Primary care
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The primary care physician must be able to recognize potentially life threatening or permanently disabling oncologic complications that may be prevented or reversed by foresight or prompt action. The physician must be able to assist the patient in treatment decisions and recognize those situations in which palliation is possible. Accurate diagnosis and treatment of oncologic emergencies and paraneoplastic syndromes may both improve the quality of life and increase the length of survival in the patient with cancer.
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This article provides general guidelines and principles for physicians caring for adolescent patients from various cultural backgrounds. Suggestions are offered for managing the special problems presented by new immigrants. Case vignettes are liberally used to illustrate health care issues.
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The preceding discussion is an attempt to stress anatomy in the diagnosis of coma. By localizing the offending lesion, the physician can apply the appropriate diagnostic and therapeutic measures more adeptly. Because physicians are also frequently asked to prognosticate, I have tried to summarize the work of Plum and Posner in their study of the outcome of patients presenting in coma. The primary care physician is encouraged to plan at least for the basics in case he or she is faced with a comatose patient.
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Careful telephone triage of women with significant obstetric and gynecologic emergencies is the optimal way to avoid devastating complications in the office. With practical knowledge and some specialized office equipment and medications, most obstetric and gynecologic emergencies can be managed effectively in the office or stabilized while arranging transport to a hospital. Management of the most common complications likely to be encountered is outlined in this article.
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The care of the trauma patient is a complex undertaking involving multiple health care professionals and represents one of the greatest challenges to any physician. There is perhaps no greater opportunity to have a positive impact on patient care than in the care of these patients. ⋯ With proper motivation and experience, the physician's care of trauma patients will continually improve. This will lead to a rewarding experience for the patient and the physician alike.