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21.
Michael Rossdale Terry Kemple Sarah Payne Michael Calnan Rosemary Greenwood 《The British journal of general practice》2007,57(535):152-154
Out-of-hours organisations are responsible for the care of patients 70% of the time, and their GPs act as gatekeepers to secondary care services. This observational study identifies the variations in GPs' out-of-hours referral rates to secondary care and factors that could explain these variations. One hundred and forty-nine GPs who worked in one UK general practice out-of-hours cooperative which served 19 practices with 167 000 registered patients. Data on patients who accessed the out-of-hours service over 3 years (2001-2004) were examined. Factors thought to be predictors of variation in referral rates were investigated using logistic regression analysis. There was a fivefold difference in referral rates between the lowest and highest referring quartiles of GPs (OR [odds ratio] = 4.56, CI [confidence interval] = 3.86 to 5.38). The sex (female) of the clinician, the time of the consultation (11 pm to 7 am), and the place of the consultation (home visit) accounted for some, but not all, of the increased referral rates. A doctor working out-of-hours disproportionately influences the fate of the patient, the number of hospital admissions, and extra costs to the health service. There is a need for follow-up studies to investigate the factors associated with referral behaviour, and how the variation relates to patient factors and the resources available. These findings could be used when planning the staffing of out-of-hours services to optimise appropriate care and minimise patients' exposure to unnecessary intrusive and expensive hospital care. 相似文献
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A simple, cost effective circuit for a two-electrode non-differential biopotential amplifier is proposed. It uses a ‘virtual
ground’ transimpedance amplifier and a parallel RC network for input common mode current equalisation, while the signal input
impedance preserves its high value. With this innovative interface circuit, a simple non-inverting amplifier fully emulates
high CMRR differential. The amplifier equivalent CMRR (typical range from 70–100 dB) is equal to the open loop gain of the
operational amplifier used in the transimpedance interface stage. The circuit has very simple structure and utilises a small
number of popular components. The amplifier is intended for use in various two-electrode applications, such as Holter-type
monitors, defibrillators, ECG monitors, biotelemetry devices etc. 相似文献
24.
O. Ravlo V. Bach H. Lybecker J. T. Møller M. Werner H. K. Nielsen 《Acta anaesthesiologica Scandinavica》1987,31(4):317-319
As part of a training programme for younger doctors, two commercially available, emergency cricothyroidotomy sets were evaluated. Prior to the surgical procedure, half of the doctors in each group received an audiovisual lesson. In a simulated but realistic emergency situation, involving autopsy material, cricothyroidotomy was performed utilizing either the "Nutrake" or the "Gentofte" system. The audiovisual lesson increased the speed and the success rate of the doctors performing this procedure as well as strengthening their confidence. Both systems allowed positive pressure ventilation. The participating doctors achieved a higher success rate at a faster speed with the "Nutrake" set. 相似文献
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Guangju Ge Huan Wang Yuanlei Chen Gonghui Li Liang Ma 《Translational andrology and urology》2021,10(2):969
Penile fracture is described as a traumatic rupture of the tunica albuginea caused by blunt injury to the erect penis. It usually occurs as a single rupture of the tunica albuginea in one of two corpora cavernosa; a rupture with urethral injury is an extremely rare condition. Although its diagnosis is usually clinical, ultrasound plays an important role in confirming diagnosis and identifying the site of the injury. Here, we presented a case of penile fracture with complete urethral injury. A 43-year-old male was admitted to the hospital because of trauma to the genital and dysuria following sexual intercourse. After admission, the patient was diagnosed with double penile fracture and complete urethral injury after the physical and B-ultrasound examinations. Emergency surgery to remove the hematoma and repair the urethra was performed. The patient recovered smoothly and was discharged on the third day after operation. After two months’ follow-up, the patient urinated smoothly and achieved an adequate erection without other complications. In this case, consistent with previous studies, emergency surgery for penile fracture is necessary and can preserve the urethral function and sexual function. In addition, there are two lesions in tunica albuginea in this case, so careful search for the penile shaft during the surgery is important to avoid the missed injuries. This report provides evidence of an uncommon and underreported clinical case. 相似文献
29.
Tolhurst H McMillan J McInerney P Bernasconi J 《The Australian journal of rural health》1999,7(2):90-96
This study aimed to identify the emergency medicine training needs of rural general practitioners (GPs) in the catchment area of the Hunter Rural Division of General Practice. The GPs were surveyed using a questionnaire in which they were asked about their confidence levels in a number of specific emergency medicine skills, and about the areas of emergency medicine that they saw as priorities for upskilling. More than a third of GPs who were responsible for on-call work at the hospital indicated that they had low levels of confidence in a number of their emergency medicine skills, in particular skills relating to paediatric emergencies, cardiovascular emergencies, and respiratory emergencies. These emergency medicine domains were also seen as high priorities for upskilling by the majority of the respondents. The study shows that rural doctors need the opportunity to access emergency medicine training that provides upskilling not only in the management of clinical problems, but also in practical procedures. 相似文献
30.
浅谈医院门诊部工作的主要特点与基本要求 总被引:5,自引:0,他引:5
翔实地阐述了门诊工作的特点:服务对象与病种的复杂性及心态的多样性;医疗质量监控缺乏系统必 ;病人就诊高峰的相对集中性;门诊诊治工作的时效性与风险性;急诊抢救工作的突发性与应性;门诊业务工作的多元性、专业性和服务保障工作的整体性;门诊部管理职能的双重性,同时提出了相应的基本要求。 相似文献