American family physician
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Dystocia is common in nulliparous women and is responsible for more than 50 percent of primary cesarean deliveries. Because cesarean delivery rates continue to rise, physicians providing maternity care should be skilled in the diagnosis, management, and prevention of dystocia. If labor is not progressing, inadequate uterine contractions, fetal malposition, or cephalopelvic disproportion may be the cause. ⋯ For nulliparous women, high-dose oxytocin-infusion protocols for labor augmentation decrease the time to delivery compared with low-dose protocols without causing adverse outcomes. The second stage of labor can be permitted to continue for longer than traditional time limits if fetal monitoring is reassuring and there is progress in descent. Prevention of dystocia includes encouraging the use of trained labor support companions, deferring hospital admission until the active phase of labor when possible, avoiding elective labor induction before 41 weeks' gestation, and using epidural analgesia judiciously.
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Most primary care physicians report at least one emergency presenting to their office per year. Asthma, anaphylaxis, shock, seizures, and cardiac arrest are among the most common adult and childhood emergencies in the office setting. Most offices are not fully prepared for these medical emergencies. ⋯ Physicians and staff should make every effort to maintain current certification in basic or advanced lifesaving courses. Offices may also wish to create a written emergency protocol that outlines the steps to be followed in the event of a medical office emergency. By preparing for medical emergencies with the correct equipment, education, and protocols, offices can greatly decrease the risk of an unfavorable outcome.
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Ginger (Zingiber officinale) is one of the more commonly used herbal supplements. Although often consumed for culinary purposes, it is taken by many patients to treat a variety of conditions. ⋯ There is less evidence to support its use for motion sickness or other types of nausea and vomiting. Mixed results have been found in limited studies of ginger for the treatment of arthritis symptoms.
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American family physician · May 2007
ReviewDrug dosing adjustments in patients with chronic kidney disease.
Chronic kidney disease affects renal drug elimination and other pharmacokinetic processes involved in drug disposition (e.g., absorption, drug distribution, nonrenal clearance [metabolism]). Drug dosing errors are common in patients with renal impairment and can cause adverse effects and poor outcomes. ⋯ Physicians should be familiar with commonly used medications that require dosage adjustments. Resources are available to assist in dosing decisions for patients with chronic kidney disease.