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Biomedical subjects

D S Lane

Publications and source records attributed to D S Lane.

At least 19 recordsLinked to original sources
PubMed2006

Analysis of a hepatitis C screening programme for US veterans.

This study analyses a screening programme for hepatitis C virus (HCV) infection among US veterans in a suburban Veterans Affairs Medical Center, in New York. This is the first study examining all 11 potential risk factors listed in the 2001 National U.S. Veterans Health Administration Screening Guidelines. A retrospective study was conducted of 5400 veterans 'at risk' of HCV, identified through a questionnaire in this institution's primary-care outpatient departments between 1 October 2001 and 31 December 2003. Multivariate logistic regression models were built to identify independent predictors of infection. Of 2282 veterans tested for HCV, 4.6% were confirmed by HCV PCR to be HCV infected. In the multivariate model developed, injection drug use, blood transfusion before 1992, service during the Vietnam era, tattoo, and a history of abnormal liver function tests were independent predictors of HCV infection. Our data support considering a more targeted screening approach that includes five of the 11 risk factors.

Adult↗
PubMed2001

An educational approach to improving physician breast cancer screening practices and counseling skills.

A multifaceted, individualized, physician education program designed to increase the breast cancer screening practices of community-based primary care physicians is described and the results are evaluated. Community-based surveys identified primary care providers with breast cancer screening educational needs who were assigned, using a factorial design, to an intervention or control condition. The sample included 154 control and 128 intervention physicians. The intervention consisted of a 1-2h in-office training program and/or self-study workbook. Self-reported overall breast cancer screening need scores improved for a greater proportion of intervention than control physicians, particularly those receiving the in-office intervention (P=0.03). Clinical breast examination (CBE) need declined (P=0.01); use of provider reminder systems increased (P=0.02); preparedness to counsel about CBE (P=0.04) and recognition that age is an important risk factor for breast cancer (P=0.02) improved in more intervention compared to control physicians.

Adult↗
PubMed2000

A systems model of clinical preventive care: the case of breast cancer screening among older women. For the NCI Breast Cancer Screening Consortium.

BACKGROUND: In older women covered by Medicare, relationships among physician recommendation, mammography in the past 2 years, and clinical breast examination (CBE) in the past year were systematically explored with a variety of predisposing, enabling, and situational factors identified in the Systems Model of Clinical Preventive Care. METHODS: A population-based survey of women age 65 years and older was conducted in five National Cancer Institute's Breast Cancer Screening Consortium geographic areas. Analyses focused on women with a regular physician and site of care (n = 5318). RESULTS: Physician recommendation and mammography use declined with women's increasing age and increased with income, education, and insurance. CBE and mammography increased with number of physicians and breast cancer family history; mammography use decreased with worsening health status. Recommendations were higher among physicians who were younger, female, and internists. Family practitioners were older and male; women who saw family practitioners reported characteristics associated with decreased screening-lower income, education, and insurance-and seeing only one physician. CONCLUSIONS: Public policy and health system changes that create a uniform system of finance and service performance expectations may reduce the persistent discrepancy in physician recommendation and mammography use due to sociodemographics and physician specialty.

Adult↗
PubMed2000

A threat to the public health workforce: evidence from trends in preventive medicine certification and training.

Evidence of a growing need for preventive medicine specialists is the congruence between needed competencies for practice in the current health care environment, as identified by the Council on Graduate Medical Education (COGME) and in other national reports, and the core competencies of preventive medicine residents. The total number of certified specialists in preventive medicine is 6091. The proportion of self-designated preventive medicine specialists among all U.S. physicians is on the decline and the greatest decline has been among those in public health (PH) and general preventive medicine (GPM). In addition, the total number of preventive medicine residents is on the decline, and the decline has been greatest among those training in PH and combined PH/GPM. One of the reasons for this decline has been inadequate funding due to the absence of Medicare graduate medical education (GME) financing for population-based vs. individual patient care services and meager and diminishing Title VII support. A paucity of faculty is apparent in medical schools with residency training and board certification in preventive medicine. Several actions may help reverse this trend and assure adequate numbers of preventive medicine specialists: expansion of Title VII to increase the number of residents receiving stipends and tuition, adding infrastructure support for faculty development and funding of demonstration projects in distance learning and in joint generalist/ preventive medicine residency training. Medicare GME reform should include recognition of population-based services and inclusion of preventive medicine residencies in provisions for "nonhospital-based" training and in up-weighting methodologies for primary care training. Expansion of Veterans Affairs, National Institute for Occupational Safety and Health, and Department of Defense support is also needed as is attention to resident debt reduction.

Aerospace Medicine↗
PubMed1999

Core competencies for preventive medicine residents: Version 2.0.

