Search PubMed⌕ Search

Biomedical subjects

L F Smith

Publications and source records attributed to L F Smith.

At least 37 records · Page 2Linked to original sources
PubMed1999

The WOMB (Women's views of birth) antenatal satisfaction questionnaire: development, dimensions, internal reliability, and validity.

BACKGROUND: Antenatal services continue to change, stimulated by the Changing Childbirth report. Women's views should be an important component of assessing the quality of such services. To date, no published quantitative multidimensional assessment instrument has been available to measure their satisfaction with care. AIM: To develop a valid, reliable, multidimensional questionnaire to assess quality of antenatal care. METHOD: A multidimensional satisfaction questionnaire was developed using psychometric methods. Following fieldwork to pilot a questionnaire, three successive versions of it were given by midwives to pregnant women in their final trimester in nine trusts in the old South Western region of England. Their replies were analysed by principal components analysis (PCA) with varimax rotation; internal reliability was assessed by Cronbach's alpha. Face, content, and construct validity were all assessed during development. RESULTS: Out of 196 women, 134 (68.4%) returned the pilot questionnaires. One hundred and seventy-two (57.3%) out of 300 women returned version 1 of the WOMB (WOMen's views of Birth) antenatal satisfaction questionnaire proper, 283 (56.6%) out of 500 returned version 2, and 328 (65.6%) out of 500 returned the final development version. This final version consisted of 11 dimensions in addition to a general satisfaction one. These were [Cronbach's alpha]: five related to antenatal clinic characteristics (travelling to clinic [0.75], waiting at clinic [0.90], clinic environment [0.69], timing of appointment [0.78], car parking [0.85]), three 'professional' characteristics (professional competence [0.80], knowing carers [0.79], information provided [0.81]), antenatal classes [0.76], social support from other pregnant women [0.83], checking for the baby's heart beat [0.63]. There were significant moderate correlations (range = 0.24 to 0.77) between individual dimensions and the general satisfaction dimension. Women's dimension scores were significantly related to age, parity, social class, and best educational achievement. CONCLUSION: This multidimensional satisfaction instrument has good face, content, and construct validity, and excellent internal reliability. It could be used to generally assess antenatal services or to screen them to detect areas where further in-depth qualitative enquiry is merited. Its sensitivity to change over time, external reliability, and transferability to non-Caucasian groups needs to be assessed.

Adult↗
PubMed1998

Impact of smoking cessation on salivary function in healthy volunteers.

BACKGROUND: Salivary bicarbonate and epidermal growth factor (EGF) have an important protective role in the oesophagus. The effect of smoking cessation on these aspects of salivary function is unknown. METHODS: Salivary bicarbonate secretion and EGF output were measured before and after attempted smoking cessation in 28 healthy volunteers. Urinary cotinine excretion was used to assess compliance. RESULTS: Negative correlations were found between salivary flow rate and age (rho = -0.34) and between cigarette consumption and salivary flow (rho = -0.27) and salivary bicarbonate concentrations (rho = -0.32). Smoking cessation was associated with a significant increase in salivary bicarbonate secretion (day 0, 1.7 (0.14-6.2); day 7, 3.6 (0.52-6.4); day 21, 3.3 (0.44-6.6) micromol min(-1); P < 0.01) but left salivary EGF output unchanged. CONCLUSION: Smoking cessation is associated with significant improvements in salivary bicarbonate secretion. This would benefit patients with reflux disease who stop smoking.

Adult↗
PubMed1997

Randomized trial comparing the tolerability of sargramostim (yeast-derived RhuGM-CSF) and filgrastim (bacteria-derived RhuG-CSF) in cancer patients receiving myelosuppressive chemotherapy.

