Influence of patient symptoms and physical findings on general practitioners' treatment of respiratory tract infections: a direct observation study

BACKGROUND: The high rate of antibiotic prescriptions general practitioners (GPs) make for respiratory tract infections (RTI) are often explained by non-medical reasons e.g. an effort to meet patient expectations. Additionally, it is known that GPs to some extent believe in the necessity of antibiotic treatment in patients with assumed bacterial infections and therefore attempt to distinguish between viral and bacterial infections by history taking and physical examination. The influence of patient complaints and physical examination findings on GPs' prescribing behaviour was mostly investigated by indirect methods such as questionnaires. METHODS: Direct, structured observation during a winter "cough an cold period" in 30 (single handed) general practices. All 273 patients with symptoms of RTI (age above 14, median 37 years, 51% female) were included. RESULTS: The most frequent diagnoses were 'uncomplicated upper RTI/common cold' (43%) followed by 'bronchitis' (26%). On average, 1.8 (95%-confidence interval (CI): 1.7–2.0) medicines per patient were prescribed (cough-and-cold preparations in 88% of the patients, antibiotics in 49%). Medical predictors of antibiotic prescribing were pathological findings in physical examination such as coated tonsils (odds ratio (OR) 15.4, 95%-CI: 3.6–66.2) and unspecific symptoms like fatigue (OR 3.1, 95%-CI 1.4–6.7), fever (OR 2.2, 95%-CI: 1.1–4.5) and yellow sputum (OR 2.1, 95%-CI: 1.1–4.1). Analysed predictors explained 70% of the variance of antibiotic prescribing (R(2 )= 0,696). Efforts to reduce antibiotic prescribing, e.g. recommendations for self-medication, counselling on home remedies or delayed antibiotic prescribing were rare. CONCLUSIONS: Patient complaints and pathological results in physical examination were strong predictors of antibiotic prescribing. Efforts to reduce antibiotic prescribing should account for GPs' beliefs in those (non evidence based) predictors. The method of direct observation was shown to be accepted both by patients and GPs and offered detailed insights into the GP-patient-interaction

Validation of a parent outcome questionnaire from pediatric cochlear implantation.

This paper analyzes the reliability and validity of a questionnaire designed by Archbold, Lutman, Gregory, O'Neil, and Nikolpoulos (2002) for the assessment of pediatric cochlear implantation. Parents of 61 youngsters (age range 5 to 16 years), who had the implant for at least 3 years, responded to the questionnaire and to an interview. The alpha reliability of the 11 questionnaire scales varied between .41 and .74. Content validity was assessed by comparison with parents' responses to an interview. In general, there was agreement between parents' concerns and views expressed in the interview and as assessed by the questionnaire. However, extra issues were identified in the interview, which suggest the need for increasing the breadth of the questionnaire. Criterion validity was assessed by identifying contrasting cases, with very low or very high scores in each scale, and analyzing the descriptions obtained in the interviews. For nine scales this analysis provided support for the validity of the questionnaire; two scales did not produce positive results. Correlations with interview scores were calculated for only four scales: two were positive and significant whereas two were not significant. A factor analysis of the questionnaire scales identified four components, interpreted as the child's functioning in social situations, attitudes to the process of implantation, support required in the long term, and effective use of the implant. Suggestions for further research and descriptive comments provided by parents are included

Deaf children's social relationships in mainstream schools

Arguments supporting the integration of deaf pupils in mainstream schools are often based on possible cognitive gains, but it has been suggested that integration should also be assessed in terms of its social consequences for pupils. If deaf pupils are rejected or feel isolated in mainstream schools, their education may ultimately suffer. We investigated the social adaptation of nine deaf pupils in two mainstream schools using three methods: peer ratings, sociometric status and interviews. The average peer ratings received by deaf pupils were not significantly different from those of hearing pupils. Thus these deaf pupils were not more disliked by their peers. However, they were significantly more likely to be neglected by their peers and less likely to have a friend in the classroom. Hearing pupils who were friends of deaf pupils described their friendship as involving pro-social functions whereas many who had no deaf friends found communication an obstacle to friendship. We conclude that, although deaf pupils are not rejected in mainstream schools, they may feel isolated. It is possible that schools can have a proactive role in helping hearing pupils learn how to overcome communication barriers and develop more positive attitudes towards deaf pupils

An intervention program for teaching children about morphemes in the classroom: Effects on spelling

In the previous chapter, we saw that teaching children about morphemes has a strong and positive effect on their ability to analyze words into morphemes and to spell their suffixes. This seems to apply not only when children are taught on a one-to-one basis or in small groups but also when the teaching is delivered to the whole class. However, in the studies we have discussed so far, the teaching was always delivered by researchers, unaffected by the daily pressures of school life, or by teachers working in close connection with researchers. In this and in the following chapter we will describe a project that assessed how our ideas work when used by teachers in real-life classroom settings and as part of their normal teaching. This chapter concentrates on the effects that the teaching program had on the children's ability to spell

What knowledge of morphemes do children and adults show in the way that they spell words?

