This study reports costs incurred over a nine-and-one-half-month period following the introduction of obstetrical ultrasound into a group family practice serving primarily prepaid health plan patients. During this introductory period, 248 examinations were performed by family physicians and refereed by a radiologist for accuracy. The estimated cost to the practice was $95 per examination. This ...

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...

OBJECTIVE To assess the clinical performance of a representative non-volunteer sample of family physicians in metropolitan Montreal, Que. DESIGN Assessment of clinical performance was based on inspection visits to offices, peer review of medical records, and chart-stimulated recall interviews. The procedure was the one usually followed by the Professional Inspection Committee of the Collège d...

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 ...

Patient Evaluation Most fishhook injuries are penetrating soft tissue injuries to the hand, face, head or upper extremity but can involve any body part. These injuries usually do not involve deeper tissue structures because of the linear forces applied along the fishing line to the fishhook that drive the point parallel to the skin and keep it from deep penetration. Many different types and siz...

Uses and Efficacy Currently, the primary use of black cohosh extract is for alleviation of menopausal symptoms. The American College of Obstetrics and Gynecology guidelines on the use of botanicals for the management of menopausal symptoms support this use for up to six months, especially in treating the symptoms of sleep and mood disturbance, and hot flushes. [Evidence level C, consensus/exper...