Primary care update for Ob/Gyns最新文献

{"title":"Primary care refugee medicineSBT>General principles in the postimmigrationcare of Somali women","authors":"Kristina Adams MD ,&nbsp;Nassim Assefi MD","doi":"10.1016/S1068-607X(02)00120-8","DOIUrl":"10.1016/S1068-607X(02)00120-8","url":null,"abstract":"<div><p><span><span>War and persecution displace millions of refugees worldwide, mostly from developing countries, where health care is often crisis oriented. Physicians in host countries far from the nations in turmoil are increasingly encountering the complex needs of refugees in their practices. Primary care refugee medicine requires more than a general knowledge of preventive medicine or infectious disease burden of a particular refugee group. This review describes the challenges of caring for Somali women as an illustration of the complexities of delivering competent, </span>culturally sensitive care to any refugee population. We begin by describing the refugee process from a historical and medical perspective. Next, we address special features of history taking and physical examination, such as acquiring an immigration history and describing </span>female circumcision. Finally, we emphasize the importance of recognizing severe psychological trauma after human rights violations common in war. Understanding the unique circumstances facing Somali women will not only improve the integrity and appropriateness of their medical encounters but may provide widely applicable lessons for the primary care of other refugee groups.</p></div>","PeriodicalId":80301,"journal":{"name":"Primary care update for Ob/Gyns","volume":"9 6","pages":"Pages 210-217"},"PeriodicalIF":0.0,"publicationDate":"2002-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1068-607X(02)00120-8","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123597597","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":"The evaluationand management of palpitations","authors":"Elizabeth R Keeler MD ,&nbsp;Robert K Morris Jr MD ,&nbsp;Dolar S Patolia MD ,&nbsp;Eugene C Toy MD","doi":"10.1016/S1068-607X(02)00118-X","DOIUrl":"10.1016/S1068-607X(02)00118-X","url":null,"abstract":"<div><p><span>Palpitations, defined as an awareness of one’s heartbeat, is a common complaint, reported by up to 16% of patients during physician </span>office visits<span>. Although palpitations may be indicative of worrisome arrhythmias<span> and sudden cardiac death<span>, they are usually associated with benign etiologies. A systematic approach with a detailed history and physical examination, an electrocardiogram, and selective testing will reveal the etiology in over 80% of cases. Palpitations associated with chest pain<span>, dyspnea, syncope, or cardiac disease are worrisome. Thus, as a primary care physician, the obstetrician/gynecologist must be skilled in detecting cardiac pathology and proficient in the evaluation and management of palpitations.</span></span></span></span></p></div>","PeriodicalId":80301,"journal":{"name":"Primary care update for Ob/Gyns","volume":"9 6","pages":"Pages 199-205"},"PeriodicalIF":0.0,"publicationDate":"2002-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1068-607X(02)00118-X","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79114458","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":"Treatment of uterine fibroids","authors":"Mira Aubuchon MD ,&nbsp;Anil B Pinto MD ,&nbsp;Daniel B Williams MD","doi":"10.1016/S1068-607X(02)00124-5","DOIUrl":"10.1016/S1068-607X(02)00124-5","url":null,"abstract":"<div><p><span>Uterine leiomyomas<span> are benign tumors<span> that arise from myometrial smooth muscle cells. They are present in 20–25% of women of reproductive age. These benign tumors are generally firm, well circumscribed and composed of smooth muscle cells in an interdigitating pattern separated by fibrous connective tissue. Fibroids are more common in black women, and on an average, 50% of all laparotomies<span> for a pelvic pathology are performed for myomas. If asymptomatic, they can generally be managed expectantly, but 75% do have symptoms.</span></span></span></span><span>1</span>, <span>2</span><span> Up to one third of patients experience abnormal uterine bleeding<span> and/or abdominal or pelvic pain.</span></span><span>3</span> They have also been associated with both impaired fertility and poor obstetric outcome. The incidence of malignancy is small, and has been reported to be 0.29% in a study of 33,000 pathology specimens.