Obstacles to continuing education.

An earlier study showed that low attendance at section 63 courses of continuing education was not explained by dissatisfaction with content or methods employed in these programmes. In this enquiry to the same sample of 105 general practitioners, several additional factors were studied related to enjoyment of professional role, practice skills and perceived obstacles to continuing education. Thirty-seven per cent of respondents said that their work was less than fully enjoyable and one in 20 found no enjoyment; similarly, 30 per cent were dissatisfied with their organizational skills but for neither of these factors was there any difference between attenders and non-attenders. Half of the sample found difficulty in keeping up to date, and in this finding the proportion who were attenders was significantly higher than non-attenders. Eighty-two per cent had encountered obstacles to their continuing education, in particular lack of time, practice commitments and the need to preserve family life. Recommendations for an ideal system of continuing education included high acceptance of self-assessment exercises as a means of identifying areas of educational need.

The general practitioner and continuing education.

Concern that the existing provision for organized continuing education was not matching the needs of general practitioners in either content or teaching method prompted this Nottinghamshire survey. An initial postal questionnaire elicited responses from 50 per cent of a sample of general practitioners in the county; the non-responding group was then followed up by use of an abbreviated questionnaire and interviews, with about 50 per cent success. The findings are derived from the main sample and from two subsamples of the non-responders.The findings from the survey have shown up the relative popularity of section 63 courses and, in addition, have revealed that two thirds of those doctors who did not attend section 63 courses had attended some other form of educational activity, which suggests that only a small number of general practitioners have poor motivation towards their own continuing education. The content on offer would appear to be in the most popular areas and the methods used the most acceptable. However, a low priority was accorded to research and audit techniques, and this is disturbing.

Comparison of the effect of amitriptyline in standard and sustained-release formulations on cardiac systolic time intervals.

Eight healthy male volunteers were given single doses of 75 mg standard and sustained-release amitriptyline in a double-blind, crossover trial. Systolic time intervals (STI) were measured hourly on drug and base-line days. Plasma amitriptyline and nortriptyline were measured hourly on drug days. To correct for diurnal variations, STI values on drug days were compared with values of base-line days at the same hour. Both formulations of amitriptyline produced initial decreases in heart rate (followed by a return to normal values) and a significant decrease in ventricular electrical systole (QTc), which began before plasma amitriptyline could be detected. One of the eight volunteers showed T wave depression following amitriptyline. The preejection period (PEPc) increased significantly in three of the eight volunteers (max 19%), and this change was due to an increase in true isovolumetric contraction time (TICT). The left ventricular ejection time (LVETc) decreased significantly in all volunteers (5%, p less than 0.001), the change being greater after sustained-release amitriptyline. Standard amitriptyline produced larger changes than sustained-release amitriptyline in QTc and PEPc. The overall increase in the PEP/LVET ratio, indicating an impairment of cardiac function, was twice as large after standard than after sustained-release amitriptyline (38% and 16%, respectively). The possible mechanisms of cardiac effects of amitriptyline are discussed. Our findings indicate that a sustained-release preparation may be safer than a standard preparation of amitriptyline, particularly if there is a risk of cardiac complications.