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Cystic fibrosis in Southern Africa. Including the preparation of a register of carriers and potential carriers.

Little has been published on cystic fibrosis (CF) in Whites in southern Africa, and no figures as to incidence exist. A register of CF patients, their parents (obligatory carriers), siblings, uncles, aunts and first cousins (potential carriers) has been compiled for southern Africa. The degree of co-operation shown by colleagues and by families whose addresses have been provided by them, and possible reasons for non-co-operation are discussed. From the numbers and birth dates of patients a rough estimate of the incidence in the Republic of South Africa, South West Africa and Rhodesia has been made. In all three regions, but especially in South Africa, incidence is likely to have been underestimated. Details available from the register include the number of CF patients alive and dead, those who presented with meconium ileus, the number of affected patients per family, consanguinity among the parents or grandparents, the frequency with which identical surnames were encountered, and the sibship sizes of all those on the register. Towns and districts with a population rich in the CF gene are mentioned. The number of potential carriers has been determined, so that they can be screened when a practicable detection test is devised. The register has answered a number of questions about CF in southern Africa. It has focused attention on the disease in the region and played a major catalytic role in the formation of the Southern African Cystic Fibrosis Association.

Child↗

A medical information system for ambulatory care, research, and curriculum in an army family practice residency: 51,113 patient problems.

Over a 16-month period, the Family Practice Residency at Madigan Army Medical Center coded 51,113 ambulatory problems using the International Classification of Health Problems in Primary Care (ICHPPC) coding scheme. The demography of this defined active duty, retired, and dependent population is described as well as the rank order of the major diagnostic categories and top 25 individual diagnoses. A plot of the major diagnostic categories seen by month over a 16-month period is presented. Comparisons between similar curves are made. Physician compliance to coding approached 75 percent and an average of 1.42 problems were dealt with (coded) per visit. Fifty percent of all patient problems recorded fell into 25 descriptive diagnoses. Ninety percent of all patient problems recorded fell into 163 descriptive diagnoses. These data compare favorably to the Virginia study. Comparison of the top 25 patient problems also revealed similarities between this and the Virginia study. Difficulties arise in comparing data because of the differences in coding schemes (RCGP vs ICHPPC). A universally adopted code for all family practice and ambulatory care research would help in overcoming this problem.

Adolescent↗

Information management in clinical practice.

Information management is essential for optimal delivery of health care services to individuals and the community. Current information techniques--largely dependent on the individual patient record--cannot effectively store, process, retrieve, and communicate the vast amount of data and information which is integral to the comprehensive health care process. Computerized techniques similar to those which are an indispensable part of almost all scientific, commercial, and administrative sectors of society are urgently needed to support a fully effective health care system.

Ambulatory Care↗

Evaluating ambulatory care: three approaches.

The article describes three approaches to establishing an ambulatory audit program for nursing. These approaches are variations of a single methodology--that of the Joint Commission on Accreditation of Hospitals--used by the University of Minnesota Hospitals and Clinics. The authors discuss three audit topics from ambulatory care; postkidney transplant; desensitization; and well child.

Ambulatory Care↗

Incorporating research in a service setting.

There are similarities between the research process and problem-solving-evaluation mechanisms already in use in nursing service. The author describes the utility of each process and the rationale for implementing research in the nursing service setting. The nursing auit is recommended as the intstitutional mechanism for implementing and sustaining research activities.

Humans↗

Analysis of primary care prescribing--a "constructive" coding system for drugs.

The introduction of a computerized medical information system as part of a project assessing quality in primary care required the coding of drugs prescribed. The development of a simple four-digit system is described, coding drug, therapeutic class, and route of administration. The system allows easy measurement of the use of combined preparations.The drugs used for insomnia and acute bronchitis have been analysed. The results show marked variation with the age of the patient.The potential for medical audit is discussed as it is now possible to link prescribing figures in routine primary care with relevant clinical information.

Adolescent↗

The power to reduce the cost of technology.

Technology has been made the scapegoat for the increasing cost of health care. Government action in the form of congressional legislation, administrative regulations, funded research, health care payments, etc., has been an important contributing factor in this increasing cost. Microcomputer/microprocessor-based systems such as MUMPS, PROMIS, COSTAR, GeMSAEC, and ASPECT have underutilized potential for producing economies of scale. Quantitative comparative cost data should be developed by every government-sponsored study or project to forcefully prove that more technology results in lowered costs.

Clinical Laboratory Techniques↗

Upper-respiratory tract complaint protocol for physician-extenders.

A protocol for upper-respiratory tract complaints was administered to 226 patients in a walk-in clinic. The protocol, for use by a physician-extender in conjunction with a physician, specified the collection of data necessary for management. A decision-making algorithm separated the major causes of upper respiratory infection (URI) complaints and led to one of four plans: a physician referral, a culture only, antibiotic treatment, or symptomatic treatment only. Each patient was seen by a physician following the health assistant's interview. Of 226 patients, 96 (42 percent) would have been sent home by the protocol without seeing the physician. None of these had a complication of URI. Sixteen (seven percent) of the 226 had serious complications - all would have been referred to the physician. The protocol proved to be safe and efficient, acceptable to patients, and a reliable approach to physician-extender management of URI.

Anti-Bacterial Agents↗