Reducing waiting times associated with an integrated child health service.

Following an increase in average waiting times associated with a child health service in East London, an initiative to rapidly reduce the numbers of children waiting long periods following a referral was undertaken over the period May to June 1999. A multidisciplinary cooperative approach was adopted operating within the existing available resources and involved medical, nursing, managerial and administrative staff. The initiative involved a review of the accuracy of the waiting list, followed by an invitation to remaining patients to provide an option of continuing to wait to be seen or offering attendance at a rapid response clinic associated with reduced waiting and consultation times. Half-hourly appointments were routinely offered instead of hourly appointments and proformas were adopted for history taking and onward referrals to save time spent on administration. A total of 162 patients were seen over the course of a month and a satisfaction questionnaire completed by relatives indicated a preference for the new service. The mean waiting time was reduced to under a quarter of the time at the start of the initiative to a mean of less than two months. The purpose of the study was to see if the waiting list could be reduced by using existing staff. We wanted to ascertain the parents' views whether shorter waits and shorter consultation periods were acceptable, and to ascertain if the waiting list could be kept down or whether the waiting list would rapidly recur after the rapid response clinics stopped. The findings are discussed in relation to initiatives elsewhere and the need to maintain a high quality service.

Bioassays of segregating plants : A strategy for studying chemical defenses.

Solanum chacoense is a wild potato species resistant to the Colorado potato beetle,Leptinotarsa decemlineata. Most genotypes ofS. chacoense synthesize the glycoalkaloids solanine (sol) and chaconine (chac) and are hosts of the beetle. A few rare genotypes have a gene(s) for acetylation of carbon-23 of the steroid aglycone of sol and chac. Laboratory bioassays and replicated field tests of clones differing in the presence or absence of the acetyl moiety showed that acetylation of sol and chac markedly affects the response of both adults and larvae to the foliage. Adult feeding deterrency conferred by acetylated forms of sol and chac (leptines) in leaf-disk preference tests was consistent with the degree of antixenosis measured in the field. Development of larvae on foliage of clones with leptines was also inhibited. The studies support the validity of using laboratory bioassays of plants segregating for levels of a suspected defense compound to determine the role the compound has in defending the plant from attack by an insect predator in the field.