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Biomedical subjects

I B McIntosh

Publications and source records attributed to I B McIntosh.

18 recordsLinked to original sources
PubMed1999

General practitioners' and nurses' perceived roles, attitudes and stressors in the management of people with dementia.

BACKGROUND: GPs and nurses play a major role in dementia care. Negative attitudes and uncertainties may be common sources of stress in both professions. Specific anxieties related to dementia management in primary care need to be identified. AIM: To assess whether dementia care is a stress-provoking experience and examine perceived roles, attitudes, and anxieties for GPs and nurses working with people with dementia and their informal family carers. DESIGN: A structured self-report questionnaire administered opportunistically to GPs and nurses attending dementia education seminars. RESULTS: 298 doctors and 487 nurses participated (response rate 98%). Over half dealing with people with dementia and their carers stressful. GPs reported more negative attitudes to dementia care than nurses (p < 0.001), and felt that professionally they could offer less to people with dementia (p < 0.001) and carers (p < 0.05) than nurses, reporting more difficulties with aspects of dementia care. For GPs and nurses, factors outwith their own profession's 'traditional' role were more stressful, e.g. responding to patients' behavioural (p < 0.001) and social problems (p < 0.001) were stressful for a greater proportion of GPs than nurses. Responding to patients' psychiatric problems was more stressful for nurses than GPs (p < 0.05). More GPs than in previous studies reported routinely administering tests of memory (70%) and depression (58%) in diagnosis. CONCLUSION: Negative attitudes towards dementia care are associated with increased stress for GPs and nurses. Difficulties and uncertainties in these professional roles should be addressed by education in dementia management and improved awareness of available services and resources for people with dementia and their carers.

Attitude of Health Personnel↗
PubMed1998

Anxiety and health problems related to air travel.

BACKGROUND: A significant proportion of air travelers experience situational anxiety and physical health problems. Take-off and landing are assumed to be stressful, but anxiety related to other aspects of the air travel process, anxiety coping strategies, and in-flight health problems have not previously been investigated. METHODS: We aimed to investigate frequency of perceived anxiety at procedural stages of air travel, individual strategies used to reduce such anxiety, and frequency of health problems on short-haul and long-haul flights. A questionnaire measuring the occurrence and frequency of the above was administered to two samples of intending travelers during a 3 month period to: (a) 138 travel agency clients, and (b) 100 individuals attending a hospital travel clinic. RESULTS: Of the 238 respondents, two thirds were women. Take-off and landing were a perceived source of anxiety for about 40% of respondents, flight delays for over 50%, and customs and baggage reclaim for a third of individuals. Most frequent anxiety-reduction methods included alcohol and cigarette use, and distraction or relaxation techniques. Physical health problems related to air travel were common, and there was a strong relationship between such problems and frequency of anxiety. Travel agency clients reported more anxiety but not more physical health symptoms overall than travel clinic clients. Women reported greater air-travel anxiety, and more somatic symptoms than men. CONCLUSIONS: Significant numbers of air travelers report perceived anxiety related to aspects of travel, and this is associated with health problems during flights. Airlines and travel companies could institute specific measures, including improved information and communication, to reassure clients and thereby diminish anxiety during stages of air-travel. Medical practitioners and travel agencies should also be aware of the potential stresses of air travel and the need for additional information and advice.

Adult↗
PubMed1997

Travellers' diarrhoea and the effect of pre-travel health advice in general practice.

