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Office-Based Procedures: Part I
PRIMARY CARE: CLINICS IN OFFICE PRACTICE (Source: Primary Care: Clinics in Office Practice)
Source: Primary Care: Clinics in Office Practice - October 29, 2021 Category: Primary Care Authors: J. Lane Wilson, Jonathon Firnhaber Source Type: research

Copyright
ELSEVIER (Source: Primary Care: Clinics in Office Practice)
Source: Primary Care: Clinics in Office Practice - October 29, 2021 Category: Primary Care Source Type: research

Contributors
JOEL J. HEIDELBAUGH, MD, FAAFP, FACG (Source: Primary Care: Clinics in Office Practice)
Source: Primary Care: Clinics in Office Practice - October 29, 2021 Category: Primary Care Source Type: research

Contents
Joel J. Heidelbaugh (Source: Primary Care: Clinics in Office Practice)
Source: Primary Care: Clinics in Office Practice - October 29, 2021 Category: Primary Care Source Type: research

Forthcoming Issues
Office-Based Procedures: Part II (Source: Primary Care: Clinics in Office Practice)
Source: Primary Care: Clinics in Office Practice - October 29, 2021 Category: Primary Care Source Type: research

Bartholin Gland Abscess Diagnosis and Office Management
While Bartholin gland abscesses are less commonly seen outpatient pathology, prompt diagnosis and treatment are essential to preventing serious complications such as sepsis and rectovaginal fistula. Owing to an unacceptably high recurrence rate, simple incision and drainage is insufficient for primary treatment; preferably, placement of a Word catheter or Jacobi ring device to reepithelize the duct may be done under local anesthesia in an outpatient clinic. Destruction of the gland through silver nitrate application or alcohol sclerotherapy is an alternative. Marsupialization is often reserved for recurrent cases, although...
Source: Primary Care: Clinics in Office Practice - October 13, 2021 Category: Primary Care Authors: Natalie Long, Laquita Morris, Krystal Foster Source Type: research

Neonatal Circumcision
Neonatal circumcision is one of the most common elective surgical procedures in the United States and globally. This procedure, to remove part of the penile prepuce or foreskin, is done for a variety of personal, social, and medical reasons. There are several proposed benefits, risks, and ethical considerations to discuss with parents before the procedure. Three equally safe and effective methods are used for circumcision, and each uses unique equipment: the Gomco clamp, the Mogen clamp, and the Plastibell device. Choice of technique should be guided by operator training and comfort. (Source: Primary Care: Clinics in Office Practice)
Source: Primary Care: Clinics in Office Practice - October 13, 2021 Category: Primary Care Authors: Matthew Zeitler, Brian Rayala Source Type: research

Pediatric Office Procedures
This article will review techniques and the current evidence for frequently performed pediatric procedures, including umbilical granuloma chemocautery, frenotomy, suture ligation of type B postaxial polydactyly, reduction of nursemaid ’s elbow, hair tourniquet removal, and tympanometry. (Source: Primary Care: Clinics in Office Practice)
Source: Primary Care: Clinics in Office Practice - October 8, 2021 Category: Primary Care Authors: Melanie H. Sanders, Vasudha Jain, Michael Malone Source Type: research

Intrauterine Device Insertion and Removal
Intrauterine devices (IUDs) are safe, highly effective, reversible contraception and come in 2 varieties in the United States: nonhormonal (copper) or levonorgestrel hormonal (LNG) IUDs. There are few absolute contraindications, making them appropriate birth control for most patients. Patients are more likely to select an IUD when counseled about IUD removal and factors that are important to them. IUD insertion and removal are uncomplicated office procedures that can be offered by primary care providers. (Source: Primary Care: Clinics in Office Practice)
Source: Primary Care: Clinics in Office Practice - October 7, 2021 Category: Primary Care Authors: Stephanie Long, Loren Colson Source Type: research

