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Biomedical subjects

M J Bass

Publications and source records attributed to M J Bass.

At least 37 records · Page 2Linked to original sources
PubMed1989

Recruiting family physicians as participants in research.

Obtaining the voluntary participation of family physicians in quality of care research is a major problem in family practice research. An innovative approach was therefore required to recruit 120 randomly selected family physicians in southern Ontario in a quality of care study by the College of Family Physicians of Canada. A network of physician recruiters oriented to the study was organized for each district. This recruitment method resulted in an 84.5% participation rate. The relationship of these physician recruiters to the candidate and the method of approach were important factors in the enrolment process: the highest participation rate (95%) was obtained when the recruiters were friends of the candidate and when a personal meeting was arranged (91%). Recruiters were given an information package to help them in the recruitment process and rated the most useful items as follows: a policy statement about confidentiality, a description of the study and reprints of a published feasibility study. These results illustrate that cooperation in research in family physicians' offices can become a reality.

Confidentiality↗
PubMed1989

The impact of discussion of non-medical problems in the physician's office.

To determine the impact of discussion of non-medical problems with the physician, patients with at least one chronic illness who were taking medication were interviewed in their family doctor's office. Of 149 patients interviewed, 90.6% reported at least one non-medical problem. Half (51%) of those patients with a problem had discussed it with their doctor. More than half (55%) of those patients discussing a problem reported that the discussion was helpful. Patient compliance and satisfaction were positively associated with 'helpful' discussion, but not with discussion per se. In particular, the two aspects of doctor-patient communication which were significantly associated with feeling helped were: 'Doctor tells me all I want to know about my illness' and 'Doctor gives me a chance to say what is really on my mind'. Both factors reflect care which is oriented to patient concerns. The study results provide support for a patient-centred approach to care.

Adult↗
PubMed1988

Study of relation of continuing medical education to quality of family physicians' care.

A random sample of 120 physicians in Ontario was studied to assess quality of care in primary care and test an hypothesis that quality of care was related to continuing medical education (CME) activities. The quality-of-care scores were obtained by an in-office audit of a random selection of charts. The scores were global scores for charting, prevention, the use of 13 classes of drugs, and care of a two-year period for 182 different diagnoses. There were no relationships between global quality-of-care scores based on these randomly chosen charts and either the type or quantity of the physicians' CME activities. These activities were reading journals, attending rounds, attending scientific conferences, having informal consultations, using audio and video cassettes, and engaging in self-assessment. The implications of these findings are significant for future research in CME and for planners of present CME programs.

Certification↗
PubMed1988

Abdominal pregnancy after in vitro fertilization and embryo transfer.

Ectopic pregnancy continues to be a major complication of in vitro fertilization (IVF) and embryo transfer. We report the first abdominal pregnancy occurring after this therapeutic approach. The patient, a 35-year-old female, presented a frozen pelvis with a history of severe endometriosis and a left salpingectomy. After the transfer of four concepti in her second IVF/embryo transfer attempt, she became pregnant. Unfortunately, ultrasound evaluation five weeks later showed an ectopic pregnancy in the cul-de-sac. During laparotomy, it was noticed that implantation had taken place near the mesentery of the sigmoid and rectosigmoid. A right cornual tubal ligation was performed. Although the benefit of IVF/embryo transfer far outweighs the risk of an ectopic pregnancy, it is imperative that physicians who care for patients after IVF/embryo transfer be fully aware of the possibility of this complication in this high-risk population.

Adult↗
PubMed1988

Is population mobility an obstacle to continuity of care? Attrition rates over five years in 17 Ontario practices.

The University of Western Ontario Hypertension Study provided an opportunity to study attrition rates over a five-year period in the population of 17 family practices in southwestern Ontario. The baseline population consisted of all patients between the ages of 20 and 65 years who were active in the practices in 1978. During the five years of the study, a medical assistant in each practice recorded data on morbidity, mortality, and patients leaving the practice. The follow-up of nonresponders to a demographic questionnaire provided additional data on patient moves. The overall five-year move rate was 13.2 percent for men and 16.6 percent for women. Those in the 20- to 29-year age group had the highest rates, and those in the 30- to 39-year age group had the next highest. The rates for men stabilized after the age of 40 years to between 8 and 10 percent, and for women after 40 years to between 11 and 13 percent. The move rates were higher in urban than in rural practices. Ninety percent of hypertensive patients received continuous care over the five-year period. In southwestern Ontario, population mobility does not appear to be a major barrier to continuing care.

