Dark Matter Search Results from the PICO-60 C_{3}F_{8} Bubble Chamber.

New results are reported from the operation of the PICO-60 dark matter detector, a bubble chamber filled with 52 kg of C_{3}F_{8} located in the SNOLAB underground laboratory. As in previous PICO bubble chambers, PICO-60 C_{3}F_{8} exhibits excellent electron recoil and alpha decay rejection, and the observed multiple-scattering neutron rate indicates a single-scatter neutron background of less than one event per month. A blind analysis of an efficiency-corrected 1167-kg day exposure at a 3.3-keV thermodynamic threshold reveals no single-scattering nuclear recoil candidates, consistent with the predicted background. These results set the most stringent direct-detection constraint to date on the weakly interacting massive particle (WIMP)-proton spin-dependent cross section at 3.4×10^{-41} cm^{2} for a 30-GeV c^{-2} WIMP, more than 1 order of magnitude improvement from previous PICO results.

Evaluation of a mass media campaign on smoking and pregnancy.

Two surveys were conducted among pregnant women throughout England, before (n = 625) and after (n = 607) a mass media campaign on smoking and pregnancy targeted at women aged 15-24 years, in the social grade C2DE. The majority of the post-campaign sample recalled having seen at least one of the campaign's series of press advertisements. There was a significant increase among this sample in those considering smoking to be very dangerous to the unborn child, in those understanding the term passive smoking and in those considering passive smoking to be very dangerous. During the campaign there was a 14% increase in the number of calls to a cessation helpline from pregnant women. Over the campaign there were no significant changes in smoking prevalence and consumption among pregnant women or partners or in the numbers of partners offering suggestions to pregnant women about their smoking behaviour.

Illness behaviour in mothers with young children.

113 families with young children were studied over a 12-month period, when all contacts with the general practitioner and hospital emergency services were recorded. Socioeconomic data was obtained at interview, together with responses to a vignette instrument describing common childhood problems. Health diaries were completed by 70% of mothers, providing further information about illness and mothers anxiety about it. Analyses showed that significant disease in any child was the strongest predictor of frequency of new consultations, with measures of mothers anxiety, number of children in the family, mothers education level and her response to the vignettes also contributing significantly. Socioeconomic deprivation was associated with increased utilisation, even when the effects of prevalence of chronic diseases, size of family and mothers' anxiety were taken into account. From the spontaneous comments made during the vignette responses further information was obtained about how mothers reach the decision to consult the family doctor about children's illness. Thus in a Primary Care setting some systematic differences have been demonstrated between high and low consulting families, which may partly explain the wide variation in spontaneous consultation rates observed.

Exploration of doctor and patient agendas in general practice consultations.

A method for the interactional analysis of doctor/patient consultations is described and applied to six naturally occurring general practice interviews by three raters. The method is reliable given sufficient training and satisfies the stringent criteria for any method of analysis for medical interviews proposed by Wasserman and Inui [1: Wasserman R.C. and Inui R.S. Med. Care 21, 279, 1983].

Clinical terminology: anxiety and confusion amongst families undergoing genetic counseling.

Genetic counseling is a rapidly expanding, but highly demanding, domain of doctor-patient communication. This paper reports results from an ethnographic study of families (n = 30) attending a genetic counseling clinic in Northern England. We suggest that the language used in this particular specialty is often confusing and misunderstood by the families involved. We found that unfamiliar terms may also conjure up also conjure up alarming images. It is important therefore, that physicians, and in particular geneticists, try to use simple, understandable language, and give clear explanations for unfamiliar terms that cannot be avoided. The careful choice of words, and detailed explanation, not only reduces the risks of "labelling" and stigmatization, but may also prevent the unnecessary anxiety experienced by patients when they hear unfamiliar medical terms, such as the eponyms frequently employed by geneticists when giving a diagnosis.

Pharmaceutical care for elderly patients shared between community pharmacists and general practitioners: a randomised evaluation. RESPECT (Randomised Evaluation of Shared Prescribing for Elderly people in the Community over Time) [ISRCTN16932128].

