Family Medicine Update

Obstetrician or family physician: are vaginal deliveries managed differently?

J Obstet Gynaecol Can. 2007 Oct;29(10):801-5

Authors: Abenhaim HA, Welt M, Sabbah R, Audibert F

Background: In Canada, obstetricians and family physicians both provide obstetrical care. However, the effect of specialty training on obstetrical outcomes of low-risk pregnancies has not recently been evaluated. In this study we examine the role of specialty training on the management of vaginal deliveries. Methods: We conducted a cohort study on all vaginal deliveries that took place at Sacré-Coeur Hospital between July 2000 and June 2006. We compared baseline characteristics of obstetricians and family physicians and used an unconditional logistic regression model to estimate the adjusted relative risk of undergoing different obstetrical interventions. Results: Of a total 8807 vaginal deliveries, 1915 were conducted by eight obstetricians and 6892 were conducted by 21 family physicians. Apart from a higher rate of induction of labour in patients of obstetricians, baseline characteristics were comparable between the two groups. Overall rates of use of instruments were similar in the two groups; however, family physicians were less likely than obstetricians to perform an episiotomy (odds ratio [OR] 0.47; 95% confidence intervals [CI] 0.41-0.55) but more likely to have patients who sustained a perineal injury (OR 1.51; 95% CI 1.36-1.68). There were no differences in the incidence of third- and fourth-degree tears, and 5-minute Apgar scores were similar in both groups. Conclusion: Obstetricians and family physicians differ in the performance of episiotomies, and their patients differ in the resulting type of perineal injury. Instrument use and neonatal outcomes were similar in both groups. Major maternal and neonatal morbidity are unlikely to differ whether women with low-risk pregnancies are delivered by an obstetrician or a family physician.

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Recommended and prescribed symptomatic treatment for acute maxillary sinusitis in Finnish primary care.

Rhinology. 2007 Sep;45(3):197-201

Authors: Pulkki J, Rautakorpi UM, Huikko S, Honkanen P, Klaukkas T, Mäkelä M, Palva E, Roine R, Sarkkinen H, Huovinen P, Varonen H,

We studied the use of symptomatic medication in the treatment of acute maxillary sinusitis (AMS) in primary care and whether this use is in accordance with national guidelines. The data was collected annually in the Antimicrobial Treatment Strategies (MIKSTRA) Program in 30 primary health care centres throughout Finland during one week in November in the years from 1998 to 2002. Physicians and nurses collected the data about the diagnoses, prescription-only medicines and over the counter medicines prescribed or recommended for all patients with an infection during the study weeks. The MIKSTRA data comprised of 23.002 first consultations for an infection: 2.448 patients were diagnosed as having AMS. Altogether, 41% of them received some symptomatic medicine. Antihistamines with or without sympathomimetics were the most commonly prescribed or recommended symptomatic medicines (23% of the patients). For comparison, systemic antibacterial agents were prescribed for 93% of the AMS patients. We conclude that Finnish physicians recommend or prescribe more symptomatic medication without proven efficacy for AMS than recommended by the national guidelines. Especially, the use of antihistamines with or without sympathomimetics, mostly the combination of acrivastine and pseudoephedrine, was common although antihistamines were recommended only for patients with allergy or nasal polyps.

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Practicing and teaching family medicine in India.

Fam Med. 2007 Oct;39(9):671-2

Authors: Abraham S

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