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Biomedical subjects

James A Hanley

Publications and source records attributed to James A Hanley.

41 records · Page 3Linked to original sources
PubMed2002

Association between licensure examination scores and practice in primary care.

CONTEXT: Standards for licensure are designed to provide assurance to the public of a physician's competence to practice. However, there has been little assessment of the relationship between examination scores and subsequent practice performance. OBJECTIVE: To determine if there is a sustained relationship between certification examination scores and practice performance and if licensing examinations taken at the end of medical school are predictive of future practice in primary care. DESIGN, SETTING, AND PARTICIPANTS: A total of 912 family physicians, who passed the Québec family medicine certification examination (QLEX) between 1990 and 1993 and entered practice. Linked databases were used to assess physicians' practice performance for 3.4 million patients in the universal health care system in Québec, Canada. Patients were seen during the follow-up period for the first 4 years (1993 cohort of physicians) to 7 years (1990 cohort of physicians) of practice from July 1 of the certification examination to December 31, 1996. MAIN OUTCOME MEASURES: Mammography screening rate, continuity of care index, disease-specific and symptom-relief prescribing rate, contraindicated prescribing rate, and consultation rate. RESULTS: Physicians achieving higher scores on both examinations had higher rates (rate increase per SD increase in score per 1000 persons per year) of mammography screening (beta for QLEX, 16.8 [95% confidence interval [CI], 8.7-24.9]; beta for Medical Council of Canada Qualifying Examination [MCCQE], 17.4 [95% CI, 10.6-24.1]) and consultation (beta for QLEX, 4.9 [95% CI, 2.1-7.8]; beta for MCCQE, 2.9 [95% CI, 0.4-5.4]). Higher subscores in diagnosis were predictive of higher rates in the difference between disease-specific and symptom-relief prescribing (beta for QLEX, 3.9 [95% CI, 0.9-7.0]; beta for MCCQE, 3.8 [95% CI, 0.3-7.3]). Higher scores of drug knowledge were predictive of a lower rate (relative risk per SD increase in score) of contraindicated prescribing for MCCQE (relative risk, 0.88; 95% CI, 0.77-1.00). Relationships between examination scores and practice performance were sustained through the first 4 to 7 years in practice. CONCLUSION: Scores achieved on certification examinations and licensure examinations taken at the end of medical school show a sustained relationship, over 4 to 7 years, with indices of preventive care and acute and chronic disease management in primary care practice.

Certification↗
PubMed2002

The role of woodstoves in the etiology of nasal polyposis.

OBJECTIVE: To determine the role of environmental pollutants in the etiology of nasal polyposis. DESIGN: Case-control study. SETTING: A community-based hospital practice in the Gaspesian peninsula in rural northeastern Quebec. PATIENTS: Fifty-five case patients with nasal polyposis and 55 age-matched control subjects without nasal polyposis who were seen at one physician's practice (J.K.) from March 1, 1998, to December 19, 1998. INTERVENTIONS: Exposure to woodstoves, indoor tobacco smoke, and pets and occupational exposures to noxious inhalant compounds. RESULTS: Forty-five (82%) of the cases, but only 14 (25%) of the controls, reported using woodstoves, yielding a crude odds ratio (OR) of 13.1. The corresponding risk associated with occupational exposure to noxious inhalant compounds was also high (OR, 6.1). When adjusted in various ways for the presence of other factors, these ORs remained high and statistically significant. For woodstove use, the point estimates of the ORs were consistently above 10, with the lower limits of 95% confidence intervals above 5. For occupational exposures to noxious inhalant compounds, the various adjusted OR estimates were above 6, with the lower limits above 1.5. CONCLUSIONS: There is a strong association between the use of woodstoves as a principal source of heating and the development of nasal polyposis. Occupational exposures to noxious inhalant compounds (other than tobacco smoke) also play an important role in its etiology.

Adolescent↗
PubMed2002

Comparison of three methods for estimating the standard error of the area under the curve in ROC analysis of quantitative data.

RATIONALE AND OBJECTIVES: Several methods have been proposed for estimating the standard error (SE) of the area under the curve (AUC) in receiver operating characteristic analysis. The authors examined the validity of three methods--the LABROC procedure, exponential approximation, and the method of DeLong et al (purely nonparametric)--for estimating the SE of the AUC in receiver operating characteristic analysis of quantitative diagnostic data. MATERIALS AND METHODS: The authors conducted a broad numerical investigation to assess how to estimate the SE of AUC in various configurations of binormal and nonbinormal pairs of distributions, in which one or both pair members were mixtures of Gaussian distributions (the samples included 100 in the diseased group and 100 in the nondiseased group). RESULTS: The authors found that exponential approximation of the SE of AUC slightly underestimates the observed SE of a nonparametric estimate of the AUC when the ratio of the standard deviation of distributions for diseased to nondiseased populations was greater than 2. With binormal data the observed SE tended to be smaller with the LABROC procedure (semiparametric) than with the method of DeLong et al, but the LABROC procedure yields more conservative estimates of SE with nonbinormal data. In particular, with bimodal data it often produces a more conservative (ie, larger) estimate of the actual (observed) fluctuation. CONCLUSION: Overall, the LABROC procedure and the method of DeLong et al yielded very close estimates of the SE of AUC, even with data generated from a nonbinormal model. The choice between these two methods can be based on users' preferences and practicality.

Area Under Curve↗
PubMedDate not supplied

Pelvic floor muscle training with biofeedback and bladder training in elderly women: a feasibility study.

OBJECTIVE: It is generally assumed that interventions used to treat urinary incontinence (UI) in young women could simply be applied to older competent and motivated women, but these assumptions have not been formally tested. The purpose of this study was to determine the feasibility of using physical therapies to treat UI in older women. DESIGN: Twelve-week time series. SETTINGS AND SUBJECTS: We recruited women older than 75 years with UI from an outpatient urology clinic and a waiting list for incontinence surgery. METHODS: After a baseline evaluation, the women collected data on their incontinence symptoms and bladder habits for 3 weeks using the 72-hour voiding diary and the 24-hour pad test. They then received 6 physical therapy treatments consisting of a combination of bladder training and pelvic floor muscle training assisted with biofeedback for 6 weeks. This was followed by another 3-week period of data collection and a final evaluation. RESULTS: Ten women participated in the study; 7 completed it. They were all comfortable with the treatment. They complied with the study demands in terms of attendance at treatment session (100%), data collection (96%), and completion of exercises at home (82%). The authors observed a decrease in the number of incontinent and urgency episodes. CONCLUSION: This preliminary study demonstrates that some women older than 75 years are good candidates to undertake physical therapies for UI and follow study demands. Random controlled studies that include this population will provide evidence regarding the effectiveness of these therapies.

Age Factors↗