Needs of handicapped infants, toddlers and families. Florida's response.

The State of Florida and its physicians are moving into a wonderful time of opportunity to serve the special needs of infants and toddlers at risk for developmental delays. If we meet our challenge we will no longer judge our success by a viable pregnancy or "graduation" from the nursery. We will begin to expect a community-wide response that prepares a child for education so successful that he or she will graduate prepared to work as a full member of the community. Not all our interventions will succeed at that level, but we have learned that good ones can place almost all our special needs children into the community. Physicians will have a major role in the success of this system of care for handicapped infants, toddlers and their families.     

Brain attack: needing resuscitation

The brain is extremely susceptible to focal ischaemia. Following vascular occlusion, a core of severely damaged brain tissue develops, surrounded by an ischaemic penumbra. This potentially-salvageable penumbra may be estimated by advanced neuroimaging techniques, particularly by diffusion-perfusion mismatch. Clinical trials have demonstrated the efficacy of intravenous thrombolysis within three hours of onset of ischaemic stroke in reducing short-term disability. Recanalisation is enhanced by intra-arterial thrombolysis, sonothrombolysis and clot-retrieval devices. Occasionally, reperfusion injury may lead to clinical deterioration. The search continues for effective neuroprotectants. Brain perfusion needs to be maintained through blood and intracranial pressure management. Hemicraniectomy for 'malignant' cerebral oedema reduces death and disability. Elevated glucose should be controlled and hypoxia alleviated. Public education of symptoms and the need for immediate presentation to a medical facility is needed. Stroke unit care reduces death and disability with little increase in cost. Current evidence supports urgent efforts to resuscitate the brain after stroke.     

Patient-doctor agreement about problems needing follow-up visit

In this study in an urban prepaid group practice, patients and practitioners agreed less than half the time as to what problems required follow-up at a subsequent visit. Problems that were mentioned by both practitioner and patient were much more likely to be followed up subsequently by the practitioner than problems initially mentioned only by the practitioner or only by the patient. Patients reported much more improvement of problems at follow-up when both practitioner and patient mentioned the problem as requiring follow-up than when they had been mentioned only by the patient. The involvement of patients in the process of care may be augmented by a variety of mechanisms. We believe greater patient participation in the processes of care should result in better follow-up of problems and better results, at least as perceived by patients.     

The need for epidemiologists.

The increasing need for epidemiologists in biomedical research has been studied by polling organizations with present and potential needs for epidemiologic services. The research institutes of the National Institutes of the National Institutes of Health and the schools of medicine reported the greatest estimated need among the respondents. They and others polled indicated a substantial need for master's and doctoral level epidemiologists that cannot be fulfilled by current training programs in epidemiology. Broad, sound methodological training applicable to all health problems, and increased funding for support of epidemiologic trainees and training programs in institutions, which would make epidemiology training competitive with that in other fields, are strongly recommened.     

医疗风险调查研究中应注意的问题

医疗风险相关情况的调查是医疗风险研究的首要环节。本文就医疗风险调查研究设计中应注意的事项即概念明确、对象选取、设计原则进行详细阐述,以期为国内同行研究提供参考。     

US ad uses lure of prompt treatment to entice Canadians needing joint replacement.

A Virginia hospital has used newspaper advertisements to solicit Ontario patients who are waiting for hip- or knee-replacement surgery. The ads promote the medical services of US orthopedic surgeons and call attention to exasperatingly long waiting lists for the same surgery in Canada. "Pain doesn't wait," they state. "Neither should you." The hospital says it has been receiving more than 100 calls a week inquiring about the procedure, which costs $15000 (US).     

CT引导下经皮穿刺活检的临床意义

目的：探讨CT引导下经皮穿刺活检的临床意义。方法：穿刺胸部48例，腹部48例，恶性34例，良性56例，穿刺诊断总准确率为90％以上。结果：2例穿刺出血，1例使用少量的止血药，3例气胸因症状轻微未作特殊处理，其余均取得满意效果。结论：CT引导下穿刺活检是损伤小、确诊率高、简便易行诊断方法，为临床的治疗提供有力的依据。     

CT引导下经皮穿刺活检及其临床应用

目的：就48例经CT扫描发现胸腹部肿块病灶,并在CT引导下经皮穿刺活检,提出了CT引导下行穿刺活检术的方法选择及其应用。方法：穿刺部胸部24例,腹部24例,恶性17例,良性31例,穿刺诊断总准确率为90％以上。结果：2例穿刺出血,1例使用少量的止血药,3例气胸因症状轻微未作特殊处理。结论：上述表明,CT引导下穿刺活检是损伤小、确诊率高、简便易行诊断方法,为临床的治疗提供了有力的依据。     

为了控制疟疾，我们需要DDT!

一位疟疾控制专家解释,为什么房屋喷洒DDT是今天与疟疾斗争唯一有效的方法。下面是摘自马里兰州Bethesda卫生科学Uniformed Services大学热带公共卫生教授Donald R.Robert博士的陈述。Robert博士的演讲题目是“DDT和疟疾控制：过去,现在和未来”,于2002年10月在由华盛顿媒体协会（Accuracy in Media）主办的一次会议上发表。     

正确评价检验数据与需要注意的问题

随着现代医学科技的进步和人们对疾病认识的不断提高，现代医学对疾病的诊断、疗效评价及预后判断越来越多地依赖实验室的检查结果。为获取准确的实验数据及对实验结果做出恰当的评价，临床医生必须对获取数据过程中引起变异的原因、所获取数据的性质、参考值确立的方法和原则、实验方法性能等有较全面的了解。下面就有关合理运用检验数据、恰当评价实验结果、标本的正确采集和质量控制做以简单的讨论。     

The identification of the general practice registrar needing assistance

Background

Doctors undertaking vocational training in general practice in Australia may require assistance, in addition to the normal training offered as part of their training programme. Issues requiring assistance may go undetected for a period of time. Delay in the identification of issues leads to delay in the provision of the assistance. The aim of this study is to determine the most common reasons registrars require extra assistance, and how these issues are identified. The findings of this study will provide direction for 21 regionally based training providers (RTPs) to develop improved tools to ensure earlier detection of registrars requiring assistance.

Method

This study is based on qualitative research methods, using semi-structured interviews with senior medical education staff of four regional general practice training providers in Victoria, Australia.

Results

Issues identified included language and cultural issues, applied knowledge and skills, attitude and professionalism, and health and family issues.The principal method that training providers identified issues was via the GP supervisor. This was predominantly by informal communication, rather than formal evaluation sheets. Other methods included the external clinical teaching visit and other training formative assessments. These more formalised procedures were more likely to identify issues later than desired. They were also used as a way of clarifying suspected problems. The selection process was not felt to be helpful, and the examinations provided information too late.

Conclusion

An increased awareness of the potential issues leading to a registrar to require assistance enables identification and subsequent action to occur in a more timely and more useful fashion. Informal communication between practices and training programme staff should be encouraged to enable these issues to be dealt with early in training.     

Autonomy: the need for limits.

This essay addresses the issue of the autonomy of the National Health Service (NHS) patient in the UK. It is argued, with reference to clinical examples, that some patients abuse their rights to medical care to the detriment of other patients and the service providers. A case is made for limiting the rights of patients in order to improve the service for all who use it. A range of mechanisms are considered with a discussion of the issues raised by each solution in turn.