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Biomedical subjects

M J Sladden

Publications and source records attributed to M J Sladden.

14 recordsLinked to original sources
PubMed2000

Community study of uncomplicated lower urinary tract symptoms among male Italien immigrants in Sydney, Australia.

OBJECTIVE: To determine the prevalence, levels of bother and self-reported management of lower urinary tract symptoms (LUTS) in Italian-born men aged 40-80 years. METHOD: 305 randomly selected men aged 40-80 years (72% response rate) participated in a community-based study (computer-assisted telephone survey) in early 1997 in Sydney, Australia. RESULTS: LUTS are common: 41% of men needed to wake up at least once at night to urinate; 35% indicated they had terminal dribbling 'sometimes' or 'frequently'; 31% experienced urgency although few (3%) had urge incontinence; 19% could retain urine in their bladder during the day for no more than 2 h, and 19% experienced hesitancy. Urinary symptoms correlated moderately/poorly with self-rated bother. The prevalence of bothersome frequency and urgency was significantly age-related. Only half (n = 49, 52%) of the men bothered by urinary symptoms had seen a general practitioner (GP) about these symptoms in the last 5 years: of these three quarters had been referred to a urologist and half of these had received surgical treatment. Anxiety about prostate cancer, but not the degree of bother from urinary symptoms, independently predicted attendance at a GP (adjusted odds ratio 6.4, p = 0.006). CONCLUSIONS: Although LUTS are common in Italian-born men, their experiences of bother do not correlate well with symptoms and do not appear to influence referral and treatment. Education is needed to improve men's understanding of the importance of 'bother' as an indicator for urological surgery.

Adult↗
PubMed1999

Australian general practitioners' views and use of colorectal cancer screening tests.

OBJECTIVES: To determine general practitioners' (GPs) current beliefs, knowledge and self-reported practices of screening for colorectal cancer. DESIGN AND SETTING: Postal survey of national random sample of 1271 GPs in 1996. OUTCOME MEASURES: GP views on effectiveness of faecal occult blood testing (FOBT) and flexible sigmoidoscopy in reducing premature death from colorectal cancer in "average-risk" patients (asymptomatic with no family history); views on frequency of tests and target group; use of these tests; and independent predictors of views and use. RESULTS: Response rate was 67%. FOBT and flexible sigmoidoscopy were said to be effective as screening tests by 38% and 61% of GPs, respectively, but 30% and 25% were unsure. Independent predictors of belief in screening effectiveness were State of practice (for FOBT), male sex and awareness of Gut Foundation guidelines (for flexible sigmoidoscopy) and increasing age (for both). Most often chosen screening frequencies were every year for FOBT (29%), and five-yearly for flexible sigmoidoscopy (24%), although 19% and 26%, respectively, were unsure of the appropriate screening interval. Most often cited target group was people aged over 40 years with first-degree relatives with colorectal cancer: 63% of GPs would offer FOBT and 74%, flexible sigmoidoscopy. Fewer than 3% of GPs were likely to adopt an opportunistic approach to screening, yet 15% would be highly likely to recommend FOBT during a dedicated health check-up for a 58-year-old male patient, and 9% for a female patient. CONCLUSION: The absence to date of a coherent national policy on colorectal cancer screening is associated with wide variations in views and practice that are inconsistent with the available evidence. If GPs are to be involved in implementing population screening, national policy must be widely and effectively promulgated.

Adult↗
PubMed1999

Skin cancer screening by Australian family physicians: variation with physician beliefs and geographic locality.

