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Biomedical subjects

M G Sheldon

Publications and source records attributed to M G Sheldon.

At least 19 recordsLinked to original sources
PubMed1997

A nurse practitioner as the first point of contact for urgent medical problems in a general practice setting.

OBJECTIVES: The aim of this study was to examine the suitability of nurse practitioners for assessing and managing urgent clinical problems presenting in primary care. METHODS: Patients registered at a suburban group practice presenting with acute medical problems were offered the choice of seeing a GP or a nurse practitioner. The outcomes of 1000 consultations were analysed by recording the repeat consultation rate, the prescription-issue rate and the rate of referral to secondary care, as well as investigating patient satisfaction and the number of dysfunctional consultations and misdiagnoses. RESULTS: Patients reported a high level of satisfaction with nurse practitioner consultations, and there were no recorded instances of medical sequelae due to poor diagnosis or mismanagement. Nurse and doctors saw patients with similar age and sex distributions, but the results suggested that there was a significant difference between the morbidity of problems seen. There was also a difference in the outcomes of repeat consultation rate and the prescription issue rate, although there was little difference in the rate of referral for secondary care. CONCLUSION: As patients expressed a high level of satisfaction with the nurse practitioner, this suggests that given the choice, patients in primary care can safely and effectively 'self triage' themselves between GPs and nurse practitioners.

Family Practice↗
PubMed1989

The Christian approach to whole-person medicine.

A working party with representatives from the Royal College of General Practitioners and the Churches' Council for Health and Healing has produced a report on the Christian approach to whole-person medicine. This emphasizes the importance of including the spiritual dimension of man in health care problems and urges closer cooperation between health care professionals and Christian ministers. Some of the difficulties inherent in this approach are highlighted in this paper and some proposals for further progress outlined.

Christianity↗
PubMed1985

Review of the health of children in one-parent families.

The evidence from the few published studies concerning the physical health of children in one-parent families, suggests that these children have both a higher rate of hospitalization and a higher consulting rate with their general practitioner than two-parent children. There is also an indication that children in one-parent families suffer more health problems in the home than children in two-parent families. However, the studies that have been reviewed provide neither detailed nor confirmed results and at present the character of child health in one-parent families remains uncertain.

Adolescent↗
PubMed1984

Use of deputising services and night visit rates in general practice.

Examining all of the claim forms for night visits submitted to the Nottingham Family Practitioner Committee over a three month period allowed us to calculate the night visit rate for all 184 practices in Nottinghamshire. To take all of the practices together the mean night visit rate (covering all visits requested and made between 11 00 pm and 7 00 am) was 15.5 visits per 1000 patients a year, range 1.2 to 46.1. Whether or not a deputising service is used accounted for 12% of the total variance detected, while the other factors studied, such as area of practice, patient list size, and number of partners, accounted for approximately 1% each. The local deputising service responds to 97% of night calls with a visit to the patient, whereas the patient's own doctor is more likely to provide advice over the telephone. The ability to provide telephone advice, however, will vary according to the breakdown of the practice by age and social class.

England↗
PubMed1984

A general practice evaluation of pivmecillinam given twice daily as a treatment for acute urinary tract infection.

In a multi-centre study in general practice, 292 female patients with acute urinary tract infection received a 5-day course of pivmecillinam at a dosage of either 200 mg or 400 mg twice-daily. Positive bacteriological cultures were obtained from 64 (31%) of 206 patients for whom bacteriological data was complete, and bacteriological cures were obtained in all 38 patients in the lower dose group and 22 (85%) of the 26 patients in the higher dose group. An equally good clinical response was seen with both treatments and the mean symptom score (maximum possible 15) was reduced from 7.46 to 0.73. Side-effects were reported for 7 (4%) patients in the lower dose group and 11 (10%) patients in the higher dose group. Two patients in each group ceased treatment due to nausea, which was the most frequently reported complaint.

Adolescent↗
PubMed1984

The accuracy of age-sex registers in general practice.

