Study Evaluates Cesarean Sections Performed by Family Physicians

(25th Annual Meeting of the North American Primary Care Research Group) For cesarean sections performed by family physicians, the clinical outcomes in both women and their infants are excellent compared with standard measures of surgical care, according to results of an evaluation of 1,175 consecutive cesarean sections performed by 60 family physicians in 21 states. Demographic, surgical and outcome measures were analyzed and reported for all of the patients in the study. Apgar scores were 7 or more at 1 and 5 minutes in 93 percent of the infants. No surgical complications occurred in 99 percent of the cases; four bladder injuries occurred in the series. Blood transfusions were used in 3 percent of the cases. The mean length of hospital stay was three days. According to the investigators, outcome measurements met or exceeded standards obtained from the medical literature.—mark e. deutchman, m.d., et al., A.F. Williams Family Medical Center, Denver.

Women Want Informed Choice About Prenatal Genetic Screening

(North American Primary Care Research Group) Results of a study designed to explore the feelings and experiences of women regarding prenatal genetic screening indicate that women want their physicians to personally give them unbiased, accurate genetic screening information as early as possible in prenatal care to allow time for reflection and time to make an informed decision based on their personal values and beliefs. The investigators focused on maternal serum screening in particular. Sixty women who had given birth since January 1994 were questioned. The study found that three factors influenced the women's decision to consent or decline prenatal genetic screening. The factors were (1) their personal values including their philosophy of life, moral and religious values, and attitudes regarding Down syndrome and disability, (2) their social support, and (3) the information they receive from their health care professionals. The investigators believe that knowing women's feelings on and experiences with this subject will help physicians facilitate informed decision-making in prenatal screening.—june c. carroll, m.d., et al., University of Toronto, Ontario, Canada.

Home Remedy May Help Prevent Surgery in Some Patients with Gallstones

(North American Primary Care Research Group) Results of a study examining the efficacy of a traditional home remedy for inducing gallstone expulsion using lemon juice, olive oil, cascara sagrada and garlic/castile enemas suggested that this protocol has the potential to safely eliminate the need for gallstone surgery in a substantial percentage of patients. Six patients with symptomatic cholelithiasis proven by ultrasound were included in the study. The subjects completed a three-day treatment protocol and collected gallstones recovered from the enema. All of the patients passed stones. No side effects were observed, except for mild nausea in one patient. Intermittent ultrasound monitoring was performed for three hours per day each day of the protocol. A final ultrasound assessed the degree of clearing of cholelithiasis. Five of the patients were asymptomatic for follow-up periods ranging from two to 27 months; mild symptoms returned in one of these patients after three months. The patient who remained symptomatic underwent cholecystectomy about one month after the home-remedy protocol. One of the asymptomatic patients who passed all of her stones underwent cholecystectomy anyway under the advice of her surgeon. The investigators believe that, with modifications, this protocol could safely eliminate the need for surgery in many patients with cholelithiasis.—richard l. garrison, m.d., University of Texas Medical School, Houston.

Circumstances Regarding Death of Patients in Primary Care Are Described

(North American Primary Care Research Group) Two hundred twenty-nine primary care clinicians throughout the United States and Canada collected information on patient deaths for one year to describe the circumstances of deaths that occur in primary care. The data included how accurately the patient's death was anticipated, location of the patient's death, who the patient's final care decision makers were, whether advance care directives were in place, whether final care was affected by advance directives, whether the patient donated organs and whether the clinician believed the patient's care was negatively influenced by medical intervention. In 37.9 percent of the cases, the patient's death was anticipated and prolonged; in 37.4 percent of cases, the death was anticipated but sudden; and in 24.6 percent of the cases, the death was sudden and unexpected. At the time of death, 57.0 percent of patients had an advance directive in place. Seventy-eight percent of the clinicians believed that advance directives had a positive effect on the situation. The investigators believe that the data indicate advance directives are empowering to patients in their final days and may lead to a more favorable experience.—byron g. burton, m.s., et al., Ambulatory Sentinel Practice Network.

Antibiotics May Be Beneficial in the Treatment of Acute Bronchitis

(North American Primary Care Research Group) The use of antibiotics appears to have a modest beneficial effect in the treatment of acute bronchitis, with only a small risk of adverse effects, according to an evaluation of eight studies with a total of 750 patients. The antibiotics used in the various studies included doxycycline, erythromycin and trimethoprim-sulfamethoxazole. Patients receiving antibiotics were less likely to feel unwell at a follow-up visit, to show no improvement on physician assessment or to have abnormal lung findings. They also returned to work or their usual activities sooner than the patients who did not receive antibiotics. The patients treated with antibiotics did have more adverse effects. The investigators note that the benefits of antibiotics in this study may be overestimated, because of the tendency to report only the outcomes found to be statistically significant.—lorne a. becker, m.d., et al.