Practice guidelines: the radiology perspective

Clinical practice guidelines have emerged as a reality for medical practitioners over the past 20 years. Although virtually all groups interested in the development of practice guidelines hope for improvements in patient care, secondary expectations vary widely among those using them. Their use in daily practice by physicians has met with resistance from barriers including concerns of “cookbook” medicine, a loss of autonomy, and increased professional liability. The recent experience of the ACR in addressing these challenges illustrates that physicians are receptive to steps perceived to mitigate the risks accompanying the use of guidelines as well as to efforts to increase their understanding of implementing guidelines in clinical practice. The experiences of other medical societies and an inventory of future trends reveal additional challenges associated with the use of practice guidelines, as third parties look to guidelines as points of reference for gauging the performance of health care providers.     

颈内动脉接近完全闭塞时的处理

目的由于卒中风险随着狭窄严重程度的增加而升高，因此认为颈内动脉（ICA）接近闭塞患者的卒中风险很高。在现有的随机试验中，还没有专门针对这种情况进行探讨，因此其处理尚存在争汶。方法：对相关文献进行系统评价。结果：对ICA接近闭塞患者的处理还存在争议：一些学者支持进行干预，而另一些学者则认为存在风险或没有益处而反对进行干预。在ICA接近闭塞的有症状患者中进行一项比较外科治疗与最佳内科治疗的多中心前瞻性随机试验似乎非常困难，因为这类研究需要大量的患者。尽管如此，基于目前的证据，似乎很难拒绝手术治疗。结论：由于目前对ICA接近闭塞患者的最佳处理方案仍存在着争议，因此需要前瞻性观察性研究以证实其在有症状和无症状人群中的患病率以及相关的卒中风险。基于目前的证据，大多数医疗中心选择手术治疗，但它相对干内科治疗的特粱尚右待证章．     

Cyclosporine interactions with miconazole and other azole-antimycotics: a case report and review of the literature.

Several antimicrobial drugs have been shown to pharmacokinetically interact with cyclosporine. On two separate occasions, we observed increases in cyclosporine plasma concentrations during concomitant miconazole therapy in a heart transplant patient with an infection secondary to Pseudallescheria boydii. To our knowledge, no interaction between cyclosporine and miconazole has previously been reported. In addition, drug interactions were observed between cyclosporine and ketoconazole and possibly between cyclosporine and SCH 39304, an investigational azole-antifungal agent. No interaction was noted between cyclosporine and fluconazole. In general, clinicians should anticipate drug interactions between cyclosporine and azole-antimycotic agents.     

Attention deficit disorder, alcoholism, and drug abuse: MMPI correlates.

Earlier research had demonstrated that alcoholics with attention deficit disorder residual type (ADDRT) differ from other alcoholics on the Minnesota Multiphasic Personality Inventory (MMPI). The purpose of this study was to explore the influence of drug abuse on the relationship of ADDRT and alcoholism as reflected on the MMPI. Groups of 48 male alcoholics, 28 ADDRT alcoholics, 25 ADDRT alcohol and drug abusers and 18 alcohol and drug abusers were all administered the MMPI. Significant differences were found between the alcoholic and ADDRT alcoholic groups on scales Pd, Sc, Si, F, and K. For the ADDRT alcohol and drug abusers versus the alcohol and drug abuser groups, they differed on scales K, Hs, D, Pd, Pa, Pt, Sc, Si, F, K, and L.     

Knowledge regarding organ donation: identifying and overcoming barriers to organ donation

Four-hundred and fifty-five undergraduate students, 26 MBA students, and 465 people from the surrounding community responded to 21 true/false questions regarding factual knowledge about organ donation. The mean number of correct answers was 74.6%. The correct response rate, however, varied widely over questions. Four questions with very large error rates suggest possible 'barriers to donation'. Specifically, these questions concerned religious support for organ donation, the concept of brain death, the normally rigid separation of physician teams who are primarily responsible for the welfare of the donor and donee, and a mistaken belief that to be valid an organ donor card must be filed with the U.S. Department of Health and Human Services. Knowledge of organ donation facts was found to be related to whether subjects carried or requested an organ donor card, their attitude towards organ donation and their willingness to donate their own organs or the organs of a deceased loved one. These findings suggest strategies for raising public support for organ donation.     

The emergency physician and patient confidentiality: A review

Confidentiality is a promise rooted in tradition, law andmedical ethics. Emergency physicians treat a variety of patients to whom confidentiality is of vital importance: employees, celebrities, victims of violence or disaster, minors, students, criminals, drug abusers, and patients with STDs. EDs should develop methods of ensuring confidentiality for all patients.³⁴Although confidentiality is an important principle thatshould be respected and guarded, it is not absolute. Various laws mandate disclosure of certain patient information; in addition, an overriding moral duty may occasionally require, a breach of confidentiality. As Beauchamp and Childress noted, “the therapeutic role may sometimes have to yield to ones role as citizen and as protector of the interests of others”.¹⁹ In general, however, circumstances requiring a breach of confidentiality are rare.