The Journal of the American Board of Family Practice / American Board of Family Practice
-
J Am Board Fam Pract · Sep 1991
ReviewAn approach to difficult management problems in otitis media in children.
Otitis media is one of the most common pediatric diseases encountered by family physicians. While isolated, acute episodes pose little clinical difficulty, recurrent infections and persistent middle ear effusions can be perplexing problems. ⋯ Recurrent infections can be treated with a trial of daily prophylactic antibiotics to decrease the rate of recurrence. Should infections continue to recur despite the daily prophylaxis, polyethylene tube placement is warranted to drain surgically the middle ear effusions that give rise to the recurrent infections. Acute episodes of otitis media are commonly followed by prolonged, asymptomatic periods of middle ear effusion. Patients with this disease have decreased hearing leading to potential deficits in their speech and academic development. If such effusions do not spontaneously resolve within 2 months, repeated courses of antibiotics with the possible addition of a course of oral steroids are warranted to speed resolution of the effusion before proceeding to placement of polyethylene tubes.
-
J Am Board Fam Pract · Sep 1991
Comparative StudyA rural-urban comparison of prehospital emergency medical services in Nebraska.
Provision of emergency medical services (EMS) in the rural United States presents a unique challenge. While rural and urban EMS outcomes have been compared, differing urban-rural population characteristics and roles for rural ambulance teams can confound such comparisons. ⋯ Prehospital EMS in this rural location involved a predominantly elderly population with a large number of routine transfers linking the nursing home and community hospital. Further comparisons of rural and urban EMS outcomes should account for possible differences in type and severity of illness and type and location of service.