PURPOSE The cost implications associated with offloading outpatient surgery from hospitals to ambulatory surgery centers and the physician office remain poorly defined. Therefore, we determined whether payments for outpatient surgery vary by location of care. MATERIALS AND METHODS Using national Medicare claims from 1998 to 2006, we identified elderly patients who underwent 1 of 22 common out...

Epidemiology At five years of age, 15 to 25 percent of children wet the bed. With each year of maturity, the percentage of bed-wetters declines by 15 percent. Hence, 8 percent of 12-year-old N octurnal enuresis is a common problem, affecting an estimated 5 to 7 million children in the United States and occurring three times more often in boys than in girls. Unfortunately, only about one third o...

Noninvasive in vivo imaging techniques have become an important diagnostic aid for skin cancer detection. Dermoscopy, also known as dermatoscopy, epiluminescence microscopy, incident light microscopy, or skin surface microscopy, has been shown to increase the clinician's diagnostic accuracy when evaluating cutaneous neoplasms. A handheld instrument called a dermatoscope or dermoscope, which has...

Etiology Although viral infection is the most common cause of pericarditis, the condition has many possible causes (Table 1), including bacterial infection, myocardial infarction, trauma, malignancy, uremia, hypothyroidism, collagen vascular disease, and the effects of certain drugs, notably hydralazine (Apresoline) and procainamide (Pronestyl). Purulent pericarditis as a result of bacterial in...

www.aafp.org/afp AMERICAN FAMILY PHYSICIAN 1981 mented. All lesions are usually of similar size and shape. Patients “dig”at their skin to relieve itching or to extract imaginary objects that they believe are imbedded or extruding from their skin. The lesions are grouped at sites of the body that are easily accessible and usually exposed, such as the extensor surfaces of the extremities, face an...

managed in the primary care setting. Surveys suggest that approximately 20 percent of U.S. adults have symptoms of GERD at least once a week.4 A subgroup of patients with GERD develop severe complications that include erosive esophagitis, stricture formation, Barrett’s esophagus, and adenocarcinoma of the esophagus. Because Barrett’s esophagus is thought to be associated with the development of...

The need for men to undergo screening for prostate cancer is controversial. Urologists are concerned about finding many men with minimal disease who may not require therapy or may be over-treated, while conversely missing men with clinically significant prostate cancer that could be treated and cured if found at an early enough stage. Most men today present to the physician with some symptoms a...

www.aafp.org/afp AMERICAN FAMILY PHYSICIAN 1269 involves human papillomavirus (HPV) infection, which leads to VIN and predisposes the patient to vulvar cancer. The second type involves vulvar non-neoplastic epithelial disorders (VNED) and advanced age, leading to cellular atypia and cancer (Table 1). Vulvar cancer most frequently occurs in women 65 to 75 years of age. It can develop in younger ...