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Am Fam Physician. 1999;59(4):969-970

Shared Obstetric Call Groups Can Offer High Levels of Satisfaction

(26th Annual Meeting of the North American Primary Care Research Group) Results of a survey showed that the use of shared obstetric call groups in family practices allows for a high level of patient satisfaction while offering a viable alternative to physicians who would otherwise not practice obstetrics because of interference with lifestyle and office practice. The survey was administered to patients of a family practice group in which eight physicians shared obstetric calls with 15 other physicians; each physician in the call group was on obstetric call only one out of every 23 days. A total of 67 women who had delivered in the previous eight months were surveyed. Of the 47 women who completed the survey, 96 percent were assisted at delivery by a physician other than their own. Eighty-eight percent of these women were satisfied with their medical care at delivery, and 96 percent were satisfied with their prenatal care. Nearly 79 percent said that they would choose this group of physicians for obstetric care again. The investigator believes that further studies on this subject are warranted.—joanna shapiro, University of Toronto, Canada.

Family Risk Factors Identified for Fatal Child Mistreatment

(North American Primary Care Research Group) Results of a population-based case control study indicate that the presence of a biologically unrelated adult in the home or the presence of an adult not filling the role of parent in the home increases the risk of death from mistreatment of children living in these homes. The study compared the histories of children who had died of mistreatment with those of children who died of natural causes or sudden infant death syndrome. The study included children younger than five years who died during the three-year study period. After controlling for confounding factors, the presence of a biologically unrelated adult in the household was found to increase the risk of death from mistreatment more than sixfold. No increased risk was associated with the presence of related adults in the household. The investigators hope that this information will help in the prevention of fatal mistreatment of children.—michael stiffman, m.d., et al., St. Paul Ramsey Medical Center, St. Paul Minn.

Patients Want Their Physicians to Ask About Family Conflict

(North American Primary Care Research Group) Most patients believe it is appropriate for family physicians to ask about family conflict and partner violence. This is the conclusion of a study conducted in six family practices in the South Texas Ambulatory Research Network. The 220 patients in the study completed self-administered surveys about partner violence and physician intervention with family conflict and stress. Sixty-four percent of the study participants were female. Among 120 men and 73 women who indicated that they were currently in relationships, 9 percent of the women reported that they had been hit or hurt by their partners within the past year and 32 percent said that they had been hit or hurt in their lifetimes. Eight percent of the men had hit or hurt their partners within the past year, and 15 percent had done so in their lifetimes. Only 3 percent of all the patients surveyed believed that physicians should never ask about family conflict. Thirty percent of the patients reported that they had been asked about family conflict by their physician, and two-thirds of these believed the advice they received from their physician was helpful. All of the women who were ever victims and all of the men who were ever perpetrators of partner violence believed that physicians should ask about family conflict.—sandra k. burge, ph.d., et al., University of Texas Health Science Center, San Antonio.

Eye Patches Do Not Benefit Treatment of Traumatic Corneal Abrasions

(North American Primary Care Research Group) Eye patching in combination with topical antibiotic treatment does not seem to provide any benefit in the treatment of traumatic corneal abrasions when compared with the use of topical antibiotic treatment alone, according to results of a randomized clinical trial. The study included 163 patients with traumatic corneal abrasions presenting to an emergency department who were randomized to receive either topical antibiotic ointment and an eye patch (82 patients) or topical antibiotic ointment four times a day with no eye patch. The two treatment groups were very similar regarding size of the lesion, presence of foreign bodies or siderosis, initial degree of discomfort and presence of irritation, foreign body sensation, photophobia, redness and pain. The patients were evaluated in terms of healing and improvement in pain and discomfort. The percentage of abrasions that healed after 24 hours was similar in the two treatment groups (58 percent in the group that received the patch and 65 percent in the group without patches). After 48 hours, these percentages were 83 percent and 86 percent, respectively. Initial discomfort was improved by 66 percent after 24 hours in the group with patches and by 60 percent in the group without patches. After 48 hours, discomfort improvement rates were 75 percent and 81 percent, respectively.—natalie lesage, m.d.,, and rené ver-rault, m.d., ph.d., Laval University, Quebec City, Canada.

Study Examines the Prevalence of Agitation in Patients in Long-Term Care

(North American Primary Care Research Group) Agitation is a highly prevalent phenomenon among institutionalized elderly patients, according to results of a study evaluating the prevalence and risk factors for agitated behaviors in a group of 2,913 nursing home residents in Quebec City. Agitation was assessed by an adaptation of the Cohen-Mansfield agitation inventory. The occurrences of 35 different types of behavior were obtained from interviews conducted with two nurses who knew the subjects. Types of behavior were grouped into four categories: physical aggressive, physical nonaggressive, verbal aggressive and verbal nonaggressive. Data on age, sex, occurrence of falls and dementia were obtained from the medical records. Nearly 71 percent of the subjects demonstrated at least one agitated behavior during the two-week study period. The risk of agitated behaviors was increased in men, and increased risk was also associated with the presence of dementia, use of restraints, disorientation and depression. Depressed or anxious mood was strongly associated with verbal nonaggressive agitation. The investigators hope this information will contribute to better management of agitation in patients in long-term care.—rené verreault, m.d., ph.d., et al., Laval University, Quebec City, Canada.

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