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Biomedical subjects

A L Kinmonth

Publications and source records attributed to A L Kinmonth.

At least 55 records · Page 3Linked to original sources
PubMed1995

No symptoms, no problem? Patients' understandings of non-insulin dependent diabetes.

Depth interviews were carried out with 46 people with non-insulin dependent diabetes. In the course of narrative accounts, respondents displayed their thinking about the nature of diabetes and their understandings of how one ought to respond to it. Two variations in patients' interpretations of diabetes are discussed here: the extent to which patients primarily orientated themselves toward symptom control or toward prevention of complications, and their perceptions of the seriousness of the condition. Most patients believed diabetes to be a serious condition, which could cause complications. However, many were able to reconcile such beliefs with a less than whole-hearted adherence to medical advice about lifestyle. The analysis suggests a range of specific areas of diabetes care where patients could be more fully informed. Most importantly it describes a range of ways in which patients present their non-adherence to medical advice about lifestyle as entirely rational, given their perceptions of diabetes and its personal implications for each of them. Better understanding of such perceptions by health professionals may improve therapeutic alliances.

Adaptation, Psychological↗
PubMed1995

Readiness for lifestyle advice: self-assessments of coronary risk prior to screening in the British family heart study. Family Heart Study Group.

BACKGROUND: Where health professionals and patients hold similar views of a problem, health outcomes may be better. AIM: The aims of this paper were to document how attenders at primary care cardiovascular screening clinics perceived their risks of coronary heart disease prior to screening; the degree of similarity between perceived level of risk and an epidemiologically derived risk score; and the relative importance assigned to individual risk factors by subjects compared with those assigned by the risk score. METHOD: These issues were investigated in 3725 middle aged men and women who accepted an invitation to attend health screening as part of the British family heart study. RESULTS: Overall, there was a tendency for subjects to be optimistic (37%) rather than pessimistic (21%) when judging their risk of coronary heart disease. Nevertheless, there were strong significant associations between perceived risk and the levels of individual risk factors, particularly personal and family medical history and body mass index. There was also a strong association with the overall risk score though a large minority (31%) held views of their risk of coronary heart disease that were quite different from those based upon the epidemiologically derived index of risk. Respondents accorded greater importance to smoking and parental death from coronary heart disease and less importance to cholesterol level and blood pressure than did the risk score. CONCLUSION: Possible explanations for the observed disagreement are over-optimism or the relative importance given to individual risk factors. The relationships between patients' perceptions of risk and the epidemiological indices likely to be espoused by health professionals are important in understanding the difficulties in communication that might arise in offering lifestyle advice after screening for cardiovascular risk.

Adult↗
PubMed1994

Effect of non-attenders on the potential of a primary care programme to reduce cardiovascular risk in the population. Family Heart Study Group.

OBJECTIVES: To determine the feasibility of enrolling non-attenders of a population based cardiovascular risk reduction programme (the British family heart study) into a further, similar programme and to assess the effect of non-attendance on the effectiveness of the programme. DESIGN: Follow up of non-attenders by practice nurses, including home visits if necessary, to administer questionnaires and obtain physiological measurements. SETTING: Eight general practices across England, Scotland, and Wales. SUBJECTS: Non-attenders in a cardiovascular risk factor screening and intervention programme compared with attenders. MAIN OUTCOME MEASURES: Number of non-attenders enrolled; sociodemographic characteristics; personal and family history of coronary heart disease; cardiovascular risk factors; and total coronary risk score. RESULTS: Data were collected from 106 (17%) of the 608 non-attending families (99 men and 42 women). Of the 543 non-attending families from five practices that attempted complete follow up, 256 had moved away or died. Only 76 were eventually enrolled into the study. The prevalence of coronary heart disease and a family history of coronary heart disease were similar among non-attenders and attenders as were the individual coronary risk factors studied except smoking. Women non-attenders were more likely to be current cigarette smokers than attenders (15/42 v 202/948, P = 0.02). CONCLUSIONS: The intensive follow up of non-attenders resulted in real intervention opportunities in only a small number. Since the effect of any intervention in a population is reduced by non-attendance audit of preventive medical programmes aimed at the population should allow for the effect of non-attenders on the overall results.

