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Biomedical subjects

D M Fleming

Publications and source records attributed to D M Fleming.

123 records · Page 7Linked to original sources
PubMed1985

The incidence of common infectious diseases: the weekly returns service of the Royal College of General Practitioners.

This article summarizes the information collected on morbidity due to infectious disease in the UK between 1967 and 1983 by the Weekly Returns Service (WRS) of the Royal College of General Practitioners. The population data base used for this purpose now exceeds 200,000 and 40 general practices and 106 principals are included. Where comparisons are available incidence rates derived from the WRS are higher than those obtained in official notifications.

Communicable Diseases↗
PubMed1984

An epidemiological method applied to practices to measure the representativeness of their prescribing characteristics.

The standardised report of the Prescription Pricing Authority, which is concerned with the prescribing characteristics of practices, was used as an epidemiological tool to evaluate the prescribing representativeness of practices. Study practices were compared with average prescribing results from family practitioner committees, which are specific for the geographical district and month sampled. The method was applied in 40 practices, representing 120 doctors who had been recruited to the third morbidity study in general practice. In these practices 488 items per 1000 people had been prescribed compared with 548 items per 1000 people from the matched values of family practitioner committees. There was a parallel reduction in the net ingredient cost of items per 1000 people--1414 pounds for the practices compared with 1600 pounds for the family practitioner committees. These differences were highly significant. The average net ingredient cost was the same for both groups. Study practices were biased towards reduced prescribing costs for drugs used to treat infections, respiratory diseases, disorders of the nervous system, skin disease, rheumatic disorders, and gastrointestinal problems. The comparison and its interpretation provide a model that may be used by individual practices to evaluate their own prescribing reports.

Aged↗
PubMed1984

Psychotropic drug prescribing.

This study was based on the recording of psychotropic drug prescribing over two weeks by 269 doctors using practice activity analysis (PAA) data sheets. The overall mean rates for patients receiving one or more psychotropic drugs were 17.5 per 1,000 list size and 130 per 1,000 consultations; and for prescriptions issued the rates were 20.6 per 1,000 list size and 153 per 1,000 consultations. Recorders were classified into five categories ;low' to ;high', by the volume of prescribing and this paper is concerned with the comparison between them. Between the high and low categories there was a twofold difference in the prescribing of new prescriptions, a fourfold difference for continuing prescriptions and a tenfold difference for repeat prescriptions; 51 per cent of all prescriptions were issued as ;repeats'.Other features of prescribing have been studied in each of the categories. Prescribing rates vary little with workload. Increasing trends are evident from the low to high categories for the use of polytherapy and for the proportion of elderly persons who received prescriptions; the proportion of male patients (28 per cent) was consistent in all categories. The relative proportion of prescriptions by drug group (tranquillizers, antidepressants and hypnotics) was reasonably uniform in all categories.

Adult↗
PubMed1983

Impact of audit on preventive measures.

The results of two reviews of practice records for information about various preventive measures are reported. The reviews were conducted two and a half years apart in the same 29 practices, on roughly 6500 records on each occasion. The first review was carried out during a postgraduate education course involving audit. Two main analyses were undertaken: one concerned with the entire record sample and the other with the individual practice results. Important and substantial improvements were shown in both analyses, which were spread throughout the practices and were not confined to practices at the lower end of the range simply "catching up." The change between the reviews in the mean recorded rates for cervical cytology was 56% to 64%; for rubella immunity 28% to 40%; for polio immunity in adults 15% to 21%; for completed primary immunisation 68% to 78%; for recorded blood pressure 53% to 61%; and for smoking information 22% to 30%. Improvement has been steady but the rate of improvement, especially for recording blood pressure and rubella immunity, has increased since the postgraduate education course.

Adolescent↗
PubMed1983

Repeat prescriptions.

Ninety-six general practitioner recorders undertook an average of 308 consultations in the two weeks reviewed, equivalent to 121 consultations per 1,000 registered patients on the list. The number of patients to whom repeat prescriptions were issued was 10,225.The mean rate of issue of repeat prescriptions was 41.9 per 1,000 list, (346 per 1,000 consultations) though these figures conceal a wide variation between the recorders, 41 per cent of recipients were aged 65+ years and 20 per cent had not been seen by their doctor in the six months prior to receipt. The repeat prescribing rate of individual doctors bears no relation to the workload as measured by the number of consultations undertaken.

