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Prospective analysis of complications 30 days after outpatient colonoscopy

GASTROINTESTINAL ENDOSCOPY 1999年第3期50卷 322-328页

作者： Zubarik, R Fleischer, DE Mastropietro, C Lopez, J Carroll, J Benjamin, S Eisen, G Georgetown Univ Hosp Dept Gastroenterol Washington DC 20007 USA Vet Affairs Med Ctr Gastroenterol Sect Memphis TN USA

Background.. Our objective was to (1) determine whether more complications are reported by patients 30 days after outpatient colonoscopy than are discussed at our monthly morbidity and mortality conferences, (2) identify complications resulting in visits to the emergency department or physician's office or leading to hospitalization, and (3) assess which factors put patients at highest risk. A secondary goal was to determine the rate of work lost after outpatient colonoscopy. Methods: Trained interviewers performed standardized telephone interviews of consecutive outpatients undergoing colonoscopy at Georgetown University Hospital over a 1-year period. Results: One thousand one hundred ninety-six patients were contacted 30 days after outpatient colonoscopy and participated in our study. Twenty patients had complications that required a visit to an emergency department or physician. Ninety percent of these cases (18) were detected at 30 days, but 15% (3) were discussed at morbidity and mortality conferences. All seven complications that necessitated hospitalization were identified at 30 days, but only two were discussed at our morbidity and mortality conference. The most common complications reported by patients were abdominal discomfort (5.4%) and rectal bleeding (2.1%). Conclusion: More complications are detected by means of contacting patients 30 days after outpatient colonoscopy than are discussed at our morbidity and mortality conferences.

关键词：腹痛/流行病学腹痛/病因学缺勤门诊医疗/标准卡方分布队列研究结肠疾病/诊断结肠镜检查/方法结肠镜检查/标准随访研究胃肠出血/流行病学胃肠出血/病因学住院/统计学和数值数据肠穿孔/流行病学肠穿孔/病因学患病率前瞻性研究直肠/损伤成年人老年人女(雌)性人类男(雄)性中年人

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Satisfaction with outpatient health care services in Manica province, Mozambique

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HEALTH POLICY AND PLANNING 1998年第2期13卷 174-180页

作者： Newman, RD Gloyd, S Nyangezi, JM Machobo, F Muiser, J Univ Washington Dept Pediat Sch Med Seattle WA 98195 USA Univ Washington Sch Publ Hlth & Community Med Int Hlth Program Seattle WA 98195 USA Dirreccao Prov Saude Manica Chimoio Mozambique Hlth Alliance Int Chimoio Mozambique

The objective of the study was to describe ambulatory health care services, determine the level of client satisfaction, and identify obstacles to care in a rural area of Mozambique. Exit surveys at 34 health clinics in Manica Province were completed on a sample of 879 adults representing between 1% and 2% of the average monthly visit totals at each clinic. Eighty-three per cent of interviewees were women. Just over half of the visits were for paediatric patients. Men were more likely to be at the clinic for their own health care needs than women (81% vs. 40%, p <0.001). Of patients seen for acute illness, 45% were examined, 22% received preventive education, and 23% received prognostic information. Overall, 55% of interviewees believed that the service they received was good or very good, 32% rated it as fair, and 13% as poor. Satisfaction was positively associated with increased training level of the provider (p < 0.005), and shorter waiting times (p < 0.001). The most common complaints about the clinic visits were lack of adequate transportation, long waiting times, lack of physical examinations, and failure to receive prescribed medications. These findings suggest that the majority of Mozambicans interviewed are moderately satisfied with the available outpatient services in Manica. Provider training, provider availability and distribution of medicines were areas identified by respondents as needing improvement.

关键词：门诊医疗/标准卫生服务范围卫生保健调查卫生政策卫生服务易得程度莫桑比克病人满意度/统计学和数值数据方案评价公共卫生管理/标准乡村卫生服务/标准青少年成年人老年人儿童女(雌)性人类男(雄)性中年人

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How well does chart abstraction measure quality? A prospective comparison of standardized patients with the medical record

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AMERICAN JOURNAL OF MEDICINE 2000年第8期108卷 642-649页

作者： Luck, J Peabody, JW Dresselhaus, TR Lee, M Glassman, P Inst Global Hlth San Francisco Vet Affairs Med Ctr San Francisco CA 94105 USA Vet Affairs Greater Los Angeles Healthcare Syst Los Angeles CA USA Vet Affairs Ctr Study Hlth Care Provider Behav Sepulveda CA USA Univ Calif San Diego Sch Med San Diego CA 92103 USA San Diego Vet Affairs Med Ctr San Diego CA USA Univ Calif San Francisco San Francisco CA 94143 USA Univ Calif Los Angeles Sch Med Los Angeles CA USA Univ Calif Los Angeles Sch Publ Hlth Los Angeles CA 90024 USA RAND Santa Monica CA USA Inst Global Hlth San Francisco CA USA

