The telephone in primary care

This paper presents a review of the use of the telephone in primary care medicine. The telephone is available to a large majority of United States citizens, a situation that is unusual in other countries. Between 15 and 20% of all primary medical contacts in the United States occur on the telephone. Approximately 40% of routine office telephone contacts are administrative in nature, the remainder involving direct requests for advice or treatment. After office hours, requests for immediate medical advice constitute almost all of the calls (for both daytime and after hours calls). Close to 70% of the medical calls are managed solely by use of telephone. Although the telephone is effectively used for medical consultation, teaching and survey purposes, it has been shown that health professionals are protocols or specific training tends to improve performance, but such programs are not a regular part of medical education.

The telephone survey in family practice

Patient surveys can be useful methods of obtaining information for the purposes of improving health services, practice management, or research in family medicine. The telephone interview is an effective and economical method of undertaking such a survey. The advantages and disadvantages of the telephone survey method are briefly illustrated by a study conducted in the Family Practice Center at the University of North Carolina concerning patient perspectives on their after-hours medical encounters with physicians.

Three hundred years of family health care: some perspectives

Many medical texts have been produced in the past to help the ordinary individual and his family care for themselves, without resorting to the services of a physician. Five "home care" books were randomly selected for study from the many hundreds spanning a period of approximately 300 years, up to the early 20th century. It is likely that these books, which dealth with a whole range of problems including morality, religion, and lifestyle, had a significant impact on the attitudes of society, many of which persist to this day. The importance of environment and natural therapies stressed in these books has been reemphasized in recent years.

Differential expression of the globin genes in human leukemia K562(S) cells induced to differentiate by hemin or butyric acid

Human leukemia K562(S) cells were induced to differentiate by 50 microM hemin or 1.4 mM butyric acid, and the types of hemoglobins synthesized were compared. In both cases, embryonal hemoglobins [Portland, Gower 1, Hb X, and fetal hemoglobin (Hb-F)] were detected. Butyric acid-treated K562(S) cells contained mostly Hb Gower 1 (zeta 2 epsilon 2) and a hemoglobin with the electrophoretic characteristics of Portland (gamma 2 zeta 2). For hemin-treated K562(S), the most abundant hemoglobin synthesized by Hb X (epsilon 2 gamma 2), and the second most abundant was Bart's (gamma 4). Traces of Gower 1 were observed in nontreated K562(S) cells. The kinetics of hemoglobin induction as a result of the two treatments differed; increased hemoglobin synthesis was detected after only 24 hr of hemin treatment, whereas 4 days were required in butyric acid-treated cells. Both hemin and butyric acid were able to induce their respective patterns of hemoglobin synthesis independent of the presence of serum in the K562(S) growth medium. Analysis of the globin chains in induced K562(S) cells induced to differentiate indicated that, with both inducers, adult alpha- but not beta-globin chains were present. Karyotype analysis of K562(S) cells revealed a nearly triploid chromosome complement with a modal number of 68 chromosomes. Three copies of chromosome 11 and four copies of chromosome 16 (coding for the beta-like and alpha-like globin genes, respectively) were present. A large marked chromosome, involving chromosome 7, and a Philadelphia chromosome were also seen. These data characterize the K562(S) subline and also indicate that hemin and butyric acid differ in their effects on the expression of embryonal globin genes.

The beta major and beta minor globin nuclear transcripts of Friend erythroleukemia cells induced to differentiate in culture

Friend erythroleukemia clone 745 cells were induced to differentiate by dimethyl sulfoxide (Me2SO) or by hemin treatment, and nuclear transcripts of the beta major and beta minor globin genes examined. The beta major and beta minor genomic sequences selectively labaeled in the nonhomologous part of the large intervening sequence 2 were hybridized to the nuclear RNA of Friend cells. The nuclear RNA of Me2SO-treated cells contained both beta major and beta minor nuclear transcripts, whereas hemin-treated cells contained only the beta minor transcripts. The beta minor nuclear transcripts were more abundant in the Me2SO-treated cells than in hemin-treated cells. Nuclear transcripts with the size of partially processed beta major globin mRNA precursors were also detected in the Me2SO-treated cells.

A life-cycle conference series; education for general practice

An all around educational programme for general practice trainees involving a conference and seminar cirriculum was developed, based on a life-cycle concept. In addition to emphasizing the study of usual life stresses and crisee for individuals and families, the programme encouraged the contribution of resource people from many related medical disciplines and also from the non-health sciences. Detailed planning allowed the structuring of the conference over an academic year. Clearly defining the objectives for each meeting led to effective evaluation and enhanced the educational process.

The concept and measurement of continuity in primary care

Continuity of care, a stated fundamental principle of family medicine, is reviewed in terms of its philosophy and definitions. A model of continuity in primary medical practice is proposed, consisting of five elements: the provider, consumer, encounter type, knowledge base, and environment of continuity. The elements are measurable, some more easily than others. There is need to define and operationalize the model more accurately in order to evaluate continuity in primary care medicine.

Original research : after-hours calls: a forgotten item of education in family practice

After-hours care is an essential ingredient of family practice and other primary care disciplines. In various countries, between three and 70 per cent of all after hours calls are handled over the telephone without the patient being seen. Little medical education is provided to train medical students or physicians to deal with clinical problems that are more frequent after surgery hours and with communication and decisionmaking over the telephone. An after-hours record card, developed by the authors, has been used over the past three years for clinical care and educational activities.

Isolation and partial sequence of recombinant plasmids containing human alpha-, beta- and gamma-globin cDNA fragments

Human globin cDNA-derived recombinants with plasmid pCR1 have been prepared for use as specific hybridisation probes and for the partial sequencing of alpha-, beta- and gamma-globin genes.

Army families and the general practitioner

The military component of a rural general practice is described with details of increased workload and morbidity for conditions associated with emotional stress.

Long-term digoxin treatment in general practice

A questionnaire was sent to several general practitioners and specialists in an attempt to obtain a consensus on standards of care for patients receiving long-term digoxin treatment. The consultants' suggested standards were slightly more stringent than those of the general practitioners. The records of 42 patients taking digoxin under the care of two general practitioners were studied to see how far their actual care matched up to the suggested standards. The models of management proposed by these patients' doctors were only slightly different from those suggested by other practitioners, but measured against these models the patients' care was in some cases inadequate. Nevertheless, there was little relationship between the recorded levels of care and the health of the patient, and it may have been the standard of recording rather than the care that was inadequate. Measuring plasma digoxin levels in these patients proved to be of little value. Medical audit is thus a useful tool in helping the general practitioner to review his work and improve his knowledge, but it may not be a practical or true way of measuring the quality of care.

Medical audit in general practice

Increasing interest is being shown in the standards of medical care in general practice. The method of measuring these standards, known as medical audit, is discussed in relation to general practice in Great Britain.