Items in AFP with MESH term: Patient Care Team

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Sialorrhea--A Management Challenge - Article

ABSTRACT: Sialorrhea (drooling or excessive salivation) is a common problem in neurologically impaired children (i.e., those with mental retardation or cerebral palsy) and in adults who have Parkinson's disease or have had a stroke. It is most commonly caused by poor oral and facial muscle control. Contributing factors may include hypersecretion of saliva, dental malocclusion, postural problems, and an inability to recognize salivary spill. Sialorrhea causes a range of physical and psychosocial complications, including perioral chapping, dehydration, odor, and social stigmatization, that can be devastating for patients and their families. Treatment of sialorrhea is best managed by a clinical team that includes primary health care providers, speech pathologists, occupational therapists, dentists, orthodontists, neurologists, and otolaryngologists. Treatment options range from conservative (i.e., observation, postural changes, biofeedback) to more aggressive measures such as medication, radiation, and surgical therapy. Anticholinergic medications, such as glycopyrrolate and scopolamine, are effective in reducing drooling, but their use may be limited by side effects. The injection of botulinum toxin type A into the parotid and submandibular glands is safe and effective in controlling drooling, but the effects fade in several months, and repeat injections are necessary. Surgical intervention, including salivary gland excision, salivary duct ligation, and duct rerouting, provides the most effective and permanent treatment of significant sialorrhea and can greatly improve the quality of life of patients and their families or caregivers.


Diagnosis and Managment of Fragile X Syndrome - Article

ABSTRACT: To complement the 2005 Annual Clinical Focus on medical genomics, AFP will be publishing a series of short reviews on genetic syndromes. This series was designed to increase awareness of these diseases so that family physicians can recognize and diagnose children with these disorders and understand the kind of care they might require in the future. The first review in this series discusses fragile X syndrome.


School Problems and the Family Physician - Article

ABSTRACT: Children with school problems pose a challenge for the family physician. A multidisciplinary team of professionals can most appropriately assess and manage complex learning problems, which are often the cause of poor school performance. The family physician's primary role in this process is to identify or exclude medical causes of learning difficulties. An understanding of the complicated nature of school problems, the methods used to assess, diagnose and treat them, and the resources available to support the child and family are essential to successful management. Various references and resources are helpful for a more in-depth study of specific school problems.


A Team Approach to Quality Improvement - Feature


Finding Success in a Capitated Environment - Feature


Creating a High-Performing Clinical Team - Feature


A New Approach to Making Your Doctor-Nurse Team More Productive - Feature


Transforming Your Practice: What Matters Most - Feature


What the Military Taught Me About Practice Management - Feature


Closing the Physician-Staff Divide: A Step Toward Creating the Medical Home - Feature


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