RESUMO
OBJECTIVE: To determine whether CD-ROMs are as fast as everyone thinks they are. METHODS: A grand contest between 2 textbooks and their electronic versions, held with the help of 10 victims. RESULTS AND INTERPRETATION: We can't be expected to tell you that now. You'll have to read the paper.
Assuntos
CD-ROM , Livros de Texto como Assunto , Senso de Humor e Humor como AssuntoRESUMO
OBJECTIVE: To survey Canadian family practice residency programs to discover which procedural skills residents are expected to learn. DESIGN: Cross-sectional eight-item questionnaire. SETTING AND PARTICIPANTS: The survey was sent to all 92 program directors and site or unit directors of family practice residency programs across Canada. MAIN OUTCOME MEASURES: Information on procedural skills lists was solicited. We sought date of creation, date of most recent revision, and who was involved in creating the list. A copy of the most recent list available was requested. RESULTS: We received 65 responses, for a 71% return rate. Surveys were received from all provinces and from all Canadian universities offering family practice residency programs. We received 24 unique lists of procedural skills: the shortest listed only 10 procedural skills; the longest, 75 skills; and the average, 36 skills. Only five procedural skills were found on more than 80% of the lists; 30 skills were listed on half or more of the lists. CONCLUSIONS: Canadian family practice residency programs have widely varying expectations of procedural skills for their residents. This survey is a first step in examining the whole issue of procedural skills training in Canadian family medicine programs.
Assuntos
Medicina de Família e Comunidade/educação , Cirurgia Geral/educação , Internato e Residência , Canadá , Estudos Transversais , Coleta de Dados , HumanosAssuntos
Acessibilidade aos Serviços de Saúde , Unidade Hospitalar de Ginecologia e Obstetrícia , Serviços de Saúde Rural , Adulto , Colúmbia Britânica , Cesárea , Feminino , Sofrimento Fetal/terapia , Acessibilidade aos Serviços de Saúde/organização & administração , Hospitais Comunitários/organização & administração , Hospitais Rurais/organização & administração , Humanos , Indígenas Norte-Americanos , Unidade Hospitalar de Ginecologia e Obstetrícia/organização & administração , Transferência de Pacientes , Gravidez , Complicações na Gravidez , Resultado da Gravidez , Fatores de Risco , Serviços de Saúde Rural/organização & administraçãoRESUMO
OBJECTIVE: To determine whether a small, isolated hospital that has no facilities to perform cesarean section and handles fewer than 50 deliveries annually can provide acceptably safe obstetric and perinatal care. DESIGN: Cohort study. SETTING: Southern region of the Queen Charlotte Islands, BC, served by a 21-bed hospital and medical clinic in Queen Charlotte City. The hospital and clinic are staffed by five family practitioners without local obstetric, pediatric, anesthetic or surgical support. PATIENTS: All women beyond 20 weeks' gestation who gave birth from Jan. 1, 1984, to Dec. 31, 1988; 33% were primiparous and 20% native. Of the 286 women 192 (67%) delivered locally, 33 (12%) were transferred after admission because of antepartum or intrapartum complications, and 61 (21%) delivered elsewhere by choice or on their physician's recommendation. OUTCOME MEASURES: Perinatal mortality rate and adverse perinatal outcome (death, birth weight of less than 2500 g, neonatal transfer or Apgar score of less than 7 at 5 minutes). MAIN RESULTS: There were six perinatal deaths, for a perinatal mortality rate of 20.8 (95% confidence interval [CI] 4.4 to 37.2). The hospital-based rate of adverse perinatal outcome was 6.2% (12 of 193 newborns) (95% CI 2.8% to 9.6%). CONCLUSIONS: The perinatal mortality rate is not a meaningful way to assess small populations; about 85 years of data would be required to decrease the 95% CIs from within 16 to within 4. The rate of adverse perinatal outcome in our study was consistent with the rate in other studies. Collaboration of small, rural hospitals is required to increase cohort size so that the correlation between the currently accepted standard, the perinatal mortality rate, and other outcome measures can be determined.