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Biomedical subjects

E Rink

Publications and source records attributed to E Rink.

32 records · Page 2Linked to original sources
PubMed1996

Vocational training for general practice in inner London. Is there a dearth? And if so what's to be done?

OBJECTIVE: To identify the nature and extent of any vocational training deficit within the London initiative zone and investigate the reasons. DESIGN: Collation of statistics and postal questionnaire surveys. SETTING: Thames regions inside and outside the London initiative zone. SUBJECTS: General practice registrars, trainers, principals from non-training practices, and vocational training course organisers. MAIN OUTCOME MEASURES: Trends in numbers of general practice registrars, proportions of trainers, views on current vocational training in inner London. RESULTS: Numbers of general practice registrars fell significantly between 1988 and 1993 within the London initiative zone and in England overall. The number of registrars within the zone fell by more than in the rest of the Thames regions, where the decline was not statistically significant. A lower proportion of principals were approved as trainers within the zone than in the rest of the Thames regions and England overall. In their responses to the survey (88% of inner London registrars responded and 81% of outer Thames registrars) registrars suggested that improving remuneration and personal safety would make training in London more attractive. Trainers and non-trainers (response rates 89% and 66% respectively) also suggested increasing remuneration for trainers together with more protected time for training. CONCLUSIONS: Less vocational training takes place within the London initiative zone than in the rest of the Thames regions and England overall, although there are discrepancies in official statistics. As well as specific recommendations for improving recruitment to vocational training in inner London, measures to tackle inner city deprivation should also remain high on the political agenda.

Adult↗
PubMed1996

Evaluation of minor surgery courses for general practitioners.

This paper describes the evaluation of a two-day minor surgery training course for general practitioners and vocational trainees. The course was developed by a team from a wide range of specialties. A pilot run of six of these courses was held in various locations in the United Kingdom during 1994, organized by the Royal College of General Practitioners and supported by the Department of Health. The courses were attended by 144 participants in total: 52 general practitioners and 92 vocational trainees. The evaluation addressed (a) the process of training which resulted in substantial changes being made to the original design and content of the courses; and (b) the outcome of the training in terms of knowledge, confidence and competence. A central feature of the course was the use of sophisticated simulated tissue. Participant feedback indicated that although the simulated tissue was not considered to be very realistic it substantially increased levels of confidence and competence to carry out minor surgery. Knowledge on various aspects of minor surgery increased significantly. The feedback from the evaluation was forwarded to a minor surgery working party at the Department of Health whose remit was to prepare guidelines for teaching, authorising and carrying out minor surgery in general practice.

Education, Medical, Continuing↗
PubMed1994

Near patient testing in general practice: attitudes of general practitioners and practice nurses, and quality assurance procedures carried out.

BACKGROUND: The evaluation of near patient testing in British general practice has largely been confined to studies examining individual tests or comparing equipment. AIM: This study set out to determine the attitudes of practice staff to near patient testing, and the extent to which staff undertook quality assessment. METHOD: Four types of near patient testing machines were introduced into 12 general practices in two regions of England, south west Thames and west Midlands. General practitioner and practice nurse attitudes to near patient testing were assessed by semi-structured interview before and six months after the introduction of the machines. The extent to which routine quality assurance procedures were carried out within the surgery and as part of local and national schemes was examined. RESULTS: Although 80% of general practitioners anticipated changing patient management with near patient testing, only two fifths reported having done so after six months. Nurses generally were enthusiastic at the outset, although one third were unhappy about incorporating near patient testing into their work schedules. Time pressure was the most important factor restricting uptake of near patient testing. Nurses performed quality control regularly but complete local external quality assurance procedures were established in only half the practices. All the practices participated in a national scheme for cholesterol assays. CONCLUSION: General practitioners in this study did not find near patient testing a very useful addition to their resources. Pressure on nurses' time was the most frequently reported limitation.

Attitude of Health Personnel↗
PubMed1993

Impact of introducing near patient testing for standard investigations in general practice.

OBJECTIVE: To assess the clinical and economic impact of surgery based near patient testing in general practice for six commonly used biochemical and bacteriological tests. DESIGN: After four months' monitoring, equipment for two bacteriological and four biochemical tests was introduced without cost into 12 practices using a crossover design. Structured request forms were used to monitor laboratory investigations. SETTING: 12 general practices in west midlands and south west Thames with list sizes above 9000. MAIN OUTCOME MEASURES: Investigation rates per 1000 consultations. Changes from baseline rates. Reasons for requesting investigations and provisional diagnoses. Cost per test and sensitivity of costs to rate of use. RESULTS: Investigation rates for the six tests rose by 16.5% (from 78.6/1000 consultations to 91.6/1000) when equipment was available in the surgery and reverted to baseline rates when it was withdrawn. The average weekly number of tests when equipment was available ranged from 0.5 to 10.5 (mean 9.0). Cholesterol tests were used as an addition to laboratory testing, usually for screening. Midstream urine analysis was often done in the surgery instead of in the laboratory, although 30% of samples were tested by both methods. Doctors' reasons for investigation and conditions tested were largely unaffected by availability of surgery tests. Costs for surgery tests were higher for all tests except midstream urine. CONCLUSIONS: Availability of surgery based testing increased the number of tests performed. It was cost effective only for midstream urine analysis.

