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Biomedical subjects

S H Woolf

Publications and source records attributed to S H Woolf.

At least 73 records · Page 4Linked to original sources
PubMed1992

United States Preventive Services Task Force recommendations on breast cancer screening.

The US Preventive Services Task Force (USPSTF) was established in 1984 by the US Department of Health and Human Services to develop recommendations on clinical preventive services based on evidence from published clinical research. Guidelines issued in 1989 addressed 169 preventive services in 60 topic areas. This article reviews the USPSTF recommendations on breast cancer screening, which call for annual clinical breast examinations after 40 years of age, mammography every 1 to 2 years beginning at 50 years of age, and early screening of women at increased risk for breast cancer. The USPSTF methodology for evaluating the quality of evidence and the scientific rationale for its recommendations are reviewed.

Breast Neoplasms↗
PubMed1992

Practice guidelines, a new reality in medicine. II. Methods of developing guidelines.

Current methods for developing practice guidelines include informal consensus development, formal consensus development, evidence-based guideline development, and explicit guideline development. Informal consensus development is the oldest and most common approach, but guidelines produced in this manner are often of poor quality and lack adequate documentation of methods. Formal consensus development uses a systematic approach to assess expert opinion and to reach agreement on recommendations. Evidence-based guideline development links recommendations directly to scientific evidence of effectiveness; rules of evidence are emphasized over expert opinion in making recommendations. Explicit guideline development clarifies the rationale by specifying the potential benefits, harms, and costs of available interventions; estimating the possibility of the outcomes; and comparing the desirability of the outcomes based on patient preferences. Steps in the development of practice guidelines include introductory decisions (selection of topic and panel members, clarification of purpose); assessments of clinical appropriateness (review of scientific evidence and expert opinion); assessment of public policy issues (resource limitations, feasibility issues); and guideline document development and evaluation (drafting of document, peer review, and pretesting).

Clinical Protocols↗
PubMed1990

Assessing the clinical effectiveness of preventive maneuvers: analytic principles and systematic methods in reviewing evidence and developing clinical practice recommendations. A report by the Canadian Task Force on the Periodic Health Examination.

This paper examines a process for evaluating clinical effectiveness and developing recommendations in which systematic methods are used to review evidence from published clinical research and to reach sound conclusions about appropriate medical policy. The methodology addresses four important components of the analytic process: (1) the criteria that must be satisfied for a clinical practice to be considered effective; (2) proper methods for reviewing evidence from published clinical research to determine whether a clinical practice meets these criteria (including methods for performing comprehensive literature reviews, for judging the quality of individual studies, and for synthesizing or pooling the results of multiple studies); (3) theoretical and practical concerns in translating the results of the scientific review into sound clinical practice recommendations; and (4) the importance of documentation, guidelines, and other safeguards to minimize the effect the reviewers themselves have on the objectivity and consistency of the analytic methods.

Epidemiologic Methods↗
PubMed1990

Practice guidelines: a new reality in medicine. I. Recent developments.

There is growing interest in the use of practice guidelines for physicians as a means of reducing inappropriate care, controlling geographic variations in practice patterns, and making more effective use of health care resources. Recent developments at the national health policy level suggest that practice guidelines will play an increasingly prominent role in the practice of medicine. The federal government has created a new US Public Health Service agency with responsibility for practice guidelines. Guidelines have been developed by more than 35 physician organizations and specialty societies. The American Medical Association and the Council of Medical Specialty Societies have endorsed practice guidelines and are organizing specialty societies to set policy on the subject. Academic medical centers have formed a research consortium on practice guidelines. Independent research centers (eg, the RAND Corporation and the Institute of Medicine) are developing methods for assessing appropriateness and setting guidelines. Other groups, such as hospitals, insurers, managed care plans, and private enterprises, are also directly involved. The implications of these developments are far reaching.

Academies and Institutes↗
PubMed1989

The medical information needs of internists and pediatricians at an academic medical center.

