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PubMed1986

Medical image management: practical, legal and ethical considerations.

The data acquired by the new medical imaging techniques, in many ways, exceeded our ability to properly store, transmit and use the images produced. As diagnostic imaging procedures become progressively less invasive and traumatic, they are being applied to a much larger patient population. The decrease in memory and other instrumentation costs, along with expanded technological capability of computer systems, has provided medicine an opportunity to create network systems for the storage, processing, recall, and remote location of these diagnostic images. Therefore, problems of access and confidentiality have become increasingly important. This communication will consider certain medical, legal, and ethical aspects of these technologies of data acquisition, storage, manipulation and retrieval.

Computers↗

PubMedDate not supplied

Practical management of patients treated with alpha interferon.

Interferon alpha is currently used in chronic hepatitis and side effects are well known. They always must be kept in mind to start and to follow a patient under this therapy. A large number of autoantibodies may appear during interferon therapy, usually without clinical manifestations. The detection of dysthyroidism, requires measurement of antithyroid antibodies and TSH before and during interferon therapy. Exacerbation of chronic liver disease under IFN may be found in case of seroconversion in a patient with hepatitis B cirrhosis or in patient with a misdiagnosis of autoimmune hepatitis. Neurolopsychological disturbances are frequently reported; most of them spontaneously disappear. However, depression must be detected because of the risk of attempted or successful suicide. Worsening or sudden onset of psoriasis or lichen planus have been reported in patients treated with interferon. Appearance or aggravation of some clinical symptoms and biochemical tests may threaten life's patient under IFN therapy. The decision to maintain or to interrupt therapy should take into account the response to interferon and the severity of side effect.

Antiviral Agents↗

PubMed1999

Epidemiological features and case management practices of imported malaria in northern Italy 1991-1995.

We report the results of a retrospective analysis of the clinical charts of imported malaria cases notified during the period 1991-95 in the Lombardy region of northern Italy. We analysed 694 admissions related to 683 individuals. The proportion of immigrants increased during the observation period from 34.4% in 1991 to 59.9% in 1995 (P = 0.002). P. falciparum was the causative species in 534 cases (78. 2%), and 591 (90.1%) of 656 cases with a full travel history had travelled to Africa. Information on chemoprophylaxis was available in 604 cases: 429 (71.0%) reported no drug intake, 140 (23.2%) an incomplete, and 35 (5.8%) a complete chemoprophylactic course. The proportion of subjects who had initiated malaria chemoprophylaxis was significantly lower among immigrants (7.4%) than nonimmigrants (50.2%) (P < 0.001). Severe disease was diagnosed in 26 (4.7%) of 551 cases of falciparum malaria, with a significantly lower incidence among immigrants (1.3% vs. 9.2%; P < 0.001). Eight deaths were recorded, all among nonimmigrants, whose fatality rate was significantly higher (P = 0.02). Mefloquine treatment of cases of uncomplicated falciparum malaria was associated with a significantly shorter fever clearance time (2.8 days +/- 1.5 vs. 3.5 days +/- 1.9; P < 0.001) and mean hospital stay (5.9 days +/- 4.4 vs. 8.3 days +/- 5.1; P < 0.001) compared to quinine treatment.

Adult↗

PubMed2006

Assessment of medical wastes management practice: a case study of the northern part of Jordan.

This study includes a survey of the procedures available, techniques, and methods of handling and disposing of medical waste at medium (between 100 and 200 beds) to large (over 200 beds) size healthcare facilities located in Irbid city (a major city in the northern part of Jordan). A total of 14 healthcare facilities, including four hospitals and 10 clinical laboratories, serving a total population of about 1.5 million, were surveyed during the course of this research. This study took into consideration both the quantity and quality of the generated wastes to determine generation rates and physical properties. Results of the survey showed that healthcare facilities in Irbid city have less appropriate practices when it comes to the handling, storage, and disposal of wastes generated in comparison to the developed world. There are no defined methods for handling and disposal of these wastes, starting from the personnel responsible for collection through those who transport the wastes to the disposal site. Moreover, there are no specific regulations or guidelines for segregation or classification of these wastes. This means that wastes are mixed, for example, wastes coming from the kitchen with those generated by different departments. Also, more importantly, none of the sites surveyed could provide estimated quantities of waste generated by each department, based upon the known variables within the departments. Average generation rates of total medical wastes in the hospitals were estimated to be 6.10 kg/patient/day (3.49 kg/bed/day), 5.62 kg/patient/day (3.14 kg/bed/day), and 4.02 kg/patient/day (1.88 kg/bed/day) for public, maternity, and private hospitals, respectively. For medical laboratories, rates were found to be in the range of 0.053-0.065 kg/test-day for governmental laboratories, and 0.034-0.102 kg/test-day for private laboratories. Although, based on the type of waste, domestic or general waste makes up a large proportion of the waste volume, so that if such waste is not mixed with patient derived waste, it can be easily handled. However, based on infections, it is important for healthcare staff to take precautions in handling sharps and pathological wastes, which comprises only about 26% of the total infectious wastes. Statistical analysis was conducted to develop mathematical models to aid in the prediction of waste quantities generated by the hospitals studied, or similar sites in the city that are not included in this study. In these models, the number of patients, number of beds, and hospital type were determined to be significant factors on waste generation. Such models provide decision makers with tools to better manage their medical waste, given the dynamic conditions of their healthcare facilities.