Cholesterol↗
PubMed1991

Epidemiology of seasonal and perennial rhinitis: clinical presentation and medical history.

BACKGROUND: Little is known about the epidemiology of rhinitis, particularly the perennial and non-allergic forms. The aim of this study was to compare the symptoms, atopic state, and medical history of individuals with seasonal and perennial rhinitis. DESIGN: Of 7702 adults aged 16-65 years registered with a London general practice, 2969 (30%) were screened by postal questionnaire. Samples of 113 subjects without rhinitis, 51 with seasonal symptoms alone, 128 with perennial symptoms and seasonal exacerbations were then interviewed. Atopic and non-atopic subjects were distinguished by skinprick testing with five common allergens. RESULTS: The estimated minimum prevalence of rhinitis was 24%: 3% had seasonal symptoms only, of whom 78% were atopic; 13% had perennial symptoms only, of whom 50% were atopic; and 8% had perennial symptoms with seasonal exacerbations, of whom 68% were atopic. Seasonal rhinitis was characterised by sneezing, itching, and a high prevalence of diurnal variation in symptoms. The most common provoking factors were dust, pollens, and infections. By comparison, perennial rhinitis was characterised by a higher prevalence of nasal blockage and catarrh, and a lower prevalence of diurnal variation and provocation by pollen. There were no significant differences among the groups in the sociodemographic characteristics examined. Subjects with seasonal rhinitis were more likely to be atopic and to have eczema and a family history of hayfever than those without rhinitis. Those with perennial rhinitis were more likely to have past or current eczema or migraine, be wheezy or labelled asthmatic, or have a family history of nose trouble other than hayfever. Subjects with both seasonal and perennial symptoms presented an intermediate clinical picture. CONCLUSIONS: Seasonal and perennial rhinitis differ in their atopic state, clinical presentation, and medical history. The extent to which these differences are genetically or environmentally determined requires further investigation.

Adult↗
PubMed1991

Labelling of rhinitis and hayfever by doctors.

Factors influencing the labelling of rhinitis by doctors were examined in 7702 adults, aged 16-65 years, registered with a group general practice in south London. Individuals with rhinitis were identified by a postal screening questionnaire. Of the 2969 (39%) subjects who replied, 1309 (44%) reported rhinitis. A sample of 340 individuals with and 126 without rhinitis was studied, each being interviewed and having allergy skinprick tests. The information given at interview was compared with that recorded in the medical notes for 75 patients with rhinitis, selected at random to include 25 with seasonal symptoms only, 25 with perennial symptoms only, and 25 with both seasonal and perennial symptoms, plus 25 control subjects. Hayfever was defined as seasonal symptoms provoked by grass and a positive skin test response to grass pollen. Subjects with seasonal symptoms were nearly twice as likely as those with perennial symptoms to be labelled as having rhinitis by their doctor. More than a quarter of the subjects fulfilling our definition of hayfever had not been diagnosed as having hayfever. Subjects from the upper social classes were more likely than those from the lower social classes to be labelled as having hayfever, though there were no significant differences between social classes in the prevalence of hayfever according to our definition. It is concluded that rhinitis is frequently underdiagnosed and misdiagnosed. Increased detection of hayfever could account for the steep rise in consultation rates seen in recent decades.

Adolescent↗
PubMed1990

Birth month variation in atopic and non-atopic rhinitis.

The association of birth month with the development of atopic and non-atopic rhinitis was investigated in 327 adults in south-west London. Birth month was a significant risk factor for both atopic and non-atopic rhinitis in subjects whose age at onset was under 20 yr, but not in those who were older at onset. The odds of being born in May-June were 1.68 (95% CI: 1.03-2.76) for atopic rhinitic subjects and 1.90 (95% CI: 1.11-3.25) for non-atopic rhinitic subjects. The birth month effect was not related to the criteria used to determine subjects' atopic status or to subjects' clinical characteristics, apart from their age at onset. The findings suggest that atopic and non-atopic rhinitis have a common aetiology which does not depend on infant sensitization to seasonal allergens.

Adolescent↗
PubMed1990

Is the prevalence of atopy increasing?

There is controversy about whether allergic disease has increased in recent decades. This study compared the prevalence of atopy, as shown by allergy skin prick testing among adults in 1988 (n = 74) with a similar study carried out in 1974 (n = 1359). Both study groups were drawn from the general population in south west London, but the 1988 sample specifically excluded people with rhinitis. The proportion of subjects with at least one positive reaction to a panel of three common allergens increased significantly from 23% in 1974 to 46% in 1988 (P less than 0.01). If allowance was made for the exclusion of rhinitis subjects from the 1988 sample, the current prevalence of atopy may be higher still. The increase in prevalence was significant in older subjects (aged 55-59 years) and women but not in other age groups or in men. This small study raises the possibility that atopy has increased in prevalence in the UK over recent decades and additional studies are needed to evaluate the validity of this hypothesis.

Adult↗