Cardiovascular Diseases↗
PubMed1992

Management of feverish children at home.

OBJECTIVES: To compare the acceptability and effects on temperature of advice to unwrap children and give paracetamol or warm sponging treatments in the management of feverish illness at home. DESIGN: A randomised, open, parallel group study using factorial design comparison of unwrapping, warm sponging plus unwrapping, paracetamol plus unwrapping, and paracetamol and warm sponging plus unwrapping. SETTING: Homes of willing families with a feverish child recruited after consulting one of 21 participating general practitioners in Southampton. SUBJECTS: 52 children aged from 3 months to 5 years with axillary temperatures before treatment of > or = 37.8 degrees C and < 40 degrees C. MAIN OUTCOME MEASURES: Response to advice assessed over four hours; temperature assessed by continuous data logging from an axillary thermistor; acceptability of treatment to child and parent scored on Likert scales immediately after treatment and on return to health. RESULTS: Response to treatment advice varied; unwrapping alone had little effect on temperature. Paracetamol increased the time below 37.2 degrees C in four hours by 109 (95% confidence interval 74 to 145) minutes compared with unwrapping; warm sponging caused the fastest reduction in temperature. Parents discriminated between treatments, preferring paracetamol. CONCLUSION: Advice to give paracetamol is more effective than sponging or unwrapping in controlling temperature in children at home and is more acceptable to parents. Warm sponging has an additive effect and reduces fever more quickly than paracetamol.

Acetaminophen↗
PubMed1992

General practice based diabetes surveillance: the views of patients.

Forty three patients with non-insulin dependent diabetes registered at two suburban practices were interviewed at least one year after the introduction of an organized general practice based system of diabetic surveillance and the results compared with data gathered from interviews administered before the introduction of the system. Structured data from the two interviews were compared in relation to the importance which patients attached to diabetes and its medical review, patients' preference for place of future review and the health professionals from whom they wished to receive diabetes care. Patients' ratings of the performance of health professionals on various aspects of care were compared with the ratings given before the introduction of the new service. At the follow-up interviews the reasons behind patients' responses to the structured questions were explored using a qualitative method. The introduction of a general practice based diabetes service was marked by an improvement in attendance for diabetes monitoring (56% before introduction, 98% in the year following introduction). This was associated with an increase in the importance which patients attached to diabetes and its medical review. After experience of diabetes care in general practice, patients remained enthusiastic about general practice involvement and confident in their general practitioners' knowledge about diabetes management. In spite of an improvement in the patients' ratings of hospital doctors' communication skills, they continued to rate general practitioners significantly more highly in these skills (P < 0.01) and in terms of convenience and accessibility (P < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

'Will you help me with my research?' Gaining access to primary care settings and subjects.

This paper is concerned with the negotiation of agreement to carry out research in primary care settings. It is argued that this is a key part of any research project, and that careful handling of this process will not only improve response rates, but will also often enhance the quality of the data obtained. A number of strategies for negotiating access are proposed which have been developed and applied in primary care settings. These strategies depend on creating a sense of collective ownership of projects between researchers and participants which contributes to the successful completion of the projects and provides a positive atmosphere for further collaboration.

Family Practice↗
PubMed1990

Review of the epidemiology of sudden infant death syndrome and its relationship to temperature regulation.

Infants dying suddenly and unexpectedly now account for 20% of all infant deaths in England and Wales, and the incidence shows no sign of falling. Recent work relating sudden infant death to a raised environmental temperature and a raised body temperature, implicates fever as a possible contributory cause of death; some infants may be unable to control their febrile response to infection, or to thermoregulate effectively, when well wrapped and heated. Death might then result from apnoea, occurring in a critical sleep state. These ideas have increased the interest in describing the normal practices of parents in caring for the environment of their infants in health and disease, and the effect of their behaviour on the child's temperature. Studies of these areas depend on collecting and interpreting data from young children during their day to day lives, and present a challenge of great relevance to primary care research.

Body Temperature Regulation↗
PubMed1989

Doctors' beliefs and the management of insulin dependent diabetes: implications for sharing care.

