Biomedical subjects
Publications and source records attributed to P Schattner.
One of the defining characteristics of general practice is its heterogeneity. GPs vary widely in their assessment and management of clinical problems. It is therefore likely that this environment will generate numerous questions that require the use of various research approaches. This paper discusses how to choose between these approaches.
BACKGROUND: Excessive stress can cause both physical and psychological health problems in GPs, and can lead to decreased quality of patient care. OBJECTIVE: This paper examines the range of coping strategies available to GPs and suggests several support mechanisms. DISCUSSION: Coping strategies include talking to family and peers, problem solving and specific stress management techniques. GPs might need to be taught how to be patients themselves. Divisions can provide support groups for stressed GPs. The profession and government must consider how extra demands on general practice, coupled with further financial pressure, can lead to excessive strain.
OBJECTIVE: To examine how asthma in children less than 5 years of age is diagnosed and managed by general practitioners (GPs) and how this compares with the National Asthma Campaign guidelines. METHOD: A cross sectional postal survey of 164 GPs in the eastern suburbs of Melbourne in November, 1995. RESULTS: General practitioners diagnose asthma primarily on history, with the symptoms of nocturnal cough, wheeze and chronic cough considered as most important. Wheeze is the most important sign. An overuse of oral beta 2 agonists and inhaled corticosteroids were found. CONCLUSIONS: Asthma is diagnosed primarily on history and the presence of a wheeze helps to confirm the diagnosis. Management is appropriate overall, but there seems to be an overtreatment of mild asthmatics, and an overuse of inhaled corticosteroids.
Tissue classification by examining sets of ultrasound parameters is an elusive goal. We report analysis of measurements of ultrasound speed, attenuation and backscatter in the range 3 to 8 MHz in breast tissues at 37 C. Statistical discriminant analysis and neural net analysis were employed. Data were acquired from 24 biopsy and 7 mastectomy specimens. Best separation of the classes normal, benign, and malignant occurred in the 18 cases where two tissue classes were present in the same specimen and parameters were corrected for within-patient mean; then 85-90% of cases in test sets were correctly classified. Most errors comprised misclassified benign cases. The neural net was comparable to discriminant analysis and slightly superior in separating normal and malignant classes.
OBJECTIVE: To assess the efficacy of a topical medication, Tiger Balm, in the treatment of acute tension headache. DESIGN: Randomised, double blind, three group comparison. SETTING: Patients were recruited by newspaper advertisements and general practitioners who were also responsible for enrolment. Pre-treatment assessments took place in seven general practices. INTERVENTION: Groups were given either Tiger Balm, topical placebo or paracetamol. MAIN OUTCOME MEASURES: Headache severity and medication relief scales were measured by self-report. RESULTS: There was a statistically significant difference (p < 0.05) in headache relief between Tiger Balm and placebo. The difference between Tiger Balm and medication was not significant.
This paper aims to assist candidates in their preparation for the RACGP Fellowship examination. Particular emphasis is placed on what to do before the event and the techniques to use on the day. Explanations about the rating schedules for the various segments are also given.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
This article describes the implementation and evaluation of a demonstration practice grant project that concerned patient education classes in general practice. The classes covered four common and important chronic conditions: hypertension, hyperlipidaemia, asthma and diabetes. Altogether, 10 one and a half hour classes were conducted in late 1992 by the author, who is an associate in a large group practice. Fifty-five people out of 113 who were invited attended, giving an average of 5 to 6 people per session. Pre- and post-knowledge questionnaires assessed the short term impact of the classes; the overall mean improvement in questions answered correctly following the discussion was 10 per cent. Satisfaction with the classes was very high. The most likely long-term difficulties with classes such as these are in the recruitment of patients and the time commitment required by the session leader. The use of computerised patient databases and greater assistance by non doctor personnel, for example, nurses, may help to overcome these problems.
OBJECTIVE: To describe the current status of general practice research activity in Australia. DESIGN: A descriptive survey of research projects included in a national research database, established by the Royal Australian College of General Practitioners. The study instrument was a mailed questionnaire. SETTING AND PARTICIPANTS: Research projects involving or directly related to general practice that had commenced in Australia since 1 January 1989. Responses were specifically sought from all universities, the Family Medicine Programme and the Royal Australian College of General Practitioners. RESULTS: Two hundred and thirty-seven projects from 130 different principal investigators, one-third of whom were not medical practitioners, were analysed. Over 85% of research took place in association with a recognised tertiary institution. Over half of the projects were descriptive only; the most common areas were medical education, prevention and screening and health services research. Of the 69 projects completed prior to 1991, 49 had been submitted for publication and 26 had been accepted. CONCLUSIONS: The amount of general practice research undertaken in Australia is still small in relation to the size of the workforce, and most are descriptive studies. This national database will enable longitudinal changes in such patterns to be effectively monitored.
A new ultrasound technique combining reflex transmission imaging (RTI) and integrated reflection C-scan (IRCS) imaging is being developed to enhance visualization of calculi for lithotripsy applications. Reflex transmission imaging/integrated reflection C-scan ultrasound produces orthographic images (similar to flat-field x-ray films) that improve the delineation of stone from soft tissue. Integrated reflection C-scan imaging is based on reflectivity while RTI is based on transmissivity of structures (stones) in the focal plane. Quantitative measurements of reflectance (IRCS) and attenuation (RTI) show potential for stone characterization and assessment of the degree of fragmentation. In vitro and in vivo images are presented.
