This clinical content conforms to AAFP criteria for evidence-based continuing medical education (EB CME). EB CME is clinical content presented with practice recommendations supported by evidence that has been systematically reviewed by an AAFP-approved source. P rimary dysmenorrhea, which is defined as painful menses in women with normal pelvic anatomy, usually begins during adolescence. It is ...

N onsteroidal anti-inflammatory drugs (NSAIDs) are commonly used to treat inflammation, pain, and fever by decreasing prostaglandin synthesis through blockage of the cyclooxygenase (COX) enzyme. Table 1 lists NSAID dosages and monthly costs. There is little evidence to support differences in effectiveness for pain treatment when comparing all NSAIDs. Aspirin is used for primary and secondary pr...

T he number of adults in North America who have congenital heart disease (CHD) has steadily increased over the past 30 years. Although this increase is partly because of the growth of the adult population, it may be more attributable to improvements in surgical management, which have resulted in a greater than 90 percent 10-year survival rate in persons with CHD. Between 1979 and 1997, mortalit...

Amid concerns that too few physicians practice in many rural areas, lower income potential is cited as one obstacle to attracting and retaining rural physicians. Congress has responded by increasing Medicare payment rates to virtually all physicians practicing in rural areas. However, average physician incomes in rural and urban areas do not differ significantly, even after accounting for diffe...

A ccurate diagnosis of the generalized rash can be difficult because of the nonspecific appearance of many rashes. If the diagnosis is not obvious, the physician must resist the common tendency to prematurely close the diagnostic process and instead generate an inclusive differential diagnosis. Part I of this two-part article discusses the common, uncommon, and rare causes of generalized rashes...

Several clinical studies have shown that valerian is effective in the treatment of insomnia, most often by reducing sleep latency. A double-blind, placebo-controlled trial compared a 400-mg aqueous extract of valerian and a commercial valerian/hops preparation with placebo of encapsulated brown sugar. A total of 128 volunteers completed a subjective study evaluating the effects of single doses ...

The pressures for closer alignment between physicians and hospitals in both rural and urban areas are increasing. This study empirically specifies independent dimensions of physician and clinical integration and compares the extent to which such activities are practiced between rural and urban hospitals and among rural hospitals in different organizational and market contexts. Results suggest t...

OBJECTIVE To illustrate the use of needs-based planning in the identification of physician surpluses and deficits and of resource misallocations within a provincial medical system at a time when provincial governments and medical associations across the country are faced with funding constraints for physician services. DESIGN For each of 4 regions in Manitoba, the authors analysed residents' ...