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Biomedical subjects

S Lydeard

Publications and source records attributed to S Lydeard.

11 recordsLinked to original sources
PubMed1993

Problems with implementing guidelines: a randomised controlled trial of consensus management of dyspepsia.

OBJECTIVE: To determine the feasibility and benefit of developing guidelines for managing dyspepsia by consensus between general practitioners (GPs) and specialists and to evaluate their introduction on GPs' prescribing, use of investigations, and referrals. DESIGN: Randomised controlled trial of effect of consensus guidelines agreed between GPs and specialists on GPs' behaviour. SETTING: Southampton and South West Hampshire Health District, United Kingdom. SUBJECTS: 179 GPs working in 45 practices in Southampton district out of 254 eligible GPs, 107 in the control group and 78 in the study group. MAIN MEASURES: Rates of referral and investigation and costs of prescribing for dyspepsia in the six months before and after introduction of the guidelines. RESULTS: Consensus guidelines were produced relatively easily. After their introduction referral rates for upper gastrointestinal symptoms fell significantly in both study and control groups, but no significant change occurred in either group in the use of endoscopy or radiology, either in terms of referral rates, patient selection, or findings on investigation. No difference was observed between the control and study group in the number of items prescribed, but prescribing costs rose by 25% (from 2634 pounds to 3215 pounds per GP) in the study group, almost entirely due to an increased rate of prescription of ulcer-healing agents. CONCLUSION: Developing district guidelines for managing dyspepsia by consensus between GPs and specialists was feasible. However, their acceptance and adoption was variable and their measured effects on some aspects of clinical behaviour were relatively weak and not necessarily associated with either decreased costs or improved quality of care.

Data Collection↗
PubMed1992

Irritable bowel syndrome in the general population.

OBJECTIVE: To determine the prevalence of symptoms compatible with a clinical diagnosis of irritable bowel syndrome in the general population. DESIGN: Validated postal questionnaire sent to 2280 subjects randomly selected in 10 year age bands from the lists of eight general practitioners. The Manning criteria were used to define irritable bowel syndrome. SETTING: Urban population in Southampton and mixed urban-rural population in Andover, Hampshire. RESULTS: A response of 71% yielded 1620 questionnaires for analysis, of which 412 (25%) reported more than six episodes of abdominal pain in the preceding year, with 350 (22%) reporting symptoms consistent with the diagnosis of irritable bowel syndrome. The male: female ratio was 1:1.38. More subjects with irritable bowel syndrome had constipation and diarrhoea and 35% with the syndrome reported rectal bleeding compared with an overall prevalence of 20%. Other symptoms and conditions including heartburn, dyspepsia, flushing, palpitations, migraine, and urinary symptoms were significantly more common in the group with irritable bowel syndrome. Abdominal pain in childhood was more common in the subjects with irritable bowel syndrome (12%) than without (3%). One third of the group with irritable bowel syndrome had sought medical advice during the study period (male:female ratio 1:1.21); consultation behaviour was influenced by age and the presence of associated symptoms, varied considerably among patients registered with different general practitioners, and was poorly correlated with symptom severity. CONCLUSION: Symptoms consistent with a diagnosis of irritable bowel syndrome are present in almost one quarter of the general population and tend to be associated with a number of other complaints and conditions, some of which may reflect smooth muscle dysfunction.

Adult↗
PubMed1992

Dyspepsia in the community: a follow-up study.

We have repeated a population-based survey of the pattern and prevalence of dyspeptic symptoms in 2460 subjects two years after the original survey, in order to document the changes in dyspeptic symptoms and consultation behaviour. A validated postal questionnaire was sent to 2460 subjects randomly selected in ten-year age bands from the lists of eight general practitioners working in the south of England. A total of 1417 individuals (58%) responded to both questionnaires. The overall six month prevalence of dyspepsia was unchanged (38%), but while 74% of dyspeptic patients were still getting symptoms, 13% became symptom-free each year. Over half of those who had reported dyspepsia before, but not at the time of, the first survey had experienced recurrence of their symptoms. In the two-year study period 113 individuals experienced dyspepsia for the first time, giving an annual incidence of 11.5%. One in four patients consulted their general practitioner, and 75% of those who had not consulted in the first survey still had not done so two years later. Resolution of symptoms appeared independent of consulting behaviour. Peptic ulcers were identified in 14 patients, mostly those with new dyspepsia, during the study period.

