Biomedical subjects

L Kehoe

Publications and source records attributed to L Kehoe.

At least 19 recordsLinked to original sources

PubMed2001

Compliance with guidelines for continuity of care in therapeutics from hospital to community.

OBJECTIVES: To evaluate compliance with the Australian Pharmaceutical Advisory Council's National guidelines to achieve the continuum of quality use of medicines between hospital and community. DESIGN: Descriptive survey, based on questionnaires filled out by general practitioners, of a sample of patients following recent discharge from public hospitals, collated with hospital record reviews for a 20% subsample of the patients. PARTICIPANTS AND SETTING: 357 GPs practising within the postcode boundaries of the South East Sydney Area Health Service were randomly selected to take part in the survey. Of 219 GPs who agreed to participate, 106 completed questionnaires on 203 patients. For a subsample of 38 patients, hospital records were reviewed and compared with the GP survey data. RESULTS: For 52% (105/203) of all patients the GP was not notified of hospital admission. Medication management was documented in the discharge plan for 13% (5/38) of the subsample. Communication in both directions between GP and hospital about medications was recorded for 13% (5/38) of the subsample. Consultation with the GP about the patient's medication during the hospital stay occurred for 11% (22/203) of all patients and 24% (9/38) of the subsample. Ninety-one per cent of patients (185/203) were discharged with sufficient medication to last until they saw their GP. Fewer than 10% of patients received all the information the Guidelines require. For 33% (66/203) of the patients, GPs considered there was at least one barrier (eg, language, cultural) to understanding the medication regimen. CONCLUSIONS: Compliance with the Guidelines is not good at present. Their acceptance may be strengthened by formulating specific target indicators. A minimum indicator would be notifying the GP of three out of four matters: the patient's admission; medications on discharge; medication changes; and follow-up arrangements.

Aftercare↗

PubMed2000

Evaluation of a workplace brief intervention for excessive alcohol consumption: the workscreen project.

BACKGROUND: The workplace provides a useful setting for early identification and intervention with individuals who have unhealthy lifestyles. The objective was to evaluate the effects of a workplace-based lifestyle intervention (Workscreen) to reduce excessive drinking. METHOD: There were eight Australia Post networks randomly allocated to experimental and control conditions, comprising 67 worksites and 1206 employees. The experimental condition involved a broad spectrum lifestyle campaign, incorporating support from management, employee awareness of health, and brief interventions for high-risk behaviors, including excessive alcohol use. Focus groups identified relevant cultural factors. Changes in workplace culture and employee behavior were assessed 10 months after baseline. Males and females were analyzed separately. RESULTS: Over half of APOST employees participated at each screening point. In the experimental condition 61% of employees overall and 58% of those identified as excessive drinkers in Phase 1 responded to the lifestyle campaign by attending health assessments. Analyses focusing on the organization as a whole did not reveal significant reductions in excessive alcohol consumption among men or women. However, a significant reduction in number of drinks was observed in the experimental condition among women for whom completion of baseline and follow-up could be confirmed (P < 0.001). CONCLUSIONS: The present study indicates that a workplace-based lifestyle campaign can assist self-selected employees in reducing their alcohol consumption. There was a moderately high level of participation among those identified as drinking excessively, which supports our approach of embedding a low-intensity alcohol program within the context of a broader health promotion campaign.

Adolescent↗

PubMed2000

Laser ultrasonic surface wave inspection of alumina ceramics of varying density

In this paper, the surface acoustic wave velocity results acquired from the inspection of specially manufactured and characterised alumina ceramic materials are presented. Ultrasonic velocity data of alumina-based ceramics in the range 60-100% theoretical density was generated utilising non-contacting laser-ultrasonic measurements based on laser generation and detection of surface acoustic waves with the objective of creating a routine technique for industrial advanced alumina inspection. With linear fitting the surface acoustic wave velocity data serves as a calibration graph for using laser ultrasonics for routine monitoring of alumina. A second laser ultrasonic technique based on the laser generation and foil transducer detection of surface acoustic waves was used to validate the surface acoustic wave velocities measured by the laser generation/detection technique.

