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Biomedical subjects

C Del Mar

Publications and source records attributed to C Del Mar.

At least 37 records · Page 2Linked to original sources
PubMed1999

Nursing's contribution to general practice: general practitioners' and practice nurses' views.

This study was instigated by the paucity of knowledge relating to the work of nurses employed by general practitioners in Australia and the phenomenal development of the practice nurse role in the United Kingdom. A mailed survey of general practitioners and practice nurses within one Division of General Practice in South-East Queensland, sought, among other things, their views about the current and potential contribution of nursing to general practice. Eighty-four out of 164 (51%) general practitioners and 37 out of 67 (55%) practice nurses responded to the survey. Results indicated that both general practitioners and practice nurses appreciated the value of nursing services in general practice and would sanction the employment of more nurses especially for the purpose of preventive care. The majority of nurses were agreeable to the notion that the nurse's role could, and should, be expanded to include autonomous functioning while most of the doctors were amenable to some extension of nursing practice but reticent or opposed to any independent interventions.

Attitude of Health Personnel↗
PubMed1999

Women's knowledge about the physical and emotional changes associated with menopause.

In 1992, a survey was undertaken to study women's knowledge of the physical and emotional changes associated with menopause. Two groups of midlife women: a random sample (n = 381) and a sample of women who attended menopause seminars (n = 95) were asked to select from a list of 39 changes those they thought were directly caused by menopause. Information from readily available books written for a general audience was used to construct the marking guide for a "commonly available knowledge" score. A template for a "biomedical" knowledge score based on an estrogen deficiency perspective of menopause was derived from recently published academic medical literature. The mean score for the commonly available knowledge items was 27 out of 39 (69.2% correct). The mean biomedical knowledge score was lower, 19.3 out of 35 (55.1% correct). While the two groups of women were significantly different in terms of current and past hormone replacement therapy (HRT) use, we found no differences between them in the mean commonly available knowledge or biomedical knowledge scores. This finding challenges the widely held assumption that active information-seekers are more interested and have a better level of knowledge than the general population. The findings also suggest that women are less likely to accept a biomedical model of menopause and that they are using HRT for a multiplicity of reasons, not just those related to estrogen deficiency.

Estrogen Replacement Therapy↗
PubMed1998

Do personalised letters in Vietnamese increase cervical cancer screening among Vietnamese women?

In Australia, Vietnamese women are at greater risk of cervical cancer than other Australian women. To increase their participation in cervical screening, the Vietnamese community was exposed to a media campaign about the advantages of cervical smear screening which was delivered in Vietnamese through Vietnamese newspapers and radio. In addition, 689 Vietnamese (18-67 years) were selected from the electoral roll. They were randomly assigned to either receive a personal letter written in Vietnamese promoting cervical screening, or not. We report on the effect of the letter on smear rates. Being randomised to be sent such a letter was not associated with any increase in screening (relative rate of appropriate screening in the intervention versus the control group was 0.85, 95% CI 0.55-1.3). It is important to carefully evaluate untested health promotion interventions.

Adolescent↗
PubMed1997

Are antibiotics indicated as initial treatment for children with acute otitis media? A meta-analysis.

OBJECTIVE: To determine the effect of antibiotic treatment for acute otitis media in children. DESIGN: Systematic search of the medical literature to identify studies that used antibiotics in randomised controlled trials to treat acute otitis media. Studies were examined blind, and the results of those of satisfactory quality of methodology were pooled. SUBJECTS: Six studies of children aged 7 months to 15 years. MAIN OUTCOME MEASURES: Pain, deafness, and other symptoms related to acute otitis media or antibiotic treatment. RESULTS: 60% of placebo treated children were pain free within 24 hours of presentation, and antibiotics did not influence this. However, at 2-7 days after presentation, by which time only 14% of children in control groups still had pain, early use of antibiotics reduced the risk of pain by 41% (95% confidence interval 14% to 60%). Antibiotics reduced contralateral acute otitis media by 43% (9% to 64%). They seemed to have no influence on subsequent attacks of otitis media or deafness at one month, although there was a trend for improvement of deafness at three months. Antibiotics were associated with a near doubling of the risk of vomiting, diarrhoea, or rashes (odds ratio 1.97 (1.19 to 3.25)). CONCLUSIONS: Early use of antibiotics provides only modest benefit for acute otitis media: to prevent one child from experiencing pain by 2-7 days after presentation, 17 children must be treated with antibiotics early.

Acute Disease↗
PubMed1997

Managing the overweight and obese. A low fat approach.

