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Biomedical subjects

John Fraser

Publications and source records attributed to John Fraser.

At least 19 recordsLinked to original sources
PubMed2006

Caregivers' inability to identify childhood adiposity: a cross-sectional survey of rural children and their caregivers' attitudes.

OBJECTIVES: To determine the prevalence of overweight and obese children in north-western New South Wales and to assess caregivers' ability to detect adiposity in their children. DESIGN: A cross-sectional survey using a standardised caregiver questionnaire and anthropometric measurements of school children attending 10 primary schools selected by stratified random sampling. SUBJECTS: A total of 598 eligible school children aged between five and eight years. MEASUREMENTS: Body mass index for children; caregivers' assessment of their children's dietary intake, physical activity and adiposity by questionnaire. RESULTS: A total of 348 caregivers responded to the survey, yielding a response rate of 58.2%. Significantly more caregivers of boys (200) than girls (144) chose to participate (chi2 = 8.3, d.f. = 1, P < 0.01). The vast majority of caregivers (87%) consented to their children being measured. Body mass index measurements revealed the following: more than three quarters of boys (82%) and girls (77%) were of normal weight. Of boys and girls 13% were overweight. Twice as many girls (6%) than boys (3%) were obese. In total, 31% of caregivers underestimated the weight of their children. This proportion of caregivers underestimating the correct weight category of their children almost doubled to 56% of caregivers of overweight children. Proportionately more caregivers of overweight boys underestimated their children's weight than caregivers of girls (67% compared with 44%). CONCLUSION: Health promotional activities need to address, as a matter of priority, caregivers' ability to accurately assess the correct weight category of their children.

Adiposity↗
PubMed2006

Evaluation of an interpractice visit peer review program for rural Australian general practice registrars.

Changes to the Australian General Practice Training Program occurred in 2001 allowing registrars in small rural communities to undertake all of their training in one practice. A disadvantage of this change was that there was limited exposure for registrars to different types of general practice. An interpractice visit program utilising peer review between registrars was developed to provide this exposure. This article describes rural Australian general practice registrars' views and experiences of a pilot interpractice visit peer review program.

Australia↗
PubMed2006

Professional autonomy - is it the future of general practice?

Internationally, rising financial costs and increasing expectations of health care delivery have increased regulation and decreased the autonomy of general practitioners and other health care professionals. This article explores professional autonomy within Australian general practice, and outlines the importance of autonomy in systems approaches to organisational change in general practice.

Attitude of Health Personnel↗
PubMed2005

Prioritisation of elective surgery in New Zealand: The Reliability Study.

AIMS: This paper describes the rationale and methodology of a study assessing the reliability of tools for clinical prioritisation (Clinical Priority Assessment Criteria [CPAC]) of patients for elective surgery in New Zealand. METHODS: Surgeons from three specialties (general, vascular, and orthopaedic surgery) completed a computerised evaluation rating clinical vignettes across a range of diagnoses using several priority tools. The study design is described and an outline of the individual tool development and definitions is given. RESULTS: Of the 124 surgeons that participated in this study, 48% (60) were general surgeons, 21% (26) were vascular surgeons and 31% (38) were orthopaedic surgeons. The response rates in the first phase of data collection were 67%, 79%, and 63% for general, vascular, and orthopaedic surgery respectively. Completion rates were high with 100%, 93%, and 98% of the same groupings of surgeons completing the first round evaluations. A further 77% to 89% of the participants from the first round also completed the re-test evaluation. CONCLUSION: This study indicates that assessment of the reliability of CPAC tools currently in use in New Zealand is feasible using a vignette-based approach. In the future, study designs that allow for some face-to-face contact may be preferable for achieving optimal response and completion rates among surgeons. Further work from this study will focus on the individual results for each specialty and examining whether altering ethnicity status in vignettes had any effect on scoring behaviour.

Activities of Daily Living↗
PubMed2005

Characterization of banked umbilical cord blood hematopoietic progenitor cells and lymphocyte subsets and correlation with ethnicity, birth weight, sex, and type of delivery: a Cord Blood Transplantation (COBLT) Study report.

