Combination antihypertensive drugs: recommendations for use.

The recommendation for first-line therapy for hypertension remains a beta blocker or diuretic given in a low dosage. A target blood pressure of less than 140/90 mm Hg is achieved in about 50 percent of patients treated with monotherapy; two or more agents from different pharmacologic classes are often needed to achieve adequate blood pressure control. Single-dose combination antihypertension therapy is an important option that combines efficacy of blood pressure reduction and a low side effect profile with convenient once-daily dosing to enhance compliance. Combination antihypertensives include combined agents from the following pharmacologic classes: diuretics and potassium-sparing diuretics, beta blockers and diuretics, angiotensin-converting enzyme (ACE) inhibitors and diuretics, angiotensin-II antagonists and diuretics, and calcium channel blockers and ACE inhibitors.

Screening for Chlamydia trachomatis infection.

Infection with Chlamydia trachomatis can be either symptomatic or asymptomatic. In adults, complications include infertility, chronic pelvic pain and ectopic pregnancy. Complications in newborns include conjunctivitis and pneumonia. Screening of asymptomatic women at high risk for the disease can identify candidates for antibiotic therapy. Until recently, chlamydia cell culture was the only diagnostic test and it was not widely available. Because the specificity of cell culture is 100 percent, it remains the standard against which other tests are measured. The recent development of nonculture tests makes it feasible for most laboratories and physicians' offices to offer testing. The main disadvantage of nonculture tests is low specificity. A positive screening test in a woman at low risk should be confirmed by a second test. Routine screening and treatment of patients who are at high risk can decrease the incidence, complications and transmission of chlamydial infection.

Professional satisfaction and dissatisfaction of family physicians.

BACKGROUND: Physicians' satisfaction with their professional life influences the quality of patient care they provide and helps to determine the number and type of students attracted to the various fields of medicine. In this study, we sought to delineate areas of satisfaction and dissatisfaction among family physicians. METHODS: A self-administered questionnaire was sent to all physicians in the state of Pennsylvania who were included in the 1990 directory of the American Board of Family Practice (N = 1944). RESULTS: Completed questionnaires were received from 1066 family physicians in full-time practice. Sixty-five percent were satisfied with their professional lives. Patient relationships, a sense of clinical competence, and their relationships with their partners were among the most satisfying aspects of practice for all family physicians. Problems identified included regulations by third-party payers and government agencies and the large amount of paperwork encountered in practice. There were significant (P < .001) differences in satisfaction between physicians in different practice arrangements. Significant differences between practice types were also found in the degree of dissatisfaction with third-party payers and government agencies, paperwork, isolation from other physicians, and the threat of a malpractice suit. CONCLUSIONS: Almost two thirds of family physicians are satisfied with their general professional lives. Conversely, one third are not. Clear areas of satisfaction and dissatisfaction have been defined for family physicians in general as well as for family physicians in various practice environments. This information may be useful in the development of policy to structure a medical system that meets the needs of both patients and physicians.

Treatment of croup. A critical review.

Although viral croup is the most common form of airway obstruction in children 6 months to 6 years of age, there is debate regarding medical care for the hospitalized patient. A complete review of the English-language literature from 1960 to 1988 was performed, using both manual and Medline searches. Critical review shows that laryngotracheitis and spasmodic croup, previously emphasized in the literature as having distinct etiologies, most likely are two ends of a broad spectrum in the clinical presentation of a single disease. Critical assessment of all prospective randomized double-blind placebo-controlled trials reported during the study period shows that there is little information on the use of humidified air or supplemental oxygen, that racemic epinephrine hydrochloride is of well-demonstrated efficacy, and that dexamethasone phosphate at a dose greater than 0.3 mg/kg is effective in decreasing the length and severity of respiratory symptoms associated with viral croup.