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Biomedical subjects

P Freeling

Publications and source records attributed to P Freeling.

At least 55 records · Page 3Linked to original sources
PubMed1988

Relationship between psychosocial factors and asthma morbidity.

A general practice study was designed to describe certain psychosocial attributes of asthma patients and to relate these to reported asthma morbidity in the previous two years. A postal questionnaire on their respiratory morbidity was completed in September 1983 and again in September 1985 by 207 asthma patients. They then completed a postal questionnaire concerning their attitudes to asthma and level of family support. The findings revealed a marked degree of psychosocial morbidity among patients. Family support showed no significant associations with past or current levels of morbidity, or with changes in morbidity over the previous two years. In contrast, negative attitudes to asthma were correlated with significantly higher levels of morbidity, the strongest associations being found between patients' present attitudes and their most recent level of morbidity. These findings in conjunction with work carried out elsewhere suggest that high levels of asthma morbidity bring about a negative attitude to the condition which in turn contributes towards continuing morbidity.

Adolescent↗
PubMed1988

Double-blind placebo-controlled trial of amitriptyline among depressed patients in general practice.

Depressed patients in general practice were included in a double-blind placebo-controlled six-week trial of amitriptyline (median dose 125 mg). The patients were relatively mildly ill and satisfied diagnostic criteria for depression and treatment with antidepressants in routine practice. Amitriptyline was found to be considerably superior to placebo after six weeks and significantly so as early as two weeks after the start of treatment. The effects of the antidepressant were on the core symptoms of depression, and were apparent in all but the most mildly ill patients. The findings suggest that tricyclic antidepressants are of considerable therapeutic benefit to depressed patients in general practice.

Adolescent↗
PubMed1988

AIDS and the future general practitioner.

Teaching by example is an essential component of vocational training in general practice and trainers should be expected to exhibit a high standard of practice. A postal questionnaire about knowledge of, attitudes to and response to the epidemic of the acquired immune deficiency syndrome (AIDS) was completed by 114 general practitioner trainers in the south west Thames region. The findings were compared with those of an identical survey of 155 non-trainer general practitioner principals in south west London. There were no appreciable differences between trainers and nontrainers in knowledge and attitudes, although trainers were significantly more likely to have discussed the problem of AIDS with their practice staff. The problems encountered in both groups included: lack of knowledge about AIDS, inability to offer AIDS counselling and advice, and reluctance to care for intravenous drug abusers. These findings suggest that trainers need to improve their practice in areas concerned with the AIDS problem in order to provide a better learning model for their trainees.

Acquired Immunodeficiency Syndrome↗
PubMed1987

Consultation analysis by triggers and symptoms (CATS). A new objective technique for studying consultations.

Doctor-patient consultation is a field of study important to general practice. The emphasis has tended to be on modes of exchange and subjective judgement of task achievement. More recently, a need to establish relationships between the information transferred and its mode of transfer has become clear. This paper describes such an approach with a specially devised scale (the consultation and analysis by triggers and symptoms (CATS) scale). The inter-rater reliability of the scale was established using a standard videotape. The CATS scale seems relatively easy to learn and to have relatively high inter-rater reliability.

Humans↗
PubMed1987

Control of hypertension in elderly patients with felodipine and metoprolol: a double-blind, placebo-controlled clinical trial.

1. Forty-nine patients aged 65-80 years, whose Phase V diastolic blood pressure (dBP) was above 95 mmHg after 4 weeks open treatment with metoprolol 50 mg twice daily were randomized to receive, double-blind, the calcium antagonist felodipine (n = 32) 2.5 mg twice daily or placebo (n = 17) in addition to metoprolol for 2 weeks. If the dBP remained greater than 95 mmHg, the dose of felodipine or placebo was doubled for a further 2 weeks; if the dBP was still greater than 95 mmHg, the dose of felodipine was doubled again to 10 mg twice daily or the corresponding placebo dose given. The duration of the double-blind period was 6 weeks, all patients receiving metoprolol 50 mg twice daily throughout. 2. At the end of the double-blind period, the seated dBP was reduced from 103 +/- 5 (mean +/- s.d.) to 88 +/- 7 mmHg (P less than 0.001) by felodipine and from 105 +/- 100 +/- 11 mmHg (NS) by placebo. The differences between these reductions (P less than 0.01) and between the final dBPs (P less than 0.001) were significant. Eighty-nine per cent of patients receiving felodipine and 33% of those receiving placebo (P less than 0.001) had controlled (dBP less than or equal to 95 mmHg) BPs. Half (14/27 completing) of the patients receiving felodipine required 2.5 mg throughout; 9/27 needed 5 mg and 4/27 10 mg twice daily. Adverse events occurred with equal frequency in the two groups, but the profile was different.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1986

Controlled evaluation of the effects of patient education on asthma morbidity in general practice.

Two different patient education programmes for asthma in general practice were evaluated in a controlled trial. Knowledge, self management, and morbidity due to asthma were assessed in 339 patients by means of a questionnaire. One group then received a maximum education programme, a second group received a limited education programme, and a third acted as a control group. 274 patients were reassessed after one 1 year. In both the intervention groups, understanding of asthma was greater after the trial. Only in the maximum intervention group was a significant improvement in knowledge of asthma shown. Neither group showed any change in self-management ability or asthma morbidity that differed significantly from changes in the control group. These simple informational education programmes were ineffective when applied to a general practice population. Further studies of factors affecting attitudes, beliefs, and actions are needed to improve the advice and support given to asthma patients.

