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Biomedical subjects

J Ward

Publications and source records attributed to J Ward.

At least 163 records · Page 9Linked to original sources
PubMed1997

Self-perceived facial appearance and psychosocial adjustment in preadolescents with craniofacial anomalies.

OBJECTIVE: To identify aspects of psychosocial adjustment related to the self-perceived facial appearance of preadolescents with craniofacial abnormalities. DESIGN: Concurrent relationships were evaluated using a within-group correlational design. PARTICIPANTS: Participants were 24 patients, aged 11 to 13, of a major craniofacial center and their parents who were contacted by telephone and agreed to participate. MAIN OUTCOME MEASURES: Self-report and parent-report questionnaires assessing psychosocial adjustment. RESULTS: Self-perceived facial appearance was positively correlated with global self-worth, self-perceived social acceptance, and number of same-sex close friends, and negatively correlated with loneliness, parent-rated social problems, and parental advice/support and concern (all p's < .05 or better). CONCLUSIONS: Dissatisfaction with facial appearance was associated with peer relationship problems and low global self-esteem, but not with other aspects of self-concept or other types of adjustment problems.

Adolescent↗
PubMed1997

Trainees' interactional skills when performing Pap smears. A needs assessment.

OBJECTIVE: Specific interactional behaviours are known to reduce the anxieties and discomforts associated with Papanicolaou (Pap) smears. Few studies have documented doctors use of such strategies or the needs of young doctors to learn them. This descriptive study was conducted to identify trainees learning needs as part of a larger study in the Royal Australian College of General Practitioners (RACCP) Training Program in New South Wales. METHOD: Audioptaped consultations with women seeing a trainee for a Pap smear during the first 3 weeks of the CP term were analysed using a 29 item interactional skills rating scale. Intra-rater reliability (i.e. consistency of rating of the researcher) was checked on a random sample of audiotapes. RESULTS: Rates of specific interactional skills in the 23 audiotaped consultations were low. Trainees explained the procedure in seven consultations (30%). No trainees explained a stop signal. Ten women (43%) were told how to find out the result of their Pap smears. No trainees offered written information Smoking status was ascertained in only two consultations (9%). CONCLUSIONS: This study adds to increasing evidence that undergraduate medical education in Australia fails to equip graduates with practical skills in preventive care. Our findings have implications for GP supervisor and the RACGP Training Program. Specifically, trainees clinical behaviour when taking Pap smears should be observed improved and assessed during supervised training before entry into independent practice.

Clinical Competence↗
PubMed1997

Comprehensive audit of quality-of-care and quality-of-life for patients with diabetes.

This comprehensive audit was conducted in a three-person general practice with an age-sex-disease register to evaluate care for patients with diabetes using metabolic indicators and validated measures of quality-of-life and patient satisfaction. Medical records were reviewed using criteria derived from guidelines published by Diabetes Australia and New South Wales Health. Self-administered questionnaires mailed to patients included the Diabetes Quality-of-Life measure (DQOL), the Well-Being Questionnaire (WBQ) and the Diabetes Treatment Satisfaction Questionnaire (DTSQ). Record audit for 71 patients with diabetes demonstrated poor control and monitoring. Frequent attenders were no more likely to have had a HgA1c performed than less frequent attenders (P = 0.72). While patient satisfaction with care was high, numerical values for quality-of-life were lower than published overseas norms, indicating a need to support better care in general practice and further research to determine Australian norms.

Adult↗
PubMed1996

Threshold models in a methadone programme evaluation.

The degree of non-compliance with a methadone programme is such that a zero is often recorded as the response variable. Such outcome variables cannot be transformed to normality in order to investigate a regression relationship between the response variable and various risk or treatment variables. The presence of a random effect as well in this regression causes added difficulty in the analysis. We show here that use of threshold models can provide a satisfactory solution to both these problems.

Australia↗
PubMed1996

Prospective evaluation of dynamic contrast enhanced magnetic resonance imaging in the evaluation of fistula in ano.

Forty-two patients with a suspected diagnosis of fistula in ano underwent prospective comparison of digital rectal examination, dynamic contrast enhanced magnetic resonance imaging (DCEMRI) and surgical exploration. There were five discordancies: DCEMRI showed an ischiorectal abscess and track with no enteric connection in one patients who at operation was found to have a well epithelialized primary fistula. Four patients with fistulas on DCEMRI had no enteric opening found at surgery and were treated as having sinuses. Long-term follow-up has shown failure to heal in all patients and further surgery confirmed missed fistula. Compared with final outcome measures DCEMRI had a sensitivity of 97 per cent and specificity of 100 per cent in the detection of fistula. DCEMRI also identified more secondary tracks and was more accurate at identifying complex fistulas than either digital rectal examination alone or surgical exploration.

