The clinical characteristics of brown recluse spider bites treated by family physicians: an OKPRN Study. Oklahoma Physicians Research Network.

BACKGROUND: The brown recluse spider (Loxosceles reclusa) has been recognized as a cause of necrotizing bites since at least 1957, but most of the literature consists of laboratory studies using animals, human sera, or case reports of more dramatic examples of bite reactions. Our goal was to develop a more comprehensive clinical description of the brown recluse spider bites treated by family physicians. METHODS: Two preprinted, postage-paid cards were given to physician members of the Oklahoma Physicians Research Network. One card was used for recording examination and treatment data, and the other was for tracking the progress of the bite until it was completely healed. For comparison, similar information was collected from the local poison control center. RESULTS: From April 1996 to August 1998, the physicians recorded 149 bites. Most of the victims were women aged 18 to 65 years, and most sought treatment within 3 days. Pain was common but not universal. Most bites were located on the extremities. Erythema was always present, but necrosis was present in only 40% of the bites. Some systemic signs or symptoms were common. The most frequent forms of treatment were systemic antibiotics (66% of cases) and conservative wound management (56%). Only 1 hospitalization occurred; 43% of the bites healed within 2 weeks; and only 13% resulted in scarring. CONCLUSIONS: The brown recluse spider bite is a relatively common problem treated by family physicians in Oklahoma. Most bites are not serious. More research at the practice level is needed to develop diagnostic criteria and to explore the effectiveness of various treatment options.

Patient-physician E-mail communication.

A significant number of Oklahomans are using computers and have e-mail access either at home or at work. Consecutive patients seen by 23 family physician members of the Oklahoma Physicians Research/Resource Network (OKPRN) were queried regarding their use of computers and access to e-mail. The numbers are higher in urban and suburban areas than in medium and smaller towns and rural areas. Of those who have e-mail access now or are planning to get it within six months, a substantial majority would like to use this medium to interact with their family physician. Potential uses for e-mail technology and problems to be overcome are discussed.

The sixth level of electronic health records: a look beyond the screen.

A recent publication details five levels of electronic health records as defined by the Medical Records Institute and notes that no computer-based patient record system from any company meets the criteria set by the Institute of Medicine. The present article calls to the attention of potential purchasers of medical record software our observation that even if a package appears to meet the abstract criteria for all five levels of electronic health records, its performance may not be satisfactory. A look beyond the user interface screen is highly recommended. Examples from our recent experience are given.