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Biomedical subjects

J E Ward

Publications and source records attributed to J E Ward.

At least 55 records · Page 3Linked to original sources
PubMed1999

Do Australian family physicians screen smokers for lung cancer?

STUDY OBJECTIVES: To determine family physicians' perceptions of the effectiveness of chest radiographs (CXRs) in reducing premature mortality from lung cancer and their self-reported levels of screening asymptomatic heavy smokers. DESIGN: National postal survey of 1,271 family physicians, obtaining 855 completed questionnaires (67% response rate). SETTING AND PARTICIPANTS: Random sample of Australian family physicians. MEASUREMENTS AND RESULTS: One in five (n = 169, 20%) indicated that an annual CXR was an effective screening test. Older physicians were significantly more likely to hold this view (p < 0.0001). Nearly 25% (n = 190, 22.5%) reported that they recommend an annual CXR as a screening test for asymptomatic heavy smokers. Three variables independently predicted such a practice: increasing physician age (p = 0.0085), being in solo practice (p = 0.0068), and the aforementioned belief in its effectiveness (p < 0.0001). CONCLUSIONS: A substantial minority of family physicians recommends an annual CXR as a screening test despite contradictory evidence from randomized controlled trials. These significant variations in the absence of epidemiologic evidence invite further research to develop effective, efficient, and affordable preventive care in family practice.

Attitude of Health Personnel↗
PubMed1998

Breast cancer screening in Australian general practice: results of a national survey.

OBJECTIVE: To determine current beliefs and knowledge about, and use of, two screening tests for breast cancer (mammography and clinical breast examination [CBE]) among general practitioners (GPs). DESIGN, PARTICIPANTS AND SETTING: National postal survey of randomly selected GPs from throughout Australia in May 1996. MAIN OUTCOME MEASURES: Belief in the effectiveness of each screening test in reducing premature deaths from breast cancer; recommended age group and screening interval for each test; likelihood of including each opportunistically or in a health check-up. Predictors were determined by regression analyses. RESULTS: The response rate was 67% (855/1271). Significantly more respondents believed in the effectiveness of mammography than of CBE (92% v. 66%). About half identified women 50 years and over as the appropriate target group for mammography. Only 40% indicated they would be "highly likely" to discuss mammography opportunistically, although 82% would be "highly likely" to discuss it in a health check-up. After adjusting for confounders, female GPs were more likely to discuss mammographic screening and to advocate a biennial frequency. Older GPs and those from New South Wales were least likely to recommend mammography (consistent with the national policy). Significantly more respondents were "highly likely" to discuss CBE than mammography in a health check-up. CONCLUSIONS: GPs are convinced of the effectiveness of mammography, but as respondents were more likely to screen by CBE than to recommend mammography in a dedicated health check-up a consistent national policy about CBE would be highly desirable.

Adult↗
PubMed1998

Do general practitioners use prostate-specific antigen as a screening test for early prostate cancer?

OBJECTIVE: To assess the proportion of prostate-specific antigen (PSA) tests being ordered for prostate cancer screening. PARTICIPANTS AND SETTING: General practitioners (GPs) in central Sydney, New South Wales, ordering PSA tests during a seven-week period. DESIGN AND METHODS: Self-administered questionnaire, attached to 179 consecutive PSA test results returned to the ordering GPs. The questionnaire assessed reasons for ordering the test, associated patient morbidity and physical findings, and intended management. RESULTS: 66% response rate with no evidence of response bias. Of 118 PSA tests, 67 (57%) were defined as screening tests on men aged 39-84 years, not otherwise indicated for clinical reasons consistent with NHMRC guidelines. "Patient request" was the sole reason for nine (13%) of the screening tests and a factor in seven others (10%). "Routine test for age" was the reason for 25 (37%) of the screening tests, on men aged 49-78 years. Results of 59 (88%) of the screening tests were normal. CONCLUSION: More than half of the PSA tests ordered during the study period were screening tests. Our method could be used to monitor the impact of guidelines and strategies for reducing PSA screening.