BACKGROUND: Rates of travel-related diarrhoea vary from 8% to 50% depending on the country visited. Travellers' diarrhoea has social, health and economic costs. The impact of these may be reduced by relevant pre-travel advice. Little is known of the effect of pre-travel advice on the incidence of diarrhoea among travellers abroad. AIM: To determine the 'true' attack rate of travellers' diarrhoea and to assess the effectiveness of pre-travel health advice in reducing the incidence of diarrhoea and the need for subsequent GP consultation. METHOD: A retrospective study was carried out in a general practice in Stirling, Scotland, using a standardized, structured questionnaire to obtain demographic details and patients' home and foreign health experience in the previous 12 months. The questionnaire was administered to a 20% sample (n = 1771) of practice patients aged 16 years or over, stratified by age and sex. Main outcome measures were reported diarrhoeal illness while abroad, its management and outcome, and a record of diarrhoea in the two weeks prior to responding to the questionnaire. RESULTS: The response rate was 97% (n = 1649). Of those responding, 44% had travelled abroad in the past 12 months; 39% of travellers reported having diarrhoea while abroad, while 6% of the same group reported diarrhoea in the two weeks prior to being questioned; 9.7% of non-travellers reported diarrhoea in the two weeks prior to being questioned. Travellers were 6.5 times more likely to experience diarrhoea while abroad than when spending a comparable 2-week period at home. Travellers who had sought pre-travel advice were more likely to be travelling to a high-risk destination (P < 0.0001) and were more likely to suffer diarrhoea while abroad (P < 0.05); however, they were less likely to need medical help while abroad or on their return (P < 0.0001). The results indicate a markedly higher attack rate of diarrhoea in patients travelling abroad than would be expected if they stayed at home. CONCLUSION: Pre-travel advice does reduce the need for medical assistance while abroad; it also reduces GP work-load in terms of post-travel health consultations with returning travellers.

Adolescent↗
PubMed1996

Standardization of health assessments for patients aged 75 years and over: 3 years' experience in the Forth Valley Health Board area.

BACKGROUND: The new contract for general practitioners (GPs) was introduced in 1990. This required all GPs to offer their patients aged 75 years of over an annual assessment. AIM: The study aimed to determine if 3 years' experience had resulted in standardization of the way in which health assessments for patients aged 75 years and over are carried out. METHOD: The study was carried out in 1993. Questionnaires were sent to the principal partners of all 55 general practices in the Forth Valley Health Board (FVHB) area. The main outcome measures were the fulfilment of contractual requirements and standardization of the health assessment process. RESULTS: Completed questionnaires were returned by 49 practices (89%) Eighty per cent (39 practices) had drawn up their own assessment programme in 1990. Responsibility for assessments was most often (41 practices) shared between different members of the primary care team (84%). Although most practices satisfied contractual requirements, there were wide variations in approach, potentially influencing outcome. CONCLUSION: Despite three years' experience, no standardized approach to the health assessment of patients aged 75 years and over has been developed. Purchasers of health care require information on the needs of their client population, and this should be available in an accessible, standardized form. There is an urgent need for a review of the way in which the 1990 contract has been implemented to standardize health assessments and improve effectiveness in meeting its original aims.

Aged↗
PubMed1994

The impact of travel acquired illness on the world traveller and family doctor and the need for pre-travel health education.

This retrospective study involved a 20% quota, age and sex stratified sample of people over 16 years of age, presenting to a group medical practice over a period of one year (N = 1568). A standardised, computer-scored, self-report questionnaire was administered. The response rate was 98.3%. 42% of respondents had travelled outwith the UK in the previous year. Of those, 42% had become ill whilst abroad. In 20.5% of cases the illness settled without treatment. However, 26% of the patients required consultation with a doctor whilst abroad and 48.4% of those becoming ill required further attention from the family doctor on return home. 5% of ill travellers were admitted to hospital abroad. 8% of all travellers did not have medical insurance cover. A large and significant population of travellers become ill whilst abroad, and travel-acquired illness has a large impact on general practice, with 1 in 5 travellers seeking GP consultation on return home. Improved practice-generated pre-travel health advice might decrease this burden on primary care.

Adolescent↗
PubMed1993

Elderly people's views of an annual screening assessment.

A survey was carried out in order to identify elderly patients' perceptions of their health status, their health worries and their opinions regarding health screening before and after the introduction of an annual screening programme. Pre- and post-assessment self report, structured questionnaires and standardized, objectively scored, functional and medical assessments were used. The cohort was an age and sex stratified, 20% sample of those aged 75 years and over (133 patients). Results showed that 96% of patients before the assessment and 98% of patients afterwards, considered the annual assessment useful. The domiciliary visit by the health visitors resulted in one third of those patients who perceived themselves to be in good health and three quarters of those who perceived themselves to be in poor health becoming less worried about their health. Only two patients became more worried. Half of those objectively assessed as being in the medium health risk group and 68% of those in the high health risk group became less worried about their health after screening. Despite the majority of patients having welcomed the assessment their visit resulted in false, and potentially harmful, reassurance for a considerable number of individuals objectively assessed as being at medium and high health risk. An adverse consequence of health screening in elderly people may be inappropriate reassurance for those objectively assessed to be at risk. However, screening procedures are a means to an end, not an end in themselves. The identification of those at high risk should see subsequent implementation of services, investigations and increased support to relieve suffering, so it may have been that patients felt less anxious because they were anticipating relief of their problems.

