Biomedical subjects

B A Raasch

Publications and source records attributed to B A Raasch.

4 recordsLinked to original sources

PubMed2000

An educational intervention to improve diagnosis and management of suspicious skin lesions.

BACKGROUND: Family physicians have an important clinical role in assessment and management of suspicious skin lesions. As a result of a previous needs assessment study, an educational intervention based on audit and feedback with opportunity for reflection on practice was introduced to 46 family physicians randomly allocated to either an intervention (23) or control group (23). As an educational tool, audit allows doctors to systematically review their practice and establish the quality of care they provide. When combined with feedback and comparison of clinical performance with peers or standards, it has been shown to increase learning and change behavior. METHODS: Data based on their own patients, on the correlation between clinical and histologic diagnosis, and excisions of skin lesions were collated and reported to the intervention group. RESULTS: Despite randomization of the doctors, the patient population of doctors in the intervention and control groups were significantly different in key characteristics, including the types of skin lesions treated. The intervention group of doctors showed improved performance in providing clinical information on pathology requests and in adequate surgical excision of skin lesions. Diagnostic performance did not improve significantly, but physicians' certainty of diagnosis did. IMPLICATIONS: This study design has highlighted the difficulty in balancing the use of evidence-based educational strategies in an equivalent setting to normal practice with evaluation of performance using measures that include characteristics of practitioners' patients that cannot be controlled.

Adult↗

PubMed1999

Suspicious skin lesions and their management.

OBJECTIVE: To describe the spectrum, diagnosis and management of non pigmented suspicious skin lesions in general practice. METHOD: General practitioners recorded all patients initiating consultations for suspicious skin lesions over 6 weeks in a tropical provincial city in Queensland as part of a study to determine the incidence of skin cancer. The spectrum of lesions and outcomes of the examinations and diagnoses are reported. Proportions of correct clinical diagnoses with 95% confidence intervals (CI) were calculated on excised lesions. Options in clinical management according to certainty of diagnosis were compared with chi-square statistics. RESULTS: Of the 81 eligible GPs 61 (75%) recorded detailed data on 1355 lesions. These included clinical diagnoses of 387 (28.6%) nonmelanoma skin cancers, 836 (61.7%) dysplastic lesions and 132 (9.7%) other benign lesions. 454 (33.5%) lesions were reported as excised or biopsied, 707 (52.2%) were treated without biopsy, 24 (1.8%) were referred to a specialist, 147 (10.9%) were monitored without treatment and 23 (1.6%) had no management specified. For lesions histologically confirmed by local pathologists as malignant (basal cell carcinoma or squamous cell carcinoma), the clinical diagnosis was correct in 69.1% of cases (95% CI 62.5-75.7%). The doctors reported managing 71.2% (95% CI, 65.6-76.7%) of clinically diagnosed BCC and 90.2% (95% CI, 85.6-94.9) of SCC by excision or biopsy. If more certain of the diagnosis of solar keratosis they were likely to treat without obtaining histology and if less certain they were likely to excise or biopsy (p = < 0.0001). CONCLUSION: GPs see a spectrum of skin lesions which are of concern to patients. A high proportion of these lesions are clinically benign and are not excised. If a BCC or SCC is suspected or diagnosis is uncertain most lesions are excised or biopsied.

Australia↗

PubMed1999

Improving educational needs assessment for general practitioners.

OBJECTIVE: To improve the quality of educational needs analysis for groups of general practitioners through the development of a range of simple, inexpensive practice based performance measures of general practice. METHOD: Members of one volunteer semi rural division of general practice were allocated randomly to groups that collected or provided data on: local referral patterns; consulting, prescribing and ordering, as collected by the Health Insurance Commission; and age, gender, reasons for encounter and management of a sample of patients. Other information was provided by a recent division community needs analysis, a consumer survey, national health targets and local health professionals. These data were combined to develop a list of educational topics that deserved attention. RESULTS: A total of 56% of GPs agreed to participate, providing Health Insurance Commission data for seven GPs, referral patterns for 11 GPs and BEACH surveys for five GPs. Much of the data collected for other purposes proved to be of little value in determining specific educational needs and the more time consuming methods attracted poor participation rates. The most useful data were those collected locally by the division. CONCLUSION: Educational needs analyses for groups of GPs should consider the perspectives of the profession, funders and patients, in addition to those of individual GPs. Practice based measures of GP performance need to be made more relevant to current practice, while remaining inexpensive and not intruding too much into GPs' time. A range of potential measures is provided.

Australia↗

PubMed1998

Incidence rates of skin cancer in Townsville, Australia.

Worldwide, incidence rates of skin cancer are increasing alarmingly in populations of predominantly Caucasian origin. A prospective population-based survey, set up to collect epidemiological information on all excised and histologically confirmed skin cancers, started in Townsville, Australia (population of 127,000) in December 1996. Data on the anatomical distribution of skin cancer has been collected using a detailed body map. Estimations of type-specific and site-specific incidence rates were age-standardized according to world standard population. Site-specific incidence rates were adjusted for surface proportion of the body site and are given per 100,000 body units. Between December 1996 and December 1997, a total of 3,536 patients with 5,945 histologically confirmed skin cancer lesions were recorded. Age-standardized incidence rates of basal cell carcinoma were 2,058.3 for men and 1,194.5 for women, 1,332.3 for men and 754.8 for women for squamous cell carcinoma, and 49.1 for men and 41.7 for women for cutaneous melanoma (CM). Site-specific incidence rates of non-melanocytic skin cancer were extreme on sun-exposed areas of the face, whereas site-specific incidence rates of CM were highest for neck, posterior trunk and face. Less exposed body sites, such as unexposed upper limbs or thighs, showed reduced incidence rates for all types of skin cancer. Tropical North Queensland has the world's highest incidence rates of skin cancer of all types. Site-specific incidence rates demonstrate that highly sun-exposed body sites are at high risk of developing skin cancer and provide, therefore, strong indirect evidence for the causal relationship between sun exposure and skin cancer.

Adult↗