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Biomedical subjects

B Arroll

Publications and source records attributed to B Arroll.

At least 37 records · Page 2Linked to original sources
PubMed1998

The impact of acne: a study of adolescents' attitudes, perception and knowledge.

AIM: To assess adolescent students' attitudes to, perceptions and knowledge of acne and to assess the effect of acne on daily living. METHOD: Students from Auckland sixth and seventh form classes were selected from ten Auckland secondary schools using a randomisation process which ensured proportional representation by socioeconomic group and gender. Eight hundred and forty-seven students completed a written questionnaire on the subject of acne vulgaris and had their acne examined. Their acne was graded using a modification of the Leeds system which determines severity on the basis of number, extent and nature of the skin lesions. RESULTS: Acne was present in 91% of males and 79% of females. Students' perceptions of the severity of their acne were significantly related to objective clinical assessment (p=0.00001). Severity of acne determined the extent of embarrassment (p<0.00001) and the lack of enjoyment of and participation in social activities (p<0.00002). These analyses were significant for both males and females. Students had misconceptions regarding the causes of acne. Parental occupation and ethnic group were related to knowledge of treatment for acne. CONCLUSION: Acne causes personal and social difficulties for a large number of adolescent students. There is a need for all students to have access to appropriate information and health services so that the social and psychological consequences of acne are minimised.

Acne Vulgaris↗
PubMed1998

Changes in CME uptake caused by reaccreditation.

AIM: To determine whether the requirements of the reaccreditation programme of the Royal New Zealand College of General Practitioners (RNZCGP) have changed the amount and type of continuing medical education (CME) done by the participating general practitioners. METHOD: A written questionnaire was sent to 200 randomly selected general practitioners doing the RNZCGP reaccreditation programme. RESULTS: The response rate was 82%. Although almost half the general practitioners had been motivated to spend more time on CME by the reaccreditation programme, for most this was a small increase. However, there was a trend towards selection of higher quality courses and towards increasing the time spent on educational activities more likely to result in changed behaviour. CONCLUSION: The RNZCGP reaccreditation programme is having beneficial effects on the CME activities of many of the participating general practitioners.

Accreditation↗
PubMed1998

The green prescription study: a randomized controlled trial of written exercise advice provided by general practitioners.

OBJECTIVES: The purpose of this study was to determine whether written advice from general practitioners increases physical activity among sedentary people more than verbal advice alone. METHODS: Sedentary patients (n = 456) received verbal advice on increasing physical activity and were then randomized to an exercise prescription (green prescription) group or a verbal advice group. RESULTS: The number of people engaging in any recreational physical activity at 6 weeks increased substantially, but significantly more so in the green prescription group. Also, more participants in the green prescription group increased their activity over the period. CONCLUSIONS: A written goal-oriented exercise prescription, in addition to verbal advice, is a useful tool for general practitioners in motivating their parents to increase physical activity.

Adult↗
PubMed1997

The validity of general practitioners' self assessment of knowledge: cross sectional study.

OBJECTIVE: To determine whether general practitioners can make accurate self assessments of their knowledge in specific areas. DESIGN: 67 general practitioners completed a self assessment of their level of knowledge over a variety of topics using a nine point semantic differential scale. An objective assessment of their knowledge was then made by administering true-false tests on two of the topics: thyroid disorders and non-insulin dependent diabetes. The study was repeated with another group of 60 general practitioners, using sexually transmitted diseases as the topic. SETTING: General practices in New Zealand. SUBJECTS: Random sample of 67 general practitioners in Auckland. MAIN OUTCOME MEASURE: Test scores for self assessment and for actual knowledge. RESULTS: Correlations between self assessments and test scores were poor for all three topics studied (r = 0.19 for thyroid disorders, 0.21 for non-insulin dependent diabetes, 0.19 for sexually transmitted diseases). CONCLUSIONS: As general practitioners cannot accurately assess their own level of knowledge on a given topic, professional development programmes that rely on the doctors' self perceptions to assess their needs are likely to be seriously flawed.

Clinical Competence↗
PubMed1997

Referral letters: are form letters better?

An essential mode of contact between general practitioners (GPs) and hospital staff is the referral letter. This must be clear and concise with sufficient information to aid the GP, the consultant and the patient. In order to ensure this, a proposal was made for the use of a structured or standardized referral letter: a form letter. This report shows that form letters were shorter than typed letters. Form letters were also proven to contain more information than nonform letters.

Correspondence as Topic↗
PubMed1997

Green prescriptions: attitudes and perceptions of general practitioners towards prescribing exercise.

