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Biomedical subjects

Y H Carter

Publications and source records attributed to Y H Carter.

At least 37 records · Page 2Linked to original sources
PubMed1999

Why? What? and How? IT provision for medical students in general practice.

OBJECTIVES: The aim of this paper is to discuss the increasing use of computers in undergraduate medical education and explore the why, what and how of providing IT facilities to undergraduate medical students when they are on placement in general practice. Adequate computing facilities are usually available within hospitals and medical schools, however, major changes are taking place in undergraduate education resulting in more teaching being undertaken in the community. Students will therefore need access to comparable facilities whilst in primary care settings in order for their training not to be compromised. SETTING: This paper describes one initiative addressing this need: the University Linked Practices (ULP) project in the Department of General Practice and Primary Care at St. Bartholomew's and the Royal London School of Medicine and Dentistry. DESIGN: We discuss the ways in which computers are currently being used in medical education and discuss some of the merits and drawbacks that are associated with this increasing drive to computerization.

Computer Literacy↗
PubMed1998

Survey of research activity, training needs, departmental support, and career intentions of junior academic general practitioners.

BACKGROUND: Recent changes in the organization of the National Health Service have created new roles and responsibilities for academic general practice. Previous work on the constraints and opportunities of a career in academic general practice is largely anecdotal and is often based on the views of more senior members of the profession. AIM: To survey the research activity, perceived level of training, support needs, and career intentions of junior academic general practitioners (GPs). METHOD: A postal, validated, semistructured questionnaire was sent to the 121 eligible junior academic GPs in the academic departments of general practice in the United Kingdom and Dublin. Main outcome measures were 'research activity score', as measured by publications in peer-reviewed journals and involvement in research projects, 'training score' devised from 13 skills required for both research and teaching, and perceived level of departmental support assessed by six different support mechanisms. RESULTS: Response rate was 89% (n = 108). Forty-six responders (43%) had no publications. Twenty-five responders (23%) had no principal project. Thirty-nine responders (37%) had a mentor. Research activity appeared to be dependent on sex, having a predominantly research role rather than a full-time teaching role, and a positive perception of academic training (P < 0.05). Increasing departmental 'support scores' and length of time in the department were both significantly associated with more positive perceptions of academic training (P < 0.05). Only 29 (27%) responders wanted to progress to senior positions within academic general practice. CONCLUSION: Training and departmental support and guidance available to junior academics in primary care are perceived as variable and often inadequate. If academic general practice is to thrive, improved academic training is required, such as taught Master's degrees, supervised personal projects or 'apprenticeship' as a co-investigator, and improved methods of departmental support.

Career Choice↗
PubMed1997

Mothers' attitudes to and experience of pre-school child health services: a comparative study in two districts in the west Midlands.

A postal questionnaire survey was undertaken amongst a ten percent random sample of mothers in Walsall and South Warwickshire in order to determine their views concerning health services available for their three year old children. A response rate of 59% and 75% respectively was obtained. Despite differences in demographic profile between the two districts, the overall views of mothers were remarkably similar. The majority of mothers were happy with services provided but mothers whose first language was other than English were less likely to be satisfied. Criticisms included dissatisfaction with waiting times, inappropriate timing of clinics, insufficient advice given as well as inconsistencies in advice offered. Health visitors in particular were perceived to be helpful and requests for further input from them were made. Specific health needs of children from ethnic minority backgrounds were discovered which should form the basis of further, more detailed local research. The survey also highlighted the high prevalence of accidents and asthma among pre-school children.

Adult↗
PubMed1997

Analysis of primary care staff language about aggression at work using concordancing techniques to identify themes.

OBJECTIVE: We aimed to describe features of language used during interviews about the extent of aggression and violence at work and their effect on primary care staff. METHOD: Forty-four primary health care team members in the West Midlands were interviewed, and interviews were recorded on videotape. The language content of these interviews was analysed using Cobuild concordancing software. Outcome measures used were word frequency, collocation and mutual information (MI) scores for language use. RESULTS: A total of 17517 words spoken by interviewees were analysed. Violence in this sample was perceived as occurring principally in connection with unmet demands for such things as prescriptions and referrals. Only patients were perceived as violent; health care workers used other terms to describe their own feelings and responses. Sixty-eight specific incidents of violence were recounted, features perceived as salient being drink, youth and to a lesser extent mental illness. CONCLUSIONS: Concordancing software can be successfully used in the qualitative examination of videotaped interviews. In this study, the technique rapidly identified a number of perceived training needs among a variety of primary care staff.

