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Biomedical subjects

P Finucane

Publications and source records attributed to P Finucane.

At least 19 recordsLinked to original sources
PubMed2005

Medical graduates of the National University of Ireland in 1978: who and where are they?

To inform debate on medical manpower planning and aspects of medical education, we gathered data on graduates of three Irish medical schools in 1978. Twenty six years later, four of the 236 graduates had died and seven were untraceable. All but one of the remainder were in clinical practice and in a wide range of disciplines. A third were overseas. The implications of these findings are briefly discussed.

Career Choice↗
PubMed2004

The career plans of Irish interns: results of a national survey.

In anticipation of major changes in medical manpower in Ireland, we surveyed all interns about their career plans. Three hundred (65% of those surveyed) responded. There were clear gender differences in career plans and overall, only 15% planned a career in general practice. There was a negative perception about the quality of postgraduate training in Ireland and 93% planned to go overseas for training. These findings need to influence the debate on medical manpower and postgraduate training.

Adult↗
PubMed2001

Recruiting problem-based learning (PBL) tutors for a PBL-based curriculum: the Flinders University experience.

OBJECTIVES: To examine the contribution made to problem-based learning (PBL) by individual teachers and by departments in years 1 and 2 of a new graduate-entry medical programme (GEMP) with a PBL-based curriculum. METHODS: We compiled a database on all PBL tutoring undertaken in years 1 and 2 during the first 3 years in which the GEMP was delivered. This allowed us to quantify and analyse the contribution made by individuals and by departments. RESULTS: At 3 years following introduction of the GEMP, 136 (25.9%) of the school's 525 staff had trained as PBL tutors and 98 (18.7%) had tutored. Both individuals and departments differed greatly in the amount of time devoted to PBL tutoring. Staff who tutored once tended to tutor again in subsequent years. Compared with staff in clinical departments, those in non-clinical departments (who constituted 12% of the total) made a greater relative contribution though a smaller absolute contribution to tutoring. CONCLUSIONS: These findings prompted us to develop a formula that distributes the PBL tutoring load more evenly across departments. This was successfully introduced in 1999. It recognizes the fact that only a minority of staff will volunteer to become PBL tutors. Strategies that might encourage more staff to tutor are briefly discussed.

Australia↗
PubMed2001

A 30-month study of patient complaints at a major Australian hospital.

Health practitioners often regard complaints about the quality of patient care in a negative light. However, complaints can indicate strategies to improve care. Therefore, an audit was undertaken of all formal complaints about patient care at a major Australian hospital over a 30-month period. The profile of complainants, the reasons for complaints, and the outcome were analysed. A total of 1308 complaints, concerning the care of 1267 patients, were received. The complaint rate was 1.12 per 1000 occasions of service. In all, 57% of complaints were lodged by advocates and 71% of complaints related to poor communication or to the treatment provided. In 97% of occasions, an explanation and/or an apology resulted. To date, no complaint has proceeded to litigation. Complaints are potentially useful quality assurance tools and can identify remediable system flaws. Health professionals and employers should understand why patients complain and be able to respond appropriately.

Adult↗
PubMed2000

Teaching medical students about disability and rehabilitation: methods and student feedback.

The predicted increase in the prevalence of chronic and disabling diseases in the population over the next 30 years calls for a more effective approach to educating medical students about the assessment and management of disability. The introduction of a new postgraduate medical course at Flinders University of South Australia in 1996 allowed the development of a new topic on disability and rehabilitation. Over a 4-week period, students undertake four activities. First, they follow a particular patient in an inpatient rehabilitation setting and learn about the multidisciplinary approach to rehabilitation. Secondly, they each visit two people with a disability living in the community and assess their physical, mental, functional and social status. Thirdly, they each visit a service which supports those people in the community. Finally, they simulate having a disability which is randomly allocated to them. During these 4 weeks, students also participate in problem-based learning (PBL) and have 27 h of associated sessions or lectures. The PBL cases and associated sessions have a 'chronic disease' theme. We developed a questionnaire to obtain student feedback on this new topic in the first 2 years of its delivery. A 69% response rate has been obtained. Overall, the topic was well-received, and as a result most students felt more comfortable in dealing with disabled people. They were enthusiastic about ward work, and enjoyed learning about aspects of multidisciplinary team care. Exercises involving simulation of disability were largely acceptable. We believe that this topic helps our students to deal better with the problems of disabled people.

