the areas treated except the forehead, where a progressive nonhealing wound developed. After seeking numerous consultations around the Southeast, the patient came to our facility, 6 months after the initial laser treatment, with exuberant granulation tissue of the forehead and temples and a painful wound. Many topical treatments had been previously tried. Debridement and split-thickness skin grafting were done using general anesthesia. Pathologic analysis revealed hyperplastic granulation tissue and epidermal appendages. The wound healed with an improved aesthetic result. This case illustrates that seemingly impossible laser complications can be handled by a basic approach to wound healing.

ISSN:0038-4348    

出版商:OVID    

年代:1999

数据来源: OVID