Exploring Rural Medicine: Current Issues and Concepts/

Chapter 1: Rural Medical Practice: Present and Future
Introduction
Characteristics of Rural Areas
Have Rural Medical Needs been Defined?
How is Rural Practice Different?
What is the Future of Rural Medicine?
Health Care Reform Terminology
What would the New System Look Like?
Practice Organization Concerns
Reimbursement Concerns
Recruitment and Retention Concerns
Summary
Chapter 2: Labor and Delivery Crises: Rural Solutions
Introduction
Dysfunctional Labor
Case Report
Diagnosis and Treatment
Discussion
Augmentation of Labor
Procedure for Augmentation of Labor
Fetal Distress
Case Report
Diagnosis and Treatment
Discussion
Shoulder Dystocia
Case Report
Diagnosis and Treatment
Discussion
Unique Rural Situations
Chapter 3: Stabilization and Transport of the Ill Newborn Infant
Introduction
Resuscitation
Consideration of Transfer of the Infant to an NICU
Stabilization
Hypothermia
Hypotension
Hypoglycemia
Hypoxemia
Hypercapnia
Acidosis
Ventilation
General Measures
Summary
Chapter 4: Bronchopulmonary Dysplasia: After the Infant goes Home
Introduction
Key Management Requirements
Nutrition
Gastroesophageal Reflux
Prevention of Cor Pulmonale
Airways Disease
Other Complications
Home Equipment Needs
Consultation Needs
Summary
Chapter 5: Attention Deficit-Hyperactivity Disorder
Introduction
Diagnosis
History
Physical Examination
Performance and Academic Evaluation
Treatment
Drug Therapy
Summary
Chapter 6: Recognition and Evaluation of Child Abuse
Introduction
Evaluation of Possible Child Abuse
History
Physical Examination
Laboratory Evidence
What to do when Suspicious
Special Rural Concerns
Summary
Chapter 7: Adolescent Pregnancies in Rural America: A Review of the Literature and Strategies for Prevention
Introduction
The Scope of Teen Sexual Activity
Conceptualization
Biology and Maturation
Social Influences
Race, Cultural, and Economic Factors
Media Exposure
Parental Influence
Peers and Dating
Personality and Self-Esteem
Risks, Benefits, and Societal Trends
Prevention of Teen Pregnancy
Abstinence Programs
School Programs
Community-Based Programs
Male-Only Programs
Recommendations and Conclusions
Chapter 8: Common Mental Health Problems
Introduction
The Mood Disorders
Definitions
Evaluation
Treatment
Referral
Prevention
Anxiety Disorders
Definitions
Evaluation
Treatment
Referral
Prevention
Psychotic Disorders
Definitions
Evaluation
Treatment
Referral
Prevention
Chemical Dependency
Definitions
Evaluation
Treatment
Referral
Prevention
Psychiatric Emergencies
Definitions
Evaluation of Suicide Risk
Summary
Chapter 9: Environmental Hazards
Introduction
Nitrates and Nitrites
Case Report
Source of the Toxin
Who is at Risk?
Effects of the Toxin
Diagnosis
Treatment
Lead Toxicity
Case Report
Definition of the Problem
Source of the Toxin
Who is at Risk?
Effects of the Toxin
Diagnosis
Treatment
Chronic Arsenic Toxicity
Case Report
Source of the Toxin
Who is at Risk?
Effects of the Toxin
Diagnosis
Treatment
Asbestos
Case Report
Exposure
Who is at Risk?
