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PubMed1999

[Communication between general practitioners and hospital interns at emergency admissions].

Communication between general practitioners and hospital interns serves as basis for the first in-hospital treatment of emergency admitted patients. The purpose of this study is to describe how this communication currently functions in Norway. The study was carried out by personal and focus group interviews with general practitioners and hospital interns, and questionnaire responses from 532 doctors. Both general practitioners (93%) and hospital interns (84%) claim that the general practitioner's information is usually valuable for the initial hospital treatment. 89% of the general practitioners and 65% of the interns (p < 0.01) responded affirmatively to general statements characterising the existing communication as good. However, 58% of the interns are of the opinion that there are many unnecessary referrals to the hospitals, and 47% respond that the general practitioners often refer a patient in order to get rid of a problem they should have been able to handle themselves. The interns single out simple problems with the referral letters, such as illegible handwriting, and left-out or unsorted information. This critical view can in part be explained by the sense of isolation, lack of autonomy and high work load that interns experience in their obligatory hospital year. We recommended that interns are invited to participate when hospital doctors and general practitioners meet.

Communication↗
PubMed1991

A demonstration of the graded nature of the generalization function of drug discrimination learning within the conditioned taste aversion procedure.

Although control of discriminative performance will often generalize to different doses of the training drug or to drugs from the same class as the training drug, the nature of this generalization is unknown. Prior work has suggested that the generalization is primarily quantal in nature with animals displaying either vehicle-appropriate or drug-appropriate responding, depending upon their detection of the drug stimulus. It has been questioned whether this quantal nature of generalization reflects a characteristic response to drug stimuli or whether such responding is a function of the specific training and testing procedures used to establish and measure drug discrimination learning. The present paper evaluated this issue by analyzing the generalization functions of individual subjects trained and tested within one specific drug discrimination procedure, i.e. the conditioned taste aversion design. Responding within this design was generally graded. It is clear that quantal responding is not a necessary outcome of drug generalization assessments and that the nature of generalization in drug discrimination learning is a function of the specific procedure utilized in training and testing the discrimination. The results of the present analysis are discussed in terms of other recent work reporting graded functions.

Journal Article↗
PubMed2001

Screening properties of questionnaires and laboratory tests for the detection of alcohol abuse or dependence in a general practice population.

BACKGROUND: Early identification of alcohol abuse or dependence is important in general practice because many diseases are influenced by alcohol. General practitioners, however, fail to recognise most patients with alcohol problems. AIM: To assess the diagnostic performance of the CAGE and AUDIT questionnaires, their derivatives, and laboratory tests in screening for alcohol abuse or dependence in a primary care population (male and female patients), attending their general practitioner (GP). DESIGN OF STUDY: A diagnostic cross-sectional study. SETTING: A random sample of patients who were over 18 years of age (n = 1992) attending 69 general practices situated in the same region in Belgium. METHOD: Alcohol questionnaires (CIDI 1.1, section I, CAGE, AUDIT, AUDIT-C, Five-Shot, and AUDIT Piccinelli) were completed, demographic information was recorded, and patients underwent conventional blood tests, including mean corpuscular volume, liver function tests, the gamma-glutamyl transferase test, and carbohydrate-deficient transferrin (CDT, estimated using %CDT). Calculations of sensitivity, specificity, positive predictive value, negative predictive value, odds ratios with their 95% CIs, and receiver operating characteristic (ROC) curves for different scores of the questionnaires and laboratory tests, using DSM-III-R as the reference standard. RESULTS: The past-year prevalence of alcohol abuse or dependence in this population was 8.9% (178/1992) of which there were 132 male and 45 female patients attending a general practice. The GPs identified 33.5% of patients with alcohol abuse or dependence. Among male patients, all questionnaires had reasonable sensitivities between 68% and 93% and hence at lower cut-points than recommended. Only the sensitivity of the CAGE, even at its lowest cut-point of > or = 1 was lower (62%). In female patients the sensitivities were lower; however, odds ratios were higher for different questionnaires. The receiver operating characteristic (ROC) curves did not differ between the questionnaires. The laboratory tests had low diagnostic accuracy with areas under the ROC curves (AUCs) between 0.60 and 0.67 for female patients and 0.57 and 0.65 for male patients. CONCLUSIONS: This is one of the largest known studies on alcohol abuse or dependence among family care practices. We confirm earlier results that the AUDIT questionnaire seems equally appropriate for males and females; however, screening properties among male patients are higher. Nevertheless, the Five-Shot questionnaire is shorter and easier to use in a general practice setting and has nearly the same diagnostic properties in male and female general practice patient populations. We confirm that conventional laboratory tests are of no use for detecting alcohol abuse or dependence in a primary care setting. Also, the %CDT cannot been used as a screening instrument in this general practice population.

