Single General Practice Research Articles

The impact of menopause on health-related quality of life: results from the STRIDE longitudinal study

We examine the impact of menopausal status, beyond menopausal symptoms, on health-related quality of life (HRQoL). Seven hundred thirty-two women aged 40-65, regardless of health condition or menopausal status, were enrolled from single general internal medicine practice. Women completed annual questionnaires including HRQoL, and menopausal status and symptoms. The physical health composite of the RAND-36 is lower in late peri (45.6, P<.05), early post (45.4, P<.05), and late postmenopausal women (44.6, P<.01), and those who report a hysterectomy (44.2, P<.01) compared to premenopausal women (47.1), with effect sizes of Cohen's d=.12-.23. The mental health composite of the RAND-36 is lower in late peri (44.7, P<.01), early post (44.9, P<.01), and late postmenopausal women (45.0, P<.05) and those who report a hysterectomy (44.2, P<.01) compared to premenopausal women (46.8), with effect sizes of Cohen's d=.15-.20. Findings are comparable adjusted for menopausal symptom frequency and bother. Over a 5-year follow-up period, we found a negative impact of menopause on some domains of HRQoL, regardless of menopausal symptoms. Clinicians should be aware of this relationship and work to improve HRQoL, rather than expect it to improve spontaneously when menopausal symptoms resolve.

Parental reasons for non-uptake of influenza vaccination in young at-risk groups: a qualitative study.

Uptake rates of influenza vaccination in young at-risk groups in primary care (UK) are known to be poor. To explore parental reasons for non-uptake of influenza vaccination in young at-risk groups. The study hypothesis was that exploration of parental reasons for non-uptake may reveal important barriers to an effective influenza vaccination programme. Thematic analysis of a questionnaire survey with interview follow-up at a single general practice in Inverness, Scotland. Parents of children identified as being in an at-risk group for influenza vaccination but who had not received vaccination were sent questionnaires and offered the opportunity to take part in a follow-up interview. Several key themes emerged, including uncertainty about the indication for vaccination, issues of choice, challenges with access, lack of parental priority, and issues relating to health beliefs. Any attempt to improve the vaccination rate needs to address the range of decision-making processes undertaken by parents and children. Better and more tailored information and educational delivery to parents, patients, and healthcare providers may lead to an increase in the rates of influenza vaccination uptake in at-risk children. Access is a barrier described by some parents.

Early predictors of the long-term outcome of low back pain—results of a 22-year prospective cohort study

poor outcome of low back pain in patients seen in general practice is related to the pain history, physical impairment and working conditions, at least in short-term follow-ups. We do not know if these findings hold, seen from the perspective of decades. to show if patients consulting the GP for the first time regarding an episode of low back pain have excess poor outcome 22 years later and, if so, whether the best predictors are data based on the symptoms, clinical signs or work history. The design of the study is a 22-year follow-up of an inception cohort of 78 patients with low back pain. The setting of the study is a single general practice in a suburb of Copenhagen, Denmark. selected predictors were separated into pain characteristics, clinical signs and indicators related to the work history. Outcome measures were the 1-year period prevalence of low back pain, use of painkillers for low back pain, use of health care providers, impairments due to low back pain and unfitness for work caused by low back pain. The influence of the predictors was assessed by relative risks. after 22 years, four out of five patients still experienced low back pain. The perception of poor working conditions correlates with recurrent low back pain, intake of painkillers and limitations to daily life. compared with pain history and clinical findings, the perception of workload is a better predictor of the long-term outcome of low back pain.

A pilot study of identification and case management of high-risk COPD patients in a general practice

A variety of individual therapeutic interventions have been shown to reduce hospital admissions and improve quality of life in patients with chronic obstructive pulmonary disease (COPD). However, there is a paucity of data of looking at the effect of case management in primary care (i.e. using an integrated care approach) of people at higher risk of mortality from COPD. To examine the effect of case management in primary care of patients with COPD at high risk of hospital admission, identified using a novel multidimensional index of disease severity (DOSE index). Observational pilot study in a single general practice. High-risk patients were identified using the DOSE index and case managed using an IT system according to British National Guidelines over a 6-month period. Eleven patients entered and completed the study. There was no improvement in health status, but there was a non-significant reduction in total hospital admissions (three versus zero) and total bed days (16 versus 0) compared to the same reference period in the previous year. There was an increase in self-management knowledge. Case management of high-risk patients in primary care may reduce hospital admissions. This needs to be tested in a randomized controlled trial.

