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Biomedical subjects

R Sanson-Fisher

Publications and source records attributed to R Sanson-Fisher.

At least 55 records · Page 3Linked to original sources
PubMed1996

General practitioner perceptions of surgical waiting times.

This study explored general practitioners' (GP) perceptions of waiting times and the importance of these perceptions in choosing a surgeon. A randomly selected sample of GPs in the Hunter Area of New South Wales, Australia, provided information prospectively on patients referred to a surgeon. The results indicated that GPs feel a lack of private health insurance makes only a small difference in waiting time to see a surgeon but a large difference in the waiting time for an operation. Additionally, GPs consider that sizeable numbers of patients will wait longer than they consider reasonable for surgical consultations and procedures. However, perceptions of waiting times do not appear to have a major influence on the choice of surgeon.

Attitude of Health Personnel↗
PubMed1995

Reducing systematic bias in studies of general practitioners: the use of a medical peer in the recruitment of general practitioners in research.

Reducing systematic bias in any group of study participants should be a priority of any researcher. This can be achieved by ensuring the sampling framework is adequate and by increasing response rates. Response rates in studies of general practitioners have to date tended to be low. Generalization of results to the wider population of GPs is therefore reduced. This paper systematically examines those factors which can reduce bias, recognising accurate identification of the target population, gaining good access to respondents, and maximising response rates as crucial factors. The importance of a medical peer in recruitment is examined. Applying these factors to a study situation, three different recruitment strategies were tested. As the strategy improved, there was an incremental improvement in the response rate (44%, 67%, 78%). These results indicate that by specifically addressing strategies which facilitate access to the target population, and increase the legitimacy and credibility of the study, significant improvements in response rates can be achieved.

Australia↗
PubMed1995

What are women told about Pap smears that lack endocervical cells?

BACKGROUND: Debate exists about the definition of what constitutes an adequate Pap smear and about the recommended rescreening interval for Pap smears lacking an endocervical component. This study aimed at determining whether women are currently informed about the endocervical status of their Pap smears and what rescreening recommendations are made to women whose smears lack endocervical cells. METHOD: Consecutive Pap smears lacking an endocervical component were identified from pathology records. After obtaining consent from the referring doctor, 165 women were interviewed by telephone. RESULTS: Only 110 (67%) of 165 women received active notification of their Pap test result and only six (4%) were aware that their smear lacked endocervical cells. Thirteen (8%) had been advised to have a repeat smear within three months. Nearly half the women reported that they would like more information about their result. CONCLUSIONS: It seems that current Pap smear notification patterns for women in New South Wales could be improved. One third are not actively informed at all about their results, and few are given detailed information about their Pap test results. Methods of enhancing the level of information women are given about their medical and screening tests need to be improved.

Adult↗
PubMed1995

A randomised controlled trial of strategies to prompt attendance for a Pap smear.

OBJECTIVE: To assess the comparative efficacy, by randomised controlled trial, of three interventions designed to encourage "at risk" women to have a Pap smear: an educational pamphlet; letters inviting attendance at a women's health clinic; and letters from physicians. METHODS: Subjects at risk for cervical cancer who had not been adequately screened were identified by a random community survey and randomly allocated to one of the intervention groups or a control group. Six months after intervention implementation, a follow up survey assessed subsequent screening attendance. Self report was validated by comparison with a national screening data base. RESULTS: A significantly greater proportion of women (36.9%) within the group receiving a physician letter reported screening at follow up than in any other group (P = 0.012). The variables most strongly predicting screening attendance were: age, perceived frequency of screening required, use of oral contraceptives, and allocation to receive the physician letter intervention. CONCLUSIONS: The relative efficacy of the GP letter in prompting screening attendance shows that this strategy is worthy of further investigation. There remains a need to examine the barriers to screening for older women, and to develop tailored strategies for this population.

Adolescent↗
PubMed1994

Risk prevalence and screening for cancer by general practitioners.

