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61.
GPs' motives for referrals to general hospitals: does access to GP hospital beds make any difference? 总被引:1,自引:0,他引:1
OBJECTIVES: We aimed to explore the relative impact of medical and other
situational motives on GP's decisions to refer patients to specialist care
in a general hospital, and to assess whether having access to a GP hospital
influences the decisions. METHODS: We carried out a prospective study of
consecutive doctor-patient contacts during one week. The effects of main
motives, medical, social/nursing, general hospital advice, distance from
the nearest general hospital and access to GP hospitals on referral
decisions were explored by logistic regression. The motives for different
referral decisions were also explored through frequency analyses. The study
was set in general practices in the county of Finnmark in North Norway,
which included 40 GPs from rural practices with access to a GP hospital and
eight GPs working closer to a general hospital without access to GP
hospital. We studied 2496 doctor-patient contacts, which resulted in 411
patients being considered for any kind of referral, of which 205 were
referred to the general hospital. RESULTS: Medical needs were recorded as
the only referral motive of major importance in about half of the cases
considered for referral, while additional motives were recorded in the
other half. The rationale for admissions to general hospitals and GP
hospitals (in-patient care) was compatible in terms of the relative
importance of the medical arguments. The GP hospital option was mainly
chosen because of the long distance from the general hospital, nursing
needs and the preferences of the patient and the family, and resulted in a
lower proportion of patients being referred to general hospitals from GPs
with access to a GP hospital. CONCLUSION: Medical motives dominate the
decision to refer patients to general hospitals, but access to a GP
hospital, in cases where nursing needs and long distances to the general
hospital are supplementary considerations, reduces the proportion of
patients being referred to general hospitals.
相似文献
62.
63.
A Shuper G Horev L Kornreich S Michowiz R Weitz R Zaizov IJ Cohen 《Archives of disease in childhood》1997,76(3):259-263
OBJECTIVE: Our experience in children with visual pathway glioma (VPG) was reviewed to delineate its clinical characteristics. DESIGN: The charts and imaging studies of 21 children with VPG who were followed up in our centre during the last 12 years were reviewed and summarised. RESULTS: VPG accounted for 13.1% of all brain tumours treated during this period. Sixty two per cent of the children with VPG had neurofibromatosis type 1 (NF-1). Among these, more than 60% were detected as part of routine work up. In some cases decreasing visual function preceded the appearance of the VPG on imaging studies. Tumour growth rate was markedly unpredictable. All treatment modalities employed led to tumour shrinkage and stabilisation for a variable period, but none was successful in totally eradicating the tumour. Complications were less severe after chemotherapy compared with radiotherapy. Three children died, none with NF-1, with a globular hypothalamic/chiasmatic tumour and accompanying electrolyte abnormalities. CONCLUSIONS: NF-1 is a favourable prognostic marker for VPG. Whenever possible a period of observation is necessary before treatment is initiated, during which time tumour size and visual function should be closely followed up; an untoward change in either of these is an indication for the start of treatment, preferably chemotherapy first. The combination of a globular hypothalamic/chiasmatic glioma and electrolyte abnormalities in a child without NF-1 are related to a poor prognosis. 相似文献
64.
R MacFaul M Stewart U Werneke J Taylor-Meek HE Smith IJ Smith 《Archives of disease in childhood》1998,79(3):213-218
AIM: To compare views of parents, consultants, and general practitioners on severity of acute illness and need for admission, and to explore views on alternative services. METHOD: Prospective questionnaire based study of 887 consecutive emergency paediatric admissions over two separate three week periods in summer and winter of five Yorkshire hospitals, combined with a further questionnaire on a subsample. OUTCOME MEASURES: Parental scores of need for admission and parent and consultant illness severity scores out of 10. Consultant judgment of need for admission. Alternatives to admission considered by consultants and, for a subsample, by parents and family GP. RESULTS: Ninety nine per cent of parents thought admission was needed. Parents scored need for admission more highly than severity of illness with no association observed between severity and presenting problem or diagnosis. High parental need score was associated with a fit, past illness, and length of stay. Consultant illness severity scores were skewed to the lower range. Consultants considered admission necessary in 71%, especially for children aged over 1 year, presentation with breathing difficulty or fit, and after a longer stay. More admissions in the evening were considered unnecessary as were admissions after longer preadmission illness, gastroenteritis, or upper respiratory tract infection. Of a subsample of parents, 81% preferred admission during the acute stage of illness even if home nursing had been available. Similar responses were obtained from GPs. Alternative services could have avoided admission for 19% of children, saving 15.6% of bed days used. CONCLUSIONS: Medical professionals and parents differ in their views about admission for acute illnesses. More information is needed on children not admitted. Alternative services should take account of patterns of illness and should be acceptable to parents and professionals; cost savings may be marginal. 相似文献
65.
