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Trauma on rural roads: the role of a peripheral hospital

INJURY-INTERNATIONAL JOURNAL OF THE CARE OF THE INJURED 1999年第5期30卷 337-340页

作者： Street, JT Winter, D Buckley, S Nicholson, P Twomey, A Cork Univ Hosp Dept Orthopaed Surg Cork Ireland

Road accident trauma is a leading cause of death and serious morbidity among healthy young adults in the developed world. The Irish Republic has the third worst road safety record in the EU. In studying the unique demographics of rural road accidents, our aim was to provide information essential to the future development of trauma care in Ireland. Our figures highlight the inadequacies of data received by the National Roads Authority, illustrate the resource impact of road trauma on a peripheral hospital, and demonstrate the need for similar studies in the rationalisation of trauma care as we approach the next millennium. (C) 1999 Elsevier Science Ltd. All rights reserved.

关键词：事故交通/统计学和数值数据年龄分布医院乡村/统计学和数值数据损伤严重度评分爱尔兰/流行病学转诊和会诊/统计学和数值数据回顾性研究农村卫生/统计学和数值数据季节创伤和损伤/流行病学创伤和损伤/病因学青少年成年人老年人老年人 80以上儿童儿童学龄前人类婴儿婴儿新生中年人

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How do general practitioners respond to reports of abnormal chest X-rays?

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JOURNAL OF THE ROYAL SOCIETY OF MEDICINE 1999年第9期92卷 446-449页

作者： Lim, WS Macfarlane, JT Deegan, PC Manhire, A Holmes, WF Baldwin, DR City Hosp Nottingham Nottingham NG5 1PB England Royal Liverpool Univ Hosp Liverpool L7 8XP Merseyside England Sherrington Med Ctr Nottingham NG5 2EJ England

General practitioners (GPs) in the UK have long had direct access to hospital radiological services, which in theory shortens investigation time and improves the quality of service. Chest X-rays (CXRs) account for a substantial proportion of requests, and we investigated what happened when an abnormality was detected. In one year, 204 GPs in the Nottingham area requested CXRs in 605 patients. 362 were reported normal, 165 abnormal but hospital follow-up not indicated and 71 abnormal with radiological follow-up or hospital referral indicated (mass lesion suspicious of tumours 27, infective shadowing 35, other 9). 64 of the 71 were seen in hospital within three months, and in those with suspected cancer the median time to follow-up was 20 days. These results show that GPs do act on the results of abnormal CXRs, but only 37% of those with a mass suspicious of cancer were seen in hospital within two weeks as recommended by the British Thoracic Society. Time might be saved if GPs agreed to direct referral from the radiology department to respiratory physicians.

关键词：英格兰家庭医学/统计学和数值数据感染/诊断显像放射摄影术胸部转诊和会诊/统计学和数值数据回顾性研究胸部疾病/诊断显像胸部肿瘤/诊断显像青少年成年人老年人老年人 80以上儿童儿童学龄前女(雌)性人类男(雄)性中年人

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Repeat general anaesthesia for paediatric dentistry

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BRITISH DENTAL JOURNAL 2000年第1期189卷 37-39页

作者： Harrison, M Nutting, L Guys Kings & St Thomas Dent Inst Dept Orthopaed & Paediat Dent London SE1 9RT England

Aims To investigate patterns of referral, disease and treatment for healthy children who had received two or more dental general anaesthetics (DGA) for exodontia. Methods Records from 200 episodes of repeat DGA were studied retrospectively. Results The mean age of patients at first referral was 5y4m, and the mean interval before repeat was 22 months. Self-referrals rose from 14% at DGA1 to 30% at DGA2. New caries at second referral, where all diagnosed disease had been treated at DCA1, accounted for only 15% of the total. Where a specific request was made in the referral, only 8% of letters matched the charting made in hospital. 30% of all specific requests were honoured, but then required treatment for previously diagnosed caries at DGA2. 75% of single-tooth extractions required repeat DGA for caries left at DGA1. Conclusions It may be too optimistic to address only the most grossly diseased teeth when a child requires GA exodontia. A more radical treatment-planning approach, combining primary care, secondary care and public health considerations, may be required to avoid the unnecessary use of DGA.

关键词：麻醉牙科/统计学和数值数据麻醉全身/统计学和数值数据儿童口腔保健/统计学和数值数据龋齿/流行病学龋齿/外科学转诊和会诊/统计学和数值数据回顾性研究拔牙/统计学和数值数据儿童学龄前人类

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Practice and attitudes of primary care physicians in a rural southern state concerning HIV/AIDS patients

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Journal of Health and Social Policy 1993年第3期4卷 65-78页

作者： Strahan, N. Gandy, M. Thompson, F.E. Page, M.D. Phillips, D.M. Replogle, W.H. Bureau of Preventive Health Services Mississippi State Dept of Health MS United States

In preparing for the development of a plan of care for persons with AIDS and other HIV related conditions, the HIV Services Planning Program, a joint effort of the Department of Family Medicine of the University of Mississippi Medical Center and the Bureau of Preventive Health of the Mississippi State Department of Health, conducted a survey of all primary care physicians throughout the state of Mississippi. The purpose of the survey was to determine health care services provided to persons with HIV/AIDS. Specific areas of interest included: (a) type of medical specialty;(b) location of primary practice;(c) services provided for persons with HIV/AIDS;and (d) utilization of universal blood and body fluid precautions, i.e., barrier techniques. Descriptive statistics were utilized in analyzing responses.