Australia↗
PubMed2000

Complaints concerning the hospital care of elderly patients: a 12-month study of one hospital's experience.

OBJECTIVE: to determine the number, instigators, nature and outcome of complaints concerning elderly patients treated at a single hospital over 1 year. DESIGN: descriptive analysis of computerized data gathered prospectively; follow-up of complaints until resolution. SETTING: large, urban, university teaching hospital in Australia. SUBJECTS: all patients aged 65 years and above whose hospital care was the subject of complaint. METHODS: analysis of computerized database of all complaints made in a single year. RESULTS: 1.44 complaints were made per 1000 occasions of service to elderly people (95% confidence intervals, 1.19 - 1.69). This was similar to the overall complaint rate of 1.32 per 1000 occasions of service for patients of all age groups (95% confidence intervals, 1.19- 1.45). However, 73% of complaints were made by advocates rather than by elderly patients themselves and 96% related to communication or treatment issues. Many complaints resulted in an explanation and/or an apology and, to date, none has resulted in litigation. CONCLUSIONS: complaints concerning older hospitalized people are as common as those concerning younger patients. Analysis of complaints provides pointers for improvements in quality of care.

Age Factors↗
PubMed1999

Exercise training and blood lipids in hyperlipidemic and normolipidemic adults: a meta-analysis of randomized, controlled trials.

OBJECTIVE: To determine the effectiveness of exercise training (aerobic and resistance) in modifying blood lipids, and to determine the most effective training programme with regard to duration, intensity and frequency for optimizing the blood lipid profile. DESIGN: Trials were identified by a systematic search of Medline, Embase, Science Citation Index (SCI), published reviews and the references of relevant trials. The inclusion criteria were limited to randomized, controlled trials of aerobic and resistance exercise training which were conducted over a minimum of four weeks and involved measurement of one or more of the following: total cholesterol (TC), high density lipoprotein (HIDL-C), low density lipoprotein (LDL-C) and triglycerides (TG). SUBJECTS: A total of 31 trials ( 1833 hyperlipidemic and normolipidemic participants) were included. RESULTS: Aerobic exercise training resulted in small but statistically significant decreases of 0.10 mmol/L (95% CI: 0.02, 0.18). 0.10 (95% CI: 0.02, 0.19), 0.08 mmol/L (95% CI: 0.02, 0.14), for TC, LDL-C, and TG, respectively, with an increase in HDL-C of 0.05 mmol/L (95% CI: 0.02, 0.08). Comparisons between the intensities of the aerobic exercise programmes produced inconsistent results; but more frequent exercise did not appear to result in greater improvements to the lipid profile than exercise three times per week. The evidence for the effect of resistance exercise training was inconclusive. CONCLUSIONS: Caution is required when drawing firm conclusions from this study given the significant heterogeneity with comparisons. However, the results appear to indicate that aerobic exercise training produced small but favourable modifications to blood lipids in previously sedentary adults.

Adult↗
PubMed1999

Recruitment of older adults for a randomized, controlled trial of exercise advice in a general practice setting.

