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Biomedical subjects

D Mant

Publications and source records attributed to D Mant.

At least 19 recordsLinked to original sources
PubMed1992

Choosing the preventive workload in general practice: practical application of the Coronary Prevention Group guidelines and Dundee coronary risk-disk.

OBJECTIVE: To determine the workload implications for general practice of the Coronary Prevention Group and British Heart Foundation action plan for preventing heart disease. DESIGN: Computer simulation of plan, including calculation of Dundee risk scores, with data from OXCHECK trial. SUBJECTS: 4759 patients aged 35-64 who had health checks during 1989-91. MAIN OUTCOME MEASURE: Effect of using different risk scores as thresholds on workload and coverage of patients at known risk. Thresholds of 6-20 were used for cholesterol screening (nearset) and 4-16 for special care (preset). RESULTS: On the basis of workload a nearset of 8 and preset of 12 would be reasonable. This implies cholesterol measurement in 1794 (37.7%) patients and special care in 1074 (22.6%). However, many patients with single risk factors were not allocated to special care at these thresholds: 11 (37.9%) patients with cholesterol concentrations > or = 10 mmol/l, 21 (33.9%) with systolic pressure > or = 180 mm Hg, and 213 (40.7%) heavy smokers (> 20 cigarettes/day) were missed. The distribution of scores was similar in those at established clinical risk, those with family history of heart disease, and others. CONCLUSION: The guidelines may help to make best use of resources within specific age-sex groups but sound protocols for unifactorial risk assessment and modification remain essential.

Adolescent↗
PubMed1992

Breast self examination and survival from breast cancer.

The survival of 616 women aged 15-59 with breast cancer, 226 of whom had been taught and practised breast self examination (BSE) prior to diagnosis and 390 of whom had not, is reported. Six year survival rates were 73.1% in the BSE taught group and 66.1% in other women (P = 0.07).

Adolescent↗
PubMed1992

Motivational effect of cholesterol measurement in general practice health checks.

A randomized trial was conducted in five general practices in and around Aylesbury, Buckinghamshire to assess the motivational effect of cholesterol measurement on compliance with advice to reduce dietary fat intake and to stop smoking. The advice was given by practice nurses during health checks for cardiovascular risk factors. A total of 578 patients were recruited to the study and randomized into two groups. Both groups were given the same advice and were followed up after a median of three months, but the intervention group was also given immediate feedback on their cholesterol concentration. Follow up was completed for 88.2% of subjects, and those who were not followed up were assumed not to have changed their behaviour. The mean fall in total cholesterol at follow up was 0.11 mmol l-1 (95% confidence interval 0.03 to 0.18) in the intervention group who were told their cholesterol result and 0.02 mmol l-1 (95% CI -0.06 to 0.10) in the control group who were not. The proportion of smokers who were not smoking at follow up was 10.7% and 10.1% in the two groups, respectively. Patients in the intervention group with an initial total cholesterol level of 6.50 mmol l-1 or greater showed a mean fall of 6.2% in cholesterol level whereas those with an initial cholesterol level of less than 5.20 mmol l-1 experienced a mean increase of 3.6%, but as differences of this magnitude were also seen in the control group they probably reflect regression to the mean rather than an effect of knowledge of cholesterol level.(ABSTRACT TRUNCATED AT 250 WORDS)

Attitude to Health↗
PubMed1992

Patient compliance with colorectal cancer screening in general practice.

