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Biomedical subjects

L M Campbell

Publications and source records attributed to L M Campbell.

At least 19 recordsLinked to original sources
PubMed1997

Efficacy and safety of atorvastatin compared to pravastatin in patients with hypercholesterolemia.

Plasma cholesterol and other lipoproteins play a significant role in the development of atherosclerosis and subsequent coronary heart disease (CHD). This 1 year study was designed to confirm the efficacy and safety of atorvastatin (Lipitor) compared to pravastatin, a marketed agent for low density lipoprotein cholesterol (LDL-C) reduction in hypercholesterolemic patients. Patients were recruited at 26 centers in six European countries. After a 6 week placebo baseline phase, patients were randomized to receive atorvastatin 10 mg or pravastatin 20 mg daily. The dose could be doubled at week 16, if LDL-C levels remained > or = 3.4 mmol/l (135 mg/dl). Atorvastatin significantly lowered LDL-C from baseline by 35% compared with 23% for pravastatin (P < 0.05). A total of 72% of atorvastatin patients attained the LDL-C target level of < 3.4 mmol/l, compared to 26% of pravastatin patients. Atorvastatin also significantly reduced TC, TG and apo B (P < 0.05). Safety was assessed by recording adverse events and measuring clinical laboratory parameters. The adverse event profile was similar for both treatment groups and neither treatment caused clinically relevant laboratory abnormalities. Atorvastatin 10 and 20 mg once daily is superior to pravastatin 20 and 40 mg once daily in treating patients with hypercholesterolemia.

Anticholesteremic Agents↗
PubMed1996

The effects of the introduction of a system of mandatory formative assessment for general practice trainees.

A series of questionnaires was used to determine the amount of formative assessment going on within the est of Scotland Region of the UK and its perceived value by trainees (General Practice [GP] Registrars) both at the beginning and end of training. The first survey was carried out in 1989 and the second in 1994. Trainers and course organizers were surveyed in 1994 to determine their attitudes to the use of videotaped consultations for formative assessment. In 1991, the region had initiated a mandatory formative assessment programme which included regular use of videotaped consultations, confidence rating scales and Manchester ratings (RCGP Occasional Paper Number 40). The use of a range of assessment methods for formative assessment of GP Registrars increased considerably between 1989 and 1994. The percentage of trainees using videotaped consultation analysis increased from 76 to 94%, for Manchester ratings from 52 to 68% and for confidence rating scales from 63 to 74%. Video and confidence scales were rated highly by trainees who were assessed by them and by most trainees at the start of the year, but less highly by those who had not been assessed by them by the end of the trainee year. Manchester ratings were not thought to be as useful, and for these there was no difference between users and non-users. Despite the mandatory system, a significant number of trainees (76%) were still not receiving the minimum assessment stipulated. Trainers rated lack of time as the main limiting factor to the greater use of video. We conclude that trainees who are exposed to assessment methods, particularly video, find it useful, but that some trainees are still receiving less than is optimal. We propose increased trainer education and intensified monitoring of the assessment carried out in training Practices.

Attitude↗
PubMed1996

A controlled assessment of an asthma self-management plan involving a budesonide dose regimen. OPTIONS Research Group.

Our aim was to assess the efficacy of budesonide (Pulmicort Turbohaler Astra) used as part of a self-management plan in a group of patients with chronic asthma. One hundred and twenty five patients with nocturnal asthma symptoms, despite the use of inhaled prophylactic and beta 2-agonist therapy, were randomized to inhaled budesonide 200, 400 or 800 micrograms b.i.d. either with dose adjustments made by the physician, i.e. doctor-managed (DM; n = 64), or as part of a self-management plan (SM; n = 61). The SM group were allowed to adjust their dose according to written guidelines based on morning peak flow. At the end of the 6 month treatment period, there were no significant differences detected between the DM and the SM groups either from the clinic or diary card data. Both groups demonstrated a significant reduction in the number of sleep-disturbed nights, by 75% in the DM group and 77% in the SM group, at the end of the study. In conclusion, for patients with mild-to-moderate asthma, either a doctor-adjusted dose regimen or a peak flow based self-management plan involving budesonide is equally efficacious. For some patients, a simple regimen, adjusted by the physician at clinic visits, may be easier to follow.

