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Biomedical subjects

N Kerse

Publications and source records attributed to N Kerse.

12 recordsLinked to original sources
PubMed2005

Effect of the addition of a "help" question to two screening questions on specificity for diagnosis of depression in general practice: diagnostic validity study.

OBJECTIVE: To determine the validity of two written screening questions for depression with the addition of a question inquiring if help is needed. DESIGN: Cross sectional validation study. SETTING: 19 general practitioners in six clinics in New Zealand. PARTICIPANTS: 1025 consecutive patients receiving no psychotropic drugs. MAIN OUTCOME MEASURES: Sensitivity, specificity, and likelihood ratios of the two screening questions, the help question, combinations of the screening and help questions, and diagnosis by general practitioners. RESULTS: The help question alone had a sensitivity of 75% (95% confidence interval 60% to 85%) and a specificity of 94% (93% to 96%). The positive likelihood ratio for the help question was 13.0 (9.5 to 17.8) and the negative likelihood ratio was 0.27 (0.17 to 0.44). The likelihood ratio for patients wanting help today was 17.5 (11.8 to 31.9). The general practitioner diagnosis had a sensitivity of 79% (65% to 88%) and a specificity of 94% (92% to 95%). CONCLUSION: Adding a question inquiring if help is needed to the two screening questions for depression improves the specificity of a general practitioner diagnosis of depression.

Depressive Disorder↗
PubMed2002

Falls: a comparison of trends in community, hospital and mortality data in older Australians.

BACKGROUND AND AIMS: Falls are major contributors to disability, morbidity and death for older people. Frequently, falls-related data for each of these areas is viewed in isolation. The aim of this study was to establish trends in incidence of falls-related events including: community reporting of falls and falls-related injuries, hospitalizations as a result of accidental falls, and mortality related to accidental falls for older people in two states of Australia (Victoria and South Australia). METHODS: We analysed data sets for falls hospitalizations and mortality rates for the period 1988 to 1997, and from two longitudinal population-based proportional samples during the same time period. RESULTS: Age-standardised falls mortality rates have steadily declined in Victoria, and remained unchanged between 1988 and 1997 in South Australia. In both states, age-standardised falls hospitalization rates have increased significantly (in Victoria, RR=1.32, 95% CI: 1.30-1.34; and South Australia, RR=1.05, 95% CI: 1.03-1.06). In both states, there was a clear age-related effect, with those in the 85-year and older age group having a falls-related mortality rate approximately 40 times that of those aged 65-69 years, and a hospitalization rate 9 times that of those in the 65-69 age group. The community studies indicated that falls rates remain high among older Australians, and that injurious falls occurred in 10% in the first wave of data collection in each of these studies. CONCLUSIONS: The results highlight that various indicators related to falls trends taken in isolation may yield differing conclusions. For a true reflection of the effectiveness of falls prevention programs, falls-related mortality, hospitalization and community data need to be integrated. Increased focus on falls prevention activity in Australia during the 1990's has not reduced the magnitude of this major public health problem.

Accidental Falls↗
PubMed2002

Do delayed prescriptions reduce the use of antibiotics for the common cold? A single-blind controlled trial.

OBJECTIVE: To test the use of a delayed prescription compared with instructions to take antibiotics immediately in patients presenting to family physicians with upper respiratory tract infections (common colds). STUDY DESIGN: Randomized controlled single-blind study. POPULATION: Subjects were 129 patients presenting with the common cold who requested antibiotics or whose physicians thought they wanted them. All patients were in a family practice in Auckland, New Zealand, consisting of 15 physicians (9 male, 6 female) who had completed medical school between 1973 and 1992. OUTCOMES MEASURED: Outcomes were antibiotic use (taking at least 1 dose of the antibiotic), symptom scores, and responses to the satisfaction questions asked at the end of the study. RESULTS: Patients in the delayed-prescription group were less likely to use antibiotics (48%, 95% CI, 35%-60%) than were those instructed to take antibiotics immediately (89%, 95% CI, 76%-94%). Daily body temperature was higher in the immediate-prescription group. The lack of difference in the symptom score between the 2 groups suggests that there is no danger in delaying antibiotic prescriptions for the common cold. CONCLUSIONS: Delayed prescriptions are a safe and effective means of reducing antibiotic consumption in patients with the common cold. Clarification of patient expectations for antibiotics may result in a lower prescription rate. When the patient demands a prescription, delaying its delivery has the potential to provide gentle education.

