Practitioner's Office Research Articles

PEDIATRIC PERCEPTIONS: THE PUBLIC HEALTH NURSE—A NEGLECTED RESOURCE

I Write to emphasize the very great assistance, particularly the kind of assistance, that I find dedicated nurses especially trained in pediatrics and Public Health can give to pediatricians. My emphasis is not on the number of patients who can be seen but the quality of service that can be given. For many years my academic environment and concentration on teaching and consultation protected me from the pressures present in a busy practitioner's office. During these years, I was often impressed by the great gratitude from parents of patients because, as they would say, "You have answered a lot of our questions." Often they would also say: "We like our own pediatrician very much, but his office is so crowded and he is so busy that we feel guilty in asking him all the questions we have about our children. What we really like about this visit is the way you have so generously given us of your time to answer all those questions that bother us."So, when I recently saw the new offices of a pair of pediatricians starting into practice, I was frankly upset to notice that in the many small examining rooms it was evident that chairs were kept at a minimum. Still more upsetting was the explanation that this arrangement made it easier for the physician to walk out of the room because he would be standing. Not only would there be less awkwardness in interrupting a conversation but the mothers would be less likely to sit down and ask questions if there were not enough chairs for everyone to be seated.

The Pedodontic Patient with Heart Disease

The child with congenital heart disease and acquired heart disease can have dental treatment done in the general practitioner's office. It is important that the dentist be familiar with the inherent risk of bacterial endocarditis that is always present when treating the child with cardiac disease. Some knowledge of the type of congenital heart disease and the forms which are more susceptible to bacterial endocarditis is advantageous to the dentist when treating these children. The child with a history of rheumatic heart disease who is on regular chemoprophylaxis for recurrent streptococcal infections requires additional coverage when undergoing dental treatment. The controversy that exists in regard to rendering dental treatment for this type of patient should be appreciated by the dentist, and a method of antimicrobial prophylaxis for these children should be formulated in consultation with the child's physician. Most dental procedures can be done for the child with cardiac disease if the following suggestions are observed: 1. Obtaining a proper history to uncover any previous episodes of rheumatic fever or presence of congenital heart defects. 2. A close professional relationship between the dentist and the child's physician in order that optimal treatment of the child with heart disease will be accomplished. 3. Elimination of all oral infection by the removal of all abscessed teeth and other foci of infection. 4. Maintenance of good oral hygiene, preservation of all carious teeth by the placement of good restorations. 5. Adequate antimicrobial chemotherapy for dental procedures that require prophylaxis.

Educational Value of the Free Clinic

To the Editor.— An interesting point not emphasized in the recent special communication Free Medical (219:603, 1972) is that of the educational possibilities of the Free Clinic, particularly in the field of venereal disease and drug education. The Free Clinic can act to educate the local physicians in the proper treatment of venereal disease and drug abuse. This type of opportunity is not available elsewhere, for the most part, to the interested physician. This is due mainly to the fact that the volume of cases seen in the average general practitioner's office or even in the average specialist's office relating to venereal disease or drug abuse is extremely limited, while the case load in these categories at the Free Clinics is considerably greater. A physician can learn all about venereal disease and learn all about these conditions at a Free Clinic within a few days, while it would

The Nation's Health Insurance aud Health Services Policies

The people need a substantially larger volume of scientific medical service than they now receive... There is need for a geographical distribution of practitioners and agencies which more closely approximates the medical requirements of the people.... There needs to be better control over the quality of medical service.... The prevailing methods of purchasing medical care have unsatisfactory consequences. They lead to unwise and undirected expenditures, to unequal and unpredictable financial burdens for the indi vidual and the family, to neglect of health and of illness, to inadequate expenditures for medical care and often to unequal remuneration of practi tioners. There needs to be some plan whereby the unequal and sometimes crushing burden of medical expenses can be distributed... Physical facilities are duplicated between the hospitals and the offices of practitioners and are insufficiently utilized in both.... Misdirected expenditures, competition and excessive specialization among practitioners and the absence o f commun ity planning and of integration of services and facilities contribute to exten sive waste [Committee on the Costs of Medical Care, 1932: 32-34].

Manual of Family Planning and Contraceptive Practice

The second edition was originally planned as a revision of the 1964 edition, but revolutionary advances in conception control necessitated a more comprehensive approach. Drs. Hans Lehfeldt and Christopher Tietze, as editorial consultants, assisted in designing the present format—a broad survey of contraception and its relationship to medical, social, legal, and psychological factors. Four classical sections by Dickinson, Lehfeldt, Masters and Johnson, and Sjovall have been retained from the first edition. Everything else is new. The section on family planning, by 25 distinguished authorities, places in clear perspective the specific roles of government agencies and voluntary organizations and succinctly presents the methods of population control practice in hospitals, public health services, and offices of private practitioners. The keystone of success is motivation. If this is strong, almost any contraceptive method will prove reasonably successful. The choice of the most acceptable method for any given couple is, therefore, a paramount issue.

