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Biomedical subjects

L McCall

Publications and source records attributed to L McCall.

At least 19 recordsLinked to original sources
PubMed2001

The patient perspective survey. Can consultations for complex health problems be enhanced?

BACKGROUND: Patients with complex health problems pose particular difficulties due to the interaction between psychosocial factors and physical disease. The aim of this study is to investigate the usefulness of a paper based instrument (the Patient Perspective Survey, or PPS) to enhance general practitioner-patient communication and patients' self reported coping skills. METHODS: A previously validated questionnaire was modified and distributed to a self selected group of 21 GPs. They recruited 77 patients with complex health problems and asked them to complete a PPS questionnaire. The patients then returned for an extended consultation to discuss the results of the questionnaire with the GP. Patients and GPs subsequently completed PPS evaluation forms. RESULTS: The PPS was useful for patients with chronic conditions with mixed physical and psychological components. It appeared to enhance the GP-patient relationship and gave patients a better understanding of their coping skills. DISCUSSION: Patients with complex health problems can use paper based questionnaires to improve the quality of communication between themselves and their GPs.

Adaptation, Psychological↗
PubMed2000

Explaining levels of within-group wage inequality in U.S. labor markets.

Most research on earnings inequality has focused on the growing gap between workers of different races and at different education, age, and income levels, but a large portion of the increasing inequality has actually occurred within these groups. This article focuses on the extent and sources of "within-group" wage inequality in more than 500 labor markets in the United States in 1990. In addition to documenting that within-group wage inequality across regions varies more widely today than over the past several decades, the analysis reveals that two frequently cited explanations of rising wage inequality over time have little impact on within-group wage inequality when measured at the local labor market level: (1) industrial shifts and (2) increased technology and trade. By contrast, flexible and insecure employment conditions (e.g., unemployment, contingent work, and immigration) are associated strongly with high local levels of within-group wage inequality, especially among women.

Career Mobility↗
PubMed2000

Distance education. Part 1. Conceptualization and development.

INTRODUCTION: The Graduate Diploma/Masters in Family Medicine were developed at Monash University as distance education courses from a previous on-campus version of a Masters course in response to real and perceived needs for more flexible forms of delivery. METHOD: Conceptualization and development involved consultation with experts in distance education and the application of adult learning principles, phenomenology and constructivism in course design. CONCLUSION: Despite initial difficulties and delays, course objectives were met through the application of standardised distance learning and teaching methods applied to four core and 15 clinical elective subjects. These were developed within a three year period for delivery in a predominantly paper based format.

Adult↗
PubMed2000

Distance education. Part 2. Student characteristics, program characteristics, administration and future direction.

INTRODUCTION: A descriptive analysis of student and program characteristics was undertaken. METHOD: Data were obtained using student enrollment forms, periodic surveys and regular feedback which formed part of the formative evaluation. RESULTS: In the five year period 1992-1996, 433 doctors enrolled in the Graduate Diploma, of which 56 proceeded onto Masters. Of the 433, 60% were male. The mean age of students was 41 years, with rural (49%) and solo (45%) practitioners over-represented; 20% held the FRACGP and 15% resided outside Australia. Around 20% deferred or withdrew during the five year period. Of the 56 Masters enrollments, 16 had completed the degree in minimum time, with a further 30 completing within two years. Reasons for enrollment were largely professional with many students expressing the need to overcome isolation and gain intellectual stimulation. CONCLUSION: This Diploma/Masters course which has a strong clinical component has attracted considerable interest among established general practitioners. The program appears to have succeeded because of its flexible delivery, lack of exclusive research orientation and its firm grounding in general practice.

Adult↗
PubMed2000

Distance education. Part 3. Assessment of and feedback to students at a distance.

INTRODUCTION: Assessment of students at distance, in a course with over 20 units (subjects), provides special challenges in providing timely, accurate and detailed feedback both formatively and summatively. METHOD: A description of assessment practices including reflective journals, essays, critical appraisal of literature, case studies or teaching presentations in video and written format, clinical audits, and large research projects is provided. The impact of a multitude of criterion-referenced methods of students, teachers and administrative services as well as quality assurance issues are measured. CONCLUSION: Students preferred multiple levels of formative and summative assessment using criterion referencing to exams. These methods were thought to be contextually relevant to clinical practice and examined knowledge, cognition and performance appropriately. Length of assessment task, difficulty with English as a second language and lack of detail or clarity on written feedback posed problems for a number of students. Quality assurance procedures have been put into place to rectify some of these problems.

