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Biomedical subjects

W Rosser

Publications and source records attributed to W Rosser.

At least 19 recordsLinked to original sources
PubMed2005

Organisation of a proposed Cochrane Diet and Nutrition Field.

The Cochrane Collaboration helps people make well-informed decisions about health care by preparing, maintaining and promoting the accessibility of systematic reviews of the effects of healthcare interventions. In all, 51 Cochrane Review Groups are responsible for preparing and maintaining the reviews. Most of these Review Groups are problem-based. However, there are a number of areas or dimensions of health care, such as the setting of care (eg primary care) or the type of patient/consumer (eg older persons), that cannot be usefully conceptualised as 'health problems'. In order to reflect the interests of these dimensions, or 'fields', of health care more effectively, the Cochrane Collaboration created another type of entity: Cochrane Fields or Networks. The core functions of these Fields are described. It is proposed that a new Cochrane Subfield for Diet and Nutrition should be set up to attract a cadre of new reviewers in order to ensure the proper representation of diet and nutrition expertise in the relevant Collaborative Review Groups. The methodological pitfalls of the use of nonrandomised studies will be a key issue for the new Subfield, since the focus of the Cochrane Collaboration's programme of searching databases, journals and conference proceedings has been on the identification of reports of randomised controlled trials (RCTs). Some of these sources will be need to be searched again for non-RCT studies. The financial considerations of establishing of a Cochrane Subfield for Diet and Nutrition are discussed.

Databases, Bibliographic↗
PubMed2001

Older immigrant Tamil women and their doctors: attitudes toward breast cancer screening.

Cultural beliefs have been hypothesized to be powerful barriers to breast cancer screening in minority women and physician recommendation is consistently reported to be the strongest incentive. This study investigated (1) beliefs regarding breast cancer and (2) the perception of barriers to mammography and clinical breast examination in a sample of immigrant Tamil women, as well as in a sample of primary care physicians. Three focus groups, each consisting of 10 immigrant Tamil women from Sri Lanka aged 50 years or over were conducted and 52 primary care physicians who serve this population completed mailed surveys. The most common barriers to screening reported by the women were (1) lack of understanding of the role of early detection in medical care, (2) religious beliefs and, (3) fear of social stigmatization. Physicians reported the most common barriers to their screening recommendations for this group of women to be (1) women's episodic care, (2) unrelated presenting problems and, (3) women refusing to be screened. Interventions to increase screening in this and other minority groups requires an elaborated understanding of utilization barriers for both women and their doctors.

Journal Article↗
PubMed2001

Studies of symptoms in primary care.

Publications on the frequency of defined symptoms in the practice setting, underlying conditions and prognosis have been rare in the past. Also, studies addressing these questions have suffered from several methodological problems. We therefore developed criteria to help investigators improve the quality of study design, implementation and publication. Studies evaluating symptoms in practice can make an important contribution to a more rational approach to diagnostic decision making especially in primary care.

Diagnosis↗
PubMed1999

Effects of perceived patient demand on prescribing anti-infective drugs.

BACKGROUND: Although patient demand is frequently cited by physicians as a reason for inappropriate prescribing, the phenomenon has not been adequately studied. The objectives of this study were to determine the prevalence of perceived patient demand in physician-patient encounters; to identify characteristics of the patient, physician and prescribing situation that are associated with perceived demand; and to determine the influence of perceived demand on physicians' prescribing behaviour. METHODS: An observational study using 2 survey approaches was conducted in February and March 1996. Over a 2-day period 20 family physicians in the Toronto area completed a brief questionnaire for each patient encounter related to suspected infectious disease. Physicians were later asked in an interview to select and describe 1 or 2 incidents from these encounters during which perceived patient demand influenced their prescribing (critical incident technique). RESULTS: Perceived patient demand was reported in 124 (48%) of the 260 physician-patient encounters; however, in almost 80% of these encounters physicians did not think that the demand had much influence on their decision to prescribe an anti-infective. When clinical need was uncertain, 28 (82%) of 34 patients seeking an anti-infective were prescribed one, and physicians reported that they were influenced either "moderately" or "quite a bit" by perceived patient demand in over 50% of these cases. Of the 35 critical prescribing incidents identified during the interviews, anti-infectives were prescribed in 17 (49%); the reasons for prescribing in these situations were categorized. INTERPRETATION: This study provides preliminary data on the prevalence and influence of perceived patient demand in prescribing anti-infectives. Patient demand had more influence on prescribing when physicians were uncertain of the need for an anti-infective.

Adolescent↗
PubMed1996

Variability in physicians' reported ordering and perceived reassurance value of diagnostic tests in children with 'growing pains'.

OBJECTIVES: To determine the variability in the reported ordering of tests and treatment and to determine physicians' perceptions of the reassurance value to families of diagnostic tests in children with "growing pains." DESIGN: Cross-sectional survey using a mailed questionnaire. SETTINGS: Primary care and referral practices in Toronto, Ontario. PARTICIPANTS: University-affiliated primary care pediatricians and family physicians were surveyed, as well as all pediatric orthopedic surgeons and pediatric rheumatologists in Ontario. Pediatric orthopedic surgeons and pediatric rheumatologists were combined into a single group. MAIN OUTCOME MEASURES: Frequency of office visits because of growing pains, frequency of diagnostic testing, management strategies for these children, and physicians' perceptions of the reassurance value of diagnostic tests. RESULTS: Of 205 eligible physicians, 181 (88.3%) responded. The median reported frequency of office visits because of growing pains was 1%. Compared with the other physician groups, family physicians were significantly more likely to order a determination of the hemoglobin level (P = .003), erythrocyte sedimentation rate (P = .01), white blood cell count (P = .01), and differential blood cell count (P = .003), but not imaging tests. Family physicians were also more likely to order diagnostic tests when they were under parental pressure to do so (P = .001) or for the child with repeated visits (P = .02). In total, 86% of pediatric orthopedic surgeons and pediatric rheumatologists, 95% of pediatricians, and 100% of family physicians perceived normal test results to be reassuring to parents. Treatment strategies were similar across the 3 physician groups. CONCLUSIONS: The frequency of diagnostic testing varied among physician groups. Virtually all physicians perceived normal test results to be reassuring to families.

