ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1996.tb122115.x

出版商:Wiley    

年代:1996

数据来源: WILEY

摘要:

There is one thing stronger than all the armies in the world: and that is an idea whose time has come — Victor Hugo (1802–1885)

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1996.tb122116.x

出版商:Wiley    

年代:1996

数据来源: WILEY

摘要:

We have the technology to make plentiful and relatively safe supplies of coagulation factors, and a cure may be within our grasp

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1996.tb122117.x

出版商:Wiley    

年代:1996

数据来源: WILEY

摘要:

Much has to be considered before widespread population gene screening can be recommended

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1996.tb122118.x

出版商:Wiley    

年代:1996

数据来源: WILEY

摘要:

Continuity — best for the patient, best for you?

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1996.tb122119.x

出版商:Wiley    

年代:1996

数据来源: WILEY

摘要:

ObjectivesTo determine whether continuous detection of adverse patient occurrences followed by analysis and medical intervention can alter the rate of adverse occurrences.Design and participants15912 patients discharged from one hospital were reviewed in two stages. Medical records were screened retrospectively by medical records staff for one or more of eight general patient outcome criteria. Those that screened positive for the criteria were reviewed by one of four doctors. If an adverse occurrence was confirmed, further analysis and recommendations for action to prevent its recurrence were made at meetings of the four doctors, and forwarded to a committee of visiting medical officers who decided on the appropriate course of action.SettingA rural base hospital in Horsham, Victoria, between July 1991 and June 1994.Main outcome measuresThe rate and severity of adverse patient occurrences in each year.Results1465 records were screened positive for one or more criteria, and an adverse patient occurrence was confirmed in 155. 88 cases were determined to be minor or not preventable and further action (mostly by changes to hospital policies) was recommended for the remaining 67. Over the three years, the number of adverse occurrences fell from 69 (1.35% of all patient discharges in the first year) to 33 (0.58% of all patient discharges in the third year) (P<0.0001) and there was no significant change in severity.ConclusionsThe rate of adverse patient occurrences can be significantly reduced by their continuous detection using retrospective screening in conjunction with review, analysis and action to prevent recurrences.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1996.tb122120.x

出版商:Wiley    

年代:1996

数据来源: WILEY

摘要:

ObjectiveTo identify individual and social characteristics of patients making sequential visits to a different rather than the same general practitioner (GP).MethodData for this study were extracted from the “Record Linkage Pilot Study” of the National Centre for Epidemiology and Population Health, which linked information from personal interviews with Health Insurance Commission and National Heart Foundation Risk Factor Survey data. Each sequence of visits (any two consecutive visits) made by each participant to the same or a different GP from January 1991 to December 1992 was treated as an event.Participants521 subjects aged between 23 and 72 years who gave consent to release of Health Insurance Commission data.Main outcome measureA visit to the same GP or a different GP from the one seen at the last visit.ResultsLogistic regression analysis showed that younger age, good physical functioning, good self‐rated health, normal body mass index, shiftwork and a longer time interval between visits were significantly associated with less continuity of care.ConclusionsOur study raises questions about the relationship between chronological continuity and quality of care. For example, if infrequent visits (associated with less continuity) are for distinct illnesses, is quality of care affected by information or treatment from a previous visit? Our results also suggest that some GPs, because of the demography of their practices (more young people, a higher proportion of shift workers), may be disadvantaged by continuity‐based reward systems. Moreover, because of lack of continuity young people may miss out on GPs’ health promotional activities.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1996.tb122121.x

出版商:Wiley    

年代:1996

数据来源: WILEY

摘要:

ObjectiveTo describe the epidemiology and clinical features of children presenting to an emergency department with suspected snakebite.DesignA retrospective study of patient records.SettingAn emergency department of a children's teaching hospital (Princess Margaret Hospital) in Perth, Western Australia.ParticipantsAll children attending the emergency department from 1984 to 1993 with suspected snakebite.Main outcome measureClinical and laboratory evidence of envenomation.ResultsOver the decade studied, 156 children (mean age, six years and eight months) presented with suspected snakebite; over two‐thirds (68%) were boys. In at least 31% of cases, no appropriate first aid had been applied. Only 14 children were envenomed according to clinical and laboratory criteria: 10 of these had coagulopathy; one of the 10 also had rhabdomyolysis. A Venom Detection Kit was used in 117 children. The test gave a positive result in 21 children (13%). Antivenom was given to 18 children, 14 of whom were definitely envenomed. Four of the envenomed children returned a negative result of Venom Detection Kit testing at all sites tested, and in five patients not clinically envenomed the urine specimen tested positive with the Venom Detection Kit (presumably a false positive result or subclinical envenomation). Of the 156 children, 130 were admitted to hospital, and 26 were discharged directly from the emergency department. All children recovered completely.Conclusions(i) Many children did not receive appropriate first aid for snakebite; (ii) Most children with suspected snakebite presenting to the emergency department were not envenomed; (iii) Envenomation was best diagnosed by clinical features and laboratory investigations, with the Venom Detection Kit being used to determine the appropriate antivenom; (iv) Discharging children directly from the emergency department is not recommended.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1996.tb122122.x

出版商:Wiley    

年代:1996

数据来源: WILEY

摘要:

ObjectiveTo assess the feasibility of offering community testing for carrier status of ΔF508, a gene mutation associated with cystic fibrosis (CF).DesignProspective pilot survey.SettingGeneral practice, the two main high schools and workplaces in the country towns of Young and Harden (combined population, 14940; with 7707 people aged 16–55 years) in New South Wales (NSW).ParticipantsIndividuals aged 16 years and over.Main outcome measuresNumber of ΔF508 carriers, test uptake rates, mode of learning about the testing, motivation for testing, retention of knowledge about CF, and test results and emotional effects of knowledge about carrier status.ResultsWe tested 610 people (8% of the population aged 16–55 years) and identified 47 carriers (20% of the expected number in the 7707 people aged 16–55 years). Testing in schools had the highest uptake. Retention of knowledge was high; all ΔF508‐positive individuals recalled their carrier status accurately. Anxiety was transient among carriers; over 90% of all respondents felt they had made the right decision to be tested.ConclusionsWe recommend community testing for carrier detection and suggest targeting those with a family history of CF and girls aged over 16 in high schools.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1996.tb122123.x

出版商:Wiley    

年代:1996

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1996.tb122124.x

出版商:Wiley    

年代:1996

数据来源: WILEY