The NHS outcomes framework makes clear that the provision of a 'good experience' of care for patients, alongside clinical effectiveness and safety, is a central goal for the NHS. Developing a comprehensive strategy for measuring patient experience requires a decision about what should be measured and how. This article discusses current policy direction and its implications for practice, and sets out the fundamentals of measuring patient experience.

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As the number of people with diabetes continues to rise, the potential for providing more care in a primary care setting needs to be explored. This will enable specialist services to focus more effectively on those with the most complex needs.

Study objective-The aim was to investigate the effect on respiratory health of male middle tar smokers changing the tar and nicotine levels of the cigarettes they smoke for a six month period.Design Main results-Changes in the measures of respiratory health showed little difference over the trial period between the three cigarette groups. Analyses of the urinary nicotine metabolites showed that smokers allocated to each of the three study cigarettes adjusted their smoking so that throughout the trial their nicotine inhalation differed little from their pretrial intakes when they were smoking their own cigarettes. As a result of the altered patterns of smoking to compensate for the reduced nicotine yields of the three study cigarettes, the tar intake of those allocated to smoke the middle tar, middle nicotine cigarettes remained essentially unchanged, while those allocated to smoke the low tar, low nicotine and low tar, middle nicotine cigarettes had calculated reductions in tar intakes of about 14% and 18%, respectively.Conclusions-Due to the phenomenon of compensation, tar intake can only be reduced substantially by using a cigarette with a markedly lower tar/nicotine ratio.Nevertheless reductions of up to about 18% in tar intake failed to result in any detectable effect on respiratory symptoms or peak expiratory flow rates over a six month period.

A COMPREHENSIVE review of the scientific litera ture on adolescent smoking published in English since 1970 shows a remarkable worldwide pattern of development in adolescent smoking. One developed country after another has reported figures showing that girls now have a higher prevalence than boys. No single factor known to be associated with the uptake of smoking in this age range would have had a large enough effect or changed enough to account for this phenomenon. Advertising and the introduction of low-tar cigarettes may have partly contributed to this development, but a new hypothesis is proposed. The fact that girls mature earlier has combined with a steady change in social attitudes, helped by the commercial pressures, so that girls now exhibit smoking behaviour similar to boys one or more years older. Advertising aimed at young women must be discouraged, and anti-smoking education pro grammes in schools should be revised with particu lar reference to their relevance for adolescent girls.