Adult↗
PubMed1987

Detecting changes in functional ability in women with premenstrual syndrome.

There has been a lack of objective assessment of the disruptive effect that the symptomatology of premenstrual syndrome has on the functional performance of affected women. This study assessed the functional performance of women with premenstrual syndrome at four phases of the menstrual cycle. Twelve women with premenstrual syndrome and nine asymptomatic women were tested on four functional instruments at the menstrual, early follicular, early luteal, and late luteal phases. Two tests of a paper-and-pencil type measured perceptual parameters, and two tests involving manipulation of objects measured manual dexterity. Mean performance on the Crawford Small Parts Dexterity Test--Part II, which tests fine motor function, was better at the late luteal testing, compared to the early follicular testing, in asymptomatic women but was worse in the women with premenstrual syndrome. This difference was statistically significant (p = 0.015). No significant differences between groups in performance changes were observed for the other functional tests. The Crawford Small Parts Dexterity Test-Part II is an objective measure that is potentially valuable in therapeutic trials involving patients with premenstrual syndrome.

Adult↗
PubMed1987

The effect of an on-site radiology facility on radiologic utilization in family practice.

Family physicians around the world are increasing their use of diagnostic x-ray examinations at a time of controversy about radiologic overutilization. To explore the role of accessibility in utilization, a study was undertaken testing the hypothesis that on-site radiology facilities are an important determinant of usage. Using a historical cohort design with chart review, rates in selected groups of patients were compared between two teaching family medicine centers, one with an on-site radiology service and one without. After controlling for confounding variables, patients with chest-related diagnoses were 2.4 times more likely (P less than .05) to have a chest film in the presence of on-site facilities. Rates for the off-site examination, upper gastrointestinal series, in patients with abdominal-related diagnoses were similar (relative risk 1.34, P greater than .5) at both centers. Higher usage brought no short-term clinical benefit. It was also observed that residents overinterpreted one quarter of chest films when compared with radiologists' reports.

Community Health Centers↗
PubMed1986

Do family physicians need medical assistants to detect and manage hypertension?

To test a new approach to detecting and managing hypertension, 34 family practices in southwestern Ontario that comprised 32 124 patients aged 20 to 65 years were randomly assigned in a 5-year study to either undertake a system of care in which a medical assistant oversaw screening and attended to education, compliance and follow-up (experimental group) or continue their usual practices (control group). The 17 physicians in the experimental practices (15 659 patients) were matched with the 17 in the control practices (16 465 patients) according to size of the community, sex, level of practice activity and length of time in practice. Hypertension was defined as at least two diastolic blood pressure readings over 90 mm Hg. More patients in the experimental group than in the control group were screened at least once (91% v. 80%); the former were more likely to have lower systolic blood pressure (p less than 0.02), to be compliant (p less than 0.05) and to be very satisfied with care (p less than 0.01). There were no significant differences between the two groups in the rates of illness and death due to cardiovascular disease for all patients or for hypertensive patients. The unassisted family physician can provide effective care for hypertensive patients. However, minor modifications in the physician's practices can improve care.

Adult↗
PubMed1986

Acceptability of a faecal occult blood screening protocol for carcinoma of the colon in family practice.

Cancer of the colon is the second most common malignancy in North America and screening methods are needed for diagnosing the lesions at an early stage. Faecal occult blood screening is a method of secondary prevention which is particularly adaptable to the family practice setting. In order to test the feasibility of using this test in family practice, 16 family physicians participated in a trial screening programme using the Hemoccult II test. During the two-month trial 776 patients over 40 years of age were screened; 19 of the tests were positive but in two cases patients were thought to have failed to follow dietary and medical restrictions. Of the 17 patients with verified positive tests, further investigation showed five patients had neoplastic disease and three of these had malignant disease. The detection rate for cancer of the colon using the Hemoccult II test was therefore 3/776, equivalent to 3.9 per 1000 cases screened. By narrowing the age range for screening patients to between 45 and 75 years, the time involved to screen the population at risk could be decreased.

Adult↗
PubMed1986

Hyperbaric oxygen therapy in chronic stable multiple sclerosis: double-blind study.

