PubMed Health⌕ Search

Biomedical subjects

Donna B Jeffe

Publications and source records attributed to Donna B Jeffe.

At least 19 recordsLinked to original sources
PubMed2006

The effects of radiotherapy for the treatment of contralateral breast cancer.

Radiotherapy following breast-conserving surgery for the treatment of first primary breast cancer is the standard of care and is widely used despite its small survival benefit. The effects of radiotherapy in metachronous contralateral breast cancer are unknown. We examined the use of radiotherapy and its effect on cause-specific and all-cause mortality among women with metachronous contralateral breast cancer treated with breast-conserving surgery in community settings. Using data from the 1985-2000 Surveillance, Epidemiology, and End Results program, we identified women with stage 0-III metachronous contralateral breast cancer that occurred at least six months after stage 0-III first primary breast cancer. Cause-specific and all-cause mortality of women age 40-69 who did and who did not receive radiotherapy following breast-conserving surgery for metachronous contralateral breast cancer were compared in proportional hazard models using propensity scores to balance covariates by radiotherapy use. We adjusted for misclassification of radiotherapy use. Based on misclassification-corrected analyses, 43.2 percent of 1,083 women with metachronous contralateral breast cancer did not receive radiotherapy after BCS. After adjustment for propensity scores and radiotherapy misclassification, women who did not receive radiotherapy had 2.2 times greater risk of cause-specific and 1.7 times greater risk of all-cause mortality. In community settings, a high percentage of women with stage 0-III metachronous contralateral breast cancer did not receive radiotherapy following breast-conserving surgery. Unlike the small survival benefit of radiotherapy after first primary breast cancer, omission of radiotherapy after metachronous contralateral breast cancer significantly increased the risk of cause-specific and all-cause mortality.

Adult↗
PubMed2006

Who are our future surgeons? Characteristics of medical school graduates planning surgical careers: analysis of the 1997 to 2004 Association of American Medical Colleges' Graduation Questionnaire National Database.

BACKGROUND: Identification of correlates of contemporary US medical graduates' surgical career plans can provide insights about the emerging surgical workforce composition and inform future recruitment efforts. STUDY DESIGN: We analyzed individualized records of 95,176 graduates who completed the 1997 to 2004 Association of American Medical Colleges Graduation Questionnaire for associations between planning a general-surgery or a surgical-specialty (orthopaedic surgery, neurologic surgery, plastic surgery, urology, or otolaryngology) career and a set of medical-school experience, professional-setting preference, and demographic variables. RESULTS: Graduates who reported better quality of their surgery clerkship experience and career-setting preference of "university faculty" compared with "nonuniversity clinical practice" were more likely to plan general-surgery or surgical-specialty careers compared with nonsurgical careers (each p < 0.001). Women and graduates from combined MD/PhD programs and those who planned to practice in underserved areas were less likely to plan general-surgery or surgical-specialty careers compared with nonsurgical careers (each p < 0.001). Graduates of nonwhite race or ethnicity and from combined MD/other-degree (non-PhD) programs were more likely to plan general-surgery careers (p < 0.001). Compared with 1997 graduates, 1998 to 2004 graduates were less likely to plan general-surgery careers than surgical-specialty careers (each p < or = 0.001), and 1999 to 2004 graduates were more likely to plan surgical-specialty careers than nonsurgical careers (each p < or = 0.006). CONCLUSIONS: Contemporary graduates planning surgical careers represent a relatively narrow spectrum of US medical graduates, and those planning general-surgery careers differ in numerous ways from those planning surgical-specialty careers. Targeted efforts are warranted to recruit US medical graduates qualified to meet the nation's future health-care needs and advance the profession of surgery.

Career Choice↗
PubMed2006

Which U.S. medical graduates plan to become specialty-board certified? Analysis of the 1997-2004 national association of American Medical Colleges Graduation Questionnaire database.

