What do physicians know and say about fetal alcohol syndrome: a survey of obstetricians, pediatricians, and family medicine physicians

Pediatricians, obstetricians, and family practice physicians in Michigan were surveyed by mail for their knowledge and opinions about Fetal Alcohol Syndrome (FAS) and Fetal Alcohol Effects (FAE). Physicians said that about 67% of their patients raised questions about drinking during pregnancy but only 2% specifically referred to FAS or FAE. Most physicians were uncertain about whether their colleagues were sufficiently aware of FAS, whether FAS could be diagnosed at birth, or if physicians were acquainted with the syndrome's major criteria. However, most believed FAS was not being overdiagnosed and believed that making a diagnosis of FAS at birth could lead to improved treatment of an affected child. Physicians also believed that physician counseling was a more effective way of reducing the incidence of FAS/FAE than warning labels. Forty-one percent of the physicians placed the threshold for FAS at one to three drinks per day and 38% placed the threshold at one or fewer drinks a day. Thirty-five percent placed the estimated incidence of FAS at 1 to 2 per 1000 in the United States. We conclude that physicians are in relative agreement about the effects of drinking during pregnancy and the value of physician counseling but are misguided as to what constitutes a true risk level of drinking as far as the etiology of FAS is concerned.     

Electroconvulsive therapy: a guide for family physicians

Electroconvulsive therapy, which works by creating a generalized seizure, is used most frequently to treat medication-resistant depression. Other indications for electroconvulsive therapy includes severe depression with suicidal ideation, acute mania and severe psychiatric illness with food and fluid refusal. Electroconvulsive therapy may be administered as an inpatient or outpatient procedure. Treatments are usually administered three times a week for six to 12 treatments. Before this therapy is used, a thorough medical and anesthetic history should be obtained, and a complete physical examination, an electrocardiogram and appropriate laboratory studies should be performed to rule out anemia, electrolyte imbalances, and cardiopulmonary and neurologic risk factors. Heart rate and rhythm, oxygenation, blood pressure and, often, the electroencephalogram are monitored continuously while the patient is anesthetized with a short-acting hypnotic agent and a muscle depolarizing agent. After electroconvulsive therapy, antidepressant or lithium therapy significantly reduces the symptom relapse rate.     

Collaboration between psychologists and family physicians: Implementing the biopsychosocial model.

Training in primary care medicine in the past decade has included more attention to the psychosocial issues of patients. With this shift, psychologists have new opportunities to collaborate with medical providers to provide comprehensive health care to medical patients and their families. Systems theory and biopsychosocial medicine provide compatible theories to underpin this collaboration. Suggestions are made for overcoming the considerable barriers to implementation of this model, and examples of creative collaboration are described. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Periocular capillary hemangioma: a review for pediatricians and family physicians

We retrospectively evaluated the incidence of late accumulation of 99Tcm-HMPAO leukocytes (99Tcm-WBC) in the right lower quadrant of a large population of children and characterized some predictive patterns that would enable differentiation of active inflammation from this late occasional accumulation of 99Tcm-WBC. We reviewed the charts of 211 children. The first group evaluated consisted of 79 controls: 30 normal children with no gastrointestinal disease, but who underwent 99Tcm-WBC scanning for other medical problems, and 49 children who had non-specific gastrointestinal (GI) complaints, but had no demonstrable inflammatory bowel disease by conventional diagnostic methods. The second group consisted of 132 children with inflammatory bowel disease: 80 children with Crohn's disease (CD), 34 with ulcerative colitis (UC) and 18 with indeterminate colitis (IC). Children were imaged at 30 min and 3 h. Fifteen (19%) of the 79 controls scanned showed accumulation of 99Tcm-WBC in the right lower quadrant at 3 h and none at 30 min. Of those 15, 8 were from the control population and 7 from the group with non-specific GI complaints and negative work-ups. There was no uptake in other segments of the bowel. The accumulation was faint, of lesser intensity than in the iliac wing, and diffuse, such that identification of a specific loop of involved bowel was not possible. Migration of the 99Tcm-WBC distal to the terminal ileum was demonstrated. The other 64 children in the control group showed no accumulation of 99Tcm-WBC at any time during their scans. All 79 scans were blindly interpreted as normal studies. There were no false-positive readings encountered in the 132 children with inflammatory bowel disease (80 CD, 34 UC, 18 IC) when the aforementioned characteristics of the late accumulation of 99Tcm were used to differentiate inflammation from this physiological excretion. In conclusion, the late accumulation of 99Tcm-WBC in the right lower quadrant is characterized by (1) accumulation at no less that 3 h, (2) no accumulation in other segments of the bowel, (3) faint accumulation of lesser intensity than in the iliac wing, (4) a diffuse accumulation pattern and (5) migration of the 99Tcm-WBC into the caecum and ascending colon over time. Recognition of this excretion pattern enables differentiation of active Crohn's disease of the small bowel from migration and accumulation of 99Tcm-WBC in the right lower quadrant of the abdomen.     

