Stuart H Shippey MD, LCDR, MC, USN , Christian R Macedonia MD, LTC, MC, USA
{"title":"Surgical treatmentof extreme obesity","authors":"Stuart H Shippey MD, LCDR, MC, USN , Christian R Macedonia MD, LTC, MC, USA","doi":"10.1016/S1068-607X(03)00068-4","DOIUrl":"10.1016/S1068-607X(03)00068-4","url":null,"abstract":"<div><p><span>The Surgeon General has identified obesity as a leading threat to public health in the United States. It is associated with a wide variety of chronic diseases, which are exacerbated by increasing degrees of overweight. Starting points for treatment of obesity include diet, exercise, and behavioral therapy. Medication can be added to help effect weight loss. However, there is a growing consensus that weight reducing<span> (bariatric) surgery is the treatment of choice for extremely obese individuals who have failed to reduce their weight through dietary, behavioral, and pharmacologic interventions. The two operations that have been most widely used in the United States are vertical banding gastroplasty<span> and Roux-en-Y gastric bypass. Between these, gastric bypass appears to have better long-term effectiveness in reducing weight and managing comorbidities related to obesity. More important than enabling the patient to reach an </span></span></span>ideal body weight, bariatric surgery can be very effective in ameliorating, or even resolving, obesity-related diseases.</p></div>","PeriodicalId":80301,"journal":{"name":"Primary care update for Ob/Gyns","volume":"10 6","pages":"Pages 278-283"},"PeriodicalIF":0.0,"publicationDate":"2003-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1068-607X(03)00068-4","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72801748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Ob/Gyn residents as primary care providers: implementing a new curriculum for diagnosing and treating depression and anxiety","authors":"Jennifer C. Stevens MD, Sandra J. Diehl MPH","doi":"10.1016/S1068-607X(03)00072-6","DOIUrl":"10.1016/S1068-607X(03)00072-6","url":null,"abstract":"<div><p>The Accreditation Council for Graduate Medical Education (ACGME) guidelines on resident work hours were created in 2002 in an effort to improve patient care. However, these changes may have a negative impact on resident education. Finding time to adequately prepare Ob/Gyn residents in core curriculum topics has become a challenge. Primary care topics such as behavioral medicine often become a lesser priority, yet Ob/Gyn physicians are expected to be competent in diagnosing and treating mental illness. Depression affects as many as 30% of all pregnant or postpartum women. When we evaluated the screening practices of a southeastern North Carolina residency program, we found that only 8% of prenatal patients were screened for symptoms of depression at their first visit and only 23% were screened at their postpartum visit. Education, screening, and treatment practices need to be addressed to ensure thorough management of Ob/Gyn patients. This paper suggests ways to do so.</p></div>","PeriodicalId":80301,"journal":{"name":"Primary care update for Ob/Gyns","volume":"10 6","pages":"Pages 297-299"},"PeriodicalIF":0.0,"publicationDate":"2003-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1068-607X(03)00072-6","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76026198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lonnie P.M.C Lin MD , Shelley L Galvin MA , Suzanne D Dixon MD
{"title":"Smoking cessation in an OB/GYN residency clinic","authors":"Lonnie P.M.C Lin MD , Shelley L Galvin MA , Suzanne D Dixon MD","doi":"10.1016/S1068-607X(03)00065-9","DOIUrl":"https://doi.org/10.1016/S1068-607X(03)00065-9","url":null,"abstract":"<div><p>The objective of this study was to evaluate changes in the behaviors of pregnant women who smoke and their care providers following implementation of a comprehensive multidisciplinary smoking cessation program<span><span>. A retrospective cohort study of 202 charts before and after program implementation was conducted. We examined patients' self-reported smoking behaviors and documentation of care providers' responses over the course of prenatal care. Chi-square analyses and Student's t-tests were used as appropriate with significance at p < 0.05. Overall smoking rates were 41% and 44% during the two time intervals. Significant reductions in daily cigarette consumption were found following implementation of the program (37% vs. 71%). No significant increase in </span>smoking cessation was observed (29% vs. 32%). A significant difference in the time interval between initial identification of smoking during pregnancy and documentation of intervention was found (11.56 ± 7.14 vs. 7.65 ± 6.06 weeks). The percentage of pregnant smokers in the clinic was 2.5 times the statewide rate and 3.5 times the national rate. While cessation is the ideal goal, reductions in daily cigarette consumption contribute to reduced risk of low birth weight babies. The majority of the patients accomplished this goal. Changes in care provider behavior were limited to cessation counseling earlier in the course of prenatal care. Suggestions for program improvements include additional structure and increased training.</span></p></div>","PeriodicalId":80301,"journal":{"name":"Primary care update for Ob/Gyns","volume":"10 6","pages":"Pages 265-269"},"PeriodicalIF":0.0,"publicationDate":"2003-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1068-607X(03)00065-9","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91634924","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Urinary incontinence in elderly women","authors":"Karen L Miller MD","doi":"10.1016/S1068-607X(03)00047-7","DOIUrl":"10.1016/S1068-607X(03)00047-7","url":null,"abstract":"<div><p><span>Urinary incontinence is a common, morbid, and costly condition affecting 10–50% of community-dwelling women over age 65.</span><span>1</span><span> Among elderly women urge incontinence<span> is more prevalent than stress incontinence and, thus, is rarely amenable to cure by a single therapeutic intervention.