J Clin Nurs. 2007 Sep;16(9):1776-7
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Family Medicine Update
Important Medical news for family physicians and primary care providers
Validation of a clinical rule to predict complications of acute cough in preschool children: a prospective study in primary care.
29 September 2007
Br J Gen Pract. 2007 Jul;57(540):530-7
BACKGROUND: Few clinical rules have been derived let alone validated in primary care. A rule was derived to predict complications of acute cough in preschool children presenting to primary care. The clinical rule used the presence/absence of fever and/or chest signs to distinguish children at low, medium, and high risk of complications. AIM: To validate a clinical rule for predicting complications of acute cough in preschool children in primary care. DESIGN OF STUDY: Prospective cohort study. SETTING: Thirteen general practices in Bristol and Tayside, UK. METHOD: Preschool children with cough up to 28 days and without asthma were recruited. The same sociodemographic, clinical history, examination, and complications data as for the derivation study were collected. First, univariable logistic regression was used to explore the associations with complications, and then predictors with stronger relationships (P<0.2) were modelled using multivariable logistic regression. These predictors were compared with derivation predictors with respect to their strength of association with complications. The derivation predictors were used in the validation dataset to allow comparison of the post-test probabilities of complications between derivation and validation studies. RESULTS: The presence of fever and chest signs in the validation study tended to be protective for complications, with univariable odds ratios (ORs) of 0.37 and 0.81 respectively, compared with ORs of 4.86 and 2.72 in the derivation study. However, 95% confidence limits were wide and evidence for two other possible reasons for these results were found: spectrum bias and confounding by indication. CONCLUSION: No evidence was found to validate the clinical rule for predicting complications of acute cough, possibly as a result of spectrum bias, confounding by indication, and/or chance. As paediatric infectious illness is costly and associated with high rates of antibiotic use, further research is needed to derive and validate prediction rules.
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[Schizophrenic patients in the family practice]
29 September 2007
MMW Fortschr Med. 2007 May 21;149 Suppl 2:98-101
For over 50 years, therapy with antipsychotics represented the mainstay for the treatment of schizophrenia.While pharmacological antipsychotic approaches are especially important during the acute course of the disease, other therapeutic procedures such as psychotherapy and sociotherapy have become increasingly important for maintenance and relapse therapies. Treatment with newer atypical antipsychotics provides a pharmacological therapy that can be adapted to the needs of the individual patient and includes aspects such as favourable side effect profiles, better quality of life and hence, increased medication compliance. Negative symptoms still represent a therapeutic challenge, especially in conjunction with chronic residual symptoms.
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