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Biomedical subjects

A Mant

Publications and source records attributed to A Mant.

At least 91 records · Page 5Linked to original sources
PubMed1989

Do general practitioners promote health? A needs assessment.

A random sample of 5% of NSW general practitioners was surveyed in December 1986 regarding their attitudes to health promotion in clinical practice. The results were compared with those of simultaneous surveys of trainee general practitioners and fourth-year medical students. Smoking, alcohol and weight reduction were the health behaviours that were considered by general practitioners to be the most difficult to change. More general practitioners than did students or general-practitioner trainees reported finding less difficulty in changing health behaviours. More than three-quarters of the general practitioners were in favour of promoting health in their practices. A commonly reported barrier was the current Medicare financing arrangements for preventive practice. Other barriers included a lack of time for preventive practice. The complaint of a lack of training was expressed commonly; half the sample was willing to participate in advanced training in health promotion that would be organized by The Royal Australian College of General Practitioners.

Adult↗
PubMed1989

Rectal bleeding. Do other symptoms aid in diagnosis?

It has been shown previously that it is difficult for a general practitioner to predict anal vs. colorectal sources of bleeding in patients presenting with rectal bleeding. The aim of the present study was to determine whether there are any aspects of such a patient's history or clinical features that strongly indicate bleeding from a colorectal cancer or polyp. One hundred forty-five consecutive patients, aged 40 years and older, who had complained of rectal bleeding to a general practitioner, were referred to a specialist for full colonic investigation. Among 15 symptoms and clinical features examined, few had any statistically significant association with the source of bleeding. There was an elevated probability of colorectal cancer (21 percent) in patients who had seen blood mixed with feces. Most bowel symptoms and clinical features are not helpful in deciding whether to proceed with full colorectal assessment in patients aged 40 and older who have rectal bleeding of recent onset.

Adult↗
PubMed1989

Interrater reliability of computer-assisted scoring of breathing during sleep.

Twenty-six records of sleep and breathing obtained with a portable monitoring system from elderly subjects were scored by three raters with computer assistance to examine interrater reliability of scoring. Raters were a medical student, a nurse practitioner, and a family physician, all of whom had at least one month's experience with the equipment. Agreement among raters was measured with the unweighted kappa statistic. Significant agreement was observed for all variables, although agreement was better for variables describing breathing (range of kappa 0.71-0.87) than for those describing sleep (range of kappa 0.34-0.57). Complete agreement among the three raters on diagnostic classification occurred in 17 cases. In the remaining 9 cases, 2 raters agreed, whereas the third differed by not more than one category for type of disturbance (e.g., normal versus hypopnea, hypopnea versus apnea) or severity (e.g., mild versus moderate). There was only one disagreement among raters for the 9 subjects with severe respiratory disturbance. We conclude that interrater reliability of identifying and characterizing breathing disturbance during sleep as recorded by portable monitoring is high among trained raters using computer assistance.

Aged↗
PubMed1988

Development of long term use of psychotropic drugs by general practice patients.

From 1984 to 1986 a prospective study was conducted of 104 general practice patients who started treatment with a benzodiazepine or an antidepressant drug. The duration of reported use of the drugs was two months for 45% of patients, four months for 17% of patients, and six months for 15%. Type of drug, age, and level of education were found to be predictive of continuing use. General practitioners have a significant effect on their patients' use of drugs and, with careful selection and review when prescribing, may help to prevent dependence on psychotropic drugs.

Adolescent↗
PubMed1988

Recognition of dementia in general practice: comparison of general practitioners' opinions with assessments using the mini-mental state examination and the Blessed dementia rating scale.

In a study of 226 elderly residents in a retirement village in Sydney, Australia, general practitioners' opinions about dementia status had high positive and negative predictive values and high specificity, but low sensitivity when evaluated against the mini-mental state examination and the Blessed dementia rating scale. General practitioners were found to disagree with these two measures more often when patients were in advanced old age, and when they considered the patients to be depressed. We conclude that the general practitioner can increase his or her sensitivity to dementia in the elderly by use of either measure.

Aged↗
PubMed1988

Sleep-related respiratory disturbance and dementia in elderly females.

Sleep-related respiratory disturbance was studied with a microprocessor-based portable monitoring system in female residents of a retirement village aged greater than or equal to 75 years. Comparisons were made between 29 demented subjects Mini-Mental State Examination Score (MMSE) less than 21 and 48 controls (MMSE greater than 25). Respiratory disturbance index (RDI, the number of episodes of apnea and hypopnea/hour of total sleep time) was higher in the demented subjects: mean RDI (+/- SD) 18.5 +/- 18.6 vs 7.3 +/- 10.8, p = .004. The number of minutes per hour of sleep spent with disturbed breathing was greater in demented subjects than in controls (p = .01). These differences between demented subjects and controls persisted after adjustment for age and relevant medical history. Other possible confounders, namely body mass index and use of sedatives, were not significant. We conclude that respiratory disturbance during sleep is more prevalent in elderly demented females than in controls.

