Is the quality of data in an electronic medical record sufficient for assessing the quality of primary care?

Objective

Quality indicators for the treatment of type 2 diabetes are often retrieved from a chronic disease registry (CDR). This study investigates the quality of recording in a general practitioner''s (GP) electronic medical record (EMR) compared to a simple, web-based CDR.

Methods

The GPs entered data directly in the CDR and in their own EMR during the study period (2011). We extracted data from 58 general practices (8235 patients) with type 2 diabetes and compared the occurrence and value of seven process indicators and 12 outcome indicators in both systems. The CDR, specifically designed for monitoring type 2 diabetes and reporting to health insurers, was used as the reference standard. For process indicators we examined the presence or absence of recordings on the patient level in both systems, for outcome indicators we examined the number of compliant or non-compliant values of recordings present in both systems. The diagnostic OR (DOR) was calculated for all indicators.

Results

We found less concordance for process indicators than for outcome indicators. HbA1c testing was the process indicator with the highest DOR. Blood pressure measurement, urine albumin test, BMI recorded and eye assessment showed low DOR. For outcome indicators, the highest DOR was creatinine clearance <30 mL/min or mL/min/1.73 m² and the lowest DOR was systolic blood pressure <140 mm Hg.

Conclusions

Clinical items are not always adequately recorded in an EMR for retrieving indicators, but there is good concordance for the values of these items. If the quality of recording improves, indicators can be reported from the EMR, which will reduce the workload of GPs and enable GPs to maintain a good patient overview.     

A genome-wide allelotype study of primary and corresponding recurrent glioblastoma multiforme in one patient

Glioblastoma multiforme (GBM) is the most common type of primary malignant brain tumor. Although comprehensive therapeutic measures are available, recurrence is very frequent and the prognosis of GBM remains dismal. To date, little is known about the molecular pathogenesis associated with GBM recurrence.     

Cataract free zone and primary health care approach to prevention of blindness in Shunyi county of Beijing.

ＣＡＴＡＲＡＣＴＦＲＥＥＺＯＮＥＡＮＤＰＲＩＭＡＲＹＨＥＡＬＴＨＣＡＲＥＡＰＰＲＯＡＣＨＴＯＰＲＥＶＥＮＴＩＯＮＯＦＢＬＩＮＤＮＥＳＳＩＮＳＨＵＮＹＩＣＯＵＮＴＹＯＦＢＥＩＪＩＮＧＨｕＣｈｅｎｇ胡铮，ＺｈａｏＪｉａｌｉａｎｇ赵家良，ＬｏｕｉｓＤ．Ｐｉ...     

Who goes where? A prospective study of referral patterns within a newly established primary care team

Background

Since the introduction of primary care teams, referral patterns of General Practitioners (GPs) in Ireland have not been studied.

Aims

To study the referral patterns of GPs within a primary care team (PCT) to allied health care professionals in a PCT and to secondary care. To identify indirect referral pathways. To study variation in individual GP referral patterns.

Method

Questionnaire based survey. Statistical analysis was carried out using Epi Info version 3.5.1.

Results

Of 3,166 consultations, 2,841 (89.7%) were dealt with by the GP and required no referral, 107 (3.4%) were referred within the PCT, and 218 (6.9%) were referred elsewhere. Therefore, 93.1% of consultations were managed in primary care alone. Ninety percent of GPs refer patients to the PCT. Indirect referrals constituted 17% of all outpatient referrals. Females have significantly higher referral rates than males. Referral rates of GPs in single-handed practices are higher than GPs in group practices.

Conclusions

GPs alone can manage the vast majority of presentations in general practice. Greater GP access to diagnostic and therapeutic interventions may reduce outpatient referrals. GPs in group practices may collectively have greater experience and expertise and therefore can manage more patients in primary care. There is a significant variation in referral rates between both genders.     

Comprehensive Acupuncture Treatment of Lumbago Due to Hemirachischisis——A Report of 48 Cases

Hemirachischisis is commonly-seen in clinic.Many patients complaining of lumbago are oftenfound to have this disease shown by radiography.Thecommon methods of treatment in Western medicineare surgical operation and administration ofanalgesics.In recent years,the authors have adopted     

“Acupuncture Journey to America” — A tale of the marvelous

On November 16,2010,China’s acupuncture was officially added to the list of world intangible cultural heritage of humanity by the 5th United Nations Educational,Scientific and Cultural Organization Intergovernmental Committee for Safeguarding Intangible Cultural Heritage.This declaration indicates that acupuncture,the needle therapy of Chinese medicine(CM),has received worldwide recognition by people from different cultures.As a medical therapy, acupuncture has been used to treat a wide range of medical disorders in more than 160 countries.     

Electroacupuncture Treatment for Constipation Due to Spasmodic Syndrome of the Pelvic Floor——A Report of 36 Cases

Thirty-six cases of constipation due tospasmodic syndrome of the pelvic floor were treatedby electroacupuncture,with satisfactory therapeuticresults reported as follows.     

