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1.
Shah KG Idrovo JP Nicastro J McMullen HF Molmenti EP Coppa G 《The International journal of angiology》2009,18(4):182-183
BACKGROUND:
Hemolysis of blood samples has been a concern in hospitals. Currently, residents and nurses have replaced traditional teams of skilled phlebotomists for both routine and ‘stat’ blood draws. Although this leads to a decreased operating cost for institutions, the lack of skill and experience leads to a higher percentage of hemolyzed specimens.OBJECTIVE:
To determine the incidence of hemolyzed ‘type and screen’ blood samples at Staten Island University Hospital (SIUH) (New York, USA).METHODS:
The study group comprised 615 consecutive trauma patients at SIUH between July 2006 and June 2007. Patients were treated according to the Advanced Trauma Life Support protocol. The primary survey for a trauma patient consists of ‘airway’, ‘breathing’ and ‘circulation’. The primary objective of ‘circulation’ is to establish vascular access and collect blood samples for analysis. The SIUH in-house laboratory provided all of the reports.RESULTS:
Of the 615 samples collected, 155 samples (25.2%) were hemolyzed.CONCLUSIONS:
The hemolysis rate of 25.2% for type and screen samples is higher than previously reported in the literature. The data suggest that the high rate of hemolysis in these trauma patients is due to the residents’ lack of experience and skills required to obtain an adequate blood draw. 相似文献2.
BACKGROUND/OBJECTIVE:
For many types of cancer, disease attribution to occupational exposures is difficult. Mesothelioma, however, is a ‘sentinel’ occupational cancer associated with asbestos exposure. The present study linked workers’ compensation claims data with cancer registry data to explore the completeness of reporting of mesothelioma to the Ontario Workplace Safety and Insurance Board (WSIB) according to characteristics of cases diagnosed among Ontario residents.METHODS:
Two data sources were linked at the person level: the WSIB Occupational Disease Information and Surveillance System and the Ontario Cancer Registry. Filing rates were calculated as the proportion of Ontario Cancer Registry mesothelioma cases (International Classification of Diseases – Oncology code 905) that linked to a WSIB-filed cancer claim. Filing rates were calculated for the period 1980 to 2002, and trends were calculated by year, age and county of residence at diagnosis.RESULTS:
The filing rate for compensation has increased little over the past 20 years, reaching a high of 43% in 2000. Overall, filing rates were highest among pleural mesothelioma cases among men (range 27% to 57%). Filing rates were highest among individuals 50 to 59 years of age and declined substantially throughout the retirement years. There was substantial variation in filing rates by area of residence, with the highest rate being in Lambton County, Ontario.CONCLUSION:
The filing rate for compensation in Ontario was much lower than the estimated proportion of cases eligible for compensation. The increased filing rate in Lambton County was likely related to this community’s awareness of the association between asbestos and mesothelioma. Physicians can play an important role in educating patients of their potential entitlement to compensation benefits. 相似文献3.
BACKGROUND:
Patient satisfaction is increasingly regarded as an important aspect of measuring treatment success in individuals with gastroesophageal reflux disease (GERD).OBJECTIVE:
To review how satisfied patients with GERD are with their medication, and to analyze the usefulness of patient satisfaction as a clinical end point by comparing it with symptom improvement.METHODS:
Systematic searches of the PubMed and EMBASE databases identified clinical trials and patient surveys published between 1966 and 2009.RESULTS:
Twelve trials reported that 56% to 100% of patients were ‘satisfied’ or ‘very satisfied’ with proton pump inhibitor (PPI) treatment for GERD. Patient satisfaction levels were higher for PPIs than other GERD medications in two trials. The sample-size-weighted average proportion of patients ‘satisfied’ with their PPI after four weeks of treatment in trials was 93% (95% CI 87% to 99%), with 73% (95% CI 62% to 83%) being ‘very satisfied’. In four surveys, the average proportion of patients ‘satisfied’ with their PPI treatment was 82% (95% CI 73% to 90%) and 62% (95% CI 48% to 75%) were ‘very satisfied’. Seven trials found a positive association between patient satisfaction and symptom improvement, and two surveys between satisfaction and improved health-related quality of life. Three trials found that continuous treatment yielded higher rates of satisfaction than on-demand therapy.CONCLUSIONS:
More than one-half of patients were satisfied with their PPI medication in trials, and more patients were satisfied with PPIs than other medication types. An association between patient satisfaction and symptom resolution was found, suggesting that patient satisfaction is a useful end point for evaluating GERD treatment success. 相似文献4.
