Biomedical subjects
Publications and source records attributed to C Silagy.
The uncertain effect on the doctor-patient relationship is often a stumbling block for many practitioners deciding whether to participate in a clinical trial. In this article, the authors explore some of the ethical issues facing doctors and patients and some of the safeguards that are in place to protect both parties as the trial proceeds.
A decision to participate in a clinical drug trial will require a commitment in time and resources from both the doctor and other practice staff. The authors explain some of the strategies that can be used to maximise the limited time available for such research and minimise unnecessary wastage of scarce resources.
OBJECTIVE: To document how often patients with varying cardiovascular risk levels reported receiving lifestyle advice from general practice. DESIGN: Cross sectional descriptive survey by postal questionnaire. SETTING: 5 general practices in Bedfordshire. SUBJECTS: 4941 people aged 35-64 years who had consulted a general practitioner at least once during the 12 months before completing the questionnaire and who subsequently attended for a health check as part of the OXCHECK trial. MAIN OUTCOME MEASURES: Report of having received advice from a general practitioner or practice nurse about smoking, alcohol consumption, exercise, or diet during the 12 months before completing the questionnaire. Cardiovascular risk assessed by a nurse during structured health check. RESULTS: The overall reported rate of advice was 27% for smoking, 4.5% for exercise, 12% for diet, and 3% for alcohol consumption. Those with unhealthy behaviour profile or at increased cardiovascular risk received more advice--for example, 47% of smokers with a history of cardiovascular disease received advice on smoking. Among those at increased risk, men were more likely than women to receive advice about exercise (11% v 4%, p = 0.04) and alcohol consumption (10% v 4%, p = 0.007), while women received more advice about weight (17% v 23%, p < 0.001). The rate of receiving advice was unaffected by age, marital status, or social class. CONCLUSION: The low rate of lifestyle advice reported by patients implies that more preventive advice could be provided in primary care.
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Preventive care is an integral component of general practice teaching in all Australian medical schools. While curriculum time and teaching methods vary, the overriding emphasis remains on integrating both epidemiological and behavioural science approaches into the primary care setting. Preventive aspects are stressed during attachments with general practitioners. Use of appropriate theoretical frameworks and models allows the role of the general practitioner in disease prevention to be formalized. Undergraduate teaching is further reinforced by programs within the Family Medicine Programme at a vocational training level, and the Royal Australian College of General Practitioners at a continuing medical education level.
OBJECTIVE: To compare three approaches for marketing a quit smoking intervention kit to general practitioners. DESIGN: Randomised trial of (a) personal delivery and presentation by an educational facilitator with a follow up visit six weeks later; (b) delivery to the receptionist by a friendly volunteer courier with a follow up phone call six weeks later, or (c) postal delivery with a follow up letter six weeks later. SETTING: Melbourne, Australia. SUBJECTS: 264 randomly selected general practitioners. DATA COLLECTION: A research assistant visited each doctor four months after delivery and measured use of components of the kit. A questionnaire measuring perceptions of aspects of the kit and its delivery was completed by doctors. Costs of each approach were calculated. RESULTS: Doctors receiving the educational facilitator approach were significantly more likely than those receiving the other two approaches to have seen the kit, to rate the method of delivery as engendering motivation to try the kit, to have used one of the "intensive intervention" components from the kit, to report that they found the kit less complicated, and to report greater knowledge of how to use the kit. There were no significant differences in use of "minimal intervention" components of the kit, ratings of overall acceptability of delivery, perceptions of cultural and structural barriers to using the kit, and ratings of the overall acceptability of the kit. The cost of the educational facilitator approach ($A142/doctor) was 24 times that of the mailed approach. The volunteer courier approach ($A14) was twice the cost of the mailed approach. CONCLUSION: Educational facilitators and volunteer couriers do not seem to be cost effective strategies for distributing smoking interventions.
This brief paper outlines the advantages for general practitioners participating in clinical trials. In particular, it is appropriate to conduct research in general practice clinical settings rather than in hospital based trials.
