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Elsevier

Publications in this journal

• Preconception counseling.

  Authors: Aaron D Lanik

  Primary care. 39(1):1-16.

  The preconception counseling visit is an ideal time to evaluate the patient and her future expectations regarding pregnancy. In fact at every patient encounter, whether for acute or chronic care,The preconception counseling visit is an ideal time to evaluate the patient and her future expectations regarding pregnancy. In fact at every patient encounter, whether for acute or chronic care, consideration should be given to any woman who, although not pregnant, may become pregnant, and what effect each ordered procedure, laboratory examination, or medication prescription might have on her or her fetus. If the primary reason for the office visit is preconception counseling there are a few specific components that should be discussed besides a complete history and physical examination.

• Family medicine obstetrics: pregnancy and nutrition.

  Authors: Jean M Harnisch, Patricia H Harnisch, David R Harnisch

  Primary care. 39(1):39-54.

  This article discusses pregnancy and nutrition in 3 main timeframes, the prepregnancy nutritional health evaluation, nutrition during pregnancy, and nutrition during the puerperium, and also includesThis article discusses pregnancy and nutrition in 3 main timeframes, the prepregnancy nutritional health evaluation, nutrition during pregnancy, and nutrition during the puerperium, and also includes comments on nutrition and lactation. This article begins with a brief review of the risks of obesity (increased body mass index [BMI]) and anorexia (decreased BMI), with special attention to these undesired conditions during pregnancy, followed by a section on nutrients other than calories. Information on body weight, minerals, and vitamins during pregnancy is reviewed. This article ends with information on nutrition in the postpartum period.

• First trimester complications.

  Authors: A Ildiko Martonffy, Kirsten Rindfleisch, Anne Marie Lozeau, Beth Potter

  Primary care. 39(1):71-82.

  Vaginal bleeding, abdominopelvic pain, nausea, and vomiting are common presenting symptoms in early pregnancy. All women of reproductive age who present with abdominal or pelvic pain or with vaginalVaginal bleeding, abdominopelvic pain, nausea, and vomiting are common presenting symptoms in early pregnancy. All women of reproductive age who present with abdominal or pelvic pain or with vaginal bleeding should be evaluated for possible pregnancy. There should be a high index of suspicion for ectopic pregnancy in women presenting with abdominal pain and bleeding after approximately 7 weeks of amenorrhea. Investigation for the cause of the bleeding should ensue. Gestational trophoblastic disease should be considered as a possible cause. Treatment options for nausea during pregnancy should be discussed with women with this common symptom.

• Third-trimester pregnancy complications.

  Authors: Emily Newfield

  Primary care. 39(1):95-113.

  Complications arising in the third trimester often challenge the clinician to balance the concern for maternal well-being with the consequences of infant prematurity. The most serious and challengingComplications arising in the third trimester often challenge the clinician to balance the concern for maternal well-being with the consequences of infant prematurity. The most serious and challenging antepartum issues relate to preterm labor and birth, hypertensive disorders, and bleeding events. This article guides the practitioner through decision-making and management of these problems.

• Complications of labor and delivery: shoulder dystocia.

  Authors: Jane E Anderson

  Primary care. 39(1):135-44.

  This article reviews one of the less common but most dreaded complications of labor and delivery, shoulder dystocia, an infrequent but potentially devastating event that results from impaction of theThis article reviews one of the less common but most dreaded complications of labor and delivery, shoulder dystocia, an infrequent but potentially devastating event that results from impaction of the fetal shoulders in the maternal pelvis. Shoulder dystocia occurs most commonly in patients without identified risk factors, and can result in both maternal and fetal morbidity. Because the vast majority of cases of shoulder dystocia are unpredictable, obstetric care providers must be prepared to recognize dystocia and respond appropriately in every delivery. Detailed documentation is essential after any delivery complicated by shoulder dystocia.

• Postpartum hemorrhage.

  Authors: Cindy W Su

  Primary care. 39(1):167-87.

  Postpartum hemorrhage (PPH) is a very common obstetric emergency with high morbidity and mortality rates worldwide. Understanding its etiology is fundamental to effectively managing PPH in an acutePostpartum hemorrhage (PPH) is a very common obstetric emergency with high morbidity and mortality rates worldwide. Understanding its etiology is fundamental to effectively managing PPH in an acute setting. Active management of the third stage of labor is also a key component in its prevention. Management strategies include conservative measures (medications, uterine tamponade, and arterial embolization) as well as surgical interventions (arterial ligations, compression sutures, and hysterectomy). Creating a standardized PPH protocol and running simulation-based drills with a multidisciplinary team may also help decrease maternal morbidity and improve perinatal outcomes, although further studies are needed.