BACKGROUND:
The absence of ongoing surveillance for childhood asthma in Montreal, Quebec, prompted the present investigation to assess the validity and practicality of administrative databases as a foundation for surveillance.OBJECTIVE:
To explore the consistency between cases of asthma identified through physician billings compared with hospital discharge summaries.METHODS:
Rates of service use for asthma in 1998 among Montreal children aged one, four and eight years were estimated. Correspondence between the two databases (physician billing claims versus medical billing claims) were explored during three different time periods: the first day of hospitalization, during the entire hospital stay, and during the hospital stay plus a one-day margin before admission and after discharge (‘hospital stay ± 1 day’).RESULTS:
During 1998, 7.6% of Montreal children consulted a physician for asthma at least once and 0.6% were hospitalized with a principal diagnosis of asthma. There were no contemporaneous physician billings for asthma ‘in hospital’ during hospital stay ± 1 day for 22% of hospitalizations in which asthma was the primary diagnosis recorded at discharge. Conversely, among children with a physician billing for asthma ‘in hospital’, 66% were found to have a contemporaneous in-hospital record of a stay for ‘asthma’.CONCLUSIONS:
Both databases of hospital and medical billing claims are useful for estimating rates of hospitalization for asthma in children. The potential for diagnostic imprecision is of concern, especially if capturing the exact number of uses is more important than establishing patterns of use. 相似文献5.
BACKGROUND:
Amiodarone-induced thyrotoxicosis (AIT) develops in 3% of amiodarone-treated patients in North America. AIT is classified as type 1 or type 2. Type 1 AIT occurs in patients with underlying thyroid pathology such as autonomous nodular goiter or Graves’ disease. Type 2 AIT is a result of amiodarone causing a subacute thyroiditis with release of preformed thyroid hormones into the circulation.OBJECTIVES:
To review the literature and present an overview of the differentiation between and management of type 1 and type 2 AIT.METHODS:
PubMed, the Cumulative Index to Nursing and Allied Health Literature and Medscape searches of all available English language articles from 1983 to 2006 were performed. Search terms included ‘amiodarone-induced thyrotoxicosis’, ‘complications’, ‘management’, ‘treatment’ and ‘colour flow Dopper sonography’.RESULTS:
There is evidence to suggest that to differentiate between type 1 and type 2 AIT, a careful history and physical examination should be performed to identify pre-existing thyroid disease. An iodine-131 uptake test and colour flow Doppler sonography should be performed. Patients with type 2 AIT should receive a trial of glucocorticoids, whereas those with type 1 should receive antithyroid therapy. For patients in whom the mechanism of the thyrotoxicosis is unclear, a combination of prednisone and antithyroid therapy may be considered. 相似文献6.
7.
Jonathan Love Edmond-Jean Bernard Alan Cockeram Lawrence Cohen Martin Fishman James Gray David Morgan 《Journal canadien de gastroenterologie》2009,23(10):706-710
BACKGROUND:
Sodium picosulfate with magnesium citrate (PSMC) has been available as a precolonoscopy bowel preparation in Canada since 2005. A high patient acceptability and preference appears to have contributed to its wide adoption across the country. Despite its frequent use, there are relatively few published studies of this product, especially reports regarding its use in routine clinical practice. Moreover, to date, there have been no Canadian studies of any kind.OBJECTIVE:
To conduct a preliminary evaluation of PSMC by prospectively collecting data describing its effectiveness.METHODS:
In the present multicentre, observational study, sequential patients used PSMC according to each institution’s standard colonoscopy protocol. Differences in bowel cleansing protocols included dose timing, fluid intake, dietary restrictions and administration of bisacodyl. During colonoscopy, preparation quality was rated separately for the right and left sides of the colon.RESULTS:
Of the 613 patients entered, 606 were evaluable for efficacy. For the right and left colon, respectively, 93.0% and 96.2% of preparations were rated either ‘excellent’ or ‘adequate’. In the 334 patients who received adjunctive bisacodyl and the 272 patients who did not, the results were similar: for the right and left colon, 92.3% and 97.1% of those who did not, and 93.4% and 95.7% of those who did receive bisacodyl, respectively, were rated either ‘excellent’ or ‘adequate’.CONCLUSIONS:
Despite the differences in bowel cleansing protocols used at each hospital (including an additional laxative), PSMC consistently yielded a high percentage of positive ratings for efficacy. 相似文献8.
