Patient recall - strengths and shortcomings of a major information source

Physicians rely on patients for needed information about past medical events, implying a belief that patients are able to understand, recall and verbalize past medical events accurately and reliably. Is this belief valid? This article discusses: 1) whether patients are accurate and reliable reporters of their own health status, medical events and medical history; 2) whether the physician is able to make correct diagnoses and prognoses based upon information provided by patients; and 3) factors that affect recall. In some ways patients are good reporters of their medical history. However, there are numerous factors that affect reporting accuracy and reliability such as: anxiety, mood, severity of illness, type and duration of a procedure, and length of time since the medical episode. Good communication appears to be a key element in eliciting accurate and reliable patient recall. Physician records remain the best source of patient information and many points of information gleaned from patients may be used with confidence. Recognizing that physician records are the repository of the best medical information about individual patients means that more needs to be done to ensure that high priority is placed upon medical record documentation, format, and sharing. It is unlikely that physician records will ever fully replace the role of the patient as a personal medical historian.published_or_final_versio

Influenza surveillance in Hong Kong: results of a trial Physician Sentinel Programme

The H5N1 influenza outbreak in Hong Kong at the end of 1997 emphasised the need for viral surveillance so that new influenza epidemics can be foreseen. Although South China is regarded as the regional epicentre of influenza epidemics, there has been little epidemiological documentation of the disease there. A sentinel physician network was established in Hong Kong in 1993 to estimate the incidence, severity, and seasonality of influenza-like illnesses and to provide data on the demand for health care that is related to this illness. Influenza-like illness occurred throughout the year of the survey, peaking from March through May and accounting for 15% of doctor visits. The incidence was approximately 117 in 1000 patients and was greatest among children aged 1 to 4 years. Ongoing physician surveillance with appropriate coverage of the general population supported by a laboratory virus isolation capability may help control future influenza outbreaks.published_or_final_versio

Cost-effectiveness study on influenza prevention in Hong Kong

Introduction: Recent studies confirm that influenza vaccination confers health benefits and reduces direct and indirect costs associated with the illness. However, these studies did not examine the situation in southern China, a hypothetical influenza epicentre for the emergence of pandemic influenza viruses. Methods: Surveillance data were collected in Hong Kong in 1993/94 and used economic model was used to estimate the medical and social costs associated with influenza-like illness (ILI) and to predict the cost-effectiveness of implementing an influenza prevention programme. Findings: The estimated ILI incidence was 110/1000. It was highest in those between 1 and 25 years of age while the rate of hospitalization was highest in the elderly. Influenza occurred throughout the study period, which was a mild influenza year. The model predicted more than 660 000 ILI cases in a non-epidemic year, in which influenza B virus predominated, with an average ILI-associated cost of HK$283/case (US$36) and vaccination-associated costs of HK$74 (US$9.50) per vaccinated individual. Conclusion: The medical, social and monetary costs of ILI in Hong Kong were not observed to be large when compared with those in more developed countries where there is a clearly defined influenza season and recognized disease burden. From the perspective of a susceptible individual, the vaccine was cost-effective but from the perspective of society it was not, even with the most cost-effective strategy of targeting the elderly. However, if the vaccine were effective in controlling newly emerging and highly virulent strains, targeted vaccination programmes might be highly cost-effective. Copyright © 2001 Elsevier Science Ireland Ltd.link_to_subscribed_fulltex

Influenza vaccination in Brazil: rationale and caveats.

Mass vaccination campaigns against influenza in the elderly have been conducted in Brazil since 1999. A search of the literature on influenza in Brazil indicated that data on disease burden are still scarce and inaccurate. Published data seem to indicate that vaccination has produced some impact in the southern and southeastern regions but not in other regions of Brazil. A discussion of the technical and scientific rationale for mass immunization against influenza is presented and it is argued that the current strategy has not taken into account potential differences in disease occurrence in different areas. It is suggested some epidemiological surveillance actions needed to address major concerns regarding mass influenza vaccination and its impact in Brazil