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Biomedical subjects

R W Sanson-Fisher

Publications and source records attributed to R W Sanson-Fisher.

At least 19 recordsLinked to original sources

Preventive and other interactional skills of general practitioners, surgeons, and physicians: perceived competence and endorsement of postgraduate training.

BACKGROUND: Perceived competencies and support for formal postgraduate training across a range of preventive and other interactional skills were examined in three medical groups. METHODS: All eligible final year students and recent graduates of the three major Australian medical colleges (n = 767) were mailed a questionnaire examining communication skills in four domains: preventive, educational, therapeutic, and general. RESULTS: Overall consent rate was 45%. For most items, at least one-third of each group reported low competence. On preventive items, low competence ratings ranged from 5 to 39% in general practice, 38 to 67% in surgery, and 33 to 51% in the speciality physician group. Significant intergroup differences occurred on eight competence items. Agreement with training on preventive topics ranged from 80 to 91% in general practice, 48 to 69% in surgery, and 72 to 82% in the specialty physician group. On all 11 training items where significant differences occurred, the general practice group reported the highest level and the surgeon group the lowest level of endorsement for formal training and assessment. CONCLUSIONS: Substantial proportions in the general practice, surgery, and the physician specialty report lack of competence in common interactional skills. There were high levels of support for formal training in preventive and other interactional skills. The strong endorsement supports the development of effective, tailored interactional skills training programs.

Adult↗

Interactional skills of students from traditional and non-traditional medical schools before and after alcohol education.

OBJECTIVE: To compare alcohol-related intervention and general interactional skills performance of medical students from a traditional (Sydney) and a non-traditional (Newcastle) medical school, before and after participation in an alcohol education programme about brief intervention. DESIGN: In two controlled trials, students received either a didactic alcohol education programme or didactic input plus skills-based training. Prior to and after training, all students completed videotaped interviews with simulated patients. SETTING: The Faculties of Medicine at the University of Newcastle and the University of Sydney, Australia. SUBJECTS: Fifth-year medical students (n=154). RESULTS: Both alcohol-related intervention and general interactional skills scores of the Newcastle students were significantly higher than those of the Sydney students at pre-test but not after training. Although alcohol-related interactional skills scores improved after training at both universities, they did not reach a satisfactory level. The educational approach used had no effect on post-test scores at either university. CONCLUSIONS: Significant baseline differences in interactional skills scores favouring non-traditional over traditional students were no longer evident after both groups had been involved in an alcohol education programme. Further research is required to develop more effective alcohol intervention training methods.

Adult↗

Australian oncologists' self-reported knowledge and attitudes about non-traditional therapies used by cancer patients.

OBJECTIVE: To assess Australian radiation and medical oncologists' self-reported knowledge about and attitudes towards a range of non-traditional therapies used by people with cancer. DESIGN: Postal survey during May and June 1997 of all 265 radiation and medical oncologists practising in Australia. PARTICIPANTS: 161 oncologists returned surveys (61% response rate). MAIN OUTCOME MEASURES: Oncologists' own level of knowledge, and, for each known therapy, their perceptions of its likely harm or benefit in patients being treated curatively and palliatively, and of the prevalence of use among their patients. RESULTS: Oncologists reported knowing most about acupuncture, antioxidant therapy and meditation and least about cellular therapy, magnetotherapy and psychic surgery. The therapies most likely to be considered helpful were meditation, acupuncture and hypnotherapy. Those most likely to be considered harmful were coffee enemas, psychic surgery, Iscador therapy and diet therapies. Perceptions of patients' use of most therapies varied widely, with herbal therapies, antioxidant therapy and meditation considered the most commonly used. CONCLUSIONS: These results indicate self-identified gaps in oncologists' knowledge about non-traditional therapies their patients may use; they suggest a need to consider including education about these therapies in oncologists' training.

Acupuncture Therapy↗

Perceived needs of women diagnosed with breast cancer: rural versus urban location.

