Medical resources and the internet. Making the connection

The Internet has provided a new forum through which medical information can be obtained and discussed. We review methods available to take advantage of this resource and provide a glimpse of electronically available information and discussions. These methods are useful for beginning and experienced users of the Internet.     

Evaluation of the quality of filling out medical records in a hypertension consultation

The aim of the study was to evaluate the completion of medical records of a hypertension clinic and to compare standardized computerized records versus standard medical records. The medical records of 163 consecutive hypertensive patients attending at the Broussais hospital hypertension clinic between December 1995, 6th and January 1996, 21st were checked. At the last visit, the patients were attended by 16 physicians working in 4 different teams. The medical data were recorded by physicians in the computerized system called ARTEMIS in 120 patients and in standard structured forms in 43 patients. The patients notes were checked to see if 9 clinical items were recorded at the first visit (V1), at the visit before last (V2) and at the last visit (V3). The overall completion rate was high at V1 (92.2%) and significantly decreased at follow-up visits (82.6% at V2 and 83.2% at V3). The completion rate was significantly higher in the computerized records than in the standard notes: 95.8% vs 82.2% at V1, 91.9% vs 56.3% at V2 and 91.6% vs 59.7% at V3. During follow-up (V2 vs V1), a significant decrease in the completion rate of 6 items was observed in the standard notes (tobacco use, alcohol consumption, physical activity, compliance to treatment, body weight, manual blood pressure measurement). In the computerized records, only physical activity completion rate decreased. In conclusion, the computer may help to increase the quality of the medical records as reflected by the completion rate of items related to hypertension care.     

Podiatric medical resources on the Internet

PURPOSE: To determine utility of polymerase chain reaction (PCR)-based urine screening for Chlamydia trachomatis in the care of adolescent females in an urban clinic. METHODS: Females > or = 15 years of age attending an adolescent clinic were approached consecutively. Each enrollee was interviewed to determine the primary reason(s) for the clinic visit and was queried about genitourinary symptoms. Nonsterile voided urine specimens were tested for C. trachomatis using PCR-based analysis. Endocervical C. trachomatis cultures were obtained from the subjects who had a pelvic examination. Main outcome measures were chlamydia infection rates in clinic attendees whether a pelvic examination was performed or not. RESULTS: A total of 315 (99.4%) of 317 patients approached agreed to participate. Overall, 47 (14.9%) patients had positive urine PCR tests. The chlamydia infection rate detected by urine PCR was 22.1% (19 of 86) among those who had pelvic examinations performed and 12.2% (28 of 229) among those who did not (p = .03; odds ratio 2.04; 95% confidence interval 1.02, 4.06). Sixty percent (28 of 47) of chlamydia infections identified during the study period were identified by the urine screening test. CONCLUSION: Urine screening was accepted by vast majority of female adolescents attending the clinic irrespective of reason for the clinic visit, and was highly effective in identifying unsuspected C. trachomatis infections, particularly among girls attending the clinic for reasons unrelated to reproductive health care and as an interim screening tool for adolescent family-planning clients.     

Rationality and allocating scarce medical resources

In an article titled, "Who Shall Live When Not All Can?", James Childress proposes a system for allocating scarce lifesaving medical resources based on random selection procedures. Childress writes of random selection procedures, [They] "cannot be dismissed as a 'non-rational' and 'non-human' ...without an inquiry into the reasons, including human values which might justify it." My thesis is that once we concentrate on determining the rationality of random selection procedures, we will see that Childress's claim that we cannot dismiss such procedures as 'non-rational' is open to question. My claim will be that while both random selection and social worth procedures are rationally defensible systems, random selection procedures easily lead to specific choices that are objectively irrational, apart from the limited perspective of the random selection process itself.     

Neurobehavioral tests as a medical surveillance procedure: applying evaluative criteria

Neurobehavioral impairment is among the earliest indicators of a toxic insult on the nervous system. Neurobehavioral tests measure behavior impairment by noninvasive procedures that assess various performance and personality changes. Neurobehavioral tests have been used on groups of workers included in epidemiologic research studies; however, their suitability for an ongoing medical surveillance program for workers exposed to neurotoxic agents has not been evaluated. In Ontario, Canada, a set of validity criteria must be met to determine whether a medical procedure may be prescribed for a specific medical surveillance program. The evaluative criteria are standards for judging the desirability of a procedure based on social values and scientific considerations. In this paper, various studies using neurobehavioral tests are reviewed, and the validity of using these procedures for medical surveillance is evaluated by applying the Ontario evaluation criteria. The conclusion is that neurobehavioral tests are useful for well-controlled, cross-sectional studies, but they do not yet meet the validity criteria for procedures prescribed in an ongoing medical surveillance program for workers exposed to neurotoxic agents.     

A learning resources centre: its utilization by medical students

The 17 described genomic species (DNA groups) of the genus Acinetobacter, including the type strains of the seven named species, were studied by using a multiplex PCR. The multiplex PCR assay combined two primer sets (rA1 and rA2 for recA gene target; rib1 and rib2 for 16S rDNA sequence) in a single reaction. Restriction analysis with two enzymes (Mbol and Hinfl) of the enzymatically amplified products allowed identification of all genospecies. This technique proved to be a rapid and reliable method for the identification of the Acinetobacter genomic species including the closely related DNA groups (1, 2, 3, 13). The results of this study suggest that the proposed method can be used for the identification of Acinetobacter spp. and as such may help to elucidate the ecology and clinical significance of the different species of this genus.     

