Clinical pathways or case management.

Clinical pathways are increasingly being used internationally as a mechanism for managing patient care to achieve improved outcomes with more efficient resource use. They are a structured templates guiding multi-professional treatment and care for specific patient groups or procedures, through a sequence of essential treatment and care steps based on the best available evidence. This paper defines clinical pathways, describes their historical context and application, and discusses benefits and concerns about their use.

Analgesic ingestion and chronic peptic ulcer.

The patterns of analgesic ingestion in gastric and duodenal ulcer patients were compared with those of matched community controls in order to ascertain differences that may exist between ulcer and nonulcer subjects of comparable age and sex. The differences sought concerned amounts and types of analgesics ingested. The types of analgesics studied were aspirin and acetaminophen, ingested either alone or together. Analgesics such as dextropropoxyphene and codeine were disregarded. It was found that there was a strong positive association between heavy analgesic intake and chronic gastric ulcer with a relative risk of 29.5. The association was most marked in female patients (relative risk = 51.8). The involvement of aspirin-containing and acetaminophen-containing drugs was of similar significance with relative risk of 17.3 and 24.4, respectively. Aspirin alone was the least frequently ingested. The association was only partly related to painful nonulcer health problems and to ulcer pain. No association was found between chronic duodenal ulcer and analgesic intake. The strong association found between gastric ulcer and heavy analgesic intake does not, per se, necessarily indicate a causal relationship.

Life events and chronic duodenal ulcer: a case control study.

The frequency of life events during the two years before an exacerbation of ulcer in a duodenal ulcer population was compared with the frequency of these events over the same time period in an age-sex matched probability sample of the community population. The mean number of events and the associated distress and life change scores were similar for both groups. When events were categorised into areas of activity, such as health, bereavement, family and social life, change of residence, etc. and were further classified on the basis of desirability, separation from persons, and problem chronicity, only one significant difference was found between patients and controls-more patients changed residence (p=0.0005). Frequency distributions of the number of events and the distress and life change scores were similar for both groups. Concerning individual events, the only significant differences in frequency were that more patients changed residence in Sydney (p=0.006) and more controls had a child leave home for reasons other than marriage (p=0.03). Patients and controls experienced the same four most frequent events. Among patients, no correlation existed between age and either the number of events experienced or distress and life change scores. Among controls, age was negatively correlated with the number of events experienced (p=0.0004) and the life change scores (p<0.003). It is concluded, therefore, that an excess of stress, as measured by the number of life events experienced and by distress and life change scores associated with these events, does not appear to be a risk factor for the exacerbation of chronic duodenal ulcer.