BMJ No. 7061 Volume 313 Saturday 5 October 1996
Geoff Cohen, John Forbes, Michael Garraway
Design - Interview and postal surveys, evidence from three independent population surveys being compared.
Setting - Scotland and Lothian.
Subjects - Randomly selected members of the general adult population who had received hospital care in the past 12 months.
Main outcome measure - Percentages of respondents dissatisfied with aspects of patient care.
Results - For items covering respect for privacy, treatment with dignity, sensitivity to feelings, treatment as an individual, and clear explanation of care there was good agreement among the surveys despite differences in wording. But for items to do with being encouraged and given time to ask questions and being listened to by doctors there was substantial disagreement.
Conclusions - Evidence regarding levels of patient dissatisfaction from national or local surveys should be calibrated against evidence from other surveys to improve reliability. Some important aspects of patient satisfaction seem to have been reliably estimated by surveys of all Scottish NHS users commissioned by the management executive, but certain questions may have underestimated the extent of dissatisfaction, possibly as a result of choice of wording.
Department of Public Health
Sciences,
Medical School,
University of Edinburgh,
Edinburgh EH8 9AG
Geoff Cohen, lecturer in medical statistics
John Forbes, senior lecturer in health economics
Michael Garraway, professor of public health
Correspondence to: Mr Cohen
Design - Patients who remained free of adverse cardiac events six weeks after myocardial infarction had stress and rest thallium-201 imaging and exercise electrocardiography and were followed up for 8-32 months. Adverse cardiac events (death, reinfarction, unstable angina, and congestive heart failure) were documented.
Setting - Large district general hospital, Middlesex.
Subjects - 100 consecutive male and female patients who were stable six weeks after thrombolysis for myocardial infarction.
Main outcome measures - Prediction of occurrence of adverse cardiac events after myocardial infarction by exercise cardiography and thallium-201 myocardial perfusion imaging.
Results - Reversible ischaemia on thallium-201 imaging predicted adverse cardiac events in 33 out of 37 patients with such events during follow up (hazard ratio 8.1 (95% confidence interval 2.7 to 23.8), P<0.001). Exercise electrocardiography showed reversible ischaemia in 33 patients, of whom 13 had subsequent events, and failed to predict events in 24 patients (hazard ratio 1.1(0.56 to 2.2), P = 0.8).
Conclusion - thallium-201 imaging is a sensitive predictor of subsequent adverse cardiac events in patients who have received thrombolysis after acute myocardial infarction, whereas exercise electrocardiography fails to predict outcome.
Department of Cardiac
Research,
Northwick Park
Hospital and Institute for
Medical Research,
Harrow, Middlesex
HA1 3UJ
Sumit Basu, research registrar
Roxy Senior, consultant
cardiologist
Avijit Lahiri, consultant
cardiologist
Medical Statistics Unit,
Royal Postgraduate
Medical School,
Hammersmith Hospital,
London
Caroline Dore, statistician
Correspondence to: Dr Lahiri.
Design - Cohort study of patients with noninsulin dependent diabetes drawn from diabetes clinics in London. Baseline investigations were performed in 1975-7; follow up continued until 1995.
Patients - 150 Europeans and 77 African Caribbeans with non-insulin dependent diabetes.
Main outcome measures - All cause and cardiovascular mortality; prevalence of microvascular and macrovascular complications.