<span>1</span><span><span><span><span> Patients presenting with infertility and with abnormal uterine bleeding have a higher incidence of uterine fibroids. Possible symptoms of uterine fibroids include bleeding, pressure, pelvic pain, </span>recurrent pregnancy loss, bladder or bowel symptoms, and infertility. Generally, uterine myomas arise from a single smooth muscle cell clone, which proliferates beyond normal control mechanisms. Surgical treatment options include laparotomy with </span>myomectomy, hysteroscopic myoma resection, or laparoscopic myomectomy. More recently, treatment of submucosal myomas has been managed almost exclusively by operative </span>hysteroscopy. The purpose of this manuscript is to briefly discuss symptoms and diagnosis but to primarily focus on treatment.</span></p></div>","PeriodicalId":80301,"journal":{"name":"Primary care update for Ob/Gyns","volume":"9 6","pages":"Pages 231-237"},"PeriodicalIF":0.0,"publicationDate":"2002-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1068-607X(02)00124-5","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88114085","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":"Patient vaccine awareness in an obstetric and gynecologic office setting","authors":"Thomas M Malone MD ,&nbsp;Bernard Gonik MD ,&nbsp;Mark Tomlinson MD","doi":"10.1016/S1068-607X(02)00117-8","DOIUrl":"10.1016/S1068-607X(02)00117-8","url":null,"abstract":"<div><p>The objective of our study was to better understand patient vaccine awareness in different ob/gyn settings. A masked questionnaire was completed by ob/gyn resident teaching clinic patients (CLINIC; <em>n</em> = 228) and private community physician patients (PVT; <em>n</em> = 254) exploring demographic, immunization recollection, and vaccine administration preferences. χ² and Student <em>t</em> test were used for statistical analyses. The results demonstrated that those in CLINIC compared with PVT were younger (27.2 ± 10.6 years old versus 38.0 ± 12.6 years old; <em>P</em> &lt; .001) and more often presented for pregnancy-related visits (57.0% versus 21.6%; <em>P</em> &lt; .001). PVT patients more commonly had documentation of childhood (34.3%) and adult (26.8%) vaccine status than those in CLINIC (25.6% and 15.5%, respectively; <em>P</em><span> &lt; .03). Of the vaccine-preventable diseases (VPDs) surveyed, those in PVT (versus CLINIC) more often reported adequate vaccination<span> or prior exposure to measles (68.5% versus 30.5%; </span></span><em>P</em><span> &lt; .001) and varicella (65.7% versus 48.5%; </span><em>P</em><span><span> &lt; .001). No differences were noted between study groups for hepatitis B, tetanus, and influenza. Those in PVT more often identified a non-ob/gyn provider for vaccine-related needs, as opposed to those in CLINIC, who more often relied on ob/gyn or </span>health department sites for such needs. Over one third of both populations could not identify a provider for vaccine administration. Both groups strongly desired availability of vaccine services through their ob/gyn office. We conclude that PVT patients demonstrate a better awareness of vaccine status compared with those in CLINIC. However, overall both populations report poor documentation and inadequate immunity against most VPDs. A variety of practice sites are currently used for vaccination, although many patients cannot identify a place to go. The majority of patients would like to see this service available as a part of their ob/gyn care.</span></p></div>","PeriodicalId":80301,"journal":{"name":"Primary care update for Ob/Gyns","volume":"9 6","pages":"Pages 195-198"},"PeriodicalIF":0.0,"publicationDate":"2002-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1068-607X(02)00117-8","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90316047","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":"The personal digital assistant in an obstetrics and gynecology residency program","authors":"Saju Joy MD ,&nbsp;Guy Benrubi MD","doi":"10.1016/S1068-607X(02)00125-7","DOIUrl":"10.1016/S1068-607X(02)00125-7","url":null,"abstract":"<div><p><span>Improvements in electronic technologies have resulted in smaller devices at faster speeds. Whether the provision of a personal digital assistant (PDA) to obstetrics and </span>gynecology<span> residents enhances their residency experience is open to question. This paper presents our institutional experience with incorporating a PDA into an obstetrics and gynecology residency training program. A PDA (Handspring Visor) was provided to residents who did not currently have a PDA. They were then instructed to use this tool at their own leisure with no requirements imposed from the department. Surveys were conducted at three intervals to determine whether this tool was impacting residency experience. Resident responses to the survey revealed that there was a decreased perceived value to this tool at follow-up intervals. However, residents felt