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This qualitative study explored those behaviours of a general practitioner which were used by patients in their evaluations of 14 aspects of general practice care. Thirty patients were interviewed immediately after visiting their general practitioner. Interview transcripts were analyzed by two authors, who independently marked general practitioners' behaviours used by patients. Then, these text fragments were categorised into task or affective behaviours according to an existing taxonomy of doctor behaviour in consultations. The results showed that patients reported using task oriented behaviours when they evaluated task oriented aspects of general practice care. However, when they evaluated affective aspects they reported using both affective behaviours and task behaviours, although the latter to a lesser extent. The evaluations of 'tell you all you wanted to know about your illness', 'explain the purpose and the course of the treatment', 'pay attention to your feelings' and 'kind and attentive' are clearly linked to specific general practitioners' behaviour. Therefore, evaluations of these aspects can be interpreted straightforwardly. Evaluation of the aspects 'GP understands you', 'having faith in your GP' and 'were you involved in decisions about your medical treatment?' were based on a large variety of physician behaviours which may lead to interpretation problems. Thus, this study gives some important considerations for a better understanding of patients' evaluations of general practice care. [ABSTRACT FROM AUTHOR]

Background: Many patients with chronic illness receive health care in primary care settings, so a challenge is to provide well-structured chronic care in these settings. Our aim was to develop and test a Dutch version of the PACIC questionnaire, a measure for patient reported structured chronic care.Methods: Observational study in 165 patients with diabetes or COPD from four general practices (72% response rate). Patients completed a written questionnaire, which included instruments for assessing chronic illness care (PACIC), evaluations of general practice (Europep), enablement (PEI), and individual characteristics.Results: The patients had a mean age of 68.0 years and 47% comprised of women. Twenty-two to 35% of responding patients did not provide answers to specific items in the PACIC. In 11 items the lowest answering category was used by 30% or more of the responders and in 6 items the highest answering category was used by this number of responders. Principal factor analysis identified the previously defined five domains reasonably well. Cronbach's alpha per domain varied from 0.71 to 0.83, and the intraclass coefficient from 0.66 to 0.91. Diabetes patients reported higher presence of structured chronic care for 14 out of the 20 PACIC items. The effect of patient evaluations of general practice on the PACIC score was positive (b = 0.72, p < 0.004), but the effect of patient enablement on the PACIC score was negative (b = -1.13, p < 0.000).Conclusion: A translated and validated Dutch version of the PACIC questionnaire is now available. Further research on its validity is recommended. [ABSTRACT FROM AUTHOR]

Positive health (PH) has been described as a promising transformative innovation to address the challenges of promoting well-being and reducing the burden of disease. For this study, we conducted a scientific literature review of the current state of knowledge about PH as introduced by Huber and colleagues, following the Cochrane Rapid Review recommendations. Three databases were searched (PubMed, Google Scholar, and CINAHL). Data were extracted and synthesised using a narrative approach. A total of 55 articles were included. The initial evaluation revealed promising results at both the individual and collective levels. However, several articles gave reason for further refinement of the conceptualisation of PH and of ways to measure the effects of PH interventions in greater detail. Professionals also expressed a desire for a more informed application and elaboration of the PH method, in various settings and populations, to increase its effectiveness in practice. The results from the rapid review highlight the transformative potential of PH in shifting from a disease-oriented to a health-oriented paradigm of healthcare. This underlines the need for continued research regarding further development of the concept and its practical method, along with the necessity for methodological innovation., Competing Interests: The authors declare no conflicts of interest.