Adult↗
PubMed1996

Development of a reference material for residues of chlorfluazuron and fluazuron in beef fat ACSL CRM 3Part I. Preparation, homogeneity and stabilit.

A beef fat sample was prepared and tested as candidate reference material for the pesticides chlorfluazuron (CFZ) and fluazuron (FZN). An analytical method employing HPLC with UV absorbance detection was developed for homogeneity and stability testing. The material consisted of beef fat spiked with acetone solutions of CFZ and FZN to achieve concentrations close to 1.0 mg/kg for each compound. The coefficients of variation of 7 analyses carried out to test between-jar homogeneity were 1.8% and 2.3% for FZN and CFZ, respectively. No instability of CFZ was detected over a three month period. The candidate reference material was found to be suitable for certification by interlaboratory testing.

Journal Article↗
PubMed1996

Development of a reference material for residues of chlorfluazuron and fluazuron in beef fat ACSL CRM 3Part II. Certificatio.

The certification by interlaboratory testing of a candidate reference material (ACSL CRM 3) for the concentration (mass fraction) of the pesticides chlorfluazuron (CFZ) and fluazuron (FZN) is described. The certification process was based on a two-stage nested design described in ISO Guide 35. Analysis of results reported by collaborating laboratories provided an assessment of the homogeneity of the RM. The certified values were chlorfluazuron -1.01 mg/kg and fluazuron -1.02 mg/kg. The upper and lower 95% confidence limits for CFZ and FZN were calculated to be: CFZ upper=1.05 mg/kg, lower=0.97 mg/kg; FZN upper=1.08 mg/kg, lower=0.95 mg/kg. A certificate was prepared according to guidelines set out in ISO Guide 31.

Journal Article↗
PubMed1996

A comparison of fast and conventional T2 weighted spin-echo sequences in the detection of focal liver lesions at 1.0T.

Conventional and fast T2-weighted spin-echo scans obtained at 1.0T were compared in 29 patients undergoing magnetic resonance imaging of the liver, 25 of whom had focal liver lesions. Conventional spin-echo (CSE) detected 49 of 50 lesions (98%), fast spin-echo (FSE) 45 of 50 lesions (90%). Qualitative assessment of lesion conspicuity, artefact level, and overall image quality by two radiologists showed conventional spin-echo was preferred to fast spin-echo. Lesion conspicuity was graded moderate or good in 84% of lesions on CSE compared to 73% on FSE. Artefact level was higher on FSE in 34%, equal in 61% and higher on CSE in 5%. Overall, CSE was preferred to FSE in 76% of cases. Mean lesion to liver contrast to noise ratio was significantly higher on conventional spin-echo than fast spin-echo: CSE mean 5.9, FSE mean 4.9 P < 0.05. This difference in contrast to noise ratio remained for malignant lesions, but no significant difference was present for cysts and haemangiomas. We advise careful assessment of new sequences before conventional T2-weighted spin-echo is replaced by fast T2-weighted spin-echo in the detection of focal liver lesions.

Adult↗
PubMed1996

An outcomes approach to population health at the local level in NSW: practical problems and potential solutions.

While a health outcomes approach has the potential to improve the health status of Australians as well as health service efficiency, such a policy will be successful only if practice at the local level follows suit. This paper briefly reviews the health outcomes approach and describes how the Central Sydney Area Health Service has established a Needs Assessment & Health Outcomes Unit to help improve health outcomes. The paper discusses issues in working with population health outcomes at the local level, such as the usefulness and limitations of routinely collected data for planning and managing health services, problems of small area data, gaps in the documentation of national health goals and targets, problems of attribution of improved outcomes to specific interventions, and definition of responsibilities for action at the local level. It offers some potential solutions relevant at the local level.

Data Collection↗
PubMed1996

Accuracy of patient recall of opportunistic smoking cessation advice in general practice.

OBJECTIVE: To determine the accuracy of patient recall of a question about smoking in a specified consultation in general practice; the accuracy of smokers' recall of advice to stop smoking; and predictors of accurate recall. DESIGN: Analysis of 1075 audiotapes was compared blind with matching patient questionnaires administered after the consultation to calculate sensitivity and specificity for patient recall as a dichotomous variable. Predictors of recall were determined by logistic regression. SETTING: General practitioner training practices, New South Wales, Australia. SUBJECTS: Thirty-four trainees and consecutive samples of their patients 16-65 years of age. RESULTS: Patient recall of a question about smoking had a high false positive rate of 21% but a sensitivity of 93%. Smokers over-reported advice to stop smoking (specificity 82%; sensitivity 92%). Predictors of accuracy of a question about smoking included patient sex (women 1.58 times more likely than men to be accurate); smoking status (smokers 1.7 times as likely as non-smokers to be accurate); and interval since consultation (those who completed their questionnaires within a week were 1.84 times more likely to be accurate). CONCLUSIONS: Patient recall is systematically biased towards over-reporting of a question about smoking status and, among smokers, of advice to quit. Although we recommend its continued application in health services evaluation, findings should be interpreted with caution, particularly if subjects are male or the interval between recall of smoking cessation advice and the occasion of service in which it might have occurred is considerably delayed.