Olivia Rempel Johann DD Pitout Kevin B Laupland 《The Canadian Journal of Infectious Diseases & Medical Microbiology》2011,22(4):e24-e28
BACKGROUND:
The validity of surveillance systems has rarely been a topic of investigation.OBJECTIVE:
To assess potential biases that may influence the validity of contemporary antimicrobial-resistant (AMR) pathogen surveillance systems.METHODS:
In 2008, reports of laboratory-based AMR surveillance systems were identified by searching Medline. Surveillance systems were appraised for six different types of bias. Scores were assigned as ‘2’ (good), ‘1’ (fair) and ‘0’ (poor) for each bias.RESULTS:
A total of 22 surveillance systems were included. All studies used appropriate denominator data and case definitions (score of 2). Most (n=18) studies adequately protected against case ascertainment bias (score = 2), with three studies and one study scoring 1 and 0, respectively. Only four studies were deemed to be free of significant sampling bias (score = 2), with 17 studies classified as fair, and one as poor. Eight studies had explicitly removed duplicates (score = 2). Seven studies removed duplicates, but lacked adequate definitions (score = 1). Seven studies did not report duplicate removal (score = 0). Eighteen of the studies were considered to have good laboratory methodology, three had some concerns (score = 1), and one was considered to be poor (score = 0).CONCLUSION:
Contemporary AMR surveillance systems commonly have methodological limitations with respect to sampling and multiple counting and, to a lesser degree, case ascertainment and laboratory practices. The potential for bias should be considered in the interpretation of surveillance data. 相似文献9.
BACKGROUND:
Multidetector computed tomography (MDCT) has demonstrated promise in the noninvasive evaluation of coronary artery disease.OBJECTIVE:
To systematically review the literature regarding the improved diagnostic accuracy of 64-slice MDCT.METHODS:
An EMBASE, OVID, PubMed and Cochrane Library database search was performed using the key words ‘computed tomography’ matched with the terms ‘coronary artery’ or ‘coronary angiography’ to identify English-language articles examining MDCT cardiac imaging. Studies that compared 16-slice or 64-slice MDCT with catheter-based coronary angiography for the detection of coronary artery disease in non-revascularized, poststent and post-coronary artery bypass graft patients were included. Data were pooled to obtain a weighted sensitivity, specificity and diagnostic accuracy for MDCT. Negative and positive predictive values, and likelihood ratios were calculated based on sensitivity and specificity.RESULTS:
Currently, 15 studies involving 1008 patients have examined the efficacy of 64-slice MDCT in the assessment of coronary artery stenosis (more than 50% luminal narrowing). In these studies, 64-slice MDCT has demonstrated a sensitivity (89%), specificity (96%) and diagnostic accuracy (95%) similar to that of 16-slice MDCT. However, 64-slice MDCT was able to assess 5% more coronary artery segments than 16-slice MDCT. In revascularized patients, MDCT can accurately assess both bypass graft occlusion and stenosis. The 64-slice MDCT is also capable of adequately detecting in-stent restenosis. Improvements in spatial and temporal resolution with 64-slice technology have decreased the occurrence of high attenuation and motion artefacts that plagued the previous generation of MDCT scanners.CONCLUSION:
MDCT offers an accurate assessment of the coronary arteries, stented arteries and bypass grafts. The improved accuracy and safety of MDCT may reduce the need for catheter-based coronary angiography. 相似文献10.
