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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

Management of Cervical Dysplasia Using Office Loop Electrosurgical Excision Procedure
Declining cervical cancer rates in the United States highlights the value of prevention and early detection of premalignant cervical disease afforded by the human papillomavirus vaccine and Pap smear. The availability of in-office loop electrosurgical excision procedure affords clinicians with a cost-effective and preferred tool for the excision of high-grade lesions of the cervix with minimal risk for severe adverse outcomes. The most recent American Society for Colposcopy and Cervical Pathology guidelines recommend a risk-based approach for the detection, treatment, and surveillance of cervical disease and specifically f...
Source: Primary Care: Clinics in Office Practice - October 7, 2021 Category: Primary Care Authors: Sarah In és Ramírez, Andrew Lutzkanin Source Type: research

Performance and Interpretation of Office Exercise Stress Testing
In an era where cardiovascular disease continues to increase in prevalence, chest pain is a commonly encountered complaint in the outpatient setting. Clinicians are often tasked with the challenge of selecting the most appropriate screening tool in the evaluation of a patient with suspected coronary artery disease. With proper consideration of indications and contraindications, exercise electrocardiogram (ECG) stress testing is an accessible, cost-conscious, and validated outpatient diagnostic modality for predicting coronary artery disease. (Source: Primary Care: Clinics in Office Practice)
Source: Primary Care: Clinics in Office Practice - October 7, 2021 Category: Primary Care Authors: Heath C. Thornton, Fadi Hanna, Kiran Mullur Source Type: research

Outpatient Vasectomy
Vasectomy is a safe, effective, and practical option for permanent contraception in men. Vasectomy is a surgical procedure used in men to disrupt and occlude the vas deferens, which delivers sperm from the testicles. By interrupting sperm transport, this procedure provides permanent sterilization. Vasectomies are typically done under local anesthesia in outpatient settings, and patients usually go home within an hour of the surgery. Surgical techniques used for vasectomy vary widely throughout the world, with limited evidence to guide the most effective approach. Current vasectomy guidelines largely rely on information fro...
Source: Primary Care: Clinics in Office Practice - October 7, 2021 Category: Primary Care Authors: Matthew Zeitler, Brian Rayala Source Type: research

Meeting Children ’s Greatest Needs
The COVID-19 pandemic has brought many challenges to all of us, especially to our pediatric patients and our own children. This last academic year was either mostly or entirely virtual, certainly not optimal, and the forward academic progression for many children was hampered. Social isolation prevented gatherings, school activities, and even playing outside in the neighborhood. We will likely not fully understand the ramifications and impact of the pandemic on our children for years to come. Moreover, it has been a challenge for many of our pediatric patients to get the health care they deserve and need. (Source: Primary ...
Source: Primary Care: Clinics in Office Practice - July 24, 2021 Category: Primary Care Authors: Joel J. Heidelbaugh Tags: Foreword Source Type: research

Common Pediatric Issues in Primary Care: An Introduction
The goal of this issue has been to create an easy reference for some of the most common pediatric issues that are encountered in the primary care setting. It is our hope that the reader can utilize the knowledge gained here to better manage these pediatric-specific problems with current and evidence-based recommendations, whether it be through therapeutics, testing, or referrals. We have concentrated on areas the clinician will encounter frequently in a typical practice. These encompass cardiac, pulmonary, musculoskeletal, dental, and gastrointestinal systems. (Source: Primary Care: Clinics in Office Practice)
Source: Primary Care: Clinics in Office Practice - July 24, 2021 Category: Primary Care Authors: Luz M. Fernandez, Jonathan A. Becker Tags: Preface Source Type: research

Common Pediatric Musculoskeletal Issues
This article reviews injuries encountered in active pediatric patients and discusses common presentations, diagnostic criteria, treatment modalities, and prevention. An emphasis is placed on overuse injuries, including a review of physeal and apophyseal injuries encountered in skeletally immature, active patients as well as back disorders often encountered in adolescents. This article is not meant to be comprehensive, but it offers directions for management of these patients in the outpatient primary care setting. (Source: Primary Care: Clinics in Office Practice)
Source: Primary Care: Clinics in Office Practice - July 24, 2021 Category: Primary Care Authors: Brittney M. Richardson, Meghane E. Masquelin Source Type: research

Attention Deficit and Hyperactivity Disorder
The treatment of attention-deficit/hyperactivity disorder can be a very rewarding and challenging task. The management of this condition has impact on a child ’s performance in school in both academics and extracurriculars, and therefore, can be a determinant of what they are able to achieve and become. Treatment can also impact the child’s self-image and ability to successfully interact with their peers. Adequate control of the disorder can break dow n barriers to successful development of a child’s potential and ability to play a role in the work force someday. (Source: Primary Care: Clinics in Office Practice)
Source: Primary Care: Clinics in Office Practice - July 24, 2021 Category: Primary Care Authors: Tina Fawns Source Type: research

Common Pediatric Issues in Primary Care
PRIMARY CARE: CLINICS IN OFFICE PRACTICE (Source: Primary Care: Clinics in Office Practice)
Source: Primary Care: Clinics in Office Practice - July 24, 2021 Category: Primary Care Authors: Luz M. Fernandez, Jonathan A. Becker Source Type: research

Copyright
ELSEVIER (Source: Primary Care: Clinics in Office Practice)
Source: Primary Care: Clinics in Office Practice - July 24, 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 - July 24, 2021 Category: Primary Care Source Type: research