Measuring Patient Satisfaction in Primary Care: a Joint Project of Community Representatives, Clinic Staff Members and a Social Scientist

We describe the process of planning and developing a questionnaireand conducting a patient satisfaction survey in a neighbourhoodclinic in Beer-Sheva, Israel. The project was conducted by theclinic staff members, patient representatives and a medicalsociologist. The satisfaction survey was conducted in patients'homes, with a 67% response rate. General satisfaction and satisfactionwith specific components of service are described. Patient satisfactionwas higher among men than among women, and negatively correlatedwith family size. The strongest predictor of general satisfactionwas satisfaction with physicians' services. Implications ofthe survey results were decided upon by active collaborationbetween the clinic staff and the patient representatives. Theinferences drawn from the patients' replies and the changesintroduced as a result of them, are discussed. Health care consumersshould be active participants in carrying out surveys of satisfactionon a regular basis.     

The Home Office Mental Health Unit and its approach to the assessment and management of risk

For a minority of offender patients in England and Wales, the court may, on convicting such a person of an imprisonable offence, set aside prison sentence in favour of a hospital order. The Crown (higher criminal) Court may also, if deemed necessary 'for the protection of the public from serious harm', add a restriction order devolving decisions on leave, transfer or discharge from hospital to the Secretary of State at the Home Office (except in the case of discharge which the Mental Health Review Tribunal may also direct). At any one time the Home Office has responsibility for in excess of 2,000 such patients resident in hospital, and over 1,000 more in the community. The Mental Health Unit of the Home Office advises the Secretary of State in the exercise of his power in this regard. The background and system for doing this are described. Similar systems operate for Scotland through the Scottish Office and Northern Ireland through the Northern Ireland Office.     

Primary Immunodeficiency Diseases in Latin America: The Second Report of the LAGID Registry

This is the second report on the continuing efforts of LAGID to increase the recognition and registration of patients with primary immunodeficiency diseases in 12 Latin American countries: Argentina, Brazil, Chile, Colombia, Costa Rica, Honduras, Mexico, Panama, Paraguay, Peru, Uruguay, and Venezuela. This report reveals that from a total of 3321 patients registered, the most common form of primary immunodeficiency disease was predominantly antibody deficiency (53.2%) with IgA deficiency reported as the most frequent phenotype. This category was followed by 22.6% other well-defined ID syndromes, 9.5% combined T- and B-cell inmunodeficiency, 8.6% phagocytic disorders, 3.3% diseases of immune dysregulation, and 2.8% complement deficiencies. All countries that participated in the first publication in 1998 reported an increase in registered primary immunodeficiency cases, ranging between 10 and 80%. A comparison of the estimated minimal incidence of X-linked agammaglobulinemia, chronic granulomatous disease, and severe combined immunodeficiency between the first report and the present one shows an increase in the reporting of these diseases in all countries. In this report, the estimated minimal incidence of chronic granulomatous disease was between 0.72 and 1.26 cases per 100,000 births in Argentina, Chile, Costa Rica, and Uruguay and the incidence of severe combined immunodeficiency was 1.28 and 3.79 per 100,000 births in Chile and Costa Rica, respectively. However, these diseases are underreported in other participating countries. In addition to a better diagnosis of primary immunodeficiency diseases, more work on improving the registration of patients by each participating country and by countries that have not yet joined LAGID is still needed. Latin American Group for Primary Immunodeficiency Diseases     

THE P300 EVENT RELATED POTENTIAL COMPONENT IN THE DIAGNOSIS OF DEMENTIA

Several studies have suggested that delays in the latency of the P300 ERP component are highly sensitive and specific to dementia and that ERP measurements may become a useful clinical tool in aiding diagnosis. This study examines the sensitivity of P300 measurements to dementia and addresses several methodological issues that limit previous research. Twenty-four patients with dementia diagnosed according to ICD-10 criteria were compared with 100 normal controls, 31 of whom were older than 60. An auditory oddball paradigm was employed to elicit the P300. Mean P300 latency did not differ significantly between the two groups. When individual subjects were examined only 13% of patients with dementia fell outside the two standard error band of the regression of P300 latency on age derived from controls. Thus, this study has not demonstrated clinically useful abnormalities of the P300 component in dementia.     

Application of the International Classification of Functioning,Disability and Health in children with neurofibromatosis type 1: a review

Aim The World Health Organization’s International Classification of Functioning, Disability and Health adapted for children and young people (ICF‐CY) is a framework for describing and classifying health and health‐related states. The aim of the present study was to review literature on neurofibromatosis type 1 (NF1) using ICF‐CY guidelines and to highlight findings about the quality of life of children with NF1. Method Electronic databases were searched to identify studies involving children with NF1. Eligible studies were classified according to ICF‐CY categories. Results Children with NF1 have a variety of cognitive and other deficits. However, very little information is available on the impact of these deficits on their daily life. Interpretation Despite the broad range of functional and structural deficits in children with NF1, the functional assessment of these children remains largely unexplored. Future studies should aim at evaluating the participation of children with NF1 in various situations, using tools with high real‐world validity.     

The concept of cure in cancer care

The concept of cure is often used in health care practices without thought to the social, cultural and psychological implications of its meaning. Frequently measured in terms of years of disease-free survival, this measure is inadequate in evaluating treatment. Iatrogenic toxicities and illness implications may linger for many months or years after a person experiences cancer. The subcultural perspectives of cure for clinicians may be very different. Historically, the clinician's concept of cure has been the focus and reported outcome of cancer treatment and research. A more dynamic view is encouraged in exploring this concept in relation to the outcomes of nursing practice.