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 ...

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...

Dermatophytoses Because dermatophytes require keratin for growth, they are restricted to hair, nails, and superficial skin. Thus, these fungi do not infect mucosal surfaces. Dermatophytoses are referred to as “tinea” infections. They are also named for the body site involved. Some dermatophytes are spread directly from one person to another (anthropophilic organisms). Others live in and are tra...

Background Rational prescription is a considerable issue which must be paid more attention to assess the behavior of prescribers. The aim of this study was to examine factors affecting family physicians’ drug prescribing.   Methods We carried out a retrospective cross-sectional study in Khuzestan province, Iran in 2011. Nine hundred eighty-six prescriptions of 421 family physicians (including 3...

Background & aim: Midwives, as a part of the healthcare team, have a remarkable role in providing health to families and societies. Midwives have a prominent role in the family physician program (FPP); therefore, the lack of proper attention to their challenges results in a decline in their efficiency and quality of care. Therefore, this study was performed to explore the midwives’ perceptions ...

BACKGROUND Among the challenges encountered during the care of patients at the end-of-life (EOL), eliciting preferences of patients with whom there is no ability to communicate is common and stressful for all those concerned and charged with patient care. Legal facilities available include patient delegation of proxy decision-makers (PDM) prior to communication incapacity. We sought to estimate...