BACKGROUND:
Inappropriate daily profile of blood pressure deteriorates the clinical outcome of hypertension and increases distant cardiovascular risk. The problem is important, especially in children and adolescents in whom early intervention helps to prevent complications of hypertension such as left ventricular hypertrophy and hypertensive retinopathy.OBJECTIVES:
To assess circadian blood pressure profile and basic determinants of inappropriate daily blood pressure variability in hypertensive children.METHODS:
The project was conducted retrospectively in 106 children six to 18 years of age (mean [± SD] 14.9±2.5 years) with essential hypertension and no use of antihypertensive drugs. The study group included 43 children with inappropriate daily blood pressure variability (‘nondippers’) and 63 controls with appropriate daily blood pressure variability (‘dippers’).RESULTS:
Nondippers, compared with dippers, had higher systolic and diastolic blood pressure at night (systolic, 123.9±10.3 mmHg versus 113.9±8.2 mmHg; diastolic, 65.1±7.6 mmHg versus 59.5±6.5 mmHg; P<0.0001), and higher blood pressure load at night (systolic, 61.9% versus 27.6%; diastolic, 20.0% versus 9.6%; P<0.0001). Male sex increased the risk for nondipping by 2.5 times (logistic OR=2.45; 95% CI 0.87 to 6.87). However, the increase was statistically nonsignificant (P=0.08). No differences were observed between dippers and nondippers in terms of anthropometric profile, family history of hypertension, morphological and biochemical blood parameters, and birth weight.CONCLUSIONS:
Among hypertensive children, nondippers have a more severe degree of hypertension. Male sex increases the risk of nondipping. To assess determinants of nondipping more precisely, further clinical investigations are needed. 相似文献11.
Masayuki Kato Atsushi Goto Takahisa Tanaka Satoshi Sasaki Akihiro Igata Mitsuhiko Noda 《Journal of diabetes investigation.》2013,4(6):667-672
Aims/Introduction
Recently, the prevalence of lifestyle‐related disease has increased, and its associated medical costs have become considerable. Although walking is thought to prevent lifestyle‐related disease, few studies have evaluated its effect on medical costs in Japanese subjects. We aimed at evaluating the effect of walking on medical costs by simulation mainly focusing on diabetes in the Japanese population.Materials and Methods
A Markov model focusing on diabetes was constructed. As complications of diabetes, ‘dialysis’, ‘ischemic heart disease’ and ‘stroke’ were included. The model has four states: ‘non‐diabetes’, ‘diabetes’, ‘dialysis’ and ‘dead’, and ‘ischemic heart disease’ and ‘stroke’ were included as events that occurred in each state. The effect of walking was included as changing the rate of transition and incident rates of events.Results
After 10 years, the numbers of subjects with diabetes were 4.3 and 7.3% lower for daily increase of 3,000 and 5,000 steps, respectively. The numbers of cases of ischemic heart disease and stroke also decreased. Lower medical costs were also seen according to the daily increase in steps. In 10 years, the total medical costs were 5.2 and 8.4% lower for 3,000 and 5,000 steps increase, respectively. The cost reduction associated with a daily increase of 3,000 steps walked was calculated as ¥0.00146 for each step.Conclusions
Walking is one of the most common and accessible forms of exercises. The present results suggested that walking reduced the medical costs associated with lifestyle‐related disease, which will have a large impact on health policy. 相似文献12.