Journal Article↗

PubMed1999

Quantitative and qualitative evaluations of brief interventions to change excessive drinking, smoking and stress in the police force.

AIMS: To evaluate the effects of a brief intervention to reduce excessive drinking, smoking and stress among police. DESIGN: (1) Controlled intervention trial with pre and post-intervention assessment approximately 8 months apart; (2) focus group identification of relevant factors). SETTING, PARTICIPANTS: Assessment was carried out of 954 NSW (Australia) police at 19 stations within two matched districts in the Sydney metropolitan area. Five focus groups were carried out with 43 randomly selected police from the matched districts. MEASUREMENTS: Weekly alcohol consumption and binge drinking, smoking and symptoms of stress were measured by a self-administered Health and Fitness Questionnaire. Recorded responses to set questions provided qualitative data. RESULTS: Participation was high (89%) at both quantitative assessments. Alcohol consumptions, particularly among men, was high at both baseline and follow-up assessments, although comparisons between groups across occasions showed no significant intervention effects. Excessive drinkers and those reporting moderate to severe stress levels reported more sick leave days (p < 0.05, p < 0.05). A significant increase in awareness of alcohol policies in the work-place showed in both experimental and control groups over time (p < 0.01). The percentage of smokers declined significantly in both intervention and control groups. Overall, women had significantly more symptoms of stress than men. Only 20% of police thought they would seek advice from work-place staff about alcohol consumption, 14% for smoking and 61% for stress. In the qualitative study, employees generally distrusted their organization's involvement in health unless work performance was affected. Seeking professional assistance for life-style issues was viewed as a sign of weakness. Alcohol use was seen as a way of obtaining information or group membership, self-medication and socializing. CONCLUSIONS: The brief interventions did not produce significant improvements in three life-style factors beyond positive trends in alcohol consumption among women and general reductions in smoking among both study groups. Combining quantitative and qualitative approaches helped identify interactive individual and organizational factors which influence behavioural and cultural norms.

Adolescent↗

PubMed1999

Influencing antibiotic prescribing in general practice: a trial of prescriber feedback and management guidelines.

BACKGROUND: The extent of use of antibiotics to treat upper respiratory infections in general practice is an area for concern due to the increasing problem of bacterial resistance. Effective educational strategies to promote rational prescribing are needed. OBJECTIVES: We aimed to examine the effectiveness of prescriber feedback and management guidelines in reducing antibiotics prescribing by GP trainees for undifferentiated upper respiratory tract infection, and in improving the choice of antibiotic for tonsillitis/streptococcal pharyngitis. The research tested a stepwise approach to targeting educational input to high prescribers. METHOD: General Practice trainees in New South Wales (n = 157) were randomly allocated to a treatment group (n = 78) which received an education intervention on antibiotic use, or to a control group (n = 79) which received an intervention on an unrelated topic. Trainees completed three practice activity surveys, each of 110 consecutive patient encounters, with 6-month intervals between surveys. Prescriber feedback and management guidelines on use of antibiotics for URTI and choice of antibiotic for tonsillitis/streptococcal pharyngitis were delivered in a written form between surveys 1 and 2. An educational outreach visit to high prescribers occurred between surveys 2 and 3. Outcome measures were the rate of antibiotic prescribing for all indications, for URTI and prescribing of select antibiotics for tonsillitis/streptococcal pharyngitis. RESULTS: Antibiotic prescribing by the intervention group declined over three occasions from 25.0 to 23.3 to 19.7 per 100 URTI problems, while the control group increased from 22.0 to 25.0 to 31.7 per 100 URTI problems (P = 0.002). Prescribing in agreement with accepted guidelines for tonsillitis/streptococcal pharyngitis increased over time in the intervention group from 55.6 to 69.8 to 73.0 per 100 problems, but decreased in the control group from 59.6 to 57.5 to 58.5 (P = 0.05). CONCLUSION: Prescriber feedback and management guidelines were shown to influence antibiotic prescribing for URTI and choice of antibiotic for tonsillitis/streptococcal pharyngitis. This study provides a model for targeting educational input to those prescribers who most need to change their behaviour.