关键词：获得性免疫缺陷综合征/流行病学获得性免疫缺陷综合征/治疗获得性免疫缺陷综合征/传播医务工作者的态度临床工作能力/统计学和数值数据 HIV感染/流行病学 HIV感染/治疗 HIV感染/传播密西西比/流行病学医生病人关系医师家庭/心理学医师家庭/统计学和数值数据防护服/统计学和数值数据防护服/利用问卷调查转诊和会诊/统计学和数值数据地区卫生计划综合预防/统计学和数值数据女(雌)性人类男(雄)性

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Genetics education for primary care providers in community health settings

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JOURNAL OF COMMUNITY HEALTH 1999年第1期24卷 45-59页

作者： Kolb, SE Aguilar, MC Dinenberg, M Kaye, CI Univ Incarnate Word San Antonio TX 78209 USA Santa Rosa Childrens Hosp Santa Rosa CA 95402 USA Univ Texas Hlth Sci Ctr San Antonio TX USA Univ Texas Hlth Sci Ctr Dept Pediat San Antonio TX USA

Patients who are in need of genetic services are often inappropriately managed, in part due to inadequate knowledge of genetic issues among primary health care providers. The purpose of this study was to determine the effect of a genetics education program on the knowledge and attitudes of primary care providers in community health settings. A total of one hundred twenty-one primary care providers who work in Texas Public Health Region VIII participated in an educational program designed to provide basic genetics information. A one-group pretest-posttest design was used to assess knowledge and attitudes of subjects, and comparisons were made pre and post intervention. Pretest assessment revealed less than adequate knowledge about basic genetic principles and relatively positive attitudes among the subjects. Following the program, there were statistically significant increases in both knowledge about genetic conditions (P = .001) and attitudes toward provision of genetic services (P = .001). These results indicate that primary health care providers, motivated to learn complex materials and new skills in order to assist their patients, can do so in a relatively short time period.

关键词：医务工作者的态度社区卫生服务/人力教育医学继续/组织和管理遗传学/教育健康知识态度实践卫生人员/教育卫生人员/心理学初级卫生保健/人力方案评价问卷调查转诊和会诊/统计学和数值数据得克萨斯人类

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Is an “ideal” service institution image the same for all referral sources? The case of chemical dependency treatment programs

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Journal of Hospital Marketing 1993年第2期7卷 101-120页

作者： Johnson, Kerenami Latour, Michael S. Old Dominion University United States Auburn University United States

In a competitive market like chemical dependency treatment, segmenting the professional referral market according to an ‘ideal’ service image may offer a service institution a strategic advantage. Results of this study suggest that while different professionals in a referral market may attach differential importance to the same service feature, a favorable or unfavorable ‘image’ seems to encompass how well both the professional and the professionals’ client are treated by the service institution. © 1993 Taylor & Francis Group, LLC.

关键词：方差分析标志和徽章集中研讨小组卫生服务使用研究人名组织文化方案评价/统计学和数值数据问卷调查转诊和会诊/统计学和数值数据美国西南部物质滥用治疗中心/标准物质滥用治疗中心/利用人类

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Deliberate self-harm and substance dependence: The management of patients seen in the general hospital

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JOURNAL OF MENTAL HEALTH ADMINISTRATION 1996年第2期23卷 246-252页

作者： Wylie, K House, A Storer, D Raistrick, D Henderson, M GEN INFIRM DEPT LIAISON PSYCHIATLEEDS LS1 3EXW YORKSHIREENGLAND

The aim of this study was to examine management decisions made at the time of assessment of an episode of deliberate self-harm seen in the general hospital and examine the extent of referral to a specialized addiction unit. Factors involved in marking a clinical decision regarding the appropriate management of self-harm cases when alcohol factors were identified are reviewed. Simply referring to a specialized addiction unit was found to be an unsatisfactory method of providing a comprehensive response to the problem of substance misuse and deliberate self-harm. It is suggested that services should be developed using active posthospital discharge community follow-up. Motivational interviewing used in such a setting may increase the number of patients who will go on to accept specialist care.