BACKGROUND: This qualitative study was part of a broader randomized controlled trial which showed that written exercise advice (green prescription) from a general practitioner (GP) increased physical activity levels among sedentary patients more than verbal advice alone over a 6-week period. AIM: To assess the attitudes and perceptions of GPs towards the practice of writing green prescriptions. METHOD: Participating GPs (n = 25) discussed attitudes and perceptions towards green prescriptions through structured focus groups within 2 weeks of the end of recruitment for the main study. RESULTS: The GPs felt comfortable discussing and prescribing exercise with and to patients. They preferred giving green prescriptions to giving verbal advice alone, and felt they were a valuable tool to formalize and document mutually agreed exercise goals. Time constraints were identified as a major barrier to the widespread implementation of green prescriptions. Appropriate training, resource materials, and patient follow-up mechanisms were identified as important elements for successful implementation of the strategy. CONCLUSION: Overall, the GPs were very positive about the green prescription concept, believing it to be beneficial for patients and achievable within general practice.

Attitude of Health Personnel↗
PubMed1996

Screening for colorectal cancer: a survey of New Zealand general practitioners.

AIM: To determine the attitudes and reported behaviours of New Zealand general practitioners concerning colorectal cancer screening and diagnosis with special consideration of the use of faecal occult blood tests. METHOD: A postal survey of a random sample of 400 New Zealand general practitioners. RESULTS: The response rate to the survey was 63%. Most of the respondents did not support a screening programme for average risk patients but did support screening in high risk groups. General practitioners favoured a screening programme offered by themselves rather than a centrally organised screening programme. A majority of respondents agreed that there was a lack of clear guidelines and a need for education regarding screening for bowel cancer. CONCLUSION: Guidelines for colorectal cancer screening are required for New Zealand general practitioners. There appears to be a need for medical education concerning screening for colorectal cancer in particular and screening and prevention in general.

Adult↗
PubMed1996

New Zealand general practice computerisation; attitudes and reported behaviour.

AIMS: To gather information from general practitioners regarding aspects of computerisation including whether certain tasks should be computerised and whether those tasks were in fact computerised at their practice. METHODS: Five hundred general practitioners randomly selected throughout New Zealand were sent a postal survey in May 1995. Results were then collated and analysed. RESULTS: The response rate was 54% (268). Computerisation is becoming a necessity according to 85% of responders and a computer was used for at least one task by 84% of doctors. Computer use during consultation interfered unduly with doctor-patient communication according to 43% of responders. Privacy issues had not been dealt with adequately for 33% of responders. The five most frequently computerised tasks were; maintaining an age-sex register (81% of responders), recalls (80%), administration (77%), making appointments (50%) and word processing (49%). The number of doctors in a practice and responders' RNZCGP membership status appeared predictive of task computerisation. Responders' gender, year of graduation and their membership on the Indicative General Practitioners Register were not statistically significant factors for determining attitudinal and behavioural responses. CONCLUSIONS: The low response rate limits generalisation but the trends in the results are important. Reported tasks with greatest potential for computerisation were doctor education; checking drug interactions/contraindications; patient education; tasks relating to interfacing with laboratories; and database enquires of patients. Significant concerns among responders were perceived interference with doctor patient communication and privacy issues. Eighty-four percent of responders use the computer for at least one task.

Adult↗
PubMed1996

Eradication treatment for Helicobacter pylori in general practice.

AIMS: To identify patients with a past history of peptic ulcer and to treat Helicobacter pylori infection if confirmed. METHODS: Patient records from 6.5 full-time equivalent general practitioners were reviewed to record prescribing of H2-receptor antagonists in the last year and to review previous upper gastrointestinal investigations. RESULTS: Two hundred and sixty-seven patients had used H2-receptor antagonists in the previous year. The indications for use were peptic ulcer 25%, reflux 21%, empiric treatment for dyspepsia 39% and dyspepsia with a normal investigation 15%. Short-term prescribing was common (52% of patients treated for 1-2 months only) and of these patients 50% had undiagnosed dyspepsia. The most common indication for long-term prescribing (6 months or more) was peptic ulcer (46%). The records of 96 patients with peptic ulcer were identified; 50 were traced and considered for recall and a 13C urea breath test for Helicobacter pylori. Thirty-eight patients agreed to a breath test; 23 were positive (60.5%). Follow up breath test was negative following eradication treatment in 16 of 22 treated patients (73%). CONCLUSION: Patients with peptic ulcer disease can be recalled using general practice case notes and treated with antibiotic treatment. The majority of H2-receptor antagonist use is for indications other than peptic ulcer disease.

Aged↗
PubMed1996

The effect of moderate exercise on mood in mildly hypertensive volunteers: a randomized controlled trial.

This study reports an investigation of the effect of participating in moderate exercise (three 40-min sessions of brisk walking a week for 6 months) on mood state in 177 sedentary, mildly hypertensive volunteers. Mood was assessed by the Profile of Mood States, Bipolar Form (POMS-BI), and no significant differences were found between control and exercise groups. The intervention group increased its exercise output more than the control group, but there was also a significant increase in exercise done by the control group. We conclude that exercise has no major effect on mood in hypertensive volunteers.

Adult↗
PubMed1996

Non-pharmacological management of hypertension: results from interviews with 100 general practitioners.