BACKGROUND: Predictors of U.S. allopathic medical-school graduates' board-certification plans have not been characterized. METHOD: Using multivariable logistic regression, graduates' responses to 11 questions on the 1997-2004 Association of American Medical Colleges Graduation Questionnaire were analyzed to identify independent predictors of plans for specialty-board certification. RESULTS: The proportion of 108,408 graduates planning specialty-board certification decreased from 97.3% in 1997 to 88.4% in 2004. Among 101,805 (93.9%) graduates with complete data, graduates who were Hispanic, rated their clinical clerkships, quality of medical education, and confidence in clinical skills more highly, had any debt, and planned "University-faculty" careers were more likely to plan becoming board certified. Females, Asians/Pacific Islanders, and graduates who planned to practice in underserved areas, planned "other" nonclinical-practice careers, and graduated with MD/other (non-PhD) degrees were less likely to plan becoming board certified. CONCLUSION: Specialty-board certification does not appear to be among the professional goals for a growing proportion of U.S. medical graduates.

Career Choice↗
PubMed2006

Effect of area poverty rate on cancer screening across US communities.

STUDY OBJECTIVE: To analyse the contextual effect of area poverty rate on never having been screened for breast, cervical, and colorectal cancer by (1) describing the extent of the variation in screening behaviours among 98 US metropolitan areas; (2) determining if the variation in lack of screening can be explained by differences in the characteristics of the persons who resided in these areas; and (3) determining if living in a metropolitan area with a higher poverty rate increased the likelihood of never having been screened for cancer over and above individual characteristics. DESIGN: Cross sectional survey using data from the 2002 Behavioral Risk Factor Surveillance System. Multilevel logistic regression included both individual level factors as well as area poverty rate. SETTING: Ninety eight areas across the USA. PARTICIPANTS: Over 118 000 persons residing in 98 areas; a sample aimed at estimating 48.3% of the US population age 18 or older. MAIN RESULTS: After adjustment for individual level factors, increasing area level poverty rate (per 5%) remained associated with never having had a mammogram (odds ratio (OR) = 1.28, 95% confidence interval (CI): 1.03 to 1.37); clinical breast examination (OR = 1.28, 95% CI: 1.11 to 1.48), colonoscopy/sigmoidoscopy (OR = 1.10, 95% CI: 1.01 to 1.19), and a faecal occult blood test (OR = 1.19, 95% CI: 1.12 to 1.27). Poverty rate was not independently associated with never having had a Pap smear (OR = 1.12; 95% CI: 0.90 to 1.41). The size of the variance among metropolitan or micropolitan statistical areas (MMSAs) varied by type of screening test, with intraclass correlation coefficients ranging from 4.9% (never having had a Pap smear) to 1.2% (never having had a colonoscopy/sigmoidoscopy). CONCLUSIONS: Area poverty rate was independently associated with never having been screened for breast and colorectal cancer, but not cervical cancer. The size of the variance among MMSAs was modest at best.

Adolescent↗
PubMed2006

Effects of implementing computerized practitioner order entry and nursing documentation on nursing workflow in an emergency department.

Nurses'perceptions of effective use of their time are critical to the successful implementation of information system changes. We examined the effects of implementing computerized practitioner order entry and nursing documentation in our emergency department with an anonymous survey of nurses and repeated time-motion studies. Emergency care nurses were positive about effects of CPOE, reporting needing less time to complete medication, laboratory, and radiology orders and less time spent clarifying orders. Their perceptions of time spent were congruent with observations from time-motion studies where combined computer-and-paper time and direct-patient-care time did not change significantly. Nurses also reported supplementing template options with free text, and those who were more comfortable using computers reported supplementing template options more often than their counterparts, suggesting that assessments of users' expertise in computer use may influence their ability to maximize their use of the functionality of emergency department information systems.

Diffusion of Innovation↗
PubMed2005

Self-report by elderly breast cancer patients was an acceptable alternative to surveillance, epidemiology, and end results (SEER) abstract data.

