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To review evidence regarding antibiotic treatment of acute otitis media in children with tympanostomy tubes and to discuss antibiotic resistance and ototoxicity.MEDLINE, EMBASE, the Cochrane Database of Systematic Reviews, and the Cochrane Central Register of Controlled Trials were searched for relevant articles. Articles providing level I evidence(randomized controlled trials) for treatment were used. Key words used in the search included otitis media(MeSH), middle ear ventilation (MeSH), tympanostomy tubes, and otorrhea.Tympanostomy tube insertion is a common procedure; acute otitis media is a frequent sequela. Treatment options include systemic or topical antibiotics with or without corticosteroids. The development of bacterial resistance to antibiotics and ototoxicity related to treatment are important considerations. There have been well-conducted randomized controlled trials of topical versus systemic antibiotic agents. Combined with proper ear cleaning and tragal pumping, topical fluoroquinolone agents offer the most effective treatment.Current evidence suggests that a topical fluoroquinolone, with or without a corticosteroid, is the treatment of choice for acute otitis media with tympanostomy tubes.

A chart audit of 250 randomly selected adult patients at a university-based family practice unit showed that 91.9% had attended the clinic during a five-year period (89.0% for males and 94.5% for females). Overall, 80.6% of the patients had their blood pressure recorded on the office chart in the five-year period (75.3% for males and 85.0% for females). For males 30-39 years old, however, the rate was only 54.5%. Flow sheets are suggested as a practical method for recording health maintenance items in an effort for the primary care physician to follow the recommended guidelines for hypertension screening.

Ultrasonography is the technique of choice in diagnosing gallbladder calculi. In the mid-1970s ultrasound was only accurate enough to use as an adjunct to oral cholecystography but refinements such as gray scale and real-time imaging mean that in experienced hands it has a sensitivity of 96% and a specificity of 93%. Sonography is also the test of choice in the initial evaluation of jaundiced patients. It is an excellent technique for distinguishing between obstructive and nonobstructive jaundice, although it is less accurate in demonstrating the cause of the obstruction. Ultrasound is painless and relatively inexpensive, and has several advantages over oral cholecystography; it doesn't depend on contrast material, causes no adverse reactions or side-effects, is safe during pregnancy, does not expose the patient to radiation, and is less time-consuming.

While previous records of a new patient can be of great benefit, the process of record transfer often leads to frustration for both the receiving and sending physician. This report describes a survey of the current record-transfer practices of 475 randomly selected Ontario family physicians who responded to a questionnaire. This represented an overall response rate of 84%. Only 36.5% of respondents always or frequently found the transferred information useful. Only 51.5% of physicians regularly obtain past records for their patients. Respondents showed a preference for consultation letters and hospital-discharge summaries. Most of the respondents sent copies of consultation letters written by other physicians, even though the CMA policy on record transfer recommends against this practice. Data on office visits was seldom perceived as useful information. A written summary of the patient's history with photocopies of select information was the most popular format for transfer of patient information. Unfortunately, it is also the most time-consuming and expensive method. Approximately 62.1% of respondents thought that a fee should be charged for transfer of patient information; 42.1% thought the patient's medical care plan should pay; while 41.5% thought that the patient should be responsible. Guidelines for information transfer are suggested.