One in 4 children will have at least 1 episode of acute otitis media (AOM) by age 10 years. AOM results from infection of fluid that has become trapped in the middle ear. The bacteria that most often cause AOM are Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. Differentiating AOM from otitis media with effusion (OME) is a critical skill for physicians, as accurate diagnosis will guide appropriate treatment of these conditions. Although fluid is present in the middle ear in both conditions, the fluid is not infected in OME as is seen in AOM patients.
Only a fraction of women seeing internists for their primary care are receiving counseling about ECPs, irrespective of receiving care from an obstetrician/gynecologist. As primary care physicians, internists should determine risk for unintended pregnancy, assess patients' knowledge and attitudes toward ECPs, and provide counseling about this effective therapy.
Background: Graduates of US allopathic and international medical schools comprise the majority of physicians who began family medicine residency in July 2011. Different procedural skills may be taught in allopathic and international medical schools leading to variation in the procedures that graduates can perform independently at the beginning of residency training. A mismatch between assigned resident tasks and procedural skills mastered during medical school may jeopardize patient safety.Methods: A survey was distributed nationwide to 3287 family medicine residents in July 2011 to determine the proportion of graduates of allopathic and international medical schools who self-reported the ability to perform each of 41 procedures independently.Results: Surveys were completed by 681 residents (response rate ؍ 21%). The proportion of allopathic and international graduates self-reporting the ability to perform 7 ambulatory, 4 inpatient and 4 maternity care procedures was statistically significantly different.Conclusions: All graduates self-reported the ability to perform few procedural skills independently upon entry to residency. More allopathic graduates self-reported the ability to perform ambulatory procedures, whereas more international graduates self-reported the ability to perform inpatient and maternity care procedures. Evaluation of individual resident competencies is key to tailor patient care responsibilities and supervision appropriately to resident abilities. (J Am Board Fam Med 2013;26: 28 -34.)
We compared the results of HFE genotype with tests for iron binding saturation (IBS) in 190 consecutive patients with liver disease using 2 IBS cutoff levels: 45% and 60%. Saturation was more than 45% in 117 patients (61.6%) and more than 60% in 89 (46.8%). The number of patients (10) with the highest-risk HFE genotype (C282Y homozygote) was higher than expected. Elevated IBS cannot be used to predict genotype. There was a modest association of C282Y homozygosity with increased IBS (7 of 10, saturation >45% and 6 of 10, >60%). There was poor correlation of elevated saturation with other genotypes containing 1 or more HFE variants. Patients with a wild-type genotype (lacking HFE variants) and elevated IBS were far more likely to have an iron binding capacity less than 250 microg/dL (<44.8 micromol/L) than those with saturation values less than 45%, suggesting that a significant percentage of elevated IBS test results in liver disease are false-positives associated with decreased synthetic capacity. Nevertheless, an appreciable number of patients with elevated IBS had normal iron binding capacity, indicating the complexity of relationships among iron absorption and binding, disease status, HFE genotype, and other potential modifying factors in liver disease.
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