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Biomedical subjects

A L Reid

Publications and source records attributed to A L Reid.

At least 19 recordsLinked to original sources
PubMed1993

A study of respiratory infections in a healthy adult population during the 1987 Australian winter.

During the 1987 Australian winter, respiratory illness patterns were studied in a population of 454 healthy adults, aged 18-59, over a period of 45 days. These patterns were matched with data obtained from laboratory diagnoses for respiratory viruses, Mycoplasma pneumoniae and bacteria. Influenza B/1/86 was by far the most prevalent pathogen but other viruses including influenza A, paramyxoviruses, respiratory syncytial virus and coronavirus OC-43 were also present, either alone or in combination during the sampling period. Overall, 92 males and 101 females experienced one episode, 12 males and 22 females experienced two episodes and four females experienced three episodes. However, there were only 52 instances of viral or M. pneumoniae infections, of which 37 had a defined aetiology, while the remainder were clinically silent. No bacterial pathogens could be detected from throat swabs taken from 15 of 37 volunteers in whom a viral infection was detected, or from 43 of 70 volunteers who did not experience such infections. The study indicates that major deficiencies in our understanding of the aetiology of respiratory viral illness are probably due to methodological problems in obtaining laboratory diagnoses for many respiratory viruses, and that great difficulties exist in establishing an aetiology for respiratory infections based upon clinical symptoms alone.

Adolescent↗
PubMed1992

Detection of alcohol-related problems in general practice.

While primary care has considerable potential as a site for detecting and intervening for alcohol-related problems, few doctors currently identify these problems. The judgments of eight primary care physicians about alcohol-related problems in 371 of their patients were compared with the patients' responses to the Short Michigan Alcoholism Screening Test (SMAST) and the CAGE. The CAGE classified 11.4% of the patients as alcoholics and the SMAST identified 23.9% as probable alcoholics. However, the doctors identified only a small proportion (7.0%) of their patients as having any level of alcohol-related problem. The doctors did not identify 65.0% of CAGE-defined alcoholics and 82.3% of those patients classified by the SMAST as probable alcoholics. The discrepancy between primary care physician's judgments and the SMAST and CAGE may be attributable to the doctor's failure to identify patients with alcohol-related problems. An alternative explanation is that the SMAST and CAGE are inappropriate screening tools for use in Australian primary care. The findings are discussed in terms of the implications for training doctors and for the development of better measures of alcohol-related problems for use within a primary care context.

Adolescent↗
PubMed1992

Early detection of colorectal cancer: a profile of current practice.

This study examines the prevalence of colorectal cancer screening among individuals in the general community. The survey was undertaken as part of a large scale general population survey of health practices and attitudes. A sample of 1090 people aged 40 years and over with no previous history of colorectal cancer or other predisposing condition was interviewed. Only 56% of this group reported that they regularly checked their bowel movements, the toilet bowl, or the toilet paper for signs of rectal bleeding. Only 13% could recall a doctor ever advising them to check for rectal bleeding; and 21% could recall a doctor asking them if they had ever noticed blood in their bowel movements. More involved practitioner-based procedures, such as digital rectal examination, fecal occult blood testing, endoscopy, and barium enema, were reported by only a minority of participants. Analysis of screening rates in the 9.3% of people who reported a family history of colorectal cancer revealed that this higher risk group was no more likely to be screened than those at average risk.

Adult↗
PubMed1991

Training medical practitioners in information transfer skills: the new challenge.

Traditionally, undergraduate medical education has concentrated on teaching students how to gather information or take medical histories from their patients. However, research increasingly indicates that there is a need for medical practitioners to improve their skills in information transfer in a way which will increase the probability that patients are active collaborators in their treatment. Consequently, Newcastle Medical School has sought to develop training packages for medical students in information transfer skills. This paper describes the resulting training programme with particular emphasis on the areas selected for training, the methods by which students are taught, the necessary interactional skills and the assessment procedures which are applied.

Clinical Competence↗
PubMed1990

The effectiveness of two smoking cessation programmes for use in general practice: a randomised clinical trial.

OBJECTIVE: To evaluate a structured, behavioural change, smoking cessation intervention designed for use within general practice. DESIGN: Randomised controlled clinical trial. SETTING: General practices in Newcastle, Australia. PATIENTS: 311 Patients identified as smokers by a screening question were enrolled in the study. Of these, 101 were assigned to a structured behavioural change programme, 104 to a simple advice programme adapted from previous research, and 106 to a control group. No significant differences were found between groups for demographic and smoking related variables before the study. INTERVENTIONS: Patients in the simple advice group received a brief statement of advice from the general practitioner as well as three pamphlets; those in the structured intervention group were given strategies which included attitude and behavioural change programmes as well as techniques to aid compliance. The amount of smoking in all groups was assessed by self reports with validation by measurement of salivary cotinine concentrations. MAIN OUTCOME MEASURE: Significant increase in cessation rates. CONCLUSIONS: Significant differences between controls and the structured behavioural change group were found at the one month follow up, but only for self reported abstinence. The simple advice programme did not produce any significant differences over the control group. General practitioner evaluation of the structured programme highlighted difficulties in relation to the duration of the intervention. Overall the structured programme in its present form did not appear to be an effective programme for use within general practice.

