PubMed Health⌕ Search

Biomedical subjects

J A Dickinson

Publications and source records attributed to J A Dickinson.

15 recordsLinked to original sources
PubMed1992

Promotion of attendance for mammographic screening through general practice: a randomised trial of two strategies.

OBJECTIVE: To compare the effectiveness of two strategies--patient education and practitioner recommendation--in encouraging women to attend for mammographic screening. DESIGN: The study was a prospective randomised controlled trial. Women aged between 40 and 70 years attending a general practitioner participated in the study. Consenting, eligible women were randomly allocated to one of the two strategy groups. SETTING: The study was conducted in private general practice in Newcastle, New South Wales. PARTICIPANTS: The general practitioners who took part in the study were a non-random sample of practitioners: 20 were approached, two declined to participate, and five failed to begin recruitment, leaving 13 practitioners who took part in the study. A total of 302 women aged 40-69 were recorded as attending the surgeries during recruitment sessions. Twenty women did not consent to the study and 73 were ineligible. Thirty-four women were not given the intervention because the general practitioner forgot or did not have time. There were 92 women in the simple recommendation group and 83 women in the patient education group. INTERVENTIONS: An intensive patient education approach based on health belief principles was compared with a simple recommendation by the general practitioner that the woman have a mammogram. MAIN OUTCOME MEASURE: Attendance rates were calculated from screening service attendance records. RESULTS: No significant difference in attendance rates was observed between the two groups, 82% of the simple recommendation group and 91% of the patient education group attended for screening. CONCLUSIONS: These results suggest that mammographic screening can be effectively promoted in general practice without extensive patient education.

Adult↗
PubMed1991

Variability in classification of consultations by content-based descriptors.

OBJECTIVE: To determine the reliability with which general practitioners use content-based descriptors of consultations. Our hypothesis was that there would be considerable variety in the opinion of general practitioners on the classification of consultations by descriptors. DESIGN: General practitioners in Newcastle, New South Wales, assessed videotaped consultations and the written consultation records by 12 general practitioners. SETTING: The medical faculty of the University of Newcastle and the general practitioners' own homes and offices. PARTICIPANTS: Twelve general practitioner participants were selected from consultation tapes recorded in 1983 by the Primary Care Research Group at the University of Newcastle. Thirty-nine observer general practitioners were randomly selected from a list of general practitioners practising in the Newcastle area maintained by the Hunter Postgraduate Medical Institute. Those whose videotapes had been selected were excluded. RESULTS: There were high levels of variation between assessments made from the original records and from viewing the tapes. Doctors varied greatly in their use of the descriptors. This variation included estimation of the duration of consultations and of the individual components of the consultation (history, physical examination, problems dealt with). No systematic relationships were found between any characteristics of the doctors and their ratings of consultations. CONCLUSIONS: There is potential for enormous variation in the use of content-based descriptors currently available in Australia. Observer general practitioners tended to underestimate the content of the consultations and overestimate the duration. It would be inappropriate to use the general practitioner patient record for audit of the content or difficulty of a consultation.

Adult↗
PubMed1991

Notification of disease. Worthwhile or not?

Disease notification is part of the community surveillance system for control of infectious diseases, but it has fallen into disuse. Understanding the goals and mechanisms of surveillance allows us to respond most appropriately to the needs of both our patients and the community.

Australia↗
PubMed1991

Asking questions.

Explore the source record for details and available documents.

Information Services↗
PubMed1991

The accuracy of Pap smear utilization self-report: a methodological consideration in cervical screening research.

One method used to determine utilization rates of cervical screening is women's self-report. Few studies have assessed the accuracy of this measure--none has been conducted in Australia--although there are a number of reasons for suspecting its validity. This study examined and quantified the accuracy of self-report of Pap smear use among a randomly selected sample of women from an Australian community. Accuracy of Pap smear utilization self-report within a three-year period was assessed by comparison with pathology records. Results indicated that almost half of the women who have not had Pap smears within three years will be missed by a self-report measure of utilization. Some implications for the measurement and use of self-report data are discussed.

Adolescent↗
PubMed1990

Emergency and after-hours work performed in country hospitals.

