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PubMed1992

On the use of the generalized t and generalized rank-sum statistics in medical research.

We have used Monte Carlo methods to compare the type I error properties of the conditional and unconditional versions of the generalized t and the generalized rank-sum tests to those of the independent samples t and Wilcoxon rank-sum tests. Results showed inflated type I errors for the conditional generalized tests but not for the unconditional tests. We also compared the power of the unconditional generalized tests to that of the t and Wilcoxon tests under a variety of conditions. Results showed the generalized tests to be much more efficient than their traditional counterparts in some circumstances, but substantially less powerful in others. Based on these and other considerations, we conclude that the application of these newer statistics in medical research needs further consideration.

Data Interpretation, Statistical↗

PubMed1983

Patient education in general practice: opinions of general practitioners.

Fifty-two general practitioners were interviewed regarding their task in patient education and various aspects of it. The view general practitioners have on patient education is complex. Although they consider it a central task, the range of methods they are willing to use is limited. Many general practitioners tend to overlook the fact that they are not the only source of information and explanation for patients. They would prefer to keep control over information given patients, fearing that patients might be confused. It is notable that many general practitioners have no clear standards of what patients need to know. Much depends on the questions the individual patient asks. There are several kinds of information that general practitioners are disinclined to give, particularly relating to uncertainties or information that might alarm the patient. The outlook for improvement must not be overestimated. Some directions are given for supporting the development of patient education.

Attitude of Health Personnel↗

PubMed2002

A brief screening tool for suicidal symptoms in adolescents and young adults in general health settings: reliability and validity data from the Australian National General Practice Youth Suicide Prevention Project.

Using data from a nationwide project on young people in Australia aimed at assessing suicidality in general health settings, we present a brief screening tool for suicidality (the depressive symptom index suicidality subscale). Two thousand eight hundred and fifty-one (15-24 year old) patients presenting to 247 Australian general practitioners between 1996 and 1998 were assessed. In addition to the suicide screen, patients completed the general health questionnaire-12 and the Center for Epidemiological Studies depression scale. Patients' chief complaints were taken from the summary sheets completed by their general practitioners. Using inter-item correlational and factor-analytic techniques, as well as a general approach to construct validity, we show that the measure has favorable reliability and validity characteristics. We also provide results on cut-points that may facilitate its use in clinical and research settings. Because the screen is brief, easy to use, reliable, and valid, we encourage its use to combat the vexing international health problem of suicide.

Adolescent↗

PubMed1975

Severity of symptoms of psychiatric outpatients: use of the General Health Questionnaire in hospital ang general practice patients.

A sample of 91 new referrals to a community based psychiatric outpatient service was compared with a cross-matched control sample of 107 patients attending the general practitioner's surgery. The subjects in both groups completed the General Health Questionnaire and there was a very marked difference between the scores of the two groups. Seventy-five of the psychiatric group had a high score on the questionnaire, and a large number of these were extremely high, while 74 of the general practice group had a low score. The 'false' positives and negatives are discussed. It is considered that the validity of this questionnaire as a screening device for demonstrating psychiatric morbidity and severity in general practice is further established in this study by showing that in matched samples the expected psychiatric morbidity in general practice can be compared with the much greater morbidity in psychiatric outpatient referrals. For the psychiatric sample more patients showed high scores and these tended to be much higher.

Adjustment Disorders↗

PubMed1993

Auditory frequency generalization and a failure to find octave generalization in a songbird, the European starling (Sturnus vulgaris).

Many species of songbirds have absolute pitch perception. They memorize tones when discriminating between sequences and fail to generalize to novel frequency ranges. I examined frequency generalization in starlings (Sturnus vulgaris) that were trained to discriminate between individual frequencies. Starlings were tested for frequency generalization after training on 2- and 3-tone discriminations. There was no evidence for octave generalization, which is a hallmark of human absolute pitch perception. This suggests that avian absolute pitch perception must not be interpreted as identical with that in humans. A control experiment with 1-tone discriminations indicated that the presence of lit response keys affects the shape of the generalization gradients. Lit response keys are a common feature in avian auditory perception experiments, and this control experiment cautions that results may be affected by this seemingly minor procedural change.

Acoustic Stimulation↗

PubMedDate not supplied

The estimation of body density in men: are general equations general?

