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...

CONTEXT Data collected in 1998 on primary physician performance, including Health Plan Employer Data and Information Set (HEDIS) measures, were the basis of reports distributed quarterly to 194 primary care physicians at 25 medical centers in Group Health Cooperative. Here, we summarize results of research designed to assess reliability of measures of physician performance and to identify pract...

A rarity as few as 25 years ago, physician networks are now the norm in health insurance coverage and health benefit service plans. In 2006, only 7 percent of all employers offered a “conventional” plan, that is, a plan whose terms of coverage are not tied to a provider network; at 54 percent, preferred provider organizations (PPOs) represented the most common type of plan offering that year. S...

OBJECTIVE To examine the extent to which health plan quality measures capture physician practice patterns rather than plan characteristics. DATA SOURCE We gathered and merged secondary data from the following four sources: a private firm that collected information on individual physicians and their health plan affiliations, The National Committee for Quality Assurance, InterStudy, and the Dar...

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 ...

BACKGROUND It is important to know the current level of primary care performance in order to evaluate and plan for desirable health policy. We tried to compare patient's assessment of primary (family physician, general practitioner, internist, pediatrician, and general surgeon) and non-primary (the other specialties) care physicians. METHODS Study subjects were physicians of primary care clin...