Robert A Elton

Publications of Robert A Elton

• Comparison of the accuracy of patients' recall of the content of telephone and face-to-face consultations: an exploratory study.

  Authors: Brian McKinstry, Philip Watson, Robert A Elton, Hilary Pinnock, Gillian Kidd, Barbara Meyer, Robert Logie, Aziz Sheikh

  Postgraduate medical journal. 03/2011; 87(1028):394-9.

  BACKGROUND To comply with an action plan patients need to recall information accurately. Little is known about how well patients recall consultations, particularly telephone consultationsBACKGROUND To comply with an action plan patients need to recall information accurately. Little is known about how well patients recall consultations, particularly telephone consultations increasingly used to triage acute problems. PURPOSE OF STUDY This was an exploratory study to measure how accurately patients recall the content of face-to-face and telephone consultations and what factors may be associated with accurate recall. STUDY DESIGN In Scotland in 2008, the advice (diagnoses; management plan(s); and safety-netting arrangements) given in audio recorded face-to-face and telephone consultations was compared with the advice recalled by patients at interview approximately 13&emsp14;days later. Patients also performed a memory test. Interactions were sought between accurate recall, consultation type, and factors postulated to influence recall. RESULTS Ten general practitioners (GPs) and 175 patients participated; 144 (82%) patients were interviewed. Patients recalled most important components of telephone and face-to-face consultations equally accurately or with only minor errors. Overall, patients presenting multiple problems (p<0.001), with brain injury (p<0.01) or low memory score (p<0.01) had reduced recall. GPs rarely used strategies to improve recall; however, these were not associated with improved recall. CONCLUSIONS Contrary to previous hospital based research, patients tended to remember important components of both face-to-face and telephone consultations-perhaps reflecting the familiar, less anxiety provoking environment of primary care. The unsuccessful use of strategies to improve recall may reflect selective use in cognitively impaired patients. Clinicians should compensate for situations where recall is poorer such as patients presenting multiple problems or with brain injury. Patients might be advised to restrict the number of problems they present in any one consultation.

• Does socio-economic status modify the effect of particulate air pollution on cardiorespiratory mortality?

  Authors: Melanie Carder, Roseanne McNamee, Iain Beverland, Robert A Elton, Geoff Cohen, James Boyd, Martie van van Tongeren, Raymond M Agius

  Occupational and environmental medicine. 09/2009;

  OBJECTIVES: To investigate whether deprivation index modifies the acute effect of black smoke on cardiorespiratory mortality. METHODS: Generalised linear Poisson regression models were used toOBJECTIVES: To investigate whether deprivation index modifies the acute effect of black smoke on cardiorespiratory mortality. METHODS: Generalised linear Poisson regression models were used to investigate whether deprivation index (as measured by the Carstairs deprivation index) modified the acute effect of black smoke on mortality in the two largest Scottish cities (Glasgow and Edinburgh) between January 1981 and December 2001. Lag periods of up to one month were assumed for the effects of black smoke. RESULTS: Deprivation index significantly modified the effect of black smoke on mortality with black smoke effects generally increasing as level of deprivation increased. The interaction coefficient from a parametric model assuming a linear interaction between black smoke (microgm-3) and deprivation in their effect on mortality - equivalent to a test of 'linear trend' across Carstairs Categories - was significant for all mortality outcomes. In a model where black smoke effects were estimated independently for each deprivation category, the estimated increase in respiratory mortality over the ensuing one-month period associated with a 10microgm-3 increase in the mean black smoke concentration was 8.0 percent (95% CI: 5.1, 10.9) for subjects residing in the 'most' deprived category (Carstairs category 7) compared to 3.7 percent (95% CI: -0.7, 8.4) for subjects residing in the 'least' deprived category (Carstairs category 1). CONCLUSIONS: The results suggest a stronger effect of black smoke on mortality among people living in more deprived areas. The effect was greatest for respiratory mortality although significant trends were also seen for other groups. If corroborated, these findings could have important public health implications.

• A time-series study of the health effects of water-soluble and total-extractable metal content of airborne particulate matter.