</span></span><span>2</span><span> As both the number and population percentage of elderly women increase, gynecologists<span> will be increasingly called upon to manage this chronic condition that impairs quality of life and socialization opportunities for millions of elders. Types, contributing factors, compensatory mechanisms, and response to therapy all differ somewhat in older compared to younger women. This article focuses on differences and nuances in the elderly that determine the likelihood of successful management. Besides bladder<span><span> and urethral function, other urinary tract factors, such as sensation, and factors external to the lower urinary tract, such as mobility, influence whether an older person can remain continent. The practitioner must review the patient's medications and understand her medical history as it relates to current function. </span>Postvoid residual<span> measurement and a voiding record are virtually essential to understand both bladder and patient behavior. A positive urine culture<span> must be interpreted with caution, because of the high incidence of asymptomatic bacteriuria<span> in the elderly. Therapeutic success will increase in proportion to recognition and treatment of multiple factors. Treatment is partially or completely successful in most individuals, and almost all can obtain “social continence.”</span></span></span></span></span></span><span>3</span></p></div>","PeriodicalId":80301,"journal":{"name":"Primary care update for Ob/Gyns","volume":"10 5","pages":"Pages 242-246"},"PeriodicalIF":0.0,"publicationDate":"2003-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1068-607X(03)00047-7","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83645337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Barbara Barnett MD, FACEP , Dawne Kort MD , Vincent James Campasano MD
{"title":"The approach to the patient with anaphylaxis","authors":"Barbara Barnett MD, FACEP , Dawne Kort MD , Vincent James Campasano MD","doi":"10.1016/S1068-607X(03)00053-2","DOIUrl":"10.1016/S1068-607X(03)00053-2","url":null,"abstract":"<div><p><span><span>Anaphylaxis<span> is an acute, life-threatening, multisystem response to a variety of triggers. Anaphylaxis affects multiple organ systems including the cutaneous, pulmonary, cardiovascular, and gastrointestinal systems<span>. In 1949, the first case of fatal anaphylaxis to penicillin was reported. Antibiotics remain the most common cause. Other drugs implicated include non-steroidal anti-inflammatory drugs. Hymenoptera stings represent the second most common cause of anaphylaxis. Food is also a common offender. The clinical manifestations of anaphylaxis are the end result of a complex cascade involving multiple </span></span></span>cell lines<span><span> and chemical mediators. The final common pathway in anaphylaxis is the activation of mast cells and circulating basophils<span><span> with subsequent degranulation and release of preformed mediators. The earliest cell mediator to be recognized was histamine. While it is important to note the signs and symptoms of anaphylaxis vary from patient to patient, one of the hallmarks of anaphylaxis is the rapidity of onset of symptoms. Cutaneous manifestations include </span>urticaria and </span></span>angioedema. The more serious aspects involve the pulmonary and cardiovascular systems. Prompt recognition and initiation of treatment is crucial. Respiratory failure and </span></span>cardiovascular collapse<span> can occur in a matter of minutes. Initial management should be directed at protecting the airway and maintaining cardiovascular function<span>. Pharmacological measures should be based on the severity of symptoms as well as the clinical presentation. As with all allergic diseases, avoidance and prevention are the mainstays of therapy.</span></span></p></div>","PeriodicalId":80301,"journal":{"name":"Primary care update for Ob/Gyns","volume":"10 5","pages":"Pages 205-209"},"PeriodicalIF":0.0,"publicationDate":"2003-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1068-607X(03)00053-2","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88590041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Postpartum depression","authors":"Yesne Alici-Evcimen MD , Donna M. Sudak MD","doi":"10.1016/S1068-607X(03)00052-0","DOIUrl":"https://doi.org/10.1016/S1068-607X(03)00052-0","url":null,"abstract":"<div><p><span><span>Obstetricians must be familiar with the diagnosis and treatment of </span>postpartum depression<span> (PPD), as they are the first contact physicians of most postpartum depressed women. Postpartum depression is particularly critical to treat as it has significant impact on the mother, the infant, and the family if left untreated. Clinicians should be able to identify the risk factors for depression in postpartum women. Self-report scales can be used to detect depressive symptoms in new mothers especially in nonpsychiatric settings, to facilitate making the diagnosis of postpartum depression. Although the symptoms of PPD are not significantly different from a major depressive episode<span><span>, physicians must note that the neurovegetative signs of depression may be confused with normal physiological changes associated with the puerperal<span> period. Assessment of suicide risk is essential, although the postpartum period is regarded as a low-risk period for self harm. Psychiatric referral is mandatory if there is any suspicion of suicidal or infanticidal ideation. The presence of psychotic and manic symptoms also requires referral to a psychiatrist as this may be a manifestation of </span></span>postpartum psychosis or </span></span></span>bipolar disorder. PPD should be treated as any major depressive episode. Untreated PPD has significant impact on the child including adverse effects on cognitive, emotional, and social development of the child in addition to impaired mother-infant bonding.