Jones J Panaccione R Russell ML Hilsden R 《Journal canadien de gastroenterologie》2011,25(10):565-569
BACKGROUND:
Little is known about physician perceptions of and practices in using infliximab – a biological agent that was approved in Canada for the treatment of Crohn’s disease in 2001, and for ulcerative colitis in 2006.OBJECTIVES:
To describe Canadian gastroenterologists’ use and perceptions of infliximab in the treatment of refractory inflammatory bowel disease (IBD), and to identify factors that may influence a gastroenterologist’s decision to initiate infliximab therapy.METHODS:
A postal questionnaire was distributed to all practicing clinicians captured in the 2007 membership of the Canadian Association of Gastroenterology. Each physician was contacted up to a maximum of three times.RESULTS:
Of 466 questionnaires mailed out, responses were received from 336 (72%), with 292 respondents (63%) returning fully completed surveys. For 80% of respondents, IBD patients comprised less than 30% of their clinical practice. Most prescribed infliximab at an initial dose of 5 mg/kg (97%), prescribed loading doses at 0, 2 and 6 weeks (88%), premedicated with corticosteroids (74%), administered maintenance infusions at eight-week intervals (89%), co-administered immunosuppressive agents (81%) and continued infliximab ‘indefinitely’ as long as it was effective and well tolerated (76%). Most gastroenterologists (>70%) identified lack of drug insurance coverage and provincial funding criteria as important barriers to prescribing infliximab.CONCLUSIONS:
Most Canadian gastroenterologists exhibited similar practice patterns with respect to the use of infliximab for induction and maintenance therapy of IBD. Common barriers to the initiation of infliximab therapy were identified. 相似文献13.
Appropriateness of diagnosis of unstable angina pectoris in patients referred for coronary arteriography 下载免费PDF全文
Alexander Goldberg Sergey Yalonetsky Michael Kopeliovich Zaher Azzam Walter Markiewicz 《Experimental & Clinical Cardiology》2008,13(3):133-137
BACKGROUND
A diagnosis of unstable angina pectoris (UAP) often carries with it a decision to catheterize the patient promptly. However, UAP remains a clinical diagnosis, based mostly on a patient’s clinical history and electrocardiogram (ECG) findings.OBJECTIVE
To evaluate whether the diagnosis of UAP is overused in patients referred for coronary arteriography.METHODS
Ninety-six patients with a diagnosis of UAP who were referred for invasive studies were re-examined clinically before catheterization. Coronarography was independently reviewed for correlation with clinical findings.RESULTS
Based on the patient’s history and ECG changes, UAP was classified by two independent cardiologists as ‘very likely’ in 58% and 49%, ‘possible’ in 19% and 30%, and of ‘low probability’ in 23% and 21%, respectively. Patients with ‘very likely’ UAP had a high incidence of significant coronary lesions (87% and 96% for each cardiologist) and complex lesions by angiography (41% and 49%, respectively). Patients with a diagnosis of ‘low probability’ UAP had a low incidence of significant coronary lesions (55% for each cardiologist) and a very low incidence of complex angiographic lesions (5% for each cardiologist). Patients with ‘possible’ UAP had intermediate results.CONCLUSION
Because of a presumptive diagnosis of UAP, approximately 22% of all patients referred for coronarography have no clinical and/or ECG evidence for this diagnosis. The incidence of complex coronary lesions in this group is very low. 相似文献14.
Yen-Wen Liu Wei-Chuan Tsai Chih-Hsin Hsu Li-Jen Lin Wei-Ting Li Chun-Hsiu Chen Jyh-Hong Chen 《The Canadian journal of cardiology》2009,25(12):703-705
BACKGROUND:
Patients with a very low probability of infective endocarditis (IE) do not benefit from transthoracic echocardiography (TTE). Because the term ‘very low probability’ has not yet been defined, the present prospective study sought to identify the population with a ‘very low probability’.METHODS:
TTE was performed between July 2005 and October 2006 in consecutive patients clinically suspected of having IE. Clinical parameters suggestive of IE and presence of infectious focus were recorded.RESULTS:
Twenty-four (15.5%) of 155 patients studied had positive findings on TTE. Significant positive predictors were embolic events, intravenous drug use, the presence of a prosthetic valve, positive blood cultures and immunological phenomena. The significant negative predictor was confirmed infection sites other than endocardium. Sixty-three (40.6%) of 155 patients without positive predictors were found to have no vegetation. Thus, the collective absence of these predictors indicated a zero probability of TTE showing evidence of IE. A significant negative predictor was a definite etiology of infection other than IE. Only one in 76 patients was diagnosed with both IE and infection at another site.CONCLUSIONS:
The absence of positive predictors or the presence of a negative predictor indicate a near-zero probability of IE being detected by TTE. Use of clinical parameters may avoid up to 41% of unnecessary TTE examinations, increasing the likelihood that such a diagnosis will be correct. 相似文献15.
