Continuity of care: in search of the Holy Grail of general practice.
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Australia↗
Biomedical subjects
M F Harris
Publications and source records attributed to M F Harris.
How general practitioners store vaccines. A survey in south-western Sydney.
OBJECTIVE: To describe how general practitioners store vaccines. DESIGN: A cross-sectional descriptive survey of general practices and observation of storage procedures for vaccines. SETTING: South-western Sydney between September and December 1993. PARTICIPANTS: 232 randomly selected general practitioners working in south-western Sydney, of whom 76% responded to a questionnaire. Vaccine storage was observed in 20 general practices. RESULTS: At 80% of practices, one person was responsible for vaccine storage. Only 30% of respondents used a vaccine-only refrigerator. Only 16% of respondents had a means of measuring temperature, while 5% kept a record of refrigerator temperature. Of the general practices that were monitored, the measured temperature of 70% of the refrigerators used for storing vaccines was within the recommended range of 2 degrees C-8 degrees C. CONCLUSIONS: Vaccine storage would improve in general practices in south-western Sydney if vaccine-only refrigerators were used and temperature was monitored with maximum-minimum thermometers.
Chi-Square Distribution↗
Remote monitoring of health status of the elderly at home. A multidisciplinary project on aging at the University of New South Wales.
This paper discusses the design and implementation of a multidisciplinary research project and associated field trials to test the hypothesis that functional health status amongst the elderly can be accurately determined remotely by continuously monitoring relatively simple parameters that measure the interaction between participants and their environment. In this study we propose that changes in such simple measures as mobility, sleep patterns, and utilisation of cooking, washing and toilet facilities, can identify changes in functional health status. One of the primary end goals of the project will be to automatically prompt appropriate, timely and cost-effective intervention of medical and community based services to help reduce morbidity and maintain an independent high quality of life for the elderly. Targeted intervention will diminish the demand for high cost medical services. This will have large potential economic implications in helping to contain and reduce the increasing cost of providing health care services to the aged.
Activities of Daily Living↗
Are childhood immunization programmes in Australia at risk? Investigation of the cold chain in the Northern Territory.
Since vaccines may lose their potency if transported or stored outside the recommended temperature range (2-8 degrees C), we carried out a study in the Darwin area of the Northern Territory of Australia to determine the links in the cold chain, including the extent of vaccine monitoring, and whether the vaccines were being exposed to unsafe temperatures. Sabin oral poliomyelitis vaccine (OPV) and recombinant hepatitis-B (HB) vaccine were selected for special monitoring. A total of 127 vials of OPV and 144 vials of HB vaccine were dispatched during October, November and December 1990 to the government, independent health services and general practitioner surgeries which routinely administer these vaccines. We distributed the two vaccines with MonitorMark time/temperature and Coldside indicator tags attached to cards for recording the date, location and temperature exposures each time the vaccines were moved or used. A total of 65% of the OPV and 41% of the HB vaccine monitor cards were returned for analysis. The vaccines were transported and stored at one to four locations prior to being administered. Some 23% of tagged OPV was exposed for 48 hours or more to a temperature > 10 degrees C; 47.5% of tagged HB vaccines were exposed to -3 degrees C or less, the majority of them during storage in health facilities or clinics. Exposures were independent of distance from the distribution centre, mode of transport, or type of facility. Our results show that the vaccines were often exposed to temperatures outside the recommended range during transport and storage, putting them at risk of loss of potency.(ABSTRACT TRUNCATED AT 250 WORDS)
Child↗
Improving general practitioner involvement in urban hospitals. Departments or divisions of general practice.
OBJECTIVE: To discover what measures have been taken in urban Australian hospitals to involve general practitioners (GPs) in public hospital services. DESIGN: A descriptive study. Data were collected by postal survey. SETTING: Hospitals in urban areas. MAIN OUTCOME MEASURES: Appointment of GP affiliates or associates, existence of departments or divisions of general practice, appointed GP liaison positions and formal arrangements for GP shared care and discharge planning. RESULTS: Ninety-five of 102 hospitals (93%) responded to a postal survey. Sixty-five per cent of respondent hospitals had appointed GP affiliates or associates, 32% had a division or department of general practice and 41% had a designated GP liaison position. Forty per cent had formal GP shared care programs and 14% had formal GP involvement in discharge planning. CONCLUSION: There was a high level of adoption of measures to involve GPs in urban hospitals. However, only a minority of hospitals had comprehensive measures in place and sufficient support for this to occur.
Australia↗
Arthritis in general practice.
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Adolescent↗
Epidemiology of blindness and visual impairment in Vanuatu.
