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Biomedical subjects

B J Crouse

Publications and source records attributed to B J Crouse.

At least 19 recordsLinked to original sources
PubMed2001

Instruments to measure cancer management knowledge of rural health care providers.

BACKGROUND: Instruments to measure cancer management knowledge of rural physicians, nurses, and pharmacists were needed to evaluate the effect of an educational intervention. Since such instruments did not exist, the authors designed and validated a new instrument for each discipline. METHODS: The design and validation process for these instruments are described. RESULTS: These three instruments were shown to be practical and to have high content and construct validity. Content validation demonstrated that all items were rated as essential or useful by 90% or more of the respondents. Construct validation show highly significant differences in mean scores among several levels of learners and practitioners as expected. CONCLUSIONS: These instruments may be useful to other investigators for measuring cancer management knowledge of rural physicians, nurses, and pharmacists.

Analysis of Variance↗
PubMed2000

Diagnosing childhood attention-deficit/hyperactivity disorder. Do family practitioners and pediatricians make the same call?

BACKGROUND: The purpose of this study was to determine whether--and if so, how--primary care physicians in Minnesota differ in diagnosing and treating childhood ADHD. METHODS: A questionnaire was mailed to 200 family physicians (100 urban; 100 rural) and 100 pediatricians (60 urban; 40 rural). The questionnaire asked about assessment, diagnosis, and treatment strategies physicians would use in response to three patient vignettes. RESULTS: While all physicians in both specialities reported similar differential diagnoses, pediatricians used more special tests and assessment scales than family physicians (p < 0.05). More family physicians referred patients for further evaluation (p < 0.05). Eighty-nine percent of pediatricians used DSM-IV criteria compared with 37% of family physicians (p < 0.001). Parents (98%) and teachers (82%) were usually involved in management planning, and methylphenidate (Ritalin) was the most commonly prescribed drug (87%). CONCLUSION: Regardless of specialty, size of community, or distance from mental health services, physicians in this study did not differ in the diagnosis or treatment of ADHD in response to hypothetical cases. Pediatricians reported using DSM-IV criteria in their practices when making diagnoses more often than family physicians.

Attention Deficit Disorder with Hyperactivity↗
PubMed1999

Physicians' perceptions of risk adjustment and health policy formation in Minnesota.

A questionnaire was used to assess Minnesota physicians' knowledge of and opinions about risk adjustment, a policy designed to modify payments to health providers based on the relative "sickness" level of the provider's patient population. Additionally, attitudes toward this policy were measured to examine physicians' perceptions of health policy formation in Minnesota. Although familiarity with this policy appears low, respondents support the concept of diagnosis-based risk adjustment. Physicians are divided on whether to further modify risk-adjusted rates with a conversion factor; their written comments suggest a mistrust of the policymaking process. Physicians most often listed the Minnesota Medical Association as a primary source for health policy information, while few respondents reported any communication with state legislators in health policy matters. Respondents perceive an imbalance in the influence wielded by various entities in health policy formation. Only 5% believe individual physicians have significant influence in policymaking. Increased communication between physicians and their legislators may be one way for physicians to gain such influence.

Attitude of Health Personnel↗
PubMed1998

Use of hazardous substances in the care of rural cancer patients. Current practice standards.

A growing number of rural cancer patients are receiving chemotherapy in hometown clinics and hospitals. Local access to cancer care offers many advantages to patients and providers, but is it safe to give intravenous chemotherapy? What precautions should be taken? Most physicians are well aware of the regulations pertaining to the use of universal precautions to prevent the spread of infectious diseases. A similar approach should be used for hazardous substances. As health care leaders and employers, physicians need to known the risk of exposing employees and themselves to potentially hazardous substances like chemotherapeutic agents. This paper offers current information for physicians to consider when providing cancer care in local health care facilities.

Antineoplastic Agents↗
PubMed1998

Maternity and family leave policies in rural family practices.

To help recruit and retain physicians, especially women, rural family practice groups need to establish policies regarding maternity and other family leaves. Also important are policies regarding paternity leave, adoptive leave, and leave to care for elderly parents. We surveyed members of the American Academy of Family Physicians in rural practice in 1995 to assess the prevalence of leave policies, the degree to which physicians are taking family leave, and the characteristics of ideal policies. Currently, both men and women physicians are taking family leaves of absence, which indicates a need for leave policies. Furthermore, a lack of family leave policies may deter women from entering rural practice.

Adult↗
PubMed1996

Use of the World Wide Web by family practitioners.

We introduced the World Wide Web to family practitioners through seminars conducted at 13 family practice clinics in northern Minnesota. The seminars included the history and applications of the Web. We also conducted searches on the Web with the family practitioners and graded the searches for physician usefulness. The physicians then evaluated the technology through a subjective survey. Thirty-three searches were attempted with 55% resulting in useful information. The average grade increased 22% over the study period, while the search time decreased 7% to an average of 8.5 minutes per search. The majority of family practitioners surveyed (65%) said they would use the Web in their practice, primarily for patient education, CME, and information retrieval. The major disadvantage they cited was the length of time to retrieve information. Our goal was to introduce the professional community to an available technology that may enhance the quality of medical practice and to determine the technology's present and future applications. These preliminary results indicate that health care professionals recognize the practical usefulness of the Web.

Attitude to Computers↗
PubMed1995

Recruitment and retention of family physicians.