Analysis of Variance↗

PubMed1998

How healthy are the police? A survey of life-style factors.

AIMS: To examine the prevalence of five life-style behaviours among New South Wales police. DESIGN: A cross-sectional survey using a self-administered questionnaire. SETTING AND PARTICIPANTS: A total of 852 police were recruited from metropolitan Sydney. MEASUREMENTS: Prevalence related to age and sex of self-reported alcohol consumption, cigarette smoking, inadequate exercise, perception of overweight and stress symptoms. RESULTS: A high level (89%) of participation was achieved in the survey. Almost half (48%) of males and more than two-fifths (40%) of females consumed alcohol excessively including continuous hazardous or harmful consumption and binge drinking. Excessive drinking was more prevalent among younger police. There were 8% of male and 15% of female police who reported that they did not drink alcohol. Over one-quarter (27%) of male and one-third (32%) of female respondents reported smoking. Almost half (46%) of men and women (47%) believed that they were overweight. More than one-fifth (21%) of men and less than one-quarter (24%) of women reported that they did not exercise. Finally, 12% of men and 15% of women reported feeling moderate to severe symptoms of stress. CONCLUSIONS: The police work-force offers an opportunity to screen for a large number of healthy, young and high risk individuals (particularly men) who are hard to reach in other settings and who rarely visit their general practitioner. A sizeable majority (83%) of NSW police had at least one unhealthy life-style behaviour with 19% reporting 3-5 unhealthy factors. The high prevalence of excessive alcohol consumption among police is of particular concern. More active health promotion and provision of brief interventions among police may reduce morbidity and mortality associated with unhealthy life-styles.

Adolescent↗

PubMed1998

Effect of training on general practitioners' use of a brief intervention for excessive drinkers.

OBJECTIVE: To determine among general practitioners (GPs) the effect of three different types of training on utilisation of a brief, controlled drinking intervention. DESIGN: A non-randomised intervention study. Setting, participants: 96 GPs (64%) within the South Eastern Sydney Division of General Practice participated; 35 chose workshop training, 39 one-to-one training and 22 received a special kit by mail. MAIN OUTCOME MEASURES: Identification by GPs of excessive drinkers by practice audits; use of the program determined by the number of patients recruited in 3 months and by GPs' use of the intervention 6 months after training. RESULTS: 41 (43%) GPs conducted practice audits, identifying 15.1% of males and 6.6% of females as excessive drinkers (regular excessive weekly consumption and/or binge). 179 patients were recruited by 36 GPs over 3 months, and 32% of these patients reported a reduction of alcohol consumption. 63% who attended workshop training, 57% who received one-to-one training, and 36% who received the kit by mail reported they were current users of the program at 6 months. Significantly fewer GPs who received the kit by mail reported ever using the program (59%) compared to the other groups (p < 0.01). CONCLUSION: This naturalistic study found that workshops and one-to-one training sessions in doctors' surgeries achieved greater uptake of a brief intervention for problem drinkers than distribution of a special kit by mail.

Adolescent↗

PubMed1998

Worldwide survey of education on tobacco in medical schools.

