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Nigel Stocks

Publications and source records attributed to Nigel Stocks.

11 recordsLinked to original sources
PubMed2006

Point of care testing for C-reactive protein - a new path for Australian GPs?

BACKGROUND: New approaches are needed to reduce antibiotic usage in respiratory tract infections in general practice without compromising patient safety. Point of care tests for C-reactive protein (CRP) are now being used for this purpose in some European countries. OBJECTIVE: Current knowledge about the CRP response in respiratory tract infections is presented, as well as the usefulness of applying the test when sinusitis and pneumonia may be suspected. DISCUSSION: A promising ability of the test in ruling in or out severe infection has been demonstrated in clinical studies. There are still controversies about the use of the CRP test in respiratory tract infections, however clinical research supports its use for some conditions, and therefore introduction into Australian general practice should be considered. Further evaluation of its utility is needed.

Australia↗
PubMed2005

Management of hyperlipidaemia.

BACKGROUND: Hyperlipidaemia is a general term for elevated concentrations of any or all lipids in the plasma. An elevated cholesterol is one of several risk factors for coronary heart disease (CHD). In Australia, the use of cholesterol lowering drugs, mainly statins, consumes over 880 million dollars or 16% of the Pharmaceutical Benefits Scheme drug budget and is growing. OBJECTIVE: This article focuses on primary hypercholesterolaemia, its relationship with CHD, and its management in the community setting. DISCUSSION: There is strong evidence that treating middle aged men with statins who have established CHD will reduce overall mortality, CHD morbidity, or mortality and stroke. There is weaker but reasonable evidence for treating men aged over 65 years and women of any age who have CHD, or people without CHD but at high risk. There may be some benefits for patients with stroke and peripheral vascular disease who are at risk of CHD. While discontinuation rates are high, the occurrence of serious adverse reactions are infrequent.

Adult↗
PubMed2004

Binners, fillers and filers--a qualitative study of GPs who don't return postal questionnaires.

BACKGROUND AND OBJECTIVES: Postal questionnaires are a frequently used method of obtaining information from general practitioners. However, getting GPs to return questionnaires or participate in research can be challenging. We wanted to ascertain reasons why GPs identified as 'routine non-responders' to postal questionnaires, do not participate in this type of research. METHODS: Qualitative study using semi-structured interviews of 14 GPs who had returned only one or none of five questionnaires sent to them during a five-year period between 1994-1999. RESULTS: Participants were classified into one of three groups--binners, filers and fillers--according to their behavior when faced with a questionnaire. Each group had slightly different attitudes toward research in general practice. Although standard strategies such as incentives and good design could influence the decision to complete a questionnaire, poor research experiences or a poor relationship between the participant and researchers were also very important. CONCLUSION: The decision not to return a postal questionnaire is multifactorial and reflects personal and professional attitudes, experiences and organisation of individual GPs as well as time pressure and interest. The development of a positive relationship with a researcher or academic department may be influential in encouraging the return of postal questionnaires and when trying to enhance response rates amongst 'routine non-responders' researchers should take into account the broader values ans practices GPs bring to their work.

Adult↗
PubMed2004

Lower respiratory tract infections and community acquired pneumonia in adults.

BACKGROUND: Lower respiratory tract infections--acute bronchitis and community acquired pneumonia (CAP)--are important causes of morbidity in Australia. Acute bronchitis is often treated with antibiotics, although the cause is usually viral. Community acquired pneumonia may be fatal, particularly in the elderly, therefore appropriate assessment and management is essential. OBJECTIVE: This article describes the aetiology, clinical assessment, investigations and management of acute bronchitis and CAP in the community. DISCUSSION: Clinical assessment is important for acute bronchitis and CAP, with investigations such as C reactive protein, serology, and chest X-ray informing diagnosis and management of the latter. Causative organisms are usually not identified, but are presumed to be viral for acute bronchitis, and Streptococcus pneumoniae for CAP; although 'atypicals' are also important. Antibiotics should generally not be prescribed for acute bronchitis, however, there is some evidence they may provide limited benefits in patients who have chest signs, are very unwell, are older, have comorbidities, or smoke. In patients with CAP, treated outside of hospital, the combination of amoxycillin and doxycycline/roxithromycin is the treatment of choice.

