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Biomedical subjects

P P Barry

Publications and source records attributed to P P Barry.

At least 19 recordsLinked to original sources
PubMed1996

Patient factors associated with breast cancer screening among older women.

OBJECTIVES: To identify patient factors that influence physicians' decisions to recommend screening mammograms for older women. DESIGN: A cross-sectional survey including clinical case vignettes. PARTICIPANTS: Random sample of Massachusetts internists, obstetrician/gynecologists, family/general practice physicians, and geriatricians. OUTCOME MEASURE: Proportion of screening mammograms recommended for women in different versions of each case vignette. RESULTS: A total of 482 (65%) of the eligible participants responded to a mailed survey of questions about breast cancer screening practices, attitudes toward ACS guidelines, and four clinical vignettes. Vignettes tested the impact of patient's age, cognitive function, nursing home residence, functional limitations, and comorbidity on the physician's decision to recommend a mammogram. Ninety-four percent of physicians reported often performing periodic clinical breast exams and mammograms for women aged 65 to 74. For women aged 75 to 84, 89% of physicians reported often performing periodic clinical breast exams, and 79% recommend mammograms. Only 48% strongly agreed with ACS guidelines for annual mammography for women over 65. Age, dementia, and nursing home residence were patient factors associated with decreased mammogram use, but limited mobility and chronic medical problems were not. Physicians were more likely to recommend a mammogram for a woman aged 65 to 74 than for a woman 75 to 84. (P = .002) Physicians were more likely to recommend a mammogram for a woman without dementia than for a woman with mild dementia (P < .05) and for a woman living with her daughter than a for a woman living in a nursing home (P < .001). CONCLUSIONS: Age older than 75, mild dementia, and nursing home residence are factors that negatively influence physicians' decisions to recommend mammography. Presence of chronic medical problems and functional limitations do not. Physicians appear to be using implicit judgments about quality of life and age rather than life expectancy based on comorbidity to determine breast cancer screening practices.

Age Factors↗
PubMed1996

Healthy aging: guidelines for cancer screening and immunizations.

With increasing life expectancy over the past 50 years, screening for treatable illness and active measures to prevent disease and promote a healthy lifestyle have become increasingly important for older patients. In general, the benefits of such efforts have become more apparent, but depend also upon general health and life expectancy of the individual. Tests for malignancies of the breast, cervix, prostate, colon, skin, and oral cavity are considered to meet screening criteria. Immunization guidelines have been recently updated, and good evidence supports the benefit of protecting older patients from influenza and pneumococcal pneumonia. Counseling on prevention of falls and injuries in the home and on the highways can help reduce the risk of accidents.

Aged↗
PubMed1994

Geriatric clinical training in medical schools.

The primary purpose of geriatric training in medical school is to improve the care of the elderly by practitioners in every specialty, by increasing their knowledge base and fostering interest in older patients. A secondary goal is to interest some students in geriatrics as a career. For > 10 years, leaders in medicine and medical education have strongly recommended clinical geriatric training for medical students, but only a few programs have been implemented. Geriatrics educational experiences must be required; otherwise, not enough medical students will elect to take these courses. Although we still do not know which model best provides this experience, evaluations of existing programs suggest that geriatrics can be taught in both long-term care and acute settings, involving well-designed curriculum and interested faculty. More studies are needed, but exposure to well elderly and community-based programs may also improve attitudes toward the elderly and thereby further improve their medical care.

Clinical Competence↗
PubMed1994

Evaluation of the demented patient.

Approaching the patient with Alzheimer's disease often requires the participation of a team of collaborating physicians and psychologists as well as others both for diagnosis and for management. This article describes the approach to the disease by a neurologist, geriatrician, psychiatrist, and psychologist. Each describes a specific diagnostic approach, and the reader can appreciate the incremental value to assessment and care that emerges from the aggregate.

Age Factors↗
PubMed1990

Electroconvulsive therapy in octogenarians.