that they were not using this tool to its maximum potential. In 94% of responses, the responder felt that the PDA should be available at residency programs and anticipated using it in private practice after completing residency. Expectations for the potential uses of a PDA were high among the obstetrics and gynecology residents. However, the voluntary implementation of a new tool added an additional responsibility in an otherwise busy residency-training program. Thus, the integration of the PDA did not meet the anticipated expectations of overwhelming use by residents. Providing additional software applications and PDA tutorials may encourage residents to take advantage of tools available for procedure logs, electronic billing, electronic prescriptions, and wireless fetal monitoring.</span></p></div>","PeriodicalId":80301,"journal":{"name":"Primary care update for Ob/Gyns","volume":"9 6","pages":"Pages 238-242"},"PeriodicalIF":0.0,"publicationDate":"2002-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1068-607X(02)00125-7","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73057084","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":"Azithromycin—a new macrolide","authors":"Carrie J Kremer MD","doi":"10.1016/S1068-607X(02)00112-9","DOIUrl":"10.1016/S1068-607X(02)00112-9","url":null,"abstract":"<div><p><span><span><span>Azithromycin is a </span>macrolide derivative<span> referred to as an azalide<span>. It was approved for clinical use in 1992 and has several advantages over traditional macrolides such as erythromycin. Azithromycin is more acid stable and therefore has greater oral bioavailability. It has a longer half life and thus can be administered once daily. Azithromycin also achieves higher tissue concentrations and enhanced </span></span></span>antimicrobial activity compared with erythromycin. Finally, azithromycin has a lower incidence of adverse side effects and drug interactions than other macrolides. In obstetrics and </span>gynecology<span><span>, azithromycin is of primary value for treatment of respiratory tract infections and </span>chlamydial infections.</span></p></div>","PeriodicalId":80301,"journal":{"name":"Primary care update for Ob/Gyns","volume":"9 5","pages":"Pages 174-175"},"PeriodicalIF":0.0,"publicationDate":"2002-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1068-607X(02)00112-9","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88091149","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":"Parvovirusinfection in women","authors":"Patricia A Devine MD","doi":"10.1016/S1068-607X(02)00107-5","DOIUrl":"10.1016/S1068-607X(02)00107-5","url":null,"abstract":"<div><p><span>Parvovirus B19 is the causative agent of the childhood exanthem erythema infectiosum<span>. Erythema infectiosum can occur sporadically, or as part of community outbreaks. Outbreaks typically occur in elementary schools during the late winter and early spring. Increasing age is associated with an increasing prevalence of prior B19 infection. The primary mode of transmission is through respiratory secretions and hand-to-mouth contact. A susceptible pregnant woman’s risk of parvovirus B19 infection is closely associated with her level of contact with children and the environment in which the exposure takes place. The greatest risk factor for seroconversion is having a child aged 6 to 7 years. The most common clinical presentation in adults is symmetrical peripheral </span></span>polyarthropathy<span>. Diagnosis of maternal infection is usually established by maternal serology<span><span>. If a patient contracts parvovirus B19 infection during pregnancy, the risk of fetal infection can be as high as 33%. The mechanism for fetal infection is maternal viremia<span> with transplacental passage of parvovirus B19. The infected fetus is at risk for developing </span></span>aplastic anemia<span><span><span>, heart failure, and hydrops. Fetal death occurs most frequently when maternal infection takes place between 10–20 weeks’ gestation, and may be as high as 10%. Pregnant women with serologic evidence of recent parvovirus B19 infection should be followed with weekly ultrasound examinations, looking for signs of hydrops. If hydrops develops, consideration should be given to </span>cordocentesis. Circumstantial evidence supports performing intrauterine transfusion in selected cases with severe fetal anemia and hydrops. Long-term </span>sequelae<span> of congenital parvovirus infection are rare.