Danger Symptoms Research Articles

MATERNAL MORBIDITY IN RURAL UPPER EGYPT: LEVELS, DETERMINANTS, AND CARE SEEKING

Although maternal morbidity constitutes a serious public health problem in Egypt, it has remained a neglected area for public health research. In this study we used a synthetic design combining quantitative and qualitative methods to determine the level of maternal morbidity as reported by mothers in rural Upper Egypt and to identify patterns and determinants of care seeking for perceived morbidity in pregnancy, childbirth, and the postpartum period. The reported incidence of danger symptoms indicated that maternal morbidity is a serious problem in Egypt and, therefore, warranted community-based interventions. The study suggested a model explaining the criteria women used to judge whether and from where they would seek care. The model incorporates three cognitive components related to the perceived frequency, and seriousness of the problem and the degree of personal responsibility for the problem. Utilization of care was shown to be low and significantly associated with poverty and husband illiteracy. Likewise, most deliveries were not attended by a trained health care workers, and these unattended deliveries were shown to be associated with nonutilization of antenatal care, illiteracy, nonownership of cattle, and inaccessibility to potable water.

General practitioners' management of low back pain: impact of clinical guidelines in a non-English-speaking country.

Cross-sectional. To evaluate the assessment of patients with low back pain by general practitioners (GPs) in a non-English-speaking country and to compare their behavior with AHCPR and CSAG clinical guidelines. The diffusion of clinical guidelines (and their everyday application by health care professionals) is a significant problem. Because most guidelines are developed in English, concerns over their diffusion are obviously greater in non-English-speaking countries. A questionnaire was sent to all the GPs in the province of Mantua, Italy (n = 318). The authors evaluated what examinations are routinely performed and what danger symptoms and signs prompt referral of patients. GPs indicated the frequency of their prescription of radiographs, computed tomography scans, magnetic resonance imaging, laboratory tests, and consultations. The findings were compared with a "gold standard": the AHCPR and CSAG clinical guidelines. The response rate was 68.2%. Only 28.0% of GPs perform all the tests considered important by the clinical guidelines, and 33.0% were aware of all the red flags. Correspondence with the clinical guideline recommendations ranged from 14.6% to 89.4%. There is a clear tendency to overprescribe examinations in acute cases, whereas in chronic cases underprescription is sometimes seen. In a non-English-speaking country the evaluation of low back pain by GPs does not reflect current recommendations, and the situation is seen to be worse than in English-speaking countries. Concerns over the diffusion of guidelines must therefore be considered greater in non-English-speaking countries, where thorough presentation to GPs of the existing "evidence-based" guidelines is to be recommended.

General practitioners' management of acute back pain: a survey of reported practice compared with clinical guidelines.

To compare general practitioners' reported management of acute back pain with 'evidence based' guidelines for its management. Confidential postal questionnaire. One health district in the South and West region. 236 general practitioners; 166 (70%) responded. Examination routinely performed, 'danger' symptoms and signs warranting urgent referral, advice given, and satisfaction with management. A minority of general practitioners do not examine reflexes routinely (27%, 95% confidence interval 20% to 34%), and a majority do not examine routinely for muscle weakness or sensation. Although most would refer patients with danger signs, some would not seek urgent advice for saddle anaesthesia (6%, 3% to 11%), extensor plantar response (45%, 37% to 53%), or neurological signs at multiple levels (15%, 10% to 21%). A minority do not give advice about back exercises (42%, 34% to 49%), fitness (34%, 26% to 41%), or everyday activities. A minority performed manipulation (20%) or acupuncture (6%). One third rated their satisfaction with management of back pain as 4 out of 10 or less. The management of back pain by general practitioners does not match the guidelines, but there is little evidence from general practice for many of the recommendations, including routine examination, activity modification, educational advice, and back exercises. General practitioners need to be more aware of danger symptoms and of the benefits of early mobilisation and possibly of manipulation for persisting symptoms. Guidelines should reference each recommendation and discuss study methodology and the setting of evidence.

Danger Signs and Symptoms

Home Healthcare Nurse: The Journal for the Home Care and Hospice Professional: September 1992 - Volume 10 - Issue 5 - p 64

A managerial approach to research and development cost-effectiveness evaluation

An overall research and development (R&D) cost-effectiveness evaluation system that is currently in operation is described and discussed. Evaluation is done on several cross sections of R&D management. For use with several usage objectives of cost effectiveness, some variations of the figure of merit (FOM) are shown. The FOM indicates R&D danger symptoms, especially on promising future trunk-line products. The authors conclude that cost-effectiveness evaluation can be used strategically by taking into consideration the phase of research, the product's life cycle, and future growth factors. Some prospects and analysis for future R&D are reviewed and discussed.< <ETX xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">&gt;</ETX>

Cancer of the Genitourinary Tract

AREALISTIC appraisal of knowledge concerning neoplastic disease in general and that affecting the organs of the genitourinary tract in particular leads to the conclusion that, although the indefinite future may bring new chemical and enzymatic means of preventing, arresting or even curing neoplastic disease, the present generation at least must continue to rely on surgical and radiation technics as the only effective methods of control. Any improvement in terms of patient survival must depend on the better application of both methods.This implies a continuation of effort to acquaint patients with the need for prompt recognition of danger symptoms and . . .