Background:The closure of obstetrics (OB) units at rural hospitals is thought to have implications for access to prenatal care (PNC) and infant mortality rate (IMR). The objective of this study was to determine whether local availability of PNC and OB services, specifically as provided by family physicians (FPs), would be associated with a lower IMR in 1 rural Alabama county.

IntroductionRadioactive iodine (RAI) has been used to treat hyperthyroidism for more than 70 years. Cure rates after RAI therapy range between 80% and 100%, with some patients requiring two or more doses. There is continued debate over which dosing regimen is optimal. We evaluated our cure rates after giving a single dose of radioactive iodine to treat hyperthyroidism using the fixed-dose regimen as opposed to the calculated-dose regimen. Materials and methodsWe retrospectively reviewed the clinical records of patients who had received their first single dose of RAI between 2016 and 2021. The patients had clinical and biochemical assessments every six weeks until six months post-RAI therapy, then every three months thereafter, if still not cured. Patients were deemed cured if they developed persistent hypothyroidism or euthyroidism after a single dose of RAI. The data included baseline demographics, adverse events, and cure rates after RAI treatment. ResultsOne hundred and thirty-eight patients received their first dose of RAI during the study period. Their mean ± standard deviation (SD) age was 56.9 ± 15.3 years, and there were 101 women and 37 men. The median duration of hyperthyroidism was 34 months, and 62% of the cases were affected by Graves' disease. A majority of patients (90%) were on an antithyroid drug prior to RAI therapy. The median (interquartile range) dose of RAI received by the group was 559 (546-577) megabecquerels (MBq). Four patients (2.9%) reported adverse events shortly after receiving RAI. Our overall cure rate was 87.7% amongst patients who received a single dose of RAI therapy. This number consisted of 96 patients (69.6%) who developed hypothyroidism and 25 patients (18.1%) who remained euthyroid. Our one-year cure rate was 84.1%. Further analysis revealed that women had a greater cure rate than men over the study period (92% vs 75.7%, p = 0.017). ConclusionWe have evaluated cure rates after a single dose of RAI therapy for the treatment of hyperthyroidism at our center. Our results are comparable to those reported at other centers using a similar dosing regimen.

Family physicians practicing rural obstetrics makes great business sense. Obstetrical complications and outcomes for family physicians are comparable to those of OB/ GYN's. The cost of malpractice insurance for family physicians who offer full service obstetrical care in Alabama is significantly less than for an OB/GYN. Family physicians can offer comparable obstetrical care to OB/GYN's at a fraction of the cost. Family Physicians who practice obstetrics are almost never sued because of their long-term relationship with the patient and family. Family physicians have lower cesarean section rates than OB/GYNs primarily because they perform more vaginal births after cesarean sections (VBAC) which translate into shorter hospital stays, fewer complications, less expensive care, fewer operative risks and hopefully, happier patients.

G, et al. How can we increase the number of general and rural surgeons in the United States? A study of 789 graduates from 3 campuses who matched into general surgery over 40 Years:

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