The Journal of the American Board of Family Practice / American Board of Family Practice
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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.
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As the population ages, an increasing number of elderly patients will need surgery. An organized medical evaluation that focuses on the patient's cardiopulmonary and nutritional status should be performed before the patient undergoes surgery. The initial history and physical examination should be performed up to 8 weeks before surgery. ⋯ The need for additional tests is indicated by the history and physical examination. Following this assessment, therapeutic and prophylactic measures to reduce surgical morbidity and mortality can be implemented. With timely identification and management of medical disease in geriatric surgical patients, the risks of surgery can be minimized.
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J Am Board Fam Pract · Mar 1991
Comparative StudyIntrapartum intervention and delivery outcome in low-risk pregnancy.
A retrospective cohort study of 1597 low-risk pregnancies assessed the effects of obstetrical intervention using logistic regression. Both maternal and neonatal morbidity were low (15.2 percent and 3.8 percent, respectively). ⋯ Both elective and medically necessary use of these interventions were associated with increased morbidity. If obstetrical interventions, particularly oxytocin and epidural analgesia, are applied in low-risk pregnancies, labors must be monitored carefully and the risk-benefit ratios judged advantageous.