Adolescent↗
PubMed1996

Hilar cholangiocarcinomas: T2-weighted spin-echo and gadolinium-enhanced FLASH MR imaging.

PURPOSE: To investigate the use of magnetic resonance (MR) imaging with dynamic gadopentetate dimeglumine enhancement in hilar cholangiocarcinoma. MATERIALS AND METHODS: Twenty-four patients (14 men, 10 women; aged 27-78 years; mean age, 51 years) with hilar cholangiocarcinoma underwent T2-weighted spin-echo MR imaging in the axial plane and multisection, breath-hold, fast low-angle shot (FLASH) MR imaging in the coronal oblique plane before and at 30, 60, 90, and 120 seconds after bolus injection of gadopentetate dimeglumine. Morphologic features were recorded, and contrast medium enhancement characteristics and contrast-to-noise ratios were calculated for each sequence. RESULTS: All the lesions were hyperintense on T2-weighted spin-echo images and hypointense on FLASH images. On dynamic gadolinium-enhanced images, progressive heterogeneous enhancement was seen in all patients. Intrahepatic ductal dilatation was present in every patient. Intraluminal components were seen in 11 patients, lobar atrophy in 12, and segmental portal venous occlusion or stenosis in 13. Satellite lesions were present in four patients, and hilar lymph nodal enlargement in 11. Contrast-to-noise ratios were statistically significantly higher on T2-weighted spin-echo images than on all other images. CONCLUSION: Hilar cholangiocarcinomas have consistent enhancement and morphologic features that can be demonstrated with dynamic contrast-enhanced MR imaging.

Adult↗
PubMed1996

Dynamic contrast-enhanced MR imaging of perianal fistulas.

OBJECTIVE: The objective of this study was to prospectively compare dynamic contrast-enhanced MR imaging with MR sequences previously described for assessing perianal fistulas in order to determine the best MR protocol for their evaluation. SUBJECTS AND METHODS: MR examinations of 42 consecutive patients with clinically suspected perianal fistulas were independently evaluated by two experienced observers blinded to the findings of digital rectal examination. The observers' evaluations occurred before definitive surgical exploration. All patients had body-coil MR imaging examinations, including the following sequences that were ranked for anatomic and pathologic information: spin-echo T1-weighted, short inversion time inversion recovery, and dynamic contrast-enhanced MR imaging in the coronal plane; and spin-echo T2-weighted imaging in the axial plane. Surgical findings were accepted as the gold standard and were recorded independently by the surgeon, who was unaware of the findings of the MR assessment. MR findings were subsequently correlated with digital rectal examination before surgery and with clinical follow-up. RESULTS: MR imaging correctly allowed our blinded observers to predict the surgical anatomy of perianal disease in 37 of the 42 patients (accuracy, 88%). For detection of the presence and site of an enteric fistulous entry, MR imaging had a sensitivity of 97%, a specificity of 67%, a positive predictive value of 88%, and a negative predictive value of 89%. On MR imaging examination, eight patients had no fistula, 12 had simple intersphincteric fistulas, and 22 had complex fistulas. MR imaging revealed all 14 perianal abscesses and fluid collections found at surgery. Digital rectal examination before surgery failed to reveal abscesses or important secondary tracks in eight of the 22 complex fistulas. For anatomic and pathologic depiction of fistulas, dynamic contrast-enhanced MR imaging ranked as the best sequence for 22 of 34 fistulas. The short inversion time inversion recovery sequence, which was unable to distinguish small abscesses from perianal inflammation and showed spurious high signal in old fibrotic tracks, led our observers to misdiagnose five cases. In four patients for which initial surgery did not confirm enteric entry sites that our observers had predicted by MR imaging, follow-up has confirmed the observers' diagnoses. The observers' evaluations of the MR examinations agreed in 37 (88%) of the 42 cases. CONCLUSION: MR imaging is more accurate than digital rectal examination before surgery in detecting complex features of perianal fistulas. MR imaging is noninvasive, is highly accurate, and has low interobserver variability. With MR imaging, observers may better predict outcome than with initial surgical exploration. MR assessment that includes dynamic contrast-enhanced MR imaging and axial T2-weighted sequences (examination time, 20 min) provides the anatomic and pathologic information required to guide surgical management.