Clinical Competence↗
PubMed2000

Distance education. Part 4. Supervision of family medicine research at a distance. A formative evaluation.

INTRODUCTION: A survey on supervision of research projects was undertaken among current general practitioner students, recent graduates and supervisors of a Masters of Family Medicine degree. The aim was to describe and compare the experience of the three groups and, in particular, to identify the problems associated with distance supervision. METHODS: A self-administered questionnaire survey was distributed to current students (n = 21), graduates (n = 16) and current supervisors (n = 7). RESULTS: Forty out of 44 doctors returned completed questionnaires. Distance was a relatively minor barrier to successful supervision, provided that the student and supervisor established good communication patterns and were able to respond to each other with minimal delay. The commencement of the study and its final write-up were critical phases in the supervision process. DISCUSSION: Communication, including emotional and psychological support, was at least as important as expert opinion in helping Masters students to successfully complete their research projects. Attention must be paid to establishing good understanding and regular means of communication at the beginning of the supervisory process.

Data Collection↗
PubMed2000

Distance education. Part 5. Family medicine research at a distance. Guidelines for supervisors.

INTRODUCTION: This paper recommends guidelines for the supervision of Masters degrees or similar postgraduate courses, in which research projects are supervised at a distance. METHODS: The guidelines are based on the experiences of the authors with a five year old Masters of Family Medicine degree and a formative evaluation conducted by questionnaire survey among its students, graduates and supervisors. RESULTS: It is important to establish ground rules for communication at an early point in the supervisory process. Supervisors need to take into account psychosocial, pedagogical and organisational aspects of their mentorship of students. DISCUSSION: These guidelines are relevant to courses where there remains a strong one-to-one relationship between supervisors and students. In these cases, 'distance' need not be a barrier provided that both sides are aware of and committed to maintaining good patterns of communications with each other.

Communication↗
PubMed2000

Distance education. Part 6. Evaluation of a core subject within the Graduate Diploma/Masters in Family Medicine. Principles of general practice.

AIM: To evaluate 'Principles of General Practice' (formerly known as the Academic Basis of General Practice), a core unit of the Graduate Diploma/Masters in Family Medicine. METHOD: Content analysis of feedback sheets and transcripts from teleconferences were analysed to facilitate the process evaluation of this core unit. Content analysis of qualitative responses to the question: 'What did you learn?' at the end of the course formed the impact evaluation. RESULTS: GPs who participated in the evaluation of the Principles of General Practice highlighted four learning outcomes in response to the question: 'What did you learn?' Categories included discipline specific and patient specific. Personal and professional outcomes were further divided into the following subcategories: affirmation of current practice; confidence in dealing with uncertainty; engaging in reflective practice; overcoming professional isolation; and providing opportunities for career change. CONCLUSIONS: The most cited reasons for participating in this course were the professional and personal. Students found that the course clarified their roles, raised self-esteem and confidence, and provided them with a sense of pride in their profession. The reflective learning style resulted in students gaining insight into themselves and their therapeutic roles, with reported changes in clinical practice, including more confidence in dealing with uncertainty. In addition to meeting course objectives there were a number of unanticipated outcomes identified. The most surprising was the recognition that general practice was a medical specialty, supported by a body of literature. For some, this assisted them to overcome feelings of professional isolation and alienation. A number of students saw this course as a stimulus to blending their clinical work with a teaching role to enhance professional growth and satisfaction.

Clinical Competence↗
PubMed2000

Distance education. Part 7. Evaluation of the Graduate Diploma of Family Medicine. Does a distance education course for GPs influence their reported clinical and professional practice?

INTRODUCTION: Course evaluation is essential for continuous enhancement of teaching. This evaluation aimed to assess the impact of the Graduate Diploma of Family Medicine on the clinical practices, community activities, learning styles and personal lives of its graduates. METHODS: Cross-sectional postal questionnaire survey of all 1993 to 1997 graduates of the Graduate Diploma in Family Medicine (n = 233). RESULTS: A response rate of 70% was achieved. Male respondents felt that they treated a greater variety of conditions (p = 0.04), had undertaken more procedural work (p = 0.03), and had increased procedural confidence (p = 0.009) compared to female respondents, while the female respondents referred more (p = 0.03). Solo practitioners tended to look for evidence in clinical decision making (p = 0.006) and applied critical appraisal techniques when reading medical information provided by pharmaceutical representatives (p = 0.04). Group practitioners tended to participate in more research projects (other than drug trials) than solo practitioners (p = 0.03). There was a difference between full and part time general practitioners, even after controlling for gender, with the former more certain that general practice is where they wanted to be (p = 0.005), they also felt more competent in interpreting data, e.g. ECGs (p = 0.013). More male students indicated they preferred a reflective learning style than females (p = 0.04). CONCLUSION: The clinical electives of the Graduate Diploma in Family Medicine had the most significant impact on the clinical practices of full time GPs who were predominantly male graduates. Gender differences were apparent in styles of practice as males tended to conduct more procedural work, while female graduates preferred the gatekeeper role and referred more. The course also impacted on the students' approach to evidence in their clinical decision making. They were more critical of medical information provided by pharmaceutical representatives who are one of the major sources of CME for many GPs. Future evaluations should be based on experimental and quasi-experimental designs in order to measure changes in student perceptions and clinical practice, as well as more objective measures of learning styles.