OBJECTIVES: To determine the extent of teaching about tobacco, tobacco-related diseases, and smoking cessation techniques in medical schools around the world; and to ascertain the problems of getting the teaching about tobacco onto the medical curriculum. DESIGN: Cross-sectional survey. Questionnaires were sent to the 1353 medical schools in 143 countries around the world using the World Health Organization's Directory of Medical Schools. The questionnaire was translated from English into French, Russian, Mandarin, and Japanese. SUBJECTS: Deans of medical schools worldwide, or their nominees. MAIN OUTCOME MEASURES: Extent and format of teaching about tobacco in the medical curriculum, objectives and content of the courses on tobacco, and problems encountered in introducing the topic of tobacco. RESULTS: 493 medical schools responded, representing 64% of countries and 36% of schools. Only 12% of medical schools did not cover the topic of tobacco in the medical curriculum. 58% of medical schools taught about tobacco during the teaching of other subjects. 40% taught tobacco by systematically integrating teaching with other modules. 11% had a specific module on tobacco. The medical schools reported on the objectives and content of their courses on tobacco, which commonly included knowledge about tobacco-related diseases and pharmacological issues. Only a third taught about smoking cessation techniques. 22% had encountered problems in introducing the topic of tobacco, and respondents offered solutions to overcome these problems. CONCLUSIONS: Medical schools need continued encouragement to include tobacco issues in their curricula, with particular emphasis on teaching about smoking cessation techniques.

Cross-Sectional Studies↗

PubMed1997

Smoking behaviour and attitudes among Australian medical students.

Teaching about tobacco and related diseases is essential in the undergraduate medical course in order for students to gain knowledge about smoking and how to intervene with patients who smoke. The objective of the study was to assess students' smoking-related behaviour, knowledge and attitudes towards tobacco, and perceptions of their future role as doctors. Data were collected from two consecutive years of year 1 and year 5 medical students at the University of New South Wales, Sydney. A total of 594 (79%) of students across the 2 years completed the survey: 90% of year 1 students, and 69% of year 5 students. The daily smoking rate among the total medical students was 2.9%: 11.8% in year 1 (2.3% daily, 9.5% occasional) and 13.7% in year 5 (3.3% daily, 10.4% occasional). There were significantly more male than female smokers in year 5 (P < 0.05). The overall smoking rates for males in years 1 and 5 were 12.4% and 19.3%, and the smoking rates for females were 11.2% and 8%. Knowledge about the causal role of tobacco in the development of specific diseases improved significantly from year 1 to year 5 (P < 0.001). Nevertheless, in year 5 there remained a lack of knowledge about the relationship of smoking and some diseases. Fifty-seven per cent of students thought that their current knowledge was sufficient to counsel smokers, with year 5 students (89%) being far more positive than year 1 students (34%) (P < 0.001). Teaching medical students about smoking-related diseases and a patient-centred smoking cessation intervention results in an increase in knowledge, as well as positive perceptions about their future role in intervening with smokers.

Adolescent↗

PubMed1997

Three year continuous abstinence in a smoking cessation study using the nicotine transdermal patch.

A total of 305 subjects from Sydney were randomly allocated to receive either an active (24 hour transdermal nicotine patch over a 10 week course) or placebo nicotine patch. All subjects participated in a multicomponent cognitive-behavioural smoking cessation programme over five weeks in two-hour group sessions. The continuous abstinence rates at three years (validated by expired carbon monoxide) were 13.8% for the active group and 5.2% for placebo group (p = 0.011). The active nicotine patch with behavioural therapy achieved more than double the abstinence rates early in treatment compared with placebo and this difference was maintained throughout the three year follow up.

Administration, Cutaneous↗

PubMed1997

Effectiveness of a 24-hour transdermal nicotine patch in conjunction with a cognitive behavioural programme: one year outcome.

Hospital-based outpatients participating in a cognitive-behavioural group programme (2 hours/week over 5 weeks) were studied to evaluate the effectiveness of a 24-hour transdermal nicotine patch in assisting smokers to stop smoking when used as an adjunct to a cognitive-behavioural group programme, and to assess weight gain following cessation, using a randomized, double-blind, placebo-controlled trial with 12 months' follow-up. The main outcome measure was a comparison between point prevalence abstinence, continuous abstinence and 12-months sustained, biochemically validated abstinence. The validated abstinence rates at 12 months for point prevalence, sustained and continuous abstinence for subjects in the active and placebo groups were all statistically significant: 28 vs. 12%; 24 vs. 11%; and 19 vs. 9%, respectively. Moderately dependent smokers using the nicotine patch were more successful than highly dependent smokers at 3 and 6 months (p < 0.05). Weight gain was greater among sustained abstainers at 12 months compared to continuing smokers (p < 0.001). When the active nicotine patch was used in combination with cognitive-behavioural therapy in an outpatient hospital clinic, 12-months sustained abstinence rates were more than double those of a placebo patch.