INTRODUCTION: Australian national policies do not recommend skin cancer screening. We measured family physicians' beliefs, self-reported practices, and predictors of using clinical skin examination for skin cancer screening. METHOD: Random self-administered postal survey of 1271 Australian family physicians (FPs) performed during 1996, obtaining 855 completed questionnaires (67% response rate). RESULTS: Eighty-six percent of FPs surveyed indicated that they thought clinical skin examination was effective in reducing premature death from skin cancer; 72% indicated that they should be performed annually; and 60% indicated that all adults should be screened. Only 3% indicated correctly that screening has not been tested to determine its effectiveness. Although most FPs were unlikely to adopt an opportunistic approach to screening, 64% indicated that they would recommend clinical skin examination during a health check-up. FPs in northern (high incidence) latitudes were 3 to 4 times more likely to adopt opportunistic screening, and twice as likely to discuss clinical skin examination in a dedicated check-up. FPs were more likely to advocate screening in male rather than female patients. Half of respondents were unaware of relevant guidelines. CONCLUSION: Although Australian policies do not recommend clinical skin examination because of insufficient evidence as yet of effectiveness, FPs show considerable support for screening. Geographic location, patient gender, and physician beliefs predict the self-reported provision of clinical skin examination by family physicians, suggesting that factors other than published guidelines affect clinical practice.

Adult↗
PubMed1999

An evaluation of a surveillance system for patients discharged from the acute psychiatry unit in southern Tasmania.

OBJECTIVES: The aim is to evaluate the current community follow-up, or health surveillance, system for patients discharged from the acute psychiatry unit into the community in southern Tasmania. METHOD: We developed a conceptual model which considered community mental health follow-up as analogous to an epidemiological surveillance system. The surveillance system was evaluated by prospectively following recorded contacts between the system and a cohort of 100 patients consecutively discharged from the acute psychiatry unit. Main outcome measures were attendance at follow-up appointments, patient re-engagement and hospital readmission. RESULTS: There is no formal system of follow-up and no policy relating to non-attenders of follow-up appointments after psychiatric hospitalisation. There is no defined role for private medical practitioners and agencies in the community. Of the 97 patients considered to need community follow-up, 11 patients were lost to follow-up after 3 months, while another 15 remained in the system because of hospital readmission. A further seven patients returned to the system during the following 2 years (six in year 1 and one in year 2) due to readmission. There is appropriate policy about the content and timing of discharge summaries; most summaries were sent promptly. CONCLUSIONS: After discharge from the acute psychiatric unit, there was inadequate community follow-up of those patients for whom follow-up was considered necessary. Research is needed to determine whether increased patient follow-up is beneficial. Stakeholders should decide whether formal follow-up or health surveillance is necessary.

Adolescent↗
PubMed1999

Do Australian family physicians screen smokers for lung cancer?

STUDY OBJECTIVES: To determine family physicians' perceptions of the effectiveness of chest radiographs (CXRs) in reducing premature mortality from lung cancer and their self-reported levels of screening asymptomatic heavy smokers. DESIGN: National postal survey of 1,271 family physicians, obtaining 855 completed questionnaires (67% response rate). SETTING AND PARTICIPANTS: Random sample of Australian family physicians. MEASUREMENTS AND RESULTS: One in five (n = 169, 20%) indicated that an annual CXR was an effective screening test. Older physicians were significantly more likely to hold this view (p < 0.0001). Nearly 25% (n = 190, 22.5%) reported that they recommend an annual CXR as a screening test for asymptomatic heavy smokers. Three variables independently predicted such a practice: increasing physician age (p = 0.0085), being in solo practice (p = 0.0068), and the aforementioned belief in its effectiveness (p < 0.0001). CONCLUSIONS: A substantial minority of family physicians recommends an annual CXR as a screening test despite contradictory evidence from randomized controlled trials. These significant variations in the absence of epidemiologic evidence invite further research to develop effective, efficient, and affordable preventive care in family practice.

Attitude of Health Personnel↗
PubMed1999

Rectal bleeding in general practice patients.