Aggression↗
PubMed1997

A national survey to medical and dental schools to assess the level of undergraduate teaching and research about HIV/AIDS in the UK.

The views of heads of academic departments in UK medical and dental schools on the extent of their specialty's involvement in teaching undergraduates about HIV/AIDS and undertaking research in this area was ascertained by postal questionnaire. Three hundred and nineteen responses were received from medical schools (61.7%) and 58 responses from dental schools (53.2%). The greatest number of responses in one specialty was received from the Departments of General Practice, Paediatrics and Children's Dentistry. The amount of teaching varied widely, was dispersed throughout the curriculum within a wide range of broader subject areas and tended to be carried out by senior staff using didactic lecture format. Dental courses were more often assessed than medical courses. The small number of patients available was seen as a major problem. Involvement in research was appreciable. However, knowledge of student awareness campaigns was not widespread. We conclude that more specific teaching on HIV/AIDS is needed, particularly discussion about attitudes towards patients and ethical issues. HIV/AIDS counsellors should have an increased involvement in undergraduate teaching and teaching methods should provide opportunities for interactive discussion. Extensive research is being conducted in the UK. However, further work is needed to identify the perceived needs of students and the extent to which these are being met.

Acquired Immunodeficiency Syndrome↗
PubMed1997

The grieving adult and the general practitioner: a literature review in two parts (Part 2).

In part 1 of this review, published last month, literature exploring the psychological bereavement theories and the health consequences of bereavement are summarized. The second part builds on this to outline the debate surrounding the characteristics of abnormal bereavement, while also focusing on risk factors for this morbidity. This leads on to a summary of the literature on bereavement care, particularly from a general practice point of view. Finally, areas for further research are highlighted.

Adult↗
PubMed1996

A randomized controlled trial of electromagnetic therapy in the primary care management of venous leg ulceration.

OBJECTIVE: The aim was to establish the potential efficacy, tolerability and side-effect profile of electromagnetic therapy as an adjunct to conventional dressings in the treatment of venous leg ulcers. METHOD: A prospective, randomized, double blind controlled clinical trial was carried out in a dedicated leg ulcer clinic based in one urban general practice. Nineteen patients with leg ulcers of confirmed venous aetiology were assessed. The main outcome measures were rate and scale of venous leg ulcer healing, changes in patient-reported pain levels, quality of life, degree of mobility, side effect profile and acceptability to patients and staff. RESULTS: Sixty-eight per cent of patients attending this dedicated clinic achieved improvements in the size of their ulcer (4, 21%, healed fully) and in reduced pain levels (P < 0.05) during the trial, despite the chronicity of ulcer histories. Patients treated with electromagnetic therapy at 800 Hz were found at day 50 to have significantly greater healing (P < 0.05) and pain control (P < 0.05) than placebo therapy or treatment with 600 Hz. All patients reported improved mobility at the end of the study. The electromagnetic therapy was well tolerated by patients, with no differences between groups in reporting adverse events, and proved acceptable to staff. CONCLUSIONS: Despite the small numbers in this pilot study, electromagnetic therapy provided significant gains in the healing of venous leg ulcers and reduction in pain.

Adult↗
PubMed1996

Reliability and feasibility of a near patient test for C-reactive protein in primary care.