OBJECTIVE: To describe the current status of funding for general practice research in Australia. DESIGN: A descriptive survey analysing funding arrangements of research projects included in a national research database, established by the Royal Australian College of General Practitioners. SETTING AND PARTICIPANTS: Research projects involving, or directly related to, general practice that had commenced in Australia since 1 January, 1989. Responses were specifically sought from all universities, the Family Medicine Programme and the Royal Australian College of General Practitioners. MAIN OUTCOME MEASURES: Extent and source(s) of funding received or requested, or both; relationship of funding received to the following: qualification and affiliations of the principal investigator; submission of the research project towards a higher degree; subject area(s) covered by the research; study design method used; and duration of project. RESULTS: A total of 237 projects from 130 principal investigators were included in the analysis. Of these, 149 (63%) had been submitted for funding and 98 (66%) had been successful. The amount of funding ranged between $300 and $855,600. The most common source of funding was the General Practice Evaluation Programme. Research contributing towards a higher degree was associated with successfully receiving funding. Other variables, including the study design and study area, were not significantly associated with an increased success of funding. CONCLUSIONS: The total amount of funds spent on general practice research is still small, relative to the size of the workforce. However, over half of general practice research undertaken in Australia is not submitted for funding. Of the research that is submitted, the success rate of receiving funds is high.
This paper describes a survey of influenza conducted in general practice from July to October 1990. The study demonstrates how interested general practitioners can be involved in community based surveillance for the early detection of influenza outbreaks.
Results of measurements of ultrasound speed and absorption coefficients in the range 3 to 8 MHz in breast tissues at 37 C are reported and analyzed in attempts to identify a set of ultrasound parameters capable of discriminating normal, benign, and malignant tissues. We analyzed 118 tissue regions, comprising 47 normal, 55 benign, and 16 malignant by straight-line fitting of frequency dependence of attenuation. Data for ten additional regions, for a total of 128, became available and were added to the cohort when we subsequently fitted quadratic curves. Sound speed consistently emerged as the variable with greatest discriminating power, particularly for separating normal from benign and malignant tissue. Great difficulty was encountered in discriminating benign from malignant, even when the jackknife technique was used. More success was found with classification and regression trees (CART), although results were sensitive to assigned misclassification costs. Best results from straight-line fits were obtained when discriminating malignant from combined normal/benign data after randomly assigning 75 percent of the data to the learning set and 25 percent to the test set. Then, 23 out of 25 normal/benign and 4 out of 4 malignant cases in the test set were correctly classified. With quadratic fitting, best results were obtained in the three-class case--the false positive rate for malignancy was reduced to zero in the learning (0/31) and test (0/10) sets. Nevertheless, the false negative rate increased to 13 out of 31 (42 percent) in the learning set, while attaining zero (0/4) in the test set.
Apparatus is described for measurement of sound speed and ultrasound attenuation coefficients by the substitution technique in the frequency range 3 to 8 MHz. Phase-cancellation artifacts leading to overestimation of attenuation coefficients are avoided by use of an acoustoelectric transducer. Specimens confined by polystyrene windows can be interrogated by focused ultrasound beams at selected locations spaced on a grid of 3 x 3 mm voxels. Pulse time of flight is measured with an accuracy of 30 ns, yielding sound speeds accurate to +/- 6.7 m/s, for samples 10 mm thick. Uncertainties in measured insertion losses range from 0.1 dB in low-loss (10 dB) specimens to 0.5 dB in high-loss (25 dB) specimens.
A survey of referrals by general practitioners to medical specialists was carried out to determine current referral patterns, and to compare them with two earlier Australian studies. The mean referral rate was 6 per cent of all consultations, with the four most frequent specialty groups referred to being proceduralists. A comparison with two previous Australian surveys reveals minimal change in general practitioner referral patterns in 18 years. The need to study the appropriateness of general practitioner referrals further is stressed.
This study is a survey of general practitioners practising in an area in Melbourne, Australia, where there are two medium sized public hospitals with limited general practitioner admitting rights. A questionnaire was mailed to the 207 general practitioners practising in the study area; 167 (81%) responded. Seventy one per cent of respondents had public hospital admitting rights and 73% aimed to manage as many medical patients in hospital as possible. The main reasons given for such involvement were patient expectation, professional satisfaction and the benefits to patients, beyond that of reassurance, which followed from continuity of care. About half of respondents (52%) agreed that their role was a liaison or coordinating one alongside hospital specialists. Fifty-four per cent of respondents overall had in fact managed at least two medical patients in public hospitals in the past 12 months. Lack of availability of general practitioner beds and specialist dominance in public hospitals rather than inadequate time or remuneration were perceived to be the main barriers to hospital practice. Almost three-quarters of respondents (72%) believed general practitioners would be excluded from public hospitals in the foreseeable future. They blamed specialist dominance and general practitioner apathy equally for this predicted state of affairs. A debate on the desirability or otherwise of such an exclusion is overdue within the medical community in order to consider what will otherwise be a fait accompli.