Statistical linkage of treatment to diagnosis for research and monitoring of practice patterns.

OBJECTIVES: At each patient contact general practitioners enter information about the diagnoses and the interventions in the electronic medical record (EMR) system. If there is only one diagnosis during a single patient-physician contact, then a causal connection between the diagnosis and the intervention is established. Otherwise it is uncertain what may have been the cause of the intervention. METHODS: Ideally the general practitioners would record a match between each intervention and the diagnosis that justifies it. However, most EMR software is not capable of recording explanatory matches. Furthermore, supplying the matches is a resource-demanding task. In this study the general practitioners were supplied with a matching module for the EMR, so data with full matching between intervention and diagnosis was collected (our "gold standard"). The study models how close the full matching can be recreated by model linkage using different kinds of simple assumptions. RESULTS: The modeling demonstrates a raise in the measure of prediction (sensitivity) from 41.9 percent for a completely random linkage to 90.9 percent based on simple assumptions in the model. The small substantial potential further gain makes it less attractive to apply more intricate assumptions or use more complex modeling (including neural networks). CONCLUSIONS: The perspective of the study lies in the support of the general practitioners with software for comparison of their decisions with those of their peers and also with guidelines. Thus a system for simple quality assurance and awareness to untypical decisions could be incorporated into the electronic medical record systems.

[Latex allergy]. / Latexallergi.

Latex allergy has been described with increasing frequency throughout the last years. The prevalence in Denmark is not yet known. The growing frequency is partly explained by the extensive use of latex-containing products (especially gloves), which has followed the appearance of the HIV-epidemic. The symptoms of latex allergy are usually those produced by type-I hypersensitivity. Type-IV allergy (contact dermatitis) to rubber chemicals is well described but is not directly associated with the latex proteins. The allergens in latex have nearly been identified; diagnostic tools are known but are not yet satisfactory. Cross-reacting antigens are found in banana, kiwi, avocado, chestnut and other plants. It is concluded, that attention to latex allergy has to be intensified and the risk factors reduced, especially concerning the health care units.

[Latex allergy in children]. / Latexallergi hos børn.

More than a thousand cases of type-1 latex allergy have been presented. In children the condition is most often described in patients with spina bifida. Six cases of latex allergy in atopic children are presented. Five of these had food allergies, especially to banana. The allergy was verified with prick-test, LHR-test and measurement of specific IgE. It is concluded that attention to latex allergy in atopic children has to be intensified. Prick-test with standardised latex extracts is the preferred method for diagnosis of the allergy. Latex dummies, latex toys, balloons etc, have to be avoided.

[Arteritis as the cause of fatal coronary thrombosis]. / Arteritis som årsag til letal koronartrombose.

Arteritis of the coronary arteries is a rare phenomenon. The cause is not always known. Transient ischaemia and even thrombosis of the arteries may be seen. The case of a 35 year-old man who died following myocardial infarction are presented and discussed. Even younger people with severe chest pain ought to be hospitalized immediately.

[Liver biopsies--complications and consequences. A retrospective study of 147 percutaneous biopsies]. / Leverbiopsier--komplikationer og konsekvenser. En retrospektiv opgørelse over 147 perkutane biopsier.

A retrospective study of 145 inpatients who during a five-year period underwent 147 percutaneous liver biopsies is presented. 8.2% of the biopsies were undertaken with ultrasound detection, 91.8% a.m. Menghini. Forty-four percent of the patients were suspected of alcohol induced liver disease, 20% had suspected malignancies. 7.5% had minor complications and 2.7% major complications after biopsy. The presence of risk factors was more pronounced among the patients who had complications than among those who did not. Seven patients underwent treatment for their liver disease after biopsy; none of these had alcohol induced liver disease, 1.6% of the bed days in the department were occupied by liver biopsy patients. It is concluded that percutaneous liver biopsy is a common, simple and cheap diagnostic procedure, but is not without risks. Risk patients can often be identified before biopsy.

The neurovascular island flap for defective sensibility of the thumb.

In six patients with defective sensibility of the thumb the transfer of a neurovascular island flap was performed according to Littler's technique. This review one to eleven years later was mainly to determine if reorientation of the cortical representation of stimuli had developed and if tactile gnosis had persisted. The pick-up test was carried through by the three patients with a lesion of the dominant hand. All six patients referred pin-prick in the flap to the donor finger; all had absent two-point discrimination corresponding to the flap, although it had been present within normal limits a few months after operation; and all had better touch, pain and temperature sensibility in the flap than in the surrounding recipient area. All six reported functional improvement. For the best results an intelligent patient is required who has a lesion of the dominant hand and is prepared to use or exercise it regularly.