66.
67.
Aaraas IJ Holtedahl K Anvik T Bentzen N Berg E Fleten N Hasvold T Medbø A Prydz P 《Scandinavian journal of primary health care》2007,25(4):198-201
With general practice recognized as one of three major subjects in the Tromsø medical school curriculum, a matching examination counterpart was needed. The aim was to develop and implement an examination in an authentic general practice setting for final-year medical students. In a general practice surgery, observed by two examiners and one fellow student, the student performs a consultation with a consenting patient who would otherwise have consulted his/her general practitioner (GP). An oral examination follows. It deals with the consultation process, the observed communication between “doctor” and patient, and with clinical problem-solving, taking today''s patient as a starting point. The session is closed by discussion of a public-health-related question. Since 2004 the model has been evaluated through questionnaires to students, examiners, and patients, and through a series of review meetings among examiners and students. Examination in general practice using unselected, consenting patients mimics real life to a high degree. It constitutes one important element in a comprehensive assessment process. This is considered to be an acceptable and appropriate way of testing the students before graduation. 相似文献
68.
Background:
Non-communicable diseases are increasing worldwide due to rapidly changing lifestyles and socio-economic status. It is contributing significantly to the global burden of diseases.Objective:
To determine the pattern of non-communicable diseases in children admitted into the Paediatrics ward in a tertiary health centre in Enugu.Materials and Methods:
A review of admissions into the Paediatrics ward of the University of Nigeria Teaching Hospital Enugu, between January 1999 and December 2008 was done using the registry of admission and discharge.Results:
The age range of patients admitted during the period was 2 months to 18 years (mean 5.27 ± 5.42 years). There were 1173 (59.6%) males and 796 (40.4%) females. Disorders of the haematological system accounted for 514 (23.3%) of the non-communicable diseases among the admissions, malignancies accounted for 424 (19.2%) among the admissions, whereas the renal, central nervous, and cardiovascular systems were involved in 282 (12.8%), 274 (12.4%), and 241 (10.9%) patients, respectively. There were 274 (12.4%) deaths and 1667 (75.5%) discharges while 38 (1.7%) were discharged against medical advice. Data on 221(10.2%) of the patients were reported missing. Malignancies contributed to 75 (27.3%) of the deaths, haematological disorders accounted for 44 (16%) whereas renal disorders and nutritional disorders contributed to 43 (15.7%) and 41 (15%) of the deaths, respectively.Conclusion:
Non-communicable diseases affect children in our environment and contribute to morbidity and mortality in children. Strategies to prevent these diseases should be encouraged in order to avert the challenges of double burden of the diseases in children. 相似文献69.
70.
Mitochondrial tRNALeu isoforms in lung carcinoma cybrid cells containing the np 3243 mtDNA mutation 总被引:1,自引:0,他引:1
We have investigated the representation of structural isoforms of the two
mitochondrial leucyl tRNAs in lung carcinoma cybrid cell lines containing
the np 3243 (MELAS) mtDNA mutation, alone or in combination with the np
12300 suppressor mutation. The mutant tRNALeu(UUR) is aminoacylated very
poorly or not at all, whereas the suppressor tRNALeu(CUN) is efficiently
aminoacylated. Deacylated mitochondrial tRNALeu(CUN) is present, in all
human cells tested, in two structural isoforms that are separable on
denaturing gels, indicating a difference in primary structure. The ratio of
the two isoforms differs between cell types and is strongly biased towards
one isoform in lung carcinoma cybrids containing high levels of the np 3243
mutation, compared with control cybrids. We propose that structural
modification of tRNALeu(CUN) could be a natural suppression mechanism for
the np 3243 and other mitochondrial tRNALeu(UUR) mutations and could
underlie some of the phenotypic variability of np 3243 disease.
相似文献