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BACKGROUND: Patients actively involved in their care demonstrate better health outcomes. Using secure internet portals, clinicians are increasingly offering patients access to their narrative visit notes (open notes), but we know little about their understanding of notes written by clinicians. OBJECTIVE: We examined patients’ views on the clarity, accuracy, and thoroughness of notes, their suggestions for improvement, and associations between their perceptions and willingness to recommend clinicians to others. DESIGN: We conducted an online survey of patients in 3 large health systems, June–October 2017. We performed a mixed methods analysis of survey responses regarding a self-selected note. PARTICIPANTS: Respondents were 21,664 patients aged 18 years or older who had read at least 1 open note in the previous 12 months. MAIN MEASURES: We asked to what degree the patient recalled understanding the note, whether it described the visit accurately, whether anything important was missing, for suggestions to improve the note, and whether they would recommend the authoring clinician to others. KEY RESULTS: Nearly all patients (96%) reported they understood all or nearly all of the self-selected note, with few differences by clinician type or specialty. Overall, 93% agreed or somewhat agreed the note accurately described the visit, and 6% reported something important missing from the note. The most common suggestions for improvement related to structure and content, jargon, and accuracy. Patients who reported understanding only some or very little of the note, or found inaccuracies or omissions, were much less likely to recommend the clinician to family and friends. CONCLUSIONS: Patients overwhelmingly report understanding their visit notes and usually find them accurate, with few disparities according to sociodemographic or health characteristics. They have many suggestions for improving their quality, and if they understand a note poorly or find inaccuracies, they often have less confidence in their clinicians.

“Learning through doing” and sharing the lessons across the NHS is an important aspect of the strategy to support the introduction of clinical governance. The CGST Web site is being developed as a national clinical governance resource. It will provide access to articles, papers and copies of presentations by members of the support team. A key part of the resource will be a collection of case studies to illustrate “Clinical Governance in Action” and show what has been achieved.

Recently, the authors of this piece spent time exploring the implications of the clinical governance programme and its future development with colleagues from patients’ organisations. This piece reflects their contribution and, by drawing on the principles of Continuous Quality Improvement (CQI), offers some practical advice on taking forward patient involvement in clinical governance. Will the circle be completed?

In order to lower the cost of optoelectronic packaging, a novel solvent bonding technique has been developed to bond two thermoplastic surfaces, permanently, with a room- temperature cure of approximately 30 seconds. This technique has been applied to a pigtailed PIN module with a canted fiber. As model has been developed as a design tool to simulate the responsivity and the optical back reflection of various configurations of different angled fibers and canted angles with respect to the PIN detector. Close agreement between simulations and measurements of responsivity and optical back reflection has been achieved. With this design tool, a low cost pigtailed PIN module utilizing a novel solvent bonding technique has been developed to meet CATV applications.© (1998) COPYRIGHT SPIE--The International Society for Optical Engineering. Downloading of the abstract is permitted for personal use only.