We carried out a randomized, double-blind, placebo-controlled trial of hyperbaric oxygen therapy (HBO) in patients with chronic stable MS. Eighty-two patients were treated in a multiplace hyperbaric chamber with gas supplied by mask. Forty-one patients received 20 consecutive daily treatments of 100% O2 followed by 7 "booster" treatments in the next 6 months; 41 control patients received "air" (12.5% O2 at 1.75 atmospheres absolute). There was no significant difference in treatment and control groups in the Extended Kurtzke Disability scores, Kurtzke Functional scores, magnetic resonance imaging, or evoked potentials after the initial 20 treatments or after the boosters. HBO is not effective in treating chronic stable MS.

Adult↗
PubMed1986

Are antihistamine-decongestants of value in the treatment of acute otitis media in children?

Acute otitis media is the most common bacterial infection of childhood. The effectiveness of oral antihistamine-decongestant mixtures in the treatment of this illness remains controversial in clinical practice. In a double-blind randomized study, 82 children (aged under 15 years) with acute otitis media were treated with amoxicillin and either a decongestant-antihistamine mixture (Dimetapp) or placebo. All diagnoses required agreement between a family practice resident and the supervising family physician. Clinical course was assessed by symptom diaries completed by parents and by follow-up examination at approximately two weeks, which included pneumatic otoscopy. No statistically significant benefit of the antihistamine-decongestant mixture was shown in terms of resolution of the symptoms or prevention of the complications of acute otitis media. It is recommended that antihistamine-decongestants not be routinely added to an antibiotic in the treatment of acute otitis media in children.

Adolescent↗
PubMed1986

The physician's actions and the outcome of illness in family practice.

The outcome of new episodes of common nonrespiratory tract symptoms was studied in 193 patients attending family physicians. After controlling for demographic, psychological, and social variables, the only element of the process of care that was related to resolution of the patient's symptom at one month was physician-patient agreement about the nature of the problem. Patients with unresolved symptoms were followed for an additional two months. Late resolution was associated with the physician's recording of attention to psychosocial problems. These results have implications both for the provision and audit of primary care.

Adolescent↗
PubMed1985

Behavior pattern A and compliance with antihypertensive treatment.

An analysis was performed on cross-sectional data on 512 hypertensive patients to look at the association of behavior pattern A (coronary prone behavior) and compliance with therapy. In a home interview behavior pattern A was assessed by a questionnaire (The Bortner scale), compliance by a vignette, and blood pressure was measured. Noncompliers showed a higher degree of Type A characteristics, that is there was a significant negative association between behavior pattern A and compliance (p = 0.02). It is proposed that a new variable, behavior pattern A, should be considered in future research on compliance.

Adult↗
PubMed1984

Head injuries related to the use of baby walkers.

To determine what proportion of head injuries in children under 24 months of age who presented to an emergency department were related to the use of baby walkers, we reviewed the charts of 52 such children. Walkers were involved in 42% of the head injuries in the children under 12 months of age and in none of those in the children aged 12 to 24 months. All walker-related injuries, including skull fractures in three children, involved stairs (p less than 0.001). Questionnaires were also sent to all families with children aged 3 to 18 months attending a private pediatric practice to determine the prevalence of falls involving baby walkers among these children and the factors associated with such falls. Of the 152 responding families 82% reported using or having used a walker. Thirty-six percent of the families reported that their child had a fall while in a walker, with 8.8% of the falls resulting in contact with a doctor. Walker-related falls were directly associated with time spent in the walker (p less than 0.001) and with a previous fall from the walker by an older sibling (p less than 0.03). Since there is no demonstrated benefit of walkers, their use should not be encouraged, and parents should be advised of their potential danger.

Craniocerebral Trauma↗
PubMed1984

Tuberculosis and nonsteroidal anti-inflammatory drugs.

In 1980 and 1982 two case reports documented reactivation of pulmonary tuberculosis in patients who had used nonsteroidal anti-inflammatory drugs (NSAIDs). A case-control study was designed to test the hypothesis that such an association does exist. Data for 38 patients were obtained from the patients' family physicians, and each patient was matched with a control from the same practice for age, sex, race and length of time in that practice. A statistically significant relation was found between the reactivation of tuberculosis and the use of NSAIDs. However, further research is imperative to determine whether the association is direct, indirect or secondary to an unknown factor. Physicians should keep in mind that NSAIDs are potent anti-inflammatory agents and may thus activate, spread and mask infections.

Aged↗