Screening for gestational diabetes mellitus: a critical review.

Gestational diabetes mellitus (GDM) occurs in 1% to 3% of pregnant women. Generally, the clinical focus in these cases is on intermediate outcomes such as macrosomia, hypoglycemia, or hypocalcemia. Only macrosomia is consistently associated with gestational diabetes, yet the risks of macrosomia such as shoulder dystocia and birth injury are highly variable. The screening test and the reference standard, the oral glucose tolerance test, are problematic in that there are no standardized testing procedures or definitive criteria for diagnostic interpretation and poor reproducibility of test results. There have been no methodologically sound randomized controlled trials of therapy for GDM. Studies that attempted randomization show, however, that therapy reduces the incidence of macrosomia, which is an intermediate outcome. A critical review of the literature revealed that there is insufficient evidence to justify routine screening for gestational diabetes. A reassessment of the relation between maternal glucose levels in pregnancy and neonatal outcomes is needed to determine if there are correctable adverse outcomes. In the meantime, management should be based on careful assessment of each individual pregnancy.

Factors influencing antibiotic use in acute respiratory tract infections in family practice.

The authors of this paper assessed the effect of psychosocial and biomedical factors on the prescription rate for upper respiratory infections. Their study, using written clinical vignettes mailed to a random sample of Ontario family practitioners, achieved a 69% response rate. Family practitioners most often used physical signs and symptoms in forming their decision to prescribe antibiotics. Psychosocial data, when present in the vignettes, significantly modified the prescription rate, often overriding the biomedical factors alone. The study is another step in exploring a complex decision-making process.

Childhood Fever: parental beliefs and management.

Childhood fever is often seen in family-practice. Clinical experience has shown the authors that parental anxiety often initiates early, aggressive treatment of fever with antipyretics. The authors studied parents' beliefs and practices relating to fever control in their children, and who or what their information sources were. The findings indicate that parents are commonly misinformed about the nature of childhood fever and its management, and that physicians need to learn more about conveying information on fever to patients.

Radioactive cesium from the Chernobyl accident in the Greenland Ice Sheet.

Measurements of cesium-134 and cesium-137 in Greenland snow together with models of long-range transport have been used to assess radionuclide deposition in the Arctic after the Chernobyl accident. The results suggest that a well-defined layer of radioactive cesium is now present in polar glaciers, providing a new reference for estimating snow accumulation rates and dating ice core samples.

Diagnosis clusters adapted for ICD-9-CM and ICHPPC-2.

An ad hoc committee of the North American Primary Care Research Group (NAPCRG) was appointed to adapt the diagnosis clusters instrument for use with the International Classification of Diseases (ICD-9-CM) and the International Classification of Health Problems in Primary Care (ICHPPC-2). This article describes the development and testing of the final roster of 110 diagnosis clusters for family physicians. Almost 90 percent of all diagnoses recorded by family physicians in a variety of settings were included in the clusters. The diagnosis clusters can be used in the analysis of large databases and facilitate comparisons between different providers and practices.

Creativity in management in family medicine.

Family practice presents some complex patient management problems with organic, social, and psychological components. There is a great potential for creative problem solving in such patient management problems, in that many alternative solutions are possible. A cross-sectional study was carried out to test the hypothesis that "more creative people as defined by a standard creativity test would have a better quality of management." Sixteen volunteers from the University of Western Ontario Family Practice Residency Program completed a written management problem and the Barron Welsh Art Scale, which is a measure of a person's preference for complexity. The number of options given in each answer was calculated, and the results showed that more creative residents had a higher quality of management score, a higher number of high-quality options, more options of an interpersonal nature, and a higher proportion of original options. The results suggest that creative people are more able to generate the number and types of options that are needed for quality management. The higher proportion of original options may represent a more comprehensive approach to management, and the creative groups' preference for complexity may enable them to deal more effectively with the problem. These results are not generalizable but indicate a need for further investigation into this area.