Alcoholism↗
PubMed2001

[Methylprednisolone-induced acute generalized exanthematous pustulosis].

BACKGROUND: Acute generalized exanthematous pustulosis is a rare drug allergy. Generalized reactions to systematically administrated corticosteroids are even rarer. We report the first case of acute generalized exanthematous pustulosis due to methylprednisolone. CASE REPORT: A thirty year-old-woman presented, a few hours after intravenous administration of methylprednisolone indicated for multiple sclerosis, a maculopapulous rash predominant in the folds rapidly becoming pustulous with malaise, fever and neutrophilia. The histologic examination and negativity of microbiological cultures were consistent with the diagnostic of acute generalized exanthematous pustulosis. The rash cleared spontaneously in one week with normalization of the biology. One month later, epicutaneous tests, confirmed the allergy to group A corticosteroids. The treatment of multiple sclerosis was pursued with dexamethasone. DISCUSSION: Clinical and histological manifestations were consistent with the diagnostic of acute generalized exanthematous pustulosis to methylprednisolone. Generalized reaction to systematically administered corticosteroids are very rare. Immediate reactions are the most frequently reported reactions, only about thirty delayed-type generalized skin eruptions have been reported to date. Group A corticosteroids are the most frequent causal agent. Epicutaneous tests have good sensitivity for acute generalized exanthematous pustulosis, for allergy to corticosteroids, delayed results are very important.

Acute Disease↗
PubMed2001

[Potential cost reductions for the National Health Service through a telecardiology service dedicated to general practice physicians].

BACKGROUND: Rising health care costs resulted in increasing pressure on the health care system and stimulated new strategies for improving the efficiency of care. A telecardiology service provides a useful support to general practitioners in the management of cardiac patients and contributes to the optimization of health care costs in terms of appropriateness of hospital admission and diagnostic testing. The aim of our study was to evaluate the reduction in the number of referrals to the Emergency Department and to cardiological evaluation resulting from the employment of a telecardiology service by general practitioners. METHODS: Eight hundred and ninety-one consecutive calls arrived to the receiving station of the telecardiology service were analyzed. One hundred and fifty general practitioners received a portable electrocardiographer (Card-Guard 7100, Rehovot, Israel) transferring, by a mobile or fixed telephone, a 12-lead ECG to a receiving station, where a cardiologist was available for reporting and for interactive teleconsultation. At the onset of the phone call, a question was asked to the general practitioner: "What would you have done without the telecardiology service?". The possible answers were: "No actions"; "Referral to the Emergency Department"; "Cardiological consultancy"; "Further investigations". Then we collected the history, risk factors, symptoms and therapy of the patients; the general practitioner sent the ECG tracing by phone. RESULTS: Eight hundred and ninety-one patients were enrolled (402 males, 489 females, mean age 59 +/- 19 years); 465 (52%) patients were symptomatic; 36.4% had no evidence of previous cardiac disease, 35.1% had systemic hypertension, 10.6% had ischemic cardiac disease, 3.7% had atrial fibrillation, and 11.9% other diseases. ECG was normal in 55%. The general practitioners would have sent to the Emergency Department 106 patients (11.9%), and requested further investigations in 717 patients (80.5%). The cardiologist of the telecardiology service solved the problems of the general practitioners in 657 cases (73.7%), sent 56 patients (6.3%) to the Emergency Department, and asked for further investigations in 178 patients (20%), with a reduction of 47% of Emergency Department admission (p < 0.001) and of 95% of further investigations (p < 0.0001) respectively. The cost analysis showed a reduction, between the two modalities, varying from Itl 22,760,000 and Itl 140,060,000 for 891 calls. CONCLUSIONS: Telemedicine is a useful tool for the support of general practitioners' daily activity, with a possible cost reduction due to increased appropriateness of hospital admission and of diagnostic testing.

Cardiology↗
PubMed2001

General practice residency training program in Thailand: past, present, and future.

