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1.
Olawunmi R. Rabiu Ayokulehin M. Kosoko Catherine O. Falade Olusegun G. Ademowo 《Medical principles and practice》2013,22(3):255-259
Objective
The aim of this study was to test the diagnostic performances of Cyscope®mini and Paracheck-Pf® for Plasmodium falciparum relative to microscopy.Subjects and Methods
209 children aged 6 months to 12 years presenting with symptoms suggestive of malaria were enrolled at the University College Hospital, Ibadan, Nigeria, within a period of 6 months. Malaria parasites were identified in capillary blood samples using Cyscope®mini (parasite DNA-based fluorescence microscope) and Paracheck-Pf® (an HRP-II-based test) with microscopy of Giemsa-stained thick blood films as reference gold standard. The overall performances were calculated using OpenEpi version 2.3 statistical package. 209 samples were performed for Cyscope®mini and light microscopy while 140 samples were done by Paracheck-Pf®.Results
The prevalence of malaria parasitaemia by light microscopy was 22.0% (46/209), while those of Cyscope®mini and Paracheck-Pf® were 85.2% (178/209) and 32.1% (45/140), respectively. Parasite density ranged from 40 to 203,883/µl. Cyscope®mini and Paracheck-Pf® had sensitivities of 91.3 and 86.21%, respectively. The respective specificities were 16.56 and 81.98% for Cyscope®mini and Paracheck-Pf® with diagnostic accuracies of 33.01 and 82.86%. The diagnostic performances of the two rapid diagnostic tests were significantly different.Conclusion
Paracheck-Pf® performed better than Cyscope®mini for diagnosis of falciparum malaria and will be a good diagnostic tool for field studies.Key Words: Diagnosis of malaria, Malaria, Paediatrics 相似文献2.
Wassenberg M Kluytmans J Erdkamp S Bosboom R Buiting A van Elzakker E Melchers W Thijsen S Troelstra A Vandenbroucke-Grauls C Visser C Voss A Wolffs P Wulf M van Zwet T de Wit A Bonten M 《Critical care (London, England)》2012,16(1):R22-8
Introduction
Pre-emptive isolation of suspected methicillin-resistant Staphylococcus aureus (MRSA) carriers is a cornerstone of successful MRSA control policies. Implementation of such strategies is hampered when using conventional cultures with diagnostic delays of three to five days, as many non-carriers remain unnecessarily isolated. Rapid diagnostic testing (RDT) reduces the amount of unnecessary isolation days, but costs and benefits have not been accurately determined in intensive care units (ICUs).Methods
Embedded in a multi-center hospital-wide study in 12 Dutch hospitals we quantified cost per isolation day avoided using RDT for MRSA, added to conventional cultures, in ICUs. BD GeneOhm™ MRSA PCR (IDI) and Xpert MRSA (GeneXpert) were subsequently used during 17 and 14 months, and their test characteristics were calculated with conventional culture results as reference. We calculated the number of pre-emptive isolation days avoided and incremental costs of adding RDT.Results
A total of 163 patients at risk for MRSA carriage were screened and MRSA prevalence was 3.1% (n = 5). Duration of isolation was 27.6 and 21.4 hours with IDI and GeneXpert, respectively, and would have been 96.0 hours when based on conventional cultures. The negative predictive value was 100% for both tests. Numbers of isolation days were reduced by 44.3% with PCR-based screening at the additional costs of €327.84 (IDI) and €252.14 (GeneXpert) per patient screened. Costs per isolation day avoided were €136.04 (IDI) and €121.76 (GeneXpert).Conclusions
In a low endemic setting for MRSA, RDT safely reduced the number of unnecessary isolation days on ICUs by 44%, at the costs of €121.76 to €136.04 per isolation day avoided. 相似文献3.
Greiver M Barnsley J Glazier RH Moineddin R Harvey BJ 《Canadian family physician Médecin de famille canadien》2011,57(10):e381-e389
Objective
To study the effect of electronic medical record (EMR) implementation on preventive services covered by Ontario’s pay-for-performance program.Design
Prospective double-cohort study.Participants
Twenty-seven community-based family physicians.Setting
Toronto, Ont.Intervention
Eighteen physicians implemented EMRs, while 9 physicians continued to use paper records.Main outcome measure
Provision of 4 preventive services affected by pay-for-performance incentives (Papanicolaou tests, screening mammograms, fecal occult blood testing, and influenza vaccinations) in the first 2 years of EMR implementation.Results
After adjustment, combined preventive services for the EMR group increased by 0.7%, a smaller increase than that seen in the non-EMR group (P = .55, 95% confidence interval −2.8 to 3.9).Conclusion
When compared with paper records, EMR implementation had no significant effect on the provision of the 4 preventive services studied. 相似文献4.
