Letter: General practitioners' opinions of a new hospital-discharge letter.
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Biomedical subjects
Publications and source records attributed to C M Boyle.
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Four years of experience in Glasgow with an automated follow-up system for thyroid disease developed initially in a low-density population area has confirmed that the approach is a successful, practical, and exportable method of sharing long-term patient management between general practitioners and a hospital specialist clinic.
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Multiple-choice questionaries completed by 234 outpatients were compared with those completed by 35 doctors to evaluate differences between their interpretation of some commonly used medical terms. There were significant differences between the "majority doctors' definition" and the number of patients agreeing with that definition in all cases except the term "a good appetite." It is suggested that unless the patient is cross-examined recording of symptoms-particularly in computer studies-may be unreliable.
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To assess the usefulness of routinely collected socioeconomic variables from the U.S. census in predicting burn incidence rates, burn rates and 25 socioeconomic variables were analyzed at the level of census tracts for the Boston Standard Metropolitan Statistical Area. The burn rates were based on data collected during the National Burn Demonstration Project and consisted of patients who sustained burns between July 1, 1978, and June 30, 1979, and who required inhospital care. Analysis of the data revealed strong associations between burn rates and six of the variables. The six variables were the percentage of families below the poverty level with a householder under age 65 years, the percentage of persons over 5 years of age whose residence in 1975 was a different dwelling but in the same county, the percentage of persons in the civilian labor force who were unemployed at the time of census enumeration, the average age of occupied dwelling units, the percentage of occupied housing units occupied on a rental basis, and the percentage of persons age 25 years or older who acquired some college education but did not complete college. Interpretation of the findings is not straightforward but seems to suggest that the previously observed association between poor socioeconomic status and increased burn risk for individuals can be quantified at the census tract population level.
We used M-mode echocardiography and recordings of systolic time intervals to follow changes in left ventricular systolic function of 10 normal subjects during administration of 200 mg oral disopyramide every 8 h. Left ventricular function was significantly depressed (peak rate of change of dimension - 17%, p less than 0.001; mean velocity of circumferential fiber shortening - 15%, p less than 0.01; percent fractional shortening - 16%, p less than 0.05) for as long as 7 h after a dose. These changes could be correlated with those in plasma concentrations of free and total disopyramide, and of its mono-N-dealkylated metabolite (change in peak rate of change of dimension versus levels of disopyramide plus metabolite, r = -0.41, p less than 0.03; changes in ratio preejection time/ejection time versus levels of disopyramide and metabolite, r = 0.62, p less than 0.002).