The Journal of the American Board of Family Practice / American Board of Family Practice
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This paper describes the clinical course of a young diabetic primigravida who presented to her physician with vomiting and abdominal pain. Despite the conventional doses of intravenous fluid and insulin that were used to treat her suspected diabetic ketoacidosis, she remained severely acidotic and developed increasing abdominal pain. ⋯ This discussion emphasizes the importance of insulin in the reversal of the hyperglycemia and acidosis that accompany a diabetic crisis. The roles of bicarbonate, phosphorous, magnesium, insulin, potassium, and fluids are discussed along with conditions such as pregnancy, infection, pancreatitis, and abdominal pain, which can complicate the management of diabetic ketoacidosis.
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J Am Board Fam Pract · Jan 1990
Review Comparative StudyFamily physicians and internists: differences in practice styles and proposed reasons.
This is a review of published reports comparing family physicians with internists. The results show that family physicians are more likely to stay in their field of training; to locate more frequently in rural and underserved areas; to see fewer referred patients; to have similar case severity; and to engage in more obstetrics and gynecology, surgery, trauma, acute illness, and pediatrics. ⋯ The reasons for the practice style differences between family physicians and internists are likely to be multiple, but they probably include such factors as: training, decision-making expertise, patient demands, types of visits, office staff, economics, and attitude. The implications of the proposed reasons for the differences are discussed.
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Obstetrical care in the United States is becoming more difficult for rural populations to obtain. Fewer family physicians are providing obstetrical services. This study is a report of one family physician's obstetric experience in a small rural town. ⋯ The rate of Cesarean section was 3 percent, significantly less than the greater than 20 percent national average. There was 1 premature delivery, and no infant deaths. These figures compare well with national averages and show the need for family physicians to provide obstetrical care in rural areas.