An evaluation of near‐patient testing of anticoagulant control in general practice

This paper aims to compare anticoagulant management in secondary care for the year prior to the introduction of near-patient testing in a general practice, and in the subsequent year after it was introduced. This paper is a retrospective, paired before-after study. Details of test results in the two-year-long periods on the 46 patients who met the inclusion criteria were collected and analysed pairwise. Despite an increase in the frequency of testing this set of patients were controlled as well in general practice as they had been with a secondary-care service, and better that in a number of studies in the literature. This research reviews a recently introduced service at a single centre. Further research of patient satisfaction and adverse events in a multi-centre longer-term trial are desirable. Technology now allows the increasing amount of individuals on anticoagualtion to be controlled with near-patient testing in general practice. This study shows that satisfactory control can be maintained in patients who transfer from a secondary care-based to a primary care-based service. This paper demonstrates that a single general practice can provide a high quality anticoagulant service using near-patient testing and computer-based decision support. This adds to the already available evidence and will hopefully encourage other practices to adopt the same.

Repair of abdominal wall defects with bovine pericardium

Background Ventral hernia repair with prosthetic mesh has recurrence rates up to 54% and is contraindicated in the setting of infection. The aim of this study was to provide our experience with acellular bovine pericardium (Veritas collagen matrix; Synovis Life Technologies, Inc., St. Paul, MN) in complex abdominal wall reconstruction where prosthetic mesh had failed or was contraindicated. Between 2005 and 2008, a retrospective review of a single general surgeon's practice identified patients reconstructed with acellular bovine pericardium. Thirty primary or recurrent ventral hernias were treated in 26 patients. All patients presented with either contaminated wounds or failure of a prosthetic mesh material. Results Hernia size ranged from 20 cm 2 to 600 cm 2 (mean 111 cm 2). Seven patients had previous hernia repair with prosthetic mesh, and 16 patients had ongoing infection or gross contamination at the time of repair. The mean follow-up was 22 months. The hernia recurrence rate in our series was 19% with no fistula development. Conclusions Acellular bovine pericardium's high strength, minimal infection rate, and low cost allow its use in the reconstruction of complex abdominal wall defects.

Diagnosing type 2 diabetes before patients complain of diabetic symptoms--clinical opportunistic screening in a single general practice.

In the UK, patients normally see their general practitioner first and 86% of the health needs of the population are managed in general practice, with 14% being referred to specialist/hospital care. Early diagnosis is the privilege of general practice since general practitioners make most medical diagnoses in the NHS. Their historic aim has been to diagnose as early as possible and if possible before patients are aware of symptoms. Over time, diagnoses are being made earlier in the trajectory of chronic diseases and pre-symptomatic diagnoses through tests like cervical screening. Earlier diagnosis benefits patients and allows earlier treatment. In diabetes, the presence of lower HbA1c levels correlates with fewer complications. Methodologically, single practice research means smaller populations but greater ability to track patients and ask clinicians about missing data. All diagnoses of type 2 diabetes, wherever made, were tracked until death or transfer out. Clinical opportunistic screening has been undervalued and is more cost-effective than population screening. It works best in generalist practice. Over 19 consecutive years, all 429 patients with type 2 diabetes in one NHS general practice were analysed. The prevalence of type 2 diabetes rose from 1.1% to 3.0% of the registered population. Since 2000, 95.9% were diagnosed within the general practice and the majority (70/121 = 57.9%) of diagnoses were made before the patients reported any diabetes-related symptom. These patients had median HbA1c levels 1.1% lower than patients diagnosed after reporting symptoms, a clinically and statistically significant difference (P = 0.01).

What factors are associated with physical activity in older people, assessed objectively by accelerometry?

Objectives:To assess physical activity (PA) levels measured objectively using accelerometers in community-dwelling older people and to examine the associations with health, disability, anthropometric measures and psychosocial factors.Design:Cross-sectional survey.Setting:Single general practice...