BACKGROUND: This study presents cancer risk prevalence and screening rates of patients attending general practitioners. Conditions addressed include smoking, skin cancer, Pap smears, clinical breast examinations, and mammography. METHODS: A cross-sectional study of 7,160 patients 18-75 years presenting to 230 general practitioners in a metropolitan and country region in Queensland, Australia, was used. Risk prevalence was assessed from patients' self-report of risk behaviors and screening prior to the consultation. Details of preventive care provided in the consultation were based on doctors' self-report at the conclusion of the consultation. RESULTS: Twenty-seven percent of men and 23% of women smoked, rates being highest in the younger age groups. Using national guidelines, prior screening had not occurred as recommended for men and women as follows: skin cancer screening--66% of men, 70% of women; cervical cancer screening--27%; clinical breast examination--45%; mammography--75%. These patients were thus categorized as "at risk," and screening rates for these patients in the consultation were as follows: smokers--34%; skin cancer--5%; cervical cancer--16%; mammography--4%; clinical breast examination--8%. CONCLUSIONS: Significant numbers of patients presenting to general practitioners were at risk of developing cancer, according to national guidelines. Of these, only small proportions of all groups had a preventive intervention by their GP at the consultation identified in this study. While GPs generally see their role in prevention as important, these results raise questions for future cancer prevention policies and training of GPs.

Adolescent↗
PubMed1994

Notification and follow-up of Pap test results: current practice and women's preferences.

BACKGROUND: This study aimed to determine women's knowledge of their Pap test results and predictors of accurate knowledge, adherence to follow-up recommendations for abnormal results, current methods of notifying women about their Pap test results, women's preferences for notification method, and women's satisfaction with the current notification system. METHOD: A telephone survey was undertaken of 315 women with a recent normal or abnormal Pap test result, drawn from pathology records in Sydney, Australia. RESULTS: Findings revealed that 61% of women with a normal result and 93% of women with an abnormal result self reported having been notified about their result. According to women's reports, 7% of those with abnormal results had not been notified and a further 11% of women with abnormal results were unaware that their result was abnormal, giving a total of 18% of abnormal results not communicated adequately to women. Self-reported adherence with follow-up recommendations among women with an abnormal result was less than optimal. The most common methods of notifying women of their results were initiated by the women such as the woman phoning the doctor or receptionist. However, women strongly preferred doctor-initiated methods, such as a written record from the doctor, the doctor phoning the woman, or consultation with the doctor. CONCLUSION: Results suggest that better methods of notifying and educating women about their Pap test results are necessary to improve women's knowledge and satisfaction and, even more importantly, to improve their level of adherence with follow-up recommendations for abnormal results.

Adult↗
PubMed1994

Screening for cardiovascular disease and risk reduction counselling behaviors of general practitioners.

BACKGROUND: This study presents prevalence of risk factors for cardiovascular disease in general practice patients and screening rates for risk factors. Conditions addressed include smoking, weight, alcohol intake, blood pressure, and cholesterol. METHODS: Adult patients (7,160) attending 230 general practitioners in a metropolitan (Brisbane) and rural (Toowoomba) region in Queensland were recruited to a cross-sectional study. A self-administered patient questionnaire provided self-reported information on lifestyle risk factors and rates of previous screening. A doctor's questionnaire completed at the conclusion of the consultation provided information about physician knowledge of patient risk factors and details of preventive care provided in the consultation. RESULTS: Twenty-five percent of patients reported that they smoked, 2% drank beyond defined safe limits, 40% had body mass index > 24.9 (kg/m2). Doctors identified 66% of self-reported smokers, 40% of heavy drinkers, and 59% of overweight patients. Over 90% of patients reported prior blood pressure measurements in agreement with national recommendations; cholesterol screening within the past 5 years was reported by 51% of patients. Screening and/or counselling of patients in the consultation was highest for blood pressure (47%) and smoking (34%) and considerably lower for overweight (22%), alcohol (19%), and cholesterol (6%). CONCLUSIONS: Although preventive activities are being undertaken in general practice, performance of these activities is less than ideal. The barriers to undertaking these activities need to be addressed for change to occur.

Adolescent↗
PubMed1994

Alcohol sales to minors: a surrogate study.

