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Am Fam Physician. 2000;62(5):941-942

Imagine this dilemma: you're amputating the leg of an elderly patient and discover that a rod previously implanted in the leg is made of titanium. This means the rod is impervious to any of the cutting instruments available to you in the O.R. What do you do? If you're operating at Montgomery General Hospital in Olney, Md., the answer is simple: call the local Wheaton Rescue Squad firefighters. They've been through this before. According to a recent article in the Olney Gazette, when a pneumatic hacksaw didn't work, the squad realized this was a job for the Wizzer, an air-powered rotary saw. They raced out to pick up a Wizzer and some new blades, then returned to the hospital where the blades were sterilized and placed in the Wizzer. The saw made quick work of cutting through the titanium rod, and the surgery continued.

From the “Dragging Information Out of Them” file: according to an article published in the American Journal of Hypertension, premenopausal women with hypertension who are otherwise healthy are likely to suffer from sexual side-effects of high blood pressure and its treatment. Because many women are reluctant to mention symptoms of sexual dysfunction to their doctors, it is important for physicians to sensitively approach the subject of sexual dysfunction with their female patients.

Too much of a good thing? It's frustrating when patients swear they are eating only low-fat, low-calorie and/or low-carbohydrate foods, and yet don't lose weight. According to an article published recently in Psychology Today, ignorance of proper portion size seems to be the biggest downfall in weight-loss efforts. In a study conducted by the American Institute for Cancer Research (AICR), out of a random group of 1,003 Americans 18 years and older, nearly 78 percent said they felt it was more important to limit or eliminate certain foods from their diet than to cut back on the quantity of their food. In addition, they said that the amount of food they consume is dictated by the amount they are served.

Anyone looking for a pediatric resident? Try Toys R Us. A study published in the Journal of the Ambulatory Pediatric Association describes a training program that involves sending pediatric residents out shopping for items such as infant formula, disposable diapers and car seats. The goal is to provide them with insight and first-hand knowledge about the cost, accessibility, effectiveness and features of products that are typically recommended to new parents. No mention was made of how many residents were observed playing with remote-control cars and basketballs in the store.

A little self-esteem can go a long way. A recent study has found that fathers with high levels of self-esteem are more involved in their children's child care than are fathers with lower self-esteem. The study, reported in a recent issue of the Journal of Family Psychology, indicates that fathers with high self-esteem not only have lower levels of depression and hostility, and better psychological adjustment, but can be expected to increase the amount of time they spend with their offspring in caregiving activities once the children are between six and 15 months of age.

Here's another reason to lower blood pressure. According to the American Journal of Hypertension, the stiffness in arteries caused by high blood pressure may be reversible. In a recent study of more than 10,000 men and women, it was found that treating hypertension and maintaining it within a normal range can reduce stiffening of vital arteries such as the carotids.

Depressed patients look to primary care physicians for help. The National Mental Health Association recently sponsored a national survey confirming that, while primary care physicians are at the frontline of diagnosing and treating mental illness, only about one half of the patients diagnosed with clinical depression and/or generalized anxiety disorder were first diagnosed by a primary care physician. The survey indicated that patients want their primary care physicians to play a larger role in their mental health care.

“A bouquet of flowers, two shirts and some penicillin, please.” Today, physicians are able to shop on the Internet for medical supplies and are saving money and valuable time in the process. According to an article published recently in Physicians Financial News, ordering supplies online can save a medical practice 10 to 50 percent. Some Web sites access several medical supply companies with inventories of nearly 400,000 products, allowing physicians to order everything in one place and expect delivery in a few days. While some companies require a credit card number (making it inconvenient at times to order large quantities, such as flu vaccine), some companies do direct billing. Currently, more than 50 “” medical supply companies are available on the Internet.

Patients snoozing in your reception area? Maybe it isn't because of the outdated magazines. American Demographics reports that more Americans than ever are getting too little sleep. According to a recent study conducted by the National Sleep Foundation, American adults get an average of one hour less sleep per night than the recommended eight hours, and then try to make up for the sleep deficit on the weekend. Unfortunately, that ploy doesn't work. About 40 percent of adults are so sleep deprived during the work day that it interferes with their daily activities. The Bureau of Labor Statistics indicates that 17.1 percent of 1997's full-time wage and salary workers worked irregular schedules, night hours, or rotating shifts—and that number is believed to be increasing.

Peer pressure may get kids started smoking, but could genetics keep them hooked? Research has shown that peer pressure and other environmental influences play a major role in a young person's decision to smoke cigarettes. According to a Washington University (St. Louis) School of Medicine newsletter, new evidence indicates that genetic factors may be significant in keeping young people smoking. In a recent study conducted by the university, positive environmental influences shared by family members were shown to have less of an effect once a young person becomes a regular smoker. At that point, genetic factors and life events have a greater effect on making it difficult for those smokers to quit.

Having trouble staying awake at the symphony? You're in good company, historically speaking. Mounting evidence indicates that composer Johannes Brahms probably had obstructive sleep apnea (OSA), according to a recent report cited in Chest, the journal of the American College of Chest Physicians. The composer reportedly suffered from loud snoring, excessive daytime drowsiness, alcoholism and obesity, and was notorious for falling asleep in public places. While the symptoms seem to point to OSA, perhaps there's a simpler explanation—maybe he just kept dozing off while mentally composing Brahms' Lullaby.

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