Emergency medical care.

A survey carried out over five periods between 1973 and 1975 to study the mode of referral of emergency medical patients to a district general hospital showed that, out of a total of 2511 patients, 51% referred themselves, 40-8% were referred by general practitioners, and only 4-7% by doctors employed by the emergency treatment service. Of the 1720 patients admitted to the medical wards, 50-9% were referred by general practitioners and 37-3% were self-referred while the corresponding figures for the 791 not admitted were 19% and 80-7% respectively. Two-thirds of the self-referred patients came from their own homes, usually by ambulance ordered by a "999" emergency call. The figures were similar in each of the five periods.     

Aid to diagnosis of melanoma in primary medical care.

OBJECTIVE--To evaluate an intervention designed to reduce the number of benign melanocytic lesions excised from the skin. DESIGN--A randomised controlled field trial based in the medical practices of two cities. Examination of histopathological reports of 5823 melanocytic skin lesions excised over the intervention period and in the preceding six months. INTERVENTION--Medical practitioners were offered an algorithm and use of an instant developing camera. SETTING AND SUBJECTS--Over 50 medical practitioners, mostly in general practice, in each of two cities in tropical Queensland, Australia. MAIN OUTCOME MEASURES--Percentages of benign (neither malignant nor potentially malignant) melanocytic lesions excised during the two year intervention period. RESULTS--There were no significant differences in the percentages of benign lesions reported in the intervention and control cities before the intervention started (93.6% and 94.0%, respectively), but there was a significant difference afterwards (88.8% and 93.8%, P < 0.001). There was no difference in the percentage of invasive melanomas excised per month in the intervention city (3.4%) compared with control city (3.4%). CONCLUSION--Clinical diagnostic accuracy may be enhanced by offering to clinicians managing suspicious melanocytic skin lesions a simple algorithm and a camera with which to record the appearance of lesions objectively.     

Use of the Hippocratic or other professional oaths in UK medical schools in 2017: practice,perception of benefit and principlism

Objective

This paper concerns the continued use of the Hippocratic Oath in United Kingdom (UK) medical schools. A survey of all UK medical schools looked at which schools use the Oath, which variants they use, and what they perceive to be the benefits of using the Oath. 27 schools participated in the study.

Results

Although some authors have deemed the Oath as out of date for the purposes of modern medicine [1], new variants of the Oath have been embraced and 19/27 (70%) of schools use an Oath, with some Universities asking student doctors to acknowledge this Oath on entry to and graduation from medical school. There is a renewed interest in use of the Oath, with use in some Schools on admission and graduation. Reasons for adopting the Oath include a desire to enhance good practice and to prevent unwanted behaviour. Variants of the Oath used were analysed according to which bioethical principles are contained within them and some do not accord with all principles. A new variant of the Oath is proposed which encompasses all four bioethical principles.

     

Making access to health care more equal: the role of general medical services.

The Resource Allocation Working Party (RAWP) recognised the need to consider both health authority and primary care services in achieving its objective. RAWP and the subsequent Advisory Group on Resource Allocation (AGRA) found (but did not publish) considerable variation in resources used by both services but could not find a clear relation between them. Statistics provided by the DHSS were used to compare spending by 80 area health authorities in 1980-1 with expenditure per head on general medical services by their corresponding family practitioner committees. There was considerable variation in the provision of resources for both services and no clear relation between the variations in spending on each service. Only 40 of the 80 areas had both health authority and family practitioner committee spending levels within 10% of "target." Subregional inequalities in resources tend to be related to variations in admission rates, which in turn are related to general practitioners'' referral behaviour. These results emphasise the importance of finding out more about inequalities in the provision of general medical services and their relation to the use of hospital services. They also suggest that RAWP''s aim of equality of opportunity of access to health care resources may be achieved only if general medical services are brought into the equation as well.     

稻飞虱的危害及再猖獗机制

稻飞虱作为水稻上重要害虫,通过直接刺吸和传播病毒对水稻生产造成很大影响。飞虱的大暴发是世界性的问题,作者对导致稻飞虱再猖獗的机制进行了综述,并推测稻飞虱再猖獗可能是农药、气候和耕作制度综合造成的,可以通过控制农药使用来调控飞虱动态。     

Osteogenesis imperfecta: effecting the transition from adolescent to adult medical care

The objective of this paper is to provide guidelines for pediatricians, adult physicians in different medical disciplines and patients' families who are planning the transition to adult care for the adolescent with osteogenesis imperfecta (OI). This observational report reflects concerns expressed by patients, their families, and involved physicians regarding the problems encountered with the transition of care. Methods for dealing with transitional issues are presented. OI is a heritable disorder of connective tissue in which fractures are the dominant clinical feature. However, OI is a systemic disorder with broad clinical variability in which there are unpredictable episodes of trauma. Coordinated team support provides the best level of care for the child with OI. This paper discusses 4 key topics related to effecting the transition from pediatric to adult care: 1) Transitioning and maintaining health, 2) Preserving or improving the level of function, 3) Assuring continuity of medical/surgical care, and 4) Re-structuring psychosocial and work-related systems. The process of transition requires active communication between the pediatric and adult team members along with a proactive approach by the patient and family. In addition, as the transition is established, the patient with OI should be encouraged to be his/her own advocate and care coordinator.