Factors influencing prescribing.
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Drug Prescriptions↗
Biomedical subjects
J Cockburn
Publications and source records attributed to J Cockburn.
Why are amnesic judgements of recency and frequency made in a qualitatively different way from those of normal people?
The Huppert and Piercy (1978) test of recency and frequency judgements was given to a group of 12 non-Korsakoff amnesics of mixed aetiology and to four non-amnesic patients with selective frontal lobe lesions. The results confirmed that non-Korsakoff amnesics show a significant tendency to base their recency and frequency judgements on memory strength and that amnesics with medial temporal lobe damage show this tendency at least with recency judgements. The patients with frontal lobe lesions performed like normal subjects. Patients who were dysexecutive or impaired in cognitive resources were less likely to base recency judgements on trace strength. Such a recency bias was not however, correlated with measures of amnesic severity. The tendency to base frequency judgements on memory strength was not related to either degree of amnesia or reduction of cognitive resources.
Adult↗
The development and validation of a test battery for detecting and monitoring everyday memory problems.
This paper describes the Rivermead Behavioural Memory Test (RMBT)-a short test of everyday memory problems with four parallel forms. It was administered to 118 control subjects aged between 16-69 years with a mean IQ of 106 (range 68-136). The limit of normal performance was established on this group and cut-off points were determined for individual components of the test. The test was also given to 176 brain-damaged people and its validity assessed both by correlating RMBT scores to performance on existing tests, to subjective ratings from patients and carers and to observation by therapists of memory lapses. Validity, parallel form and interrater reliability all proved to be high. It is concluded that the RBMT is a short, reliable, and valid test of everyday memory problems.
Adolescent↗
Community views about the role of general practitioners in disease prevention.
The role of preventive medicine in reducing mortality and morbidity is now widely recognized. Although general practitioners appear to be in an excellent position to offer preventive care, there is evidence that they currently do not detect or intervene for common risk behaviours. One reason for this may be the general practitioner's perception that patients do not expect such preventive activities to be a part of the doctor's role. A postal survey of 309 people randomly selected from the community was undertaken to examine perceptions about the general practitioner's role in detection and intervention for smoking, alcohol abuse, emotional problems and hypertension. Responses to the survey from 264 usable questionnaires indicated that people in the community accepted the general practitioner's role in preventive care, with most respondents indicating that they would appreciate being asked about the risks examined, would like the offer of intervention and would try treatments in these areas offered by the doctor. Few respondents indicated that they would change doctors as a result of preventive activity.
Attitude to Health↗
Measuring everyday memory in elderly people: a preliminary study.
The effectiveness of a short test of everyday memory in discriminating memory ability of independently living and of partially dependent elderly people has been investigated. Results indicate that overall test performance is significantly different in the two groups but that not all individual items discriminate equally well. The test as a whole correlates well with a standard cognitive screening test but it also contains items for abilities not measured in the general test, notably visuo-spatial memory. In addition, it appears to provide a more sensitive measure of memory function when general cognitive decline is minimal.
Aged↗
Response bias in a study of general practice.
Response bias in quality of care research is an important, but largely neglected concern. Differences between health care professionals who consent to participate in research and those who do not may distort the conclusions and prevent the results being generalizable. This is particularly likely when response rates are low, as they often are in studies evaluating primary health care. The present study outlines a method for examining this important area. Fifty-six general practitioners who consented to participate in an observational study of general practice were compared with 52 doctors who declined to participate in the research. Comparisons were made of general characteristics including age, sex, practice size and postgraduate qualifications, as well as attitudes toward their role. This last analysis was deemed particularly important, as the attitudes expressed may have affected the behaviour of the doctor in the consultation, and therefore outcomes such as accurate diagnosis, compliance and satisfaction. Such outcomes are often the object of study in quality of care research. The only significant difference to emerge in the present study was that non-consenters were more strongly in favour of a medical system based on free enterprise and fee for service (t83 = 2.3P less than 0.05). No systematic differences were found on other general characteristics or attitudes relating to patient care. Response bias using the stated variables was therefore considered to be minimal. The results are discussed in terms of strategies aimed at increasing response rates in quality of care research.
Adult↗
Rehabilitation programs for drink drivers: a critical appraisal.
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Accidents, Traffic↗
Effects of intervention on antibiotic compliance in patients in general practice.
