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Biomedical subjects

F Quirce

Publications and source records attributed to F Quirce.

16 recordsLinked to original sources
PubMed2005

The effect of written information on adherence to antibiotic treatment in acute sore throat.

A randomised clinical trial was conducted to establish whether written instructions, in addition to verbal ones, significantly improve adherence to antibiotic treatment for acute sore throat in comparison with verbal instructions only. Patients were selected by consecutive sampling at seven primary healthcare surgeries. The pill count average was 87.4+/-25.2% and it was higher in the intervention group (93.7+/-24.5%) than in the control group (81.1+/-24.5%) (P < 0.05). Absolute risk reduction was 14% (95% confidence interval (CI), -3.77 to 26.56); relative risk reduction was 24.9% (95% CI, -11.04 to 58.28); the number needed to treat was 8.77. Written instructions, in addition to verbal ones, significantly improve compliance with antibiotic treatment in tonsillitis of acute sore throat in comparison with verbal instructions only.

Acute Disease↗
PubMed1996

[Quality of drug prescriptions by the Spanish internal medicine services].

Many registered drugs in different countries not always have been tested by clinical assays and their efficacy has no definitively proved. Good clinical practice must assume the prescription of the more efficacy drugs. The aim of this study is to evaluate the quality of the drugs prescribed by spanish general internists. We analyze the treatments prescribed by general internists using their hospital medical records. The records were offered by the Heads of the Internal Medecine Departments of Spanish hospitals with 250 beds or more when required by the Spanish Society of Internal Medecine. A random sample, stratified by the hospital size, was obtained from the whole of the Spanish hospitals. Quality of the drugs was determined using two criteria: A. Their intrinsic value; it was decided it was high if clinical assays showed their efficacy and security, and low of it was not B. The number of different chemical substances in the drug; we considered a high quality criteria if only one chemical substance, or two with proved synergistic efficacy were present, and low if it was more than two, or without proved synergistic efficacy. The sample was 250 clinical records, with 1022 different prescriptions; the records were collected between February and July 1994. We found that 94.06 +/- 1.45 of evaluated treatments have a high intrinsic value, and 96.93 +/- 1.06 have only one chemical component. The drugs without a high intrinsic value were: oral hypoglycaemics, some including several combinations of vit B, drugs acting on the cerebral blood flow and some mucolitics. Spanish general Internists usually prescribed monocomponent drugs with proved efficacy and safety.

Drug Prescriptions↗
PubMed1995

[Importance of HDL cholesterol determination in the evaluation of coronary risk in clinical practice].

OBJECTIVE: To validate to what extent the isolated determination of total Cholesterol (TC) is effective when seeking to predict coronary risk. DESIGN: An observational crossover study of the analytic determinations of the clinics which systematically request TC and HDL-Cholesterol (HDL)--case-finding method. SETTING: Health Centre. PARTICIPANTS: 631 analytic determinations, with samples from people who attended a Health Centre between May and November 1992, were studied. MEASUREMENTS AND MAIN RESULTS: As proof of certainty the Atherogenic Index (AI) was used for the relative risks (RR) of suffering a coronary event in line with the Framingham study. The confidence limits (CL) were calculated to 95% in order to quantify random error and permit comparison. On varying the cut-off points of TC the indicators changed, being more sensitive (S) and less specific (E) with the lower figures: 180 mg/dl, RR > 1, S = 97.5% (CL: 100-94.7) and E = 30.5% (36.8-24.2); RR > 2, S = 100%, E = 22.1% (26.9-17.3) and RR > 3, S = 100%, E = 20.8% (25.3-16.3). As values of TC increase, S diminishes and E increases: 250 mg/dl, RR > 1, S = 48.3% (57.2-39.4), E = 87.2% (91.8-82.6); RR > 2, S = 58.6% (76.5-40.7), E = 77.2% (82-72.4) and RR > 3, S = 63.6% (92-35.2), E = 75.3% (80.1-70.5). CONCLUSIONS: HDL must be determined if TC is -200 mg/dl. If everyone with RR > 2 is to be detected, HDL-cholesterol from TC > or = 180 mg/dl must be measured.

