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Biomedical subjects

P S Frame

Publications and source records attributed to P S Frame.

47 records · Page 3Linked to original sources
PubMed1975

A critical review of periodic health screening using specific screening criteria. Part 4: selected miscellaneous diseases.

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 last in a series of four articles which have critically examined 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 is proposed. Cost and patient education are two important factors in any viable screening program.

Adult↗
PubMedDate not supplied

After the grant runs out. Long-term provider health maintenance compliance using a computer-based tracking system.

OBJECTIVE: To measure long-term provider (physicians and physician's assistants) health maintenance compliance 4 years after the completion of a grant-funded project to improve provider compliance by using a computer-based health maintenance tracking system. DESIGN: Cross-sectional comparison of provider health maintenance compliance for patients receiving computer-based health maintenance tracking in 1992 and 1996. SETTING: Rural, multiple-office, nonprofit, fee-for-service family practice. MAIN OUTCOME MEASURES: Overall provider compliance with the common elements of the health maintenance protocols in 1992 and 1996. Provider compliance with specific, individual preventive interventions was compared. RESULTS: Overall provider compliance was 83% in 1996, compared with 80% in 1992. This difference was statistically significant (P = .05) but not clinically significant. Provider compliance was significantly higher in 1996 for 3 procedures: blood pressure determination, tetanus-diphtheria immunization, and weight. It was unchanged for 5 procedures: clinical breast examination, mammography, Papanicolaou smears, cholesterol determination, and fecal occult blood testing for colon cancer. Provider compliance with obtaining a history of tobacco use declined. CONCLUSION: Improvements in provider health maintenance compliance associated with installation of a computer-based health maintenance tracking system were maintained 4 years after cessation of the formal research intervention.

Cross-Sectional Studies↗
PubMedDate not supplied

Can computerized reminder systems have an impact on preventive services in practice?

This report reviews computerized reminder systems for tracking health maintenance in clinical practice and discusses the features of a useful, cost-effective system. Systems presently available are predominantly designed for large groups. The primary product of these systems is a health maintenance status report for the provider that is generated at each patient visit. Systems for smaller groups that will generate reminders for providers and patients at specified appropriate intervals and will easily send reminders to patients who do not have appointments or are inactive are not available. Necessary features of such "ideal" computerized tracking systems include: 1) Demographic data must be obtainable from the practice's billing system and not require separate data entry. 2) Data entry must be quick, preferably single-screen. 3) Multiple-entry options must be available for each procedure. 4) The system must generate reminders regardless of whether a patient has an appointment. 5) Providers must be able to specify or cancel patient reminders. 6) A status report must be created for the chart at specified intervals. 7) The frequency and description of indicated procedures must be modifiable without programmer assistance.

Ambulatory Care Information Systems↗
PubMedDate not supplied

Determinants of cancer screening frequency: the example of screening for cervical cancer.

BACKGROUND: Cancer screening frequency should be based on the rate of progression of the disease and the sensitivity of the screening test. A common misconception is that a person's risk of getting the disease determines how often they should be screened. METHODS: We describe algebraically the theoretical interaction of disease progression rate and screening test sensitivity determining the portion of invasive cancers prevented by screening. After discussing the assumptions and limitations of the model, we apply this model to the example of screening for cervical cancer. Actual data from large screening programs assembled by the International Agency for Research on Cancer (IARC) are used to test the assumptions of the model. RESULTS: A simple formula can express the relation between disease progression rate, sensitivity of the screening test, screening frequency, and screening error. Disease prevalence does not figure in this equation. The IARC data suggest that, at least for cervical cancer, as screening frequency increases, incremental sensitivity of the test decreases or remaining undetected cases progress more rapidly so that anticipated benefits from more frequent screening are not realized. CONCLUSIONS: Rate of disease progression and sensitivity of the screening test are the proper determinants of cancer screening frequency. Because these factors can vary depending on screening frequency, however, the optimal screening interval for a particular cancer must be determined by clinical trials.