BACKGROUND: The applications of new diagnostic technologies such as near patient tests are relevant to the further development and potential of primary care. Through their use, doctors in the community may increase the accuracy of their diagnoses and improve their ability to monitor disease. A reliable indicator of disease activity in various clinical conditions is C-reactive protein (CRP) and a near patient test for this is now available, although there is little information on its use outside hospitals. AIM: A study was set up to evaluate the feasibility of using a novel near patient test for CRP in primary care to validate the results against the laboratory "gold standard' for CRP (Beckman Array) and to compare results with the usual inflammation test used in general practice. METHOD: Prospective recording of CRP as a near patient test on an "intention to investigate' basis, with validation of results against the Beckman Array system for CRP and hospital laboratory erythrocyte sedimentation rate results, in six general medical practices in Birmingham. Main outcome measures were change in local laboratory usage, characteristics of patients chosen for testing, use of quality control, and comparison of readings with results from the same sample sent to an independent laboratory. RESULTS: Tests of CRP levels were rarely requested before the study was undertaken. During the 3-month study period, 181 near patient tests were carried out, 146 (81%) to establish a diagnosis and the remainder for disease monitoring. Out of the tests, 67% were performed by general practitioners, mostly during the consultation itself. Using a cut-off level of 10 mg I-1, the near patient test and the Beckman Array gave results which agreed in 84% of cases. The sensitivity and specificity of the near patient test results were 97 and 79%, respectively. The predictive value of a positive result was 59% and that of a negative result was 99%. Cohen's Kappa was 62% and the overall mean bias for results in the range of the test was 6.11 mg I-1 (SE = 3.07 mg I-1). Each test took 6 min on average to perform, including all preparations, blood letting, performing the test and averaging the time for quality control estimations. The cost per test averaged pounds 1.72, rising to pounds 4.17 including labour, capital costs, quality controls and consumables (general practitioner performing the assay at average frequency found in this study). CONCLUSIONS: Measurement of CRP is rarely used in primary care and awareness of its value could be raised. This near patient test proved feasible for use by general practitioners and practice nurses. Its reliability compared with a laboratory result was satisfactory overall, and excellent with adequate operator technique.

Biomarkers↗
PubMed1995

General practitioners' attitudes to child injury prevention in the UK: a national postal questionnaire.

OBJECTIVE: To survey the level of interest and involvement in child injury prevention among general practitioners and their practice teams, and to identify factors associated with current interest. DESIGN: Postal survey of a random sample of United Kingdom (UK) medical practitioners. SETTING: Medical practices throughout the UK. SUBJECTS: 957 general practitioners (50% of the total sample) who responded to the survey questionnaire. OUTCOMES: Answer to questions about role in injury prevention. RESULTS: Despite a response rate of only 50%, this study is the largest to examine the role of general practitioners in child injury prevention. Seven hundred and twenty five (77%) of the respondents considered injury prevention to be part of the general practitioner's role, but only 260 (28%) felt that they did enough in this area. Time was cited as the most significant limiting factor. Women doctors, rural practitioners, members of the Royal College of General Practitioners, and doctors with previous personal experience of serious accidents all had more positive attitudes to injury prevention as a routine part of their activities (p < 0.05). Practices providing first aid training for staff were also associated with an interest in injury prevention. The most appropriate times for offering prevention advice were thought to be during child health surveillance clinics and during treatment of an accident. CONCLUSIONS: Awareness about injury prevention opportunities might be improved by emphasising the roles of individual team members and by better addressing the training needs of the whole team.

Adult↗
PubMed1994

The role of the teacher in child accident prevention.

A sample of 278 head teachers of children aged between three and 11 years in North Staffordshire were sent a postal questionnaire to determine the manner and extent to which they were involved in accident prevention. The majority of respondents agreed that accident prevention was a suitable subject to be taught in schools. However, a minority felt that they had enough background information or training on the subject. First-aid instruction was particularly requested. Levels of reporting and management of individual accident cases varied. It is desirable that guidelines are agreed on accident reporting, the role of the school medical service in accident prevention and the supervision of children during recreation periods.

Accident Prevention↗
PubMed1993

General practitioners' beliefs about their role in the prevention and treatment of accidents involving children.

This questionnaire survey set out to determine the perceptions of family doctors in north Staffordshire regarding their role in the prevention and treatment of childhood accidents. Of 277 doctors sent questionnaires, 207 (75%) replied. Only 23% of respondents considered that they did enough child accident prevention work; lack of time was mentioned as a limiting factor by 66%. Child health surveillance clinics and home visits were considered by 60% and 59% of respondents, respectively, to be appropriate occasions on which to give prevention advice. However, only 12% of respondents frequently gave safety advice while visiting a child. Significantly more older general practitioners (over 44 years) gave advice during a visit than younger doctors. Among doctors with a health visitor who was practice rather than geographically based significantly more gave advice on a home visit and discussed safety issues with their health visitors. Significantly more general practitioners in practices more than five miles from the nearest accident and emergency department offered to provide treatment for children following an accident than those in practices nearer to a hospital. Child accident prevention has recently been targeted as an important area for health promotion in primary care. However, this district based survey has identified a relatively low profile for the subject in the everyday activities of the general practitioner. The need for further research to determine the precise role of the family doctor in the prevention and treatment of children's accidents is highlighted.

Accident Prevention↗