Christopher Brightman provides a brief account of the background to antibiotic treatment, describing those antibiotics that are most frequently used in general practice, with indications for their use.
Clinical trials P-270 iMPrOVeMent in PreDiCteD ChD riSK With a nOVel ChD riSK eValuatiOn/ COMMuniCatiOn PrOGraM iS relateD tO Patient attituDeS anD BehaViOr (the reaCh Out StuDy) Joshua Benner1, Leif Erhardt2, Martina Flammer3, Robert Moller3, Natasa Rajicic3, Komal Changela3, Carla Yunis3, Spencer Cherry1, Zbigniew Gaciong4, Eric Johnson5, Miriam Sturkenboom6, Juan Garcia-Puig7, Xavier Girerd8. 1IMS Health; 2Lund University, Sweden; 3Pfizer Inc; 4Medical University of Warsaw, Poland; 5Graunt & Co, LLC; 6Erasmus University Medical Center, Netherlands; 7Hospital La Paz, Spain; 8Hôpital Pitié Salpêtrière, France.
Each title in the First Experiences series introduces very young children, in an amusing and friendly way, to a situation they might find themselves in for the first time. The use of simple vocabulary also enables slightly older children to read the books for themselves. The series aims to offer just the right amount of information and provide an opportunity for children and adults to share new experiences, while the illustrations are packed with things for children to look for and talk about.
different scales are used.In such a case the intraclass correlation coefficient computed for each method will indicate which is the more reliable, provided each method of measurement uses the same population, as in a dataset we recently examined.'In summary, we agree with Chinn when she says that "the intraclass correlation coefficient should be used only for comparative purposes.The within-subject standard deviation or 95 per cent range for change should be calculated as the absolute measure of repeatability."2
Medical Journal of AustraliaVolume 156, Issue 10 p. 701-709 For The Record Medical records in general practice† Jill Gordon MB, BS, BA, PhD, FRACGP, Jill Gordon MB, BS, BA, PhD, FRACGP State Director Family Medicine Programme, PO Box 197, North Ryde, NSW, 2113Search for more papers by this authorMary Kearney MB BS, MSc, FFPHM, Mary Kearney MB BS, MSc, FFPHM Medical Educator Family Medicine Programme, PO Box 197, North Ryde, NSW, 2113Search for more papers by this authorPhyllis Watson MSc, MRA, Phyllis Watson MSc, MRA Associate Professor of Health Information Management Faculty of Health Sciences, Sydney University, 31 East Street, Ltdcombe, NSW, 2141Search for more papers by this author Jill Gordon MB, BS, BA, PhD, FRACGP, Jill Gordon MB, BS, BA, PhD, FRACGP State Director Family Medicine Programme, PO Box 197, North Ryde, NSW, 2113Search for more papers by this authorMary Kearney MB BS, MSc, FFPHM, Mary Kearney MB BS, MSc, FFPHM Medical Educator Family Medicine Programme, PO Box 197, North Ryde, NSW, 2113Search for more papers by this authorPhyllis Watson MSc, MRA, Phyllis Watson MSc, MRA Associate Professor of Health Information Management Faculty of Health Sciences, Sydney University, 31 East Street, Ltdcombe, NSW, 2141Search for more papers by this author First published: 01 May 1992 https://doi.org/10.5694/j.1326-5377.1992.tb121511.xCitations: 2 No reprints will be available. Correspondence: Dr Jill Gordon. †This article is part ol a series which has been arranged and coordinated by the Australian Association for Academic General Practice. AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Citing Literature Volume156, Issue10May 1992Pages 701-709 RelatedInformation
Sir, The contribution of Wessely and colleagues (January Journal, p.26) to the management of chronic (post-viral) fatigue syndrome, while disclaiming any 'a priori assumption as to aetiology' of the condition, concentrates largely upon the psychological condition of the patient. No consensus exists as to the aetio-pathology of the condition, and many suggestions (for example candida infection) are based more on emotion than demonstrable evidence. It is illogical, however, to outline one facet of treatment without some concept of the underlying pathology. There is real evidence that the post-viral fatigue syndrome, with its highly diverse symptomatology, is organically based. Careful examination with a 64 tuning fork almost always shows diminished vibration sense when tested against a standard; abdominal reflexes are not uncommonly absent; internal rectus muscle paralysis may occur and a unilateral extensor plantar response has been seen. Since a great many viruses have been blamed, it would seem that a primary lowered immunity allows opportunistic infection(s) with special proclivity for the lymph glands and nervous system (both cerebral, spinal and autonomic). Evidence of an organic basis for the disease in muscle has been provided by a study of single fibre myography in 40 patients with myalgic encephalomyelitis, I and by Friman and colleagues who concluded that there was defective muscle fibre membrane conduction.2 Recent work at Oxford using nuclear magnetic resonance has shown that the biochemistry of muscle is profoundly disturbed in post-viral fatigue syndrome.3'4 In addition, the immune system has been shown to be at fault.5 In the nervous system itself every case of post-viral fatigue syndrome or myalgic encephalomyelitis (a distinction recently emphasized by Ramsay 1988,6 though difficult to sustain in practice) is found to have organic destruction of the nervous system. Of course organic disease is accompanied by some psychological overlay though this should not be sought out and treated as a disease sui generis.7'8 Tests enable distinction between destruction of brain tissue by multiple sclerosis and destruction from another cause. Cases of post-viral fatigue syndrome always fall within the latter category. Nuclear magnetic resonance has shown small lesions over the high convexity of the brain and also a snowstorm effect. Some of these oedematous lesions involve the Wernicke and Broca areas and the brain stem. Much more needs to be done along these lines bearing in mind, however, that examination by nuclear magnetic resonance is a considerably blunter weapon than was originally thought and depends greatly upon skill in interpretation. Wessely and colleagues should evaluate evidence of the nature of the disease, even though there seems little effective physical therapy at the moment, before going overboard on the psychological approach. Incidentally, about 80% of families (first degree relatives) studied by the Naomi Bramson Medical Research Trust show more than one case in the family. The interpretation of this is unclear; it could be exposure to the same bad environment laden with viruses, preservatives, fungicides, water pollution or stress, all of which may well lower immunity. Therapy should clearly be directed to rectifying this lowered immunity.
