Items in AFP with MESH term: Physicians, Family
What's in a Name? - Editorial
How to Recruit New Residency Graduates - Feature
It's Not Too Early to Prepare for Semi-Retirement - Salaried FP
Going Solo: Making the Leap - Feature
ABSTRACT: Frustrated by current practice and convinced of a better way, the author left his salaried position and opened a solo practice with no staff. Because his overhead costs are extremely low, the author is able to see fewer patients per day and create more meaningful interactions. By offering unfettered access, the author finds that his patients trust him more and actually call him less.
ABSTRACT: The incidence of hip fracture is expected to increase as the population ages. One in five persons dies in the first year after sustaining a hip fracture, and those who survive past one year may have significant functional limitation. Although surgery is the main treatment for hip fracture, family physicians play a key role as patients' medical consultants. Surgical repair is recommended for stable patients within 24 to 48 hours of hospitalization. Antibiotic prophylaxis is indicated to prevent infection after surgery. Thromboprophylaxis has become the standard of care for management of hip fracture. Effective agents include unfractionated heparin, low-molecular-weight heparin, fondaparinux, and warfarin. Optimal pain control, usually with narcotic analgesics, is essential to ensure patient comfort and to facilitate rehabilitation. Rehabilitation after hip fracture surgery ideally should start on the first postoperative day with progression to ambulation as tolerated. Indwelling urinary catheters should be removed within 24 hours of surgery. Prevention, early recognition, and treatment of contributing factors for delirium also are crucial. Interventions to help prevent future falls, exercise and balance training in ambulatory patients, and the treatment of osteoporosis are important strategies for the secondary prevention of hip fracture.
ABSTRACT: The development of topical anesthetics has provided the family physician with multiple options in anesthetizing open and intact skin. The combination of tetracaine, adrenaline (epinephrine), and cocaine, better known as TAC, was the first topical agent available for analgesia of lacerations to the face and scalp. Cocaine has been replaced with lidocaine in a newer formulation called LET (lidocaine, epinephrine, and tetracaine). For analgesia to nonintact skin, LET gel is generally preferred over TAC because of its superior safety record and cost-effectiveness. EMLA (eutectic mixture of local anesthetics) is perhaps the most well-known topical anesthetic for use on intact skin. EMLA can be used to anesthetize the skin before intramuscular injections, venipuncture, and simple skin procedures such as curettage or biopsy. To be fully effective, EMLA should be applied at least 90 minutes before the procedure. ELA-Max is a new, rapidly acting topical agent for intact skin that works by way of a liposomal delivery system and is available over the counter. Other delivery vehicles for topical anesthesia currently in development, including iontophoresis and anesthetic patches, may one day give patients and physicians even more flexibility.
Influenza Vaccine: Got It, Give It! - Editorials
What You Need to Know About HIPAA Now - Feature