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Biomedical subjects

E J Robinson

Publications and source records attributed to E J Robinson.

At least 55 records · Page 3Linked to original sources
PubMed1988

Contributions of patients to general practitioner consultations in relation to their understanding of doctor's instructions and advice.

126 patients of 6 general practitioners were tape recorded in consultation with their doctor and interviewed immediately afterwards, and 81 of the patients were interviewed again 2 days later. We related the accuracy of patients' accounts of the instructions and advice they were offered to two characteristics of patient's participation during their consultation: (i) the frequency of spontaneous comments or queries about diagnosis, cause, consequences or treatment of the problem presented, and (ii) the frequency of comments and queries which sought to clarify something said by the doctor. The incidence of the latter was unrelated to accuracy of patients' subsequent accounts. However, people who made errors or omissions in both immediate and home interviews in their accounts of instructions and advice offered, were more likely than those who gave accurate accounts to have produced spontaneous comments or queries during their consultation. Whether the doctor accepted, rejected or ignored these ideas was irrelevant to the incidence of post-consultation errors and omissions.

Family Practice↗
PubMed1987

Participation of patients during general practice consultations: comparison between trainees and experienced doctors.

Consultations with 494 patients were tape-recorded, transcribed and coded. The sample consisted of 168 patients of six experienced general practitioners from training practices, and 326 patients of six trainee general practitioners. Talk in the consultations of trainees and experienced doctors was similar in many respects, including total quantity of talk per consultation. However, twice as many patients of the trainees than those of the experienced doctors produced questions and comments which followed from something already said by the doctor. In addition, the trainees were more likely than the experienced doctors to ask the patients questions about the suggested treatment, rather than simply to offer instructions and advice. These features of doctors' and patients' behaviour were significantly correlated with each other for both the trainees and the experienced doctors. It is suggested that the strategy of engaging patients in discussion about treatment, used more by the trainees, encouraged patients to think of queries which otherwise might not have occurred to them during the consultation.

Family Practice↗
PubMed1986

Sodium and chloride transport by the tracheal epithelium of fetal, new-born and adult sheep.

In vitro measurements were made of Na+ and Cl- isotopic fluxes across the tracheal epithelium of mature fetal lambs (130-143 days gestation), new-born lambs (up to 41 days of age) and adult sheep under conditions of continuous short circuiting. The effects of a variety of drugs were examined, but only in the case of amiloride and isoprenaline were observations made in all three groups. Experiments designed to elucidate the mechanism of basal Cl- secretion were performed in adult trachea only. Under resting conditions the net flux of Na+ from lumen to submucosa exceeds that of Cl- in the reverse direction in fetal and adult trachea. In the new-born the two fluxes are more or less equivalent in magnitude. In none of the three groups is the sum of ion fluxes significantly different from the short-circuit current (Isc). Removal of Na+ from, or addition of furosemide (10(-3) M) to, the solution bathing the submucosal surface of adult trachea has the effect of reducing Isc by an amount which approximates to the Cl- current (29%). At a concentration of 10(-4) M on the submucosal side of adult trachea, ouabain causes potential difference and Isc to fall to zero within 70 min of addition to the bathing solution. Nevertheless, there remains a significant net Na+ flux from submucosa to lumen. The addition of isoprenaline (10(-4) M) to the medium bathing the submucosal surface of both fetal and adult trachea causes an increase in the one-way flux of Cl- from submucosa to lumen with consequent increase in net Cl- flux towards the lumen. (The Na+ fluxes are unchanged.) However, in the adult the Cl- secretory response to isoprenaline is very much less and is not accompanied by an increase in electrical conductance. As judged by the change in Isc, all the post-natal fall in beta-agonist responsiveness takes place within the 3 week period following birth. Whereas, in the fetus, the effect of luminally applied amiloride on the Na+ fluxes is negligible, in the adult the one-way flux of Na+ from lumen to submucosa is reduced by 35% with a consequent 60% fall in net Na+ flux towards the submucosa.(ABSTRACT TRUNCATED AT 400 WORDS)

Age Factors↗
PubMed1986

Values and CPR decisions: a comparison of physicians and administrators in training.

A report of a study to analyze the effect of sociocultural patient characteristics (age, terminal diseases, drug abuse, alcoholism, mental retardation, dementia, suicide attempts, institutionalization, noncompliance with medical regimens, violent crimes, lack of support system, or relationship to a staff physician) on decisions to initiate or withhold cardiopulmonary resuscitation in an emergency situation. Pairs of vignettes were presented to residents in internal medicine and graduate students in an MBA program for comparisons of physicians' decisions with administrators' decisions. On some patient characteristics there were significant differences between the two groups. For most factors (drug abuse, multiple suicide attempts, age, violent crime, lack of known support systems, and relationship to staff), doctors are more likely to initiate CPR than are business students representing health care administrators. In chronic, long-term situations (carcinoma or heart disease, dementia, mental retardation, and institutionalization), the doctors are less likely to initiate CPR than the business students. If objectivity is a goal in deciding whether or not to initiate CPR, physicians should be aware of differences between their opinions and others'.

