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Biomedical subjects

J Cockburn

Publications and source records attributed to J Cockburn.

At least 19 recordsLinked to original sources
PubMed1999

Postpartum perineal management and best practice.

Sutured damage to the perineum occurs in at least 39% of women being delivered in Australia and perineal wound breakdown is associated with perineal oedema. The available literature was reviewed to ascertain what might constitute best practice for postpartum perineal wound management. Classification of levels of evidence was used to prioritise the available evidence. Little evidence that might be considered scientifically robust was found. Recommendations based on the available levels of evidence include a careful emphasis on perineal hygiene, cryotherapy, elevation of the foot of the bed in the presence of perineal oedema and regularly performed pelvic floor exercises.

Benchmarking↗
PubMed1999

Perceptions of screening mammography among women aged 40-49.

OBJECTIVE: The aim of this study was to survey women aged 40 to 49 to determine their perceptions of the benefits and the downsides of screening mammography for women in this age group, and the degree of support for targeting women aged 40 to 49 in the national BreastScreen program. METHOD: Telephone interviews were used in a two-stage survey of 200 women aged 40 to 49 from across Australia in 1997. Information that outlined some of the evidence for costs and effectiveness of screening in this age group was sent to the women after the first survey. RESULTS: Women saw both benefits and downsides of mammography screening in this age group. Although the proportion of women reporting downsides increased from (39%) to (69%), after reading the information most women (62%) still thought the benefits outweigh the downsides of offering a screening program to women aged 40-49 and the majority (66%) supported the notion of government funding for this. Most women agreed that women aged 40 to 49 have to be informed about all the advantages and disadvantages of screening before making a decision to attend. CONCLUSION: If women aged 40-49 were to be actively recruited to a government screening program, an information campaign should be undertaken that outlines the benefits and downsides of screening mammography to foster informed participation. IMPLICATIONS: Community views are a helpful contribution to debates about policy when existing data are ambiguous.

Adult↗
PubMed1999

Knowledge and perceptions about breast cancer incidence, fatality and risk among Australian women.

OBJECTIVE: Breast cancer is the most common fatal cancer among Australian women. This study aimed to provide an accurate national picture of women's understanding of breast cancer incidence, fatality and risk. METHOD: A telephone survey explored the knowledge and perceptions of a sample of 2,935 Australian women in relation to breast cancer incidence, fatality, risk factors, risk perception and level of concern. RESULTS: Australian women were well aware of breast cancer in general terms, however, there were major aspects of incidence and risk which were poorly understood. Only 5% of women nominated age as a risk factor, and only one-third were able to make an approximately correct estimate of the incidence of breast cancer in Australia. CONCLUSIONS AND IMPLICATIONS: Recommendations for future information campaigns include targeting understanding of lifetime risk of developing breast cancer, age as a risk factor, survival from breast cancer and the need to separately address the perceptions of older versus younger women.

Adult↗
PubMed1998

Should women take part in clinical trials in breast cancer? Issues and some solutions.

PURPOSE: The purpose of this review is to consider the issues for women related to participation in clinical trials that evaluate the management of breast cancer and provide some recommendations for future initiatives to address the identified areas of concern. METHODS: The National Health and Medical Research Council (NHMRC) National Breast Cancer Centre hosted an international workshop to address the question "Clinical Trials in Breast Cancer: Should Women Take Part?" We also reviewed the literature on informed participation in clinical trials that was identified in a broadly based search that covered Medline, PsycLIT, and HealthPlan from 1986 to 1996. RESULTS AND CONCLUSION: When women are asked to participate in a clinical trial, they are faced with a number of questions and dilemmas. These include issues related to the conduct and ethical considerations of the trial; the effect of participation or nonparticipation on treatment; the roles of the doctor as clinician and as researcher; the process of informed consent; the timing of the request for participation; and the benefits and costs of participation. A number of steps are identified that could help women decide whether to participate in clinical trials. These include provision of community information about clinical trials; establishment of independent brokers and registers for clinical trials; consumer review of information and protocols and involvement in trials; review of the role of ethics committees; collection of data about the proportion of women currently recruited to clinical trials, their reasons for participating or declining, and their views about the process of recruitment and participation; models for optimal practice in recruiting women to clinical trials and encouraging ongoing participation in trials; evidence-based communication skills training for clinicians to teach skills to inform women adequately of clinical trial participation; and auspicing and promotion of trials by an independent agency.

