The Journal of family practice
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Some patient encounters may produce a variety of unpleasant reactions such as guilt, anger, frustration, or dissatisfaction in the physician. These troubling feelings may arise from various sources and can affect the outcome of medical care. ⋯ Just under 30 percent of these encounters were troubling to the physician, but psychosocial problems and lower social class patients produced a significantly greater frequency of troubling. More experienced physicians had significantly fewer troubling encounters.
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Comparative Study
Measuring continuity of care in a family practice residency program.
While the significance of continuity of care in medical practice has not yet been completely assessed, this concept has been espoused by the new specialty of family practice along with some other specialties. It is an integral component in family practice residency programs. The purpose of this paper is to identify several methods of measuring continuity of care in a residency setting and to demonstrate their application. Measurements called COC (Continuity of Care) and UPC (Usual Provider Continuity) will be described as they apply to overall patient visits, visits for chronic conditions, and visits by family members.
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A total of 9,955 isolates of Staphylococcus aureus (SA) from an urban hospital and clinic and from rural office settings obtained during 1971 through 1978 were compared for susceptibility to penicillin G. Clear downward trends in susceptibility of SA were noted for all urban settings during the 1970s. ⋯ Penicillin G susceptibility of SA from two rural sources was likewise very low (20.9 percent and 28.7 percent). Therefore, Staphylococcus aureus must be considered resistant to penicillin G until proven otherwise, irrespective of the source of the isolate.
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Shock is a descriptive term indicating generalized inadequancy of organ perfusion. In the critically ill patient, the common denominator is insufficient microcirculatory flow. All patients have excessive sympathetic tone with arteriolar and venular vasoconstriction. ⋯ Although the presentation of shock may vary with age, one usually detects evidence of inadequate tissue perfusion, hypotension, and poor urine output. Treatment consists of early recognition, establishment and maintenance of intravascular volume, and cardiorespiratory assistance with mechanical ventilation and various inotropic and vasoactive drugs. Pediatric mortality remains high despite new and sophisticated treatment methods.
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The emergency management of the agitated patient is a common medical problem. Agitated behavior is not a diagnosis but a descriptive term; the initial task of the physician involves determining the etiology of the behavioral disturbance and evaluating the possible contribution of organic factors. ⋯ Agitated patients will generally fall into one of four diagnostic categories: agitation precipitated by drug intoxication, agitation precipitated by drug withdrawal, agitation precipitated by an organic brain syndrome, or agitation precipitated by a functional disorder. Appropriate pharmacological and psychological management techniques for these situations are discussed.