BACKGROUND AND OBJECTIVES: The purpose of this study was to compare breast cancer patients' self-report and surveillance, epidemiology, and end results (SEER) abstract data regarding type of treatment received (radiation, chemotherapy, and hormonal therapies). METHODS AND DESIGN: Patients 65 years of age or older diagnosed during 1999-2001 with stage I-II breast cancer and treated with conserving surgery were identified from the Iowa SEER registry; 307 (41% of those eligible) completed telephone interviews. SEER-registry abstract data also were obtained. RESULTS: Agreement between self-reports and SEER data varied by type of treatment, with almost perfect agreement for chemotherapy (kappa = 0.93) and moderate to substantial agreement for ever use of hormonal therapy (kappa = 0.61), receipt of radiation therapy (kappa = 0.60), and current use of hormonal therapy (kappa = 0.54). If the SEER data are assumed to be the "gold standard," the sensitivity was generally high (>87%) for all types of treatment. Specificity varied according to type of treatment: highest for chemotherapy (98.4%) and lowest for radiation therapy (49.0%). Predictive values positive and negative were above 75% across type of treatment. CONCLUSION: Using self-reported data was an acceptable alternative to reviewing medical records for documenting some types of breast cancer treatment.

Aged↗
PubMed2005

Development of a measure of knowledge and attitudes about obstructive sleep apnea in children (OSAKA-KIDS).

BACKGROUND: Primary care physicians play an important role in screening for childhood obstructive sleep apnea syndrome (OSAS) that, if untreated, can result in serious complications. OBJECTIVE: To describe the development of the Obstructive Sleep Apnea Knowledge and Attitudes in Children (OSAKA-KIDS) questionnaire for use in measuring physicians' knowledge and attitudes about childhood OSAS and its treatment. DESIGN: Cross-sectional survey to pilot administration of the 23-item OSAKA-KIDS questionnaire, mailed to 1195 community- and academic-based physicians in Louisville, Ky; Philadelphia, Pa; and St Louis, Mo. MAIN OUTCOME MEASURES: Analysis of variance measured differences in knowledge and attitudes between academic- and community-based physicians and between pediatricians and family practitioners. Using stepwise multiple linear regression, we analyzed the associations between various predictors (including specialty, practice setting, and years since medical school graduation) and each item of knowledge and attitudes. All tests were 2-tailed. RESULTS: Questionnaires for 497 respondents (44% female; mean [SD] age, 45.7 [10.5] years; and mean [SD] number of years since medical school graduation, 18.7 [11.0] years) were analyzed. The mean (SD) knowledge score (percentage of 18 possible) was 69.6% (14.6%). In regression analyses, more knowledge was associated with more positive attitudes overall and more recent graduation from medical school; having a more positive attitude was associated with having completed a pediatrics residency and more knowledge about OSAS. CONCLUSIONS: Deficits in basic knowledge about childhood OSAS were observed regardless of physician practice setting and specialty training. More education focusing on the diagnosis and treatment of childhood OSAS and identifying children at risk for OSAS is recommended.

Analysis of Variance↗
PubMed2005

Safe medication prescribing: training and experience of medical students and housestaff at a large teaching hospital.

PURPOSE: To assess medical students' and housestaff's knowledge, attitudes, and behaviors regarding safe prescribing. METHOD: In 2003, 214 housestaff (interns and residents) and 77 medical students in medicine and surgery at Barnes-Jewish Hospital, St. Louis, Missouri, were asked to complete an anonymous, self-administered questionnaire about safe prescribing. Questions asked about training in and attitudes about safe-prescribing and current prescribing behaviors. Fisher exact test was used to compare attitudes and behaviors among subgroups. RESULTS: Of the 175 (60%) respondents, 73 (59%) of 123 housestaff and eight (15%) of 52 students agreed that their safe-prescribing training was adequate (p < .001), and 145 (83%) total respondents agreed that prescribing errors were unacceptable. Respondents reported always doing the following: 156 (89%) checked prescribing information before prescribing new drugs, 131 (75%) checked for drug allergies, 103 (59%) double-checked dosage calculations, 98 (56%) checked for renal impairment, and 53 (30%) checked for potential drug-drug interactions. CONCLUSION: Routine use of safe medication prescribing behaviors among housestaff and medical students was poor. Contributing factors may have included inadequate training and a culture that does not support safe prescribing. Effective strategies to increase safe medication prescribing need to be identified and implemented.

