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Biomedical subjects

J Gérvas

Publications and source records attributed to J Gérvas.

At least 19 recordsLinked to original sources
PubMed2000

[The mortality at 2 years in chronic patients confined to home].

OBJECTIVE: To analyse the relationship between the mortality of the chronically ill confined to their homes and the risk of death predicted by the doctor and other variables. DESIGN: Longitudinal descriptive study. PATIENTS: 223 patients were studied over 2 years. MEASUREMENTS AND MAIN RESULTS: Survival was related to the variables measured at the beginning of the follow-up: age, sex, social class, time of confinement, number of diagnoses, hours in bed, evaluation with the Katz index and the Nottingham health profile, number of medicines, family help available, and doctor's opinion on the risk of death. 67% of the patients considered at very serious risk of death died within 6 months, as against 6.91 who died in the same period but had a different prognosis. 40.6% at serious risk died within a year, against 12.4% with a different prognosis. The variables independently associated with higher mortality are: the doctor considering that the risk of death is serious/very serious, OR and 95% CI; 2.57 (1.64-4.03); remaining over 16 hours a day in bed, OR 2.39 (1.31-4.36); being over 80, OR 3.41 (1.74-6.66) and being male, OR 1.61 (1.11-2.33). CONCLUSIONS: The prognostic judgement of the general doctor behaved as a predictor of mortality, and may be an indirect indicator of his/her capacity to foresee the need for health services.

Aged↗
PubMed1999

[The frequency of illnesses attended and its relationship with the maintenance of the family doctor's skill].

OBJECTIVE: To describe the incidence of health problems dealt with less often in primary care medical consultations, and to discuss its relationship with the maintenance of professional skill, with in-work training and case-load planning. DESIGN: A prospective observational study based on a year's recording. SETTING: The clinics of 44 primary care doctors from 10 autonomous communities. PATIENTS: 418,98 people were attended. INTERVENTIONS: The unit of analysis was the care episode. The incidence per 1000 people attended, in total and by demographic mean, of the less common health complaints (incidence less than 1/1000) was calculated. RESULTS: Primary care doctors attended at greater frequency than 1/1000 all diseases of eyes, ears, mastoids (except salpingitis) and menstrual disorders codifiable under the classification CIPSAP; almost all the respiratory, skin and locomotive diseases, and more than half of the circulatory, genito-urinary, digestive and endocrine-metabolic diseases. Incidence was less than 1/1000 in all the malignant tumours and contagious diseases, except viral hepatitis and tuberculosis in the urban setting. CONCLUSIONS: Primary care doctors do not often attend certain serious diseases, which are nevertheless present in many differential diagnoses (malignant tumours). This should be borne in mind in the training strategies aimed at maintaining doctor's diagnostic skills.

Clinical Competence↗
PubMed1999

[Teaching].

Explore the source record for details and available documents.

Curriculum↗
PubMed1997

[Episodes of sickness attended by general/family physicians according to demographic context. 2. Utilization].

OBJECTIVES: To describe the use of consultations, the place where care is given and referral demand, in function of episodes of illness and the demographic context. DESIGN: An observational, prospective study based on a year-long record. SETTING: 43 practices spread over 10 Autonomous Communities. INTERVENTIONS: Identification, date of birth and sex of each patient attended, date of their first consultation and the number of consultations per episode, the health problem, place of consultation and existence or otherwise of referral, were all recorded. RESULTS: 74.57% in the rural areas, 56.21% in the urban and 56.74% in the mixed saw the doctor over the year. In the rural context there were 2.26 consultations per episode and 5.41 consultations per person, against 1.88 and 4.55 in the urban context. Figures for the mixed context were in between. In all the illness groups (except that for accidents) the number of consultations per episode in the urban context: 13.90% against 10.74 in the rural. CONCLUSIONS: Greater use of the doctor in rural areas could be because of the lower population/doctor ratio and easier access. Higher referral rates in urban areas could be due to the closeness of the second care level. A low percentage of home consultations was observed.