A randomized controlled trial to test patient compliance with screening for colorectal cancer in association with general practice health checks was carried out in six practices (three urban and three rural). A total of 1588 patients aged 45-64 years were randomized to one of four intervention groups. In the first group patients were posted a Haemoccult test (Kline Beckman) kit. This group was not invited for a health check. In the second group patients were posted the Haemoccult test kit, together with an invitation to attend for a health check. In the third group patients were posted an invitation for a health check, which explained that the patient would be offered the Haemoccult test kit by the nurse at the health check. In the fourth group patients were just invited for a health check. It was found that combining faecal occult blood testing with the health check did not reduce attendance at the health check--43.5% of patients attended when the Haemoccult test kit was offered by the nurse at the health check, 43.6% attended when a test kit was included with the invitation to attend the health check and 42.9% attended when the health check invitation was posted on its own. Overall, compliance with Haemoccult testing was not significantly increased by associating it with a health check (26.2% versus 25.5%) but compliance was higher when the faecal occult blood testing kit was enclosed with the health check invitation than when it was offered at the health check (31.7% versus 20.6%, P less than 0.001). It is easier and cheaper to combine various screening procedures. Although the overall use of the Haemoccult test in the study population was low, there is no reason why the relatively higher compliance rate obtained on posting the test kit with a health check invitation cannot be achieved in previously unscreened populations with higher expected compliance rates. However, faecal occult blood screening for colorectal cancer should not be undertaken on a population basis until its effectiveness in reducing mortality has been proven by randomized trial.

Colonic Neoplasms↗
PubMed1991

Cholesterol screening and life assurance.

OBJECTIVES: To examine how insurance companies assess proposals for life assurance from applicants with raised cholesterol concentrations and to determine the excess mortality rating applied. DESIGN: Survey of 49 companies underwriting term life assurance. SETTING: United Kingdom. SUBJECTS: Four fictional men aged 30 seeking 20 year term policies paying benefit only on death. Two had total cholesterol concentrations of 6.4 and 8.1 mmol/l but no other cardiovascular risk factors; one was overweight, hypertensive, smoked 20 cigarettes daily, and had a total cholesterol concentration of 8.1 mmol/l; and one had possible familial hypercholesterolaemia and a total cholesterol concentration of 10.7 mmol/l after treatment. MAIN OUTCOME MEASURE: Percentage excess mortality rating. RESULTS: All companies used explicit criteria to assess the mortality risk associated with hyperlipidaemias, and 47 companies applied the same criteria to men and women. No excess mortality rating was imposed on an applicant with a total cholesterol concentration of 6.4 mmol/l, but a small excess was applied to an applicant with a concentration of 8.1 mmol/l (median excess 50%, range 0-75%). When multiple cardiovascular risk factors were present the same concentration of 8.1 mmol/l resulted in a substantial excess (median 135%, range 50-200%). A smaller but more variable excess was applied to an applicant with possible familial hypercholesterolaemia (median 75%, range 0-200%). CONCLUSIONS: Despite considerable differences among companies in the excess mortality ratings applied, increases in term life assurance premiums are likely to be restricted to patients with severe hypercholesterolaemia, in particular those with familial hypercholesterolaemia. In the absence of other cardiovascular risk factors milder hypercholesterolaemia is unlikely to result in higher premiums.

Adult↗
PubMed1991

Use of computerised general practice data for population surveillance: comparative study of influenza data.

OBJECTIVE: To assess the potential for using routine computerised general practice data for surveillance of illness. DESIGN: Comparison of the incidence of influenza during the 1989 epidemic derived from a computerised database with that derived from the Royal College of General Practitioners's weekly returns service--a well established predominantly manual surveillance system. SETTING: 433 general practices throughout the United Kingdom that used a commercial computer system linked to a central databank. MAIN OUTCOME MEASURE: Incidence of influenza. RESULTS: The slope of the influenza epidemic curve was essentially the same whether derived from the routine computerised data or royal college's weekly returns service data, and the computerised data were geographically consistent. Throughout the study period, however, the computer derived incidence was between one third and one quarter of that derived from the royal college's system (which is served by practitioners trained in surveillance methods). The peak weekly rates were 164 cases per 100,000 for the computerised system and 583 cases per 100,000 for the royal college's surveillance system. CONCLUSIONS: The apparent underreporting in the routine computerised data probably reflects lack of motivation and experience in disease surveillance and haphazard computer entry (particularly of consultations that took place outside of the surgery and consultations that did not result in a prescription), along with overestimation of the population under surveillance. Nevertheless, routine computerised surveillance allows rapid data collection from a large number of practices over a wide geographical area and would greatly augment existing methods.