关键词：决策大不列颠医院综合/组织和管理精神卫生服务/利用转诊和会诊/统计学和数值数据危险因素自我伤害行为/治疗物质相关性障碍/治疗自杀成年人女(雌)性人类男(雄)性

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Selection of a hospital for a transfer: The roles of patients, families, physicians and payers

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Journal of Hospital Marketing 1997年第1期12卷 61-77页

作者： Gombeski, W.R. Konrad, D. Kanoti, G. Ulreich, S. Skilogianis, J. Clough, J. Marketing KK20 The Cleveland Clinic Foundation Cleveland OH 44195 9500 Euclid Avenue United States

Objective. This study investigates the reasons for hospital transfers and the role patients, their families, physicians, and payers play in the choice of a referral center. Data Sources. A thirty-three item questionnaire and clinical data from the hospital's discharge database. Study Design. A study of all 307 hospital transfer patients admitted between November 9 and December 3, 1993 was conducted to understand the factors contributing to the increase in transfers and the reasons patients were sent to CCH. Data on the transfer decision were collected by interviewing patients 48 hours after admittance to the hospital or by telephone if they were discharged before an interview could be completed. Two hundred and sixty-two (85%) patients were interviewed.

关键词：用户参与决策家庭医院联合开业/利用保险范围卫生服务使用研究俄亥俄病人转诊/统计学和数值数据问卷调查转诊和会诊/统计学和数值数据小地区分析成年人老年人女(雌)性人类男(雄)性中年人

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Variations in use of cardiac services in England: Perceptions of general practitioners, general physicians and cardiologists

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Journal of Health Services Research and Policy 1998年第3期3卷 153-158页

作者： Chapple, A. Gatrell, A. Natl Primary Care Res Develop Centre Williamson Building The University of Manchester Mancherster M13 9PL United Kingdom

Objective: To explain why those who live some distance from tertiary cardiac centres make less use of coronary angiography and revascularisation than those who live close by, and why people living in particular wards within certain districts make less use of services than might be expected from their level of need. Method: Semi-structured interviews with 24 general practitioners (GPs) in two English health districts (Morecambe Bay and East Lancashire), five general physicians working in district general hospitals, and four interventional cardiologists working in tertiary centres. Transcripts of audiotape recording were analysed using the constant comparative method. Results: Those living far from tertiary centres are usually referred to general physicians before they are referred for angiography. The general physicians tend to be more conservative in their approach to treatment than interventional cardiologists. GPs working near tertiary centres are able to refer directly to interventional cardiologists. There are also logistical and economic reasons for inequitable use of services. Some GPs perceived that patients of South Asian descent undergo fewer investigations than might be expected because of communication or other difficulties. Conclusion: Use of cardiac services would be more equitable if there were interventional cardiologists based in district general hospitals who could perform angiograms for their own patients in the tertiary centres. Patients might also benefit if angiogams could be conducted in selected district general hospitals. Further qualitative research, involving both doctors and patients, is needed to explore other reasons for relatively low rates of investigation and revascularisation in certain groups of patients.

关键词：医务工作者的态度心脏病学科医院/利用卫生服务范围冠状血管造影术/利用英格兰家庭医学/统计学和数值数据地理学卫生服务易得程度心肌血管重建术/利用医师诊疗模式/统计学和数值数据转诊和会诊/统计学和数值数据地区卫生计划公费医疗运输人类

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The benefits of telephone-access medical consultation

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Journal of Rural Health 1993年第3期9卷 240-245页

作者： Smego, R.A. Khakoo, R.A. Burnside, C.A. Lewis, M.J. Program in International Health Section of Infectious Diseases West Virginia Univ. Health Sci. Ctr. Morgantown WV 26506 United States

A major disadvantage of rural medical practice is the limited reserve of consultative options. To determine the perceived clinical utility and educational impact of the West Virginia University Medical Access and Referral System (MARS), a 24-hour prompt telephone-consultation service, a mailed questionnaire was administered to 303 West Virginia clinicians who had used MARS for infectious disease problems. The overall questionnaire response rate was 62 percent. Callers included family practitioners (35%), medical specialists (32%), surgical specialists (13%), pediatricians (11%), obstetricians (5%), and nonphysicians (4%). Major referral questions posed were therapeutic (60%), diagnostic (48%), and epidemiologic (10%) in nature. On a scale of 1 (not useful) to 5 (very useful), survey responders rated the overall clinical usefulness of MARS as either a 4 (22%) or 5 (76%). Callers felt that MARS consultation assisted in accurate case diagnosis in 80 percent of cases, and aided in successful therapeutic management of 96 percent of cases. An educational benefit was reported by 96 percent of responders. Physicians located in more rural, underserved areas tended to use MARS to a greater degree than colleagues in more populated, medically accessible areas (P<0.005). These findings suggest that an academic telephone-access consultation program can be a clinically relevant and educational consultative tool for practicing clinicians, especially those located in rural areas.

关键词：医学科学研究中心/组织和管理医务工作者的态度传染病/诊断传染病/治疗用户满意/统计学和数值数据医师/心理学医师/统计学和数值数据方案评价问卷调查转诊和会诊/统计学和数值数据转诊和会诊/利用专业医学/统计学和数值数据远程医学/统计学和数值数据远程医学/利用西弗吉尼亚人类

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