Anemia.

Abnormalities in the routine blood count alert the physician to hematologic problems. The most common of these are red cell abnormalities as reflected in decreased levels of hemoglobin and hematocrit together with changes in mean corpuscular volume and red cell morphology. When the history and physical examination are not diagnostic, systematic use of laboratory tests can determine the category of anemia present. An approach for the laboratory workup of anemia is discussed. Particular attention is paid to the differential diagnosis of the most common anemias in which iron is the limiting factor in erythropoiesis.

Childbirth preparation and outcomes of labor and delivery in primiparous women.

Preparation for childbirth (Lamaze classes) is becoming an increasingly popular addition to patient education. This retrospective study investigates its effect on 64 primiparas in comparison with a control group who had not taken classes. The two groups were matched for age, antenatal risk scores, ethnic derivation, and socioeconomic status. No difference was found in the use of analgesia and anesthesia, the length of labor, type of delivery, incidence of fetal distress, infant birth weights, Apgar scores, or maternal and neonatal complications. However, there was a statistically significant increase in the use of oxytocin for augmentation of labor (P less than 0.01) in the prepared group.

Suction curettage.

In the decade after the legalization of elective abortion by a Supreme Court decision in January 1973, suction curettage has been widely used and accepted as a safe outpatient procedure for first-trimester abortion. Evaluation of the patient for feasibility of the procedure requires careful assessment of gestational age and the determination of the absence of an ectopic pregnancy and conditions that might contraindicate local anesthesia. Counseling clarifies the patient's options and ensures her understanding of the implications of abortion so that she can give an informed consent. Suction curettage is performed under local anesthesia using a sterile plastic cannula or curette inserted through a progressively dilated cervix with aspiration of the uterine contents by an electric pump. The procedure is completed by the physician's examination of the aspirate for the presence of placental villi. Postoperative instructions include contraception and monitoring for hemorrhage and infection prior to a return visit in 10 to 14 days. Complications can be reduced by careful selection of patients with appropriate duration of pregnancy, the use of gentle operative technique, antibiotics for prophylaxis of infection, and a continued maintenance of experience and procedural skill by the physician.

Use of nutritional supplements by family practice patients.

Sixty patients and their physicians were interviewed to assess their attitudes and practices with respect to nutritional supplements. Forty patients (67%) used nutritional supplements on a regular daily basis or had used them to treat an illness. Thirty-two (80%) of the supplement users believed supplements were effective in increasing energy, vitality, and physical strength. The majority of supplementation was suggested by friends, family, and lay publications. Thirty-seven (62%) of the supplement users had never discussed nutritional supplements with their physicians. For the most part, physicians were unaware of supplement use in their patients and did not regard this as their responsibility. Implications of the independent and unmonitored action of the patient in this aspect of health maintenance is discussed.

Stress and coping in first pregnancy: couple-family physician interaction.

First pregnancy and childbirth produce life changes and require adaptation. This pilot study examined the role of the family physician in caring for nine couples during first pregnancy through the postpartum period. Interviews of individuals and couples were conducted to evaluate their support, stresses, and coping styles. Concurrently, physicians were interviewed for their knowledge of these dimensions. Interactions between physicians and couples were observed in third trimester and at labor and delivery. Each of the participants perceived predelivery stresses relating to the pregnancy and to concomitant changes. Emotional and technical support was high; only two of the nine husbands felt a marked lack of emotional support from any source. All women felt a high level of support. While pregnancy related concerns and support were perceived by all physicians, general stresses and sources of emotional support were infrequently known. Significantly more was known about the women than their husbands. Attention to psychosocial issues appeared to depend on physician style of interaction with the couple. When recognized, stresses were reduced by provision of information, discussion, and reassurance.

Failed appointments: a review.

Failed appointments disrupt office operations. Most studies involved hospital clinics with low socioeconomic populations, which have shown fail rates between 19 and 28 percent. Family practice centers report fail rates which vary from 5 to 11 percent. Young adults, adults with young children, and patients in low socioeconomics groups tend to increase the fail rate. Sex and race are probably not a factor. Reasons for failing appointments include communication problems, the absence of a sense of urgency for keeping the appointment, and the lack of a personal physician. An interval greater than two weeks between appointment scheduling and the appointment date places patients most at risk for failing the appointment. Mail and telephone reminders significantly reduced the fail rate and are cost efficient. Incentives are also used in reducing the fail rate. By examining the process, the patients, the provider, and the environment with respect to appointment keeping behavior, a more quantitative approach to research on the subject can be effected.

The efficiency and cost effectiveness of diagnostic tests for infectious mononucleosis.

The problem of diagnosis and appropriate treatment of patients presenting with pharyngitis is a common occurrence in family practice. The study of these patients includes laboratory tests to differentiate between infectious mononucleosis and other bacterial and viral infections. This study reviews the diagnosis of infectious mononucleosis in two large ambulatory populations, where different approaches were used. In one approach, all laboratory tests were concurrent, while in the other, serology was performed only after satisfaction of hematologic criteria for infectious mononucleosis. In the latter case, sequential use of laboratory tests resulted in a significant improvement in cost effectiveness. In both approaches, no appreciable gain was obtained from heterophil titers. Since the heterophil titer in confirmed cases of infectious mononucleosis does not correlate with prognosis or severity of the disease, this procedure can be replaced by the Monospot/"monoscreen" test alone.