  Authors: Mathew R Heal, Robert A Elton, Leon R Hibbs, Raymond M Agius, Iain J Beverland

  Occupational and environmental medicine. 06/2009;

  OBJECTIVES: To assess whether adverse acute cardiopulmonary health outcomes are associated with concentration of trace metals in airborne particulate matter. METHODS: Daily PM10 and PM2.5 wasOBJECTIVES: To assess whether adverse acute cardiopulmonary health outcomes are associated with concentration of trace metals in airborne particulate matter. METHODS: Daily PM10 and PM2.5 was collected for one year in Edinburgh, UK, and the water-soluble and total-extractable content of 11 trace metals determined in each sample. Time series were analysed using generalised additive Poisson regression models, including adjustment for minimum temperature and loess smoothing of trends. Methods were explored of extending the time series of metal concentration in daily PM10 for the previous 7 years using multiple regression of the variation in metal content for the 1 year of measurements and the associated variation in air mass source region and other concurrently-measured potential predictor variables. RESULTS: The 1 year of direct measurements showed no evidence of significant associations of particle-bound metal concentration with health outcomes beyond that expected by chance. Analysis of the extended time series showed significant positive associations with cardiovascular admissions both for total PM10 and for a number of the metals (e.g. Cu, Fe, Ni, V, Zn) but the metal effects were no longer significant after adjusting for PM10. CONCLUSIONS: Within the limitations of its power, the epidemiological results have not provided evidence for associations between particle-bound metal concentrations and adverse health outcomes that are substantially greater than for total PM. The generally strong correlations between metal and total PM suggest that quantifying independent effects of PM metal exposure on health will be difficult, even using more powerful time series of direct measurements.

• Leniency and halo effects in marking undergraduate short research projects.

  Authors: Brian H McKinstry, Helen S. CAMERON, Robert A Elton, Simon C. RILEY

  BMC medical education. 11/2004; 4(1):28.

  BACKGROUND: Supervisors are often involved in the assessment of projects they have supervised themselves. Previous research suggests that detailed marking sheets may alleviate leniency and haloBACKGROUND: Supervisors are often involved in the assessment of projects they have supervised themselves. Previous research suggests that detailed marking sheets may alleviate leniency and halo effects. We set out to determine if, despite using such a marking schedule, leniency and halo effects were evident in the supervisors' marking of undergraduate short research projects (special study modules (SSM)). METHODS: Review of grades awarded by supervisors, second markers and control markers to the written reports of 4th year medical students who had participated in an SSM during two full academic years (n = 399). Paired t-tests were used to compare mean marks, Pearson correlation to look at agreement between marks and multiple linear regression to test the prediction of one mark from several others adjusted for one another. RESULTS: There was a highly significant difference of approximately half a grade between supervisors and second markers with supervisors marking higher. (t = 3.12, p < 0.01, difference in grade score = 0.42, 95% CI for mean difference 0.18-0.80). There was a high correlation between the two marks awarded for performance of the project and the written report by the supervisor (r = 0.75), but a low-modest correlation between supervisor and second marker (r = 0.28). Linear regression analysis of the influence of the supervisors' mark for performance on their mark for the report gave a non-significant result. This suggests a leniency effect but no halo effect. CONCLUSIONS: This study shows that with the use of structured marking sheet for assessment of undergraduate medical students, supervisors marks are not associated with a halo effect, but leniency does occur. As supervisor assessment is becoming more common in both under graduate and postgraduate teaching new ways to improve objectivity in marking and to address the leniency of supervisors should be sought.

• Low birth weight predicts higher blood pressure but not dermal capillary density in two populations.

  Authors: R John Irving, Angela C Shore, Neville R Belton, Robert A Elton, David J Webb, Brian R Walker

  Hypertension. 03/2004; 43(3):610-3.