Sir, Two new H2-receptor antagonists nizatidine and famotidine have been available since autumn 1987. Do these new drugs offer any real benefit over their established rivals cimetidine and ranitidine? In August 1988 an article in the Drug and Therapeutics Bulletin' concluded that the new H2-receptor antagonists do not offer any important clinical advantage over cimetidine or ranitidine. It advised using cimetidine on the basis of cost and ranitidine when avoidance of anti-androgenic effects or drug interaction was required. We would like to report the results of a questionnaire sent to all 349 general practitioners in the greater Belfast and North Down area to determine to what extent they were prescribing nizatidine and famotidine and why they had chosen to prescribe these newer drugs. Of the 349 questionnaires sent out 231 (66%) were completed and returned. Only 66 (2907) of the 231 general practitioners had prescribed nizatidine, famotidine or both 37 at the request of the hospital, 18 on their own initiative and 11 under both circumstances. Of the 231 doctors 113 (49%) were aged 40 years or under and 131 (57%) were vocationally trained. Among the 29 general practitioners who initiated prescribing of nizatidine and/or famotidine 20 (69%) were aged 40 years or under and 20 (69%o) were vocationally trained, suggesting that it is younger doctors who are more willing to alter their prescribing habits. The most frequent reason for prescribing nizatidine or famotidine was that there had been no improvement when a patient was prescribed cimetidine or ranitidine (21 doctors). Other reasons included side effects with cimetidine and/or ranitidine (three doctors) and the availability of a calendar pack (two doctors). Three doctors had tablets available in their bag when called out at night and three wished to try out the new drug(s). Some doctors gave more than one reason. None of the general practitioners felt that the smaller size of the famotidine tablet (40 mg) compared with the equivalent cimetidine (800 mg) and ranitidine (300 mg) tablets had influenced their prescribing. Table 1 shows how the general practitioners received information about the new drugs. The majority learnt about the drugs by direct information from the pharmaceutical companies. TWenty eight of the 29 doctors who initiated prescribing of these new H2-antagonists had received information about them from meetings with pharmaceutical representatives.
1 Month 20xx, Vol. xxx, No. x By definition, occult spinal dysraphism (OSD) is characterised by intact overlying skin, although most patients have some form of cutaneous stigmata. Because the underlying pathology is so variable, the clinical presentation and course of the condition vary significantly from severely disabling to asymptomatic throughout life. Management usually requires a multidisciplinary team of paediatricians, paediatric neurosurgeons, urologists, orthopaedic surgeons, occupational therapists, physiotherapists and geneticists. Although the spectrum of dysraphic abnormalities includes cranial anomalies (encephalocele), this article will focus on the spinal manifestations.
Sir, Hypothermia caused 516 deaths in England and Wales in 1985 (OPCS, personal communication). Many deaths occur in people with identifiable risk factors such as chronic illness, immobility, social isolation and drug problems (including alcohol). In a recent survey, we have investigated the feasibility of introducing an alert system and assessed its appropriateness to a rural general practice of 6000 patients scattered over 300 square miles in central Devon. The system is initiated by a Meteorological Office forecast of particularly inclement weather which is transmitted to a clerical officer who would telephone a small number of volunteers who in turn would contact further volunteers in a 'snowballing' fashion. These volunteers would visit and offer help to those previously identified by the primary health care team as being 'at risk' of hypothermia. Local figures show that 75% of cases of hypothermia are among patients aged 80 years or over (unpublished results). This age group of patients was identified from the practice age-sex register and of the 225 people 96% were known personally to at least one member of the practice team. Those considered to be potentially at risk and all of the 4% not known personally were visited by a general practitioner and their circumstances reviewed. Only one of the latter group was considered to be 'at risk' and she was one of five who had not seen a doctor in the previous yearthe 10 other patients were either well supported (five) or fit and well (five). In the entire survey group 28 patients were considered to be potentially 'at risk'. Eighteen of these patients had informal support systems, ranging from knocking on walls, a baby alarm connected through to a neighbours' house and arrangements with neighbours to investigate if milk bottles were not taken in by a certaln time, to one lady who spends her winters The exceptional potential of the consultation revisited Nigel Stott 520
Simple rehabilitative strategies are proposed to help patients with the chronic fatigue syndrome. A model is outlined of an acute illness giving way to a chronic fatigue state in which symptoms are perpetuated by a cycle of inactivity, deterioration in exercise tolerance and further symptoms. This is compounded by the depressive illness that is often part of the syndrome. The result is a self-perpetuating cycle of exercise avoidance. Effective treatment depends upon an understanding of the interaction between physical and psychological factors. Cognitive behavioural therapy is suggested. Cognitive therapy helps the patient understand how genuine symptoms arise from the frequent combination of physical inactivity and depression, rather than continuing infection, while a behavioural approach enables the treatment of avoidance behaviour and a gradual return to normal physical activity.
