Control of blood pressure and lifestyle-related risk factors in elderly Japanese hypertensive subjects.
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The aim of this study was to analyze the treatment of elderly hypertensive patients by Japanese physicians specializing in hypertension. We enrolled 939 patients with hypertension who were treated in the outpatient clinics of 11 hospitals in 1995; 793 of these patients (388 men and 405 women; mean age, 66.6+/-9.0 years) received follow-up examinations in 1996, and the data on these patients was used for the present analysis. Blood pressure (BP), body mass index, lifestyle, and laboratory data were analyzed in all patients. The average BP was 143+/-16/81+/-10 mmHg in 1995 and 142+/-15/80+/-10 mmHg in 1996. The patients whose baseline BP was at the level of Grade 2 or 3 in the WHO-ISH classification (n=117) were characterized by a higher women-to-men ratio, higher age, a higher serum total cholesterol concentration, and higher QRS voltage. In these patients, from 1995 to 1996, the average BP significantly decreased, whereas fasting plasma glucose, serum total cholesterol and serum creatinine concentrations showed only negligible changes. In 220 patients (28%), BP was <140/<90 mmHg at both the initial and the follow-up examinations, whereas 351 patients (44%) were hypertensive in both 1995 and 1996. Thirty-three percent of the patients were smokers. More smokers than nonsmokers had had prior cardiovascular events, diabetes mellitus, or overt proteinuria. In conclusion, the average BP level among the patients treated by Japanese physicians specializing in hypertension was somewhat higher than that recommended by WHO-ISH Guidelines (1999). Patient education to control lifestyle-related risk factors, particularly to stop smoking, should be emphasized. (+info)
Communication breakdown in the outpatient referral process.
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OBJECTIVE: To evaluate primary care and specialist physicians' satisfaction with interphysician communication and to identify the major problems in the current referral process. DESIGN: Surveys were mailed to providers to determine satisfaction with the referral process; then patient-specific surveys were e-mailed to this group to obtain real-time referral information. SETTING: Academic tertiary care medical center. PARTICIPANTS: Attending-level primary care physicians (PCPs) and specialists. MEASUREMENTS AND MAIN RESULTS: The response rate for mail surveys for PCPs was 57% and for specialists was 51%. In the mail survey, 63% of PCPs and 35% of specialists were dissatisfied with the current referral process. Respondents felt that major problems with the current referral system were lack of timeliness of information and inadequate referral letter content. Information considered important by recipient groups was often not included in letters that were sent. The response rate for the referral specific e-mail surveys was 56% for PCPs and 53% for specialists. In this e-mail survey, 68% of specialists reported that they received no information from the PCP prior to specific referral visits, and 38% of these said that this information would have been helpful. In addition, four weeks after specific referral visits, 25% of PCPs had still not received any information from specialists. CONCLUSIONS: Substantial problems were present in the referral process. The major issues were physician dissatisfaction, lack of timeliness, and inadequate content of interphysician communication. Information obtained from the general survey and referral-specific survey was congruent. Efforts to improve the referral system could improve both physician satisfaction and quality of patient care. (+info)
The use of the Cusum technique in the assessment of trainee competence in new procedures.
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Continuous quality assurance (QA) in health care has necessitated the adoption of statistical methods developed as industrial process monitoring techniques. One such statistical technique is the cumulative summation (Cusum) methodology, which can monitor continuously a production process and detect subtle deviations from a preset defined level of achievement. The method is practical, simple to apply, easy to introduce and has proved popular with trainees in some specialities. This article introduces the concepts of a sequential analysis, deals with the practical steps of setting up a data collection and monitoring performance for procedures in health care. (+info)
The general practitioner and changes in obstetric practice.
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Compared with the 1960s fewer general practitioners today are obtaining a postgraduate diploma in obstetrics, and the future more stringent criteria for practitioners wishing to undertake this will probably restrict the numbers of family doctors wishing to practise in this field. More deliveries are being performed in institutions--either in consultant or general-practitioner units. Morever, within a decade probably few G.P.s will attend during normal labour or delivery, which can and should be conducted by midwives. In future, therefore, G.P.s should have a new role in obstetrics, being responsible for some antenatal supervision and postnatal care, including postnatal examinations, taking a cervical smear, and advice on birth control. (+info)
Career and training patterns of students entering Canadian medical schools in 1965.
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This paper follows the careers of the 1128 students who entered Canadian medical schools in 1965, most of whom graduated in 1969. The type of career pursued (whether general or specialty practice or some combination thereof), the type of specialty undertaken, the place of internship and residency training and the 1973 practice location of the graduates are examined. The wide variation in careers followed by the 12 schools' graduates provides the major focus of the paper. (+info)
Acceptance of the different denominations for reflex sympathetic dystrophy.
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OBJECTIVE: To elucidate the real impact in the medical literature of the different denominations for reflex sympathetic dystrophy (RSD). METHODS: A search was performed through the Medline database (WinSPIRS, SilverPlatter International, NS), from 1995 to 1999, including the following descriptors: RSD, complex regional pain syndrome (CRPS), CRPS type I, algodystrophy, Sudeck, shoulder-hand syndrome, transient osteoporosis, causalgia, and CRPS type II. RESULTS: The descriptor RSD was detected in 576 references, algodystrophy in 54, transient osteoporosis in 42, CRPS type I in 24, Sudeck in 16, and shoulder-hand syndrome in 11. One hundred records were obtained for the descriptor causalgia and five for CRPS type II. The descriptor RSD was detected in the title of 262 references, algodystrophy in 29, transient osteoporosis in 29, CRPS type I in 15, Sudeck in 3, shoulder-hand syndrome in 5, causalgia in 17, and CRPS type II in 3 references. CONCLUSIONS: The new CRPS terminology has not effectively replaced the old one. RSD and causalgia are the most used denominations. (+info)
Examination of the Distinctive Awards System.
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When they stopped secrecy, the consultants of an internationally-famous postgraduate teaching centre in psychiatry--not a designated teaching hospital--discovered that they had one-tenth the national average of distinction awards. Subsequent investigation of the whole system suggests that this is not an isolated case. Moreover, official figures are scanty and misleading. This paper explores the difficulties in understanding, investigating, and influencing the system. The composition of the committees involved, the de facto quota system, the method of collecting information, and the convention of secrecy are examined and critized. (+info)
Career choices of physicians 15 years after entering medical school.
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The career status of 149 graduates of the University of Toronto faculty of medicine who entered in 1958 and graduated in 1962 was determined in 1973. The response rate to the mailed questionnaire was 96.6%. Of the graduates 4.7% were not practising medicine, 2.0% stated that medicine was not their primary gainful activity and 4.1% were untraceable or unknown. Of the 24 women in the class 17 (70.8%) were practising at least 76% of their time and 4 (16.7%) were practising 26 to 75% of their time. General practice or family medicine had been chosen by 39.0% of the class and a specialty by 55.7%; 5.4% were unknown or untraceable. The place of longest residence before entrance to university was a good predictor of ultimate location of practice but not of type of practice. (+info)