Conventional weight loss methods usually fail in the long term. An approach that focuses on a low fat diet together with moderate increases in physical activity shows promise. Its most attractive feature is that patients do not have to starve themselves. This approach can be used in general practice.

Body Weight↗
PubMed1996

The menopause and hormone replacement therapy: Australian general practitioners' self-reported opinions, attitudes and behaviour.

OBJECTIVES: We describe the attitude and views of general practitioners towards the menopause and hormone replacement therapy (HRT) in metropolitan Brisbane, Australia. METHODS: A total of 216 general practitioners were nominated by a random sample of urband-welling women aged 45-54 years who formed the Brisbane Women's health study. A 20-30 minute face-to-face questionnaire with the general practitioners was administered and analysed by demographic characteristics. RESULTS: There was a 93% response rate. Management of the menopause and HRT was routinely undertaken by general practitioners for their own patients. After deciding to initiate HRT, > 60% of general practitioners ordered five investigations or more. They may have confused the risk of thrombo-embolism from oestrogens used in the post-menopause with that for contraception. There were differences between male and female practitioners in some areas. Male general practitioners, in particular, reported more difficulty with tailoring and adjusting regimes. CONCLUSIONS: Specific areas for further education are explored to meet the educational needs of general practitioners.

Adult↗
PubMed1996

Methodology of morbidity and treatment data collection in general practice in Australia: a comparison of two methods.

OBJECTIVES: To compare two methods of data collection of patient-practitioner encounter data in general practice: from medical records consultation notes and from data recorded on encounter forms. METHOD: Data were collected from two sources: (i) Medical Records Study: a study of the efficacy of an intervention designed to improve the quality of medical records provided details of 3107 patient encounters with 163 general practitioners (GPs) which had been photocopied from medical records; and (ii) Australian Morbidity and Treatment Survey (AMTS): from a national sample of 495 GPs and over 100,000 patient encounters, data from 47 GPs in the same geographical area as those in the Medical Records Study provided encounter forms for 10,392 patient encounters including details about patient demographics, reason for encounter, management, treatment, tests and investigations, admissions, referrals and planned follow-up. The International Classification of Primary Care (ICPC) was used to code reasons for encounter and problems managed. Drugs were classified according to an in-house classification by generic name and broad drug group. RESULTS: Patient details and all items of clinical information were recorded less frequently or were more often illegible in medical records than on encounter forms. There was a higher rate of management of problems classified as general or non-specific in the medical records. A lower prescribing rate for drugs acting on the cardiovascular system was recorded in the medical records, but higher rates were found for antibiotics, drugs acting on the immune system and miscellaneous drugs. Coding of all data was more reliable both between and within coders using the data from the encounter forms compared to the medical records. CONCLUSION: General practice data obtained from encounter forms are more comprehensive and are coded more reliably than those drawn from medical records.

Adolescent↗
PubMed1996

What is the quality of general practitioner records in Australia?

OBJECTIVE: To describe the quality of general practitioner (GP) medical records. SUBJECTS AND SETTING: One hundred and fifty fee-for-service GPs in suburban Brisbane. SETTING OF STANDARDS: Standards were set at meetings with general practitioner educators, and refined after circulating drafts to participants. Criteria were established in the 12 areas of: general ease-of-use (legibility; consciousness; and layout); whether certain patient data could be found (date of birth; past medical history; family history; allergies; alcohol and tobacco use; and immunisation status); and whether information about the most recent consultation could be found, (the reason for the consultation; its assessment; and management). MAIN OUTCOME MEASURES: Ten randomly selected medical records of consultations from each of the GPs scored blind by medical students. RESULTS: The mean weighted score was 11.4 out of a maximum possible of 18. Most records attained the standard with: consciousness (97%); recording date of birth (94%); and immunisation status (92%). Fewest attained the standard with family history (12%); adequate layout (17%); and recording alcohol and tobacco use (31%). Practice size and membership of the Royal Australian College of General Practitioners were not associated with significant differences in score, although sex, (being female) and date of graduation, (recent), were associated with significantly higher scores. CONCLUSION: There is considerable room for improvement in the quality of the clinical records of Australian GPs.

Analysis of Variance↗
PubMed1995

Women's perceptions and experience of menopause: a focus group study.

