Medical audit activity in primary and secondary care in the west of Scotland.

OBJECTIVES: To look at the level of activity and motivation towards audit in primary and secondary care in the West of Scotland. DESIGN: An anonymised postal questionnaire survey. SETTING: Area covered by six Health Boards in West of Scotland. SUBJECTS: 150 GPs and 150 hospital-based clinicians randomly selected from two departmental databases. RESULTS: There appears to be a rule of diminishing returns in operation where half of those involved in audit have completed a project and half again have repeated a project. The current level of activity is significantly higher in secondary than primary care (chi 2 p = 0.05). There is significantly more audit activity in teaching than non-teaching hospitals (chi 2 p = 0.01) and significantly more GPs from larger practices have been involved in audit than those from smaller practices (chi 2 p = 0.05). All of those involved in audit have set standards. Levels of motivation towards audit were significantly higher amongst hospital-based clinicians than general practitioners (chi 2 p = 0.001). CONCLUSIONS: There has been a widespread involvement in audit in both primary and secondary care in the West of Scotland, but activity and enthusiasm or motivation are lower amongst general practitioners.

Vanadate inhibits both intercellular adhesion and spreading on fibronectin of BHK21 cells and transformed derivatives.

Both intercellular adhesion and spreading on fibronectin of BHK21 hamster cells are inhibited by vanadate at concentrations that cause specific regulatory effects rather than general metabolic inhibition. Inhibition of aggregation of these cells in suspension (half-maximal in 10(-5) M vanadate) is rapid and reversible. The extent of inhibition, and its decline with culture age parallel inhibition by agents that depolymerize microtubules. Vanadate also reversibly inhibits spreading of both BHK cells and transformed derivatives on fibronectin. If 10(-4) M vanadate is added to BHK cells that have spread in its absence, they remain spread, but transformed derivatives are sensitive to rounding by vanadate at 10(-6) M. The mechanisms by which vanadate inhibits both intercellular adhesion and spreading are unknown, and may be different for the two phenomena. Possible sensitive targets include cytoplasmic dynein for the former, and protein tyrosyl phosphatase for the latter.

Detection and quantitation of HLA class II molecules on keratinocytes by quantitative immunofluorescence.

The paper describes measurements of HLA-DR antigen expression on normal human keratinocytes in culture using anti-HLA-DR antibodies and fluorescent Protein A or fluorescent second antibody methods and a low-light level video camera and image analysis program to quantitate the fluorescence output. The measurements are ultimately quantitated in terms of molecules of Ia antigen reacting material per cell. The method has a sensitivity at a S/N ratio of 10:1 of 180 molecules/micron2. The results show that normal keratinocytes do indeed express class II antigens on their surfaces at levels well above background. We confirm that treatment of the cells with gamma-interferon produces enhanced expression of DR antigens within 4 days. The method of quantitation is applicable to fluorescence and other low light level images.

Conversion of blebs to microvilli: cell surface reorganisation after trypsin.

The blebbed surface morphology produced by trypsinisation of Chinese hamster ovary cells is subsequently reorganized to a microvillous topography, even in the continued presence of trypsin. Scanning and transmission electron microscope (SEM and TEM) observations of this transition showed the initial formation of a "crown' of densely clustered microvilli at one pole of the cell. At the periphery of this region the blebs coalesced to form ridges which subsequently extended over the entire cell surface. Long, and occasionally branched microvilli were generated from the ridges. Large numbers of membrane associated vesicles were also characteristic of these areas of surface reorganisation.