Preemployment evaluations present primary care physicians with numerous medical, ethical, and legal dilemmas. These examinations are especially problematic for community-based primary care providers unaccustomed to standards used by physicians in occupational settings. In response to a mailed questionnaire, 255 family physicians and general practitioners described their current methods of perfo...

www.aafp.org/afp AMERICAN FAMILY PHYSICIAN 461 Renin-Angiotensin System The renin-angiotensin system is systemically and locally driven. The systemic process is triggered by the kidney’s response to decreased effective blood volume and begins with the secretion of renin from the renal cortex. Once released, renin cleaves angiotensinogen to form angiotensin I. This product, in turn, is catalyzed...

The purpose of this qualitative study was to examine family practice physician and staff views on the benefits of, barriers to, and use of personal health records (PHRs). Four focus groups were conducted at four family medicine practices in Iowa and included a total of 28 providers. Overall, participants seemed to view PHRs as a source of medical information for healthcare providers when the pa...

www.aafp.org/afp AMERICAN FAMILY PHYSICIAN 93 eral insulin resistance, increased hepatic glucose production, impaired insulin secretion, and fat and protein breakdown, with potential hyperglycemia and even ketosis in some cases. The degree of this response depends on the complexity of the surgery and any postsurgical complications. In addition to counter-regulatory hormone excess and relative i...

www.aafp.org/afp AMERICAN FAMILY PHYSICIAN 2103 tients presenting with unexplained lymphadenopathy were determined to have malignancies, while a third study retrospectively found a 1.1 percent prevalence of malignancy in primary care patients presenting to the office with unexplained lymphadenopathy. Essential to identifying the infrequent but serious causes of peripheral lymphadenopathy are th...

The typical MC lesion is an asymptomatic, firm, smooth, round papule with central umbilication (Figure 1). Lesions are usually 3 to 5 mm in diameter and number less than 30, although these parameters often are exceeded in persons with HIV and other immunocompromised conditions. In children, the papules typically are found on the M olluscum contagiosum (MC) and warts are benign epidermal eruptio...

www.aafp.org/afp AMERICAN FAMILY PHYSICIAN 631 clues that may indicate the presence of a serious underlying disorder (Table 1). In determining the appropriate laboratory and imaging studies, the physician should follow the approach to low back pain given in an algorithm (Figure 1) prepared by the Agency for Healthcare Research and Quality (formerly the Agency for Health Care Policy and Research).

fly. Rather, they are transmitted by person-toperson contact. Despite the introduction of new treatments, the frequency of lice infestation may be increasing. One explanation may be the development of resistance to current treatments. Fortunately, head and pubic lice do not transmit systemic disease. Hence, treatment is directed at relieving symptoms and preventing reinfestation and transmission.

with weakness accompanied by tingling dysesthesias in the extremities. This weakness is prominent in the proximal muscles; legs are more often affected than arms. Paresthesias occur, spreading proximally but seldom extending past the wrists and ankles. Deep tendon reflexes disappear within the first few days of symptom onset. The progressive phase of the syndrome lasts from a few days to four w...

OBJECTIVE To examine the relationship between continuity of family physician care and all-cause mortality and acute hospitalizations in older people with diabetes. DESIGN Retrospective cohort study of administrative health databases. Continuity of family physician care for elderly patients newly diagnosed with diabetes was estimated by 3 continuity indexes using physician claims data. The rel...