Objective-To determine the frequency of poor perception ofseverity ofasthma in general practice.Design-Asthmatic patients recorded their perceived severity of asthma, with a visual analogue score, and a coded measurement of their peak expiratory flow up to four times daily for 14 consecutive days.Settings-1 general practices in and around Bristol.Subjects-255 asthmatic patients (139 men and 116 women) aged 17-76 who were recruited by random selection from the general practices' disease registers or when they requested prescriptions for inhaled bronchodilators.Main outcome measures-Correlation between visual analogue scores and peak expiratory flow (as a percentage ofpredicted peak flow).Results-152 (60%) of the patients showed no significant correlation between visual analogue asthma scores and simultaneous peak flow measurements (p>0.05) and were termed poor discriminators. The distribution of good and poor discriminators within each general practice was similar (X2=6-l1, df= 10). The two groups were not characterised by differences in the maximum, miniimum, or standard deviation of peak expiratory flow or visual analogue score; in age; or in the proportion ofmen and women in each group.Conclusion-In general practice a high proportion of asthmatic patients do not reliably detect changes in their lung function. This reinforces the need for careful objective assessment of lung function in the management ofasthma.

Objective-To compare general practitioners' care of adult patients with learning disability with that of control patients in the same practice. Design-Case-control study of patients and controls by a structured interview study of general practitioners. Setting-Avon. Patients-78 adult patients with learning disability and 78 age and sex matched controls -cared for by 62 general practitioners. Main measures-Number and content of consultations and opinions of the general practitioners.Results-There were more consultations for diseases of the central nervous system and of the skin among the patients than the controls (15 v 3 for central nervous system disease and 15 v 4 skin disease). There were also significantly fewer recordings of blood pressure and cervical cytology tests (34 v 51 for blood pressure and 2 v 18 for cytology). Although more patients were taking drugs affecting the central nervous system (33 v 6), more controls were taking drugs for musculoskeletal complaints (17 v 7). Conclusions-Although adult patients with learning disability consult with their general practitioners at equivalent rates to other patients, they get less preventive care and consult for different types of problems than do other patients. The reasons for these differences in preventive care are not clear. Carers and general practitioners should be informed of these differences to ensure that appropriate care is given.

Purpose: Several studies have explored the scientific platforms on patient use of the internet for health information. In contrast physicians' perspective on evolving internet environment is lacking. The purpose of this study is to assess and correlate the extent of internet use among healthcare professionals and examine its effects on clinical practice. Methods: Cross sectional survey conducted in the USA using questionnaires distributed randomly to healthcare professionals attending distinct continuing medical education programmes between 2003 and 2004. Multiple choice and yes/no questions related to the trends of internet use and its effects on clinical practice were extracted and responses analysed. The main outcome measures are self reported rates of internet use, perceived effects, and the role of medical web sites in clinical practice. Results: The overall response rate was 60%. A total of 277 survey respondents (97%) had internet access. Some 7% in private practice and 1% of group practice physicians did not have internet access. Most (71%) used the internet regularly for medical or professional updating and 62% (n = 178) felt the need for sharing web sites designed for healthcare professionals with patients. Some 27% of the physicians currently own established personal practice web sites. Sixty three per cent have recommended a web site to a patient for more information, matching the positive trust (.70%) on the general quality of selected medical web sites. Conclusion: This cross sectional survey shows that internet use and web based medical information is widely popular among physicians and patients. About 23%-31% of the healthcare professionals report .80% interaction with web informed patients in their daily practice. E very year more and more patients turn to the internet for medical advice along with physicians for medical updating, making it an important and emerging mass medium. With rapid changes in both technology and the institutions of heath care, online informatics is becoming more central to healthcare services. The widespread availability of medical and scientific information on the internet has a profound impact on physician-patient relationship. 9The internet is clearly the modern vehicle with the potential to improve information dissemination and perhaps change the way health care is delivered.

Valid measures of patient satisfaction can be developed; untested instruments should no longer be used.