directors of Nursing (DONs) from 196 of 206 Nebraska long-term-care (LTC) facilities were sent a pre-tested questionnaire. The aim was to assess available on-site dental services, existing oral health education and pr...
directors of Nursing (DONs) from 196 of 206 Nebraska long-term-care (LTC) facilities were sent a pre-tested questionnaire. The aim was to assess available on-site dental services, existing oral health education and prevention programs as well as future needs/preferences, and the influence of 10 factors in assessing and maintaining residents' oral health. Of the 196 DONs contacted, 126 (64%) participated. Only 36% of DON responders reported having on-site dental services. DONs indicated a preference for nursing staff (NS) oral health in-service training over other educational and/or programmatic proposals. When asked to select the five most influential factors in assessing and maintaining residents' oral health in their respective facilities, DONs selected resident factors (mean, 2.8) more often than NS factors (mean, 2.2). DONs most often identified residents' (R′) ability to perform oral hygiene (n = 99), R′ cooperation with OH assistance (n = 98), R′ interest in their oral health (n = 83), NS interest in R′ dental health (n = 70), and NS time constraints (n = 69).
作者：
MELVIN, SYAssistant Director
Family Medicine Residency Program Long Beach Memorial Medical Center； Assistant Clinical Professor University of California at Irvine Irvine California Assistant Professor of Family Medicine
College of Osteopathic Medicine of the Pacific Pomona California
SUMMARY Syphilis has persisted for centuries, yet over the last few years with public emphasis on “safe sex” practices there is still a resurgence of this disease. Control of this potentially devastating illness can...
SUMMARY Syphilis has persisted for centuries, yet over the last few years with public emphasis on “safe sex” practices there is still a resurgence of this disease. Control of this potentially devastating illness cannot be achieved by physicians alone. It requires a combined effort from the public, educators, government, and the medical community. Physicians may contribute by patient education, frequent testing of all individuals at high risk, and treatment and close follow-up of patients and contacts.
作者：
HALVORSEN, JGAssistant Professor
Department of Family Practice & Community Health and Associate Program Director Academic Family Medicine Residency University of Minnesota Minneapolis Minnesota
SUMMARY The oral cavity is an area of the human body that is often given only cursory surveillance by primary care physicians. In this article, I have discussed a comprehensive approach for collecting subjective and o...
SUMMARY The oral cavity is an area of the human body that is often given only cursory surveillance by primary care physicians. In this article, I have discussed a comprehensive approach for collecting subjective and objective data from the patient that is pertinent to oral conditions. Most common and critical problems have been reviewed in detail, focusing on their definition, epidemiology, pathophysiology, clinical manifestations, diagnosis, and management. This review is intended to sensitize physicians to the need to evaluate oral complaints more completely, to diagnose them more accurately, and to treat them more successfully.
作者：
BRECHTELSBAUER, DAAssistant Professor
Department of Family Medicine University of South Dakota School of Medicine Sioux Falls and Associate Director Sioux Falls Family Practice Residency Program Sioux Falls South Dakota
SUMMARY Identification and evaluation of adult hearing loss is an important task for primary care physicians. Recent studies reporting the reliability and validity of simple testing instruments reinforce this conclusi...
SUMMARY Identification and evaluation of adult hearing loss is an important task for primary care physicians. Recent studies reporting the reliability and validity of simple testing instruments reinforce this conclusion. Although most cases will be secondary to noise exposure or age-related and benefit from amplification, a diligent search for more unusual causes, some of which have specific curative therapy, is always needed. The initial prescription and fitting of hearing aids is the realm of the audiologist. The primary care physician can enhance the treatment program by providing global evaluation, educating the patient as to likely therapy and realistic expectations of results, and providing long-term follow-up and functional assessment of hearing aid use. The burden of hearing loss is particularly heavy in the nursing home population. In this arena, the physician can ease the burden by being attentive to the possibility of hearing loss causing unexpected behavior, searching for, and when possible, treating reversible causes, and using assistive devices and behavioral techniques to enhance communication when the hearing impairment cannot be corrected.
作者：
GRAU, TJAssistant Professor
Department of Family Medicine Mayo Graduate School of Medicine Rochester Minnesota Program Director
St. Francis-Mayo Family Practice Residency La Crosse Wisconsin
SUMMARY A careful history and physical examination is essential in diagnosing and treating salivary gland disorders. This alone may identify congenital lesions, trauma, acute and chronic inflammatory diseases, and a v...
