Chest pain evaluation.

Chest pain is one of the frequent complaints in patients presenting to emergency rooms and ambulatory care clinics. For the primary care physician evaluating these patients, there are three essential steps in the evaluation of chest pain. The first step is to determine whether the chest pain is cardiac in origin or not. If the pain is suspected to be cardiac, then the next step would be to determine if the chest pain is secondary to an acute coronary syndrome (acute myocardial infarction or unstable angina) that requires immediate referral to an emergency room to initiate therapy and admit to the hospital. If the pain is not considered to be due to an acute coronary syndrome, then we proceed with a systematic approach to try to determine the likelihood that a particular patient has significant coronary artery disease (CAD). This is determined based on the patient's history, risk factors and electrocardiogram. Once the likelihood is assessed, this will determine what further invasive or non-invasive tests would be required to complete the patient's evaluation.

Recommendations for the school health physical examination in Lebanon.

School health developed gradually over the years; starting with efforts to keep contagion out of schools to global programs of comprehensive services. One of its components, school medicine, covers screening examinations, record maintenance, emergency care, immunization monitoring and health counseling. This paper proposes the essential health activities to be performed during a screening school examination in Lebanon. The recommendations are based on a combination of international literature review of evidence and the existence of Lebanese epidemiological reports identifying specific problems. Vaccination record review, tuberculin testing, vision, hearing, dental and skin disorders screening procedures are proposed as essential activities of the school physical examination.

List of essential drugs for primary care in Lebanon.

In 1966, Lebanon had around 19,000 drug formulations registered in the Ministry of Public Health. The government decreased that number to 5400 in 1992 through numerous interventions. In 1995 and in an effort to rationalize drug prescribing, the Lebanese government organized an ad hoc committee of medical and pharmaceutical experts to review the 1992 list and create a list of essential drugs for primary care (LEDPC). This report describes the process and the studies used to update the 1992 list by the ad hoc committee.

Data from a public school health project in Beirut.

The health status of 2778 elementary students enrolled in twenty-five government schools in Beirut was evaluated. Parents completed special forms relating to demographic information, socioeconomic status, the students' medical and vaccination history, and the presence of certain medical conditions in the family. A complete physical examination of each student was carried out. Seventy-six percent of the children belonged to families with a monthly income between US $118-237. The most common medical problems encountered were poor dentition (53%), incomplete immunization (22-63%) for the various vaccines, enuresis (9%), pediculosis (8%), and defective vision (6%). It was also noticed that 72% of the students have at least one member in the family who smokes. The data presented in this study show the need for fluoridation of public water; provision of accessible and affordable medical and dental care; carrying vaccination campaigns and introducing health education in elementary schools in Lebanon.

Purified protein derivative (PPD) conversion rate among Lebanese children in Beirut.

To determine the purified protein derivative conversion rate among Lebanese children we followed a cohort of 1236 students, ages 5-14 years, enrolled in 25 public schools in Beirut. All cases received an intradermal injection of purified protein derivative in 1992 and one year later. Test administration was done using standard techniques and results were read by the same physician 48-72 hours later. Demographic information was also obtained on the enrolled students. The majority of children identified belonged to a low socioeconomic class. The one year conversion rate was 1.4%. This underscores the urgent need for preventive programs.

Lessons from a courageous dying patient.

The atypical reaction of a patient to the news of her terminal illness raises a number of questions about care for the dying.

Common prescriptions in ambulatory care in Lebanon.

OBJECTIVE: To describe prescribing practices of family physicians in a staff model health maintenance organization at a university health center in Lebanon and estimate costs of such practices for common diseases. METHODS: All prescriptions issued between July 1, 1997, and June 30, 1998, were prospectively collected. The diagnoses made by physicians at each encounter were recorded, and the total price of medications prescribed was calculated. The core prescribing indicators as defined by the World Health Organization and the mean annual prescription price per person for the 25 most common diagnoses were calculated. RESULTS: Prescribing occurred in 27.1% of encounters, with a mean of 1.6 medications per encounter; 17.5% of all prescriptions included an antibiotic. Generic drugs and essential drugs each accounted for 2.9% of all medications. Approximately 50% of the consultations for either respiratory or ear infections resulted in a prescription. Cervical spine syndromes and lipid metabolism disorders cost most among recorded diagnoses, with mean annual prescription prices per person of US $2016 and $1128, respectively. CONCLUSIONS: The low rate of generic and essential drug prescribing, as well as the frequency of prescribing in respiratory infections, highlight the need for initiatives to help rationalize prescribing in primary care in Lebanon. Together with the diagnostic categories incurring high cost per person, these issues can be part of physician education or treatment guideline development. These measures may aid the government in its subsidy of primary health care centers.