  The association between low birth weight and high blood pressure is well established, but underlying mechanisms remain undefined. Vascular rarefaction, which may elevate peripheral vascularThe association between low birth weight and high blood pressure is well established, but underlying mechanisms remain undefined. Vascular rarefaction, which may elevate peripheral vascular resistance, has been observed in capillaries of young men at risk for hypertension and men who had low birth weight. We looked for evidence that capillary rarefaction explains the association of low birth weight with high blood pressure in two cohorts. Participants in study 1 included 107 healthy boys aged 6 to 16 years recruited at random from a single school. Study 2 included 61 members of a cohort recruited at birth and studied at age 24 years. Measurements included indices of current size, blood pressure by automated sphygmomanometer, and dermal capillary density by video capillaroscopy of dorsal index finger skin after 10 minutes of venous occlusion. Lower birth weight predicted higher systolic blood pressure in both studies: in study 1, 3.57 mm Hg/kg birth weight (after adjustment for current height, 95% confidence interval 0.38 to 6.75, P<0.05); in study 2, 122+/-12 mm Hg in low birth weight (<2 kg) versus 115+/-9 in controls (P<0.05). Dermal capillary density was not associated in either group with birth weight or systolic blood pressure. We have found no evidence in these 2 cohorts that reduced capillary density explains the associations between lower birth weight and higher blood pressure.

• Trial of the effects of an advice and relaxation tape given within the first 24 h of admission to hospital with acute myocardial infarction.

  Authors: Robert J P Lewin, David R Thompson, Robert A Elton

  International journal of cardiology. 03/2002; 82(2):107-14; discussion 115-6.

  BACKGROUND: The study was performed to examine the effects of giving patients with acute myocardial infarction an advice and relaxation audio tape within 24 h of admission to hospital. METHODS: ABACKGROUND: The study was performed to examine the effects of giving patients with acute myocardial infarction an advice and relaxation audio tape within 24 h of admission to hospital. METHODS: A prospective, two-group design was used with 243 subjects randomised to receive either the advice and relaxation tape or a music tape of their choice within 24 h of sustaining a myocardial infarction. Outcomes comprised anxiety, cardiac misconceptions, lifestyle change, attendance at a cardiac rehabilitation programme, and quality of life. RESULTS: Although the advice and relaxation tape reduced the number of cardiac misconceptions this did not lead to any improvements in outcome, whilst in hospital or at 6 months. Both tapes were equally appreciated by the patients, 98% of whom said that they would recommend them to other patients. CONCLUSIONS: An advice and relaxation tape reduces cardiac misconceptions but does not confer any other benefits over a music tape.

• Blood group and susceptibility to disease caused by Escherichia coli O157.

  Authors: C Caroline Blackwell, Stephanie Dundas, Valerie S James, Doris A C Mackenzie, Jan M Braun, Abdulhamid M Alkout, W T Andrew Todd, Robert A Elton, Donald M Weir

  The Journal of infectious diseases. 03/2002; 185(3):393-6.

  Patients (n=186) infected during the Escherichia coli O157 outbreak in Scotland in 1996 were assessed for blood group markers (ABO, Lewis, and P) associated with other gastrointestinal infections.Patients (n=186) infected during the Escherichia coli O157 outbreak in Scotland in 1996 were assessed for blood group markers (ABO, Lewis, and P) associated with other gastrointestinal infections. Binding of bacteria to epithelial cells was assessed by flow cytometry. Buffy coats from blood donors were examined for inflammatory responses to culture filtrates of the outbreak strain. Individuals of blood group O comprised 63.4% of patients, compared with 53.4% (P <.05) and 53.9% (P <.01) of neighboring populations in Airdrie and Glasgow, respectively; group O also comprised 64.3% of patients with hemolytic uremic syndrome (HUS) and 87.5% of patients who died (P <.05). No or weak agglutination by anti-P antiserum was observed for 40.7% of control persons (n=122), 61.5% of all patients (P =.0027), and 83.3% of patients with HUS (P =.013). The susceptibility of group O to E. coli was not associated with increased binding of bacteria to epithelial cells or with higher production of tumor necrosis factor (TNF)-alpha or interleukin-6. Leukocytes of P-negative blood donors produced higher levels of TNF-alpha than those of P-positive donors.