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  1. Recognising meningococcal disease in primary care : qualitative study of how general practitioners process clinical and contextual information.

    Article - En anglais

    Objectives 

    To describe the presentation of meningococcal disease in primary care ; to explore how general practitioners process clinical and contextual information in children with meningococcal disease ; and to describe how this information affects management.

    Design 

    Qualitative analysis of semistructured interviews.

    Setting 

    General practices in South Glamorgan.

    Subjects 

    26 general practitioners who between January 1994 and December 1996 admitted 31 children (under 16 years of age) in whom meningococcal disease was diagnosed.

    Main outcome measures 

    Categories of clinical rules and techniques used by general practitioners in processing each case.

    Results 

    22 children had rashes ; in 16 of them the rashes were non-blanching.

    When present, a haemorrhagic rash was the most important factor in the doctor's decision to admit a child. 22 children had clinical features not normally expected in children with acute self limiting illnesses-for example, lethargy, poor eye contact, altered mental states, pollor with a high temperature, and an abnormal cry.

    Contextual information, such as knowledge of parents'consultation patterns and their normal degree of anxiety, played an important part in the management decisions in 15 cases.

    Use of penicillin was associated with the certainty of diagnosis and the presence and type of haemorrhagic rash.

    Conclusion 

    The key clinical feature of meningococcal disease-a haemorrhagic rash-was present in only half of the study children. (...)

    Mots-clés Pascal : Exanthème, Méningococcie, Bactériose, Infection, Diagnostic, Soin santé primaire, Médecin généraliste, Méthodologie, Relation, Symptomatologie, Evaluation performance, Enfant, Homme, Peau pathologie

    Mots-clés Pascal anglais : Exanthema, Meningococcal disease, Bacteriosis, Infection, Diagnosis, Primary health care, General practitioner, Methodology, Relation, Symptomatology, Performance evaluation, Child, Human, Skin disease

    Logo du centre Notice produite par :
    Inist-CNRS - Institut de l'Information Scientifique et Technique

    Cote : 98-0104995

    Code Inist : 002B05B02C. Création : 22/06/1998.