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Biomedical subjects

F J Romm

Publications and source records attributed to F J Romm.

15 recordsLinked to original sources
PubMed1991

Practical grantsmanship: the application process in health care research.

The creation of the Agency for Health Care Policy and Research presents expanded opportunities for research in primary care. This paper discusses the grant review process and includes section-by-section suggestions for successful proposal writing. Applicants should choose topics of their own interest, be aware of the funding agency's priorities, pick co-investigators who complement their own backgrounds and training, and perform at least some preliminary study of the topic which can be discussed in a proposal. Successful grantsmanship also requires patience, perseverance, and flexibility because several attempts may be necessary to receive funding.

Humans↗
PubMed1987

The periodic health examination in a family practice center: use, content, and results.

Records of 176 patients coming to a family practice center for complete physical examinations were reviewed to learn about the use, content and results of such examinations. The patients provided new or updated histories and were given full physical examinations. Blood pressures, breast, and rectal examinations were performed on at least 70 percent of the patients. Stool blood checks and mammograms were performed on 40 percent or less of the patients. Urinalyses, blood counts, and multichannel chemistry tests were performed as routine procedures for about one-half the patients. Most abnormalities found on these tests appeared relatively minimal; only about one-fourth of the abnormal results were repeated or commented upon in the record. Few diagnoses or changes in therapy resulted from routine laboratory testing. These studies should be used to screen only for preventable or treatable conditions, or to evaluate specific problems noted on history or physical examination.

Adult↗
PubMed1986

Low back pain and x-ray films of the lumbar spine: a prospective study in primary care.

We prospectively studied 96 men with low back pain to evaluate the association of x-ray findings with clinical diagnosis, treatment, functional outcome, and satisfaction with care. Degenerative joint disease (DJD) was the most common radiologic finding (70%). Making the diagnosis of spinal DJD has little effect on patient management, but patients with x-ray evidence of DJD were three times more likely than those with normal films to receive nonsteroidal anti-inflammatory drugs other than aspirin. Furthermore, patients given a "diagnostic label" of DJD were more likely to express satisfaction with medical care and less likely to seek care elsewhere than patients with similar x-ray results who were given nonspecific diagnoses. These factors will need to be considered in arriving at an estimate of the net benefits of x-ray examination of the lumbar spine.

Adult↗
PubMed1985

Periodic health examination: effect of costs on patient expectations.

The periodic health examination accounts for many visits to primary care practitioners and is a major source of preventive care. The purpose of this study was to compare our results with results of previous studies suggesting that patients desire periodic check-ups, including extensive laboratory studies. The effect of knowledge of cost of these procedures was determined by a randomized inclusion of this information in patient questionnaires. At Bowman Gray Family Practice Center, 91% of adult patients requested periodic examinations. The laboratory studies and other procedures selected by most patients were in excess of the recommendations of the Canadian Task Force on the Periodic Health Examination for adequate preventive care. Patients who were told the costs of these procedures selected them less frequently than those who were not told. Knowledge of personal risks as well as the effectiveness of studies to detect or prevent disease should be assessed to promote appropriate patient expectations of preventive care.

Adult↗
PubMed1985

The family and hypertension in family practice.

The influence of the family in the care of family practice patients has not been studied extensively. This study uses hypertension as an index condition to characterize the extent of involvement of family around family practice center (FPC) patients and to examine whether the presence of family members influences patient outcomes. Records of 366 hypertensive patients were reviewed for information about blood pressures, demographic characteristics, associated medical conditions, and treatment. Three hundred forty-three of these patients responded to questions about family members, including their use of the FPC and whether they also had hypertension. Twenty percent of patients lived alone. Of the rest, two thirds had some, and one half had all family members enrolled in the FPC. Seventy-three listed family with hypertension, and 42 said these relatives were treated at the FPC. At the time of the first visit to the FPC for hypertension, the mean diastolic blood pressure was 93 mmHg. At their most recent visit, the mean was 83 mmHg, and 69 percent were below 90 mmHg. There was no association between blood pressure control and family enrollment in the FPC.

Adult↗
PubMed1979

Care process and patient outcome in diabetes mellitus.

The relationship between the process of medical care and patient outcome is a central issue in health services research. We examined this relationship in 244 patients with adult-onset diabetes mellitus, who were under the care of private internists and family physicians. Process measures included physician awareness of patients' concerns, communication of information from physician to patient, medication-taking behavior, physician adherence to minimum care criteria, and extent of patient utilization of services. Outcomes measured during and after a 6-month follow-up period, included diabetic control status and patient satisfaction with medical care. Potentially confounding variables included practice and physician characteristics, patient demographic characteristics, and measures of disease severity. There was a small statistically significant correlation between physician awareness and control status, but the association was not maintained when controlling for other variables. Communication of information from physician to patient was significantly (p less than .005) associated with satisfaction in the multiple regression analysis but explained only 4 per cent of the variance in patient satisfaction. Thus, in patients under treatment for diabetes, there was little association between certain measures of care process and patient outcome. We suggest that process and outcome assessments are distinct but complementary aspects of quality of care.