The General Practice was approved by the Thai Medical Council as a specialty in 1969. The residency training programs were revised in 1992. The first three - year rotating postgraduate residency training program was started in 1973 with a total of 9 programs by the late 1980s. Seven were in Bangkok, and the other 2 were in the North. The programs contained curricula objectives, clinical rotation in various disciplines including a general practice block in provincial or community hospitals. The weakness of the programs was the lack of a general practice department, a general practice trainer or preceptor and a general practice course organizer. Finally, the General Practitioners Association played a little role in the postgraduate general practice residency. After the revision, the general practice residency was changed to family medicine residency training in 1999. The College of Family Physicians of Thailand was established to take a central role in postgraduate education.

Certification↗
PubMedDate not supplied

[Drugs associated with acute generalized exanthematic pustulosis].

INTRODUCTION: Acute generalized exanthematous pustulosis is a severe eruption which is usually drug related. If the causative drug is discontinued, acute generalized exanthematous pustulosis resolves spontaneously in ten days. The aim of this study was to compare drugs suspected of causing acute generalized exanthematous pustulosis reported to French Pharmacovigilance centres and those reported in the literature. MATERIALS AND METHODS: All cases of "pustular eruption" qualified as "serious" reported to the French Pharmacovigilance Centers between January 1985 and December 2001 were analyzed. Cases for which the diagnosis of acute generalized exanthematous pustulosis was not clearly identified were reviewed by a dermatologist. The relationship between acute generalized exanthematous pustulosis and drug exposure was re-examined by one of us. An exhaustive review of the literature was also performed. RESULTS: Review of the data base revealed 207 cases of serious acute generalized exanthematous pustulosis leading to death in 4 cases (2%). Of these cases of acute generalized exanthematous pustulosis, only one drug was suspected in 107 cases (51.6%). The main drugs involved were: pristinamycin (18 cases), amoxicillin (+/- clavulanic acid) (16 cases), hydroxychloroquine (8 cases) and a combination of spiramycin + metronidazole (5 cases). DISCUSSION: The most frequent causal drugs in our study and in the literature are: amoxicillin +/- clavulanic acid, pristinamycin, hydroxychloroquine, ampicillin, diltiazem, co-trimoxazole, terbinafine, carbamazepine and spiramycin +/- metronidazole. Only pristinamycin and diltiazem have information in their summary of product characteristics regarding the risk of acute generalized exanthematous pustulosis. Because it is essential to discontinue the causative drug as soon as possible if a pustular eruption occurs, physicians must be informed of the risk, which should be added to the "adverse events", and "warnings" sections of the summary of product characteristics of the drugs concerned. CONCLUSION: Our results show the relevance of notification of side effects by physicians to pharmacovigilance centres, leading to the identification of a signal and public health dissemination of warnings.

Acute Disease↗
PubMed1992

Why do patients consult the general practitioner? Determinants of their decision.

In order to obtain more information about the reasons why patients consult their general practitioner 1000 patients completed a questionnaire in the waiting rooms of eight general practices. After the consultation the patients received a second questionnaire. The aim of the study was to determine why people decide to consult their general practitioner about one complaint but not about a second complaint. Both questionnaires were based on the health belief model, augmented by three other factors: the perceptions patients have of their own abilities to cope with their condition (efficacy of self care), their knowledge about the complaint and their need for information. The results showed that two of the additional factors (efficacy of self care and need for information) as well as most of the factors of the health belief model (efficacy of general practitioner care, perceived severity of complaint and cues to consult) were important determinants of consulting the general practitioner. The results suggest that patients sometimes expect information from their general practitioner rather than medical treatment. Furthermore, as the perceived efficacy of general practitioner care is also an important determinant, unnecessary consultation or unnecessary delay in treatment could be prevented by offering patients information about the potential effectiveness of medical care or self care for specific conditions. Implications for general practitioners' daily practice and future research are discussed.

Attitude to Health↗
PubMed1992

Relationship between the working styles of general practitioners and the health status of their patients.

The aim of this study was to relate the working style of general practitioners to the health status of a sample of their patients. From a large regional sick fund forming part of the national health insurance system in the Netherlands a stratified sample was taken of general practitioners with at least 1000 patients on their list, taking into account the degree or urbanization of the area in which they practised and their annual referral rates to specialists. These 75 general practitioners were observed for two days in their surgeries by trained doctors and rated according to criteria defined beforehand. Taking into account these ratings and the annual figures from the sick fund for prescribing selected drugs and referrals to specialists, the general practitioners were classified into styles of practice - integrated, interventionist or minimal diagnostic. Twenty randomly selected women, aged 50-65 years, from each general practitioner's list, were interviewed and examined by independent doctors. The patients of general practitioners with the integrated practice style appeared to feel more healthy and to have more realistic expectations about the possibilities of professional help for common ailments. They tended to visit their doctor less frequently and to have fewer symptoms. The results showed an association between the quality of general practitioners and patients' health, and it may therefore be concluded that good general practitioners can further the health and well being of their patients.

