Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0242429 (sore throat)
 2,760 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We describe an outcome-based approach to quality assurance in primary care and present data from an initial study made to explore its usefulness. A questionnaire, which asked patients to report on the status of their problem in terms of the amount of symptoms, activity limitation, and anxiety it caused, was mailed to adults who had been seen a month previously for upper respiratory tract infection, sore throat, or urinary tract infection. Outcome standards developed for these conditions indicated that patients should report no symptoms, activity limitation, or anxiety. Of the 127 patients who responded, 17% failed to meet these standards. A review of their medical records was conducted to test the value of using substandard problem-status outcome as an indicator of important deficiencies in care. Definite deficiencies in care were found for 57% of those with substandard outcomes and for 2% of those with acceptable outcomes. Corrective action was judged likely to benefit 95% of the cases with substandard outcome and 7% of those with acceptable outcomes. Data from the medical records were insufficient to explain the reasons for substandard outcome in all cases, thus emphasizing the need to examine also patient- and system-related variables not evident in the medical record. An approach to quality assurance that is based on measuring outcome and then determining the reasons for poor outcome in useful for uncovering correctable errors in the delivery of primary care. In order for the approach to be effective in improving care, the outcome measures used must be sensitive to the role of primary care in assisting partients to resolve health problems.
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PMID:Quality assurance in primary care: a strategy based on outcome assessment. 73 Aug 40

A case study was conducted among college women using a student health service at a university in southern Michigan to identify and evaluate behavioral factors which may be determinants of urinary tract infection. Women who presented to the student health service with symptoms suggestive of urinary tract infection and found to have pyuria on urinalysis were offered the opportunity to participate in a clinical trial comparing antibiotic regimens in the treatment of their urinary infection. Women with identified structural abnormalities of the urinary tract were not admitted to the study. On their 1st visit, women enrolled in the antibiotic study were asked to complete a questionnaire for the epidemiologic study described here. Midstream specimens were obtained during the 1st visit prior to therapy and were cultured quantitatively using standard methods. A patient with symptoms of acute urinary tract infection was included as a case if the urine culture was positive or probable. 2 different control groups were used to assess risk factors for urinary tract infection. For the 1st control group, women presenting to the student health service with coryza and/or sore throat, an oral temperature of less than 38.9 degrees Centigrade, and a clinical diagnosis of uncomplicated viral upper respiratory infection were asked to complete the same questionnaire as cases. For the 2nd control group, women attending the gynecology clinic at the same student health service for routine scheduled pelvic examinations and/or contraceptive services were asked to complete the same questionnaire. Cases were entered into the study from March through December 1982. The students used as controls participated from March 1982 through March 1983. The subjects completed a standard self-administered multiple-choice questionnaire, asking primarily about activities during the 3 weeks prior to completion of the questionnaire. 47 women with presumptive urinary tract infection participated in the clinical trial. 43 cases of confirmed urinary tract infection were identified, 38 with a positive and 5 with a probable urine culture result. In all, 149 upper respiratory infection controls and 227 gynecology controls participated. The history of previous urinary tract infection was significantly greater in cases than in either of the control groups. 4 variables were included in the final logistic model: coital frequency within 3 weeks, use of the diaphragm within 3 weeks, history of previous urinary tract infection, and age. Coital frequency during the previous 3 weeks was associated strongly with illness, with generally higher risk at higher frequencies. A significant association with the diaphragm was observed in comparison with both control groups. The findings failed to show an association with many of the factors commonly believed to be important such as type of clothing worn and volume of fluids consumed.
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PMID:Risk factors for urinary tract infection. 363 Oct 58