Administration, Cutaneous↗

PubMed1996

General practitioners' promotion of healthy life styles: what patients think.

The study examined the prevalence of cigarette smoking, alcohol consumption, exercising to keep fit and dieting to lose weight among general practice patients, and patients' perceptions of the role of the general practitioner in advising about life style. A cross-sectional survey using a self-administered questionnaire was completed by 13,017 patients aged 18 to 70 years who were attending one of 119 general practitioners from 40 group practices in metropolitan Sydney over a six- to eight-week period. More women than men reported dieting to lose weight, just over half of the men and women were exercising regularly to keep fit, 35 per cent of men and 29 per cent of women reported smoking, and 12 per cent of men and 10 per cent of women were drinking alcohol at levels considered hazardous or harmful. More young people were smoking, drinking hazardously or harmfully, dieting to lose weight and exercising than the older age groups, and their smoking rates exceeded those of the general population. Most patients reported that general practitioners should be interested in their life-style behaviours, particularly smoking. Substantially fewer patients (particularly women who drank excessively) reported receiving advice about their habits. General practitioners were more likely to give advice when smoking and drinking levels were very high. There were discrepancies between patients' expectations of the doctor's role in promoting healthy life styles, and their likelihood of receiving advice. Doctors could reduce the diseases associated with unhealthy practices. Developments in medical training in the 1990s may extend the way they engage in advising on issues of life style.

Adolescent↗

PubMed1995

Controlled evaluation of a general practice-based brief intervention for excessive drinking.

In a controlled evaluation of general practitioner (GP)-based brief intervention, 378 excessive drinkers identified opportunistically by screening in 40 group practices in metropolitan Sydney were assigned to groups receiving: (i) a five-session intervention by the GP (the Alcoholscreen Program); (ii) a single session of 5 minutes' advice by the GP plus a self-help manual (minimal intervention); (iii) an alcohol-related assessment but no intervention; (iv) neither intervention nor assessment. Among all patients allocated to receive it, the Alcoholscreen Program did not result in a significantly greater reduction in consumption at follow-up than control conditions but patients offered Alcoholscreen reported a significantly greater reduction in alcohol-related problems in the period to 6 months follow-up. A greater proportion of patients who returned for the second Alcoholscreen visit were drinking below recommended levels at follow-up than in the remainder of the sample. There was no evidence that minimal intervention or alcohol-related assessment were effective in reducing alcohol consumption or problems. Implications for further research into GP-based brief interventions are discussed.

Adolescent↗

PubMed1994

General practitioner diagnosis of depression and dementia in the elderly: can academic detailing make a difference?

The objective was to improve the ability of general practitioners (GPs) to diagnose depression and dementia compared with standard screening measures. The setting was a retirement village on the outskirts of Sydney, Australia. The study used a prepost design with a 6 month follow-up. The intervention involved a visit to the GP by an academic detailer who spent 15 minutes discussing the diagnosis of depression and dementia. Ratings of depression and dementia on two occasions by GPs, and by independent interviews were made using the Geriatric Depression Scale, Mini-mental State Examination and Canberra Interview for the Elderly. In the case of depression, the level of agreement (Kappa) between the GPs and all instruments increased significantly by a factor of between 2.3 and 3.3. The doctors did not significantly improve in their agreement with the instruments on the diagnosis of dementia. An academic detailing approach to improving GPs' abilities in the diagnosis of depression can be effective. A controlled trial would be justified to confirm this finding.

Aged↗

PubMed1993

Weight change after smoking cessation in general practice.