Aged↗
PubMed2006

[General practice research supervision].

INTRODUCTION: General practice is a subject with a relatively short scientific tradition. The purpose of this study was to elucidate who gives long-cycle general practice research supervision in Denmark, who is supervised and how research students get on. MATERIALS AND METHODS: All research students with research advisers in the field of general practice filled out a questionnaire in 1997 (n = 50) and 2003 (n = 52). There were questions about project/research training, professional education, advisers and the students' attitude to taking on advisory functions in the future. In 2003, 48 of those from the 1997 cohort also answered a follow-up questionnaire. RESULTS: The number of research students with a connection to the general practice research field was fairly constant from 1997 to 2003. The number of permanently employed general practice advisers, on the other hand, has doubled, and these now undertake more of the advisory functions. The great majority of research students complete their projects, most of them at PhD level. Most of the research students surveyed indicated that they are prepared to take on advisory functions when they have acquired the competence to do so. DISCUSSION: The general practice research students vary greatly with regard to age, interests and career paths, but almost all complete their research studies. This may be due to the flexible framework for research in general practice and the increase in recent years of advisory capacity in general practice. This positive development is expected to continue through the development of networks, course activities and continuing follow-up of the advisory functions.

Biomedical Research↗
PubMedDate not supplied

The changing face of nurses in Australian general practice.

OBJECTIVE: To describe the workforce characteristics and current responsibilities of nurses working in Australian general practice settings. DESIGN: Survey research combining qualitative and quantitative data collected through telephone interview. SUBJECTS: 222 enrolled (RN Division 2 in Victoria) and registered nurses (RN Division 1 in Victoria) working in general practice in rural and urban areas of Australia. RESULTS: General practice nurses in Australia are likely to be RNs (84.7%) who work on a part-time basis (75.3%) in a medium to large practice (93.7%). Often the nurse has worked less than five full time equivalent years (52.3%) in a general practice environment and is likely to work in a practice where at least one other nurse works (64.4%). The nurse is likely to have some post-basic formal education (65.9%), and to have participated in professional development in the past two years (94.9%). The nurse performs a diverse range of activities within the general practice. No substantial differences were found in the workforce characteristics or role of urban and rural general practice nurses. CONCLUSION: It appears that nurses working in general practice are no longer the 'handmaiden' to the doctor but are professionals who perform a vast range of clinical, administrative and organisational responsibilities within the general practice primary health care setting.

Australia↗
PubMedDate not supplied

Occupational health and general practice: from opportunities lost to opportunities capitalised?

BACKGROUND AND AIM: Western populations are in the middle of the epidemiological transition of chronic diseases. Care of patients with chronic disease is directed at optimising life expectancy and quality of life. Daily and social functioning, including paid work are part of the treatment objectives. Yet, advice for and support in work related coping with chronic diseases, and collaboration with occupational health are not--yet--part of routine curative medical care procedures. This is also the case in general practice, where most patients with chronic conditions are treated. This 'blind spot' signals a generic lost opportunity in optimizing the care of patients with chronic disease. This paper analyses from empirical data the importance of integrating work-related advice and support in general practice and explores potential evidence of the benefits this provides for patients: the opportunities that can be capitalised through better interaction between occupational physicians (OP) and general practitioners (GP). METHODS: The paper is based on a review of three sources: (i) Epidemiology of chronic diseases: the Nijmegen Continuous Morbidity Registration; (ii) The relevant guidelines of the Dutch College of General Practitioners; (iii) Studies of work-related implications of asthma and COPD management of GPs of the Nijmegen centre of Evidence-Based Practice. RESULTS: Chronic diseases like cardiovascular disease, diabetes mellitus, COPD and asthma dominate general practice and lead annually to a large number of consultations. Although a majority of patients are 65 years or older--in particular for the first three diseases--GPs also care for a substantial number of under-65 years old. General practice guidelines for these disorders advocate care directed at normal functioning but do not systematically address functioning in the working place. Analysis of work-related functioning in case of chronic respiratory diseases, however, highlight that work-related factors and circumstances play an important role in patients' coping strategies. Patients tend to ignore negative effects of their workplace on their physical condition and as a consequence suffer undue limitations. Despite these work related risks, COPD patients who were in paid employement perceived higher quality of life than COPD patients who were disabled for work, but had similar disease severity (airway obstruction). Interestingly, a programme of patients' self-management of asthma resulted, in comparison to GP-supervised usual care in a substantial and lasting reduction of asthma related absence from work and other social-daily activities. CONCLUSIONS AND DISCUSSION: All consultations with employees with a chronic (respiratory) disease can be considered as opportunities to supervise work-related implications of the disease. Patients value their ability to work but frequently apply inefficient coping through ignoring the implications of their circumstances for their disease. A more efficient coping can probably be achieved through a more active involvement of patients in managing their own disease. Guidelines--like the Dutch College of General Practitioners'--have developed into a sophisticated and generally respected system of guidance of patient care. Explicit emphasis of management in relation to the workplace may present a logical opportunity to capitalise on.