Focus groups were used to investigate women's perception and experience of menopause, hormone replacement therapy, osteoporosis and doctor-patient relationships. Forty women aged between 45 and 55 years participated in seven focus groups. Most women thought that these topics were not widely or freely discussed in the community. Nevertheless they were able to share their experiences on this occasion. Lack of reliable, accessible and current information on menopause and related topics was identified as a problem. This was compounded by the contradictory nature of the information which was available. Hysterectomy and osteoporosis were identified as specific areas in which information was inadequate and not readily accessible. Solutions suggested by the women included distributing information pamphlets with contact numbers for further information to non-health-related settings such as hairdressing salons. The need to foster open discussion between women and their doctors was highlighted, with contributions required from both parties to develop a more equal partnership. A review of doctors' and women's surveillance practices with regard to hormone replacement therapy may also be warranted. We found focus groups a useful method for accessing women's experiences and perceptions. There was particular benefit in researchers being involved as moderators and scribes, and in an early post-focus group meeting to amplify and clarify records of the discussions. Small group size and an emphasis on confidentiality were, we believe, helpful strategies in encouraging discussion of intimate topics.

Attitude to Health↗
PubMed1995

Incidence patterns of respiratory illness in Queensland estimated from sentinel general practice.

Incidence rates of six respiratory infections were calculated from sentinel practice data of 33,407 reports coming from 31 general practitioners in Queensland over 34 months in 1986/1988. Upper respiratory tract infection had an annual incidence of 301 per 1000 people, most in children aged under five, and a winter rate twice the summer rate. Sore throat (incidence 112:1000) and Infectious mononucleosis (incidence 2.7:1000) had little seasonal variation and were maximal among those aged 15-19 (in whom there was one case of Infectious mononucleosis for every 14 sore throats). Influenza (incidence 44:1000) underwent a prominent epidemic in the winter of 1988. Measles (incidence 1.9:1000), and pertussis and pertussis-like syndrome (incidence 0.8:1000) were most commonly reported in the under-fives, and rarely among adults. Sentinel practices networks collect useful epidemiological data from which disease incidences can be calculated.

Adolescent↗
PubMed1994

General practitioners in public obstetrics--an underutilized resource.

We questioned 229 general practitioners (GPs), 288 women who had recently delivered babies in public hospitals, 26 public hospital doctors, and 33 midwives in South Brisbane. Shared antenatal care was undertaken by 84% of mothers, and recently provided by 88% GPs. Mothers valued having sufficient time with their antenatal clinician, continuity of care, and short waiting and travel times. They preferred a GP to provide antenatal care, and a hospital midwife to deliver them. GPs were interested in providing even more obstetric care--one third in providing intrapartum care--and in gaining continuing education in obstetrics. Hospital doctors and midwives were supportive of women choosing the personnel to deliver them, and of an increased GP and midwife role in public hospital obstetrics, but unenthusiastic about home deliveries. There is widespread support for an increased role for GPs in public obstetrics.

Attitude of Health Personnel↗
PubMed1994

Melanocytic lesions excised from the skin: what percentage are malignant?

We estimated the diagnostic skill of clinicians managing melanocytic skin naevi by measuring the percentage of malignant melanomas, premalignant and potentially malignant naevi, in 1896 excised melanocytic lesions submitted to a pathology service over 11 weeks. They comprised 8 per cent. The percentage increased with age: 4 per cent in the under-40s, 17 per cent in those aged 40-59, and 30 per cent in those over 60, (P < 0.001, sex-adjusted). Although the percentage was twice as high in males (11 per cent) as females (6 per cent), after adjustment for age the difference was not significant. Invasive melanomas, 3 per cent of the total, were similar: 1 per cent were from under-40s; 7 per cent from those aged 40-59 years; and 14 per cent from those over 60. They comprised 4 per cent of lesions from males and 2 per cent from females. These trends may indicate poor specificity of clinical diagnosis, notwithstanding other reasons for removal of naevi (cosmetic), particularly among patients under 40, and females.

Adolescent↗
PubMed1993

Infant feeding in Queensland, Australia: long-term trends.

Infant feeding practices were retrospectively ascertained in a random cohort of parous women (mean age 54.8 years) from Brisbane, Australia. Reported proportions of infants who were ever breast-fed fell from around 90% before 1960 to around 70% in the early 1970s, with some subsequent increase. Similar but stronger trends were reported in proportions of infants breast- but not bottle-fed. Few maternal characteristics were associated with feeding practices, but women with more education appear to have led both the early retreat from and the later return to breast-feeding.

Bottle Feeding↗
PubMed1993

Audit of a general practice.

A clinical activities audit is a method of obtaining interesting information about one's general practice. It is likely to generate improvement in practice, thereby fulfilling the most important requirement of quality assurance, even in the absence of nationally accepted standards of general practice. A five-day audit of clinical activities in one practice is detailed, and some of the changes that this prompted in consultation time management, investigation and referral rates, and conditions managed are frankly discussed.

Appointments and Schedules↗