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Medical confidentiality underpins the doctor-patient relationship and ensures privacy so that intimate information can be exchanged to improve, preserve, and protect the health of the patient. The right to information applies to the patient alone, and, only if expressly desired, can it be extended to family members. However, it must be remembered that one of the primary tenets of family medicine is precisely that patient care occurs ideally within the context of the family. There may be, then, certain occasions when difficulties will arise as to the extent of the information provided to family members.
This study aimed to describe family doctors' attitudes to confidentiality and providing patient information to relatives as well as their justifications for sharing information.
A descriptive postal questionnaire was self-administered by family doctors.
Of 227 doctors, 95.1% provided information to a patient's family and over a third (35%) disclosed information to others without prior patient consent.
The findings reveal that family doctors should pay more attention to their patients' rights to information, privacy, and confidentiality, and reflect very carefully on the fine balance between this and the occasional need for the support and collaboration of family members in delivery of care. Emphasis should be placed on ethics and legal problems during undergraduate education and in-service training of doctors.
This review summarises reports of food poisoning, salmonellosis, campylobacteriosis and other acute foodborne illness to the PHLS Communicable Disease Surveillance Centre, and notifications of food poisoning collated by the Office of Population Censuses and Surveys, in the period 1989-1991. During this period there were continuing rises in notifications of food poisoning and reports of salmonellosis and campylobacteriosis. There was considerable success in the control of foodborne listeriosis. Newly emerging pathogens, such as Vero cytotoxin producing Escherichia coli, became more important. There was unprecedented scrutiny of the salmonella data by experts and politicians, reflecting continuing concern over the role of eggs as well as poultry meat in the increase of Salmonella enteritidis phage type 4 infection. This concern, along with advances in information technology, has led to developments in the collection and dissemination of information which continue to be implemented.
This study presents estimates of lifetime and 12-month prevalence of 14 DSM-III-R psychiatric disorders from the National Comorbidity Survey, the first survey to administer a structured psychiatric interview to a national probability sample in the United States.
The DSM-III-R psychiatric disorders among persons aged 15 to 54 years in the noninstitutionalized civilian population of the United States were assessed with data collected by lay interviewers using a revised version of the Composite International Diagnostic Interview.
Nearly 50% of respondents reported at least one lifetime disorder, and close to 30% reported at least one 12-month disorder. The most common disorders were major depressive episode, alcohol dependence, social phobia, and simple phobia. More than half of all lifetime disorders occurred in the 14% of the population who had a history of three or more comorbid disorders. These highly comorbid people also included the vast majority of people with severe disorders. Less than 40% of those with a lifetime disorder had ever received professional treatment, and less than 20% of those with a recent disorder had been in treatment during the past 12 months. Consistent with previous risk factor research, it was found that women had elevated rates of affective disorders and anxiety disorders, that men had elevated rates of substance use disorders and antisocial personality disorder, and that most disorders declined with age and with higher socioeconomic status.
The prevalence of psychiatric disorders is greater than previously thought to be the case. Furthermore, this morbidity is more highly concentrated than previously recognized in roughly one sixth of the population who have a history of three or more comorbid disorders. This suggests that the causes and consequences of high comorbidity should be the focus of research attention. The majority of people with psychiatric disorders fail to obtain professional treatment. Even among people with a lifetime history of three or more comorbid disorders, the proportion who ever obtain specialty sector mental health treatment is less than 50%. These results argue for the importance of more outreach and more research on barriers to professional help-seeking.
To evaluate the acceptability and efficacy of adding cognitive behaviour therapy to the medical care of patients presenting with the chronic fatigue syndrome.
Randomised controlled trial with final assessment at 12 months.
An infectious diseases outpatient clinic.
60 consecutively referred patients meeting consensus criteria for the chronic fatigue syndrome.
Medical care comprised assessment, advice, and follow up in general practice. Patients who received cognitive behaviour therapy were offered 16 individual weekly sessions in addition to their medical care.
The proportions of patients (a) who achieved normal daily functioning (Karnofsky score 80 or more) and (b) who achieved a clinically significant improvement in functioning (change in Karnofsky score 10 points or more) by 12 months after randomisation.
Only two eligible patients refused to participate. All randomised patients completed treatment. An intention to treat analysis showed that 73% (22/30) of recipients of cognitive behaviour therapy achieved a satisfactory outcome as compared with 27% (8/30) of patients who were given only medical care (difference 47 percentage points; 95% confidence interval 24 to 69). Similar differences were observed in subsidiary outcome measures. The improvement in disability among patients given cognitive behaviour therapy continued after completion of therapy. Illness beliefs and coping behaviour previously associated with a poor outcome changed more with cognitive behaviour therapy than with medical care alone.
Adding cognitive behaviour therapy to the medical care of patients with the chronic fatigue syndrome is acceptable to patients and leads to a sustained reduction in functional impairment.