A ;point-prevalent evaluation' of the accuracy of the age-sex register (ASR) was undertaken in 10 general practices. The average ASR inflation rate was 4 per cent when compared with the Family Practitioner Committee (FPC) register (range 2.2-8.3 per cent) and 7.2 per cent when compared with the patients themselves (range 2.6-19.4 per cent). List deflation was no more than 2 per cent overall. There was a wide interpractice variation in the accuracy of the ASR, and two of the factors that may be associated with this are the situation in an inner city renewal area and a large proportion of patients in the 20-40 years age group. When the patients were asked to verify the information contained on the ASR it was found that the address was incorrect for 10 per cent of patients (range 5.0-20.0 per cent) and the date of birth was incorrect for 5 per cent.Before using it for research purposes, the ASR should be checked against the FPC register, and in view of our findings it should also be checked with a sample of the patients themselves to ensure a sufficiently accurate population denominator.

England↗
PubMed1983

Controlled trial of faecal occult blood testing in the detection of colorectal cancer.

20 525 patients from general practitioners' lists were randomly allocated into test and control groups. The 10 253 test subjects were invited to perform haemoccult faecal occult blood testing over 3 days. 3613 (36 . 8%) of the 9807 who received their invitations completed the test. Compliance was improved by direct invitation from the general practitioner and by prior health education by letter or interview. 77 people (2 . 1%) had a positive test result, and 50% of these on investigation had neoplastic disease--12 had invasive carcinomas (9 Dukes' stage A, 2 stage B, 1 stage C) and 27 had 40 adenomas (12 over 2 cm, 2 of which contained areas of severe dysplasia). In the year following the screening test 1 carcinoma (stage C) has presented in the group which accepted the test, and 10 carcinomas (4 stage B, 4 stage C, 2 stage D) have presented in the control group. This respresents a 3 . 6 times greater detection rate per 1000 persons in the test group than in the control group. Only 8 adenomas have presented in the control and non-responding groups. Fibreoptic sigmoidoscopy identified the 10 carcinomas within its range and 39 of the 40 adenomas. Double-contrast barium enema identified only 9 of the 12 carcinomas and 24 (62%) of the 40 adenomas. All 3 carcinomas not identified by barium enema were polypoid Dukes' stage-A lesions.

Adenoma↗
PubMed1982

Giving patients a copy of their computer medical record.

Medical summaries were prepared by a general practitioner for inclusion in a computer system. Both the medical records and a patient-filled questionnaire were used. A representative sample of the practice population were then sent their summaries. In creating the summaries the general practitioner felt the need to exclude 11 diagnoses whenever they appeared (5 per cent of the patients), and to suppress one or more diagnoses in a further 14 per cent of patients. In 2 per cent of summaries the general practitioner felt unable to give a copy to the patient because he was afraid of an adverse reaction by the patient or immediate relatives.The patients' views of the usefulness of the summaries, and of their accuracy and completeness, were sought by a questionnaire. Replies were received from 71 per cent; of these, 91 per cent reported that they thought the summary useful. However, in 18 per cent of cases, the patients requested additions, corrections or deletions. Only 1 per cent of patients replied that they definitely did not like the idea of a computer containing their medical information.Some of the benefits and difficulties both of using a computer to store medical information, and of giving the patient a copy of the medical summary, are discussed.

Computers↗
PubMed1979

Self-audit of prescribing habits and clinical care in general practice.

General practitioners' prescribing habits were studied using encounter forms during a period of three years. Analysis of the first year's forms revealed examples of inappropriate prescribing, so an audit was undertaken on the treatment of fungal skin infections and coughs and colds in children. Data collection was continued for a further year to measure any changes in prescribing. Analysis after audit showed that more appropriate prescribing had reduced the number of drugs prescribed as well as the number of repeat consultations needed before resolution of the problem. These findings suggest that the continuous use of encounter forms can accurately reveal the prescribing habits of general practitioners. Self-audit can then be performed on a continuing basis with little disruption of the general practitioner's normal routine.

Adolescent↗
PubMed1976

A trial of Fortagesic and Paramol 118 in osteoarthritis.

Fortagesic was compared with Paramol 118 in a fourteen day single-blind crossover study in patients with moderate pain due to osteoarthritis. Both preparations were shown to be similarly effective. More side-effects were seen with Paramol 118 than with Fortagesic and more patients preferred Fortagesic. These differences were not statistically significant, but it is concluded that Fortagesic is a useful effective analgesic for standard use in moderate pain.

Acetaminophen↗