Len Kelly John Guilfoyle Joe Dooley Irwin Antone Lianne Gerber-Finn Roisin Dooley Nicole Brunton Kara Kakegamuck Jill Muileboom Wilma Hopman Helen Cromarty Barb Linkewich Jennifer Maki 《Canadian family physician Médecin de famille canadien》2014,60(10):e493-e498
Objective
To document the incidence and outcomes of narcotic use during pregnancy in northwestern Ontario.Design
Three-year prospective cohort study.Setting
Sioux Lookout and surrounding communities in northwestern Ontario.Participants
A total of 1206 consecutive births in a catchment area of 28 000 First Nations patients.Main outcome measures
Incidence of narcotic use, and maternal and neonatal outcomes.Results
Incidence of narcotic use in pregnancy has risen to 28.6% (P < .001) and incidence of neonatal abstinence syndrome has fallen to 18.0% of narcotic-exposed births (P = .003). Daily intravenous drug use is now a common pattern of abuse.Conclusion
Narcotic abuse in pregnancy has dramatically increased in northwestern Ontario. Neonatal outcomes have improved as a result of a family medicine–based prenatal and obstetric program that includes a narcotic replacement and tapering program. 相似文献5.
6.
Citation
Annane D, Sebille V, Bellissant E: Effect of low doses of corticosteroids in septic shock patients with or without early acute respiratory distress syndrome. Crit Care Med 2006, 34:22–30 [1].Background
Experimental evidence suggests that corticosteroids may be beneficial in early acute respiratory distress syndrome (ARDS).Methods
Objective
To investigate the efficacy of low doses of corticosteroids in septic shock patients with or without early ARDS by post hoc analysis of a previously completed clinical trial.Design
Retrospective analysis of a placebo-controlled, randomized, double-blind trial of low doses of corticosteroids in septic shock.Setting
Nineteen intensive care units in France.Subjects
Among the 300 septic shock patients enrolled, we selected those meeting standard criteria for ARDS at inclusion.Intervention
Seven-day treatment with 50 mg of hydrocortisone every 6 hrs and 50 μg of 9-alpha-fludrocortisone once a day.Measurements and main results
There were 177 patients with ARDS (placebo, n = 92; corticosteroids, n = 85) including 129 (placebo, n = 67; corticosteroids, n = 62) nonresponders and 48 (placebo, n = 25; corticosteroids, n = 23) responders. In nonresponders, there were 50 deaths (75%) in the placebo group and 33 deaths (53%) in the steroid group (hazard ratio 0.57, 95% confidence interval 0.36–0.89, p = .013; relative risk 0.71, 95% confidence interval 0.54–0.94, p = .011). The number of days alive and off the ventilator was 2.6 +/- 6.6 in the placebo group and 5.7 +/- 8.6 in the steroid group (p = .006). There was no significant difference between groups in responders. There was no significant difference between groups in the two subsets of patients without ARDS. Adverse events rates were similar in the two groups.Conclusion
This post hoc analysis shows that a 7-day treatment with low doses of corticosteroids was associated with better outcomes in septic shock-associated early ARDS nonresponders, but not in responders and not in septic shock patients without ARDS. 相似文献7.