Results - Duration of diabetes was shorter in African Caribbeans, particularly women. African Caribbeans were more likely than the Europeans to have been given a diagnosis after the onset of symptoms and less likely to be taking insulin. Mean cholesterol concentration was lower in African Caribbeans, but blood pressure and body mass index were not different in the two ethnic groups. Prevalence of microvascular and macrovascular complications was insignificantly lower in African Caribbeans than in Europeans. 59 Europeans and 16 African Caribbeans had died by the end of follow up. The risk ratio for all cause mortality was 0.41 (95% confidence interval 0.23 to 0.73) (P = 0.002) for African Caribbeans v Europeans. This was attenuated to 0.59 (0.32 to 1.10) (P = 0.1) after adjustment for sex, smoking, proteinuria, and body mass index. Further adjustment for systolic blood pressure, cholesterol concentration, age, duration of diabetes, and treatment made little difference to the risk ratio. Unadjusted risk ratios for cardiovascular and ischaemic heart disease were 0.33 (0.15 to 0.70) (P = 0.004) and 0.37 (0.16 to 0.85) (P = 0.02) respectively.
Conclusions - African Caribbeans with noninsulin dependent diabetes maintain a low risk of heart disease. Management priorities for diabetes developed in one ethnic group may not necessarily be applicable to other groups.
Department of
Epidemiology and Public
Health,
University College
London,
London
WC1E 6BT
Nish Chaturvedi, senior
lecturer
John H Fuller, professor
London SE26 4PA
John Jarrett, professor
South Wing,
Bedford
Hospital,
Bedford
MK42 9DJ
Nick Morrish, consultant physician
Unit for Metabolic
Medicine,
Guy's Hospital,
London SE1 9RT
Harry Keen, professor
Correspondence to: Dr Chaturvedi.
Design - Analyses of data from a community based coronary heart disease register.
Setting - Auckland region, New Zealand.
Subjects - 5,106 patients aged 25-64 years with an acute cardiac event leading to coronary death or definite myocardial infarction within 28 days of onset, occurring between 1986 and 1992.
Main outcome measures - Case fatality before admission, 28 day case fatality for patients in hospital, and total case fatality after an acute cardiac event
Results - Despite a more unfavourable risk profile women tended to have lower case fatality before admission than men (crude odds ratio 0.88; 95% confidence interval 0.77 to 1.02). Adjustment for age, living arrangements, smoking, medical history, and treatment increased the effect of sex (0.72; 0.60 to 0.86). After admission to hospital, women had a higher case fatality than men (1.76; 1.43 to 2.17), but after adjustment for confounders this was reduced to 1.18 (0.89 to 1.58). Total case fatality 28 days after an acute cardiac event showed no significant difference between men and women (0.85; 0.70 to 1.02).
Conclusions - The higher case fatality after an acute cardiac event in women admitted to hospital is largely explained by differences in living status, history, and medical treatment and is balanced by a lower case fatality before admission.
Department of
Community Health,
Faculty of Medicine and
Health Science,
University of Auckland,
Private Bag 92019,
Auckland,
New Zealand
Gabe S Sonke, visiting student
Robert Beaglehole, professor
Alistair W Stewart,
biostatistician
Rodney Jackson, associate
professor
Department of Medicine,
Auckland Hospital,
Auckland
Fiona M Stewart, cardiologist
Correspondence to: Professor Beaglehole.
Design - Group discussions generated data for initial qualitative research. The quantative survey comprised a doorstep survey of 2003 people in 143 places around the United Kingdom.
Results - The lay public in general seemed to be sympathetic to those with depression but reluctant to consult. Most (1704 (85%)) believed counselling to be effective but were against antidepressants as addictive.
Conclusions - Although people are sympathetic towards those with depression, they may project their prejudices about depression and the rationale for antidepressant treatment. In particular, patients should know that dependence is not a problem with antidepressants.
Department of Psychiatry,
Imperial College School of Medicine at St Maryšs,
Paterson Centre,
London W2 1PD
Robert G Priest, professor
Christine Vize, lecturer
Ann Roberts, senior registrar
John Connolly Unit,
Ealing Hospital,
Southall UB1 3EU
Megan Roberts, senior registrar
Royal College of General Practitioners Unit for Mental Health,
Division of General Practice and Primary Care,
St Georgešs Hospital Medical School,
London SW17 ORE
Andre Tylee, director
Correspondence and requests for reprints to: Professor Priest