Biomedical subjects

A Balshem

Publications and source records attributed to A Balshem.

25 records · Page 2Linked to original sources

PubMedDate not supplied

Hospital procedure volume and teaching status do not influence treatment and outcome measures of rectal cancer surgery in a large general population.

A clear benefit of increased hospital procedure volume or teaching hospital status on outcomes of rectal cancer surgery has yet to be shown. Few have examined treatment differences that may lead to varying outcomes. This study assessed the impact of hospital procedure volume and teaching status on both treatment and outcome measures of rectal cancer surgery in a large general population. Data were obtained for 1072 incident cases of rectal adenocarcinoma diagnosed in 1990 from Ontario, Canada, and treated with a major resection. Hospitals were classified by teaching status and procedure volume. Pathology reports were examined for 418 procedures. Abdominoperineal resections accounted for 31.0% of all procedures. There were no clinically significant differences in treatment measures, operative mortality, and long-term survival among the hospital groups according to both univariate and multivariate analyses. In conclusion, the absence of a hospital volume or teaching status effect on treatment and outcome measures suggests that for rectal cancer surgery in Ontario, centralization of procedures into high-volume or teaching centers is unlikely to improve surgical quality.

Adenocarcinoma↗

PubMedDate not supplied

Feasibility of a telephone survey to recruit health maintenance organization members into a tamoxifen chemoprevention trial.

A large-scale, nationwide tamoxifen chemoprevention trial is currently being planned as a primary preventive strategy against breast cancer. The recruitment of health asymptomatic women into a long-term clinical trial will pose unique recruitment problems. This study examines the feasibility of telephone recruitment from a health maintenance organization population into such a trial. A random sample of 203 women aged 50 and older with a personal family history of breast cancer were contacted by telephone. A structured interview was administered to assess self-perceived risk of breast cancer, willingness to participate in a trial, and anticipated barriers to participation. Of the 203 names generated from the health maintenance organization membership roster 128 (63%) met eligibility criteria and participated in the interview. Forty-five % of the eligible women expressed interest in the tamoxifen trial. Women who felt that their family would support their participation expressed significantly more interest, while concern about possible side effects emerged as potential barriers. We conclude that contact by telephone among health maintenance organization members can identify a significant proportion of women who are interested in primary chemoprevention for breast cancer. Participation rates may be improved by bolstering family support and by addressing concerns about drug toxicity.

Aged↗

PubMedDate not supplied

Breast cancer screening: effect of physician specialty, practice setting, year of medical school graduation, and sex.

We surveyed physicians of different specialties in a large metropolitan area to determine how their characteristics affected their performance and beliefs about breast cancer screening. Of 664 general internists, obstetrician-gynecologists, and cardiologists surveyed, we received 298 responses (45%). We found significant differences in reported performance of breast cancer screening and physicians' beliefs about mammography screening among practicing obstetrician-gynecologists, internists, and cardiopulmonary specialists. Cardiopulmonary specialists performed the fewest breast examinations and screening mammograms and were most likely to believe annual mammography screening unnecessary even for women in their 50s. We observed no difference between physicians graduating before 1960 and those graduating afterward and no differences according to physician sex. We found similar screening practices and beliefs in the three types of practice settings examined: community-based, private practices, a large health maintenance organization (HMO), and academic medical centers. Obstetrician-gynecologists and internists differed only in the frequency with which they performed breast examinations. Physicians graduating before 1960 in these two groups reported somewhat poorer performance and knowledge of breast cancer screening than those graduating more recently. A majority of all respondents disagreed with American Cancer Society guidelines for mammography screening. Physicians of all specialties reported performing far more breast examinations than screening mammograms on women of all ages, even for those 50-59 years of age. We conclude that all physicians need to improve their screening rates. However, intervention programs should first target those physicians with the greatest deficiencies in breast cancer screening performance and knowledge; these include medical specialists and older physicians in primary care specialties.

Age Factors↗

PubMedDate not supplied

Breast screening practices among primary physicians: reality and potential.

