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Biomedical subjects

J Feather

Publications and source records attributed to J Feather.

At least 19 recordsLinked to original sources
PubMed1999

A story/dialogue method for health promotion knowledge development and evaluation.

Arguments have been made in favour of a constructivist or postpositivist approach to health promotion knowledge development and program evaluation, but little has been articulated about what such an approach would look like. This article describes a 'story/dialogue method' that was created with and for practitioners in response to their concerns that much of their practice did not lend itself to a positivist, or conventional, methodology. Derived from constructivist, feminist and critical pedagogical theory, and with roots in qualitative methods, the method structures group dialogue around case stories addressing particular generative practice themes. While intended for practitioner training, organizational development and evaluation, the method to date has been used primarily for training purposes. This article describes the method, provides an example of its application, and discusses its strengths, weaknesses and relevance to health promotion.

Anecdotes as Topic↗
PubMed1996

Preserving the patient referral process in the managed care environment.

Referrals are a central component of the American health care system, defining the relationship among generalists, patients, and specialists. The dynamics of the referral process as they existed in a fee-for-service medical environment will evolve under managed care, but retain the basic "Try-out" approach of the generalist and "Rule-out" approach of the specialist. A managed care, contract-based health care system alters some of the assumptions on which the referral relationship has been structured. A four-step approach to assuring quality interactions among patient, generalist, and specialist within the managed care environment is described, including: (1) engage; (2) anticipate; (3) feedback; and (4) reassess. When the referral process is structured as suggested, it can be evaluated for quality and efficacy. Armed with mutual respect and understanding, the forces that polarized specialist and generalist care in the 1980s can be redirected to enhancing patient care in the 1990s.

Communication↗
PubMed1995

Enhancing physician adoption of practice guidelines. Dissemination of influenza vaccination guideline using a small-group consensus process.

BACKGROUND: A dissemination intervention to facilitate adoption of a preventive practice guideline (influenza vaccination for older adults) in group practices was developed and evaluated. The intervention, small-group consensus process, started with a physician expert presenting the guideline and followed with the group participating in a structured discussion of ways to implement the guideline that culminated in a public commitment (ie, "buy in") to adopt the guideline. METHODS: Thirteen group practices and their primary care physicians (mean size, 5) were assigned randomly to intervention or control arms. In each group practice, physicians in the intervention arm met for 1 hour. Control physicians participated in an unrelated discussion (non-steroidal drug use). Guideline adoption was determined by changes in physicians' vaccination rates that were obtained through prechart and postchart reviews of 51 physicians. Prequestionnaires and postquestionnaires measured influenza knowledge and prevention attitudes. RESULTS: Using analysis of covariance, the small-group consensus process was found to increase physician vaccination rates by 34% compared with the control arm (F (1,48) = 19.49). All intervention arm physicians increased vaccination rates from before to after compared with 54% of control arm physicians. Attitudes and knowledge did not change and were unrelated to increased vaccination rates. CONCLUSIONS: A case is made for the small-group consensus process as an effective utilization-focused dissemination method. Interventions based on group dynamics and sensitive to local practice contexts can be useful in facilitating adoption of guidelines by physicians in group practices.

Decision Making↗
PubMed1993

Factors in perceived hospital discharge planning effectiveness.

Hospital discharge planning is the process of assessing the needs of hospitalized patients for post-acute care and developing a coordinated plan to provide the care needed. It is an important component of both the financial viability of the hospital and of the overall quality of care provided to the patient across health care settings, and has historically been an important part of social work practice. This research, based on a random sample survey of U.S. non-federal acute medical/surgical hospitals (N = 378 hospitals), suggests those variables that may be most important in shaping the effectiveness of the hospital discharge planning program. A multivariate analysis framework is used to identify those variables that have the strongest independent effect on effectiveness, and to assess the relative strength of each. Power (including discharge planner influence and physician and hospital administrator support) and role clarity emerge as the most important predictors of perceived effectiveness. The model of discharge planning used and characteristics of the hospital (such as size or urban-rural location) are not significant independent predictors. The single most important factor is cooperation and support from the physician staff of the hospital. This research suggests that organizational factors, rather than the use of a particular "system" of discharge planning, may be most important in discharge planning effectiveness.

Activities of Daily Living↗
PubMed1991

Radon exposure, cigarette smoking, and other mining experience in the beaverlodge uranium miners cohort.

A nested case-control study within the Beaverlodge Uranium Miners Cohort was undertaken to assess any possible contribution of confounding by smoking and other mining experience to the risk estimate derived from the original cohort study. Next of kin have been interviewed for 46 lung cancer cases and 95 controls enrolled in the Beaverlodge Uranium Miners Cohort Study who died between 1950 and 1980. Confounding by cigarette smoking and other mining experience appears unlikely to have contributed to the relative risk coefficient for exposure to Rn decay products derived in the parent study. Data for smoking and exposure to Rn decay products are consistent with a multiplicative model, although considerable caution must be applied to this interpretation.

Case-Control Studies↗
PubMed1987

Clinical features of pulmonary tuberculosis in young and old veterans.