Adolescent↗
PubMed1990

Breast self-examination and breast examination by a health care provider: prevalence and predictors of screening in a randomly selected sample of Australian women.

Professional organizations recommend the practice of monthly breast self-examination (BSE), and examination of the breasts by a health care provider every three years for women up to the age of 40 and annually thereafter. These practices were examined in a randomly selected sample of 1454 women. Only 39% (95% confidence interval [CI], 36%-42%) of the sample reported monthly BSE. Women were more likely to examine their breasts each month if they had found a breast lump, believed they were likely to get breast cancer, were not single, or were frequent users of general practitioners. Only 51% (95% CI, 45%-53%) of women under the age of 40 reported receiving three-yearly breast examinations; of those women aged 40 or more, 31% (CI, 27%-35%) of those with no additional risk factors and 35% (95% CI, 27%-42%) of those with at least one additional risk factor reported annual examinations. Women were more likely to have received a breast examination in the past three years if they had previously had a breast lump, were not single, had reached a higher educational level, were more frequent users of general practitioners, had private health insurance, or were described as other than ill or retired. There was a substantial association between BSE and breast examination by a health care provider with 25% (95% CI, 23%-27%) practising BSE and being screened by a health care provider. Thirty-five per cent (95% CI, 32%-38%) of women were not being screened by either method. The implications of the results for health education campaigns are discussed.

Adolescent↗
PubMed1990

General practitioners and the provision of Papanicolaou smear-tests: current practice, knowledge and attitudes.

General practitioners are the main providers of Papanicolaou smear-tests yet, given the current suboptimal rates of cervical screening, it is clear that their full potential as screening providers is not being realized. To date, no information has been available concerning the possible barriers to the provision of Papanicolaou smear-tests by general practitioners. The present study assessed the views of a random sample of NSW general practitioners regarding the value of smear-tests, the most appropriate providers, the recommended screening protocol, and factors that were thought to influence both practitioners' provision and women's utilization of screening. The results indicate a number of changes to the current system which could counter screening barriers such as educational programmes for general practitioners, more female providers and the investigation of alternative services, consensus screening guide-lines, and screening registers and recall systems.

Adult↗
PubMed1989

Improved colorimetric assay for detecting influenza B virus neutralizing antibody responses to vaccination and infection.

An automated neutralization test for influenza B virus is described in which antibody titers are determined according to the release of neutral red from infected or uninfected cells of the Madin-Darby canine kidney line. Endpoints are determined in a standard enzyme-linked immunosorbent assay reader. The test requires no expensive immunologic reagents and was used to evaluate responses to both vaccination and natural infection against influenza B virus. Overall responses to vaccination were comparable with those obtained by hemagglutination inhibition, using Tween-ether-split influenza B/Ann Arbor/1/86 virus as the antigen (the HI-TE test). The sensitivities of neutralization responses compared with those obtained by the HI-TE test for two vaccines were 88 and 89%; the specificities were lower at 61 and 60%, respectively. Responses to vaccination, measured by hemagglutination inhibition, were significantly higher with split virus compared with whole virus. However, seroconversion by both the HI-TE and neutralization tests was observed in 5 of 10 individuals from whom virus was detected by either culture of nasal or throat washings or the presence of antigen from immunofluorescence in cells from nasal washings.

Animals↗
PubMed1988

A study of intranasally administered interferon A (rIFN-alpha 2A) for the seasonal prophylaxis of natural viral infections of the upper respiratory tract in healthy volunteers.

The efficacy of interferon A (rIFN-alpha 2A), an Escherichia coli-derived interferon, in the prophylaxis of acute upper respiratory tract infection, was evaluated in a community-based double-blind placebo-controlled study in the Australian winter of 1985. The trial population of 412 healthy volunteers (190 males and 222 females, aged 18-65 years) self-administered 1.5, 3.0 and 6.0 megaunits (MU) of interferon A per day or a placebo, intranasally for 28 days. The period of study coincided with an outbreak of H3N2 influenza A (detected in 35 of the 107 acute specimens) as well as substantial numbers of respiratory syncytial virus and adenovirus infections. Rhinoviruses were isolated from only three specimens. In many cases, subjects had laboratory and clinical evidence of having had more than one respiratory tract infection during the period of the study. Viruses were detected in 54 or 107 acute specimens (49%). No statistically significant differences were noted between the various treatment groups in the incidence of laboratory-proven viral infection (virus isolation and/or antibody response). Analysis of reported symptoms indicated that blood-tinged mucus and nasal stuffiness occurred more frequently with higher doses of interferon. There appeared to be no clinical benefit from the use of interferon A in the amelioration of symptoms.