Increased use of regular screening mammograms and clinical breast examinations (CBE) among women aged 40 years and more could have a dramatic impact on mortality from breast cancer, but patient and physician barriers to mammography impede its acceptance. We conducted a survey of 300 primary care physicians to assess their knowledge, attitudes, beliefs, and breast screening practices. Our results show that only 71 percent of the respondents ordered mammograms for all women aged 50 to 75 years, which is the recommendation by the National Cancer Institute and American Cancer Society. Approximately 46 percent of respondents performed CBE on all women patients aged 50 to 75 years. Inadequate patient insurance coverage, equivocal radiology reports, patient reluctance or worry, and patient embarrassment all appear to be barriers to physicians' utilization of breast screening.

Adult↗

PubMedDate not supplied

Recruiting high risk women into a breast cancer health promotion trial.

This study sought to identify factors that facilitate or hinder participation in a breast cancer health promotion trial among high-risk women. The subjects were 271 women ages 35 years and older who had a family history of breast cancer in at least one first-degree relative. All subjects were eligible for participation in a randomized trial which compares breast cancer risk counseling with general health counseling. Structured telephone interviews evaluated demographic characteristics, risk factors, risk perceptions, breast cancer concerns, and past screening practices. The results showed that education level was a key determinant of the importance of these factors in participation. Logistic regression modeling indicated that women with a high school education or less were most likely to participate if: (a) their relatives' diagnoses had greatly increased their perceptions of their personal risks [OR (OR) = 4.1], particularly if they perceived that risk to be very high (OR for interaction = 6.4); and (b) if they were ages 40-49 years versus 35-39 or 50 + years (OR = 2.6). By contrast, among women with education beyond high school, participation was predicted by (a) marital status (OR = 2.6), (b) employment (OR = 0.03 for employed), (c) number of affected relatives (OR = 0.07 for 1 versus 2 first-degree relatives), and (d) previous biopsy (OR = 0.42). These findings suggest that recruitment strategies that tailor messages to women's educational levels might be most effective.

Adult↗

PubMedDate not supplied

The effect of a comprehensive breast screening program on self-reported mammography use by primary care physicians and women in a health maintenance organization.

BACKGROUND: Mammography use is increasing in the United States, but most women older than 50 years still are not being screened regularly. A multicomponent program, with components for women and physicians, was conducted to increase screening among women aged 50 to 74 years in an independent practice association (IPA)-model health maintenance organization (HMO). METHODS: The participating women and physicians were surveyed in four waves to evaluate the program. We report on changes in mammography practices by both women and physicians between 1988 (preintervention year) and 1992 (postintervention year). Bivariate and multivariate analyses were calculated. RESULTS: The proportion of responding HMO physicians who recommended annual mammograms for women aged 50 to 74 years increased by 16 percent from 1988 to 1992 compared with an increase of 10 percent for control group physicians (nonsignificant). There was a 30 percent increase from 1988 to 1992 in the proportion of HMO women respondents who reported having had a mammogram in the past year compared with a 19 percent increase among control group women. The difference between these differences was highly significant. The intervention had the strongest effect on women with incomes of less than $30,000. CONCLUSIONS: A multicomponent program in an IPA-model HMO resulted in significant increases in the proportion of HMO women who had mammograms. Similar approaches should be tested in other settings.

Adult↗

PubMedDate not supplied

Impact of an HMO-based intervention to increase mammography utilization.

A health maintenance organization (HMO)-based program designed to increase breast cancer screening was evaluated, focusing on changes in mammography utilization. The program consisted of a multistage intervention aimed at women members and primary care physicians of the HMO. This report examines the effect of the intervention on mammography utilization. The program was evaluated using a quasiexperimental design in which a random sample of women aged 50-74 from the HMO (intervention) was compared to a similarly aged geographic control group selected through random digit dialing. From 1988 to 1990, 450 intervention women and 450 control women were sampled (without replacement) each year and surveyed about breast cancer screening practices and related knowledge. A clear increase in self-reported mammography utilization was associated with the intervention. The percentage of women who reported a mammogram in the 12 months prior to the survey increased from 41% in 1988 (baseline) to 68% in 1990 among HMO women, compared to a change from 39% to 49% among control women. Comparing postintervention rates of mammography in HMO versus control women yielded a rate ratio (RR) of 1.4. However, this effect was strongly modified by income and race. Women with annual incomes of $31,000 or more showed little (whites, RR = 1.2) or no (blacks, RR = 1.0) effect of the intervention. Among women with incomes less than $31,000, the effect among whites (RR = 1.9) was much stronger than among blacks (RR = 1.2).

Black or African American↗