Background: Nurse care management programs for patients with chronic illness have been shown to be safe and effective. Objective: To determine whether a telephone-media-ted nurse care management program for heart fail...Background: Nurse care management programs for patients with chronic illness have been shown to be safe and effective. Objective: To determine whether a telephone-media-ted nurse care management program for heart failure reduced the rate of rehospitalization for heart failure and for all causes over a 1-year period. Design: Randomized, controlled trial of usual care with nurse management versus usual care alone in patients hospitalized for heart failure from May 1998 through October 2001. Setting: 5 northern California hospitals in a large health maintenance organization. Patients: Of 2786 patients screened, 462 met clinical criteria for heart failure and were randomly assigned (228 to intervention and 234 to usual care). Intervention: Nurse care management provided structured telephone surveillance and treatment for heart failure and coordination of patients’care with primary care physicians. Measurements: Time to first rehospitalization for heart failure or for any cause and time to a combined end point of first rehospitalization, emergency department visit, or death. Results: At 1 year, half of the patients had been rehospitalized at least once and 11%had died. Only one third of rehospitalizations were for heart failure. The rate of first rehospitalization for heart failure was similar in both groups (proportional hazard, 0.85[95%CI, 0.46 to 1.57]), The rate of all-cause rehospitalization was similar (proportional hazard, 0.98[CI, 0.76 to 1.27]). Limitations: The findings of this study, conducted in a single health care system, may not be generalizable to other health care systems. The overall effect of the intervention was minor. Conclusions: Among patients with heart failure at low risk on the basis of sociodemographic and medical attributes, nurse care management did not statistically significantly reduce rehospitalizations for heart failure or for any cause. Such programs may be less effective for patients at low risk than those at high risk.展开更多
Objective: To evaluate the accuracy of ultrasonographic examination in boys with an undescended testis. Material and methods: All patients who were referred to the paediatric surgeon after detection of an undescended ...Objective: To evaluate the accuracy of ultrasonographic examination in boys with an undescended testis. Material and methods: All patients who were referred to the paediatric surgeon after detection of an undescended testis were evaluated prospectively between November 2001 and November 2004. Among these 377 patients, 87 were referred with an ultrasonogram previously prescribed by the referring primary physician. The results of the ultrasonogram were compared to the results of the clinical examination of the paediatric surgeon and, in cases of no palpable testis, to the surgical findings. Results: Ultrasonography did not detect the retractile testes. Ultrasonography detected 67% of the palpable undescended testes. In cases of no palpable testis, the ultrasonographic examination missed the abdominal testes and sometimes other structures were falsely interpreted as a testis. Conclusion: Sonography has no place in the diagnosis of undescended testis.展开更多
PURPOSE: To survey comprehensive ophthalmology patients about their use of vit amins and herbal supplements. DESIGN: Cross-sectional survey. METHODS: A survey instrument was developed and distributed to 397 patients p...PURPOSE: To survey comprehensive ophthalmology patients about their use of vit amins and herbal supplements. DESIGN: Cross-sectional survey. METHODS: A survey instrument was developed and distributed to 397 patients presenting to a main c ampus university-based comprehensive ophthalmology clinic and to an off-site c omprehensive ophthalmology clinic. Information gathered included demographics, u se of prescription medications, use of vitamin and herbal supplements, the reaso ns for using these supplements, perceived benefits of these products, where the information regarding them was gathered, and with whom patients had discussed th eir use. RESULTS:Fiftyeight percent of patients reported nearly daily use of vit amins. Multivitamins were the most common vitamin and were used by 46%of the pa tients. Eight percent of patients used herbal products on a daily basis. Twenty -six percent learned about vitamins from their primary care physician (PCP), an d just 2%from their ophthalmologists, while 35%discussed their actual use with a PCP, and 5%with their ophthalmologists. Just 2%of these patients learned of herbs from a PCP, and <1%from an ophthalmologist. Older patients used multivit amins and other vitamins most frequently, while gender and education were not pr edictive of vitamin or herbal use. Mean monthly spending on vitamins by users wa s $15.74, while herbal users spent a monthly mean of $15.35. CONCLUSIONS: Vita mins and herbs are used by a significant number of patients in a comprehensive o phthalmology setting. Given the prevalence of vitamin and herbal use, ophthalmol ogists should systematically inquire about their use.展开更多
