Search PubMed⌕ Search

Biomedical subjects

R Sanson-Fisher

Publications and source records attributed to R Sanson-Fisher.

At least 73 records · Page 4Linked to original sources
PubMed1990

A critical review of Australian cancer organizations' public education material.

Because of the potential benefits of primary prevention and early detection of cancer, a considerable proportion of the efforts of State cancer organizations has been directed towards public educational programs. The study aimed to determine the level of agreement in the messages contained in the written educational material of the State and Territory cancer organizations in Australia. Pamphlets and brochures dealing with primary and secondary prevention of breast, cervical, skin and bowel cancers were obtained. The materials were compared on a number of dimensions: the characteristics of people who are at increased risk of contracting the cancer, how to avoid the cancer through primary prevention, how and when to screen in the case of secondary prevention, and action to be taken if a sign or symptom indicative of cancer is discovered. The study found a lack of agreement in the messages of the State cancer organizations. Some hypotheses are suggested to explain the discrepancies. In addition, some suggestions for remedying this situation are provided.

Australia↗
PubMed1990

Feasibility of sigmoidoscopic screening for colorectal cancer in the Hunter Region.

The success of a cancer detection programme depends on the co-operation of the target population. The aim of this study was to identify factors which might influence those at average and at higher risk of developing colorectal cancer to undergo a sigmoidoscopic screening test if offered. This was addressed by means of a household survey of individuals aged 40 years and over. Overall consent to undergo screening approximated 45%. There was a significant relationship between agreement to sigmoidoscopy and each of the following: age, marital status, educational level attained, and a previous episode of rectal bleeding. Individuals who had undergone sigmoidoscopy in the past were less willing to have the test performed again. Although individuals with a family history of bowel cancer in first-degree relatives perceived themselves as being more likely to develop colorectal cancer, this had no apparent impact on their willingness to have the test. The implications of these findings for community education programmes directed at colorectal cancer are discussed.

Adult↗
PubMed1988

Patients as a direct source of information on adverse drug reactions.

To determine whether patients should participate directly in detecting adverse reactions to drugs their ability to provide written reports of symptoms experienced during treatment with amoxycillin or trimethoprim-sulphamethoxazole was investigated. When compared with telephone interviews forms on which patients reported events were reliable (the observed agreement with the same statements posed during telephone calls was 85%, kappa = 0.56) and valid (sensitivity = 54%, specificity = 94%). Patients were also supplied with forms that invited them to report adverse reactions, and their perceptions were compared with those of a panel of experts, who were informed of all clinical events that had been reported during the detailed telephone interviews. Patients were more conservative than the experts in attributing clinical events to drug treatment. The extent of agreement varied and was notably poor for skin and bowel complaints (kappa = 0.13 in each case). The performance of event report forms and reaction report forms as instruments of detection was compared in a hypothetical situation in which the experts' views represented the "truth" about adverse reactions to a new drug. Event reporting had a higher sensitivity than reaction reporting (42% v 24%) but a lower specificity (58% v 98%). National centres monitoring adverse drug reactions should probably resist pressure to accept reports of reactions directly from the public, but a system based on large scale reporting of events might be valuable in aiding the early detection of symptomatic reactions to new drugs.

Adolescent↗
PubMed1988

Identification of simulated patients by interns in a casualty setting.

Fifty-four interns agreed to a study in which their clinical performance in an out-patient unit with standardized patients was recorded on videotape. In order to examine whether they could distinguish standardized from real patients, the interns were asked to note any patients who they thought might be simulating their complaints and report these to the researchers at the end of each 2-day period of study. Thirty-two of the interns were assessed again at the end of their internship, using the same clinical problems presented by different simulators. The consultations took place in the casualty department of a large urban hospital. At the beginning of the year there were 152 consultations with standardized patients and 328 consultations with appropriate genuine patients. Standardized patients were identified definitely as 'not genuine' in only 12 of the 152 consultations (sensitivity 7.8%) whereas 320 of the 328 genuine consultations were accepted by the interns as genuine (specificity 97.8%). When the level of confidence required to distinguish the two groups was reduced from 'definite' to 'probable', the number of correctly identified simulator consultations increased to 36/152 (27%) but the rate of misclassification of genuine patients also increased from 8 to 37 out of 328 consultations (11%). At the end of the year there were 81 consultations with standardized patients and 149 consultations with genuine patients. Identification rates were only slightly changed. We conclude that simulator identification is not a problem in applying standardized patients to evaluate the quality of care provided in a hospital casualty.

Clinical Competence↗
PubMed1987

Behavioral medicine programs in teaching hospitals.