OBJECTIVE: To assess the prevalence and predictors of perceived unmet needs among women diagnosed with breast cancer, with a particular focus on the impact of location (rural/urban). METHOD: A random sample of women in NSW diagnosed with breast cancer was surveyed during 1995-96. The Breast Cancer Patients' Needs Questionnaire (BR-CPNQ) explores patients' perceived needs across five domains: psychological, health information, physical/daily living, patient care/support and interpersonal communication. Items assessing breast cancer specific needs and access to services and resources were included. Of 235 eligible rural women, 134 (57%) consented to participate and 129 (55%) returned completed surveys. Of 196 eligible urban women, 102 (52%) consented to participate and 100 (51%) returned completed surveys. RESULTS: For 12 of the 52 items, at least one-third of the sample reported ever having a moderate/high need for help. Of the 15 highest moderate or high unmet needs, 10 related to health information and three to psychological needs. There were few differences in the prevalence of needs reported by rural and urban women. Only in the physical/daily living domain were rural women more likely than urban women to report some need for help (OR = 2.59, 95% CI 1.21-5.52). CONCLUSIONS: Unmet needs, particularly in the information and psycho-social domains, are reported by both rural and urban women with breast cancer, with sub-groups experiencing different types of needs. IMPLICATIONS: There is a need to develop and trial targeted and innovative strategies to meet the health information and psychological needs of women with breast cancer, and the physical/daily living needs of rural women diagnosed with breast cancer.

Activities of Daily Living↗

Accidents in older people living at home: a community-based study assessing prevalence, type, location and injuries.

OBJECTIVES: To assess the prevalence, type, location of and injuries from home accidents, including falls and other accidents, and to explore whether variables including socio-demographic characteristics, medication use and home hazards were associated with all home accidents and falls. METHOD: 657 older people were interviewed about accidents in the previous four weeks. For a subsample (n = 425), a home hazard check was completed. RESULTS: Of the 101 accidents reported, 51% (n = 51) were falls and 50% (n = 50) were other accidents. The most common location for all accidents was outside (30%). Most resulted in minor injury to the legs (43%) or arms (39%). Medical treatment was sought for 14% of accidents. Having more than five hazards and infrequent home visits by healthcare providers were associated with having at least one accident and at least one fall. Use of a walking aid was also associated with falling. CONCLUSION: Rates of falls and other accidents are considerable. IMPLICATIONS: Work is required to confirm the importance of the relationships suggested and to provide data on the burden of injury associated with non-fall accidents.

Accidental Falls↗

Benzodiazepine prescribing by GP registrars. A trial of educational outreach.

BACKGROUND: Despite ongoing concern about adverse effects and dependence on benzodiazepines, approximately 2% of Australians are still taking them on a regular basis. The aim of this study was to evaluate the effectiveness of an educational outreach or 'academic detailing' program about prescribing of benzodiazepines. METHOD: In this randomised trial general practice registrars (n = 157) in New South Wales were allocated to an intervention group (n = 79), which received a 20 minute educational outreach visit; or a control group (n = 78) which received an intervention on an unrelated topic. Prescribing behaviour was monitored by a pre-intervention and two post-intervention practice activity surveys. MAIN OUTCOME MEASURES: These were the rate of benzodiazepine prescribing for all indications, for anxiety and for sleep disorders. RESULTS: Overall benzodiazepine prescribing by the intervention group declined from 2.3 to 1.7 per 100 encounters, while the control group also declined from 2.2 to 1.6 per 100 encounters. Analysis of variance showed this was a significant drop over time (P = 0.042) but there was no difference between groups (P = 0.99). The prescribing decrease observed was in continuing rather than initial prescriptions. CONCLUSIONS: A marked decrease in benzodiazepine prescribing was seen over the course of the study in both intervention and control groups but no differential effect due to the educational outreach visit was found.

Analysis of Variance↗

Collecting cancer risk factor data from hospital outpatients: use of touch-screen computers.

The aim of this study was to assess the prevalence of selected cancer risk factor data from hospital outpatients and the proportion of "at risk" patients who would like help from hospital staff to reduce risk factors. A touch-screen computer collected data from outpatients in Newcastle, NSW, Australia. Eight hundred and nineteen outpatients completed the computerized interview. Of these, 35% were smokers, of whom 25% said that they would like help to stop smoking; 47% were overweight, with 48% indicating that they wanted assistance; 17% consumed harmful levels of alcohol, with 2% wanting help; 30% of eligible women were overdue for a Pap test, of whom 75% said that they wanted a referral to be screened, and 25% were overdue for a mammogram, of whom 83% said that they would like a referral for an examination. Touch-screen computerized health risk assessments are practical for collecting and monitoring valid cancer risk factor data for hospital outpatients.