Background: Patient care teams have an important role in providing medical care to patients with chronic disease, but insight into how to improve their performance is limited. Two potentially relevant determinants are the presence of a central care provider with a coordinating role and an active role of the patient in the network of care providers. In this study, we aimed to develop and test measures of these factors related to the network of care providers of an individual patient., Methods: We performed an observational study in patients with type 2 diabetes or chronic heart failure, who were recruited from three primary care practices in The Netherlands. The study focused on medical treatment, advice on physical activity, and disease monitoring. We used patient questionnaires and chart review to measure connections between the patient and care providers, and a written survey among care providers to measure their connections. Data on clinical performance were extracted from the medical records. We used network analysis to compute degree centrality coefficients for the patient and to identify the most central health professional in each network. A range of other network characteristics were computed including network centralization, density, size, diversity of disciplines, and overlap among activity-specific networks. Differences across the two chronic conditions and associations with disease monitoring were explored., Results: Approximately 50% of the invited patients participated. Participation rates of health professionals were close to 100%. We identified 63 networks of 25 patients: 22 for medical treatment, 16 for physical exercise advice, and 25 for disease monitoring. General practitioners (GPs) were the most central care providers for the three clinical activities in both chronic conditions. The GP's degree centrality coefficient varied substantially, and higher scores seemed to be associated with receiving more comprehensive disease monitoring. The degree centrality coefficient of patients also varied substantially but did not seem to be associated with disease monitoring., Conclusions: Our method can be used to measure connections between care providers of an individual patient, and to examine the association between specific network parameters and healthcare received. Further research is needed to refine the measurement method and to test the association of specific network parameters with quality and outcomes of healthcare.

Objective: To identify associations between various cultural and demographic factors and patients' primary health care preferences., Search Strategy: Searches were performed in MEDLINE (1966-December 2000), PsycINFO (1977-May 2001) and Sociological Abstracts (1963-December 2000). Identified papers were checked for more papers., Inclusion Criteria: Studies with a focus on primary health care or health care in general, asking patients about preferences with regard to health care, reporting quantitative results and examining the relations between specific patient characteristics and patient preferences., Data Extraction and Synthesis: Data were extracted from studies using a scoring form to register what methods were used, which patient characteristics were analysed and which patient characteristics significantly influenced patients' preferences with regard to different aspects of health care (P < 0.05)., Main Results: A total of 145 studies were included with 2276 comparisons between subgroups of patients. Of all the comparisons, 607 (27%) showed a significant association between patient characteristics and preferences with regard to primary health care. Age and economic status significantly related to patient preferences in 38 and 33% of the comparisons, respectively. Education, health status, family situation, sex, and utilization of health care related significantly to patient preferences in less than 25% of the comparisons., Conclusions: This review of the literature showed patient characteristics to be an important determinant of preferences regarding many aspects of primary health care defined as general practice care or health care, in general. All of the patient characteristics examined here showed at least some significant associations with preferences for primary health care.

Objectives: To compare patients' and general practitioners' (GPs') evaluations of the quality of general practice care., Design: Written surveys among patients and GPs., Setting: General practice in the Netherlands., Subjects: 1772 patients (from 45 GPs) and a random sample of 315 GPs., Main Outcome Measures: Patients' and GPs' evaluations of 23 aspects of general practice care and GPs' perceptions of patients' evaluations using a 5 point scale., Results: The response rate was 88% in the patient sample and 63% in the GP sample. The patients' ratings of care were significantly more positive (mean 4.0) than those of the GPs (mean 3.7) as well as GPs' perceptions of patients' evaluations (mean 3.5) (p<0.001). The overall rank order correlations between the patients' evaluations, GPs' evaluations, and GPs' perceptions of the patients' evaluations were 0.75 or higher (p<0.001). Patients and practitioners gave the most positive evaluations of specific aspects of the doctor-patient relationship ("keeping patients' records and data confidential", "listening to patients", and "making patients feel they had enough time during consultations") and aspects of the organisation of care ("provide quick service for urgent health problems" and "helpfulness of the staff (other than the doctor)"). The aspects of care evaluated least positively by patients as well as by GPs were other organisational aspects ("preparing patients for what to expect from specialist or hospital care" and "getting through to practice on the telephone")., Conclusions: GPs and patients have to some extent a shared perspective on general practice care. However, GPs were more critical about the quality of care than patients and they underestimated how positive patients were about the care they provide. Furthermore, specific aspects of care were evaluated differently, so surveys and other consultations with patients are necessary to integrate their perspective into quality improvement activities.

