The effect of temperature reduction on respiratory rate in febrile illnesses

A raised respiratory rate is a useful sign in the diagnosis of pneumonia in children. It was observed that children with malaria and other febrile illnesses may also present with a raised respiratory rate. To determine the extent to which increased body temperature contributes to the raised respiratory rate observed in these children the effect of change in body temperature on respiratory rate was measured in 186 sick Gambian children with a raised respiratory rate, including those with pneumonia or malaria. A temperature dependent effect on respiratory rate of 3.7 breaths per minute per degree centigrade was demonstrated for the whole study cohort, with no significant difference between children with pneumonia or malaria. Twenty three per cent of children with pneumonia whose temperature fell had a final respiratory rate below that currently recommended by the World Health Organisation for the diagnosis of pneumonia. It is concluded that respiratory rate is to some extent dependent on body temperature in children with febrile illnesses such as pneumonia and malaria, but that this does not alone account for the raised respiratory rate seen in these children. The effect of reduction in body temperature on respiratory rate does not help to distinguish children with pneumonia from those with malaria. A history of recent use of an antipyretic or other measures to control fever is important when evaluating children for possible pneumonia.     

Flutamide in the treatment of hirsutism.

Ten hirsute women were treated with flutamide (250 mg/day) for 6 months to evaluate its effect. Hair growth as assessed by the Ferriman and Gallwey hair score was significantly reduced in all patients (P less than 0.01). The only significant change in endocrine levels was an increase in serum androstenedione (P less than 0.01). Acne and seborrhea improved markedly. No side effects were noted during the treatment. Our data suggest that the antiandrogenic properties of flutamide render it a suitable single agent in the treatment of hirsutism.     

Are patients' decision‐making preferences being met?

Objective To investigate the information and decision‐making expectations of general practice patients during real life consultations. Design Post‐consultation, quantitative patient preference and enablement questionnaire. Setting and participants Patients attending for routine appointments in general practice surgeries in Oxfordshire, UK. Results Thirteen Oxfordshire general practitioners (GPs) volunteered to take part and a total of 171 patients completed and returned the questionnaire. Between a quarter and one‐third of patients reported receiving less information than they desired, particularly in relation to the risks and benefits of medical treatments. Patients who preferred the doctor to make decisions for them (35%), were more likely to have their preferences met (64%) compared with patients wishing to share decisions (47%) or make their own (18%) who were less likely to achieve this role (52 and 41%, respectively). However, it could not be demonstrated unequivocally that these differences were statistically significant. In total, 61% of patients perceived that they achieved their preferred decision‐making role. No significant differences were found in post‐consultation enablement scores between any of the decision preference groups. Patients' assessments indicated that some doctors were more successful at achieving congruence than others. Conclusion The decision‐making preferences of general practice patients tend to vary. However, there was a substantial mismatch between the stated preferences of patients for the role they wanted to have in decision‐making and what they felt actually took place in their consultation. Therefore, it remains a challenge for doctors to match their consultation style to the decision‐making preferences of individual patients.     

Self-reported use of shared decision-making among breast cancer specialists and perceived barriers and facilitators to implementing this approach

BACKGROUND: Physicians are increasingly urged to practice shared decision-making with their patients. Using a cross-sectional survey, we explored the extent to which Ontario breast cancer specialists report practising shared decision-making with their patients, their comfort level with this approach, and perceived barriers and facilitators to implementation. PARTICIPANTS AND METHODS: All Ontario surgeons and oncologists (radiation and medical) treating women with early-stage breast cancer were eligible for this study. Likert scales were used to measure physicians' comfort level with and self-reported use of different treatment decision-making approaches as well as perceived barriers and facilitators to treatment decision-making with patients. RESULTS: The response rate was 79% for oncologists and 72% for surgeons. More physicians from each specialty (87% of oncologists and 89% of surgeons) expressed high levels of comfort with clinical example 4 (designed to illustrate a shared approach) than with any of the other examples presented (e.g. the informed and paternalistic approach). Similarly, more oncologists and surgeons reported that their usual approach to treatment decision-making was like example 4 than like any other approach presented (56% of oncologists and 69% of surgeons, respectively). Comfort levels with example 4 for oncologists and surgeons were 31% and 20% higher, respectively, than the reported use of this approach. Lack of time and patient anxiety, patient lack of information and/or misinformation, and patient unwillingness or inability to participate were perceived by a substantial minority of both oncologists and surgeons as barriers to patient involvement in treatment decision-making. Key facilitators identified included patients' emotional readiness, support, information and trust in the physician. More research is needed to identify contextual, physician, patient, and interaction factors that will facilitate shared decision-making in the medical encounter and help both parties create an environment conducive to implementing this approach to the extent desired.     