BACKGROUND: The Cord Blood Transplantation (COBLT) Study banking program was initiated in 1996. The study goals were to develop standard operating procedures for cord blood (CB) donor recruitment and banking and to build an ethnically diverse unrelated CB bank to support a transplantation protocol. STUDY DESIGN AND METHODS: The hematopoietic progenitor cell (HPC) and lymphocyte subset (LS) content of approximately 8000 CB units were characterized, and these results were correlated with donor ethnicity, birth weight, gestational age, sex, and type of delivery. RESULTS: There was a significant correlation of CD34+ cell count with colony-forming unit (CFU)-granulocyte-macrophage (r=0.68, p<0.001), CFU-granulocyte-erythroid-macrophage-megakaryocyte (r=0.52, p<0.001), burst-forming unit-erythroid (BFU-E; r=0.61, p<0.001), and total CFUs (r=0.67, p<0.001). Nucleated red blood cell count was significantly correlated with total CD34+ (r=0.56, p<0.001), total CFU (r=0.50, p<0.001), BFU-E (r=0.48, p<0.001), and counts of CD34+ subsets (p<0.001). Caucasian ethnicity was significantly correlated with higher CD3+/CD4+, CD19+, and CD16+/CD56+ LSs. Furthermore, CD34+/CD38- and CD34+/CD61+ CB units (HPC-C) were significantly lower in African American and Asian persons compared to Caucasian and Hispanic persons. Male sex was associated with significantly fewer CD3+/CD4+, CD19+, and CD16+/CD56+ but increased CD3+/CD8+ LSs (p<0.001). Finally, cesarean section was associated with significantly higher total CFU and CD16+/CD56+ but lower CD3+/CD4+, CD3+/CD8+, and CD19+ LSs. CONCLUSION: These results provide a standard and range for uniformly processed HPC-C progenitor cells and LSs. CB progenitor cells and/or LSs may in the future predict for rapidity of engraftment, incidence of graft-versus-host disease, speed and quality of immunore- constitution, graft-versus-tumor effects, and/or success of gene transfection after CB transplantation.

Antigens, CD34↗
PubMed2005

Population and public health in Australian general practice--changes, challenges and opportunities.

Public health and medicine have evolved into different disciplines with (at times) competing values and philosophies. The public health role in general practice is expanding. This article reviews the interface between population health, public health, and 'new' public health and general practice, and suggests educational strategies to foster collaboration between these disciplines.

Australia↗
PubMed2005

Professional career needs of GPs and registrars working in northwestern NSW.

BACKGROUND: The Australian general practice workforce increasingly comprises international medical graduates. These doctors come from a range of professional backgrounds. AIM: This project aimed to document the current education, training and support needs of the general practice workforce, including international medical graduates, who currently train and/or practise in northwestern New South Wales. METHOD: Cross sectional survey of all 66 registrars and all 149 GPs who work in this area. RESULTS: Irrespective of doctors' origin or gender, priority information needs were related to indigenous health, rural health, and key community issues. Training and pre-employment opportunities, and continuing professional development were high priority areas for all participants. DISCUSSION: Educational initiatives are best targeted at identified groups but not necessarily reserved for international medical graduates only. Supporting the professional careers of doctors in a region requires the provision of integrated educational programs that focus on specific information and skills deficits, as well as requested programs.

Adult↗
PubMed2004

A case report: ethics of a proposed qualitative study of hospital closure in an Australian rural community.

BACKGROUND: The GP and qualitative researcher use similar patient-centred approaches, but their roles are different. Guidelines for conducting GP research in small communities are limited. I planned a qualitative study about hospital closure in a small rural Australian town where I worked. Few studies have researched community reaction to hospital closure and this process of change. METHODS: I used historical analysis to improve external reliability, and purposeful sampling to develop and pre-test a qualitative semi-structured research instrument. Newspaper articles, minutes and tape recordings of public meetings, annual reports from 1991 to 1997, quality assurance data and interviews with two health professionals were analysed in this process. These sources were coded using content and thematic analysis. Ethical issues arose during early stages of planning. Ethical guidelines and bioethics principles were discussed with colleagues and a member of an ethics committee. I validated my findings with three other community members involved in the hospital closure. RESULTS: Themes of a transition, from resistance to change and divisions between key stake holders, to a need to appreciate the benefits of change emerged in coding material from 1991 to 1997. The principle of non-maleficence outweighed the principle of beneficence in this study. Existing health services could be harmed by examining the process of change after spending time and resources to reconcile community differences. Individuals could be harmed as confidentiality in a small community was difficult to maintain, and discussions about sensitive issues could produce adverse public criticism. The autonomy of participants to give informed consent was complicated by the author providing clinical services in the community, raising concerns about patients feeling an obligation to participate. CONCLUSIONS: A justified case for discontinuing this study was made by the researcher on ethical grounds. Use of bioethical principles and community representatives to validate findings was a useful technique to guide decisions in a small rural community. This discussion has application in planning other small community studies.

Data Collection↗
PubMed2004

Hepatitis C education needs of rural general practitioners working in northern New South Wales.

