Understanding practice management: a qualitative study in general practice.

Reports a qualitative study of practice managers' roles and responsibilities in eight practices in the Grampian region of Scotland. Observes wide variations in the roles and responsibilities of managers associated with the size and fundholding status of the practice. Notes that larger practices had better developed management structures allowing the managers to delegate tasks and undertake a more proactive planning and executive role, and that medium and smaller practices had less well developed management structures and managers were more likely to act as practice administrators with limited autonomy. Concludes that practice managers are playing an increasingly important role in general practice. Also that the influential role of the practice manager in the development of practice policies and the transfer of administrative responsibilities from the partners to the manager have all contributed to a change in general practitioners' perceptions of the practice manager.

Late respiratory sequelae of blunt chest injury: a preliminary report.

Eighty-six survivors of blunt chest injury were assessed for pre- and post-injury respiratory symptoms using a standardised questionnaire. A comparison was made between observed and expected symptom prevalence and lung function. Respiratory symptom prevalence after injury was greater than expected, 23 survivors (27%) claiming a persistent productive cough, 18 (21%) persistent wheezing, and 22 (26%) grade 2 dyspnoea. After injury persistent productive cough (p less than 0.05) and occasional wheezing (p less than 0.01) were more common among smokers and ex-smokers when compared with non-smokers. Mean forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) were not statistically different from expected values. We concluded that respiratory sequelae of blunt chest injury are common and that smokers and ex-smokers are at particular risk.