Medical information needs were examined in a survey of sixty-seven physicians selected from the faculty and housestaff at Johns Hopkins Hospital. A standardized questionnaire was administered personally by a medical informatics physician to collect data on information needs, attitudes, and previous experience with computers. The types of information most frequently required by both faculty and housestaff were treatment recommendations and differential diagnosis. The sources of reference information most commonly used were textbooks and colleagues. The information needs of housestaff differed significantly in several categories from those of faculty physicians. Housestaff more frequently needed information for patient care (P less than 0.05), and preferred the use of textbooks (P less than 0.01) and handbooks (P less than 0.001) as information sources. Faculty more frequently needed information for activities unrelated to patient care (P less than 0.01) and placed greater importance on basic science information (P less than 0.01). When asked to suggest references for online access, the respondents named 143 journals and textbooks, with journals overwhelmingly preferred over textbooks. Only one reference, the New England Journal of Medicine, was requested by a majority of the respondents. The importance of a broad understanding of physician information needs through improved data-collection techniques is discussed as a means of increasing the use of medical information systems.

Academic Medical Centers↗
PubMedDate not supplied

Selection bias from requiring patients to give consent to examine data for health services research.

BACKGROUND: New rulings nationwide require health services researchers to obtain patient consent before examining personally identifiable data. A selection bias may result if consenting patients differ from those who do not give consent. OBJECTIVE: To compare patients who consent, refuse, and do not answer. DESIGN: Patients completing an in-office survey were asked for permission to be surveyed at home and for their records to be reviewed. Survey responses and practice billing data were used to compare patients by consent status. SETTING: Urban family practice center. PATIENTS: Of 2046 eligible patients, 1106 were randomly selected for the survey, were approached by staff, and agreed to participate. Approximately 87% of the nonparticipants were eliminated through a randomization process. MAIN OUTCOME MEASURE: Consent status. RESULTS: A total of 33% of patients did not give consent: 25% actively refused, and 8% did not answer. Consenting patients were older, included fewer women and African Americans, and reported poorer physical function than those who did not give consent (P<.05). Patients who did not answer the question were older, included more women and African Americans, and were less educated than those who answered (P<.02). Visits for certain reasons (eg, pelvic infections) were associated with lower consent rates. On multivariate analysis, older age, male sex, and lower functional status were significant predictors of consent. CONCLUSIONS: Patients who release personal information for health services research differ in important characteristics from those who do not. In this study, older patients and those in poorer health were more likely to grant consent. Quality and health services research restricted to patients who give consent may misrepresent outcomes for the general population. Arch Fam Med. 2000;9:1111-1118

Adult↗
PubMedDate not supplied

The need for perspective in evidence-based medicine.

Research advances are generating a growing body of clinical trial and other data on the effects of tests and treatments on outcomes, but there is no information resource within the health care system that systematically puts that information in perspective. Policy makers, clinicians, and individuals lack a ready means to compare the relative effectiveness of various interventions in prolonging survival or preventing the occurrence or complications of a disease: information that is critical in setting priorities. A crude analysis of preventable deaths suggests that evidence-based primary prevention (getting the population to stop smoking, exercise, lower cholesterol levels, and control blood pressure) would prevent considerably more deaths per year than would various evidence-based treatments for cardiovascular disease. Examining evidence from this perspective calls attention to mismatched priorities-most health care expenditures in the United States go toward treatment of diseases and their late-stage complications and relatively few resources are devoted to primary prevention and health promotion. Similar analyses at the individual level can help patients put personal options in perspective. This article proposes a bibliographic evidence-collection center and simulation modeling program to estimate potential benefits and harms of competing interventions for populations and individuals. Such evidence-based projections would enable policy makers, clinicians, and patients to judge whether they give due priority to the interventions most likely to improve health. With the steady growth in research data, the need for a system that enables society and individuals to put evidence in perspective will become progressively more urgent.

Cost of Illness↗
PubMedDate not supplied

Background and objectives of the U.S. Preventive Services Task Force.

Clinical preventive services have always been recognized by clinicians as an important part of primary care medicine, but for many years there has been some uncertainty as to the effectiveness of these maneuvers in preventing disease and exactly how and when they should be performed. The recent report of the U.S. Preventive Services Task Force provides a comprehensive review of the science base for preventive services and offers specific recommendations for clinicians on the appropriate delivery of screening tests, counseling interventions, immunizations, and other preventive services. The recommendations provide guidance on how to design an appropriate package of services based on the medical history and risk profile of each patient. This article describes the historical background behind the formation of the task force, its methodology and rationale, and the format of the final report, the "Guide to Clinical Preventive Services." The potential implications of this report and its limitations are also discussed.

Canada↗