Well-woman Clinic in General Practice

During a four-year period 1,169 women attended a well-woman clinic in a group practice. Eight positive smears were detected, together with one case of breast carcinoma, 94 cases of anaemia, and a number of other abnormalities. The clinic is part of a practice cervical-screening programme aimed at regular tests for women in the practice aged between 25 and 64. Patients appear to prefer attending screening clinics run by their own family doctor, and if more practices would adopt such a programme a higher proportion of the female population might be screened, and at a lower cost.     

对普通门诊预约诊疗服务的定性分析

?????? 目的 描述制约普通门诊预约诊疗服务的因素,分析提高普通门诊预约诊疗服务的途径。方法 依据调查、访谈等定性方法对影响普通门诊预约诊疗服务的因素进行归纳。结果 主要的影响因素包括：患者就医观念尚未转变、信息系统的缺失、缺乏制约患者行为的手段、临床实践的属性和缺少标准化的评价指标。结论 医患双方逐渐意识到普通门诊预约诊疗服务的价值,但其适宜性和开展方式需要得到进一步分析。基于普通门诊的基础性作用,推动预约诊疗服务对医疗机构具有积极的作用。     

Efficacy of Control-IQ Technology in a General Endocrine Clinic

ObjectiveRecent advances in technology have allowed for the expanded use of hybrid closed-loop insulin pump therapy and automated insulin delivery systems for the management of diabetes mellitus. We assessed the outcomes of introducing Tandem t:slim X2 with the Control-IQ technology in a general endocrine clinic.MethodsData from 66 adults with type 1 (n = 61) and type 2 (n = 5) diabetes mellitus were aggregated for analysis. Patients were either transitioned from traditional insulin pump therapy or multiple daily injection therapy to Tandem t:slim X2 with the Control-IQ technology from January 2020 to June 2021. The assessed clinical end points included changes in time below range, time above range, and time in target range. Changes in hemoglobin A1C before and after Control-IQ technology implementation were noted. The primary outcome was a change in time in target range with the Control-IQ technology.ResultsThere was a significant increase in time in target range when comparing pre- and post–Control-IQ technology (49.5% vs 63.3%, P < .0003) values. There was a reduction in time above range (46.8% vs 34.9%, P < .0013), a decrease in time below range (4.0% vs 1.7%, P = .017), and a decrease in hemoglobin A1C after transitioning to the Control-IQ technology (7.7% [61 mmol/mol] vs 7.1% [54 mmol/mol], P < .017). The patient dropout rate was low (7%).ConclusionThe Control-IQ technology system was effective in reducing hyperglycemia while increasing time in target range and decreasing hypoglycemia. This technology is a useful and effective addition to the growing number of automated insulin delivery systems. The clinical outcomes mirror the results found in the key adult pivotal trials.     

某专科医院普通门诊分时段预约挂号的探讨

目的 了解某专科医院普通门诊分时段预约的特点和效果,探索适宜的评价指标、评价方式及提升预约服务的有效手段。方法 通过HIS系统提取2015年7月至2016年3月复旦大学附属妇产科医院杨浦院区4个普通门诊参与预约的12 889人次患者的预约信息及挂号就诊的181 447人次患者的相关数据,比较不同门诊的预约情况、流量分布及预约与非预约患者平均候诊时间等的差异。结果 普通门诊预约率仅7.24%,而爽约率高达25.90%;诊间预约不到全部预约的1%,普通门诊预约患者的平均候诊时间普遍短于非预约患者,无论预约率还是预约效果各科室间都存在明显差异。结论 评价普通门诊的预约情况应对各科室设置不同的基线和目标;结合专科医院的特点推动诊间预约;可将门诊流量监控引入门诊预约管理中。     

Bloodstream Infection among Children Presenting to a General Hospital Outpatient Clinic in Urban Nepal

Background

There are limited data on the etiology and characteristics of bloodstream infections in children presenting in hospital outpatient settings in South Asia. Previous studies in Nepal have highlighted the importance of murine typhus as a cause of febrile illness in adults and enteric fever as a leading bacterial cause of fever among children admitted to hospital.

Methods

We prospectively studied a total of 1084 febrile children aged between 2 months and 14 years presenting to a general hospital outpatient department in Kathmandu Valley, Nepal, over two study periods (summer and winter). Blood from all patients was tested by conventional culture and by real-time PCR for Rickettsia typhi.

Results

Putative etiological agents for fever were identified in 164 (15%) patients. Salmonella enterica serovar Typhi (S. Typhi) was identified in 107 (10%), S. enterica serovar Paratyphi A (S. Paratyphi) in 30 (3%), Streptococcus pneumoniae in 6 (0.6%), S. enterica serovar Typhimurium in 2 (0.2%), Haemophilus influenzae type b in 1 (0.1%), and Escherichia coli in 1 (0.1%) patient. S. Typhi was the most common organism isolated from blood during both summer and winter. Twenty-two (2%) patients were PCR positive for R. typhi. No significant demographic, clinical and laboratory features distinguished culture positive enteric fever and murine typhus.

Conclusions

Salmonella infections are the leading cause of bloodstream infection among pediatric outpatients with fever in Kathmandu Valley. Extension of immunization programs against invasive bacterial disease to include the agents of enteric fever and pneumococcus could improve the health of children in Nepal.     

Association between Air Pollution and General Outpatient Clinic Consultations for Upper Respiratory Tract Infections in Hong Kong

Background and Objectives

Many studies have shown the adverse effects of air pollution on respiratory health, but few have examined the effects of air pollution on service utilisation in the primary care setting. The aim of this study was to examine the association between air pollution and the daily number of consultations due to upper respiratory tract infections (URTIs) in general outpatient clinics (GOPCs) in Hong Kong.

Methods

Daily data on the numbers of consultations due to URTIs in GOPCs, the concentrations of major air pollutants, and the mean values of metrological variables were retrospectively collected over a 3-year period (2008–2010, inclusive). Generalised additive models were constructed to examine the association between air pollution and the daily number of consultations, and to derive the relative risks and 95% confidence intervals (95% CI) of GOPC consultations for a unit increase in the concentrations of air pollutants.

Results

The mean daily consultations due to URTIs in GOPCs ranged from 68.4 to 253.0 over the study period. The summary relative risks (and 95% CI) of daily consultations in all GOPCs for the air pollutants PM₁₀, NO₂, O₃, and SO₂ were 1.005 (1.002, 1.009), 1.010 (1.006, 1.013), 1.009 (1.006, 1.012), and 1.004 (1.000, 1.008) respectively, per 10 µg/m³ increase in the concentration of each pollutant.

Conclusion

Significant associations were found between the daily number of consultations due to URTIs in GOPCs and the concentrations of air pollutants, implying that air pollution incurs a substantial morbidity and increases the burden of primary health care services.