This study used a randomized clinical control design to test first, whether decreasing the complexity of antibiotic regimens resulted in increased compliance and, secondly, whether the added component of written information and behavioural tailoring increased compliance in patients with twice-a-day schedules. Twenty-eight general practitioners who were selected at random and 232 of their patients took part in the study. Patients were allocated at random to receive either doxycycline (one dose a day); co-trimoxazole (two doses a day); amoxycillin (three doses a day); or co-trimoxazole (two doses a day) with a written instruction sheet and advice on how to best fit the tablets into a daily routine. Decreasing complexity of the regimen significantly increased the probability that patients would not miss any doses of the course (absolute compliance: chi 2 = 25.04; df = 2; P less than 0.001). There was also a significant association between complexity and non-compliance at a level which might be clinically significant (chi 2 = 6.78; df = 2; P = 0.03). Written information and behavioural tailoring did not further augment compliance in patients with one- or two-doses-a-day schedules. It was also shown that general practitioners predicted potential non-compliance in patients at a rate no better than would be expected by chance.
Amoxicillin↗
The process and content of general-practice consultations that involve prescription of antibiotic agents.
We devised a reliable coding system in order to analyse interactional events between general practitioners and patients that were observed on the videotapes of 201 consultations in which an antibiotic agent was prescribed. Of total consultation events, doctors contributed 14% on the collection of information about the presenting condition for which antibiotic agents were prescribed; 22% on the giving of such information; 17% on social exchanges; and 21% of events were devoted to other problems that emerged during the consultation. Patient questions made up 2% of events and were encouraged specifically by 1% of events. Whereas 75% of patients were told the dose and length of the course, only 46% of patients were told the name of the antibiotic agent, only 10% of patients were told of side-effects, and no patient was told what to do if he or she forgot a dose. Not surprisingly, with the exception of the justification of the treatment that was chosen, practitioners seldom used techniques which have been shown to be effective in the improvement of patient compliance or recall of information. Given that antibiotic agents are prescribed commonly, and compliance is frequently poor, our findings have implications for undergraduate, vocational and continuing education.
Anti-Bacterial Agents↗
Determinants of non-compliance with short term antibiotic regimens.
The contribution of doctor, patient, and consultation interaction patterns to compliance with antibiotic treatment was examined in 233 adult patients seen in general practice. Twelve variables were shown to discriminate between compliers and non-compliers. Discriminating variables relating to patients included health state, employment state, knowledge of tablet, and perception of anxiety level, difficulty in complying, and their observed anger, distance, and assertiveness in the consultation. Discriminating variables relating to doctors included provision of advice on duration of treatment, complexity of dosage schedule, age of doctor, and number of years in practice. For the most part these results confirmed previous research. It is concluded that the doctor should consider both the dosage schedule and the patient's daily routine when prescribing antibiotic tablets. Advice on how to take the tablets should be given in specific rather than in general terms. The significant effect of the age of the doctor and the years spent in practice has not been found in previous work. This finding may reflect differences in behavior between younger doctors and their patients. This difference was not detected in the observation of consultation events.
Adult↗
Construction and validation of a questionnaire to measure the health beliefs of general practice patients.
The health belief model has been widely used as a conceptual framework for understanding and explaining compliance behaviour. A weakness characterizing work in the area has been lack of standardization of measurement of the components of the health belief model. This paper describes the development and validation of a questionnaire to measure these components. The questionnaire was designed for use with general practice patients who have a wide range of different illnesses, therefore the nature of the patients' illness is not mentioned in the content of the items. Principal components analysis was used to determine the dimensions underlying patients' beliefs. Principal components analysis and application of Cronbach's alpha statistic identified four reliable sub-scales of the questionnaire. The sub-scales measured patient's beliefs about: the threat caused by illness, the efficacy of traditional medical care, the way illness is dealt with and the barriers to taking medications.
Attitude to Health↗
Measuring general practitioners' attitudes towards medical care.
The construction and development of a questionnaire which measures the attitudes of general practitioners towards their role in the medical care system is described. Factor analytic procedures identified seven reliable factor-based subscales. The subscales measured attitudes towards: a psychological orientation to patient care, government involvement in the health care system, preventive medicine, patient participation in the consultation, communication with patients, responsibility for decision making and the appropriateness of consultations. The responses of 387 randomly selected Australian general practitioners to this measure are described. Overall, there was strong support for the importance of fostering patient participation, facilitating open communication and understanding, having a psychological orientation, and implementing preventive activities in general practice. However, the sample was strongly opposed to a government regulated health care system. Age and sex of the general practitioner were shown to influence orientations on some dimensions.
Attitude to Health↗
Development of a behavioral test of visuospatial neglect.