This study investigates the factors family physicians report as influencing their recruitment and retention. Fifty family physicians who completed their residency training at the Duluth Family Practice Residency received surveys one year and three years after entering practice. Spouses' preferences were most important at the time of recruitment, while children's issues were more influential at the time of the retention survey. The diversity of the higher-ranked variables indicates the multifactorial nature of decisions to settle and maintain practice in a community. Communities and facilities that are recruiting family physicians need to work together. The community's educational system and needs of the spouse must be directly addressed for effective recruitment and retention. Income is important to retention, even though individuals ranked it low as a variable.

Adult↗
PubMed1994

Recruitment of family physicians in rural practice.

We report the results of a study to find out how rural family physicians choose their practice location--information that could allow physicians and practices to be more appropriately and easily matched. We interviewed rural family physicians who completed a Minnesota residency in 1990 or 1991 to determine what factors influenced their final practice selection. The survey revealed that partners in practice are physicians' greatest concern, followed by geographic location, recreational activities, call schedule, and opportunities for spouse and children. Despite numerous available practice options, it was difficult for physicians to find practices and communities that met the majority of their personal, professional, and familial needs. This study suggests a need for a physician placement network that would increase retention and help ease the current health care provider shortage in rural Minnesota.

Career Choice↗
PubMed1994

Hospital-based strategies for improving influenza vaccination rates.

BACKGROUND: Patients at highest risk for complications from influenza have the lowest rates of vaccination. Each year there are thousands of deaths related to influenza. Many of those who are hospitalized or who die from influenza-related conditions were hospitalized during the preceding influenza vaccination season but not vaccinated. METHODS: Six community hospitals in northern Minnesota participated in a pilot project to assess the feasibility and effectiveness of three different community hospital-based influenza vaccination programs during the 1991-1992 immunization season. Records of patients discharged from each institution during November and December 1991 were reviewed for documentation of indications for influenza immunization and to determine whether vaccination was offered and whether vaccination occurred before discharge. RESULTS: In hospitals choosing to implement standing orders for their nursing staffs to review indications for influenza vaccination and administer if indicated, 95.2% of patients were offered vaccination. In hospitals depending on physician chart reminders, 22% of patients were offered vaccination. In hospitals relying on physician education strategies to promote influenza vaccine, only 11.7% of patients were offered vaccination. Documented immunization rates in these three groups were 40.3%, 17%, and 9.6%, respectively. CONCLUSIONS: Programs implementing standing orders for nursing staffs were more effective than educational programs or physician reminders in offering and administering influenza vaccine to hospitalized patients. Hospital policies can expand the number of high-risk and elderly persons who receive influenza vaccination each year, but hospitals need to be reimbursed for this service to ensure institutional support.

Hospitalization↗
PubMed1993

Clinical follow-up of cervical sampling with the Ayre spatula and Zelsmyr cytobrush.

OBJECTIVE: To determine if cervical smears obtained with an Ayre spatula and a cytobrush are better detectors of atypia and dysplasia than the modified Ayre spatula alone, as determined by a 2-year clinical follow-up study. METHOD: Paired cervical samples were obtained, one using a modified Ayre spatula and the other a cytobrush. In those smears with any abnormality, follow-up after 2 years documented subsequent cytologic and/or histologic diagnosis. The statistical relationship between the screening tests and follow-up cytologic diagnosis was investigated. SETTING: Seven hundred ninety-two women, aged 18 years and older, who presented to a family practice residency clinic for Papanicolaou tests. RESULTS: The correlation coefficient for the diagnoses obtained using the modified Ayre spatula and the clinical follow-up was .40 (P = .0008), while the correlation coefficient between the cytobrush samples and the clinical follow-up diagnoses was .25 (P = .04). The kappa statistics indicate statistically significant concordance only between the spatula and the follow-up diagnoses. CONCLUSIONS: Cervical smears obtained with a modified Ayre spatula correlated significantly with the follow-up diagnoses. As cervical sampling tools emerge, they need to be evaluated on the basis of accurate identification of significant clinical disease, not only on the basis of obtaining endocervical cells to avoid unnecessary repetition of screening tests and diagnostic workups.

Adolescent↗
PubMed1993

Health care needs of Appalachian trail hikers.

BACKGROUND: With a growing interest and participation in hiking, predictions indicate that over 45 million Americans will participate in backpacking and day hiking in 1993. There has been very little assessment of the health care needs of this group. The purpose of this study was to assess the health care needs of Appalachian Trail backpackers. METHODS: Backpackers who completed hiking the Appalachian Trail in 1987 or 1988 received a 3-page survey questionnaire. The survey contained questions to elicit demographic information, general health characteristics, and health care experiences during the hike. Information about injuries, medications carried and used during the backpacking activities, health care needs, and trail time lost because of health problems was also requested. RESULTS: Injuries and illnesses were reported by 82% of the respondents, incurring an average loss of 4.7 days of hiking. Musculoskeletal complaints, traumatic injuries, and gastrointestinal complaints were most often reported. The severity of these problems was such that medical attention was sought in 25% of these events. CONCLUSIONS: Hikers need to anticipate that musculoskeletal, gastrointestinal, and skin problems may occur during hiking. It is prudent to carry medications such as analgesics in the form of aspirin or other nonsteroidal anti-inflammatory agents, topical antibiotics, and bandages. Methods to purify water need to be used regularly, and adequate preparation of food needs to be a priority.

Adult↗