The Journal of family practice
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Comparative Study
A comparison of labor and delivery management between nurse midwives and family physicians.
Practice associations between family physicians and nurse midwives have been suggested as a means to increase the availability of obstetric care in rural areas. No evidence exists, however, that family physicians and midwives have comparable practice styles or achieve similar outcomes in obstetric patients. ⋯ Family physicians and nurse midwives managed patients in labor similarly, but nurse midwives were more likely to achieve a vaginal delivery in primiparous women and do so without an episiotomy. Although the differences found would not interfere with a collaborative practice, subtle differences in patient management do exist. Further exploration of these differences may be helpful in understanding the impact of these differences on mixed-specialty practices.
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The use of radiography in evaluating inversion ankle injuries remains high despite several studies suggesting that x-ray examination should be limited to patients meeting certain clinical criteria. These studies were all done in emergency departments. The present study examined detection of ankle fractures by clinical evaluation alone in private family practice offices. ⋯ The fracture rate in these family practice offices is lower than that reported in most emergency department studies. It is important that family physicians order radiographs judiciously rather than routinely for patients with inversion ankle injuries. The clinical criteria reported here are likely to reduce unnecessary ordering of radiographs and are compatible with recently published, prospectively validated rules for acute ankle injury in an emergency department setting.
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Proteinuria is an early indication of renal disease. This study was conducted to evaluate the usefulness of dipstick urinalysis in patients with chronic diseases including hypertension and diabetes mellitus. ⋯ Regular dipstick evaluation for proteinuria may be indicated in patients with hypertension or diabetes mellitus or both, particularly African American patients with these disorders.
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Surveys show that most Americans favor the decriminalization of physician-assisted suicide in certain circumstances. Several states are now considering legislation to bring this about and make the United States the first place in the civilized world where physician aid in dying is sanctioned. In the Netherlands, where physician-assisted suicide is practiced but officially remains illegal, 85% of assisted suicides occur in the elderly, and most involve the help of general practitioners. ⋯ The problem of suffering in persons with chronic and terminal illness cannot be ignored. Compassionate, effective, and ethical solutions must be found. As a former family physician and now geriatric psychiatrist, I review the pros and cons of physician-assisted suicide (emphasizing arguments against legalization) and encourage family physicians to debate this matter.