A population-based survey of blindness was conducted in Vanuatu. Data were gathered on a sample of 3520 of the approximately 150,000 inhabitants of Vanuatu aged at least 6 years, in order to estimate the prevalence and causes of blindness among the whole population. An overall prevalence of blindness of 4.0 per 1000 was found, 85% of which was due to cataract, an avoidable cause of this disability.
Adolescent↗
Management of acute lower respiratory infections.
Acute lower respiratory infections are important causes of mortality and morbidity in Australia. Assessment, diagnosis and management in general practice can be improved by using very simple clinical protocols to identify serious problems early, to reduce reliance on investigations and overuse of antibiotics, and to involve the patients more in their own management.
Acute Disease↗
Anaesthesia for Proteus syndrome.
A 14-year-old boy with Proteus syndrome presented for orthopaedic surgery to his legs. No report in the literature exists on anaesthesia for this condition. Our patients posed airway problems that were managed by tracheal intubation under sedation using a fibreoptic bronchoscope. Anaesthesia was induced with thiopentone and maintained with nitrous oxide and isoflurane in oxygen. His lungs were ventilated mechanically throughout surgery, which was uneventful.
Abnormalities, Multiple↗
Change in aboriginal childhood morbidity and mortality in Bourke 1971-84.
In the early 1970s, the Aboriginal community of Bourke attempted to improve its socioeconomic and health status through a number of community development activities. As a result, markers of nutrition in early childhood, housing conditions and access to health care all improved, in spite of a deterioration in employment opportunities and adult health. Coincidentally, most markers of the health of Aboriginal children in Bourke improved over the period 1971-84. In particular, Aboriginal child admissions due to gastroenteritis, eye and ear infections and accidents, and the community prevalence of trachoma, middle ear disease and pneumonia among Aboriginal children, decreased. Skin infections were an exception to this general picture, becoming more prevalent over the period.
Adolescent↗
The change in rural practice. Bourke 1968 to 1985.
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Adolescent↗
The change in rural practice. Bourke 1968 to 1985.
This second part of a study comparing general practice consultations in Bourke in 1968 and 1985 examines attendances with non communicable diseases. Over the period, Aboriginal consultations for genitourinary diseases, diabetes, alcohol abuse, hypertension, and musculoskeletal disorders have increased. By 1985, most of these were more common among Aboriginal than non Aboriginal patients in the 30 to 50 year age group. This group also has a higher mortality. The role of the general practitioner is discussed.
Adolescent↗
Bridging the gap--health care for the homeless.
In Australia and other countries concern exists about the extent of homelessness. Because we live in a period in which access to adequate shelter is an increasing problem for many persons, we report on the health needs of long-term homeless persons. Little attention was given to their health needs during the International Year of Shelter for the Homeless in 1987.
Adult↗
Iron deficiency in Bourke children.
A study of 121 Aboriginal and 91 non-Aboriginal children aged 6 years and under was carried out in Bourke during 6 months of 1986. These children were selected either because they were admitted to hospital and had an incidental blood test or were screened at various childcare and preschool facilities in the town. A haemoglobin level of below 100 g/l was found in 12.4% of Aboriginal children compared with only 3.3% of non-Aboriginal children. A mean corpuscular volume of less than 80 was found in 15.7% of Aboriginal children and 3.3% of non-Aboriginal children. Of the total sample, 17.4% of Aboriginal children and 6.6% of non-Aboriginal children had a serum ferritin level of less than 10 ng/ml. These markers of iron deficiency were associated with low weight and crowded living conditions in Aboriginal children. The prevalence of haemoglobin below 100 g/l among Aboriginal children under 5 years has fallen from 24.7% in 1971 to 14.1% in 1986.
Child↗
Early childhood pneumonia in Aborigines of Bourke, New South Wales.
We carried out a retrospective survey of all children born in the district of Bourke , New South Wales, over a three-year period to determine the frequency of lobar pneumonia in the first three years of life. Although more non-Aboriginal children (167) than Aboriginal children (103) were born during this period, there was a striking difference between these groups in the frequency of pneumonia. Twenty-six (25.2%) Aboriginal children had one or more episodes of lobar pneumonia, compared with only five (3%) non-Aboriginal children born during the same period. Characteristic features of the disease in the Aboriginal children included a high rate of recurrent pneumonia (35%), frequent involvement of the upper lobe of the right lung (77%), and often a family history of pneumonia in early childhood. Of those with siblings, 39% of the affected infants had siblings who had suffered from pneumonia in early childhood. No perinatal factors which correlated with the subsequent development of lobar pneumonia could be identified. However, a greater proportion of the affected than of the non-affected children lived in substandard housing conditions.
Australia↗
The safety of measles vaccine in severe illness.
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Child, Hospitalized↗