Aged↗
PubMed1988

General practice geriatric surveillance scheme.

This project converted an on-demand, crisis intervention service into a doctor-initiated, anticipatory, preventive programme to improve management, based on home visiting and 'activities of daily living' screening by state enrolled nurse, with serial medical assessment and regular surveillance by the general practitioner. Opportunistic and domiciliary organised, standardised, serial, numerically scored, medical, social and functional assessment of list patients over 75 years, allowed comparison over time and identification of high need/risk patients--focus for anticipatory service and aids provision. 24% healthy, 41% moderately impaired and 35% high risk patients were contacted or visited annually, six-monthly and quarterly respectively. Patient-initiated calls decreased by 41% but additional surveillance input increased work load by 9% per annum. Improved standards of care helped patients live longer at home however. The nurse proved effective and economical in this role.

Activities of Daily Living↗
PubMed1986

Acetazolamide in prevention of acute mountain sickness.

A controlled comparative between-group study of 48 climbers ascending Kilimanjaro (5895m) was designed as an extension to our previous double-blind cross-over trial on the same peak in 1980, using acetazolamide to decrease the incidence and effects of Acute Mountain Sickness. A group taking acetazolamide 500 mg each morning for one day before reaching 3000m were compared with 3 control groups of Caucasian subjects and lowland and highland Africans. Efficacy was assessed on climbing performance and scores derived from symptoms recorded daily by subjects. Those taking acetazolamide reached higher altitudes and had lower symptom scores than those in control groups. The results support the use of acetazolamide as an effective prophylactic for Acute Mountain Sickness, for most people in a dose of 500 mg in the morning starting one day before ascent above 3000m. The optimal dose of prophylactic acetazolamide is not established, nor is the most appropriate time for medication prior to ascent.

Acetazolamide↗
PubMed1981

Acetazolamide in prevention of acute mountain sickness: a double-blind controlled cross-over study.

Twenty-four amateur climbers took part in a double-blind controlled cross-over trial of acetazolamide versus placebo for the prevention of acute mountain sickness. They climbed Kilimanjaro (5895 m) and Mt Kenya (5186 m) in three weeks with five rest days between ascents. The severity of acute mountain sickness was gauged by a score derived from symptoms recorded daily by each subject. On kilimanjaro those taking acetazolamide reached a higher altitude (11 v 4 reached the summit) and had a lower symptom score than those taking placebo (mean 4.8 v 14.3). Those who had taken acetazolamide on Kilimanjaro maintained their low symptom scores while taking placebo on Mt Kenya (mean score 1.9), whereas those who had taken placebo on Kilimanjaro experienced a pronounced improvement when they took acetazolamide on Mt Kenya (mean score 2.5). Acute mountain sickness prevented one subject for completing either ascent. Acetazolamide was acceptable to 23 of the 24 subjects. Acetazolamide is recommended as an acceptable and effective prophylactic for acute mountain sickness.

Acetazolamide↗
PubMed1977

Butazolidin suppository medication in rheumatism; a clinical study in general practice.

One hundred and seventeen patients with various rheumatic conditions were admitted by eighteen general practitions to a multicentre open clinical trial of the acceptability, effectiveness and tolerability of Butazolidin Suppositories. Dosage was one or two suppositories (= 250 mg or 500 mg phenylbutazone) per day for up to eight weeks. Of the 117 patients entered onto the register for the study, 10 patients refused suppository medication and 8 had local conditions contra-indicating their use. Of the 99 patients starting the trial proper, half had excellent symptomatic relief and tolerance. Sixteen patients discontinued because of poor response. The remainder (34) whilst having significant improvement as shown by mean symptom scores, discontinued treatment. The majority who discontinued did so because of minor local discomfort or minor gastric symptoms, suggesting that acceptability of medication was at least as important as intolerance. No patient had a serious or persistent adverse effect. Comparison with previous studies suggests that gastro-intestinal tolerance to phenylbutazone is improved when it is administered by suppository.