</p></div>","PeriodicalId":80301,"journal":{"name":"Primary care update for Ob/Gyns","volume":"10 5","pages":"Pages 210-216"},"PeriodicalIF":0.0,"publicationDate":"2003-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1068-607X(03)00052-0","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136556407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Environmental and occupational hazards to pregnancy","authors":"Iffath Abbasi Hoskins MD","doi":"10.1016/S1068-607X(03)00045-3","DOIUrl":"10.1016/S1068-607X(03)00045-3","url":null,"abstract":"<div><p>As our knowledge about occupational and environmental hazards increases, obstetrician/gynecologists are increasingly being asked to address these concerns for their pregnant patients. While there are numerous biologically active substances that can be considered as being hazardous, the purpose of this review is to address some of the more common exposures that could pose a threat to the mother and her developing fetus. These exposures may produce adverse effects through many different mechanisms of action and may have consequences that are either immediate or affect future reproduction. However, the most significant factors that should be considered are the exposure and the maternal physiologic changes that are present at the time.</p></div>","PeriodicalId":80301,"journal":{"name":"Primary care update for Ob/Gyns","volume":"10 5","pages":"Pages 253-257"},"PeriodicalIF":0.0,"publicationDate":"2003-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1068-607X(03)00045-3","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83010200","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Acute coronary syndromes","authors":"Louis Filippone MD , Gino A Farina MD, FACEP","doi":"10.1016/S1068-607X(03)00050-7","DOIUrl":"10.1016/S1068-607X(03)00050-7","url":null,"abstract":"<div><p><span><span>Cardiac complaints are very common in office practice. Eliciting a history of chest pain, shortness of breath, or jaw/arm pain during a routine visit should prompt the physician to investigate these symptoms, and in some cases initiate appropriate management. The variety of </span>therapeutic modalities available to physicians today, both invasive and non-invasive, should be well understood by all primary care physicians. In 1996, the National Center for Health Statistics reported over 1.4 million hospitalizations for unstable angina/non–ST-segment elevation myocardial infarction in the U.S.,</span><span>1</span><span> while nearly 500,000 patients are hospitalized with ST-segment elevation myocardial infarction each year. Advancements in the acute coronary syndrome definitions and management change rapidly; this article will serve as a review and update for the Obstetrician-Gynecologist, who may be providing care for these women.</span></p></div>","PeriodicalId":80301,"journal":{"name":"Primary care update for Ob/Gyns","volume":"10 5","pages":"Pages 224-230"},"PeriodicalIF":0.0,"publicationDate":"2003-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1068-607X(03)00050-7","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86709630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Late life depression and dementia","authors":"William Reichman MD","doi":"10.1016/S1068-607X(03)00048-9","DOIUrl":"10.1016/S1068-607X(03)00048-9","url":null,"abstract":"","PeriodicalId":80301,"journal":{"name":"Primary care update for Ob/Gyns","volume":"10 5","pages":"Pages 238-241"},"PeriodicalIF":0.0,"publicationDate":"2003-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1068-607X(03)00048-9","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81068708","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Walter Reed, MD","authors":"Tara Irland Ezzell MD","doi":"10.1016/S1068-607X(03)00049-0","DOIUrl":"10.1016/S1068-607X(03)00049-0","url":null,"abstract":"<div><p><span>Walter Reed, son of a Methodist minister, was born in 1851. His father sent each of his five sons to the University of Virginia, but in order to preserve family finances, Walter completed his education quickly. He remains the University of Virginia School of Medicine's youngest graduate, receiving his degree at age 18. He pursued further training in New York, but found civilian medicine disillusioning. At age 24, he passed the Army Medical Corps<span><span> entrance examination and subsequently spent 14 years as an Army surgeon on the American frontier. He treated soldiers, prospectors, and Indians for little, if any, payment. Yearning to become part of the scientific revolution, Reed returned to academia, auditing pathology and bacteriology courses at Johns Hopkins University. He learned the principles of the scientific method and made important contacts during that period of training. The Surgeon General then called him to aid in the definition and resolution of the epidemics of infectious diseases affecting American troops. He presided over the investigative board that refuted the water-borne theory of typhoid fever and identified files, feces, and </span>fomites as the source of this dreaded illness. After his success with this epidemic, he was sent to Cuba to tackle the problem of yellow fever. In approximately 6 months, he was able to disprove a bacterial cause of the illness, establish the mosquito as the likely source, and conduct a controlled trial to successfully confer illness throughthat vector. This information facilitated elimination of a horrific tropical pest. At 51, just one and a half years after his landmark work with yellow fever, he fell victim to </span></span>appendicitis and died.</p></div>","PeriodicalId":80301,"journal":{"name":"Primary care update for Ob/Gyns","volume":"10 5","pages":"Pages 231-234"},"PeriodicalIF":0.0,"publicationDate":"2003-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1068-607X(03)00049-0","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85937799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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