The Journal of family practice
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Physician performance was assessed in cardiopulmonary resuscitation (CPR) by the number and type of errors committed. In simulated arrests, physicians previously certified in advanced life support made fewer errors (5.6 vs 14.3, P = .007) than those not certified. ⋯ Guidelines for successful completion of these simulations were developed. This study indicates the need for continued physician education in CPR.
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The predictive value positive of serum iron studies and erythrocyte indices in differentiating between iron deficiency anemia and the anemia of chronic disease (ACD) were determined in 82 hospitalized patients with an iron-binding saturation of 15 percent or less. Iron deficiency, determined by serum ferritin of 20 ng/mL or less, was present in only 31 percent of patients with a serum iron level of 10 micrograms/dL or less; 39 percent of patients with a transferrin saturation of 5 percent or less, and 54 percent of patients with a total iron-binding capacity (TIBC) of 350 micrograms/dL or greater; conversely, iron deficiency was present in only 3 percent of patients with a TIBC of 250 micrograms/dL or less. Iron deficiency was present in 83 percent of patients with a mean corpuscular volume (MCV) of 75 microns3 or less, but only 2 percent of patients with an MCV of 86 microns3 or greater. It is concluded that the MCV has strong predictive value positive (and negative) when below (or above) the values just cited, but that serum iron studies do not have sufficient predictive value to justify their use in the routine differentiation between iron deficiency anemia and the ACD in hospitalized patients when no other cause for anemia is likely.
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A review of the charts of 79 patients with urticaria was conducted in a residency-based family practice center. All patients seen with urticaria in 7 years who were identified by the practice-data retrieval system were included in the review. The annual incidence of urticaria was 0.27 percent. ⋯ In 25 charts coded for other skin disorders, three cases (12 percent) of urticaria were noted by the chart reviewers. Coding errors involving digit transposition were noted in three of 1,044 cases. Diagnostic error, incorrect coding by nonphysicians or by physicians not familiar with the coding system, or even clerical error may be a significant problem in this type of study.
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Comparative Study
New screening method for occult gastrointestinal bleeding: immunologic and guaiac slide tests.
A valid mass screening method for occult, bleeding gastrointestinal pathology including colorectal cancer should be monospecific for human hemoglobin, sensitive for approximately 3 mg of human blood per 1 g of stool, capable of differentiating upper and lower gastrointestinal bleeding, cost effective, uncomplicated, and acceptable to patients. Hemoccult II, a guaiac peroxidase detection test, is nonspecific for human blood and cannot differentiate between upper and lower gastrointestinal bleeding. ⋯ The findings of this study indicate that the immunologic test may remedy the deficiencies of the guaiac test. The concomitant use of the immunologic and appropriately sensitive guaiac test appears to fulfill screening test requisites.