Effect of the 80-Hour Work Week on Resident Case Coverage

On July 1, 2003, residency training programs were required to institute restricted duty hours as mandated by the Accreditation Council for Graduate Medical Education. A major concern, voiced by both surgical residents and faculty, was an expectation that this would result in a decrease in operative experience. We hypothesized that implementing restricted duty hours would decrease case coverage by resident trainees. A retrospective study was performed of operative and endoscopic cases scheduled for a single general surgery practice for a year before and after July 1, 2003. Data collected included operation performed, number of attending surgeons present, whether a resident was present, and level of resident. From July 2002 to June 2003, there were 1,278 cases scheduled; 890 records were available. From July 2004 to June 2005, there were 1,182 cases scheduled; 960 records were available. Before institution of the restricted duty hours, 24.6% of junior-level (PGY1 and 2) cases, 21.7% of intermediate-level (PGY3) cases, and 6.2% of senior-level (PGY4 and 5) cases were not covered by residents. After restricted duty hours were implemented, 27.3% of junior-level cases, 15.9% of intermediate-level cases, and 8.1% of senior-level cases were not covered by residents. Overall 20.8% (185 of 890) and 20.4% (196 of 960) of cases were not covered by residents before and after instituting restricted duty hours, respectively. No difference in case coverage was statistically significant in each category or overall. Restricted duty hours have not affected resident case coverage.

Rx for Cough: A Sweet Solution

Uniform Services| March 01 2008 Rx for Cough: A Sweet Solution AAP Grand Rounds (2008) 19 (3): 28. https://doi.org/10.1542/gr.19-3-28 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Rx for Cough: A Sweet Solution. AAP Grand Rounds March 2008; 19 (3): 28. https://doi.org/10.1542/gr.19-3-28 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: cough, prescriptions, drug, honey Source: Paul IM, Beiler JJ, McMonagle A, et al. Effect of honey, dextromethorphan, and no treatment on nocturnal cough and sleep quality for coughing children and their parents. Arch Pediatr Adolesc Med. 2007;161(12):1140–1145. Researchers from Pennsylvania State University conducted a randomized, partially double-blinded study to compare the effectiveness of dextromethorphan (DM), honey, and no treatment on nocturnal cough in children with URIs. Patients were recruited from a single outpatient general pediatric practice. Children 2–18 years old presenting with a URI and cough of seven or fewer days’ duration were eligible for the study. Parents assessed the severity of five symptoms related to cough in their child during the previous night (frequency, severity, how bothersome it was to the child, loss of sleep in child, and loss of sleep in parent) using Likert scale responses. Only patients with bothersome cough symptoms were enrolled. Children diagnosed with asthma, pneumonia, sinusitis, or allergic rhinitis were excluded from the study as were patients using a drug known to affect the metabolism of DM (eg, SSRIs) and those who had used DM or an antihistamine for treatment of the cough within the day prior to enrollment. A total of 130 children were enrolled; 105 (81%) completed the single-night study. The median age of study patients was 5.2 years (range, 2.2–16.9). Thirty-five were randomized to receive one dose of buckwheat honey, 33 to one dose of honey-flavored DM, and 37 to no treatment. The dose for DM was adjusted for age, approximating the label recommendations: 2–5 years, ½ teaspoon; 6–11 years, 1 teaspoon; 12–18 years, 2 teaspoons. The honey group received similar volumes. There were no differences in cough severity at baseline between children in the different groups. Parents assessed cough symptoms during the night of the study using the same scale as was used previously. The main study outcome was change in cough severity symptoms from baseline. Children treated with honey had the greatest improvement in each of the five cough symptoms and total cough severity score, followed by those receiving DM, while the no-treatment group consistently showed the least amount of improvement. In two-way comparisons, children treated with honey had a significantly greater improvement in cough frequency (P=.01) and combined total symptom score (P=.04) than those randomized to no treatment. However, consistent with an earlier study by these authors,1 the results indicated that DM was not significantly better than no treatment at all for any cough symptom. Comparison of honey with DM revealed no significant differences. The authors conclude that buckwheat honey is an effective treatment for cough in children 2–18 years of age and offers a generally safe and well-tolerated alternative to DM. Dr. Dubik has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. The use of DM is not supported by the AAP2 or the American College of Chest Physicians,3 and the FDA recently recommended... You do not currently have access to this content.

