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Biomedical subjects

P S Frame

Publications and source records attributed to P S Frame.

At least 37 records · Page 2Linked to original sources
PubMed1988

Is routine influenza immunization indicated for people over 65 years of age? An opposing view.

It is true that persons aged over 65 years have greater morbidity and mortality from influenza. This increased morbidity and mortality, however, is mostly the result of a higher prevalence of other chronic diseases in the elderly. There is no evidence that vaccination, even in epidemic years when the antigenic match of the influenza strain and the vaccine is good, benefits the 60 percent of the noninstitutionalized population over the age of 65 years who do not have other high-risk diseases. In fact, the grade II-3 evidence cited by the US Preventive Services Task Force actually supports not immunizing this population group. Even among high-risk patients, the benefit from influenza vaccination is highly variable and difficult to demonstrate. In some years there will be little influenza, and little benefit will accrue; in other years the vaccine-influenza antigenic match will not be good, and little benefit will be obtained. In a few years (two of the 12 years during which Barker's studies were done), a reduction in morbidity can be demonstrated for high-risk elderly persons. Even then, vaccine efficacy is only about 33 percent. Patients are telling physicians that they do not feel influenza vaccination is worthwhile. Less than 25 percent of high-risk persons are vaccinated annually. Many of those vaccinated do so because they falsely believe influenza vaccination will prevent the common cold. In accordance with the ACIP recommendation, high-risk patients with concomitant chronic disease (priority 1) should be immunized, because at least some benefit can be demonstrated.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1987

Ten years of screening for cancer in a family practice.

The Cohocton office of Tri-County Family Medicine has maintained an active screening program for breast cancer, colorectal cancer, and cervical cancer since 1974. This article reports a retrospective study of all patients with a diagnosis of cancer during the ten-year period from July 1974 to June 1984. Particular attention was paid to the relationship of screening to the diagnosis of these cancers. Sixty-nine cancers were diagnosed during the study period. Screening detected 7 of 11 breast cancers, 2 of 11 colorectal cancers, and 2 of 3 cervical cancers. In addition, all cases of respiratory cancer occurred in cigarette smokers and were therefore theoretically preventable. The data suggest that a large population of inactive, unscreened patients is a major obstacle to cancer prevention.

Adult↗
PubMed1986

A critical review of adult health maintenance. Part 1: Prevention of atherosclerotic diseases.

This is the first paper in a four-part series that presents an updated protocol for selective longitudinal health maintenance of asymptomatic adults. Five conditions related to atherosclerotic diseases are reviewed with reference to six generally accepted screening criteria. A recommendation is made for each condition and is compared, when appropriate, with the recommendations of the Canadian Task Force on the Periodic Health Examination. In the fourth paper, the recommendations will be combined into a practical health maintenance flow sheet for use by primary care physicians.

Adult↗
PubMed1986

A critical review of adult health maintenance. Part 3: Prevention of cancer.

This is the third paper in a four-part series that presents an updated protocol for selective longitudinal health maintenance of asymptomatic adults. Selected types of cancer are reviewed with reference to six generally accepted screening criteria. A recommendation is made for each condition and compared, when appropriate, with the recommendations of the Canadian Task Force on the Periodic Health Examination and the American Cancer Society. In the fourth paper the recommendations will be combined into a practical health maintenance flow sheet for use by primary care physicians.

Adult↗
PubMed1986

A critical review of adult health maintenance: Part 4. Prevention of metabolic, behavioral, and miscellaneous conditions.

This is the last article in a four-part series that presents an updated protocol for selective longitudinal health maintenance of asymptomatic adults. Nine metabolic, behavioral, and miscellaneous conditions are reviewed with reference to six generally accepted screening criteria. A recommendation is made for each condition and is compared, when appropriate, with the recommendations of the Canadian Task Force on the Periodic Health Examination. The recommendations for all 30 conditions reviewed in this four-part series are combined into a practical health maintenance flow sheet for use by primary care physicians.

Accident Prevention↗
PubMed1985

Effectiveness of tuberculin skin test screening in a rural family practice.

