The Bristol prostate cancer pilot screening study--a 3-year follow-up.

OBJECTIVE: To undertake a follow-up study of 472 men who were screened 3 years previously, in general practice, for prostate cancer, and to investigate the efficacy and patient acceptability of a 3-year screening interval. SUBJECTS AND METHODS: Eligible men (n = 472) were sent postal invitations to attend their Health Centre in North Bristol. Serum prostate-specific antigen (PSA) was the initial screening test. Men with PSA > 4 ng/ml (Hybritech) were referred to the Department of Urology for digital rectal examination and transrectal ultrasound +/- biopsy. RESULTS: A total of 132 (28%) men were excluded because of intercurrent illness, death and migration. Two hundred of 340 (59%) men were re-screened. Thirty-seven men had an elevated PSA and were referred as above. Seventeen men had prostatic biopsies, resulting in the diagnosis of six carcinomas; five were localized to the prostate and one was metastatic. In the latter patient, the PSA had risen from 2 to 120 ng/ml over 3 years. CONCLUSION: Serum PSA alone can be used as an acceptable repeat screening test to detect prostate cancer in general practice, but 3-year repeat screening will not always protect the individual against the interval development of metastatic disease.

Pilot study of screening for prostate cancer in general practice.

The success of a screening programme for cancer depends on the sensitivity of the tests used and on the proportion of the target population that comes forward for screening. To assess the value of digital rectal screening and prostate-specific antigen (PSA) measurement as screening measures, the 814 men in a city general practice aged between 55 and 70 were recruited in one of five different ways. Men with a palpably suspicious prostate or a serum PSA greater than 4 ng/ml were referred for transrectal ultrasonography and, if indicated, biopsy. 472 men (58%) were screened; of these 68 underwent transrectal ultrasonography and 29 biopsy. In 7 the biopsy specimen showed carcinoma. Serum PSA was better than digital examination as a screening test--all men with prostate cancer had raised concentrations of serum PSA, whereas only 1 had a palpably abnormal prostate. All 7 had localised disease, and 5 underwent radical prostatectomy. The best methods of patient recruitment were to send an appointment for screening and to "tag" the patient's notes.

Audit of diabetes in general practice.

OBJECTIVES: To complete a first audit cycle of diabetes care in a general practice and to develop a simple method for continuing the audit cycle. DESIGN: Retrospective examination of the medical records of all diabetic patients in a general practice in 1990. SETTING: A group general practice in a Bristol health centre with roughly 13,200 patients, which since 1983 had had a protocol for care of its diabetic patients. PATIENTS: 223 known diabetic patients in the practice. MAIN AUDITED MEASURES: Comparison against previously agreed standards of process and outcome of diabetes care in the practice, including number of patients whose care had been reviewed in accordance with the practice protocol, serum fructosamine and blood glucose concentrations in patients aged under 70, and number of newly diagnosed patients given explicit education and referred for diatetic advice. RESULTS: Defined standards were not met for several criteria--for example, percentages of patients aged below 70 (n = 149) with serum fructosamine concentrations less than 3.5 mmol/l (62% v 90% defined value) and less than 2.8 mmol/l (35% v 70%) and last recorded blood glucose concentrations less than 10 mmol/l in insulin dependent patients (n = 48) (23% v 90%) and less than 8 mmol/l in non-insulin dependent patients (n = 101) (17% v 90%). Of newly identified diabetic patients (n = 32), 59% and 28% respectively were referred to dietitians and given educational material compared with the 100% standard. CONCLUSIONS: The practice has a high prevalence of diabetes (1.7%) but has the resources for their care. The format and implementation of the agreed systematic process of care for diabetic patients needs improvement. IMPLICATIONS: A simple audit suitable for most general practices might record two measures of the process of care--a disease register of all diabetic patients in a practice and an attendance register to determine whether they have regular check ups--and one measure of the outcome of care, such as serum fructosamine concentration (or local equivalent). A practice could establish its own standards for these measures and monitor its performance against them.

Study of children not immunised for measles.

The results of a survey of the 165 children born in 1980 in a population served by a health centre showed that 42 were not immunised against measles. The reasons for non-immunisation included 18 refusals (usually on the grounds of incorrect contraindications) and 19 defaulters (where the children were not brought for immunisation). Twenty of the children had contracted measles by March 1984. Among the 19 defaulters 12 had been registered with the health centre since age six months or under. Their average number of consultations a year was four. None of the 42 children had Department of Health and Social Security recommended contraindications to measles immunisation.