Pulmonary tuberculosis (TB) continues to pose a health threat to the elderly population. In order to delineate age-related differences in disease presentation a comparison between young and old male veterans hospitalized over a five-year period with culture proven Mycobacterium tuberculosis is reported. The study sample included 27 patients 60 years of age and older (range, 60 to 85; mean, 70) and 52 patients under 60 years of age (range, 22 to 59; mean, 51). The elderly were significantly less likely to demonstrate cavitary lesions on admission radiographs or present with hemoptysis but were more likely to present with right lower lobe infiltrates and complaints of dyspnea. Symptoms prior to admission occurring with equal frequency in both young and old subjects included fever, anorexia, weight loss, and cough. Although treatment was delayed in the elderly, there were no age-related differences in mortality. Skin testing was underutilized in all patients regardless of age. The results support the notion that the clinical presentation of pulmonary TB is remarkably similar in young and old males.

Adult↗
PubMed1982

Using macro variables in program evaluation.

This paper discusses the importance of using macro-level variables for program analysis. It is argued that three types of macro variables--cultural, economic, and demographic--provide a context for evaluation, and offer alternative explanations for the success or failure of a program. The problems of causality and availability of data are discussed. Macro variables are seen to be especially useful in "meta evaluation," and in integrating the results of specific program evaluations into general conclusions.

Culture↗
PubMed1978

A comparison of dietary methods in epidemiologic studies.

Three methods of estimating group and individual dietary consumption have been developed and assessed in a case-control study of diet and breast cancer. The methods comprised a 24-hour recall, a detailed quantitative diet history directed to the most recent two-month period and the two-month period six months before, and a four-day diet diary. There is a high degree of correlation between the estimates of food consumption for the controls using each of the methods. The highest estimate was obtained from the diet history, with a slightly higher estimate in the period six months before than the current period, while the lowest is found in the 24-hour recall. The latter corresponds with the same method in a Nutrition Canada Survey. It is concluded that all methods ara applicable to case-control studies, but the diet history is preferred when current food intake may be influenced by a disease.

Breast Neoplasms↗
PubMed1978

A study of diet and breast cancer.

A case-control study has been conducted in four areas in Canada in which 400 cases of breast cancer matched by age and marital status with neighborhood controls were administered a medical and dietary history questionnaire, a 24-hour recall for dietary information and a four-day diet record. The Study has produced evidence of an association between an increased intake of nutrients, especially total fat, in both pre-menopausal and post-menopausal women with breast cancer. Reasons why a weak association might have been anticipated are discussed, and it is concluded that in reality the association is stronger. Furthermore, its consistency with other evidence, both experimental and international, suggests that it is causal.

Age Factors↗
PubMed1978

An epidemiologic study of breast cancer.

A case-control study has been conducted in four areas of Canada in which 400 cases of breast cancer matched by age and marital status with neighborhood controls were administered medical and dietary questionnaires. The study is suggestive of an increased risk of breast cancer in post-menopausal women with younger age at menarche and an increased risk with delay of age at natural menopause. No protective effect of early age at first pregnancy was demonstrated in either pre- or post-menopausal women. An increased frequency of pregnancies of four months duration or less was found in cases compared to controls and a greater frequency in pre-menopausal cases compared to controls of a history of irregular menstrual periods. In pre-menopausal women no association has been found between increased height and weight as risk factors for breast cancer. For post-menopausal women, however, a weak association with increased height has been found, while a strong association with increased weight both at the time of menopause and the 12 months preceding diagnosis has ben confirmed.

Adolescent↗
PubMed1976

Utilization of health services in Western Canada: basic Canadian data from the World Health Organization/International Collaborative Study of Medical Care Utilization.

In a household health survey more than 15 000 individuals in four areas of Canada were interviewed as part of the World Health Organization/International Collaborative Study of Medical Care Utilization. Data were collected to describe the health services system in each area and to measure the population's utilization of health professionals, hospitals, medicines and selected preventive services, perceived acute and chronic morbidity, attitudes and beliefs about health and health care, and sociodemographic characteristics. The proportion of persons with perceived morbidity was twice that of persons reporting visits with a physician in the same 2-week period. Prescribed and nonprescribed medications had been used by more than 50% of respondents in each area in the 2 days before the interview, nonprescribed medicines accounting for more than half of this use. Respondents were found to be more sceptical of medical doctors than of medical science.

Attitude to Health↗
PubMedDate not supplied

Duplication of well-baby services.

Parents, community health nurses (CHNs) and physicians in Saskatoon were surveyed to determine if specific components of well-baby services provided by CHNs and physicians were duplicated. A response was obtained from 348 (81%) of the parents, 34 (89%) of the CHNs and 129 (87%) of the physicians. Results of the study indicate that there is extensive duplication of measurements taken by CHNs and physicians at the two, four, six, and twelve-month well-baby visits, especially that of height and weight. Content of well-baby care was also examined. The percentage of both physicians and CHNs who "usually or always" perform specific tasks at each well-baby visit was very high, particularly screening tests and inquiries about nutrition. Assessments and inquiries regarding development were performed less frequently, as were inquiries about safety issues.

Canada↗