Survey of enterovirus infections in Matsue district, Shimane Prefecture

Enteroviruses were detected during April to December, 1968, on 290 samples of cerebrospinal fluids, throat swabs and feces materials of 221 patients visiting medical practitioner's offices or general hospitalsin Matsue city, Shimane prefecture and giving suspicion of viral infections. Most of the samples were from the department of pediatrics of Matsue Red Cross Hospital and Dr. Nishino's office.In some of them, neutralization tests for Cox. B5 were paralleled by paired sera.Besides, the results of a serological survey carried out in Decembeir, 1967, the previous year, on a number of Children.at the age, 0-14, were presented as a discussion for 1968's prevalence of aseptic meningitis in this city.The summary is as follows:1) Of all 290 materials, 84 were revealed as enterovirus positive; 25 out of 66 cerebrospinal fluids, 6 out of 58 throat swabs and 53 out of 166 feces materials. Thus, 60 patients out of 221 were virologically positive, the rate being 27.1%.2) Isolation rate in every clinical diagnosis was 72.5% in aseptic meningitis, 33.3% in myalgia, 19.2% in what was tentatively diagnosed as fever disease, and 6.7% in herpangina. No viruses were isolated in 21 cases of pharyngitis, 1 case of stomatitis aphthosa, two cases of hand-foot-and-mouth disease, and other 10 cases.3) The viruses were most frequently isolated in July and August. Ages of the cases were mostly within 0-7.4) In aseptic meningitis, isolation rate is particularly high (51.8%) in cerebrospinal fluids.5) No particular relation between cell count of cerebrospinal fluid and virus isolation rate is reognized.6) Isolation rate was visibly higher in the case of specimens sent from the medical practitioners' than from the general hospitals. The gap was particularly wide in the case of cerebrospinal fluid. One of the reasons seemed to be procedural deficiency, such as delay in transportation, on the part of the general hospitals.7) Neutralization tests for Cox. B5 were paralleled in 8 cases; 3 of them were Cox. B5-positive aseptic meningitis, 3 were virus-negative aseptic meningitis and two others were virus negative. Except one virusnegative aseptic meningitis case who had already shown positive at 16 folds in tht earlier serum, the later sera of all cases rose 4 times or over than the earlier ones in the antibody titer.8) In serological investigations performed in December, 1967, the antibody possessing rate for Cox. B5 was null in the healthy children tested of 0-3 years age and low even in the age group 4-14. This fact is thought to be one of the main causes of 1968' prevalence of aseptic meningitis in this city.

Organization and Delivery of Personal Health Services: Public Policy Issues

This paper will examine some of the alleged defects in the present personal health services system, state some assumptions that may condition changes, pose public policy issues that require resolution to effect desirable changes, and set forth specific proposals designed to improve these services. 'lhe viewpoint will be primarily that of the patient and the community, but not to the exclusion of the views of the health professions and institutions. The object will be to identify major issues and nodal points in the health services system that might be influenced by leadership, discussion or programs initiated at the federal level. Personal Health Services means all health services other than Environmental Health Services. Specifically, those things done to ancl for all individuals who request or require health services provided by doctors, nurses and dentists and the allied health professions. No distinction is made between so-called preventive, diagnostic, therapeutic and rehabilitative functions, nor would it be helpful to separate the physical, emotional and social components of illness. These are transient divisions of interest, emphasis, organization and style based more on tradition and arbitrary jurisdictional arrangements than on humanaitarian, scientific or technical constraints. No distinction is made between the various sites of care at which Personal Health Services may be given; for example, the solo practitioner's office, the outpatient dispensary, the voluntary, private or public hospital-their clinics and wards, the health department clinic, the group practice clinic, the home, the factory or the school. Nor is the posture of the patient, vertical or

THE NATIONAL MENTAL HEALTH PROGRAM.