Arthritis, Rheumatoid↗
PubMedDate not supplied

Health professionals' attitudes toward acute diarrhea management.

BACKGROUND: Travelers' diarrhea is the most frequent health problem in those participating in international journeys, and is responsible for many consultations abroad and on return home. METHODS: A questionnaire assessing attitudes toward treatment and management of travel-related and nontravel-related diarrhea was administered to 542 GPs, nurses and pharmacists. RESULTS: Health professionals' attitudes to management of acute diarrhea are variable, with marked divergence regarding adherence to published "good practice" guidelines and recommendations. Inconsistencies exist in stated attitudes toward prescribing antispasmodics and antimotility agents and actual prescribing behavior. CONCLUSIONS: Current treatment guidelines may be outdated. Inappropriate or delayed treatment disadvantages the patient. Limiting the use of antidiarrheal agents can deny access, for those inflicted with diarrhea, to a medication which may shorten symptomatology and morbidity, and speed the return to normality. Review of guidelines for diarrhea management in adults is overdue, as is standardization of treatment response. Educational initiatives are required to encourage active intervention and improved provision of care.

Acute Disease↗
PubMedDate not supplied

Psychological effects of an epidemiological study of benign prostatic hypertrophy.

The psychological impact of an epidemiological study of benign prostatic hypertrophy (BPH) was assessed in a representative sample of practice list patients. Of the 889 men completing a general health self-report questionnaire previously validated in a screening programme, 75% knew nothing of problems of the prostate, and 84.5% were not at all worried about prostate problems prior to commencement of the study. Receiving the letter of invitation and the procedures neither increased nor reduced anxiety levels for 69% and 70% respectively. In the 227 men referred to hospital for further investigation the procedure increased anxiety in 28%, decreased anxiety in 20%, and had no effect on the remainder. The sample of 137 (16%) men who, prior to interview, were in some way worried about problems of the prostate had significantly more urinary tract symptoms than those who were not at all worried about prostatic problems. Despite being worried about prostatic problems and having significant urinary symptoms, this group was no more likely to have attended a GP for investigation and/or treatment. Results are discussed in relation to the possible psychological effects of general health screening and the reluctance of men to attend for consultation despite awareness and concern regarding urinary symptomatology.

Adult↗
PubMedDate not supplied

The psychological effects of breast screening in terms of patients' perceived health anxieties.

This study aimed to assess and compare the impact of letter of invitation, initial breast screening mammography, and subsequent recall procedures on the level of anxiety over breast problems. The survey of females undergoing routine breast screening procedures in a primary care setting is part of the first wave of a national breast screening programme in the UK. Women aged 50-64 registered with six general practices (n = 2618) were invited by letter to attend for screening. Their self-perceived impact of receipt of invitation letter, attendance at initial screening, and recall, in terms of anxiety and concern about breast problems, was measured by a self-report questionnaire and the physical, emotional and social dysfunction subscales of the Psychological Consequences of Screening Mammography Questionnaire (PCQ). Overall, subjects' anxiety levels diminished between the receipt of their invitation letter and the completion of their screening examination. Subjects did not, however, respond to the letter of invitation and screening procedure in a homogeneous manner. In a sample of 1253, the letter of invitation reduced anxiety about breast problems in 39.7%, increased anxiety in 24.6%, and had no appreciable effect in 35.7%. In the 1280 who attended for breast screening, the examination procedure reduced anxiety about breast problems in 55.9%, increased anxiety in 12.8%, and had no appreciable effect in 31.3%. In a smaller sample (n = 33) who completed questionnaires at recall, there were significant increases in PCQ-measured anxiety. Throughout the study, the PCQ was sensitive to change in anxiety over breast problems. We conclude that screening procedures can either increase or reduce anxiety about breast problems, or have no appreciable effect. Subjects' perception of the impact of receiving the letter of invitation and undergoing the screening examination procedure is related to previous levels of concern over breast problems. Conclusions about the psychological effect of breast screening cannot be drawn without consideration of the time and place of the baseline assessment. Participants in breast screening programmes therefore cannot be considered a homogeneous entity. Caution should be exercised when assessing the impact of screening procedures on entire populations as this approach might mask an important diversity of response.

Anxiety↗