Breast Neoplasms↗
PubMed1997

Mammographic screening: results from the 1996 National Breast Health Survey.

OBJECTIVE: To establish the extent of women's knowledge of mammographic screening, particularly in relation to the national screening program, BreastScreen Australia, and to estimate the proportion of women who are participating in screening both within and outside BreastScreen Australia. DESIGN AND SETTING: Validated prospective telephone survey of women aged 30-69 years selected at random from across Australia. PARTICIPANTS: 2935 women with no previous breast cancer diagnosis. RESULTS: The adjusted response rate was 64%. Almost 90% of women had heard of the national program; only 1% correctly stated that screening is for asymptomatic women. 60% correctly identified the current recommended age of starting screening is about 50 years of age; 26% thought screening should begin at about 40 years of age. Approximately 60% correctly reported that the recommended screening interval is every two years; 27% thought screening should be done annually. 55% reported ever having had a mammogram, and 37% reported having had at least one screening mammogram. Among women in the target age group (50-69 years) about 70% reported ever having had a screening mammogram, and about 50% reported having had a screening mammogram within the national program in the last two years. Among women aged 40-49 years, 29% reported ever having had a screening mammogram, and 22% reported having been screened in the last two years. CONCLUSIONS: Awareness of the national screening program is high, but some women do not know the purpose of screening, the target age group and the recommended screening interval. Compliance with screening is good among women in the target age group; many women in their 40s are also participating in screening.

Adult↗
PubMed1997

Prescribing behaviour in clinical practice: patients' expectations and doctors' perceptions of patients' expectations--a questionnaire study.

OBJECTIVES: To examine the effect of patients' expectations for medication and doctors' perceptions of patients' expectations on prescribing when patients present with new conditions. DESIGN: Questionnaire study of practitioners and patients. SETTING: General practice in Newcastle, Australia. SUBJECTS: 22 non-randomly selected general practitioners and 336 of their patients with a newly diagnosed medical condition. MAIN OUTCOME MEASURES: Prescription of medication and expectation of it. RESULTS: Medication was prescribed for 169 (50%) patients. After controlling for the presenting condition, patients who expected medication were nearly three times more likely to receive medication (odds ratio = 2.9, 95% confidence interval 1.3 to 6.3). When the general practitioner thought the patient expected medication the patient was 10 times more likely to receive it (odds ratio = 10.1, 5.3 to 19.6). A significant association existed between patients' expectation and doctors' perception of patients' expectation (chi 2 = 52.0, df = 4, P = 0.001). For all categories of patient expectation, however, patients were more likely to receive medication when the practitioner judged the patient to want medication than when the practitioner ascribed no expectation to the patient. CONCLUSIONS: Although patients brought expectations to the consultation regarding medication, the doctors' opinions about their expectations were the strongest determinants of prescribing.

Adolescent↗
PubMed1997

Training experiences immediately after medical school.

Trainees in all teaching hospitals in New South Wales were surveyed using a self-completion, postal questionnaire to assess perceptions of the quality and extent of training received for interactional and technical skills. The response rate was 67.1%. Mean age was 25.4 years and 38.8% were female. Overall, training was found to be generally poor in terms of time and educational strategies used. Interactional skills were found to receive lower levels of training than technical skills both prior to and during the intern year with significantly fewer (P < 0.000) educational strategies reported for training received in interactional skills than for technical skills. Trainees' perceptions of the adequacy of training was significantly more negative for interactional than technical skills (P < 0.001). Assessment of competence was also significantly lower for interactional than technical skills (P < 0.001). On average, fewer than one in three trainees considered themselves to be competent in interactional skills compared to two-thirds who reported themselves as competent for technical skills. The findings of this study highlight the need for improved efforts with regard to both the quality and quantity of training provided during the intern year. Considerable scope exists for improved educational experiences for both interactional and technical skill areas, but particularly for interactional skills. Overall, greater use of a range of basic educational strategies such as the provision of 'observation' and 'critical feedback' is indicated. Efforts also need to be directed toward the training of clinical educators to optimize the potential of the preregistration period.

Adult↗
PubMed1997

Effective teaching of communication skills for medical practice: selecting an appropriate clinical context.