Decision Making↗
PubMed1985

Improving the efficiency of patients' comprehension monitoring: a way of increasing patients' participation in general practice consultations.

The aim of the investigations reported was to examine the effects of helping patients to check their understanding of instructions and advice given during their consultations with general practitioners. Three groups of patients were both tape recorded during their consultation and interviewed immediately afterwards. The groups differed in the written information they were given prior to their consultations. The 'Normal' group were informed only that the researcher was interested in how well doctors and patients understand each other. The 'Permission' group was explicitly invited to raise queries with the doctor during their consultation. The 'Guidance' group was asked to use two specified strategies to check their understanding of instructions and advice given by the doctor. We coded the frequency of questions and comments about treatment which patients produced during their consultations, and the accuracy and completeness of their subsequent accounts of the recommended treatment. The Normal and Permission groups did not differ in either respect. The Guidance group produced significantly more questions and comments than the Normal group and gave more complete and accurate accounts of the recommended treatment. A partial replication in a different practice produced consistent results.

Family Practice↗
PubMed1984

Realising you don't understand: a further study.

Comprehension monitoring skills of younger (5- to 6-yr-old) and older (8- to 9-yr-old) children were compared. Children examined ambiguous and incomplete pictorial instructions as to how to make two models, and were asked whether there was anything else they would need to know in order to make the models. Questions were answered, and their oral instructions recorded. Both age groups were equally likely to judge the instructions to be incomplete, but the younger children were apparently less able to recognise their lack of understanding. Differences found were taken as evidence of more active and detailed processing of the instructions by the older children.

Child↗
PubMed1983

Communication and metacommunication: quality of children's instructions in relation to judgments about the adequacy of instructions and the locus of responsibility for communication failure.

Relationships between 5- and 7-year-old children's communicative performance, and their level of understanding about message ambiguity and communication failure, were examined in three investigations. Communicative performance was assessed in terms of quality of instructions given for constructing a Lego model or a picture from felt pieces. The child speaker instructed the experimenter (Investigations 1 and 2) or another child (Investigation 3). Level of understanding about communication was assessed by asking the child to ascribe blame for communication failure following an ambiguous message, and to judge whether the speaker had told enough. In all three investigations, children with more advanced understanding about communication gave more detailed descriptions of pieces needed and supplied more information about positioning of pieces. In addition, in the first investigation those more advanced in understanding gave their instructions in a sequence more suitable for building. In the third investigation, child pairs more advanced in understanding communicated more effectively. It was suggested that the close association between communicative performance and understanding about communication occurred because the social experience which advances understanding, namely, the giving of explicit information when and/or why a listener fails to understand what the speaker means, at the same time encourages the child speaker to take responsibility for conveying a particular meaning unambiguously: the same experiences modify both communicative behavior and understanding about communication.

Child↗
PubMedDate not supplied

Residents' decisions to breach confidentiality.

This study assessed variables involved in physician decisions to breach confidentiality in cases of patients' self-reported past crimes. Seventy internal medicine residents completed a questionnaire containing case vignettes of patients' self-reports of crimes; likelihood of informing the police was ascertained. Results were analyzed according to the type and cost of the crime, previous criminal record, patient characteristics, and intent of the patient to commit future crimes. Results also were analyzed by postgraduate year of the resident. Patient characteristics of race and socioeconomic status had no effect on the decision (p less than 0.122 and p 0.182), although age did (p less than 0.001). Reports of past violence (p less than 0.001), previous criminal record (p less than 0.001) and high-cost crime (p less than 0.007) increased the likelihood of breaching confidentiality. Future intent affected the decision (p less than 0.005), but less than reports of past violence. No differences were seen among postgraduate years of respondents (p less than 0.873). Residents base decisions to breach confidentiality on factors other than the future intent of specific violence. This finding has legal and ethical implications.

Adult↗
PubMedDate not supplied

Children's suggestibility in relation to their understanding about sources of knowledge.

In the experiments reported here, children chose either to maintain their initial belief about an object's identity or to accept the experimenter's contradicting suggestion. Both 3- to 4-year-olds and 4- to 5-year-olds were good at accepting the suggestion only when the experimenter was better informed than they were (implicit source monitoring). They were less accurate at recalling both their own and the experimenter's information access (explicit recall of experience), though they performed well above chance. Children were least accurate at reporting whether their final belief was based on what they were told or on what they experienced directly (explicit source monitoring). Contrasting results emerged when children decided between contradictory suggestions from two differentially informed adults: Three- to 4-year-olds were more accurate at reporting the knowledge source of the adult they believed than at deciding which suggestion was reliable. Decision making in this observation task may require reflective understanding akin to that required for explicit source judgments when the child participates in the task.

Child Development↗
PubMedDate not supplied

Kith and skin.

Explore the source record for details and available documents.

Dermatitis, Atopic↗