Does eating yogurt prevent antibiotic-associated diarrhoea? A placebo-controlled randomised controlled trial in general practice

Probiotic capsules have been shown to reduce the incidence of antibiotic-associated diarrhoea in a number of settings. If probiotic yogurt were equally efficacious then it would provide a simple and cost-effective means of preventing antibiotic-associated diarrhoea. To investigate whether eating live bio yogurt at the time of taking oral antibiotics can prevent antibiotic-associated diarrhoea. This study was a three-arm (bio yogurt, commercial yogurt, no yogurt) randomised controlled trial with double blinding between the two yogurt arms. A single primary care general practice surgery in Hingham, Norfolk. The study population included all ages except babies. Patients aged over 1 year who required a 1-week course of antibiotics were included in the study. There was complete follow up for 369 patients. The intervention was the consumption of 150 ml of live strawberry-flavoured yogurt for 12 days, starting on the first day of taking the antibiotic. Diarrhoea was defined as 'three or more loose stools per day over at least 2 consecutive days' within 12 days of starting the antibiotics. Of the 120 patients in the no-yogurt group, 17 (14%, 95% confidence interval [CI] = 9.0 to 21.5) developed diarrhoea. Of the 118 given commercial yogurt, 13 (11%, 95% CI = 6.6 to 17.9) developed diarrhoea; nine of the 131 patients (7%; 95% CI = 3.7 to 12.5) given bio yogurt developed diarrhoea (P = 0.17). Overall, this study failed to demonstrate that yogurt has any effect on antibiotic-associated diarrhoea.

Evaluation of B-type Natriuretic Peptide for validation of a heart failure register in primary care

BackgroundDiagnosing heart failure and left ventricular systolic dysfunction is difficult on clinical grounds alone. We sought to determine the accuracy of a heart failure register in a single primary care practice, and to examine the usefulness of b-type (or brain) natriuretic peptide (BNP) assay for this purpose.MethodsA register validation audit in a single general practice in the UK was carried out. Of 217 patients on the heart failure register, 56 of 61 patients who had not been previously investigated underwent 12-lead electrocardiography and echocardiography within the practice site. Plasma was obtained for BNP assay from 45 subjects, and its performance in identifying echocardiographic abnormalities consistent with heart failure was assessed by analysing area under receiver operator characteristic (ROC) curves.Results30/217 were found to have no evidence to suggest heart failure on notes review and were probably incorrectly coded. 70/112 who were previously investigated were confirmed to have heart failure. Of those not previously investigated, 24/56 (42.9%) who attended for the study had echocardiographic left ventricular systolic dysfunction. A further 8 (14.3%) had normal systolic function, but had left ventricular hypertrophy or significant valve disease. Overall, echocardiographic features consistent with heart failure were found in only 102/203 (50.2%). BNP was poor at discriminating those with and without systolic dysfunction (area under ROC curve 0.612), and those with and without any significant echocardiographic abnormality (area under ROC curve 0.723).ConclusionIn this practice, half of the registered patients did not have significant cardiac dysfunction. On-site echocardiography identifies patients who can be removed from the heart failure register. The use of BNP assay to determine which patients require echocardiography is not supported by these data.

Polymorphisms in ALOX12, but not ALOX15, Are Significantly Associated With BMD in Postmenopausal Women

The murine arachidonate 15-lipoxygenase gene (Alox15) has recently been identified as a negative regulator of peak bone mineral density (BMD). The human ALOX15 gene shares significant sequence homology with the murine Alox15 gene; however, the human arachidonate 12-lipoxygenase gene (ALOX12) is functionally more similar to the mouse gene. Multiple single-nucleotide polymorphisms (SNPs) in the human ALOX15 and ALOX12 genes have previously been reported to be significantly associated with BMD in humans. On the basis of these data, we carried out our own investigation of the human ALOX15 and ALOX12 genes and their relationship with hip and spine BMD parameters. The study population consisted of 779 postmenopausal women with a mean (+/- standard deviation) age of 62.5 +/- 5.9 years at BMD measurement and was recruited from a single large general practice in Chingford, northeast London. Three SNPs from ALOX15 and five from ALOX12 were analyzed. None of the SNPs that we analyzed in ALOX15 were significantly associated with any of the BMD parameters or fracture data. However, we found that three SNPs from ALOX12, all previously associated with spine BMD in women, were significantly associated with spine and various hip BMD parameters in our cohort (P = 0.029-0.049). In conclusion, we found no association between polymorphism in ALOX15 and BMD phenotypes but were able to replicate previous findings that genetic variation in ALOX12 seems to play a role in determining bone structure in Caucasian women.

