The treatment of acute myocardial infarction.

A questionnaire on the management of acute myocardial infarction was sent to 100 randomly selected general practitioners. From the replies received, only 42 provided worthwhile information. The approach to the care and treatment of actual patients and their common complications is discussed and recommendations relating to future audits are made.

Depressive illness in general practice.

A review of published literature concerning psychological illness in General Practice shows that the spectrum of illness seen differs considerably from that met with in hospital practice. The incidence of depressive illness in General Practice is described and the relationship of life events, physical disease and social factors to depression are noted. The difficulties experienced in the diagnosis of depression in the General Practice setting are described and evidence is given of the high use of drug therapy in the General Practice management of depression. The need for education in psychological illness that is more appropriate to the understanding and management of depression in General Practice is stressed.

Audit of process and outcome in a mini-clinic for children with asthma.

A mini-clinic for the management of children with asthma was started in a general practice, and 31 children aged between five and 14 years were invited to attend. Thirty-one age and sex matched asthmatics were recruited for comparison from a neighbouring practice. There was evidence of only slight improvement in outcome among the children attending the mini-clinic, although they required considerably more respiratory consultations than the children in the comparison practice. These observations, and the methodology, are discussed.

Variation in peak expiratory flow in children with asthma.

Twice daily peak expiratory flow measurements were obtained at home from 65 asthmatic children and 34 non-asthmatic controls, and a measure of the daily variation in peak expiratory flow was calculated for each child (mean daily variation). Children aged less than 7.5 years appeared unable to provide reproducable peak expiratory flows, but above that age the mean of the mean daily variations was significantly higher for the asthmatics than the controls. This was true even on days when the asthmatics exhibited no wheeze or took no medication. The significance of the findings is discussed, and it is suggested that calculation of the mean daily variation might assist in the assessment of children presenting with atypical respiratory symptoms.

Development and evaluation of teaching course in general practice.

The further development of a teaching course in general practice medicine for fifth year students at Glasgow University is described. Lessons learnt from a previous experimental course have been applied: eight afternoon sessions of a structured nature and related to prescribed objectives and a syllabus were given to small groups of students. Questionnaires showed that the in-depth study of selected patients in their own homes, with student involvement in the preparation of problem lists for group discussion were thought by the students to be valuable. An objective assessment of the course using the modified essay question technique showed an improvement in factual clinical knowledge (P less than 0.05) and more importantly in areas relating to the general practice content of the teaching (P less than 0.001).

The diagnosis of pregnancy in general practice.

In 1,631 pregnancies presenting to general practitioners, the reliability of three proprietary slide tests for the diagnosis of pregnancy was assessed both against the outcome and against the results of hospital tests done at the same time. When all patients were considered the reliability of such tests done in the surgery was 85 per cent against a 90 per cent for hospital tests and when only patients who were more than 42 days pregnant were included, the accuracy figure rose to 87 per cent in general practice and 91 per cent in hospital.The time delay before the results of the hospital test was assessed showed a mean of three days which is considered unacceptable if there are urgent clinical reasons for the test being done. The doctors participating listed their reasons for doing tests and in 54 per cent of cases urgent confirmation or otherwise of the pregnancy was considered essential by either doctor or patient. In the remaining 46 per cent this confirmation was considered simply helpful rather than essential. The study showed that the accuracy of the test, when delegated to a nurse, was acceptable and that in a proportion of three to one the participating doctors considered that the test was of value and worthwhile in patient care.

The benefits to an elderly population of continuing geriatric assessment.

There is currently great interest in the care of the elderly in general practice and discussion about the role of surveillance programmes. We report a comparison between two surveys of an elderly population carried out with a view to determining the difference in findings between two surveys of the same population.Each patient had an average of 4.8 problems at the time of the second assessment. The number of active and unknown problems fell from 6.4 per patient at the initial assessment.The greatest improvements were found in such topics as clothing, bedding, heating, dentition, diet, vision, and hearing, and the least in such aspects as dependency, home hazards, and problems with a caring relative.We remain convinced that a continuing programme of geriatric assessment is valuable in general practice.