Evaluation of medical audit

Purified lipase from wheat germ was used for the determination of preferential interaction parameters under different stabilizing cosolvent conditions. The partial specific volume of the enzyme was measured under both isomolal and isopotential conditions in phosphate buffer at pH 7.0, 0.02 M, and the value was found to be 0.730 +/- 0.001 and 0.731 +/- 0.002 mL/g, respectively. The partial specific volume measurements with different cosolvents indicated that the enzyme has a (delta g3/delta g2)T,mu1,mu3 values of -0.119 +/- 0.012, -0.073 +/- 0.009 and -0.141 +/- 0.020 g/g, respectively, in 25% glucose, 25% sucrose and 25% DMSO. The (delta g3/delta g2)T,mu1,mu3 values in 10 and 20% glycerol were -0.054 +/- 0.012 and -0.073 +/- 0.016 g/g, respectively. Based on these values it is clear that the enzyme is stabilized in the presence of these cosolvents by increasing its hydration, of which DMSO is stabilizing to the maximum extent. The stabilization of the enzyme was also confirmed by the thermal denaturation measurements in the presence of these cosolvents which indicated a shift in the apparent thermal denaturation temperature of the enzyme towards higher temperatures. The data are supported further by the ultraviolet difference spectral as well as fluorescence measurements in the presence of these cosolvents. The stabilization has been attributed to the preferential hydration of the enzyme in the presence of these cosolvents.     

Predicting achievement in medical school: a comparison of preclinical and clinical criteria.

For 129 medical students, scores on an aptitude test battery were correlated with general grade averages at the end of both the first and third years of medical school. The trial battery, administered at the beginning of the first year, included (1) USAFI Reading Interpretation, (2) Miller Analogies, (3) DAT Space Relations, and (4) AGCT Validities with first-year grades (.44 to .04) were about the same as validities with third-year grades (.39 to .13), Reading Interpretation having the highest validity in each case. Correlations between the criteria and scores on the medical Professional Aptitude Test followed the same pattern. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

基于不同划分优度的因特网拓扑聚合特征

因特网拓扑的社区聚合特征对网络性能具有重要影响.本文选取两种不同的社区划分算法:基于模块度Q的MOME算法与基于伸缩变换覆盖测度SCM的SACA算法,利用10年实际测量数据,对因特网AS层拓扑分别进行社区划分,获得的社区结构具有显著差异,究其根源在于两种算法采用的社区划分优度不同.分析发现:微小社区占大多数的幂律分布以及社区结构以星型为主的现象是SCM测度自身限制的效果.基于模块度Q的社区划分显示因特网拓扑聚合程度显著且呈增长趋势,社区规模随网络规模增长,社区结构以稠密的非星结构为主.研究表明,设计适当的社区划分优度及划分算法对于正确理解实际网络真实聚合特征具有重要意义.     

Evaluation of a quality assessment manual: effectiveness in a quality assurance program

1. An occupational health quality assessment manual was evaluated to judge its effectiveness as part of an overall quality assurance program. 2. The first step in the evaluation process examined standards; the second step determined measurable process criteria. 3. A quality assessment evaluation should promote accountability among care providers and clarify standards and criteria.     

Evaluation criteria in follow-up studies of flexor tendon therapy

Oxphenisatin is known to induce liver damage and is suspected to cause or perpetuate chronic liver disease. In order to evaluate the hepatotoxic effect of long-term therapy with oxyphenisatin 26 consecutive patients with rheumatoid arthritis were investigated for the presence of liver disease. In all cases, liver biopsy, biochemical liver function tests and determination of Hepatitis-B antigen were performed. Ten patients showed no pathological changes in the liver biopsy and a further 2 had only non-specific changes. Seven patients had fatty liver, 5 passive congestion, one haemosiderosis and only one had cirrhosis of the liver. No correlation was found between the activity of rheumatoid arthritis, and duration of the disease, the drug therapy given, and the liver damage.     

井下空气质量评价研究

介绍了高峰矿井下空气质量的测定和评价情况。指出了影响该矿井下空气质量的有毒害气体主要的一氧化碳（ＣＯ）、二氧化碳（ＳＯ２）二氧化碳（ＮＯ２）。针对该矿今后生产提出了建议措施。     

Global physician budgets as common-property resources: some implications for physicians and medical associations

Since 1990 payment for physician services in the fee-for-service sector has shifted from an open-ended system to fixed global budgets. This shift has created a new economic context for practising medicine in Canada. A global cap creates a conflict between physicians' individual economic self-interest and their collective interest in constraining total billings within the capped budget. These types of incentive problems occur in managing what are known in economics as "common-property resources." Analysts studying common-property resources have documented several management principles associated with successful, long-run use of such resources in the face of these conflicting incentives. These management principles include early defining the boundaries of the common-property resource, explicitly specifying rules for using the resource, developing collective decision-making arrangements and monitoring mechanisms, and creating low-cost conflict-resolution mechanisms. The authors argue that global physician budgets can usefully be viewed as common-property-resources. They describe some of the key management principles and note some implications for physicians and the provincial and territorial medical associations as they adapt to global budgets.