Increasingly, courses in communication skills are being incorporated into medical training. In order for communication skills to be effectively maintained in post-training medical practice, they must be taught within an appropriate clinical context. The present paper describes and provides rationale for seven criteria by which to select clinical issues which are appropriate foci for communication skills courses. The criteria are: (1) the issue must be one which is encountered frequently in clinical practice; (2) the issue must be associated with a high burden of illness; (3) there must be evidence that practitioners need to improve skills for dealing with the issue; (4) there must be an intervention, of which communication skills are an integral component, that is demonstrably effective for dealing with the clinical issue; (5) the intervention must represent a cost-effective means of dealing with the issue; (6) the intervention must be acceptable to doctors and be able to be incorporated into routine medical practice; (7) the intervention must be acceptable to patients. Examples of clinical issues which fit these criteria are given in the paper and include smoking, hazardous alcohol consumption, non-adherence to treatment instructions, overdue cervical screening, inappropriate diet, recovery from medical interventions, and breaking bad news to patients.

Clinical Competence↗
PubMed1997

Consulting about priorities for the NHMRC National Breast Cancer Centre: how good is the nominal group technique.

The National Health and Medical Research Council National Breast Cancer Centre was established to improve outcomes for women by reviewing the literature, developing best practice guidelines and resources and developing a national monitoring system. Its broad terms of reference meant that it was important at the outset to identify priorities for action. The Centre used a national consultative process based on nominal groups to identify priorities. Thirteen consultative workshops were held with over 300 participants including women diagnosed with breast cancer, some of their families and health professionals. There was a high level of agreement between workshops in priorities identified, indicating that the nominal group process results in reliable data. A sub-sample of participants surveyed after the workshops reported being highly satisfied with their participation in the process. The findings indicate that the nominal group process can be useful in selecting priorities for action in health.

Academies and Institutes↗
PubMed1997

Predictors of attendance at a relocatable mammography service for rural women.

This study aimed to identify factors that predicted attendance at a relocatable screening mammography service in a rural centre in Victoria. A cohort design was used whereby 180 women from the target population were interviewed by telephone two weeks before the service moved to the area for a 10-week period of operation. Attendance data were ascertained from service records. Fifty per cent of the sample attended the service. Significant predictors of attendance were: mammographic history, with women who reported previous screening mammography being less likely to attend than women who had not had a previous mammogram (odds ratio (OR) 0.38, 95% confidence interval (CI) 0.17 to 0.83); perception of personal risk for breast cancer, with women who perceived at least some risk being more likely to attend than women who perceived no risk (OR 2.73, CI 1.07 to 6.99); stated intention of attending (OR 2.01, CI 1.49 to 2.71); knowing the correct location of the service (OR 3.08, CI 1.37 to 6.89); and education, with higher education being associated with a lower likelihood of attending (OR 0.65, CI 0.44 to 0.96). Our study raised some issues, including the high prevalence of rural women who reported a previous screening mammogram, although BreastScreen services had not previously been available in their area; factors underlying perceptions of personal risk for breast cancer; and the generalisability of our finding of an inverse relationship between higher education and attendance for screening.

Aged↗
PubMed1997

Predictors of returning for second round screening at a population based mammographic screening programme in Melbourne, Australia.

OBJECTIVE: To examine factors associated with returning for second round mammography screening. SETTING: This was a population based mammographic screening programme in Melbourne, Australia. DESIGN: A cohort design was used whereby 668 women were interviewed before the screening programme began and attendance for both first and second round screening was ascertained from programme records. The cohort sample was drawn from two regions of a defined area (close to and distant from the screening centre). MAIN RESULTS: Of the 315 women who attended for first round screening, 75% from the proximal sample and 70% from the distal sample returned for second round screening. Attendance at the second round was predicted by the following: the method of recruitment for first round screening, with women who required a letter of invitation and a reminder being less likely to reattend than those who initially attended in response to a community campaign (OR = 0.34; CI 0.19, 0.61); mammographic history before the initial screen, with women who reported previous diagnostic mammography being more likely to reattend than those who did not (OR = 2.97; CI 1.01, 8.9); stated intention of attending for the initial screen, with those with weakest intention of attending for their first round being less likely to attend for second round (OR = 0.44; CI 0.23, 0.85); and increasing scores on a scale that measured preventive orientation to health (OR = 1.24; CI 1.02, 1.50). CONCLUSION: Our findings corroborate other findings of reduced long term attendance for screening from people who are "reluctant participants" initially.