Adult↗
PubMed1996

Absorption, metabolism and excretion of tamsulosin hydrochloride in man.

1. The absorption, excretion and metabolism of tamsulosin hydrochloride (TMS), a potent alpha 1-adrenoceptor blocking agent, were studied in four healthy male subjects after a single oral administration of 14C-TMS at a dose of 0.2 mg. 2. Plasma and blood radioactivity concentrations attained peak levels (Cmax) within 1 h after dosing and then declined biphasically. Mean terminal elimination half-lives were 11.8 h for plasma and 9.1 h for blood. The respective mean area under the radioactivity concentration-time curves (AUC0-infinity) were 122.8 and 57.8 ng equivalents h/ml. 3. Mean plasma Cmax of unchanged TMS was 13.0 ng/ml. Plasma levels of TMS declined biphasically. Mean terminal elimination half-life and AUC0-infinity were 8.4 h and 90.3 ng h/ml. The percentage of unchanged TMS to total radioactivity was 91% for Cmax and 74% for AUC0-infinity indicating small amounts of metabolites in plasma. 4. By 1 week post-dosing, 76.4% of the administered radioactivity was recovered in urine and 21.4% in faeces. The major part of radioactivity excreted in urine was recovered within the first 24 h (62.2% of the dose). 5. Unchanged TMS and 11 metabolites in 0-24-h urine samples were quantified. TMS accounted for 8.7% of the dose. Extensive excretion of the sulphate of the O-deethylated metabolite (M-1-Sul) and o-ethoxyphenoxy acetic acid (AM-1) was seen, accounting for 15.7 and 7.5% of the dose respectively.

Absorption↗
PubMed1996

Ergonomic data of elderly people and their application in rehabilitation design.

The population of the First World is ageing, and as it does so elderly people are becoming an increasingly significant consumer group. This process has important ramifications for the ergonomics and design professions. The demand for products that have been developed with consideration for the elderly consumer will require designers to develop new skills and ergonomists to supply new data. This paper highlights the inadequacy of current design data pertaining to the elderly. Anthropometric studies which have been carried out within the fields of ergonomics and rehabilitation are reviewed, and their usefulness to the product designer discussed. Recommendations are made regarding future needs for the collection and dissemination of further data.

Activities of Daily Living↗
PubMed1996

Prophylaxis of deep venous thrombosis after total hip arthroplasty by using intermittent compression of the plantar venous plexus.

A randomized, prospective, blinded study comparing the efficacy of prophylaxis of deep venous thrombosis by using (A) heparin-aspirin therapy, (B) intermittent pulsatile pneumatic-pump compression of the plantar venous plexus, or (C) both methods, was conducted in patients undergoing elective total hip replacement arthroplasty. Duplex ultrasonography was obtained in all 75 patients before surgery, at 1 week, and 2 weeks after surgery, to detect the presence or absence of deep venous thrombosis, with venograms confirming all positive results. Five of 25 patients in group A (heparin-aspirin) developed deep vein thrombosis. No deep venous thrombi were detected in groups B or C. One pulmonary embolus was detected in group A. The reduction in detectable deep venous thrombosis by the use of intermittent compression of the plantar venous plexus was significant. Wound drainage was decreased by 2 to 3 days (P < 0.05) in group B. It is concluded that, in this group of 75 consecutive patients, intermittent pulsatile compression of the plantar venous plexus was superior to heparin/aspirin pharmacologic prophylaxis for the prevention of deep venous thrombosis proximal to the calf.

Adult↗
PubMed1996

Patient surveys in general practice: a randomised trial of an instant lottery ticket to increase return rate.

BACKGROUND: Patient surveys are becoming increasingly common and already are an obligatory activity to qualify for a Better Practice Program Grant. Strategies to increase return rates remain unevaluated in Australian general practice. AIM: To evaluate the effectiveness of an instant lottery ticket as a response-aiding technique in patient surveys. METHOD: A random sample of adult patients was selected from an age-sex-disease register, stratified by sex and randomised to receive an instant lottery ticket with the self-administered questionnaire mailed out in December 1994. RESULTS: There was no significant difference by group either for women (P = 0.68), men (P = 0.88) or both sexes combined (P = 0.68). However, irrespective of inclusion of the lottery ticket, men were significantly less likely to return questionnaires than women (P = 0.02). CONCLUSIONS: Instant lottery tickets do not increase return rates to questionnaires and are not recommended. Other strategies need to be tested, particularly to involve male patients in general practice research.

Adult↗