Informal complaints procedure in general practice: first year's experience.

OBJECTIVE--To evaluate the first year''s experience of an informal patient complaints system that encourages extensive patient participation. DESIGN--Audit of an informal complaints procedure. SETTING--The Marylebone Health Centre, London. SUBJECTS--39 complaints received over the audit period. MAIN OUTCOME MEASURES--Types of complaints (administrative, about doctors or medical care or both, staff about patients, mixed, other) and resolution of complaints (how complaints were dealt with and their resolution). RESULTS--37 of the 39 complaints were resolved within two weeks. Two complaints sent direct to the family health services authority were resolved (with patients'' agreement) by the informal complaints procedure. CONCLUSIONS--The informal complaints procedure was more cost effective than the family health services authority system and was comparatively straightforward to implement within the practice without major organisational restructuring. The two way process of the procedure ensured patients received a quick response to complaints and helped morale of health centre staff.     

Incidence of stroke in Oxfordshire: first year's experience of a community stroke register.

The Oxfordshire Community Stroke Project is a prospective study of all new cases of stroke and transient ischaemic attack in a defined population of about 103 000 patients registered with 49 general practitioners; every case is assessed by a neurologist and most patients undergo a CT scan or are examined post mortem, or both, to ensure accurate diagnosis. Out of 404 cases registered in the first year, 168 patients had suffered a first stroke, 52 a recurrent stroke, and 41 a transient ischaemic attack; 143 were excluded. Of the 168 patients with their first stroke, 153 (91%) were seen by a neurologist and 149 (89%) had a CT scan or came to necropsy. The pathological diagnosis was cerebral infarction in 127 cases (76%), intracranial haemorrhage in 22 (13%), and unknown in 19 (11%). The estimated yearly incidence of first stroke was 1.95/1000 population (age adjusted to 1981 population of England and Wales).     

BACUP--the first two years: evaluation of a national cancer information service.

The cancer information service of the British Association of Cancer United Patients (BACUP) was launched in October 1985 as a national service to patients and their relatives, the public, and health professionals. Information is provided by telephone and letter by seven nurses trained in oncology. In the first two years over 30,000 inquiries were received: 23,527 (80%) were from women; 9445 (32%) were from cancer patients 11,574 (39%) from relatives of patients, and 2869 (10%) from health professionals. Inquiries came from all over the United Kingdom and from all sections of society but users were predominantly middle class, aged between 30 and 49, and living in south east England. Information about specific cancer sites, treatment, and how to cope was most commonly sought. Nearly a third of all inquiries were related to breast cancer. Though the service is used more by particular groups focusing on particular diseases, clearly there is a need for a cancer information service in the UK.     

Surgical audit: one year's experience in a teaching hospital.

For 12 months the surgical staff at Hope Hospital have operated a form of audit. The monitored information included work load, methods of treatment, complications, misdiagnoses, and deaths. The method described is suitable for any district general or teaching hospital provided adequate secretarial help is available. In addition to helping to maintain standards, an audit of this type has a positive educational role.     

The clinical psychologist in a health centre: one year's work.

The Livingston integrated health services project is an attempt to provide a fully integrated area health service with special emphasis on developing multidisciplinary community health teams. As part of this experiment a clinical psychologist was appointed to work in general practice. Ninety-four patients with behavioural, emotional, and cognitive problems were referred in the first year (1% of the 10 000 patients registered at the practice). The psychologist thus provided treatment for some patients who would otherwise have been seen by a general practitioner with neither the time nor the training to deal adequately with their problems.     

Continuous ambulatory peritoneal dialysis: one year's experience in a UK dialysis unit.

Thirty-two patients aged 8-63 years trained to manage themselves by continuous ambulatory peritoneal dialysis for end-stage renal failure achieved better steady-state serum biochemistry and much higher haemoglobin and lower serum phosphate concentrations than during treatment with haemodialysis up to one year before. Two patients, however, returned to intermittent haemodialysis because of recurrent peritonitis. Costs of the technique during the first year were less than half those incurred in the first year of home haemodialysis. Nevertheless, the major advantage was the ease with which patient independence and rehabilitation could be achieved. This technique is an appreciable advance over other forms of management for end-stage renal failure. Nevertheless, until it is more refined and long-term problems have been assessed it should probably be used only in established renal units where back-up treatments are available.     

The first clinical experience with cryopreserved erythrocyte concentrate

After a brief illustration of the manufacturing procedure for frozen stored erythrocyte concentrate (GK-EK) the compatibility and transfusion success are assessed by means of clinical and laboratory-chemical parameters. Ensured febrile transfusion responses could not be observed. Indications for GK-EK are given.     

Surgical instruments and dressings: an information service.

A regional information service on surgical equipment, instruments, and dressings is proposed that would be staffed by information scientists. It would appreciably reduce the time spent on administration and make the buying of equipment more efficient. Such a service could be extended to all health service staff.     

Transfusion-induced malaria: risks, prevention and cost (1 year's experience)

Three cases of transfusion induced paludism have been seen in Rouen since 1976. Two of them were due to Plasmodium falciparum and the third to Plasmodium malariae. In order to improve the prevention of this disease, a survey was carried out in 1980 which concerned 51,000 blood samples, 1,020 blood donors were selected because they had lived in a malarial endemic zone. Among them, 92 subjects were detected by an indirect immunofluorescence reaction as having a titer exceeding 1: 20 and their blood was kept aside any transfusional use. These results were studied according to the geographical area concerned, the ethnical origin, the time elapsed since the return and whether or not a chemoprophylaxis had been used. The present study gives further evidence of the risk linked to a stay in Africa. But neither the time since the return, nor the use or not of a chemoprophylaxis seemed to influence the serological results. The five years exclusion rule, used up until now, came to be at the same time too much and insufficiently limitative, since it would have eliminated 1.4% blood donors while the serological controls would eliminate only 0.18%. On the other hand, 14 blood donors, who were back in France for more than 5 years and presented with a positive serology, would have been considered as normal. In the light of these results, a practical line is given based on the association of a simple inquiry to a malarial serology.     

CT-guided stereotaxy: first 10-year experience

The authors present an overview on CT-guided stereotaxy performed in the last 10 years in the University Hospital Olomouc. During this period a total of 811 stereotactic brain operations were performed. Of these, 710 were done in the field of afunctional and 101 in the field of functional stereotaxy. The majority of procedures were biopsies of intracranial lesions (n = 464), evacuations of intracerebral hematomas with or without drainage and fibrinolysis (n = 147) and thalamotomies in patients with Parkinson's disease (n = 88). With the exception of the two years at the beginning, the number of yearly performed stereotaxies varied between 66-106 (mean, 86.9). Serious complications appeared after three procedures (0.37 %).     

Creating a new drug service in Edinburgh.

After one year Edinburgh''s Community Drug Problem Service has shown that if psychiatric services offer consultation and regular support for drug users many general practitioners will share the care of such patients and prescribe for them, under contract conditions, whether the key worker is a community psychiatric nurse or a drug worker from a voluntary agency. This seems to apply whether the prescribing is part of a "harm reduction" strategy over a long period or whether it is a short period of methadone substitution treatment. Given the 50% prevalence of HIV infection among drug users in the Edinburgh area and the fact that only half of them have been tested for seropositivity, the health and care of this demanding group of young people with a chaotic lifestyle are better shared among primary care, community based drug workers, and specialist community drugs team than treated exclusively by a centralised hospital drug dependency unit. As the progression to AIDS is predictable in a larger proportion of drug users who are positive for HIV, there is an even greater need for coordinated care between specialists and community agencies in the near future.