Aged↗
PubMed1997

Behavioural dynamics of a clinical trial of sunscreens for reducing solar keratoses in Victoria, Australia.

OBJECTIVE: To determine whether the behaviour of participants based on perception of treatment group in a randomised trial contributed to clinical outcome. DESIGN: A double blind randomised controlled trial of the effect of daily application of SPF 17 broad spectrum sunscreen cream (or placebo) on solar keratoses. SETTING: A rural city in Victoria, Australia. Residents aged 40 years or over were invited by letter to attend for a skin cancer screening check. Of these, 588 people with between one and 30 solar keratoses enrolled in the trial and 431 completed the trial, which extended over a six month period that included summer. Participants' perceptions of their treatment allocation, adherence with the treatment regimen, adoption of other sun protection behaviours, side effects, and perceptions of change in condition were measured at two monthly intervals. RESULTS: There were no significant differences between those who completed the study and those that did not for sex, age, treatment group, skin type, number of solar keratoses or correct perception of treatment group. Thirty per cent of those completing the study correctly guessed their treatment allocation, and people were just as likely to be right as to be wrong when they stated their opinion about their treatment allocation (z = 1.04; p = 0.15). Study group, skin type, amount of time spent outdoors, presence of side effects, perceptions of change in skin condition did not significantly predict correct perception of treatment allocation. Multivariate analysis of variance indicated that adoption of other sun protection and adherence with cream use were not significantly affected by actual treatment allocation, correct perception of treatment allocation nor by their interaction. Poisson regression analysis showed a significantly lower difference ratio of solar keratoses in the sunscreen group compared with the placebo base cream group (OR 0.55; CI = 0.46, 0.64), and for women compared with men (OR = 0.76; CI = 0.63, 0.93) but no independent effect of any of the indices of other sun protection or adherence. CONCLUSIONS: A sufficient level of commitment to study procedures was achieved, so that trial participants did not adopt other behaviours that affected treatment outcomes. It is recommended that the potential threat to validity posed by the behaviour of participants be recognised at an early stage in planning of clinical trials, so that strategies to deal with this can be integrated into study protocols.

Adult↗
PubMed1997

An evaluation of educational outreach to general practitioners as part of a statewide cervical screening program.

OBJECTIVES: The purpose of this study was to determine the acceptability, effectiveness, and cost of a face-to-face educational outreach intervention in the context of a program aimed at increasing cervical screening in Victoria, Australia. METHODS: All identified general practitioners in a specified intervention area were offered a visit by a general practitioner educator. Practitioners completed a questionnaire evaluating the acceptability of the visit. Odds ratios for a woman being screened in the 3 months following the visits were determined. RESULTS: Fifty-nine general practitioners (69.4%) accepted the offer of a visit. Most found both the process and the content of the intervention to be acceptable. The intervention and nonintervention regions did not differ either before or after the intervention. In both regions, there was a statistically significant increase in number of Pap tests performed. There was no difference in the change in screening between the two regions. Costs were estimated at Au$34 per general practitioner visited. CONCLUSIONS: This strategy cannot be recommended for widespread use in a cervical screening program.

Adult↗
PubMed1996

Failure of prospective memory after acquired brain damage: preliminary investigation and suggestions for future directions.

This paper investigates the premise that the greater frequency of errors after acquired brain damage will facilitate identification of essential components of successful prospective memory. It examines performance by patients with recent acquired non-progressive brain damage and age-matched control subjects on two experimental measures of prospective memory. A significant different between patients and control subjects arises mainly from performance on a time-based prospective memory task. Results from patients on tests of time- and event-based prospective memory are compared with scores on tests of episodic memory and executive skills. A relationship is identified between event-based prospective memory and retrospective episodic memory but not between time-based prospective memory and executive skills. Premorbid intelligence and current mood state are identified as variables that should be considered when investigating prospective memory under experimental conditions.

Adult↗
PubMed1996

Morphological classification of facial features in adult Caucasian males based on an assessment of photographs of 50 subjects.

Fifty sets of photographs showing facial features of Caucasian males aged 18 to 60 years were examined to establish a morphological classification of the face. It is suggested that such a classification could assist facial identification by photocomparison. The selection criteria stress the importance of interassessor agreement and discrimination among feature subset units in formulating the proposed classification.

Adolescent↗