The academic base for general practice: the case for change.

University departments of general practice and the postgraduate education system for general practice have developed separately over the past 30 years. This separation is now impeding the academic development of the discipline and causes difficulties with recruitment and career progression. These problems could be eased by the creation of integrated departments. This would establish a critical mass for research and educational development, allow human and other resources to be used more flexibly and effectively, and provide a strong base for undergraduate education, vocational training, higher professional training, and continuing education. It could encourage collaborative ventures with other disciplines and also lead to higher standards of patient care.     

To translocate or not: that is the problem

The botulinum toxins (BoNTs) enter the cytosol of host cells by translocation across the limiting membrane of acidic endosomes. In this issue, Sun et?al. (2011) show that BoNT binding to one of its cell surface receptors renders it susceptible to pH-dependent conformational changes required for translocation and cellular toxicity.     

Why general practitioners and consultants change their clinical practice: a critical incident study.

OBJECTIVE: To describe the complete range of factors which doctors recognise as changing their clinical practice and provide a measure of how often education is involved in change. DESIGN: Interviews using the critical incident technique. SETTING: Primary and secondary care. SUBJECTS: Random sample of 50 general practitioners and 50 consultants. MAIN OUTCOME MEASURES: Categories of reasons for change in clinical practice. RESULTS: Doctors described 361 changes in clinical practice, with an average of 3.0 reasons per change. The three most frequently mentioned reasons were organisational factors, education, and contact with professionals, together accounting for 47.9% of the total number of reasons for change. Education accounted for one sixth (16.9%) of the reasons for change and was involved in one third (37.1%) of the changes. Education was seldom mentioned as a reason for change in referral practice but was more often mentioned in management and prescribing changes. Consultants were influenced by medical journals and scientific conferences, while general practitioners were more influenced by medical newspapers and postgraduate meetings. CONCLUSIONS: Education is involved in about a third of changes in clinical practice. The wide range of other factors affecting changes in practice need to be taken into account in providing and evaluating education. The role of education in the numerous changes in clinical practice that currently have no educational component should also be considered.     

Age-sex registers as a screening tool for general practice: size of the wrong address problem.

Age-sex registers were compiled and updated for the east London general practices participating in a screening study for hypertension. Of 1435 addresses in the registers of two practices that were checked, 228 (16%) were incorrect, according to the return by the post office of the screening invitations and checking the addresses of the non-responders using telephone directories and the medical records. The non-responders to the screening invitation for whom a new address was not found, were visited at the address as recorded on the age-sex register. This showed that the true address error rate from the original age-sex registers was 26% and thus substantially greater than that calculated from returned letters. It is concluded that the non-acceptance rate of screening in general practice might be exaggerated as a result of the lack of a correct address for a substantial proportion of the patients on a general practice list.