Rick Kellerman

Epistaxis: evaluation and treatment.

Epistaxis, or nosebleed, is a common disorder that many patients will experience. Most patients go to the emergency room when they have an uncontrolled nosebleed, or they may present to an outpatient office. Most nosebleeds are not life-threatening and can be managed conservatively. Occasionally, hospital admission, referral to an otolaryngologist physician, and/or blood transfusion may be necessary. This article is an update on the latest information related to the prevention, causes, and treatment of epistaxis.

Self-Reported Ability to Perform Procedures: A Comparison of Allopathic and International Medical School Graduates

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.

Time Required for Screening for Visual Impairment in Primary Care A Randomized Comparison of 3 Common Visual Tests

Objective: To determine the time required for adults older than 50 years to complete 1 of 3 vision impairment assessment tools in a family medicine residency office. Methods: Patients older than 50 years with no known cognitive or physical deficits that impaired ability to follow directions or complete screening tasks were invited to participate in this trial. Participants were randomized to complete 1 of 3 screening modalities, namely, the Functional Vision Screening Questionnaire (questionnaire), mixed contrast sensitivity reading card (card), or Snellen eye chart (Snellen). The time required to complete the vision assessment was obtained and recorded. Results: Sixty-nine patients, with a mean age of 63 years (SD, 10), participated in the study. The card required 94 less seconds to administer than did the questionnaire (95% confidence interval, 61.24 to 127.11 seconds). Similarly, the card required 67 less seconds to administer than did the Snellen (95% confidence interval, 34.20 to 100.06 seconds). No significant difference existed between time to administer the questionnaire and the Snellen (mean difference, 27 seconds; 95% confidence interval, –5.89 to 59.97 seconds). Conclusions: Primary care–based vision screening may detect patients with impairment who would otherwise not have vision assessment. However, a time-intensive screen will not likely be successfully implemented in a primary care office. The card required statistically significantly less time to administer than did the questionnaire or Snellen. With all modalities requiring at least 1 minute, perhaps none are suitable for use for universal, primary care–based vision screening programs. Further work is needed to characterize the reliability and ease of use of each tool.

Gastroesophageal Reflux Disease

Gastroesophageal reflux disease (GERD) is a gastrointestinal motility disorder that results from the reflux of stomach contents into the esophagus or oral cavity resulting in symptoms or complications. The typical symptoms of GERD are heartburn and regurgitation of gastric contents into the oropharynx. GERD affects quality of life and may cause erosive esophagitis, esophageal strictures, and Barrett esophagus, a precursor to esophageal adenocarcinoma. GERD is a clinical diagnosis and is most effectively treated with proton-pump inhibitors (PPIs). Long-term use of PPIs is associated with bone fractures, chronic renal disease, acute renal disease, community-acquired pneumonia, and Clostridium difficile intestinal infection.

Emerging Topics in Gastroenterology

The bacteria and fungi in the human gut make up a community of microorganisms that lives in symbiosis with humans, engaging in numerous diverse interactions that influence health. This article outlines the current knowledge on emerging topics in gastroenterology, including microbiome and probiotics, fecal microbiota transplantation, cyclic vomiting syndrome, eosinophilic esophagitis, and microscopic colitis.