OBJECTIVE: To describe the type and level of non-pharmacological management offered by general practitioners for essential hypertension. DESIGN: An open-ended interviewer-administered survey using a standard case of a 60-year-old man with essential hypertension. Seventy interviews were conducted face-to-face and 30 by telephone. SETTING: Auckland general practices. SUBJECTS: A random sample of 100 Auckland general practitioners. MAIN OUTCOME MEASURES: Aspects of the medical histories of patients, physical examination, laboratory testing and treatment relevant to non-pharmacological management. RESULTS: There was an 84% response rate. Most general practitioners reported offering non-pharmacological management at the first consultation before prescribing medication. However, few offered detailed programmes. Dietary therapy, restriction of alcohol consumption and exercise were suggested by most general practitioners. Restriction of sodium intake and behavioural therapy were less popular non-pharmacological interventions. The median number of visits of patients to a general practitioner before drugs were prescribed was five, which is in keeping with guidelines. The median number of days from the first visit to prescription of drug therapy was 42 (range 2-341). The clinical advice given by the majority of participants was consistent with current guidelines on the treatment of hypertension but the range of advice given was wide. CONCLUSIONS: The results suggest that general practitioners are aware of non-pharmacological interventions for the management of hypertension. They report making routine use of non-pharmacological therapies for blood pressure reduction and other health benefits early in the clinical process before considering pharmacological therapy. These non-pharmacological therapies are not delivered with well-defined and detailed programmes.

Alcohol Drinking↗
PubMed1995

Prevalence of acne vulgaris in Auckland senior high school students.

AIM: To assess the prevalence and severity of acne vulgaris in adolescent students. METHOD: 867 students in Auckland sixth and seventh form classes were interviewed on the subject of acne vulgaris. Of these 847 students were examined and graded for severity of their acne using a modification of the Leeds technique which ranks severity according to number, extent and nature of the acne lesion. RESULTS: Ninety-one percent of males and 79% of females had some acne. Severe acne was present in 6.9% males and 1.1% females. Severe and moderately severe acne was significantly more common in males (OR = 2.6 95% Cl 1.73 < OR < 3.9). In the univariate analysis there was no association of moderately severe and severe acne with parental occupational group nor ethnicity. CONCLUSION: Moderate and severe acne is a common finding in Auckland senior high school classes with males being more affected than females.

Acne Vulgaris↗
PubMed1995

Salt restriction and physical activity in treated hypertensives.

AIM: To determine the effect on blood pressure from brisk walking with or without salt restriction in a community based sample of treated hypertensives. METHODS: The intervention was undertaken in a community setting with a factorial randomised controlled trial and blinded assessment of blood pressure. One hundred and eighty one healthy adult volunteers with a sedentary lifestyle and on pharmacological therapy for hypertension briskly walked for 40 minutes three times per week with or without salt restriction. Systolic and diastolic blood pressure were assessed at three and six months. RESULTS: Of the original 208 participants 181 (87%) completed the study. significant reductions of up to 7 mm Hg were found in systolic blood pressure at 3 months for brisk walking alone (p = 0.04) and salt restriction alone (p = 0.03) but not for the combined intervention (p = 0.17). No significant change was found for diastolic blood pressure. There was no significant change in blood pressure at 6 months. CONCLUSIONS: Simple advice on exercise and sodium restriction in a community setting can significantly lower systolic blood pressure at least for 3 months. The combination of the two interventions was less effective than each therapy alone.

Combined Modality Therapy↗
PubMed1995

Management of hypertension and the core services guidelines: results from interviews with 100 Auckland general practitioners.

AIM: To determine if the management of a hypothetical case of essential hypertension by general practitioners conforms with the Report to the National Advisory Committee on Core Health and Disability Services guidelines on the Management of Raised Blood Pressure in New Zealand (Core Services Report on Hypertension) sent to all general practitioners in November 1992. METHOD: A cross-sectional survey of a random sample of 100 Auckland general practitioners using a standard case of a 60 year old man with essential hypertension. Seventy interviews were conducted by a face-to-face interview and 30 by telephone interview. The main outcome measures were. Initial choice of medication and levels at which blood pressure would require treatment. RESULTS: Forty one percent of the interviewed doctors had read the Core Services report on hypertension. Fifty percent of the doctors indicated they would use the recommended first line antihypertensive medication (ie, diuretic or beta blocker). Doctors who prescribed beta blockers had been graduated a significantly longer time than those who did not. The majority of doctors indicated that they would initiate pharmacological treatment at lower blood pressures in younger patients than older patients contrary to the recommendation of the report. CONCLUSIONS: Current reported practice is only partially consistent with that suggested by the Core Services report on hypertension. Approximately half of the doctors interviewed were prescribing the recommended first line medication. Treatment was more likely to be initiated at lower levels in younger patients than in older patients in spite of the higher absolute risk and potential absolute benefit in the latter group. Adherence to the guidelines could see a shift from overtreatment of younger patients to an increase in treatment for older patients who are at higher risk of blood pressure related disease. More specific graduate educational measures will be needed if the Core Services report on hypertension are to be implemented.

Adult↗