Adult↗
PubMed1998

Improving smoking cessation advice in Australian general practice: what do GPs suggest is needed?

Smoking cessation advice from a general practitioner (GP) significantly increases quit rates among patients who smoke. However, smoking is not discussed during most routine consultations with smokers. This study describes GPs' own views about strategies to support their cessation advice. In 1997, a random sample of 311 GPs in NSW (73% response rate) completed a self-administered questionnaire about smoking cessation. Most respondents were 'very confident' about discussing the health effects of smoking (81.7%). Fewer were as confident about negotiating a quit date (21.5%) or using evidence-based smoking cessation techniques (19.3%). The top three preferred strategies to support smoking cessation advice were all resources for patients: subsidised nicotine replacement therapy (rated as 'quite useful' by 60.5%), pamphlets (55.0%) and free access to smoking cessation clinics (50.8%). Skills training (39.7%) was the preferred resource to improve practitioner effectiveness. Interventions combining skills training with patient resources are likely to be well received by GPs.

Adult↗
PubMed1998

Influence of physician and patient gender on provision of smoking cessation advice in general practice.

OBJECTIVE: To examine the association between physician and patient gender and physicians' self-reported likelihood of providing smoking cessation advice to smokers using hypothetical case scenarios in primary care. DESIGN: Cross-sectional analysis of a self-administered questionnaire. SUBJECTS: National random sample of Australian general practitioners (GPs). MAIN OUTCOME MEASURES: Self-reported likelihood of advising hypothetical male and female smokers to stop smoking during a consultation for ear-syringing ("opportunistic" approach) or a dedicated preventive health "check up". RESULTS: 855 GPs returned questionnaires (67% response rate). Significantly more respondents indicated they would be "highly likely" to initiate an opportunistic discussion about smoking with a male smoker (47.8% (95% confidence intervals (CI) = 44.5 to 51.2)) than a female smoker (36.3% (95% CI = 33.1 to 39.5]). Older, male GPs were less likely to adopt an opportunistic approach to smoking cessation for patients of either sex. Respondents were more likely to recommend that a male patient return for a specific preventive health check up. Furthermore, in the context of a health check up, a greater proportion in total of respondents indicated they would be "highly likely" to discuss smoking with a man (86.9%, 95% CI = 84.5 to 89.0) than a female smoker (82.5%, 95% CI = 79.8 to 84.9). CONCLUSIONS: As measured by physician self-report, the likelihood of advising smokers to quit during primary care consultations in Australia appears to be influenced by gender bias. Gender-sensitive strategies to support cessation activities are recommended.

Adult↗
PubMed1998

Reliability of the MOS SF36 health status measure in Australian general practice.

OBJECTIVE: Past studies suggest that the MOS SF36 holds promise as a useful instrument to assess health outcomes. Although it is being promoted for use in general practice, it is important first to examine its reliability in this setting. METHOD: A consecutive sample of 64 adult patients were recruited from an experienced general practitioner's waiting room in metropolitan Sydney. They were asked to complete identical questionnaires containing the Medical Outcomes Study (MOS) SF36 mailed to them on two separate occasions. RESULTS: There was a 66% response rate for both Time 1 and Time 2 surveys resulting in 64 paired questionnaires with high item completion rates (95-100%). The results demonstrated high internal consistency for both tests (Cronbach's a > 0.87). The reliability coefficients ranged from 0.59 to 0.89 across scales. CONCLUSIONS: This study provides support for the psychometric stability of the MOS SF36 as quality of life measure for patients in general practice. However, a large study is required to establish much needed normative ranges for self administered instruments in general practice.

Adolescent↗
PubMed1997

Local impact of the NHMRC early breast cancer guidelines: where to from here?