BACKGROUND: Legislation is a potentially important health promotion strategy to control the consumption of tobacco and alcohol by minors. Effectiveness of such laws may depend on the extent of which laws are adequately drafted, implemented, and enforced. However, studies of adherence with laws banning the sale of cigarettes to minors indicate low levels of enforcement. As a comparison, this study investigated adherence of alcohol retailers to legislation banning the sale of alcohol to minors in New South Wales, Australia. The aim was to determine the proportion and characteristics of alcohol retail outlets which sell alcohol to apparently underage youth. METHOD: Eight 18-year-olds who were judged by independent raters to look younger than the legal age attempted to purchase alcohol from 168 alcohol retail outlets (hotels, registered clubs, and bottle shops), in a nonmetropolitan region of New South Wales. RESULTS: No challenge about age was made for 68% of purchases. Youth were asked their age on 8% of occasions and proof of age was required on only 24% of occasions. Display of a warning sign was not associated with being required to show proof of age, nor was gender or dress of the buyer (casual clothes vs school uniform). Bottle shops were more likely to require proof of age than hotels or clubs. CONCLUSIONS: The results suggest that the implementation of legislation banning the sale of alcohol to minors is currently inadequate and that new efforts are needed to discourage the sale of alcohol to minors.

Adolescent↗
PubMed1994

Allocation of research funds in the drug and alcohol field: report of the Consensus Workshop.

Issues concerning the allocation of research funds in the drug and alcohol field have been widely debated. A consensus workshop involving senior researchers and policy makers was convened to examine the appropriateness of current drug and alcohol research activities in Australia. The workshop identified several major barriers restricting research developments including lack of monitoring of research efforts, limited community support, inappropriate allocations of research funds which contributed to a low level of intervention studies, the lack of application of research findings by practitioners and ethical constraints in studies involving Aboriginal populations and in multi-centre trials. Agreement was reached on 16 recommendations which could increase the amount of high quality research in Australia directed at reducing the harm associated with alcohol, tobacco and other drug use. Strategies which funding bodies could use to encourage intervention studies were identified. A proposal for the Australian Medical and Professional Society on Alcohol and other Drugs to establish a Researchers' Group to encourage implementation of the recommendations was also endorsed by workshop participants.

Journal Article↗
PubMed1994

Reliability of naevus counts in identifying individuals at high risk of malignant melanoma.

The majority of deaths from malignant melanoma could be prevented by regular screening of at-risk individuals. However, the feasibility of introducing active screening programmes depends on the reliability of criteria for identifying those individuals who are at increased risk. Several case-control studies indicate that one of the most important risk factors is the number of benign pigmented naevi. This criterion might constitute a practical means of identifying individuals suitable for inclusion in an active screening programme. The aim of this study was to assess the reliability of using naevus counts as an indicator of risk. Two possible methods of assessment were compared: assessment by trained interviewers, and assessment by experienced dermatologists. The results suggest that this criterion may not be as practical or reliable as originally anticipated. Interviewer naevus counts correlated poorly with dermatologists' assessments (kappa = 0.19). Counts by dermatologists of the number of naevi on the left arm differed by up to nine naevi, although most counts were within four naevi of each other. There was reasonable correlation between naevus counts on the left arm and those on the whole body (r = 0.71). However, the relationship was not perfect. Selection of individuals for screening solely based on the number of naevi on the left arm may exclude many people with high total body counts but relatively low left arm counts.

Arm↗
PubMed1993

Smoking control in restaurants: the effectiveness of self-regulation in Australia.

OBJECTIVES: The provision of smoke-free areas in restaurants has been a controversial issue; the restaurant industry largely opts for a self-regulation approach. This study aimed to examine the effectiveness of self-regulation as a strategy in meeting the industry's and customers' perceived needs. METHODS: Restaurateur and customer perspectives on the provision of smoke-free areas in restaurants were examined by survey among 365 restaurateurs and 1327 customers in New South Wales, Australia. RESULTS: Less than 2% of restaurants were totally smoke-free; 22% provided some smoke-free areas. Customers were much more likely than owners to think that smoke-free areas should be provided. Owners appeared to be unaware of customers' views about smoke-free areas in restaurants. CONCLUSIONS: Little evidence was found to support the effectiveness of the self-regulation policy adopted by the restaurant industry. Characteristics of restaurants and owners associated with the provision of smoke-free areas are presented and implications of the findings are discussed.

