The Journal of family practice
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An elderly woman taking 50 mg of nitrofurantoin daily for six months for suppression of recurrent urinary tract infections developed increasing dyspnea and bilateral pulmonary infiltrates. An open-lung biopsy confirmed diffuse interstitial fibrosis consistent with chronic nitrofurantoin pulmonary reaction. A chronic disabling respiratory illness persists in this person 10 months after discontinuing nitrofurantoin. ⋯ Physicians must maintain a high index of suspicion for adverse reaction to nitrofurantoin, particularly in the elderly in whom declining renal function may lead to inadvertent toxic accumulations. Use of alternative antimicrobial agents with higher benefit-to-risk ratios for treatment of urinary tract infections should be considered. Persons suffering serious adverse reactions to nitrofurantoin should carry written warnings about reexposure.
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The teaching of practical clinical skills to medical students and residents has been traditionally taught on an unstructured basis. This has led to situations in which physicians have been expected to perform manual procedures without adequate prior exposure or instruction. As a result of this perceived deficit in training, a curriculum has been designed to prepare new family medicine residents for some of the procedures they will be expected to perform in their first year of training. These procedures include airway management and endotracheal intubation, orthopedic casting, use of outlet forceps, suturing, and cardiopulmonary resuscitation.
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A family data base is defined along with the method for obtaining it. It can be used in its entirety to evaluate troubled families, or it can be abbreviated for intake and screening functions. ⋯ The primary focus of the data base is psychosocial, but other problems, such as inherited or infectious disease in the family, are also included. This method has been used to teach concepts of family oriented care and to facilitate health care delivery in a variety of settings.