Adult↗
PubMed1995

[Diabetes mellitus mortality in Spain: a comparative analysis between Spanish provinces in the period of 1981-1986].

OBJECTIVE: To find and compare mortality because of diabetes mellitus (DM) among the different provinces of Spain in the 1981 to 1986 period. SETTING: The natural movement of population figures of the National Institute of Statistics (INE) and the census of 1981 and register of 1986 were used. DESIGN: A descriptive observation study of a crossover type. Standardisation of rates by the indirect method. Calculation of the ratio of standardised mortality for each province. RESULTS: At the national level, the Communities with an excess of mortality in 1981 were Andalusia, Melilla, the Community of Valencia, Murcia, the Balearics, the Canaries and Extremadura, as well as the provinces of Tarragona, Gerona, Ciudad Real and Albacete. In 1986 the following still had excess of mortality: Andalusia, the Community of Valencia, Murcia, the Balearics, the Canaries, Asturias and Cantabria, along with the provinces of Badajoz and Pontevedra. CONCLUSIONS: The provinces with an excess mortality because of diabetes mellitus are geographically grouped (with some exceptions) in the south and south-east of Spain and the island communities.

Adult↗
PubMed1995

[Opinion of university professors on the suitability of specific primary care training in medical students].

OBJECTIVE: To find the opinion of teachers at the University of Alicante about the appropriateness of a Primary Care Theory-Practice programme within the Medicine curriculum. DESIGN: A descriptive observation study of a crossover nature. SETTING: Teachers of the Departments of Medicine and Public Health who had had contact with the Primary Care Theory-Practice programme. PARTICIPANTS: 44 out of 71 teachers (62%) replied. INTERVENTION: An 11-question survey was answered anonymously between October 1993 and June 1994. MEASUREMENTS AND MAIN RESULTS: 77.3% (95% Confidence Interval 64.9-89.7%) considered appropriate the theoretical content at undergraduate level, where there was an average 18.5 hours teaching (C.I. 15.8-21.2); and 95.5% (C.I.89.4-100%), the practicals at a Health Centre, where there was an average 65.2 hours (C.I. 43.1-87.3) work. 43.9% thought it was appropriate to form a separate subject and 39% favored integrating these themes into other subjects. Theoretical contents would be basically teaching general information about Primary Care; and practical work would be clinical activities. The greatest advantages regarding carrying out practical work in Health Centres were: the student finds pathology more prevalent and learns to provide practical answers. The greatest disadvantages were: the low methodological knowledge and teaching preparation of the Teams. CONCLUSIONS: Those interviewed considered that the teaching at undergraduate level of a Primary Care subject with theoretical-practical content would be useful. The advantages, its contents and some difficulties were noted.

Aged↗
PubMed1994

[An opinion/satisfaction survey on 2 models of clinical histories used in primary care].

OBJECTIVE: We aimed to discover the opinion of primary care doctors regarding the structure, usefulness and problems when using two models of clinical records employed consecutively in the same health centres. DESIGN: A double crossover study. An opinion poll (with 22 closed questions and one open), filled out in 1988 (evaluating the type A clinical record) and then in 1992 (for type B), was used. Chi squared statistical analysis with Yates corrections and Fisher test. SETTING AND PARTICIPANTS: Staff doctors and third-year family and community medicine interns at their teaching centres in Alicante province. In 1988, 49 doctors took part, and in 1992, 68: 70 and 75% respectively of the target group. RESULTS: The new record was an improvement over the earlier one. It was broader and corresponded more closely to the actual case. But problems of completion and legibility persisted, as did the difficulties in filling out socio-economic data and work/school history. Model B favoured use by all the team members. It was better for new patients and when doing later checks, although it did not avoid the accumulation of inactive documentation. The need for specific documents for preventive activities was detected. Computerisation would improve manageability. For both models lack of time was the main reason for under-recording. CONCLUSIONS: The new model is better than the earlier one but is lacking in the areas of manageability and difficulty in retrieving information. The methodology employed shows its use for evaluating health-care innovations and detecting insufficiencies, as well as allowing user-satisfaction to be more easily identified.