Attitude of Health Personnel↗
PubMed2005

What predicts USMLE Step 3 performance?

BACKGROUND: Academic and other student-specific variables associated with United States Medical Licensing Examination (USMLE) Step 3 performance have not been fully defined. METHOD: We analyzed Step 3 scores in association with medical school academic-performance measures, gender, residency specialty, and first postgraduate year (PGY-l) of training program-director performance evaluations. RESULTS: There were significant first-order associations between Step 3 scores and each of USMLE Step 1 and Step 2 scores, third-year clerkships' grade point average (GPA), Alpha Omega Alpha election, Medical Scientist Training Program graduation, broad-based specialty residency training, and PGY-l performance evaluation score. In a multiple linear regression model accounting for over 50% of the total variance in Step 3 scores, Step 2 scores, broad-based-specialty residency training, and GPA independently predicted Step 3 scores. CONCLUSIONS: Individualized Step 3 scores provide medical schools with additional means to externally validate their educational programs and to enhance the scope of outcomes assessments for their graduates.

Clinical Clerkship↗
PubMed2005

Patient concerns about medical errors in emergency departments.

OBJECTIVE: Despite large numbers of emergency encounters, little is known about how emergency department (ED) patients conceptualize their risk of medical errors. This study examines how safe ED patients feel from medical errors, which errors are of greatest concern, how concerns differ by patient and hospital characteristics, and the relationship between concerns and willingness to return for future care. METHODS: Multiwave telephone interviews of 767 patients from 12 EDs were conducted. Patients were asked about their medical safety, concern about eight types of medical errors, and satisfaction with care. RESULTS: Eighty-eight percent of patients believed that their safety from medical errors had been good, very good, or excellent; 38% of patients reported experiencing at least one specific error-related concern, most commonly misdiagnosis (22% of all patients), physician errors (16%), medication errors (16%), nursing errors (12%), and wrong test/procedure (10%). Concerns were associated with gender (p < 0.01), age (p < 0.0001), ethnicity (p < 0.001), length of stay (p < 0.001), ED volume (p < 0.0001), day of week (p < 0.0001), and hospital type (p < 0.0001). Concerns were highly related to a patient's willingness to return to the ED. CONCLUSIONS: The majority of ED patients felt relatively safe from medical errors, yet a significant percentage of patients experienced concern about a specific error during their emergency encounter. Concerns varied by both patient and hospital characteristics and were highly linked to patient satisfaction. The selective nature of concerns may suggest that patients are attuned to cues they perceive to be linked to specific medical errors, but efforts to involve patients in error detection/prevention programs will be challenging given the stressful and intimidating nature of ED encounters.

Adolescent↗
PubMed2005

Physicians' knowledge and attitudes about coronary heart disease prevention guidelines and technology assisted interventions.

BJC Healthcare is conducting a randomized controlled study to evaluate the impact of a technology-assisted pharmacist intervention on physicians' adherence to national coronary heart disease (CHD) prevention guidelines. We surveyed physicians to assess their knowledge of the guidelines and attitudes toward pharmacist-mediated interventions.

Attitude of Health Personnel↗
PubMed2004

What predicts surgical internship performance?