OBJECTIVE: To examine the attitudes of junior hospital doctors toward rural training and practice in Victoria. DESIGN AND PARTICIPANTS: A cross-sectional survey of 300 randomly selected Victorian hospital interns, junior and senior resident medical officers was undertaken in 1988 using a mailed self-administered questionnaire. The questionnaire was developed after a literature review, interviews and pilot testing and consisted of categorical and non-categorical items. STATISTICAL METHODS: Responses to the questionnaire were subjected to univariate, bivariate and factor analysis of variables. Testing for differences between those doctors choosing to train and work in rural areas and those choosing metropolitan areas was carried out by chi 2 test for discrete variables and Student's t test for means. RESULTS: A 64% response rate was achieved (n = 192). Only 15% indicated a preference for rural training the following year. Those from a rural background were more likely to express intention to train and practise in the country (P less than 0.05). The most important determinants in choosing a rural training post to emerge on factor analysis were the perceived quality of education and training facilities and the view of the doctors' partners or spouses. The decision to practise in the country was more likely to be influenced by "family" than "professional" factors (P less than 0.05). CONCLUSION: Perceptions regarding the academic status of rural hospitals as well as failure to address the needs of doctors' spouses or partners were major deterrents to rural training. These areas need to be addressed if the shortage of rural practitioners is to be reversed.
Isolated systolic hypertension (ISH) has been defined as an elevation in systolic blood pressure of 160 mmHg or above associated with a diastolic blood pressure of less than 90 mmHg. The significance of ISH arises because of a number of factors including its prevalence, its likely role as a major predictor of cardiovascular morbidity and mortality, and the uncertainty about its cause.
A new approach to a more realistic measurement of blood pressure taken over a 24 hour period involves ambulatory monitoring of the patient. The information from the recorder is then fed into a computer. Although expensive now, developments of technology and know-how should foreshadow routine usage.
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There has been much recent interest in the hypothesis that aspirin and other non-steroidal anti-inflammatory agents (NSAIDs) protect against gastrointestinal, particularly colorectal, carcinoma. Three lines of evidence support this hypothesis: First, NSAIDs inhibit the growth of colorecal neoplasms in laboratory rodents. Epidemiological studies in humans also suggest a protective effect. Three case control and two cohort studies have examined the relation between aspirin use and large bowel neoplasia, and four of these five studies found a risk reduction for either incidence or mortality of about 50% in regular users of aspirin. Finally, two small intervention studies in patients with familial polyposis showed a short-term reduction in polyp formation in patients treated with NSAIDs. In contrast, a large randomized trial of aspirin in human subjects detected no reduction in incidence of colorectal carcinoma in those assigned to aspirin compared to placebo. Colorectal cancer is common and an effective primary prevention strategy could lead to significant public health benefits. Further research into the potential of aspirin to achieve this is keenly awaited. It is, however, premature to recommend it specifically for this purpose on the basis of current evidence, given the known adverse effects of aspirin and related compounds, especially on the gastrointestinal tract.
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Garlic supplements may have an important role to play in the treatment of hypercholesterolaemia. To determine the effect of garlic on serum lipids and lipoproteins relative to placebo and other lipid lowering agents, a systematic review, including meta-analysis, was undertaken of published and unpublished randomised controlled trials of garlic preparations of at least four weeks' duration. Studies were identified by a search of MEDLINE and the ALTERNATIVE MEDICINE electronic databases, from references listed in primary and review articles, and through direct contact with garlic manufacturers. Sixteen trials, with data from 952 subjects, were included in the analyses. Many of the trials had methodological shortcomings. The pooled mean difference in the absolute change (from baseline to final measurement in mmol/l) of total serum cholesterol, triglycerides, and high-density lipoprotein (HDL)-cholesterol was compared between subjects treated with garlic therapy against those treated with placebo or other agents. The mean difference in reduction of total cholesterol between garlic-treated subjects and those receiving placebo (or avoiding garlic in their diet) was -0.77 mmol/l (95% CI: -0.65, -0.89 mmol/l). These changes represent a 12% reduction with garlic therapy beyond the final levels achieved with placebo alone. The reduction was evident after one month of therapy and persisted for at least six months. In the dried garlic powders, in which the allicin content is standardised, there was no significant difference in the size of the reduction across the dose range of 600-900 mg daily. Dried garlic powder preparations also significantly lowered serum triglyceride by 0.31 mmol/l compared to placebo (95% CI: -0.14, -0.49).(ABSTRACT TRUNCATED AT 250 WORDS)