Computer Systems↗
PubMed1991

The effect of self-administered faecal occult blood tests on compliance with screening for colorectal cancer: results of a survey of those invited.

To determine the relative importance of health beliefs and the characteristics of different methods of faecal occult blood screening in predicting acceptance of the test a self completed questionnaire was offered to 590 patients registered with a practice in an Oxfordshire market town. The patients were an age-sex stratified random sample of those who had been offered screening as part of a trial in which one of three different faecal occult blood screening tests, two of which were self-reported, had been offered. The overall adjusted response rate was 70.1%. Those who complied with the test had more positive attitudes to the implications of a positive test, to treatment and to the value of screening in general. The experience of a close relative or friend with bowel cancer was associated with an increased likelihood of compliance [odds ratio = 15.2 (9.4-24.3)]. Three were marked differences between the tests in the proportions of patients finding them 'messy' or 'disgusting' (Haemoccult 72.0%, Coloscreen 48.0%, Early Detector 55.4% chi 2 Haemoccult vs. self-reported = 5.05 P less than 0.05), and the odds of finding the procedure disgusting were significantly higher among patients who did not complete the test [odds ratio 6.9 (3.1-15.5)].

Attitude to Health↗
PubMed1991

Breast self-examination.

Breast self-examination (BSE) continues to be widely promoted by Government agencies and medical practitioners in Europe and the United States. Point 10 of the European Code Against Cancer exhorts women to 'examine their breasts regularly'. Breast lumps are common and most women will detect a breast abnormality at some time in their life, irrespective of the promotion of BSE by the medical profession. It should be possible to increase a woman's ability to deal better with this anxiety-provoking situation, and to reduce the number of women presenting with locally advanced disease, by appropriate health education. But this does not mean that BSE should be promoted as a screening test for cancer, with the consequent emphasis on vigilance and early self-referral. The natural course of breast cancer is not completely understood. Although stage at diagnosis is related to survival, and mammographic screening trials suggest that early diagnosis (often before a lump is palpable) can lead to effective treatment which prolongs life, earlier treatment of a palpable lump detected by BSE is not guaranteed to improve survival.

Aged↗
PubMed1991

Factors affecting women's response to an invitation to attend for a second breast cancer screening examination.

A survey was conducted to study the impact of women's previous experiences of breast cancer screening on their subsequent readiness to reattend. Women aged 45-64 years from three general practices were invited to attend for a second breast cancer screening test at a mobile clinic. Of the 1582 women who were invited, 1408 (89.0%) reattended. A questionnaire about their experience of the previous screening test was completed by 641 women who attended and 124 who did not attend the second test. Twenty six per cent of the women had found the previous test painful, and a minority also reported embarrassment (7%) or distress (6%). Women who did not reattend were significantly more likely than those who did to report the previous screening test as embarrassing or distressing and were significantly less likely to have found the clinic staff helpful or attendance for screening worthwhile or reassuring. No significant difference was found in the reattendance rate of women who had experienced a false positive result at the previous screening test compared with the remaining women. These results show that there may be substantial scope for reducing non-attendance by improving the way the service is provided, thereby enhancing the overall impact of breast cancer screening.

Breast Neoplasms↗
PubMed1991

Patient participation in general practice: who participates?

A postal survey of 4066 men and women aged between 16 and 64 years was carried out in a general practice in Oxfordshire which had a patient participation group, established in 1972. The aim of the survey was to ascertain the knowledge and use of the group among adults aged 16-64 years. The adjusted response rate was 73%. Despite the length of the group's existence only 45% of these patients were aware of it and only 7% had ever attended a meeting. Awareness of the group and sometime attendance were significantly less in men, patients aged between 16 and 29 years, those in social classes 4 and 5, single people and those who smoked. Patients who consulted more than four times per year were more likely to be aware of the group than less frequent consulters. The possible reasons for the unrepresentative nature of the patients attending the group are discussed, together with implications for practice policies and development. Various strategies for making the group more representative are proposed, including advertising within the practice and elsewhere, and the formation of special interest groups for patients with defined medical and social needs, in the hope that this will make the concept of patient participation more relevant.

