Apendagitis epiploica como causa inusual de dolor abdominal agudo: características clínicas y radiológicas de 7 pacientes / Epiploic appendagitis as unusual cause of acute abdominal pain: clinical and radiologic features of 7 patients

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Influence of physicians' attitudes on under-notifying infectious diseases: a longitudinal study.

OBJECTIVES: To identify practitioners' demographic and professional characteristics associated with reporting of mandatory-reporting diseases (MRDs), and to identify attitudes associated with MRD reporting. DESIGN: Longitudinal study. SETTING: Regional Health Service of Galicia (North-western Spain). SUBJECTS: Random sample of 600 physicians. MAIN OUTCOME MEASURES: A postal questionnaire was used to measure the physicians' beliefs, knowledge and attitudes regarding MRDs. Associations between the independent variables and outcomes (notification or non-notification of MRDs every week during 1998) were modelled using the Andersen-Gill proportional hazards model. RESULTS: The response rate was 60.1%. The following beliefs, knowledge and attitudes were statistically associated with a smaller probability of reporting any given MRD: (1) I would only notify an MRD after confirming diagnosis; (2) the MRD reporting system interferes with my daily clinical practice; (3) besides the legal requirements, I would have to report MRDs as a medical professional; and (4) only the reporting of relevant or severe MRDs is necessary. Under-reporting was not associated with specialization (general or paediatric) or the type of contract (fixed or temporary), but was associated with gender. CONCLUSIONS: Some physicians' beliefs, knowledge and attitudes regarding MRDs are associated with under-reporting. This suggests that modification of certain attitudes and knowledge in physicians could greatly reduce the under-reporting of MRDs.

Variables explicativas del gasto evitable generado por la no prescripción de la especialidad equivalente de menor precio / Explanatory variables of avoidable cost produced by not prescribing a cheaper equivalent drug

Objetivo: Identificar las variables explicativas del gasto evitable por la no prescripción de la especialidad de menor precio. Métodos: Se diseñó un estudio transversal sobre la población de médicos generales de atención primaria de Galicia (n = 1.500). Se seleccionó una muestra de 405 sujetos. Se recogieron las siguientes variables independientes a través de cuestionario postal: especialidad del médico, percepción de la calidad de las distintas fuentes de información de medicamentos, integración en equipos de atención primaria y número de pacientes. Las características del entorno fueron obtenidas a través de fuentes secundarias. Se generaron dos modelos de regresión múltiple utilizando como variables dependientes dos indicadores basados en el gasto evitable generado por la no prescripción de la especialidad esencialmente similar de menor precio. Resultados: El porcentaje de respuesta fue del 77,4 por ciento. La eficiencia de la prescripción no se encontró asociada con el nivel de formación del médico ni con las variables de utilización y de calidad atribuida a la información comercial o institucional. Tampoco la variable modelo sanitario resulta significativa. Únicamente el número de cartillas y el porcentaje de cartillas de pensionista muestran significación estadística. Conclusiones: Los resultados del estudio sugieren la escasísima importancia que los médicos conceden a la eficiencia en la prescripción. Así, con el fin de disminuir el gasto evitable por la no prescripción de la especialidad esencialmente similar de menor precio se debería reorientar los planes de estudios en la línea de asegurar que sus contenidos reflejen las prioridades sanitarias nacionales y los recursos existentes (AU)

One-to-one versus group sessions to improve prescription in primary care: a pragmatic randomized controlled trial.