Effects of the Toxin
Diagnosis
Treatment
Summary
Chapter 10: Managing Trauma in the Rural Emergency Department: Basic Organization
Introduction
Epidemiology of Rural Trauma
Unique Problems of Rural Trauma
Understanding the Rural Trauma System
Communications and Dispatch: Access to Emergency Care
Preparations before the Accident
Preparing the Resuscitation Area
Preparing the Staff
The Trauma Protocol
The Rural Hospital Trauma Team
Approach to the Injured Patient
Summary
Chapter 11: Managing Trauma in the Rural Emergency Department: Specific Problems
Introduction
Airway Management
Blind Nasotracheal Intubation
Orotracheal Intubation with Rapid Sequence Intubation
Technique for RSI
Cricothyrotomy
Procedure for Cricothyrotomy
Shock
Recognition of Shock
Head Injuries
Trivial Head Injury
Minor Head Injury
Moderate Head Injury
Severe Head Injury
Amputations
Care of the Amputated Part: Complete Amputations
Care of the Amputated Part: Incomplete Amputations
Care of the Stump
Transferring the Patient
Summary
Chapter 12: Treatment of Acute Myocardial Infarction with Thrombolytic Drugs in the Rural Hospital
Introduction
Selection of Patients
Informed Consent
Evaluation before Administering Thrombolytic Agents
Choice of Thrombolytic Agent
Method of Administration
Adjunctive Therapy
Complications
Follow-up Care
Summary
Chapter 13: Women's Health Issues
Introduction
Prevention
Pap Tests
The Abnormal Pap Test
Screening for Breast Cancer
The Breast Lump
Contraception
Barrier Methods
Natural Family Planning (NFP)
Intrauterine Device (IUD)
Oral Contraceptives
Progestin Implants
Depo-Provera
Vaginitis
Sexually Transmitted Diseases
Chlamydia
Human Papilloma Virus
Hepatitis B Virus (HBV)
Genital Herpes Simplex Virus (HSV)
Pelvic Inflammatory Disease (PID)
Violence against Women
The Female Menopause
Osteoporosis
Cardiovascular Disease
Techniques of Hormone Replacement Therapy (HRT)
Summary
Chapter 14: Caring for the AIDS Patient in a Rural Practice
Introduction
Background
Pathophysiology and Natural History
Transmission
Testing
Counseling and Diagnosis
The Patient with a Positive HIV Test
HIV Infection and Moderate Immunosuppression (CD4 = 200–500)
HIV Infection and Severe Immunosuppression (CD4 < 200)
Clinical AIDS
End-of-Life Issues
Doctor (Docere—to Teach)
How to Keep up to Date
Chapter 15: Treatment of Patients with Terminal Cancer
Introduction
What Care is Futile?
Therapeutic Benefit Marginal
Plan of Care for TBM Patients
Therapeutic Benefit Unlikely
Plan of Care of TBU Patients
Therapeutic Benefit Futile
Plan of Care of TBF Patients
Assessing Futility of Treatment
Non-Small Cell Lung Cancer (NSCLC)
Breast Cancer
Colon Cancer
Prostate Cancer
Renal Cell Cancer
Leukemia
Pancreatic Cancer
Ovarian Cancer
Summary
Chapter 16: Caring for Dying Patients and their Families
Setting the Stage: Telling the Truth, with Hope
Walking the Path: Let the Patient set the Pace Emotionally
Self-Determination: Establish a Road Map for the Future
Guidelines for Self-Determination
Opening the System: Involving Family and Consultants
Negotiate Conflict: See the Big Picture
Total Pain Management
Physical Pain Management
Emotional Pain: Anticipatory Grief Management
Actively Dying: Letting go of Life
Summary
Chapter 17: Health Maintenance in Clinical Practice: Strategies and Barriers
Introduction
Barriers to Clinical Prevention
Health System Barriers
Patient Barriers
Physician Barriers
Strategies for Implementing Prevention
Health Maintenance Flow Sheet
Example of a System
Computerized Systems
Time Management
Behavior Reinforcement
Summary
Chapter 18: Patient Education in the Rural Practice
Introduction
Rationale for Patient Education
Philosophy of Practice
Patient Education Committee
Assessing Needs
Applying Adult Education Research
Appropriate use of Patient Education Materials
Practical Implementation Considerations
Locating and Selecting Materials
Reading Level
Evaluative Service
Creating your Own Materials
Organizing Materials
Premade Packets for Special Types of Visits
Computer Software in Patient Education
Beyond the Office Visit
Role Modeling
Chapter 19: Making your Practice Palatable for your Patients: Cultural Competency
Introduction
Awareness of the Role of Culture
When Cultural Sensitivity is Mandatory for Success
Resources for Gathering Cultural Information
Starting a New Practice
When you Need the Information Yesterday
Southeast Asians
American Indians or Native American People
African Americans
Summary
Chapter 20: Ethics Dilemmas in Rural Practice
Introduction
Ethics Conflicts in Rural Settings
The Ethics Decision-Making Process
Ethics Decision Making: A Case Analysis
Case Presentation
Discussion
Autonomy
Beneficence
Utility
Justice
Outcome
Recommendations
Summary
Chapter 21: Quality Assessment in Rural Practice
Introduction
Hospital Quality Assessment
Outpatient Quality Assessment
The CQI Process
Developing Criteria and Setting Goals
Measuring Care
Results
Improving Care
Example: Pediatric Eye Care
Topic Selection
Criteria and Goal Selection
Data Collection and Data Summary
Results
Improving Care
Remeasuring
Chapter 22: Living through Malpractice Litigation
Introduction
Rationale
Caplan's Theory of Crisis
Phase I: Impact
Phase II: Disorganization
Phase III: Recovery
Phase IV: Reorganization
Caplan's Theory Applied to the Family and Community
Human Responses to Medical Litigation
The Impact of Receiving the Subpoena
The Legal Process Exacerbates Disorganization
Coping with the Litigation Process
Recovery
Community Impact and Disorganization
Impact of Litigation on Medical Practice
Peer Responses to Litigation: Physicians and Nurses
Helping Families Cope
Summary