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Biomedical subjects

D S Lane

Publications and source records attributed to D S Lane.

49 records · Page 3Linked to original sources
PubMed1976

The community hospital as a focus for health planning.

A community hospital focus for health planning has been developed by a Department of Community Medicine in a "non-teaching" voluntary hospital. Results of three years of planning experience have included: descriptions of service area populations and utilizer populations; implementation of neighborhood based health centers with transportation and outreach programs; integration of emergency services with other ambulatory care resources; and proposals for geriatric day-care, ambulatory surgery, and patient education. Working relationships have been developed between the hospital Department and local planning bodies, among them the Comprehensive Health Planning agency, the County Health Services Department, consumer groups, voluntary agencies and a University Health Services Center.

Aged↗
PubMed1975

Assessment of maternal health care quality: conceptual and methodologic issues.

Past efforts in assessment of the quality of maternity care have been analyzed in order to develop an evaluation framework that will have utility and applicability beyond a specific program, population, or health discipline. Presently available evaluation approaches have focused attention on either "high risk" populations or upon women experiencing a complicated pregnancy or delivery. Quality has been defined as the extent to which normative or empirically derived standards of obstetrical care have been applied. An alternative approach is suggested which conceives of the pregnancy as a normal physiological event but with the potentiality of either causing or exacerbating social or health problems. Maternity care quality is viewed as the application of those necessary health and health-related services that are required to safeguard the health of the mother and offspring, minimize the noxious consequences of pre-existing or concurrent health hazards or conditions, and upgrade the health and social functioning of those women who require it. Additionally, the system of services should be functionally organized to optimize care. Indicators of quality are suggested which incorporate structural, process, and outcome variables, and which link medical and consumer criteria in a comprehensive community level approach to quality assessment.

Child Health Services↗
PubMedDate not supplied

Education and counselling for cancer patients--lifting the shroud of silence.

A demonstration education and counselling project for cancer patients was developed in a community hospital. A team comprising a psychologist and a nurse patient educator were added to existing hospital staff. Based on this experience, we have defined the primary educational and emotional needs of the cancer patient and delineated the related functions and activities of project staff. The organization, nature, and volume of the education and counselling services are presented to provide a framework for others interested in embarking on similar efforts.

Counseling↗
PubMedDate not supplied

Current perspectives on physician barriers to breast cancer screening.

BACKGROUND: Despite reports of rising mammography utilization, breast cancer screening rates still lag behind national recommendations and goals, particularly for older women. This study explores current modifiable physician barriers to screening. METHODS: Family physicians and internists on the staff of 10 Long Island community hospitals were surveyed during three successive waves (1988, 1990, 1995) about breast cancer screening behavior. The final survey also assessed current attitudes and level of confidence in screening abilities and beliefs relating to cancer risk and screening of the elderly. RESULTS: The proportion of physicians reporting regularly referring all women aged 50 to 75 years for mammography increased significantly from 37 percent (1988) to 64 percent (1995), while the proportion reporting regularly performing clinical breast examinations remained stable at 56 percent. More than 25 percent of respondents to the 1995 survey were not aware that breast cancer risk increases with aging, and more than one half did not recognize that breast cancer detection by mammography is enhanced in older postmenopausal women. Some physicians reported lack of confidence in aspects of patient counseling, examination, and use of office systems to promote screening. CONCLUSION: Continuing medical education programs addressing knowledge deficits and perceived physician needs for enhancement of clinical breast examination skills are needed to promote continued improvement in inadequate mammography screening rates.

Adult↗
PubMedDate not supplied

Are self-reported dates of mammograms accurate?

BACKGROUND: This paper assesses the accuracy of self-reported dates of last mammograms from a postal survey compared to dates of mammograms in medical records. METHODS: The subjects included women 50 years of age and older who were members of a local health maintenance organization, had reported ever having a mammogram, and had completed a postal questionnaire about breast cancer screening. The date of last mammogram from the postal surveys was compared to the date in medical records. RESULTS: Of 78 women who self-reported both the month and year of last mammogram in a postal survey, agreement within 1 month with the medical record data was 62.8% and agreement within 3 months was 75.6%. A total of 32.1% of the subjects underestimated the time since their last mammogram, while only 5.1% overestimated. Based on self-reported dates, 85.9% of the subjects had a mammogram within the last year compared to 76.9% based on medical records. Using medical records as the "gold standard", the sensitivity of self-reported mammogram within the last year versus more than 1 year ago was 98% and the specificity was 56%.

Aged↗
PubMedDate not supplied

Developing primary care curricula in preventive medicine: some practical considerations.

I describe a practical approach to developing primary care curricular in preventive medicine, starting with the articulation of a rationale that relates training to current medical education, mortality, medical manpower, and health care system characteristics. I discuss recommended features of the ambulatory care setting for instruction and include automated record systems, practice teams, multidisciplinary staff, faculty role models, conferences and rounds, and needs of low-income populations. Further, I advocate a careful review of the three-year residency curriculum including conferences, rounds, and rotations to identify elements of the desired curriculum on which to build preventive medicine training so as to alter scheduling minimally. I consider longitudinal as well as block rotation experiences. I highlight published resources for defining preventive medicine content areas and recommend local resources for preventive medicine training and for involving residents in personal health promotion. Finally, I offer an example of a family medicine resident experience in breast and cervical cancer screening to illustrate an approach to accomplishing specific objectives for preventive medicine training.

Curriculum↗
PubMedDate not supplied

Meeting an expanding educational role for ambulatory care services.