Expanded abstract
Citation
Kang DH, Kim YJ, Kim SH, Sun BJ, Kim DH, Yun SC, Song JM, Choo SJ, Chung CH, Song JK, Lee JW, Sohn DW: Early surgery versus conventional treatment for infective endocarditis. N Engl J Med 2012, 366: 2466-2473.Background
The timing and indications for surgical intervention to prevent systemic embolism in infective endocarditis (IE) remain controversial. This trial compares clinical outcomes of early surgery and conventional treatment in patients with IE.Methods
Objective
To determine the effect of early surgery (<48 hours) to decrease the rate of death or embolic events as compared with conventional treatment for IE.Design
Prospective randomized trial.Setting
Two academic medical centers in Korea.Subjects
Adult patients with left-sided, native-valve IE and a high risk of embolism.Intervention
Valve repair or replacement with removal of vegetation within 48 hours of random assignment versus no early surgery.Outcomes
Composite primary endpoint of in-hospital death and embolic events occurring within 6 weeks after random assignment. Secondary endpoints, at 6 months, included death from any cause, embolic events, recurrence of IE, and repeat hospitalization due to the development of congestive heart failure.Results
Thirty-seven patients were assigned to the early-surgery group (<48 hours), whereas 39 were assigned to conventional therapy. Of the 39 randomly assigned to conventional therapy, 27 patients (77%) underwent surgery during the initial hospitalization and three during follow-up. One patient (3%) in the early-surgery group and nine (23%) in the conventional-treatment group reached the primary endpoint (hazard ratio (HR) 0.10, 95% confidence interval (CI) 0.01 to 0.82; P = 0.03). There was no significant difference in all-cause mortality at 6 months in the early-surgery and conventional-treatment groups (3% and 5%, respectively; HR 0.51, 95% CI 0.05 to 5.66; P = 0.59). The rates of the composite endpoint of death from any cause, embolic events, or recurrence of IE at 6 months were 3% in the early-surgery group and 28% in the conventional-treatment group (HR 0.08, 95% CI 0.01 to 0.65; P = 0.02).Conclusions
Early surgery in patients with IE and large vegetations significantly reduced the composite endpoint of death from any cause and embolic events by effectively decreasing the risk of systemic embolism. 相似文献8.
Expanded abstract
Citation
Stelfox HT, Hemmelgarn BR, Bagshaw SM, Gao S, Doig CJ, Nijssen-Jordan C, Manns B: Intensive care unit bed availability and outcomes for hospitalized patients with sudden clinical deterioration. Arch Intern Med 2012, 172:467-474.Background
Intensive care unit (ICU) beds are a scarce resource, and admissions may require prioritization when demand exceeds supply. However, there are few empiric data on whether the availability of ICU beds influences triage and processes of care for hospitalized patients who develop sudden clinical deterioration.Methods
Objective
The objective was to evaluate the effect of ICU bed availability on the processes and outcomes of care for hospitalized patients with sudden clinical deterioration on a hospital ward.Design
We conducted a retrospective cohort study.Setting
The study was conducted in three hospitals in Calgary, Alberta, Canada, with 2,040 beds and a catchment population of 1.5 million individuals.Subjects
Hospitalized adults (n = 3,494) with a sudden clinical deterioration triggering medical emergency team (MET) activation between 1 January 2007 and 31 December 2009 participated.Analysis
This study compared treatments and outcomes among sudden clinical deterioration patients according to the number of ICU beds available (zero, one, two, or more than two) at the time of the MET activation. The outcomes of interest were ICU admission rates (within 2 hours of MET activation), changes in the goals of care (resuscitative, medical, and comfort), and hospital mortality. All analyses were adjusted for hospital, physician, and patient factors.Results
The cohort consisted of 3,494 patients. Reduced ICU bed availability was associated with a decreased likelihood of ICU admission within 2 hours of MET activation (P = 0.03) and with an increased likelihood of change in patient goals of care (P <0.01). Patients with sudden clinical deterioration when zero ICU beds were available were 33.0% (95% confidence interval (CI), −5.1% to57.3%) less likely to be admitted to the ICU and were 89.6% (95% CI, 24.9% to 188.0%) more likely to have their goals of care changed compared with when more than two ICU beds were available. However, hospital mortality did not vary significantly by ICU bed availability (P = 0.82).Conclusions
For hospitalized patients with sudden clinical deterioration, ICU bed scarcity decreases the probability of ICU admission and increases the probability of initiating comfort measures on the ward but does not influence hospital mortality. 相似文献9.