Regression equations for estimating body density and fatness from anthropometric measurements are usually specific to the populations from which they are derived, owing to methodological and biological factors. Some equations are, however, regarded as having general validity for subjects of different ages, levels of fatness and fitness. In this study, five such general equations were tested by comparing estimated body density (Dest) with measured body density (Dmeas) in 138 European men employed in an Italian shipyard. Body density was measured by underwater weighing with the simultaneous determination of lung residual volume. Measurements were also made of height, weight, eight skinfolds, four circumferences and seven diameters by standard techniques. Dest from the five general equations were significantly different from Dmeas (P less than 0.001). New prediction equations for estimating D were drawn up by simple and multiple regression of various combinations of skinfolds expressed as individual skinfolds, sums, log sums and the quadratic form. Equations were drawn up on a validation sample (N = 92) and tested on a cross-validation sample (N = 46). The form of skinfolds and the combination selected made little difference to the SEEs and R2 but the inclusion of age resulted in lower SEEs. Stepwise multiple regression produced an equation incorporating thorax and triceps skinfolds and age with an SEE of 6 kg/m3 and R2 of 79%. The derived equations were successfully cross-validated, Dmeas and Dest were not significantly different, ryy' and SEE were similar to those of the validation sample. When the cross-validation sample was divided into two according to age, density or VO2 max, the derived equations were applicable to the upper and lower groups for age or physical fitness but not to the groups differing in fatness. These equations should be validated further on other samples by studies performed with due regard to the methodological factors, both technical and statistical, that may result in specificity. However, the poor performance of the general equations tested and the specificity for fatness of the derived equations suggest that biological factors may preclude the development of general prediction equations for body density.

Adult↗

PubMed1991

Hormone replacement therapy in general practice: a survey of doctors in the MRC's general practice research framework.

OBJECTIVES: To survey current prescribing practice for hormone replacement therapy among general practitioners and to elicit their views on the role of hormone replacement therapy in the prevention of osteoporosis and cardiovascular disease; to determine whether they would participate in randomised controlled trials to evaluate the long term beneficial and adverse effects of hormone replacement therapy. DESIGN: Postal questionnaires to general practitioners throughout the United Kingdom. PARTICIPANTS: 1268 general practitioners in the Medical Research Council's general practice research framework. RESULTS: 1081 (85%) doctors in 220 (95%) practices responded. The doctors were currently prescribing hormone replacement therapy to an estimated 9% of their female patients aged 40 to 64, and 55% of doctors were prescribing opposed hormone replacement therapy (oestrogen plus progestogen) to more patients than a year previously. Over half the doctors would consider prescribing hormone replacement therapy for prevention of osteoporosis (670, 62%) and cardiovascular disease (611, 57%) to asymptomatic women. Overall, 79% of the doctors (851) would definitely or probably consider entering women who have had a hysterectomy into a randomised controlled trial comparing unopposed (oestrogen only) hormone replacement therapy with opposed hormone replacement therapy; 49% (524) would enter patients with a uterus into such a trial. Among a subsample, 85% (180/210) would consider entering patients without menopausal symptoms into a trial comparing hormone replacement therapy with no treatment (unopposed in patients who have had a hysterectomy, opposed in those with a uterus). CONCLUSION: There is considerable uncertainty among general practitioners as to the balance of beneficial and harmful effects of hormone replacement therapy in the long term, particularly relating to its use for prevention of osteoporosis and cardiovascular disease. Most of these doctors would be prepared to participate in randomised controlled trials to determine the long term effects of this increasingly widely used treatment.

Adult↗

PubMed1996

Socioeconomic determinants of rates of consultation in general practice based on fourth national morbidity survey of general practices.

OBJECTIVE: To identify the socioeconomic determinants of consultation rates in general practice. DESIGN: Analysis of data from the fourth national morbidity survey of general practices (MSGP4) including sociodemographic details of individual patients and small area statistics from the 1991 census. Multilevel modelling techniques were used to take account of both individual patient data and small area statistics to relate socioeconomic and health status factors directly to a measure of general practitioner workload. RESULTS: Higher rates of consultations were found in patients who were classified as permanently sick, unemployed (especially those who became unemployed during the study year), living in rented accommodation, from the Indian subcontinent, living with a spouse or partner (women only), children living with two parents (girls only), and living in urban areas, especially those living relatively near the practice. When characteristics of individual patients are known and controlled for the role of "indices of deprivation" is considerably reduced. The effect of individual sociodemographic characteristics were shown to vary between different areas. CONCLUSIONS: Demographic and socioeconomic factors can act as powerful predictors of consultation patterns. Though it will always be necessary to retain some local planning discretion, the sets of coefficients estimated for individual level factors, area level characteristics, and for practice groupings may be sufficient to provide an indicative level of demand for general medical services. Although the problems in using socioeconomic data from individual patients would be substantial, these results are relevant to the development of a resource allocation formula for general practice.

