The Journal of family practice
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Every primary care physician should be familiar with three methods of draining fluid or air from the pleural cavity. These methods are: (1) the insertion of a needle or Intracath catheter into the pleural space; (2) a tube thoracostomy using a Trocar catheter; and (3) a tube thoracostomy using a large intercostal tube. Complete anesthesia can be obtained with lidocaine, remembering that the intercostal nerve runs on the undersurface of the rib above. ⋯ The tube thoracostomy, using the Trocar catheter, is best done through the fourth interspace in the anterior axillary line but can be done wherever the exploratory needle shows the major fluid and air collection to be. The tube thoracostomy, using a large intercostal tube, is best done through the fourth intercostal space at the anterior axillary line. The intercostal catheter or tube should be fixed to the chest wall with sutures and then led to an underwater seal for collection of the contents of the pleural cavity.
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Do physician's assistants (PAs) and their physician employers disagree about levels of supervision and autonomy, and does level of physician's assistant autonomy relate in any way to other aspects of practice satisfaction? An indepth study of MD-PA teams in practice reveals that there is greater consensus than conflict concerning the autonomy of the physician's assistant; that the level of physician's assistant autonomy is not related to salary or to physician's assistant employment satisfaction; and that physician-employers who consider their physician's assistants to be more autonomous also tend to feel that the quality of their lives has improved as a result of hiring an assistant.
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Little research has been done on family practice residents and their sexual counseling attitudes, knowledge, and abilities. This study sought answers to five broad questions about family practice residents' perceptions of sexual counseling. Subjects were 132 residents and 21 faculty members from eight family practice training units in Minnesota, which were affiliated with the University of Minnesota. ⋯ Respondents indicate a lack of ability as well as discomfort with several areas of sexuality, notably frigidity and homosexuality. Family practice residents need to develop their skills in specific areas of sexual counseling. While these findings are most applicable to the eight units involved, the diversity in respondents' backgrounds and differences between units suggest that the results may be relevant to other residency programs.
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The purpose of this paper is to bring into sharp focus the intricate and vital linkages among the active participants in the consultation process (Figure 1). For too long the profession has been locked into a ritualistic, buck-passing processing frequently resulting in unorganized efforts on behalf of objects rather than subjects. The essential overriding concern then could well be represented by the center diagram (the patient and his family) and the supporting persons - communicating before, during, and after the consultation - completing a process which could bring about improvement in the quality of life for the patient, the referring physician, and the family. Through the added efforts to give feedback to the specialist we could conceivably improve the consultant's quality of life too.
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Three of the most widely used concepts in education, objectives, curriculum, and evaluation, have direct parallels in primary care. This parallelism suggests an approach which may help family physicians both in understanding these educational concepts and in applying them with judgment. By drawing specific attention to the parallels and by the use of examples drawn both from clinical practice and from teaching, the author hopes to encourage physicians to view their teaching as an analog of clinical skills that are already familiar to them. This approach is applied to the problem of accommodating to individual differences in students, the most difficult obstacle to the proper application of educational concepts.