Tuberculin skin tests were performed on 1,146 patients out of an active patient population of 3,112 patients over a ten-year period in a rural western New York State family practice. There were 19 new positive tuberculin reactions and six cases of active tuberculosis discovered in the population. All but two of the patients with new positive tuberculin reactions and all of the patients with new cases of active tuberculosis were members of at least one of the following high-risk groups: (1) contract with an individual with active tuberculosis, or a positive family history of the disease; (2) immigrants to the United States; (3) a history of alcohol abuse; (4) having lived in an institutional setting; (5) health care personnel; and (6) having signs and symptoms of tuberculosis (cough, anorexia, weight loss, positive chest roentgenogram). All new cases of active tuberculosis were diagnosed because of symptoms. No asymptomatic person with a positive tuberculin test developed active disease during the study period. The positive predictive value of using risk factors to prescreen for the tuberculin skin test was 16 percent. The negative predictive value of not screening people without risk factors (because they will have a negative tuberculin test) was 99.8 percent.

Adolescent↗
PubMed1984

Improving physician compliance with a health maintenance protocol.

A two-year prospective study was conducted to determine whether specific educational, organizational, and behavior reinforcing interventions could improve physician performance of selected health maintenance procedures in the private practice setting. The procedures studied included history of tobacco use, blood pressure determination, history of alcohol use, fecal occult blood testing for colon cancer, Pap smears, and physician breast examinations. Overall compliance with these procedures improved from 58 percent to 72 percent. There were marked differences in compliance among the procedures, ranging from 99 percent of patients having their blood pressure recorded to 51 percent having a fecal occult blood screening for colon cancer. Compliance with use of a screening flow sheet was much less than compliance with specific procedures. The screening flow sheet was completed on only 29 percent of patients' charts.

Cooperative Behavior↗
PubMed1982

Stool occult blood screening for colorectal cancer.

During a five-year prospective study of patient compliance with the Hemoccult slide test as a screen for colorectal cancer, 772 adults above 40 years of age received 1,693 sets of Hemoccult slides. Overall compliance with returning the slides was 75 percent. Compliance remained high with repeat testing. Sixty percent of patients returned all sets of slides. Thirty percent of patients who did not return the first two sets of slide ultimately changed their behavior and returned subsequent slides. Two to five minutes of provider time were required for instruction and distribution of the first set of slides. Distribution of subsequent sets of slides required less than one minute of provider time. Three cancers were detected during the study period. Two of these cancers were diagnosed only by colonoscopy or subsequent surgery and were missed by rigid sigmoidoscopy and barium enema. Stool occult blood screening for colorectal cancer is accepted by patients and requires little physician time in the private practice, fee-for-service setting.

Adult↗
PubMed1978

A model for the use of physician's assistants in primary care.

The function and long-term viability of physician's assistants in primary care is controversial. The authors hypothesize that to remain a viable entity the physician's assistant (PA) must meet criteria including ability to make independent decisions, to obtain the complete trust of the supervising physician, to deliver care of quality equal to that of physicians, and to produce revenue in excess of the PA's cost and overhead. A model for the use of a PA in primary care is described which has been in operation for four years. This model is tested against these criteria to see if conditions for long-term viability are met. The results show physician's assistants do have a valuable role im primary health care delivery which should not be eliminated by future increases in physician manpower.

Clinical Competence↗
PubMed1975

A critical review of periodic health screening using specific screening criteria. 3. Selected diseases of the genitourinary system.

Despite the increasing interest in recent years in prevention and early recognition of asymptomatic disease, an objectively based program for periodic health screening of asymptomatic adults has yet to be proposed for the primary care physician. This is the third in a series of four articles which will critically examine the feasibility of screening procedures for 36 selected diseases. Six basic criteria are adopted as necessary to justify periodic screening. Specific screening recommendations are made for each disease, and a longitudinal screening program for asymptomatic adults will be proposed in the concluding article of this series.

Adenocarcinoma↗
PubMed1975

A critical review of periodic health screening using specific screening criteria. Part 2: Selected endocrine, metabolic and gastrointestinal diseases.

Despite the increasing interest in recent years in prevention and early recognition of asymptomatic disease, there has been a lag in development of a sound scientific basis for efforts in this area. No objectively based program for periodic health screening of asymptomatic adults has yet been proposed for the primary care physician. This is the second in a series of four articles which will critically examine the feasibility of screening procedures for 36 selected diseases. Six basic criteria are adopted as necessary to justify periodic screening. Specific screening recommendations are made for each disease, and a longitudinal screening program for asymptomatic adults will be proposed in the concluding article of this series.

Adult↗