Adolescent↗

PubMed2001

Access to the evidence base from general practice: a survey of general practice staff in Northern and Yorkshire Region.

AIM: To identify and describe current methods of making health related research evidence accessible to general practice staff in the Northern and Yorkshire Region. METHOD: A postal survey questionnaire of general practice staff in the Northern and Yorkshire Region. RESULTS: At least one completed questionnaire was obtained from 70% of the general practices surveyed, and the individual response rate to the survey was 45%. Just under 60% of all respondents reported having no access to the NHS internet and just under 50% also reported having no access to the internet. All respondents in this survey reported greater access to paper based information than to electronic databases. However, this research provides evidence of differential access to information resources between different professions in general practice with GPs clearly having easier access than other professions to both paper based resources and electronic databases. 70% of all respondents said that they would need to be trained to use either a computer, the internet, or to search databases if the opportunity for easy access to any of these information services was available. CONCLUSIONS: At the time of this survey, general practices seemed to be struggling to set up the infrastructure and develop the skills that are necessary to make best use of available research evidence. In addition, there is a need for further investigation into the reasons why different professions working in the same practice setting have differential access to information resources available in primary care.

Computer User Training↗

PubMed2002

Comparison of patients' and general practitioners' evaluations of general practice care.

OBJECTIVES: To compare patients' and general practitioners' (GPs') evaluations of the quality of general practice care. DESIGN: Written surveys among patients and GPs. SETTING: General practice in the Netherlands. SUBJECTS: 1772 patients (from 45 GPs) and a random sample of 315 GPs. MAIN OUTCOME MEASURES: Patients' and GPs' evaluations of 23 aspects of general practice care and GPs' perceptions of patients' evaluations using a 5 point scale. RESULTS: The response rate was 88% in the patient sample and 63% in the GP sample. The patients' ratings of care were significantly more positive (mean 4.0) than those of the GPs (mean 3.7) as well as GPs' perceptions of patients' evaluations (mean 3.5) (p<0.001). The overall rank order correlations between the patients' evaluations, GPs' evaluations, and GPs' perceptions of the patients' evaluations were 0.75 or higher (p<0.001). Patients and practitioners gave the most positive evaluations of specific aspects of the doctor-patient relationship ("keeping patients' records and data confidential", "listening to patients", and "making patients feel they had enough time during consultations") and aspects of the organisation of care ("provide quick service for urgent health problems" and "helpfulness of the staff (other than the doctor)"). The aspects of care evaluated least positively by patients as well as by GPs were other organisational aspects ("preparing patients for what to expect from specialist or hospital care" and "getting through to practice on the telephone"). CONCLUSIONS: GPs and patients have to some extent a shared perspective on general practice care. However, GPs were more critical about the quality of care than patients and they underestimated how positive patients were about the care they provide. Furthermore, specific aspects of care were evaluated differently, so surveys and other consultations with patients are necessary to integrate their perspective into quality improvement activities.

Adolescent↗

PubMed1996

Comparison of appropriateness of cholesterol testing in general practice with the recommendations of national guidelines: an audit of patient records in 20 general practices.