A prospective, randomized, double-blind, multicenter study in cancer patients receiving myelosuppressive chemotherapy was undertaken to evaluate and compare the tolerability of sargramostim (yeast-derived recombinant human granulocyte-macrophage colony-stimulating factor, RhuGM-CSF) and filgrastim (bacteria-derived recombinant human granulocyte colony-stimulating factor, RhuG-CSF) in the prophylaxis or treatment of chemotherapy-induced neutropenia. In all, 137 evaluable patients received sargramostim (300 micrograms; 193 mg/m2) or filgrastim (481 mg; 7 mg/kg) once daily by self-administered s.c. injection, usually beginning within 48 h after completion of chemotherapy. With the exception of a slightly higher incidence of grade 1 fever (< 38.1 degrees C) with sargramostim, there were no statistically significant differences in the incidence or severity of local or systemic adverse events possibly related to the growth factors. Although the study was not designed to evaluate efficacy directly, there also were no statistically significant differences between treatment groups in total days of growth factor therapy, days of hospitalization, or days of i.v. antibiotic therapy during the treatment period. Both sargramostim and filgrastim were comparably well tolerated when given by s.c. injection in this group of patients, and no clinically significant differences between the growth factors were demonstrated.

Chi-Square Distribution↗
PubMed1997

Diagnostic dilemmas in dysphagia aortica.

OBJECTIVE: Dysphagia aortica describes swallowing difficulty caused by external compression from a tortuous or aneurysmal aorta. We present 5 cases in which dysphagia to solids accompanied a localised high pressure barrier (HPB) on manometry suggestive of dysphagia aortica, and explore other investigation modalities useful to confirm the diagnosis. METHODS: Four females and 1 male with a median age of 56 years (range 47-58) were investigated. All underwent investigation with endoscopy, chest radiography, CT scanning, barium swallow, and video solid bolus swallow in addition to oesophageal manometry and 24 h ambulatory pH monitoring. RESULTS: Median basal pressure rise at the mid oesophageal HPB was 45 mmHg (range 40-80). In addition to the HPB, 4 patients had manometric abnormalities of swallow activity and 2 patients had significant gastroesophageal reflux disease (GORD). Contrast enhanced computed tomography and barium swallow were normal in all cases. Video bolus swallow showed pronounced obstruction to transit at the aortic arch in 2 cases and excluded significant dysphagia aortica in 2 others. CONCLUSIONS: Dysphagia aortica commonly coexists with motility disorders and GORD. Video solid bolus swallow allowed us to determine the clinical significance of a manometric HPB in 4 out of 5 patients suspected on dysphagia aortica where standard evaluation would have failed. We recommend its use in those patients with a manometric HPB suggestive of dysphagia aortica in whom standard barium swallow is normal.

Aortic Aneurysm, Thoracic↗
PubMed1997

Research general practices: what, who and why?

BACKGROUND: By the autumn of 1995, 14 research general practices had been funded. These are service NHS general medical practices that are supportive of primary care research and have a lead GP who has research experience as evidenced by publication in peer-reviewed journals. AIM: To ascertain the characteristics of those who have been successful in securing the first 14 grants, the effect the process has had on them, and the practical advice they would offer to future applicants and to future funding bodies. METHOD: A confidential postal survey of research general practices. RESULTS: They are atypical practices (high level of research and teaching involvement, mostly non-urban) with atypical lead GPs (male, research degrees, possess MRCGP, publications and grants obtained). Practices contemplating applying for future research practice grants should consider planning ahead, use of grant monies, protection of research time, involving the primary health care team, and sources of both internal and external support. Funding bodies need to make adequate funding available for capital expenditure and running costs as well as staff and lead GP time. CONCLUSION: Research general practices are ideal for integrating the core values of the medical profession, providing clinical care by medical generalists, teaching the discipline and researching its basis. Such practices should be funded on a rolling basis and throughout the United Kingdom. Future evaluation of funding such practices is needed and should confirm their utility both to the discipline and to patient care within the NHS.

Family Practice↗
PubMed1997

Predictors of the provision of intrapartum care by general practitioners: five-year cohort study.