Our book has two aims. Its first is to persuade our readers that morphemes are extremely important for children learning to read and write. Our second aim is to describe a set of studies that we carried out on teaching children about morphemes and their relation to written words. The first two chapters in the book are all about the first of these two aims. In the remaining chapters we will try to fulfill our second aim by describing our work on teaching children about morphemes and spelling. In the first chapter we showed how many spelling principles in English and in several other languages are based on morphemes, and we also reported some research that established the existence of a strong relationship between children's knowledge of the morphemic structure of spoken words and the progress that they make in learning about written words. In this second chapter we shall look at a series of studies on children's actual spellings and examine what they tell us about their morphemic knowledge and about the way that they are using this knowledge in their writing. So this chapter focuses on what we can find out about people's knowledge of morphemes if we treat spelling as a window on their knowledge of morphemes. We shall show how children's spellings tell us a great deal about their knowledge of morphemes. In the studies that we shall describe we used three different techniques to detect how people use morphemes in spelling. In these tasks we ask children: 1. to spell words that contain a morpheme whose spelling cannot be entirely predicted from the way that it sounds but can be predicted on the basis of how that morpheme is spelled: For example, the past-tense ending; 2. to spell pseudowords which contain particular morphemes: We create invented words using actual stems and affixes, place them in sentences that clearly identify the word type, and ask the children to spell the pseudoword that we dictate to them; 3. to spell some real words and pseudowords and then to explain their choice of spelling. We carried out many different studies using these techniques. The results of these studies tell us a great deal about what children (and adults) know about morphemes without much explicit teaching, because there is currently little teaching about English morphemes in English schools. This chapter presents a summary of what we found out. The sections are organized by the target spellings and the aims of each of the studies. The first section focuses on suffixes that have a fixed spelling which is not completely predictable from oral language. The second section focuses on the spelling of stems. The third section focuses on how children and adults spell pseudowords made with real stems and suffixes and the explanations that they give for their choice of spellings. The final section presents an overview of the results and raises questions about the possibility of improving children's knowledge of morphemes through teaching. Although the focus of the chapter is on spelling, the aim of our investigations is to understand the connection between knowledge of morphemes and literacy in a broader and a better way

An intervention program for classroom teaching about morphemes: Effects on the children's vocabulary

We have now described, in Chapters 3 and 4, how our ideas about teaching morphemes fared when we took the path to the classroom and asked schoolteachers to use our methods with whole classes of children. In this chapter we shall describe what happened when we took the same path with our idea that teaching children about morphemes should help them to learn new words as well. We had three reasons for investigating whether teaching children about morphemes has a positive effect on their vocabulary growth. The first is that various theories (see Chapter 1) suggest that growth in vocabulary is a possible outcome of enhancing children's awareness of morphemes. Morphemes are units of meaning, and most of the words that children learn from the middle of primary school on are polymorphemic words. So, if children have a way of analyzing these words, they might find them easier to learn. The second reason is that vocabulary is an important part of literacy learning: Children's text comprehension is highly related to the size of their vocabulary. The third reason is also important: Research on how to teach children about vocabulary has dealt predominantly with the question of how to teach specific new words. This research focuses mainly on how many repetitions are required and whether it is best to get the children to encounter new words in a text or in isolation, to provide them with definitions or with different sentences in which the meaning and use of the word is illustrated. Our own idea is different to this. We argue that teaching children word-attack strategies based on morphemes should help them to analyze new words in order to understand their meaning. We carried out the next study to test this idea

What knowledge of morphemes do children and adults show in the way that they spell words?

Our book has two aims. Its first is to persuade our readers that morphemes are extremely important for children learning to read and write. Our second aim is to describe a set of studies that we carried out on teaching children about morphemes and their relation to written words. The first two chapters in the book are all about the first of these two aims. In the remaining chapters we will try to fulfill our second aim by describing our work on teaching children about morphemes and spelling. In the first chapter we showed how many spelling principles in English and in several other languages are based on morphemes, and we also reported some research that established the existence of a strong relationship between children's knowledge of the morphemic structure of spoken words and the progress that they make in learning about written words. In this second chapter we shall look at a series of studies on children's actual spellings and examine what they tell us about their morphemic knowledge and about the way that they are using this knowledge in their writing. So this chapter focuses on what we can find out about people's knowledge of morphemes if we treat spelling as a window on their knowledge of morphemes. We shall show how children's spellings tell us a great deal about their knowledge of morphemes. In the studies that we shall describe we used three different techniques to detect how people use morphemes in spelling. In these tasks we ask children: 1. to spell words that contain a morpheme whose spelling cannot be entirely predicted from the way that it sounds but can be predicted on the basis of how that morpheme is spelled: For example, the past-tense ending; 2. to spell pseudowords which contain particular morphemes: We create invented words using actual stems and affixes, place them in sentences that clearly identify the word type, and ask the children to spell the pseudoword that we dictate to them; 3. to spell some real words and pseudowords and then to explain their choice of spelling. We carried out many different studies using these techniques. The results of these studies tell us a great deal about what children (and adults) know about morphemes without much explicit teaching, because there is currently little teaching about English morphemes in English schools. This chapter presents a summary of what we found out. The sections are organized by the target spellings and the aims of each of the studies. The first section focuses on suffixes that have a fixed spelling which is not completely predictable from oral language. The second section focuses on the spelling of stems. The third section focuses on how children and adults spell pseudowords made with real stems and suffixes and the explanations that they give for their choice of spellings. The final section presents an overview of the results and raises questions about the possibility of improving children's knowledge of morphemes through teaching. Although the focus of the chapter is on spelling, the aim of our investigations is to understand the connection between knowledge of morphemes and literacy in a broader and a better way

An intervention program for teaching children about morphemes in the classroom: Effects on spelling

In the previous chapter, we saw that teaching children about morphemes has a strong and positive effect on their ability to analyze words into morphemes and to spell their suffixes. This seems to apply not only when children are taught on a one-to-one basis or in small groups but also when the teaching is delivered to the whole class. However, in the studies we have discussed so far, the teaching was always delivered by researchers, unaffected by the daily pressures of school life, or by teachers working in close connection with researchers. In this and in the following chapter we will describe a project that assessed how our ideas work when used by teachers in real-life classroom settings and as part of their normal teaching. This chapter concentrates on the effects that the teaching program had on the children's ability to spell