A comparison of a Patient Enablement Instrument (PEI) against two established satisfaction scales as an outcome measure of primary care consultations

OBJECTIVES: We aimed to compare a new primary care outcome measure-the Patient Enablement Instrument (PEI)-against two established satisfaction measures [the Medical Interview Satisfaction Scale (MISS) and the Consultation Satisfaction Questionnaire (CSQ)]. Specifically, we sought (i) to test whether enablement and satisfaction are related or separate concepts; and (ii) to assess whether the internal consistency of the PEI might be enhanced by the inclusion of items from the satisfaction instruments. METHODS: Questionnaire forms containing the three instruments in a variety of combinations were distributed to a total of 818 patients attending for routine surgery consultations in three urban general practices of varying socio-economic mix. The main outcome measures were: scores on the PEI; scores on the CSQ, the MISS and their individual components; rank correlations between scores on the PEI and scores on the CSQ, the MISS and their component subscales; and Cronbach's alpha coefficient for the PEI. RESULTS: Overall mean scores, expressed as percentages of maximum scores attainable, were 44.1% for the PEI, 76.9% for the CSQ and 77.6% for the MISS. Rank correlations between PEI scores and scores for the complete CSQ and MISS instruments were 0.48 (P < 0.01) and 0.47 (P < 0.01), respectively. Correlations of PEI scores with individual component scores on the CSQ were generally lower and ranged from 0.14 to 0.53; correlations of PEI scored with MISS component scores were also generally lower and ranged from 0.21 to 0.53. Internal consistency of the PEI items (assessed by Cronbach's alpha coefficient) was lowered when items from the CSQ or MISS were added. CONCLUSIONS: The study shows that 'enablement' is a primary care outcome measure which is related to but is different from general satisfaction.      

Evidence that platelet density depends on the alpha-granule content in platelets

The relation between platelet buoyant density and beta-thromboglobulin (beta-TG), a marker for platelet alpha-granule content, was assessed by three independent approaches. (1) Platelets were separated on iso- osmolar discontinuous Stractan density gradients into five fractions, ranging in density from 1.061 g/ml to 1.091 g/ml (20 degrees C). The beta-TG content (mean +/- SD, n = 17) increased with the platelet density from 27.8 +/- 8.6 micrograms beta-TG/10(9) cells (20% less- dense platelets) up to 65.6 +/- 15.5 micrograms beta-TG/10(9) cells (15% most-dense platelets). (2) Activation of platelets in platelet- rich plasma with thrombin, adenosine diphosphate, collagen, or epinephrine resulted in a decreased density of the platelets. This was only seen when there was simultaneous secretion of beta-TG. (3) The less-dense and the more-dense platelet fractions, after isolation by density gradient centrifugation, were separately treated with thrombin. After complete degranulation, the density distribution of the originally less-dense and more-dense platelets were identical and were much narrower than the density distribution of resting platelets.     

Management of patients with angina pectoris by GPs: a study with standardized (simulated) patients in actual practice

BACKGROUND: Little is known about the management of patients with angina pectoris by GPs. OBJECTIVE: The purpose of this study was to assess how a group of GPs managed a patient with angina pectoris complaints in a real-life practice setting during unbiased consultations with standardized patients. METHODS: GPs were consulted during normal surgery hours by a standardized patient portraying a patient with angina pectoris. The setting was Trondheim, Norway. All 87 GPs in the city of Trondheim (Norway) were informed by letter about a study with standardized patients and invited to take part. They were asked to give consent to be visited during actual surgery hours by standardized patients. The date, number and content of the visits planned were not mentioned. They were not told that the study focused on angina pectoris. For budgetary reasons it was decided to ask 24 physicians to participate. The GPs were consulted during normal surgery hours by a standardized patient portraying a patient with angina pectoris. The patients reported on the consultations using a checklist based on guidelines for management of angina pectoris. Outcome measures were the content and number of actions undertaken from the guidelines. RESULTS: Twenty-eight GPs (32%) agreed to participate. Of these, 24 were selected and visited. One doctor detected the standardized patient. The results showed that the participating physicians met 76% of the guidelines used. However, the GPs ordered 31 different types of laboratory test (mean = 7.9, range = 1-18 per physician). In addition, the 23 consultations resulted in seven referrals (two for chest X-rays, four for an exercise test and one referral to a specialist in cardiology). Twenty-two of the 23 doctors made the correct diagnosis and informed the patient accordingly. CONCLUSIONS: When assessed in an unbiased situation in real practice, GPs performed well against a pre- set standard for management of angina pectoris patients. Much variation was found in the request for laboratory tests. These real-life practice data suggest that there is a need for discussing guidelines for effective ordering of laboratory tests in general practice.      

Coil holder and marker system for MR imaging of the total spine

To improve the efficiency of magnetic resonance imaging of the total spine, the authors developed a coil holder and marker system to accurately localize the level of the spine imaged. The patient's external auditory canal and the alignment light on the imager are lined up with marks on the coil holder. The spine is then imaged in three segments by using a 24-cm field of view. The device has been successful in 20 of the 23 patients in whom it was used. The three failures were due to technical problems.