OBJECTIVE: To examine weight change among patients attending a smoking cessation program administered by general practitioners. DESIGN: Body weight and smoking level were measured at the initial assessment and at a six-month follow-up visit. Pretreatment measures of demographic, attitudinal and smoking-related variables were examined for relationship to weight gain. PARTICIPANTS: A total of 235 patients who were part of a smoking cessation study in Sydney. MAIN OUTCOME MEASURE: Change in weight over six months. RESULTS: Abstainers (n = 52) gained an average of 4.0 kg, significantly more than continuing smokers who gained an average of 1.2 kg. Among abstainers, only self-ratings of good health predicted weight gain. CONCLUSIONS: Results indicate that weight gain among general practice patients following smoking cessation is similar to that in other research settings.

Adult↗

PubMed1993

Opiate receptor subtype involvement in the stimulation of prolactin release by beta-endorphin in female rats.

The prolactin secretory response to beta-endorphin and the involvement of opiate receptor subtypes in this response was determined in both diestrous and postpartum, lactating female rats. The involvement of the mu-, delta- and/or kappa-site was determined by administering specific antagonists for each of these sites prior to beta-endorphin. beta-Funaltrexamine (beta-FNA, 1 or 5 micrograms) was administered to block mu-sites, ICI 154,129 (5, 10 or 25 micrograms) blocked delta-sites and nor-binaltorphimine (norBNI, 8 micrograms) blocked kappa-sites. The ability of beta-FNA and ICI 154,129 to block prolactin secretion following morphine administration was also determined. A dose response study for beta-endorphin indicated that beta-endorphin, at doses as low as 25 ng, was a potent stimulus for prolactin release producing an increase in prolactin that mimicked the suckling-induced prolactin increase. In addition, all three antagonists were capable of antagonizing the stimulatory effect of beta-endorphin in both diestrous and postpartum female rats. These results indicate that beta-endorphin is a potent stimulus for prolactin secretion and that these three opiate receptor subtypes interact to produce its stimulatory effect on prolactin release.

Animals↗

PubMed1992

Effects of immobilization stress on tuberoinfundibular dopaminergic (TIDA) neuronal activity and prolactin levels in lactating and non-lactating female rats.

The effects of immobilization stress on the prolactin secretory response and on the activity of the tuberoinfundibular dopaminergic (TIDA) neurons were determined in intact, virgin female rats on the morning of diestrus or proestrus and in post-partum, lactating female rats. The virgin females exhibited a significant increase in circulating levels of prolactin which was evident by 1 minute and persisted during the immobilization (5 minutes). In contrast, the prolactin secretory response in lactating females was significantly attenuated compared to non-lactating animals. The activity of the TIDA neurons was not altered by the 5 minutes of stress. Even after 30 minutes of immobilization, TIDA neuronal activity was not affected in either the lactating or cycling females. These data suggest that the cycling female rat is capable of a prolactin secretory response to the stressor without inhibition of TIDA neuronal activity. It seems likely that prolactin releasing factors mediate this response. In contrast, stress did not produce a similar prolactin increase during lactation. It seems likely that, during lactation, the pituitary is not sensitive to releasing factors unless the TIDA neurons are inhibited. There appear to be differences in the sensitivity of the pituitary depending on the physiological state of the model employed.

Animals↗

PubMed1992

Estimates of the number of injecting drug users in a defined area.

Three estimates of the number of injecting drug users residing within the Eastern Sydney Area Health Service (ESAHS) were obtained by applying the capture-recapture technique to data from three reliable sources, specifically, Methadone Services, the Bourke Street Drug Advisory Service and the Albion Street Clinic. The obtained estimates were 3449, 3046 and 1103 respectively. Statewide methadone statistics were also used to obtain an estimate of 15,082 injecting drug users in New South Wales. This estimate was close to the linearly projected estimates (14,274 and 14,416) from two previous studies. Estimates based upon the methadone statistics indicate that approximately 23% of injecting drug users in New South Wales reside within the ESAHS. A sensitivity analysis was performed to assess the effects on the estimates of the likely violation of the closed population assumption.

Ambulatory Care↗