A comparative study was made regarding the complications of abdominal and vaginal sterilization operations in order to evaluate the efficacy and safety of the 2 procedures. The cases were selected from outpatient departments and family planning clinics of the Patna Medical College (Patna, India) over the 1974-79 period. A preoperative assessment and investigation were performed in all cases. The operations were performed by modified Pomeroy's technique in 300 cases (Group A) by abdominal route and in 300 cases (Group B) by vaginal route. General anesthesia was administered in all cases. Subsequent follow-up was done at intervals of 6 weeks, 3 months, 6 months, 1 year, and up to 5 years. Follow-up attendance was unsatisfactory, but a comparative evaluation of the complications was done in both groups among patients who came for follow-up. Puerperal sterilization cases were excluded from the series. In Group A 149 sterilizations were done with medical termination of pregnancy (MTP) and the remaining were interval sterilizations. In Group B 148 were sterilizations with MTP and the remaining were interval sterilizations. The age varied between 28-42 years. The majority of the patients were more than 4 para in both groups. Pelvic sepsis was more common with vaginal sterilization operations. Complications were as follows in Group A: pyrexia, 30 cases; pain in abdomen, 75; urinary tract infection, 30; sore throat, cough, 60; stitch induration, 90; and wound disruption, 3. For Group B, complications were as follows: pyrexia, 90; pain in abdomen, 30; urinary tract infection, 75; sore throat, cough, 60; tuboovarian mass, 12; wound infection, 45; and persistent temperature rise, 12. The nature of complaints at follow-up for Group A were: leukorrhea, 30; menorrhagia, 60; irregular bleeding, 30; dysmenorrhea, 12; dyspareunia, 9; loss of libido, 9; and incisional hernia, 1. Complaints at follow-up were as follows for Group B: leukorrhea, 45; menorrhagia, 21; irregular bleeding, 60; dysmenorrhea, 75; dyspareunia, 60; loss of libido, 12; abdominal pain, 12; and stress incontinence, 3. In sum, the sterilization operation by abdominal route was much safer compared to the vaginal route.
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PMID:Complications after abdominal and vaginal sterilization operation. 687 69

Agranulocytosis is a rare complication of antithyroid drugs, and the aetiologies of community-acquired, life-threatening infections in patients taking these drugs have not previously been systematically described. Of 5653 hyperthyroid patients treated with antithyroid drugs at National Taiwan University Hospital between January 1987 and December 1997, 13 (0.23%) developed agranulocytosis with life-threatening infections. The most common presentations were fever (92%) and sore throat (85%). Initial clinical diagnoses were acute pharyngitis (46%), acute tonsillitis (38%), pneumonia (15%) and urinary tract infection (8%). Positive blood cultures from six patients yielded Pseudomonas aeruginosa (3), Escherichia coli (1), Staphylococcus aureus (1), Capnocytophaga species (1). Two patients died of uncontrolled infection, thyroid storm and multiple organ failure. Cases of antithyroid-drug-induced agranulocytosis in the English language literature are reviewed; Gram-negative bacilli, including Klebsiella pneumoniae (4 patients) and P. aeruginosa (3), were the most common pathogens in clinical isolates. Our observation and review suggest that broad-spectrum antibiotics with anti-pseudomonal activity should be given to patients with antithyroid drug-induced agranulocytosis who present with severe infection.
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PMID:Antithyroid-drug-induced agranulocytosis complicated by life-threatening infections. 1062 62

The purpose of our study was to determine the extent to which patients use antibiotics without consulting a physician and to examine patient characteristics associated with such oral antibiotic misuse. The study design was a prospective survey. The setting was a suburban, community, emergency department (ED). The participants were a convenience sample of oriented, ED patients who were enrolled during an 8-week period. Subjects provided written answers to standardized questions regarding their use of oral antibiotics over the 12 months preceding their ED visit. Categorical and continuous data were analyzed by chi-square and t-tests respectively. All test were 2-tailed with alpha set at 0.05. One thousand three hundred sixty three subjects were enrolled; 80% were White, 54% were female, 58% had attended college, 85% had a private physician, and 88% had health insurance. The mean age was 45 +/- 19 years. 43% of patients had used oral antibiotics within the past year. Twenty-two percent of patients indicated that their physicians routinely prescribed antibiotics for their cold symptoms. Seventeen percent of patients had taken "left-over" antibiotics without consulting their physician, most commonly for a cough (11%) or sore throat (42%), and much less frequently for urinary tract infection symptoms (0.7%). Women (19% versus 15% men; P =.04) and patients who attended college (19% versus 14% no college; P =.01) were more likely to have taken "left-over" antibiotics. A significant percentage of our ED patients had taken oral antibiotics without consulting a physician for symptoms frequently caused by viruses. Further study is warranted to examine whether local patterns of outpatient self-prescribing affect community oral antibiotic resistance.
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PMID:Oral antibiotic use without consulting a physician: a survey of ED patients. 1114 21

