The Journal of family practice
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Competence in the techniques of Advanced Cardiac Life Support is essential for physicians who are in frequent contact with patients at high risk for cardiac arrest. The methods utilized are complex and rapidly changing. ⋯ These can be characterized as (1) errors in the general management of patients, (2) erros in basic cardiopulmonary resuscitation (CPR) techniques, (3) mistakes in the use or omission of appropriate drugs, (4) errors in the associated necessary techniques which require some technical skills, and (5) errors in management of the patient subsequent to the cardiac arrest. Attention to these details may increase success in management of patients with cardiac arrest.
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A home based hospice was evaluated by means of questionnaires filled out by surviving relatives of patients who had participated in the hospice program prior to their deaths. Respondents reported that the hospice was helpful in reducing the prevalence of pain, physical disabilities, and anxiety to the dying patient. ⋯ Problems in the physician-patient relationship were identified. Although help with bereavement is generally regarded as an integral function of the hospice, respondents in this study reported that it was not an important area with which the hospice needed to concern itself.
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The family physician will rarely see patients with bone tumors; however, when bone tumors do arise, they can be devastating as they unfortunately occur in young patients and are among the most malignant of lesions. The diagnosis of a bone tumor should be suspected if there is deep aching pain, a mass, or a pathological fracture. ⋯ In general, benign tumors are treated with biopsy, local excision, or curettage with bone grafting. Malignant tumors require much more extensive surgery including wide radical excision (probably amputation), chemotherapy, and/or radiation therapy as indicated.
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Pulmonary function tests provide important clinical information in patients with pulmonary disease. Spirometry gives accurate, rapid information regarding the presence or absence of obstructive or restrictive lung disease and the response to bronchodilators. Particular attention to technique is necessary for valid results. Further information on pulmonary function is provided by the measurement of static lung volumes by dilution techniques or body plethysmography; in some instances lung compliance measurements are indicated.
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Informed consent, regardless of patient recall, is required in increasing detail. The family physician must obtain consent from every patient for every procedure except for a few clearly defined areas: "Emergency," "Waiver," "Therapeutic Privilege," "Immaterial Risks," and "Generally Known Risks." Because courts have adopted the "reasonable patient" standard of disclosure, suits can be won without expert testimony. The elements of informed consent require explaining the nature of the procedure, the consequences that will probably occur, the material risks that may occur, alternatives available, and problems in recuperation. Consent, like any contract, is a meeting of the minds and the physician has an obligation to himself to document that agreement.