Expanded abstract
Citation
Ranieri VM, Thompson BT, Barie PS, Dhainaut JF, Douglas IS, Finfer S, Gårdlund B, Marshall JC, Rhodes A, Artigas A, Payen D, Tenhunen J, Al-Khalidi HR, Thompson V, Janes J, Macias WL, Vangerow B, Williams MD: Drotrecogin alfa (activated) in adult patients with septic shock. N Engl J Med 2012, 366:2055-2064.Background
There have been conflicting reports on the efficacy of recombinant human activated protein C, or drotrecogin alfa (activated) (DrotAA), for the treatment of patients with septic shock.Methods
Objective
To test the hypothesis that DrotAA, as compared with placebo, would reduce mortality in patients with septic shock.Design
A randomized, double-blind, placebo-controlled, multicenter trial, conducted from March 2008 through August 2011. Patients were followed until either 90 days or death.Setting
Patients were enrolled from 208 sights in Europe, North and South America, Australia, New Zealand, and India.Subjects
Subjects included 1,697 patients with infection, systemic inflammation, and shock who were receiving fluids and vasopressors above a threshold dose for 4 hours.Intervention
DrotAA (at a dose of 24 μg per kilogram of body weight per hour) or placebo for 96 hours.Outcomes
Death from any cause 28 days after randomization.Results
At 28 days, 223 of 846 patients (26.4%) in the DrotAA group and 202 of 834 (24.2%) in the placebo group had died (relative risk in the DrotAA group, 1.09; 95% confidence interval (CI), 0.92 to 1.28; P = 0.31). At 90 days, 287 of 842 patients (34.1%) in the DrotAA group and 269 of 822 (32.7%) in the placebo group had died (relative risk, 1.04; 95% CI, 0.90 to 1.19; P = 0.56). Among patients with severe protein C deficiency at baseline, 98 of 342 (28.7%) in the DrotAA group had died at 28 days, as compared with 102 of 331 (30.8%) in the placebo group (risk ratio, 0.93; 95% CI, 0.74 to 1.17; P = 0.54). Similarly, rates of death at 28 and 90 days were not significantly different in other predefined subgroups, including patients at increased risk for death. Serious bleeding during the treatment period occurred in 10 patients in the DrotAA group and 8 in the placebo group (P = 0.81).Conclusions
DrotAA did not significantly reduce mortality at 28 or 90 days, as compared with placebo, in patients with septic shock. 相似文献10.
David Barber Tyler Williamson Suzanne Biro Karen Hall Barber Danyal Martin Lorne Kinsella Rachael Morkem 《Canadian family physician Médecin de famille canadien》2015,61(12):e570-e576
Objective
To evaluate the transformation in smoking status documentation after implementing a standardized intake tool as part of a primary care smoking cessation program.Design
A before-and-after evaluation of smoking status documentation was conducted following implementation of a smoking assessment tool. To evaluate the effect of the intervention, the Canadian Primary Care Sentinel Surveillance Network was used to extract aggregate smoking data on the study cohort.Setting
Academic primary care clinic in Kingston, Ont.Participants
A total of 7312 primary care patients.Interventions
As the first phase in a primary care smoking cessation program, a standardized intake tool was developed as part of a vital signs screening process.Main outcome measures
Documented smoking status of patients before implementation of the intake tool and documented smoking status of patients in the 6 months after its implementation.Results
Following the implementation of the standardized intake tool, there was a 55% (P < .001; 95% CI 0.53 to 0.56) increase in the proportion of patients with a completed smoking status; more than 1100 former smokers were identified and the documented smoking rate in this cohort increased from 4.4% to 16.2%.Conclusion
This study shows that the implementation of an intake tool, integrated into existing clinical operational structures, is an effective way to standardize clinical documentation and promotes the optimization of electronic medical records. 相似文献11.
Expanded abstract
Citation
Thiele H, Zeymer U, Neumann FJ, Ferenc M, Olbrich HG, Hausleiter J, Richardt G, Hennersdorf M, Empen K, Fuernau G, Desch S, Eitel I, Hambrecht R, Fuhrmann J, Böhm M, Ebelt H, Schneider S, Schuler G, Werdan K; IABP-SHOCK II Trial Investigators: Intraaortic balloon support for myocardial infarction with cardiogenic shock. N Engl J Med 2012, 367:1287-1296.Background
In the current international guidelines, intra-aortic balloon pump (IABP) counterpulsation is considered a class I treatment for acute myocardial infarction complicated by cardiogenic shock. However, evidence is based mainly on registry data, and there is a paucity of randomized clinical trials.Methods
Objective
To test the hypothesis that IABP counterpulsation, as compared with the best available medical therapy alone, results in a reduction in mortality among patients with acute myocardial infarction complicated by cardiogenic shock for whom early revascularization is planned.Design
Randomized, prospective, open-label, multicenter trial.Setting
Thirty-seven centers in Germany.Subjects
All adults had acute myocardial infarction complicated by cardiogenic shock and were expected to undergo early revascularization (by means of percutaneous coronary intervention or bypass surgery).Intervention
After enrollment, 600 patients were randomly assigned to intra-aortic balloon counterpulsation (IABP group, 301 patients) or no IABP counterpulsation (control group, 299 patients).Outcomes
The primary efficacy endpoint is 30-day all-cause mortality.Results
At 30 days, 119 patients in the IABP group (39.7%) and 123 patients in the control group (41.3%) had died (relative risk with IABP, 0.96; 95% confidence interval, 0.79 to 1.17; P = 0.69). There were no significant differences in secondary endpoints or in process-of-care measures, including the time to hemodynamic stabilization, the length of stay in the intensive care unit, serum lactate levels, the dose and duration of catecholamine therapy, and renal function.Conclusions
The use of IABP counterpulsation did not significantly reduce 30-day mortality in patients with acute myocardial infarction complicated by cardiogenic shock for whom an early revascularization strategy was planned. 相似文献12.
