Biomedical subjects
Publications and source records attributed to L Ridsdale.
The epilepsies are the commonest of serious disorders of brain function. Medical, psychological, social and financial implications can adversely affect quality of life in both patient and family. Accurate categorization of seizure type and epilepsy syndrome, with appropriate choice of drug and other management, can minimize the burden of a seizure disorder.
Approximately 30-40% of people with epilepsy continue to have seizures despite drug treatment. Factors related to cognitive abilities, physical handicap, psychiatric illness and social circumstances are of great importance in the overall management.
OBJECTIVE: To test the feasibility and effect of nurse run epilepsy clinics in primary care. DESIGN: A randomised controlled trial of nurse run clinics versus "usual care." SETTING: Six general practices in the South Thames region. SUBJECTS: 251 patients aged over 15 years who were taking anti-epileptic drugs or had a diagnosis of epilepsy and an attack in the past two years who met specified inclusion criteria and had responded to a questionnaire. MAIN OUTCOME MEASURES: Questionnaire responses and recording of key variables extracted from the clinical records before and after the intervention. RESULTS: 127 patients were randomised to a nurse run clinic, of whom 106 (83%) attended. The nurse wrote 28 letters to the general practitioners suggesting changes in epilepsy management. For this intervention group compared with the usual care group there was a highly significant improvement in the level of advice recorded as having been given on drug compliance, adverse drug effects, driving, alcohol intake, and self help groups. CONCLUSIONS: Nurse run clinics for patients with epilepsy were feasible and well attended. Such clinics can significantly improve the level of advice and drug management recorded.
OBJECTIVE: To explore patients' views about what they would or would not like to read on the computer screen, and how this might be managed. DESIGN: A qualitative study using semi-structured interviews with patients who had recently consulted, and who were representative of the age-sex structure of our practice population. SETTING: Primary health care, patients' homes. PATIENTS: 30 patients aged 18-89 years. MAIN OUTCOME MEASURES: Patients were likely to state that information about lifestyle (e.g. smoking and drinking) might be helpful to read on condition that it had been provided by the patients themselves, and not by a third party. Most patients would not want to read personal comments. Nearly half of the patients expressed concern about seeing a serious illness on the screen, especially if it had not been fully discussed in advance. Over a third were concerned about seeing a mental illness listed. They suggested that these labels were subjective, confusing, and likely to be rejected by patients. CONCLUSIONS: Doctors need to develop and evaluate ways by which patients gain access to reading about their problems on desk-top computers, and devise strategies whereby this can be integrated constructively with information exchange in the consultation.
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This paper reports on early results of an investigation of the effectiveness of a specialist epilepsy nurse in primary care. Based on before-and-after interviews with sub-samples of adults with epilepsy, these results suggest that not only are expectations of the usefulness of epilepsy nurse interventions high, but also that these expectations are not disappointed in practice. Particular areas where epilepsy nurses may be able to complement and enhance medical approaches to treatment and care are identified.
BACKGROUND: Epilepsy is a common condition that is managed at the interface between primary and secondary care. AIM: A study aimed to describe general practitioners' criteria for aspects of optimal epilepsy care and their estimates of current levels of care achieved; to compare these estimates with clinical data extracted from their patients' medical records; and to compare general practitioners' estimates and recorded data with information provided by the patients themselves. METHOD: Thirty seven general practitioners from six practices in the south Thames region were sent a questionnaire enquiring about current practice with regard to general practitioner and specialist monitoring of patients with epilepsy and provision of advice, and about their criteria for the optimum levels of aspects of epilepsy care. Of patients aged over 15 years in the study practices, 0.6% were found to have active epilepsy; 283 of these 326 patients were sent a questionnaire enquiring about their epilepsy, the service and advice provided, and whether they required more information. Responses to the general practitioners' questionnaire and to the patients' questionnaire were compared and also compared with information extracted from the patients' medical records. RESULTS: Ninety five per cent of the general practitioners responded. Of 255 patient questionnaires (90%) returned, 251 could be analysed. Of 247 patients, 168 (68%) reported having had no seizure in the previous six months. Forty of 241 patients (17%) had a regular arrangement to see their general practitioner regarding their epilepsy. Of 191 patients who expressed a preference, 116 (61%) reported preferring to receive their epilepsy care mainly from their general practitioner. General practitioners reported that ideally patients should be monitored in primary care every six months (the median recorded frequency was 14 months) and that there should be a record of advice given to all patients on driving, adverse effects of antiepileptic drugs, and self-help groups. Advice was recorded in patients' records as having been given on driving (46% of records), adverse effects of antiepileptic drugs (9%), and self-help groups (3%); 82 of 237 patients (35%) reported not receiving enough advice. CONCLUSION: Patients generally preferred to receive their epilepsy care in general practice. Monitoring and provision of advice were less than optimal from both the general practitioners' and the patients' point of view. New resources and skills will be necessary to bridge this perceived gap. Specially trained nurses may have a role in this monitoring and advice provision.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
BACKGROUND: The use of computers in general practice consultations is becoming widespread. AIM: A qualitative study was undertaken to determine how patients in one practice responded to the use of computers, and the issues which particularly concerned them when doctors used computers in the consultation. METHOD: Thirty patients whose age-sex characteristics were proportional to the age-sex distribution of one practice were selected to be interviewed within two weeks of a consultation. The interviews were taped, transcribed and analysed. RESULTS: Patients had seen or used computers in many other places and accepted their role in data management. Patients with more experience of computers were more aware of their limitations, particularly with regard to the possibility of loss of confidentiality. Patients did not think the use of a computer led to a loss of the personal touch in the consultation as long as verbal skills and eye contact were maintained. However, they did expect doctors using computers to have acquired computer skills. All but one patient said they wanted to see what was on the screen, although 11 did not know they had the right to read their notes on the screen. CONCLUSION: Patients regarded the use of computers by their doctors as normal and indicative of the doctors being up to date. Most respondents were concerned about possible loss of confidentiality. This concern, and their expressed preference for computer details to be visible and shared, pose challenges to doctors' technical and communication skills.