BACKGROUND: This trial aims to investigate the effectiveness and cost implications of 'pharmaceutical care' provided by community pharmacists to elderly patients in the community. As the UK government has proposed that by 2004 pharmaceutical care services should extend nationwide, this provides an opportunity to evaluate the effect of pharmaceutical care for the elderly. DESIGN: The trial design is a randomised multiple interrupted time series. We aim to recruit 700 patients from about 20 general practices, each associated with about three community pharmacies, from each of the five Primary Care Trusts in North and East Yorkshire. We shall randomise the five resulting groups of practices, pharmacies and patients to begin pharmaceutical care in five successive phases. All five will act as controls until they receive the intervention in a random sequence. Until they receive training community pharmacists will provide their usual dispensing services and so act as controls. The community pharmacists and general practitioners will receive training in pharmaceutical care for the elderly. Once trained, community pharmacists will meet recruited patients, either in their pharmacies (in a consultation room or dispensary to preserve confidentiality) or at home. They will identify drug-related issues/problems, and design a pharmaceutical care plan in conjunction with both the GP and the patient. They will implement, monitor, and update this plan monthly. The primary outcome measure is the 'Medication Appropriateness Index'. Secondary measures include adverse events, quality of life, and patient knowledge and compliance. We shall also investigate the cost of pharmaceutical care to the NHS, to patients and to society as a whole.

Audit in general practice: students and practitioners learning together.

OBJECTIVES: To describe and evaluate the use of medical audit in general practice as an educational activity shared by undergraduate medical students and general practitioners. DESIGN: A descriptive study, evaluated by a questionnaire survey of all participating practices and by results of completed student projects on general practice audit topics during three weeks in the first year of completed projects (1990-1). SETTING: One university department of general practice, collaborating with 18 general practices in contract with Liverpool Family Health Services Authority. PARTICIPANTS: 150 medical students, working in groups of two to six, and the general practitioners with whom they worked in 18 practices. MAIN MEASURES: The nature of topics proposed by practices and chosen by the students; methods of audit used by students; reported effects of the audits on the practices; general practitioners' opinions of the projects' usefulness to the practice. RESULTS: The range of topics was wide, and both quantitative and qualitative methods were used. Fifteen of the 18 questionnaires sent out were completed. Six practices reported that the final project had changed substantially after joint planning with the students. Two thirds (10) attached high value to the audits and were making changes in the delivery of care as a result. CONCLUSIONS: Medical audit "project work" by medical undergraduates is an effective tool for motivating students to learn and can lead to change in the clinical setting in which it occurs. IMPLICATIONS: By meeting the learning needs of both undergraduates and established practitioners audit project work has wider application within medical education.

The outpatient experience: results of a patient feedback survey.

Patient surveys can be used to enable hospital management to evaluate the services they provide. This study shows high levels of patient satisfaction with the quality of their consultations and the attitude shown to them by medical staff. Patient feedback shows that despite the introduction of the Patients' Charter, waiting times from referral to appointment and delays in clinics are still identified as the main areas for improvement. Findings show that patients are, however, remarkably tolerant and understanding of the pressures and demands placed upon outpatient staff.

Smoking cessation. Pulling out the stops.

The launch of smoking-cessation drug Zyban in June last year greatly increased demand on a local smoking-cessation service. It is important to use local media to increase awareness of local services. Health authorities and pharmaceutical companies should work with the media when new drugs may put extra strain on local services.

Epiglottitis.

A case of acute epiglottitis due to Haemophilus influenzae is described. The problems of making this diagnosis as early as possible are discussed, with a review of the literature.

Psoriasis and cancer.

A possible association between psoriasis and cancer was investigated by a study of general practice records in 25 practices.No difference was found in the prevalence of malignant disease between a group of 738 psoriasis cases and a group of matched controls.This result accords with the recent finding that tissue from psoriasis patients does not differ from normal in its response to potentially carcinogenic substances.