The British journal of general practice : the journal of the Royal College of General Practitioners
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As part of a study to determine reasons for early unplanned readmission of elderly patients to hospital, the provision of nursing and social services before and after admission was assessed for two groups of patients aged 65 years and over. A random sample of 133 patients who had been readmitted in an emergency and 133 matched controls who had not been readmitted were interviewed. Prior to the first admission the readmitted patients had received more services than the control patients. ⋯ Problems were experienced with services after discharge from hospital. These included: no arrangements, delay in starting services and inadequate services to meet the patient's needs. Guidelines for the provision of nursing and social services after discharge of patients from hospital are suggested.
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Over a two year period an inner city primary health care team constructed a manifesto which defined the common aims and objectives of the team. The statement was not comprehensive, but it served a variety of purposes. Audit was made explicit and a framework was provided for the team's annual report. ⋯ The manifesto was conceived in advance of the government's white paper and new contract for general practitioners. It addresses the perceived health needs of the practice population in a practical way. Other primary health care teams may wish to adapt or use the framework of the manifesto to produce their own version.
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Methaemoglobinaemia may be caused by ingestion of a number of drugs, among them nitrites, some of which are remarkably toxic. This was tragically highlighted by the death of a 17 year old dental nurse after taking a single 1 g tablet of sodium nitrite. ⋯ The toxicity of this chemical should be more widely recognized and its storage made correspondingly more secure. Methaemoglobinaemia should be considered as a diagnosis in any patient with significant central cyanosis in whom there is no obvious cardiorespiratory cause.
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A random sample of referral letters from general practitioners to outpatient departments of general medicine, dermatology, neurology, and gastroenterology at an Amsterdam teaching hospital were analysed together with the specialists' replies for 144 referrals. The pairs of letters were judged by a panel of four general practitioners and four specialists. ⋯ The judges were also asked to assess whether in their opinion the letters were of value in teaching or were discourteous. Though in general intraobserver agreement on what constitutes a good letter was low, deficiencies were revealed in the quality of letters and there were delays in transmission and missed educational opportunities.
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The Nederlands Huisartsen Genootschap (NHG), the college of general practitioners in the Netherlands, has begun a national programme of standard setting for the quality of care in general practice. When the standards have been drawn up and assessed they are disseminated via the journal Huisarts en Wetenschap. In a survey, carried out among a randomized sample of 10% of all general practitioners, attitudes towards national standard setting in general and to the first set of standards (diabetes care) were studied. ⋯ Although a large majority of doctors said they agreed with most of the guidelines in the diabetes standards fewer respondents were actually working to the guidelines and some of the standards are certain to meet with a lot of resistance. A better knowledge of the standards and a more positive attitude to the process of national standard setting correlated with a more positive attitude to the guidelines formulated in the diabetes standards. The results could serve as a starting point for an exchange of views about standard setting in general practice in other countries.