There have been many studies of the health beliefs of patients but relatively few have considered the beliefs of doctors and the influence these have on the management of a disease. This paper reviews the evidence that such beliefs are important and reports a preliminary study examining differences in the beliefs of doctors as a function of their experience and chosen specialty. Thirty four general practitioner teachers responded to a questionnaire measuring beliefs about diabetes and its management. The results were compared with those of a previous study among hospital doctors with an interest in diabetes. In comparison with hospital doctors, general practitioner teachers had a more pessimistic outlook on diabetes, perceiving that the disease carried more risks and having less confidence that achieving goals of treatment would reduce these risks. In accord with these beliefs their approach to treatment was less rigorous than that of hospital-based doctors. These results have implications for shared care; such differences between groups of doctors are likely to be a barrier to the effective sharing of patient care. The results also add further strength to the view that doctors' beliefs about a disease and its management need to be considered alongside those of the patient to explain more of the variance in patient health outcomes.

Attitude of Health Personnel↗
PubMed1989

Diabetes and its care--what do patients expect?

A sample of 77% of the non-insulin dependent diabetics aged 30-70 years from two urban practices offering no structured diabetic care were interviewed. The 55 patients (mean age 60 years) were asked about their experiences and expectations of diabetes and the health professionals involved in their care. Twenty-six patients attended the hospital diabetic clinic regularly but 13 patients received no review at all; 46 patients wanted their general practitioner to be involved in future care and only six wanted to continue with hospital review alone. Patients gave hospital doctors and general practitioners similar high ratings for knowledge of diabetes and its management but general practitioners and practice nurses were rated more highly for communication and accessibility. The aspect of care valued most was being given clear information about diabetic management. Twenty two patients thought that diabetes would have a significant impact on their future health and 35 rated regular diabetic review as extremely important in keeping themselves healthy. Most patients felt it likely that they would have a high blood glucose level most of the time and develop diabetic complications. Little difference was found between the views of clinic attenders and non-attenders, and there was no evidence that non-attenders had actively rejected review. These non-insulin dependent diabetics considered diabetes to be a serious disorder warranting regular care and expressed confidence in the primary care team's ability to provide such care.

Adult↗
PubMed1989

Organized personal care--an effective choice for managing diabetes in general practice.

A system of diabetic review was introduced in two Southampton training practices in March 1985. Each partner, with the help of the practice nurse, retained responsibility for review of their own diabetic patients. During the study period (1984-86) 213 diabetics remained with the practices. In 1984 there were 94 non-insulin dependent patients who were not receiving hospital outpatient care. Over the study period there was an increase in the surveillance of blood glucose, blood pressure, weight, urine (for protein), fundi, visual acuity and feet for this group so that in 1986 between 79% and 89% of patients were having these parameters checked at least annually. More complications were found and more referrals for specialist evaluation were made. There was a trend towards transfer of care from the hospital to the general practitioner, and the proportion of non-insulin dependent diabetic patients receiving their care entirely from general practice increased from 22% to 60% over the period. There was a small increase in the workload of the general practitioners and a considerable contribution to care was made by the practice nurses. It is concluded that structured personal diabetic care based on a nurse coordinated service is a satisfactory alternative to the 'specialist' general practitioner mini-clinic model.

Aged↗
PubMed1988

British Diabetic Association holidays--what are they worth?

A postal survey among families of 63 children attending two BDA educational holidays studied their expectations before (Questionnaire 1) and experiences 3 months afterwards (Questionnaire 2). Of 47 families replying to both questionnaires (22M, 25F; mean age 8.4 years, range 5-13.8 years), expectations expressed by parents for their children were that they gain in confidence and independence (n = 36), mix with other diabetic children (n = 32), learn to self-inject (n = 27), improve diet (n = 23), and have a good holiday (n = 10). Thirty-five families subsequently reported that their expectations had been met. After the holiday, although there was no change in frequency of blood or urine testing, there was an increase in children doing tests on their own (Q1: 15, Q2: 28, p = 0.003); more parents reported confidence in their child recognizing a hypoglycaemic episode (Q1: 29, Q2: 39, p = 0.001); and there was a sustained increase in independence with insulin injections (Q1: 29, Q2: 35, p = 0.042). This study provides evidence that BDA holidays benefit parents and their children, and do so mainly by increasing the children's confidence and independence in diabetic care.

Anxiety, Separation↗