The Journal of family practice
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Family physicians must make complex decisions regarding which procedures to learn in training and which to perform in practice. Factors that influence these decisions include community needs, the potential profitability of a procedure, and the desires and skills of the individual physician. ⋯ Family physicians in Wisconsin vary greatly in the number and types of procedures performed. Community size, sex, and age are important variables associated with the number and type of procedures performed. The performance of procedures is dynamic: physicians both discontinue learned procedures and learn new procedures. The profitability of the procedure influences the learning and discontinuation of procedures.
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Comparative Study
The quality of clinical trials published in The Journal of Family Practice, 1974-1991.
Previous analyses of published clinical trials have identified major deficiencies in reporting, design, analysis, and overall quality. The purpose of this study was to determine the strengths and weaknesses of published clinical trials in family practice, and to identify predictors of quality in these trials. ⋯ The overall quality of these clinical trials was less than optimal but comparable to previously analyzed groups of trials. The improvement in quality over time may be related to improvement in the quality of the trials themselves, or more exacting editorial standards, or a combination of the two.
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Comparative Study
An analysis of randomized controlled trials published in the US family medicine literature, 1987-1991.
Randomized controlled trials (RCTs) are frequently used to evaluate the effectiveness of health care interventions in family medicine. The value of the information obtained from RCTs depends largely on the quality of design and the way in which they are conducted and reported. Despite the increasing number of RCTs being conducted in family medicine, there is a scarcity of descriptive data on the methodological characteristics, including design features and quality of RCTs in this setting. ⋯ The RCTs analyzed offered some imaginative solutions to the logistic difficulties of conducting RCTs in general practice. Nevertheless, the methodology and reporting of RCTs in the future should be improved.
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Comparative Study
The safety of dorsal penile nerve block for neonatal circumcision.
Dorsal penile nerve block (DPNB) was first described for use in neonatal circumcision in 1978. Since then, many studies have documented its effectiveness in alleviating pain in newborns undergoing circumcision. In 1989, the American Academy of Pediatrics acknowledged that DPNB may relieve the pain and stress of circumcision but stopped short of endorsing its routine use in this procedure, citing lack of data on its safety. ⋯ This study corroborates findings of smaller case studies, indicating that DPNB is associated with a low rate of minor complications.
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Review Case Reports
Pneumomediastinum and subcutaneous emphysema following vaginal delivery. Case report and review of the literature.
A 23-year-old woman, gravida 1, para 0, at 42 weeks of pregnancy gave birth to a healthy female infant without complications except for a 4th-degree tear. Three hours after delivery, her voice was noted to have an unusual nasal quality, she complained of chest pain, and she developed extensive swelling of the neck and upper throat.