Vocational training for general practice: a preliminary report.

Walker, J. H.; Smith, Andrew; Irvine, Donald

doi:10.1136/bmj.1.5739.41

Cited by 5 publications

(1 citation statement)

References 2 publications

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“…2 Many activities in small groups34 convinced general practitioner trainers of the value of medical audit. Meanwhile, local paediatricians were considering ways of improving paediatric care in general practice after the Court report.'…”

Section: Introductionmentioning

confidence: 99%

Medical audit in general practice. I: Effects on doctors' clinical behaviour for common childhood conditions. North of England Study of Standards and Performance in General Practice.

1992

BMJ

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OBJECTIVE--To estimate the effects of medical audit, particularly setting clinical standards, on general practitioners' clinical behaviour. DESIGN--Before and after study strengthened by a replicated Latin square. SETTING--62 training general practices in the north of England. SUBJECTS--92 general practitioner trainers, 84 (91%) of whom completed the study; random sample of 3500 children consulting one of these trainers for any of five conditions--acute cough, acute vomiting, bedwetting, itchy rash, and recurrent wheezy chest--stratified by doctor consulted, condition, and age. INTERVENTIONS--Clinical standard set by each of 10 small groups of general practitioner trainers for one randomly selected childhood condition. Each group also experienced a different type of medical audit, randomly selected, for each of the four other study conditions (receiving a clinical standard set by another trainer group, tabulated data comparing clinical performance with that of all other groups, tabulated data from only their own group, and nothing ("control" condition)). MAIN MEASURES--Content of initial consultation divided into: history, examination, investigation, diagnosis, and management (abstracted from medical records and "enhancement forms" completed by doctors). RESULTS--There was increased prescribing of bronchodilators for acute cough, oral rehydration fluids for acute vomiting, antibiotics for itchy rash, and bronchodilators and oral steroids for recurrent wheezy chest and reduced prescribing of antibiotics for acute cough and recurrent wheezy chest and tricyclic antidepressants for bedwetting. Fewer children were "discharged." Each change was consistent with the standard and either limited to doctors who set a standard for that condition or significantly greater for them than all other doctors. CONCLUSION--Setting clinical standards improved prescribing and follow up.

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Section: Introductionmentioning

confidence: 99%

Medical audit in general practice. I: Effects on doctors' clinical behaviour for common childhood conditions. North of England Study of Standards and Performance in General Practice.

1992

BMJ

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Effect of phenobarbitone on hepatic drug‐metabolizing enzymes and urinary D‐glucaric acid excretion in man.

Lecamwasam¹,

Franklin²,

Turner³

1975

Brit J Clinical Pharma

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1The activities of some hepatic drug-metabolizing enzymes representative of the four major pathways for the biotransformation of drugs were estimated in diagnostic wedge biopsy specimens obtained from 22 patients with Hodgkin's disease. Twelve patients (nine males and three females) were not on prolonged pre-operative treatment with any known inducing drugs.In this group, hexobarbitone oxidase activity, cytochrome P450 and microsomal protein contents were in the same range as those reported by other workers. 2 Ten patients (five males and five females) were pre-operatively treated with phenobarbitone (90 mg daily) for at least seven days. This resulted in a significant increase of hexobarbitone oxidase activity, cytochrome P450 and microsomal protein contents when the phenobarbitone untreated and treated groups were compared as a whole and provides direct evidence of induction of hepatic mixed function oxidase system. In respect of p-nitroreductase, I-leucyl-f-naphthylamide splitting enzyme and UDP glucuronyl transferase, there was no difference between the treated and untreated groups. 3 When untreated and treated patients were compared, the induction of the hepatic mixed function oxidase system, was associated with a significant increase in urinary D-glucaric acid excretion. In treated patients, however, there was no correlation between any of the indices studied and post-phenobarbitone D-glucaric acid content or the rise in D-glucaric acid excretion. However, the correlation between cytochrome P4so content and post-phenobarbitone D-glucaric acid or the rise in D-glucaric acid excretion was only just below statistical significance (r = 0.696 and 0.690 respectively, 0.10> P> 0.05) whereas in the untreated group there was no correlation (r = 0.231, P > 0.60). 4 In two patients, whose phenobarbitone was discontinued for at least six days prior to surgery, all indices studied had returned to untreated values, except the microsomal protein content which remained significantly elevated.

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Age as a determinant of sensitivity to warfarin.

Shepherd

Hewick

Moreland

et al. 1977

Brit J Clinical Pharma

243

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1 Parallel human and rat studies were carried out to confirm the previous suggestion of an increased sensitivity to warfarin in old age. 2 The anticoagulant response to warfarin was found to be greater in the elderly groups despite, in the case of the patient study, the elderly subjects being given a smaller weight‐related dose. 3 At the same plasma warfarin concentrations there was greater inhibition of vitamin K‐dependent clotting factor synthesis in the elderly. There was no difference in the rate of clotting factor degradation in the two age groups. 4 There was no appreciable difference in warfarin pharmacokinetics (plasma half‐life, apparent volume of distribution, plasma clearance, plasma protein binding or plasma warfarin alcohol levels) in the two age groups. 5 There appeared to be no major age‐ related differences in warfarin pharmacokinetics and the increased effect of warfarin in the elderly seemed to result from an increased intrinsic sensitivity to warfarin.

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Vocational training for general practice: a preliminary report.

Cited by 5 publications

References 2 publications

Medical audit in general practice. I: Effects on doctors' clinical behaviour for common childhood conditions. North of England Study of Standards and Performance in General Practice.

Medical audit in general practice. I: Effects on doctors' clinical behaviour for common childhood conditions. North of England Study of Standards and Performance in General Practice.

Effect of phenobarbitone on hepatic drug‐metabolizing enzymes and urinary D‐glucaric acid excretion in man.

Age as a determinant of sensitivity to warfarin.

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