Jonathan E. Rodnick

Current Diagnosis of Venous Thromboembolism in Primary Care: A Clinical Practice Guideline from the American Academy of Family Physicians and the American College of Physicians

This guideline summarizes the current approaches for the diagnosis of venous thromboembolism. The importance of early diagnosis to prevent mortality and morbidity associated with venous thromboembolism cannot be overstressed. This field is highly dynamic, however, and new evidence is emerging periodically that may change the recommendations. The purpose of this guideline is to present recommendations based on current evidence to clinicians to aid in the diagnosis of lower extremity deep venous thrombosis and pulmonary embolism.

Management of venous thromboembolism: a clinical practice guideline from the American College of Physicians and the American Academy of Family Physicians.

Venous thromboembolism is a common condition affecting 7.1 persons per 10,000 person-years among community residents. Incidence rates for venous thromboembolism are higher in men, African-Americans, and increase substantially with age. It is critical to treat deep venous thrombosis at an early stage to avoid development of further complications, such as pulmonary embolism or recurrent deep venous thrombosis. The target audience for this guideline is all clinicians caring for patients who have been given a diagnosis of deep venous thrombosis or pulmonary embolism. The target patient population is patients receiving a diagnosis of pulmonary embolism or lower-extremity deep venous thrombosis.

Health behavior changes associated with health hazard appraisal counseling in an occupational setting

Abstract A Health Hazard Appraisal (HHA) and counseling session for 292 employees was performed initially and repeated 1 year later. The following changes in medical risk factors over the year period were observed: reduction in blood pressure—especially in those with mild hypertension, decrease in cholesterol level in middle-aged men, some cessation of cigarette smoking, increase in reported exercise in women and men who initially were more sedentary, increase in the performance of breast self-examination by women, decrease in alcohol consumption in men, and increase in seat belt use by men. These changes resulted in a significant reduction in risk age for men. The program was subjectively judged to be very successful by both employees and the employer.

Community models for cancer prevention and detection

Optimal community programs in cancer prevention and detection have as their goals the lowering of incidence, complications, and mortality from cancer in a population, and are characterized by efficiency, self‐sustainability, and generalizability. Programs fall into three categories according to their degree of integration into the normal health‐care system. “Extra‐systemic” programs are temporary demonstration activities, which may have research goals. “Quasi‐systemic” activities include public health department programs, worksite programs, and specialized centers such as breast screening centers. “Systemic” activities involve counseling and screening in routine medical practice. The greatest potential for reaching the indicated goals lies in facilitating systemic activities by allowing primary‐care practitioners to define their own prevention goals, to make changes in their practices to address these goals, and to educate consumers of the need to demand preventive services.

Clinical Trial Examining Effectiveness Of Three Cough Syrups

Background: Cough is one of the most common symptoms of respiratory infections for which patients seek relief. This study was done to assess the effectiveness of three commonly prescribed cough syrups. Methods: In this multipractice, office-based, randomized clinical trial, guaifenesin was compared with guaifenesin plus codeine or guaifenesin plus dextromethorphan in patients with uncomplicated respiratory tract infections. Family physicians enrolled 97 patients between February 1988 and April 1990. Patients were randomly assigned to treatment and were interviewed by telephone at 2, 4, and 10 days to assess cough relief, treatment adherence, and side effects. There were no statistically significant differences among treatment groups at base line. Results: At day 2 there were no statistically significant differences among treatment groups for any of the outcome measures. At day 4 five of the outcome measures of cough quality, frequency, sleep disturbances, and absenteeism were not statistically significantly different among groups. The only statistically significant difference was the ability to keep up with usual activities, which improved least in patients assigned to dextromethorphan than in patients in other groups. There were no statistically significant differences among the three groups at day 10 for any of the outcomes. Conclusion: It appears that codeine, dextromethorphan, and guaifenesin are equally effective in relieving cough symptoms.

Development of family medicine education in Moldova with Carelift International.

BACKGROUND As in other former Soviet republics, Moldovas health system has been dependent upon multispecialty and hospital care. The government has undertaken a planning process to develop a primary care-based system utilizing family physicians. Carelift International and Moldova State Medical and Pharmaceutical University joined together to design an educational program to help create a family medicine specialty in the country. METHODS Introductory concepts were incorporated into a workshop co-sponsored by the World Health Organization, Carelift International, UNICEF and Moldova Ministry of Health. Faculty teams participated in Carelifts 8-week US program, comprising a range of topics in family medicine: educational development at all levels, public health applications, health care organization, insurance, financing, and technology. Training also included 1 week in Finland, a fellowship in Lithuania, an in-country workshop on rural health, and a supplemental 5-week US immersion program. OUTCOMES A Department of Family Medicine was established, and a residency program instituted. It has already been strengthened with a 2-week introduction to the specialty, and rotations in family practice centers. Continued improvements and updates are planned. Urban and rural model family practice centers serve concurrent purposes of teaching, demonstrating and health care. Carelift shipped equipment for the principal center and a department library, and is equipping a teaching family practice center near the university. The Society of Family Physicians of Moldova was founded. The introduction of family medicine as a discipline into the health system of Moldova could be a valuable model for other former Soviet republics.

Current diagnosis of venous thromboembolism in primary care

This guideline summarizes the current approaches for the diagnosis of venous thromboembolism. The importance of early diagnosis to prevent mortality and morbidity associated with venous thromboembolism cannot be overstressed. This field is highly dynamic, however, and new evidence is emerging periodically that may change the recommendations. The purpose of this guideline is to present recommendations based on current evidence to clinicians to aid in the diagnosis of lower extremity deep venous thrombosis and pulmonary embolism.

Annals Journal Club: Current Diagnosis of Venous Thromboembolism in Primary Care: A Clinical Practice Guideline from the American Academy of Family Physicians and the American College of Physicians

This guideline summarizes the current approaches for the diagnosis of venous thromboembolism. The importance of early diagnosis to prevent mortality and morbidity associated with venous thromboembolism cannot be overstressed. This field is highly dynamic, however, and new evidence is emerging periodically that may change the recommendations. The purpose of this guideline is to present recommendations based on current evidence to clinicians to aid in the diagnosis of lower extremity deep venous thrombosis and pulmonary embolism.

Initiating Proper Blood Pressure Control

Pharmacologic choices afford physicians the opportunity to tailor drug therapy to the individual patients profile, and we are bolstered by a broad understanding of controllable risk factors. Choice of regimen--whether or not it involves drugs--requires accurate diagnostic information. Success depends on both control of blood pressure and patient satisfaction.