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Biomedical subjects

F Sullivan

Publications and source records attributed to F Sullivan.

At least 37 records · Page 2Linked to original sources
PubMed1995

Examination of the effects of emotional disturbance and its detection on general practice patients' satisfaction with the consultation.

BACKGROUND: A patient's satisfaction with a consultation may be influenced by many factors relating to both patient and doctor. AIM: This study set out to examine the effects of emotional disturbance and its detection on general practice patients' satisfaction with the consultation. METHOD: A prospective study involving 893 adult patients attending 12 general practitioners in Glasgow was carried out. Questionnaires were completed by general practitioners after consecutive surgery consultations. Patients completed forms assessing mental state and satisfaction with inter-personal aspects of the consultation. RESULTS: Patients reporting frank psychological disturbance tended to express more dissatisfaction with the inter-personal aspects of the consultation. This effect was alleviated in the majority by recognition of the disturbance by the general practitioner. General practitioners differed markedly in their assessment of the psychological component of consultations. Fewer dissatisfied patients were found in the surgeries of doctors who tended to rate the psychological component of consultations more highly. In contrast, the general practitioner's overall accuracy of diagnosis of psychological distress was a poor predictor of the proportion of dissatisfied patients. CONCLUSION: This preliminary study suggests that a tendency among doctors to assign importance to the psychological component of consultations may enhance elements of patient satisfaction. It is not clear whether this [psychological-mindedness' is an attribute which can be learnt. To resolve this uncertainty, studies are needed of the effects on patients of educational interventions designed to increase general practitioners' sensitivity to psychological distress.

Adult↗
PubMed1992

The productive use of threat in primary care: behavioural responses to health promotion.

The importance of a scientific understanding of the behavioural change processes involved in certain health promotion interventions is stressed. A model for guiding the behavioural dimensions in health promotion in primary care is presented. This distinguishes between information-giving and -providing skills to facilitate behavioural change. The social factors which impinge upon processes of behaviour change are highlighted. It is suggested that health promotion clinics in primary care may produce a situation with which the client has to cope. The manner of their coping will be a critical factor in determining outcome. Some key organizational issues are underlined.

Adaptation, Psychological↗
PubMed1992

Patient controlled analgesia: the relation of psychological factors to pain and analgesic use in adolescents with postoperative pain.

OBJECTIVE: To examine the relationship of psychological variables to pain and patient-controlled analgesia (PCA) use in adolescents undergoing orthopedic surgeries. DESIGN: Cohort. PATIENTS: Fifty adolescents and their parents. MAIN OUTCOME MEASURES: Visual analogue scales of pain, the McGill Pain Questionnaire, and questionnaires that assessed overall psychological distress, anxiety, and family environment. RESULTS: Correlations of the psychological variables with measures of pain and PCA use showed that high levels of anxiety and distress in adolescents were related to higher postoperative pain. Adolescents from controlling and conflicted families also had higher pain ratings and made more frequent PCA demands during the lockout interval when drug was unavailable. Parent anxiety and distress were also related to adolescent pain and PCA use. CONCLUSIONS: The psychological status of adolescents and their parents can significantly influence postoperative pain and PCA use.

Adolescent↗
PubMed1992

Optimizing staff scheduling by Monte-Carlo simulation.

DOCS is a computer program which generates the staff schedule. An accounting framework is combined with an optimization technique that searches for a schedule in which all accounts are simultaneously in balance. The search is accomplished using a Monte-Carlo process which shuffles staff within the schedule. The shuffling is biased according to each staffer's account balance: the staffer who owes the most is most likely to be scheduled.

Algorithms↗
PubMed1991

Children seen frequently out of hours in one general practice.

OBJECTIVE: To identify reasons why some children receive more out of hours visits than most. DESIGN: A one year prospective study to identify the study group. This was followed by a case-control study involving a record search and personal interviews. SETTING: One three doctor urban general practice in West Lothian with 4812 patients. SUBJECTS: 40 children aged under 10 years identified as high users of the out of hours service (more than two visits a year) and 40 age and sex matched controls. MAIN OUTCOME MEASURES: Numbers of visits; social factors such as lone motherhood, low educational attainment; score for management response to clinical vignette. RESULTS: 147/756 (19%) out of hours visits in the study year were to children aged under 10 years; 109 (74%) to 41 children (6%). Problems seen were mainly minor, and little active management was required. Family and social factors which were significantly more common for the cases than for the controls included a lone mother (15 v 4), low educational attainment by the mother (25 v 14), receipt of income support (22 v 7), and non-ownership of the home (45 v 22) or a car (19 v 9). Mothers of the cases were more likely to choose to contact a doctor when presented with vignettes describing common childhood illnesses (median score for 16 vignettes 16.5 for cases v 14.5 for controls, Wilcoxon signed rank test, p = 0.01). CONCLUSIONS: Children seen more frequently than expected out of hours came from more socially disadvantaged families and their mothers were more likely to seek medical advice about minor childhood illness. Maternal education, to promote confidence in managing minor illness, may reduce their use of the out of hours service.