Background: The current assumption is that noncardiac chest pain (NCCP) patien ts diagnosed by a cardiologist are commonly referred to a gastroenterologist for further evaluation. Thus far, there are no studies that a...Background: The current assumption is that noncardiac chest pain (NCCP) patien ts diagnosed by a cardiologist are commonly referred to a gastroenterologist for further evaluation. Thus far, there are no studies that assess the clinical app roach and referral patterns of cardiologists when evaluating subjects with NCCP. Aim: To determine the extent of involvement of cardiologists in the management of NCCP patients. Methods: Cardiologists were randomly selected from the America n College of Cardiology national membership list and sent a 20-item questionnai re that included demographic information, characteristics of practice, preferenc es of diagnostic tests, referral patterns, and treatment plans. Results: A total of 246 (33%) cardiologists returned the questionnaire. A mean of 12.6%of pati ents were diagnosed with NCCP and 45.5%were treated by a cardiologist in the pa st 6 months. Of the NCCP patients that were referred, most ended up in the prima ry care physician clinic (45.9%) followed by gastroenterologist clinic (29.3%) . Most cardiologists are either comfortable (35%) or very comfortable (43.1%) in diagnosing NCCP. Proton pump inhibitors (44.9%), life-style modifications ( 28.7%), and H2 blockers (11.8%) are the three most commonly used therapeutic m odalities for NCCP. Conclusion: Cardiologists manage about half of the diagnosed NCCP patients by themselves. Of those NCCP patients that are referred, cardiolo gists prefer to send them to a primary care physician rather than a gastroentero logist.展开更多
BACKGROUND AND OBJECTIVE: The objective of this pilot study was to determine whether a new screening system, the DigiScope (EyeTel Imaging, Inc., Columbia, MD), can detect the presence of age-related macular degenerat...BACKGROUND AND OBJECTIVE: The objective of this pilot study was to determine whether a new screening system, the DigiScope (EyeTel Imaging, Inc., Columbia, MD), can detect the presence of age-related macular degeneration (AMD) at a level requiring referral to an ophthalmologist for further evaluation and possible treatment. PATIENTSANDMETHODS: The DigiScope is an Internet-based semi-automated digital imaging system designed to be in primary care physicians’offices. Forty-two eyes of 21 patients with different categories of AMD were imaged with both the DigiScope and a standard color fundus camera. The imaging capability of the two modalities was compared for identification of lesions associated with AMD and classification into stages. RESULTS: There was good agreement for low-risk lesions and excellent agreement for high-risk lesions. Thirty-five of 36 eyes with intermediate or advanced disease were correctly identified with DigiScope images. Choroidal neovascularization was identified in all cases with the DigiScope due to the presence of subretinal hemorrhage or subretinal fibrosis. The DigiScope was found less capable of detecting subretinal fluid than standard stereo fundus photographs. CONCLUSIONS: This pilot study suggests that the DigiScope may be a useful screening tool for AMD.展开更多
Background: Pediatric after-hours telephone triage by call center nurses is an important part of pediatric health care provision. Objectives: To use a computerized database including the afterhours telephone calls for...Background: Pediatric after-hours telephone triage by call center nurses is an important part of pediatric health care provision. Objectives: To use a computerized database including the afterhours telephone calls for 90%of the pediatricians in Colorado to examine: (1) the epidemiology of after-hours calls during a 1-year period including the volume, seasonality, and timing of after-hours calls, the age of the patients, the presenting complaint, the triage dispositions, and mean rates of calls per pediatrician; (2) the process of care measures at the call center, including waiting times for nurse telephone call-backs, the length of triage calls, and how these factors varied by season; and (3) the frequency and content of calls requesting information but not requiring triage. Designs Descriptive study. Setting and Participants: All telephone calls from the After-Hours Telephone Care Program, Denver, Colo, received between June 21, 1999, and June 20, 2000, were retrieved from a computerized database and categorized by age, season, triage disposition, and algorithm. Main Outcome Measures: The volume, seasonality, timing, age distribution, algorithms used, and triage disposi-tions of after-hours calls. The reasons for calls requesting informa tion. Results: During the 1-year period 141922 calls were returned by the call center. Of the total calls, 88%were for a clinical illness; 5%, for information or advice; 5%, for calls in which the parent could not be recontacted; 1%, for duplicate calls, and 1%, for miscellaneous reasons. Listed in rank order for the year, the 10 most common algorithms used for illness calls were vomiting, colds, cough, earache, sore throat, fever, diarrhea, croup, head trauma, and eye infection. Of illness calls, 21%of callers were told to go in for urgent evaluation, 30%were told to contact their primary care physician either the next day or at a later time, 45%were given home care instructions, and 4%were referred to call the on-call physician. Conclusions: This study describes the epidemiology of afterhours telephone calls regarding children in 90%of the private practices in Colorado. Data provided are useful in guiding the planning of health care provision, providing staffing of after-hours facilities, and planning for the educational training of telephone care staff. They also highlight opportunities for patient education that might decrease unnecessary after-hours calls.展开更多
