Impact of audit on preventive measures.

The results of two reviews of practice records for information about various preventive measures are reported. The reviews were conducted two and a half years apart in the same 29 practices, on roughly 6500 records on each occasion. The first review was carried out during a postgraduate education course involving audit. Two main analyses were undertaken: one concerned with the entire record sample and the other with the individual practice results. Important and substantial improvements were shown in both analyses, which were spread throughout the practices and were not confined to practices at the lower end of the range simply "catching up." The change between the reviews in the mean recorded rates for cervical cytology was 56% to 64%; for rubella immunity 28% to 40%; for polio immunity in adults 15% to 21%; for completed primary immunisation 68% to 78%; for recorded blood pressure 53% to 61%; and for smoking information 22% to 30%. Improvement has been steady but the rate of improvement, especially for recording blood pressure and rubella immunity, has increased since the postgraduate education course.     

Dr. Mary Fanning: caring for AIDS patients at Toronto General.

Although amoxicillin has long been the preferred drug for treatment of acute otitis media, resistant strains of two relatively common causal organisms have emerged, prompting a search for other antibiotics. We performed a randomized double-blind trial comparing amoxicillin and trimethoprim-sulfamethoxazole in 221 children in whom acute otitis media was diagnosed in an outpatient setting. Diagnosis was on the basis of symptoms, otoscopic examination and acoustic reflectometry. No culture specimens were taken. A research nurse, using the same methods, evaluated patients in a follow-up home visit at around 14 days and measured compliance by examination of the medicine bottle. Equal proportions of children in the two groups were cured or improved (88% and 87%). Therapeutic efficacy was related to compliance in both groups, and there were few side effects in either group. This study had statistical power of 80% to detect a difference of 15%. We conclude that trimethoprim-sulfamethoxazole can be considered a first-line antibiotic in the treatment of acute otitis media.     

The fractionation of cell components in Oscillatoria agardhii: an audit of procedures

Carbon partitioning techniques for the separation of physiologically important macromolecules (lipid, carbohydrate and protein) need to be efficient if they are to yield meaningful estimates of carbon flow in macromolecular synthesis, as measured by [¹⁴C] bicarbonate incorporation techniques. However, the efficiency of partitioning is rarely checked. Using existing methods, we found highly variable extraction efficiency of these macromolecules particularly of carbohydrate from cells grown under light:dark regimes. We report on a highly reproducible modification to existing methods which involves autoclaving with 5% trichloroacetic acid and centrifugation to separate carbohydrate and protein fractions. The presence of a structural non-extractable carbohydrate pool is reported.     

A novel anaesthetic regimen for surgical procedures in guineapigs.

A combination of tiletamine/zolazepam, xylazine and butorphanol provides deep surgical, long-duration anaesthesia in guineapigs with a smooth induction and recovery period. The described dosages mainly affect the respiratory functions and blood gas parameters, with a minor-to-moderate effect on the cardiovascular system.     

List size,screening methods,and other characteristics of practices in relation to preventive care.

Twenty eight practices carried out a review of patient records for information about preventive procedures on two occasions in 1980 and 1982. We have now undertaken a survey of certain characteristics of the practices in an attempt to demonstrate features associated with effective preventive care. Significant favourable factors are a small list size, the setting up of a formal screening programme for cervical cytology and measuring blood pressure, and few registered patients in social classes IV and V. More successful practices also tend to be training practices, have principals with higher qualifications, and have developed good records organization. Opportunistic screening for cervical cytology and measuring blood pressure was not shown to be more effective than no policy of screening at all.     

Implications of caring for an aging parent.

The burden of care for the aged often falls on their adult children, who are themselves stressed by the developmental tasks of middle age. These people are frequently unprepared for the role of caregiver, in which they become parents to their own parents. The author describes the potentially turbulent effect of this role and discusses the origin of the stresses that the caregiver may experience. Doctors need to recognize and deal with the negative feelings, such as resentment, anger, frustration, ambivalence, guilt and demoralization, that may arise in adult children who care for their parents. These emotions must be put into proper context if the mental and physical health of the caregivers as well as the vital support they provide for their elderly parents are to be maintained.     

Aspects of audit. 4: Acceptability of audit.

Whether or not audit is accepted in Britain will be determined principally by how it is controlled, how much it costs, and how effective it is. The objectives of audit have been defined as education, planning, evaluation, research, and anticipatory diplomacy--that is, starting internal audit before external audit is imposed on the medical profession. Published reports suggest that in Britain internal audit would be more effective andless expensive than the complex professional standards review organisation devised by the Federal Government in the United States.     

Comparison of verification procedures for the membrane filter total coliform technique

[This corrects the article on p. 1127 in vol. 45.].     

A three years follow-up of total serum IgE levels in three patients treated for strongyloidiasis.

A three years follow-up of the level of serum total IgE was made for the first time in three patients with strongyloidiasis after efficient treatment. The decrease of IgE was slow and progressive, showing a logarithmic curve. This regular decrease of total serum IgE could be used as an additional criterion for the evaluation of the efficiency of drug therapy in patients with strongyloidiasis. The persistence of high levels of total IgE two or three years after the elimination of the intestinal parasites, after the return of blood eosinophils to a normal level (within six months), and after the disappearance of specific antibodies, shows that the regulation of the IgE elimination seems to be a complex mechanism.     

Evaluating care of patients reporting pain in fundholding practices.

OBJECTIVE--To compare quality of care between 1990 and 1992 in patients with self diagnosed joint pain. DESIGN--Questionnaire and record based study. SUBJECTS--Patients identified at consecutive consultations during two weeks in 1990, 1991, and 1992. SETTING--Six practice groups in pilot fundholding scheme in Scotland. MAIN OUTCOME MEASURES--Length of consultation; numbers referred or investigated or prescribed drugs; responses to questions about enablement and satisfaction. RESULTS--About 15% of patients consulted with joint pain each year. 25% (316) of them had social problems in 1990 and 37% (370) in 1992; about a fifth wanted to discuss their social problems. Social problems were associated with a raised general health questionnaire score. The mean length of consultation for patients with pain was 7.6 min in 1990 and 7.7 min in 1992. Patients wishing to discuss social problems received longer consultations (8.5 min 1990; 10.4 min 1992); but other patients with social problems received shorter consultations (7.4 min; 7.2 min). The level of prescribing was stable but the proportion of patients having investigations or attending hospital fell significantly from 1990 to 1992 (31% to 24%; 31% to 13% respectively). Fewer patients responded "much better" to six questions about enablement in 1992 than in 1990. Enablement was better after longer than shorter consultations for patients with social problems. CONCLUSIONS--Quality of care for patients with pain has been broadly maintained in terms of consultation times. The effects of lower rates of investigation and referral need to be investigated further.