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Biomedical subjects

F Carter

Publications and source records attributed to F Carter.

14 recordsLinked to original sources
PubMed2006

Competence assessment of laparoscopic operative and cognitive skills: Objective Structured Clinical Examination (OSCE) or Observational Clinical Human Reliability Assessment (OCHRA).

BACKGROUND: There is no agreed system that is acknowledged as the ideal assessment of laparoscopic operative and cognitive skills. A new approach that combines Objective Structured Clinical Examination (OSCE) and Observational Clinical Human Reliability Assessment (OCHRA) was developed and used to assess trainees' operative and cognitive skills during laparoscopic training courses. METHODS: Performance of 60 trainees participating in 3-day essential laparoscopic skills training (cognitive and psychomotor) courses were assessed and scored using both OSCE and OCHRA. RESULTS: The study showed significant inverse correlations between the number of technical errors identified by OCHRA and the scores obtained by OSCE for individual tasks performed either by electro-surgical hook or laparoscopic scissors (r = -0.864 and r = -0.808, respectively). Significant differences between trainees were observed in relation to both overall OSCE scores and OCHRA parameters: execution time, total errors, and consequential errors (P < 0.001). CONCLUSIONS: OCHRA provides a discriminative feedback assessment of laparoscopic operative skills. OCHRA and OSCE are best regarded as complementary assessment tools for operative and cognitive skills. The present study has documented significant variance between surgical trainees in the acquisition of both cognitive and operative skills.

Cholecystectomy, Laparoscopic↗
PubMed2004

Clinical presentation of acute chest syndrome in sickle cell disease.

In this study the records of 45 patients with sickle cell disease involved in 63 presentations of acute chest syndrome at the Princess Margaret Hospital in Nassau, the Bahamas, between 1997 and 2001 were examined. Patients were divided into three groups on the basis of age (<13 years, 13-18 years, >/=19 years) with a view to assessing clinical presentation. The incidence of symptoms, physical signs, and laboratory findings were enumerated and significant differences between age groups determined. The data were analysed using analysis of variance, t test, and chi(2) test and compared with existing knowledge on the subject. This study proposed to evaluate the clinical presentation of acute chest syndrome with emphasis on historical and physical findings, and to encourage the physician to maintain a high index of suspicion for the condition in susceptible patients. It was found that presentation varied significantly with age groups, children presenting most classically with fever and cough and adults, with chest pain. The 13-18 age group emerged as the group which presented most frequently with the typical symptoms of chest infection, thus potentially making diagnosis easier. Of note, the most frequent finding was a normal examination, while the second commonest physical finding was crepitations on auscultation of the chest.

Acute Disease↗
PubMed2000

What kind of patients and physicians value direct-to-consumer advertising of prescription drugs.

Direct-to-consumer (DTC) advertising of prescription drugs can enhance the physician-patient relationship, as well as benefiting its sponsor. However, overall benefits can only occur if the patients value the information enough to discuss it with their physicians and the physicians are not predisposed against the DTC information. We investigate the impact of demographics and exposure to marketing on consumers' and physicians' receptiveness to DTC advertising of prescription drugs, using data from two nationwide surveys. We find that consumers who have an ongoing need for health care, that is, those with children or with a chronic condition requiring medication, value prescription drug advertising more highly, while older consumers, consumers who have been sick recently, or more educated consumers are more likely to trust their physicians instead. We find that more experienced physicians, physicians who see more patients, or those who have more exposure to pharmaceutical advertisements are more accepting of DTC advertising of prescription drugs.

Advertising↗
PubMed1999

Socio-demographic variations in perspectives on cardiovascular disease and associated risk factors.

Coronary heart disease (CHD) rates in Ireland are very high but little is known about attitudes to the disease. Qualitative attitudinal data were collected in focus group settings from 74 individuals across socio-demographic categories in order to assess knowledge of and attitudes to CHD and associated risk factors. Focus group questions were derived from group deconstruction of constructs from the Health Belief Model, Theory of Planned Behaviour, Protection Motivation Theory and Social Learning Theory. Participants were drawn from the personnel lists of local government and a health authority hospital. Eight types of groups were constructed according to the various permutations of the three variables: age, gender and occupational group. Analyses revealed good knowledge levels about risk factors among participants. However, participants exhibited mixed loci of control and low motivation to change behaviours. Men generally were less motivated to change than women; older men thought it too late and younger ones too soon. Though white and blue collar groups' views were similar, the discussion in white collar groups was more varied. Participants were sceptical about apparently contradictory medical advice which undermined motivation to change. The data complement earlier work and suggest preventative initiatives should be more focused.

