The Journal of family practice
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Insults from corneal foreigh bodies range from trivial windblown debris through destructive chemicals, penetrating wounds, and severe secondary infection. History and preliminary examination should begin concurrently, particularly in the case of chemically active compounds. Needed auxiliaries are topical anesthetics, oblique light, magnification, sterile sodium fluorescein for diagnostic staining of surface breaks, removal instruments, and topical antibiotics to reduce the potential of secondary infection. ⋯ Corneal thickness varies from slightly above 1 mm in the periphery to less than 0.5 mm centrally. Therefore, it is essential to have clear visualization of the foreign body in relation to corneal depth. Dislodgment into the anterior chamber or incidental perforation of the cornea generally require hospitalization, intensive antibiotics, and steroid therapy.
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Dental emergencies are common in everyday practice, and the family physician may frequently be called upon to evaluate and, at times, to provide initial care for such problems. This article acquaints the family physician with diagnosis and treatment of the most common dental emergencies: disorders secondary to trauma, including soft tissue laceration, fracture or displacement of teeth, and bone fractures; and severe pain related to acute alveolar infection.
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Exudate, adenopathy, and fever were used to predict clinically whether pharyngitis was streptococcal, nonstreptococcal, or questionable in 466 adults and 234 children. Clinical accuracy was: nonstreptococcal - adults 94.6 percent, children 86.9 percent; streptococcal - adults 44.2 percent, children 53.5 percent. Significance of results was determined by calculating the cost of routine cultures compared to risk of rheumatic fever. ⋯ The fatality risk after penicillin injection compared to the increased risk of rheumatic fever after oral penicillin is: adults 7.5 percent (clinical diagnosis), 3.3 percent (laboratory diagnosis); children 1.8 percent and 0.8 percent respectively. It is recommended that throat culture be obtained for all questionable patients and clinically nonstreptococcal children. Penicillin should be administered orally in the majority of adults.
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A definite identity crisis was recognized among first-year family practice residents prior to this year. A specific solution was found through a carefully planned one month family practice rotation that enabled the residents to become fully acquainted with the Family Practice Clinic operation while firmly establishing their identity as unique family practice residents. There is good evidence that this approach has been highly successful in dealing with the problem, and the alleviation of identity crises in first-year residents has, in addition, strengthened other areas of the residency program.