Acute Disease↗
PubMed2002

General practice based intervention to prevent repeat episodes of deliberate self harm: cluster randomised controlled trial.

OBJECTIVES: To evaluate the impact of an intervention based in general practice on the incidence of repeat episodes of deliberate self harm. DESIGN: Cluster randomised controlled trial in which 98 general practices were assigned in equal numbers to an intervention or a control group. The intervention comprised a letter from the general practitioner inviting the patient to consult, and guidelines on assessment and management of deliberate self harm for the general practitioner to use in consultations. Control patients received usual general practitioner care. SETTING: General practices within Avon, Wiltshire, and Somerset Health Authorities, whose patients lived within the catchment area of four general hospitals in Bristol and Bath. PARTICIPANTS: 1932 patients registered with the study practices who had attended accident and emergency departments at one of the four hospitals after an episode of deliberate self harm. MAIN OUTCOME MEASURES: Primary outcome was occurrence of a repeat episode of deliberate self harm in the 12 months after the index episode. Secondary outcomes were number of repeat episodes and time to first repeat. RESULTS: The incidence of repeat episodes of deliberate self harm was not significantly different for patients in the intervention group compared with the control group (odds ratio 1.2, 95% confidence interval 0.9 to 1.5). Similar findings were obtained for the number of repeat episodes and time to first repeat. Subgroup analyses indicated that there was no differential effect of the intervention according to patient's sex (P=0.51) or method used to cause deliberate self harm (P=0.64). The treatment seemed to be beneficial for people with a history of deliberate self harm, but it was associated with an adverse effect in people for whom the index episode was their first episode (interaction P=0.017). CONCLUSIONS: An invitation to consult, sent by the general practitioner of patients who have deliberately harmed themselves, and the use of management guidelines during any subsequent consultation did not reduce the incidence of repeat self harm. A subgroup analysis that indicated that patients who had previously harmed themselves benefited from the intervention was inconsistent with previous evidence and should be treated with caution. More research is needed on how to manage patients who deliberately harm themselves, to reduce the incidence of repeat episodes.

Adolescent↗
PubMed2002

Labelling of acute respiratory illness: evidence of between-practitioner variation in the UK.

BACKGROUND: It is unclear which symptoms and signs GPs use when attributing diagnostic labels to patients with acute respiratory illness (ARI). OBJECTIVE: We sought to ascertain GPs' self-reported definitions of ARI. METHODS: A postal questionnaire concerned with the diagnosis of ARI was sent to all registered GPs in Avon Health Authority. GPs were asked to choose a clinical term that would describe the clinical presentation in four hypothetical patients, and the next three questions asked them to define acute bronchitis, upper respiratory tract infection (URTI) and any other term they used for ARI (excluding pneumonia). We measured proportions and compared responses across the three diagnostic categories. RESULTS: The majority (88%) of GPs agreed that cough associated with fever should be labelled as a URTI. When sputum and chest signs were also present, opinion was more divided, with 62% diagnosing acute bronchitis in young patients and 72% lower respiratory tract infection in old patients. CONCLUSIONS: This study demonstrates that there is more consistent use of diagnostic labels for URTI than for acute bronchitis or other terms used to label ARI. In the future, researchers should quantify the prognostic significance of symptoms and signs in ARI and provide GPs with a more rational approach to the diagnosis and management of ARI.

Acute Disease↗
PubMedDate not supplied

Improving the learning needs survey by using four approaches.

BACKGROUND: Learning needs analyses are often undertaken to plan continuing education programs. They usually use questionnaires that have shortcomings regarding validity, relevance, breadth and detail. We tested a questionnaire using four questioning strategies to approximately 1762 general practitioners. METHOD: Our questionnaire listing 104 topics asked open ended questions and specific information about desired topics. It was distributed by The Royal Australian College of General Practitioners and divisions of general practice in South Australia and the Northern Territory. RESULTS: The survey yielded 578 responses (33%). The different survey strategies highlighted different areas of learning need. Overall, the highest ranked topics were dermatology, complementary medicine, psychiatry, and business and practice management. Participating divisions were generally satisfied with the feedback. DISCUSSION: Despite a poor response rate, the survey provided interesting information, and a set of broad learning topics.

Aged↗