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Biomedical subjects

P Fahey

Publications and source records attributed to P Fahey.

At least 19 recordsLinked to original sources
PubMed2004

General practitioners' perceptions of after hours primary medical care services: a Toowoomba, Queensland, Australia study.

INTRODUCTION: This article reports on a project, undertaken in 2002 in the regional city of Toowoomba, Queensland, Australia, that investigated the viability of establishing an after-hours primary medical care (AHPMC) service. OBJECTIVES: To ascertain GPs' perceptions of the adequacy of AHPMC services in Toowoomba. DESIGN: Thirty GPs were randomly selected to participate in face-to-face interviews using a semi-structured interview tool. SETTING: Toowoomba, Australia is the largest inland non-capital city in Australia. It is located approximately 130 km west of Brisbane, the State capital city and is a referral centre for patients from the rural and remote communities of south-west Queensland. PARTICIPANTS: 15 male and 15 female GPs. RESULTS: While the majority of participants believed the current provision of AHPMC in Toowoomba was adequate, they stated that the provision of AHPMC services was onerous and, given a choice, they would prefer to refer all patients seeking care between 2200 and 0800 hours to an Emergency Department (ED). Similar to GPs who work in rural and remote areas of Australia, they believed that AHPMC work was poorly remunerated, had an adverse effect on their lifestyle and could endanger their personal and their patient's safety. CONCLUSION: The findings of this study confirm previous studies into the perceptions of GPs to the provision of AHPMC in a regional city. Additionally, while the GPs in Toowoomba have the options of referring after-hours patients to an ED and being part of a large GP after hours cooperative, their opinions on after-hours work did not differ significantly from those expressed by GPs working in rural and remote areas of Australia. The GPs in this study, given the option, would prefer not to undertake an AHMPC service provision between 2200 and 0800 and many had chosen not to do so, instead directing their patients at this time to one of the two EDs located in Toowoomba.

Journal Article↗
PubMed2004

Planning research in rural and remote areas.

INTRODUCTION: In order to set a regional research agenda, an interactive research workshop was planned by the joint University of Queensland and University of Southern Quennsland Centre for Rural and Remote Area Health (CRRAH), in which researchers and regional organisations would meet together to discuss and prioritise local research needs, then formulate constructive ideas and activities. METHODS: Selection of Participants: Organisations representing all key consumer, academic and health professionals within the Toowoomba, Queensland, Australia region were sent a letter inviting them to attend and to send at least one representative, resulting in a total of 75 workshop participants from 45 organisations representing 20 separate entities. The Design of the Workshop: The workshop was planned as an interactive research workshop, with a preliminary brainstorming to identify and prioritise topics, followed by facilitated small group discussions, and finally presentations to the reassembled total group. RESULTS: Forty three topics were put forward by participants during the plenary session, in which the following 12 major themes were evident: (1) health professional development and support; (2) mechanisms for identifying regional/local needs; (3) mental health; (4) health and interaction with the environment; (5) management of common conditions of which little is known; (6) post acute/aged care; (7) evidence based practice; (8) health workforce including volunteers; (9) indigenous health; (10) access to health service delivery; (11) economic impact of new programs; and (12) outcomes impact of research partnerships. Five subject areas from four of these themes were chosen for further small group discussion. A summary of the views, ideas and conclusions of each group, which were presented to a plenary session of reassembled participants over a 10-15 minute period by each group facilitators, are discussed below. Following each presentation, a 5-10 minute question session was provided after each topic. CONCLUSION: A workshop, enabling rural and remote organisations and regional researchers to meet and identify local research needs attracted strong local support. Although the final benefits of the workshop remain to be determined, a number of new collaborative research avenues are now being actively explored within the region, by a number of the participants.

Journal Article↗
PubMed1997

Sports-related and other soft-tissue injuries, tendinitis, bursitis, and occupation-related syndromes.