Adult↗
PubMed1999

Targeting the right journal.

While research is scientific, publication is a mixture of science and political pragmatism. Targeting the right journal is influenced by the following factors: the discipline that best represents the subject; the purpose of the message; the audience who are to be recipients of the message; the realities of geographic parochialism; the desire of authors to maximise personal and professional opportunities. If the originally targeted journal rejects the article, authors should have alternative publication strategies that give them professional recognition without requiring them to compromise the message or their ethics.

Australia↗
PubMed1999

Preventive health behaviour among general practitioners in Victoria.

UNLABELLED: This study describes the preventive health behaviour of general practitioners in Victoria, with particular emphasis on hepatitis B prevention, and their use of medical services, and seeks to explain these behaviours. METHODS: Cross sectional postal questionnaire survey of a 10% random sample (n = 544) of all GPs in Victoria, Australia. RESULTS: A valid response rate of 58.5% was achieved. Only 4% of the sample smoked, 93% had a blood pressure check in the past 3 years, and 64% had a cholesterol check in the past 3 years. About half followed a 'healthy' diet and 20% took a high level of physical exercise. With regard to hepatitis B prevention, 87% had completed vaccination, and 49% had confirmed immunity. Needlestick injuries had been suffered by 49% in the previous year, and half of the respondents would take no action after such an event. Over two-thirds (69%) reported having no GP. Psychological factors were associated with preventive health behaviour independent of age and gender. Internal locus of control and health value were positively associated with whether the doctor would take any action after needlestick injury, had a blood pressure or cholesterol test in the past 3 years or had their own GP. CONCLUSION: This study shows that GPs in Victoria have a relatively high level of preventive health activity although they have a low level of utilisation of their GP colleagues in service provision. There are measurable differences in psychological variables between doctors that are associated with their level of preventive care. Plans to improve their personal health care should concentrate on psychological well being.

Adult↗
PubMed1999

Gastroesophageal reflux and quality of life. Patient's knowledge, attitudes and perceptions.

INTRODUCTION: Gastroesophageal reflux (GER) is one of the most common conditions seen in general practice. The objective of this study was to determine patients' knowledge and attitudes about GER and its effects on their stated quality of life. METHODS: A cross sectional survey using a self administered questionnaire of a random sample of 400 patients, from the principal author's practice in outer western Sydney. RESULTS: GER affected 53% of this sample of patients with Asians and manual workers being overrepresented. In 62% of these, GER was shown to adversely affect quality of life. Most patients in this study (70%) were unaware of the potentially serious complications of GER. CONCLUSION: The prevalence of GER and the impact of the condition on sufferers' quality of life is generally unknown but requires further research. A history of cough and hoarse voice with no known cause, should be investigated for GER. Most patients are unaware of the serious complications of GER and should be educated about these.

Adult↗
PubMed1998

Perspective from the Department of Defense Breast Cancer Research Program.

The Department of Defense (DOD), Breast Cancer Research Program (BCRP) was established in 1993. Since its inception, Congress has appropriated more than 878 million dollars for the BCRP, a unique public-private partnership between the DOD, consumer advocacy, and scientific communities which has funded approximately 1,800 breast cancer research grants. Through this partnership, the BCRP designed a model program for consumer involvement in scientific peer review. This paper describes the BCRP's approach to the processes of recruitment, selection, and preparation of consumers for this expanded role. Further, factors critical to program implementation, such as effective program management, ongoing process improvement, strong program leadership, and allocation of resources, that led to the BCRP's success in developing the previously undefined role of breast cancer survivors as members of scientific peer review panels are discussed. The BCRP demonstrates the feasibility and unique contributions of consumers in scientific peer review and provides a critical foundation for future efforts to ensure consumer involvement in scientific research programs.