Adult↗
PubMed1992

Reasons for consultation in irritable bowel syndrome: symptoms and patient characteristics.

This study compared the characteristics of patients with symptoms of irritable bowel syndrome who had either consulted or not consulted a general practitioner in the preceding two years. The subjects were identified by questionnaire in a community survey of irritable bowel syndrome symptoms and samples of 24 consulting and 24 non-consulting patients were interviewed. The groups were well matched for demographic characteristics, although those who consulted for irritable bowel syndrome also consulted more frequently for other problems. The only significant differences in the pattern, frequency and severity of a range of symptoms, which included the Manning criteria, were that more of the consulting patients experienced visible abdominal distension and had a higher mean score for severity of pain than the non-consulters. Mean negative life event scores and anxiety and depression scores were higher in the group who consulted and more of these patients were concerned about the possible serious nature of their symptoms, including fear of cancer, emphasizing the importance of eliciting patients' beliefs and anxieties about the meaning of their symptoms.

Adult↗
PubMed1991

The questionnaire as a research tool.

This article explores the design, development and application of questionnaires in primary care research. Particular attention is given to the need for care in sampling, piloting and validating, along with practical information on the importance of identifying sources of error and minimizing their damaging effect.

Bias↗
PubMed1989

Endoscopy: a patient's view.

Patients with inflammatory bowel disease have many sigmoidoscopies and colonoscopies, these could be made less unpleasant by good dialogue and mental preparation. Follow-up by a GP instead of a consultant may also help.

Adolescent↗
PubMed1989

Prevalence of symptoms of dyspepsia in the community.

To study the prevalence of dyspepsia in the community a postal questionnaire was sent to 2697 patients who were selected at random from the lists of patients registered in two health centres in Hampshire. A total of 2066 returned questionnaires were suitable for analysis (response rate 77%). It was found that the six month prevalence of dyspepsia was 38%. There was considerable overlap between symptoms of heartburn and upper abdominal pain, with over half of patients with dyspepsia experiencing both. One in four of these patients had consulted their general practitioner during that time. The proportion of patients with dyspepsia who consulted their general practitioner varied widely among the eight doctors who participated in the study, from 17% to 45%. Frequency of symptoms tended to fall with age, particularly in men, while the proportion of patients with dyspepsia who sought medical advice increased with age. Almost one in five of the 2066 patients had been investigated with radiology or endoscopy at some time, and 143 (7%) of them claimed to have had a diagnosis of peptic ulcer.

Adult↗
PubMed1989

Life events, vulnerability and illness: a selected review.

In this review we examine the links between life stress and illness and the research approaches and methodologies which have been used to study them. Evidence is presented of causal relationships between adverse life events and illness onset and we discuss ways in which these events may be detected and measured. The notion that 'moderating variables' may affect both an individual's vulnerability to the effects of adversity and the coping strategies adopted to deal with life stress is emphasized. Typically, research has focused on the effect of a single psychosocial variable on the correlation between life events and illness. We conclude that research aimed at eliciting factors associated with successful coping is of more importance if primary care physicians are to identify vulnerable patients and make therapeutic interventions to minimize the damaging effect of stress and adversity.

Adaptation, Psychological↗
PubMed1989

Factors affecting the decision to consult with dyspepsia: comparison of consulters and non-consulters.

To identify factors associated with the decision to consult with dyspepsia, patients with dyspepsia were identified from a postal survey in the community. A random sample of 69 patients who had consulted their general practitioner and 66 patients with dyspepsia who had not consulted were interviewed in their homes. Differences in consultation behaviour were not explained by differences in self-reported severity or frequency of symptoms or by the presence of associated symptoms. The most striking difference between the two groups was concern among the consulters about the possible seriousness of symptoms. Consulters were also more likely to be worried about cancer and heart disease and to have experienced more disruptive or threatening life events than the non-consulters. These results emphasize the importance of looking beyond the presentation of common symptoms in general practice to patients' fears about the significance of the symptoms and to non-physical determinants of consultation behaviour.

Anxiety↗