Adult↗
PubMed1979

Developing criteria for quality of assessment: effect of the Delphi technique.

We examined the effect of the Delphi iteration procedure in developing explicit criteria for ambulatory care assessment. Practicing internists chose items they believed to be essential with regard to the care of certain specified conditions. The initial responses were tabulated and "fed-back" to the participants. The second round of criteria selection, with the first-round summary available, produced few and relatively minor changes in the items chosen by group consensus.

Ambulatory Care↗
PubMed1975

Food-borne hepatitis A in a general hospital. Epidemiologic study of an outbreak attributed to sandwiches.

In November and December 1973, an outbreak of food-borne hepatitis A occurred in a busy general hospital. Epidemiologic investigation implicated cafeteria-made sandwiches. Eventually, 44 clinical and 22 subclinical cases of hepatitis were diagnosed among hospital employees. In addition, at least seven persons in the community became ill with hepatitis after eating in the hospital cafeteria; hospital patients were not, in general, affected. Two cafeteria workers were potentially implicated in the spread of hepatitis; both would have had subclinical hepatitis during the probable transmission period. It was recommended that food-handlers with icteric hepatitis remain out of work for at least two to three weeks after the onset of jaundice, while food-handlers with subclinical hepatitis remain out of work for at least two to three weeks after the peak of enzyme level elevation.

Alanine Transaminase↗
PubMed1975

A comparison of program and contraceptive use continuation rates in a family planning clinic.

Programs and contraceptive use continuation rates were obtained for a rural Georgia family planning clinic. Program continuation is a measurement of maintenance of clinic attendance, while use continuation is related to actual use of effective contraceptives regardless of clinic activity status. Program continuation rates ranged from 0.77 at 12 months to 0.48 at 36 months. Contraceptive use continuation rates were 0.78 at 12 months and 0.58 at 36 months. Women who moved or were otherwise lost to follow-up formed the largest category of discontinuation. The highest rate of discontinuation from clinic attendance occurred after the first visit with secondary peaks around the time of scheduled annual checkups. Women who were younger and had fewer living children had a greater likelihood of discontinuing clinic attendance and contraceptive use. The reasons for and timing of discontinuation from clinic attendance suggest that clinic personnel should place special emphasis on the first visits, arrange referral for women who might have plans to leave the service area before the scheduled return visit, send reminders before first revisits, and follow up patients soon after missed visits. Priority might be assigned to the younger women of low parity who have been shown to be at higher risk of discontinuation. Other factors which might influence continuation include method of contraception, marital status, and race. Program continuation can be determined by analysis of clinic records alone while contraceptive use continuation often requires follow-up of patients. Although the two continuation rates were not equivalent, program and use continuation were roughly parallel through much of the study period. This suggests that a simple review of records in the clinic or on computer tape, when available, to determine program continuation may give an estimate of actual contraceptive use in the population.

Community Health Services↗
PubMedDate not supplied

Teaching clinical epidemiology: a controlled trial of two methods.

The teaching of clinical epidemiology to second-year students at the Bowman Gray School of Medicine is carried out using journal articles to illustrate concepts. Because of the need for discussion, the instructors believed that the concepts of epidemiology might best be learned by, and that greater satisfaction with the learning process might be derived from, small group discussions rather than large lecture sessions. To test these hypotheses, students were randomized into either one of two discussion groups or a larger lecture group. The course handouts and text were identical, and the three instructors presented the same material successively to each group. In the final examination, all three groups answered approximately 26 of 36 questions correctly. Seventy percent of students responded to a questionnaire at the end of the course. There were no significant differences between the discussion and lecture groups in their ability to read and understand medical articles. However, the discussion group students were more favorable in their assessment of the success of the teaching method and in their perception of the importance and overall quality of the course. While there may be little difference in the short-term retention of epidemiological principles between the two teaching methods, the greater satisfaction reported by the students in the small groups will stimulate us to try to provide that type of learning environment in the future.

Curriculum↗
PubMedDate not supplied

"Routine" chemistry testing.

This study examines the use and results of a multichannel chemistry test (SMAC) in asymptomatic patients attending a family practice center. Of 288 patients, 71 (25%) presenting for complete physical examinations had apparently "routine" or baseline SMACs. Forty-three (61%) had at least one abnormal value in their chemistry profiles. Most abnormal results appeared to be of little clinical significance, but few were repeated or otherwise evaluated. Screening or baseline chemistry testing is a common feature of general health evaluations, but the efficacy of such studies is not clear.

Ambulatory Care Facilities↗