BACKGROUND: Variables associated with postgraduate year 1 (PGY-l) performance in surgical training have not been fully defined. METHODS: Mean composite PGY-l evaluation scores were calculated from responses to questionnaires mailed to surgical program directors of 87 surgical graduates from 1997 to 2001. We analyzed evaluation scores for associations with sex, surgical specialty choice, United States Medical Licensing Examination (USMLE) step 1 and step 2 scores, Alpha Omega Alpha (AOA) election, and third-year clerkships' grade point average (GPA). RESULTS: There were significant first-order associations between PGY-l performance evaluation score and each of USMLE step 2 score and GPA. In a multiple linear regression model that included sex, surgical specialty choice, USMLE step l and step 2 scores, AOA, and GPA, USMLE step 2 score was the only significant predictor of PGY-l performance. CONCLUSIONS: Multiinstitutional studies are warranted to determine the predictive value of USMLE step 2 scores in residency performance beyond PGY-l and to identify other predictors of surgical PGY-l performance.

Adult↗
PubMed2004

Using focus groups to understand physicians' and nurses' perspectives on error reporting in hospitals.

BACKGROUND: To increase error reporting, a better understanding of physicians' and nurses' perspectives regarding medical error reporting in hospitals, barriers to reporting, and possible ways to increase reporting is necessary. METHODS: Nine focus groups--four with 49 staff nurses, two with 10 nurse managers, and three with 30 physicians--from 20 academic and community hospitals were conducted in May-June 2002 in the St. Louis metropolitan area. Qualitative analysis of focus group transcripts characterized participants' perspectives. RESULTS: Although participants knew they should report errors associated with serious adverse events, there was much uncertainty about reporting less serious errors or near misses. Nurses were more knowledgeable than physicians about how to report errors. All groups mentioned barriers to reporting, such as fear of reprisals and lack of confidentiality, time, and feedback after an error is reported. Some physicians doubted the benefit of reporting errors, but, generally, both physicians and nurses agreed that reporting was intended to change practice and policy to promote patient safety. CONCLUSIONS: A culture characterized by anonymous reporting, freedom from repercussions, and feedback about error reports should promote error reporting.

Academic Medical Centers↗
PubMed2003

Development of the obstructive sleep apnea knowledge and attitudes (OSAKA) questionnaire.

STUDY OBJECTIVES: To develop and validate a questionnaire that assesses physicians' knowledge and attitudes about obstructive sleep apnea (OSA): the Obstructive Sleep Apnea Knowledge and Attitudes (OSAKA) questionnaire. DESIGN: Questionnaire study. SETTING: Physicians associated with the Washington University Physicians Network. PARTICIPANTS: Twenty physicians in the pilot testing and 115 physicians in the final testing of the instrument. INTERVENTIONS: Physicians completed the OSAKA questionnaire containing sections regarding knowledge about OSA (18 items), attitudes about OSA (five items), and demographics of the study participants. MEASUREMENTS AND RESULTS: Knowledge scores ranged from 0 to 18 (mean+/-SD=13.3+/-2.8). Individual knowledge items did not differ significantly by gender or by whether or not respondents had completed subspecialty training. The five attitude items were significantly correlated with one another. Knowledge scores correlated with the 5-item attitude scale. There was a negative correlation between age and knowledge (r=-0.368, P<0.001) and between age and the single attitude item pertaining to physicians' confidence in managing patients with OSA (r=-0.198, P=0.036); thus, the older the respondent, the lower the knowledge score and the less confident they were in managing patients with OSA. CONCLUSIONS: The OSAKA appears to be a useful instrument to measure physicians' knowledge about OSA, their views on its importance as a clinical disorder, and their confidence in identifying and managing patients with this disorder.

Adult↗
PubMed2003

Identifying factors associated with disability-related differences in breast cancer screening (United States).