Brookes-Howell L Elwyn G Hood K Wood F Cooper L Goossens H Ieven M Butler CC 《Journal of general internal medicine》2012,27(7):766-772
BACKGROUND
Interventions promoting evidence based antibiotic prescribing and use frequently build on the concept of antibiotic resistance but patients and clinicians may not share the same assumptions about its meaning.OBJECTIVE
To explore patients’ interpretations of ‘antibiotic resistance’ and to consider the implications for strategies to contain antibiotic resistance.DESIGN
Multi country qualitative interview study.PARTICIPANTS
One hundred and twenty-one adult patients from primary care research networks based in nine European countries who had recently consulted a primary care clinician with symptoms of Lower Respiratory Tract Infection (LRTI).APPROACH
Semi-structured interviews with patients following their consultation and subjected to a five-stage analytic framework approach (familiarization, developing a thematic framework from the interview questions and the themes emerging from the data, indexing, charting, and mapping to search for interpretations in the data), with local network facilitators commenting on preliminary reports.RESULTS
The dominant theme was antibiotic resistance as a property of a ‘resistant human body’, where the barrier to antibiotic effectiveness was individual loss of responsiveness. Less commonly, patients correctly conceptualized antibiotic resistance as a property of bacteria. Nevertheless, the over-use of antibiotics was a strong central concept in almost all patients’ explanations, whether they viewed resistance as located in either the body or in bacteria.CONCLUSIONS
Most patients were aware of the link between antibiotic use and antibiotic resistance. The identification of the misinterpretation of antibiotic resistance as a property of the human body rather than bacterial cells could inform clearer clinician–patient discussions and public health interventions through emphasising the transferability of resistance, and the societal contribution individuals can make through more appropriate antibiotic prescribing and use.KEY WORDS: antibiotic resistance, primary health care, qualitative research, patient beliefs 相似文献16.
Madison Dennis Mary Jane Salpeter Susy Hota 《The Canadian Journal of Infectious Diseases & Medical Microbiology》2015,26(1):30-32
BACKGROUND:
Despite mounting evidence supporting fecal transplantation (FT) as a treatment for recurrent Clostridium difficile infection (CDI), adoption into clinical practice has been slow.OBJECTIVE:
To determine the health literacy and attitudes of academic physicians in Toronto and infectious disease physicians in Ontario toward FT as a treatment for recurrent CDI, and to determine whether these are significant barriers to adoption.METHODS:
Surveys were distributed to 253 general internists, infectious diseases specialists, gastroenterologists and family physicians.RESULTS:
The response rate was 15%. More than 60% of physicians described themselves as being ‘not at all’ or ‘somewhat’ familiar with FT. Of the 76% of physicians who had never referred a patient for FT, the most common reason (50%) was lack of awareness of where to access the treatment. The ‘ick factor’ accounted for only 13% of reasons for not referring. No respondent believed that the procedure was too risky to consider.CONCLUSION:
Despite general poor health literacy on FT, most physicians sampled share similar positive attitudes toward the treatment. 相似文献17.
BACKGROUND:
The mainstay of therapy for gastrocutaneous (GC) fistulas has been surgical intervention. However, endoclips are currently used for management of perforations and fistulas but are limited by their ability to entrap and hold the tissue.OBJECTIVE:
To report the first North American experience with a commercially available over-the-scope clip (OTSC) device, a novel and new tool for the endoscopic entrapment of tissue for the closure of fistula and perforations.METHODS:
The present single-centre study was conducted at a tertiary referral academic gastroenterology unit and centre for advanced therapeutic endoscopy and involved patients referred for endoscopic treatment for the closure of a GC fistula. The OTSC device was mounted on the tip of the endoscope and passed into the stomach to the level of the fistula. The targeted site of the fistula was grasped with the tissue anchoring tripod and pulled into the cap with concomitant scope channel suction. Once the tissue was trapped in the cap, a ‘bear claw’ clip was deployed.RESULTS:
The patients recovered with fistula closure. No complication or recurrence was noted. Fistula sizes >1 cm, however, were difficult to close with the OTSC system. The length of stay of the bear claw clip at the fistula site is unpredictable, which may lead to incomplete closure of the fistula.CONCLUSION:
Closure of a GC fistula using a novel ‘bear claw’ clip system is feasible and safe. 相似文献18.