OBJECTIVE: To determine the prevalence of observed rectal bleeding in general practice patients, the health seeking behaviour of those with rectal bleeding, and what rectal bleeding 'means' to patients in terms of perceived health risk. METHOD: Self administered questionnaire survey of general practice patients aged 50 years and over in northern Tasmania recruited as they visited their general practitioner (GP). RESULTS: The reported lifetime prevalence of rectal bleeding in our sample was 33% (299 of 903 respondents). It was more common in younger people, becoming less common with increasing age. Many respondents do not examine for bleeding. Only 45% of respondents with rectal bleeding consulted their GP about the most recent bleed. Patients were more likely to consult if they reported blood in the toilet pan and if they sought advice from a family member. There were significant differences between the meaning of bleeding for GP consulters and non consulters. This may have important implications for health education. CONCLUSION: Colorectal cancer (CRC) is a common problem managed by a combination of screening and case finding. With the high prevalence of rectal bleeding and low consultation rates for this problem there is potential to enhance the effectiveness of early detection of CRC through general practice based public health and education campaigns.

Adult↗
PubMed1995

General practitioners' attitudes to screening for prostate and testicular cancers.

OBJECTIVE: To assess general practitioners' (GPs') perceptions of the effectiveness of screening for prostate and testicular cancers, and their self-reported levels of screening for these conditions in the light of the conflicting advice available to GPs, and a lack of evidence to support testing for either of these cancers. DESIGN: A questionnaire sent to all 101 GPs in the Division of General Practice, southern Tasmania. RESULTS: There was an 82% response rate to the questionnaire. GPs had an accurate knowledge of the epidemiology of these cancers. Of 57 GPs who thought that digital rectal examination was an effective screening test for prostate cancer, 56 said they should screen asymptomatic patients but only 37 said they actually did screen. The corresponding results for prostate-specific antigen screening were 45, 26 and 13, respectively. For testicular cancer screening, 59 GPs thought that clinical examination of the testes was an effective screening test, 55 said they should screen asymptomatic patients but only 21 said they actually did screen. Corresponding results for testicular self-examination were 56, 57 and 21, respectively. CONCLUSIONS: Many GPs are uncertain about the tests available for screening for prostate and testicular cancers. Some think they should screen, but few do so consistently. Clear and precise evidence-based guidelines for screening for these conditions are necessary.

Adult↗
PubMed1989

How many GP referrals to dermatology outpatients are really necessary?

In a survey of patients referred to the dermatology outpatients department of a British teaching hospital, 26% of referrals were considered unnecessary by a senior house officer with three months practical dermatological experience. We conclude that better undergraduate and postgraduate education in dermatology is essential. A period spent in dermatology should be included in all vocational training schemes for general practice.

Ambulatory Care↗
PubMedDate not supplied

How do general practitioners manage rectal bleeding?

OBJECTIVE: To determine how general practitioners (GPs) in northern Tasmania manage rectal bleeding in terms of examination, referral, and patient investigation and estimate the value of early diagnosis of colorectal cancer (CRC). METHOD: Self reported postal questionnaire survey sent to 100 randomly selected GPs in northern Tasmania. RESULTS: Sixty-eight per cent of GPs responded. The clinical action proposed by GPs varied considerably according to patient age and type of rectal bleeding. The proportion of GPs who would refer a patient to a specialist varied from 15 to 100% depending on the specific scenario. Responses were not consistent with the available consensus guidelines and evidence. Most GPs believed that early diagnosis of CRC through screening and the early detection of rectal bleeding improved outcomes. However, fewer than half the respondents believed that there were clear guidelines about the management of a patient with rectal bleeding, emphasising the need for evidence-based guidelines which are effectively disseminated and clinically evaluated. Rural GPs indicated that distance from specialist investigation and referral centres would influence patient management. CONCLUSIONS: There is a wide variation in the way GPs manage rectal bleeding and inconsistent knowledge about the existence of guidelines for managing rectal bleeding. Evidence-based education about the management of this common clinical problem, which is effectively disseminated and clinically evaluated, would seem appropriate.

Adult↗