Age Factors↗
PubMed1991

Persistent polyclonal B lymphocytosis with Epstein-Barr virus antibodies and subsequent malignant pulmonary blastoma.

Persistent polyclonal B lymphocytosis (PPBL), a rare benign lymphoproliferative disorder, occurred in a 25 year old woman. The lymphocytes showed the phenotype cIgM+, FMC7+, CD19+, CD20+, which was similar to that seen in Waldenstrom's macroglobinaemia, but the proliferation was repeatedly shown to be polyclonal both immunologically and by immunoglobulin gene rearrangement studies. Eleven years after presentation the patient developed a malignant pulmonary blastoma, a rare pulmonary tumour of combined epithelial and mesenchymal origin. The failure to develop a lymphoid malignancy over 11 years together with immunological and genetic evidence of polyclonality confirms that PPBL is a benign lymphoproliferative disorder. The subsequent occurrence of a nonhaemopoietic malignancy suggests that benign lymphoid proliferations, like their malignant counterparts, may predispose to the development of neoplasia. A role for Epstein-Barr virus in the pathogenesis of one or both of these rare conditions is suggested by the finding of raised Epstein-Barr viral capsid antigen titres.

Adult↗
PubMed1990

The Medical Outcomes Study Instrument (MOSI)--use of a new health status measure in Britain.

The Medical Outcomes Study Instrument (MOSI), a 20 item functional health status measure was sent to all women aged 30-40 years (n = 486) in a General Practice (list size 6447). There was a 73% response rate to two mailings. Lower scores on all six dimensions of the MOSI were associated with the number of diagnoses and identified mental illness on the patient summaries, unemployment and with positive scores on the Nottingham Health Profile. In two categories, General Health Perceptions and Mental Health, the scores were lower for those on long-term medication. The paper suggests that the MOSI may be a candidate for Health Status measurement in research and audit in primary care, but further research is required.

Adult↗
PubMed1987

Chronic hypothermia in multiple sclerosis.

Two patients with clinically definite multiple sclerosis presented with acute hypothermia and on recovery were found to be chronically hypothermic. Thermoregulatory studies indicated a central, hypothalamic defect which is presumed to be due to a plaque of demyelination.

Adult↗
PubMed1985

Multiple antibiotic resistance plasmids in Enterobacteriaceae isolated from diarrhoeal specimens of hospitalized children in Indonesia.

We studied the plasmid and antibiotic resistance characteristics of 35 strains of Enterobacteriaceae recovered from faecal specimens of children with diarrhoea in Central General Hospital, Bandung, Indonesia. Twenty three Escherichia coli, three Providencia, three Proteus, three Klebsiella, two Enterobacter and one Citrobacter were examined. All strains were multiply resistant, many carrying six to nine antibiotic resistances. Most of these resistances were transferable to a laboratory E. coli strain and were carried on large-sized plasmids. All recently-described tetracycline resistance determinants (Classes A----D) were represented; the most common was the Class B, or TN10 type. The TEM-1 beta-lactamase was detected in 17 out of 21 ampicillin-resistant strains examined. The OXA-1, PSE-1, and SHV-1 enzymes were also found. Of 23 plasmids tested, all could be classified into one of eight different incompatibility groups: IncFII, IncN, IncB, IncF1, IncI1, IncI2, IncH2 and IncT. These studies demonstrate the existence of large multiresistant transferable plasmids representing common incompatibility groups and bearing common tetracycline and ampicillin resistance determinants in enteric strains isolated from children hospitalized in Indonesia.

Child↗
PubMed1985

Treatment of severe aplastic anaemia with anti-thymocyte globulin.

Ten patients (9 adults, 1 child) with severe aplastic anaemia (SAA) were treated with anti-thymocyte globulin (ATG). All patients developed serum sickness. No long-term adverse sequelae attributable to ATG were noted. Fifty percent of patients are alive at 1 year post-ATG. One patient received an allogeneic bone marrow transplant because of failure to respond to ATG. One long-term survivor is severely thrombocytopenic and requires support, and one patient has mild thrombocytopenia requiring oxymetholone therapy.

Adolescent↗
PubMed1975

PSRO: advantages, risks, and potential pitfalls.

The authors propose that active physician participation in current review methodologies, including PSRO, can lessen the potential for such problems as the development of unrealistic standards, emphasis on review and record keeping as ends rather than means, and ineffectuality of the systems themselves. Potential advantages of PSRO are seen in areas of quality assessment and improvement, economy, and enhancement of the continuing learning processess of physicians. The authors suggest that physicians should resist pressures toward separation of reviewing authority from clinical competence.

Clinical Competence↗