Dean A. Seehusen

Postpartum Labial Adhesions

Background: Labial adhesions are common in young girls and menopausal women. Topical estrogen is the first line of therapy for these adhesions. Based on a systematic literature review, postpartum labial adhesions are uncommon in clinical practice. They are not painful but can prevent patients from resuming normal sexual activity. Topical estrogen therapy is an ineffective treatment option for adhesions in this setting. Surgical division under local anesthesia is usually effective. Case: A 29-year-old women presented at 6 weeks after an uncomplicated vacuum-assisted delivery for a routine postpartum evaluation. Examination revealed a 5-mm labial adhesion connecting her left and right labia minora. Division under local anesthetic resulted in a complete recovery within 3 days. Conclusion: Postpartum labial adhesions can usually be surgically divided under local anesthetic with complete and rapid recovery.

Screening for Veteran Status in the Primary Care Setting

Almost 24 million Americans are military veterans.[1][1] The size of this population and the fact that veterans are at increased risk for a wide variety of health complications make the care of veterans an important component of primary care. The large demand placed on the National Guard and

Maintenance of Skills for Today's Family Physician: The SAGE Approach to Physician Learning

Physicians need practical ways to maintain and augment clinical skills after residency training. The problem is amplified when a physician encounters a new practice environment that requires retraining in particular skills. With their broad scope of practice, family physicians are especially prone to deterioration of infrequently used skills. The SAGE model for lifelong learning provides a simple solution for todays military family physicians. Scan, assess, gather, and experience are four key steps physicians should take when maintaining or upgrading clinical skills. This approach allows physicians to identify available resources and to develop action plans to improve skills. Supervisors must encourage physicians to be honest in self-assessment of patient care skills and should support the acquisition of improved skills. System-based solutions, in keeping with suggestions from the Institute of Medicine, are introduced.

Advancing the Science of Implementation in Primary Health Care

Implementation Science is commonly described as the study of methods and approaches that promote the uptake and use of evidence-based interventions into routine practice and policymaking. In this issue of JABFM, investigators share a wealth of new insights from the frontlines of Implementation Science in primary care: what it is, how we are doing it, and how it is advancing the evidence base of primary care. The breadth of implementation science in primary care is affirmed by the range of topics covered, from thought leader recommendations on future directions for the field, to reports on how best practices in policy and practice are shaping primary care implementation in the United States and Canada. There are also important updates on agents of primary care implementation themselves, such as practice facilitators, geriatric care teams, and family physicians interested in providing obstetric care. Other articles report on novel practice transformation efforts that advance health promotion and disease prevention, and innovative approaches to identifying and addressing social determinants of health in primary care practices and the communities they serve. The articles seem to generate as many new questions as they answer, and highlight the need for continued emphasis on advancing the science of implementation in primary health care.

The Potpourri of Family Medicine, in Sickness and in Health

Some aspects of the health of Americans are declining, and family medicine is addressing these ailments. Obesity is one factor, and family physicians provide nutrition counseling. Despite new models such as direct primary care, we have not found an ideal method for providing primary care to everyone in our health system. Not all family physicians report burnout: what is their secret? Scribes: some positives and negatives from one group. Rural America is in need of more family physicians who provide prenatal and natal care, and the proof is in the infant mortality rate. We also have 2 articles on improving pediatric care, and research on the relationship of thrush to mode of infant delivery. We have reviews of new cancer and cholesterol drugs, raising awareness of important knowledge for the primary care clinicians seeing the patients who take these drugs. In addition: tick bites and delayed anaphylaxis—when and how, culture-related skin findings, and helping male perpetrators of domestic violence.

Health Care Integration and Coordination with Emphasis on Mental Health, but Not for Medical Marijuana

Care coordination and behavioral health care integration are the subject of 4 of this months articles. Patients with significant illness report that care coordination provides great challenges to them, and they expect family physicians to assist with the referrals and communication between the doctors. Patients primary care providers were usually not the prescribers of patients medical marijuana and were often unaware of its use, indicating lack of health care integration and coordination. Two articles provide insight into medication adherence. Also, how are family physicians addressing patient engagement at the practice level? Clinical topics in this issue include the following: specific exercises were not the answer to restless legs; epidural anesthesia may be associated with fewer, not more, vaginal lacerations; and fecal incontinence is less discussed but not necessarily less problematic than urinary incontinence. On the popular culture front, opioid mentions in top 100 songs are increasing. Lastly, what does it mean for the field of family medicine that some of us choose to become hospitalists?