Journal Article↗
PubMed1997

Pleasantness, activation, and sex differences in advertising.

Advertisements in men's, women's, girls', and boys' magazines (n = 38,195 words) were scored objectively in terms of 15 measures of linguistic style, e.g., use of common words, use of long words, use of specific words and emotional tone (pleasantness and activation, as measured by the Dictionary of Affect). There were several sex- and age-related differences among advertisements from different sources. Advertisements from boys' magazines were extremely active, those from women's and girls' magazines were shorter and unusually pleasant. In two follow-up studies (N = 122 volunteers), objective emotional measures of advertising text proved to be related to ratings of persuasion and of success of appeal for individual advertisements. The most preferred advertisement for women was pleasant and active, that for men unpleasant and active. When men and women created advertisements, women's were shorter and more pleasant.

Adolescent↗
PubMed1995

At(a-) phenotype: description of a family and reduced survival of At(a+) red cells in a proposita with anti-Ata.

BACKGROUND: There is a paucity of data on the August (At) blood group antigen and clinical significance of anti-Ata. STUDY DESIGN AND METHODS: A proposita with the At(a-) phenotype was identified by the finding of anti-Ata in the cord blood eluate of her fifth live infant. Family members were studied, and a small aliquot of 51Cr-labeled At(a+) red cells was transfused to determine survival. RESULTS: There was no evidence of hemolytic disease of the newborn, as determined by the normal hemoglobin and bilirubin and normal clinical conditions. Six of seven siblings were tested, and two At(a-) female siblings were identified. In contrast to the proposita, neither sister had detectable anti-Ata in her serum, although each has had only one pregnancy. A monocyte monolayer assay performed on serum from the proposita gave a result of 20-percent hemolysis (normal, <3%), which is consistent with a clinically significant antibody. Transfusion of a small volume of allogeneic red cells that were phenotypically matched with the proposita, except for Ata, resulted in a 1-hour survival of 95 percent, but a 24-hour survival of only 18 percent, of the transfused cells. The survival pattern was exponential, which is characteristic of a non-complement-binding IgG antibody. CONCLUSION: Despite the absence of hemolytic disease of the newborn, this example of anti-Ata would appear to be a clinically significant antibody for the purposes of transfusion practice. Therefore, approaches to the management of clinical situations in which transfusion is required or likely should focus on the availability of autologous cells or frozen allogeneic At(a-) red cells.

Black People↗
PubMed1992

Case report: hemolytic anemia produced by tolmetin.

Tolmetin, a nonsteroidal anti-inflammatory drug, was found to be the etiologic agent in a case of drug-induced hemolytic anemia. A 35-year-old female who had ingested tolmetin sporadically in the past took two doses that resulted in acute hemolysis. Two days after taking the second dose, she had a hemoglobin of 7.0 g/dL, increased serum lactate dehydrogenase, reticulocytosis, and indirect reacting hyperbilirubinemia. The direct antiglobulin test was weakly positive with anti-IgG and anticomplement reagents. The patient's serum was nonreactive with reagent red cells in the absence of tolmetin, but addition of tolmetin to the serum resulted in strong agglutination of all reagent red cells tested. Serologic evaluation of this patient's serum indicated that tolmetin caused hemolysis by an immune complex mechanism. Hemolysis subsided and anemia improved spontaneously.

Journal Article↗
PubMed1984

Nucleus basalis magnocellularis: optimal coordinates for selective reduction of choline acetyltransferase in frontal neocortex by ibotenic acid injections.

The present experiment was designed to determine the optimal placement of ibotenic acid in the nucleus basalis magnocellularis (NBM) in order to get a substantial destruction of cholinergic input to the frontolateral cortex, while sparing that to the hippocampus. Two different volumes of ibotenic acid were injected at four different placements in the basal forebrain. Choline acetyltransferase (ChAT) levels were measured in three regions of neocortex and two regions of hippocampus. Lesions in the NBM produced significant decreases in neocortical ChAT (up to 54%), with the greatest and most extensive effects being produced by lesions that were more lateral and caudal (0.9 mm posterior to Bremga; 2.6 mm lateral to the midline). All lesions that were placed 0.4 mm posterior to bregma, or placed 2.0 mm lateral to the midline, produced significant decreases in ChAT activity levels in the ventral hippocampus. The results show that the specific coordinates and volumes of ibotenic acid are critical to produce selective and substantial destruction of cells in the NBM. These findings have substantial implications for the interpretation of results of experiments examining the behavioral changes that occur following injections of ibotenic acid into the NBM.

Animals↗