Search PubMed⌕ Search

Biomedical subjects

N C Stott

Publications and source records attributed to N C Stott.

At least 19 recordsLinked to original sources
PubMed1994

Avoidable referrals? Analysis of 170 consecutive referrals to secondary care.

OBJECTIVE: To determine appropriateness of referrals from primary care to secondary care. DESIGN: Retrospective evaluation of appropriateness of referrals from a single-handed general practice: evaluations carried out independently by referring doctor and by second general practitioner who worked in same area and had access to similar secondary care services. SUBJECTS: 168 referrals made between 1 October 1990 and 31 March 1991 and followed up for up to 12 months by matching with available information on outcome of episode of care. MAIN OUTCOME MEASURES: Appropriateness of referral and reasons for inappropriate referrals. RESULTS: 110 referrals were agreed to be appropriate and 58 were considered avoidable. The reason for 32 of the inappropriate referrals was lack of resources: 10 were due to lack of information (mainly failure of hospitals to pass on information to general practitioner), nine were due to a deficient primary health care team; five were due to insufficient use of home care nurses, three were due to absence of direct access to day hospital, and five were due to lack of access to general practitioner beds or other facilities. Most of the remaining 26 avoidable referrals were because available resources had not been fully used, because recognised management plans had not been followed, or because of lack of skills to perform certain procedures. CONCLUSIONS: Many theoretically avoidable referrals were due to managers' and politicians' decisions about allocation of resources, but some inappropriate referrals could be avoided by assessment of general practitioners' needs for further knowledge and skills.

Attitude of Health Personnel↗
PubMed1994

Feasibility, reliability and women's views of a risk scoring system for cervical neoplasia in primary care.

BACKGROUND: A risk assessment scale for cervical neoplasia has been developed which gives a risk score based on four factors: level of education, current smoking status, number of years of oral contraceptive use and number of sexual partners ever. AIM: A pilot study was undertaken to determine the feasibility and acceptability of a self-report data form, used to assess risk of cervical neoplasia, and the test-retest reliability of women's responses to the questions. METHOD: A sample of women attending one general practice were asked to complete a self-report data form which included some highly personal questions, and a questionnaire assessing their level of difficulty and discomfort completing the form. Women were sent a second self-report data form four weeks later in order to assess test-retest reliability. RESULTS: There was a high level of cooperation with the study (94% initial participation rate), little evidence of discomfort with the questions posed, and high test-retest reliability. CONCLUSION: The results of this pilot study have positive implications for a large prospective study evaluating the predictive power of the risk scale in relation to the result of the cervical smear test.

Adolescent↗
PubMed1994

Prospective evaluation of a risk scoring system for cervical neoplasia in primary care.

BACKGROUND: Against a background of concern over the costs of the cervical screening programme in the United Kingdom, increased precision in targeting groups at high risk of having an abnormal cervical smear offers a means of increasing efficiency. Previous papers have described the development of a risk scoring system and its feasibility and reliability in primary care. AIM: A study was carried out to assess the validity of the scoring system by testing its predictive ability on a prospective data set. METHOD: Consecutive attenders for cervical smear tests at seven practices and three clinics were recruited for the study. The women completed a questionnaire from which their risk scores could be calculated. The scores were compared with cytology and histology results. Various performance statistics were obtained. RESULTS: In terms of cervical intraepithelial neoplasia (CIN) 2 or 3, there was an 11 fold increased risk among the low risk group (scores of four or five) compared with the very low risk group (scores of three or less). The system enabled the identification of 75% (95% confidence interval 62% to 84%) of cases of CIN 2 or 3 among the 21% of the 3629 women with known histology who had a score of four or five. CONCLUSION: Given the ease with which risk status can be ascertained (a risk score could not be calculated for only 23 of 3661 women) and the magnitude of difference in risk, the risk scoring system appears to have potential for assisting the targeting of screening resources. Studies of risk perception and behaviour, and ultimately a randomized controlled trial, are required to assess the effectiveness and cost effectiveness of risk targeting.

Adolescent↗
PubMed1993

The universities' research assessment exercise 1992: a second opinion.

We compared assessments of university departments of general practice by the heads of department with those of The UK University Funding Council. There was little difference between them. The departmental heads' assessment was quicker and cheaper. Current means of assessing academic departments may need to be reconsidered.

Humans↗
PubMed1992

Risk targeting in cervical screening: a new look at an old problem.