PURPOSE: Despite widespread reliance on chart abstraction for quality measurement, concerns persist about its reliability and validity. We prospectively evaluated the validity of chart abstraction by directly comparing it with the gold standard of reports by standardized patients. SUBJECTS AND METHODS: Twenty randomly selected general internal medicine residents and attending faculty physicians at the primary care clinics of two Veterans Affairs Medical Centers blindly evaluated and treated actor-patients (standardized patients) who had one of four common diseases: diabetes, chronic obstructive pulmonary disease, coronary artery disease, or low back pain. Charts from the visits were abstracted using explicit quality criteria;standardized patients completed a checklist containing the same criteria. For each physician, quality was measured for two different cases of the four conditions (a total of 160 physician-patient encounters). We compared chart abstraction with standardized;patient reports for four aspects of the encounter: taking the history, examining the patient, making the diagnosis, and prescribing appropriate treat-ment. The sensitivity and specificity of chart abstraction were calculated. RESULTS: The mean (+/- SD) chart abstraction score was 54% +/- 9%, substantially less than the mean score on the standardized-patient checklist of 68% +/- 9% (P <0.001). This finding was similar for all four conditions and at both sites. "False positives"- chart-recorded necessary care actions not reported by the standardized patients-resulted in a specificity of only 81%. The overall sensitivity of chart abstraction for necessary care was only 70%. CONCLUSIONS: Chart abstraction underestimates the quality of care for common outpatient general medical conditions when compared with standardized-patient reports. The medical record is neither sensitive nor specific. Quality measurements derived from chart abstraction may have important shortcomings, particularly as the basis

关键词：门诊医疗/标准规范/方法加利福尼亚全体教工医学院校/标准内科学/标准实习医师和住院医师职务/标准病案/统计学和数值数据结果与过程评价(卫生保健)/方法病人模拟初级卫生保健/标准前瞻性研究卫生保健质量/统计学和数值数据可重复性结果人类

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Standardisation of ambulatory urodynamic monitoring:: Report of the Standardisation Sub-Committee of the International Continence Society for Ambulatory Urodynamic Studies

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NEUROUROLOGY AND URODYNAMICS 2000年第2期19卷 113-125页

作者： van Doorn, EV Anders, K Khullar, V Kulseng-Hanssen, S Pesce, F Robertson, A Rosario, D Schäfer, W Univ Hosp Maastricht Dept Urol NL-6202 AZ Maastricht Netherlands

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Antimicrobial therapy for infants and children: Guidelines for the inpatient and outpatient practice of pediatric infectious diseases

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MAYO CLINIC PROCEEDINGS 2000年第1期75卷 86-97页

作者： Henry, NK Hoecker, JL Rhodes, KH Mayo Clin Sect Pediat Infect Dis Rochester MN 55905 USA Mayo Clin Sect Community Pediat & Adolescent Med Rochester MN USA

In this article, we discuss antimicrobial regimens for both outpatient and inpatient use in infants and children. substantial number of pediatric patient visits annually result in the prescribing of antimicrobial drugs, The emergence of bacteria resistant to commonly used antimicrobial agents is a growing concern. Information on newer drugs such as meropenem, which is active against penicillin-resistant Streptococcus pneumoniae and gram-negative bacilli, and cefepime, which has activity against gramnegative bacilli including Pseudomonas aeruginosa and against gram-positive cocci is also presented. Management of patients with congenital or acquired immunodeficiencies continues to be challenging in regard to the use of antimicrobial drugs to treat various fungal and viral infections. New formulations of older drugs such as aerosolized tobramycin and amphotericin B lipid complex are available. New antiviral agents have been approved, most of which are antiretroviral agents. Childhood tuberculosis is an ongoing concern, and regimens to treat Mycobacterium tuberculosis in children are discussed.

