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Biomedical subjects

S J Zyzanski

Publications and source records attributed to S J Zyzanski.

At least 19 recordsLinked to original sources
PubMed1997

Intermittent claudication in 8343 men and 21-year specific mortality follow-up.

PURPOSE: As Western populations live longer, peripheral vascular disease will become a greater individual and public health problem. Therefore, the long-term natural history of intermittent claudication (IC) needs further delineation. The study objective was to describe the 21-year mortality and relative risk for cause-specific mortality for subjects with incident IC. METHODS: The subjects were 8343 Israeli male governmental employees aged 40-65 years who were free of coronary heart disease and symptomatic peripheral vascular disease in 1963. These men were followed for 21 years to measure differences in mortality between those who did and did not develop incident IC. Incident IC was diagnosed in 1965 and 1968 by the London School of Hygiene IC Questionnaire. All other cardiovascular disease risk factors were measured by standardized and validated procedures. Cause-specific mortality through 1986 was determined through death certificates from the Israeli Mortality Register. RESULTS: A total of 360 men with IC and 7983 symptom-free men were followed for survival from 1965 to 1986; 159 men with IC (44%) and 2330 symptom-free men (29%) died. For total mortality, the Kaplan-Meier 21-year survival probabilities were 56% for IC and 71% for symptom-free men (P < 0.0001 for the entire 21-year survival difference between the two groups). For coronary heart disease (CHD), stroke, and other causes of death, the survival probabilities for men with IC and symptom-free men were, respectively: 85% vs. 90%, 89% vs. 97%, and 79% vs. 83% (P = 0.0004; P < 0.0001; and P = 0.007, respectively, for the entire 21-year survival difference between the two groups). Cox's proportional hazards model was used to control confounding from incident myocardial infarction and angina through 1968, as well as for demographic, physiologic, psychosocial, and other cardiovascular disease risk factors. The 21-year adjusted all-cause mortality relative risk for IC was 1.50 (95% confidence interval (CI), 1.28-1.77). For stroke deaths the relative risk was 2.76 (95% CI, 1.89-4.02). For stroke mortality, IC was the third strongest predictor of death after elevated systolic blood pressure and increasing age. Incident IC had a relative risk of CHD deaths of 1.31, but it was not statistically significant (P = 0.08; 95% CI, 0.97-1.77). IC was not statistically significantly related to other causes of death (P = 0.10) after adjustment for covariates. CONCLUSIONS: IC is strongly predictive of long-term cerebrovascular disease mortality among men. Incident IC is a stronger indicator of cerebrovascular than of CHD death.

Adult↗
PubMed1996

Medical decision making and perceived socioeconomic class.

OBJECTIVE: To examine the effects that a physician's knowledge of a patient's socioeconomic status or profession has on clinical decision making in an outpatient setting. METHODS: We mailed a survey to all 336 members of the Academy of Medicine of Cleveland who are general internists, family practitioners, or general practitioners. Physicians were randomized before the initial mailing to receive one of the two questionnaires. Physicians in group A were given two simulated clinical scenarios in which the socioeconomic status or profession of the patient was identified, followed by management options. Physicians in group B were given the same scenarios without any suggestion of the patient's profession or social standing. Outcomes that reflect decision making, intensiveness of evaluation, and treatment course were compared for the two groups. Data were analyzed using t tests and chi 2. After Bonferroni correction, a P < or = .01 was considered significant. RESULTS: The response rate was 60%. For clinical scenario 1, no difference was noted in the number of tests ordered. However, physicians in group A responding to clinical scenario 2 ordered more total tests than did physicians in group B (P = .03), including complete blood cell counts (45% vs 29%, P = .01). In both scenarios, earlier follow-up visits were scheduled by physicians in group A compared with those in group B (P = .01). CONCLUSION: Our results do not support findings by other investigators that more tests are ordered when physicians perceive their patients to be of higher socioeconomic status. Intensity of follow-up, however, was greater when physicians believed the patient was in a more prominent profession or was of higher socioeconomic status.

Adult↗
PubMed1996

Selection of key community descriptors for community-orientated primary care.

BACKGROUND: Community-oriented primary care (COPC) requires the development of practical tools if it is to be carried out. A previous study demonstrated a practical approach to carrying out one portion of a community assessment for COPC using a few representative health indicators. OBJECTIVE: To determine the validity of this process elsewhere, we tested whether these findings were generalizable to other settings and to the same setting a decade later. METHOD: In a cross-sectional study design, data on 18 health indicators were collected for census tracts in two target areas and for the entire state of Ohio, USA, for 1990. A factor analysis was performed to identify factors underlying the health indicators in the three areas examined. RESULTS: Two underlying factors, termed age and poverty, were present in all locations and over time. Each factor was defined by core indicators and a cluster of associated indicators. CONCLUSIONS: These results suggest that one part of a COPC community assessment can be done by selecting very few indicators. The distribution of indicators of age and income explains the variability of most of the health related indicators studied. These factors are stable over time and location. A community assessment should include indicators which, at a minimum, provide information on these two factors.