Sociodemographic factors associated with cervical cancer screening and follow-up of abnormal results
Laurie Elit Monika Krzyzanowska Refik Saskin Lisa Barbera Asma Razzaq Aisha Lofters Naira Yeritsyan Arlene Bierman 《Canadian family physician Médecin de famille canadien》2012,58(1):e22-e31
Objective
To determine the sociodemographic factors associated with cervical cancer screening and follow-up of abnormal results.Design
Population cohort study.Setting
Ontario.Participants
Women between the ages of 18 and 70 years who were eligible for Papanicolaou testing.Main outcome measures
Rates of cervical cancer screening and follow-up of abnormal and inadequate Pap test results, and associated sociodemographic factors such as age, neighbourhood income level, and health region. Multivariate logistic regression was used to identify independent factors associated with screening and follow-up.Results
Of the 3.7 million women eligible for screening, 69% had had Pap tests in the past 3 years. These rates varied by age, income, and region (P < .001). Women residing in the lowest-income neighbourhoods were half as likely to be screened (odds ratio 0.56, 95% CI 0.55 to 0.56). Only 44% of those whose Pap test results revealed atypical squamous cells of uncertain significance or low-grade squamous intraepithelial lesions had repeat Pap tests or colposcopy within 6 months, and this varied by age, income, and region (P < .001). Among women with unsatisfactory Pap test results, only 35% were retested within 4 months, and this varied by age (P < .001).Conclusion
Despite universal health coverage, cervical cancer screening rates are suboptimal among low-income women at greatest risk. Follow-up among women with inadequate or abnormal test results is often poor. Novel models of cervical cancer screening are needed to address these inadequacies. 相似文献13.
Patrocinio C. Mateo Kyong-Soon Lee Matthew Barozzino Michael Sgro 《Canadian family physician Médecin de famille canadien》2013,59(8):e379-e386
Objective
To survey current practices among different types of medical practitioners in Ontario to assess if national guidelines for screening and management of neonatal hyperbilirubinemia were being followed.Design
An anonymized, cross-sectional survey distributed by mail and e-mail.Setting
Ontario.Participants
From each group (general practitioners, family medicine practitioners, and pediatricians), 500 participants were randomly selected, and all 390 registered midwives were selected.Main outcome measures
Compliance with national guidelines for screening, postdischarge follow-up, and management of newborns with hyperbilirubinemia.Results
Of the 1890 potential respondents, 321 (17%) completed the survey. Only 41% of family physicians reported using national guidelines, compared with 75% and 69% of pediatricians and midwives, respectively (P < .001). Bilirubin was routinely measured for all newborns before discharge by 42% of family physicians, 63% of pediatricians, and 22% of midwives (P < .001). Newborn follow-up was completed within 72 hours after discharge by 60% of family physicians, 89% of pediatricians, and 100% of midwives. Management of neonatal hyperbilirubinemia differed significantly (P < .001), with 91% of family physicians, 99% of pediatricians, and 79% of midwives correctly managing a case scenario according to the guidelines.Conclusion
The management of jaundice varied considerably among the different practitioner types, with pediatricians both most aware of the guidelines and most likely to follow them. Increased knowledge translation efforts are required to promote adherence to the jaundice management guidelines across all practitioner types, but particularly among family physicians. 相似文献14.