Absenteeism↗
PubMed1992

General anaesthesia versus epidural anaesthesia for primary caesarean section--a comparative study.

Forty-seven healthy parturients undergoing elective Caesarean section were randomly allocated to either general anaesthesia (n = 24) or epidural anaesthesia (n = 23) under standardized anaesthetic and surgical conditions. Seven women of the epidural group required additional systemic analgesia or sedation following delivery of the neonate. Nine of 24 newborns obtained 1-min Apgar scores below 7 after general anaesthesia compared to only 3/23 after epidural anaesthesia. The time period to establish normal colour in the babies was 2.2 min after epidural and 4.9 min after general anaesthesia. Three of the 24 general-anaesthesia newborns demonstrated a tendency to hypotonia compared to only one in the epidural group. Twenty-four hours and 7 days after delivery all infants of both groups were completely normal. At the time of delivery maternal PO2 was higher in the general anaesthesia compared to the epidural group, due to higher inspired oxygen concentrations. Comparable results were obtained in umbilical PO2 venous values; lower pH values, however, were observed in the umbilical artery after general anaesthesia. There were no significant differences in the glucose levels between the groups. A significant correlation was established between uterine incision-delivery interval and 1-min neonatal Apgar scores in the general-anaesthesia group, but not in the epidural group. Our investigation did not show either the incision-delivery interval or the start of operation-delivery interval to play a role in neonatal outcome. Epidural anaesthesia is superior to general anaesthesia in Caesarean section under normal conditions with regard to neonatal outcome. Whether this is also true for critical conditions cannot be concluded from this study.

Adolescent↗
PubMed1990

General practitioner referral rates to district psychiatry and psychology services.

The number of referrals made to a district psychiatry service by each of the local general practitioners over a five year period was counted and a large variation in general practitioner referral rate was found. Ten referral letters from each of the general practitioners were independently assessed for the amount of detail included and a mean score for each general practitioner obtained. A significant negative correlation was found between referral rate and amount of detail in referral letters, that is low referrers wrote very detailed letters. The procedure was repeated over an 18 month period including referrals to the district psychology service. Referral rate to the psychologists was positively correlated with detailed referral letters, that is those who referred many patients to the psychologists wrote detailed letters. This study has indicated a wide variation in the use of the psychiatry and psychology services by general practitioners which cannot be explained solely on the basis of a general referral tendency. It is likely that constructive liaison between psychiatrists and general practitioners, especially those who refer a large number of patients, could enhance the care of patients with psychiatric disorder in general practice.

Clinical Competence↗
PubMed1987

An ethical committee for general practice in the west for Scotland: proposals received in the first year.

The particular ethical problems of research in general practice and pressure from local general practitioners and hospital ethical committees led to the development of an ethical committee for general practice in the west of Scotland. The workload of this ethical committee in its first year of existence is described.Despite the fact that many of the studies considered by the committee were sponsored by pharmaceutical companies and were often sophisticated, the ethical issues of a general practice setting had not always been fully appreciated. Of the 21 study proposals submitted over the year 13 showed areas of ethical uncertainty. However, all the studies were eventually approved. Most of the problems encountered were easily overcome and might have been avoided if the general practitioners undertaking the research had been able to seek advice from those with experience of research in general practice and in particular of the ethical issues involved. Local ethical committees for general practice, made up largely of general practitioners but with at least one lay member, might provide one such source of advice.

Ethics Committees, Research↗
PubMed1995

Membership of the Royal College of General Practitioners by assessment: attitudes of members and non-members in one faculty area.