BACKGROUND: There is little published evidence that any aspect of vocational training for general practice improves the quality of care provided by general practitioners (GPs). AIM: To investigate whether aspects of education and vocational training predict whether GPs provide intrapartum care. METHOD: A five-year prospective cohort study was carried out in the United Kingdom (UK) using responders to a 1990 national survey of GPs for whom a current UK address could be found. Main outcome measures were factors associated with provision of GP intrapartum care in 1995. RESULTS: In 1995, a minority of ex-trainees (65 out of 349, 18%) provided intrapartum care as GPs, although 28% would ideally have wished to do so; 8% provided home delivery care. Four education and training variables were associated with ex-trainees booking women for GP delivery in 1995: the number of partners in the ex-trainee's GP training practice providing GP intrapartum care (odds ratio (OR) = 1.30); performing forceps deliveries as an obstetric senior house officer (SHO) (OR = 1.24), witnessing episiotomies as a student (OR = 1.17), and witnessing twin deliveries as a student (OR = 0.75). CONCLUSIONS: In the case of GP intrapartum care, future service provision is associated with certain education and training variables. There is a mismatch between GPs' ideal and actual maternity care provision. Changes to enhance such care would be needed at least at three levels: selection and approval of training practices, content and base for SHO posts, and practice arrangements for maternity cover.

Cohort Studies↗
PubMed1996

A new procedure for improvement of the ptotic melolabial fold.

OBJECTIVE: To demonstrate a new surgical technique for improving the ptotic melolabial fold. DESIGN: Case series. SETTING: University medical center. PATIENTS: Consecutive sample of 8 patients with ptotic melolabial folds. INTERVENTION: Preoperative and postoperative analysis evaluating surgical intervention. Surgical treatment of the ptotic melolabial fold consists of 3 steps: removal of ptotic adipose tissue, excision of a crescent-shaped segment of skin along the nasoalar crease, and detachment of the dermal-connective tissue attachments. MAIN OUTCOME MEASURES: Evaluation of the improvement of the ptotic melolabial folds and correlation with concomitant aesthetic surgical procedures. CONCLUSIONS: Early results demonstrated improvement in the ptotic melolabial fold. Patients were pleased with the procedure, rating improvement as fair to good. The surgeons' evaluation correlated well with the patients' evaluation.

Female↗
PubMed1996

Should general practitioners have any role in maternity care in the future?

Maternity services in England are currently being reorganized. The success of the changes will be judged against the recommendations of the Changing Childbirth report. This paper describes the nature of maternity care and of general practice. It is argued that maternity care provision by general practitioners is a central and essential part of British general practice. Specifically, it is shown how general practitioners can help to achieve the objectives of the report, and thus, have a future role. It is suggested that all general practitioners who wish maternity care to remain an essential part of general practice need to argue the case with providers and purchasers. If they do not, then it is quite likely that general practitioners will be increasingly excluded as the commissioning and contracting mechanisms become more effective with midwives providing low-risk care and consultant obstetricians high-risk care.

England↗
PubMed1996

Views of pregnant women on the involvement of general practitioners in maternity care.

BACKGROUND: The reorganization of maternity services in England following the report Changing childbirth is likely to impinge upon general practitioners' contribution to maternity care. Professionals and managers are increasingly expected to take account of patients' views when reorganizing services. AIM: This study aimed to elicit women's views about the involvement of general practitioners in maternity care and to establish the extent of continuity provided by general practitioners. METHOD: A prospective cohort postal questionnaire survey was undertaken in the Bath health district to elicit the views of pregnant women about the general practitioner's role in maternity care, the continuity provided, patient satisfaction and the general practitioner-patient relationship. Responses were rated on five-point Likert scales. Women completed questionnaires at 24 and eight weeks before the birth and at two and eight weeks after the birth. RESULTS: Of 164 women entering the study (28 of whom were booked for home delivery and 136 for hospital delivery), 116 (71%) completed all four survey questionnaires. Of respondents 68% agreed that general practitioners play an important role in routine antenatal care and 53% that they have an important role in normal labour. These opinions appeared to be stable over time. Most women (73%) were cared for throughout their pregnancy by one general practitioner whom they knew well; such continuity was desired by nearly all the women in the study. Approximately three quarters of women were satisfied with the antenatal, postnatal and overall care provided by their general practitioner. Over half of respondents (56%) wished to get to know the doctor who would be present at the birth: the general practitioner was involved in 19 labours (16%), being present at the birth for only nine women. Women delivering at home were significantly more likely to agree with the statement that they knew the doctor present at the birth compared with those women delivering at hospital. Most women (91%) had their final six-week postnatal check with their general practitioner. CONCLUSION: Most women in this study believed that general practitioners are important in maternity care, providing continuity of antenatal and postnatal care but not of intrapartum care. These beliefs might be an indicator of the future situation in the United Kingdom when more women give birth at home and under non-consultant care. The vocational training and continuing education of general practitioners should accommodate their possible future roles in maternity care.

