The Journal of family practice
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There are many factors that have mitigated against optimal or even adequate medical care of the dying patient despite recent technological advances in medicine. Major changes are now taking place in terms of public expectations, medical practice, and legislation related to dying and death in this society. The dying patient has five basic requirements that must be met: independence, dignity, acceptance by others of an individual approach to dying, relief of symptoms, and physical care. ⋯ Regardless of setting, the family physician plays a central role in the care of the dying patient and his or her family during preterminal, terminal, and follow-up stages. This paper presents an approach to comprehensive care whereby the symptoms of incurable terminal illness can be effectively relieved on an individualized basis. Anticipatory guidance and care are important for the effects of terminal illness and death of a family member on the surviving family members, particularly with regard to recognition and treatment of depression.
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Examination of the larynx is neglected as a regular part of the physical examination by many physicians, largely because of difficulties inherent in the angled-mirror technique of visualizing this area. Simple, relatively inexpensive right-angle telescopes especially designed for laryngoscopy are now available to facilitate this examination. ⋯ This procedure has an important role as a screening procedure and as a diagnostic aid in the workup of patients with laryngeal symptoms. The technique can be readily learned and used in everyday medical practice.
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Comparative Study
A multi-institutional study of depression in family practice.
Depression among outpatients of three descriptively and geographically dissimilar family practice residency programs was studied. The Beck Depression Inventory, the Popoff Index of Depression, and the Multiscore Depression Inventory (MDI) were compared. Reliabilities of all three instruments were high, as were correlations among the instruments. ⋯ Regression analyses were then performed to compute equivalent scores on the Beck Depression Inventory short form from the MDI and Popoff instruments. This allowed approximate conversion of scores to the four levels of severity of depression described by Beck and Beck. This study provides the first extensive normative data for family practice on these measures, thus providing family physicians with a comparison group appropriate for a family practice rather than a psychiatric population.
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Acute epiglottitis, considered primarily a disease of infancy and early childhood, is seen rarely in adulthood but may be increasing in incidence. Although it may appear more slowly in adults, it is imperative to establish a rapid diagnosis and promptly assure care for this life-threatening disease. ⋯ The diagnosis should be considered if dysphagia and sore throat are not accompanied by hoarseness. Management of the airway is the first priority, but intravenous antibiotic use is justified.
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The changes in family practice residency selection from 1978 to 1981 were studied by means of a questionnaire, and selection of family practice residency was identified by region. The relationship between the administrative status of family practice (department, division, or no formal unit) and selection of family practice residency was studied, and the opinions of medical school faculty respondents were sought concerning why interest in family practice has increased (or decreased) at their institution. ⋯ Schools with stronger institutional commitment to family practice, as evidenced by departmental status, have a higher percentage of graduates entering family practice. Respondents felt that the presence or absence of student contact with family practice was the most important reason for changes seen in residency choice.