Aims: To examine whether variations in pathology test requesting between different general practices can be accounted for by sociodemographic or other descriptive indicators of the practice. Method: This was a comparative analysis of requesting patterns across a range of pathology tests representing 95% of those requested in general practice, in 22 general practices in a single district, serving a population of 165 000. Spearman correlation coefficients were calculated and both the top and bottom fifths of activity were displayed graphically to detect trends at the extremes of the ranges. Results: The proportion of women of childbearing age, median practice Townsend scores, or the existence of specialist miniclinics within the practice did not have a demonstrable impact on requesting patterns. A weak correlation was found between the proportion of elderly patients and creatinine/electrolyte testing but not for the other two tests examined for this patient group. Conclusions: The large differences observed in general practice pathology requesting probably result mostly from individual variation in clinical practice and are therefore potentially amenable to change.A lthough the relation between sociodemographic parameters, morbidity rates, and the use of medical services on a large scale is well established, 1 2 we are not aware of similar reports for the use of pathology services, either on a broad population basis or within individual health localities. Clinical practice is often assumed to account for differences in the use of pathology tests, but there is little published evidence to support this.Recently, we have published details of a simple model that may be used to monitor test requesting activity in general practice across different tests in pathology.3 This model produced stable results over time, and showed considerable differences between the test requesting activity of 22 general practices. In a context of primary care groups being able to use this type of model in a clinical governance setting, it is important to exclude potential confounding variables that could explain these differences, to provide credibility for any intervention designed to change practice."Clinical practice is often assumed to account for differences in the use of pathology tests, but there is little published evidence to support this"To examine whether these variations could be explained by differences in the general practices themselves, or in the general practice catchment area, we have considered several individual factors in the cohort of 22 general practices studied.We had previously shown that adjusting the overall rankings of requesting numbers for age and sex to produce standardised requesting ratios for each practice did not alter the unadjusted rankings of request activity.3 However, most practices in these distributions lie within a broad modal band of requesting, and it is possible that age and sex adjustment of overall activities may not detect particular extremes of activity for certain tests. Therefore, we set ou...
In our study population, the proportion of dry taps at myringotomy was 18 per cent. The presence of a dry tap was rarely due to the induction of anaesthesia. Multivariate analysis revealed that the combination of factors most likely to predict a dry tap were non type B tympanogram and delay to operation.
The efficacy of structured education for 158 Type 2 diabetic patients in primary care (80 male, mean age 63 yr, median diabetes duration 3 yr) was assessed with respect to change in knowledge of diabetes, weight, and haemoglobin A1 over a 6-month period. The programme supplemented a primary care initiative in our semi-rural population. Teaching was carried out by a Diabetes Nurse Educator within primary care health centres (141 patients) and a hospital diabetes clinic (17 patients). For all patients mean baseline questionnaire score (maximum possible 12) was 6.2 rising after the programme to 10.5 (p < 0.01). At 6 months mean score fell to 9.5 (p < 0.01 compared to end of the programme), but still significantly better than baseline (p < 0.01). For patients on the primary-care-based programme mean haemoglobin A1 at baseline was 10.7% (normal range 6%-9%) decreasing after 6 months to 9.6% (p < 0.01). No significant changes were found in mean weight. Unlike many previous studies, these results demonstrate a highly beneficial effect not only on knowledge but also on metabolic control in patients who received their education in the primary-care setting. These results have obvious implications for patients residing in rural or semi-rural populations.
SummaryThe effect of ursodeoxycholic acid treatment on survival in primary biliary cirrhosis was studied in 40 patients with symptomatic disease. Two patients developed early exacerbation of symptoms and stopped therapy in days; they are both alive 4 and 41/2 years later. The other 38 patients have continued on treatment for up to 10 years. Results were compared with 12 other similar cases previously seen but not given specific therapy. Kaplan-Meier analysis showed that ursodeoxycholic acid treatment was associated with better survival (p <0.05) after the first two years of therapy. Predictors of favourable outcome included histological stage I disease. In 26 patients with primary biliary cirrhosis stage II, III or IV, therapy showed a trend to improved survival, but this was still significantly worse than the general population. Prognosis was not different between these different advanced stages. Symptoms improved in 28 out of 40 patients on ursodeoxycholic acid, but 50% had a recurrence by two years.
The Serious Hazards of Transfusion Scheme's (SHOT) annual report continues to emphasize the importance of investigating serious transfusion errors. It is now recognized that lessons can also be learnt from near-miss events as these occur more frequently than serious errors in transfusion. One of the key features in developing a culture that can promote safety in relation to transfusion is providing feedback to staff on what is acceptable and unacceptable practice. We have developed a scoring system based on the number of serious errors and near misses that occur in the transfusion service to provide feedback to staff on their performance in relation to the administration of blood components and blood products. This was developed as part of an ongoing error logging system that we have previously described. The implementation of this feedback has resulted in an increased awareness within our organization of safety issues in relation to transfusion, and has highlighted the importance of the detection and correction of less serious errors.
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