Background: Patients' evaluations can be used to improve health care and compare general practice in different health systems., Aim: To identify aspects of general practice that are generally evaluated positively by patients and to compare opinions of patients in different European countries on actual care provision., Method: An internationally-validated questionnaire was distributed to and completed by patients in 10 European countries. A stratified sample of 36 practices per country, with at least 1080 patients per country, was included. A set of 23 validated questions on evaluations of different aspects of care was used, as well as questions on age, sex, overall health status, and frequency of visiting the GP., Results: The patient sample included 17,391 patients in 10 different countries; the average response rate was 79% (range = 67% to 89%). In general, patients visiting their general practitioner (GP) were very positive about the care provided. For most of the 23 selected aspects of care more than 80% viewed care as good or excellent; in particular, keeping records confidential, GP listening to patients, time during consultations, and quick services in case of urgent problems were evaluated positively. Patients were relatively negative about organisational aspects of care. The evaluations in different countries were largely similar, with some interesting differences; for instance, service and organisational aspects were evaluated more positively in fee-for-service health systems., Conclusions: Patients in Europe are positive about general practice but improvements in practice management in some countries are requested. More research is needed to study the complex field of differences in expectations and evaluations between countries with different health systems.

Randomized trials were performed in Denmark and The Netherlands to determine the effect of mailed reminders on the response rate in surveys among patients in general practice. In both countries, general practitioners handed out questionnaires to 200 adult patients who came to visit them. An intervention group of 100 patients received reminders at 3 weeks after the visit, whereas a control group of the remaining 100 patients did not receive reminders. The response rate was significantly higher in the intervention groups than in the control group in The Netherlands (86% versus 55%, respectively) but not in Denmark (87% versus 81%, respectively). Mailed reminders can improve the response rate in surveys related to a general practice, but they are not effective in all situations.

Molecular genetics recently uncovered the mystery of the protean picture of McCune-Albright syndrome by identification of the somatic gain of function mutations in the GNAS1 gene. Here we present an adult patient with fibrous dysplasia and an endocrinopathy resulting in unusual giant height. The clinical diagnosis in the patient could be confirmed by molecular investigations in tissues involved in the process of fibrous dysplasia.

To make health care more responsive to patient needs, insight into patient priorities is needed. A systematic literature review, using electronic and manual searches, was made of studies on patient priorities with regard to primary health care. Data-extraction was performed by two researchers, followed by systematic analyses of study features. 57 studies were included. The aspects of care and methods used showed a wide variation. Aspects most often included were "informativeness", "humaneness" and "competence/accuracy". Based on an analysis of 19 studies, the following aspects were seen by patients as most important in more than 50% of the studies that included them: "humaneness", "competence/accuracy", "patients' involvement in decisions", "time for care", "other aspects of availability/accessibility", "informativeness", "exploring patients' needs", "other aspects of relation and communication" and "availability of special services".

Background: General practitioners (GPs) are expected to be responsive to patients' expectations, but patients and doctors may have different views on what constitutes good general practice care., Aim: To elicit areas of controversy as well as areas of mutual agreement between the opinions of patients and GPs with regard to good general practice care., Method: A questionnaire, distributed to 850 patients and 400 GPs, measured which of 40 aspects of general practice care were given priority. A second questionnaire, distributed to 400 different GPs, measured the GPs' perception of the priorities of patients., Results: The priority rank order of all 40 aspects was highly correlated for patients and GPs (0.72), as was the rank order of aspects for patients and the perception of them by GPs (0.71). Nevertheless, when comparing the priorities of patients and GPs, 23 out of 40 aspects differed significantly (P = 0.00125) in their rank number. Similarly, when comparing the priorities of patients with the perception of them by GPs, 23 aspects differed significantly., Conclusions: There is great similarity between the priorities of patients and those of GPs. GPs are quite capable of assessing most of the priorities of patients. However, potentially controversial areas of general practice care do exist.

Complete sterile covering of operating microscopes for ENT operations has been achieved using sterilizable cases of stainless steel, which offer the following advantages: Quick and easy application to different types of microscopes. Considerable cost savings. Significant waste reduction.

Between 1988 and 1992 lengthenings axial, corrections and reconstructions have been performed by distraction on lower arms, upper and lower legs in 25 patients because of deviations in length due to either congenital or acquired (multiple cartilaginous exostoses, posttraumatic conditions, congenital pseudarthrosis deformations or defects (fibula-defect, amnion-band-complex, amputation). On the average elongation amounted to 4 cm for an average installation time of the fixator system of 22 weeks and a mean duration of 25 weeks for the adaptation to full strength. Problems arose in the form of soft tissue infections at the rod perforation sites, the necessity for secondary interventions because of early fractures and for corrections of the fixator respectively. Complications compromising the expected goal of treatment did not occur. Consideration of the biological principle of distraction is essential whereas the type of fixator-system is of only minor importance.