Adult↗
PubMed2001

Evidence databases, the Internet, and general practitioners: the New Zealand story.

AIM: To determine self-reported access to and use of the Internet and the Cochrane Library by general practitioners (GPs) in New Zealand. METHODS: A national cross sectional postal and fax survey of randomly selected GPs. RESULTS: A total of 381 of 459 eligible GPs returned completed questionnaires (83%). The mean age of this sample was 45.7 years (SD 8.6) and average years in general practice was 15.7 years (SD 8.8 years). 74% (277) were male and 77% (289) in full-time practice. Internet access was present in 40% (95% CI 36-46%) of practices and 76% (72-81%) of GP's homes. The majority, 56% (51-61%), of GPs had used the Internet with regard to a patient. Younger GPs (<35 years old OR = 2.69, 95% CI 1.10-6.60) and male GPs (OR 1.72, 95% CI 1.02-2.90) were significantly more likely to report use of the Internet with respect to patients. 42% (95% CI 37-47%) of GPs were aware of the Cochrane Library but only 15% (11-19%) had used it. Those in group practice were more likely to be aware of the Cochrane database (adjusted OR 1.85, CI 1.09-3.12). CONCLUSIONS: Internet use is prevalent among GPs. Solo practitioners, older GPs and female GPs are least likely to avail themselves of this resource. Although half of GPs knew about Cochrane, a minority used it. Access and use of evidence databases can be improved in New Zealand. Strategies to assist those least likely already to use Cochrane may help our collective efforts towards evidence based practice.

Adult↗
PubMed2000

Care for older persons. Are divisional programs meeting needs?

BACKGROUND: A national forum on healthy ageing was convened for divisions of general practice in November 1998. OBJECTIVE: Views of delegates were sought regarding divisional programs for older people related to the following areas: working in collaboration; integration; the context of the older person; ageism; and structural barriers. These areas were felt to influence success of current prospects for future programs for older people. DISCUSSION: Further communication, collaboration and integration appears essential to realise the potential that general practice offers to programs for older people. Issues from the forum are discussed in relation to relevant National General Practice Strategy Review and the changes introduced into the Medical Benefits Schedule in November 1999. Consideration of these themes will aid future divisional programs for older people.

Aged↗
PubMed1998

The psychosocial health status of carers of persons with dementia: a comparison with the chronically ill.

This project aimed to determine overall psychosocial health (measured using the psychosocial dimension of the Functional Limitations Profile) and factors which influence this in a group of carers of those with dementia and to compare their psychosocial health with that of older people attending general practitioners (GPs); arthritis support groups and a pain clinic (out-patients) and a group of community dwellers undergoing renal dialysis. The carer group showed a significant decrease in recreation and pastimes and social interactions compared to older GP attenders. The carers showed similar restrictions in social interactions and recreation to those with chronic arthritis, but the latter were more impaired in the domains of emotional behaviour and sleep and rest. The older people attending a pain clinic did not differ in the areas of alertness and social interactions compared to the carer group. The dialysis group demonstrated the greatest dysfunction overall. These results suggest that the psychosocial health of carers of those with dementia is impaired, the profile of which differs from those suffering with chronic diseases. Social and recreation activities appear most affected in the carers. Commensurate with studies exploring the health status of those suffering from diseases, the measurement of the psychosocial health status of carers should also be considered in the scope of assessment and intervention.

Analysis of Variance↗
PubMed1994

Case finding in the elderly: a postal questionnaire.

AIMS: To evaluate a postal questionnaire designed to identify elderly persons in need of geriatric evaluation and intervention in the community. METHODS: A sample of elderly persons, over 75 years, was randomly selected from the age-sex register of four general practices in the Auckland area. All respondents filled out postal questionnaires and a blinded assessment was made in their own homes using validated geriatric assessment tools (the reference test). Objective evaluations were compared to self report questionnaire results and sensitivity, specificity, positive and negative predictive values were calculated. RESULTS: Sixty-four persons aged 75-93 were evaluated. Thirty-nine subjects (61%) answered the questionnaire in a way which indicated they had one or more unmet needs. Reference test evaluations showed that 23 persons (36%) had problems in one or more areas. Sensitivity for the questionnaire was 0.78 (18/23 correctly identified) and specificity was 0.49. Positive and negative predictive values were 46% and 80% respectively. CONCLUSIONS: A postal questionnaire may be a useful adjunct to health surveillance of the elderly in general practice in New Zealand.

Aged↗