Family practice and internal medicine clinical judgment in a university setting

There were no significant differences between family practice and internal medicine residents in the proportion of total diagnoses that were reasonable (72 percent and 77 percent, respectively) and unreasonable (14 percent and 15 percent, respectively) or average number of consultations requested per examination (.15 and .16, respectively). There was a significant difference between the two types of physicians in the average number of laboratory tests requested per examination (1.42 per family practice and 1.88 per internal medicine) and average number of x-ray examinations requested per examination (0.35 for family practice and 1.02 for internal medicine). The average length of examination for internal medicine tended to be longer than for family practice. Although generalizability of this study is limited, the results suggest that there may be important differences in the practice patterns of family practice and internal medicine with implications for training programs.     

降钙素原对急性胰腺炎诊疗价值的临床研究

目的 探讨降钙素原在急性胰腺炎的诊断和疗效观察中的临床价值.方法 选取98例急性胰腺炎患者为病例组,分为水肿组40例、无菌坏死组34例和感染性坏死组24例,分别于入院时、入院后d3、d7和离院前1 d(Out)采集标本检测血清PCT水平.结果 病例组血清PCT水平显著高于对照组(P＜0.001);入院后d3血清PCT水平达到最高,随后逐渐降低,离院时达到最低;同一时段,血清PCT水平表现为感染性坏死组＞无菌坏死组＞水肿组.结论 降钙素原是一项早期、快速、安全、高敏感性和高特异性的生物学指标,与临床感染的严重程度密切相关,对急性胰腺炎具有非常重要的临床价值.     

Enzyme immunoassays in diagnostic medicine. Theory and practice.

Serological methods are playing an increasingly important role in the diagnosis and epidemiological assessment of diseases. Simple, inexpensive methods for large-scale application are urgently needed. The enzyme immunoassay methods developed recently and reviewed here hold great promise for application in a wide variety of conditions. Under laboratory conditions they can be as sensitive as radio-immunoassay, but they can also be adapted as simple field screening procedures. These methods are based on the use of antibodies or antigens that are linked to an insoluble carrier surface. This is then used to “capture” the relevant antigen or antibody in the test solution and the complex is detected by means of an enzyme-labelled antibody or antigen. The degradation of the enzyme substrate, measured photometrically, is proportional to the concentration of the unknown “antibody” or “antigen” in the test solution. The application of these techniques to endocrinology, immunopathology, haematology, microbiology, and parasitology is reviewed.     

儿童急性胰腺炎的病因及临床特征分析

目的 探讨儿童急性胰腺炎(AP)病因、分型及危险因素.方法 选择2009年1月至2018年10月在四川大学华西医院及华西第二医院住院治疗的217例AP患儿为研究对象.按照既往病史,将其分为初发性AP组(n=181)及复发性AP组(n=36).收集AP患儿一般临床资料,实验室检查与影像学检查结果及并发症发生率等.采用单因...     

Epidemiologic, pathologic, diagnostic and clinical features and therapy of Helicobacter pylori infection based on latest data

Helicobacter pylori is one of the most common human microorganisms. The outcome of its acquisition is not predictable, nevertheless a great amount of knowledge has accumulated concerning the virulence factors of the bacteria and the diseases associated with the infection. In most cases, this indigenous bacterium of the human stomach does not cause serious illnesses and the consequences of the infection depend on host and environmental factors. A more comprehensive insight into bacterial pathogenic and immunogenic mechanisms and host immune response may result in a more reasonable, cost-effective therapy and disease prevention.     

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.     

Epidemiologic study and containment of a nosocomial outbreak of severe acute respiratory syndrome in a medical center in Kaohsiung, Taiwan.

OBJECTIVE: We conducted an epidemiologic investigation at the beginning of a nosocomial outbreak of severe acute respiratory syndrome (SARS) to clarify the dynamics of SARS transmission, the magnitude of the SARS outbreak, and the impact of the outbreak on the community. METHODS: We identified all potential cases of nosocomially acquired SARS, linked them to the most likely infection source, and described the hospital containment measures. SETTING: A 2,300-bed medical center in Kaohsiung, Taiwan. RESULTS: A total of 55 cases of SARS were identified, and 227 hospital workers were quarantined. The index patient and neighboring patients were isolated. A chest physician team reviewed medical charts and chest radiographs and monitored the development of SARS in patients staying in the ward. The presence of underlying lung disease and immunocompromise in some patients made the diagnosis of SARS difficult. Some cases of SARS were diagnosed after the patients had died. Medical personnel were infected only if they cared for patients with unrecognized SARS, and caretakers played important roles in transmission of SARS to family members. As the number of cases of nosocomial SARS increased, the hospital closed the affected ward and expedited construction of negative-pressure rooms on other vacated floors for patient cohorting, and the last case in the hospital was identified 1 week later. CONCLUSIONS: Timely recognition of SARS is extremely important. However, given the limitations of SARS testing, possible loss of epidemic links, and the nonspecific clinical presentations in hospitalized patients, it is very important to establish cohorts of persons with low, medium, and high likelihoods of SARS acquisition. Rapid closure of affected wards may minimize the impact on hospital operations. Establishment of hospitals dedicated to appropriate treatment of patients with SARS might minimize the impact of the disease in future epidemics.     