OBJECTIVE: To assess hepatitis C continuing medical education (CME) needs of GPs working in rural northern New South Wales (NSW). METHODS: Anonymous reply paid postal questionnaires sent to all 634 GPs working in northern NSW in August 2000 with a follow-up in September 2000. Data were analysed using descriptive and chi(2)statistics for association. RESULTS: Two hundred and ninety-two GPs replied (response rate 46.1%). Sixty-three per cent of respondents were aware of hepatitis C management protocols. Hepatitis C information was most accessed by reading written material (93%), attending seminars (63%) and using the protocol (57%). Rural GPs need to balance hepatitis C education with other competing topics. We found restricted access to CME in rural areas with GPs requesting a greater range of delivery modes. CONCLUSIONS: GPs have an increasing role in hepatitis C management. Hepatitis C CME must be balanced against GPs' patient load, interest and competing learning needs.

Clinical Competence↗
PubMed2004

How to plan, deliver and evaluate a training session.

The long term aim of general practice teaching is to train competent general practitioners to provide high quality care to patients in any setting. The Royal Australian College of General Practitioners' (RACGP) curriculum sets educational outcomes for postgraduate general practice training programs throughout Australia. Registrars have input to this process by reflecting on their learning needs and developing learning plans. This article discusses the teaching of practical procedures in general practice and describes the planning, delivery and evaluation of an educational session about the management of shoulder conditions for general practice registrars.

Australia↗
PubMed2003

Health career promotion in the New England area of New South Wales: a program to support high school career advisers.

OBJECTIVE: To facilitate the area's high school careers advisers' ability to effectively promote health careers to students. DESIGN: Three cross sectional evaluation surveys at the end of each one-day workshop. SETTING: Conference rooms in three regional centres (Armidale, Moree and Tamworth, New South Wales). SUBJECTS: Twenty-two high school careers advisers. INTERVENTION: One-day workshop. MAIN OUTCOME MEASURES: High school careers advisers' self-rated assessment in terms of the effective delivery of appropriate information and opportunities to network. RESULTS: Participants agreed that the workshop conveyed relevant information (3.8), were of high standard (3.5) and enabled them to identify students wanting to pursue health careers (2.9). Networking between health professionals and career advisers was rated as the most beneficial aspect by a majority of participants (60%). The scenario was rated as a useful tool to educate advisers about health careers (3.8). CONCLUSION: Collaborative workshops between advisers and health professionals are useful in facilitating networks to promote health careers in high schools in rural areas. The use of a farm injury scenario as a learning tool was effective in educating advisers about health careers. WHAT IS ALREADY KNOWN: Previous research carried out in the USA6 and Australia demonstrated that high school careers advisers needed to target high school students earlier in their studies before senior subjects were decided and that about a quarter of careers advisers indicated poor knowledge about health careers.10 WHAT THIS STUDY ADDS: Provision of practical support to high school careers advisers, such as distributing a mentorship directory and up-to-date health career kits as well as facilitating networking with health professionals constitute effective means to promote health careers to high school students.

Career Choice↗
PubMed2003

Comparison of multi-lineage cells from human adipose tissue and bone marrow.

Our laboratory has recently characterized a population of cells from adipose tissue, termed processed lipoaspirate (PLA) cells, which have multi-lineage potential similar to bone-marrow-derived mesenchymal stem cells (MSCs). This study is the first comparison of PLA cells and MSCs isolated from the same patient. No significant differences were observed for yield of adherent stromal cells, growth kinetics, cell senescence, multi-lineage differentiation capacity, and gene transduction efficiency. Adipose tissue is an abundant and easily procured source of PLA cells, which have a potential like MSCs for use in tissue-engineering applications and as gene delivery vehicles.

Adipose Tissue↗
PubMed2003

Teaching practical procedures in general practice. A primer for supervisors of medical students and registrars.

BACKGROUND: Practical procedures are central to many general practitioners' job satisfaction and their ability to provide comprehensive care. Despite this, students lack opportunities to learn skills and fewer GPs perform them. OBJECTIVE: This article develops a framework for teaching practical skills and their assessment in general practice. DISCUSSION: True competence means more than performing a task in isolation: knowledge, skills and attitudes are needed to perform in the workplace. Teaching should be closely related to assessment in general practice. A four stage method of instruction can facilitate learning of task skills. This should be followed by a series of case discussions, scenarios or simulations to teach and assess the learners' ability to manage tasks in the work environment. Linking teaching, assessment and feedback is integral to improving learning opportunities in general practice.

Clinical Competence↗