The clinical diagnosis of acute bacterial rhinosinusitis in general practice and its therapeutic consequences

In a randomized double-blind trial 251 adults with sinusitis-like symptoms were given amoxicillin/clavulanate or placebo for 6 days. Seven diagnostic indicators for acute bacterial rhinosinusitis are compared by their accuracy assuming a latent class model and by the treatment effect that they would have had if used to select a subset of patients for antibiotic treatment. Under a latent class model, radiography is a more efficient indicator then C reactive protein (CRP), which is, in turn, more efficient than other clinical signs and symptoms. However, a history of purulent nasal discharge, and signs of pus in the nasal cavity and throat, are better criteria than radiography or CRP for selecting those patients who will benefit from antibiotic treatment. These contradictory results are a salutary reminder that diagnostic indicators need to be evaluated in terms of therapeutic consequences for the patient.     

The risks of clinical practice

The hospital workplace is changing dramatically, moulded in part by the need to protect medical staff from the increasing physical and mental risks of medical practice today. This article examines the risks and look to the future.     

The place of ezetimibe in clinical practice

Ezetimibe is the first selective cholesterol absorption inhibitor to be licensed in the UK. It interferes both with dietary cholesterol absorption and the enterohepatic circulation of cholesterol synthesized by the liver. As monotherapy it leads to modest reductions in plasma low-density lipoprotein cholesterol levels, but has synergistic effects when used with statins.     

急诊急救专科护士在临床实践中的作用

文章探讨了急诊急救专科护士在临床实践中发挥的作用。认为急诊急救专科护士在急诊护理领域具有先进的专业知识、广博的临床经验和高超的临床能力,能直接向患者提供高质量护理服务。充分发挥急诊急救专科护士的作用,对提高急诊护理质量和急诊护士的整体素质有积极的意义。     

The economic evaluation of clinical practice

This paper considers a series of questions: why economists are concerned with evaluating clinical practice; whether economic evaluation has much impact on clinical practice; possible reasons for the observed lack of impact; and the future role of evaluation. The prime reasons for the interest of economists are that the health service absorbs substantial resources and that clinicians have a major role in directing their use. Evaluations that have been carried out have had a limited impact on practice. This is because of weaknesses in the studies themselves; the widespread lack of receptivity to economic arguments found among clinicians; and the absence of incentives to encourage clinicians to be concerned with cost-effectiveness. The conclusion is drawn that major changes in clinician behaviour will not be brought about by evaluation alone. A major role for evaluation lies in educating clinicians to use economic concepts and modes of thinking in their day-to-day practice.     

The emergence of clinical practice guidelines

Clinical practice guidelines are now ubiquitous. This article describes the emergence of such guidelines in a way that differs from the two dominant explanations, one focusing on administrative cost-cutting and the other on the need to protect collective professional autonomy. Instead, this article argues that the spread of guidelines represents a new regulation of medical care resulting from a confluence of circumstances that mobilized many different groups. Although the regulation of quality has traditionally been based on the standardization of professional credentials, since the 1960s it has intensified and been supplemented by efforts to standardize the use of medical procedures. This shift is related to the spread of standardization within medicine and especially in research, public health, and large bureaucratic health care organizations.     

辅助生殖双胎与自然妊娠双胎的临床分析

目的 探讨辅助生殖双胎与自然妊娠双胎的临床结局.方法 对照分析陕西省妇幼保健院2007年50例辅助生殖双胎(辅助生殖组)与113例自然妊娠双胎(自然妊娠组)孕产妇的年龄、孕产次、孕周、剖宫分娩与自然分娩、双胎妊娠并发症、新生儿体重、新生儿评分、窒息、死亡及畸形、双胎体重不协调状态、孕产妇并发症以及脐带缠绕等临床资料,比较其妊娠结局.结果 辅助生殖组与自然妊娠组在孕产妇年龄(P＞0.05)、分娩方式(x2=0.208,P＞0.05)及母体合并症(P＞0.05)方面比较无显著性差异,但早期早产发生率和足月分娩率辅助生殖组高于自然妊娠组,分别为6.0%、4.4%、44.0%、22.2%.新生儿结局比较,新生儿足月低体重辅助生殖技术组(31.0%)高于自然妊娠组(15.0%),x2=6.670,P＜0.05.其他无明显差异,且新生儿预后良好.结论 对双胎妊娠孕妇,需加强双胎围生育期保健,以提高双胎妊娠周数减,少早产儿及低体重儿的发生.     

The role of clinical epidemiology in medical practice

Epidemiological research has been carried out traditionally in the field on non-clinical populations and has sought to reveal the aetiology of disease. But in the 1960's a possible role for epidemiology in the study of clinical practice emerged. A series of articles on scientific methodology and clinical medicine argued that much of the reasoning underpinning clinical practice might be expressed in numerical terms. This numerical expression would require the counting of diseases and events in groups of patients and would thus employ similar methods to traditional epidemiology where diseases are counted in populations. Although the term 'clinical epidemiology' was introduced as early as 1938, Sackett was instrumental in promoting the concept in 1969 as the 'application by a physician... of epidemiologic and biometric methods to the study of the diagnostic and therapeutic process in order to effect an improvement in health'. The management of individual patients involves the clinician in a multitude of decisions, concerned with making a diagnosis, ordering tests, prescribing treatment and estimating prognosis. Decisions are often made in a state of uncertainty because no reasonably objective information is available to indicate the best decision in the given circumstances, or because the most appropriate sequence of decisions for an individual patient is not apparent. Although the state of the art does not allow us to do this completely, the role of clinical epidemiology is, by way of clinical research, to provide clinicians with the information to make decisions that are most appropriate for the welfare of their patients, and in combination with information derived from decision theory to make these decisions rapidly and logically.(ABSTRACT TRUNCATED AT 250 WORDS)     

The broadening use of leflunomide in clinical practice

Autoimmune diseases make up a large proportion of chronic disease care. Inducing remission by immunosuppression remains the cornerstone of long-term management. This article reviews the place of leflunomide in clinical practice and outlines its potential applications beyond its licenced indication, rheumatoid arthritis.     

Finding a way between nihilism and romanticism: Some reflections on the practice and politics of the sociology of risk

This editorial argues that aspects of a number of contemporary debates within the sociology of risk, including those concerned with the nature of expert knowledge, the capacity of theory to address practical real-world issues, and the appropriate political stance of the scholar, were pre-figured in helpful and insightful ways in the work of the British medical sociologist Philip M. Strong (1945–1995). The recent publication of a selection of Strong's essays, which had earlier appeared in a disparate range of books and journals, makes a valuable resource available not only to specialist health researchers, but also to the wider risk research community.     

The art and nature of health: a study of therapeutic practice in museums

Drawing on ethnographic fieldwork and interviews at a major metropolitan art museum and botanic garden, this article considers the practical accomplishment of American museums’ ‘health turn’ by tracing how museum staff develop therapeutic programmes for visitors with disabilities. In doing so, it considers one of medical sociology's fundamental theoretical questions – how ideologies of health order social life – in an unconventional empirical setting. Acknowledging contemporary arguments for both the relative merits and unintended consequences of this policy trend, I focus instead on the particular institutional arrangements, professional norms, and material cultures of art and nature that shape museums’ therapeutic work, so as to reveal its effects. Data reveals ideological similarities, but practical differences, between museological and medical understandings of wellness. Extending a ‘medical sociology of practice’ to new contexts ultimately foregrounds the contingencies, and diversity, of therapeutic mechanisms and meanings, thereby broadening sociological research on healing and healthism.