RESUMO
Wide variations in antibiotic prescribing for otitis media have suggested the need to discover the causes of the differences and help doctors reach agreement. Simulated cases--in the form of written clinical data extracts based on real patients--were used to study the diagnostic and prescribing behaviour of a group of six general practitioners. Clinical judgement analysis was used to model the way in which doctors diagnosed otitis media and their policy for using antibiotics. Most doctors performed consistently and their judgements could be fitted well to models using a small number of symptoms and signs. These models often differed from the policy they believed they were operating. This information was used as process feedback in a group discussion to help improve agreement within the practice on the management of otitis media. Some of the variation in behaviour observed at the start of the study was reduced by significant changes in that of the trainee. Other doctors changed little and some were sceptical of the validity of the experimental methods. The prospects for and difficulties of this type of analysis are discussed.
Assuntos
Antibacterianos/uso terapêutico , Medicina de Família e Comunidade , Julgamento , Otite Média/tratamento farmacológico , Uso de Medicamentos , Retroalimentação , Seguimentos , Humanos , Otite Média/diagnósticoAssuntos
Antibacterianos/uso terapêutico , Otite Média/tratamento farmacológico , Fatores Etários , América , Criança , Pré-Escolar , Europa (Continente) , Feminino , Antagonistas dos Receptores Histamínicos H1/uso terapêutico , Humanos , Lactente , Masculino , Otite Média/epidemiologia , Estações do Ano , Fatores Socioeconômicos , Membrana Timpânica/cirurgia , Reino Unido , Vasoconstritores/uso terapêuticoRESUMO
Seventy-six patients receiving regular haemodialysis, without biochemical or radiological evidence of renal osteodystrophy, entered a five-year double-blind placebo-controlled trial of calcitriol (1,25-dihydroxycholecalciferol) in the prevention of bone disease. Significantly more patients on placebo developed bone disease as judged by a sustained elevation of plasma alkaline phosphatase or the development of sub-periosteal erosions on hand radiographs. Serum parathyroid hormone fell significantly in the patients receiving calcitriol and was significantly lower than in patients receiving placebo. It is concluded that calcitriol delays and may prevent the development of metabolic bone disease in patients receiving regular haemodialysis therapy.
