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In vitro laboratory and in vivo animal models support the biologic plausibility that chronic infection is a potential cause of asthma. (1,2) Arising from that hypothesis, macrolide antibiotics have been [...]

In the June Photo Rounds column, 'Foot rash and joint pain' (J Fam Pract. 2021;70:249-251), Badon et al presented a case of chlamydia-associated reactive arthritis (ReA), formerly called Reiter syndrome, [...]

In 'Asthma: Newer Tx options mean more targeted therapy' (J Fam Pract. 2020;65:135144), Rali et al recommend azithromycin as an add-on therapy to ICS-LABA for a select group of patients [...]

"For Depression, the Family Doctor May Be the First Choice but Not the Best." --New York Times, June 24, 2003 (review of Kessler RC, Berglund P, Demler O, et al, [...]

Background. Some diseases previously believed to be noninfectious, eg, peptic ulcer disease, are now known to be caused by chronic infection. Recently, chronic Chlamydia pneumoniae infection has been suggested as [...]

Background. In the primary care setting, patients often report that their asthma began after an acute respiratory infection such as bronchitis, pneumonia, or an influenza-like illness ("infectious asthma"). Preceding respiratory [...]

In 1986, Dr Harold Williamson, Jr, wrote an editorial published in The Journal of Family Practice entitled "Acute Bronchitis: A Homely Prototype for Primary Care Research,"(1) in which he argued [...]

Background. Adult-onset asthma is frequently associated with antecedent respiratory symptoms that could represent either previously undiagnosed asthma or previous lung infections that result in subsequent asthma. To further investigate a [...]

Background. Adult-onset asthma is frequently encountered in primary care and is responsible for a large proportion of asthma morbidity and mortality. The primary goal of this survey was to describe [...]

CLINICAL ENCOUNTERS 1. After a brief clinical visit for an urelated problem, a patient asks why he is still having trouble controlling his urine 1 year after having a radical [...]

In the Clinical Inquiry, 'Does prophylactic azithromycin reduce the number of COPD exacerbations or hospitalizations?' (J Fam Pract. 2018;67:384-385), Lyon et al state that azithromycin 'doesn't benefit patients The authors [...]

Like many of my colleagues, I support President Obama's call to demonstrate value as part of health care reform. One way to do that is through public reporting. The rationale [...]

Physicians are increasingly called upon to provide preventive health care, but a variety of barriers at the levels of the physician, the patient, and the health care system make this goal difficult to achieve. A report of the integration of a systematic health maintenance (SHM) protocol into a private practice involving four family physicians and more than 1,400 patients is presented. The protocol was designed so that preventive medicine was included in all visits to the doctor. This was accomplished by means of a health maintenance flow sheet (presented in the report). On the flow sheet, health maintenance behaviors and certain tests were listed. The patient's age when tests were performed was noted, and patient participation was encouraged. The length of time that implementation of the protocol added to the patient's visit was recorded. Results from an 18-month study comparing SHM patients (of one of the physicians) with usual-care patients (of the other three physicians in the practice) revealed that SHM patients had higher rates of utilizing tetanus immunizations, cholesterol screenings, physician breast examinations, mammographies, tests for fecal occult blood, and sigmoidoscopy (an examination of part of the colon). A similar proportion of patients in both groups received Papanicolaou smears (for detecting cervical cancer at an early stage), and blood pressure measurements. For seven of eight health maintenance education items (smoking, breast self-examination, seat belt use, and similar topics), SHM patients recorded more performance than usual-care patients. The time required to fill in the flow sheet was two minutes at the first patient visit, and never more than four minutes on subsequent visits. The results indicate that physicians who have specific plans for the provision of health maintenance services can perform these services. A critique is provided of the report in the associated Commentary. (Consumer Summary produced by Reliance Medical Information, Inc.)

It is estimated that colorectal cancer will kill 60,900 people in the US, and another 155,000 new cases will be diagnosed in 1990. Colorectal cancer is second only to lung cancer in frequency, and the prognosis is poor if the disease is diagnosed in an advanced stage. As yet, there is no technique that provides a definitive diagnosis, but reports indicate that flexible fiberoptic sigmoidoscopy may be very useful in screening for this disease. Sigmoidoscopy is a procedure that involves the insertion of a flexible scope, which enables visualization of the colon; the procedure may be performed in the physician's office. Some controversy exists on who should have this examination on a routine basis. To help ascertain the most appropriate target population for this test, the relevance of sex and race were evaluated as risk factors for colorectal cancer. Data were analyzed from statistics compiled by the World Health Organization for incidence of colorectal cancer reported between 1978 and 1982. The results indicated that both sex and age are independent risk factors for colorectal cancer. A significant difference between the sexes was found, with men at higher risk than women both in the US and worldwide. Orientals had a higher risk than blacks or whites; blacks had a lower risk than the other two racial groups. The racial differences within the US were not significant; the incidence for all races was similar. These findings reflected the incidence of colorectal cancer that was considered detectable using the sigmoidoscope. When the physician targets a group for routine screening, both race and sex should be considered, along with other known risks for colorectal cancer. Additional research is recommended to further investigate the significance of these factors. (Consumer Summary produced by Reliance Medical Information, Inc.), There is controversy about the efficacy and feasibility of flexible fiberoptic sigmoidoscopy (FFS) as a screening test for colorectal cancer in asymptomatic adults aged 50 years and over. Some authorities recommend periodic FFS screening for all such adults, whereas other authorities do not recommend screening FFS at all. There is evidence that some physicians have adopted a policy of selective screening" by emphasizing screening FFS for adults with ancillary risk factors such as a personal history of colon polyps or previous colorectal cancer, or a family history of colon, female genital, or breast cancer. Results of this study of the subsite distribution of colorectal cancer show that both male sex and Oriental race are risk factors for colorectal cancer within reach of FFS, and that the risk of being male and Oriental (relative risk [RR] = 1.9) is of the same magnitude as that for other ancillary risk factors known for the general population excluding specific rare disorders). Knowledge that sex and race are risk factors for colorectal cancer detectable by screening FFS may be important to those physicians who choose the selective screening approach. Further research is necessary to determine whether selective screening for colorectal cancer is efficacious, or whether the race and sex differences noted in this study are important in the etiology of colorectal cancer. J FAM PRACT 1990; 30:409-416., Colorectal cancer is the second most common cancer in the United States (after lung cancer and excluding skin cancer) and will account for an estimated 155,000 new cases and 60,900 [...]

A significant portion of research project costs is incurred before the receipt of grant funds. This poses a problem for the initiation of primary care research, especially in community practice [...]

An inverse association has been documented between the magnitude of patient care responsibilities (health maintenance organization penetration) and the amount of clinical research produced by academic medical centers. The output [...]

BACKGROUND. Evidence-based clinical preventive services are underutilized. We explored the major factors associated with delivery of these services in a large physician-owned community-based group practice that provided care for both [...]

To the Editor: I read with interest the elegant review by Smucny and colleagues[1] in the December issue of the Journal. I use the adjective "elegant" to denote the distillation [...]

I was disappointed, recently, when I read a handout from the American College of Physicians (ACP) that was designed to help physicians talk to patients about the benefits and harms [...]

In the PURL, 'Consider adding this drug to fight COPD that's severe'(J Fam Pract. 2012;61:414-416), Drs. Hobbs and Brown state that 'there was an increase in the prevalence of macrolide-resistant [...]