Clinical prediction rule for pulmonary infiltrates

Article Abstract:

Chest X-rays are generally ordered for adult patients with acute respiratory problems to determine whether they have pulmonary infiltrates and should be diagnosed with pneumonia. However, the prevalence of pneumonia in such patients is low and, consequently, patients without pneumonia have unnecessary X-rays, resulting in increased cost and excess radiation exposure. It is possible to construct a set of clinical rules, based on signs and symptoms, which may be valid in predicting the presence of pneumonia. Because validation of these rules is essential, a set of prediction rules was developed using a population of 1,134 patients with acute respiratory complaints, and then tested in additional groups of 150 and 152 patients with similar problems. Five indicators were found to be predictive of pneumonia in adults with acute respiratory illness: temperature greater than 37.8 degrees Celsius (100 degrees Fahrenheit), pulse greater than 100 beats per minute, rales (abnormal chest sounds), decreased breath sounds, and the absence of asthma. In general, these rules detected between 90 and 93 percent of pneumonia cases and correctly excluded 35 to 47 percent of patients without pneumonia. The predicted prevalence of pneumonia correlated well with the actual frequency of pneumonia among the patients who were examined. These clinical prediction rules should be useful in predicting the probability of any patient having pneumonia and in helping a physician decide whether or not to order a chest X-ray. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Diagnosis, Pneumonia, Medical protocols

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Measuring procedural skills

Article Abstract:

A few preliminary studies have shown that guidelines can be developed for assessing the mastery of surgical procedures among surgical residents. Often the number of procedures needed to gain mastery is as many as twice that currently recommended. However, many health care facilities do not perform enough procedures to realistically provide residents with this level of experience. The quality of a resident's training may not be reflected in the number of procedures performed but rather in the competence displayed during evaluated procedures. Many currently practicing surgeons may not meet the standards proposed.

Editorial, Evaluation, Training, Residents (Medicine), Surgeons

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Bundle-Branch Block and In-Hospital Mortality in Acute Myocardial Infarction

Article Abstract:

Patients with bundle-branch blocks may be less likely to receive treatment after a heart attack, and more likely to die while hospitalized. Bundle-branch blocks (BBB) are electrical conduction defects in the heart. Researchers compared 297,832 heart attack patients, based on the presence or absence of a BBB. Only 16-32% of patients with BBBs received clot-dissolving drugs when indicated, while 67% of patients with electrically normal hearts received the drugs. Twenty-three percent of patients with a BBB died in the hospital, compared to only 13% of patients with no BBB.

Care and treatment, Prognosis, Heart attack, Heart, Electric properties, Heart block

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