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Biomedical subjects

K S Ogle

Publications and source records attributed to K S Ogle.

17 recordsLinked to original sources
PubMed2000

Cancer and comorbidity: redefining chronic diseases.

BACKGROUND: A narrow subspecialty model of cancer care has led to cancer treatment often being given outside the full medical context of the patient. The full range of comorbid illness must be considered in all aspects of diagnosis and treatment. This study was conducted to describe the prevalence of comorbidity in cancer patients and examine its relation with multiple demographic and clinical variables. METHODS: A case comparison study of 15,626 population-based incident cases of cancer was conducted between 1984-1992 in 3 metropolitan Detroit counties (a National Cancer Institute Surveillance, Epidemiology, and End Results program). Chronic disease status and demographics were collected by self-report; cancer diagnoses and staging were obtained by medical record review. Univariate and multiple logistic regression analyses were performed. RESULTS: Comorbidity was present in 68.7% of cancer patients, and 32.6% of these individuals had > or = 2 comorbid conditions. Frequency was increased in the elderly, African-American patients (particularly African-American women), smokers, and those with lower socioeconomic status. Rates also appeared to vary by specific tumor site. CONCLUSIONS: Comorbid chronic diseases are common in persons with cancer. The prevalence of comorbidities has important clinical, health service, and research implications. The disease specific model of oncology may limit appropriate care for these patients, and enhanced integration of primary care into the ongoing management of cancer may offer better outcomes.

Adult↗
PubMed2000

Access to hospice: a perspective from the bereaved.

Access to hospice care continues to be an enigma. Hospice has been available for nearly three decades in the United States, but the services continue to be underutilized. In an effort to better understand access barriers, a series of focus groups were held with recently bereaved caregivers (mean = 9.9 months since the death of the patient). During the process of the focus group discussions, participants relived their experience with hospice. Although the purpose of this research was to ascertain access recommendations, participants integrated their access comments into the overall richness of their hospice experience. The 12 participants were divided into two groups, and each group met twice with a 2-week interval between sessions. From the focus group discussions, six themes emerged. Two of the six themes related to access issues: (1) societal and health system issues related to delayed hospice access and (2) education and practice needs of health professionals that affect hospice access. Participants provided recommendations to address the concerns expressed through both of these access themes.

Journal Article↗
PubMed1997

Graduating medical students' competencies and educational experiences in palliative care.

Palliative care involves an interdisciplinary approach to patient care and specific clinical skills. Little prior research on palliative care education has involved medical students, and the few reported studies focus mainly on student attitudes. This study describes a needs assessment of senior medical students based on a newly developed competency-based palliative care curriculum. Prior to graduation, 102 senior students were mailed an anonymous survey with four parts: a self-assessment of attitudes, knowledge, and skills; adequacy of instruction; exposure to specific clinical experiences; and demographic information. The response rate was 47%. While attitudinal goals were strongly endorsed by students, they were less confident with regards to knowledge and skills. Ratings varied across the five content areas of the curriculum. The results suggest a need for educational efforts more focused on specific clinical competencies as well as systematic evaluation of student competencies.

Curriculum↗
PubMed1996

The emperor's new clothes: the OSCE reassessed.

In response to increasing concerns about the prevalence of knowledge- based assessments of medical student competency, leaders in medical education have emphasized the importance of methods that quantify student performance. As a result, the use of objective structured clinical examinations (OSCEs) is viewed by many as the newest and most promising technique for assessing students' abilities. In considering the implementation of a fourth-year OSCE, faculty at the College of Human Medicine at Michigan State University became uncomfortable with some of the technical limitations of the method (limited generalizability; weak linkages to the curriculum; little opportunity provided for improvement in examinees' skills; and others), as well as the possible ramifications of such an innovation within their school's specific curricular and organizational contexts. This essay is offered as a reflection of the challenges and possible alternatives that have emerged as the faculty have considered how best to design and implement performance-based assessment within their institution. Rather than using the OSCE as a milestone marker of student performance, they consider the possibility of smaller assessment events, closely tied to the curriculum and consistent with the guiding principles of the medical school.

Academic Medical Centers↗
PubMed1996

The role of the primary care physician in the care of the terminally ill.

The primary care physician is often the provider best situated and suited to deal with all aspects of the care and management of the elderly patient with a terminal illness. Despite the many barriers physicians face (the most significant of which are inadequate training and poor reimbursement), providing quality care for the terminally ill is a critically important task. As Angell editorialized in 1982 about pain management, "the quality of mercy is essential to the practice of medicine. Here, of all places, it must not be strained."

Aged↗
PubMed1992

Pain management in advanced cancer.