Adolescent↗
PubMed1996

A comparison of US and Canadian family physician attitudes toward their respective health-care systems.

OBJECTIVES: To examine how family physicians in the United States and Canada evaluate their respective health-care systems. METHODS: The study design was a cross-sectional survey of 300 randomly selected US family physicians and 300 Canadian family physicians. Outcome measures included: attitudes about professional satisfaction and views on health-care delivery and government involvement in health care. RESULTS: Sixty-one percent of the US sample and 67% of the Canadian sample responded. After performing factor and discriminant analyses, we were able to identify nine characteristics differentiating the two groups of physicians. United States physicians were more likely to be older, male, working in rural areas, conservative in their political thinking, and satisfied with their ability to obtain diagnostic tests. United States physicians viewed the health-care system as being in need of fundamental changes, less likely to advocate a central role for government, and more likely to report that litigation concerns influence their clinical decisions. CONCLUSIONS: This study documents differences between Canadian and US family physicians, and suggests that US family physicians might not easily accept a Canadian-style health-care system. Policy makers implementing health-care system changes should be cognizant of the attitudes of physicians that might determine their acceptance or rejection of such changes.

Adult↗
PubMed1996

Skindex, a quality-of-life measure for patients with skin disease: reliability, validity, and responsiveness.

To measure the effects of skin disease on patients' quality of life, we developed a 61-item self-administered survey instrument called Skindex. Skindex has eight scales, each of which addresses a construct, or an abstract component, in a comprehensive conceptual framework: cognitive effects, social effects, depression, fear, embarrassment, anger, physical discomfort, and physical limitations. Item responses are standardized from 0 (no effect) to 100 (maximal effect); a scale score is the average of responses to items addressing a construct. In 201 patients seen by dermatologists, mean scale scores (+/-SD) ranged from 14 (+/-17) for physical limitations to 31 (+/-22) for physical discomfort. Scale scores were reproducible after 72 h (r = 0.68-0.90) and were internally consistent (Cronbach's alpha = 0.76-0.86). Construct validity was assessed in two ways: (i) in a comparison of patients with inflammatory dermatoses and patients with isolated lesions, patients with inflammatory dermatoses had higher scale scores, and (ii) in an exploratory factor analysis, 78% of the common variance was explained by seven factors that correlated with the scale scores of Skindex. Most of the a priori scale scores changed in the expected direction in patients who reported that their skin conditions had improved or worsened after 6 mo. Finally, physicians' judgments of disease severity did not consistently correlate with Skindex scores. These preliminary data suggest that Skindex reliably and responsively measures the effects of skin disease on patients' quality of life and may supplement clinical judgments of disease severity.

Adult↗
PubMed1996

Academic achievement of successful candidates for tenure and promotion to associate professor.

BACKGROUND AND OBJECTIVES: For faculty to achieve promotion and tenure, a clear understanding is needed of the measures by which performance will be judged. This study describes the specific academic achievements of successful candidates for tenure and promotion to associate professor in family medicine. METHODS: A survey questionnaire was mailed to all members listed in the Society of Teachers of Family Medicine database as holding the rank of associate professor. The questionnaire sought information about items as they were at the time the individual was being considered for promotion to associate professor with tenure. The items included scholarly accomplishments, time for research, areas of scholarly expertise, and departmental policy regarding promotion and tenure. RESULTS: Of the 296 eligible faculty, 197 (67%) returned a completed survey. The mean number of publications of these successfully promoted individuals was 10. The respondents averaged 78% of their publications in peer-reviewed journals and were first author on 64% of their peer-reviewed articles. The mean number of peer-reviewed publications per year was 1.5. Research grant support as principal or coinvestigator was reported by 44%, and respondents averaged 9 hours a week on scholarly activities. Scholarly activity was found to vary significantly by type of school, degree, and tenure track status. CONCLUSIONS: Information reported here can be of value for prospective promotion and tenure candidates, their advisors, and members of review committees.

Achievement↗
PubMed1995

Self-reported physical activity predicts long-term coronary heart disease and all-cause mortalities. Twenty-one-year follow-up of the Israeli Ischemic Heart Disease Study.