Jane A. Buxton Cheryl C. McIntyre Andrew W. Tu Brennan D. Eadie Valencia P. Remple Beth Halperin Karen L. Pielak 《Canadian family physician Médecin de famille canadien》2013,59(11):e514-e521
Objective
To report the findings of a knowledge survey of nurse and physician immunization providers.Design
Cross-sectional postal survey assessing demographic characteristics and vaccine knowledge.Setting
British Columbia (BC).Participants
Nurse and physician immunization providers in BC.Main outcome measures
Knowledge of vaccine-preventable diseases, vaccines in general, and vaccine administration and handling practices.Results
Survey responses were received from 256 nurses and 292 physicians (response rates of 48.6% and 18.3%, respectively). Most nurses (98.4%) reported receiving immunization training outside of the academic setting compared with 55.6% of physicians. Overall, nurse immunizers scored significantly higher than physician immunizers on all 3 domains of immunization knowledge (83.7% vs 72.8%, respectively; P < .001). Physicians scored highest on the vaccine-preventable disease domain and least well on the general vaccine domain. Nurses with more experience as health care providers scored higher. Physicians scored higher if they were female, served patient populations predominantly younger than 5 years, or received immunization training outside of academic settings.Conclusion
In BC, nurse immunizers appear to have higher overall immunization knowledge than physicians and are more likely to receive immunization training when in practice. Physician immunizers might benefit most from further training on vaccines and vaccine administration and handling. 相似文献15.
Monitoring of international normalized ratios: Comparison of community nurses with family physicians
Max A. Levine Wei Shao Douglas Klein 《Canadian family physician Médecin de famille canadien》2012,58(8):e465-e471
Objective
To determine whether community-based, nurse-led monitoring of the international normalized ratio (INR) in patients requiring long-term warfarin therapy was comparable to traditional physician monitoring.Design
A retrospective cohort analysis of patients taking long-term warfarin therapy.Setting
The study used data gathered from 3 family medicine clinics in a primary care network in Edmonton, Alta.Participants
Medical records of patients currently taking warfarin were examined.Intervention
Implementation of nurse-led monitoring in a primary care network in place of standard family physician INR monitoring.Main outcome measures
The degree of INR control before and after the implementation of nurse-run INR monitoring was assessed. The average proportion of time spent outside of therapeutic INR ranges, as well as the average number of days between successive INR readings, was calculated and compared. The degree of control placed patients into either a good-control group (out of range ≤ 25% of the time) or a moderate-control group (out of range > 25% of the time) and these groups were compared.Results
Before nurse monitoring, INR values were out of range 20.4% of the time; after nurse monitoring they were out of range 19.2% of the time (P = .115); the time between sequential INR readings also did not differ before and after implementation of nurse monitoring (23.9 vs 21.6 days, P = .789).Conclusion
Nurse-led monitoring of INR is as effective as traditional physician monitoring. Advantages of nurse-led monitoring might include freeing family physicians to see more patients or to spend less time at work. It might also represent potential cost savings. 相似文献16.
Background
The role of exchange transfusion in the management of severe malaria is not well documented in Emergency Medicine literature.Objectives
The goal of this article is to review the importance of considering malaria in the differential diagnosis of the febrile returned traveler and to discuss the role of exchange transfusion in the management of severe Plasmodium falciparum malaria.Case Report
A 59-year-old woman presented to the Emergency Department (ED) with severe P. falciparum malaria. Her physical examination was remarkable for scleral icterus, dry mucous membranes, and tachycardia. Her complete blood count revealed a white blood cell count of 6.9 k/uL, with 71% segmented neutrophils, 19% bands, a hemoglobin level of 11.9 g/dL, hematocrit of 37.2%, and a platelet count of 9 k/uL. Hepatorenal impairment was present and malaria parasites with ring form were seen on malaria prep in 18% of red blood cells. The patient was treated with fluids, platelets, quinidine gluconate, doxycycline, and exchange transfusion with significant improvement in the patient's clinical condition.Conclusions
The high level of parasitemia presenting with acute kidney injury, hyperbilirubinemia, and thrombocytopenia supported the use of exchange transfusion as adjunct therapy. Exchange transfusion was a reasonable consideration in this case and was well tolerated by our patient. Institutions that are equipped with apheresis units should evaluate each case individually in concert with Centers for Disease Control experts and local consultants and weigh the risks and benefits of the use of exchange transfusion as an adjunct in the treatment of severe P. falciparum malaria. 相似文献17.
