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Biomedical subjects

M Shapley

Publications and source records attributed to M Shapley.

8 recordsLinked to original sources
PubMed2005

Ten years of skin malignancies in a single general practice.

BACKGROUND: Generalists within the UK have for many years been performing minor surgical procedures. Little has been published concerning this activity. OBJECTIVES: To determine the management of skin malignancy in a UK general practice in order to allow comparison of activity with other practices and disciplines and to identify areas for research. METHODS: Retrospective cohort study in an urban 4-partner general practice of 10,000 patients. Total ascertainment of all diagnosed skin malignancies over 10 years achieved by undertaking computerised searches. RESULTS: 136 skin malignancies were identified in 101 patients. The recurrence rates for basal cell carcinomas managed in primary care were comparable to rates published for secondary care. A quarter of patients developed a metachronous skin malignancy or a recurrence. CONCLUSION: Almost half of all skin malignancies were wholly managed within primary care. There appeared to be no consistent pattern of management. There is a need for research and consensus on optimal care.

Adolescent↗
PubMed2004

An investigation in primary care of the relationship between consultation behaviour, increased vaginal bleeding and mental disorder.

Studies have shown an association between consultation for increased vaginal bleeding and the presence of psychological disturbance. However, many of the studies have failed to control the known link between psychological distress and propensity to consult in general. The aim of this case-control study was to determine whether psychological distress in women consulting with increased vaginal bleeding is associated with the illness or with the propensity to consult. Women consulting as cases of 'increased vaginal bleeding' were compared with three sets of control women: two sets of consulting controls ('acute respiratory tract infection' or a physical 'other illness') and one set of community controls. Predictor measures were consultations and prescriptions in the previous 5 years. There was no difference in overall consultation rates (P = 0.19), proportion consulting for a mental disorder (P = 0.39), frequency of consultation for a mental disorder (P = 0.46) or having a prescribed hypnotic or anxiolytic (P = 0.29) between the three consulting groups. However, the consulting groups had higher rates of consulting both overall and specifically for a mental disorder than the community controls. The association between increased vaginal bleeding and mental disorder or use of psychotropic medication appeared to be explained by consultation behaviour.

Adolescent↗
PubMed2003

Increased vaginal bleeding: the reasons women give for consulting primary care.

A previous study identified interference with life as the main reason for consultation with increased vaginal bleeding. The purpose of this study was to determine the reasons why the heaviness of periods interferes with life and how this may be related to consultation. The design was a case-control study in which questionnaires were sent to women who consulted primary care with new episodes of increased vaginal bleeding and two groups of controls: consulting controls with another illness and non-consulting community controls. Of the 186 women who reported that heaviness of periods interfered with life the most common reason given was 'mood' (87%). There was no difference in the reporting of 'mood' interfering with life or general health questionnaire score between cases, consulting controls and non-consulting controls. Women who report heavy periods interfering with life complain most commonly of mood as one of the reasons. This does not distinguish consulters and non-consulters and is not reflected in objective measures of psychological distress. Clinicians should focus initially on treating the presenting physical symptoms.

Adolescent↗
PubMed2000

The introduction of a routine monitoring system in primary care for patients with a first episode of cardiovascular disease.

A study at a group general practice in the English midlands found that health promotion advice had not been routinely provided to some patients with cardiovascular disease and stroke. The purpose of this project therefore was to introduce a monitoring system to ensure that health promotion issues were covered systematically with patients following a first episode of cardiovascular disease. Patients with a first episode of a relevant condition would be identified by an automated search on the practice database, and contacted by the health visitor. A checklist would ensure that all appropriate issues were covered. The system was easily introduced at the practice and no difficulties were experienced with its administration. A total of 62 patients were seen during the year. A substantial number of secondary prevention issues were addressed through advice and information leaflets. The project was felt to be a useful addition to care by the workers involved. Although some of the issues may have been addressed in routine care, early organized nurse contact ensures systematic coverage and early referrals where necessary, as well as potential psychological benefit to patients.

Adult↗
PubMed2000

Does psychological status predict the presentation in primary care of women with a menstrual disturbance?

Thirty per cent of women aged 35 years and over suffer from heavy menstruation, but only 7% have consulted a doctor in the previous six months, suggesting that a significant number of these women do not consult a general practitioner. There is evidence that women who report heavy menstruation are more likely to have symptoms of psychological disturbance. This study sets out to determine whether the presence of symptoms of anxiety and depression might be linked to subsequent consultation for increased vaginal bleeding in primary care.

Adolescent↗
PubMed1997

Endometrial sampling and general practice.

Endometrial sampling is an 'office' technique that has gained widespread acceptance in the United States (US). It is as accurate as dilatation and curettage (D&C) in the diagnosis of endometrial atypia and carcinoma. It appears to be the most suitable method of endometrial assessment for general practice. It has the potential for the earlier detection of endometrial abnormality and for increasing the number of women with abnormal vaginal bleeding who can be wholly managed within primary care. However, research is lacking on the effect of the widespread introduction of the technique into general practice. This paper puts forward recommendations for the use of endometrial sampling by general practitioners (GPs) based on current evidence.

Biopsy↗
PubMedDate not supplied

Units of intonation in discourse: a comparison of acoustic and auditory analyses.

Measurements were made of the correspondence between acoustic (declination) units and auditory (intonation) units in American English conversation in an attempt to relate these two levels of description. The results showed that 99% of the acoustic unit boundaries coincided with auditory unit boundaries, indicating that the acoustic cues of F0 reset, pause, and speaker change used in defining the acoustic units were perceived, verifying the validity of both types of analyses. However, the units differed in scope, with many more auditory units occurring than acoustic units. This result suggests that the common practice of assuming the 'intonational phrase' to be the primary domain of prosodic phenomena such as declination does not adequately account for our data of larger periods of speech. Both acoustic and auditory analysis are needed for a satisfactory description of intonation. The establishment of a methodological connecting link between the acoustic and auditory dimensions suggests that further comparisons of such different data types may yield guidelines for regularizing the relationship between the two levels.

Adult↗