Medical records of 81 older patients (65 years of age and over) who underwent electroconvulsive therapy (ECT) at a university-affiliated private geriatric hospital were reviewed to evaluate the safety and efficacy of this treatment for depression in the "young-old" (65 to 80 years) compared with the "old-old" age group (over 80 years), a group that has not yet been adequately studied. Information was obtained regarding demographics, medical and psychiatric diagnosis, medications, indications for ECT, number and laterality of treatments, outcome, and complications. Thirty-nine patients 80+ years of age (mean age, 85 +/- 3.2) were compared with 42 patients 65 to 80 years of age (mean age, 74 +/- 5.2). Statistical analysis was performed using confidence intervals of the difference in proportions of patients in each group. There were no significant differences in the demographics, number and laterality of ECT treatments, indications for ECT treatment, medical diagnosis, medications, or prior history of falls, but psychiatric diagnoses differed slightly. Patients over 80 years had significantly more cardiovascular complications and falls (95% confidence interval) and tended to have a worse ASA (American Society of Anesthesiologists) scale rating and a somewhat less successful outcome. This study confirms the role of ECT as a relatively safe and effective treatment, which may be lifesaving in selected depressed older patients. Prospective studies are needed to understand better the long-term outcome and to prevent the morbidity and mortality associated with ECT in this frail, high-risk older group.

Accidental Falls↗
PubMed1989

Decreasing the toxic potential of intravenous regional anaesthesia.

In an attempt to reduce the dose of local anaesthetic agent during intravenous regional anaesthesia (IVRA) of the upper limb, we have used a forearm tourniquet in 12 adult volunteers. The volume of the forearm venous system was predetermined angiographically. We performed IVRA with three solutions of lidocaine (0.25, 0.375, 0.5 per cent) administered in a volume equal to the forearm venous system. Angiographic results indicate that: a forearm tourniquet provides adequate vascular isolation; the volume of the forearm venous system can be correlated with body weight; the progression of the fluid in the venous system follows a pattern that is similar for all patients with the small veins of the distal forearm and proximal hand being filled last. With this technique, lidocaine 0.5 per cent resulted in a dose of 1.5 mg.kg-1 and provided excellent analgesia. Lower concentrations were unsatisfactory. We conclude that the use of a forearm tourniquet allows reduction of the local anaesthetic dose to a non-toxic level and thus increases the safety of IVRA.

Adult↗
PubMed1988

Why elderly patients refuse hospitalization.

To identify important factors in the refusal of hospitalization by elderly patients, a study was conducted of 35 such "refusers" on the Home Medical Service (HMS) of University Hospital and a comparison group of 70 patients who accepted hospitalization. Data were collected from health care providers and patient records at entry and six weeks later. The two groups were compared on the basis of demographic factors, health care factors, medical condition, and outcomes. Reasons for refusal were most commonly related to a negative perception of the health care system or a passive acceptance of death. Refusers were significantly less ill than acceptors and did not change in health or functional status at follow-up. The results suggest that refusal of hospitalization is most often related to interaction with the health care system and that less ill patients may have reasonable outcomes when treated at home.

Aged↗
PubMed1988

Tobacco advertisements in physicians' offices: a pilot study of physician attitudes.

A pilot study evaluated the feasibility of a campaign to eliminate magazines advertising cigarettes from doctors' office waiting rooms. Only six of 51 waiting rooms visited did not contain cigarette ads. Only 25 per cent of physicians interviewed would participate in a subscription-cancellation campaign; they expressed doubt that this would influence patients' smoking behavior. This suggests that such a campaign will fail unless it is possible to change physicians' beliefs in its effectiveness.

Advertising↗
PubMed1988

The diagnosis of reversible dementia in the elderly. A critical review.

Evaluation of the elderly demented patient includes a search for treatable diseases; recommendations for this approach have been based on reports of a high prevalence of "reversible" dementia in several series of patients in the medical literature. A critical review of the methodology of these reports was undertaken to determine their validity as sources for the protocols often recommended. Several methodologic flaws were found in many studies that recommended extensive "screening" of the demented elderly, limiting their usefulness as resources. More carefully designed studies are needed to understand better the frequency and etiology of reversible causes of dementia.

Aged↗
PubMed1987

Primary care evaluation of the elderly for elective surgery.

The role of the primary physician in the preoperative evaluation of the elderly patient is critical. Due to the many associated changes of aging, careful assessment is required to reduce morbidity and mortality, and to identify treatable medical conditions which increase operative risk. Although increasing age is a major risk factor for surgery, the increased incidence of major diseases may be more important than age alone. Emergency surgery also involves considerably greater risk. It is important that the patient be involved in the decision-making process to the extent possible, and also that adequate postoperative and discharge planning be part of the preoperative management of the elderly person.

Aged↗