The mid-1980s have been marked by a growing shift in the locus of health care delivery: from the in-patient setting to ambulatory care programs. As a result of cost containment strategies--exemplified by the diagnosis related group method for hospital reimbursement--the ambulatory care network has assumed responsibility for many patients with advanced or complicated diseases. This increased responsibility is in addition to preventive services, health maintenance, and routine care of acute and chronic conditions. This shift not only requires expansion of the current system for delivery of primary care services, but will also increase the role that organized ambulatory care programs will have to play in the education of health professionals. On the basis of a ten-year experience in utilizing two county funded neighborhood health centers for primary care training of family practice residents and medical students, undergraduate and postgraduate medical education programs are discussed in terms of the changes they impose on ambulatory care program organization (e.g., staffing, space, patient assignment and consent), proposed financing, and agreements with educational institutions. The increased administrative burden of training programs is offset by benefits which include staff satisfaction, enhanced quality of care, and an increase in the pool of appropriately trained physicians.

Ambulatory Care↗
PubMedDate not supplied

The postgraduate education of physicians in preventive medicine.

The Graduate Medical Education National Advisory Committee report projected a serious shortage of preventive medicine specialists in 1990, and the recommendations of a recent report from the Association of American Medical Colleges called for increased training of medical students in health promotion and disease prevention and in adapting to changes in health and health care. To help meet the need for physician manpower in preventive medicine a new residency was established at the State University of New York at Stony Brook in July 1983. The program features a structured approach to the practicum year, incorporating an organized core curriculum and opportunities for a varied field experience. In addition to the School of Medicine and University Hospital, major training sites include two large county health departments on Long Island, three community hospital departments of community medicine, a health maintenance organization as well as several neighborhood health centers, and community-based programs operated by these hospitals and health departments. The curriculum includes both longitudinal experiences at the medical school involving teaching, research, and didactic conferences, and block field rotations within the above affiliated agencies, providing practice experience in preventive medicine and public health. The diversity in the organization and type of preventive medicine institutions used for training enriches the residency experience and is complemented by core educational activities.

Education, Medical, Graduate↗
PubMedDate not supplied

Performance indicators for assessing competencies of preventive medicine residents.

Heightened national interest in population-based medicine, clinical preventive services, and health care management underscores the current need for definition and assessment of physician competency in these areas. This article describes a project sponsored by the Health Resources and Services Administration (HRSA) to develop competencies for each of the three specialty areas in preventive medicine and appropriate measures for the achievement of those competencies. We discuss fundamental issues surrounding assessment that helped guide the process, types of measurement strategies, and criteria for effective competencies and performance indicators. The article also explains the Work Group process used to reach consensus and identifies concerns and challenges raised during this process. We include the list of specialty competencies and performance indicators developed by the project. The project, entitled "Improving Training of Preventive Medicine Residents through the Development and Evaluation of Competencies," served as a model for interorganizational collaboration between the federal government (HRSA); a specialty society, the American College of Preventive Medicine (ACPM); and a preventive medicine residency program, State University of New York (SUNY) at Stony Brook. The commonality of competencies expected of residents in all three specialty areas of preventive medicine--occupational medicine, general preventive medicine and public health, and aerospace medicine--reaffirmed the rationale for including all of these areas within the single specialty of preventive medicine.

Aerospace Medicine↗
PubMedDate not supplied

Consensus on core competencies for preventive medicine residents.

Of the currently available literature on assessment of physician competency, very little applies to the needs of preventive medicine specialists. Yet the diversity of the field and the confusion among other medical specialists about the particular expertise of preventive medicine physicians suggest a need for consensus on fundamental competencies expected of graduates of preventive medicine residency training programs. We apply theoretical material on competency-based education from teacher training and instructional development to professional training in preventive medicine. We describe the process by which the Graduate Medical Education Subcommittee of the American College of Preventive Medicine (ACPM), a working group of specialists, derived and refined core competencies in working sessions at professional meetings. The drafts produced at these sessions were circulated widely to residency directors and other individuals and groups in preventive medicine before being approved by the ACPM Board of Regents and included in the Residency Training Manual distributed by ACPM. This article includes this list of core competencies for preventive medicine residents. In addition, the article describes assumptions about competency development that guided the process and identifies recurrent problems in competency development. This information may be helpful to readers who wish to develop additional competencies or to tailor these competencies for their own preventive medicine residency programs.

Clinical Competence↗
PubMedDate not supplied

Outcomes of recommendations for breast biopsies in women receiving mammograms from a county health van.

OBJECTIVE: To describe the outcomes of breast biopsy recommendations for women screened through a mobile mammography van. METHODS: Data on all women screened through the Mobile Mammography Program in Suffolk County, Long Island, NY, from 1990 to 1994 were analyzed to determine biopsy recommendation rates, biopsy rates, positive biopsy rates, and cancer detection rates. Follow-up information was obtained from the women's physicians. RESULTS: The breast cancer detection rate for women screened through the Mobile Mammography Program averaged 0.33% over a five-year period. The biopsy recommendation rate based on abnormal mammograms remained stable, at about 1% to 2%, over a five-year period, as did the rate of positive biopsies among women having biopsies (36.8% to 44.4%). For women ages 50 and older, the cancer rate in 1994 was 0.36%, while for women younger than age 50, the cancer rate was 0.25% (0.32% for all ages). CONCLUSIONS: These findings show that a breast cancer screening program using a mobile van can have comparable cancer detection rates to national figures and a fairly stable biopsy recommendation rate from which follow-up resource needs can be estimated.

Adult↗