Administration, Inhalation↗
PubMed1996

Summative assessment of vocational trainees: results of a 3-year study.

BACKGROUND: Summative assessment of general practice trainees will be introduced across the UK for trainees completing vocational training after 1 September 1996. AIMS: A study was set up to assess the reliability of the consulting skills assessment which will be used to develop audit and factual knowledge testing as summative assessment tools and to determine the probable impact of the system on the numbers of trainees identified as not yet competent for independent practice. METHOD: Videotaped consultations, an audit project, a trainer's report and a multiple-choice paper were evaluated for 359 trainees in the West of Scotland completing their training between 31 July 1993 and 31 July 1995. RESULTS: A total of 77 trainees (22%) were identified as being potentially of doubtful competence and 17 (5%) were adjudged to be as yet incompetent for independent practice. Videotaped consultation produced the highest pickup rate (14) followed by trainer's judgement (3). Subsequent analysis of the video tapes identified one trainee who should have been picked up by this method but was not. CONCLUSION: The videotape instrument reliably identified the non-competent trainees. Audit and factual knowledge tests have a distinct role in summative assessment. The proportion of trainees being refused certificates by this assessment is likely to increase considerably but will still represent only about 5% of all trainees.

Education, Medical, Graduate↗
PubMed1996

Assessment of competence.

While it is essential that professional competence should be maintained, it is equally important that entry to the specialist ranks should be conditional on the demonstration of an acceptable level of competence. Multiple-choice papers and videotaped consultations are two parts of a multi-format approach to assessment which also includes a trainer's report and an audit report. The number of doctors identified as unsatisfactory at the recertification stage could be reduced by these methods, and the system could also provide a template for the introduction of recertification procedures.

Certification↗
PubMed1995

Use of videotaped consultations in summative assessment of trainees in general practice.

BACKGROUND: There are many different methods by which trainees may be assessed summatively. AIM: The objective of the study was to determine if videotaped consultations could be used to identify reliably those general practitioner trainees who have not yet reached acceptable levels of competence. METHOD: Videotapes of 10 trainees carrying out normal consultations were assessed by 20 assessors for acceptable competence using a rating scale specifically developed for the purpose. RESULTS: A principal components analysis showed a strong correlation among the items in the rating scale used, indicating that a single underlying factor accounted for 76% of the overall scores. Agreement between assessors on the scoring of individual consultations was limited. There was much greater consistency with regard to the decision on overall competence, examined for the first consultation. A non-competent trainee would have a 95% probability of being identified by the process as described using two assessors for each videotape. The assessors had reached firm judgements on each trainee by the time four consultations had been viewed. CONCLUSION: The workload involved in producing and analysing the tapes is discussed. Considerations of patient consent are addressed. It is concluded that the use of videotaped consultations appears to offer a feasible and reliable method of summative assessment of general practitioner trainees.

Education, Medical, Graduate↗
PubMed1993

Summative assessment: a pilot project in the west of Scotland.

In the autumn of 1991 the Committee in General Practice of the west of Scotland region appointed a working party to investigate the possibility of developing a credible, valid and reliable programme of summative assessment for general practitioner trainees. The working group formulated a four-part package consisting of a multiple true-false paper, a trainee audit project, the trainers' judgement, and analysis of videotaped consultations. The reasons for the use of this selection of methods are discussed. It is suggested that a summative assessment process for trainees should make use of the trainers' considerable knowledge of the trainee, have an external component, be criterion referenced, have an element of continuous assessment, and involve direct assessment of clinical competence. A pilot study of assessment of clinical competence using videotapes of routine trainee consultations by 25 volunteer general practitioner assessors is described. A rating instrument for use in differentiating the competent from the not yet competent trainee is discussed. The working group and the group of videotape assessors came to the provisional conclusion that the use of videotaped consultations may be a valid and feasible method of assessing the competence of general practitioner trainees as part of a balanced summative assessment programme.

Clinical Competence↗