Michael Pentzek ScD Angela Fuchs MSc Birgitt Wiese MSc Gabriela Cvetanovska-Pllashniku MD Franziska Haller MSc Wolfgang Maier MD Steffi G. Riedel-Heller MD Matthias C. Angermeyer MD Horst Bickel PhD Edelgard Mösch PhD Siegfried Weyerer PhD Jochen Werle PhD Hendrik van den Bussche MD Marion Eisele MSc Hanna Kaduszkiewicz MD 《Journal of general internal medicine》2009,24(12):1314-1317
Background
General practitioners (GP) play an important role in detecting cognitive impairment among their patients.Objectives
To explore factors associated with GPs’ judgment of their elderly patients’ cognitive status.Design
Cross-sectional data from an observational cohort study (AgeCoDe study); General practice surgeries in six German metropolitan study centers; home visits by interviewers.Participants
138 GPs, 3,181 patients (80.13 ± 3.61 years, 65.23% female).Measurements
General practitioner questionnaire for each patient: familiarity with the patient, patient morbidity, judgment of cognitive status. Home visits by trained interviewers: sociodemographic and clinical data, psychometric test performance. Multivariate regression analysis was used to identify independent associations with the GPs’ judgment of “cognitively impaired” vs. “cognitively unimpaired.”Results
Less familiar patients (adjusted odds ratio [aOR] 2.42, 95% CI 1.35–4.32, for poor vs. very high familiarity), less mobile patients (aOR 1.29, 95% CI 1.13–1.46), patients with impaired hearing (aOR 5.46, 95% CI 2.35–12.67 for serious vs. no problems), and patients with greater comorbidity (aOR 1.15, 95% CI 1.08–1.22) were more likely to be rated as “cognitively impaired” by their GPs.Conclusions
The associations between GPs’ assessments of cognitive impairment and their familiarity with their patients and patients’ mobility, hearing, and morbidity provide important insights into how GPs make their judgments.KEY WORDS: general practice, cognition, dementia, clinical judgment 相似文献19.
Diego Ardenghi Marina Martinengo Laura Bocciardo Paola Nardi Gino Tripodi 《Trasfusione del sangue》2007,5(4):210-216
Backgroung
The monitoring of near miss errors, in other words events that cannot be classified as substantial errors, but whose occurrence suggests that there is probably a critical point in a working procedure, can be useful in order to prevent these ‘almost errors’ from occurring again or to prevent them evolving into ‘relevant errors’.Study design and methods
The methods for picking up and studying near miss errors use widely tested systems that have recently also been applied to medicine. These systems are based on the process of identifying the risk through spontaneous notifications of events (incident reporting). In our Service of Immunohaematology and Transfusion Medicine (SIMT) these reports were assessed using root cause analysis, allowing us to introduce corrective actions to eliminate or reduce the risk.Results
We report the distribution, type and frequency of near miss errors, divided according to the stage of the working procedure in which they occurred, and for each of them describe the possible causes and corrective actions identified. We show how the possibility of an error, with potentially harmful consequences for the patient, is present throughout the whole transfusion chain. Near miss errors in Transfusion Medicine can be included in the wider field of ‘clinical risk, a problem that concerns not only SIMT, but also numerous other sectors of health care.Conclusion
The instruments identified through this study can lower the threshold of clinical risk in a Transfusion Service. 相似文献20.
Zachary R. Hunter Robert J. Manning Christine Hanzis Bryan T. Ciccarelli Leukothea Ioakimidis Christopher J. Patterson Megan C. Lewicki Hsuiyi Tseng Ping Gong Xia Liu Yangsheng Zhou Guang Yang Jenny Sun Lian Xu Patricia Sheehy Massimo Morra Steven P. Treon 《Haematologica》2010,95(3):470-475