In praise of non-fundholding practices.
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Biomedical subjects
Publications and source records attributed to P Hodgkin.
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Mycobacterium chelonei was isolated from the broncho-alveolar lavage fluid of seven patients on eight occasions over a 6-month period. The same bacterium was identified in the hospital water supply. Despite the use of a recommended disinfection procedure, it proved impossible to eradicate the organism until the bronchoscopes were treated with ethylene oxide and the use of tap water in rinsing was abandoned.
Interleukin-6 (also called B cell stimulatory factor 2, hepatocyte activating factor, interferon-beta 2) has been shown to have effects on various lineages of hemopoietic cells. Some of its activities appear to overlap those of interleukin-1. In particular, recombinant murine IL-6 induced proliferation of phytohemagglutinin-activated thymocytes, an assay widely used to detect IL-1. In this report, we compared several features of IL-1 and IL-6 dependent thymocyte proliferation. The results indicate that IL-2 is the major second mediator of both IL-1 and IL-6 dependent proliferation. Finally, we tested whether IL-6 would also have activity in other T cell-based IL-1 assays using the T cell lymphoma LBRM33 1A5 and the T cell clone D10-G4.1. IL-6 had no activity in the latter two assays. These results indicate that IL-1 assays using LBRM33 1A5 and D10-G4.1 selectively detect Il-1, and are more specific assays for the detection of IL-1 in samples that may also contain IL-6.
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The management of 12 330 cases of minor illness by 201 urban general practitioners has been studied. The results were analysed by the characteristics of the patients (age and social class) and by the characteristics of the doctors (for example, age of doctor, area of practice, mean time spent with patient).The age of the patients had little effect on the management of minor illness. Prescribing rates were not found to vary with the social class of the patient but the level of home visiting was affected.Doctors working in the most affluent wards were found to be lower prescribers than those in the less affluent wards and younger doctors tended to be low prescribers while older doctors tended to be high prescribers. There was a large proportion of non-vocationally trained doctors among the high prescribers. Doctors with short mean consultation times were found to be high prescribers and were more likely to label patients as having minor illness than doctors with longer mean consultation times. In addition, those doctors who used the minor illness codes more often were higher prescribers than those who used them less often.
Detailed classification of morbidity data provides problems in large-scale surveys in general practice: a balance between precise diagnosis and realistic uncertainty must be maintained, and it can be hard to detect the overall pattern when a large number of rubrics is involved. This paper reports the development of a system of clustered diagnoses in which similar diagnoses are linked together in homogeneous clusters. The system is based on the RCGP codes and is compatible with ICHPPC-2. The aim was not to produce another classification of morbidity but to use the system to apply to data already coded using a specific primary code.
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