The psychiatric review of symptoms: a screening tool for family physicians

The psychiatric review of symptoms is a useful screening tool for identifying patients who have psychiatric disorders. The approach begins with a mnemonic encompassing the major psychiatric disorders: depression, personality disorders, substance abuse disorders, anxiety disorders, somatization disorder, eating disorders, cognitive disorders and psychotic disorders. For each category, an initial screening question is used, with a positive response leading to more detailed diagnostic questions. Useful interviewing techniques include transitioning from one subject to another rather than abruptly changing subjects, normalization (phrasing a question to convey to the patient that such behavior is normal or understandable) and symptom assumption (phrasing a question to imply that it is assumed the patient has engaged in such behavior). The psychiatric review of symptoms is both rapid and thorough, and can be readily incorporated into the standard history and physical examination.     

Physician practice styles and patient outcomes: differences between family practice and general internal medicine

OBJECTIVES: This study compared patient health status, patient satisfaction, and physician practice style between family practice and internal medicine. METHODS: New adult patients (n = 509) were prospectively and randomly assigned to family practice or internal medicine clinics at a university medical center and followed for 1 year of care. Practice styles were characterized by the Davis Observation Code. Self-reported health status (Medical Outcomes Study, Short Form-36) and patient satisfaction also were measured. RESULTS: There were no significantly different changes in self-reported health status or patient satisfaction between family practice and internal medicine physicians during the course of the study. Family practice initial encounters, however, were characterized by a style placing greater relative emphasis on health behavior and counseling, whereas internists used a more technical style. Improved health status scores after treatment were predicted by a practice style emphasis on counseling, whereas improvements in patient satisfaction scores were predicted by a style of care stressing patient activation. Although this is the first known randomized trial studying this issue, the conclusions are limited by a 38% loss of patients from enrollment to care and a loss of 18% at the 1-year follow-up evaluation. CONCLUSIONS: There were significant differences in practice styles between family physicians and internists; however, it was the physician's behavior, not specialty per se, that affected patient outcomes. A practice style emphasizing psychosocial aspects of care was predictive of improvements in patient health status, whereas a practice style emphasizing patient activation was predictive of improvements in patient satisfaction.     

About the nomination and training of family physicians

OBJECTIVE: To study sister chromatid exchange (SCE) frequency in lymphocytes of pregnant women with intrauterine growth retardation (IUGR) infants. METHODS: The frequency of SCE in peripheral blood lymphocytes of 14 pregnant women with IUGR babies and 90 normal pregnant women as well as the umbilical blood of their infants were investigated. RESULTS: The mean frequency of SCE in maternal and umbilical blood with normal pregnancy were 7.58 +/- 0.32 and 5.05 +/- 0.29 respectively, while they were 10.53 +/- 2.69 and 7.25 +/- 1.34 in IUGR group respectively. The difference of SCE levels between the 2 groups of mother was statistically significant (P < 0.01), so was that of the umbilical blood group. CONCLUSION: One of the causes of IUGR may be related to heredity injury. Thus, SCE will be a new diagnostic index to predict IUGR.     

Minor head injury in children: current management practices of pediatricians, emergency physicians, and family physicians

OBJECTIVE: To describe variation in the clinical management of minor head trauma in children among primary care and emergency physicians. DESIGN: A survey of pediatricians, family physicians, and emergency physicians drawn from a random sample of members of the American Academy of Pediatrics, the American Academy of Family Physicians, and the appropriate American Medical Association specialty listings, respectively. Physicians were given clinical vignettes describing children presenting with normal physical examination results after minor head trauma. Different clinical scenarios (brief loss of consciousness or seizures) were also presented. Information was gathered on initial and subsequent management steps most commonly used by the physician. RESULTS: Surveys were returned by 765 (51%) of 1500 physicians. Of these, 303 (40%) were pediatricians, 269 (35%) family practitioners, and 193 (25%) emergency physicians. For minor head trauma without complications, observation at home was the most common initial physician management choice (n = 547, 72%). Observation in office or hospital was chosen by 81 physicians (11%). Head computed tomographic (CT) scan was chosen by 7 physicians (1%) and skull x-ray by 24 physicians (3%) as the first management option. Most physicians (n = 445, 80%) who initially chose observation at home would obtain a CT scan if the patient showed clinical deterioration. In the original scenario, if the patient had also sustained a loss of consciousness, 383 physicians (58%) altered management. Of these, 120 (18%) chose CT, 13 (2%) chose skull x-ray, 1 (1%) chose magnetic resonance imaging, 141 (21%) chose inpatient observation, and 125 (19%) chose a combination of CT scanning and observation. With seizures, 595 (90%) altered management, with 176 physicians (27%) choosing CT scan, 5 (1%) skull x-ray, 60 (9%) inpatient observation, and 299 (45%) a combination of radiological evaluation and observation. CONCLUSIONS: Most physicians surveyed chose clinic or home observation for initial management of minor pediatric head trauma. Clinical management was more varied when patients had sustained either loss of consciousness or seizures. Further study of the appropriate management of minor head trauma in children is needed to guide physicians in their care.     