OBJECTIVE: To determine whether self-reported physical activity predicts a decreased rate of coronary heart disease (CHD) and all-cause mortalities in middle-aged men when rates are adjusted for known confounders. DESIGN: Cohort Analytic Study of Israeli government employees in 1963. SUBJECTS: Eight thousand four hundred sixty-three Israeli male government employees, aged 40 years or older, representing six areas of birth, excluding those with known cardiovascular disease in either 1963 or 1965, from an original cohort of 10,059. MAIN OUTCOME MEASURE: Comparison of rates of death due to CHD and all causes, determined from death certificates in 21 years of follow-up, for subjects with different baseline levels of self-reported leisure-time and work-related physical activities measured in 1965. RESULTS: Self-reported leisure-time but not work-related physical activity was inversely related to both CHD (adjusted relative risk, 0.79; 95% confidence interval, 0.66 to 0.95) and all-cause mortalities (adjusted relative risk, 0.91; 95% confidence interval, 0.83 to 0.99). Most of the apparent benefit accrued was from light physical activity on less than a daily basis. These inverse relationships persisted after adjustment for age, systolic blood pressure, cigarette smoking, total and high-density lipoprotein cholesterol levels, body mass index, psychosocial factors, and other potential confounders. CONCLUSION: Baseline levels of self-reported leisure-time physical activity predicted a decreased rate of CHD and all-cause mortalities in employed middle-aged Israeli men followed up prospectively for 21 years.

Adult↗
PubMed1995

Factors associated with medication noncompliance in rural elderly hypertensive patients.

This study sought indicators of patient noncompliance with medications prescribed for hypertension. A sample of 62 elderly, rural hypertensive patients were interviewed regarding demographics, history and knowledge of hypertension, quality of life, the physician-patient relationship, drug use, and side effects encountered. A five-variable composite was able to detect the patients who were defined as noncompliant. The composite included: 1) number of chronic illnesses, 2) perceived amount of time the physician spends with the patient, 3) the patient's household composition, 4) family history of hypertension, 5) and whether hypertension affects work or home activities. More accurate identification of noncompliant patients sets the stage for interventions to improve compliance.

Aged↗
PubMed1995

Taped therapeutic suggestions and taped music as adjuncts in the care of coronary-artery-bypass patients.

A randomized, single-blinded, placebo-controlled trial examined the benefits of taped therapeutic suggestions and taped music in coronary-artery-bypass patients. Sixty-six patients listened to either suggestion tapes or music tapes, intraoperatively and postoperatively; 29 patients listened to blank tapes intraoperatively and listened to no tapes postoperatively. Half the patients who listened to a tape found it helpful. There were no significant differences between groups in length of SICU or postoperative hospital stay, narcotic usage, nurse ratings of anxiety and progress, depression, activities of daily living, or cardiac symptoms. There were no significant differences in these same outcomes between the patients who were helped by the tapes and the patients not helped. These results suggest that if taped therapeutic suggestions have a measurable effect upon cardiac surgery patients, demonstrating this effect will require more detailed patient evaluations to identify subgroups of patients responsive to this type of intervention.

Aged↗
PubMed1995

A practical tool for community-oriented primary care community diagnosis using a personal computer.

BACKGROUND AND OBJECTIVES: Community-oriented primary care (COPC) is considered an attractive concept by many but has had limited implementation due to a lack of practical methodology. An important step in COPC is assessment of a community's health status, using health indicators as one means of assessment. Currently, there is no easy way to combine these indicators and examine their distribution over a community. This study analyzed a process for doing that by using a personal computer. METHODS: For the community studied, all available community-based health indicators were identified. A process for combining these indicators, using commonly available database and spreadsheet software, was developed and analyzed for cost, clinical utility, and problems encountered. RESULTS: Problems were encountered with collecting and combining some data, but a clinically useful tool was produced. Costs, including purchase of all software (with mapping software), were $1,500-$2,000. CONCLUSIONS: With efforts to reduce the initial costs, this is a practical and clinically useful tool for viewing the geographic distribution of community health indicators. Such practical methodology is essential for COPC development.

Community Health Planning↗
PubMed1995

Factors associated with research productivity in family practice residencies.