SUMMARY A careful history and physical examination is essential in diagnosing and treating salivary gland disorders. This alone may identify congenital lesions, trauma, acute and chronic inflammatory diseases, and a variety of other conditions affecting the salivary glands. The most common presenting complaint is that of a lump in a salivary gland, and the onus is on the physician to prove the presence or absence of malignancy. Laboratory and radiographic studies are of minimum value in making this distinction, and biopsy, under general anesthesia, by a competent head and neck surgeon with microscopic evaluation is often necessary. Office biopsy or large or fine-needle aspiration should not be attempted. Fortunately, most neoplasms are benign, and many malignant forms are low grade and have a good prognosis.
作者：
WAKEFIELD, KMHENDERSON, STSTREIT, JGGeriatric Director
St. Joseph Family Practice Residency Program； and Associate Professor Department of Family and Community Medicine University of Kansas School of Medicine—Wichita Wichita Kansas Fellow
Department of Family and Community Medicine University of Kansas School of Medicine-Wichita Wichita Kansas Associate Director
St. Joseph Family Practice Residency Program； and Assistant Professor Department of Family and Community Medicine University of Kansas School of Medicine—Wichita Wichita Kansas
Fever is a prominent sign of an acute-phase response induced by microbial invasion, tissue injury, immunologic reactions, or inflammatory processes. This generalized host response is produced by a multiplicity of loca...
Fever is a prominent sign of an acute-phase response induced by microbial invasion, tissue injury, immunologic reactions, or inflammatory processes. This generalized host response is produced by a multiplicity of localized or systemic diseases and characterized by acute, subacute, or chronic changes in metabolic, endocrinologic, neurologic, and immunologic functions. The fundamental event is an initiation of the acute-phase response by the production of a mediated molecule called IL-1. This polypeptide is produced primarily from phagocytic cells such as blood monocytes, phagocytic lining cells of the liver and spleen, and other tissue macrophages. IL-1 produces a local reaction but also enters the circulation, acting as a hormone to mediate distant organ system responses to infection, immunologic reaction, and inflammatory processes. Fever is the result when IL-1 initiates the synthesis of prostaglandins, notably prostaglandin E 2 in the thermoregulatory center located in the anterior hypothalamus. The thermostatic set point is then raised and mechanisms to conserve heat (vasoconstriction) and to produce heat (shivering) are initiated. The result is a sudden rise in body temperature. The same basic mechanisms are involved in FUO. Many of the biologic and biochemical changes that are seen in FUO are also evidence of an acute-phase response. The elevated erythrocyte sedimentation rate is partly due to increased synthesis of hepatic proteins, including compliment components, ceruloplasmin, fibrinogen, and C-reactive protein. IL-1 acts directly on the bone marrow to increase absolute numbers and immaturity of circulating neutrophils. Anemia is produced by many mechanisms, including the reduction of circulating serum iron. Although fever production in the elderly maybe delayed or of less intensity, it is still a marker of significant disease. When fever is an indicator of infectious disease, its severity can be followed by documenting an increased C-reactive protein. Cau
The Family Environment Scale (FES), an instrument that evaluates several aspects of family functioning, was given to 114 young women subjects and a parent of each. Twenty subjects had restricting anorexia nervosa (AN)...
The Family Environment Scale (FES), an instrument that evaluates several aspects of family functioning, was given to 114 young women subjects and a parent of each. Twenty subjects had restricting anorexia nervosa (AN), 13 had bulimic AN, and 24 had normal-weight bulimia, whereas 57 were age-matched controls. The score of each subject and her parent was averaged on each FES subscale to derive a family score. One-way analyses of variance, used to compare the 4 subject, 4 parent, and 4 family means, revealed significant differences on 5 of the 10 FES subscales: cohesion, expressiveness, conflict, achievement orientation, and activerecreational orientation. These data, together with those of other investigators, suggest that the family environment in eating disorder families differs in important ways from that of normal families. The possible significance of these findings is discussed.
作者：
CROUCH, MAAssistant Professor
Department of Family Medicine and Comprehensive Care； Associate Director Family Practice Residency Program； and Medical Director Family Practice Center Louisiana State University School of Medicine in Shreveport Shreveport Louisiana
The symptoms of irritable bowel syndrome (IBS) are usually a subset of a broader problem that meets DSM-III criteria for depression, anxiety disorder, somatization disorder, or adjustment disorder. A biopsychosocial p...
The symptoms of irritable bowel syndrome (IBS) are usually a subset of a broader problem that meets DSM-III criteria for depression, anxiety disorder, somatization disorder, or adjustment disorder. A biopsychosocial perspective that addresses multigenerational family patterns of anxiety, depression, and somatization of stress suggests guidelines for understanding and treating patients with IBS symptoms. Effective treatment focuses primarily on helping patients cope with emotional disorders and psychosocial stressors, and secondarily on direct symptom relief. Psychotherapy is a valuable adjunct to medical treatment. The medications most likely to yield lasting benefits are the antidepressants.
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