OBJECTIVES: The success of any clinical trial depends strongly on recruiting enough participants in a reasonable time period. This paper aims to identify the obstacles, as well as the successful aspects, of recruiting of older participants into an exercise study. DESIGN: This describes the recruitment of 299 older adults into a randomized, controlled trial of exercise advice in a general practice setting. Letters of invitation were sent from two general practices inviting the patients to attend a 15-minute screening appointment. Patients considered eligible for enrollment were then scheduled for a baseline appointment and randomized into the trial. SETTING: Two general practices in Adelaide, South Australia. PARTICIPANTS: Healthy, sedentary, community-dwelling patients aged 60 years or older. RESULTS: A total of 2878 letters of invitation were sent, and 913 patients attended a screening appointment. Of these, 351 (38.4%) were initially eligible, with one-third excluded because they were already too physically active. Two hundred ninety-nine participants, approximately 1 of every 10 patients sent letters, were enrolled in the project at the end of a 15-week period. DISCUSSION: A general practice approach was effective in recruiting 299 older adults to an exercise project within an acceptable time frame. Factors promoting the success of recruitment through general practice included choosing large, well established practices, computerized age-sex registers, and placing minimal demands on the general practitioners and practice staff. A continuing problem with recruiting participants for a project involving exercise is that the volunteer population tends to be healthy and interested in physical activity.

Aged↗
PubMed1997

The effectiveness of exercise training in lowering blood pressure: a meta-analysis of randomised controlled trials of 4 weeks or longer.

OBJECTIVE: To identify the features of an optimal exercise programme in terms of type of exercise, intensity and frequency that would maximise the training induced decrease in blood pressure (BP). DATA IDENTIFICATION: Trials were identified by a systematic search of Medline, Embase and Science Citation Index (SCI), previous review articles and the references of relevant trials, from 1980 until 1996, including only English language studies. STUDY SELECTION: The inclusion criteria were limited to randomised controlled trials of aerobic or resistance exercise training conducted over a minimum of 4 weeks where systolic and diastolic BP was measured. RESULTS: A total of 29 studies (1533 hypertensive and normotensive participants) were included, 26 used aerobic exercise training, two trials used resistance training and one study had both resistance and aerobic training groups. Aerobic exercise training reduced systolic BP by 4.7 mm Hg (95% CI: 4.4, 5.0) and diastolic BP by 3.1 mm Hg (95% CI: 3.0, 3.3) as compared to a non-exercising control group, however, significant heterogeneity was observed between trials in the analysis. The BP reduction seen with aerobic exercise training was independent of the intensity of exercise and the number of exercise sessions per week. The evidence for the effect of resistance exercise training was inconclusive. CONCLUSIONS: Aerobic exercise training had a small but clinically significant effect in reducing systolic and diastolic BP. Increasing exercise intensity above 70% VO2 max or increasing exercise frequency to more than three sessions per week did not have any additional impact on reducing BP.

Adolescent↗
PubMed1997

Fasting and post-methionine homocyst(e)ine levels in a healthy Australian population.

BACKGROUND: Plasma homocyst(e)ine (H[e]) is frequently measured in patients with occlusive vascular disease, but levels vary between populations and between laboratories. AIMS: We sought to derive reference values for an Australian population over a wide age range. METHODS: We measured plasma H(e) in the fasting state and after methionine loading in 116 volunteers selected at random from the Hunter districts of the New South Wales electoral roll and in 49 apparently healthy, active subjects recruited from the region's lawn bowling clubs. Reference ranges were derived for both sexes, in three age strata. We collaborated with two international laboratories in standardising our results. RESULTS: Mean fasting H(e) levels were approximately 2.7 mumol/L higher in men than women, at all ages (95% CI for the difference, 1.2 to 4.1 mumol/L). Levels increased with age (approximately 1.0 mumol/L/decade, 95% CI 0.5 to 1.5) and were correlated with serum creatine (r = 0.48), serum folate (r = -0.30), red cell folate (r = -0.25) and serum B12 (r = -0.31) (all p < 0.001). These results are similar to those reported in other populations. CONCLUSIONS: We have defined reference ranges for a typical Australian population, following careful laboratory standardisation. H(e) levels must be interpreted with regard to age, sex, renal function and vitamin B12 and folate status.

