Primary care
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Pediatric patients are frequently evaluated in primary care clinics. Thus, there exists a need to understand common pediatric problems and to acquire a degree of familiarity with pediatric procedures. This article will review techniques and the current evidence for frequently performed pediatric procedures, including umbilical granuloma chemocautery, frenotomy, suture ligation of type B postaxial polydactyly, reduction of nursemaid's elbow, hair tourniquet removal, and tympanometry.
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Embedded fishhooks, digital ring entrapment, and foreign bodies of the ear, nose, and superficial eye and conjunctiva may present to primary care clinics and can often be managed there. This review is a guide for primary care clinicians for effective, pragmatic, and safe techniques to address these scenarios in the office and when to refer them to a surgeon.
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Vasectomy is a safe, effective, and practical option for permanent contraception in men. Vasectomy is a surgical procedure used in men to disrupt and occlude the vas deferens, which delivers sperm from the testicles. ⋯ Surgical techniques used for vasectomy vary widely throughout the world, with limited evidence to guide the most effective approach. Current vasectomy guidelines largely rely on information from observational studies, with few controlled clinical trials.
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Nexplanon is the only contraceptive implant currently available in the United States. It exerts its contraceptive effects primarily by suppressing ovulation. The Nexplanon is the most effective method of long-acting reversible contraception. ⋯ All health care providers must be trained on Nexplanon before performing insertions or removals of the implant. A Nexplanon can be inserted and/or removed as an office-based procedure. The most common adverse reaction is change in menstrual bleeding patterns.
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In an era where cardiovascular disease continues to increase in prevalence, chest pain is a commonly encountered complaint in the outpatient setting. Clinicians are often tasked with the challenge of selecting the most appropriate screening tool in the evaluation of a patient with suspected coronary artery disease. With proper consideration of indications and contraindications, exercise electrocardiogram (ECG) stress testing is an accessible, cost-conscious, and validated outpatient diagnostic modality for predicting coronary artery disease.