Stephen Wetmore Leslie Boisvert Esther Graham Susan Hall Tim Hartley Lynda Wright Jo-Anne Hammond Holly Ings Barbara Lent Anna Pawelec-Brzychczy Stacey Valiquet Jamie Wickett Joanne Willing 《Canadian family physician Médecin de famille canadien》2014,60(4):e230-e236
Objective
To determine patient satisfaction with care provided at a family medicine teaching clinic.Design
Mailed survey.Setting
Victoria Family Medical Centre in London, Ont.Participants
Stratified random sample of 600 regular patients of the clinic aged 18 years or older; 301 responses were received.Main outcome measures
Patient satisfaction with overall care, wait times for appointments, contact with physicians, and associated demographic factors. Logistic regression analysis and analysis were used to determine the significance of factors associated with satisfaction.Results
The response rate was 50%. Overall, 88% of respondents were fairly, very, or completely satisfied with care. Older patients tended to be more satisfied. Patients who were less satisfied had longer wait times for appointments (P < .001) and reduced continuity with specific doctors (P = .004). More satisfied patients also felt connected through other members of the health care team.Conclusion
Patients were generally satisfied with the care provided at the family medicine teaching clinic. Older patients tended to be more satisfied than younger patients. Points of dissatisfaction were related to wait times for appointments and continuity with patients’ usual doctors. These findings support the adoption of practices that reduce wait times and facilitate continuity with patients’ usual doctors and other regular members of the health care team. 相似文献18.
Kidane B Gandhi R Sarro A Valiante TA Harvey BJ Rampersaud YR 《Canadian family physician Médecin de famille canadien》2011,57(7):803-810
Objective
To assess the concerns of adult patients with spine-related complaints during the period between referral to and consultation with a spine surgeon.Design
Prospective survey.Setting
Toronto, Ont.Participants
A total of 338 consecutive, nonemergent patients before consultation with a single spine surgeon over a 5-month period.Main outcome measures
Patient concerns, effect of referral to a spine surgeon, and effect of waiting to see a spine surgeon.Results
The issues patients reported to be most concerning were ongoing pain (45.6% rated this as most concerning), loss of function (23.4%), need for surgery (12.1%), and permanence of the condition (9.6%). Regression analysis demonstrated that older age was an independent predictor of increased level of concern regarding pain (P = .01) and disability (P = .04). Forty-seven percent of all patients listed the need for surgery among their top 3 concerns. Mere referral to a spine surgeon (P = .03) was an independent predictor of increased concern regarding the need for surgery. Sex, diagnosis, surgical candidacy, and actual wait time were not predictive of increased concerns. Patients reported family physicians to be their most influential information source regarding spinal conditions.Conclusion
Timely provision of more specific information regarding the benign and non-surgical nature of most degenerative spinal conditions might substantially reduce patients’ exaggerated concerns regarding the probability of surgery for a considerable number of patients referred to spine surgeons. 相似文献19.
Jonathan M. Lam Geoffrey M. Anderson Peter C. Austin Susan E. Bronskill 《Canadian family physician Médecin de famille canadien》2012,58(11):1241-1248
Objective
To describe the characteristics and practice patterns of family physicians who regularly treat long-term care (LTC) residents in order to inform quality improvement strategies.Design
Cross-sectional study involving a 2005 province-wide census of LTC residents’ charts linked to additional health care administrative databases.Setting
All LTC homes in Ontario.Participants
Residents aged 66 years and older (n = 50375) and the family physicians (n = 1190) most responsible for their care.Main outcome measures
Distribution of LTC residents across family physicians, and physician demographic characteristics and practice patterns.Results
The distribution of residents across physicians was highly skewed (median 27 residents, mean 42.5 residents). The care of 90.4% of residents was accounted for by 628 (52.8%) identified physicians. Family physicians practising in LTC facilities were more likely to be older (mean age 52.4 years vs 48.2 years, P < .001) and male (82.4% vs 61.5%, P < .001) than other family physicians. Urban physicians who provided care to LTC residents had bigger LTC practices than rural LTC physicians did (median 50 residents vs median 12 residents).Conclusion
About 600 family physicians are responsible for the regular care of more than 90% of LTC residents in Ontario and quality improvement efforts could be aimed at this relatively small group of physicians. Half of the urban physicians who practise in LTC homes are responsible for 50 or more LTC residents. This might represent a key part of their overall practice. 相似文献20.