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BACKGROUND: Few prospective studies have been carried out in primary care on patients presenting with tiredness. AIM: A study was undertaken to describe patients whose main complaint was fatigue or of being "tired all the time'. METHOD: Over one year, doctors in four practices in Lancashire, Mid-Glamorgan, Suffolk and Surrey recruited 220 patients aged 16 years or more presenting with fatigue, and matched them with a comparison group from their lists. The general health questionnaire, a fatigue questionnaire and an attribution questionnaire were used to measure outcomes over six months. General practice records of consultations were also examined. RESULTS: Patients consulting for tiredness attended the doctor significantly more frequently than the comparison group both in the six months before and after entering the study. The frequency of attending could not be related to the duration or severity of fatigue alone. The majority consulting with tiredness scored highly on the general health questionnaire but so also did patients with equivalent fatigue scores in the comparison group. The correlation between fatigue and general health questionnaire scores was close for those patients who still had high fatigue scores six months later than it was for patients on entry to the study. Six months following study entry 61% of patients perceived the cause of the tiredness to be physical, while 57% of doctors viewed the problem as psychological. A small number of patients changed their views during the six months follow up from physical to psychological attributions. CONCLUSION: Patients consulting for tiredness are likely to report symptoms of psychological distress and attend more frequently than other patients. They tend to view the problem as physical while their doctors view the problem as psychological. Having established that there is no physical problem, doctors may need to focus more on sharing ideas and explanations when patients complain of being "tired all the time'.
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OBJECTIVE: To describe the characteristics of patients attending their general practitioners and complaining of fatigue or being "tired all the time." DESIGN: Prospective study of cohort aged 16 years and older with follow up at two weeks and by questionnaires at two and six months. SUBJECTS: 220 patients (164 women) with mean age 43 years and an age-sex matched comparison group. SETTINGS: Doctors and patients in four practices in Lancashire, Mid Glamorgan, Suffolk, and Surrey. MAIN OUTCOME MEASURES: General clinical data, results from standard group of laboratory tests, fatigue questionnaire, and 12 item general health questionnaire. RESULTS: Over twice as many patients with fatigue had high scores on the health questionnaire compared with the comparison group (156 (75%) v 69 (34%)). Results of laboratory tests were abnormal and contributed to the diagnosis in 19 patients. 59 out of 102 patients who responded had high fatigue scores six months later. Patients with persistent fatigue were more likely to have a history of anxiety or depression and to have had fatigue for more than three months on entry to the study. CONCLUSIONS: Women are particularly at risk of fatigue. The outcome is better if patients have had symptoms for three months or less or there is no history of emotional illness.
Mothers' beliefs and evaluations of their child's illness were studied in a group of 30 mothers who had consulted a general practitioner because of a cough. Data were collected by tape-recorded semi-structured interviews conducted in their own homes. A major concern for mothers was their fear that their child was going to die, usually because of choking on phlegm or vomit, but also through an asthma attack or cot death. Mothers were also worried that their child would develop long-term chest damage. Particularly important in mothers' assessments were their experience of disturbed sleep because of worries about their child dying at night and their belief that the cough was 'on the chest' which gave rise to worries about dying through choking on phlegm and long-term chest damage. Antibiotics were commonly believed to be required to break up phlegm which might cause the long-term damage or the choking and death.
A total of 174 families of service personnel with children between 3 and 6 years of age were studied over a 6 month period. All contacts with the general practitioner, both in and out of hours together with the local casualty department were recorded. Mothers of the children were posted a specially designed questionnaire to measure how seriously they perceived various childhood symptoms to be and a copy of the general health questionnaire, 28 question version (GHQ 28). The perceived severity questionnaire had been piloted previously in a neighbouring practice. The overall response rate was 77%. Analyses of the data showed that the factors most significantly associated with a child's consultation frequency were the psychological state of the mother, the mother's own consultation frequency and the number of children in the family; the last being an inverse relationship. No evidence was found to suggest that the perception of the severity of illness varied with the psychological state of the mother. In addition, the childhood consultation rate was not influenced by the mother's perception of the severity of childhood illness as measured by the perceived severity questionnaire. Other factors such as the age of the mother or child, within the age range studied, were not found to be significantly related to the child's frequency of consulting. A mother's own consultation frequency was highly correlated with her GHQ 28 score, but more specifically with the subsections that scored for depression and somatic symptoms. From the study, doctors who see children should seriously consider the main reasons for a child's consultation.(ABSTRACT TRUNCATED AT 250 WORDS)