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BACKGROUND. In the last 15 years, family physicians and general internists have adopted flexible fiberoptic endoscopy as a procedure to screen patients at risk of premature death from colorectal cancer. [...]

Background. Helicobacter pylori is emerging as an important cause of peptic disease; however, few studies have been performed in primary care settings. This study examines the prevalence of H pylori in a population of primary care patients with refractory dyspepsia and evaluates the usefullness of currently available H pylori tests. Methods. Consecutive patients with dyspepsia refractory to standard therapy were studied by endoscopy and tested for the presence of H pylori by means of four methods: office-based serology testing on endoscopically obtained specimens (CLO test), reference laboratory serology testing, rapid urease testing, and histologic diagnosis using special staining techniques. Results. Among 41 patients with refractory dyspepsia, 19 (46%) were serology-positive, indicating past infection with H pylori. When compared with the reference laboratory standard, office-based serology testing had a sensitivity of 87% and a specificity of 100%. Using special stains on specimens obtained by biopsy, active H pylori infection was detected in 14 (34%) patients. Using special stains as a biopsy standard, the CLO test had a sensitivity of 93% and a specificity of 93%. Conclusions. Family physicians should consider adding H pylori eradication strategies to the treatment of patients with refractory dyspepsia. The rapid urease (CLO) test may be a useful adjunct for office-based family physicians who perform esophagogastroduodenoscopy. Serology alone is associated with a high false-positive rate due to past infection without active disease. Key words. Helicobacter pylori; dyspepsia; primary health care; diagnostic tests, routine; endoscopy, digestive system. (J Fam Pract 1995; 41:245-249), Dyspepsia is a frequent complaint of patients presenting to family physicians.[1] Many of these patients receive empiric medical therapy, and a substantial number do not respond.[2,3] The emergence of data [...]

Early detection of colon cancer is imperative for a good prognosis. Family physicians are therefore becoming the front line of defense in the fight against colorectal malignancy. Many family physicians [...]

Recent data have suggested that family physicians, trained in the use of obstetrical ultrasound, can develop skills that provide an acceptable level of care, confirmed by interobserver agreement in 85 and 89 percent of cases. At this urban health center it was noted that obstetrical patients referred to the University Medical Center for ultrasound examinations frequently did not have the imaging procedure performed, usually for socioeconomic reasons. Consequently, ultrasound examination was made available to obstetrical patients on-site. This study reports the results of the initial 227 prenatal ultrasound examinations performed by two family physicians at this urban community health center. These physicians were trained in the use of ultrasound during a three-day course which involved performing between 15 to 25 supervised examinations. Follow-up was obtained on 186 examinations and 162 infants were represented in the study. An important use of ultrasound is to determine gestational age and estimate the date of delivery; this was achieved with 92 to 96 percent accuracy. These results compare well to physicians receiving more rigorous training. The examinations detected one placenta previa, one fetal death and two unsuspected twin pregnancies. This is the first detailed report describing the outcomes of family physicians performing obstetrical ultrasound. The high rate of accuracy suggests that the short training course was satisfactory for these physicians. (Consumer Summary produced by Reliance Medical Information, Inc.), The initial 227 consecutive prenatal ultrasound examinations by to family physicians in an urban community health center were compared with actual birth outcomes. Of 186 examinations for which follow-up information was available, 162 infants were represented. The sampling rate was 81%. No serious anomalies were noted by ultrasound. One placenta previa, one fetal death, and two unsuspected cases of twins were detected by ultrasound. These data represent one of the first detailed reports of outcomes reflecting family physicians' psychomotor and cognitive skill in the use of obstetric ultrasound. The high accuracy (92% to 96%) of correct ultrasound dating suggests that a short postgraduate continuing medical education course was effective for these two family physicians. The accuracy rate compares favorably to more rigorous training. This structured format utilizing the average of four direct measurements for ultrasound-estimated gestational age and three anatomy ratios for assessing proper imaging relationships or growth symmetry may be useful as other family physicians develop educational methods and quality-assurance protocols in this area. J FAM PRACT 1990; 30:163-168., Availability of obstetric ultrasound imaging in the office may be of benefit in risk management while providing an opportunity for needed role model involvement by family physician-educators. (1-3) Morgan et [...]

A 26-year-old man presented with intermittent bright red blood per rectum. His physical examination was unremarkable; however, because microcytic anemia was noted, the patient underwent colonoscopy. A large ascending colonic [...]

ABSTRACT: An 11-question analysis will help you get an immediate bearing on the source of a patient's pain. Clues include location and characteristics of the pain, as well as patterns [...]

D The American Cancer Society estimates that approximately 13,000 new cases of invasive cervical cancer and 34,000 cases of endometrial and uterine cancer will develop in 1988.* Almost 20% of [...]

In the past decade, androscopy, use of a magnifying scope to examine the penis, has been widely performed to detect the presence and progression of human papillomavirus (HPV) infections. HPV infections often cause abnormal Pap smears in women and are thought to be associated with an increased risk for cervical cancer. However, although visible signs of infection may not be detectable with an androscope, the HPV virus may still be present. In the August 1991 issue of The Journal of Family Practice, a study by Epperson examined the use of androscopy in controlling HPV infections in males. The study found that 79 percent of men with such infections who underwent proper treatment did not show clinical signs of infection at follow-up when examined androscopically. Other results of the study, however, show the difficulty in diagnosing HPV infections using androscopy alone. Further studies in this area are needed, but until then, the general use of androscopy to diagnose and monitor the course of HPV infections is not recommended. (Consumer Summary produced by Reliance Medical Information, Inc.), The technological advances coming in the 21st century no doubt will astound us. Perhaps they will involve computer-controlled tractor devices that pull the colono-scope through the bowel, eliminating alpha loops [...]