Aged↗
PubMed1987

Trends in psychotropic drug prescribing in Australia.

In 1983-1984, 9.8 million prescriptions were written for the 12 most common psychotropic drugs that are available under the Pharmaceutical Benefits Scheme. Our analysis shows that, of these prescriptions, 59% (374 per 1000 persons) were for the four most commonly prescribed benzodiazepine agents; 34% (216 per 1000 persons) were for the five main antidepressant agents; and 7% (41 per 1000 persons) were for the three main phenothiazine agents. In the period from 1977-1978 to 1983-1984, prescription volumes were relatively stable for antidepressant and phenothiazine drugs. Fluctuations in the prescribing of individual benzodiazepine agents are discussed. Older patients and women of all ages receive the majority of the psychotropic drug prescriptions that are written by Australian general practitioners.

Australia↗
PubMed1987

A survey of new users of psychotropic drugs in Australian general practice.

During 1984 and 1985, a study was conducted of 104 new adult users of benzodiazepines or antidepressants prescribed by sixty-two general practitioners in Sydney, Australia. New users of antidepressants tended to be older than new users of benzodiazepines. Seventy per cent of new users of psychotropic drugs were women and 67% were suffering significant psychological distress according to the 12-item general health questionnaire administered in a home interview. It was estimated that the general practitioners initiated approximately one new episode of use per week, and that repeat prescriptions constituted the bulk of general practitioner prescribing of these drugs.

Adolescent↗
PubMed1987

Evaluation of a microprocessor-based portable home monitoring system to measure breathing during sleep.

Study of the epidemiology of disturbances of breathing during sleep was hampered until recently by the need to conduct studies in the laboratory, with attendant inconvenience and limited sample sizes. We assessed the accuracy of a microprocessor-based portable monitoring system (Vitalog PMS-8, Vitalog Corp., CA) to detect and classify episodes of disturbed breathing during sleep in 14 patients with sleep apnea by simultaneously recording oxygenation and thoracoabdominal motion on the portable system and a polygraph. Each patient slept in the laboratory for 1 night. In two subjects, the portable system failed to record thoracoabdominal signals. In the remaining subjects, the portable system detected 78% of 2,340 episodes of disturbed breathing, but the recorded information was not sufficient to allow confident classification into central or obstructive events. The positive predictive value of disturbed breathing detected by the portable system was 64%, Respiratory disturbance indices (RDI) computed from the polygraph and portable records were correlated (r = 0.70; p less than 0.01), and all patients with sleep apnea were correctly diagnosed by the portable system. The portable system overestimated arterial oxygen saturation (SaO2) recorded by an ear oximeter (Biox IIA, Ohmeda, CO) but the error was less than 10% of the true value at SaO2 greater than 60%. Seven normal subjects were studied while awake to examine the accuracy of volume measurements made by the portable system and the system's ability to detect paradoxical thoracoabdominal motion of various degrees. Absolute measurement of tidal volume was inaccurate, but detection rate of paradoxical thoracoabdominal motion was excellent (97%). We conclude that the portable system is sufficiently sensitive to allow detection of patients with breathing disorders during sleep, but further developments are necessary before the system can be relied on for accurate classification of apneas and hypoventilation.

Adult↗
PubMed1987

Self-care and self-medication. An evaluation of individuals' health care decisions.

A panel of six experienced general practitioners evaluated the actions taken by 340 respondents who had experienced a minor symptom or condition in the 2 weeks prior to interview. In only 2% of cases were the actions taken assessed as inappropriate and potentially harmful. The use of leftover prescription medicines was most often disapproved of by the panel. The panel did not agree about the use of home remedies and over-the-counter medicines. Discriminant analysis was used to describe the profile of respondents whose actions the panel considered either appropriate or inappropriate.

Adolescent↗
PubMed1985

Long-term psychotropic drug prescribing for general practice patients.

Although 11.3% of patients of an academic general practice unit were prescribed one of the four commonest psychotropic drugs in 1978, only 1.6% received six or more prescriptions. During the following three years further prescriptions for the same drug were issued in 61% of the patient years for which information was available. Most of the frequent recipients were elderly women. Further research is needed into the natural history of conditions for which psychotropic drugs are prescribed in general practice.

Australia↗