The Journal of family practice
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Comparative Study
Graded exercise stress test training in family practice and internal medicine residencies.
A mail survey of upper Midwest family practice and internal medicine residency program directors was performed to determine the prevalence and characteristics of exercise stress test training. Two mailings provided a 68% response rate for the 184 programs surveyed. Internal medicine programs were significantly more likely to offer exercise stress test training than family practice programs (57% vs 34%). ⋯ Otherwise there were few differences between family practice and internal medicine program instruction in exercise stress test training. Family practice program directors were more likely to believe that their residents should be taught this procedure and to include family physicians in their panel of instructors. Specific guidelines should be created to assure adequate stress test training for interested residents.
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The process of grieving for the death of a neonate is different from other grief processes. The family physician is in the unique position of playing a significant role in assisting families who are living through this tragedy. Even if the family physician has not been part of the prenatal care and delivery, he or she will continue to see the parents for weeks, months, and even years, long after most other support is gone. This paper outlines seven possible specified times when a family physician can intervene in aiding the couple through the evolving grief process.
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The prevalence of symptoms in thyrotoxicosis at the time of diagnosis has received little attention in studies of this condition. Vomiting, nausea, and abdominal pain have not been included as common presenting symptoms for thyrotoxicosis in standard textbooks of medicine and endocrinology. Some reports in the medical literature, however, indicate that these abdominal symptoms may be important manifestations of this condition. ⋯ Of 25 thyrotoxic patients who had thyrotoxicosis diagnosed during or immediately prior to admission, 44% reported vomiting, 28% reported nausea, and 20% complained of abdominal pain. One or more of these abdominal symptoms were included as a chief complaint in 36% of cases reviewed. Further study of the clinical presentation of thyrotoxicosis in the outpatient setting is needed to improve the timeliness and cost effectiveness of the clinical diagnosis of this condition.
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Currently, attempts are being made to integrate family systems theory and technique into the practice of family physicians. Although the importance of the family has been demonstrated in a number of medical situations and although several authors have indicated situations in which it is useful for the physician to convene the family, to date no explicit guidelines have been developed for conducting a single-session family interview. ⋯ The single-session family interview provides the family physician with realistic guidelines for helping families who face medical dilemmas and for improving the physician's practice. The guidelines have proven useful in teaching residents the skills involved in understanding family dynamics and conducting productive family meetings.