OBJECTIVE: The purpose of this study was to identify factors that could explain breast cancer underutilization among women age 40 and older with disabilities. METHODS: The data are part of the 1996 Medical Expenditure Panel Survey (MEPS), a nationally representative sample of medical care use and expenditures in the United States. Two different definitions of disability were used: limitations in activities of daily living (ADL) and limitations in instrumental activities of daily living (IADL). Annual mammography was used as the outcome measure. The data are restricted to noninstitutionalized women at least 40 years of age. RESULTS: Crude odds ratios showed that women with long-term limitations in their ADLs or IADLs were less likely to be screened for breast cancer compared to those without such limitations. These associations remained while controlling for possible confounders and were observed among women age 40 or older, those 50-69, and among women 70 years of age and older. CONCLUSIONS: Reasons for the underutilization of breast cancer screening among women with long-term disabilities remain elusive. Future studies need to examine additional factors in order to improve screening use, especially among women with long-term disabilities who are 50-69 years of age, for whom screening has been shown to be beneficial in terms of reduced risk of mortality from breast cancer.

Activities of Daily Living↗
PubMed2003

Disparities related to socioeconomic status and access to medical care remain in the United States among women who never had a mammogram.

OBJECTIVE: This study examined whether disparities in mammography use between women of differing socioeconomic status (SES; income and education) and varying access to medical care (healthcare insurance and routine medical check-up) remained over time despite overall increased breast cancer screening. METHODS: Analysis of changes over time were made using data from the 1992, 1996, and 2000 Behavioral Risk Factor Surveillance System data from 53,846 women 50-69 years of age. Women who reported that they never had a mammogram were compared with those who ever had a mammogram. Multivariate logistic regression was used to determine whether and to what extent disparities between subgroups of women changed over time. RESULTS: The percentage of women 50-69 years of age who had never had a mammogram declined 65% from 22.1% in 1992 to 7.7% in 2000. Racial and ethnic differences in mammography prevalence disappeared over time. However, disparities among women of differing SES and among those with varying access to medical care remained based on multivariate analysis. CONCLUSIONS: Despite a substantial reduction in the proportion of women who had never had a mammogram among women 50-69 years of age from 1992 to 2000, disparities in use of mammography among the various population subgroups persisted.

Aged↗
PubMed2003

Diagnosis and treatment of acute otitis media: an assessment.

OBJECTIVE: To assess compliance with the Centers for Disease Control and Prevention (CDC) evidence-based guidelines for the judicious use of antimicrobials in children with acute otitis media (AOM). METHODS: Compliance with CDC's recommended diagnostic criteria and antimicrobial treatments for management of AOM was assessed by chart review and self-report for 29 community pediatricians in St. Louis, Missouri. For each physician, a simple random sample of AOM visits was selected and reviewed by trained reviewers. In addition, each physician completed a questionnaire. RESULTS: Compliance with recommended diagnostic criteria was 38% (95% confidence interval: 34%-42%; n = 573) by chart audit and 41% (95% confidence interval: 24%-61%; n = 29) by self-report. Antimicrobial selection assessed by chart audit was consistent with CDC guidelines in 68% (95% confidence interval: 64%-72%) of visits for a new infection, 63% (95% confidence interval: 47%-78%) of visits for treatment failure, and 50% (95% confidence interval: 33%-67%) for recurrent disease. Self-reported compliance with treatment guidelines for new infection was 100% (95% confidence interval: 88%-100%) and 83% (95% confidence interval: 64%-94%) for treatment failure. Noncompliance was most frequently attributable to overuse of broad-spectrum antimicrobials. Most patients treated with amoxicillin received a 10-day course (98%). Subtherapeutic dosing occurred in 26% of patients treated with amoxicillin. CONCLUSIONS: Overdiagnosis of AOM is common. Efforts to improve the judicious use of antimicrobials for AOM should focus on improving diagnostic accuracy, limiting the use of broad-spectrum antimicrobials to cases where they offer clinical benefit, and ensuring that amoxicillin dosing regimens are optimal.

Acute Disease↗