Use of laboratory services and communication of results to patients in an urban practice: an audit.

The pattern of investigations in an urban practice of 4200 patients was monitored over an eight-week period. An assessment was made of the characteristics of patients who sought the results of their investigations.During the study period there were 1522 consultations and 186 investigations were carried out on 155 patients. More females were investigated than males (3.4:1) with most tests among 31-40 year old women. At the end of the study period only 95 patients (61.3%) knew the results of their tests and of 34 abnormal results nine were not relayed to patients. The probability of a patient collecting a result was not influenced by the patient's age or sex, the reason for carrying out the test or the instructions given by the doctor for collection of the result. Abnormal test results were more likely to be collected than normal results.These findings suggest that many practice systems of relaying information to patients need modifying. Whose responsibility it should be to pass on the results of patients' investigations is discussed.

Early diagnosis of pregnancy in general practice.

The value of the signs and symptoms of pregnancy and of the pregnancy diagnostic test as predictors of pregnancy was estimated for 1,592 women seen in general practice. The presence of a sign or symptom alone is a poor pointer to a diagnosis of pregnancy. The combination of pairs of features improves the value, the best being breast signs combined with either the presence of signs of pregnancy on vaginal examination or a palpable fundus, both giving predictive values of 0.89. The pregnancy diagnostic test alone, however, had a predictive value of 0.91, a value of 1.00 indicating 100 per cent reliability.

The workload of a commercial deputizing service.

The analysis of 1,098 calls to a commercial deputizing service during a period of four weeks is described. Approximately 20 per cent of the calls were for illnesses considered potentially life-threatening while in 22 per cent telephone advice was given and the patient was not visited by the deputy on call.

Oxatomide in the management of hay fever--a placebo-controlled double-blind study in general practice.

Sixty-three patients completed a double-blind placebo-controlled study of oral oxatomide (30 mg t.d.s.) in the management of seasonal allergic rhinitis and/or conjunctivitis. Hay fever symptom scores were significantly lower for oxatomide-treated patients than for the placebo group on the majority of days during periods of high pollen counts. Moreover, on days when pollen counts were 10/m3 or more, a statistically significant positive correlation between symptom score and pollen count was demonstrated for the placebo group but not for the oxatomide group. Oxatomide also appeared to be superior to placebo in terms of patients' requirements for supplementary mepyramine (Anthisan) tablets, and the doctor's global assessment. Side-effects were reported by four patients in the oxatomide group and by three receiving placebo.

An ethical committee for general practice in the west for Scotland: proposals received in the first year.

The particular ethical problems of research in general practice and pressure from local general practitioners and hospital ethical committees led to the development of an ethical committee for general practice in the west of Scotland. The workload of this ethical committee in its first year of existence is described.Despite the fact that many of the studies considered by the committee were sponsored by pharmaceutical companies and were often sophisticated, the ethical issues of a general practice setting had not always been fully appreciated. Of the 21 study proposals submitted over the year 13 showed areas of ethical uncertainty. However, all the studies were eventually approved. Most of the problems encountered were easily overcome and might have been avoided if the general practitioners undertaking the research had been able to seek advice from those with experience of research in general practice and in particular of the ethical issues involved. Local ethical committees for general practice, made up largely of general practitioners but with at least one lay member, might provide one such source of advice.

Wide variations in the night visiting rate.

The night visit record of an out-of-hours rota service of a large health centre which includes 10 group practices was examined. The mean annual night visiting rate for the health centre was 35.2 per 1000 patients, ranging from 25.8 to 43.5 between individual practices. The organization of medical care at night was the same for all the practices, and no major demographic differences between practices were identified. It is argued that the doctor-patient relationship may have an influence on differences in night visiting rates.