摘要:

With clinical information it is frequently difficult or impossible to make objective measurements to prove that a particular finding is correct. In these circumstances, the agreement of experienced clinicians is the best guide to the accuracy of clinical findings. However, studies of clinical judgement usually show a distressingly high level of disagreement among clinicians. We examine why such disagreement is so common, how clinical disagreement can be measured and how clinicians can be trained so that they are able to agree on important findings.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb121372.x

出版商:Wiley    

年代:1991

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb121373.x

出版商:Wiley    

年代:1991

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb121374.x

出版商:Wiley    

年代:1991

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb121375.x

出版商:Wiley    

年代:1991

数据来源: WILEY

摘要:

ObjectiveTo determine the feasibility of laboratory reporting of infectious diseases and to compare the value of this system with the existing medical practitioner notification system.DesignA sample of notifications was selected from medical practitioner notifications and was compared for both completeness and timeliness of notification with a sample of notifications obtained through the Laboratory Infectious Diseases Surveillance Project.SettingThe New South Wales Health Department and the Public Health Unit of the Eastern Sydney Area Health Service.ParticipantsMedical practitioners forwarding notifications of infectious diseases to the New South Wales Health Department and laboratories participating in the Laboratory Infectious Diseases Surveillance Project.Main outcome measuresWe counted the number of infectious diseases reported by medical practitioners and participating laboratories and estimated the proportion of these diseases which were common to both sources of data. We also estimated the time taken between the diagnosis of a notifiable infectious disease and the receipt of the notification by the Medical Officer of Health.ResultsThere was substantial underreporting of notifiable infectious diseases by medical practitioners. During the study there were 461 cases of a notifiable disease reported by either medical practitioners or by participating laboratories. Of these cases, 75% were reported only by laboratory staff, 20.2% were reported by medical practitioners alone and 4.8% of cases were reported by both laboratory staff and medical practitioners. The Medical Officer of Health received the reports from the participating laboratories within a significantly shorter time than the notifications from medical practitioners.ConclusionThe use of infectious disease notifications by laboratories can substantially improve the surveillance of infectious diseases.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb121376.x

出版商:Wiley    

年代:1991

数据来源: WILEY

摘要:

ObjectiveTo determine the incidence and age distribution of invasiveHaemophilus influenzaetype b (Hib) disease in children (0–14 years) in the Sydney Statistical Division (SSD).DesignRetrospective ascertainment from a defined population, 1985–1987. Eligible cases had Hib isolated from a normally sterile site or endoscopically proven epiglottitis.SettingSydney Statistical Division, which had a population of children aged 0–4 years of 229 165 in 1986.PatientsCases were identified from all potential sources of relevant recorded information.Mainoutcomes:There were 292 eligible cases. Among 284 previously well children, those under 18 months of age contributed 81 of 143 cases (57%) of meningitis and 22 of 71 (71 %) of cellulitis/arthritis but only 8 of 91 (11%) of epiglottitis and 4 of 18 (22%) of infection in other foci. Overall, 9% of cases had occurred by 6 months of age, 42% by 18 months and 55% by 24 months. The annual incidence of invasive Hib disease was 38.5 per 100 000 children aged 0–4 years. In areas with the lowest proportion of young children (less than 5.5%), the incidence of Hib disease in the first 12 months of life was significantly lower than in the remainder of Sydney, although there were no differences in overall disease incidence in the age group 0–4 years.ConclusionsThis study indicates that approximately 1 in 500 urban Australian children develop invasive Hib disease by their fifth birthday. Vaccination of children in Sydney with a conjugate Hib vaccine at 18 months of age would result in a greater potential reduction in Hib disease than in the United States, where universal vaccination at this age is current policy.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb121377.x

出版商:Wiley    

年代:1991

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb121378.x

出版商:Wiley    

年代:1991

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb121379.x

出版商:Wiley    

年代:1991

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb121380.x

出版商:Wiley    

年代:1991

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb121381.x

出版商:Wiley    

年代:1991

数据来源: WILEY