OBJECTIVE: To compare the profiles of those patients selected by general practitioners for measurement of serum cholesterol with the recommended profiles for opportunistic cholesterol testing described in the national practice guidelines published by the Dutch College of General Practitioners. DESIGN: Retrospective audit of general practitioners' records. MATERIALS: Practice records of 3577 adult patients systematically sampled from 20 general practices. MAIN MEASURES: With criteria set by the national guidelines, the proportion of patients per practice (a) for whom cholesterol testing would be considered justified, and (b) for whom cholesterol testing would be considered unjustified, and the proportion of patients within each of these groups who had had a cholesterol measurement recorded. RESULTS: Cholesterol tests were performed on 415 (11.7%) of the 3577 patients. National guidelines on the management of hypercholesterolaemia state that a positive cardiovascular risk profile is an indication for cholesterol measurement. Just under one fifth (668) of the patients in this study were recorded as having a positive cardiovascular risk profile, but only 31% of these had had their cholesterol measured. Of the patients without recorded evidence of a positive cardiovascular risk profile cholesterol had been measured in 8%. Restricting the analyses to the age group 18-65 (n = 3060) of whom 12.5% had a positive risk profile, did not improve the results. In practices with a computerised information system 37% of patients with recorded evidence of a positive cardiovascular risk profile had had their cholesterol measured. CONCLUSIONS: Cholesterol testing was not targeted as selectively as recommended by the national guidelines. The major problem was failure to test those likely to benefit. Improving the targeting of cholesterol measurements would undoubtedly increase the workload of general practitioners. If the national guidelines are to have an effect on health promotion the first step must be to increase the proportion of patients with positive cardiovascular risk profiles who get their cholesterol tested. A major factor in successfully selecting cases seems to be that practices are equipped with a computerised medical information system.

Adolescent↗

PubMed1986

Generalized anxiety and generalized anxiety disorder: description and reconceptualization.

One hundred eight patients complaining of anxiety were diagnosed using the Anxiety Disorders Interview Schedule and classified into the various anxiety disorder categories as well as major depression. Although patients with a primary diagnosis of generalized anxiety disorder were more chronic than were panic disorder patients, most patients in each category met the DSM-III criteria for generalized anxiety disorder with the exception of simple phobic patients. On the basis of these data, it would seem that generalized anxiety disorder is a residual category within the anxiety disorders, since generalized anxiety disorder symptoms are almost always present. But if one distinguishes anticipatory anxiety, which is often part of panic or phobic disorders, from generalized anxiety, an independent anxiety disorder category emerges. This category is characterized by apprehensive expectation or chronic worry focused on multiple life situations.

Adult↗

PubMed1995

A critical incident study of general practice trainees in their basic general practice term.

OBJECTIVE: To obtain information on the experiences of general practice (GP) trainees during their first general practice (GP) attachment. DESIGN: Critical incident technique--a qualitative analysis of open-ended interviews about incidents which describe competent or poor professional practice. SUBJECTS: Thirty-nine Western Australian doctors from the Royal Australian College of General Practitioners' (RACGP) Family Medicine Program who were completing their first six months of general practice in 1992. RESULTS: Doctors reported 180 critical incidents, of which just over 50% involved problems (and sometimes successes) with: difficult patients; paediatrics; the doctor-patient relationship; counselling skills; obstetrics and gynaecology; relationships with other health professionals and practice staff; and cardiovascular disorders. The major skills associated with both positive and negative critical incidents were: the interpersonal skills of rapport and listening; the diagnostic skills of thorough clinical assessment and the appropriate use of investigations; and the management skills of knowing when and how to obtain help from supervisors, hospitals and specialists. Doctors reported high levels of anxiety over difficult management decisions and feelings of guilt over missed diagnoses and inadequate management. CONCLUSION: The initial GP term is a crucial transition period in the development of the future general practitioner. An analysis of commonly recurring positive and negative critical incidents can be used by the RACGP Training Program to accelerate the learning process of doctors in vocational training and has implications for the planning of undergraduate curricula.

Adult↗

PubMed1998

General hospital and personal use devices: proposed classification of liquid chemical sterilants and general purpose disinfectants--FDA. Proposed rule.

The Food and Drug Administration (FDA) is proposing to classify both liquid chemical sterilants intended for use as the terminal step in processing critical and semicritical medical devices prior to patient use, and general purpose disinfectants intended to process noncritical medical devices and equipment surfaces. Under the proposal, liquid chemical sterilants would be classified into class II (special controls) and general purpose disinfectants would be classified into class I (general controls). FDA also proposes to exempt general purpose disinfectants from the premarket notification requirements. The agency is publishing in this document the recommendations of the General Hospital and Personal Use Devices Panel (the Panel) regarding the classification of these devices. After considering public comments on the proposed classification, FDA will publish a final regulation classifying these devices. This action is being taken to establish sufficient regulatory controls that will provide reasonable assurance of the safety and effectiveness of these devices.

Device Approval↗

PubMed2001

Patients in general practice in Denmark referred to physiotherapists: a description of patient characteristics based on general health status, diagnoses, and sociodemographic characteristics.

