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Biomedical subjects

D R Hannay

Publications and source records attributed to D R Hannay.

At least 19 recordsLinked to original sources
PubMed1999

The presentation and management of female breast symptoms in general practice in Sheffield.

BACKGROUND: Relatively little is known about the incidence of breast symptoms in primary care consultations and GPs' patterns of referral to secondary care. OBJECTIVE: We aimed to identify the consultation rate for breast symptoms in general practice and to describe the management of those symptoms, including patterns of referral to secondary care. METHOD: Prospective data were collected by 248 GPs concerning 508 women consulting for breast symptoms. A verification study was carried out in nine practices to compare the data collected prospectively with information recorded contemporaneously in the same patients' notes. Main outcome measures were number of patients with lump, pain, nipple discharge, skin or nipple problems, family history or other symptoms at first or subsequent consultation, management action, age of patient and number of patients meeting study criteria for whom GPs did not record information in the prospective study. RESULTS: The mean number of consultations per GP over the 4-week recording period was 2.05. However, examination of a patient's notes from a sample of nine practices participating in the verification study suggested that GPs recorded only slightly over half of the consultations for breast symptoms on the study pro forma. At their first consultation, 40% of women presented with a breast lump and 40% with breast pain. Fifty-eight per cent of women with lumps were referred for specialist evaluation after a first or subsequent consultation, whereas the comparable percentage for women referred for pain was 17%. CONCLUSIONS: At an initial consultation for breast symptoms, GPs refer approximately one-third of women to secondary care. Women are most likely to be referred for a lump or for a family history of breast cancer and least likely to be referred for breast pain. The verification study suggests that relying on GPs to collect data on a specific group of patients may produce an underestimate of the consultation rates for a specified condition.

Adolescent↗
PubMed1997

Patients' perceptions of primary health care in an inner-city practice.

BACKGROUND: The 1978 Alma Ata declaration by the World Health Organization emphasized the importance of primary health care, which includes social services and participation, as well as primary medical care. In the UK, primary medical care is based on general practice, increasingly working from purpose-built premises with primary care teams. However, this does not usually include social services or involve patient participation. Both general practice and social services are undergoing reorganization as separate entities, with little emphasis on intersectoral collaboration. OBJECTIVES: We aimed to assess patients' perceptions of primary health care in an inner-city practice in terms of primary medical care, social services and participation. METHODS: Perceptions of medical and social services, together with levels of satisfaction and patient participation, were assessed by self-completed questionnaires for 248 patients attending an inner-city health centre and by 74 home interviews for those who had requested house calls. RESULTS: Patients were more satisfied with primary medical care than with other aspects of primary health care, such as housing. Older patients at home were less satisfied with primary medical care and more satisfied with social services than younger patients attending the health centre. Physiotherapy, chiropody and pharmacy were the services most requested at the health centre. A domiciliary pharmacy, help with hearing aids and a social worker at the health centre were the main requests by older patients at home. CONCLUSIONS: Medical and social services at primary care level should have coterminous boundaries based on general practice populations, ideally with access through multipurpose health centres.

Adult↗
PubMed1993

Local confidential inquiry into avoidable factors in deaths from stroke and hypertensive disease.

OBJECTIVE: To audit avoidable deaths from stroke and hypertensive disease. DESIGN: Details of care before death were obtained from general practitioners and other doctors, anonymised, and assessed by two experts against agreed minimum standards of good practice for detecting and managing hypertension. SETTING: Health authority with population of 250,000. SUBJECTS: All patients under 75 years who died of stroke, hypertensive disease, or hypertension related causes during November 1990 to October 1991. MAIN OUTCOME MEASURES: Presence of important avoidable factors and departures from minimum standards of good practice. RESULTS: Adequate information was obtained for 88% (123/139) of eligible cases. Agreement between the assessors was mostly satisfactory. 29% (36/123, 95% confidence interval 21% to 37%) of all cases and 44% (36/81, 34% to 55%) of those with definite hypertension had avoidable factors that may have contributed to death. These were most commonly failures of follow up and continuing smoking. Assessment against standards of minimum good practice showed that care was inadequate but not necessarily deemed to have contributed to death, in a large proportion of patients with definite hypertension. Common shortcomings were inadequate follow up, clinical investigation, and recording of smoking and other relevant risk behaviours. CONCLUSIONS: This method of audit can identify shortcomings in care of patients dying of hypertension related disease.

