Family Medicine Update

Work-related eye injuries and illnesses.

Am Fam Physician. 2007 Apr 1;75(7):1017-22

Authors: Peate WF

More than 65,000 work-related eye injuries and illnesses, causing significant morbidity and disability, are reported in the United States annually. A well-equipped eye tray includes fluorescein dye, materials for irrigation and foreign body removal, a short-acting mydriatic agent, and topical anesthetics and antibiotics. The tray should be prepared in advance in case of an eye injury. Eye patching does not improve cornea reepithelialization or discomfort from corneal abrasions. Blunt trauma to the eye from a heavy object can cause a blow-out fracture. Sudden eye pain after working with a chisel, hammer, grinding wheel, or saw suggests a penetrating globe injury. Chemical eye burns require immediate copious irrigation. Nontraumatic causes of ocular illness are underreported; work-related allergic conjunctivitis increasingly has been recognized among food handlers and agriculture workers who are exposed to common spices, fruits, and vegetables. The patient’s history of eye injury guides the diagnosis. Primary prevention and patient counseling on proper eye protection is essential because over 90 percent of injuries can be avoided with the use of eye protection. As laser use increases in industry and medical settings, adequate personal protection is needed to prevent cataracts. Outdoor workers exposed to significant ultraviolet rays need sun protection and safety counseling to prevent age-related macular degeneration. Contact lenses do not provide eye protection, and physicians should be familiar with guidelines for the use of contacts in the workplace.

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Practice-based referrals to a tobacco cessation quit line: assessing the impact of comparative feedback vs general reminders.

Ann Fam Med. 2007 Mar-Apr;5(2):135-42

Authors: Wadland WC, Holtrop JS, Weismantel D, Pathak PK, Fadel H, Powell J

PURPOSE: We undertook a study to assess the impact of comparative feedback vs general reminders on practice-based referrals to a tobacco cessation quit line and estimated costs for projected quit responses. METHODS: We conducted a group-randomized clinical trial comparing the impact of 6 quarterly (18 months) feedback reports (intervention) with that of general reminders (control) on practice-based clinician referrals to a quit-line service. Feedback reports were based on an Achievable Benchmark of Care approach using baseline practice, clinician, and patient survey responses, and referrals per quarter. Comparable quit responses and costs were estimated. RESULTS: Three hundred eight clinicians participated (171 family medicine, 88 internal medicine, 49 obstetrics-gynecology) from 87 primary care practices in Michigan. After 18 months, there were more referrals from the intervention than from the control practices (484 vs 220; P <.001). Practice facsimile (fax) referrals (84%, n = 595) exceeded telephone referrals (16%, n = 109), but telephone referrals resulted in greater likelihood of enrollment (77% telephone vs 44% fax, P <.001). The estimated number of smokers who quit based on the level of services utilized by referred smokers was 66 in the feedback and 36 in the gentle reminder practices. CONCLUSION: Providing comparative feedback on clinician referrals to a quit-line service had a modest impact with limited increased costs.

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Exercise testing and myocardial perfusion scintigraphy in primary care patients with chest pain of new onset.

Scand J Prim Health Care. 2007 Jun;25(2):117-22

Authors: Scheike M, Nilsson S, Nylander E

Objective. To analyse the outcome of exercise testing and myocardial perfusion scintigraphy (MPS) in primary care patients with chest pain of new onset. Design. Prospective, observational. Patients aged 20-79 years, consulting due to chest pain of new onset, were enrolled consecutively. Setting. Three primary care health centres in south-eastern Sweden. Patients. 191 patients where the possibility of stable ischaemic heart disease (IHD) could not be excluded by clinical examination alone. Main outcome measures. Exercise test results, when equivocal completed by MPS. Results. Exercise testing revealed IHD in 14 (7%) and no IHD in 134 (70%) of the cases. In 43 (23%) the exercise test results were equivocal. Thirty-nine of these patients underwent MPS, which showed IHD in 19 and no IHD in 20 cases. Among previously diagnosed cardiovascular disease and risk factors only atrial fibrillation in the male group showed a significant correlation to the outcome IHD. Conclusion. Exercise testing and MPS are both useful when investigating chest pain patients in primary care.

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