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Biomedical subjects

A J Tulloch

Publications and source records attributed to A J Tulloch.

12 recordsLinked to original sources
PubMed2002

The MRC trial of assessment and management of older people in the community: objectives, design and interventions [ISRCTN23494848].

BACKGROUND: The benefit of regular multidimensional assessment of older people remains controversial. The majority of trials have been too small to produce adequate evidence to inform policy. Despite the lack of a firm evidence base, UK primary care practitioners (general practitioners) are required to offer an annual health check to patients aged 75 years and over. DESIGN: Cluster-randomised factorial trial in primary care comparing a package of assessments (i) universal versus targeted assessment and (ii) management by the primary care team (PC) or a multidisciplinary geriatric assessment team (GM). The unit of randomization is the general practice. METHODS: Older people aged 75 and over eligible for the over 75s health check and excluding those in nursing homes or terminally ill were invited to participate. All participants receive a brief assessment covering all areas of the over 75s check. In the universal arm all participants also receive a detailed health and social assessment by a study nurse while in the targeted arm only participants with a pre-determined number and range of problems at the brief assessment go on to have the detailed assessment. The study nurse follows a standard protocol based on results and responses in the detailed assessment to make referrals to (i) the randomised management team (PC or GM) (ii) other medical services, health care workers or agencies (iii) emergency referrals to the GP. The main outcomes are mortality, hospital and institutional admissions and quality of life. 106 practices and 33,000 older people have been recruited to the trial.

Aged↗
PubMed1993

General practice workload during normal working hours in training and non-training practices.

The aim of this study was to design and test a form to review workload in training and non-training practices. The study was conducted in the Oxford, Reading and Milton Keynes districts over a period of one week and involved 31 training and 21 non-training practices consisting of 156 and 66 doctors, respectively. Doctors in training practices (excluding trainees) spent a mean of one hour less per week in contact with their patients than doctors in non-training practices. Doctors in training practices spent approximately the same time per week on administration as those in non-training practices, one hour more in both meetings and non-practice work and almost two hours more in training and studying. The mean total practice workload per doctor in training practices was two hours more than in non-training practices and, when non-practice work was included, the difference increased to three hours. Compared with other doctors, trainees saw fewer patients in the surgery, in clinics and on visits, but spent more time on studying and training. This study produced broadly similar results to previous surveys, although doctors in the present study saw fewer patients each week and spent more time with each patient than in other studies.

Data Collection↗
PubMed1985

Prevalence of disability observed in an Oxfordshire practice.

A register was compiled of disabled patients in an Oxfordshire practice; patients were considered to be disabled when an impairment appreciably affected their day-to-day life. The rates of disability rose with age. Three-quarters of the disabled patients had one disability, 21% two and 5% three or more disabilities. The most common source of disability was disorders of the nervous system followed by circulatory and musculoskeletal conditions. More than two-thirds of the disabilities were capable of amelioration and 4% could be completely resolved. Most patients had come to terms with their disability, only 8% finding adjustment difficult.

Activities of Daily Living↗
PubMed1979

A randomized controlled trial of geriatric screening and surveillance in general practice.

A randomized controlled trial of geriatric screening and surveillance was undertaken on a practice population of 295 patients aged 70 years or more over a two-year period. In the screened group (145 patients) many social problems were found and a total of 380 medical conditions were reported during the study period, 144 (38 per cent) of which were previously undetected. Conditions found most frequently involved the circulatory, musculoskeletal and nervous systems; 67 per cent of the conditions found were manageable, half being improved and the remainder resolved completely.The screening programme was found to increase the use of social and health services but it did also decrease the expected duration of stay in hospital.Independent assessment of patients in the study and control groups at the end of the two-year period showed that the screening programme had made no significant impact on the prevalence of socio-economic, functional, and medical disorders affecting health.We formed the firm impression that the study patients were made more comfortable (by control of pain) and less disabled, although there was no unequivocal objective evidence of this. They were, however, kept independent for longer.The findings are discussed and a model of geriatric care is suggested combining conventional management on demand with comprehensive screening to identify the high-risk patients on whom care might need to be focussed.

Aged↗
PubMed1975

Hospital discharge reports: content and design.

The information required by family doctors on initial and final discharge reports from hospitals was specified and 546 such reports from hospitals in Aylesbury, Amersham, Banbury, Oxford, and High Wycombe were reviewed for the availability and accessibility of important information. Several items could have been recorded better, including the name of the hospital, the specialty (or department) concerned, and the name of the consultant in charge of the case. Drug reactions seemed to be under-reported in the initial discharge reports and information about treatment on discharge was inadequate. The recording of the prognosis and information given to the patient was deficient and communication on follow-up needs to be improved. The use of obscure abbreviations was widespread. There is room for improvement in the ease of access to important information, especially the diagnostic assessment, and the time taken for final reports to reach the general practitioner.

England↗