During the early 1990s, the American College of Preventive Medicine (ACPM), with support from the Health Resources and Services Administration (HRSA), identified core competencies and performance indicators (measures to assess their achievement) for all preventive medicine residents. After the competencies were approved, distributed by the ACPM and HRSA, and published in the American Journal of Preventive Medicine, they were integrated in various ways into the operation of individual residency programs. Changes in the health care system during the decade, however, necessitated an update of the original competencies to better equip preventive medicine educators to prepare residents for new roles those in preventive medicine can play in a restructured health care system. HRSA funded an effort to produce Version 2.0 of the preventive medicine competencies based on review and refinement of the original competencies through a consensus process. This article includes these revised core competencies and performance indicators.

Clinical Competence↗
PubMed1999

Methodology for targeting physicians for interventions to improve breast cancer screening.

INTRODUCTION: Uneven increases in mammography utilization rates call for methods to efficiently target educational interventions to women who do not regularly use mammography and physicians who do not adhere to national guidelines for breast cancer screening. This paper discusses a method for identifying physicians who are nonadherers to breast cancer screening guidelines or in need of continuing medical education (CME) in this area. METHODS: A 1995 community-based telephone survey of randomly selected women aged 50-80, residing in four Long Island, NY, townships was used to identify women who underuse mammography and their regular physicians. Community-based surveys of physicians permitted identification of nonadherent providers. Nonadherence to breast cancer screening recommendations was the primary criterion, but because of anticipated physician reluctance to self report nonadherence with screening guidelines, additional criteria were developed to identify physicians with educational needs relating to breast cancer screening. These criteria included lack of office reminder systems and knowledge relating to breast cancer screening, and lack of confidence in patient counseling and clinical breast examination skills. RESULTS: Overall response rates were 77% for women's survey, and 66% for the physician survey. 3427 women were classified as underusers (38.5%) and 87% of underusers provided the name and address of their regular physicians. By physician self report, 45% of physicians were classified as nonadherers and 42% were identified as having related educational needs. CONCLUSION: A feasible method for identifying physicians who are nonadherers to breast cancer screening recommendations or in need of CME about this is described, permitting efficient targeting of educational interventions to those with patients who underuse mammography. The method is not dependent on access to a specific provider or patient population.

Aged↗
PubMed1998

Defining competencies and performance indicators for physicians in medical management.

The recent and profound changes in the American health care delivery system have created a need for physicians who are trained and willing to assume a high level of responsibility for managing evolving health care organizations. Yet most physicians receive no formal training in medical administration and management because changes in medical school and residency education have lagged behind changes in clinical practice and reimbursement. To avoid haphazard approaches and unnecessary duplication of resources, it is important for physicians involved in managerial medicine to collectively identify competencies in this area needed in the marketplace. The American College of Preventive Medicine (ACPM), with funding from the Health Resources and Services Administration (HRSA), undertook an effort to identify competencies essential for physicians who will fill leadership roles in medical management. Like ACPM's earlier effort to develop core competencies in preventive medicine, this project drew upon the theoretical model of competency-based education. This article describes the strategy we followed in reaching consensus among a diverse group of physician executives and preventive medicine residency program directors, and includes the list of medical management competencies and performance indicators developed. Recurrent issues that can sidetrack competency development projects are also presented as well as suggestions for overcoming them. The competencies can serve as a framework for expanding current core preventive medicine training in management and administration and for developing new training programs to equip physicians with the special expertise they will need to provide management leadership within the changing landscape of health care delivery.

Competency-Based Education↗
PubMed1998

Breast cancer screening knowledge and skills of students upon entering and exiting a medical school.

PURPOSE: To assess needs for breast cancer screening education by comparing medical students' training and knowledge of breast cancer screening upon their entry to and exit from medical school. METHOD: Seventy-seven medical students at one medical school completed questionnaires as first-year students (in 1992) and again as fourth-year students (in 1996) that assessed their breast cancer screening knowledge. The fourth-year questionnaire included additional questions about the students' clinical training in breast cancer screening skills and their perceptions of needs for further training. RESULTS: Although the students performed significantly better on the knowledge-based questions in their fourth year than they did in their first year, considerable room for improvement remained. The students reported learning the most from surgery rotations and more from standardized patients than from faculty. Women medical students performed significantly more clinical breast examinations than did men students. CONCLUSIONS: Most of the medical students reported needing additional training in clinical breast examination. More curricular time devoted to education about breast cancer screening is needed.

Breast Neoplasms↗
PubMed1997

Confirmatory analysis of opinions regarding the pros and cons of mammography.

This investigation extends prior research to apply decision-making constructs from the transtheoretical model (TTM) of behavior change to mammography screening. Study subjects were 8,914 women ages 50-80, recruited from 40 primarily rural communities in Washington State. Structural equation modeling showed that favorable and unfavorable opinions about mammography (i.e., pros and cons) fit the observed data. Analysis of variance supported the associations between readiness to obtain screening (i.e., stage of adoption) and opinions about mammography (i.e., decisional balance) previously found in research using smaller samples from another geographic region. This report extends these earlier studies by using structural equation modeling, opinion scales based both on principal component analyses and on a priori definitions, a developmental sample and a confirmatory sample, and by sampling from a different geographic region. It is recommended that future research examine whether opinions regarding the cons of mammography are more individually specific than the pros.