Adult↗
PubMed1993

Effect of patient characteristics and disease manifestations on the outcome of acute otitis media at 2 months.

BACKGROUND: Optimal therapy for acute otitis media (AOM) is controversial and there is no consensus regarding which antibiotic to use, how long to administer it, or whether antibiotics are effective at all. Knowledge of the effects of patient characteristics and disease manifestations is needed to individualize treatment and to evaluate large-scale trials. METHODS: Data originated from 2251 patients with AOM, aged newborn to 15 years, who participated in a prospective primary care study in eight countries. At the initial visit, medical history, symptoms, physical findings, and treatment data were recorded. Follow-up 2 months later identified changes in treatment and outcome. RESULTS: Patients younger than 13 months were less likely to have recovered than those aged 13 months to 15 years (P = .05). Using univariate analysis for infants aged 12 months or younger, male sex, prior episodes of AOM, and serous otitis media were associated with poor outcome. For older patients, poor outcome was associated with initial history of ear tubes, prophylactic antibiotic use, ear discharge, decreased hearing, serous otitis media; and past episodes of AOM; the symptom of decreased hearing; and the finding of pus exuding from the tympanic membrane. Using multivariate analysis for infants aged 12 months or younger, a history of serous otitis media (odds ratio [OR], 2.3; 95% confidence interval [CI], 0.95-5.7), past episodes of AOM (OR, 1.9; 95% CI, 0.82-4.5), and male sex (OR, 1.7; 95% CI, 1.0-3.0) made independent contributions to poor outcome. For children aged 13 months to 15 years, significant variables included pus drainage (OR, 2.2; 95% CI, 1.5-3.3), a history of ear tubes (OR, 2.3; 95% CI, 1.5-3.6), past episodes of AOM (OR, 1.8; 95% CI, 1.3-2.34), and a history of serous otitis media (OR, 1.4; 95% CI, 1.0-1.9). CONCLUSIONS: Patient characteristics and disease manifestations are significant determinants of AOM outcome.

Acute Disease↗
PubMed1989

Effect of medicolegal liability on patterns of general and family practice in Canada.

As part of the Federal/Provincial/Territorial Review on Liability and Compensation Issues in Health Care, in 1988 we surveyed Canadian general practitioners and family physicians to determine the effect of liability concerns on their practices in the previous 5 years. Questionnaires were sent to a random, stratified national sample of 1295 physicians, with a response rate of 64.6%. However, a high proportion of the returned questionnaires were ineligible because the physicians were not in general or family practice, were not involved in direct patient care, or had died or moved; thus, the corrected response rate was 50.8%. The newsletter of the Canadian Medical Protective Association was the source of information on liability most frequently cited (by 88.1% of the physicians) and most influential (to 62.4%). Only 15.5% of the physicians cited personal involvement with medicolegal issues as a source of information; the rate was higher for Ontario physicians and those in urban areas generally. A total of 74.6% of the respondents had altered their style of practice in the previous 5 years, and 56.3% reported changes in the scope of their practice. Concern about litigation was the most important reason for changing style of practice and reducing or eliminating administration of anesthesia, whereas lifestyle and other issues along with liability concerns most influenced decisions to reduce obstetric care and emergency department work. Our findings suggest that physicians' perceptions of liability issues have had a profound influence on primary care practice in Canada in the past several years.

Anesthesia↗
PubMed1989

A randomized trial of computerized reminders for blood pressure screening in primary care.

In a randomized, controlled trial (N = 8,298) the authors compared three ways of encouraging patients in a large family practice to obtain a blood pressure check. Working from computerized medical records at a teaching family-medicine center, the study included patients aged 18 years and over who had not had a blood pressure measurement during the previous year. In a normal-care control group, 21.1% of those due for a blood pressure reading obtained one during the trial year. In one intervention group, a computer-generated message reminded the doctor to check the blood pressure of patients who happened to visit the center for an appointment; 30.7% of patients allocated to this group were checked. In the second group, the nurse contacted patients by telephone and encouraged 24.1% of those who were due for a check to obtain one. Sending a letter to patients in the third group yielded a 35.7% compliance rate. Considering the costs of the three interventions, the physician reminder was the most cost effective, followed by the letter reminder. Although statistically significant, the impact of the reminders was modest. A better approach might involve a combination of routine reminders to the physician, followed by letters to noncompliant patients.

Adolescent↗
PubMed1989

Computerized reminders to encourage cervical screening in family practice.

In a randomized trial three ways of increasing rates of cervical screening were compared for women attending a family medicine center. Working from computerized medical records, 1,587 women aged 18 to 35 years who were overdue for a screening test were included in the study. In a control group, no formal method was used to encourage patients to attend for screening, and 13.7 percent obtained a test within the trial year. In one intervention group the physician was issued a message identifying those women visiting the center for a routine appointment who were due for screening; 16.1 percent were screened. Sending a letter to patients in a second group yielded a 25.9 percent compliance rate. In a third group the practice nurse called patients on the telephone to advise them to obtain the test, and 20.0 percent complied. Reminders issued to the physician provide a low-cost, opportunistic approach to reach women who happen to visit the practice, but this approach should be supplemented by telephoning or sending a letter to those women who do not attend regularly.

Adolescent↗