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Biomedical subjects

J J Gordon

Publications and source records attributed to J J Gordon.

At least 19 recordsLinked to original sources
PubMed2000

Benzodiazepine prescribing by GP registrars. A trial of educational outreach.

BACKGROUND: Despite ongoing concern about adverse effects and dependence on benzodiazepines, approximately 2% of Australians are still taking them on a regular basis. The aim of this study was to evaluate the effectiveness of an educational outreach or 'academic detailing' program about prescribing of benzodiazepines. METHOD: In this randomised trial general practice registrars (n = 157) in New South Wales were allocated to an intervention group (n = 79), which received a 20 minute educational outreach visit; or a control group (n = 78) which received an intervention on an unrelated topic. Prescribing behaviour was monitored by a pre-intervention and two post-intervention practice activity surveys. MAIN OUTCOME MEASURES: These were the rate of benzodiazepine prescribing for all indications, for anxiety and for sleep disorders. RESULTS: Overall benzodiazepine prescribing by the intervention group declined from 2.3 to 1.7 per 100 encounters, while the control group also declined from 2.2 to 1.6 per 100 encounters. Analysis of variance showed this was a significant drop over time (P = 0.042) but there was no difference between groups (P = 0.99). The prescribing decrease observed was in continuing rather than initial prescriptions. CONCLUSIONS: A marked decrease in benzodiazepine prescribing was seen over the course of the study in both intervention and control groups but no differential effect due to the educational outreach visit was found.

Analysis of Variance↗
PubMed1995

Mental health care practices and educational needs of general practitioners.

OBJECTIVES: To describe current mental health care practices of general practitioners and to identify their educational priorities and training preferences. METHOD: Self-administered questionnaire to a stratified random sample of New South Wales general practitioners. SUBJECTS: 721 full-time general practitioners, of whom 534 (74%) responded. RESULTS: Mental health problems recognised by general practitioners at least once per week were psychosomatic (93%), emotional (89%), addiction (79%), social/economic (71%) and family (69%). At least two-thirds recognised sexual problems, sexual abuse and major psychiatric problems less frequently than once per week. Sixty-four per cent of general practitioners reported that patients felt uncomfortable about being referred to psychiatrists; 53% that referral service waiting lists were too long; 51% that there were insufficient local mental health services; and 25% that communication difficulties between referring general practitioners and mental health specialists obstructed optimal care. Educational priorities were diagnostic and counselling skills, with particular emphasis on crisis, family, individual and marital counselling and strategies to prevent general practitioner burn-out. CONCLUSIONS: General practitioners are interested in improving their mental health counselling and diagnostic skills but barriers remain. Both structural and educational initiatives are essential to enhance the quality of mental health care in general practice.

Adolescent↗
PubMed1995

Clinical competence of interns. Programme Evaluation Committee (PEC).

A clinical supervisors rating form addressing 13 competencies was used to assess the clinical competence of graduates one year after qualification in New South Wales (NSW), Australia. Data from 485 interns (97.2%) showed that graduates from the problem-based medical school were rated significantly better than their peers with respect to their interpersonal relationships, 'reliability' and 'self-directed learning'. Interns from one of the two traditional NSW medical schools had significantly higher ratings on 'teaching', 'diagnostic skills' and 'understanding of basic mechanisms'. Graduates from international medical schools performed worse than their peers on all competencies. These results were adjusted for age and gender. Additionally, women graduates and younger interns tended to have better ratings. Junior doctors have differing educational and other background experiences and their performance should be monitored.

Adult↗
PubMed1995

Evaluation of an educational program in rational prescribing for GP trainees.

Education on rational prescribing is receiving increased emphasis but the effectiveness of this education is not well researched. This study used a randomised trial to evaluate a seminar for general practice trainees on rational prescribing of antibiotics and benzodiazepines, two important areas of general practice prescribing. Results show a decrease in prescribing of antibiotics by the group of trainees attending the seminar but no effect on an already low level of benzodiazepine prescribing. The study provides evidence that group educational approaches to influencing prescribing behaviour can be effective.

Chi-Square Distribution↗
PubMed1994

Antibiotic and benzodiazepine prescribing by general practice trainees.

OBJECTIVE: To study the prescribing of antibiotics and benzodiazepines by a group of general practice trainees. METHODS: Forty-six trainees in their general practice term with the Royal Australian College of General Practitioners Training Program and 495 experienced general practitioners were compared with regard to patients managed, prescribing of antibiotics for respiratory tract infections and prescribing of benzodiazepines for anxiety, sleep disorders and depression. RESULTS: Trainees saw more young patients and patients with acute respiratory infections, and fewer patients with psychological problems, than the experienced practitioners. Trainees prescribed antibiotics less often for undifferentiated upper respiratory tract infection and their prescribing for tonsillitis was more frequently in agreement with prescribing guidelines. Trainees were less likely to prescribe a benzodiazepine for anxiety or sleep problems. CONCLUSIONS: General practice trainees were relatively conservative prescribers of antibiotics and benzodiazepines. At times both groups did not prescribe in accordance with antibiotic prescribing guidelines and an appreciable number of patients continue to be prescribed benzodiazepines on a long term basis.

Anti-Anxiety Agents↗
PubMed1991

The effects of gender on diagnosis of psychological disturbance.

