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Biomedical subjects

J F Forbes

Publications and source records attributed to J F Forbes.

At least 55 records · Page 3Linked to original sources
PubMed1989

Quality and the use of time in general practice: widening the discussion.

To examine the association between different consulting styles in general practice (defined according to the average length of doctor-patient contact time in surgery consultations) and the process of care for those patients presenting with new episodes of respiratory illness, 1787 consultations conducted by 85 general practitioner principals in Lothian from November 1987 to May 1988 were analysed. Short as against long consultations resulted in less attention being given to psychosocial issues that the doctor recognised as relevant. When psychosocial problems were dealt with prescribing of antibiotics decreased. In this volunteer sample of doctors the process of care seemed to reflect decisions as to how time was allocated rather than inherently different patterns of clinical behavior. Organisational and contractual changes will shift the mix of financial and professional incentives for general practitioners in ways that could lead to doctors reallocating their time toward shorter consultations; such a reallocation could have important implications for patient care.

Anti-Bacterial Agents↗
PubMed1988

Undergraduate education about cancer: a survey in Australian medical schools.

The goals of undergraduate medical education are to provide a core of basic knowledge, and a framework to permit further development of that knowledge. The structure of teaching and experience in cancer medicine should reflect the increasing importance of cancer in the community. Undergraduate teaching of oncology and its scientific bases is currently fragmented, and in some cases may be deficient. Until now, there have few analyses of what is being taught about cancer at different medical schools. We have undertaken a survey of final year medical students or recently qualified doctors in Australia enquiring about their cancer education. The results indicated that substantial differences existed between the medical schools, and we therefore surveyed the teaching faculty in the schools to determine their view of the validity of the questions we used. Together these surveys showed that significant disparities existed between what the faculty felt should be taught and what students had actually experienced.

Australia↗
PubMed1988

Development of a neonatal case-mix classification.

This article introduces a neonatal classification based on latent class analysis. The neonatal classification generates five distinct classes ranging from the normal-birth-weight, full-term, healthy baby to the low-birth-weight preterm infant with many life-threatening problems. Unlike several suggested neonatal classifications, latent class analysis accommodates the range and severity of illness typically encountered in neonatal populations. It also provides a classification based solely on the personal characteristics of the newborn that can be used to investigate variation in the use of neonatal services.

Child Health Services↗
PubMed1987

Access to intensive neonatal care and neonatal survival in low birthweight infants: a population study in Norway.

This study evaluates the impact of regional differences in access to intensive neonatal care on neonatal survival in geographically defined populations of 4,692 low birthweight births in Norway 1979-81. For infants weighting 1,250 to 2,499 g our results are consistent with the existence of a dose-response association between neonatal survival and the level of immediate access to intensive neonatal care. Although not statistically significant, there was a clear gradient in the risk of mortality within 24 hours. A similar pattern of survival could not be consistently demonstrated for infants weighing less than 1,250 g.

Birth Weight↗
PubMed1987

Economic appraisal of preventive dental techniques.

In this paper the principles and particular problems involved in applying economic appraisal to the evaluation of preventive dental care are investigated. There is no cost benefit analysis in the existing literature which gives a reliable indication of the relative efficiency of preventive and restorative dental techniques. This is because of difficulties involved in trying to attach monetary values to the benefits of programmes which are publicly provided. These difficulties are not resolved by representing the benefits of prevention by restorative costs averted. Although cost effectiveness analysis may seem a more straightforward method, it suffers from the inappropriateness of the dmft (or dmfs) statistic for measuring the relative effectiveness of restorative and preventive treatments. An alternative measure of dental health outcome is suggested which encompasses aspects of the quantity (in life years) and quality of teeth produced by restorative and preventive care. The full potential of economic appraisal of preventive dentistry will be realised only if such comprehensive measures of dental health outcome are produced. The task of producing such measures should involve dentists, consumers of dental care and health care researchers.

Cost-Benefit Analysis↗
PubMed1987

Male unemployment and cause-specific mortality in postwar Scotland.

This article reports a time-series analysis of male unemployment and mortality in postwar Scotland. The results provide little evidence to support the hypothesis that unemployment exerts a significant and consistent positive impact on mortality from all causes, lung cancer, ischemic heart disease, and cerebrovascular disease. Although significant positive associations between unemployment and mortality from lung cancer and ischemic heart disease were detected for older males in the short term, the long-term association between unemployment and mortality tends to be negative. Further progress on establishing possible causal relationships between unemployment and health requires both the collaboration of medical and social scientists and a well designed prospective study that avoids many of the problems associated with time-series and cross-sectional analyses.

Adolescent↗
PubMed1986

Psychological treatment of phobic anxiety associated with adjuvant chemotherapy.

A 50-year-old patient with breast cancer was about to withdraw from her adjuvant chemotherapy regimen because of a long-standing phobia about being injected, which had been compounded by anxieties that were associated with the severe side-effects of adjuvant chemotherapy. She experienced a conditioned nausea response to hospital and medical situations. A psychological programme that incorporated relaxation training, systematic desensitization by way of the patient's visual imagination and videotape modelling, allowed her to complete the course of chemotherapy and to feel less anxious in hospital and medical settings.

Antineoplastic Agents↗
PubMed1986

Economic aspects of health education.

Economic aspects of health education have, to date, received inadequate attention. An economic framework for discussing and evaluating health education is offered, with health education being placed in the already well established economic framework for assessing both health and education respectively. Health education is shown to yield both consumption and investment benefits. The application of cost-benefit analysis and cost-effectiveness analysis to health education activities is explored, and the reasons for the absence of successful applications of the cost-benefit technique to health education programmes are described. The somewhat greater scope for the application of cost-effectiveness analysis is then discussed. A detailed economic evaluation is provided of the North Karelia Project which was concerned with the prevention of cardiovascular disease. The inadequacy of the limited economic evaluation of that project is described and an attempt made to assess the true economic consequences of the project.

Cardiovascular Diseases↗
PubMed1986

Preventive dentistry in a health centre: effectiveness and cost.

The clinical and economic effects of a programme of preventive dentistry for children in an inner-city health centre are compared with those for traditional restorative care. Reductions in the rate of dental caries are estimated to be 70% for children aged 4-6 after 4 years in the programme (dmft) and 85% for children aged between 7 and 10 years after 4 years (DMFT). The cost-effectiveness analysis on which the economic appraisal is based identifies the issue of differences in the quality of output as critical to choices between the two treatment regimes. The preventive programme was primarily intended for pre-school children; for this younger group, assumptions about the quality of the preventive outcome would have to value it at between 0.8 and 1.2 times the quality of the restorative outcome in order to make up the difference in cost between the two regimes. For 7-10 year olds, the 4-year analysis showed the preventive programme to be more costly than restorative care largely because of low rates of incremental change at these ages. These rates were partly influenced by the design of the study and partly by the eruption status of the permanent dentition across this age-group. There is a need for further study of measures of dental outcome which combine aspects of both the quality and length of life of teeth.

Child↗
PubMed1985

Surgical oncology.

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General Surgery↗