Activities of Daily Living↗
PubMed1986

Bowels: beliefs and behaviour.

A postal questionnaire about knowledge, beliefs, and experiences of bowel function was returned by 171 patients aged 55 years and over from a group general practice in London. Of the respondents, 10% reported no predictable frequency of movement, a higher proportion being women than men; 79% believed that a daily movement is important and 90% that 'regularity' is necessary for good health; 14% were dissatisfied with their bowel habits and 16% regularly self-treated; 95% gave reasonable definitions of 'regular' and 'diarrhoea'; a tenth were unsure about the definition of 'constipation'. Although 76% believed there were bowel symptoms which require immediate medical attention, 98% would in the first instance treat themselves for constipation, 90% for diarrhoea, and 25% for rectal bleeding. To reduce delay in the diagnosis of colorectal cancer, it is suggested that consultations for disturbance of bowel function be encouraged among the middle-aged and the elderly. Doctors should examine such patients with the diagnosis of malignancy in mind.

Aged↗
PubMed1985

Unrecognised depression in general practice.

Patients attending their general practitioner were screened and a group with unrecognised major depressive disorder identified. This group was interviewed and the findings compared with those in a group of patients recognised correctly as depressed by their general practitioners. Half of the patients with severe depression screened in their doctors' waiting rooms went unrecognised, and they differed in few ways from those who were recognised. The differences found were that the patients with unrecognised depression were less obviously depressed and their illness had lasted longer. Physical illness was present in nearly 30% of patients in the unrecognised group, and the depression seemed related to it. Patients with unrecognised depression were more likely to have feelings other than those of normal sadness and more likely to respond with change of mood to intercurrent events. These data suggest that patients might benefit if general practitioners were better trained to recognise depression, although it is not known whether treatment would be effective.

Adolescent↗
PubMed1985

My doctor.

Explore the source record for details and available documents.

Adult↗
PubMed1985

Depression in general practice: case thresholds and diagnosis.

Using multiple diagnostic and epidemiological criteria, three samples of general practice (GP) depressives were studied: those prescribed a new course of antidepressants, those given other treatment, and those missed by the GP. The majority of patients qualified as psychiatric cases on the PSE Index of Definition, the Bedford College Criteria, and the Research Diagnostic Criteria. Most satisfied diagnostic criteria for depression, or (fewer) anxiety. The disorders were relatively mild and often borderline on all three systems. Depressives given other treatment most often failed to meet diagnostic criteria. About half the antidepressant treated patients received RDC diagnoses of major depression. Among the other treatment sample, only one-fifth met these criteria, and half had non-depressive diagnoses. Most cases of depression treated by GPs satisfy criteria for psychiatric disorder, but tend to be relatively mild and borderline in quality.

Adolescent↗
PubMed1985

Depression in general practice: clinical features and comparison with out-patients.

General practice (GP) depressives prescribed an antidepressant were compared with those given other treatment, and with antidepressant-treated psychiatric out-patient depressives. GP depressives were considerably less severely ill than out-patients, with fewer depressive symptoms and shorter illness, as well as less primary and less endogenous depression. The two groups of GP depressives differed less, but those receiving other treatment tended to have less severe depression than those receiving antidepressants and were less likely to satisfy diagnostic criteria for depression. Depressives in GP differ considerably in clinical characteristics from psychiatric out-patient depressives, and clinical features influence the GP's decision to treat with antidepressants.

Adolescent↗
PubMed1983

Decision-making in acute asthma.

The management of an eight-year-old child with acute asthma was investigated by putting a semi-structured patient management problem (PMP) to 618 general practitioners. Of the 321 (52 per cent) who replied, 112 (35 per cent) would arrange for immediate admission to hospital and a further 154 (48 per cent) would have the child admitted after 30 minutes when initial home treatment appeared not to be working. Among those who would treat at home there was considerable variation in the type and intensity of treatment given. The more recently qualified were more likely to admit immediately or to treat vigorously at home (with intravenous steroids and/or aminophylline); no other characteristic of the doctor or the practice was related to admission decision or to treatment. Expectations concerning the immediate hospital management of the patient also varied widely. Comparison of the expected hospital management with actual management recorded in hospital case-notes suggested that general practitioners overestimate the use of intensive treatments (steroids, intravenous drip, oxygen) and investigations (blood gases, lung function tests, chest radiograph).

Asthma↗
PubMed1982

Objectives and students' learning in general practice.

Student views of objectives and learning, during 4 weeks spent in general practice in the fifth year, are compared to those of the GPs to whom they were attached. Relationships between these views are discussed, together with their implications, for the wider contributions made by general practitioners to the undergraduate curriculum.

Education, Medical, Undergraduate↗
PubMed1982

Studying general practice in the inner city--a model for linking available sources of data: preliminary communication.

The effect of implementing proposals intended to improve general practice primary care in inner London is not known. To test it requires a model of how general practice works and methods of measuring appropriate variables. The methods must be sufficiently simple to allow measurement prior to, as well as during, change. This paper presents such a model, describes methods used to measure some of those variables, and illustrates the results.

Age Factors↗