The clinical features of the sickle syndromes do not appear until after the sixth month of life, at which time most of the HbF has been replaced by HbS. Thrombo-embolic complications, retinopathy and renal papillary necrosis are more frequent in HbSC disease than in other sickle cell syndromes. First presentation of HbSC disease after the second decade is considered late in this environment. A 25 year-old Nigerian female patient is hereby presented with renal papillary necrosis as first presentation of HbSC disease. The patient presented with a sudden onset of total haematuria without history suggestive of urinary tract infection, trauma, instrumentation and significant analgesic consumption. No history of usage of herbal remedies, diabetes mellitus, sore throat, abdominal pains, skin rashes or joint pains. Physical examination did not show any characteristic habitus or findings. Findings on intravenous urography suggested renal papillary necrosis.
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PMID:Renal papillary necrosis as first presentation of a Nigerian sickle cell patient. 1240 47

Monitoring of general practice antibiotic prescribing is important to allow concordance with prescribing guidelines to be assessed. National Prescribing Analysis and Cost Data are limited by lack of information on the condition for which antibiotics are prescribed. Using the General Practice Research Database, we found that the 10 leading indications for antibacterial prescribing were (in descending order): upper respiratory tract infection (RTI), lower RTI, sore throat, urinary tract infection, otitis media, conjunctivitis, vague skin infections without a clear diagnosis, sinusitis, otitis externa and impetigo. Although for some conditions there appeared to be inappropriately high levels of antibacterial prescribing, the antibiotics chosen were usually those recommended for first-line treatment.
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PMID:Antibacterial prescribing in primary care. 1765 80

The landscape of primary care medicine is rapidly changing. The decline in interest, both in primary care fields and students choosing these career paths, has left a vacuum in the health care system that must be filled. One of the recent developments has been the birth of "convenient care centers," also known as "retail clinics." This form of health care delivery has mostly been entrepreneurial and based in retail organizations, such as drug stores. These walk-in clinics provide basic medical care for minor common medical conditions, such as sore throat, urinary tract infection, the common cold, and ear infections. Much of this care is provided not by physicians, but by nurse practitioners or physician assistants. After seeing the success of the earliest of these clinics, MinuteClinic by CVS, many other businesses joined the venture, and retail clinics popped up in Wal-Mart, Target, and many local grocery stores. Gradually, hospital systems, physician groups, and managed care companies have also entered the market, sometimes partnering with retail outlets, such as the local grocery store or Wal-Mart, and less often, starting a stand-alone facility. Only 12% of retail clinics are owned by hospital systems or physician groups, while 73% are owned by CVS, Walgreens, or Target. There is even a national nonprofit organization called the Convenient Care Association, started in 2006, and based in Philadelphia, PA. This new trend in delivering health care has been mostly, if not totally, ignored by the medical school practice plans, with the exception of the Mayo Clinic in Minnesota, which has developed several "express care" clinics as stand-alone facilities. As a medical school practice plan and a division of general internal medicine, we could continue to keep a blind eye toward this new trend in primary care medicine or embrace the concept. We aim to develop a new convenient care model integrating our College of Medicine practice plan in partnership with our College of Nursing graduate nursing program to form a stand-alone clinic within a bustling business district in downtown Philadelphia.
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PMID:Embracing the convenient care concept. 2010 83