Adult↗
PubMed1995

Factors associated with the decision of family physicians to provide intrapartum care.

OBJECTIVE: To investigate which characteristics and beliefs of family physicians determine their decision to provide intrapartum care. DESIGN: Confidential survey questionnaire mailed in spring 1993. SETTING: Alberta and Ontario. SUBJECTS: Random selection of 207 physicians who had graduated from medical school between 1953 and 1990 and were thought to be in family or general practice. Of 178 eligible physicians, usable replies were received from 104 (58.4%). OUTCOME MEASURES: Beliefs (measured on a 7-point Likert scale) about the relevance of 16 primary factors to the type of obstetric care provided; demographic, training and practice characteristics. RESULTS: The respondents who provided intrapartum care differed from those who did not in their beliefs about the availability of a local hospital suitable for intrapartum care (p < 0.001), their practice partners' views on the role of family physicians in providing obstetric care (p < 0.002), their own concept of the role of family physicians in providing obstetric care (p < 0.001) and women's views on the type of obstetric care they want (p < 0.002). They also differed, although less significantly, in their beliefs about the adequacy of their obstetric training before entering family practice (p < 0.04), the expected effects of providing obstetric care on their free time (p < 0.006), their fear of malpractice litigation (p < 0.028) and their perceived competence in performing practical obstetric procedures (p < 0.05). Logistic regression analysis revealed that certain secondary factors were particularly relevant to the respondents' provision of intrapartum care at present. These included the physician's perceived competence at managing postpartum maternal hemorrhage (odds ratio [OR] 48.90, 90% confidence interval [CI] 4.70 to 509), the belief that medical insurance premiums should not be affected by the type of obstetric care provided (OR 3.55, 90% CI 1.67 to 7.57]) and the number of practice partners who provided intrapartum care (OR 10.08, 90% CI 2.31 to 44.10). CONCLUSION: Several factors appear to influence family physicians in their decision to provide intrapartum care. This information will help to focus efforts to provide appropriate obstetric training for family practice residents and to retain involvement of family physicians in intrapartum care.

Alberta↗
PubMed1995

Obstetric and neonatal competence of medical students.

During 1991-1992 a confidential questionnaire was administered to a sample of United Kingdom medical students to determine if undergraduate education improved students' perceived competence at eight practical procedures. Of 2521 students given questionnaires, 1483 (58.8%) replied; 948 (65.5%) had had some obstetric and 866 (60.8%) some neonatal education. Such education did improve students' perceived competence (P < 0.001) on self-assessed Likert scales, but most still believe themselves not to be competent when they have completed their obstetric and neonatal education. Regression models were able to explain much (38.7-65.1%) of the variability in perceived competence at obstetric procedures: obstetric education, performing practical procedures, and witnessing deliveries in a general practitioner unit were all associated with higher competence; but less (4.8-20.8%) of the variability in perceived neonatal competence. It is suggested that undergraduate experience should be congruent with the aims and objectives of obstetric and neonatal education, and that these need to be reviewed in the light of the recent General Medical Council proposed changes to medical education.

Attitude↗