In the face of continuing debate about the level of effectiveness of the United Kingdom cervical cytology screening programme in preventing cervical cancer, more precise targeting of high risk groups might offer a means of enhancing its efficiency. Broad risk targeting is already practised by screening only sexually active women aged 20 to 65 years. This paper describes a risk scoring system constructed from the available literature and designed to be used by primary care health professionals and patients. The system involves four independent risk factors: educational level, current smoking habit, years of oral contraceptive use and number of sexual partners. Since the objective is simply to identify women at relatively high risk, inclusion of a factor neither requires nor implies causality. The next steps are to study the feasibility of putting the scale to practical use and to investigate its predictive value in a prospective evaluation.

Age Factors↗
PubMed1990

'Advise yes, dictate no'. Patients' views on health promotion in the consultation.

Interviews with 130 mothers of lower social class provided the basis for studying their views on the desirability of general practitioner intervention in their lifestyle habits; the study used both quantitative (questionnaire) and qualitative (interview) techniques. The majority of women were in favour of counselling on specific topics by the general practitioner but the qualitative data also revealed that most respondents expected the issues to be relevant to their presenting problem. Moreover they were keen to assert their right to accept or reject the advice given. The same picture was obtained whether specific or general approaches were used. The results highlight the need for qualitative methods to amplify and clarify the results of quantitative techniques when views or attitudes are being explored. The practical implications of the conclusions touch on both the ethical and clinical dimensions of health promotion.

Adult↗
PubMed1990

Treatment of peptic ulcer in general practice and in hospital: a comparison of omeprazole and cimetidine.

The aim of this study was to compare duodenal ulcer healing and symptom relief after two and four weeks treatment with omeprazole or cimetidine in groups of patients treated in general practice and as hospital out-patients. It was a randomised, double-blind, parallel group study with stratification for trial centre (hospital or GP). Endoscopy was performed at entry, after two weeks and, if unhealed at two weeks, after four weeks. All endoscopies were carried out in hospitals. In all, 189 patients were randomised (98 omeprazole, 91 cimetidine), 79 (42 per cent) of which by GPs, to either omeprazole 20 mg om (n = 41) or cimetidine 800 mg nocte (n = 38) for two to four weeks. After two weeks, ulcer healing occurred in 56 per cent (omeprazole) and 29 per cent (cimetidine) (p less than 0.05) of patients treated by GPs, and 67 per cent (omeprazole) and 36 per cent (cimetidine) (p less than 0.005) of those treated as hospital out-patients. Similar differences in healing rates were seen after four weeks. Omeprazole produces faster duodenal ulcer healing than cimetidine whether patients are treated as hospital out-patients or by GPs.

Adolescent↗
PubMed1989

Opportunistic health promotion: quantity or quality?

A cohort of 130 working class mothers has been studied in depth over five years to quantify the extent of recording and counselling of lifestyle problems by general practitioners and their staff. Clinical records and mothers' personal accounts at two home interviews five years apart provide the data for this work. Fifty-nine per cent of women had one or more aspects of lifestyle recorded in their records, the commonest being smoking habits. Despite this evidence for good coverage of smokers in the population, alcohol and exercise problems were under-recorded. Clinical records only included details of advice given and follow-up plans for lifestyle problems in 40% of patients' records yet the women themselves remembered advice being given in 48% of cases. An analysis of the womens' accounts in conjunction with the clinical records revealed that over three quarters of those receiving advice remembered it several years later. The primary care team was most likely to target advice and plans on women who were heavy smokers and very obese. This study shows that clinical records underestimate the amount of lifestyle counselling which is conducted in general practice and that a surprising number of working class women remember and act on the advice from their doctors. The implications for clinical recording of lifestyle factors are discussed.

Adult↗
PubMed1988

The Open University pack on coronary heart disease: reactions of Welsh general practitioners.

The introduction of the new Open University distance learning pack on coronary heart disease to a selected group of Welsh general practitioners has been evaluated. The most commonly perceived disadvantages were the amount of time required to study the pack, the cost of buying it and the work involved in implementing its study in a practice by the whole primary-care team. Despite a relatively high level of awareness among the group, only 17% declared a positive intention to introduce the pack and another 17% thought they 'probably' would. Contact with primary care facilitators and informal feedback from colleagues appeared to distinguish those general practitioners who were motivated to try innovative postgraduate learning methods in their practices from the rest of the sample. The implications of trying to disseminate novel kinds of teaching material to general practitioners are considered.

Adult↗
PubMed1987

Development of a measure of potential health behaviour: a salience of lifestyle index.

The development of a salience of lifestyle index to measure potential health behaviour is described with its validation, including the relationship between the new index and various measures of preventive health behaviour. The complex cascade of antecedents which contribute to a decision to make or not make a specific lifestyle choice is summarised to clarify the contribution of the salience of lifestyle index to pure research and evaluative studies.

Adult↗