Objective To determine the extent to which implementation of an evidence based treatment, antithrombotic treatment in atrial fibrillation, is possible in general practice. Design Audit and qualitative study of patients with atrial fibrillation and an educational intervention for patients judged eligible for antithrombotic treatment. Setting South east England.

For patients with atrial fibrillation, treatment recommendations from clinical practice guidelines often differ from patient preferences, with substantial heterogeneity in their individual preferences. Since patient preferences can have a substantial impact on the clinical decision-making process, acknowledgment of their importance should be incorporated into clinical practice guidelines. Practicing physicians need to balance the patient preferences with the treatment recommendations from clinical practice guidelines.

O1jectives-To compile a register of diabetic patients within the catchment area of a district general hospital and evaluate the characteristics of the population using aggregated data from a general practice audit.Design-Cross sectional study. Practices identified all known diabetics and completed a questionnaire from information in each patient's medical record.Setting-Practices affiliated to a district audit group in south east England.Main outcome measures-Number of participating practices; prevalence of diabetes and its complications; and sex distribution of patients, age at diagnosis and review, treatment, and metabolic control. Comparisons with similar data from other studies.Results-41 out of 43 practices participated, and 2574 diabetic patients were identified (prevalence 1-18%). 52 40/o of patients were male. The mean age was 61*6 years. 32% of patients were treated with insulin, 51*5% with oral hypoglycaemic agents, 16-5% with diet alone. The mean random blood glucose concentration was 10*4 mmol/l and glycosylated haemoglobin 10/1%. 8%/ had proteinuria, 7% a history of myocardial infarction, 5% a history of stroke, and 2% a diabetes related amputation. These proportions were not significantly different from those found in studies performed by different methods in Poole, Islington, Powys, Trowbridge, and Southall.Conclusion-It is feasible to compile a register of diabetic patients in a district and evaluate their characteristics by using only general practice sources.

General practice websites offer a wide range of information. They are technically satisfactory, but do not exploit fully the potential for electronic doctor-patient communication. The quality of information they provide is poor. The instrument may be developed as a template for general practices producing or revising their own websites.

Summary A case of warfarin-induced skin vasculitis in a 52-year-old female is reported. Bilateral breast involvement occurred but without progression to necrosis as in previously described cases. The pathogenesis is discussed and prescribing recommendations made in an attempt to avoid the complication in susceptible individuals.