BACKGROUND AND PURPOSE: Both musculoskeletal illness and mental illness characterized by somatic symptoms are common in primary care, and it is hypothesized that many patients with musculoskeletal illness have relatively poor mental health. The purpose of this study was to describe the characteristics of patients in general practice in Denmark who are referred to physiotherapists with signs and symptoms of musculoskeletal illness. SUBJECTS AND METHODS: One hundred ninety-four general practitioners, representing 124 practices, participated in a survey of 2,042 consecutive patients with musculoskeletal illness. RESULTS: The diagnoses were generally poorly defined. Compared with the general population, patients with musculoskeletal illness had markedly poorer physical health and poorer mental health. Patients with poorly defined diagnoses did not differ from patients with well-defined diagnoses in terms of physical health, but they scored lower on the mental health component summary scale of the Danish version of the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). CONCLUSION AND DISCUSSION: Of patients referred to physiotherapists by general practitioners in Denmark, the subgroup with poorly defined diagnoses had lower mental health scores than those with well-defined diagnoses, suggesting that a biopsychosocial approach to care may be appropriate for this group of patients.

Adult↗

PubMed2001

Randomized controlled trial of general practitioner tutor visit or mailing to encourage general practice-based education.

OBJECTIVES: Evaluation of a general practitioner tutor visit, or mailing, with regard to the amount of practice-based education occurring in general practices. DESIGN: An initial survey of all practices in the Mersey Deanery was undertaken. General practices which replied were randomly allocated to receive a GP tutor visit (n=38), to receive a mailing (n=38) or to a control group (n=36). Visits carried out by tutors covered a loosely agreed format. All practices were sent a follow-up survey identical to the original one at 6 months after the intervention. SETTING: General practices in the Mersey Deanery, north-west England. SUBJECTS: General practices which had replied to an initial survey. RESULTS: The amount of both specifically arranged and informal practice-based meetings increased in all groups. No changes were statistically significant. CONCLUSIONS: This study illustrates the difficulty of assessing educational interventions by randomized controlled trials. Such interventions are often expensive, complex and difficult to standardize. A substantial amount of practice-based education is taking place.

Education, Medical, Continuing↗

PubMed1992

Educating students with mild handicaps in general classrooms: essential teaching practices for general and special educators.

This study was designed to identify and validate essential teaching practices needed by both general and special educators to successfully educate students with mild handicaps in general classrooms. An interdisciplinary panel of 105 experts, evenly divided into university-based and field-based participants from 35 states, identified 96 of 125 practices in six categories as being essential for effective teaching of mainstreamed students with mild handicaps. Based on a two-round Delphi procedure, a substantial majority (82%) of these teaching practices were seen as being essential for both general and special educators across all six rated categories. Panel ratings were significantly higher for special educators than general educators on four of the six categories. No significant differences in ratings were found for university-based versus field-based panelists, or for field-based panelists who were professionals directly involved in elementary or secondary teaching roles versus administrators, supervisors, and consultants. Based on essential teaching practices validated in this study, implications for preservice teacher preparation and staff development programs for general and special educators are discussed.

Persons with Disabilities↗

PubMed1989

[Diagnostic activity in general practice. 2. Frequency of examination of urinary glucose and blood pressure determination among patients in general practice].

In order to estimate how frequently examinations of urine for glucosuria and blood pressure measurements are performed in the primary health care sector to detect common incapacitating diseases such as diabetes and hypertension, the authors carried out a study in five general practices in Denmark for a period of five years. The study was retrospective because it is not possible to study one's own behaviour prospectively. Nearly 1,000 persons aged 30 years or more were involved. 9% of the group had no contact with the health care sector during the period. In 49%, the urine had been tested at least once for glucose; 58% where women were concerned but only 40% of the men. Men under the age of 55 years were significantly underrepresented. Examination of the urine was only undertaken in 51% of the persons aged 55-74 years. Twelve new cases of diabetes were discovered, nine of these were diagnosed in general practice. Hypertension had been diagnosed in 52 patients before the registration period. 60% of the remainder had blood pressure measurements on at least one occasion during the period. Men under 55 years were significantly underrepresented (42%). Sixty-four new cases of hypertension were discovered, 59 of these in general practice. Screening for common diseases such as these is primarily performed by general practitioner. Several other works from general practice where no special efforts were made to systematize screening for diabetes or hypertension did not reveal any better results. It is estimated that 25% of diabetic patients and 50% of hypertensive patients remain undiagnosed. The present rather random screening for these diseases is insufficient.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