IN view of the speed with which events in the mental health field have moved in the past year, and of the gratifying advances which have been achieved in the National Mental Health Program, it is time that a report be rendered to our colleagues in this Association. This has, indeed, been a momentous year for all of us who have a concern for the over two million persons who, each year, seek assistance for mental and emotional illnesses and disturbances. As I look back over the events of the past year, I realize I am looking back at the close of an era in the history of our care of the mentally ill from which we are emerging. We are in transition from an era of primarily custodial care for many of our mentally ill to an era of comprehensive and dynamic treatment for all mentally ill: treatment that is both comprehensive at any particular point in the patient's illness, and over whatever period of time-whether short, continuous, or intermittent-such treatment is needed. We are now concerned with a framework of service which admits no separation of prevention, treatment, and rehabilitation. This is the crux of the new concept of community medicine which focuses on the social aspects of medicine as well as on the specific actions intended to prevent or cure disease in the individual patient. It implies that all organized services in the health field are mutually dependent one upon the other, and that care in any one setting-the home, the private practitioner's office, the public clinic, the hospital, or other institution-is not an isolated experience.

The Emergency Clinic

In the last decade hospitals have been forced to re-examine their emergency clinics because increasing numbers of patients are using such facilities. In most hospitals today the traditional concept of the emergency room, as a receiving ward for accidentally injured and critically ill patients, no longer holds. Indeed, emergency clinics in most hospitals could more properly be called dispensaries, or ambulatory clinics, dealing as they do with relatively very few cases that could not be adequately treated in the practitioner's office. Shortliffe et al.1 found an average increase of 400% in emergency room visits in the 15-year period, 1940 to 1955, in 90 United States hospitals. The Hartford Hospital saw its annual emergency room load increase from 3,000 in 1944 to just under 18,000 in 1955. Likewise, emergency room visits at the Beth Israel Hospital in Boston increased from 5,500 in 1951 to 13,000 in 1959. 2 The situation appears to

The emergency clinic—a study of its role in a teaching hospital

In the last decade hospitals have been forced to re-examine their emergency clinics because increasing numbers of patients are using such facilities. In most hospitals today the traditional concept of the emergency room, as a receiving ward for accidentally injured and critically ill patients, no longer holds. Indeed, emergency clinics in most hospitals could more properly be called dispensaries, or ambulatory clinics, dealing as they do with relatively very few cases that could not be adequately treated in the practitioner's office. Shortliffe et al.1 found an average increase of 400% in emergency room visits in the 15-year period, 1940 to 1955, in 90 United States hospitals. The Hartford Hospital saw its annual emergency room load increase from 3,000 in 1944 to just under 18,000 in 1955. Likewise, emergency room visits at the Beth Israel Hospital in Boston increased from 5,500 in 1951 to 13,000 in 1959. 2 The situation appears to

An Introduction to Social Psychiatry.

This is a publication of the Salmon Lectures delivered by Dr. Alexander Leighton. It is, avowedly, an attempt both to define social psychiatry in terms of certain current psychiatric practices and to post benchmarks for further developments. Perhaps it is due to the lecture format (brief and a bit discursive) that the book falls somewhat short of its objectives—short of what is ordinarily expected of a formal introduction to some subject matter. The book is divided into two sections: Part I—Actions and Uses; Part II—The Widening of Knowledge. In the first, Leighton takes the reader on a tour of various locations where psychiatry is practiced, other than in clinics and private practitioner offices: courtrooms and prisons, armed forces, schools, industrial plants, and governmental agencies. In addition, Leighton indicates how psychiatrists alone or in teams with parapsychiatric professionals and behavioral scientists are involved in the study of mental institutions and small

Effectiveness of Mass Survey of Diagnostic X-Ray Equipment in Promoting Radiation Safety

The Division of Radiological and Occupational Health of the Florida State Board of Health, in conjunction with local health departments, is presently engaged in a state-wide mass safety survey of operating diagnostic x-ray equipment in the offices of private practitioners. This is a voluntary program approved by the local medical societies. The initial study (1) in Dade County involved 204 fluoroscopes and 204 roentgenographic units. These were examined with reference to adequate coning, filtration, target-panel distance, table surface dose rate, shutter adjustment, and the presence of such safety equipment as protective flaps, Bucky slot covers, timers, protective aprons and gloves, gonadal shields, operator shielding, fast-film and high-speed cassettes. The total aluminum equivalent filtration was determined indirectly, where necessary, by the method of Hale et al. (2). A standard Victoreen 520 r-rneter and two 25-r chambers were used for direct measurements and a calibrated 2-mm. thick aluminum cap was...

A Manual of Bandaging, Strapping and Splinting. Fourth edition.

This manual, with the use of pen and ink illustrations (which make up more than three-quarters of the content), admirably presents the commonly used techniques. The illustrations are sufficiently clear so that the inexperienced intern, after careful reading, should be able to apply dressings, bandages, splints, and casts. Subject material has been chosen with discrimination and is limited to the commoner injuries seen in a hospital emergency department or in a general practitioner's office. A concise text complements the illustrations. The brief bibliography provides useful references; an index adds to the usefulness of the book. This manual is recommended to medical students, interns, and all persons concerned with first aid practice and education. The experienced general practitioner and surgeon will find it elementary and of little use.

