Teleretinography into diabetes integrated care: an Italian experience.

Introduction: Integrated care, by allowing information exchange among health professionals, improves outcomes and favours a reduction in hospital admission in diabetes. Retinal complications can be sight-threatening, and diabetic patients often miss the suggested yearly clinical examination.

Methods: Teleretinography can be easily performed in patients attending Diabetes Clinics: images are sent to a remote ophthalmologist, grading and instructions are received and forwarded to General Practitioners by a dedicated software.

Testing the reliability and efficiency of the pilot Mixed Methods Appraisal Tool (MMAT) for systematic mixed studies review.

Background: Systematic literature reviews identify, select, appraise, and synthesize relevant literature on a particular topic. Typically, these reviews examine primary studies based on similar methods, e.g.

Assessing the benefits of participatory research: a rationale for a realist review.

Participatory research (PR) experts believe that increased community and stakeholder participation in research augments program pertinence, quality, outcome, sustainability, uptake, and transferability. There is, however, a dearth of assessments and measurement tools to demonstrate the contribution of participation in health research and interventions. One systematic review of PR, conducted for the Agency for Health Research and Quality (AHRQ), provided no conclusive evidence concerning the benefits of community participation to enhance research and health outcomes.

Assessing the outcomes of participatory research: protocol for identifying, selecting, appraising and synthesizing the literature for realist review.

Background: Participatory Research (PR) entails the co-governance of research by academic researchers and end-users. End-users are those who are affected by issues under study (e.g.

Through interpreters' eyes: comparing roles of professional and family interpreters.

Objective: We describe and compare the perceptions of professional and family member interpreters concerning their roles and tasks as interpreters in primary care clinical encounters.

Methods: Encounters between physicians (19) and patients (24) accompanied by a professional (6) or a family (9) interpreter were videotaped. Stimulated recall was used to elicit interpreters' perceptions of their role in the clinical encounter.

Doctor-patient communication in primary care with an interpreter: physician perceptions of professional and family interpreters.

Objective: This paper explores physician perceptions of the ways professional and family interpreters affect their performance of doctor-communication tasks described in the Calgary-Cambridge Framework.

Methods: Physicians' (19) encounters with patients (24) accompanied by an interpreter were videotaped. Stimulated recall was used to elicit each of the participants' perceptions of the clinical encounter.

[Pure gonad dysgenesia or Swyer sindrome. A case report having tumoral development: melanoma].

A 14 year old girl having 10-days lumbar pain, polaquiuria and moderate pain to palpation is reported. Blood and urine analysis were normal. Abdominal ultrasound scan showed cavity free and solid, rounded, heterogeneous, intrapelvic mass compressing bladder and uterus.

Expanded polytetrafluoroethylene graft for bypass surgery using the excimer laser-assisted nonocclusive anastomosis technique.

Object: Patients with complex craniocerebral pathophysiologies such as giant cerebral aneurysms, skull base tumors, and/or carotid artery occlusive disease are candidates for a revascularization procedure to augment or preserve cerebral blood flow. However, the brain is susceptible to ischemia, and therefore the excimer laser-assisted nonocclusive anastomosis (ELANA) technique has been developed to overcome temporary occlusion. Harvesting autologous vessels of reasonable quality, which is necessary for this technique, may at times be problematic or impossible due to the underlying systemic vascular disease.

Efficient diagnosis of common complaints: a comparative study in the United States and England.

Background: The purpose of this investigation was to compare the diagnostic efficiency of American and British family and general practitioners, as measured by their utilization of health care resources and the average length of the diagnostic interval, in diagnosing common complaints.

Methods: Several hundred charts from teaching practices in the United States and England were identified by computer search and reviewed. The charts were those of patients who had presented between 1978 and 1988 with a complaint of chest pain and were subsequently diagnosed as having angina pectoris or reflux esophagitis, or who presented with a complaint of shortness of breath and were subsequently diagnosed as having heart failure or asthma.

Teaching the differential diagnosis of common complaints to medical students.

Differential diagnosis of common complaints is a curricular area appropriate for family medicine. Not usually taught in medical school, it is an area in which family medicine faculty are competent and effective teachers. A new component of our sophomore family medicine seminars has been the use of cases that demonstrate problems in the differential diagnosis of common complaints and that illustrate important aspects of family medicine.

Differential diagnosis of chest pain.

The article is organized to approximate the process of problem solving that most physicians use to make a diagnosis in patients who complain of chest pain. Initially, the presenting symptom suggests several diagnostic possibilities. Additional, more specific, historic findings, physical findings, and the results of diagnostic studies further define and reduce the initial diagnostic list.

Influence of stereotypes in the diagnosis of depression by family practice residents.

The focus of this study was on the diagnosis of depression by family practice residents. The sensitivity and specificity of the residents for depression were determined by comparing their diagnoses with the results of an objective assessment of depression for a group of 222 ambulatory patients from a family practice center. The objective assessment involved the administration of the Beck Depression Index to the patients, whereas charts were audited for resident diagnoses.

The application of behavior modification to behavior management: guidelines for the family physician.

Treatment in ambulatory care settings depends on the patient's behavior to implement the regimen prescribed by the family physician. Behavior modification offers a means for developing behavioral programs that will improve the physician's ability to effectively influence the patient's behavior. This article outlines some of the principles of behavior modification as they can be applied in office settings to diverse behavioral problems.

Effective use of patient resources: a training guide for family physicians.

Effective use of resources available to patients in their homes, in their neighborhoods, and in their communities can give the family physician much assistance in the provision of total health care to his patients and their families. Patients' resources can be divided into two broad categories--"Personal" and "Institutional". Examples of the former are family, church, neighbors, unions, etc.

Increasing the inotropic effect and toxic dose of digitalis by the administration of antikaliuretic drugs--further evidence for a cardiac effect of diuretic agents.

In prior studies, we have shown that the antikaliuretic drugs, triamterene and amiloride, through a direct cardiac effect reduce the loss of cardiac potassium induced by the administration of digitalis. Since loss of myocardial potassium is thought to underlie digitalis arrhythmias, this study was performed to determine whether triamterene and amiloride also extend the toxic dose and thus the therapeutic effect of digitalis. In twelve dogs, acetylstrophanthidin was infused (100 ug per minute) serially at 2.

Cardiac effect of diuretic drugs.

Triamterene, amiloride, ethacrynic acid, and furosemide were studied to determine whether they modified the digitalis-induced egress of myocardial potassium which is thought to facilitate the development of digitalis arrhythmias. In a control group of 15 dogs, potassium was measured in samples obtained simultaneously from the femoral artery (FA) and the coronary sinus (CS) in a control period and at intervals after the administration of 1 mg. of acetylstrophanthidin.