A population-based audit of ethnicity and breast cancer risk in one general practice catchment area in North London, UK: implications for practice

ObjectivesTo conduct a pilot population-based study within a general practice catchment area to determine whether the incidence of breast cancer was increased in the Ashkenazi population.DesignPopulation-based cohort study.SettingA single general practice catchment area in North London.Participants1947 women over the age of 16 who responded to a questionnaire about ethnicity and breast cancer.Main outcome measuresIncidence of breast cancer, ethnicity.ResultsThis study showed a 1.5-fold (95% CI 0.93–2.39) increase in breast cancer risk in the Ashkenazim compared with the non-Ashkenazi white population. The increased incidence was for both premenopausal and postmenopausal breast cancer (expected incidence pre:post is 1:4 whereas in the Ashkenazim it was 1:1; 51 and 52% of cases respectively). This increase was not shown in the Sephardim. Asians had a reduction in incidence (OR = 0.44; 95% CI 0.10–1.89). Results were adjusted for other risk factors for breast cancer.ConclusionThis study showed a 1.5-fold increase in breast cancer rates in Ashkenazim compared with the non-Jewish white population when adjusted for age (i.e. corrections were made to allow comparison of age groups) and this is not observed in the Sephardic population. The proportion of premenopausal breast cancer was just over double that of the general population. This is the first general practice population-based study in the UK to address this issue and has implications for general practitioners who care for patients from the Ashkenazi community.

Chronic Frequent Headache in the General Population: Prevalence and Associated Factors

We studied the prevalence and short-term natural course of chronic frequent headache (CFH) in the general population and identified risk factors. In the Netherlands everyone is registered at a single general practice. We sent questionnaires to all persons (n = 21 440) aged 25-55 years, registered at 16 general practices. We compared the characteristics of 177 participants with CFH (>14 headache days/month for >3 months) with 141 participants with infrequent headache (1-4 days/month) and 526 without headache (<1 day/month). The prevalence of CFH was 3.7% [95% confidence interval (CI) 3.4, 4.0]. In 5 months, 12% showed a clinically relevant decrease to <7 days/month. In both headache groups 70% were women vs. 41% in the group without headache. Compared with the group with infrequent headache, the CFH group had more subjects with low educational level [35% vs. 11%; odds ratio (OR) 4.3, 95% CI 2.3, 7.8], medication overuse (62% vs. 3%; OR 38.4, 95% CI 13.8, 106.9), sleeping problems (44% vs. 8%; OR 8.1, 95% CI 3.6, 18.1), a history of head/neck trauma (36% vs. 14%; OR 4.0, 95% CI 2.2, 7.1), high scores on the General Health Questionnaire (62% vs. 34%; OR 2.7, 95% CI 1.3, 3.6) and more smokers (45% vs. 19%; OR 3.1, 95% CI 1.9, 5.3). We conclude that headache frequency fluctuates. CFH is common and associated with overuse of analgesics, psychopathology, smoking, sleeping problems, a history of head/neck trauma and low educational level. Female sex is a risk factor for headache, not for chronification of headache.

An e-Health Approach to Managing Vascular Surgical Patients

The objective of this study was to investigate an e-health approach to managing patients presenting with vascular-type symptoms. A pilot study of a prospective cohort of patients referred from a single general practitioner practice of 5700 patients using electronic referral, assessment by a practice nurse, and teleconferencing facilities as an adjunct to normal referral and management practice was designed and conducted. Thirty-eight patients aged 30-93 years old (median 72 years) were enrolled in the study between March 2001 and July 2004. Twelve patients had leg ulceration and 12 complained of leg pain. The remainder had a range of symptoms potentially vascular in nature. All but 1 patient had an initial teleconsultation. This initial teleconsultation lasted a median of 11 minutes (interquartile range 9 minutes (min) 59 seconds (sec)-12 min 43 sec). For 10 patients this was their only contact with the hospital. One patient had teleconsultation follow-up only, 26 patients attended the hospital for vascular laboratory studies or angiography, and 8 of these went on to have radiological and/or surgical intervention. Three patients attended the outpatient department for follow up; all other follow-ups were managed via the teleclinic. Overall, 57 standard outpatient attendances in these patients were replaced by teleconsultations. Common vascular-type symptoms can be satisfactorily evaluated across a telelink with the aid of a practice nurse and baseline patient data transmitted electronically. Decisions can be made regarding the need for further investigation and attendance in outpatient clinic can be largely eliminated.

