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In order to assess the effects of the new contract on practice organization, all general practices in Sheffield were surveyed just before the new contract came into effect in April 1990, and again one year later. Of the 120 practices, 57% responded in 1990 and 61% in 1991, with 47% responding in both years. There were significant increases in the mean number of clinics and employed staff for the practices responding to both questionnaires and in the proportion of these practices which had a computer. These changes represent a response to the incentives and stated aims of the new contract.

During their final year, medical students at Sheffield University are required to undertake a research or audit project. The students' project reports are assessed using a grid-style criterion-based profile. This is described, and the validity and reliability of this method of summative assessment are discussed.

A booklet was developed in the author's practice that provided advice for parents on the home management of cough, fever, sore throat, diarrhoea and vomiting in children, and included specific recommendations about when to seek medical help. The effect of distributing this booklet on the frequency of parent-initiated consultations was evaluated in a randomized, controlled trial. The overall effect of the booklet was a statistically non-significant reduction in consultations for the symptoms that it addressed ('booklet symptoms'). However, this finding masked a statistically significant reduction in daytime home visits for booklet symptoms (especially for cough, fever and sore throat) and a significant increase in out of hours consultations (for fever, diarrhoea and vomiting). Had all the households in the practice been sent a copy of the booklet then it was estimated that over the following year some 28% fewer home visits and some 173% more out of hours consultations would have been undertaken for booklet symptoms than if none of the households had been sent a copy.

Infusion of angiotensin II into a patient with dexamethasone-suppressible hyperaldosteronism caused a brisk increase in plasma aldosterone concentration. In this behaviour, the patient resembled those patients with idiopathic hyperaldosteronism rather than those with tumorous primary hyperaldosteronism. Sodium depletion of a small group of patients with mild essential hypertension elicited a spectrum of increases in plasma aldosterone levels ranging from zero to normal. Angiotensin II infusion in both sodium replete and deplete states also caused variable aldosterone responses. These results suggest that the derangement of adrenal function in this condition varies continuously in severity.

The night visit record of an out-of-hours rota service of a large health centre which includes 10 group practices was examined. The mean annual night visiting rate for the health centre was 35.2 per 1000 patients, ranging from 25.8 to 43.5 between individual practices. The organization of medical care at night was the same for all the practices, and no major demographic differences between practices were identified. It is argued that the doctor-patient relationship may have an influence on differences in night visiting rates.

The recruitment thresholds, twitch tension, twitch contraction time and fatiguability of human motor units have been studied in the first dorsal interosseous of the hand. Units recruited at contraction strengths less than 50 g had relatively low twitch tensions (0.18-1.9 g), long contraction times (59-146 msec) and were non-fatiguable. Units recruited at higher contraction strengths (less than 200 g) had higher twitch tensions (15-26g), faster contraction times (33-57 msec) and were highly fatiguable. It is concluded that during graded voluntary muscle contractions motor units are recruited in order of increasing contraction strength and diminishing fatigue resistance.

Fifty general practitioners replied to a survey of the advice that they would offer to a tourist planning a package holiday in western Turkey. The range of prophylactic immunizations and other medication recommended by the respondents was wide, suggesting that some tourists travel without adequate protection, while some receive unnecessary injections. Most of the doctors would offer little other health advice to the traveller. General practitioners receive conflicting guidance on prophylactics for travellers, and it is suggested that the disagreements should be resolved. Wider availability of written advice for the traveller would also be valuable.

Twice daily peak expiratory flow measurements were obtained at home from 65 asthmatic children and 34 non-asthmatic controls, and a measure of the daily variation in peak expiratory flow was calculated for each child (mean daily variation). Children aged less than 7.5 years appeared unable to provide reproducable peak expiratory flows, but above that age the mean of the mean daily variations was significantly higher for the asthmatics than the controls. This was true even on days when the asthmatics exhibited no wheeze or took no medication. The significance of the findings is discussed, and it is suggested that calculation of the mean daily variation might assist in the assessment of children presenting with atypical respiratory symptoms.