Skills that Iowa family physicians desire in a new physician partner

BACKGROUND AND OBJECTIVES: The importance of specific skills in primary care continues to be debated. As a result, there is not consensus on which skills need to be stressed during residency training. Our project asked community-based family physicians to rate the importance of specific skills in a new family physician partner. METHODS: Data were collected through a cross-sectional survey of all active members of the Iowa Academy of Family Physicians. Participants were surveyed by mail, using a list of 83 skills pertinent to primary care. Physicians were asked to rate the importance of a new member of their practice having the individual skills on this list. RESULTS: A total of 546 family physicians (67%) completed questionnaires. Fourteen skills (seven cognitive and seven psychomotor) were reported to be "essential" or "very important" by at least 80% of the physicians. A total of 43 skills were rated as "essential" or "very important" by at least 50% of responding family physicians. Many of the hospital-based procedural skills, particularly those used in an intensive care setting, were rated as less important. The importance ratings of many skills were associated with the physicians' ages, size of their primary hospitals, and availability of other medical specialties. CONCLUSIONS: Family physicians tended to rate office-based procedural skills, counseling skills, and management skills as "essential or very important" to their practices. These rating might be used to guide residency training in family practice.     

Relations between family predictors and child outcomes: Are they weaker for children in child care?

Studies suggesting that family factors predict developmental outcomes more strongly for children reared principally by their parents than those with extensive early child-care experience stimulated the examination of the differential prediction of child outcomes using a subsample of families participating in the National Institute of Child Health and Human Development (NICHD) Study of Early Child Care. A variety of factors were used to predict development of children who averaged 30 hr of nonparental care per week for each month of their lives and for those who never experienced more than 10 hr of care per week by someone other than their mothers. Multivariate analyses provided no evidence that family factors predicted outcomes differentially for these 2 groups, though exploratory analyses revealed several instances of differential prediction. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Opinions and practices of family physicians regarding measles-mumps-rubella vaccination

BACKGROUND: Measles-mumps-rubella immunization rates among young children depend on the awareness and responsibility of parents and physicians. In order to improve immunization programmes, it is important to enhance our knowledge about attitudes of physicians in regard to MMR immunization. A random sample of 1013 general practitioners was interviewed by telephone in December 1994, with the collaboration of the BVA Institute. The large majority of French physicians (86%) have a favourable opinion about MMR immunization that they systematically propose to each child aged 12-24 months. However, barriers remain among some physicans. Favourable opinion about MMR immunization to infants was less frequent among physicians aged 41-50 years, homeopaths, those practicing in Southern France, those asking for higher payment to patients, those who are treating a small proportion of patients receiving public medical aid, those not convinced about the role of physicians in health education, those who experienced side-effects of immunization and those who are not personnally immunized against hepatitis B. Eradication of measles, mumps and rubella in France will be only achieved through a stronger and well-argumented information of physicians supported by health professional organizations.     

Linking psychologists and family physicians for collaborative practice.

This article describes a pilot, demonstration project that linked psychologists and family physicians to improve the care of patients with alcohol and other drug abuse problems. The project facilitated collaborative practice between family physicians and psychologists to enhance treatment of patients with alcohol and other drug abuse and other psychosocial problems in rural America. Ten pairs of psychologists and family physicians in rural Texas and Wyoming participated in the project. The training successfully established linkages between psychologists and family physicians for the care of a broad range of medical and psychological problems. This article discusses the linkage training, factors that facilitated and hindered collaboration, as well as implications for future training and collaborative health care practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A comparison of linear and nonlinear relations between organizational commitment and work outcomes.

The authors compared linear and nonlinear relations between affective and continuance commitment and 3 commonly studied work outcomes (turnover cognitions, absenteeism, and job performance), observed in 3 separate research settings. Using a linear model, they replicated the common observation in the literature that affective commitment is more strongly related to work outcomes than continuance commitment. Introducing a higher order continuance commitment term into the same equations, however, they found that the linear model seriously understated the magnitude of continuance commitment's effect on all 3 criterion measures. These findings are consistent with recent developments that identify different motivational mindsets associated with affective and continuance commitment (J. P. Meyer, T. E. Becker, & C. Vandenberghe, 2004). (PsycINFO Database Record (c) 2010 APA, all rights reserved)