BACKGROUND: Fewer than half of the principals in general practice in the United Kingdom are members of the Royal College of General Practitioners. As the membership examination is closely linked to the endpoint of vocational training, a case can be made for another method of entry to the RCGP for established principals. Such a method could be membership by assessment. AIM: A study was undertaken to examine the attitudes of existing members and fellows of the RCGP to membership by assessment and to determine whether there was any demand from general practitioner principals who were not RCGP members to join by this route. METHOD: One questionnaire was sent to all RCGP members and fellows in the Vale of Trent faculty area and another questionnaire was sent to those principals in general practice in the Vale of Trent faculty area who were not RCGP members. RESULTS: In total, 396 (83%) of the 480 RCGP members and fellows responded, as did 543 (81%) of the 671 non-members in the faculty area. When asked if they were in favour of the concept of membership by assessment, 245 of the members and fellows replied yes (62%) and 138 replied no (35%). Of the non-members, 91 (17%) ahd previously been members of the RCGP; the main reason given by these general practitioners for relinquishing membership was that the annual subscription was too high (65% of 91 general practitioners). When the 451 general practitioners who had never been members were asked if they would be interested in joining the RCGP by an assessment method, 271 replied positively (60%). CONCLUSION: There was widespread support from the members and fellows of the Vale of Trent faculty of the RCGP for the concept of membership by assessment. Principals in general practice in this area who had never been members of the RCGP showed a high degree of interest in joining by this method. Despite the caveats that must be applied, for example, to ensure that the standards are set appropriately, these results indicate that membership by assessment should be explored by the RCGP, and indeed a working party on the meaning of membership of the RCGP has been convened.

Family Practice↗
PubMed1994

Antidepressant prescribing: a comparison between general practitioners and psychiatrists.

BACKGROUND: The 'defeat depression' campaign emphasizes the importance of adequate prescribing of antidepressants in general practice. AIM: A study was undertaken to investigate the prescribing habits of a group of general practitioners and psychiatrists. METHOD: A postal questionnaire was sent to 123 general practitioners and 97 psychiatrists in south Wales. RESULTS: The response rate among general practitioners was 60% and among psychiatrists it was 67%. As a group, the psychiatrists reported using significantly higher daily dosages of antidepressant medication for adult and for elderly patients over a longer period compared with general practitioners. Fifty two per cent of 68 general practitioners and 17% of 60 psychiatrists reported using lower than recommended daily treatment dosages for adult patients and 40% of 68 general practitioners and 7% of 62 psychiatrists used a shorter than recommended period of continuation therapy (less than four months). Both groups showed a wide variation in the use of maintenance therapy. CONCLUSION: Educational efforts should be made to improve the prescribing habits of general practitioners and psychiatrists.

Antidepressive Agents↗
PubMed1995

Non-acute abdominal complaints in general practice: diagnostic value of signs and symptoms.

BACKGROUND: Although many patients are evaluated initially by their general practitioner, clinicians' accuracy at diagnosing organic gastrointestinal disease has not been studied in a primary care setting. Different spectra of severity of disease in general practice and hospital populations may lead to different values for diagnostic tests in these two populations. AIM: This study set out to determine the diagnostic value of history and physical and laboratory items for organic and neoplastic disease in general practice patients with nonacute abdominal complaints. METHOD: The one-year prospective, observational study was carried out in 1989 in 80 general practices in Limburg, the Netherlands. The study subjects were 933 patients (aged 18-75 years) presenting to their general practitioner with new non-acute abdominal complaints of minimum duration two weeks, and with whom the doctor had a diagnostic problem. Patients were physically examined by their general practitioner and asked to complete pre-structured questionnaires. Basic laboratory tests were carried out. Patients were followed up for at least one year by researchers and then a diagnosis was determined by an independent panel of three general practitioners using patient records, blinded for the results of the questionnaires. Sensitivity, specificity and odds ratios were calculated for clinical items. Stepwise forward logistic regression analysis was undertaken to identify independent predictors of organic gastrointestinal disease. RESULTS: Of the 933 patients 14% had organic gastrointestinal disease. No clinical item had both high sensitivity and specificity. Logistic regression analysis showed only eight independent predictors of organic disease: male sex, greater age, epigastric pain, no specific character to pain, pain affecting sleep, history of blood in stool, no pain relief after defecation and abnormal white blood cell count. When the model was programmed to predict neoplasms five items were found: male sex, greater age, no specific character to pain, weight loss and erythrocyte sedimentation rate greater than 20 mm hour-1. CONCLUSION: In a general practice population with non-acute abdominal complaints some clinical findings can be used as predictors for organic and neoplastic gastrointestinal disease.

Adolescent↗