"Only a GP?'': is the solution to the general practice crisis intellectual?

General practice is suffering a crisis of status, as shown by financial, power and intellectual markers. This is serious as a strong general-practice workforce is important to deliver cost-effective, high-quality healthcare. We argue that strengthening the intellectual aspects of general practice (particularly critical thinking) is essential. Most strategies to achieve this centre on research, with many initiatives in Australia and overseas to enhance research by general practitioners; there is still insufficient clinical research in general practice. Other ways to improve critical thinking include promoting use of evidence-based medicine, provided it is not implemented only via cook-book guidelines. Other innovations are desperately needed.

Self-reported difficulty in conceiving as a measure of infertility

BACKGROUND: This study aimed to explore the meaning and potential use of women's self-reported difficulties in conceiving as a measure of infertility in epidemiological studies, and to compare women's stated reasons for infertility with information in their medical records. METHODS: Data were available from a population-based case-control study of ovarian cancer involving 1638 women. The sensitivity and specificity of women's self-reported infertility were calculated against their estimated fertility status based on detailed reproductive histories. Self-reported reasons for infertility were compared with diagnoses documented in women's medical records. RESULTS: The sensitivity of women's self-reported difficulty in conceiving was 66 and 69% respectively when compared with calendar-derived and self-reported times taken trying to conceive; its specificity was 95%. Forty-one (23%) of the 179 women for whom medical records were available had their self-reported fertility problem confirmed. Self-reported infertility causes could be compared with diagnoses in medical records for only 22 of these women. CONCLUSIONS: Self-reported difficulty conceiving is a useful measure of infertility for quantifying the burden of fertility problems experienced in the community. Validation of reasons for infertility is unlikely to be feasible through examination of medical records. Improved education of the public regarding the availability and success rates of infertility treatments is proposed.

Aeropalynology of Australian native arboreal species in Brisbane, Australia

The influence of meteorological parameters on airborne pollen of Australian native arboreal species was investigated in the sub-tropical city of Brisbane, Australia over the five-year period, June 1994–May 1999. Australian native arboreal pollen (ANAP), shed by taxa belonging to the families Cupressaceae, Casuarinaceae and Myrtaceae accounts for 18.4% of the total annual pollen count and is distributed in the atmosphere during the entire year with maximum loads restricted to the months May through November. Daily counts within the range 11–100 grains m–3 occurred over short intervals each year and were recorded on 100 days during the five-year sampling period. Total seasonal ANAP concentrations varied each year, with highest annual values measured for the family Cupressaceae, for which greater seasonal frequencies were shown to be related to pre-seasonal precipitation (r 2 = 0.76, p = 0.05). Seasonal start dates were near consistent for the Cupressaceae and Casuarinaceae. Myrtaceae start dates were variable and established to be directly related to lower average pre-seasonal maximum temperature (r 2 = 0.78, p = 0.04). Associations between daily ANAP loads and weather parameters showed that densities of airborne Cupressaceae and Casuarinaceae pollen were negatively correlated with maximum temperature (p < 0.0001), minimum temperature (p < 0.0001) and precipitation (p < 0.05), whereas associations with daily Myrtaceae pollen counts were not statistically significant. This is the first study to be conducted in Australia that has assessed the relationships between weather parameters and the airborne distribution of pollen emitted by Australian native arboreal species. Pollen shed by Australian native Cupressaceae, Casuarinaceae and Myrtaceae species are considered to be important aeroallergens overseas, however their significance as a sensitising source in Australia remains unclear and requires further investigation.

Are diagnosis specific outcome indicators based on administrative data useful in assessing quality of hospital care?

Background: Hospital performance reports based on administrative data should distinguish differences in quality of care between hospitals from case mix related variation and random error effects. A study was undertaken to determine which of 12 diagnosis-outcome indicators measured across all hospitals in one state had significant risk adjusted systematic ( or special cause) variation (SV) suggesting differences in quality of care. For those that did, we determined whether SV persists within hospital peer groups, whether indicator results correlate at the individual hospital level, and how many adverse outcomes would be avoided if all hospitals achieved indicator values equal to the best performing 20% of hospitals. Methods: All patients admitted during a 12 month period to 180 acute care hospitals in Queensland, Australia with heart failure (n = 5745), acute myocardial infarction ( AMI) ( n = 3427), or stroke ( n = 2955) were entered into the study. Outcomes comprised in-hospital deaths, long hospital stays, and 30 day readmissions. Regression models produced standardised, risk adjusted diagnosis specific outcome event ratios for each hospital. Systematic and random variation in ratio distributions for each indicator were then apportioned using hierarchical statistical models. Results: Only five of 12 (42%) diagnosis-outcome indicators showed significant SV across all hospitals ( long stays and same diagnosis readmissions for heart failure; in-hospital deaths and same diagnosis readmissions for AMI; and in-hospital deaths for stroke). Significant SV was only seen for two indicators within hospital peer groups ( same diagnosis readmissions for heart failure in tertiary hospitals and inhospital mortality for AMI in community hospitals). Only two pairs of indicators showed significant correlation. If all hospitals emulated the best performers, at least 20% of AMI and stroke deaths, heart failure long stays, and heart failure and AMI readmissions could be avoided. Conclusions: Diagnosis-outcome indicators based on administrative data require validation as markers of significant risk adjusted SV. Validated indicators allow quantification of realisable outcome benefits if all hospitals achieved best performer levels. The overall level of quality of care within single institutions cannot be inferred from the results of one or a few indicators.

Estimating disease likelihood: a case of rubbery figures

In diagnosis and prognosis, we should avoid intuitive “guesstimates” and seek a validated numerical aid