A qualitative investigation into why patients change their GPs

BACKGROUND: In the past patients have rarely changed doctor. The UK Government has made such change easier and it appears to be becoming more common. Changing doctor without changing address may be indicative of dissatisfaction with the GP service. Previous research in this area has been largely quantitative. OBJECTIVE: To identify why patients change their GP although they have not moved house. METHOD: Qualitative investigation of patients' experiences. In depth interviews of 24 patients were conducted to determine why they had left their previous doctor. Letters describing the process of change were received from a further 17 patients. Analysis was performed using standard qualitative techniques. RESULTS: The decision to change was in most cases multi- factorial. Interviews yielded more detailed and richer accounts than letters. For interviewees, rudeness or the attitude of the doctor was the commonest reason. Overall, 19 different reasons, in four categories, were identified. The largest single category was accessibility, closely followed by attitudinal problems. Clinical issues and personal characteristics of the doctor were less common. The majority of those responding by letter gave only one reason, usually distance. CONCLUSION: Patients change doctor after careful consideration and commonly for interpersonal reasons. There is usually one critical factor in the decision to change. Factors may be modifiable or non-modifiable. Critical event audit may enable GPs to analyse the reasons why patients leave their lists.      

Cecum gangrene as a complication of amyloidosis in myeloma]

It is a report of a rare case of amyloidosis in myeloma with a predominant localization in the caecum wall with the narrowing of blood vessels and a caecum gangrene and peritonitis as complications. Rarity of the case resulted in an erroneous clinical diagnosis and unjustified appendectomy.     

Current approaches to the early diagnosis of primary subacute infectious endocarditis

A study of 22 patients with a diagnosis of primary infectious endocarditis based on clinical, laboratory and instrumental (electro-, phono- and echocardiography) investigation showed the fever syndrome and rigors to be the main clinical manifestations of the disease. Echocardiography can contribute to its early diagnosis, while increased erythrocyte sedimentation rate remains the most valuable diagnostic test.     

变形杆菌对β—内酰胺类和氨基糖苷类抗生素的敏感性取决于其种属和来源

文献中化学药物对变形杆菌代表性菌种,主要是部分吲哚阴性和吲哚阳性变形杆菌属的抗菌活性已有报道。在吲哚阴性变形杆菌中除奇异变形杆菌外,还有Proteus penner,在吲哚阳性变形杆菌中除普通变形杆菌外,还有摩氏变形杆菌和普罗威登斯菌。各种变形杆菌对化学药物的敏感性不同。然而,它们对化学药物敏感性取决于其来源的报道不多。因此,我们用分离自不同病理材料的变形杆菌培养物对β-内酰胺类和氨基糖苷类抗生素的敏感性进行了研究。对1985年分离自各种病理材料的130株变形杆菌菌株培养物进行了敏感性测定,其中分离自脓汁30株,分离自各种化脓炎症性疾病患者的尿和急性肠道感染患者的粪各50     

Severe oral ulceration in patients with HIV infection: A case series

OBJECTIVE: Oral ulceration occurs in an estimated 2–4% of patients with HIV infection. This retrospective observational study describes the aetiology and characteristics of 94 HIV-positive patients with either severe and/or recurrent oral ulceration presenting at a dedicated HIV dental unit over a 4-year period. METHODS: Case records were reviewed for diagnosis investigations, CD4 count, CDC stage and treatment modality. RESULTS: Of the 94 patients 50% had an AIDS diagnosis. In patients with asymptomatic HIV disease minor recurrent oral ulceration was the commonest diagnosis whilst large non-specific neutropenic ulcers were more frequently seen in patients with symptomatic disease with low CD4 counts. A variety of treatment modalities were used including thalidomide. An algorithm is presented for the management of patients with severe oral ulceration.     

Moot points of diagnosis and treatment of hormone-producing neuroendocrine tumors of pancreas

Based on literature data and own experience of treatment of 225 patients with neuroendocrine tumors (NET) authors discuss moot points of diagnosis and treatment of this severe category of patients. It is demonstrated that the most appropriate algorithm of diagnosis before surgery is the combination of US with endoscopic US and angiography. Intraoperative diagnosis must be performed with intraoperative US and endoscopic transillumination. Authors demonstrate positive results of staged surgical treatment of MEN-1 syndrome. Malignant NET with distant metastases is not contraindication for surgical treatment. This situation is indication either for radical surgery with excision of all metastases or for cytoreductive surgery with subsequent chemoembolization and chemotherapy.     

Interleukin-3 is significantly more effective than other colony- stimulating factors in long-term maintenance of human bone marrow- derived colony-forming cells in vitro

Human bone marrow cells cultured for 21 days in the presence of recombinant human interleukin-3 (IL-3) produced up to 28 times more colony-forming cells (CFC) than could be obtained from cultures stimulated with granulocyte colony stimulating factor (G-CSF) or granulocyte-macrophage CSF (GM-CSF). IL-3-cultured cells retained a multipotent response to IL-3 in colony assays but were restricted to formation of granulocyte colonies in G-CSF and granulocyte or macrophage colonies in GM-CSF. Culture of bone marrow cells in IL-3 also led to accumulation of large numbers of eosinophils and basophils. These data contrast with the effects of G-CSF, GM-CSF, and IL-3 in seven-day cultures. Here both GM-CSF and IL-3 amplified total CFC that had similar multipotential colony-forming capability in either factor. G-CSF, on the other hand, depleted IL-3-responsive colony-forming cells dramatically, apparently by causing these cells to mature into granulocytes. The data suggest that a large proportion of IL-3- responsive cells in human bone marrow express receptors for G-CSF and can respond to this factor, the majority becoming neutrophils. Furthermore, the CFC maintained for 21 days in IL-3 may be a functionally distinct population from that produced after seven days culture of bone marrow cells in either IL-3 or GM-CSF.