CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne
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Multicenter Study
Diagnostic accuracy and short-term surgical outcomes in cases of suspected acute appendicitis.
To test the hypothesis that, with modern diagnostic methods and antibiotics, more conservative use of surgery in cases of suspected appendicitis would not result in increased rates of short-term complications in confirmed cases. ⋯ A higher diagnostic accuracy rate is associated with more perforated appendixes. Although perforation itself leads to adverse outcomes, a higher accuracy rate does not. This suggests that hospitals with higher accuracy rates incur more perforations, but, with close observation, timely laparotomy and the use of modern antibiotics, these patients have favourable outcomes. This contrasts with adverse effects of perforation among patients at high risk for perforation (especially very young children and elderly people) in centres at all accuracy levels. The variation in hospitals' diagnostic accuracy rates suggests that some proportion of appendectomies could be safely avoided.
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To assess the completeness of hospital discharge summaries and the efficiency of the discharge summary system in two urban teaching hospitals. ⋯ Considerable deficiencies in the completeness of the discharge summaries and the efficiency of the discharge summary system were found in the participating hospitals. Replication of this study in other settings is indicated, and strategies to improve the process should be pursued.
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Australia has embarked on a National Aboriginal Health Strategy that aims to give aboriginals equal access to health services by 2001. Although the harmful effects of colonization are now recognized, it is not possible to eradicate overnight the health problems resulting from 200 years of mistreatment and neglect, officials say. In implementing the strategy, the Australian government is spending $1.3 billion over 5 years to improve the basic infrastructure of housing, water, waste disposal, roads and communications in aboriginal communities, enhance health services and encourage more aboriginals to seek careers in health care.
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The possibility that an amendment to new firearms legislation would require physicians to report potentially violent patients raises the controversial issues of physicians' legal duty to warn and the ability of physicians and other health care professionals to predict violent behaviour. For these reasons, it will be necessary to follow carefully any proposed amendments to the legislation.