</span></span></span></span></p></div>","PeriodicalId":80301,"journal":{"name":"Primary care update for Ob/Gyns","volume":"9 5","pages":"Pages 149-153"},"PeriodicalIF":0.0,"publicationDate":"2002-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1068-607X(02)00107-5","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81917153","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":"Coding and documentation 101: current procedural terminology versus health care finance administration guidelines for office services","authors":"Seine Chiang MD","doi":"10.1016/S1068-607X(02)00116-6","DOIUrl":"10.1016/S1068-607X(02)00116-6","url":null,"abstract":"<div><p>Documentation and coding principles are intimately linked and affect patient care, reimbursement, and compliance. An understanding of the principles is required for the successful practice of medicine today. All physicians should receive formal education and practical training in chart documentation and coding of medical services. As with other medical knowledge, this education must begin early in training and be continually updated. This article will discuss documentation and coding in the ambulatory setting using Health Care Finance Administration and Current Procedural Terminology guidelines.</p></div>","PeriodicalId":80301,"journal":{"name":"Primary care update for Ob/Gyns","volume":"9 5","pages":"Pages 184-193"},"PeriodicalIF":0.0,"publicationDate":"2002-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1068-607X(02)00116-6","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76477914","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":"Quinupristin–dalfopristin: a streptogramin antibiotic","authors":"Amanda Murchison MD","doi":"10.1016/S1068-607X(02)00113-0","DOIUrl":"10.1016/S1068-607X(02)00113-0","url":null,"abstract":"<div><p><span>Over the past 10 years, hospitals have witnessed the growing resistance of gram-positive organisms to many antibiotics. In September 1999, quinupristin–dalfopristin (Synercid) was approved by the U.S. Food and Drug Administration. It is the first injectable streptogramin antibiotic and is indicated for the treatment of serious infections (bacteremia and complicated skin infections) caused by vancomycin-resistant </span><span><em>Enterococcus faecium</em></span> (VREF) and methicillin-susceptible <em>Staphylococcus aureus</em> and <span><em>Streptococcus</em><em> pyogens</em></span><span>. The dosage is 7.5 mg/kg intravenously every 8 hours for VREF infections and every 12 hours for skin and skin structure infections. The most common side effect is pain and inflammation at the infusion site. Other side effects include nausea, arthralgias<span>, myalgias, diarrhea, vomiting, and rash. The average wholesale price of quinupristin–dalfopristin is $107 for a 500-mg vial.</span></span></p></div>","PeriodicalId":80301,"journal":{"name":"Primary care update for Ob/Gyns","volume":"9 5","pages":"Pages 176-177"},"PeriodicalIF":0.0,"publicationDate":"2002-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1068-607X(02)00113-0","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74763394","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":"Fluconazole:a valuable fungistatic","authors":"Theresa Dawn Hilley Vensel MD","doi":"10.1016/S1068-607X(02)00115-4","DOIUrl":"10.1016/S1068-607X(02)00115-4","url":null,"abstract":"<div><p><span><span>Fluconazole<span> (Diflucan) is an important drug in obstetrics and gynecology<span> in treating vaginal yeast infections<span>. It is fungistatic and indicated for the treatment of oropharyngeal, esophageal, vaginal, and systemic candidiasis; urinary tract infections; </span></span></span></span>peritonitis<span>; cryptococcal meningitis<span><span>; and as prophylaxis for bone marrow transplant<span> recipients. It is preferred by many patients for treatment of vaginal candidiasis because it is easier to use than topical medications. It has proven to be as effective as the standard intravaginal creams, mainly because of its ability to penetrate well into body fluids and tissues. Fluconazole’s side effects are mild to moderate in nature. They include </span></span>gastrointestinal disturbances<span> and headaches. Fluconazole also may interact with many drugs. It is contraindicated in patients taking cisapride and terfenadine. It potentiates </span></span></span></span>oral hypoglycemic agents<span><span> and may cause patients to have symptomatic hypoglycemia. It also increases the prothrombin time in patients on </span>oral anticoagulants. A single 150-mg dose costs approximately $12.00.</span></p></div>","PeriodicalId":80301,"journal":{"name":"Primary care update for Ob/Gyns","volume":"9 5","pages":"Pages 181-183"},"PeriodicalIF":0.0,"publicationDate":"2002-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1068-607X(02)00115-4","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90086523","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}