OBJECTIVES: To determine clinicians' recall of the National Health and Medical Research Council's (NHMRC) Clinical practice guidelines for the management of early breast cancer six months after publication, and their reactions to its content and potential dissemination and implementation strategies. SETTING: Greater Western Region of Sydney, May 1996. METHOD: Self-administered survey of clinicians with an involvement or interest in the management of women with breast cancer. RESULTS: Of the 69 respondents to the questionnaire (77% response rate), 20% did not recall ever seeing the guidelines. Although most agreed with the defined parameters of potential strengths of the guidelines, there was less agreement as to their medicolegal implications. The four treatment sections of the guidelines were the most highly rated, followed by the sections on communication skills and investigations. Education programs, including college-based programs, as well as endorsement of the guidelines by the learned colleges and respected colleagues, were rated highly as dissemination strategies, far outranking Internet availability. Local revision of the guidelines was considered important as an implementation strategy by three-quarters of respondents. Only 20% indicated that the guidelines had influenced clinical practice, although 46% agreed that they would improve outcomes for women with early breast cancer. CONCLUSIONS: The NHMRC early breast cancer guidelines have been relatively well received in the Greater Western Region of Sydney, although local activities within public institutions and private practice will be needed to achieve implementation.

Adult↗
PubMed1997

Men's estimates of prostate cancer risk and self-reported rates of screening.

OBJECTIVE: To determine rates of prostate cancer screening and predictors of men's participation in this screening in the light of national recommendations against prostate cancer screening DESIGN: Community-based study (computer-assisted telephone survey). SETTING: Central Sydney Area Health Service. PARTICIPANTS: Randomly selected men aged 40-80 years. RESULTS: 340 men participated (65% response rate). While the true lifetime (0-74 years) risk of developing or dying from prostate cancer is reported to be one in 18 (6%) and one in 65 (1.5%), respectively, 37% of respondents thought that at least one in five men (20%) would develop prostate cancer before the age of 75 years and 11% that one in five (20%) would die from it. Twenty-two per cent of men aged 50 years or over had been screened for prostate cancer within the previous 12 months. Ever worrying about prostate cancer and bothersome urinary symptoms independently predicted the probability of screening within the previous year. Sociodemographic characteristics such as age, occupation and country of birth were not associated with screening. CONCLUSIONS: Public health initiatives to discourage prostate cancer screening should focus particularly on men with bothersome urinary symptoms and those who worry about prostate cancer. Accurate information about the low risks of dying from prostate cancer needs to be communicated, and the speculative nature of current evidence in support of screening as a means of reducing this risk should be emphasised.

Adult↗
PubMed1997

Clinical practice guidelines in general practice: a national survey of recall, attitudes and impact.

OBJECTIVE: To determine Australian general practitioners' (GPs') views about and recall of clinical practice guidelines. DESIGN: Self-administered questionnaire survey. SUBJECTS: Randomly selected Australian GPs. RESULTS: 286 of 373 GPs returned questionnaires (77% response rate). GPs' recall of each of nine guidelines ranged from 52% to 94%; 49% considered that their practice had changed as a result of a guideline. While 92% of respondents agreed that guidelines were "good educational tools", 85% indicated that guidelines were "developed by experts who don't understand general practice". Factors most frequently identified as important in deciding whether to follow the guideline recommendations were whether the guideline was based on evidence and credible endorsement. CONCLUSIONS: Australian GPs have positive views about the purpose of clinical practice guidelines and an evidence-based approach to guidelines development. However, respondents rating of the perceived impact of available guidelines in everyday practice was low. The dissemination of specific guidelines is patchy and there is little evidence of systematic implementation.

Adult↗
PubMed1997

Comparison between alfentanil, pethidine and placebo in the treatment of post-anaesthetic shivering.

We have compared the effects of pethidine, alfentanil and placebo in the treatment of post-anaesthetic shivering. Ninety patients who shivered after routine surgery were allocated randomly to receive normal saline (n = 30), alfentanil 250 micrograms (n = 30) or pethidine 25 mg (n = 30). After 10 min, 26 patients had stopped shivering in the pethidine group which was significantly more than the incidence in the two other groups (placebo = 7; alfentanil = 12) (P < 0.0002). Alfentanil was not significantly different from normal saline in affecting shivering. We conclude that alfentanil 250 micrograms was not effective in the treatment of post-anaesthetic shivering.

Adolescent↗