March 1, 2000

A systematic approach can improve overall accuracy in diagnosing heart failure. Keys to the diagnosis include a history of coronary artery disease and the presence of dyspnea, tachycardia and an S3 gallop.

Chronic pain is associated with disabling physical and emotional symptoms. The treatment of chronic pain should address the physical pathology that initiated the chronic pain and the social and psychologic sequelae of chronic symptoms.

The vaso-occlusive crisis is a common painful complication of sickle cell disease in adolescents and adults. It is important to recognize a pain crisis early, correct the inciting causes, control pain, maintain euvolemia and, when necessary, administer adequate hemoglobin to…

Although cervical cancer is preventable, 12,800 women were diagnosed with this disease in 1998, and 4,800 women died as a result of it.

The tissue adhesive Dermabond offers certain advantages in the repair of superficial wounds.

Hormone replacement therapy may benefit patients with many of the immediate long-term consequences of menopause, but scientific studies are incomplete and often disagree. Current treatment options allow individualization of a plan.

All family physicians should understand how to recognize the stages of change behavior in patients and be able to help them with this process.

The treatment of patients who somatize is based on a solid relationship with a single primary care physician. Brief but regular and frequent visits are the foundation of successful management.

Federal guidelines specifically limit the indications and dosing for antidepressant, anxiolytic, sedative-hypnotic and antipsychotic medications in residents of long-term care facilities.

This feature is part of a year-long series of excerpts and special commentaries celebrating AFP's 50thyear of publication. Excerpts from the two 1950 volumes of GP, AFP's predecessor, appear along with highlights of 50 years of family medicine.

January 2000 ushered in the AAFP's new Annual Clinical Focus (ACF), an educational initiative on mental health. This program, developed in cooperation with the National Institute of Mental Health, American Psychiatric Association, National Alliance for the Mentally Ill and…

Selected policy and health issues news briefs from AAFP News Now.

Alternative remedies are gaining ground with more than two-thirds of Canadians convinced that natural herbal supplements can be as effective as over-the-counter remedies or even prescription drugs. According to a survey released by Traditional Medicinals, more than 50 percent…

A two-part article on somatization, one part appearing in this issue of American Family Physician1 and the other appearing in the previous issue,2 examines diagnosis and treatment of this illness in primary care. Somatizing patients have symptoms caused by emotional distress…

With the advent of unprecedented numbers of women baby boomers now entering the perimenopausal and menopausal years, family physicians will increasingly be called on to discuss options and issues concerning menopause. Information that is widely available in the popular press…

During the cough and flu season, the treatment of URIs is our bread and butter. Although we see many cases each day, we try not to be lulled into a sense of complacency. Indeed, each patient seems to add a new wrinkle to an age-old problem. Today, a particularly familiar…

Photo Quiz presents readers with a clinical challenge based on a photograph or other image.

(Canada—Canadian Family Physician, November 1999, p. 2607.) Best's disease, or vitelliform macular degeneration, is an autosomal dominant disease of the macula. This disorder usually presents in childhood or adolescence as visual distortion or central loss of vision. The…

The American Pain Society (APS) has released a new guideline to aid physicians and other health care professionals in the management of patients with acute and chronic pain associated with sickle cell disease.

The American Thoracic Society (ATS) has updated its statement on pulmonary rehabilitation in patients with chronic respiratory impairment. The report outlines the scope of pulmonary rehabilitation and provides data on its benefits, patient assessment and the essential…

The Committee on Native American Children and the Committee on Injury and Poison Prevention of the American Academy of Pediatrics (AAP) completed a subject review of the prevention of unintentional injury among American Indian and Alaska Native children. The report appears in…

The scenario described above will become increasingly familiar to most practicing physicians over the next few years. Currently, we are witness to at least 40 million “medically indigent” patients without insurance and the number continues to increase.

Also Received

Pain is what you feel when you've been hurt or have a disease or illness. There are two types of pain: acute and chronic. Acute pain doesn't last long and usually goes away as your body heals. Chronic pain lasts a long time (at least 6 months) after your body has healed…

Sickle cell disease is a hereditary problem that causes a type of faulty hemoglobin in red blood cells. Hemoglobin carries oxygen in the blood.

People with chronic unexplained medical problems may have a condition that is called “somatization.” These people are usually more sensitive than the average person to changes in the way their body works. If you have this condition, you may have pain or other symptoms…

When doctors talk about depression, they usually mean major depression. Someone with major depression has symptoms like those listed below nearly every day, all day, for 2 weeks or longer. If you are depressed, you may also have headaches, other aches and pains, digestive…

Depression is a medical illness like diabetes or high blood pressure. People don't choose to be depressed. They aren't weak or “crazy.” Depression is an illness. It affects about 17 percent of people at some time in their lives. It's twice as common in women as in men.

Anxiety can be a normal “alarm system” alerting you to danger. Imagine coming home and finding a burglar in your home. Your heart beats fast. Your palms get sweaty. Your mind races. In this situation, anxiety can be helpful. It can add an extra spark to help you get out of…

Obsessive-compulsive disorder (OCD) is an illness that traps people in endless cycles of repetitive thoughts (obsessions) and behaviors (compulsions). Although we all have habits and routines that help us organize our daily lives, people with OCD develop patterns of behavior…

Seasonal affective disorder (also called SAD) is a kind of depression that follows the seasons. The most common type of SAD is called winter depression. It usually begins in late fall or early winter and goes away by summer.