BACKGROUND: Research productivity and the associated features of research productivity in family practice residencies have not been well described. The objectives of this study are to describe residency research productivity and identify the set of independent factors that best characterize programs at various levels of productivity. METHODS: A 23-item survey was mailed to 226 randomly selected family practice residency directors. The survey included items on program demographics, mentoring, resident and faculty research activities, and program research resources. Factor and discriminant analyses were performed to identify the major independent factors associated with productivity. RESULTS: A total of 154 completed surveys were received for a response rate of 68%. Based on a cross tabulation of grants per program and publications per faculty, 22% of programs had high productivity, 46% had medium productivity, and 32% had low productivity. The significant factors of mentor support, amount of research activity, and program size contributed independently to the classification of programs by relative level of research productivity. These associations remained significant when university programs were excluded. CONCLUSIONS: Family practice residencies with relatively higher research productivity are more likely to have three characteristics than lower productivity programs: availability of a research mentor, more faculty research activities, and larger program size.

Efficiency↗
PubMed1995

An educational intervention to increase faculty publication productivity.

BACKGROUND: Writing is an essential skill for academic family physicians. It is essential in all of the academic physicians' roles, and publications are critical for promotion and tenure. This study describes a three-part faculty development instructional program designed to teach writing skills. The instructional program was repeated over a 3-year period involving two different institutions with departments of family medicine. METHODS: Educational interventions included seminars, workshops, and independent practice, with feedback from senior advisors. The practice and feedback sections centered on the faculty members' own written products. RESULTS: This series resulted in the publication of 16 papers from 13 of the 40 faculty participants. CONCLUSIONS: Our experience suggests that a writing series is one effective method that departments of family medicine may use to facilitate the writing productivity of faculty.

Authorship↗
PubMed1994

Epidemiology of intermittent claudication in middle-aged men.

Intermittent claudication, myocardial infarction, and angina pectoris share many epidemiologic and biologic features. Yet few large cohort studies describing the prevalence, incidence, and risk factors for intermittent claudication have been done. The authors evaluated intermittent claudication in 10,059 Israeli men aged 40-65 years, of whom 8,343 were free of coronary heart disease and symptoms of peripheral vascular disease; this latter group was followed for 5 years from 1963 to 1968. Prevalent and incident cases of intermittent claudication were defined by the London School of Hygiene Cardiovascular Disease Questionnaire, and all cardiovascular disease risk factor evaluations were standardized. Baseline prevalence was 27.0/1,000 (211/10,029). A total of 360 previously healthy men developed intermittent claudication for a crude 5-year incidence rate of 43.1/1,000 (360/8,343) or a crude annual incidence of 8.6/1,000. Following univariate analysis with demographic, physiologic, psychosocial, and other cardiovascular disease variables, logistic regression was used to identify risk factors for intermittent claudication. These were the following: > 20 cigarettes per day, odds ratio (OR) = 2.02, 95% confidence interval (CI) 1.54-2.66; serum cholesterol (50-mg/dl difference), OR = 1.35, 95% CI 1.18-1.54; 11-20 cigarettes per day, OR = 1.69, 95% CI 1.24-2.30; anxiety (high vs. low), OR = 1.85, 95% CI 1.29-2.65; socioeconomic status, OR = 1.82, 95% CI 1.26-2.64; and diabetes, OR = 1.85, 95% CI 1.25-2.75. Other significant predictors of smaller magnitude included in the regression were age, psychosocial coping factors, Quetelet's index, and exsmoking. The risk factors for intermittent claudication were a blend of those related to myocardial infarction (smoking, cholesterol, diabetes, but not hypertension) and others related to angina pectoris but not to myocardial infarction (stress and coping variables). There is reason to believe that preventing or modifying these factors will prove effective in altering the natural history and clinical outcomes of peripheral vascular disease as shown in other forms of atherosclerosis.

Adult↗
PubMed1994

The clinical utility of a day of hospital observation after switching from intravenous to oral antibiotic therapy in the treatment of pyelonephritis.

BACKGROUND: This study was undertaken to investigate the clinical utility of a widespread practice: the 24-hour in-hospital observation period that commonly follows when the treatment of patients hospitalized with acute pyelonephritis is switched from intravenous to oral antibiotics. A preliminary survey of infectious disease specialists confirmed the pervasiveness of this practice and the lack of scientific evidence to support it. METHODS: The clinical utility of in-hospital observation was examined by means of a retrospective chart review of 138 consecutive nonpregnant adult patients who were between the ages of 17 and 65 and had been admitted to a university hospital with a diagnosis of acute pyelonephritis. The progress notes, temperature charts, and laboratory test results were reviewed for any evidence of clinical relapse or adverse reaction to the antibiotic that occurred in the 24-hour period after the switch from intravenous to oral antibiotic therapy. RESULTS: Only two (1%) patients had evidence of clinical relapse within the study period. Five (4%) patients had adverse reactions to their oral antibiotic, none of which were serious. The 95% confidence interval for the percentage of patients who might experience a clinical relapse was from 1% to 5%; for adverse antibiotic reaction, 1% to 8%. CONCLUSIONS: This study shows the limited usefulness of an in-hospital observation period. Savings resulting from avoiding an extra day of hospitalization could amount to millions of dollars annually in the United States.

