Evaluation of the efficacy of an instructional programme in the self-management of patients with asthma.

The restrictions imposed on patients with asthma is problematic to them, in that their physical disability interferes with personal, interpersonal and/or professional goals. Twenty-three patients under the care of general practitioners were surveyed by interview in their homes, doctors' surgery or at work to determine their current control of selected variables related to their asthma: exercise, use of drugs and related factors. An instructional programme was offered to interested participants to assist in complying with their prescribed medication regimens and to tailor exercise to their tolerance levels. Findings showed that 18 patients experienced moderate to severe restrictions when troubled with asthma. Although over one-half of the patients exercised regularly for fitness, including seven with aerobic exercise, some chose sports they thought could provoke an asthmatic attack. Half took precautionary measures when exercising. All patients used bronchodilators to relieve their asthma, yet one-third did not keep their inhalers accessible. None of the most troubled 18 lived in a smoke-free environment, and one-third kept furry animals as pets. Recommendations are made for further study of the effects of instructional programme to improve compliance to a healthy lifestyle.

Are departments of general practice in medical schools really needed?

Few medical schools appear aware of modern developments in general practice and of its educational potential in helping provide balance to a predominantly teaching hospital approach to the diagnosis and treatment of disease. Contributing to the problem are a lack of clarity about the term "undifferentiated doctor", failure to understand the different purposes of undergraduate and vocational training and the erroneous view that general practice is not a "proper" university discipline because it lacks an intellectual basis.

Academic general practice in Australian medical schools.

This paper reports on a survey of the current state of academic general practice in the ten Australian medical schools. Despite its lack of resources, low profile and ambivalent acceptance in Australian medical schools, academic general practice has survived. Its problems and potential contribution for producing better doctors are outlined and discussed.

Care of the dying. Relevance of the hospice concept to general practice.

Care of a hospice type can be offered by any general practitioner who is interested in care of the dying; is prepared to share in professional team work; knows the skill of prescribing for symptom relief; and who is prepared to spend that extra time and effort to foresee and alleviate the many problems facing a family when one of them is dying. Steps to be taken in terminal care: 1. Try to predict the likely course of events. 2. Have a clear plan of management, based on your predictions, which can be explained to the patient and family members as needs change. 3. Involve the relatives in your care plan as much as possible. 4. Keep in close communication with the nurses and other professionals providing care.

Deafness in adults-screening in general practice.

A random sample of 1,083 people, drawn from the lists of two practices in Leeds, was used to estimate the prevalence of deafness among adults. A test for deafness (defined as failure to hear 35 decibels at 1000 Hz in one or both ears) using a portable audiometer proved simple to operate with little observer variation. Eight per cent of adults were found to be deaf. The prevalence of deafness increased with age and was lowest in social classes I and II; there was no significant difference between the sexes. Audiometry showed that 17 per cent of those who thought their hearing was abnormal had no recorded loss of hearing using the stated test and that 18 per cent of those who are deaf would be overlooked if the question "Do you think your hearing is normal?" was used for initial screening in general practice. Less than 20 per cent knew of any services or aids for the deaf apart from those available through general practitioners.

A study in general practice of the symptoms and delay patterns in the diagnosis of gastrointestinal cancer.

GASTROINTESTINAL CANCER WAS CLASSIFIED INTO FOUR GROUPS ACCORDING TO THE SITE: stomach, caecum and ascending and transverse colon, sigmoid colon and rectum. The incidence of these cancers in general practice is as rare as three per 10,000 consultations. I report on a study in general practice of the symptoms and delays in diagnosis in 150 patients with gastrointestinal cancer. There was an interval of many weeks between the onset of symptoms and diagnosis in the majority of cases. In approximately 50 per cent of cases there was an interval of weeks between the patient consulting the general practitioner and being referred for hospital investigation. No association was demonstrated between delay and social class, age, physical isolation, or the regular consulting rate of the patient. There was evidence that the consulting rate of some patients with gastrointestinal cancer increased in the 12 months before diagnosis because of the presence of symptoms not specific to the gastrointestinal tract.Much more knowledge of the early symptoms of these cancers is required if the general practitioner is to be able to identify those patients with a high probability of early cancer from others who have symptoms which are common both to non life-threatening conditions and to cancer lesions.