Adolescent↗

Randomized controlled trial of a computer strategy to increase general practitioner preventive care.

BACKGROUND: Previous interventions targeting primary care practitioners with the aim of increasing preventive care delivery have demonstrated limited effectiveness. The primary aim of this study was to assess the effectiveness of a computerized continuing medical education program to increase rates of three screening behaviors (cholesterol, blood pressure, and cervical screening) and to identify three risk behaviors (smoking, alcohol consumption, benzodiazepine use) in general practice. METHODS: Nineteen general practitioners were randomly allocated to intervention or control conditions. Those given the intervention received a computerized feedback system. The intervention was delivered using a touch-screen computer located in the surgery waiting area. The preventive behaviors of interest were patient smoking, alcohol use, benzodiazepine use, and blood pressure, cholesterol and cervical screening using the Papanicolou test. Differences in performance by group in each of the outcomes was measured at baseline and 3-month follow-up. Logistic regression analyses with generalized estimating equations were conducted as the main analyses. RESULT: At 3-month follow-up, statistically significant differences were evident in the following outcome measures: accurate classification of benzodiazepine users (z = 2.8540, P < 0.05); accurate classification of non-benzodiazepine users (z = 2.7339, P < 0.05); accurate classification of hazardous or harmful alcohol drinkers (z = 2.3079, P < 0.02); blood pressure screening (z = 3.4136, P < 0.001); and cholesterol screening (z = 6.6313, P < 0.001). CONCLUSION: A computerized system of performance-specific feedback was effective at increasing some preventive care services in general practice.

Adult↗

The accuracy of self-reported health behaviors and risk factors relating to cancer and cardiovascular disease in the general population: a critical review.

OBJECTIVE: To critically review the literature concerning the accuracy of self-reported health behaviors and risk factors relating to cancer and cardiovascular disease among the general population. METHOD: A literature search was conducted on three major health research databases: MEDLINE, HealthPLAN, and PsychLit. The bibliographies of located articles were also checked for additional relevant references. Studies meeting the following five inclusion criteria were included in the review: They were investigating the accuracy of self-report among the general population, as opposed to among clinical populations. They employed an adequate and appropriate gold standard. At least 70% of respondents consented to validation, where validation imposed minimal demands on the respondent; and 60% consent to validation was considered acceptable where validation imposed a greater burden. They had a sample size capable of estimating sensitivity and specificity rates with 95% confidence intervals of width +/-10%. The time lag between collection of the self-report and validation data for physical measures did not exceed one month. RESULTS: Twenty-four of 66 identified studies met all the inclusion criteria described above. In the vast majority, self-report data consistently underestimated the proportion of individuals considered "at-risk." Similarly, community prevalences of risk factors were considerably higher according to gold standard data sources than they were according to self-report data. CONCLUSIONS: This review casts serious doubts on the wisdom of relying exclusively on self-reported health information. It suggests that caution should be exercised both when trying to identify at-risk individuals and when estimating the prevalence of risk factors among the general population. The review also suggests a number of ways in which the accuracy of individuals' self-reported health information can be maximized.

Cardiovascular Diseases↗

Factors relating to cervical screening in New South Wales, Australia.

The aims of this paper were to describe the geographical variation in Pap smear screening rates, standardised for age and adjusted for rates of hysterectomies and to assess the sociodemographic and health care factors associated with the variation. The data used in the study were the percentage of women who had had Pap smears between the years 1990 and 1992 based on the records of the Australian Health Insurance Commission (HIC). The best predictors of screening extracted from the model were the Index of Economic Resources and the proportion of women within each region who were born in non-English speaking countries.

Adolescent↗

The physical and psycho-social experiences of patients attending an outpatient medical oncology department: a cross-sectional study.

The aim of this study was to assess the prevalence and predictors of physical symptoms, anxiety, depression and perceived needs among patients receiving treatment at an outpatient medical oncology department using a cross-sectional survey. It was carried out at the outpatient clinic of an academic medical oncology department, which sees around 150-180 outpatients each week; 201 patients were selected. These patients answered questions to assess their levels of anxiety and depression (Hospital Anxiety and Depression Scale), perceived needs (Cancer Needs Questionnaire) and the frequency and severity of 15 physical symptoms. Fatigue, nausea, appetite loss and vomiting were the most commonly experienced and most debilitating physical symptoms. Approximately 25% of participants had borderline or clinical levels of anxiety and depression. Although relatively low levels of perceived needs were reported, physical and psychological needs were the most common. Levels of each outcome measure tended to be predictive of each other. Medical oncology outpatients experience a wide range of physical and psycho-social problems which appear, to some extent, interrelated.