文摘Background: Nurse care management programs for patients with chronic illness have been shown to be safe and effective. Objective: To determine whether a telephone-media-ted nurse care management program for heart failure reduced the rate of rehospitalization for heart failure and for all causes over a 1-year period. Design: Randomized, controlled trial of usual care with nurse management versus usual care alone in patients hospitalized for heart failure from May 1998 through October 2001. Setting: 5 northern California hospitals in a large health maintenance organization. Patients: Of 2786 patients screened, 462 met clinical criteria for heart failure and were randomly assigned (228 to intervention and 234 to usual care). Intervention: Nurse care management provided structured telephone surveillance and treatment for heart failure and coordination of patients’care with primary care physicians. Measurements: Time to first rehospitalization for heart failure or for any cause and time to a combined end point of first rehospitalization, emergency department visit, or death. Results: At 1 year, half of the patients had been rehospitalized at least once and 11%had died. Only one third of rehospitalizations were for heart failure. The rate of first rehospitalization for heart failure was similar in both groups (proportional hazard, 0.85[95%CI, 0.46 to 1.57]), The rate of all-cause rehospitalization was similar (proportional hazard, 0.98[CI, 0.76 to 1.27]). Limitations: The findings of this study, conducted in a single health care system, may not be generalizable to other health care systems. The overall effect of the intervention was minor. Conclusions: Among patients with heart failure at low risk on the basis of sociodemographic and medical attributes, nurse care management did not statistically significantly reduce rehospitalizations for heart failure or for any cause. Such programs may be less effective for patients at low risk than those at high risk.
文摘Objective: To evaluate the accuracy of ultrasonographic examination in boys with an undescended testis. Material and methods: All patients who were referred to the paediatric surgeon after detection of an undescended testis were evaluated prospectively between November 2001 and November 2004. Among these 377 patients, 87 were referred with an ultrasonogram previously prescribed by the referring primary physician. The results of the ultrasonogram were compared to the results of the clinical examination of the paediatric surgeon and, in cases of no palpable testis, to the surgical findings. Results: Ultrasonography did not detect the retractile testes. Ultrasonography detected 67% of the palpable undescended testes. In cases of no palpable testis, the ultrasonographic examination missed the abdominal testes and sometimes other structures were falsely interpreted as a testis. Conclusion: Sonography has no place in the diagnosis of undescended testis.
文摘PURPOSE: To survey comprehensive ophthalmology patients about their use of vit amins and herbal supplements. DESIGN: Cross-sectional survey. METHODS: A survey instrument was developed and distributed to 397 patients presenting to a main c ampus university-based comprehensive ophthalmology clinic and to an off-site c omprehensive ophthalmology clinic. Information gathered included demographics, u se of prescription medications, use of vitamin and herbal supplements, the reaso ns for using these supplements, perceived benefits of these products, where the information regarding them was gathered, and with whom patients had discussed th eir use. RESULTS:Fiftyeight percent of patients reported nearly daily use of vit amins. Multivitamins were the most common vitamin and were used by 46%of the pa tients. Eight percent of patients used herbal products on a daily basis. Twenty -six percent learned about vitamins from their primary care physician (PCP), an d just 2%from their ophthalmologists, while 35%discussed their actual use with a PCP, and 5%with their ophthalmologists. Just 2%of these patients learned of herbs from a PCP, and <1%from an ophthalmologist. Older patients used multivit amins and other vitamins most frequently, while gender and education were not pr edictive of vitamin or herbal use. Mean monthly spending on vitamins by users wa s $15.74, while herbal users spent a monthly mean of $15.35. CONCLUSIONS: Vita mins and herbs are used by a significant number of patients in a comprehensive o phthalmology setting. Given the prevalence of vitamin and herbal use, ophthalmol ogists should systematically inquire about their use.
