The Journal of family practice
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Family physicians are often requested to provide preoperative evaluation of elderly patients. Age independently increases the risk of morbidity and mortality in the perioperative period. In addition, the altered physiology of the older patient, in combination with the increased number of disease processes, increases the potential for complications. ⋯ Evaluation includes a thorough history, physical examination, and laboratory testing. Special considerations in preoperative assessment of the elderly patient include the assessment of nutrition, functional capabilities, and evaluation of the cognitive and emotional status of the patient. Special concerns include prophylaxis for deep vein thrombosis and pulmonary embolus, and antibiotic prophylaxis for endocarditis and for patients with joint prostheses.
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Comparative Study
Attitudes of family medicine residents toward homosexuality.
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Concern that febrile infants younger than 3 months of age are at high risk of serious infection has prompted a management policy of routine hospitalization with antibiotic administration. Ten published studies of febrile infants younger than 3 months of age were reviewed, and data were statistically combined to develop estimates of the risk of bacteremia and serious infection. Factors that predicted increased risk were similarly evaluated. ⋯ Younger age, higher fever, and elevated white blood cell count were associated with increased risk of serious infection. Data from these studies do not support the belief that febrile infants younger than 3 months are uniformly at greater risk of serious infection than older infants. Judicious evaluation of younger infants could lead to more selective, cost-efficient management.
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A national mail survey was performed that examined reports of recent residency graduates about hospital privileges for family physicians, perceptions of residency program directors about the percentage of their graduates who obtain privileges, and plans of third-year residents for seeking privileges. Privileges in medicine, pediatrics, surgery, obstetrics, and coronary care/intensive care units (CCU/ICU) were examined. Questionnaires were mailed to a random sample of 308 residency graduates aged 30 to 35 years, all 383 family practice residency directors, and a random sample of 319 third-year residents. ⋯ Directors were accurate in their perceptions of privileges attained by graduates in medicine, pediatrics, and CCU/ICU, but underestimated the percentage who had privileges in surgery and overestimated the percentage who had privileges in obstetrics. Residents planned on seeking privileges in medicine, pediatrics, and obstetrics at a rate similar to recent graduates, with lower percentages planning on seeking them in surgery and CCU/ICU. Privileges in surgery and obstetrics were more prevalent in the Midwest and West.