OBJECTIVES: The objective of the study was to evaluate the effectiveness of 2 educational strategies aimed at improving prescribing standards in primary care. METHODS: A pragmatic controlled trial was designed; the study population included general and family practitioners in Galicia (northwestern Spain) divided into 3 study groups: a one-to-one education group (n = 98), a by-group education group (n = 92), and a control group (n = 405). The educational intervention included explicit recommendations for selecting nonsteroidal anti-inflammatory drugs (NSAIDs) for inflammation signs. Some of the subjects were given reminders. Mixed-effect linear models were applied to data analysis. Analyses were done by intention-to-treat. The dependent variable is a rate with a numerator that is the number of prescribed units of the NSAIDs recommended during intervention; the denominator is the total number of prescribed units of the NSAID total. RESULTS: One-to-one education obtained an average prescribing behavior improvement of 6.5% (P < 0.001) in the 9 months after intervention. In the education group, the average improvement was 2.4% (P < 0.05) for the same period. Statistically significant differences were observed between the group intervention and one-to-one groups. The reminder increased significantly the effectiveness of the one-to-one intervention. CONCLUSIONS: A single, short educational session to primary care doctors can improve their prescribing standards during long periods of > or = 9 months. Of the 2 strategies followed in the trial, one-to-one education has shown to be the most effective. Results also show that the effectiveness of these interventions increases when presented together with written material.

[Explanatory variables of avoidable cost produced by not prescribing a cheaper equivalent drug]. / Variables explicativas del gasto evitable generado por la no prescripción de la especialidad equivalente de menor precio.

OBJECTIVE: To identify the explanatory variables of avoidable cost produced by not prescribing a cheaper equivalent drug. METHODS: We conducted a cross-sectional study of 1,500 primary care physicians in Galicia (northwest Spain). The sample consisted of 405 primary care physicians. The following independent variables were collected through a postal questionnaire physicians' training and specialty, physicians' perception of the quality of available drug information sources, type of practice, and number of patients. The environmental characteristics of the practice were obtained from secondary sources. Multiple regression models were constructed using as dependent variables two indicators based on unnecessary cost produced by not prescribing cheaper equivalents. RESULTS: The response rate was 77,4%. No association was found between prescription efficiency and the level of the physician's training, or with the variables of utilization or the quality of commercial and institutional information. The variable of health model was not significant. The only statistically significant variables were the number of identification cards and the percentage of pensioners' identification cards. CONCLUSIONS: The results of this study suggest that physicians attach little importance to prescription efficiency. Thus, to decrease avoidable cost produced by not prescribing a cheaper equivalent drug, the medical curriculum should be modified to ensure that is contents reflect national health priorities and current resources.

¿Es legítimo el uso de placebo en atención primaria? / Is it legitimate to use placebos in primary care?

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Efficacy of various surface disinfectants on an irregular surface.

Representative samples of hard surface disinfectants were tested against Pseudomonas aeruginosa (ATCC 27853) on frosted glass rods. The same protocol was followed by two investigators on 100 rods for each product tested. Results showed Sporicidin surface disinfectant (Ash Dentsply, York, Pa.) and household bleach 1:10 to be most effective against P. aeruginosa. Lysol disinfectant spray (Lehn & Fink Products, Montvale, N.J.), performed similarly whereas Biocide (Biotrol International, Woods Cross, Utah) failed to inhibit growth on more than half of the rods treated. Failure of the iodophor may be attributed to the use of cotton-filled gauze, because cellulose is believed to react with nascent iodine.

Identification of pathogens in the condensates from air pressure systems in dental offices.

We examined the air pressure systems in 23 dental offices and found growth of Group A Streptococci and/or Staphylococcus Aureus in 91 percent of them. We also examined nine handpiece lines from these 23 offices and found growth of pathogens in 78 percent of them. Correlation of the growth found in the handpiece lines and the growth found in the air pressure tanks needs further study to determine if an interrelationship exists between these two areas of contamination. However, contamination does exist in both areas and these areas deliver contaminated air under pressure to the oral environment. We need to consider mechanisms for filter entrapment or sterilization of these pathogens.

Evaluation of a prototype CPR assist-tool.

A CPR provider is often called upon to expand considerable physical energy to deliver external cardiac compressions. This research evaluates and compares the performance of recently certified basic rescuers on a mannequin using the standard method of CPR, and the performance with an adjunctive CPR assist-tool. Use of the tool significantly increased the overall quality of individual performances by reducing the frequency of inadequate compressions and increasing the time of acceptable performance. Other common errors were not significantly affected.