Adult↗

Teaching medical students alcohol intervention skills: results of a controlled trial.

OBJECTIVE: To assess the relative effectiveness of videotape feedback and lecture methods for teaching alcohol brief intervention skills. DESIGN: In a controlled trial, two student blocks received a manual, lecture and demonstration about the principles and practice of brief alcohol intervention. In addition, experimental students made a 20-min videotape and participated in a 1.5-h small group feedback session. Prior to and after training, all students completed questionnaires and videotaped interviews with simulated patients. SETTING: Faculty of Medicine and Health Sciences of the University of Newcastle, Australia. SUBJECTS: Final-year medical students. RESULTS: Levels of alcohol-related knowledge, attitudes and interactional skills as well as general interactional skills were significantly improved after teaching. Alcohol-related interactional skills that were unsatisfactory at pretest reached satisfactory standards at post-test. An intergroup comparison of the improvement between pre- and post-teaching scores indicated that there was no significant difference in the effectiveness of the two methods. CONCLUSIONS: Training can improve medical student performance in alcohol intervention. Further research is required to examine the relative effectiveness of different teaching methods.

Adult↗

Is there consensus between breast cancer patients and providers on guidelines for breaking bad news?

Eighty-four breast cancer patients, 64 oncologists, and 140 oncology nurses rated the importance of 15 general principles and 12 recommended steps to guide clinicians in breaking bad news to patients. At least 70% of the three samples rated 7 of the 15 principles and 6 of the 12 steps as essential. All three groups agreed that patients have a legal and moral right to accurate and reliable information and that patients should be given the diagnosis and prognosis honestly and in simple language, though not bluntly. The groups differed on the relative importance of other items, with less variation about the steps than about the principles. Patients' perceptions of the importance of various guideline steps and principles are probably most important, given that patients receive the troubling news and that research indicates that how the news is delivered is associated with important patient outcomes. Recommendations for further research are discussed.

Adult↗

Factors associated with waiting time for surgery.

OBJECTIVE: To explore the factors associated with waiting times for surgery in public hospitals. SETTING: Three major acute care public hospitals in one Area Health Service. PARTICIPANTS: 691 adult patients entered onto the computerised booking list between 16 and 22 November 1994, and then between 16 January and 12 February 1995, were interviewed prospectively and followed up over a minimum of 18 months. Data were obtained from the Area Health Service's computerised booking system and patient self-report. RESULTS: Relevant surgical specialty, urgency rating, employment status and health insurance status were significantly associated with waiting time. Age, hospital, sex, country of birth, education, marital status and holding a Health Care Card were not significantly associated with waiting time. Self-reported health status (as measured by the SF-36) was not associated with waiting time for surgery. CONCLUSIONS: Waiting time for surgery was not simply determined by how urgently patients need surgery, but also by the type of surgery needed and patient's employment and health insurance status. The extent of disability experienced by patients, as measured by the SF-36, was not reflected in waiting times for surgery.

Adult↗

How well do medical oncologists' perceptions reflect their patients' reported physical and psychosocial problems? Data from a survey of five oncologists.

BACKGROUND: Modern cancer treatments can cure or prolong patients' lives. However, the associated physical and psychosocial problems can detrimentally affect patients' compliance with treatment and, ultimately, their outcomes. Therefore, oncologists need to recognize the problems experienced by their patients and, when possible, help resolve these problems. METHODS: The authors conducted a cross-sectional survey of physical symptoms, anxiety, depression, and perceived needs among 204 consenting patients visiting an outpatient medical oncology department. Immediately following consultations with consenting patients, medical oncologists and registrars also completed a survey in which they indicated their perception of each patient's level of each problem. These two data sets were then compared. RESULTS: Five oncologists' perceptions of patients' levels of the major physical symptoms cited in the survey (fatigue, nausea, vomiting, and hair loss) demonstrated the highest levels of awareness, with sensitivity rates up to 80%. Although sensitivity was less than 50% for all other physical symptoms, specificity was greater than 78% for all symptoms except fatigue. Only 17% of patients classified as clinically anxious and 6% of those classified as clinically depressed were perceived as such by their oncologists. However, the oncologists perceived much higher levels of perceived needs than patients reported, resulting in high sensitivity but low specificity rates. Oncologists' knowledge of and rapport with their patients and the pressure of their workloads were associated with their awareness of their patients' reported problems. CONCLUSIONS: Medical oncologists' perceptions may not accurately reflect their patients' reported physical and psychosocial experiences. Further interventions should be developed to assist oncologists in detecting such problems, especially psychosocial ones.