England↗
PubMed1990

Lipid screening: is it enough to measure total cholesterol concentration?

OBJECTIVES: To determine whether measurement of total cholesterol concentration is sufficient to identify most patients at lipoprotein mediated risk of coronary heart disease without measurement of triglyceride and high density lipoprotein (HDL) cholesterol concentrations. DESIGN: Cross sectional screening programme. SETTING: Six general practices in Oxfordshire. PATIENTS: 1901 Men and 2068 women aged 25-59. MAIN OUTCOME MEASURE: Cardiovascular risk as assessed by fasting venous plasma concentrations of total cholesterol, triglyceride, and HDL cholesterol. RESULTS: 2931 Patients (74% of those screened) had a total cholesterol concentration of less than 6.5 mmol/l. If the triglyceride concentration had not been measured in these patients isolated hypertriglyceridaemia (greater than or equal to 2.3 mmol/l) would have remained undetected in 185. Among these 185 patients, however, 123 were overweight or obese and only 18 (0.6% of those screened) had an increased risk associated with both a raised triglyceride concentration (greater than or equal to 2.3 mmol/l) and a low HDL cholesterol concentration (less than 0.9 mmol/l). Conversely, in the 790 patients with predominant hypercholesterolaemia (cholesterol concentration greater than or equal to 6.5 mmol/l and triglyceride concentration less than 2.3 mmol/l) measurement of HDL cholesterol concentration showed that 348 (9% of those screened) had only a moderately increased risk with a ratio of total to HDL cholesterol of less than 4.5 and 104 had a low risk with a ratio of less than 3.5. CONCLUSIONS: Fasting triglyceride and HDL cholesterol concentrations identify few patients at increased risk of coronary heart disease if the total cholesterol concentration is less than 6.5 mmol/l. HDL cholesterol and triglyceride concentrations should, however, be measured in patients with a total cholesterol concentration exceeding this value. Total cholesterol concentration alone may overestimate risk in a considerable number of these patients, and measurement of HDL cholesterol concentration allows a more precise estimate of risk. Measurement of the triglyceride concentration is required to characterise the lipoprotein abnormality. A patient should not be started on a drug that lowers lipid concentrations without having had a full lipoprotein assessment including measurement of HDL cholesterol concentration.

Adult↗
PubMed1990

Health checks in general practice: another example of inverse care?

OBJECTIVE: To assess attendance at and the characteristics of patients attending health checks for cardiovascular disease offered in a general practice over a period of five years (1984-9). DESIGN: Medical record audit and postal questionnaire survey. SETTING: One general practice in Oxfordshire with a socially diverse population. PARTICIPANTS: 1101 Men and 1110 women aged 35-64 registered with the practice. MAIN OUTCOME MEASURES: Age, sex, marital state, social class, smoking habits, alcohol consumption, and diet. RESULTS: Of the 2211 men and women in the target age group (35-64) in 1989, 1458 (65.9%) had been offered screening and 963 (43.6%) had attended for a health check. Attenders were more likely to be women, aged greater than or equal to 45, married, non-smokers, and of higher social class than patients who did not respond to the invitation. The relative likelihood of non-attendance was 1.24 for smokers, 1.20 for the overweight, 1.16 for heavy drinkers, and 1.28 for those with a less healthy diet, even after adjustment for age, sex, marital state, and social class. CONCLUSIONS: After five years of offering health checks, opportunistically (to men) and in the context of cervical smear tests (to women), less than half of the eligible patients had attended. The likelihood of acceptance of an invitation to attend was inversely related to the patient's cardiovascular risk for all factors measured except age. A coherent strategy to reduce cardiovascular disease depends on more careful targeting of scarce health service resources and more emphasis on public health measures (such as dietary regulation and tobacco taxation). Doctors should be careful not to absolve the government of its public health obligations by substituting unproved preventive interventions aimed at the individual patient.

Adult↗