This article presents a primary care approach to pain management in patients with advanced cancer. Assessment of "total" pain is reviewed along with interdisciplinary care. Pharmacologic and nonpharmacologic therapies are outlined, with emphasis on the correct use of narcotics and adjuvant analgesics.

Analgesics↗
PubMed1992

Hospice care.

Hospice care is a philosophy and system of care for the terminally ill patient that accepts death in an affirmative way and provides palliative care and emotional support to dying patients and their families. The primary care physician needs to better understand the hospice concepts, the reasons for and growth of hospice care, and the depth of resources that can assist in equality management of the terminally ill.

Home Care Services↗
PubMed1986

Gender-specific differences in family practice graduates.

In 1979 the American Academy of Family Physicians (AAFP) conducted a study of family practice residency graduates to develop a database of personal and professional characteristics. Questionnaires were sent to 4,295 physicians, and results were based on a total of 3,021 respondents. Female physicians made up 7.1 percent of this sample; however, analysis of the data at that time did not distinguish between men and women. The current study is a reanalysis of the data collected by the AAFP to include comparisons of male and female respondents and to determine whether gender differences that have been reported in the literature continue to persist. Results indicate that gender differences did persist in four of six areas studied; however, these differences were not so large as described in earlier studies. Areas in which differences were found are demographics, family structure, practice arrangements, and salary. Notable differences were not found in the areas of career choice development and professional activities. Now that the number of female physicians approaches 20 percent of all new family physicians, further data collection efforts are needed to determine their impact on family practice as a specialty.

Family Characteristics↗
PubMedDate not supplied

Internet resources for end-of-life care.

Numerous publications highlight the need for critically evaluating medical information on the Internet. This review identifies Internet resources specifically dedicated to end-of-life care. An annotated review of key web-based resources is presented. The Internet has the potential to catalyze the doctor-patient relationship toward true "partnership." Physicians and patients will benefit from using a focused research strategy.

Computer User Training↗
PubMedDate not supplied

Easing cancer pain through treatment options.

The diagnosis of life-threatening illness delivers patients and families into new and often unfamiliar territory--a place one author has named "the country of illness." There are no easy road maps in that new world, and the way is made harder by the burdens thrust upon its inhabitants. For cancer patients, one of the greatest burdens is the pain that comes with the disease.

Analgesics, Non-Narcotic↗
PubMedDate not supplied

Screening for hypercholesterolemia in a family practice residency.

Coronary artery disease (CAD) is a significant health problem in the United States, and hypercholesterolemia is a major risk factor for its development. The role of the primary care physician in screening and treatment is increasingly recognized as crucial. Our research addressed screening of 296 adult male patients aged 20-39 for hypercholesterolemia during two time periods. A chart review was conducted in a family practice residency model office to determine if screening was being performed and what factors influenced it (CAD risk factors, demographics, and insurance status). Forty-three percent of the patients had a cholesterol test on record, of which only 10% were ordered specifically to check the cholesterol. Demographic characteristics, insurance, and CAD risk factors did not influence the rate of testing, with the single exception of hypertension; an educational conference and the development of a practice policy between the two time periods did not change the rate of screening.

Adult↗
PubMedDate not supplied

Breast and testicular self-examination in primary care.

Among a random sample of Michigan family physicians, attitudes about encouraging patients to perform breast and testicular self-examination were very positive. The physicians' self-reported incorporation of such encouragement into their practices was much lower for testicular than breast self-examination. Two hundred seventy-eight randomly selected family physicians in Michigan were surveyed about their beliefs about and professional practices regarding encouraging patients to perform breast self-examination (BSE) and testicular self-examination (TSE). Attitudes were very positive about both techniques. Self-reported incorporation of patient encouragement into professional practice was much lower for TSE than for BSE. The physicians' own personal practices were similarly skewed: female physicians performed BSE for themselves far more regularly than young male physicians did TSE. The barriers they identified to incorporating encouragement into their practices were similar for testicular and breast self-examination, with lack of patient motivation the leading barrier seen.

Adult↗
PubMedDate not supplied

Preventive medicine: physician practices, beliefs, and perceived barriers for implementation.

Despite increasing recognition of the need for physicians to practice preventive medicine, there is much evidence that performance is well below the ideal recommended by experts. The purpose of this study was to determine what preventive medicine activities physicians practice, whether their personal health practices and beliefs about preventive medicine correlate with professional practices of preventive medicine, and what barriers to practicing preventive medicine physicians identify. Results from a questionnaire mailed to a random sample of 430 family physicians indicated physicians practice health promotion for themselves more than revealed in earlier studies and that physicians frequently incorporate many preventive medicine activities into their professional practices. Several exceptions, however, were noted. When identifying barriers to practicing preventive medicine, respondents overwhelmingly selected lack of patient motivation more than any other factor.

Attitude to Health↗