Adult↗

Surgeons' opinions about the NHMRC clinical practice guidelines for the management of early breast cancer.

OBJECTIVE: To explore the opinions of surgeons about the NHMRC clinical practice guidelines for the management of early breast cancer (the Guidelines) and their views about and use of the accompanying Consumer's guide. DESIGN: Cross-sectional telephone survey. PARTICIPANTS AND SETTING: Surgeons throughout Australia who manage breast cancer, designated as "breast" or "general" (members or non-members of the Royal Australasian College of Surgeons' Section of Breast Surgery) and "urban" or "rural". RESULTS: Among 150 respondents (64% response rate) more than 80% of surgeons reported having read all or most of the Guidelines and believed they were useful in improving women's management and wellbeing, easy to understand, evidence-based, a good summary of recent evidence, and that they would assist agreement between women and healthcare providers. Surgeons agreed with most of the recommendations in the Guidelines, but 26% disagreed that "women should ideally be treated by a specialist who treats a large number of similar patients and who has access to the full range of treatment options in a multidisciplinary setting". In terms of medicolegal implications, 41% believed that the Guidelines would protect clinicians, while, of the 37% of surgeons who believed that they would expose doctors to increased problems, significantly more breast than general surgeons believed this (50% v. 19%; P < 0.001). Only 37% of surgeons routinely gave the Consumer's guide to all or more than half their patients. CONCLUSIONS: Surgeons are generally positive about the Guidelines, but certain issues should be addressed if they are to be optimally implemented, including confusion about the medicolegal implications, perceived difficulties with providing multidisciplinary care and poor use of the Consumer's guide.

Academies and Institutes↗

Computers in community-based drug and alcohol clinical settings: are they acceptable to respondents?

The use of computer technology is not new in the delivery of health services. Previous studies have assessed the reliability and validity of computerised surveys, relative to pen and paper versions or interviews or the acceptability of computers in a range of treatment settings. Generally, these studies have reported that the reliability, validity and acceptability of computer surveys is at least comparable to more traditional survey methods. This study provides evidence for the appropriateness of using computers in community-based drug and alcohol clinical settings, reporting a high level of computer acceptability among clients. The advantages of utilising computers in clinical settings, for researchers and clinicians, are discussed.

Adult↗

Testing the equivalence of translations of widely used response choice labels: results from the IQOLA Project. International Quality of Life Assessment.

The similarity in meaning assigned to response choice labels from the SF-36 Health Survey (SF-36) was evaluated across countries. Convenience samples of judges (range, 10 to 117; median = 48) from 13 countries rated translations of response choice labels, using a variation of the Thurstone method of equal appearing intervals. Judges marked a point on a 10-cm line-representing the magnitude of a response choice label (e.g., "good" relative to the anchors of "poor" and "excellent"). Ratings were evaluated to determine the ordinal consistency of response choice labels within a response scale; the degree to which differences between adjacent response choice labels were equal interval; and the amount of variance due to response choice label, country, judge, and interaction between response choice label and country. Results confirmed the hypothesized ordering of response choice labels; the percentage of ordinal pairs ranged from 88.7% to 100% (median = 98.2%) across countries and response scales. Examination of the average magnitudes of response choice labels supported the "quasi-interval" nature of the scales. Analysis of variance (ANOVA) results supported the generalizability of response choice magnitudes across countries; labels explained 64% to 77% of the variance in ratings, and country explained 1% to 3%. These results support the equivalence of SF-36 response choice labels across countries. Departures from the assumption of equal intervals, when observed, were similar across countries and were greatest for the two response scales that are recalibrated under standard SF-36 scoring. Results provide justification for scoring translations of individual items using standard SF-36 scoring; whether these items form the same scales in other countries as they do in the United States is evaluated with tests of scaling assumptions.

Analysis of Variance↗