PubMed · 14715606
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Nat M J Wright, Charlotte N E Tompkins. 2004-01-10. Supervised injecting centres.. https://doi.org/10.1136/bmj.328.7431.100
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BACKGROUND AND PURPOSE: In Germany, the discharge medication is usually reported to the general practitioner (GP) by an inital short report (SR)/notification (handed over to the patient) and later by a more detailed discharge letter (DL) of the hospital. The quality and appropriateness of these reports have been occasionally objected. Until now, a systematic survey has not been reported. METHODS: N = 536 GPs (from Franfurt am Main and Luebeck) were asked after the typical report format of their patients discharge medication by the local hospitals. The questionnaire asked for 26 items covering (1) the designation of the medication (brand name, generic name) in SR and DL, (2) further specifications, e. g., possibilities of generic substitution or supervision of sensible medications, (3) reasons why GPs do not follow the hospitals recommendations, and (4) possibilities for an improvement in the medication-related communication between GP and hospitals. RESULTS: 39% GPs responded sufficiently to the questionnaire. The majority of the GPs (82%) quoted that in the SR only brand names are given (often or ever) and neither the generic name nor any further information on generic substitution is available (seldom or never). 65% of the responders quoted that even in the DL only brand names are given. Only 41% of the reponders quoted that further treatment-relevant specifications are given (often or ever). 95% responded that new medications or change of custom medication are seldom or never explained in the DL and GP were not explicitly informed about relevant medication changes. 58% of the responders quoted economic reasons for readjustment of the discharge medication, e.g., by generic substitution. The majority of responders (83%) are favoring (useful or very useful) a predischarge information (e. g., via fax) about the medication and 54% a hot line to some relevant person in the hospital should treatment problems emerge. 67% of the responders quoted in favor of regular meetings between GPs and hospital doctors regarding actual pharmacotherapy. CONCLUSION: This survey points to marked deficiencies in reporting the discharge medication to GPs, which leave room for improvement.
CONTEXT: During the first year of life, the growth process is highly vulnerable to several impairing factors that need to be understood. OBJECTIVE: To perform follow-up evaluation on newborns weighing less than or equal to 2,000 g in a population of low socioeconomic level. TYPE OF STUDY: Retrospective. SETTING: Hospital Maternidade Escola de Vila Nova Cachoeirinha, São Paulo, Brazil. METHODS: The study included 60 children born between March 1996 and January 1998, weighing less than or equal to 2,000 g. They were divided into three subgroups, according to birth weight and adequacy for gestational age. The factors studied were maternal variables, illnesses among the newborns, hospital admissions subsequent to discharge from the nursery, and the evolution of weight from birth until 12 months of life. Statistical analyses were performed through application of the Statistical Package for Social Sciences (SPSS) V.9.0 and Curve Expert 1.3 programs. RESULTS: Previous maternal diseases occurred in 38.6% of the pregnant women and intercurrent events occurred in 100%. The prevailing neonatal diseases were sepsis (30%) and hyaline membrane disease (25%). There were 404 visits on an outpatient basis: the most frequently diagnosed complaints related to respiratory diseases (26%). Among visits to specialists, 81.7% were to the neuropediatrician. A diagnosis of normality was made for 80% of all visits, for all specialties. For each of these groups, a growth curve was established. These were shown to be below the reference curve standards, with such differences least evident with regard to the children's corrected age. DISCUSSION: The severity of the newborns'conditions may be related to the high incidence of maternal diseases prior to pregnancy as well as intercurrent events during pregnancy. The differences in growth in relation to NCHS charts show that corrected age should be used as a parameter. CONCLUSIONS: Socioeconomic conditions, clinical/obstetric events and newborn diseases during the hospital stay had repercussions on these children's progress during their first year of life. Their growth profile was found to be very far from the reference standard, thus indicating a need for constant, differentiated assessment.
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