Gatekeeping in primary care: a comparison of internal medicine and family practice

Five hundred twenty new patients were randomly and prospectively assigned to receive their care in the Internal Medicine Clinic or Family Practice Clinic of a large university hospital. The patients were followed by residents in training under the supervision of board-certified internists or family physicians. After a mean length of care of slightly over two years, the charts were reviewed for frequency of visits to primary care providers (internal medicine or family practice), Emergency Room, Acute Care Clinic, and all clinics other than the two primary care clinics. The records were also reviewed for laboratory tests ordered. Frequency of visits to the clinic of primary care, Emergency Room, Acute Care Clinic, and broken appointments were all significantly higher for patients randomized to the Internal Medicine Clinic. In addition, the median total annual cost of laboratory tests for patients followed by internal medicine physicians was significantly higher, largely because of higher laboratory charges generated by the specialist consultants. Over the study period, internal medicine patients had a significantly higher number of visits to all nonprimary care clinics and specifically to the dermatology, obstetrics and gynecology, and general surgery consultant clinics. It can be concluded that in this clinical environment, the practice styles of internal medicine and family practice are different.     

广州市白云区区域医学检验中心实践及发展研究

区域医学检验中心作为促进医疗联合体政策落地的重要举措和组成部分之一,在提升区域医学检验质量、推动优质医疗资源下沉、降低医疗机构运营成本、减少政府财政重复投入、实现区域医学检验结果互认及区域医学检验资源共享等方面发挥着重要作用。在我国各项政策的规定下,区域医学检验中心呈现出快速发展的趋势。广州市白云区通过汲取其他地区区域医学检验中心的建设经验,结合实际情况,对白云区区域医学检验中心进行认真部署并落实建设。其所采取的建设方式既具有个性化特色,又可为其他区域提供共性化参考。     

北京市急性腹泻病例流行病学特征和临床特征分析

目的探讨北京市肠道门诊急性腹泻病例的流行病学特征和临床特征。方法研究对象为北京市肠道门诊2008年和2009年在4月1日至10月31日就诊急性初诊病例,7日内复诊病例和病程超过2个月的慢性病例被排除。资料来源于北京市肠道门诊早期预警系统。结果 2008年和2009年符合标准的病例数为159 244例和173 151例,发病并就诊率分别为9.75‰和10.24‰,男性比例分别为55.90%和54.30%。年龄呈双峰分布,0~1岁年龄组就诊并发病率最高,两年分别达到153.46‰和133.26‰,其次是20~30岁之间。病例集中在7~8月份,城区发病并就诊率明显高于郊区。超过80%的病例在72 h内就诊,病例每日发病高峰在早8点和14点、就诊高峰在9~10点和14点。大便多为稀便,两年分别占56.29%和57.70%,呕吐分别为21.18%和21.30%。结论急性腹泻病仍然是影响北京市公众健康的重要的疾病,儿童、特别是0~1岁婴儿是腹泻病的主要危害群体,其次是20~30岁青年群体。北京市不同地区发病并就诊率有较大差异,病例日分布和每日就诊时间分析应有助于医疗资源的合理利用。     

Utilization of hospital services. A comparison of internal medicine and family practice

Five hundred twenty new patients were randomly and prospectively assigned to receive care in the Internal Medicine Clinic or Family Practice Clinic of a large university hospital. Previous analyses of outpatient data demonstrated that the frequency of visits to the clinic of primary care, acute care clinic, emergency room, and consultant clinics were all significantly higher for patients randomized to internal medicine compared with family practice. In the present study, patients' charts were reviewed for information regarding hospitalizations. During the 3.4-year study period, there were a total of 61 hospital admissions for internal medicine (35 of 249 patients), and 58 for family practice (27 to 271 patients). Age (mean 47 years) and sex of patients in both groups were equivalent. The average total cost of hospitalization for each patient was greater for those randomized to the Internal Medicine Clinic: $7,193 for internal medicine patients as compared with $5,764 for family practice patients. The professional costs per hospitalization showed greater variation: $913 for Internal Medicine Clinic patients and $629 for Family Practice Clinic patients. Internal Medicine Clinic patients had a longer mean length of hospitalization (7.5 days) when compared with that of Family Practice Clinic patients (6.3 days). It can be concluded that in this clinical environment the hospitalization patterns are different for patients assigned to the Internal Medicine Clinic compared with the Family Practice Clinic: both cost and length of care for hospitalization are less for those followed by the Family Practice Clinic.     

Cost-effectiveness analysis of cataract surgery: a global and regional analysis

OBJECTIVE: To estimate the population health effects, costs and cost effectiveness of selected cataract surgery interventions in areas of the world with different epidemiological profiles. METHODS: Effectiveness estimates are based on a review of the literature taking into account factors such as operative failure, complications and patient non-compliance. A population model was applied to follow the lifelong impact on individuals having cataract surgery. Costing estimates are based on primary data collected in 14 epidemiological subregions by regional costing teams and on a literature review. Costings were estimated for different geographical coverage levels using non-linear cost functions. FINDINGS: Intra- and extra-capsular cataract surgeries are cost-effective ways to reduce the impact of cataract-blindness. Extra-capsular cataract surgery is more cost-effective than intra-capsular surgery in all regions considered. Providing extra-capsular cataract surgery to 95% of those who need it (95% coverage level) would avert over 3.5 million disability-adjusted life years (DALYs) per year globally. The cost-effectiveness ranges from 57 International dollars (1 dollar) per DALY in the WHO South-East Asia Region where there is high overall child and adult mortality to 1 dollar 2307 per DALY in the WHO Western Pacific Region where there is low overall child and adult mortality. CONCLUSION: Extra-capsular surgery for cataracts at a high level of coverage is the most cost-effective way of restoring sight in all epidemiological subregions considered. Analysts from countries within a region are encouraged to further contextualize the results based on their own country's specific parameters.