We have searched, using a sensitive nested-PCR, for enterovirus RNA in cerebrospinal fluid and post mortem central nervous system (CNS) tissue from patients with previous poliomyelitis with or without late functional deterioration, patients with motor neuron disease (MND), and control patients with other neurological disease or without neurological disease. Enterovirus RNA was detected in patients with previous poliomyelitis and MND, but also in control patients with and without neurological disease. Our results do not provide any evidence that such enterovirus infection is related to late functional deterioration in patients with previous poliomyelitis, which could be attributed to other medical conditions in most instances, and do not support the hypothesis that MND is associated with enterovirus infection of the CNS. Nucleotide sequence analysis of enterovirus RNA sequences detected indicated that enteroviruses detected were of the non-polio type.
We conducted a randomized controlled trial to determine whether empirical treatment of severe acute community-acquired gastroenteritis (four fluid stools per day for > 3 days) with ciprofloxacin reduces the duration of diarrhea and other symptoms and to determine what effect ciprofloxacin has on the duration of long-term fecal carriage of gastrointestinal pathogens. A total of 173 patients were recruited for the study and received either ciprofloxacin (500 mg b.i.d.) or placebo for 5 days, during which time they recorded the duration of diarrhea and other symptoms (fever, abdominal pain, vomiting, and myalgia). Fecal samples were collected before treatment and regularly after treatment to determine the duration of carriage of gastrointestinal pathogens. Antibiotic susceptibility tests were performed, and the minimum inhibitory concentrations (MICs) of ciprofloxacin were determined. A significant reduction in the duration of diarrhea and other symptoms was observed after treatment, regardless of whether a pathogen was detected (P = .0001). Treatment failure occurred in 3 of 81 patients in the ciprofloxacin group and 17 of 81 patients in the placebo group. Significant pathogens were detected in 87% of patients, 85.5% of whom had cleared the pathogen at the end of treatment with ciprofloxacin, as compared with 34% who received placebo. Six weeks after treatment, there was no difference between the two groups in terms of the pathogen carriage rate (12%). Treatment with ciprofloxacin did not prolong carriage. High-level resistance to ciprofloxacin (MIC, > 32 mg/L) was detected in three strains (4%) of Campylobacter species.
Cognitive behavior therapy for chronic fatigue syndrome was compared with relaxation in a randomized controlled trial.
Sixty patients with chronic fatigue syndrome were randomly assigned to 13 sessions of either cognitive behavior therapy (graded activity and cognitive restructuring) or relaxation. Outcome was evaluated by using measures of functional impairment, fatigue, mood, and global improvement.
Treatment was completed by 53 patients. Functional impairment and fatigue improved more in the group that received cognitive behavior therapy. At final follow-up, 70% of the completers in the cognitive behavior therapy group achieved good outcomes (substantial improvement in physical functioning) compared with 19% of those in the relaxation group who completed treatment.
Cognitive behavior therapy was more effective than a relaxation control in the management of patients with chronic fatigue syndrome. Improvements were sustained over 6 months of follow-up.
Morbidite importante provoquant des pertes de temps dans les pays developpes, mortalite importante dans les pays en voie de developpement. Les maladies et leur traitement different selon les germes responsables; Shigella, Salmonelloses autres que la typhoide, Escherichia coli, Campylobacter, Yersinia, cholera, autres vibrions, diarrhee liee aux antibiotiques et colite pseudomembraneuse, diarrhee du voyageur
Psychiatrists and general practitioners have found new ways of working together in the last ten years, but there have also been separate activities which could develop into rivalry. These opportunities and dangers are the central theme of this paper. Ways are considered in which the psychiatry of general practice differs from the experience of psychiatrists. Forms of help are suggested which general practitioners need from psychiatrists, whether in clinical practice or education.
Three instances of extra-intestinal infection in elderly patients and the recent outbreak at Stanley Royd Hospital promoted a retrospective review of all salmonella infections seen at the Regional Diseases Unit over a 30-month period with particular reference to management of those over the age of 65 years. The survey has confirmed a more protracted illness with higher mortality and morbidity in elderly people suggesting a need for routine antibiotic treatment in these patients.
In a study of 297 internal fixation operations for fractures or joint injuries performed during 1982, a second operation for implant removal was undertaken in 42% of cases. Significant complications occurred following the second procedure in 19%. Implants which were retained did not give rise to appreciable problems. It is suggested that implants should only be removed when there are clear clinical indications for doing so.
Age-dependent poliomyelitis is a paralytic disease of C58 and AKR mice caused by cytocidal infection of anterior horn neurons with neuropathogenic strains of lactate dehydrogenase-elevating virus (LDV). The motor neurons are rendered LDV-permissive via an unknown mechanism through the expression of ecotropic murine leukemia virus (MuLV) in central nervous system (CNS) glial cells. Only old mice develop paralytic disease after LDV infection, but mice 5-6 months old or older can be rendered susceptible by suppression of anti-LDV immune responses by a single treatment with cyclophosphamide or X-irradiation before LDV infection. Younger mice appeared to be resistant in spite of this immunosuppresive treatment. The present results confirm that mice as young as 1 month of age possess CNS cells expressing ecotropic MuLV and show that these mice are susceptible to paralytic LDV infection provided their anti-LDV immune responses are blocked for an extended period of time by repeated cyclophosphamide treatments or by a genetic defect. Furthermore, old mice become naturally susceptible to paralytic LDV infection because of an impaired ability to mount a motor neuron protective anti-LDV immune response.