关键词：门诊医疗/标准抗菌药/治疗应用抗真菌药/治疗应用抗病毒药/治疗应用感染/药物疗法诊疗准则(主题) 美国儿童儿童学龄前人类婴儿

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Controlled analysis of factors associated with insufficient sample on outpatient endometrial biopsy

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BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY 2000年第10期107卷 1312-1314页

作者： Bakour, SH Khan, KS Gupta, JK Univ Birmingham Acad Dept Obstet & Gynaecol Birmingham Minimal Access & Surg Training MAST Ct Birmingham B15 2TT W Midlands England

We examined the relative significance of hysteroscopic and ultrasonographic evidence of endometrial atrophy in relation to insufficient sample on outpatient endometrial biopsy in women with abnormal uterine bleeding. Multivariate logistic regression modelling was used to evaluate the independent effects of age, menopausal status, hysteroscopic findings and sonographic endometrial thickness on outpatient endometrial sampling (sufficient or insufficient) used as the binary dependent variable. Insufficient sample on endometrial biopsy was associated with hysteroscopic finding of endometrial atrophy (OR 4.79, 95% CI 1.05-21.91, P = 0.04) and sonographic endometrial thickness below 5 mm (OR 0.19, 95% CI 0.07-0.53, P = 0.001). There was no association with patient's age and menopausal status. In conclusion, when reassuring women with insufficient sample on outpatient endometrial biopsy, one can be confident about absence of pathology provided the hysteroscopic and sonographic endometrial assessment is consistent with endometrial atrophy.

关键词：门诊医疗/标准活组织检查/标准子宫内膜/病理学宫腔镜检查/方法回归分析危险因素子宫出血/病理学女(雌)性人类中年人

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Fever without source in children - Recommendations for outpatient care in those up to 3

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POSTGRADUATE MEDICINE 2000年第2期107卷 259-+页

作者： Park, JW Texas Tech Univ Hlth Sci Ctr Dept Pediat Odessa TX 79763 USA

PREVIEWPREVIEWManagement of fever without source in young children, especially those between birth and 3 years of age, needs to be structured to minimize unfafvorable outcomes and to avoid undue pain to the child and inconvenience to the family from often unnecessary hospital admission. In this article, Dr Park provides practical recommendations for the care of such children and comments on differences between the approach in an emergency department and that in a physician's office.

关键词：年龄因素门诊医疗/标准体温发热原因不明/诊断发热原因不明/病因学发热原因不明/病理生理学发热原因不明/治疗儿童学龄前人类婴儿婴儿新生

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Assessing ambulatory blood pressure in renal diseases: facts and concerns

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NEPHROLOGY DIALYSIS TRANSPLANTATION 1999年第11期14卷 2564-2568页

作者： Lurbe, E Redon, J Univ Valencia Hosp Clin Hypertens Clin E-46010 Valencia Spain Gen Hosp Dept Paediat Valencia Spain

In summary, the management of patients with renal diseases may be improved by assessing ambulatory BP. Several monitors are now available meet the required criteria of the validation protocols. Accurate devices and easier validation protocols, however, should be developed due to the rapidly expanding use of devices for measuring BP outside the clinic and the imminent retirement of the classic sphygmomanometer using mercury.

关键词：门诊医疗/标准血压血压测定/仪器和设备血压测定/方法血压测定/标准昼夜节律肾疾病/病理生理学监测生理学/标准自我护理人类

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Interdisciplinary treatment of chronic pain.

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Current review of pain 2000年第1期4卷 18-23页

作者： Gardea, M.A. Gatchel, R.J. Department of Psychiatry Division of Psychology University of Texas Southwestern Medical Center at Dallas 5323 Harry Hines Boulevard Dallas 75235 TX United States

Interdisciplinary treatment care must address more than the physical pathology. Chronic pain comprises a range of interdependent variables including biologic, cognitive, affective, behavioral, and social factors. This article discusses these psychosocial issues, as well as the four levels of pain management programs, and the characteristics and goals of interdisciplinary treatment. Finally, recent clinical studies demonstrating the efficacy and cost benefits of interdisciplinary pain management programs are reviewed.

关键词：门诊医疗/经济学门诊医疗/标准慢性病卫生保健费用疼痛/经济学疼痛/治疗疼痛测定病人医疗小组人类

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Effects of preventive outpatient geriatric assessment: Short-term results of a randomized controlled study

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Home Health Care Services Quarterly 1995年第2期15卷 81-96页

作者： Schrijnemaekers, Veron J. J. Haveman, Meindert J. Department of Epidemiology University of Limburg MD 6200 P.O. Box 616 Netherlands

No abstract available for this article.

关键词：日常生活活动门诊医疗/标准卫生服务研究/方法老年人保健服务/标准健康状况干预性研究精神卫生服务荷兰结果评价(卫生保健)/统计学和数值数据预防卫生服务/标准老年人女(雌)性人类男(雄)性

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