Biomedical subjects
Publications and source records attributed to G F Snell.
Management of febrile seizure involves diagnosis and treatment of the underlying cause and assessment of risk factors for recurrence. What should physicians tell anxious parents about this frightening occurrence? Is prophylaxis with anticonvulsant agents appropriate? The authors address these questions and discuss the changing approach to management of febrile seizure.
The primary care physician can utilize the various techniques discussed in this article to close complex lacerations, modify scars, and perform excisional biopsies. Various methods for closure of square, triangular, semicircular, circular, and rectangular defects were described. The principle of flap advancement and Z-plasties was explained, and the method for performing excisional biopsies was detailed. These techniques can be mastered by the primary care practitioner and can lead to improved patient satisfaction. These techniques can be practiced using pig's feet. These minor plastic surgery techniques are an important component in a primary care practice.
Epithelial cysts and cutaneous abscesses account for a significant percentage of visits to primary care physicians. The majority of these skin problems can be handled in the office setting. In this article, a variety of modes of treatment for these common lesions are outlined.
Tympanocentesis, punch biopsy of the skin, bone marrow aspiration and biopsy, and temporal artery biopsy are procedures discussed in this article. They are principally diagnostic procedures used in the evaluation of skin and serious systemic disease.
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This study was designed to compare the outcomes achieved in a series of acute care episodes by different levels of family practice providers working in the clinic setting. The study utilizes a method which depends upon the provider to estimate level of function expected and earliest date of recovery for each episode. When the patients are viewed as a single group, those patients treated by the medex appear to fare considerably better and those seen by a faculty member do worse; however, when each functional status group is examined separately, only the asymptomatic but clinically ill patients (45 cases) show a statistically significant difference in outcomes among the providers, with the medex having good results and the faculty poor results.
A method of instruction in basic wound repair and the teaching of suturing skills such as might be used in the office or Emergency Room is described which has been used effectively in family practice resident training. The method utilizes pigs' feet with four specific exercises and objectives accomplished: (1) stellate or Y-shaped laceration; (2) semi-circular, bevelled, flap-type laceration; (3) elliptical, excisional biopsy with "dog ear" correction; and (4) Z-plasty revision. Diagrams are provided, explicitly demonstrating proper techniques of the above exercises. A brief comment on skill evaluation concludes the paper.
This study examined the relationship between levels of medical training and direct costs for 1,700 episodes of acute illness treated in ambulatory-care clinics. Faculty, family practice residents, and physician assistants were included as the providers. Total cost and four component costs were examined. An outcome was defined as good if the patient returned to his usual level of functioning after an acute illness episode. Average total cost per episode was not related to type of provider, but there were significant (P less than .05) differences among providers in laboratory and medication costs. Faculty and physician assistants produced higher costs, especially for patients who experienced bad outcomes. Both costs and percentage of good outcomes achieved were similar in first-, second-, and third-year residents.
This study developed a practical method for determining the functional outcome status of patients in an ambulatory setting. Health status of 1,840 primary care patients in an ambulatory setting. Health status of 1,840 primary care patients was compared at three points in time: patient's usual status, status at the initial visit, and status at time of telephone follow-up. Follow-up status was also compared with the physician's expectation, which was estimated at the time of the initial visit. Of the patients, 62% showed improvement, 31% remained at the same level, and 7% deteriorated from the time of their initial clinic visit. Physicians tended to overestimate either the speed or degree with which patients return to their usual functional status; 32% of the patients studied reported themselves as being less well than usual at the time of follow-up.