Acute Disease↗
PubMed1994

Markers of successful recruitment of students to family practice residency programs.

BACKGROUND AND OBJECTIVES: With limited numbers of medical students choosing a primary care specialty, family practice residency programs have had to complete to fill available residency positions. The purpose of this study was to determine the characteristics of the recruiting process used by US family practice residencies and to compare recruiting strategies used by successful and unsuccessful programs. METHODS: We surveyed program directors of all 361 nonmilitary, accredited, US family practice residency programs in existence for more than 2 years. The questionnaire elicited information on program descriptors, recruitment process, and fill rate in the National Resident Matching Program. RESULTS: Seventy-eight percent (282) of the program directors returned usable questionnaires. Success in filling available positions through the Match was significantly associated with high quality of current housestaff and faculty and current residents' positive feelings about the program (P < .01). Program directors perceived successful programs as having an outstanding reputation and being regarded positively by other departments within the institution (P < .01). Programs in the Pacific and Mountain regions of the United States are more successful in recruitment. Programs not filling available positions through the Match spent more effort in recruiting strategies such as mailing and marketing materials (P < .01). CONCLUSION: Having high-quality faculty, housestaff, and residents with good attitudes are markers of success in the Match. Less successful programs appear to try harder to attract residents.

Academic Medical Centers↗
PubMed1994

Family physicians' disagreements with the US Preventive Services Task Force recommendations.

BACKGROUND: The 1989 recommendations of the US Preventive Services Task Force (USPSTF) represent an emerging consensus about which clinical preventive services should be delivered. However, practicing physicians disagree with a number of the recommendations in the Task Force prevention guidelines, and the reasons for disagreement have not been widely explored. METHODS: A survey questionnaire assessing physician agreement or disagreement with the USPSTF recommendations was sent to all 1784 active members of the Ohio Academy of Family Physicians in October 1990. A factor analysis was performed on the items with which at least 5% of physicians disagreed. Associations of physician demographics and attitudes with the factor scores were then examined. RESULTS: At least 5% of the 898 responding physicians disagreed with 67 of 150 USPSTF recommendations. Physicians disagreed with the USPSTF recommendations in three ways: (1) they believed that screening for some cancers is appropriate, even though not recommended by the USPSTF; (2) they believed that screening for other diseases in some populations is appropriate, even though not recommended by the USPSTF; and (3) they disagreed with some USPSTF recommendations for screening that is considered time-consuming or intrusive. Further analyses showed that practice setting and experience with the USPSTF guidelines were predictive of all three disagreement factors. Physician age, race, residency training, and reasons for disagreement were associated with two of the three factors. CONCLUSIONS: Physician disagreement with the USPSTF recommendations was not random but clustered into three distinct factors. An opportunity exists to design educational interventions for targeted subgroups of physicians. The views of practicing physicians should be incorporated into future guidelines.

Adult↗
PubMed1994

How do family physicians prioritize delivery of multiple preventive services?

BACKGROUND: In spite of the recommendations of experts, little is known about the priority that physicians assign to various preventive services provided to patients within the time pressures and competing demands of the office visit. METHODS: A survey presenting the case of a 53-year-old woman was sent to a national random sample of 480 practicing family physicians. Physicians were asked which items on a list of preventive services they would provide during 5 minutes remaining at the end of an illness visit for sinusitis, and during a visit for a 30-minute physical examination. Descriptive analyses rank ordered the most commonly provided services. Additional analyses using chi-square and analysis of variance were used to characterize physicians who performed high and low levels of services recommended and not recommended by the US Preventive Services Task Force (USPSTF). RESULTS: Among 268 responding physicians, more than 50% provided smoking cessation advice, blood pressure, height, and weight measurements, and the scheduling of a return visit during the illness visit. During a physical examination visit, many other services, including breast examination, Papanicolaou test, pelvic examination, and ordering a mammogram were also commonly chosen. Physicians performing a high level of USPSTF-recommended preventive services and a low level of not recommended services were characterized by their young age, residency training, not being in solo practice, and greater experience with USPSTF recommendations. CONCLUSIONS: Physicians offer more preventive services during patient visits for physical examinations than during visits for illness. Physician characteristics associated with the delivery of recommended levels of preventive services may be useful in identifying interventions that will direct medical resources toward the most effective preventive services.

Adult↗