Conservation of Natural Resources↗

PubMed1996

[Family practice management of risk patients with reference to preclinical emergency medicine].

Chances of surviving myocardial infarction or cardiocirculatory arrest depend on an early and appropriate emergency call as well as on bystander CPR. This study uses a questionnaire to assess to what extent these factors guide the private practitioners caring for high-risk cardiac patients. Almost all physicians responding (44%) treat such patients. More than 70% try to include the patients' relatives in a medical briefing. Recognition of early warning signs is discussed with 80% of the patients and 70% of relatives. How to identify acute life-threatening conditions is discussed with 60% of patients and relatives. In case of sudden chest pain and dyspnoea, physicians commonly advise calling the family doctor, a hospital or a regional physician on call. Calling 112, the emergency physician/rescue service, is rarely recommended. Initiating CPR is recommended for an emergency by 30% of the physicians, whereas 20% encourage relatives of patients at risk to take a CPR course. CPR instruction is judged to be generally useful by 50% of physicians, of limited use by 40% and of no use by 10%. When asked why they do not encourage CPR, 15% of physicians said they have no time, 25% cited the inefficiency of the courses, 40% said CPR is psychologically too stressful for laypersons, and 50% felt it was physically too stressful. This study points out the necessity of additional, appropriate instruction of laymen regarding cardiac emergencies.

Cardiopulmonary Resuscitation↗

PubMed2005

Practical management issues for idiopathic generalized epilepsies.

The idiopathic generalized epilepsies (IGE) are a group of epilepsies that are genetically determined, have no structural or anatomic cause, and usually begin early in life. Neurologic examination, intelligence, and imaging studies are normal, and EEG shows only epileptiform abnormalities (i.e., no abnormal slow activity or evidence for diffuse encephalopathy). In some IGE, the genetic substrate has been identified, whereas in most, it remains unknown. Depending on the age at onset and predominant seizure type, individual subtypes of IGE (syndromes) are defined. However, overall, there are more similarities than there are differences among the various subtypes, and the IGE are best viewed as a spectrum or continuum of conditions. In general, IGE respond to treatment, with 80-90% becoming fully controlled. However, not all antiepileptic drugs (AED) are equally effective in IGE. Some AED are ill advised because they either do not work or exacerbate seizure types other than generalized tonic-clonic (GTC) seizures, that is, absence and myoclonic seizures. These include carbamazepine, oxcarbazepine, phenytoin, gabapentin, and tiagabine. Their use is the main cause of "pseudo-intractability," and at least in the United States where PHT and CBZ are the most commonly used AEDs, patients with IGE are often on inadequate medications. For patients with clear IGE, the drug of choice is generally valproic acid because it effectively controls absence myoclonic seizures and GTC seizures. Second-line drugs (when first-line drugs fail or are not tolerated) may include benzodiazepines, but the use of second-line drugs is evolving rapidly. Some of the newer AEDs are considered broad spectrum, meaning that they work in IGE and focal epilepsies, although the evidence is largely preliminary at this point. These newer AEDs include lamotrigine, topiramate, levetiracetam, and zonisamide.

Age Factors↗

PubMed2005

[Neuraminidase inhibitors in the general practice management of influenza: who prescribe them, when and with which results?].