Development of an information source for patients and the public about general practice services: an action research study

OBJECTIVE: The publication of information about the performance of health-care providers is regarded as central to promoting greater accountability and empowering patients to exercise choice. The evidence suggests that the public is not very interested in accessing or using current sources of information. This study aimed to explore the information needs of patients in the context of UK primary care and to develop an information source about general practice services, designed to be usable by and useful to patients. DESIGN: An action research study making use of data from formal and informal interviews, focus groups, participant observation and document review. SETTING: The geographical areas covered by two Primary Care Trusts in the north of England and two Local Health Boards in south Wales. PARTICIPANTS: A partnership between 103 members of the public, general practice staff from 19 practices, NHS managers from four Primary Care Organizations and the research team. RESULTS: The public would like to know more about the quality and range of general practice services but current sources of information do not meet their needs. The public do not like league tables comparing the performance of practices and only a small number of people want to use comparative information to choose between practices. They seem to be more interested in the context and availability of services and the willingness of practices to improve, than in the practice's absolute or relative performance. They want to be clear about the source of the information so that they can make personal judgements about its veracity. Information is most likely to be useful if it adheres to the basic principles of cognitive science in terms of its structure, content and presentation format. Using these findings, paper and electronic prototype versions of a guide to general practice services have been developed. CONCLUSIONS: In order to maximize the potential use of performance information by the public it is necessary to move beyond provider-led and professionally constructed approaches to information provision and ensure that the public is actively involved in the development of information sources. Such involvement produces a different kind of information to that currently available to the public. The findings of this study have important implications for policy. Most importantly, it seems that the traditional consumerist model underlying a policy of making comparative performance information available to the public to enable them to exercise choice between primary care providers may not be appropriate. An alternative model of information provision, which recognizes the public's commitment to their practice and is integrated with 'soft' sources of knowledge is more likely to engage and be of use to the public.     

单纯疱疹性角膜炎几种常用辅助诊断方法的比较

目的 比较常用的3种检测单纯疱疹性角膜炎(HSK)辅助诊断方法的敏感性和临床实用性。方法6只新西兰白兔双眼接种1×105PFU单纯疱疹病毒I型(HSV-I)McKrea株。病毒接种后第8天应用无环鸟苷眼膏每2 h 1次,共4次。另外2只兔中1只兔双眼在角膜上划痕但不接种病毒,另1只兔双眼角膜接种曲霉菌作为阴性对照。在病毒接种后的3、9、21天,利用病毒分离、多聚酶链反应(PCR)和蛋白吸附膜快速单纯疱疹病毒I型抗原检测方法进行检测。结果 接种后第2天全部角膜出现典型的HSK点状或树枝状浸润,第5天出现地图状溃疡,第21天仍有2只角膜有持续性感染。抗病毒治疗1天后无明显好转。2只兔于接种后14和16天死亡。病毒分离方法只有接种后3天的泪液培养阳性,第9、21天的标本检测均为阴性。有11/12、11/12和6/8只角膜在接种后的第3、9、21天用PCR方法检测到了HSV-I DNA。蛋白吸附膜抗原检测在接种后的第3、9、21天的阳性率分别为12/12、12/12和3/8。结论 蛋白吸附膜快速HSV—I检测是一种快速、简便、经济的方法。其阳性结果与临床表现相吻合。