In this review, four areas are discussed: fluoroquinolone-induced tendinitis, volar flexor tenosynovitis (trigger finger), Achilles tendon lesions, and occupational medicine issues. The relationship of fluoroquinolone treatment to musculoskeletal lesions, especially Achilles tendinitis and tear, is most intriguing. The steady increase in reports of the association cannot be ignored. Although Achilles tendinitis and rupture have comprised the most frequently seen lesions, articles on additional sites of involvement, such as in lateral epicondylitis and De Quervain's tenosynovitis, are reviewed. Volar flexor tenosynovitis and trigger finger are among the most common musculoskeletal problems, and additional studies support the success of corticosteroid injections. Although the value of injections was reported well over 25 years ago, surgery is still unfortunately the first-choice treatment of some physicians. We review three studies on Achilles tendinopathy. In one of the reports, diagnostic ultrasonography is again demonstrated to be of value in assessing tendon lesions. The push to use the term tendinosis rather than tendinitis continues as a result of histologic studies of tendinitis that lack the usual findings of inflammation. However, the presence or absence of chemical inflammation is yet to be ascertained. We review an article that fails to show that work activities are the sole cause of such musculoskeletal syndromes as cumulative trauma or repetitive use. Further studies are needed in the area of work-related upper extremity disorders.

Athletic Injuries↗
PubMed1994

An inappropriate thyrotropin-secreting pituitary adenoma in a 30-year-old man.

Thyrotropin-secreting pituitary adenomas are rare, especially in the family practice setting. We report a case of such a tumor and review the literature. The key clinical finding is hyperthyroidism in the absence of a suppressed thyrotropin level. The patient was unusual in not having an elevated alpha-subunit. All patients with hyperthyroidism should be screened for a thyrotropin level to rule out this unusual cause of hyperthyroidism. Other aspects of this case pertinent to primary care management are reviewed.

Adenoma↗
PubMed1994

Statistical tools for understanding variation: the allocation of operating suite time.

Australian hospitals are becoming increasingly familiar with the 'new' tools for continuous quality improvement. In particular, many are becoming increasingly competent in establishing and supporting quality improvement teams for process evaluation and improvement. The main problems with such teams now seems to arise in relation to the analysis and interpretation of data on the process. This paper provides an example of the types of analyses and interpretations required of today's quality improvement practitioner in health care.

Australia↗
PubMed1991

The validity of parental report of vaccination as a measure of a child's measles immunisation status.

OBJECTIVE: To determine the validity of parental report of vaccination as a measure of a child's measles immunisation status. DESIGN: Cross-sectional survey. SETTING: Four 24-hour medical centres in western Sydney. PATIENTS: Parents of children aged 12-36 months were approached in the clinic waiting room. Of the 160 parents approached, 137 agreed to be interviewed and a successful venepuncture to yield a 2 mL blood sample was achieved with 128 children. MAIN OUTCOME MEASURES: Measles IgG antibody, determined by means of an indirect ELISA, was compared with parental report of measles vaccination status by McNemar's chi 2 test. RESULTS: Parental report significantly over-estimates the immunisation status of children. Eighty-four per cent of the parents in the sample stated that their child had been vaccinated, but only 74% were immune (95% confidence interval, 65%-81%). A positive predictive value of 84% meant that only 84% of children who were reported to have been vaccinated were immune to measles. Further, of all those who were not immune to measles, only one half would have been identified by asking the parents. Failed seroconversion may have accounted for up to 70% of cases of non-immunity in children reported to have been vaccinated. CONCLUSIONS: Parental report is limited as a measure of a child's measles immunisation status.

Child, Preschool↗
PubMed1990

Patient education policy and practice in Australian hospitals.

In Australia little is known of the quality and range of patient education programs or their level of support. A national survey was conducted to establish a baseline of the number of programs being conducted, the level of administrative support and the sophistication of practice. This survey shows that most hospitals in Australia conduct some patient education programs. Teaching and metropolitan public hospitals conduct the most, 95% and 88%, respectively, private hospitals the least, 47%. The programs conducted mainly cover chronic health problems such as diabetes (80% of all hospitals offering programs), heart disease (52%) and cancer (36%). The main reason given for not conducting education programs is lack of trained staff (59%). Of the programs which are conducted only half are planned. Most of the hospitals surveyed had few of the administrative components found to be necessary to support planned, patient education programs. The two most common administrative components were documentation in patient notes (48% of hospitals conducting programs) and a resource center (34%).