Aged↗
PubMed1993

The provision and use of medical services during the 1991 World Student Games in Sheffield.

This paper describes the provision and use of medical services organized by Sheffield during the World Student Games in 1991. A descriptive study of medical and physio-therapy records, together with minor incident logs and hospital referrals, was carried out. It was found that 571 medical records and 357 physiotherapy records were completed, of which 83 per cent were generated at the Games Village. The majority of patients were competitors, although team officials accounted for a disproportionate number. Most physiotherapy requests were for sports injuries, whereas this was not so for medical cases. Twenty-five per cent of medical records and 40 per cent of physiotherapy records were for recurrent conditions which had started before arrival. Athletics and football accounted for the greatest number of records per competitor. During the Games, 82 patients were referred to hospital, of whom only 12 were admitted. The largest group of hospital referrals was for dental treatment, and the next largest was for minor trauma. A total of 1089 minor incidents were recorded, mainly at the competition venues and in the Physiotherapy Room at the Games Village. In addition, the Red Cross and the St John Ambulance Association attended to 330 people during the Games. The smallest national teams tended to make most demands on services, probably because the larger teams were accompanied by their own medical and physiotherapy staff. It is concluded that the main demands for medical services at the World Student Games were for general practice and physiotherapy at the Games Village, and for first aid at competition venues.(ABSTRACT TRUNCATED AT 250 WORDS)

Athletic Injuries↗
PubMed1992

Practice organization before and after the new contract: a survey of general practices in Sheffield.

In order to assess the effects of the new contract on practice organization, all general practices in Sheffield were surveyed just before the new contract came into effect in April 1990, and again one year later. Of the 120 practices, 57% responded in 1990 and 61% in 1991, with 47% responding in both years. There were significant increases in the mean number of clinics and employed staff for the practices responding to both questionnaires and in the proportion of these practices which had a computer. These changes represent a response to the incentives and stated aims of the new contract.

Appointments and Schedules↗
PubMed1991

Family attachments and medical sociology: a valuable partnership for student learning.

This paper reports association within a curriculum of a theoretical programme in medical sociology for undergraduate medical students with a practical family attachment. These two components constitute the 'sociology' element of a course in behavioural science, and have equal weight for assessment purposes. Recognition of, on one hand, the mutuality of the two elements, and on the other, their similar but distinct theoretical underpinnings, suggests that such an association has the benefit of retaining the individual contributions of each component to student learning, while enabling theoretical and practical components to inform each other. Both are administered from the Department of General Practice of the University of Sheffield, UK. The consequences of such an educational provision are discussed.

Education, Medical, Undergraduate↗
PubMed1990

Communication skills and clinical methods: a new introductory course.

In the revised medical curriculum at Sheffield University, a new 4-week introductory clinical course has been introduced to teach communication skills, clinical history-taking and physical examination. There is no formal examination for the course, which has been evaluated by feedback from students and tutors with questionnaires and group discussion.

Attitude of Health Personnel↗
PubMed1985

Storing summary patient data as a microcomputer file.

The time taken to summarize 1000 patient records and store this data as a hard disc file on a microcomputer was evaluated in a health centre with about 7300 patients. On average it took 25 minutes to prepare or update summary sheets for each patient and between three to five minutes to input the data to the computer. About one in 10 of the records were long and complicated and took considerably more time to summarize. An error rate of 9% over six months was determined for the age-sex register, mostly owing to patients who had left the practice. In about 5% of cases important information was missing from the A4 folders and was only obtainable from the health visitor records.

Computers↗
PubMed1982

Behavioural symptoms in the community.

The prevalence of behavioural symptoms amongst a sample of 380 children of 15 years and under, is described. 24% of children had behavioural symptoms, as defined by the subjective responses of parents to a structured questionnaire at home interviews. The frequency of behavioural symptoms was correlated with a number of personal and environmental variables, of which long stays in hospital, not being looked after by a parent, and a high neuroticism score for the parent or responsible adult, were the main predictors for the presence of behavioural symptoms in children.

Age Factors↗
PubMed1981

The paper chase.

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Family Practice↗