Behavioral medicine is a relatively new interdisciplinary field which combines biomedical and behavioral science knowledge, and applies them to prevention, diagnosis, treatment and rehabilitation. Behavioral medicine programs provide a valuable service to patients with chronic illness, psychosomatic or functional disorders, treatment noncompliance, and behavioral risk factors. Behavioral medicine faculty are also active in teaching and research on patient behavior, interviewing skills, health promotion and counseling, and management of chronic illnesses. However, the survival of behavioral medicine programs in teaching hospitals depends on their economic viability and academic status. Positive action is needed to ensure their continued growth and development.

Behavior Therapy↗
PubMed1986

Patient satisfaction with primary-care consultations.

This study examines patients' perceptions of their latest consultation with a primary-care physician. A new questionnaire measured patients' views on their "ideal" physician prior to the visit and their satisfaction on similar dimensions immediately afterward. Ratings by the 503 eligible patients (87% response rate) showed that all 43 items were relevant and that a shortened version could also be used successfully. Patients held high expectations for, but were also quite satisfied with, their physicians' actual behavior during the consultation. Factor analysis of perceptions supported other research findings and raised some anomalies in relation to overordering of investigations and waiting time. Other analyses showed which characteristics of physicians and patients were most influential on satisfaction and which dimensions of care were common or distinct to the 22 physicians involved in this study.

Adolescent↗
PubMed1983

The teaching of interviewing skills: comparison of experienced and novice trainers.

During a clerkship in psychiatry thirty-six medical students were randomly allocated to one of three teachers who differed widely in their experience of teaching essential interviewing skills. Each teacher taught two groups of six medical students using videotape feedback and discussion of practice interviews. Independent raters who were blind to the teachers to whom the students had been assigned rate pre- and post-training interviews. All three teachers proved effective in teaching interviewing skills and it is concluded that most teachers could probably be taught to carry out this training.

Clinical Clerkship↗
PubMed1982

Medical students' evaluation of tutors in a group-learning curriculum.

This study focused on students' evaluation of tutors' effectiveness during an academic term, using a nineteen-item questionnaire. The study took place within an integrated problem-solving medical course. Four major factors in the tutor's behaviour were identified as having importance in the rating process: the ability to care for students, a knowledge of course structure and teaching staff philosophy, the ability to encourage independent thinking in students and a knowledge of the specific medical problems being studied. Further analysis suggested that students distinguish between good and bad tutors, those in different medical strands and with differing status. In general, the findings complement those dealing with student evaluation of lectures and to some extent, patient satisfaction with doctors.

Australia↗
PubMed1980

Should skills in communicating with patients be taught in medical schools?

Doctors' skills in communication affect the adequacy of their clinical interviews, their patients' satisfaction, recall of offered advice, compliance, and the impact of potentially distressing medical and surgical procedures. Yet traditional clinical courses do not include formal teaching in these skills and several reasons probably account for this. Recent research has demonstrated that training in communication skills is both feasible and effective. It should become an integral part of medical education.

Communication↗
PubMedDate not supplied

Two sequential randomized trials of community participation to recruit women for mammographic screening.

BACKGROUND: If mammographic screening is to reduce mortality from breast cancer, it is essential that a high proportion of the target population attend for screening. In order to achieve this, effective recruitment strategies are needed. This paper reports two trials of recruitment strategies for mammographic screening involving eight communities in rural New South Wales (NSW), Australia. METHODS: Each trial involved two matched pairs of towns in the Hunter Valley region of NSW. Towns were randomly allocated to intervention, receiving either mass media promotion or community participation in Trial 1 and community participation or family physician involvement in Trial 2. RESULTS: In Trial 1, significantly higher attendance rates were observed in the two towns that received the community participation intervention compared with their matched media promotion towns (63% vs 34%, P < 0.001 and 51% vs 34%, P < 0.01). In Trial 2, a significantly higher attendance rate was observed in one town that received the family physician involvement intervention compared with its matched town which received the community participation intervention (68% vs 51%, P < 0.01). There was no significant difference in attendance in the other pair of towns (68% vs 58%, P = 0.11). CONCLUSIONS: Both community participation and family practitioner involvement are more promising strategies for the promotion of attendance at mammographic screening facilities than media promotion alone.

Adult↗
PubMedDate not supplied

Teaching smoking cessation skills to senior medical students: a block-randomized controlled trial of four different approaches.

