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Carcinoid tumors are rare, slow-growing neuroendocrine neoplasms that often are indolent and may not become clinically apparent until there has been metastatic spread or evidence of carcinoid syndrome. Recent evidence has revealed that the overall incidence of carcinoid tumors has been steadily increasing, and although the disease was thought to be relatively benign, it is now considered one of increasing malignancy. Carcinoid tumors derive from different embryonic divisions of the gut: foregut carcinoid tumors commonly originate in the lungs, bronchi, or stomach; midgut carcinoid tumors in the small intestine, appendix, or proximal large bowel; and hindgut carcinoid tumors in the distal colon or rectum. Carcinoid syndrome, although rare, is most associated with midgut carcinoid tumors. The diagnosis of a carcinoid tumor often is coincidental with surgery performed for another reason. Treatment and prognosis are dependent on the location of the primary tumor and the degree and extent of metastasis at the time of diagnosis. [ABSTRACT FROM AUTHOR]

Background: Increasing regulation of physician office laboratories (POLs), increased complexity of outpatient care, and technological advances have increased the need to train family practice residents in POL management. There is little information on how residency laboratories are organized, how they are regulated, and how often quality controls and proficiency testing are done., Methods: A questionnaire was sent to 385 ACGME-approved family practice residencies to determine the scope of testing, quality-assurance activities, and administrative structure of the residency laboratory., Results: Two hundred and ninety-seven programs responded, for a response rate of 77%; 91.6% were performing routine office tests and 40.7% were performing automated testing. Of programs that performed automated tests, 71.2% were performing daily normal and abnormal quality-control specimens. Proficiency testing was only performed by 57.8% of programs. The program's parent hospital viewed the residency laboratory as a POL in 55.6% of cases and as a satellite of the hospital laboratory in 32.6%., Conclusions: Residency laboratories are more frequently organized as POLs than satellite laboratories of the parent hospitals. The POL model offers an excellent opportunity to teach residents about office laboratory management. Residency laboratories should be implementing proficiency testing for both patient safety and resident teaching. Many residency laboratories will need to increase the frequency of quality controls as the new CLIA '88 regulations are implemented. Accreditation by a private organization may be an attractive option for family practice office laboratories.

Background: Despite growing emphasis on preventive services, physicians still provide low levels of these services to their patients. Barriers to providing preventive services might be modified by more effective teaching models at the residency level. The purpose of this study was to evaluate a practice-based teaching model designed to increase resident compliance with the US Preventive Services Task Force Guidelines., Methods: In Phase One of this study, physicians received didactic education about the US Preventive Services Task Force Guidelines. Subsequently, physicians' compliance with these recommendations was monitored. During Phase Two of the study, a comprehensive two-visit "Health Check" appointment was instituted. It incorporated a computerized health risk appraisal that was reviewed with patients. After the Health Check program was implemented, physicians' compliance with the guidelines was again audited., Results: The chart audits revealed an overall increase in the level of preventive services provided by physicians from 31% in Phase One to 74% in Phase Two (P < .01)., Conclusions: This type of teaching model can effectively increase the level of preventive services provided to patients in a family practice residency.

Wegener's granulomatosis is a rare disease of unknown etiology. Until recently it was considered uniformly fatal. Family physicians should be aware of the variable presentations of this disease and keep the diagnosis in mind when faced with a puzzling, chronic, progressive multisystem process. New laboratory markers can lead to earlier diagnosis, and aggressive treatment can improve the prognosis.

Background: Rapidly changing Medicare reimbursement policies since 1983 have affected every primary care physician. This study has attempted to quantify the attitudes and behaviors of Ohio primary care physicians toward these changes., Methods: In Ohio, 1758 primary care physicians were surveyed by a mailed questionnaire about their attitudes toward recent changes in Medicare reimbursement policies and the resulting changes in their practices., Results: More than 80% of respondents termed most Medicare policies as "objectionable" or "very objectionable." Fifty percent were limiting the number of Medicare patients in their practices. Family physicians and physicians who perceived their income to have decreased and their staff workload to have increased were also more likely to limit the number of Medicare patients in their practices., Conclusions: Ohio primary care physicians have a negative opinion of Medicare reimbursement policies and have limited their practices significantly as a result.

Thirty-eight patients admitted to the Coronary Care Unit were interviewed to discover the natural history of their moods and to assess their level of understanding of their medical condition. A progression of moods from anxiety to denial to depression was noted. Only seven of 38 patients were found to have a good understanding of their illness. Several barriers to doctor-patient communication were identified, including patient's denial, patient's distractibility due to surroundings, patient's "wishfully hearing," doctor's unwarranted assumptions about the patient's understanding, doctor's overuse of medical terminology, and doctor's unawareness of patient's emotional state. Finally, four suggestions for improving total patient care in the Coronary Care Unit are proposed: (1) understand the natural history of patient mood and perceive where your patient is in the progression, (2) institute formal teaching on dealing with patients' moods for nursing and medical personnel, (3) be aware of, and deal with, the barriers to physician-patient communication, and (4) institute formal patient education programs to aid communication and understanding.