Attitude↗
PubMed1993

Beyond opportunistic Pap smears in general practice. Women's views of strategies to promote regular screening.

BACKGROUND: An opportunistic reminder for a Pap smear is effective and acceptable in general practice. Women's views of strategies to promote ongoing attendance for Pap smears were unknown at the time of this study. OBJECTIVE: To determine women's perceptions of strategies to help them attend for their next Pap smear. SETTING AND PATIENTS: Randomly selected male general practitioners in urban Sydney and 174 of their female patients. RESULTS: Seventy-eight per cent response rate to a questionnaire sent after a consultation in which opportunistic screening was offered. A reminder letter from the GP was nominated as likely to help 'a lot' by at least 50 per cent of respondents. Free Pap smears and child-minding were nominated by at least 50 per cent of respondents as making 'no difference'. CONCLUSION: This survey has explored women's perceptions of potential strategies to promote continuing Pap smear screening. Given the disappointing results when these strategies have been implemented in individual general practices, however, the authors recommend prospective controlled evaluation before widespread adoption.

Adult↗
PubMed1992

Drug use in Australia: a community prevalence study.

OBJECTIVE: To estimate the prevalence of drug use in a representative Australian community. DESIGN: Using a Census district sampling framework supplied by the Australian Bureau of Statistics, we randomly selected dwellings for our survey. A household was defined as all those people living permanently at the postal address. All eligible members of each household, 15 years and older, were asked to participate. SETTING: The data were collected in the context of a large scale general population survey of health practices and attitudes, conducted in the Greater Newcastle area of New South Wales, during 1987 and 1988. PARTICIPANTS: Seventy-two per cent of eligible individuals approached (2623) agreed to participate in the survey. MAIN OUTCOME MEASURES: Participants were asked about their use of a number of drug types: medically prescribed drugs, non-prescription drugs, tobacco, alcohol and illicit drugs. For alcohol, only the results for use at a hazardous level according to the National Health and Medical Research Council guidelines are reported here. RESULTS: Seventy-eight per cent (95% confidence interval, 76%-80%) of the community sample reported having recently consumed at least one of these drug types. There were significant age and sex differences in drug use. A greater proportion of women and the older age groups (over 45 years) reported the use of both non-prescription and prescription medications than did men and the younger age groups. Conversely, a significantly greater proportion of men and the younger age groups reported the use of social and illicit drugs. CONCLUSION: The importance of regular, representative, methodologically comparable community studies of drug use is stressed, particularly in view of the inadequacy of the current routine sources of epidemiological data on drug use.

Adolescent↗
PubMed1992

Pap smear tests in general practice. An update.

Reduction of deaths due to cervical cancer by two-yearly Papanicolaou smear screening of women at risk aged 18 to 70 years is now a national health goal. We report a study conducted with general practitioners that suggests improving levels of coverage of women at risk. Our research, however, has also identified unexpected challenges in documenting preventive care in general practice.

Adolescent↗
PubMed1991

Agreement between two measures of drug use in a low-prevalence population.

The present study examined the agreement between two measures of prevalence of drug use in the community: self-report and specific pharmacological analyses of urine samples. The data were collected in the context of a random community survey of health practices and attitudes. A random 20% of the households participating in the health study were targeted for biochemical assay. Compliance with urine delivery was relatively high at 79%. Urine samples were screened qualitatively for cannabinoids and benzodiazepines using the enzyme multiplied immunoassay technique (EMIT) (Syva Diagnostics, Palo Alto, CA). Screening for pharmaceuticals used a standard thin-layer chromatography (TLC) technique. Agreement between the self-report and biochemical assay estimates of prevalence was statistically significant (p less than .05). While self-report of substance use is not a perfect measure of consumption, it remains a relatively economical and reasonably accurate method of obtaining estimates of substance use in community samples.

Adolescent↗
PubMed1991

Cancer prevention: what's worth doing in general practice?

Primary prevention aims to circumvent the onset of malignant change. Secondary prevention aims to detect early cancer or lesions with high malignant potential before extensive local growth or metastatic spread compromises the effectiveness of treatment. This article should help general practitioners appraise the value of cancer prevention measures and plan an effective approach to cancer prevention in clinical practice.

Family Practice↗