Data Interpretation, Statistical↗
PubMedDate not supplied

Use of colchicine to treat severe constipation in developmentally disabled patients.

BACKGROUND: Patients with severe developmental disabilities often have concurrent decreased neuromuscular tone of the gastrointestinal tract, which can lead to a weak gag reflex, esophageal reflux, aspiration, and severe intractable constipation. High doses of multiple laxatives are frequently needed to maintain bowel motility in these patients. Colchicine, a natural alkaloid that is primarily used for the treatment of acute attacks of gout, causes an increase in gastrointestinal motility by neurogenic stimulation. The purpose of this study was to determine whether daily colchicine administration can improve bowel function and reduce laxative use in profoundly disabled patients with severe, intractable constipation who currently require large doses of multiple laxatives. METHODS: Twelve developmentally disabled patients who required three or more different laxatives to manage their chronic constipation were selected to participate in a double-blind, crossover study. Eleven patients who completed the study received placebo treatment for 8 weeks and colchicine treatment for 8 weeks. The total number of bowel movements and the total number of laxatives used during each of the two 8-week periods were compared. RESULTS: Eight of 11 patients experienced an improved bowel pattern while on colchicine compared with placebo, as defined by an increase in total number of bowel movements or a decrease in total number of rectal laxatives used. No clinically important complications were related to use of colchicine. CONCLUSIONS: Colchicine appears to be a valuable adjunct in the management of severe intractable constipation. Larger, long-term studies are needed to confirm these preliminary results.

Adult↗
PubMedDate not supplied

Description of a computerized health maintenance tracking system for primary care practice.

This article describes the development of a computerized health maintenance tracking system for primary care practice and its features. Research has shown existing computerized health maintenance tracking systems are unsatisfactory for the average practitioner for these reasons: (1) Data entry is slow or requires duplication of entries for billing purposes; (2) the system is linked to a totally computerized medical record that is expensive and complex to maintain; (3) health maintenance status options are limited to "YES/NO" and do not inform the practitioner of the full range of possible situations; (4) physician reminders are created only for patients with an appointment; (5) patient reminders are not generated on a regular basis regardless of appointment status; (6) it is difficult to change individual and global health maintenance schedules. The system described here downloads demographic and health maintenance data from the practice's billing system. Six health maintenance status options are available: D = done and normal, X = done but abnormal, N = not indicated, R = patient refused, E = done elsewhere, I = abnormal but inactive. A health maintenance status report is created for both the patient and provider once a year, in the month of the patient's birth unless an alternate month has been designated, regardless of the patient's appointment status. Patients are encouraged to make an appointment for overdue health maintenance procedures, unless already scheduled.

Appointments and Schedules↗
PubMedDate not supplied

Computerized health maintenance tracking systems: a clinician's guide to necessary and optional features. A report from the American Cancer Society Advisory Group on Preventive Health Care Reminder Systems.

BACKGROUND: To promote preventive health care by primary care physicians and the development of computerized health maintenance tracking systems, the American Cancer Society sponsored an expert advisory group to define necessary and desirable, but optional features of computer-based health maintenance tracking software for use in primary care practice. METHODS: Systematic literature review and structured consensus development were followed by independent expert critique. RESULTS: Necessary input features include a comprehensive, practice-specific health maintenance protocol, multiple entry codes to indicate the current status of each procedure, and a mechanism for patient-specific exclusion or alteration of procedure frequency. Necessary features of the information management system include a linkage to a demographic data system, optional tracking of all or selected patients, identification of each patient's primary provider, and the ability to provide either a paper or electronic interface for the provider. Necessary outputs include provider reminders, patient reminders sent regularly regardless of visit status, and summary reports of provider and patient compliance. CONCLUSIONS: Although the ideal computer-based health maintenance tracking system is still evolving, knowledge of these necessary and optional features can aid clinicians interested in buying or developing a system for their own practice.

Preventive Medicine↗