Aged↗
PubMed1996

Trends in mammography use and their relation to physician and other factors.

This study examines trends and factors (e.g., physician utilization) affecting mammography use from 1988 to 1990 among women residing in an area of high breast cancer incidence. Mail surveys of independent random samples of over 2000 women 50 to 75 years of age residing on Long Island were conducted each of the three study years, and responses were compared. Statistically significant increases in reported mammography use occurred over the 3-year period within all age, income, and educational subgroups. These were accompanied by a decline in reporting that the doctor did not recommend it, as a reason for not having a mammogram, and by a statistically significant increase in reported physician recommendation among those who visit a doctor annually, particularly those using a gynecologist. Clinical breast examination was the strongest predictor of mammography use, with knowledge of the recommended screening frequency also strong associated. Despite a regionally high incidence of breast cancer, screening mammography use corresponded to national rates. Access and visits to a regular physician were critical factors and substantiated the need for education of women, family practitioners, and internists about breast cancer screening guidelines.

Aged↗
PubMed1995

The use of cohort vs repeated cross-sectional sample survey data in monitoring changing breast cancer screening practices.

BACKGROUND: The method used to select a study sample is a key element in designing a research protocol. This article explores two of the more common methods used, focusing on the relative advantages and disadvantages of each one. METHODS: Both cohort and repeated, independent cross-sectional surveys were conducted in each of 3 years (1988-1990) in the Awareness of Breast Cancer Screening Project to follow changing breast cancer screening rates among a population of women 50-75 years of age on Long Island, New York. RESULTS: Both survey methods revealed statistically significant increases in self-reports of mammography use. The cohort and repeated cross-sectional survey sample responses to questions concerning knowledge, attitudes, and behavior regarding breast cancer screening were comparable. An educational effect of the baseline survey itself on the cohort was not seen. CONCLUSIONS: Each of the two survey methods has advantages and disadvantages with respect to the other. The cohort method permits examination of changes in the same individual over time and is less costly and less time-consuming to perform. On the other hand, the cross-sectional method does not suffer from cumulative losses in respondents with repeated surveys and better reflects the changing community. The study findings can be used to guide the selection of an appropriate survey methodology for monitoring breast cancer screening practices in other settings.

Aged↗
PubMed1994

The use of mammography vans by low-income women: the accuracy of self-reports.

The objective of this study was to determine the accuracy of self-reports of mammography use by low-income income women. Mammography van records were used to verify self-reports of mammography use in the past year by women aged 50 through 75 years who had visited five community health centers (n = 237). Van records verified mammography use for 99% of these women (82% within the previous year and 98% within the past 2 years). Forty percent of those with van records who reported both the month and year of the mammogram were accurate. Inaccurately reported dates were more frequently after (74%) rather than before (26%) the actual date. These findings indicate that self-reports of mammography use by low-income women are generally reliable.

Aged↗
PubMed1992

Changes in knowledge, attitudes and behavior of women participating in a community outreach education program on breast cancer screening.

A community-based intervention project on Long Island was supported by the National Cancer Institute to increase the use of mammography and breast physical examination among older women. During a 1-year period 526 women aged 50 and older attended educational sessions presented by the project staff conducted in the community in a variety of settings. Sixty-eight percent (355) of the women who participated provided identifying data and completed pre- and post-session surveys while 40% (210) also completed a mail survey 6-12 months later. Screening behavior improved subsequent to the intervention, at follow-up 61% had taken some related action. More than half of the 109 women who had a mammogram after attending the session indicated that the presentation influenced them to do so. The use of a game created a positive atmosphere for conveying information about a sensitive subject and encouraged discussion among women who had a variety of experiences with screening.

Breast Neoplasms↗
PubMed1992

Breast cancer screening practices among users of county-funded health centers vs women in the entire community.

BACKGROUND: Breast cancer screening rates tend to be lower among women with lower income and/or education. METHODS: Telephone surveys of random samples of women aged 50 to 75 who had visited five health centers (n = 795) and women in the same age group residing in the entire community (n = 404) were conducted in 1988. RESULTS: Despite the significantly lower socioeconomic level, a higher proportion of minority women, and a poorer knowledge of mammography, screening rates in the health center group were not lower than in the community sample. About half or more of the health center respondents had ever had a mammogram regardless of income, education, age, and ethnic group. Of the community respondents, 49% had ever had a mammogram, but the proportion varied significantly by income and education. Within the subgroup of women having annual incomes below $15,000, mammography use was actually higher among health center women; that is, 50% of health center vs 35% of community women reported ever having a mammogram and 31% vs 14%, respectively, reported having a mammogram in the past year. CONCLUSION: The findings demonstrate the importance of publicly funded health centers in achieving screening rates among the socioeconomically disadvantaged that are comparable to (or even higher than) those in the general population.

Age Factors↗