The Journal of family practice
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Excision is the most effective treatment for thrombosed external hemorrhoids. For prolapsed internal hemorrhoids, the best definitive treatment is traditional hemorrhoidectomy. Of nonoperative techniques, rubber band ligation produces the lowest rate of recurrence.
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Consider any alteration of mental status that follows a trauma to be a concussion, whether or not there is also a loss of consciousness. Don't order neuroimaging routinely; it is not necessary for diagnosing concussion. Neuroimaging is important, however, for patients who exhibit prolonged unconsciousness, focal neurologic deficits, or worsening symptoms. Treat post-concussive headache, a common complaint, with acetaminophen or ibuprofen.
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Randomized Controlled Trial Multicenter Study
What's growing on your stethoscope? (And what you can do about it).
Studies have shown that rubbing alcohol pads on stethoscope diaphragms can reduce bacterial colonization, but alcohol pads are used infrequently used and not always available. ⋯ Simultaneously using hand foam to clean hands and stethoscope heads reduces bacterial counts on stethoscopes. Further research is needed to determine whether this intervention can reduce morbidity and mortality associated with bacterial infection.
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Building strong relationships among physicians and staff improves the practice's ability to deal with the uncertainties of a rapidly changing environment. Interacting proactively with the economic, social, political, and cultural environment-the practice landscape-provides opportunities for adaptation and ongoing learning.