• The art of prenatal care.

  Authors: Joel J Heidelbaugh

  Primary care. 39(1):xiii-xiv.

• Prenatal care: touching the future.

  Authors: Erin Kate Dooley, Robert L Ringler

  Primary care. 39(1):17-37.

  The provision of preconception and prenatal care is a critical and time-honored role for family physicians. It could even be termed the first preventive care a human being receives. It has beenThe provision of preconception and prenatal care is a critical and time-honored role for family physicians. It could even be termed the first preventive care a human being receives. It has been suggested by some studies that, because of the continuity of care that is considered a cornerstone of family practice, family physicians provide prenatal care that may improve birth outcome. Although prenatal care is acknowledged as important for a healthy pregnancy and delivery, there is debate regarding the true efficacy of prenatal care.

• Genetic screening and counseling: family medicine obstetrics.

  Authors: K M Rodney Arnold, Zachary B Self

  Primary care. 39(1):55-70.

  Genetic screening and counseling have become routinely offered during prenatal care in the United States, involving invasive and noninvasive options for assessing fetal genetics. As DNA testingGenetic screening and counseling have become routinely offered during prenatal care in the United States, involving invasive and noninvasive options for assessing fetal genetics. As DNA testing continues to expand proportionately to the increasing ability to detect genetic variations, ethical and fiscal concerns arise. Societal shifts, such as delayed childbearing and the associated genetic consequences, have made antenatal genetic screening more common. Still, genetic screening may be confounded by inaccurate information, false-positives, socioeconomic barriers to testing, and cultural differences. This article reviews these concerns and provides a framework for training in family medicine obstetrics training.

• Update on gestational diabetes mellitus.

  Authors: Ann E Evensen

  Primary care. 39(1):83-94.

  The incidence of gestational diabetes mellitus (GDM) is increasing in the United States. Universal GDM screening is recommended, although evidence of benefit is lacking. Treatment of GDM reduces theThe incidence of gestational diabetes mellitus (GDM) is increasing in the United States. Universal GDM screening is recommended, although evidence of benefit is lacking. Treatment of GDM reduces the risk of shoulder dystocia, preeclampsia, and macrosomia. Intensive treatment is more effective than less-intensive treatment. Traditional management includes diet, exercise, and short- and intermediate-acting insulin regimens. Use of metformin and glyburide is controversial, but evidence supporting safety and efficacy is accumulating. Postpartum screening with a glucose tolerance test rather than a fasting blood glucose level should be performed 6 weeks after delivery.

• Electronic fetal monitoring: family medicine obstetrics.

  Authors: John R M Rodney, Benjamin J F Huntley, Wm Macmillan Rodney

  Primary care. 39(1):115-33.

  Electronic fetal monitoring assesses fetal health during the prenatal and intrapartum process. Intermittent auscultation does not detect key elements of fetal risk, such as beat-to-beat variability.Electronic fetal monitoring assesses fetal health during the prenatal and intrapartum process. Intermittent auscultation does not detect key elements of fetal risk, such as beat-to-beat variability. Family medicine obstetric fellowships have contributed new knowledge to this process by articulating a method of analysis that builds on evidence-based recommendations from the American College of Obstetrics and Gynecology as well as the National Institute of Child Health and Development. This article summarizes the development, interpretation, and management of electronic fetal heart rate patterns and tracings.

• Cesarean delivery.

  Authors: Lee T Dresang, Lawrence Leeman

  Primary care. 39(1):145-65.

  Cesarean delivery rates rose from 20 to 33% of births in the United States from 2006-2009 without an accompanying improvement in neonatal outcomes. The cesarean rate may be safely decreased byCesarean delivery rates rose from 20 to 33% of births in the United States from 2006-2009 without an accompanying improvement in neonatal outcomes. The cesarean rate may be safely decreased by increasing vaginal birth after cesarean, encouraging external cephalic version for breech presentation, maintaining operative vaginal delivery skills, and applying stricter criteria for operative intervention in labor dystocia. A variety of cesarean operative techniques are supported by randomized controlled trials. Optimal maternity care outcomes depend on sound medical decision-making, appropriate operative technique and skills, and effective communication between maternity care team members.