Attitude of Health Personnel↗
PubMed1993

[The benefits of auditing clinical histories. Our experience over 5 years].

OBJECTIVE: To evaluate how our clinical records (CR) are filled in and to observe the impact of measures taken to correct faults found over a five-year follow-up period. DESIGN: Three descriptive studies (auditing methodologies) on representative samples of CR selected at random. Four quality indicators were fixed: internal communication (i.e. legibility and comprehensibility), external communication, manageability and the quality of the activity at attendances measured by the SOAP. The optimum standards (OS) were agreed by the team (technique of nominal group). SETTING: "Florida" Health Centre, Alicante. PATIENTS AND OTHERS PARTICIPANTS: Periodic team meetings to analyse results and agree activities. In 1986, N of CR = 367; in 1988, 370; and in 1990, 372. MAIN MEASUREMENTS AND RESULTS: During the follow-up period, the filling-in of all the variables, except the address, the test carried out and blood pressure, improved. But the following did not reach the OS: code, affiliation, origin, instruction, habits, allergies, working activity, socio-economic data, age and gender, family/personal background, test carried out, blood pressure and analytical data. The following all reached the OS: legibility, which went up from 88% to 96.5%, comprehensibility from 62 to 75.3%, external communication from 81 to 88.9%, manageability from 53 to 79.6% and SOAP from 62 to 82.5%. CONCLUSIONS: Auditing allows the level of the filling-in of the CR to be measured. Deficiencies which appear to be due to the design of the record itself can be detected. The efficacy of corrective measures to improve records can also be assessed.

Communication↗
PubMed1993

[Undergraduate training in primary health care: 6 years' experience at the University of Alicante].

OBJECTIVE: To assess the opinion of medical students on the teaching offered in the Primary Care context (TOPC). DESIGN: Observational and crossover study. The assessment used an opinion questionnaire. PARTICIPANTS: 296 sixth-year medical students between 1987 and 1992. INTERVENTIONS: The TOPC consisted of four weeks stay in a Health Centre with an eminently practical programme. However this also included hour-long theoretical seminars on the most important Primary Care questions and the student's completion of a research project related to Primary Care. RESULTS: The students expressed satisfaction with the TOPC (average score of 4 out of 5). Moreover this satisfaction increased over the five years (from 3.7 to 4.6, p = 0.0001). They believed the TOPC to be useful (3.6 to 4.7, p = 0.0001) and relevant to their future professional activity (3.1 to 4.6, p = 0.0001). They thought that the tutors were very competent (4 out of 5, with no significant variation) and the Health Centres' teaching facilities suitable (3.8 to 4, with no significant variation). Finally, they considered that TOPC should become a compulsory undergraduate subject (3.9 out of 5). CONCLUSIONS: Medical students give a positive rating to the Primary Care teaching offered and believe it should be integrated into the Medicine syllabus as a compulsory subject.

Adult↗
PubMedDate not supplied

[Medicine at the primary care level (optional undergraduate subject at the University of Alicante): 2 years of experience].

OBJECTIVE: We want to put on record two years' experience of undergraduate teaching of an optional subject, "Medicine at the Primary Care level". This was given to sixth-year students by Family and Community Medicine specialist doctors within the Department of Medicine. DESIGN AND SETTING: A crossover study carried out at the University of Alicante. PARTICIPANTS: In the first year, 73 out of the 102 students making up the complete course took part (71.6%); and in the second year, 33 out of 93 (35.5%). MEASUREMENTS AND MAIN RESULTS: The methodology employed, the teaching staff and the documents handed out were given high marks by the students in both cases; as were the course contents in the second year. Deficiencies were noted in the presentation of practical hypotheses. In the first course the students criticised the lack of certain points, basically the tackling of the more common chronic pathologies, something which was corrected in the second year. The survey identified students' wishes to spend longer on the subject. CONCLUSIONS: The students valued positively the existence of a theoretical content specific to Primary Care Medicine. In particular, they requested to be taught performance patterns for prevalent pathologies and for seminars to be organised around practical hypotheses.

Education, Medical↗