Adolescent↗
PubMed1997

[Episodes of disease taken care of in general practice/family medicine according to demographic context (I): morbidity].

OBJECTIVES: To identify the population seen at general/family medical practices and quantity the episodes of illnesses attended, in function of the demographic context. DESIGN: An observational, prospective study based on a year-long record. SETTING: 43 practices spread over 10 autonomous communities. INTERVENTIONS: Identification, sex and date of birth of each patient attended, the type of episode, health problem and date of their first consultation, were all recorded. Standardisation by the indirect method was used to compare morbidity rates. RESULTS: 2.39 episodes per person seen were attended in rural areas, 2.42 in urban ones, and 2.45 in mixed areas. The rural context had rates below 15% of the standard rate for neoplasias, endocrine diseases, neurological illness and additional categories; and over 15% for digestive tract diseases, traumas and side-effects. The urban context had higher rates for neoplasias, endocrine, blood and neurological diseases, and additional categories; and lower for respiratory system illnesses. In the mixed areas, rates were higher for contagious, neurological, respiratory system and congenital diseases. CONCLUSIONS: The morbidity attended varies in function of context. Some differences could be due to age distribution (younger in the mixed areas) or accidents (greater in rural areas). Others could be affected by use or problem-solving criteria varying according to the demographic context.

Adolescent↗
PubMed1997

A multinational study of the factorial structure and other characteristics of the Dartmouth COOP Functional Health Assessment Charts/WONCA.

BACKGROUND: The 'Dartmouth COOP Functional Health Assessment Charts/WONCA' constitute a relatively new derived instrument for assessing health status that is specifically intended for use in primary care on a world-wide basis. It needs further validation in its special area of use. OBJECTIVES: Over a range of countries, social backgrounds and case mixes, our aim was (i) to examine the factorial structure of the instrument; (ii) to explore how well it was understood; (iii) to check its acceptability; and (iv) to assess the value of the pictures on the charts. METHODS: The charts themselves, accompanied by a short questionnaire about the charts, were administered to 1719 patients at eight varied types of treatment centre in Canada, Japan, Nepal and Spain. The responses to the instrument were subjected to standard factor analysis and a special Q-type principal components analysis. The responses to direct questions about the charts were compared with the answers to open-ended questions. RESULTS: Factor analysis suggested a shared factorial pattern for all sites, with the first two factors accounting for 88.5% of the variability in correlations between the charts across the sites. The individual questions were understood by most patients, but a substantial minority did not appear to grasp the underlying purpose of the instrument. The instrument was well accepted. The pictures were considered to be helpful by most respondents, especially those at the Nepal sites. The variability in the scores for the individual charts across sites was less than expected and not always in the expected direction. CONCLUSIONS: The COOP/WONCA system continues to show promise, but needs more validation.

Canada↗
PubMed1996

[Evaluation of computerized medical records].

BACKGROUND: A wide and expensive supply of electronic medical records obliged us to evaluate them before selecting one. In this study a questionnaire was used to evaluate computerized medical records. MATERIAL AND METHODS: Descriptive and prospective study with personal interviews in which a questionnaire was used, that had been previously published. RESULTS: The 12 questionnaires were completed in 99%. The greatest difficulty for answering the questions was the medical terminology. Four of the twelve computer programs were designed for hospitals, another 4 were designed for health centers and the rest were designed for both hospitals and health centers. The preventive and social data and annex were the more scarce of the elements (47%). Postsells services (100%), the ICE-9-CM classification (75%) and medicals data (51%) were the more frequent elements. CONCLUSIONS: In Spain there are few medical records regulated, and computerized designers do not have a standard model. The sellers of medical record softwares don't have knowledge of medical terminology. Medical record software programs are not designed for specific health settings (health centers or hospitals).

Evaluation Studies as Topic↗