Waiting list statistics. II: An estimate of inflation of waiting list length.

The discrepancy between the length of the waiting list and eventual admissions from the waiting list was investigated by comparing data from two different sources of routine statistics in the Oxford region. It was estimated that about 28% of the waiting list comprised patients who were not eventually admitted to hospital within the region.     

Effect on prescribing of the limited list in a computerised group practice.

The prescribing of drugs in the therapeutic classes that are affected by the government''s limited list was investigated in a computerised group practice of just over 3,000 patients. Prescribable drugs in categories that are affected by the list were identified for two consecutive six month periods before and one six month period after the introduction of the list. A significant decrease in the prescribing of cough and cold remedies, vitamins, and antacids occurred after the list was introduced, whereas no change occurred in the prescribing of laxatives, benzodiazepines, or analgesics. The prescribing of iron and penicillin increased significantly after the list was introduced, whereas the use of H2 antagonists and non-steroidal anti-inflammatory drugs showed no significant change.     

Waiting list management in general practice: a review of orthopaedic patients.

OBJECTIVE: To review all patients on a current general practice orthopaedic waiting list for outpatient appointments with regard to accuracy of the list, clinical priority, and need for further radiological investigation before hospital attendance. DESIGN: Record review by one general practitioner and a radiologist, and discussion with patients of management alternatives. SETTING: Six partner city centre urban fund-holding general practice, list size 8651 (29% low deprivation payment status). SUBJECTS: 116 adults on an orthopaedic waiting list. MAIN OUTCOME MEASURES: List accuracy (patient details and status on waiting list); clinical priority (severity of condition); further investigations (results of tests after radiological review). RESULTS: 32 patients (28%) were removed from the waiting list because of inaccuracies. 14 patients were considered to be high priority and referred to other hospitals by utilising waiting list initiative funds. Of these patients, five agreed to referral to another hospital (treatment completed on average within three months of rereferral), six did not wish to be rereferred, and two did not attend to discuss the offer and remained on the original waiting list. One prioritised patient had further radiological investigations, was reassured, and was taken off the waiting list. 10 patients had further investigations. These resulted in six patients being referred to other hospitals, three being taken off the waiting list, and one seeking private care. CONCLUSIONS: Systematic review of patients on an orthopaedic waiting list of one general practice, though time consuming, led to the identification of inaccuracies in the list and changes in management. Costs need further evaluation, but if the findings occur widely substantial benefits could be achieved for patients.     

Maintaining the accuracy of a computer practice register: household index

In this practice, with a family practitioner committee list of 9726 patients, we use a computer register for recall, screening, morbidity data, audit, and repeat prescribing. The computing techniques used to achieve accuracy in maintaining the register are described. After one year of full use the register was validated by using the computer to select a random sample of 200 patients from patients'' computer records that had not been updated recently. Two patients were untraceable, and in only 11 records were errors of information found, none of which was important. We think that it is feasible and valuable to have a household index.     

Instant age-sex register.

An age-sex register for use in general practice was obtained directly from the family practitioner committee computer by direct transfer of data to a microcomputer.     

Changes in strength of lung inflation reflex during prolonged inflation.

Recovery from respiratory inhibition produced by the lung inflation reflex was studied in anesthetized dogs, paralyzed and ventilated with a respiratory pump. During constant ventilation the lungs were periodically inflated using positive end-expiratory pressure, while the respiratory motor output was monitored in the phrenic nerve. Inhibition of the phrenic discharge was followed by gradual recovery throughout 8-min inflation periods despite constant blood gases. Recording afferent potentials in a vagus nerve indicated that adaptation of pulmonary stretch receptors contributed to the initial recovery of the phrenic discharge, but this recovery continued after the receptor discharge had stabilized. The phrenic discharge also recovered after initial inhibition in two situations which avoided stretch receptor adaptation: a) when the stretch receptor discharge from the separate lungs was alternated in an overlapping manner by asynchronous pulmonary ventilation, and b) during continuous electrical stimulation of a vagus nerve. Phrenic activity was temporarily increased above its control value after periods of lung inflation, asynchronous ventilation and vagal stimulation. It is concluded that the lung inflation reflex gradually attenuates during prolonged stimulation due to both stretch receptor adaptation and changes within the central pathways.     

Developing a register of randomised controlled trials in primary care.

OBJECTIVE--To determine the number, nature, site of publication, and feasibility of identifying randomised controlled trials relevant to primary care. DESIGN--Review of literature using three strategies: approaching journal editors, Medline search, and manual search of individual journals. SETTING--Journals containing publications of studies based in primary care. MAIN OUTCOME MEASURES--The number, site of publication, and subject of trials identified. RESULTS--No journal had a system which enabled identification of all the randomised controlled trials it published. 266 trials relevant to primary care were identified from 110 different journals during 1987-91 by Medline. Of these, only 62 trials were published in primary care journals. Hand searching of seven major primary care research journals showed that between 13% and 38% of the trials had been missed by the Medline search. Of the trials identified, 47 (18%) were concerned with mental disease (including neuroses, tobacco misuse and alcohol misuse) and 43 (16%) were concerned with hypertension. CONCLUSION--Given the diversity of publication sources and topics, this supports the need for a centrally based register of randomised controlled trials that may be relevant to primary care overviews in the future.     

Rabbit skeletal alpha-tropomyosin chains are in register.

2-Acetamido-2-deoxy-3-O-(D-2-propionyl-L-alanine)-D-glucopyranose ($\text{5}$) and 2-acetamido-2-deoxy-3-O-(D-2-propionyl-L-alanyl-D-isoglutamine)-D-glucopyranose ($\text{10}$) have been synthesized by condensation of benzyl 2-acetamido-4,6-O-benzylidene-3-O-(D-1-carboxyethyl)-2-deoxy-β-D-glucopyranoside ($\text{1}$) respectively with the L-alanine derivative $\text{2}$ and the dipeptide $\text{7}$, followed by debenzylidenation and hydrogenolysis. Compound $\text{10}$ is adjuvant active, whereas $\text{5}$ is inactive, so that $\text{10}$ is the smallest adjuvant active structure for the time being.     

Waiting list statistics. I: Relation between admissions from waiting list and length of waiting list.

The relation between changes in inpatient workload, measured as increases or decreases in the number of inpatients admitted from the waiting list, and the overall length of the waiting list was studied. Overall trends in admissions from the waiting list, the influence of seasonal patterns, and the impact of industrial action on admissions were also studied. The hypothesis was that when admissions from the waiting list increased the length of the waiting list would decrease and vice versa. No such simple relation was found. In fact, if anything, as the number of admissions from the waiting list increased so did the length of the waiting list. This result could be due to inconsistencies in compiling waiting list data or to the use of waiting lists to improve organisational efficiency. It is also possible, and perhaps likely, that the ability to meet need in admitting patients to hospital influences patients and their doctors to translate previously unmet need into demand for hospital services.