摘要:

The American Medical Association called for the establishment of guidelines to allow electronic prescription of medications “for established patients.” Based on experience writing more than 10,000 Internet-based prescriptions, we agree that guidelines are long overdue. Restricting such prescribing to patients with whom a face-to-face relationship has previously been established violates patient autonomy and distorts the physician-patient relationship without improving patient safety or convenience. A study comparing information obtained and used by Internet-based physicians prescribing sildenafil with that obtained by clinic-based physicians writing similar prescriptions suggests that safety may be greater on the Internet. Data regarding the appropriateness of prescriptions for other medications suggest that the in-office visit is not the panacea it is often assumed to be. Guidelines for electronic prescribing, like guidelines for other aspects of medical practice, need to be based on evidence. Such evidence is currently lacking, and a serious effort to obtain it should be a top priority.

ISSN:0038-4348    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:0038-4348    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:0038-4348    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

BackgroundWe analyzed the incidence of balanitis xerotica obliterans (BXO) by both age and ethnicity at an equal-access health care facility.MethodsWe retrospectively reviewed discharge records from 1997 to 1999 at Brooke Army Medical Center to determine ethnicity and age of patients with BXO.ResultsOf 153,432 male patients, 108 (0.070%) had a diagnosis of BXO. The age distribution was similar over a range from 2 to 90 years, with the exception of the third decade, when the incidence almost doubled. Black and Hispanic patients had twice the incidence found in white patients (10.59, 10.67 and 5.07 per 10,000 patients, respectively).ConclusionAt our equal-access health care facility, the incidence of BXO in black and Hispanic patients was double that in whites. This unexpected finding, in concert with the greater incidence in the third decade, may result from greater access to medical attention for these patients in the military setting. Nevertheless, further research into the origin of the disease is warranted.

ISSN:0038-4348    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

ObjectiveThis study evaluates the efficacy of recombinant factor VII (rVIIa) in the treatment of coagulation dysfunction in pediatric patients.MethodsWe retrospectively reviewed the records of pediatric patients who received rVIIa in the intensive care unit or operating room for treatment of coagulopathy. Case series in the literature were also reviewed.ResultsTen patients, ranging in age from 3 months to 19 years, received 22 doses of rVIIa. Seven of the 10 patients had received fresh frozen plasma and cryoprecipitate before the administration of rVIIa without effect. All 10 patients had a fibrinogen level above 100 mg/dl and platelet count above 100,000/mm3at the time of rVIIa administration. After rVIIa administration, there were significant decreases in prothrombin time, international normalized ratio, and partial thromboplastin time. No adverse effects were noted.ConclusionRecombinant factor VIIa can be used to effectively reverse coagulation disturbances in the pediatric patient even when treatment with fresh frozen plasma has failed. Given its therapeutic potential, prospective, randomized trials are warranted.

ISSN:0038-4348    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

ObjectiveDeep venous thrombosis (DVT) is a major cause of morbidity and mortality after surgery for primary and metastatic brain tumors.MethodsWe conducted a confidential survey of American neurosurgeons interested in tumor surgery to assess DVT risk awareness and thromboprophylaxis patterns.ResultsOf the 172 respondents, 108 (63%) underestimated the DVT risk after brain tumor surgery. After operating on patients who had brain or spinal tumors, 81.4 and 78.5% of respondents, respectively, reported using DVT prophylaxis. After performing brain tumor surgery, 76.2% of respondents reported using solely mechanical methods of prophylaxis “always” or “most of the time.”ConclusionAmerican neurosurgeons tend to underestimate the risk of DVT associated with brain tumor surgery and to use mechanical thromboprophylaxis despite the availability of effective pharmacologic antithrombotics. A better appreciation of the risk of thrombosis, combined with clinical studies to address safety, may enhance the use of prophylaxis and the perceived safety of antithrombotics in this setting.

ISSN:0038-4348    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

ObjectiveGuidelines for emergency treatment of stroke are not always known or followed. Florida Medical Quality Assurance, Inc. collaborated with hospitals to determine how closely the current American Heart Association (AHA) and the Florida Agency for Health Care Administration (AHCA) guidelines were being followed and to improve compliance with these guidelines.MethodsMedical records of patients admitted for acute stroke to 32 hospitals were retrospectively reviewed for compliance with six quality indicators (QIs) on the basis of AHA and AHCA guidelines. Hospitals were provided feedback on their levels of guideline compliance, and they subsequently implemented measures to improve compliance. After 6 months, the records of patients admitted after the provision of feedback were reviewed for compliance with the same six QIs.ResultsCompliance improved with regard to all QIs and was statistically significant for three of them.ConclusionFeedback on performance, coupled with proactive collaboration with emergency department staff, resulted in improved compliance with the stroke guidelines.

ISSN:0038-4348    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

BackgroundCurrent medical education policy seeks to address the health care needs of underserved populations, among whom are individuals associated with agriculture.MethodsThis paper describes a focus group approach to planning farm field trips whereby medical students accompany agricultural extension agents to study the personal, occupational, and environmental health concerns of farmers.ResultsThe resulting plan joins a state's cooperative extension system, medical school, and farm community in partnership to provide an experiential approach to agricultural medicine and rural health education.ConclusionThe planning exercise and the field trips are successful examples of agromedicine, a partnership approach to preventive agricultural medicine involving professionals in medicine and in agriculture.

ISSN:0038-4348    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Restorative proctocolectomy with ileal pouch anal anastomosis has become the most commonly used procedure for elective treatment of patients with mucosal ulcerative colitis and familial adenomatous polyposis. Since its original description, the procedure has been modified in an attempt to obtain optimal functional results with low morbidity and mortality, and yet provide a cure for the disease. These modifications of the technique are discussed in this review, limited to the current points of controversy. We reviewed the current literature describing restorative proctocolectomy with ileal pouch anal anastomosis. The current “hot topics” for debate are transanal mucosectomy with hand-sewn anastomosis versus the double-stapled technique, the use of diverting ileostomy, indeterminate colitis, the role of laparoscopy, and indications for pouch surgery in the elderly. Longer follow-up of patients and increased knowledge and experience with pouch surgery, coupled with active prospective evaluation of the procedure are required to settle these issues. Patients must be fully informed to understand inherent risks of each choice.

ISSN:0038-4348    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:0038-4348    

出版商:OVID    

年代:2003

数据来源: OVID