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
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.
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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.