Frame Work of Data Envelopment Analysis——A Model to Evaluate the Environmental Efficiency of China's Industrial Sectors

Objective To evaluate the environmental and technical efficiencies of China＇s industrial sectors and provide appropriate advice for policy makers in the context of rapid economic growth and concurrent serious environmental damages caused by industrial pollutants. Methods A data of envelopment analysis （DEA） framework crediting both reduction of pollution outputs and expansion of good outputs was designed as a model to compute environmental efficiency of China＇s regional industrial systems. Results As shown by the geometric mean of environmental efficiency, if other inputs were made constant and good outputs were not to be improved, the air pollution outputs would have the potential to be decreased by about 60% in the whole China. Conclusion Both environmental and technical efficiencies have the potential to be greatly improved in China, which may provide some advice for policy-makers.     

Estimation of Acute Toxicity of Ammonium Sulphate to the Fresh—Water Catfish,Heteropneustes fossilis——Ⅱ.A Histopathological Analysis of the Epidermis

The toxicity of 4000 ppm(96h LC50 value)of the inorganic fertilizaer ammonium sulphate on the epidermis of Heteropneustes fossilis(H.fossilis)at different intervals of time has been studied.The destruction induced by the ammonium salt is massive.Secretion of a copious amount of slime from the goblet mucous cells leading to their exhaustion and/or shedding and subsequent disappearance is perhaps the first reaction to the toxicity of the irritant.Later,the polygonal epithelial cells of the outermost layer show cyclic stages of necrosis and sloughing followed by their regeneration and repair.The contents of the club cells show enormous shrinkage and condensation with subsequent replacement of their areas with a hazy substance.In the earlier stages of exposure,regeneration takes place quickly,side by side with the degenerative changes at different stages of experimentation.Later after 8 50 10d,the degenerative changes slow down and the epideris appears identical to that of the normal skin.Goblet mucous cells also showed several cyclic increases followed by decreases in number and activity.     

Treatment of Cough and Dyspnea due to Acute Bronchitis by Plaster for Cough and Dyspnea——A Report of 735 Cases

In the light of the theory of treating the internal disease externally,an externally used plaster tortreating cough and dyspnea due to acute bronchitis(Ke Chuan Yi Tie Kang 咳喘一贴康)wassuccessfully applied to 735 cases of acute bronchitis(the treatment group),with the other 423 casestreated with routine western drugs as controls.The results showed that the cure rate in the treatmentgroup was significantly higher than that in the control group(P<0.01);and that in the treatmentgroup,the cure rate for the wind-cold type of acute bronchitis was significantly higher than that forthe wind-heat type of acute bronchitis(P<0.01).     

General practitioners’ challenges and strategies in dealing with Internet-related health anxieties—results of a qualitative study among primary care physicians in Germany

Wiener Medizinische Wochenschrift - Time and again, it is discussed that in medical practices, the number of patients who develop health anxieties due to extensive health information searches on...     

The Short-term Therapeutic Effect of the Three-part Massotherapy for Insomnia Due to Deficiency of Both the Heart and the Spleen——A Report of 100 Cases

Objective: To evaluate the short-term therapeutic effect of the three-part massotherapy on insomnia due to deficiency of both the heart and spleen. Methods: Two hundred cases were randomly divided into a treatment group and a control group, each consisting of 100 cases. Patients in the treatment group were treated with the three-part massotherapy, while those in the control group with oral administration of Guipi Wan (归脾丸 Pill for Invigorating the Spleen and Nourishing the Heart). The total clinical therapeutic effects, the total scores of Pittsburgh Sleep Quality Index (PSQI), Self-rating Anxiety Scale (SAS), and Self-rating Depression Scale (SDS) of the treatment group were compared with those of the control group. Results: After the treatment, the total therapeutic effects, PSQI, SAS, and SDS of the two groups all showed significant improvement (P<0.01), and the scores of the treatment group were superior to those of the control group (P<0.01). Conclusion: The three-part massotherapy has definite therapeutic effects on insomnia due to deficiency of both the heart and the spleen, which is safe and easy to operate, and worthy of popularization.     

UV—A Coexposure Enhances the Toxicity of Aromatic Hydrocarbons,Munitions,and Metals to Photobactrium phosphoreum

Johnson et al.(1993)showed that coexposure to UV-A between 300-400 nm enhanced the toxicity of nitrotoluenes to Photobacterium phosphoreum,a marine bioluminescent bacteria used in the Microtox test(Microbics Inc).This paper reports that UV-A photoenhanced the toxicity of polynuclear aromatic hydrocarbons,other types of organic compounds,and some transition metals to P.phosphoreum.Coexposure tp 400μw/cm^2 for 15 min increased the toxicity of psoralen,α-terthienyl,anthracene,acridine,fluoranthene,15 min increased the toxicity of psoralen,α-terthienyl,anthracene,acridine,fluoranthene,TNT,Cu^2 ,As^3 ,Ni^2,and Cd^2 .Phenanthrene was photoenhanced after 30 min coexposure at 400μw/cm^2 ,and Mn^2 at 800μw/cm^2 after 15 min.Naphthalene was not enhanced at 800μw/cm^2 for 30min.