Adult↗
PubMed1999

Prostate cancer screening in primary care.

BACKGROUND: Little is known about the actual frequency with which men have prostate screening in primary care settings, nor are the determinants of screening understood. METHODS: We examined the records of 50 consecutive primary care office visits by men aged 50 or older. Men were asked to complete a brief questionnaire outlining their previous use of prostate screening services and the factors that influenced screening. RESULTS: Screening in the previous year with digital rectal examination (DRE) and prostate specific antigen (PSA) was reported by 46% and 30% of respondents, respectively. Most respondents (86%) had heard of prostate screening and most (78%) believed it was effective. The only factor predictive of screening with DRE in multivariate analysis was a doctor's discussion of screening (odds ratio, 4.8). Two factors were predictive of PSA screening--knowing someone who had prostate cancer (odds ratio, 12.8) and advancing age (odds ratio [per year], 1.1). CONCLUSIONS: Many men are not having annual prostate screening. Men who were older, who reported knowing someone with prostate cancer, and whose doctors discussed screening, were more likely to have been screened in the past year.

Attitude to Health↗
PubMed1995

Clamping the small intestine during surgery: predicted and measured sealing forces.

During bowel surgery it is often necessary to occlude the bowel using clamps. Occlusion occurs in two stages: approximation of bowel internal surfaces followed by sealing which is necessary to prevent seepage. The occlusive force at both stages depends on the luminal pressure, the latter stage requiring greater force than the former. The difference in luminal pressure across the sealing line results in a slipping force which is resisted by friction between the bowel and the clamp jaw surfaces. A theoretical model was developed to describe these forces and the predicted values obtained from this model were compared with direct measurements carried out on porcine bowel samples in a test rig. It was found that the measured approximation force was between 25 and 50 per cent of the maximum theoretical values and that sealing without seepage requires a clamp force of about ten times the approximation force. Using these results and known intraluminal pressures in the human gastrointestinal tract, a bowel clamp must apply around 7 N to prevent seepage and the coefficient of friction between clamp and bowel should be between 0.6 and 0.9.

Animals↗
PubMed1978

Subspecialization manpower in obstetrics and gynecology.

Growing interest in the emergence of subspecialties within obstetrics and gynecology prompted a survey of all Junior Fellows of the ACOG. That survey, representing the attitudes and expectations of 1702 housestaff and practitioners, disclosed that nearly 31% of obstetric-gynecologic residents planned to subspecialize as contrasted to 19.5% of postresidency obstetrician-gynecologists who either engaged in or plan to engage in subspecialty training/practice. The highest demand areas seemed to be in endocrinology and perinatology, and most subspecialists either limit or plan to limit their practice to the area specified. There was, in addition, a general feeling that subspecialists should confine their activities to major medical centers, and an unfavorable attitude was expressed toward subspecialty-board-imposed practice restrictions. Details regarding the factors influencing Junior Fellows' response to subspecialization are discussed.

Attitude of Health Personnel↗
PubMed1976

Cost of management of patients with haemophilia.

The cost of managing 114 adult haemophiliacs in the west of Scotland was assessed for the period 1 March 1971 to 28 February 1974. Altogether 23 of them (20%) accounted for 80% of the resources used. The cost of hospital treatment of these patients during the period was compared with the predicted cost of home treatment, given the availability of freeze-dried factor VIII concentrate in sufficient amounts. We calculate that adequate on-demand home treatment would cost only 16% more than the present treatment, which is substantially less efficient.

Adult↗
PubMed1976

Screening for spina bifida cystica. A cost-benefit analysis.

The costs and economic benefits are examined of introducing a programme for the mass-screening of pregnancies for the detection and abortion of fetuses with spina bifida cystica. A benefit-cost index is derived, and the possible effects on it of making different input assumptions are discussed. It is considered that, on economic grounds, screening may be worthwhile only in populations in which the incidence of spina bifida is high.

Amniocentesis↗