OBJECTIVE: To describe in real-life conditions the flu therapeutic management, motivations to prescribe or not NAI (General Practitioners' (GPs) characteristics, decisional factors) and treated patients' course. DESIGN: A prospective, longitudinal, pharmacoepidemiological study involved 305 GPs in France during 2002-2003 winter epidemic peak. All patients>or=1 year old, with a clinical diagnostic of flu were included. RESULTS: One hundred and eighty-five GPs (150 NAI prescribing and 30 non-prescribing physicians) have included at least 1 patient. Prescribing physicians were the best informed on flu and NAI. 660 patients were analysed (250 NAI+ and 410 NAI-). 66% of NAI+ and 40% of NAI- attended to a consultation within 24 h (P<0.001). 31% of NAI+ and 20% of NAI- had a visit at home (P=0.002). Among the patients without complication at inclusion (N=585), 3% of NAI+ received an antibiotherapy vs 13% of NAI- (P<0.001). 43% of the patients had a sick leave, shorter for the NAI+ than NAI- (respectively, 3.7+/-1.7 vs 4.2+/-1.7 days, p=0.017). NAI was taken within 3 hours (median) after prescription by the 78% of the patients who returned their diary cards. The NAI+ patients had a faster improvement of symptoms than NAI- (within 24 h, respectively: 18 vs 5%, P<0.001) and they returned faster to routine activities (within 48 h, respectively: 27 vs 11%, P<0.001). CONCLUSIONS: This study evidenced the good use of NAI by the physicians. It confirms their therapeutic efficacy in real-life conditions and suggests their prescription allows decreasing antibiotic co-prescriptions and sick leaves duration, profits to consider in NAI benefit/risk ratio.

Anti-Bacterial Agents↗

PubMed2001

Preparing to practice and manage: A program for educating orthodontic residents in practice management.

The purpose of this article is to describe how the integration of practice management principles into orthodontic graduate programs can help young practitioners avoid many of the mistakes commonly made in developing an orthodontic practice and to provide guidelines and resources for starting off in the right direction. This article also describes how practice management education was integrated as one of the 4 principal components of contemporary orthodontic education at a California university. Specific goals, concepts, and components of a comprehensive practice management program are outlined. A structured practice management curriculum can provide opportunities for residents and alumni to learn some of the latest developments and techniques in orthodontic practice management.

Curriculum↗

PubMed1995

Practical management of osteoarthritis. Integration of pharmacologic and nonpharmacologic measures.

Pharmacotherapy should play an adjunctive role to nonpharmacologic measures in the overall management of patients with symptoms due to osteoarthritis. Patients should be instructed in how to rest or unload involved joints; protect them through appropriate manipulation of their environment and appropriate methods of lifting and bending; and maintain and improve muscle strength and flexibility to ensure joint stability and prevent contractures. In most patients, acetaminophen in doses of up to 4 g/d is preferable to nonsteroidal anti-inflammatory drugs (NSAIDs) as a first-choice agent because of its lower toxicity. If NSAIDs are used, they should be prescribed initially in lower (analgesic) doses. Ibuprofen may be the preferred initial NSAID because it can be given in low doses for short durations, has been associated with lower rates of gastrointestinal tract side effects, and is inexpensive.

Acetaminophen↗

PubMed2001

Temporal trends (1986-1997) in cholesterol level assessment and management practices in patients with acute myocardial infarction: a population-based perspective.

BACKGROUND: Elevated serum cholesterol levels are associated with increased risk for acute myocardial infarction (AMI) and adverse patient outcomes. It is unclear what proportion of patients have their serum cholesterol levels measured during hospitalization for AMI and are given hypolipidemic therapy. OBJECTIVE: To examine decade-long trends in measurement of serum cholesterol levels during hospitalization for AMI and use of hypolipidemic therapy. METHODS: Observational study of 5204 residents of the Worcester, Mass, metropolitan area hospitalized with validated AMI in all greater Worcester hospitals in seven 1-year periods from 1986 through 1997. RESULTS: Increases in the measurement of serum cholesterol levels during hospitalization for AMI were observed between 1986 and 1991, followed by a progressive decrease; only 24% of patients with AMI in 1997 underwent cholesterol level testing. Younger age, male sex, and absence of a history of cardiovascular disease were associated with an increased likelihood measurement of serum cholesterol levels. Although the relative use of hypolipidemic therapy increased significantly over time (0.4% in 1986 vs 10.7% in 1997), the absolute rate of use remained low. In patients with elevated serum cholesterol levels (>/=6.2 mmol/L [>/=240 mg/dL]), 1.9% received hypolipidemic therapy in 1986 and 36.6% in 1997. CONCLUSIONS: These findings suggest recent declines in the assessment of total cholesterol levels in patients hospitalized with AMI. Although the use of hypolipidemic therapy during hospitalization for AMI has increased over time, considerable room for improvement remains.

Age Distribution↗

PubMed1959