Carotid Sinus Hypersensitivity in Asymptomatic Older Persons

Carotid sinus hypersensitivity is the most commonly reported cause of falls and syncope in older persons. Recent guidelines recommend 5 to 10 seconds of carotid sinus massage in supine and upright positions with beat-to-beat monitoring. The aim of this study was to determine the prevalence of carotid sinus hypersensitivity in (1) an unselected community sample of older people and (2) a subsample with no history of syncope, dizziness, or falls using recently standardized diagnostic criteria. One thousand individuals older than 65 years were randomly sampled from a single general practice register; 272 participants underwent supine and upright carotid sinus massage with continuous heart rate and phasic blood pressure monitoring. Carotid sinus hypersensitivity was defined as asystole of 3 seconds or greater and/or a drop in systolic blood pressure of 50 mm Hg or greater. Carotid sinus hypersensitivity was present in 107 individuals (39%); 24% had asystole of 3 seconds or greater during carotid sinus massage; and 16% had symptoms (including syncope) with carotid sinus hypersensitivity. Age (odds ratio, 1.05; 95% confidence interval, 1.00-1.09) and male sex (odds ratio, 1.71; 95% confidence intervals, 1.04-2.82) were the only predictors of carotid sinus hypersensitivity. In 80 previously asymptomatic individuals, carotid sinus hypersensitivity was present in 28 (35%) and accompanied by symptoms in 10. The 95th percentile for carotid sinus massage response was 7.3 seconds' asystole and a 77-mm Hg drop in systolic blood pressure. Carotid sinus hypersensitivity is common in older persons, even those with no history of syncope, dizziness, or falls. The finding of a hypersensitive response should not necessarily preclude further investigation for other causes of syncope.

Is our evidence‐based practice effective?

PurposeThe purpose of this article is to review all patients having received a steroid injection for rheumatic problems in the period 1995‐2003 by one general practitioner.Design/methodology/approachSelf‐completion questionnaire given to patients at the time of the injection to be returned after one month.FindingsMost of the 435 patients (92 per cent) were pleased that they had received the injection. Pain was relieved better than mobility. Results for different sites were similar. Complication rates were low and many patients had further steroid injections.Practical implicationsIt is feasible to collect large series reviewing the outcome of interventions in general practice. Results can be usefully compared with those obtained in randomised controlled trials.Originality/valueThis is the largest review of steroid injections carried out in a single general practice in the UK. It provides information with which others can compare their own practice and results, especially in primary care.

Involving service users in the evaluation and redesign of primary care services for depression: A qualitative study

Aim: To understand the experiences, expectations and needs of service users with mild to moderate depression, and to use these to inform the design and redesign of local services in primary care. Design of study: Needs assessment using in-depth semi-structured qualitative interviews. Setting: A single general practice in eastern England. Methods: Nine patients with depression were identified from the practice register using purposeful sampling and interviewed by a practice nurse who had not previously provided any care to them. Ritchie and Spencer's Framework approach was used to analyse the qualitative data. Results: Participants welcomed the opportunity to provide feedback on their experiences. They told many positive stories which affirmed the overall accessibility and acceptability of the existing service. They reported symptoms that were distressing and difficult to live with, even when their depression was classified by health professionals as 'mild'. Participants considered they had good access to care. Despite this, many participants identified gaps in the current service such as access to information and concerns about discontinuing medication in the future. Conclusion: In-depth interviews with patients with depression are a feasible and acceptable way of identifying service gaps and enabling users to contribute to service evaluation and redesign. © 2005 Librapharm Limited.

Ten Years of Skin Malignancies in a Single General Practice

Background: Generalists within the UK have for many years been performing minor surgical procedures. Little has been published concerning this activity. Objectives: To determine the management of skin malignancy in a UK general practice in order to allow comparison of activity with other practices and disciplines and to identify areas for research. Methods: Retrospective cohort study in an urban 4-partner general practice of 10,000 patients. Total ascertainment of all diagnosed skin malignancies over 10 years achieved by undertaking computerised searches. Results: 136 skin malignancies were identified in 101 patients. The recurrence rates for basal cell carcinomas managed in primary care were comparable to rates published for secondary care. A quarter of patients developed a metachronous skin malignancy or a recurrence. Conclusion: Almost half of all skin malignancies were wholly managed within primary care. There appeared to be no consistent pattern of management. There is a need for research and consensus on optimal care.