The Rivermead Behavioral Inattention Test (RBIT), consisting of nine items sampling activities of daily living, was administered to 28 patients after unilateral right (20) or left (8) cerebrovascular accidents, and to 14 non-brain-damaged controls. All patients were tested on two parallel forms of the RBIT with order of presentation balanced and on at least two of six conventional tests of visual neglect. Control subjects were tested on either form 1 or form 2 of the RBIT. Interrater reliability of scoring was tested on seven subjects chosen at random. Using control scores to determine the cutoff point between visual inattention and noninattention, 14 patients (50%) showed evidence of visuospatial neglect on the RBIT. Correlation between the two forms of the test was 0.83. The RBIT also correlated well with five of the conventional tests. Interrater reliability was 100%. The RBIT appears to be a valid and reliable test of visuospatial neglect and one which is likely to provide more information about everyday problems than existing measures of neglect.
Activities of Daily Living↗
An evaluation of perceptual retraining.
A group of head injury and stroke patients with impairment of visual perception were randomly allocated to receive either perceptual retraining or conventional occupational therapy. No significant differences were found between the groups, either before or after 4 weeks of treatment, on measures of visual perception or on activities of daily living scale.
Activities of Daily Living↗
Hand preference: its provenance, development, and associations with intellectual ability at the age of 7.5 years.
The development of 199 children was studied at regular intervals from birth to 7.5 years. On each occasion hand preference was recorded. Their preferred hand was evident in 89.4% right and 85.7% left-handers by 4 years. Analyses on 242 children seen at birth and 7.5 years showed no associations between left-handedness and nine factors representing different aspects of "birth stress." For 12 of 15 aspects of ability at 7.5 years left-handed children had slightly higher scores than right-handers. Pathological factors do not seem to feature in the provenance or consequences of left-handedness in a normal healthy population.
Age Factors↗
Factors associated with the intellectual ability of children born to women with high risk pregnancies.
The intellectual abilities of 242 children born to women who had been hypertensive during pregnancy were assessed at the age of 7 1/2 years. Associations between 15 maternal, fetal, perinatal, postnatal and environmental factors, and test scores were investigated. After adjustment for confounding variables children in the upper social classes, born to non-smokers, who were first born, breast fed, and with birth weights above the 10th centile had significantly higher scores in some aspects of ability than the rest. Children whose mothers had developed superimposed pre-eclampsia had higher scores than those whose mothers had not suffered preeclampsia; and children delivered by elective caesarean section had lower scores than those delivered spontaneously. In a small subgroup of women with particularly high risk pregnancies perinatal mortality had been 10 times greater than in the rest of the sample. At 7 1/2 years the intellectual ability of the survivors in this subgroup did not differ from that of the rest. These findings do not support the notion that there is a quantitative continuum of "reproductive casualty" from mortality to morbidity.
Birth Weight↗
Maternal hypertension with superimposed pre-eclampsia: effects on child development at 71/2 years.
Children born to women participating in a prospective study of hypertension during pregnancy were followed up from birth. Data on growth and development at the age of 71/2 years of 56 children whose mothers had superimposed pre-eclampsia are compared with results of 176 children whose mothers had only hypertension. Perinatal mortality in the hypertension-only group was similar to that for the hospital population in general at the time of their birth; but in the group who developed preeclampsia it was significantly higher. At the age of 71/2 years no differences were found in the frequency of health, handicap, sight and hearing problems, weight, height, head circumference, and standing and supine blood pressures. For six aspects of intellectual development children in the pre-eclampsia group had slightly higher mean scores; and in one of these, "perceptual matching' the difference was significant after adjustment had been made for confounding variables. Pre-eclampsia superimposed on hypertension does not increase the likelihood of impaired growth and development among children who survive the perinatal period.
Child↗
Developmental assessment at four years: are there any differences between children who do, or do not, cooperate?
Among preschool children failure to cooperate in a developmental assessment is not uncommon, but many reports do not mention this awkward situation. Can such children be ignored? The abilities of 203 children were assessed at age 4 years and 7 1/2 years. At 4 years 37 (18%) did not cooperate fully and an overall developmental score could not, therefore, be calculated. For those sections in which they did achieve a score, the mean values, in all areas of development, were lower than those of complete cooperators and the differences were significant for visuomotor function, language, and comprehension. At 7 1/2 years children in the lower social classes who had been uncooperative at age 4 years had lower scores in all six areas of ability tested than those who had cooperated fully at 4 years. No differences were found for upper class children. Refusal to cooperate may in some cases indicate inability to perform and such children should not be ignored or discarded from follow up analyses.
Aptitude↗