Drug Prescriptions↗
PubMed1982

Workload review. Birmingham Research Unit, Royal College of General Practitioners.

Consultation rates, visiting rates and a selection of miscellaneous services were recorded over two weeks in February 1981 by 82 doctors in Bedfordshire and Hertfordshire. The findings are reported here with an emphasis on the variation between individual doctors. Consultations (including visits) were at the rate of 3.27 per patient per year. Undertaking a selection of miscellaneous services for patients is estimated to be equivalent to one third of the doctor's consultation workload. In addition, participating doctors spent an average of 9(1/2) hours in the two weeks undertaking tasks connected with education and health service administration. Time spent in the administration and management of the practice was not included in this study.The home visiting rate reported in this study was 14 per cent of all consultations and, although a little lower than that reported in the General Household Survey, it is similar to the results from the National Morbidity Survey for 1970 and 71 and also similar to other PAA results.The material is presented in such a way that it provides an analysis of workload in a large number of practices, and describes a method which doctors can use to measure their own performance and compare it with the overall results.

England↗
PubMed1981

Debendox in early pregnancy and fetal malformation.

During the mid-1960s, 22 977 pregnant women in Scotland and England were followed up prospectively for the incidence of malformations in their infants evident at birth or within six weeks. During the first 13 weeks of gestation 620 of these women had been prescribed Debendox (dicyclomine-doxylamine-pyridoxine) and 743 other women agents other than Debendox containing pyridoxine. Of the 620 women given Debendox, 589 (95%) had a normal outcome of pregnancy, 8 (13%) delivered a malformed infant, and 23 (3.7%) had other outcomes. Of the 22 357 women who were given Debendox, 445 (2.0%) produced infants with malformation; and the rates for all abnormal outcomes among women given Debendox and those not given the drug were 5.0% and 5.4% respectively. These results support the hypothesis that Debendox is not teratogenic.

Abnormalities, Drug-Induced↗
PubMed1981

An evaluation of recorded information about preventive measures in 38 practices.

This paper reports the results of a review of practice records for information about various preventive measures; 8,500 records from 38 practices were studied. In collecting the data a Practice Activity Analysis data sheet was used.The results are presented in a way which makes it possible for others undertaking these analyses to compare their results with those reported here. They point to a number of conclusions, in particular:1. Much less cervical cytology has been done for women in their 50s than for those in their 30s and 40s; in particular 45 per cent of women in their 50s have never had a smear.2. Only 35 per cent of girls aged 15 to 19 were known to be immune to rubella.3. Only 14 per cent of adults aged 20 to 40 were known to be immune to polio.4. Of men in their 40s, 47 per cent had no record of their blood pressure having been taken during the previous 10 years.5. Information about smoking habits was available in 23 per cent of records.

Adolescent↗
PubMedDate not supplied

Respiratory syncytial virus or influenza?

We compared data from clinical surveillance of acute respiratory infections in elderly people reported by a network of sentinel general practitioners, virus isolate data for respiratory syncytial virus (RSV) and influenza A and B viruses, and registered deaths, during the past four winters. Cases of acute respiratory disease (ARD) and deaths (3-week moving averages) showed strong similarity in timing. Periods of high incidence of ARD and numbers of deaths were followed within 2-3 weeks by reports of high numbers of RSV or influenza virus isolates. The epidemic period in December, 1989, was followed by high numbers of both virus isolates, but in all other epidemic periods one virus predominated. The lethality of epidemics due to RSV or influenza A or B varied both within and between years. These analyses suggest that RSV is as important as influenza viruses in causing morbidity and excess deaths among elderly people. RSV was prevalent at the end of each of the past four years in the UK; its importance as a cause of excess deaths would therefore be concealed in any analysis based on several years' experience. By contrast, the inconsistency of epidemics due to influenza viruses makes excess deaths due to these viruses easily recognisable. Integrated clinical and viriological surveillance is essential if epidemics due to RSV, influenza virus, or any other virus are to be correctly interpreted.

Adolescent↗