Family Medicine Update

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A practical guide to the evaluation and treatment of male lower urinary tract symptoms in the primary care setting.

Int J Clin Pract. 2007 Jul 11;

Authors: Rosenberg MT, Staskin DR, Kaplan SA, Macdiarmid SA, Newman DK, Ohl DA

Aims: Lower urinary tract symptoms (LUTS) are common in both men and women, and are among the most prevalent patient complaints heard by primary care physicians (PCPs). This article aims to provide PCPs with a logical algorithm for the assessment and initiation of treatment for LUTS in the male patient. Results: Management of LUTS involves a focused history and physical, as well as the assessment of bother. In patients for whom treatment is warranted, a series of decisions regarding therapy should be considered. Male patients commonly suffer from storage and/or voiding symptoms. Treatment of male LUTS is commonly begun with agents that are aimed at remedying the outlet symptoms of benign prostatic hyperplasia (BPH). When this intervention is ineffective or when refractory symptoms persist, consideration should be given to treating the storage symptoms characteristic of overactive bladder (OAB). Discussion: This article is intended to provide the PCP with a logical guide to the treatment of male LUTS. Benign prostatic hyperplasia and OAB predominate among the causes of these symptoms, and the PCP should be comfortable treating each. Recent data detailing the safety of the use of these treatments in the male patient are reviewed and incorporated into the algorithm. Conclusion: Primary care physicians are in a unique position to successfully identify and treat male patients with LUTS. With this paper, they now have a tool to approach treatment logically and practically.

PMID: 17627768 [PubMed - as supplied by publisher]

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Perceptions and practices of graduates of combined family medicine-psychiatry residency programs: a nationwide survey.

Acad Psychiatry. 2007 Jul-Aug;31(4):297-303

Authors: Warner CH, Morganstein J, Rachal J, Lacy T

OBJECTIVE: The authors evaluate the current practices and perceptions of graduates of combined family medicine-psychiatry residency programs in the following areas: preparation for practice, boundary formation, and integration of skills sets. METHOD: The authors conducted an electronic cross-sectional survey of all nationwide combined family medicine-psychiatry training graduates in the spring of 2005. RESULTS: Twenty-seven (62.8%) graduates participated. Nearly 30% worked in positions designed specifically for combined trained physicians, though only 11.1% participated in fully integrated practice. The mean time spent practicing psychiatry and family medicine is 70% and 16%, respectively. CONCLUSIONS: Combined trained graduates felt well prepared for practice in both specialties but somewhat less comfortable providing integrated care. Most are in positions that underutilize their ability to integrate family medicine and psychiatry in one practice. Contributing factors may include limited preparation for integration during residency training and lack of integrated job opportunities. Enhancing combined residents’ training in the provision of integrated services may optimize their utilization.

PMID: 17626192 [PubMed - in process]

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The comprehensiveness of family cancer history assessments in primary care.

Community Genet. 2007;10(3):174-80

Authors: Murff HJ, Greevy RA, Syngal S

Background: Accurate family history information is required for adequate breast and colorectal cancer risk assessments. Few studies have examined the comprehensiveness of the family medical history interview in primary care. Methods: We compared family cancer history information collected through a self-completed survey with that documented within medical charts for 310 patients. Results: Forty-three percent (18/42) of individuals at increased risk for breast or colorectal cancer based on their family history had documentation of this risk within their chart. Age of cancer diagnosis was recorded for 40% (50/124) of affected relatives identified by chart review compared with 81% (203/252) identified through the survey (p < 0.0001). Conclusions: Over half of the individuals at increased risk for breast or colorectal cancer based on their family history did not have documentation of this risk within their medical record, and the age of relatives at diagnosis was frequently missing. Copyright (c) 2007 S. Karger AG, Basel.

PMID: 17575462 [PubMed - in process]

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