• Intrapartum care the midwifery way: a review.

  Authors: Anita C Jaynes, Kathleen E Scott

  Primary care. 39(1):189-206.

  Midwifery offers concepts and techniques for intrapartum care that could be integrated into the practice of a family physician. Normal birth has virtually been replaced by a medicalized model ofMidwifery offers concepts and techniques for intrapartum care that could be integrated into the practice of a family physician. Normal birth has virtually been replaced by a medicalized model of maternity care in the American health care system, despite research indicating that many interventions are not necessary and even harmful. A low-tech, high-touch approach to low-risk women in labor is evidence based and results in improved perinatal outcomes as well as higher patient satisfaction with the birth experience.

• Prenatal care. Preface.

  Authors: David R Harnisch

  Primary care. 39(1):xv-xvi.

• How the immune response to vaccines is created, maintained and measured: addressing patient questions about vaccination.

  Authors: Barbara Watson, Kendra Viner

  Primary care. 38(4):581-93, vii.

  This article gives an overview of the immune response to vaccines, including ways in which it is measured and/or augmented to enhance its effectiveness. A brief description is given of the immuneThis article gives an overview of the immune response to vaccines, including ways in which it is measured and/or augmented to enhance its effectiveness. A brief description is given of the immune response, adaptive immunity, immunologic memory, antibodies, and adjuvants. Given that many young parents and physicians have never witnessed the ravages of vaccine-preventable diseases, it is hoped this article will aid the many people involved in the prevention of infectious disease to understand better the concepts and practicalities of immunization and vaccine development.

• Adult vaccination.

  Authors: Christina M Hillson, Joshua H Barash, Edward M Buchanan

  Primary care. 38(4):611-32, vii.

  Immunization has effectively decreased the burden of disease on society. Nevertheless, over 50,000 deaths occur annually in the United States from vaccine-preventable disease, and nearly all of theseImmunization has effectively decreased the burden of disease on society. Nevertheless, over 50,000 deaths occur annually in the United States from vaccine-preventable disease, and nearly all of these occur in adults. It is essential for primary care physicians to be knowledgeable about the unique immunization-related needs of adults and to be aware of the factors that determine the need for vaccination.

• Immunization in travel medicine.

  Authors: Suzanne Moore Shepherd, William Hudson Shoff

  Primary care. 38(4):643-79, viii.

  The specialty of travel medicine encompasses a broad and dynamic practice. A thorough pretravel consultation provides an individual with a comprehensive, evidence-based, contextual discussion of theThe specialty of travel medicine encompasses a broad and dynamic practice. A thorough pretravel consultation provides an individual with a comprehensive, evidence-based, contextual discussion of the risk profile for specific itinerary-based, travel-related illness and injury, allowing the traveler to use this information in conjunction with his or her personal health belief model, risk tolerance, and experience to decide on an informed management plan. This article focuses on the pretravel consultation with emphasis on the contribution of immunization to traveler's health.

• Vaccination refusal: ethics, individual rights, and the common good.

  Authors: Jason L Schwartz, Arthur L Caplan

  Primary care. 38(4):717-28, ix.

  Among the obstacles to the success of vaccination programs is the apparent recent increase in hesitancy and outright resistance to the recommended vaccination schedule by some parents and patients.Among the obstacles to the success of vaccination programs is the apparent recent increase in hesitancy and outright resistance to the recommended vaccination schedule by some parents and patients. This article reviews the spectrum of patient or parental attitudes that may be described as vaccine refusal, explores related ethical considerations in the context of the doctor-patient relationship and public health, and evaluates the possible responses of physicians when encountering resistance to vaccination recommendations. Health care providers should view individuals hesitant about or opposed to vaccines not as frustrations or threats to public health, but as opportunities to educate and inform.

• The course and management of the 2009 H1N1 pandemic influenza.

  Authors: Sanford R Kimmel

  Primary care. 38(4):693-701, viii.