Country doctors perform emergency work in addition to their conventional general practice role. Over a one-month period 17 general practitioners in four Hunter Region towns recorded all emergency calls describing the time they were called, the severity of the patients' conditions, the skills used and the time taken. A scale to measure severity of illness was devised and tested for this purpose. There were 1197 emergency calls, mostly seen at the local hospital, either in the outpatients department or on the wards. They were unevenly distributed in time, with fewer calls at night, but the doctors were disturbed during nearly half of their nights on call. Of the calls 15% were for trivial reasons, 34% were for patients who needed standard general practice care, and 50% were for patients who needed the services of the hospital or were already inpatients. Most attendances were brief, but 15% took more than 30 minutes and some much longer. Counselling skills were used for 47% of patients and technical skills in 22%. The strain of the work involved and the disturbance of personal life justify extra payments to country doctors, and the adequacy of current pay schedules is questioned. However, the peculiarities of funding result in the State Health Department underwriting most emergency costs in country towns, whereas in the cities the Commonwealth Department of Health pays for a larger proportion, leading to concern about the high apparent costs of country hospitals. The information in this survey may help improve planning for training and remuneration of country doctors to help ease the current shortage.

Clinical Competence↗
PubMed1990

A survey of running injuries in 1505 competitive and recreational runners.

A 33 item multiple choice questionnaire was circulated; completed questionnaires from 1505 runners (1130 male and 375 female) were obtained. Questions focused upon training, injuries sustained, and medical care. Biomechanical imbalances such as leg length inequality appear to be a major contributing factor to running injuries. Correction of an underlying biomechanical defect may be important in the treatment of many running injuries. Female runners were found to be more susceptible than males to stress fractures at higher mileages. The cause of this increased incidence may be attributable to lower bone mineral density levels as a result of hormonal factors. Factors such as running surface, age and stretching techniques do not appear to play a significant part in the pathogenesis of running injuries.

Adult↗
PubMed1989

General practitioners' detection of patients' smoking status.

We examined the detection of smoking by 50 randomly-selected general practitioners. The practitioners said that they should detect smokers among their patients with a high degree of accuracy: a median of 100% of smokers under ideal conditions, and a median of 80% of smokers given the realities of practice. Practitioners actually identified 56.2% of their patients who were smokers--360 of 641 smokers among 2044 patients in the study. Some 65% of patients with a smoking-caused or smoking-exacerbated disease were detected, and this degree of detection was not related to age. For smokers of greater than 50 years of age and without any obvious smoking-related condition, the detection rates were similar to those of patients with smoking-related disease; however, in those patients who were less than 30 years of age, only 41% of smokers were detected--although the prevalence of smoking was higher in the younger than it was in the older patients. For all age-groups, the prevalence of smoking in men was about 15% higher than it was in women, but there was no significant difference between the detection rates in the sexes. In spite of their higher risks from smoking, the detection rates for pregnant women, or women who were taking oral contraceptive agents, were no higher than those for other women of less than 35 years of age. The doctors said that they had treated for smoking 78% of the detected smokers who had smoking-caused disease, compared with 35% of detected smokers with no smoking-related condition. They rated the value of such treatment higher in the former group than in those patients who had not yet developed smoking-related problems. Doctors appear to respond to the evidence of disease that is caused by smoking more than to the habit itself, which is a handicap in the prevention of smoking-related disease.

Adult↗
PubMed1979

Incidence and outcome of symptomatic urinary tract infection in children.

The incidence of symptomatic urinary tract infection in 2879 children aged under 15 years was studied over 18 months in a single general practice. Infection was diagnosed if bacterial counts in three consecutive samples exceeded 100,000/ml. The incidence of urinary tract infection was 1.7 per 1000 boys at risk per year and 3.1 per 1000 girls. These values are lower than those of comparable studies, possibly because of the stricter diagnostic criterion used in the study. Urinary pus cell counts were also carried out and sometimes found to be misleading. Of the 14 children found to have an infection, three had a radiological abnormality. Five of the children had a recurrence of infection within the first two years, and one an asymptomatic bacteriuria seven years after diagnosis. Only six out of 34 children presenting with dysuria had infected urine, and an association was discovered between abacterial dysuria (or the urethral syndrome) in the remainder and a concurrent upper respiratory tract infection. All children should undergo radiological investigation after their first confirmed infection. Diagnosis and management could be improved by providing all general practitioners with a semiquantitative method of urine culture such as the dip slide.

Adolescent↗
PubMed1975

Undergraduate general practice teaching in Australasian medical schools: the student viewpoint.

A survey was conducted to find what type of general practice teaching is offered to Australasian undergraduates. Of 11 medical schools, one had no pretence at general practice teaching, four had very inadequate and six had sufficient courses devoted to the subject. Comments on the place of general practice teaching in the medical curriculum are added. An attempt is made to summarize student expectations.

Attitude of Health Personnel↗