Is a fluoroscope useful to the general practitioner.

Recent concern over the amount of ionizing radiation to which the public is exposed raises the question of the safety and utility of the fluoroscope in the general practitioner's office. There is evidence that the amount of exposure during fluoroscopy varies widely, as does the output of the fluoroscopes actually found in use. The busy practitioner does not always take time for his eyes to achieve maximal dark adaptation, and optimal filtration and other safety precautions have often been neglected. Fluroscopy is most valuable in observing abnormal movements. It therefore supplements the data obtained from roentgenography, which is otherwise more precise, yields permanent records, and gives more diagnostic information in proportion to the amount of radiation involved.

Preventive medicine in the general practitioner's office.

Preventive Medicine in the General Practitioner's Office Affiliation John S. DeTar CopyRight*Presented at a Joint Session of the Academy of Medicine of Cleveland, the Cuyahoga County Medical Society, and the Health Officers and Medical Care Sections of the American Public Health Association at the Eightieth Annual Meeting in Cleveland, Ohio, October 22, 1952. https://doi.org/10.2105/AJPH.43.2.125 Published Online: August 29, 2011

Fertile fields for the general practitioner.

In 1948 Dr. Eric Royston 1 read a paper entitled Renaissance of the General Practitioner at the Annual Session of the American Medical Association. In 1949 Dr. Winfred Harm 2 stated that every general practitioner's office should be a cancer detection center. I hope to present other phases of the work of the physician who engages in many fields of medical practice. His position is unique, both in the community and in organized medicine. It is my purpose to continue in the same tenor as Dr. Harm, the former chairman of the Section on General Practice, in presenting fields of usefulness and influence of the family physician. HOME AND FAMILY CONTACTS The general practitioner is the only man in America today who is ready to answer any and all emergency calls in the home. These emergencies range from ruptured gastric ulcer, acute coronary occlusion, fractured bones, uterine hemorrhage, circulatory

Exercise and Keep Fit

logical manner with discussions of etiology, pathological and physiological changes, symptomatology and the evaluation of various forms of treatment. The author has a wide knowledge of the literature and this together with his intimate experience with most of the subjects discussed makes the book a valuable guide to the clinician. The appendix prepared by MansonBahr's assistant for many years is an important laboratory aid in diagnosis. There is a bibliography of 23 pages and a detailed index. One of the best features of the book is the illustrations, many of which present the macroscopic lesions of the tongue and intestine. Those reproduced in color are especially valuable. There are also many reproductions of x-ray pictures of the colon. The drawings of intestinal protozoa have mostly been borrowed from Dobell and Wenyon and are supplemented by two colored plates by the senior author. Although the British point of view predominates and some forms of treatment vary from approved practices in the United States, the reviewer believes that this book should be available generally in medical libraries and in the offices of practitioners who deal with this group of diseases. It is splendidly printed on glossy paper which takes the illustrations well, and the authors and publishers are to be commended on the result. HENRY E. MELENEY

THE PERNICIOUS TYPE OF NERVOUS DYSPEPSIA

Excerpt That there is such a nosological entity as nervous dyspepsia is generally admitted. It constitutes a large proportion of the practitioner's clinical office material. The real difficulty beg...

New Developments in the Departments of Sociology in Relation to Courses in the Law School

T HE historic relation between and sociology needs to be kept in mind if one is to arrive at a sound conclusion concerning the relationships between sociology and in our American universities. It must not be forgotten that the schools arose in response to the need of an institution to train lawyers. Until schools were organized, the lawyer like the doctor, was trained in a practitioner's office. He prepared to practice by reading law in a lawyer's office under the guidance of a practicing lawyer. The chief end of the lawyer was to advise his clients with relation

A NEW FARADIC BATTERY AND ITS USE.

Read before the Section of Practice of Medicine of the American Medical Association at Washington, May 8, 1884. The object of this paper is to urge the necessity of having a reliable faradic battery ready to work, at a moment's notice, in every practitioner's office; and to exhibit here a new improvement, which promises the completion of this desideratum. The faradic current of electricity acts chiefly mechanical. From reports of clinical cases, it seems that it has other qualities, which at present are not sufficiently defined, but unquestionably the principal action is mechanical. It is a mistaken idea, which some entertain, that a faradic battery has some galvanic action, because one part of such a battery consists of one or two cells. The patient never gets an effect from these cells, as they act solely as a motor power to the induction coil; and never can give galvanism. The faradic