  The 2009 influenza A (H1N1) pandemic provided a major test to the public health system in the United States and abroad. Although the virus was rapidly identified, it took longer than expected toThe 2009 influenza A (H1N1) pandemic provided a major test to the public health system in the United States and abroad. Although the virus was rapidly identified, it took longer than expected to bring an effective vaccine to market. During the interim the virus demonstrated a predilection for infecting younger persons, particularly those with medical conditions such as asthma or pregnancy, placing them at risk. Early treatment with neuraminidase inhibitors was found to be of some benefit. When the 2009 H1N1 influenza A vaccine became available, there were distribution issues in matching the number of doses to areas of need.

• Keeping up-to-date with immunization practices.

  Authors: Donald B Middleton, Richard K Zimmerman, Judith A Troy, Robert M Wolfe

  Primary care. 38(4):747-61, ix.

  This article presents sources of information for those in practice, administration, or education to stay up-to-date in vaccine recommendations. Web-based repositories predominate in the provision ofThis article presents sources of information for those in practice, administration, or education to stay up-to-date in vaccine recommendations. Web-based repositories predominate in the provision of information. Other sources include newsletters, conferences, journals, expert opinion, community organizations, and books. The promise of the electronic health record remains unfulfilled but improving.

• Immunizations as the nucleus of prevention.

  Authors: Joel J Heidelbaugh

  Primary care. 38(4):xi-xii.

• Routine pediatric immunization, special cases in pediatrics: prematurity, chronic disease, congenital heart disease: recent advancements/changes in pediatric vaccines.

  Authors: Daniel Walmsley

  Primary care. 38(4):595-609, vii.

  Vaccination is a powerful and dynamic weapon in reducing the impact of infectious diseases in children. The field and schedules are constantly evolving, with significant changes resulting in new andVaccination is a powerful and dynamic weapon in reducing the impact of infectious diseases in children. The field and schedules are constantly evolving, with significant changes resulting in new and exciting vaccines almost yearly. Special cases in pediatrics represent unique challenges and differences in vaccinations. Health care providers need to be knowledgable about the current vaccines and to remain up to date with the constant evolution, as well as be aware of the latest recommendations, warnings, and news about vaccines and their use. This article updates and discusses current but ever-changing routine pediatric vaccination programs.

• Vaccine-preventable diseases and foreign-born populations.

  Authors: Giang T Nguyen, Marc Altshuler

  Primary care. 38(4):633-42, vii-viii.

  According to the most recent census data, foreign-born individuals account for more than 12% of the US population. Because many vaccine-preventable outbreaks in the United States have been correlatedAccording to the most recent census data, foreign-born individuals account for more than 12% of the US population. Because many vaccine-preventable outbreaks in the United States have been correlated with disease importation, Congress has mandated vaccinations for numerous immigrant populations. It is essential for primary care physicians to be knowledgeable about the unique immunization-related needs of foreign-born individuals to recognize some of the cultural and linguistic challenges that immigrants have accessing health care and to remember to use each medical encounter as an opportunity to provide necessary vaccinations.

• Passive immunization.

  Authors: Christopher P Raab

  Primary care. 38(4):681-91, viii.

  Passive immunization employs preformed antibodies provided to an individual that can prevent or treat infectious diseases. There are several situations in which passive immunization can be used: forPassive immunization employs preformed antibodies provided to an individual that can prevent or treat infectious diseases. There are several situations in which passive immunization can be used: for persons with congenital or acquired immunodeficiency, prophylactic administration when there is a likelihood of exposure to a particular infection, or treatment of a disease state already acquired by the individual. Passive immunization is limited by short duration (typically weeks to months), variable response, and adverse reactions. This article focuses on specific immunoglobulins for preventing or treating infectious diseases, as these are the most likely scenarios one might encounter in primary care practice.

• Cancer vaccines.

  Authors: Christopher V Chambers

  Primary care. 38(4):703-15, viii-ix.

  The term cancer vaccines encompasses 2 different types of vaccines. Prophylactic vaccines block infection by viruses that can alter host DNA and result in cancer. The hepatitis B vaccine and theThe term cancer vaccines encompasses 2 different types of vaccines. Prophylactic vaccines block infection by viruses that can alter host DNA and result in cancer. The hepatitis B vaccine and the human papillomavirus vaccines are examples of prophylactic vaccines that can prevent cancer from developing. More recently, therapeutic vaccines have been developed and used as adjunctive therapy in patients who have already been diagnosed with cancer. Therapeutic vaccines stimulate the host's immune system to recognize cancer cells as foreign and to attack them. Most of the therapeutic vaccines being studied are used in combination with other forms of cancer therapy.

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