Adult↗
PubMed1997

Exercise profile and subsequent mortality in an elderly Australian population.

Although the importance of exercise as a public health issue is increasingly recognised, little attention has been paid to exercise in very old people. We examined exercise patterns in 1788 subjects aged 70 years and over who were participating in the Australian Longitudinal Study of Ageing. In the two weeks before interview, 39 per cent of subjects had taken no exercise and only four per cent had exercised vigorously. When compared with those who took no exercise, exercisers were more likely to be male and younger, to self-report better health, to be former smokers and regular alcohol users. Mortality rates at two years follow-up were inversely related to the level of exercise at baseline. This research indicates that exercise is important for the very old as well as younger groups.

Aged↗
PubMed1997

Use of patient restraints in four Australian teaching hospitals.

To examine the patterns of use of patient restraints in Australian hospitals and the level of adherence to accepted guidelines, we undertook a point-prevalence study in four teaching hospitals in three different States. This involved ward inspections and review of case notes. Overall, 51 (12.5%) of the 408 people audited were being restrained with a variety of physical and chemical agents. The rate of restraint use varied from 8.5% to 18.5% between hospitals. Although the overall prevalence of restraint use increased with age, the hospital with the oldest patients used restraints least. At all hospitals, there was scant documentation in the case notes concerning the use of restraints. The prevalence of restraint use varies widely in different hospitals. As this is not explained by the patient profile, it probably reflects different philosophies of care. Documentation of the use of restraints needs to be improved in all the centres studied.

Adolescent↗
PubMed1996

Cardiovascular findings in self-reported healthy elderly. The Elite Seniors Study.

BACKGROUND: A descriptive study of self-reported healthy elderly in Newcastle was undertaken for an adequate understanding of the normal characteristics of the elderly. AIMS: We sought to determine the frequency of abnormal clinical, laboratory and echocardiographic findings in a self-reported healthy elderly population. METHODS: Volunteers aged greater than 75 years were recruited from active members of the region's bowling clubs. Forty-five subjects with no self-reported vascular or cardiac disease underwent clinical, laboratory and echocardiography assessment. RESULTS: Minor cardiovascular abnormalities were frequently detected. Echocardiography correspondingly found a high frequency of haemodynamically insignificant degenerative valvular lesions. Doppler left ventricular filling pattern of abnormal relaxation was a universal finding. CONCLUSION: There is a high prevalence of age-related echo-Doppler abnormalities in the self-reported healthy elderly with important implications for the interpretation of echo-Doppler studies.

Aged↗
PubMed1995

Preoperative assessment and postoperative management of the elderly surgical patient.

The population undergoing surgery is aging and this trend will continue for many decades to come. Better anaesthetic and surgical techniques are lowering the risk-benefit ratio for surgery, making it an increasingly attractive treatment option. Good preoperative assessment and postoperative management form an integral part of strategies to minimise morbidity and mortality while maximising hospital efficiency.

Aged↗
PubMed1995

Comparison of teachers at a 'traditional' and an 'innovative' medical school.

A 50% random sample (n = 186) of teaching staff at a 'traditional' medical school and all staff (n = 205) at an 'innovative' school were surveyed on their attitudes to teaching and teacher training. Response rates were 80% and 93% respectively. Staff at both institutions were predominantly men, highly experienced and active as teachers. Though only a minority had undergone recent teacher training, some 95% rated their teaching as 'average' or 'above average'. High levels of enthusiasm for teaching were detected in both schools. Staff at the 'innovative' school were more positive about the rewards for teaching. There was a common perception that formal training would improve the quality of teaching, though a third would not wish to participate. When developing strategies to enhance the quality of medical teaching, it is important to appreciate the existing attitudes of teachers. This survey indicates that inflated views of their own teaching ability, a perceived lack of reward for teaching, and ambivalence towards formal teacher training are three problem areas which need to be considered.

Academic Medical Centers↗