This research examines the effect of patient gender on the detection of psychological disturbance. In Study 1, primary-care patients were requested to complete the General Health Questionnaire (GHQ), a measure of nonpsychiatric psychological disturbance, prior to their consultation. The patient's GHQ score was compared with physician judgments about the level of disturbance in that patient (N = 1913). Although there were a similar number of GHQ high scorers among males and females, the physicians classified significantly more females than males as disturbed. The doctors classified as disturbed a larger proportion of nondisturbed women than nondisturbed men. In order to explore the behavior of recent medical graduates, Study 2 examined the detection behavior of interns in an outpatient department with 384 of their patients. The interns behaved in a similar manner to the primary-care physicians.

Adolescent↗
PubMed1989

Evaluating interns' performance using simulated patients in a casualty department.

An observational study examined the care that was provided by 61 interns for three simulated (standardized) patients in a casualty department within a large teaching hospital. The consultations were recorded on videotape and were scored by reference to explicit criteria that were set by an expert panel. The criteria described standards of clinical competence, communication skills and preventive care for each of the three cases. An additional list of the general opportunities for preventive advice that were suggested by the patients' case histories also was compared with the interns' actual behaviour. Clinical competence was not demonstrated uniformly across the three cases. The problem of urinary-tract infection was managed best; 19% of the interns complied with all criteria, and 93% of the interns complied with 75% of the criteria. For tension headache, only 3% of the interns complied with all the criteria but 67% of interns complied with 75% of the criteria. In the case of bronchitis, only 3% of interns complied with all the criteria but 58% of interns met 75% of the criteria. The quality of preventive care also varied from case to case, being best for the patient with bronchitis and worst for the patient with tension headache. Over all, only three of the 13 criteria were met by more than half the interns. The communication-skills criteria identified three behaviours which the interns were most likely to omit: the interns summarized the patients' problems in only 73 of the 173 consultations; they explained the aetiology of the problems in only 127 of the 173 consultations; and they ensured that the patients understood their plan of management in only 21 of the 173 consultations.

Adult↗
PubMed1988

Interns' identification of patients' health risks in a casualty department.

This study examined whether the interns who staffed a hospital casualty department identified correctly four common health risks among their patients. When compared with patients who were attending general practitioners, patients who attended the casualty department were more likely to be cigarette smokers. They were also more likely to be heavy drinkers of alcohol and to score highly on a standardized measure of psychological disturbance. Women were less likely to have undergone a Papanicolaou smear-examination within the previous two years. The interns, who were the subjects in this study, failed to identify 56% of the smokers, 84% of the heavy drinkers, 35% of the psychologically-disturbed patients and 95% of the women who had not undergone a Papanicolaou smear-test in the last two years. The findings were in contrast with the interns' own opinions on what would constitute good-quality care in this setting. The subjects were just beginning their internship at the time of the study. Their failure to integrate important questions about common health risks suggests that their undergraduate training has been deficient in this area. The internship is the last formal opportunity to correct this deficiency before these doctors are registered for independent medical practice.

Adolescent↗
PubMed1988

Response bias in a study of general practice.

Response bias in quality of care research is an important, but largely neglected concern. Differences between health care professionals who consent to participate in research and those who do not may distort the conclusions and prevent the results being generalizable. This is particularly likely when response rates are low, as they often are in studies evaluating primary health care. The present study outlines a method for examining this important area. Fifty-six general practitioners who consented to participate in an observational study of general practice were compared with 52 doctors who declined to participate in the research. Comparisons were made of general characteristics including age, sex, practice size and postgraduate qualifications, as well as attitudes toward their role. This last analysis was deemed particularly important, as the attitudes expressed may have affected the behaviour of the doctor in the consultation, and therefore outcomes such as accurate diagnosis, compliance and satisfaction. Such outcomes are often the object of study in quality of care research. The only significant difference to emerge in the present study was that non-consenters were more strongly in favour of a medical system based on free enterprise and fee for service (t83 = 2.3P less than 0.05). No systematic differences were found on other general characteristics or attitudes relating to patient care. Response bias using the stated variables was therefore considered to be minimal. The results are discussed in terms of strategies aimed at increasing response rates in quality of care research.

Adult↗
PubMed1985

Meningitis due to Staphylococcus aureus.

A retrospective analysis of 10 adult patients with community-acquired Staphylococcus aureus meningitis was performed in order to elucidate the characteristics and treatment of this lethal disease. In all patients, a focus of infection outside the central nervous system was apparent at presentation. A poor prognosis was associated with severe underlying disease, greater degree of hyponatremia at presentation, development of seizures, failure of nuchal rigidity to develop, persistent or recurrent bacteremia, and the presence of concurrent S. aureus bronchopneumonia. Degree of deterioration in mental status and cerebrospinal fluid pleocytosis, protein levels, and glucose levels did not appear to have any prognostic significance. Therapy with rifampin and a semisynthetic penicillin effected a cure in all six patients treated with this regimen. In contrast, three of four patients treated with other antibiotic combinations died. On the basis of this experience, it is concluded that further trials with rifampin in combination with another anti-staphylococcal antibiotic for the treatment of S. aureus meningitis are warranted.

Adult↗