BACKGROUND: Medical practitioners have considerable untapped potential to assist patients in stopping smoking. However, marked deficits have been found in the amount and type of training medical practitioners receive in smoking cessation counseling with little attention paid to determination of effective training methods. METHOD: A randomized controlled trial was conducted to examine the relative effectiveness of four different educational programs in teaching smoking cessation skills to 5th-year medical students in an Australian medical school. The four programs comprised: (a) a traditional didactic lecture mode (control group), (b) audio feedback through the use of audiotaped role plays, (c) role plays with peer feedback, and (d) video feedback. Students' smoking cessation intervention skills were assessed prior to training and at the end of term via videotaped interviews with simulated patients. RESULTS: Senior medical students demonstrated significantly improved skills in smoking intervention when exposed to any of the educational approaches other than traditional didactic teaching. No overall differences in smoking intervention skills were found between the three experimental training methods. CONCLUSIONS: Specific training in smoking cessation techniques is necessary to increase the intervention skills of medical students. Traditional teaching methods are ineffective in developing smoking cessation intervention skills. Enhanced teaching, of an appropriate nature, at undergraduate and postgraduate levels is needed.

Adult↗
PubMedDate not supplied

Correlates of physician counseling associated with obesity and smoking.

BACKGROUND: Patient, physician, and consultation variables associated with overweight and smoking counseling in general practice consultations were examined. METHODS: A random sample of full-time general practitioners was used. The sample consisted of 7,160 patients from 230 GPs who attended for consultations on consecutive days, and self-reported information from the doctor and the patient was collected via questionnaire. The aim of this paper is to identify variables associated with the doctor's identification of overweight and smoking status and with the occurrence of counseling for these two behavioral risk factors. RESULTS: Forty percent of patients were overweight (BMI > 24) and 25% were self-reported smokers. Doctors identified 59% of overweight patients and 66% of smokers. Doctors only counseled patients identified as having the risk factor, counseling 36% of identified overweight patients and 49% of identified smokers. Identification of overweight was associated with being female, being heavier, having been previously counseled, being less well educated, presenting with an associated condition, and visiting a doctor who is younger and knows the patient's medical history well. Counseling for overweight was associated with being younger, being previously counseled, presenting with an associated condition, presenting for a routine checkup, visiting a GP who generally has longer consultations, having BP measured in the consultation, visiting an older doctor and visiting a doctor who considers identification of risk behaviors important. Identification of smokers was associated with being a heavier smoker, with those who had been previously counseled, with marital status other than single or married, with a BP measurement being taken in the consultation, and with a doctor who believed it possible to influence lifestyle change. Counseling for smoking was associated with younger patients, longer consultations, previous counseling, BP measurement, presenting with an associated condition, and not presenting frequently. CONCLUSIONS: We have identified factors associated with counseling about behavioral risk factors which provide a framework for planning education programs to increase the level of primary preventive activities within general practice.

Adult↗
PubMedDate not supplied

Does a 3-day workshop for family medicine trainees improve preventive care? A randomized control trial.

OBJECTIVE: To evaluate the impact on clinical behavior of a 3-day workshop designed to increase trainees' rates of smoking cessation counseling and reminders about Pap smears in routine consultations. DESIGN: Randomized control trial. SETTING: Accredited teaching practices of the Royal Australian College of General Practitioners' Training Program. SUBJECTS: Thirty-four trainees and 1,500 consecutive adult patients ages 16-65 years. METHOD: Trainees randomly allocated to the experimental group participated in a 3-day interactive workshop on disease prevention during their 13-week family medicine term. Audiotapes of consultations with adults conducted by trainees at the beginning and end of the rotation were analyzed blind to compare assessment of patients' smoking status and, for women, date of last Pap smear. A questionnaire mailed to each patient after the consultation also allowed identification of smokers and women overdue for a smear. Consultations with these patients at risk were analyzed for preventive counseling. Inter- and intrarater reliability was calculated for audiotape analysis. RESULTS: Preworkshop rates of questions about smoking were low, occurring in 22% of consultations. While trainees allocated to the experimental workshop were more likely to ask a routine question about smoking at the end of the term than those in the control group (P = 0.01), two-thirds of smokers remained undetected irrespective of trainee group and fewer than one in five were advised to stop smoking. Reminders about Pap smears did not change as a result of training and remained low in fewer than 20% of consultations. kappa values demonstrated high reliability of audiotape analysis. CONCLUSION: This direct measurement of clinical behavior revealed that low levels of preventive care provided by trainees are resistant to skills training without reinforcement in clinical practice. In view of the importance of prevention in routine consultations, we recommend continued evaluation of more intensive educational programs. Those withstanding rigorous evaluation could be considered for implementation in similar training contexts seeking to improve the frequency and quality of disease prevention in primary medical care.

Adolescent↗