Patient satisfaction with general practitioner deputising services.

Proposed increases in the average hours of surgery sessions of general practitioners as part of the government programme for improving primary health care may result in more use of deputising services to provide off duty cover. The satisfaction of patients with such a service was studied during one week of October 1987 at nine of the 29 branches of Air Call Medical Services in urban areas in Britain by means of a postal questionnaire. Of a sample of 4626 callers to the service, 3887 (84%) responded. An estimated 32% of the patients expected that a doctor from their own practice would have attended them, 19% expected that they would be admitted to hospital and 8% were admitted. Over 90% of patients were satisfied with the telephonist''s handling of the call; 79% of those visited were satisfied with the waiting time; and over 80% were satisfied with various aspects of the doctor''s handling of the visit (bedside manner, communication, taking of history, physical examination, and explanation of findings), the lowest figure being for explanation of findings (81%). Satisfaction was generally higher during the daytime; among the elderly, especially men; and among patients who did not anticipate that a doctor from their doctor''s practice would call. The results suggest that a high proportion of patients were satisfied with the deputising service they received.     

Weather fronts and acute myocardial infarction

Some methodological aspects are discussed of the investigation of acute infarct myocarditis (AIM) in relation to weather fronts. Results of a new method of analysis are given. Data were analysed from about the hour of the onset of symptoms, and led to the diagnosis of AIM either immediately or within a few hours or days (3019 cases observed over 4.5 years during 1982–1986 in Plzen, Czechoslovakia). Weather classification was based on three factors (the type of the foregoing front, the type of the subsequent front, the time section of the time interval demarcated by the passage of the surfaces of the fronts). AIM occurrence increased in particular types of weather fronts: (i) by 30% during 7–12 h after a warm front, if the time span between fronts exceeded 24 h; (ii) by 10% in time at least 36 h distant from the foregoing cold or occlusion front and from the succeeding warm or occlusion front; (iii) by 20% during 0–2 h before the passage of the front, provided the foregoing front was not warm and the interval between fronts exceeded 5 h. AIM occurrence decreased by 15%–20% for time span between fronts > 24 h at times 6–11, 6–23 and 6–35 h before a coming warm or occlusion front (for interfrontal intervals 25–48, 49–72 and possibly > 72 h), and also at 12–23 and possibly 12–35 h before a cold front (for intervals 49–72 and possibly > 72 h), if the foregoing front was cold or an occlusion front.     

Use of urokinase in acute myocardial infarction

In a prospective study 88 patients with acute MI were treated with urokinase. In comparison to a control group without thrombolytic therapy 50% of the urokinase treated patients showed an improvement as well of coronary sinus blood flow as of parameters of QRST mapping.