Administration, Intranasal↗
PubMed1987

Effects of intervention on antibiotic compliance in patients in general practice.

This study used a randomized clinical control design to test first, whether decreasing the complexity of antibiotic regimens resulted in increased compliance and, secondly, whether the added component of written information and behavioural tailoring increased compliance in patients with twice-a-day schedules. Twenty-eight general practitioners who were selected at random and 232 of their patients took part in the study. Patients were allocated at random to receive either doxycycline (one dose a day); co-trimoxazole (two doses a day); amoxycillin (three doses a day); or co-trimoxazole (two doses a day) with a written instruction sheet and advice on how to best fit the tablets into a daily routine. Decreasing complexity of the regimen significantly increased the probability that patients would not miss any doses of the course (absolute compliance: chi 2 = 25.04; df = 2; P less than 0.001). There was also a significant association between complexity and non-compliance at a level which might be clinically significant (chi 2 = 6.78; df = 2; P = 0.03). Written information and behavioural tailoring did not further augment compliance in patients with one- or two-doses-a-day schedules. It was also shown that general practitioners predicted potential non-compliance in patients at a rate no better than would be expected by chance.

Amoxicillin↗
PubMed1987

The process and content of general-practice consultations that involve prescription of antibiotic agents.

We devised a reliable coding system in order to analyse interactional events between general practitioners and patients that were observed on the videotapes of 201 consultations in which an antibiotic agent was prescribed. Of total consultation events, doctors contributed 14% on the collection of information about the presenting condition for which antibiotic agents were prescribed; 22% on the giving of such information; 17% on social exchanges; and 21% of events were devoted to other problems that emerged during the consultation. Patient questions made up 2% of events and were encouraged specifically by 1% of events. Whereas 75% of patients were told the dose and length of the course, only 46% of patients were told the name of the antibiotic agent, only 10% of patients were told of side-effects, and no patient was told what to do if he or she forgot a dose. Not surprisingly, with the exception of the justification of the treatment that was chosen, practitioners seldom used techniques which have been shown to be effective in the improvement of patient compliance or recall of information. Given that antibiotic agents are prescribed commonly, and compliance is frequently poor, our findings have implications for undergraduate, vocational and continuing education.

Anti-Bacterial Agents↗
PubMed1987

Determinants of non-compliance with short term antibiotic regimens.

The contribution of doctor, patient, and consultation interaction patterns to compliance with antibiotic treatment was examined in 233 adult patients seen in general practice. Twelve variables were shown to discriminate between compliers and non-compliers. Discriminating variables relating to patients included health state, employment state, knowledge of tablet, and perception of anxiety level, difficulty in complying, and their observed anger, distance, and assertiveness in the consultation. Discriminating variables relating to doctors included provision of advice on duration of treatment, complexity of dosage schedule, age of doctor, and number of years in practice. For the most part these results confirmed previous research. It is concluded that the doctor should consider both the dosage schedule and the patient's daily routine when prescribing antibiotic tablets. Advice on how to take the tablets should be given in specific rather than in general terms. The significant effect of the age of the doctor and the years spent in practice has not been found in previous work. This finding may reflect differences in behavior between younger doctors and their patients. This difference was not detected in the observation of consultation events.

Adult↗
PubMed1986

Detection of patients with high alcohol intake by general practitioners.

General practitioners have the potential to treat patients with alcohol problems effectively. Despite the medical implications of excessive alcohol intake, it appears that general practitioners are not sufficiently aware of the drinking habits of their patients. The aim of the study was to investigate the accuracy of 56 randomly chosen general practitioners in detecting which of their patients had a high alcohol intake. Altogether, 2081 patients were recruited in general practitioners' waiting rooms, where they answered questions about their drinking habits. After the consultations general practitioners were asked to indicate the patients' levels of alcohol intake. The results showed that general practitioners correctly identified only 27.5% of patients who were classified as "high risk" drinkers, using Australian Medical Association criteria. They correctly identified only 45.2% of patients who were classified as "moderate to heavy" drinkers, defined by them as drinkers who consume four or more standard drinks a day. These findings have important implications for clinical practice since they indicate that general practitioners are failing to perform adequately in an important area of preventive medicine. This issue needs to be addressed in undergraduate and postgraduate medical education.

Adult↗