文摘Background: The current assumption is that noncardiac chest pain (NCCP) patien ts diagnosed by a cardiologist are commonly referred to a gastroenterologist for further evaluation. Thus far, there are no studies that assess the clinical app roach and referral patterns of cardiologists when evaluating subjects with NCCP. Aim: To determine the extent of involvement of cardiologists in the management of NCCP patients. Methods: Cardiologists were randomly selected from the America n College of Cardiology national membership list and sent a 20-item questionnai re that included demographic information, characteristics of practice, preferenc es of diagnostic tests, referral patterns, and treatment plans. Results: A total of 246 (33%) cardiologists returned the questionnaire. A mean of 12.6%of pati ents were diagnosed with NCCP and 45.5%were treated by a cardiologist in the pa st 6 months. Of the NCCP patients that were referred, most ended up in the prima ry care physician clinic (45.9%) followed by gastroenterologist clinic (29.3%) . Most cardiologists are either comfortable (35%) or very comfortable (43.1%) in diagnosing NCCP. Proton pump inhibitors (44.9%), life-style modifications ( 28.7%), and H2 blockers (11.8%) are the three most commonly used therapeutic m odalities for NCCP. Conclusion: Cardiologists manage about half of the diagnosed NCCP patients by themselves. Of those NCCP patients that are referred, cardiolo gists prefer to send them to a primary care physician rather than a gastroentero logist.
文摘BACKGROUND AND OBJECTIVE: The objective of this pilot study was to determine whether a new screening system, the DigiScope (EyeTel Imaging, Inc., Columbia, MD), can detect the presence of age-related macular degeneration (AMD) at a level requiring referral to an ophthalmologist for further evaluation and possible treatment. PATIENTSANDMETHODS: The DigiScope is an Internet-based semi-automated digital imaging system designed to be in primary care physicians’offices. Forty-two eyes of 21 patients with different categories of AMD were imaged with both the DigiScope and a standard color fundus camera. The imaging capability of the two modalities was compared for identification of lesions associated with AMD and classification into stages. RESULTS: There was good agreement for low-risk lesions and excellent agreement for high-risk lesions. Thirty-five of 36 eyes with intermediate or advanced disease were correctly identified with DigiScope images. Choroidal neovascularization was identified in all cases with the DigiScope due to the presence of subretinal hemorrhage or subretinal fibrosis. The DigiScope was found less capable of detecting subretinal fluid than standard stereo fundus photographs. CONCLUSIONS: This pilot study suggests that the DigiScope may be a useful screening tool for AMD.
文摘Background: Pediatric after-hours telephone triage by call center nurses is an important part of pediatric health care provision. Objectives: To use a computerized database including the afterhours telephone calls for 90%of the pediatricians in Colorado to examine: (1) the epidemiology of after-hours calls during a 1-year period including the volume, seasonality, and timing of after-hours calls, the age of the patients, the presenting complaint, the triage dispositions, and mean rates of calls per pediatrician; (2) the process of care measures at the call center, including waiting times for nurse telephone call-backs, the length of triage calls, and how these factors varied by season; and (3) the frequency and content of calls requesting information but not requiring triage. Designs Descriptive study. Setting and Participants: All telephone calls from the After-Hours Telephone Care Program, Denver, Colo, received between June 21, 1999, and June 20, 2000, were retrieved from a computerized database and categorized by age, season, triage disposition, and algorithm. Main Outcome Measures: The volume, seasonality, timing, age distribution, algorithms used, and triage disposi-tions of after-hours calls. The reasons for calls requesting informa tion. Results: During the 1-year period 141922 calls were returned by the call center. Of the total calls, 88%were for a clinical illness; 5%, for information or advice; 5%, for calls in which the parent could not be recontacted; 1%, for duplicate calls, and 1%, for miscellaneous reasons. Listed in rank order for the year, the 10 most common algorithms used for illness calls were vomiting, colds, cough, earache, sore throat, fever, diarrhea, croup, head trauma, and eye infection. Of illness calls, 21%of callers were told to go in for urgent evaluation, 30%were told to contact their primary care physician either the next day or at a later time, 45%were given home care instructions, and 4%were referred to call the on-call physician. Conclusions: This study describes the epidemiology of afterhours telephone calls regarding children in 90%of the private practices in Colorado. Data provided are useful in guiding the planning of health care provision, providing staffing of after-hours facilities, and planning for the educational training of telephone care staff. They also highlight opportunities for patient education that might decrease unnecessary after-hours calls.
文摘慢性前列腺炎(chronic prostatitis,CP)是中青年男性的常见病、多发病,造成了医疗资源的巨大浪费,并给患者和社会带来了巨大的经济负担^[1]。目前由于临床医师对该病的发病机制、分类、诊断及治疗等方面仍充满困惑,临床上无论是医师还是患者都经历过明显的挫折与失望。近年来,国内外学者开展了多项临床医师包括全科医师(general practitioners,GP)、初级保健医师(primary care providers,PCP)及泌尿外科医师对CP认知与行为模式的调查研究^[2-11],