Australia↗
PubMed1990

A comparison of two methods of eliciting the ankle jerk.

Two methods of eliciting the ankle jerk have been compared. One, the traditional method, involved tapping the Achilles tendon (the tendon tap); the other (the plantar tap) involved tapping the sole of the foot. The study was done on 110 inpatients in the medical wards of a teaching hospital. The results showed an 89% agreement between the two methods. The extent of agreement was unrelated to the level of experience of the examiner. Forty three per cent of patients favoured the plantar tap method; 14% the tendon tap. The plantar tap method of eliciting the ankle jerk is an acceptable alternative to the traditional method.

Adult↗
PubMed1990

The fate of elderly patients discharged from the accident and emergency department of a general teaching hospital.

This paper describes the experience of a cohort of elderly patients who were discharged after attending the accident and emergency department of a large Australian teaching hospital. Before-and-after comparisons of aspects of physical functioning revealed a considerable loss of independence in the period immediately after the visit to the hospital. Subsequent hospital admission or death was observed in 30 of the 90 patients studied. It is suggested that elderly patients discharged from the accident and emergency department are at risk and require special consideration and a high index of suspicion in terms of evaluation at the time of presentation. Before discharge, account should be taken of aspects of physical and mental function, social networks, and community supports available to each patient. A lowered threshold for admission is recommended on the basis of the high rate of return found in this study.

Activities of Daily Living↗
PubMed1990

Discriminant attitudes and beliefs about condoms in young, multi-partner heterosexuals.

Four hundred and eight people aged 15-35 years who reported having more than one sexual partner of the opposite sex in the past year or who thought it likely that they would do so in the next year were surveyed about their sexual behaviour, concern about acquired immunodeficiency syndrome and sexually transmitted diseases and attitudes to condom use. Differences in concerns and attitudes between regular and non- or irregular condom users and between men and women are reported. Three conceptually coherent factors (condom use as positive action; condom use as cue to embarrassment; and condom use as antithetical to good sex) discriminated between users and non-users. Implications for health promotion campaigns designed to promote condom use are discussed.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Oral hygiene program for orthodontic patients.

The gingival and periodontal health of 62 adolescent orthodontic patients was assessed before and again after orthodontic treatment in a controlled clinical study. Before the commencement of orthodontic treatment, the experimental group received an oral hygiene program consisting of 4 weekly sessions of oral health education, instruction on plaque-control techniques and reviews in plaque removal performance. The control group did not receive this program. It was found that there was a general trend in the study population for improved gingival health as measured by the bleeding index, gingival index, plaque index and gingival crevicular fluid volume. Furthermore, the oral hygiene program induced in the experimental group significantly lower scores in the measured clinical indices compared to the control group. However, no significant difference was noted in the measured probing depths in all subjects before or after the study period.

Dental Plaque↗
PubMed1988

Interns' identification of patients' health risks in a casualty department.

This study examined whether the interns who staffed a hospital casualty department identified correctly four common health risks among their patients. When compared with patients who were attending general practitioners, patients who attended the casualty department were more likely to be cigarette smokers. They were also more likely to be heavy drinkers of alcohol and to score highly on a standardized measure of psychological disturbance. Women were less likely to have undergone a Papanicolaou smear-examination within the previous two years. The interns, who were the subjects in this study, failed to identify 56% of the smokers, 84% of the heavy drinkers, 35% of the psychologically-disturbed patients and 95% of the women who had not undergone a Papanicolaou smear-test in the last two years. The findings were in contrast with the interns' own opinions on what would constitute good-quality care in this setting. The subjects were just beginning their internship at the time of the study. Their failure to integrate important questions about common health risks suggests that their undergraduate training has been deficient in this area. The internship is the last formal opportunity to correct this deficiency before these doctors are registered for independent medical practice.

Adolescent↗