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Clinic Records (clinic + record)

Distribution by Scientific Domains
Medical Sciences75%

Selected Abstracts

The Impact of Governmental Guidance on the Time Taken to Receive a Prescription for Medication for ADHD in England

CHILD AND ADOLESCENT MENTAL HEALTH, Issue 1 2010
David M. Foreman
The National Health Service in England has deployed guidance from the National Institute of Clinical Excellence (NICE) to assist practitioners in the diagnosis and treatment of Attention Deficit Hyperactivity Disorder (ADHD) but, though the number of prescriptions has risen since its introduction, the impact of the guidance on prescribing practice has not been studied. Clinic records of all open ADHD cases (296) in three English Child and Adolescent Mental Health Services were examined. The time from referral to either prescription or data collection was extracted for a survival analysis. It was hypothesised that NICE guidance, clinic, patient and referral characteristics would all influence the speed and likelihood of prescription. Following the introduction of NICE guidance, the median time to start prescribing medication fell from 1262 to 526 days: the minimum realistic time to complete a routine assessment was approximately 70 days. Overall, 70% were prescribed medication. Most of the wait was after face-to-face appointments at the clinic had been initiated. Waiting times differed between clinics and shorter waits were likely for older children and those referred from an educational source. While the introduction of NICE guidance has increased the rate of prescription, the time taken before prescription suggests that the tendency in England is still to postpone treatment by medication. The reasons for this require further research. [source]

Associations between tobacco and cannabis use in remote indigenous populations in Northern Australia

ADDICTION, Issue 3 2005
Alan R. Clough
ABSTRACT Aims To assess whether cannabis use, recently taken up by many indigenous Australians in remote communities, has reinforced tobacco use. Design Cross-sectional study. Setting Three eastern Arnhem Land communities (Northern Territory, NT); total population = 3384, in 2001. Participants From 1247 people aged 17,36 years, 190 (120 males, 70 females) were opportunistically recruited. Measurements Self-reported life-time and current tobacco, cannabis and other substance use were confirmed by local health workers and using clinic records. Participants reported level of substance use, frequency and duration (years used). Associations with tobacco use were calculated (odds ratios: OR) using logistic regression with age, sex, alcohol use and a history of petrol sniffing as confounders. Findings In univariate analyses current tobacco users were more likely than non-users to be using cannabis (OR = 3.1, 1.5,6.2, P = 0.002) and this association remained in multivariate analyses (OR = 3.0, 1.4,6.8, P = 0.006). Tobacco use was associated with the number of years of cannabis use (P = 0.035). The likelihood that tobacco users were also cannabis users increased as quantity of cannabis used increased (P = 0.008). Current tobacco use was no more likely in those who initiated cannabis from 1998 onwards than in those who initiated cannabis before 1998 (OR = 1.1, 0.4,3.2, P = 0.881). One-third of life-time users of both tobacco and cannabis initiated their use at or near the same time, and very few of these (12%) had discontinued either cannabis or tobacco. Conclusions Cannabis appears to have influenced the continued use of tobacco in these populations with possible additional burdens for cardiovascular and respiratory diseases and challenges for interventions. [source]

Untreated Hypertension and the Emergency Department: A Chance to Intervene?

ACADEMIC EMERGENCY MEDICINE, Issue 6 2008
Craig A. Umscheid MD
Abstract Objectives:, Untreated hypertension (HTN) is a major public health problem. Screening for untreated HTN in the emergency department (ED) may lead to appropriate treatment of more patients. The authors investigated the accuracy of identifying HTN in the ED, the proportion of ED patients with untreated HTN, patient characteristics predicting untreated HTN, and provider documentation of untreated HTN. Methods:, The authors performed a retrospective cross-sectional study on a random sample of 2,061 adults treated at an urban academic ED. The validity of six candidate definitions of HTN in the ED was assessed in a subsample using outpatient clinic records as the reference standard. "Untreated HTN" was HTN without a HTN medication listed in the ED history. "Documentation of untreated HTN was documentation of HTN as a visit problem, specific referral for HTN, or ED discharge with a HTN" information sheet or a HTN medication. Multivariable logistic regression was used to determine associations. Results:, The preferred definition of HTN in the ED had sensitivity of 86% (95% confidence interval [CI] = 80% to 90%), specificity of 78% (95% CI = 69% to 85%), and accuracy of 83% (95% CI = 78% to 87%). Of the 42% (95% CI = 40% to 44%) of ED patients with HTN, 43% (95% CI = 39% to 46%) had untreated HTN. Patients who were younger and male, without primary care physicians, with fewer prior ED visits, and without cardiovascular comorbidities, had higher odds of untreated HTN. Of those with untreated HTN, 8% (95% CI = 5% to 11%) had their untreated HTN documented. Conclusions:, Untreated HTN was common in the ED but rarely documented. Providers can use ED blood pressures along with patient characteristics to identify those with untreated HTN for referral to primary care. [source]

Our experience in eight cases with urinary hydatid disease: A series of 372 cases held in nine different clinics

INTERNATIONAL JOURNAL OF UROLOGY, Issue 9 2006
LMAZ
Objectives: Hydatid disease, a parasitic infestation caused by the larval stage of the cestode Echinococcus granulosus, is diagnosed commonly in the east and south-east regions of Turkey. The aim of this study is to emphasize the relatively frequent occurrences of echinococcosis in our region, and to discuss therapeutic options and treatment results according to current literature. Methods: A retrospective 10-year review of nine different clinics' records of the Research Hospital of the Medical School of Yüzüncü Y,l University revealed 372 hydatid disease cases that were localized in various organs and treated surgically (271 cases) or drained percutaneously (99 cases). Hydatid disease was diagnosed by ultrasonography (US) and computed tomography scans (CT) and confirmed histopathologically. Results: The involved organ was lung in 203 cases (131 adults, 72 children), liver in 150, spleen in 9, brain in 2, kidneys in 7 cases and the retrovesical area in 1 case. The urogenital system is involved at a rate of 2.15%. Two hundred and seventy-one cases were treated surgically and 99 percutaneously. Two cases with renal hydatid cyst refused the surgical procedure (one had a solitary kidney with hydatid cyst). Albendazole was administered to 192 patients; 93 patients had open surgical procedure and 99 patients underwent percutaneous procedure. Cysts were excised totally in the open surgical procedure; however, involved kidneys were removed totally (four cases) except one. Cystectomy and omentoplasty was performed in one case. Complications were as follows: in six cases, cystic material was spilled into the bronchial cavity during the dissection and a renal hydatid cyst ruptured and spilled retroperitoneally. Conclusion: Hydatid disease is a serious health problem in Turkey. The mainly affected organs are liver and lung. It can be treated surgical or by percutaneous aspiration. [source]