An audit was performed of the documentation of pneumococcal vaccination in splenectomy patients in three major hospitals involving a geographical population base of 350,000 patients in British Columbia, Canada. Overall, 111 of the 164 hospitalized splenectomy patients (68%) had received pneumococcal vaccination. Of elective splenectomy cases, only 11 of 55 (20%) had been vaccinated prior to surgery, as is currently recommended. One hundred fifty-five patients (95%) had splenectomy status mentioned in the discharge summary. However, only 35 (21%) had mention of vaccination status, 10 (6%) mention of the need for future revaccination, and only 8 (5%) notation of the possibility of future infectious risks. The rate of pneumococcal vaccination was as satisfactory as any reported in the literature to date. However, there is need for improved education in relation to the timing of vaccination and discharge summary documentation. A checklist for potential splenectomy patients may aid in improving this situation as may geographically based splenectomy registries.

A simple method has been developed to classify the verbal interaction during medical consultations in terms of the relative proportions of medical and social content and the initiator of conversational topics discussed. The method has been applied to video tape recordings of three doctors' consultations with and without a computer present to classify and compare the items discussed. Actual computer use has been shown to have a medical effect on the consultations (p less than 0.05) and to increase the proportion of topics initiated by the doctor (p less than 0.001). Although this was largely accounted for by the massive increase in doctor initiated medical items resulting directly from computer use, there was evidence that, for two of the doctors, these topics were replacing some of the normal social and patient initiated medical exchanges.

This technical report describes the process followed in the development of the AAP practice parameter on acute gastroenteritis, as well as the evidence used to formulate the final recommendations. An evidence model that defined acute gastroenteritis and identified diagnostic tests and interventions used in its management and outcomes of importance was used to identify topics to include in the guideline. The three topics selected were: (1) methods of rehydration, (2) refeeding after rehydration, and (3) the use of antidiarrheal agents. Primary outcomes of interest were duration of disease, complications of therapy, parental satisfaction, and cost. Multiple bibliographic sources were searched to identify articles related to these areas; the sources included MEDLINE, reports on gastroenteritis from the Centers for Disease Control and Prevention and the World Health Organization, the Federal Register, a report to the Food and Drug Administration, and files of the expert panel. More than 4000 articles were initially reviewed, of which 230 were identified as being potentially related to the three topics. Qualitative aspects of the literature reviewed were summarized in evidence tables. Sufficient data for quantitative summary were available only for refeeding after rehydration. In this analysis, the weighted difference across studies between treatment and control groups in the mean duration of diarrhea was used as the measure of the relative benefit of one form of therapy over another. Methods of Rehydration Evidence comparing oral rehydration and intravenous therapy was limited to five reports of randomized trials conducted in developed countries. It was not possible to perform a quantitative synthesis of this information because of a lack of similar outcomes.

No abstract

No abstract