A clinical audit of the quality of care of hypertension in general practice / Una Auditoría Clínica de la Calidad del Cuidado de la Hipertensión en la Práctica Médica General

Clinical audits monitor the use of particular interventions, or the care received by patients, against agreed standards. Any departures from [quot ]best practice[quot ] can then be examined, and causes can be determined and acted upon. The Ministry of Health (MOH), Jamaica, has recently published standards of care for hypertension. The medical records of a convenience sample of 125 hypertensive patients being managed by five current family medicine residents in their respective primary care practices were audited Initial results showed limited adherence to the MOH recommended hypertension management guidelines. The same practices were re-audited after an interval of six months, during which time the physicians were sensitized to the results of the preliminary audit. Marked improvements were noted in the second audit. Assessment for co-risk factors for hypertension-related diseases improved: nutritional advice (33% to 74%), smoking and alcohol intake history (40% to 65%) and history taking of physical activity (30% to 47%). Assessment for target organ damage also improved: fundoscopy done (11% to 54%), foot examination done (30% to 58%) and yearly electrolytes done (28% to 62%). There are clear gaps between current practice and standards that exist internationally and locally for management of hypertension. The MOH needs to disseminate and educate general practitioners about the standards of care guidelines

Los auditores clínicos monitorean el uso de intervenciones particulares, o la atención recibida por los pacientes, a fin de verificar si se cumplen las normas establecidas. Cualquier desviación de "la práctica estándar" puede ser entonces analizada, determinándose de ese modo las causas, y empren-diéndose las correspondientes acciones sobre ellas. El Ministerio de Salud (MS) de Jamaica, ha publicado recientemente las normas del cuidado de la hipertensión. A las historias clínicas de una muestra de conveniencia de 125 pacientes hipertensos tratados por cinco residentes de medicina familiar en sus respectivas consultas de atención primaria, se les practicó una auditoría. Los resul-tados iniciales mostraron una correspondencia limitada con las pautas para el tratamiento de la hipertensión recomendadas por el MS. Las mismas prácticas fueron sometidas de nuevo a auditoría, luego de un intervalo de seis meses, durante el cual se sensibilizó a los médicos con los resultados de la auditoría preliminar. En la segunda auditoría se observaron mejorías considerables. Mejoró la evaluación de los factores de co-riesgo por enfermedades relacionadas con la hipertensión: consejo nutricional (33% a 74%), historia de hábito de fumar y consumo de alcohol (40% a 65%), confección de historia de la actividad física (30% a 47%). También mejoró la evaluación de daños dirigida a órganos predeterminados: fondoscopia realizada (11% a 54%), examen de pies realizado (30% a 58%) y electrólitos anuales hechos (28% a 62%). Evidentemente hay lagunas entre la práctica común y las normas existentes internacional y localmente para el tratamiento de hipertensión. El MS necesita diseminar y educar médicos generales versados en las normas de cuidado establecidas.

A clinico-pathological study of yellow fever with demonstration of the virus in the human liver

The clinical histopathological and serological findings in three patients who developed yellow fever after entering the Guayaguayare forest in south-east Trinidad in January and February 1979 are described in this report. The patients were all previously healthy young males and the clinical features of the disease varied from fulminant viral hepatitis with hepato-renal failure to a self-limiting anicteric viral illness. The first patient died, and histopathological examination of the liver was done post-mortem. Needle biopsy of the liver was done on case 2 which presented with the clinical picture of infective hepatitis, and on case 3 with the features of an anicteric viral illness. The histopathological hallmarks of midzonal necrosis, granular eosinophilic degeneration (Councilman bodies) and fatty change in the parenchymal cells of the liver were seen in three cases. The electron microscopic study demonstrated the presence of the yellow fever virus in the liver of the patient who died.