Sedation for office esophagogastroduodenoscopy.
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Benzodiazepines↗
Biomedical subjects
J A Swedberg
Publications and source records attributed to J A Swedberg.
Esophagogastroduodenoscopy by family physicians phase II: a national multisite study of 2,500 procedures.
We have prospectively studied 1,783 upper gastrointestinal tract endoscopy procedures as performed by family physicians from thirteen separate office practices. Phase I of the study previously reported on 717 procedures in which patient management was enhanced, diagnostic yields were high, and biopsies were performed where appropriate. In Phase II, the data totaled 2,500 procedures representing 51.1 years of cumulative practice experience by the entire group. All cases were gathered prospectively and biopsies were confirmed by a pathologist's independent tissue analysis. In this series, family physicians were asked to record all complications, and to specify the exact manner in which performance of the procedure enhanced patient management. There have been biopsies in 1,230 (69% biopsy rate) Phase II cases with biopsy reports available in 1,194 (97% reporting rate) cases. There is pathological confirmation of the family physicians' visual diagnosis in 1,104 of 1,194 (93%) available biopsy reports for a 92% accuracy rate. There have been no complications, and the complication rate for the total series (1/2, 500) is now 0.0004.
Biopsy↗
Osteoarthritis.
Osteoarthritis is a frequent cause of physical impairment in the elderly. The disease has a slow, progressive course that ends with joint failure and subsequent disability. The hands and the large weight-bearing joints are most commonly affected. The cause of osteoarthritis is unknown. The strongest risk factor is age, but age alone does not cause the disease. Clinically, osteoarthritis is manifested by joint pain and stiffness. Radiographs reveal joint space narrowing, subchondral sclerosis, osteophytes and, later, subchondral cysts and intra-articular osseous bodies. Biochemically, the cartilage in osteoarthritis differs from normal cartilage in elderly patients. The goals of treatment are to control pain, maintain function through strengthening and range-of-motion exercises, protect the joint and limit iatrogenic injury by selecting treatment options that minimize complications. Even when cure is not possible, appropriate medical care can improve the patient's functioning and well-being.
Aged↗
Emergency resuscitation in children. The role of intraosseous infusion.
Intraosseous infusion is a temporary procedure for use in pediatric emergencies when intravenous access is difficult. Multiple drugs and fluids can be safely administered through the intraosseous route. Dosage and rate of infusion are essentially the same as with intravenous infusion.
Child, Preschool↗
Vulvovaginitis: diagnosis and management.
Successful treatment of vaginitis is based on a specific diagnosis and therapy (Table 2). The diagnostic category of nonspecific vaginitis is not helpful in therapy or in prevention and should be abandoned. In addition, sulfonamide creams and other broad-spectrum vaginal preparations have not been effective in treating vaginitis and should not be used for empiric treatment. The goal of therapy is not only to relieve symptoms, but also to achieve high cure rates and to prevent recurrence or transmission of the condition.
Anti-Bacterial Agents↗
Bacterial vaginosis: etiology, association with preterm labor, diagnosis, and management.
Bacterial vaginosis is a polymicrobial condition (anaerobes, Gardnerella vaginalis) that is associated with symptomatic vaginal discharge. Bacterial vaginosis can be reliably diagnosed through clinical indicators such as clue cells on wet preparation of vaginal discharge, an increased pH of vaginal discharge, a fishy, amine odor emitted when a sample of vaginal discharge is placed in potassium hydroxide, and cultures that isolate G. vaginalis. The vaginal discharge is often heavy and foul smelling, and usually resolves when treated with metronidazole, 500 mg twice a day for seven days. It is unclear whether bacterial vaginosis is caused by G. vaginalis or whether G. vaginalis is simply associated with the condition and its development is related to other factors. More importantly, the association of bacterial vaginosis with preterm labor (whether merely a risk factor or a causal factor) needs to be clarified, and the question of whether treatment of bacterial vaginosis in pregnancy will improve fetal outcome by decreasing prematurity needs to be addressed.
Female↗
Esophagogastroduodenoscopy by family physicians: a national multisite study of 717 procedures.
This is the first multisite report of esophagogastroduodenoscopies (EGDs) performed by family physicians. The first 717 EGDs performed by family physicians from 8 separate office practices provide a practical and safe rationale for selected cognitive and psychomotor aspects of continuing medical education after residency training. Although primarily in private practice, these physicians were affiliated with 6 academic institutions. This group of family physicians received training in short courses. The average amount of hands-on training before independent EGD was 8 supervised cases. Cumulatively, these data represent 227 months (18.9 years) of office practice. All cases were collected sequentially from the beginning of each physician's experience, and 454 cases were collected prospectively. Physicians reported excellent patient tolerance. Diagnostic yields were high, and biopsies were performed where appropriate. Pathologists reviewed biopsy specimens from 213 sites. The family physician endoscopic diagnosis agreed with the tissue diagnosis in 188 cases (88 percent). Physicians believed that EGD enhanced management or changed the diagnosis in more than 89 percent of cases. One bleeding complication requiring overnight hospitalization was noted. This complication rate 0.0014 (1/717) compares favorably with published subspecialty complication rates 0.0013 (1.3/1000). These data confirm the ability of some family physicians to perform EGD and suggest that continuation is safe. Biopsy analysis indicates diagnostic accuracy is high. Further study on the cognitive aspects and the defragmentation of care is needed.
Adolescent↗