Contraceptive Implant Insertion and Removal
Nexplanon is the only contraceptive implant currently available in the United States. It exerts its contraceptive effects primarily by suppressing ovulation. The Nexplanon is the most effective method of long-acting reversible contraception. The implant should be removed by the end of the third year of use. Persons will experience a rapid return to fertility once the implant is removed. All health care providers must be trained on Nexplanon before performing insertions or removals of the implant. A Nexplanon can be inserted and/or removed as an office-based procedure. The most common adverse reaction is change in menstrual...
Source: Primary Care: Clinics in Office Practice - October 7, 2021 Category: Primary Care Authors: Bernadatte G. Gilbert Source Type: research

Endometrial Biopsy
Abnormal uterine bleeding is a frequent medical concern for premenopausal and postmenopausal patients. Endometrial biopsy is a safe, cost-effective option offered in the office setting. Although endometrial biopsy may result in insufficient tissue or false-negative results, data suggest that endometrial biopsy is 90% sensitive for endometrial cancer and 82% sensitive for atypical hyperplasia, with specificity of 100% for postmenopausal patients and similar results in premenopausal patients. Topical cervical analgesia and oral nonsteroidal anti-inflammatory drugs decrease a patient ’s discomfort during endometrial biopsy....
Source: Primary Care: Clinics in Office Practice - October 7, 2021 Category: Primary Care Authors: Stephanie Long Source Type: research

Performance and Interpretation of Office Spirometry
Pulmonary function testing (PFT) is an important component of the evaluation, monitoring, and management of patients with suspected or established lung disease. Spirometry is easily accomplished in the primary care office setting; determination of lung volumes and diffusion capacity is performed in a pulmonary laboratory. Spirometry evaluates vital capacity of the lungs and expiratory flow rates and provides both numeric data and a graphic depiction of respiratory air flow. Characteristic patterns in spirometry-derived data allow the clinician to identify potential lung disease, as well as establish relative reversibility ...
Source: Primary Care: Clinics in Office Practice - October 7, 2021 Category: Primary Care Authors: Jonathon M. Firnhaber Source Type: research

Primary Care Removal of Fishhooks, Rings, and Foreign Bodies from the Ear, Nose, and Superficial Eye and Conjunctiva
Embedded fishhooks, digital ring entrapment, and foreign bodies of the ear, nose, and superficial eye and conjunctiva may present to primary care clinics and can often be managed there. This review is a guide for primary care clinicians for effective, pragmatic, and safe techniques to address these scenarios in the office and when to refer them to a surgeon. (Source: Primary Care: Clinics in Office Practice)
Source: Primary Care: Clinics in Office Practice - October 7, 2021 Category: Primary Care Authors: J. Lane Wilson Source Type: research

Office Management of Genitourinary and Gastrointestinal Procedures
Insertion of urinary catheters (most often Foley catheters) can be performed in outpatient settings to manage acute urinary obstruction without referral to emergency services, as well as to obtain urine samples in patients not able to provide a clean catch urine sample. For patients with established suprapubic urinary catheters, routine exchange can also occur safely in primary care settings. Excision of a thrombosed external hemorrhoid can be performed in the office setting with local anesthesia. The procedure offers better clinical outcomes than symptomatic treatment if performed within the first 72  hours from the onse...
Source: Primary Care: Clinics in Office Practice - October 7, 2021 Category: Primary Care Authors: Jonathon M. Firnhaber, Bridgid Hast Wilson Source Type: research

Laboratory and Diagnostic Light Office Procedures
Office-based laboratory and bedside diagnostic procedures can be a helpful tool when assessing patients in the ambulatory setting. Diagnostic tests using a microscope (including assessment of vaginal discharge, urinary sediment, or skin scraping) or a diagnostic ultraviolet (UV) light (when evaluating the cornea or skin) can add valuable information to aid in proper diagnosis. This chapter will review necessary materials, technique, and interpretation for these often simple and inexpensive evaluations. (Source: Primary Care: Clinics in Office Practice)
Source: Primary Care: Clinics in Office Practice - October 7, 2021 Category: Primary Care Authors: Annie Rutter, Madeline Haas Source Type: research